Bening solitary pulmonary necrotic focal lesions: possibilities of morphological diagnostics

Abstract

Objective — to analyze the diagnostic possibilities of histological examination of single necrotized focal lung lesions by determining their histological features and etiology. Materials and methods. The study was conducted as a cohort, retrospective. The group included 68 patients with solitary focal lesions of the lungs (from 1 to 3), the size of each focus did not exceed 3 cm. The size, shape and contours of the detected foci were evaluated based on the results of radiographs or tomograms. Morphological diagnostics included cytological and histological examination. The results of microbiological examination of operative material for the presence of mycobacteria and non-specific microorganisms, the results of molecular genetic analysis for the presence of tuberculosis mycobacteria must be taken into account; as well as a number of indicators of clinical-biochemical and immunological studies of biological fluids, clinical data as needed. Histological findings, preliminary and final clinical diagnoses were compared. Results and discussion. According to the results of X-ray analysis and traditional histological examination, a number of signs of solitary necrotic foci-nodules were identified and compared with the results of histochemical, microbiological and molecular genetics examination. It was established that solitary necrotic nodules (78.0 %), larger than 1 cm (81.0 %) of irregular shape predominate. In two-thirds of cases (62.0 %), a granulomatous process was observed, and namely in these cases mycobacteria were detected during microbiological examination. Also, only in cases of histological diagnosis of caseous necrosis or necrosis of mixed type, positive results of microbiological examination for the presence of MBT were obtained. Final histological conclusions with an accurate formulation of the pathological process were obtained in 88.2 %, while the etiology was established in 85.3 % of cases. The final clinical diagnoses had differences compared to the histological conclusions because they have a different formulation principle. Conclusions. A complex histological study in combination with microbiological and molecular genetic studies plays a decisive role in establishing of the etiology of solitary necrotic pulmonary foci. According to the results of our work, the dominated etiology of nodules was foci as a result of limited disturbances in the pulmonary blood circulation system (infarcts and focal thrombus, infarct pneumonia), tuberculous and fungal nature. The overall diagnostic efficiency of morphological diagnostics was 85.3 %.