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经支气管肺冷冻活检诊断酷似真菌感染的白血病肺部浸润:首例病例报告。

Diagnosis of leukemic lung infiltration mimicking fungal infection by transbronchial lung cryobiopsy: the first case report.

机构信息

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea.

Department of Internal Medicine, College of Medicine, Chungnam National University, 266 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea.

出版信息

BMC Pulm Med. 2024 Oct 8;24(1):494. doi: 10.1186/s12890-024-03300-6.

Abstract

BACKGROUND

We here report the first case of leukemic lung infiltration diagnosed by transbronchial lung cryobiopsy (TBLC). TBLC is likely to be a superior method to transbronchial forceps biopsy because TBLC can get larger specimens, resulting in a higher chance of containing the leukemic cells infiltrated tissues. TBLC is generally considered a superior diagnostic method compared to transbronchial lung forceps biopsy (TBLB) because it utilizes cryotechnology to obtain larger specimens, increasing the likelihood of capturing tissues infiltrated with leukemic cells.

CASE PRESENTATION

A 69-year-old male patient with acute myeloid leukemia presented with a fever. His initial chest CT scans revealed consolidative lesions, raising suspicion of fungal infection such as angioinvasive aspergillosis or mucormycosis. TBLC and TBLB were conducted to achieve a precise diagnosis, and eventually, leukemic lung infiltration was identified exclusively in the tissues obtained from TBLC. Two cycles of chemotherapy was administrated to patient, showing improvements in symptoms and chest CT findings.

CONCLUSIONS

TBLC has greater potential as a differential diagnostic method for pulmonary lesions than TBLB in leukemia patients facing therapeutic challenges due to its higher diagnostic yield.

摘要

背景

我们在此报告首例通过经支气管肺冷冻活检(TBLC)诊断的白血病肺部浸润病例。TBLC 可能是一种优于经支气管活检钳(TBLB)的方法,因为 TBLC 可以获取更大的标本,从而增加包含白血病细胞浸润组织的机会。与经支气管肺活检钳(TBLB)相比,TBLC 通常被认为是一种更优越的诊断方法,因为它利用冷冻技术获取更大的标本,增加了捕获白血病细胞浸润组织的可能性。

病例介绍

一名 69 岁男性急性髓系白血病患者出现发热。他的初始胸部 CT 扫描显示实变病变,提示侵袭性血管内曲霉菌病或毛霉菌病等真菌感染。为了明确诊断,进行了 TBLC 和 TBLB,最终仅在 TBLC 获得的组织中发现了白血病肺部浸润。患者接受了两个周期的化疗,症状和胸部 CT 发现均有所改善。

结论

对于面临治疗挑战的白血病患者的肺部病变,TBLC 作为一种鉴别诊断方法,比 TBLB 具有更高的诊断率,具有更大的潜力。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c253/11462713/a38a0bd1db50/12890_2024_3300_Fig1_HTML.jpg

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