局灶性机化性肺炎40例误诊分析

目的探讨局灶性机化性肺炎(FOP)的临床表现、病理学特征和影像学特点,以提高临床医师对本病的认识。方法回顾性分析2013-2018年江苏省人民医院住院手术切除的40例误诊为肺癌的FOP患者的临床资料,对其临床表现、病理学特征、影像学特点、实验室检查等综合分析。结果(1)40例FOP患者中,男34例,女6例,年龄范围为26~82岁,平均年龄(55.55±10.52)岁。(2)临床表现中,咳嗽咳痰21例,发热6例,咯血8例,胸痛12例,体检发现14例。(3)病变在肺野外、中、内带及各肺叶均有发生。CT表现多样,除结节影和实变影外,合并有分叶状、边缘毛刺征、支气管充气征、空泡征、密度不均、胸膜牵拉等。病灶范围≥3 cm的26例,<3 cm的14例。(4)共有8例患者行PET-CT检查,其中6例患者均有不同程度氟代脱氧葡萄糖代谢增高,提示恶性病变可能;2例未见氟代脱氧葡萄糖代谢增高,考虑炎症后改变。(5)40例患者中,癌胚抗原、糖类抗原199均正常,仅有1例神经元特异性烯醇化酶轻度增高,D-二聚体均正常。(6)病理提示间质纤维组织增生,肺泡腔扩张,腔内见纤维素样黏液栓形成,间质多量淋巴细胞浸润伴淋巴滤泡形成。(7)40例手术患者中,1例患者半年后复查手术缝线周围复发;余复查均正常。结论FOP临床相对少见,因其特殊影像表现极易误诊。临床医师需不断加强对FOP的认识,通过基本信息、临床特征、影像、实验室检查、病理特征等综合诊断,以减少临床误漏诊。

Misdiagnosis analysis of 40 cases of focal organizing pneumonia

Objective To discuss the clinical manifestations,pathological features and imaging features of focal organizing pneumonia(FOP)in order to improve the understanding of the disease among clinicians.Methods The clinical data of 40 patients with FOP misdiagnosed as lung cancer in the People′s Hospital of Jiangsu Province from 2013 to 2018 were retrospectively analyzed.The clinical manifestations,pathological features,imaging features,laboratory tests were analyzed.Results(1)Of the 40 patients with FOP,34 cases were male,six cases were female,the age was 26-82 years old,and the average age of onset was(55.55±10.52)years old.(2)In clinical manifestations,there were 21 cases of cough and expectoration,six cases of fever,11 cases of hemoptysis,12 cases of chest pain,and 14 cases had no any symptoms.(3)The lesions occurred in the field,middle and inner zones and in the lobes of the lungs.CT manifestations were varied.In addition to nodular shadow and solid change,there were lobulation,marginal burr sign,bronchial inflation sign,vacuole sign,uneven density,pleural traction and so on.There were 26 cases with lesions larger than 3 cm and 14 cases with lesions less than 3 cm.(4)A total of 8 patients underwent PET-CT examination,six patients showed different degrees of increased fluorodeoxyglucose metabolism,suggesting malignant lesions,two cases did not see increased fluorodeoxyglucose metabolism,considering inflammatory changes.(5)Among 40 patients,carcinoembryonic antigen,carbohydrate antigen199 and D-dimer were normal,neuron-specific enolase was increased in only one case.(6)Pathology results showed interstitial fibroplasia,alveolar cavity expansion,fibrous mucoid plug in the cavity,interstitial lymphocytic infiltration with lymphoid follicle formation.(7)Among the 40 surgical patients,one patient recurred after half a year.Conclusions FOP is relatively rare in clinic.Because of its special imaging manifestations,it is easily misdiagnosed.Clinicians need to constantly strengthen their understanding of FOP,and make comprehensive diagnosis through basic information,clinical manifestations,imaging performance,laboratory examination and pathological features,so as to reduce clinical misdiagnosis.