伴肺癌的特发性间质性肺炎七例临床病理学分析  

Idiopathic interstitial pneumonia complicated with lung cancer:a clinicopathologic analysis of seven cases

作　　者：易祥华[1] 罗本芳[2] 李惠萍[2] 吴西雅[3] 芮炜玮[1] 王彦丽[2] 曾郁[1] 

机构地区：[1]同济大学附属同济医院病理科,上海200065 [2]同济大学附属上海市肺科医院呼吸科 [3]江西省人民医院呼吸科

出　　处：《上海医学》2009年第12期1113-1117,I0006,共6页Shanghai Medical Journal

基　　金：上海市科学技术委员会科研基金(034119868);上海市科学技术委员会科研基金医学重点(09411951600)资助项目

摘　　要：目的探讨伴肺癌的特发性间质性肺炎(IIP-LC)的临床病理特征。方法对7例经电视胸腔镜或开胸肺活组织检查诊断为IIP-LC的病例进行临床、影像和病理学比较分析,治疗后随访。结果7例IIP-LC患者中男6例,女1例,年龄54～69岁,中位年龄为56岁,5例有吸烟史。临床主要表现为咳嗽和咳痰、活动后气促和咯血。胸部CT检查示两肺有网织、斑片和条索状阴影以及局部的实变影。病理学检查示普通型间质性肺炎5例,淋巴细胞间质性肺炎2例;肺癌组织学类型为鳞状细胞癌、腺癌、复合癌(腺鳞癌和腺癌伴大细胞癌)各2例,大细胞癌1例。1例行单纯化疗;6例行肿瘤肺叶切除,其中4例予术后化疗,2例予术前化疗。术后随访,3例带瘤生存,4例死亡,其中2例术后2周内死于呼吸衰竭,另2例分别在术后15、17个月死亡。结论高龄、男性、吸烟是IIP-LC的高危因素。与单纯的特发性间质性肺炎相比,IIP-LC的临床、影像和病理诊断更加困难,外科肺活组织检查取材局限时易误诊,治疗和预后更差。Objective To investigate the clinicopathologic features of idiopathic interstitial pneumonia complicated with lung cancer （IIP-LC）. Methods The clinical, radiologic and pathological features of 7 IIP-LC patients, who were confirmed by open or video-assisted thoracoscopic lung biopsy, were compared and analyzed. The patients were fellowed-up after treatment. Results The patients included 6 males and 1 female, with an age range of 54-69 years and a mean of 56 years old. Five of them had a history of smoking. The clinical manifestations mainly included cough, production of sputum, breathlessness on exertion and emptysis. Computed tomography of the chest showed reticular, patchy and stripe shadow and focal consolidation in both lungs. Histopathologically, 5 cases had usual interstitial pneumonia, and two had lymphatic interstitial pneumonia. The histopathological subtypes cancer included 2 squamous cell carcinoma, 2 adenocarcinoma, 2 mixed carcinoma （adenosquamous carcinoma and adenocarcinoma mixed with large cell carcinoma）, and 1 large cell carcinoma. One patient was treated only by chemotherapy; the other six underwent the pulmonary Iobectomy, and 4 received chemotherapy before the operation and 2 after the operation. Three patients survived with the tumors and 4 died. Two patients died of respiratory failure two weeks after the operation and the other two died 15 and 17 months after the operation. Conclusion Old age, male sex, and smoking are risk factors for IIP-LC. Compared with idiopathic interstitial pneumonia, the clinical, radiologic and pathological diagnoses of IIP-LC are more difficult. Misdiagnosis may occurr when the surgical pulmonary biopsy specimen is limited, which may result in poorer treatment and prognosis.

关 键 词：特发性间质性肺炎 肺癌 纤维化 肺 临床病理 诊断 

分 类 号：R734.2[医药卫生—肿瘤] R563.1[医药卫生—临床医学]