原发性肺隐球菌病临床与病理对照观察

目的探讨原发性隐球菌病（PC）的临床表现与病理变化特点。方法对23例肺原发性肺隐球菌病临床及病理资料进行对比分析，组织化学染色及光镜观察。结果23例中8例术前经肺穿刺活检明确诊断，15例开胸探查，病理证实为此真菌病，病理诊断5例为粘液胶样病变，炎性肉芽肿病变12例，结节状纤维肉芽肿病变6例，所有病例均检出新型隐球菌并行手术病灶切除，粘液卡红（Mc），过碘酸雪夫染色（PAS）及六胺银（GMS）组织化学染色隐球菌呈阳性。术后3例并发隐球菌性脑膜炎，占本组病例13％（3／23），本组病例术后经6周～3个月不同疗程的抗真菌治疗，术后随诊3个月～1年，均无隐脑及肺部复发。结论PC的临床与影像学表现均无特异性，肺穿刺活检病理检查有助于此病的诊断，术后应常规抗真菌治疗，以防发生隐脑与肺部复发。

Clinical and pathological analysis of primary pulmonary crytococcosis (a study of 23 Cases)

Objective To investigate the diagnostic histopathological characteristic and clinical feature of primary pulmonary cryptococcosis （pc）. Methods Clinical data and pathologic finds of p. c were retrospectively reviewed. Results The specimens, consisted of 8 cases of fine needle aspiration lung biopsies and 15 cases of open Lung biopsies by histopathological examination in 23 cases of cryptococcosis, 5 cases with mucoid gum - like lesion, 12 cases with inflammatory granuloma, and 6 cases with nodular fiber-like granuloma. All patients were treated surgically for lesion. 3 cases were found with cryptococcal meningitis at post operation. All patients were treated by antifungcal therapy for 3 months to one year. No recurrence was found in any patient. Conclusion The clinical manifestation and image of PC are nonspecific. The lung biopsy is helpful in the diagnosis. Correct diagnosis of pc should rely on the combination by histopathological examination. The antifungcal therapy is necessary to decrease its recurrence.