Endo S, Murayama F, Yamaguchi T, Hasegawa T, Sohara Y, Fuse K, Fujii T, Saito K
Department of Thoracic Surgery, Jichi Medical School, Tochigi, Japan.
Surg Today. 1998;28(12):1316-8. doi: 10.1007/BF02482825.
A case of pulmonary histoplasmosis, which is rare in Japan, is reported herein. A 43-year-old man who had worked in Mexico for 2 years and had come back to Japan 3 months earlier, presented at our hospital because of an abnormal shadow on his chest roentogenogram with no symptoms. His chest roentogenogram as well as chest computed tomograms revealed a 2-cm-diameter nodule in the anterior basal segment of his right lung and an enlargement of the subcarinal lymph node. Although these pictures seemed to indicate an advanced lung cancer, no malignant cells were found based on the brushing cytology findings after bronchoscopy. An exploratory thoracoscopic tumor resection and biopsy of the enlarged lymph node led to a histological diagnosis of an abscess due to histoplasma. The hospital course was uneventful. Postoperatively, amphotericin B was administered for 1 year. This is the eighth case of pulmonary histoplasmosis reported in Japan. A pulmonary nodule together with mediastinal lymphoadenopathy seems to be characteristic in these patients. Histoplasmosis should therefore be considered in the differential diagnosis, since overseas travel has now become common-place for the Japanese.
本文报告了一例在日本较为罕见的肺组织胞浆菌病病例。一名43岁男性，曾在墨西哥工作2年，3个月前返回日本，因胸部X线片出现异常阴影但无症状而前来我院就诊。其胸部X线片及胸部计算机断层扫描显示右肺前基底段有一个直径2厘米的结节，以及隆突下淋巴结肿大。尽管这些影像表现似乎提示为晚期肺癌，但支气管镜检查后的刷检细胞学结果未发现恶性细胞。经胸腔镜进行肿瘤切除及对肿大淋巴结进行活检，组织学诊断为组织胞浆菌引起的脓肿。住院过程顺利。术后给予两性霉素B治疗1年。这是日本报告的第八例肺组织胞浆菌病病例。肺部结节伴纵隔淋巴结肿大似乎是这些患者的特征表现。鉴于海外旅行如今在日本人中已很常见，因此在鉴别诊断中应考虑组织胞浆菌病。
