有趣病例86：这不是肺大泡，这是淋巴瘤

常记溪亭日暮，沉醉不知归路。

公众号：小小医生之有趣的医学

诗

萧萧梧叶送寒声，江上秋风动客情。

知有儿童挑促织，夜深篱落一灯明。

前言

相关阅读：

这竟然不是简单的“肺大泡”，可能是“囊性肺癌”！

肺大泡，很简单，但是复杂的时候：最简单的也是最复杂的。

肺大泡！

so easy！

A 58-year-old Japanese woman initially visited a local hospital for an evaluation of an abnormal chest X-ray film in December 2009. No abnormal findings were observed on the chest X-rays findings at that time; however, chest CT revealed multiple cystic lesions in both lungs. Therefore, the patient was referred to our hospital in February 2010. She had been healthy with no sicca symptoms, such as dry eyes or dry mouth. She had not undergone a chest X-ray for 10 years。

一句话：58岁女性，10年没有体检。

此次CT：双肺多发肺大泡。

02 肺功能

A pulmonary function test showed mild obstructive impairment; however, the vital capacity and diffusing capacity were normal.

肺功能：轻度阻塞性损伤;肺活量和弥散量正常。

03 化验单

血清类风湿因子、抗核抗体、抗ss - a抗体水平升高，抗ss - b抗体水平正常。

An elevation of the serum rheumatoid factor and antinuclear and anti-SS-A antibody levels was observed, while the serum anti-SS-B antibody level was normal.

04 仔细看CT

有结节。

还有结节。

肺淋巴管平滑肌瘤病？

肺朗格汉斯组织细胞增生症？

淋巴细胞性间质性肺炎？

这个“肺大泡”的壁，有一小丁点厚，外形不够圆：只可意会不可言传。

事后诸葛亮：大人，此事有蹊跷！

下面这个CT，看着可能是肺囊肿，但是，外科手术切下来，病理：肺大泡。

肺大泡与肺囊肿，很难鉴别，非常难。

相关阅读：

CT基础：肺大泡、肺气肿、肺的气囊、囊肿、空洞，CT如何鉴别

05 派特CT

Fluorodeoxyglucose-positron emission tomography did not demonstrate a high uptake level of the standard uptake value。

派特CT未见异常。真有钱，这就拉去做派特CT。

06 气管镜

Flexible bronchoscopy disclosed no abnormal findings in the trachea or bronchi。

The histopathology of the specimens obtained with a transbronchial lung biopsy (TBLB) showed no specific findings.

气管镜：未见异常。经支气管镜肺活检：无特殊发现。

在中国，派特CT自费6000多（以前约1万元），气管镜+肺活检也1000多元，啥都没有发现，白白浪费了病人的钱，还受罪。

07 肿么办？

Therefore, lung biopsy specimens of the right S2 and S8 were obtained via video-assisted thoracoscopic surgery (VATS). The histopathology of the specimens (Fig. 2) revealed infiltration of small- and middlesized lymphocytes, follicular colonization and the presence of lymphoepithelial lesions with a large amount of proliferation of lymphocytes around the bronchovascular bundles and bronchioles. The lymphocytes were immunohistochemically positive for CD20 and CD138 and negative for CD3 and exhibited a monoclonal expression ofλ-chain. These findings were consistent with a diagnosis of mucosa-associated lymphoid tissue (MALT) lymphoma.

外科胸腔镜肺活检，病理：肺粘膜相关淋巴瘤。

在本例中，血清RF和抗核抗体和抗ss - a抗体水平升高;然而，没有主观症状，包括唾液或泪腺分泌水平下降。因此，本病例不符合Sjögren综合征的诊断标准。

piu

There was a lack of evidence of extrapulmonary involvement for three months after diagnosis, and the patient was diagnosed with primary p-MALT lymphoma. She has not received any chemotherapy, and her clinical symptoms and radiologic findings have been stable for two years.

诊断后3个月无肺外受累迹象，患者被诊断为原发性p-MALT淋巴瘤。

她没有接受任何化疗，她的临床症状和放射学表现稳定了两年。

Noguchi S, Yatera K, Kido T,et al. Pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma with multiple thin-walled pulmonary cysts: a case report and review of the literature. Intern Med. 2013;52(20):2325-9.

Bae et al. (5) showed that the chest CT findings of p-MALT lymphoma consist of single nodular or consolidative patterns (33%), multiple nodules or areas of consolidation (43%), bronchiectasis and bronchiolitis (14%) and diffuse interstitial lung disease (10%).

Bae等(5)发现p-MALT淋巴瘤的胸部CT表现包括：单发结节或实变类型(33%)、多发结节或实变区域(43%)、支气管扩张和细支气管炎(14%)和弥漫性间质性肺疾病(10%)。

09 学习视频

呼吸重症：呼吸机参数设置指南（入门版），附视频

文章汇总：支气管镜、胸腔镜、胸腔穿刺

杨柳岸，晓风残月。

视频

这感觉也不能怪她，是我我也憋不住。

蜘蛛侠电影盘点。

三国群聊（7）：华佗再治曹操，暗杀司马懿！

大葱看电影：雄狮少年。

陈翔六点半：兄弟，来搬砖不，我觉得你挺会抬杠的。

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