| Part one:Clinical features and radiological features and characteristicsof pulmonary cryptococcosisObjective:The clinical and imaging data of 53 patients with pulmonary cryptococcosis confirmed by pathological or laboratory examinations were analyzed to study the clinical and imaging characteristics of pulmonary cryptococcosis in patients with different immune functions,and to explore the correlation between the immune status of patients and their pulmonary imaging manifestations.To analyze and summarize the predisposing population,age and susceptible factors of pulmonary cryptococcosis,and the imaging signs of pulmonary cryptococcosis with diagnostic significance,so as to further improve the diagnostic rate of pulmonary cryptococcosis.Method:A retrospective analysis was performed to collect 53 patients with pulmonary cryptococcosis who were over 18 years old from the First Hospital of Soochow University from November 2011 to December 2018.These patients underwent biomechanics in surgery and lung biopsy specimens.Or cytological diagnosis,diagnosis by positive results of respiratory specimen culture or positive results of cryptococcal capsular antigen,detailed records of patients with general information,life history,clinical manifestations,imaging features,initial diagnosis,final diagnosis and Diagnostic methods,treatment options and prognosis were statistically analyzed by SPSS 22.0 software.Result:1?53 cases were included in the study,including 38 male patients(71.70%),significantly higher than females(15 patients,28.30%).The average age was 52.81 ± 12.36 years,and the high-risk age range was 40-60 years old.2?Among the patients in this group,8(15.10%)had a history of exposure to poultry or pigeons,and there was no history of contact with mold and mildew.Among them,3(5.70%)had a history of contact with birds such as pigeons;5(9.40%)patients There was a history of close contact with poultry;8(18.10%)patients had a history of smoking.18 patients(34.00%)had no underlying disease,and 35(66.00%)had one or more underlying diseases,including hypertension,diabetes,and malignant tumors;patients with long-term hormone or immunosuppressive therapy history 5 Example(9.40%).3?Of the 53 patients in this group,28(52.83%)were asymptomatic,and the remaining 25(47.17%)patients had one or more of the following symptoms:cough,cough,chest pain,blood stasis or hemoptysis,difficulty breathing,fever,headache.4?Of the 53 patients,46(86.79%)were nodule/mass type,23(43.40%)were single,23(43.40%)were multiple,2(3.78%)were infiltration/consolidation type,and 5(9.43%)were diffuse or mixed type.The lesions were mainly located in the single lobe,subpleura and bilateral lower lung.Halo sign,burr sign and lobulation sign were the most common accompanying signs.There was no significant difference in the distribution and number of lesions between sex groups and different immune status(P>0.05).5?45 patients(84.90%)were diagnosed by thoracoscopic wedge resection,4(7.55%)were diagnosed by percutaneous lung biopsy,and 2(3.77%)were diagnosed by laboratory examination(positive cryptococcal capsular antigen test).One patient(1.89%)was diagnosed with cervical lymph node puncture,and one patient(1.89%)had cryptococci directly in the sputum.In 50 patients with histopathology,the pathological pathology showed inflammatory granuloma changes.Round or oval fungal spores were seen in the cytoplasm of endothelium-like or extranuclear macrophages,4 of which(8.00%)had pathology with necrosis,and 1 case(2.00%)showed visible cavities on CT.Positive rate of PAS staining 99%,the positive rate of hexamine silver staining was 100%,and all tissues were negative for acid-fast staining.6?Of the 47 patients(88.7%)who were followed up,surgical treatment was the main treatment,30(63.8%)underwent surgical treatment alone.A total of 17(36.2%)patients received antifungal drugs(8 received antifungal drugs alone,9 received antifungal drugs after operation).Most of the antifungal drugs were taken orally(52.9%)with an average course of treatment ranging from 1 week to 24 months.The course of treatment was 7.24±5.93 months.Of the 53 patients,47 were followed up for 2 months to 5 years.Among them,38(80.9%)recovered,14(29.8%)improved,1(2.1%)relapsed and 0 died.Conclusion:1?In this group of experiments,the clinical manifestations of patients with pulmonary cryptococcosis lack specificity;the rate of misdiagnosis is extremely high;2?The image performance is mainly nodular or mass-type,single-leaf distribution,mainly located in the subpleural,outfield,accompanied by signs of halo,burrs and lobes;3?For the patients suspected of pulmonary cryptococcosis,cryptococcal entrapment antigen and other examinations are recommended,or pulmonary biopsy is recommended;for patients whose pathology is difficult