早期肺软化斑：使用聚合酶链反应检测马红球菌

摘要(中文译文)

软斑病是一种罕见的炎症性疾病，其特征为良性巨噬细胞积聚，并伴有具有诊断特异性的Michaelis-Gutmann小体（MGBs）。该病通常见于泌尿生殖道，并与免疫缺陷状态相关。在本简短报告中，我们介绍了5例临床怀疑为原发性或转移性肺癌的肺结节患者。手术标本的组织学检查显示为非特异性肉芽肿性慢性疾病，尽管典型的MGBs较少，仍怀疑为肺软斑病。在所有病例中，均通过16S rRNA基因序列分析鉴定出机会性病原体马红球菌（R. equi），从而最终作出软斑病的病理诊断。我们得出结论：与R. equi相关的肺软斑病是一种罕见疾病，也可累及免疫功能正常的患者。本文对其发病机制及诊断难点进行了讨论。由于R. equi感染是可治疗的，应强调早期识别的重要性。

Abstract

Malacoplakia is a rare inflammatory condition characterized by the accumulation of benign macrophages associated with pathognomonic Michaelis-Gutmann bodies (MGBs). It is usually found in the genito-urinary tract, and has been associated with immunocompromised states. In this short report, we present 5 patients with pulmonary nodules clinically suspicious for primary or metastatic lung cancer. The histologic examination of the surgical specimens revealed a nonspecific granulomatous chronic disease, and despite the paucity of classical MGBs, a pulmonary malacoplakia was suspected. In all cases the opportunistic pathogen Rhodococcus equi (R. equi) was identified by 16S rRNA gene sequence analysis, leading to the final pathological diagnosis of malacoplakia. We conclude that pulmonary malacoplakia associated with R. equi is a rare disease affecting also immunocompetent patients. The pathogenesis and the diagnostic problems are discussed. Since infection by R. equi is treatable, the importance of its early recognition should be emphasized.

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