Multimacronodular pulmonary tuberculosis (bacteriologically negative) confirmed histologically.

Q4 Medicine
Pneumologia Pub Date : 2016-07-01
Gabriela Jimborean, Roxana Maria Nemeş, Paraschiva Postolache, Doina Milutin, Edith Simona Ianoşi
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引用次数: 0

Abstract

Background: Pulmonary tuberculosis can be confirmed by positive bacteriology of sputum, bronchial aspirate or by biopsies (microscopy and/ or culture) or by histopathological examination highlighting specific tuberculous granulomas. When microscopy is repeatedly negative during noninvasive methods, lung biopsy by thoracoscopy is needed for confirmation and differential diagnosis.

Case presentation: A 40-year-old female patient (nonsmoker, diabetic, with previous exposure to chemicals) was admitted to the hospital for weight loss, dry cough, loss of appetite, pallor, and fatigue. Chest-X-ray and thoracic CT revealed multiple irregular macronodules with various shapes, randomly spread across the lungs. Bacteriology for acid fast bacilli (AFB) from six spontaneous sputum was negative. Bronchoscopy showed an acute bronchitis. Bronchial aspirate was negative for tumor cells and AFB. Several biopsies from bronchial wall showed unspecific changes. The molecular biology tests for specific nucleic acids detection (Polymerase Chain Reaction) or positron-emission-tomography (to differentiate benign nodules from malign ones) were not accessible. Multiple biopsies from lung parenchyma and pleura were obtained using thoracoscopy. Histopathology revealed multiple specific tuberculous granulomas. The complex antituberculous treatment (9 months) has led to the total cure of the disease and resorption of the nodules. The patient’s last visit (after 2 years) showed no clinical/imagistic or bacteriologic relapse of the disease.

Conclusion: Tuberculosis may present in the form of multiple macronodules spread randomly across the lung parenchyma. Thoracoscopy coupled with multiple large lung biopsies are recommended for diagnosis of multinodular lung lesions, especially when common bacteriology/cytology from bronchoscopic aspiration failed to achieve diagnosis. Histological exam from thoracoscopic biopsies allows differential diagnosis between entities that have macronodular features: tuberculosis, primitive lung cancer, lymphomas, metastatic disease or invasive fungal disease.

多结节性肺结核(细菌学阴性)组织学证实。
背景:肺结核可通过痰、支气管吸痰细菌学阳性或活检(显微镜和/或培养)或组织病理学检查(突出特定的结核性肉芽肿)确诊。在无创方法中,当显微镜检查反复阴性时,需要胸腔镜肺活检进行确认和鉴别诊断。病例介绍:一名40岁女性患者(非吸烟者、糖尿病患者,既往接触过化学品)因体重减轻、干咳、食欲不振、脸色苍白和疲劳入院。胸部x线及胸部CT示多发形状各异的不规则大结节,随机分布于肺部。6例自发性痰液抗酸杆菌(AFB)细菌学检测均为阴性。支气管镜检查显示急性支气管炎。支气管吸出液肿瘤细胞及AFB阴性。支气管壁活检显示非特异性改变。特异核酸检测的分子生物学测试(聚合酶链反应)或正电子发射断层扫描(区分良性结节和恶性结节)无法获得。胸腔镜下行肺实质及胸膜活检。组织病理学显示多发特异性结核性肉芽肿。复杂的抗结核治疗(9个月)导致疾病的完全治愈和结节的吸收。患者的最后一次就诊(2年后)没有临床/影像学或细菌学上的疾病复发。结论:结核可表现为多个大结节随机分布于肺实质。对于多结节性肺病变的诊断,建议胸腔镜联合多次大肺活检,特别是当支气管镜下常见的细菌学/细胞学检查无法诊断时。胸腔镜活检的组织学检查可以鉴别具有大结节特征的实体:结核病、原始肺癌、淋巴瘤、转移性疾病或侵袭性真菌疾病。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Pneumologia
Pneumologia Medicine-Pulmonary and Respiratory Medicine
CiteScore
0.20
自引率
0.00%
发文量
10
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