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酷似胆管细胞癌的肝结节病:一例报告及文献复习

Hepatic sarcoidosis mimicking cholangiocellular carcinoma: A case report and literature review.

作者信息

Miyamoto Ryoichi, Sano Naoki, Tadano Sosuke, Inagawa Satoshi, Adachi Shinya, Yamamoto Masayoshi

机构信息

Department of Gastroenterological Surgery, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki, 305-8558, Japan.

Department of Gastroenterological Surgery, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki, 305-8558, Japan.

出版信息

Int J Surg Case Rep. 2017;41:165-168. doi: 10.1016/j.ijscr.2017.10.032. Epub 2017 Oct 25.

Abstract

INTRODUCTION

Sarcoidosis is a multisystem disease characterized by the presence of non-caseating granulomas in affected organs. Almost 70% of patients with a sarcoidosis reaction have hepatic involvement. However, evidence-based clinical management or treatment strategies for hepatic sarcoidosis are poorly defined. Here, we present a case of a resected hepatic sarcoidosis patient. Additionally, we review the relevant hepatic sarcoidosis literature and discuss the clinical management of hepatic sarcoidosis.

PRESENTATION OF CASE

A 20-mm liver tumor of segment 8 was incidentally detected in a 64-year-old female. Radiological images resembled the enhancement pattern of cholangiocellular carcinoma. Thus, this lesion was assigned a preoperative classification of pT1N0M0 stage I according to the 7th Union for International Cancer Control guidelines. The patient underwent a partial liver resection. Histologically, the tumor contained sarcoidosis lesions indicated by a conglomerate of epithelioid granulomas with giant cells. These histopathological findings were consistent with the diagnosis of hepatic sarcoidosis.

DISCUSSION

Histopathological examination has been established as the definitive diagnostic tool for hepatic sarcoidosis. Therefore, liver biopsy or surgical resection of a liver tumor should be considered in cases that are difficult to preoperatively distinguish from malignant tumors.

CONCLUSION

We present the case of a patient with surgically resected hepatic sarcoidosis that was difficult to preoperatively distinguish from cholangiocellular carcinoma.

摘要

引言

结节病是一种多系统疾病,其特征是受累器官中存在非干酪样肉芽肿。几乎70%的结节病反应患者有肝脏受累。然而,肝结节病的循证临床管理或治疗策略尚不明确。在此,我们报告一例接受手术切除的肝结节病患者。此外,我们回顾了相关的肝结节病文献,并讨论了肝结节病的临床管理。

病例介绍

一名64岁女性偶然发现肝8段有一个20毫米的肝肿瘤。影像学图像类似于胆管细胞癌的强化模式。因此,根据国际癌症控制联盟第7版指南,该病变术前分类为pT1N0M0 I期。患者接受了部分肝切除术。组织学检查显示,肿瘤含有结节病病变,表现为上皮样肉芽肿与巨细胞的聚集。这些组织病理学发现与肝结节病的诊断一致。

讨论

组织病理学检查已被确立为肝结节病的确诊诊断工具。因此,对于术前难以与恶性肿瘤区分的病例,应考虑进行肝活检或肝肿瘤手术切除。

结论

我们报告了一例手术切除的肝结节病患者,该病例术前难以与胆管细胞癌区分。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a2a6/5686224/c9a3b5f56164/gr1.jpg

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