Sekosan M, Cleto M, Senseng C, Farolan M, Sekosan J
Department of Pathology, University of Illinois at Chicago 60612.
Am J Surg Pathol. 1994 Oct;18(10):1065-8. doi: 10.1097/00000478-199410000-00010.
A rare spindle cell pseudotumor in the skin, lymph nodes, and bone marrow has been previously reported in immunosuppressed transplant patients and patients with acquired immunodeficiency syndrome. All reported cases were caused by Mycobacterium avium-intracellulare or other nontuberculous mycobacteria. We are reporting spindle cell pseudotumors in the lungs caused by Mycobacterium tuberculosis. The patient had insulin-dependent diabetes mellitus and was status post cadaveric renal and pancreatic transplants. His hospital course was complicated by pulmonary tuberculosis due to M. tuberculosis. At autopsy, the lungs showed numerous bilateral gray nodules ranging from 0.2 to 2.5 cm. Microscopic examination uncovered a cellular proliferation composed of spindle cells arranged in fascicles. There were no granulomata. An acid-fast stain showed numerous acid-fast bacilli within the spindle cells. To our knowledge, this is the first case of spindle cell pseudotumor caused by M. tuberculosis of the lungs. Awareness of this unusual manifestation of mycobacterial infection in immunosuppressed patients underscores the need for acid-fast staining of biopsies with spindle cell proliferation even in the absence of overt granulomatous lesions in order to prevent misdiagnosis.
此前已有报道称，免疫抑制的移植患者和获得性免疫缺陷综合征患者的皮肤、淋巴结及骨髓中存在一种罕见的梭形细胞假瘤。所有报道病例均由鸟分枝杆菌或其他非结核分枝杆菌引起。我们现报告由结核分枝杆菌导致的肺部梭形细胞假瘤。该患者患有胰岛素依赖型糖尿病，接受过尸体肾和胰腺移植。他的住院病程因结核分枝杆菌引起的肺结核而复杂化。尸检时，肺部可见无数双侧灰色结节，大小从0.2厘米至2.5厘米不等。显微镜检查发现由呈束状排列的梭形细胞组成的细胞增殖。未见肉芽肿。抗酸染色显示梭形细胞内有大量抗酸杆菌。据我们所知，这是首例由肺部结核分枝杆菌引起的梭形细胞假瘤。认识到免疫抑制患者中这种分枝杆菌感染的不寻常表现强调，即使在没有明显肉芽肿病变的情况下，对有梭形细胞增殖的活检组织进行抗酸染色以防止误诊的必要性。
