Warren Alpert Medical School of Brown University.
Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Lifespan Medical Center, Warren Alpert Medical School of Brown University.
R I Med J (2013). 2022 Jun 1;105(5):36-40.
We report a collection of lung findings in a patient with a remote history of cigarette smoking, but now engaged in heavy nicotine vaping with daily edible and combustible cannabis use. Computed tomography (CT) imaging demonstrated numerous, small, and bilateral nodules with ground-glass appearance. The largest nodule is demonstrated in the right upper lung lobe. Clinically the differential diagnosis at this time included hypersensitivity pneumonitis and sarcoidosis. Atypical infection, particularly of a fungal etiology, and metastatic malignancy were also considered. Initial pathology of the right lung needle biopsy revealed alveolar septal thickening with associated atypical pneumocyte proliferation, suggestive of atypical adenomatous hyperplasia (AAH). Subsequently the patient underwent wedge resection of the right upper, middle and lower lobes. Pathology examination revealed pulmonary Langerhans cell histiocytosis (PLCH) in the upper and lower lobes, with CD1a staining highlighting the aggregates of Langerhans cells. Vascular changes were also present including intimal thickening of muscular pulmonary arteries, consistent with pulmonary hypertensive changes. Background lung parenchyma demonstrated respiratory bronchiolitis, smoking-related interstitial fibrosis, an organizing thrombus in muscular artery and associated pneumocyte hyperplasia.
我们报告了一例患者的肺部发现，该患者有吸烟的既往史，但现在大量吸食尼古丁电子烟，并每日使用可食用和可燃大麻。计算机断层扫描（CT）成像显示多个双侧小结节，呈磨玻璃样外观。最大的结节位于右上肺叶。目前，临床鉴别诊断包括过敏性肺炎和结节病。不典型感染，特别是真菌性病因和转移性恶性肿瘤也被考虑在内。右肺经皮肺穿刺活检的初始病理显示肺泡间隔增厚，伴有相关的非典型肺泡细胞增生，提示非典型腺瘤样增生（AAH）。随后，患者接受了右上、中、下肺楔形切除术。病理检查显示上、下肺的朗格汉斯细胞组织细胞增生症（PLCH），CD1a 染色突出显示朗格汉斯细胞聚集。还存在血管改变，包括肌性肺动脉内膜增厚，符合肺动脉高压改变。背景肺实质显示呼吸性细支气管炎、与吸烟相关的间质纤维化、肌性动脉中的机化血栓和相关的肺泡细胞增生。
