原发干燥综合征合并双原发肺癌及胸腺囊肿一例并文献回顾  

Primary Sjogren syndrome with double primary lung cancer and thymic cyst:a case report and literature review

作　　者：熊鑫[1] 崔健 刘领[1] 薛兵[1] Xiong Xin;Cui Jiang;Liu Ling;Xue Bing(Department of Respiratory Medicine,Beijing Chuiyangliu Hospital,Beijing 100022,China;Department of Thoracic Surgery,Beijing Chuiyangliu Hospital,Beijing 100022,China)

机构地区：[1]北京市垂杨柳医院呼吸内科,100022 [2]北京市垂杨柳医院胸外科,100022

出　　处：《国际呼吸杂志》2021年第17期1344-1349,共6页International Journal of Respiration

摘　　要：目的探讨原发干燥综合征(pSS)累及肺部的影像学表现,以及pSS合并双原发肺癌(double primary lung cancer,DPLC)、胸腺囊肿的临床特征。方法通过对1例伴有肺部囊腔样表现的pSS合并双原发肺癌、胸腺囊肿患者的临床资料进行分析,并结合文献进行回顾,对该病的临床特点进行总结。以"干燥综合征,肿瘤"为检索词,检索万方数据库,以"Sjogren syndrome AND tumor or cancer"为检索词,检索PubMed数据库。结果本例患者女,67岁,干燥综合征病史20年,因"咳嗽、咳痰、发热9天,发现肺部阴影7 d"入院。患者9天前出现发热,最高体温38.6℃,胸部X线检查,发现肺部阴影。给予口服头孢类抗生素治疗后体温降至正常。复查胸部CT发现多发肺部无壁囊样透亮区,多发肺部阴影,前纵隔肿物。遂行右肺上叶及右肺中叶楔形切除,右肺下叶切除,纵隔肿物切除术。术后病理诊断右肺下叶肺腺癌,右肺中叶浸润性肺腺癌,右肺上叶不典型腺瘤样增生,胸腺囊肿。随访1年无复发。共检索到相关文献11篇,其中我国的个案报道4篇(共计4例)。结论pSS常累及肺部,表现为无壁囊腔样改变,并可合并少见的DPLC、胸腺囊肿存在。pSS存在肺部囊样变者,合并肺癌,尤其是腺癌风险增加。临床医生应定期对高危患者进行肺癌相关检查,及早发现,及早治疗,改善患者预后。Objective To investigate the imaging manifestations of primary Sjogren syndrome(pSS)involving the lung and the clinical features of double primary lung cancer(DPLC)and thymic cyst.Methods A case of pSS complicated with pulmonary cystoid manifestations of PPLC and thymic cyst was analyzed with the clinical data,and the literature were reviewed.The clinical characteristics of this disease were summarized."Sjogren syndrome,tumor"was used as the retrieval term.AND Wanfang database was retrieved."Sjogren syndrome AND tumor or cancer"was used as the retrieval term,AND PubMed database was retrieved.Results A 67-year-old woman with a 20-year history of Sjogren syndrome was admitted to the hospital due to"cough,expectoration with fever for 9 days and lung shadow for 7 days".Patients with fever before 9 days,the highest temperature was 38.6℃.Chest X-ray found lung shadow.Giving oral cephalosporin antibiotics,the body temperature of the patient dropped to normal.Review of chest CT revealed multiple lung without wall sac sample bright area,multiple lung shadow,anterior mediastinum lesions.Wedge resection of the right upper lobe and right middle lobe was performed,also with right lower lobectomy,mediastinal mass resection.Postoperative pathological diagnosis was right lower lobe lung adenocarcinoma,right middle lobe invasive lung adenocarcinoma,right upper lobe atypical adenomatous hyperplasia,thymic cyst.No recurrence was observed after one year of follow-up.A total of 11 relevant literature were retrieved,including 4 cases reported of China.Conclusions pSS is often involved in the lung,presenting as a nonmural cystic change,and can be associated with the presence of rare DPLC and thymic cysts.pSS patients with cystic degeneration of the lung are at increased risk of lung cancer,especially adenocarcinoma.Therefore,clinicians should regularly check high-risk patients for lung cancer,strive for early detection and treatment,and improve the prognosis of patients.

关 键 词：干燥综合征 肺肿瘤 纵隔囊肿 肺疾病 间质性 

分 类 号：R734.2[医药卫生—肿瘤] R593.2[医药卫生—临床医学] R583