引起中心气道阻塞的近端颈段气管EB病毒相关炎性息肉：一例病例报告。

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中文摘要

背景： 中心气道的腔内病变可引起严重阻塞，且通常为恶性。Epstein-Barr病毒（EBV）相关炎性气管息肉极为罕见，可能类似于气道肿瘤或EBV相关淋巴增殖性疾病。
病例介绍： 一名35岁女性因进行性呼吸困难和喘息1个月就诊。增强胸部计算机断层扫描和支气管镜检查显示，一个孤立的腔内息肉样病变起源于近端颈段气管左前壁，无真正的声门下受累。该病变从声带尾侧约26.3 mm延伸至40.8 mm，头尾方向长度约为14.5 mm。最狭窄处的最小残余气道直径约为1.7 mm，估计管腔阻塞约为54%。实施了急诊硬质支气管镜下冷冻切除和冷冻治疗，症状迅速缓解。组织病理学显示来自近端颈段气管的息肉样组织碎片，鳞状上皮下可见反应性淋巴组织增生。免疫组织化学支持反应性过程，无淋巴瘤或恶性肿瘤证据。EBER原位杂交在一部分淋巴细胞中呈阳性。基于组织的靶向下一代测序检测到大量EBV序列，并经PCR和Sanger测序证实。最终诊断为近端颈段气管EBV相关炎性息肉。
结论： EBV相关炎性气管息肉可表现为危及生命的气道阻塞。对于伴有反应性增生和EBER阳性的罕见气道病变，整合组织病理学、免疫组织化学、原位杂交和分子分析对于避免误诊非常重要。支气管镜干预可有效解除阻塞，但需要随访以监测复发和气道狭窄。

英文摘要

BACKGROUND: Intraluminal lesions of the central airway can cause severe obstruction and are usually malignant. Epstein-Barr virus (EBV)-associated inflammatory tracheal polyps are extremely rare and may mimic airway tumors or EBV-associated lymphoproliferative disorders.
CASE PRESENTATION: A 35-year-old woman presented with progressive dyspnea and wheezing for 1 month. Contrast-enhanced chest computed tomography and bronchoscopy revealed a solitary intraluminal polypoid lesion arising from the left anterior wall of the proximal cervical trachea, without true subglottic involvement. The lesion extended from approximately 26.3 mm to 40.8 mm caudal to the vocal cords, with a craniocaudal length of approximately 14.5 mm. The minimum residual airway diameter at the narrowest point was approximately 1.7 mm, and the estimated luminal obstruction was approximately 54%. Emergency rigid bronchoscopic cryoresection and cryotherapy were performed, resulting in rapid symptom relief. Histopathology showed polypoid tissue fragments from the proximal cervical trachea with reactive lymphoid hyperplasia beneath the squamous epithelium. Immunohistochemistry supported a reactive process, with no evidence of lymphoma or malignancy. EBER in situ hybridization was positive in a subset of lymphocytes. Tissue-based targeted next-generation sequencing detected abundant EBV sequences, which were confirmed by PCR and Sanger sequencing. The final diagnosis was EBV-associated inflammatory polyp of the proximal cervical trachea.
CONCLUSIONS: EBV-associated inflammatory tracheal polyps may present as life-threatening airway obstruction. For rare airway lesions with reactive hyperplasia and EBER positivity, integrated histopathological, immunohistochemical, in situ hybridization, and molecular analyses are important to avoid misdiagnosis. Bronchoscopic intervention can effectively relieve obstruction, but follow-up is needed to monitor recurrence and airway stenosis.