X0417:[求助][讨论]大家帮帮忙看看这个是什么病啊

jessie_valeron · 发表于 2005-10-15 06:04

以下使这个人的病案
patient history:
a twelve-year-old girl was referred to the pediatric pulmonary service for evaluation
of recurrent lung nodules. she had a past medical history of multiple immunologic
disorders, including idiopathic thrombocytopenic purpura (itp), common variable
immune deficiency (cvid), and autoimmune hemolytic anemia (aiha).
her medication consisted of intravenous gamma globulin every other week. the lung
nodules were initially seen on a chest x-ray and a computerized tomography (ct)
scan 10 months earlier. at that time, the patient was hospitalized for an exacerbation
of autoimmune hemolytic anemia. her anemia was treated with steroids and the lung
nodules resolved. the nodules reappeared with a more severe pattern after the
steroids were tapered. she had some fatigue with exertion but was otherwise
asymptomatic. her physical examination was remarkable for bilateral crackles in the
lung bases. pulmonary function studies revealed combined obstructive and restrictive
patterns. the patient underwent an open lung biopsy.
gross description:
the specimen contained of a 6.5 x 2.0 x 0.9 cm wedge biopsy of the lung parenchyma,
which was firm, with focal yellow to white vaguely nodular areas.
microscopic description:
sections of the lung biopsy showed expansion of the alveolar septa by multifocal dense
nodular and diffuse interstitial infiltrates  composed of mature lymphocytes and plasma
cells. multiple lymphoid aggregates  with active germinal centers  were also seen.
secondary inflammatory changes included abundant collections of histiocytes  and focal
prominent type ii pneumocyte hyperplasia.

[本贴已被 jiajie 于 2005-10-15 18:30:43 修改过]