Madan N, Abdelrazek H, Patil P D, Ross M D, Roy S B, Thawani N, Hahn M F, Bremner R M, Panchabhai T S
Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
Transplant Proc. 2018 Dec;50(10):4080-4084. doi: 10.1016/j.transproceed.2018.07.034. Epub 2018 Aug 9.
Lung transplant recipients have a significant incidence of posttransplant lung nodules. Such nodules can occur from various etiologies, both in the lung allograft or in the native lung. They most commonly originate from infections, such as Pseudomonas or Aspergillus species, or from posttransplant lymphoproliferative disorder. Lung cancer is challenging to diagnose in a native lung, especially with an underlying fibrotic disease. We present a case of a 75-year-old woman who presented with classic clinical features of pulmonary aspergillosis in the native right lung with idiopathic pulmonary fibrosis 5 years after left-sided single-lung transplant. She required a right lower lobectomy and antifungal treatment with isavuconazonium sulfate and inhaled amphotericin. A persistent right upper lobe lung nodule was noted during surveillance imaging and was initially presumed to be recurrent Aspergillus infection; however, growth of the nodule and change in its characteristics prompted additional examination. A navigational bronchoscopic biopsy was positive for squamous cell carcinoma. Her options for stage IIIA squamous cell carcinoma were limited to chemotherapy with paclitaxel and carboplatin plus radiation. Although initial surveillance scans showed adequate tumor response, metastatic squamous cell carcinoma was found in the liver 6 months later. She was eventually transitioned to palliative care. This case highlights the importance of a high index of suspicion for examination of nodules in the native lung of lung transplant recipients, even in cases of a known diagnosis, owing to the high morbidity and mortality associated with primary lung cancer in this population.
肺移植受者移植后肺部结节的发生率很高。此类结节可由多种病因引起，既可见于移植的肺脏，也可见于自身肺脏。它们最常见的起源是感染，如假单胞菌属或曲霉菌属，或移植后淋巴组织增生性疾病。在自身肺脏中诊断肺癌具有挑战性，尤其是在存在潜在纤维化疾病的情况下。我们报告一例75岁女性病例，该患者在左侧单肺移植5年后，出现了右肺自身特发性肺纤维化伴肺曲霉菌病的典型临床特征。她需要进行右下肺叶切除术，并接受硫酸艾沙康唑和吸入用两性霉素的抗真菌治疗。在监测成像过程中发现右肺上叶有一个持续存在的肺结节，最初推测为复发性曲霉菌感染；然而，结节的生长及其特征变化促使进一步检查。经导航支气管镜活检，结果为鳞状细胞癌阳性。她的IIIA期鳞状细胞癌治疗方案仅限于使用紫杉醇和卡铂化疗加放疗。尽管最初的监测扫描显示肿瘤有足够的反应，但6个月后在肝脏发现了转移性鳞状细胞癌。她最终转入姑息治疗。该病例强调了即使在已知诊断的情况下，对肺移植受者自身肺脏中的结节进行检查时保持高度怀疑的重要性，因为该人群原发性肺癌的发病率和死亡率很高。
