北京大学学报(医学版)

• 病例报告 • 上一篇    下一篇

哮喘样表现的支气管腺样囊性癌1例

路明1,王敏1,朱翔2,3△,陈亚红1,姚婉贞1   

  1. (北京大学第三医院 1.呼吸科,2.病理科, 北京100191;3. 北京大学基础医学院病理学系, 北京100191)
  • 出版日期:2018-04-18 发布日期:2018-04-18
  • 通讯作者: 朱翔 E-mail: zj_summer2@163.com

Bronchial adenoid cystic carcinoma masquerading as bronchial asthma:a case report

LU Ming1, WANG Min1, ZHU Xiang2, 3△, CHEN Ya-hong1, YAO Wan-zhen1   

  1. (1. Department of Respiratory Medicine, 2. Department of Pathology, Peking University Third Hospital, Beijing 100191, China; 3. Department of Pathology, Peking University School of Basic Medical Sciences, Beijing 100191, China)
  • Online:2018-04-18 Published:2018-04-18
  • Contact: ZHU Xiang E-mail: zj_summer2@163.com

摘要: 哮喘是呼吸科常见病,典型表现为慢性咳嗽、喘息,夜间症状为著,以及可逆性气流阻塞。腺样囊性癌是一种少见的特殊类型的气道恶性肿瘤,常见于气管中下段,临床上以慢性咳嗽、喘鸣、进行性呼吸困难、固定性中心气道狭窄为主要表现[1]。现将北京大学第三医院2015年收治的1例发生于左主支气管,肺功能表现为可逆性气流阻塞,被误诊为难治性哮喘的支气管腺样囊性癌报告如下,并进行临床分析和文献复习。

关键词: 支气管肿瘤, 癌, 腺样囊性, 哮喘, 诊断, 鉴别

Abstract: Here we reported a case of bronchial adenoid cystic carcinoma from Peking University Third Hospital. A 40-year-old female presented with dry cough for 1 year and nocturnal paroxysmal attacks of wheezing for 4 months. She was a non-smoker, and did not have past histories of asthma or allergy. On physical examination, no stridor, wheezing and cyanosis were present and the general appearance was good. The results of the laboratory analysis, including blood eosinophils count, immunoglobulin E level and chest X-ray were normal. Spirometry revealed reversible airflow obstruction, and post-bronchodilator forced expiratory volume in one second (FEV1) showed an increase of 12% and 230 mL from baseline. Bronchial asthma was diagnosed, however, she responded poorly despite the adequate anti-asthma therapy including high dose inhaled corticosteroid plus long-acting beta2-agonist, theophylline and montelukast. Then chest computed tomography (CT) was performed which showed a polypoid mass occupying the lumen of left main bronchus. Then the bronchoscopy revealed a polypoid endobronchial mass arising from the left main bronchus, causing subtotal obstruction of the lumen. Biopsy was carried out through the bronchoscopy, the pathological findings showed characteristic cribriform and tubular pattern which was formed by two-layered cells with ductal and myoepithelial phenotypes, which were consistent with adenoid cystic carcinoma. Re-examining the patient, the lung was clear without any wheeze when she was seated. However, inspiratory wheeze was heard in her left upper lung when she was supine, and disappeared after sitting up again. Subsequently the patient underwent a resection surgery. At the operational site, the tumor was seen on the anterolateral wall of the left main bronchus, without submucosally expanding histologically. Therefore, a sleeve resection surgery of the left main bronchus was performed. Following surgery, chest CT scan revealed complete resolution of the tumor. Her symptoms improved significantly, as did her pulmonary function tests, although all the medicines for asthma were stopped. Now, two years after the operation, the patient remained asymptomatic, and spirometry was performed again which showed normal completely. The presenting case report emphasizes the fact that not all wheezes and reversible airflow obstruction are asthma. It is critical to bear in mind that if a “difficult asthma” patient does not respond to appropriate anti-asthma therapy; localized obstructions should be differentiated.

Key words: Bronchial neoplasms, Carcinoma, adenoid cystic, Asthma, Diagnosis, differential

中图分类号: 

