Yamamoto Takatsugu, Miyazaki Toru, Kurashima Yukiko, Ohata Kazunori, Okawa Masato, Tanaka Shogo, Uenishi Takahiro, Miyaji Katsuhiko, Fukumoto Nobusuke
1 Department of Surgery and.
2 Department of Gastroenterology, Ishikiri Seiki Hospital, Osaka, Japan.
Int Surg. 2015 Jun;100(6):1011-7. doi: 10.9738/INTSURG-D-14-00126.1.
A 43-year-old Japanese woman visited for a hepatic tumor incidentally found. We suspected eosinophilic granuloma of the liver (EGL) due to visceral larva migrans (VLM). However, neither past history nor medical interview indicated a risk of parasitosis. Blood testing revealed eosinophilia, serum examination showed normal results for immunoglobulin E, and enzyme-linked immunosorbent assay yielded negative for Toxocara and Anisakis. Gastric and colonic endoscopy revealed normal features. Several imagings showed central necrosis of the tumor. After informed consent, laparoscopic resection was performed. Histopathological examination showed EGL without parasites. No recurrence had occurred postoperatively. Most reports documented that EGL are caused by VLM. However, parasites are not always demonstrable on serum, histopathological, or immunochemical examinations. When acting as allergens to induce type I responses, microscopic agents other than parasites in the intestinal tract could induce eosinophilic inflammation in the liver. Accumulation of more cases should help clarify other pathogeneses for EGL.
一名43岁的日本女性因偶然发现肝脏肿瘤前来就诊。我们怀疑是内脏幼虫移行症（VLM）导致的肝脏嗜酸性肉芽肿（EGL）。然而，既往史和问诊均未提示寄生虫病风险。血液检查显示嗜酸性粒细胞增多，血清检查显示免疫球蛋白E结果正常，酶联免疫吸附试验显示弓蛔虫和异尖线虫均为阴性。胃和结肠内镜检查未见异常。多项影像学检查显示肿瘤中央坏死。在获得知情同意后，进行了腹腔镜切除术。组织病理学检查显示为无寄生虫的EGL。术后未出现复发。大多数报告记载EGL由VLM引起。然而，在血清、组织病理学或免疫化学检查中并不总能发现寄生虫。当作为变应原诱导I型反应时，肠道内除寄生虫外的微观介质可诱导肝脏嗜酸性炎症。积累更多病例将有助于阐明EGL的其他发病机制。
