PDF(Pubmed)
Abstract：
Silicosis caused by the inhalation/deposition of free silica particles is characterized by pulmonary inflammation/fibrosis. Among the clinical disorders associated with silicosis, tuberculosis is by far the most prominent. A 66-year-old male non-smoker, originally from North Africa, reported a dry cough and significant weight loss. He was a foundry worker. He had a medical history of bladder carcinoma associated with schistosomiasis. Computed tomography (CT) and positron emission tomography (PET)/CT showed bilateral multiple hypermetabolic lung nodules, some with cavitation. The patient underwent surgical resection of the largest nodule, which was highly suspicious of lung metastasis. The histological examination revealed multiple nodular formations. Several lesions showed the characteristic features of silicotic nodules. There were also adjacent well-formed granulomas, some with central caseous necrosis. A real-time polymerase chain reaction, performed for the identification and quantification of the DNA of the Mycobacterium tuberculosis complex, was positive. Pulmonary silico-tuberculosis is often encountered in patients with a history of silica exposure in tuberculosis-endemic areas. This case serves as a reminder to never underestimate patient occupational exposure and geographic origin. A careful histological diagnosis and molecular investigation are mandatory when approaching difficult cases, especially patients with a prior cancer history and clinical/radiological features suggestive of tumour recurrence/metastasis.
摘要：
由游离二氧化硅颗粒的吸入/沉积引起的矽肺的特征在于肺部炎症/纤维化。在与矽肺病相关的临床疾病中，结核病是迄今为止最突出的。一个66岁的男性不吸烟,最初来自北非，报告干咳和明显的体重减轻。他是一名铸造工人。他有与血吸虫病相关的膀胱癌病史。计算机断层扫描（CT）和正电子发射断层扫描（PET）/CT显示双侧多发高代谢肺结节，一些有空化。患者接受了最大结节的手术切除，高度怀疑肺转移。组织学检查显示多个结节形成。几个病变显示了矽肺结节的特征性特征。附近也有形成良好的肉芽肿，一些有中央干酪样坏死。实时聚合酶链反应,用于鉴定和定量结核分枝杆菌复合体的DNA，是积极的。在结核病流行地区，有二氧化硅暴露史的患者经常会遇到肺结核。此病例提醒我们永远不要低估患者的职业暴露和地理来源。当接近困难病例时，必须进行仔细的组织学诊断和分子检查，特别是有既往癌症病史和临床/放射学特征提示肿瘤复发/转移的患者。
