肺隐球菌病临床病理分析

目的分析肺隐球菌病（PC）的临床病理特征及鉴别诊断，提高对PC的认识及诊断。方法应用HE染色、特殊染色（PAS和银染）及免疫组织化学染色对14例PC患者进行观察及分析。结果14例患者中男女均7例，年龄16～66岁，平均43岁。临床主要表现为咳嗽、咳痰、咳血、发热、胸闷及胸背疼痛。影像学检查：6例显示片状实变影；4例呈孤立性结节影；4例表现为多发低密度影，其中1例同时伴有胸椎、肝脏、脾脏多发病变。大体表现为瘤样肿块，切面灰褐色，中央区域可见坏死及囊性变。镜下为非干酪样坏死性肉芽肿伴大量炎细胞浸润。特殊染色巨噬细胞胞质及间质中可见具有诊断意义的圆形空泡状隐球菌孢子。结论PC客易与肺癌、结核及组织胞质茵病等混淆，其诊断主要依靠特殊染色，免疫组织化学及形态学分析。

Pulmonary cryptococcosis., a clinicopathological analysis

Objective To investigate the clinicopathologic features and differential diagnosis of pulmonary cryptococcosis （PC） to increase pathological awareness for clinical diagnosis. Methods 14 cases of PC were analyzed by HE staining or specific stainings （Periodic Acid Schiff staining, PAS and Gomori methenamine silver staining, GMS） and immunohistochemistry staining. Results A total of 14 patients （including 7 males and 7 females with an average age of 43 years old, ranged from 16 to 66 years） were diagnosed. Their clinical symptoms presented with cough, expectoration, hemoptysis, fever,chest tightness and thoracodorsal pain. Chest imaging depicted as flake con- solidation shadow in 6 cases, solitary nodule in 4 cases and multiple low-density shadow in 4 cases. One case associat- ed with pathological changes in thoracic spine, liver, spleen, simultaneously. Grossly, the tumor-like lesion showed as a pale to tan cut surface with central necrosis and cystic change. Microscopically, non caseating granuloma and inflam- matory cells were seen in these cases. Meanwhile, specific staining revealed a diagnostic criterion that vascular spheri- cal spores were observed in cytoplasma of maerocytes,multinuclear giant cell and mesenchyma. Conclusion PC is i- dentified by specific staining and histochemical staining as well as morphological analysis. It should be distinguished from pulmonary tuberculosis and histoplasmosis.