弥漫性囊腔病变的肺腺癌误诊为肺朗格汉斯细胞组织细胞增生症：病例报告。
Lung carcinoma with diffuse cystic lesions misdiagnosed as pulmonary langerhans cell histocytosis: a case report.
机构信息
Department of Respiratory and Critical Care Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China.
Department of Pathology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China.
出版信息
BMC Pulm Med. 2020 Feb 4;20(1):30. doi: 10.1186/s12890-020-1066-5.
BACKGROUND
Cystic airspace is an uncommon imaging manifestation involved in non-small lung cancer (NSCLC). Diffuse cystic lesion is even rarer as pulmonary manifestation of NSCLC. In the present study, we reported a rare case of NSCLC associated with progressive diffusion of cystic lesions misdiagnosed as Pulmonary langerhans cell histocytosis (PLCH), finally diagnosed by transbronchial cryobiopsy (TBCB).
CASE PRESENTATION
A 52-year-old woman was admitted to our hospital due to cough and dyspnea. High-resolution computed tomography (HRCT) presented diffuse cystic shadow mostly, concomitantly with nodular densities in bilateral lungs. A lung biopsy revealed poorly differentiated adenocarcinoma with vascular tumor emboli. The epidermal growth factor receptor (EGFR) mutation on exon 18 (G719X, G719) was detected by mutation test. The patient received treatment of tyrosine kinase inhibitor (afatinib).
CONCLUSIONS
Diffuse cystic lesion can be a rare manifestation of lung cancer. It was important to improve the recognition of diffuse cystic lung diseases to avoid misdiagnosis.
背景
囊性气腔是一种不常见的非小细胞肺癌（NSCLC）影像学表现。弥漫性囊性病变作为 NSCLC 的肺部表现更为罕见。本研究报告了一例罕见的 NSCLC 伴进行性弥漫性囊性病变，误诊为肺朗格汉斯细胞组织细胞增生症（PLCH），最终通过经支气管冷冻活检（TBCB）确诊。
病例介绍
一名 52 岁女性因咳嗽和呼吸困难入院。高分辨率计算机断层扫描（HRCT）显示双侧肺部弥漫性囊性阴影，同时伴有结节密度。肺活检显示低分化腺癌伴血管肿瘤栓子。通过突变检测发现外显子 18（G719X、G719）的表皮生长因子受体（EGFR）突变。患者接受了酪氨酸激酶抑制剂（阿法替尼）治疗。
结论
弥漫性囊性病变可能是肺癌的一种罕见表现。提高对弥漫性囊性肺部疾病的认识，避免误诊非常重要。
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