Гістоморфологічні особливості поєднаних форм туберкульозу та раку легень

The pathological features of combined forms of tuberculosis and non-small cell lung cancer in 72 patients who underwent radical surgical resection interventions from transsternal access with mediastinal lymph node dissection, with predominance of pneumonectomy - 63.9%, were studied. Three main categories of pathological changes were identified: cancer on the background of post-tuberculosis changes, cancer in tuberculoma, cancer in the wall of the active cavity. Post-tuberculosis changes were presented by dense centers, fibrosis, cirrhosis areas, sanitized cavities with histological predominance of coarse fiber connective tissue with giant cell granulomas, with areas characterized by the appearance of the lung tissue with atypical proliferation and metaplasia of bronchopulmonary epithelium, which is a precancerous condition. This malignant tumor process was presented mainly by adenocarcinomas and squamous cell cancer and differred by polymorphic macro- and microscopic picture. Cancer in tuberculoma and fibrous wall cavity differed by pronounced activity of tuberculosis process in the form of lymphohistiocytic infiltration, foci of caseous necrosis and presence of expressed granulation layer of Pirogov-Langhans’ cells. The basic morphological causes of carcinogenesis due to secondary changes of lung tissue in patients with tuberculosis were determined. The features of metastasis of malignant tumors on the background of specific tuberculous and post-tuberculosis changes in regional lymph nodes and the interrelation between the frequency of metastatic lesions with severity of tuberculosis and post-tuberculosis changes in them were studied; this has clinical significance in the surgical treatment of patients with concomitant forms of tuberculosis and lung cancer. Изучены патоморфо­логические особенности сочетанных форм туберкулеза и немелкоклеточного рака легких у 72 пациентов, которым проведены радикальные хирургические резекционные вмешательства из трансстернального доступа с использованием медиастинальной лимфодиссекции, среди которых преобладали пневмонэктомии - 63,9%. Выявлены 3 основные категории патоморфологических изменений: рак на фоне посттуберкулезных изменений, рак в туберкуломе, рак в стенке активной каверны. Посттуберкулезные изменения были представлены плотными очагами, фиброзом, участками цирроза, санированными кавернами с гистологическим пре­обладанием грубоволокнистой соединительной ткани с гигантоклеточными грунулемами, при этом ха­рактерно п