Gan Eugene, Tay Chee Kiang
Department of Respiratory and Critical Care Medicine Singapore General Hospital Singapore.
Respirol Case Rep. 2024 Jul 30;12(8):e01438. doi: 10.1002/rcr2.1438. eCollection 2024 Aug.
A 66-year-old male from Myanmar presented with 3 months of cough and constitutional symptoms. He was an ex-tobacco user with no significant medical or exposure history. Chest x-ray showed ill-defined bilateral opacities and a left pleural effusion. Chest CT revealed two right lower lobe masses, and a moderate-sized left pleural effusion. PET-CT demonstrated hypermetabolic uptake in the thickened nodular pleura, pericardium, and hilar/mediastinal lymph nodes. EBUS-TBNA of the right lower paratracheal node and TBLB of the right lower lobe mass yielded epithelioid granulomas comprising multinucleated giant cells, epithelioid histiocytes and lymphoplasmacytic cells. Thoracoscopy revealed hard, whitish mass-like parietal pleural plaques, and pleural biopsy revealed identical histopathologic results. His symptoms resolved quickly after commencing prednisolone 25 mg daily. Chest CT at 6 months demonstrated near complete resolution of the parenchymal masses and pleural effusion. We highlight this unique case of pleuroparenchymal sarcoidosis mimicking metastatic lung cancer in a tuberculosis-endemic region.
一名来自缅甸的66岁男性，出现咳嗽及全身症状3个月。他既往吸烟，无重大疾病史或接触史。胸部X线显示双侧边界不清的模糊影及左侧胸腔积液。胸部CT显示右肺下叶有两个肿块，以及中等量的左侧胸腔积液。PET-CT显示增厚的结节状胸膜、心包及肺门/纵隔淋巴结有高代谢摄取。右肺下气管旁淋巴结的EBUS-TBNA及右肺下叶肿块的TBLB检查发现上皮样肉芽肿，由多核巨细胞、上皮样组织细胞及淋巴浆细胞组成。胸腔镜检查发现坚硬、白色的块状壁层胸膜斑块，胸膜活检显示相同的组织病理学结果。开始每日服用25mg泼尼松龙后，他的症状迅速缓解。6个月时的胸部CT显示实质肿块及胸腔积液几乎完全消退。我们重点介绍了这例在结核病流行地区酷似转移性肺癌的胸膜实质结节病的独特病例。
