Held T, Rössler W, Reichelt A, Mielke M, Alexander M
Abteilung Innere Medizin mit Schwerpunkt Infektionskrankheiten, Freien Universität Berlin.
Dtsch Med Wochenschr. 1991 Aug 2;116(31-32):1186-90. doi: 10.1055/s-2008-1063734.
A 44-year-old man, a heavy smoker over many years, complained of hoarseness for 8 weeks with weight loss and dysphagia. Malignant tumour of the pharynx was suspected. Examination revealed a swelling of the right upper lip, tumorous changes in the right buccal mucosa, about 6 x 6 cm in size, as well as enlargement of the cervical lymph-nodes. Microlaryngoscopy revealed a three-level tumour of the entire side of the right larynx. Histological examination of biopsies of the right false and true vocal cords as well as the buccal mucosa demonstrated numerous, partly caseous epithelioid granulomas with Langhans giant cells. Ziehl-Neelsen staining showed acid-fast rods. Combined tuberculostatic treatment with isoniazid, rifampicin, ethambutol and pyrazinamide achieved regression of all signs and symptoms within two months. This case emphasizes the need for including laryngeal tuberculosis in the differential diagnosis of seemingly malignant laryngeal tumours.
一名44岁男性，多年来一直重度吸烟，主诉声音嘶哑8周，伴有体重减轻和吞咽困难。怀疑为咽部恶性肿瘤。检查发现右上唇肿胀，右侧颊黏膜有肿瘤样改变，大小约6×6厘米，以及颈部淋巴结肿大。显微喉镜检查显示右侧喉全侧有三级肿瘤。对右侧真假声带以及颊黏膜活检组织进行组织学检查，发现大量部分为干酪样的上皮样肉芽肿，并伴有朗汉斯巨细胞。齐-尼氏染色显示抗酸杆菌。联合使用异烟肼、利福平、乙胺丁醇和吡嗪酰胺进行抗结核治疗，两个月内所有体征和症状均消退。该病例强调在看似恶性的喉部肿瘤鉴别诊断中需要考虑喉结核。
