Tirelli Claudio, Zanframundo Giovanni, Valentini Adele, Bortolotto Chandra, Dore Roberto, Oggionni Tiberio, Milani Paolo, Bravi Elena, Kadija Zamir, Mariani Francesca, Codullo Veronica, Morbini Patrizia, Palladini Giovanni, Meloni Federica, Cavagna Lorenzo
Department of Internal Medicine and Therapeutics, Division of Respiratory Diseases, University of Pavia and IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy.
Radiol Case Rep. 2020 Sep 14;15(11):2331-2334. doi: 10.1016/j.radcr.2020.08.012. eCollection 2020 Nov.
Pulmonary involvement in Sjogren syndrome (SS) could manifest as cystic lung disease (CLD). CLD in SS includes lymphocytic interstitial pneumonia (LIP) and pulmonary amyloidosis. Differential diagnosis usually requires surgical lung biopsy, whereas CT-guided percutaneous fine needle aspiration biopsy (CT-FNAB) has not yet explored. We describe the case of a 63-year-old never smoker Caucasian female with a SS diagnosis who displayed a newly detected diffuse CLD at high-resolution computed tomography, though totally asymptomatic. Given the favorable location of one big lesion at the superior left lobe, a CT-FNAB was proposed instead of a more invasive SLB. At histology examination a diagnosis of pulmonary nodular AL kappa amyloidosis in the context of SS was established. In conclusion, CT-FNAB might represent an alternative and less invasive diagnostic procedure than SLB in the differential diagnosis of CLD, even if further research is needed. Moreover, this case presents an unusual association between SS and pulmonary nodular AL kappa amyloidosis, with pulmonary nodules and cysts without systemic manifestations.
干燥综合征（SS）的肺部受累可表现为囊性肺疾病（CLD）。SS中的CLD包括淋巴细胞间质性肺炎（LIP）和肺淀粉样变性。鉴别诊断通常需要外科肺活检，而CT引导下经皮细针穿刺活检（CT-FNAB）尚未得到探索。我们描述了一例63岁从不吸烟的白种女性病例，该患者诊断为SS，在高分辨率计算机断层扫描中显示新发现的弥漫性CLD，但完全无症状。鉴于左上叶一个大病灶位置良好，建议采用CT-FNAB而非更具侵入性的SLB。组织学检查确诊为SS背景下的肺结节性AL κ淀粉样变性。总之，CT-FNAB在CLD的鉴别诊断中可能是一种比SLB更具侵入性的替代诊断方法，尽管还需要进一步研究。此外，该病例呈现了SS与肺结节性AL κ淀粉样变性之间不寻常的关联，伴有肺结节和囊肿且无全身表现。