  • R734.1
[1] 卢昕,张立宁. 肌活检在特发性炎性肌病诊断和临床分型中的价值[J]. 北京大学学报(医学版), 2018, 50(6): 949-951.
[2] 田晓军,邱敏,刘茁,肖若陶,黄毅,王国良,侯小飞,张树栋,庄申榕,马潞林. 微创手术治疗肾癌合并Mayo 0~2级静脉癌栓的单中心研究[J]. 北京大学学报(医学版), 2018, 50(6): 1053-1056.
[3] 王小慧,张岩,刘林枝,尚晨光. 二甲双胍与脂联素对子宫内膜癌细胞增殖的作用[J]. 北京大学学报(医学版), 2018, 50(5): 767-773.
[4] 孙静,宋卫东,闫思源,席志军. 氯喹抑制肾癌细胞活性促进舒尼替尼诱导的细胞凋亡[J]. 北京大学学报(医学版), 2018, 50(5): 778-784.
[5] 丁振山,邱敏,徐梓程,肖若陶,葛力源,马潞林. 乳头状肾细胞癌合并癌栓患者的临床病理分析[J]. 北京大学学报(医学版), 2018, 50(5): 805-810.
[6] 黄子雄,杜依青,张晓鹏,刘士军,徐涛. 肾细胞癌骨转移的临床与病理分析[J]. 北京大学学报(医学版), 2018, 50(5): 811-815.
[7] 郝一昌,陈昆,刘余庆,卢剑,肖春雷,马潞林. 输尿管软镜下钬激光切除术治疗肾盂癌6例报道及文献复习[J]. 北京大学学报(医学版), 2018, 50(5): 816-821.
[8] 王明,李辉,王静,高嵩. 利用X射线衍射增强成像技术诊断肝纤维化[J]. 北京大学学报(医学版), 2018, 50(5): 899-904.
[9] 叶雄俊,刘军,安立哲,熊六林,徐涛,黄晓波. 麦氏点斜切口在全腹腔镜下肾输尿管全长切除术中的应用[J]. 北京大学学报(医学版), 2018, 50(4): 762-封三.
[10] 唐旭,赵卫红,宋琴琴,殷华奇,杜依青,盛正祚,王强,张晓威,李清,刘士军,徐涛. SOX10对前列腺癌细胞增殖及侵袭的影响[J]. 北京大学学报(医学版), 2018, 50(4): 602-606.
[11] 唐兴国,颜野,邱敏,卢剑,陆敏,侯小飞,黄毅,马潞林. 单中心16年青年膀胱尿路上皮癌患者的诊治[J]. 北京大学学报(医学版), 2018, 50(4): 630-633.
[12] 张晓东,刘德若. 肺腺癌新分类与表皮生长因子受体基因突变之间的关系[J]. 北京大学学报(医学版), 2018, 50(4): 640-644.
[13] 盖晓燕,常春,王娟,梁瀛,李美娇,孙永昌,贺蓓,姚婉贞. 中性粒细胞型哮喘患者的气道炎症与小气道重构分析[J]. 北京大学学报(医学版), 2018, 50(4): 645-650.
[14] 张苏杰,赵卫红,于路平,殷华奇,张晓威,李清,刘士军,徐涛. 伴多发淋巴结肿大的乏脂型血管平滑肌脂肪瘤并发术后顽固性淋巴瘘1例报道及文献回顾[J]. 北京大学学报(医学版), 2018, 50(4): 717-721.
[15] 黄子雄,张晓鹏,董森,刘士军,杨荣利,周宇石,马伟国. 肾黏液性小管和梭形细胞癌合并骨转移1例及文献回顾[J]. 北京大学学报(医学版), 2018, 50(4): 732-735.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 王瑞永, 马绪臣, 张万林, 柳登高. 健康成年人颞下颌关节间隙锥形束计算机体层摄影术测量分析[J]. 北京大学学报(医学版), 2007, 39(5): 503 -506 .
[2] 常磊, 马康涛, 张蘅. 阿尔茨海默病淀粉样前体蛋白可与低密度脂蛋白受体相关蛋白6直接作用[J]. 北京大学学报(医学版), 2000, 32(4): 366 -368 .
[3] 王晓霞, 王兴, 李自力. 下颌骨牵引成骨对下牙槽神经超微结构的影响[J]. 北京大学学报(医学版), 2001, 33(6): 520 -524 .
[4] 杨京平, 张燕, 钟延丰, 郑杰. 固定液及抗原修复液pH值对免疫组化染色的影响[J]. 北京大学学报(医学版), 2003, 35(1): 87 -90 .
[5] 冀栋, 隋滋野, 崔彩莲, 罗非, 韩济生. N-甲基-D-天冬氨酸受体拮抗剂氯胺酮抑制大鼠吗啡戒断症状的表达[J]. 北京大学学报(医学版), 2002, 34(4): 326 -332 .
[6] 王学清, 齐宪荣, 刘跃鹏. 盐酸丁卡因脂质体凝胶剂的经皮渗透性[J]. 北京大学学报(医学版), 2002, 34(4): 365 -367 .
[7] 牟向东, 王广发, 阙呈立, 李桂莲. H3N2型人流行性感冒合并金黄色葡萄球菌败血症及金黄色葡萄球菌肺炎1例[J]. 北京大学学报(医学版), 2007, 39(6): 663 -665 .
[8] 范蓉, 张成飞, 高岩, 李斌斌, 王晶. 核因子-κB受体活化因子配体和骨保护素在慢性根尖周炎病损组织中的表达[J]. 北京大学学报(医学版), 2008, 40(1): 39 -42 .
[9] 周团锋, 王新知, 张桂荣, 孙凤. 后牙金沉积内冠熔结镍铬桥体烤瓷桥的实验力学分析[J]. 北京大学学报(医学版), 2008, 40(1): 74 -76 .
[10] 张婷婷, 徐冲, 俎鲁霞, 何金汗, 蒲申申, 郭晓蕙, 徐国恒. 高浓度葡萄糖刺激脂肪细胞脂肪分解的效应及其机制[J]. 北京大学学报(医学版), 2008, 40(3): 273 -279 .