肺隐球菌病(pulmonary Cryptococcosis, PC)临床表现及影像学特征缺乏特异性，极易与肺结核、肺癌及肺部其他感染性疾病混淆，导致误诊、漏诊率较高，延误最佳治疗时机。探讨以慢性肉芽肿性炎为主要病理表现PC的临床、影像学及病理学特征。为临床早期识别肺隐球菌病、合理选择辅助检查手段、减少不必要的有创操作及抗生素药物滥用提供参考依据，提高对肺部真菌病的诊治水平。

选择2023年1月至2025年6月我院收治的20例经病理确诊为肺隐球菌病且组织学表现为慢性肉芽肿性炎患者为对象，分析患者临床、病理资料，并进行复习文献。

20例患者中男6例，女14例，8例无临床症状，表现为咳嗽8例、咳痰3例、胸痛3例、发热2例、气促3例及乏力2例；有明确鸽子接触史2例。病灶分布于右肺12例(60.00%)、左肺5例(25.00%)、双肺3例(15.00%)；下叶受累10例(50.00%)。影像学以单发结节常见11例(55.00%)，病灶邻近胸膜13例(65.00%)；病灶直径0.4~5.6 cm，直径<3 cm者15例(75.00%)。CT平扫多呈高密度实性结节影，伴磨玻璃晕征3例(15.00%)、毛刺征4例(20.00%)、空泡征2例(10.00%)、支气管充气征2例(10.00%)，斑片状实变影9例(45.00%)，1例(5.00%)见空洞及少量胸腔积液。组织病理学示慢性肉芽肿性炎或慢性炎，伴多核巨细胞及上皮样细胞聚集；其中上皮样肉芽肿型14例(70.00%)，伴坏死3例(15.00%)，伴机化3例(15.00%)，无明显干酪样坏死。PAS及GMS特殊染色阳性20例，清晰显示隐球菌菌体及孢子。同时确诊PC与肺腺癌2例；宏基因组高通量测序(metagenomic next generation sequencing, mNGS)检测提示隐球菌感染4例，痰培养阳性1例，支气管镜检阳性1例。

肺隐球菌病临床表现隐匿，影像学缺乏特异性，易与肺癌、肺结核混淆。对于肺外周胸膜下高密度结节，尤其伴磨玻璃晕征、无钙化者，应警惕肺隐球菌病可能。联合HE形态学、真菌特殊染色(PAS/GMS)及mNGS检测可提高慢性肉芽肿性炎肺隐球菌病病原体检出率与诊断准确性。

Pulmonary Cryptococcosis (PC) lacks specificity in clinical manifestations and imaging features, making it highly prone to being confused with pulmonary tuberculosis, lung cancer, and other pulmonary infectious diseases. To a relatively high rate of misdiagnosis and missed diagnosis and delays the optimal timing of treatment. This study aims to investigate the clinical, imaging, and pathological characteristics of PC with chronic granulomatous inflammation as the main pathological manifestation, so as to provide a reference for early clinical identification of pulmonary cryptococcosis, rational selection of auxiliary examinations, reduction of unnecessary invasive procedures and antibiotic misuse, and improvement in the diagnosis and treatment of pulmonary fungal diseases.

A total of 20 patients with pathologically confirmed PC and histological manifestations of chronic granulomatous inflammation, admitted to our hospital from January 2023 to June 2025, were enrolled. Their clinical and pathological data were analyzed, and relevant literature was reviewed.

Among the 20 patients, there were 6 males and 14 females. Eight patients were asymptomatic; symptomatic presentations included cough in 8 cases, sputum production in 3, chest pain in 3, fever in 2, dyspnea in 3, and fatigue in 2. A definite history of pigeon exposure was noted in 2 cases. Lesions were located in the right lung in 12 cases (60.00%), left lung in 5 (25.00%), and both lungs in 3 (15.00%); lower lobe involvement was observed in 10 cases (50.00%). Imaging revealed solitary nodules in 11 cases (55.00%) and lesions adjacent to the pleura in 13 cases (65.00%). The lesion diameter ranged from 0.4 to 5.6 cm, with 15 cases (75.00%) having a diameter <3 cm. CT scans predominantly showed highdensity solid nodules, accompanied by groundglass halo sign in 3 cases (15.00%), spiculation sign in 4 cases (20.00%), vacuole sign in 2 cases (10.00%), air bronchogram sign in 2 cases(10.00%), and patchy consolidation in 9 cases (45.00%); cavity and a small amount of pleural effusion were observed in 1 case (5.00%). Histopathologically, all cases exhibited chronic granulomatous inflammation or chronic inflammation with aggregates of multinucleated giant cells and epithelioid cells; among them, 14 cases (70.00%) were of epithelioid granulomatous type, 3 (15.00%) with necrosis, and 3 (15.00%) with organization, without obvious caseous necrosis. PAS and GMS special staining were positive in all 20 cases, clearly revealing cryptococcal organisms and spores. Concurrent PC and lung adenocarcinoma were diagnosed in 2 cases; metagenomic nextgeneration sequencing (mNGS) indicated Cryptococcus infection in 4 cases, sputum culture was positive in 1 case, and bronchoscopy was positive in 1 case.

Pulmonary cryptococcosis presents with insidious clinical manifestations and nonspecific imaging features, and is easily confused with lung cancer and pulmonary tuberculosis. For peripheral subpleural highdensity nodules, especially those with groundglass halo sign and without calcification, PC should be suspected. The combination of HE morphology, fungal special staining (PAS/GMS), and mNGS detection can improve the pathogen detection rate and diagnostic accuracy for PC presenting as chronic granulomatous inflammation.