肺浸润型黏液性腺癌误诊为肺脓肿  

Invasive Mucinous Adenocarcinoma Misdiagnosed as Pulmonary Abscess

作　　者：王妍敏[1] 郭雪君[1] 郏琴[1] 管雯斌[2] 刘乾[1] 

机构地区：[1]上海交通大学医学院附属新华医院呼吸内科,上海200092 [2]上海交通大学医学院附属新华医院病理科,上海200092

出　　处：《临床误诊误治》2014年第10期30-32,共3页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨肺浸润型黏液性腺癌的临床和病理特点,减少误漏诊。方法对我院收治的1例肺浸润型黏液性腺癌的误诊资料进行回顾性分析。结果本例为74岁女性,因咳嗽、咳痰、气促半年余,反复发热半月余入院。CT提示两肺多发结节伴空洞,急诊一度误诊为肺脓肿,给予多种抗生素治疗效果欠佳。复查胸部CT示病变持续进展,于胸外科手术肺活检病理检查确诊为肺浸润型黏液性腺癌,予对症支持和中医药治疗,随访9个月疾病进展,出现多发淋巴结转移和呼吸衰竭。结论临床遇到以肺部多发结节、空洞为主要表现者,除考虑肺部感染性疾病外还需警惕肺癌的可能;治疗后应及时多次复查病灶的影像学变化,对病灶吸收不佳或进展者应尽早行活检病理检查以明确诊断。Objective To investigate the pathological and clinical features of lung invasive mucinous adenocarcinoma in order to reduce the misdiagnosis and missed diagnosis rates. Methods Clinical data of one patient with lung invasive mucinous adenocarcinoma in our hospital was retrospectively analyzed. Results A 74-year-old female patient complained of having cough, expectoration and anhelation more than half a year, and fever more than half a month. Chest CT showed bilateral multiple pulmonary cavity and nodules, so she was misdiagnosed as having pulmonary abscess in Emergency Department. She had a variety of antibiotics and the treatment results were not satisfactory. CT showed that the lesion continued to progress, then she was finally diagnosed as having lung invasive mucinous adenocarcinoma by surgical biopsy. Although supporting treatment and traditional Chinese medicine were used, the disease progressed in the 9-month follow-up, accompanied by multiple lymph node metastasis and respiratory failure. Conclusion Multiple pulmonary cavity and nodules are not only the main performances of pulmonary infectious diseases but can also be observed in certain types of pulmonary carcinoma. Repeated chest CT after treatment should be performed. Early biopsy may be helpful to diagnosis when CT image shows signs of deterioration.

关 键 词：腺癌 黏液 误诊 肺脓肿 

分 类 号：R734.2[医药卫生—肿瘤]