巨细胞间质性肺炎2例临床病理分析.pdfVIP

临床与实验病理学杂志 ChinJClinExpPathol2011Feb；27(2) ·163 · 巨细胞间质性肺炎2例临床病理分析 孟凡青 ，蔡后荣。，樊祥山 ，王景关 ，周 强 摘要 ：目的 提高病理医师对巨细胞间质性肺炎(giantcellinterstitialpneumonia，GIP)的认识。方法 对2例GIP患者的临床 特征、影像学表现及组织病理改变进行观察和分析，并复习相关文献。结果 GIP临床表现主要有咳嗽、咳痰和活动后呼吸困 难，肺功能检查显示弥散性和限制性功能障碍；胸部 x线和 cT表现为两肺毛玻璃影、实变影、弥漫性的小结节影、网状影和牵 拉性支气管扩张；病理改变为肺泡腔内大量巨噬细胞、特征性多核巨细胞沉积伴间质性肺炎。结论 GIP是罕见的慢性间质 性肺炎，无特异性的临床及影像学改变，需结合临床病史、临床表现、影像学及病理改变作出诊断。 关键词：巨细胞间质性肺炎；尘肺；硬金属 中图分类号：R563．1 文献标识码：A 文章编号：1001—7399(2011)02—0163—05 Giantcellinterstitialpneuminia：aclinicopathologicanalysisof2cases MENGFan—qing，CAIHou—rong，FANXiang—shan ，WANGJing—mei，ZHOUQiang (DepartmentofPathologyandDepartmentofPulmonaryMedicine，AffiliatedDrumTowerHospital，NanjingUniversitySchoolofMedi— cine，Nanjing 210008，China) Abstract：Purpose Toimprovepathologists’understandingofgiantcellinterstitialpneumonia(GIP)．Methods Theclinicalcharac— teristics，radiologicalpresentationsandpathologicalchageswereobservedandanalyzedin2casesofGIP，withreviewoftherelevantlit— eratures．Results PatientswithGIPusuallyhadahistoryofexposuretohardmetaldust．Clinicalpresentationsincludedcough，expec— toration，anddyspneaonexertion．Pulmonary functiontestingshowedadiffuseandrestrictiveabnormMity．GIPpresentedonchestradio— graphicmanifestationsandhigh-resolutionCTscansasbilateralground—glassopacity，consolidation，diffusesmallnodules，extensivere— ticularopacitiesandtractionbronchiectasis．Themainpathologicalfindingsincludedinterstitialpneumoniawithintra—alveolarmacropha— gesandalargenumberofmuhinucleatedhistiocytes．Thefindingofgiantcellinterstitialpneumoniawasalmostpathognomonicforhard metalpneumoconiosis．Conclusions GIP，ararechronicinterstitialpneumonia，hasnocharacteristic clinical manifestations．Radio— graphicfindingsofabnormalitiesofGIParesimilartothoseofotherinterstitialpneumonias．Meticuloushistory takingisimportantfor thediagnosisofGIP． Keywords：giantcellinterstitialpneumonia；hardmetal；pneumoc0niosis 巨细胞间质性肺炎 (giantcellinterstitialpneu— 院病理科