Bronchioloalveolar carcinoma masquerading as pneumonia.
Bronchioloalveolar carcinoma masquerading as pneumonia.
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伪装成肺炎的细支气管肺泡癌。
作者：
W. Thompson
细支气管肺泡癌（BAC）是一种相对罕见的腺癌，通常发生在肺周围并沿肺泡壁生长，不破坏肺实质。它通常是多中心的，可能由先前稳定的疤痕引起。由于实质被保留，并且 BAC 可能同时出现在多个肺叶中，因此胸部 X 光片和症状（咳嗽、胸痛和咳痰）可能与肺炎或其他非感染性炎症过程（例如过敏性肺炎或闭塞性细支气管炎）难以区分。如果看似肺炎但没有发烧或白细胞增多或对抗生素没有反应，临床医生应怀疑 BAC。 BAC 占所有肺癌的 2.6-4.3%。在放射照片上，BAC 通常表现为孤立结节，但也可能表现为斑片状、大叶或多叶浸润，通常伴有与肺炎难以区分的空气支气管征。正电子发射断层扫描无法帮助区分 BAC 和肺炎。在 BAC 患者中，62% 的患者没有任何症状，仅有 X 光片异常，而 38% 的患者则出现咳嗽、胸痛和咳痰的症状。支气管镜检查通常是正常的。术前通过经支气管活检、支气管镜细胞学检查或痰液细胞学检查进行诊断对于弥漫性或多中心型更为常见。治愈取决于完全切除。尝试抗生素并重新评估临床结果是一种合理的方法，但活检或细胞学是诊断恶性肿瘤并排除其他病因的唯一方法，因此当疑似肺炎对抗生素没有反应时，应始终考虑活检。我见到了一位61岁的男子，他的初步诊断结果是肺炎。他服用了10天的口服阿奇霉素疗程，但他的症状和胸片没有变化。断层扫描显示右上叶和右下叶有间质突出和周围气腔疾病。右上叶经支气管活检显示克拉拉细胞，具有明显的异型性和不同的核质比。底层的肺部结构被保留，没有看到侵入性成分。诊断改为非粘液性 BAC。肺切除术很成功，他在大约 10 个月内没有患癌症，之后癌症复发，最终他去世了。
Bronchioloalveolar carcinoma (BAC) is a relatively rare adenocarcinoma that typically arises in the lung periphery and grows along alveolar walls, without destroying the lung parenchyma. It is often multicentric and may arise from a previously stable scar. Because the parenchyma is preserved and because BAC may arise simultaneously in multiple lobes, the chest radiograph and symptoms (cough, chest pain, and sputum production) may be indistinguishable from pneumonia or other noninfectious inflammatory processes (eg, hypersensitivity pneumonitis or bronchiolitis obliterans). The clinician should suspect BAC if what otherwise appears to be pneumonia lacks fever or leukocytosis or does not respond to antibiotics. BAC accounts for 2.6-4.3 % of all lung cancers. On a radiograph, BAC often appears as a solitary nodule, but may also appear as a patchy, lobar or multilobar infiltrates, often with air bronchograms indistinguishable from pneumonia. Positron-emission tomography does not help distinguish BAC from pneumonia. Among BAC patients, 62% present without symptoms and with only an abnormal radiograph, whereas 38% present with symptoms of cough, chest pain, and sputum production. Bronchoscopy is usually normal. Preoperative diagnosis with transbronchial biopsy, bronchoscopic cytology examination, or expectorated sputum cytology is more common with the diffuse or multicentric forms. Cure depends on complete resection. A trial of antibiotics and reassessment of clinical findings is a reasonable approach, but biopsy or cytology is the only means of ruling in malignancy and ruling out other etiologies, so biopsy should always be considered when a presumed pneumonia does not respond to antibiotics. I saw a 61-year-old man whose initial diagnosis was pneumonia. He took a 10-day course of oral azithromycin, but his symptoms and chest radiograph were unchanged. A tomogram showed interstitial prominence and peripheral air-space disease in the right upper and lower lobes. Transbronchial biopsy of the right upper lobe showed Clara cells, with substantial atypia and various nuclear-cytoplasmic ratios. The underlying pulmonary architecture was preserved and no invasive component was seen. The diagnosis was changed to nonmucinous BAC. Pneumonectomy was successful and he was cancer-free for about 10 months, after which the cancer returned and from which he eventually died.