Bohn J, Schippers E, Wagner S, Küsters W, Müller J, Meesmann M, Scheppach W
Medizinische Klinik, Juliusspital Würzburg.
Dtsch Med Wochenschr. 2010 Feb;135(6):236-9. doi: 10.1055/s-0029-1244839. Epub 2010 Feb 2.
A 65-year-old female was admitted with fever of unknown origin.
Abdominal computed tomography showed a solid mass (7.5 cm in diameter) with central fluid, located in the right lobe of the liver. Fine-needle aspiration cytology was unremarkable. Further work-up procedures for suspected liver abscess included colonoscopy, which surprisingly revealed adenocarcinoma at 13 cm from the anal orifice.
Both lesions in the rectum and liver were resected. While a moderately differentiated (G2) adenocarcinoma of the rectosigmoid junction (stage T3/ N0) was confirmed, histology of the hepatic mass showed liver infarction due to polyarteritis nodosa of the medium-sized arteries. Treatment with 20 mg/d prednisolone was initiated and tapered off over the next three months. The clinical course after discontinuation of corticosteroids was unremarkable over a 6-month follow-up.
It is suggested that polyarteritis nodosa of the liver occurred in this patient as a paraneoplastic phenomenon and subsided after resection of colorectal cancer and short-term immunosuppression with prednisolone.
一名65岁女性因不明原因发热入院。
腹部计算机断层扫描显示肝脏右叶有一个直径7.5厘米的实性肿块，中央有液体。细针穿刺细胞学检查无异常。对疑似肝脓肿的进一步检查程序包括结肠镜检查，令人惊讶的是，在距肛门孔13厘米处发现了腺癌。
直肠和肝脏的病变均被切除。虽然确诊为直肠乙状结肠交界处中度分化（G2）腺癌（T3/N0期），但肝脏肿块的组织学检查显示为中型动脉结节性多动脉炎导致的肝梗死。开始使用泼尼松龙20毫克/天进行治疗，并在接下来的三个月内逐渐减量。在6个月的随访中，停用皮质类固醇后的临床过程无异常。
提示该患者肝脏结节性多动脉炎作为副肿瘤现象发生，在切除结直肠癌并使用泼尼松龙进行短期免疫抑制后消退。
