Kwon K Y, Myers J L, Swensen S J, Colby T V
Department of Pathology, Keimyung University School of Medicine, Taegu, Korea.
Hum Pathol. 1995 Mar;26(3):302-7. doi: 10.1016/0046-8177(95)90062-4.
Middle lobe syndrome (MLS) is an uncommon lung disorder involving the right middle lobe and/or lingula and is characterized by a spectrum of clinical and pathological lesions ranging from recurrent atelectasis or pneumonias to bronchiectasis. Despite several series reporting the clinical features of MLS, histopathological descriptions are rare. We reviewed the clinical characteristics and pathological findings in 21 patients with MLS who underwent surgical resections. Six male and 15 female patients between the ages of 5 and 80 years (mean, 47 years) were studied. All patients were symptomatic and complained of chronic cough (8), hemoptysis (6), chest pain (4), dyspnea (3), or fever (2). The right middle lobe was involved in 11 patients, the lingula in four patients, and both right middle lobe and lingula in six patients. Chest radiographs, bronchograms, and/or computed tomography scans were available for review in 19 patients and showed consolidation (8), bronchiectasis (9), patchy infiltrates (5), and atelectasis (4) in various combinations. Pathological findings included bronchiectasis in 10 patients, chronic bronchitis/bronchiolitis with lymphoid hyperplasia in seven, patchy organizing pneumonia in six, atelectasis in five, granulomatous inflammation in five, and abscess formation in four. Three patients with granulomatous inflammation had associated atypical mycobacterial infection. Broncholithiasis was confirmed by pathological examination in one patient. No pathological cause for bronchial obstruction was identified in the remaining 20 patients, although one was thought to have had broncholithiasis on the basis of preoperative bronchoscopy. The presence of bronchiectasis, bronchitis or bronchiolitis, organizing pneumonia, or atelectasis in specimens from the right middle lobe or of lingula in the absence of an identifiable cause of bronchial obstruction should suggest a diagnosis of MLS.
中叶综合征（MLS）是一种罕见的肺部疾病，累及右中叶和/或舌叶，其特征是一系列临床和病理病变，范围从反复肺不张或肺炎到支气管扩张。尽管有多个系列报道了MLS的临床特征，但组织病理学描述却很少见。我们回顾了21例接受手术切除的MLS患者的临床特征和病理结果。研究对象为6例男性和15例女性患者，年龄在5至80岁之间（平均47岁）。所有患者均有症状，主诉慢性咳嗽（8例）、咯血（6例）、胸痛（4例）、呼吸困难（3例）或发热（2例）。11例患者累及右中叶，4例累及舌叶，6例同时累及右中叶和舌叶。19例患者有胸部X线片、支气管造影和/或计算机断层扫描可供回顾，显示有不同组合的实变（8例）、支气管扩张（9例）、斑片状浸润（5例）和肺不张（4例）。病理结果包括10例支气管扩张、7例伴有淋巴组织增生的慢性支气管炎/细支气管炎、6例斑片状机化性肺炎、5例肺不张、5例肉芽肿性炎症和4例脓肿形成。3例肉芽肿性炎症患者伴有非典型分枝杆菌感染。1例患者经病理检查确诊为支气管结石。其余20例患者未发现支气管阻塞的病理原因，尽管有1例根据术前支气管镜检查被认为可能有支气管结石。在没有可识别的支气管阻塞原因的情况下，右中叶或舌叶标本中出现支气管扩张、支气管炎或细支气管炎、机化性肺炎或肺不张，应提示MLS的诊断。
