Unusual Pulmonary Radiological Manifestation: Coexistence of Neoplasm and Mycobacterium-A Case Report

少見的肺部放射學上表現：腫瘤合併分枝桿菌感染－病例報告

鄭世文(Shih-Wen Cheng) ； 李榮壽(Rong-Sow Lee) ； 王家弘(Jia-Horng Wang) ； 陳名聖(Ming-Sheng Chern)

《胸腔醫學》 20卷6期 (2005/12) Pp. 613-618

https://doi.org/10.29806/TM.200512.0014

摘要

肺腫瘤合併分枝桿菌感染的表現是多樣化的，但大多皆僻鄰而生。同時表現自發性消退，薄壁開洞，以及衛星病灶是相當少見的。在此我們報告一例72歲男性病志，罹患肺癌和分枝桿菌感染，症狀為左胸痛及咳嗽，放射學上一開始表現肺浸潤增加以及衛星病灶，再加上痰液的培養發現耐酸性染色痰液檢查陽性反應，於是我們馬上給予抗肺結核藥物。之後肺部病灶呈現縮小和開洞，似乎對藥物有不錯效果；雖然之後痰液培養出Mycobacterium fortuitum，因影像上覺得稍有進步，所以抗結核藥物仍持續給予，當作治療。然而在治療後期發現病灶漸漸變大，進一步的經由超音波導引穿刺細胞學檢查發現惡性腫瘤細胞，證實有肺癌基於此不常見的肺腫瘤合併非結核分枝桿菌感染的表現，使我們了解縱使痰液的培養有耐酸性桿菌的存在或培養出非結核分枝桿菌，也要考慮惡性腫瘤存在的可能性。

關鍵字

結核分枝桿菌 ； 肺腫瘤 ； 自發性消退 ； 薄壁開洞

並列摘要

The pulmonary manifestations of coexisting bronchogenic carcinoma and Mycobacterium are diverse, but most tumors and Mycobacterium cluster in close proximity. The radiographic presentation is primarily composed of spontaneous regression thin-walled cavitation and satellite lesions are rare. We report a case of 72 year-old healthy male who presented with the symptoms of left chest pain and cough. Chest X-ray and chest computerized tomography revealed an ill-defined lesion with satellite infiltrates in the left upper lung field. The result of sputum smear for acid-fast stain initially was positive and anti-tuberculous therapy was prescribed. The pulmonary lesion became smaller with thin-walled cavitation after anti-tuberculosis therapy. Progressive enlargement was noted at the outpatient clinic. Lung cancer was proved by sono-guided aspiration cytology. The possibility of malignancy coexisting with pulmonary tuberculosis in an ill-defined lesion is considered.

並列關鍵字

Tuberculosis ； lung cancer ； spontaneous regression ； thin wall cavitation ； satellite lesion