肺浸润性黏液腺癌六例误诊分析  

Misdiagnosis Analysis of Six Cases of Pulmonary Invasive Mucinous Adenocarcinoma

作　　者：熊鑫[1] 刘领[1] 吴文杰[1] 何彦侠[1] 薛兵[1] XIONG Xin;LIU Ling;WU Wen-jie;HE Yan-xia;XUE Bing(Department of Respiratory Medicine,Beijing Chuiyangliu Hospital,Beijing 100022,China)

机构地区：[1]北京市垂杨柳医院呼吸内科

出　　处：《临床误诊误治》2020年第1期17-20,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨肺浸润性黏液腺癌(pulmonary invasive mucinous adenocarcinoma,PIMA)的临床特点及误诊原因,以减少临床误诊的发生。方法回顾性分析2016年5月—2018年12月我院收治的6例曾被误诊的PIMA患者资料。结果6例中误诊为肺结核、重症肺炎各2例,肺脓肿及肺炎合并支气管扩张各1例,误诊时间2周~2年。临床表现为发热、咳嗽、咳痰3例(伴呼吸衰竭2例、咳白色泡沫痰1例),咳嗽、咳痰伴胸痛1例,气短、呼吸困难1例,无症状1例。胸部CT表现为双肺弥漫型病变4例,孤立型病变2例。3例由CT引导下经皮肺穿刺病理检查确诊,2例由B超引导下经皮肺穿刺病理检查确诊,1例由胸腔穿刺病理检查确诊。6例确诊后给予手术切除治疗、化疗、靶向治疗各1例,放弃治疗2例,转院1例。化疗者随访1年,仍在治疗中,病情相对稳定;靶向治疗者随访3个月,病情基本稳定;手术切除者随访2年,病情平稳,无复发;转院者失访;放弃治疗者1月余后死亡。结论PIMA临床表现无特异性,影像学表现多样,当遇到胸部CT检查提示存在实变合并支气管充气征的难治性或无反应肺炎,以及存在囊液性或空泡型卫星灶患者时应考虑到PIMA可能,必要时可行穿刺活检,以避免或减少误诊。Objective To investigate the clinical characteristics and misdiagnosis causes of pulmonary invasive mucinous adenocarcinoma(PIMA),so as to reduce the incidence of misdiagnosis in clinical settings.Methods Data of 6 patients misdiagnosed as PIMA who were admitted to our hospital from May 2016 to December 2018 were retrospectively analyzed.Results Among the 6 cases,2 cases were misdiagnosed as tuberculosis,2 cases as severe pneumonia,1 case as pulmonary abscess and 1 case as pneumonia combined with bronchiectasis.And the duration of misdiagnose was 2 weeks to 2 years.The clinical manifestations included fever,cough and expectoration in 3 cases(2 cases with respiratory failure and 1 case with white foam sputum),cough and expectoration with chest pain in 1 case,shortness of breath and dyspnea in 1 case,and no symptoms in 1 case.Chest CT findings revealed double lung diffuse lesions in 4 cases,and isolated lesions were found in 2 cases.Three cases were confirmed by CT guided percutaneous lung puncture for pathological examination,2 cases were confirmed by B-ultrasound guided percutaneous lung puncture for pathological examination,and 1 case was confirmed by thoracic puncture for pathological examination.After diagnosis,6 cases were given surgical resection,2 cases underwent chemotherapy,2 undergoing targeted therapy,2 cases declined to receive treatment,and 1 case was transferred to another hospital.The patients reveiving chemotherapy were followed up for 1 year,and are still under treatment with relatively stable condition.The patients receiving targeted therapy were followed up for 3 months and their condition was basically stable.The patients undergoing surgery were followed up for 2 years with stable condition and no recurrence.The transferee was lost to follow-up.Those who gave up treatment died more than a month later.Conclusion PIMA has no specific clinical manifestations but diverse imaging manifestations.When patients have refractory or unresponsive pneumonia with chest CT examination suggesting consolidation

关 键 词：肺肿瘤 误诊 肺结核 肺炎 肺脓肿 支气管扩张症 

分 类 号：R734.2[医药卫生—肿瘤]