Bonnet D, Balandraud P, Lonjon T, Rey P, Van de Walle J P, Cador L, Jancovici R, Martet G, Branquet D, De Muizon H
Service de Pneumologie, l'Hôpital d'Instruction des Armées LAVERAN, Marseille, France.
Med Trop (Mars). 1995;55(1):55-60.
From 1989 to 1994, 71 patients were hospitalized for diagnosis of round lung lesions including 49 servicemen under the age of 45 years who had been stationed in tropical areas. In 6 of these servicemen, the diagnosis was pulmonary histoplasmosis at the tertiary stage of histoplasmoma. All had done duty in French Guyana and were negative for human immunodeficiency virus. The subpleural lung opacity was the only lesion in 5 out of 6 patients and was calcified in 4 out of 6 patients. Since skin tests with histoplasmin and serologic testing for histoplasmosis failed to achieve definitive diagnosis, surgical biopsy was performed by conventional thoracotomy in 2 cases and video-assisted thoracic surgery in 4 cases. The specimens obtained confirmed diagnosis of histoplasmosis on mycologic criteria in 3 cases and on a combination of findings including compatible histologic evidence in 3 cases. Treatment consisted in surgical excision of the nodules, for which video-assisted thoracoscopic surgery proved to be an excellent technique because of its simplicity and rapidity.
1989年至1994年期间，71例因肺部圆形病变入院诊断的患者中，有49例为45岁以下曾驻扎在热带地区的军人。其中6名军人被诊断为组织胞浆菌病三期的肺组织胞浆菌病。他们都曾在法属圭亚那服役，且人类免疫缺陷病毒检测呈阴性。6例患者中有5例的胸膜下肺部混浊是唯一病变，6例中有4例出现钙化。由于组织胞浆菌素皮肤试验和组织胞浆菌病血清学检测未能确诊，2例行传统开胸手术活检，4例行电视辅助胸腔镜手术活检。所取标本中，3例根据真菌学标准确诊为组织胞浆菌病，3例根据包括相符的组织学证据在内的综合结果确诊。治疗方法为手术切除结节，电视辅助胸腔镜手术因其操作简单、速度快，被证明是一种很好的技术。
