32例酷似粟粒性肺结核的肺泡癌的临床诊断

目的通过对32例弥漫性细支气管肺泡癌（DBAC）病例的分析,提高对DBAC及粟粒性肺结核（MPTB）的认识,降低临床误诊率。方法回顾1997年9月-2007年9月曾被误诊为MPTB的32例DBAC的临床及影像特点、误诊情况。结果32例最后确诊为DBAC,男∶女=15∶17。15例吸烟,平均40包/年。胸部X线和肺部CT表现为局部肿块合并双肺弥漫结节影12例; 单纯双肺弥漫分布小结节影20例。经纤维支气管镜肺活检、刷检、冲洗检阳性率达66.7% ;痰脱落细胞学检查阳性率达46.9%;B超或CT引导下经皮肺穿刺活检及淋巴结活检阳性率更高。结论DBAC男女发病相近,患者吸烟较少或不吸烟。临床表现为咳嗽、白色泡沫痰,进行性气促,可有咯血、胸腔积液,锁骨上、纵隔、肺门淋巴结转移,X线胸片及肺部CT有特征性改变,本病的发病率低及部分患者有结核史或结核接触史是造成误诊率高的原因。

Clinical diagnosis of 32 diffuse bronchiolo-alveolar carcinomas that similar to miliary tuberculosis

Objective 32 diffuse bronchiolo -alveolar carcinoma （DBAC） were analyzed to better understand of DBAC and miliary tuberculosis （MPTB） and to reduce the misdiagnosis rate. Methods Review the clinical data and imaging of 32 DBAC misdiagnosed as MPTB between September, 1997 and September, 2007. Results 32 cases were finally diagnosed as DBAC （M： F = 15： 17） , in which there were 15 smokers with average 40 - pack/year smoking history. 12 cases presented as local tumor combined with diffuse bilateral pulmonary nodules ;20 cases presented as purely diffuse distribution of small lung nodules. The positive rate of fiberoptic bronchoscopy biopsy, brush biopsy and bronchial washing was 66.7% ;Sputum cytology - positive rate was 46.9%. The positive rate under B - ultrosonic or CT - guided percutaneous transthoracic biopsies l PTB） was higher. Conclusion The incidence of DBAC is similar between men and women. Patients were non - smokers or smoke seldom. The clinical manifestation include cough, white foam sputum, progressive dyspnea, and even with hemoptysis, pleural effusion, supraclavieular, mediastinal, and hilar lymph node metastasis. X - ray and chest CT have characteristic performances. The low incidence of the disease and some patients with TB history or a history of exposure to tuberculosis are the causes of misdiagnosis.