肺黏液腺癌合并鳞状细胞乳头状瘤及惠普尔养障体感染1例  

Pulmonary Mucinous Adenocarcinoma Combined with Bronchial Squamous Cell Papilloma and Infection with Tropheryma Whipplei:A Case Report

作　　者：岳晓蕾 席晓霞 张敏 卞均雨 陈永林[2] Xiaolei YUE;Xiaoxia XI;Min ZHANG;Junyu BIAN;Yonglin CHEN(The First Clinical Medical School of Lanzhou University;Department of Pathology,The First Hospital of Lanzhou University,Lanzhou 730000,China)

机构地区：[1]兰州大学第一临床医学院,兰州730000 [2]兰州大学第一医院病理科

出　　处：《中国肺癌杂志》2023年第7期553-558,共6页Chinese Journal of Lung Cancer

基　　金：兰州市城关区科技计划项目(No.2022JSCX0031)资助。

摘　　要：肺部同侧同时双原发性肿瘤且合并惠普尔养障体(Tropheryma whipplei,TW)感染较为少见,本文对1例原发性肺黏液腺癌(primary pulmonary mucinous adenocarcinoma,PPMA)合并支气管鳞状细胞乳头状瘤(bronchial squamous cell papilloma,BSCP)及TW感染患者的临床资料、影像学表现、病理结果及诊疗经过进行回顾,并分析诊疗经验。患者主要表现为长期咳嗽咳痰,胸部计算机断层扫描(computed tomography,CT)示双肺炎症改变与多发结节影,右肺下叶穿刺活检结果为PPMA;常规气管镜见右肺亚支结节,活检结果为BSCP。肺泡灌洗液高通量测序(metagenomics next generation sequencing,mNGS)结果考虑肺炎链球菌、TW混合感染,抗感染效果不佳。胸水未检测到明确基因突变,行化疗并定期随访。在临床中应该提高对肺部多发病变的认识,避免漏诊、误诊,尽快明确诊断后进行综合治疗。Simultaneous multiple primary tumors on the same side of the lung with Tropheryma whipplei(TW)infection are rare.We reviewed the clinical data,imaging manifestations,pathological results,diagnosis and treatment of a primary pulmonary mucinous adenocarcinoma(PPMA)patient with bronchial squamous cell papilloma(BSCP)and TW infection,and discussed our treatment experience.The patient mainly presented with chronic cough and sputum,and computed tomography(CT)showed inflammatory changes with multiple nodular shadows.Biopsy of the lower lobe of the right lung showed PPMA,and right lung sub-branchial nodules discovered during bronchoscope revealed BSCP.Metagenomics next generation sequencing(mNGS)of bronchoalveolar lavage fluid showed mixed infection of Streptococcus pneumoniae and TW with a poor anti-infective effect.No clear genetic mutation was detected,and the patient was treated with chemotherapy and regularly followed up.We should improve the awareness of multiple pulmonary pathologies during clinical practice,avoid missed diagnosis and misdiagnosis,and carry out comprehensive treatment after clarifying the diagnosis as soon as possible.

关 键 词：肺肿瘤 肺黏液腺癌 鳞状细胞乳头状瘤 惠普尔养障体 

分 类 号：R734.2[医药卫生—肿瘤]