Jolanda Nikolla, D. Xhemalaj, Arben Dhima, Daniela Bega
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引用次数: 0
摘要
简介单发肺结节(SPN)是指小于 3 厘米的单发肺不张。尤其是小细胞肺癌(SCLC)患者中,老年患者和重度吸烟者较多。胸部对比增强计算机断层扫描、氟脱氧葡萄糖(FDG)正电子发射断层扫描/计算机断层扫描(PET/CT)和病理学检查是确定诊断的主要方法。病例报告:一位 33 岁的年轻患者是一名不吸烟的男性采矿工程师,因病毒性干咳就诊。无其他已知合并症,有肺癌家族史。他接受了常规胸部 X 光检查,发现右肺顶端有圆形不透明物。进行了痰结核分枝杆菌检查,结果呈阴性。造影剂胸部扫描显示,右肺顶端有一个单发肺结节,轮廓分明,大小为 28 x 22 毫米。鉴于该结节的尺寸较大,对良性病变没有特异性,医生要求进行 PET/CT 检查,结果证实该结节的 SUV 值超过 4.5,对肺结核也没有特异性。随后对结节进行了组织学检查,结果不幸为右肺小细胞肺癌。结论大多数情况下,小细胞肺癌是肺部的肿块病变。在这种情况下,肺结核(TB)和肺癌的鉴别诊断是肺科医生和放射科医生面临的一大难题。
Small Cell Lung Cancer in a Young, Non-Smoker Patient
Introduction: A single lung nodule (SPN) is defined as a solitary lung opacification less than 3 cm in size. In particular, small cell lung cancer (SCLC) affects more patients, older and heavy smokers. A contrast-enhanced computed tomography of the chest followed by a f-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and the pathology examinations are the main ones that determine the diagnosis.
Case Report: A young patient, 33 years old, a non-smoking male mining engineer, presented to the clinic with a dry cough that started after a viral situation. No other known comorbidities and family history of lung cancer. A routine chest x-ray was ordered, where an apical round opacity in the apex of the right lung was seen. Sputum for mycobacterium tuberculosis was done and came back negative. A chest scan with contrast showed a solitary pulmonary nodule in the apex of the right lung with well-demarcated contours with dimensions 28 x 22 mm. Given that the dimensions of the nodule were large and not specific for benign pathology, a PET/CT was ordered, which confirmed the nodule resulted in an SUV over that 4.5, which was also not specific for lung TB. The histologic examination of the nodule was done then, and the result, unfortunately, was a small cell lung cancer in the right lung.
Conclusion: SCLC is found to be a mass lesion in the lungs in most cases. Differential diagnosis between lung tuberculosis (TB) and lung cancer in such cases is an excellent dilemma for pulmonologists and radiologists.