to diagnose and differentiate from lung cancer,surgical treatment is recommended;for patients with pulmonary cryptococcosis of nodular or mass type,only surgical resection can achieve curative effect.4?For patients with confirmed pulmonary cryptococcosis,regardless of postoperative antifungal therapy,regular chest imaging examinations are recommended,which is helpful for timely detection of recurrence or spread of infection.Part two:Clinical and imaging characteristics of ALK-positive NSCLC patientsObjective:To explore the imaging features of ALK-positive NSCLC patients and its correlation with clinical pathology.Methods:The clinical and imaging data of 2268 patients with NSCLC diagnosed by the First Affiliated Hospital of Soochow University from February 2015 to May 2017 were collected.The pathological confirmation methods included surgical resection of the lung or lung segment,CT-guided percutaneous lung puncture,and fiber.Bronchoscopy biopsy and pathological specimens of metastases.The ALK status was detected by Ventana IHC method.Among them,144 cases of ALK positive patients,75 cases of patients with incomplete data,lost to follow,were excluded.The clinical,pathological and imaging features of ALK-positive NSCLC were analyzed in 69 patients.Results:1?A total of 144 EML4-ALK-positive patients were detected in 2268 patients with pathologically confirmed NSCLC in this study.The detection rate was 6.30%.The positive rate of ALK in the group aged ?40 years(17.50%,14/80)was significantly higher than that in the age group>40 years(5.90%,130/2188),the difference was statistically significant(P<0.05);The odds of ALK positive in female patients(8.00%,80/1006)were higher than those in males(5.10%,64/1262),and there was a statistically significant difference(P<0.05).There was no significant difference in ALK expression from specimen source and differentiation(P>0.05).2?Among the 144 patients with ALK-positive NSCLC in this study,the proportion of non-smokers(83.33%,120/144)was higher than that of the smoking group(16.67%,24/144),indicating that ALK-positive patients mainly occurred in non-smokers.The clinical stage of ALK positive group was lower than that of negative group,75 cases(52.10%,75/144)in stage ?-? 69 cases(47.90%,69/144)in stage III-IV;126 cases of tumor marker detection Among them,98 cases(77.80%)had normal CEA(52 cases were stage ?-?,46 cases were stage ?-?),and 28 cases(23.20%)had elevated CEA(5 cases were stage ?-? and 17 cases were stage ?-? patients),indicating that most patients with ALK-positive lung cancer had normal CEA at the time of initial diagnosis,but there was no significant difference between clinical stage and CEA(P>0.05).3?In terms of pathological type,135(93.80%,135/144)patients with NSCLC adenocarcinoma in ALK-positive group were significantly higher than NSCLC non-adenocarcinoma patients(6.20%,9/135),and the difference between ALK expression status and lung cancer pathological type Statistically significant(P<0.05).In terms of tissue subtype,among the 144 patients with ALK-positive NSCLC,102 pathological reports did not describe the pathological subtype in detail.The remaining 42 patients with ALK-positive adenocarcinoma were mainly solid-type and acinar-based.4?In terms of imaging features,69 patients with ALK-positive NSCLC who had complete imaging data were the most common peripheral type,with 61 cases(88.40%),while only 8 cases(11.60%)were from the central type.?3cm(nodular)28 cases(40.60%),diameter>3cm(lump type)38 cases(55.10%),3 cases(4.37%)due to a large number of pleural effusion or lesion irregularity can not be measured;further to whether Subgroup analysis of GGO-containing lesions,57(82.60%)showed solidity,9(13.00%)were solid with GGO components,and only 3(4.40%)showed pure GGO,indicating most EML4-ALK positive tumors showed a solid growth pattern without GGO on CT.Conclusion:1?In this group of cases,the positive rate of ALK was 6.3%(144/2268),mainly young,female and non-smokers,and the positive rate of age ?40 years(17.50%,14/80)was significantly higher than age.>40 years old group(5.90%,130/2188);2?ALK positive lung adenocarcinoma is mainly based on solid lesions without GGO on CT,the lesion volume is large,and lymph node metastasis is easy to occur,rarely accompanied by GGO,pleural intaglio sign,bronchial aeration sign;helpful to clinicians Identify ALK positive dominant populations based on imaging features,while also highlighting the importance of genetic testing;3?The retrospective analysis of this group also reflects the existence of a certain gap between the actual clinical practice and the guideline recommendation.The whole process of standardized lung cancer management needs to be implemented in clinical practice. |
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