中国实用儿科杂志

中国实用儿科杂志 ›› 2023, Vol. 38 ›› Issue (9): 714-716.DOI: 10.19538/j.ek2023090613

• 病例报告 • 上一篇    下一篇

儿童原发性支气管非霍奇金淋巴瘤误诊为肺结核1例

  

  1. 河北省儿童医院  a 呼吸三科，b 儿科研究所，河北  石家庄  050031
  • 出版日期:2023-09-06 发布日期:2023-09-26
  • 通讯作者: 张中平，电子信箱：lingbohebei@sina.com
  • 基金资助:
    河北省卫健委课题项目（20231122）

One case of primary endobronchial non-Hodgkin lymphoma in children misdiagnosed as pulmonary tuberculosis

  1. Hebei Children’s Hospital，Shijiazhuang  050031，China
  • Online:2023-09-06 Published:2023-09-26

摘要： 儿童原发性支气管非霍奇金淋巴瘤罕见，该文报告1例误诊为原发性肺结核的支气管淋巴瘤患儿。1例10岁男性患儿因间断发热伴咳嗽40余天于2020年2月17日收入院。患儿有肺结核密切接触史，结核菌素试验（PPD）阴性，肺CT示纵隔及右肺门淋巴结肿大，临床诊断原发性肺结核。给予抗结核治疗后症状无好转，且出现喘息及呼吸困难。纤维支气管镜检查示右中叶开口可见团块状肿物阻塞，经支气管黏膜活检确诊间变性淋巴瘤激酶（ALK）阳性间变性大细胞淋巴瘤，无胸外器官受累。经规范化疗，患儿症状消失，肺部影像学恢复正常。提示对PPD阴性的纵隔/肺门淋巴结肿大的患儿，应及时行支气管镜检查及组织活检。

关键词: 原发性支气管淋巴瘤, 支气管内肿物, 气道梗阻, 肺结核

Abstract: Primary bronchial non-Hodgkin's lymphoma in children is a rare occurrence. This article reported the case of a child with bronchial lymphoma misdiagnosed as primary pulmonary tuberculosis.A 10-year-old male patient with intermittent fever and cough for more than 40 days was admitted to the hospital on February 17，2020.The patient had a history of close contact with tuberculosis， and the tuberculin test （PPD） was negative.Pulmonary CT showed lymph node enlargement in the mediastinum and right hilar of the lung. Primary pulmonary tuberculosis was clinically diagnosed. The symptoms did not improve after anti-tuberculosis treatment， and wheezing and dyspnea occurred.Fibrobronchoscopy revealed mass obstruction in the right middle lobe opening. A bronchial mucosal biopsy confirmed anaplastic lymphoma kinase （ALK） -positive anaplastic large cell lymphoma without involvement of external thoracic organs. After standard chemotherapy treatment，the child's symptoms disappeared and lung imaging returned to normal.It is suggested that bronchoscopy and tissue biopsy should be performed in time for PPD negative children with mediastinal/hilar lymph node enlargement.

Key words: primary endobronchial lymphoma, endobronchial mass, airway obstruction, pulmonary tuberculosis