Holstege Axel, Zolinski Peter, Woidy Ludwig, Permanetter Willibald
Medizinische Klinik 1, Klinikum Landshut, Robert-Koch-Str. 1, 84034 Landshut, Germany.
Best Pract Res Clin Gastroenterol. 2007;21(3):535-50. doi: 10.1016/j.bpg.2007.01.003.
The pattern of elevated serum liver enzymes in symptomatic or asymptomatic patients allows for an initial classification of liver diseases into cholestatic or hepatocellular diseases. A female patient with extrahepatic cholestasis due to segmental bile duct strictures and a localized mass lesion within the pancreas is presented. Although many diagnostic procedures were performed in this case the diagnosis was not obtained before surgical laparotomy was initiated with bioptic sampling from bile ducts, lymph nodes and pancreatic tissue. Microscopic examination of the specimen revealed extensive biliary and pancreatic scarring together with periductal infiltrates composed of lymphocytes and plasma cells consistent with sclerosing cholangitis in systemic autoimmune pancreatitis. The patient completely recovered upon treatment with prednisone and azathioprine. The difficult approach to the final diagnosis is discussed in light of established and modern diagnostic tools.
有症状或无症状患者血清肝酶升高的模式有助于将肝病初步分类为胆汁淤积性或肝细胞性疾病。本文介绍了一名女性患者，因节段性胆管狭窄和胰腺内局限性肿块病变导致肝外胆汁淤积。尽管该病例进行了许多诊断程序，但在通过胆管、淋巴结和胰腺组织活检取样进行手术剖腹探查之前，仍未明确诊断。对标本的显微镜检查显示广泛的胆管和胰腺瘢痕形成，以及由淋巴细胞和浆细胞组成的导管周围浸润，符合系统性自身免疫性胰腺炎中的硬化性胆管炎。该患者经泼尼松和硫唑嘌呤治疗后完全康复。结合已有的和现代的诊断工具，讨论了最终诊断的困难之处。
