原发性肺隐球菌病8例并文献复习

为探讨原发性肺隐球菌病(pulmonary cryptococcosis,PC)的临床表现、临床病理特征、诊疗方法,回顾性分析2014-2018年遵义医科大学附属医院收治的8例经病理组织学确诊的PC患者的临床资料,收集其临床病理特征、苏木精-伊红(HE)及特殊染色等相关资料,并复习相关文献。8例PC患者中均为免疫力正常人群,无一例患者近期有鸽粪接触史。7例表现为咳嗽、咳痰或胸痛表现,1例患者无明显症状;影像学表现以单发或多发结节肿块影为主,亦有斑片渗出影表现。临床初步诊断肺癌、肺结核、肺炎及炎性假瘤,无一例考虑肺真菌病。病理组织学表现为慢性炎症及肉芽肿性病变,PAS、六胺银染色下均可见新型隐球菌孢子。7例患者只采取了外科肺叶切除术,1例患者行肺穿刺并行系统抗真菌药物治疗,随访至今,无一例复发。以上结果表明大部分PC患者无明显免疫功能损害,临床表现及影像学表现无特异性。大多数病例通过组织病理学找到隐球菌孢子可确诊,六胺银、过碘酸希夫染色特殊染色有助于病理诊断。免疫功能正常的PC患者行外科肺叶切除后如未行系统抗真菌治疗,则需密切随访。氟康唑和伊曲康唑治疗仍是经典的内科治疗手段。

Eight cases of pulmonary cryptococcosis and literature review

To explore the clinical manifestations,clinicopathological features,the methods of diagnosis and treatment in pulmonary cryptococcosis(PC),we retrospectively analyzed the clinical data of 8 PC patients admitted by the Affiliated hospital of Zunyi Medical University from 2014 to 2018,which included the clinicopathological parameters,Hematoxylin eosin(HE)staining,special staining and other relevant materials,and we reviewed the related literatures.All of the 8 PC patients were normal immune population,and all of them denied contact history of pigeon dung.Seven of patients showed symptoms of cough,expectoration or chest pain,while one patient had no obvious symptoms.The imaging examinations were mainly single or multiple nodules and lumps,as well as patchy exudation.These were considered for lung cancer,tuberculosis,pneumonia,inflammatory pseudotumor,and none for pulmonary fungal disease.All the 8 cases presented chronic inflammation and granulomatous lesions,and the staining of Schiff hyperiodic acid and hexamamine silver was helped to find cryptococcus.Only surgical lobectomy was performed in 7 patients,1 patient was treated with pulmonary puncture and systemic antifungal drugs,there was no recurrence during the follow-up.Most PC patients have no obvious immune function impairment,no special characteristics for clinical and imaging.Cryptococcus spores can be found in most cases by histopathology,and special staining such as hexamine silver and Schiff hyperiodic acid is helpful for pathological diagnosis.Surgical treatment of pulmonary cryptococcosis is still a common method.Patients with PC with normal immune function need to be followed up closely if they do not receive systematic antifungal treatment after lobectomy.Fluconazole and itraconazole are still classic medical treatments.