Tamura A, Matsubara O, Hebisawa A, Akagawa S, Shishido H, Kurashima A, Mohri M, Katayama T
Department of Respiratory Disease, Tokyo National Chest Hospital, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1994 Dec;32(12):1149-58.
To elucidate the relationship between the clinical manifestations and pathologic findings of the lung in patients with cryptococcosis, we reviewed 14 autopsied cases of cryptococcosis. Five patients had pulmonary cryptococcosis and 9 had disseminated cryptococcosis. Patients with pulmonary cryptococcosis showed granulomatous reactions of the lung, such as fibrocaseous cryptococcoma (n = 2), discrete granuloma (n = 2), and granulomatous pneumonia (n = 1). Patients with disseminated cryptococcosis showed intracapillary/interstitial involvement (n = 2), mucoid pneumonia (n = 3), histiocytic pneumonia (n = 1), and granulomatous pneumonia (n = 3). There was a distinct difference between pulmonary cryptococcosis and disseminated cryptococcosis in lung pathology. Intracapillary/interstitial involvement and mucoid pneumonia were fatal because of extensive hematogeneous dissemination to other organs. Hilar lymph node involvement of cryptococcosis was found in all of the nine patients with disseminated cryptococcosis and in one of the five patients with pulmonary cryptococcosis. Pleural involvement of cryptococcosis was found in six of the nine patients with disseminated cryptococcosis. We conclude that the clinical manifestations of cryptococcosis are closely associated with the variety of lung pathology of cryptococcosis. Clinicians should understand the morphologic features to cope with patients with cryptococcosis.
为阐明隐球菌病患者肺部临床表现与病理结果之间的关系，我们回顾了14例隐球菌病尸检病例。5例为肺隐球菌病，9例为播散性隐球菌病。肺隐球菌病患者表现出肺部的肉芽肿反应，如纤维干酪样隐球菌瘤（n = 2）、散在肉芽肿（n = 2）和肉芽肿性肺炎（n = 1）。播散性隐球菌病患者表现为毛细血管内/间质受累（n = 2）、黏液样肺炎（n = 3）、组织细胞性肺炎（n = 1）和肉芽肿性肺炎（n = 3）。肺隐球菌病和播散性隐球菌病在肺部病理方面存在明显差异。毛细血管内/间质受累和黏液样肺炎因广泛血行播散至其他器官而致命。9例播散性隐球菌病患者及5例肺隐球菌病患者中的1例均发现有隐球菌病累及肺门淋巴结。9例播散性隐球菌病患者中有6例发现有隐球菌病累及胸膜。我们得出结论，隐球菌病的临床表现与隐球菌病肺部病理的多样性密切相关。临床医生应了解其形态学特征以应对隐球菌病患者。
