Hashimoto Kazuhiko, Nishimura Shunji, Oka Naohiro, Kakinoki Ryosuke, Akagi Masao
Department of Orthopedic Surgery, Kindai University Hospital, Osaka-Sayama, Osaka 589-8511, Japan.
Mol Clin Oncol. 2018 Aug;9(2):207-210. doi: 10.3892/mco.2018.1652. Epub 2018 Jun 12.
Despite the increasing incidence of tuberculosis, even in developed countries like Japan, tuberculoma is a relatively uncommon disease. Furthermore, given the rarity of tuberculoma, a definitive diagnosis is often delayed. We herein present the case of a 79-year-old man who presented with an erythematous and warm mass in the left forearm. Radiography revealed calcification of the wrist's volar side, and magnetic resonance imaging revealed a mosaic pattern at the lesion. Soft tissue sarcoma of the wrist was suspected, and an incisional biopsy was performed, which revealed numerous yellow rice bodies. A rapid pathological evaluation revealed caseous necrosis and Langhans giant cells, and a histological evaluation confirmed the diagnosis of tuberculoma. All the rice bodies were resected and the patient received postoperative antibiotic treatment with pyrazinamide, isoniazid, rifampicin and ethambutol. However, the patient developed hepatic insufficiency during treatment, and the regimen was discontinued. The patient had not experienced recurrence 1 year after the treatment. In conclusion, tuberculoma should be considered in the differential diagnosis of a wrist mass mimicking an inflamed soft tissue tumor.
尽管结核病的发病率在不断上升，即使在日本这样的发达国家，结核瘤也是一种相对罕见的疾病。此外，鉴于结核瘤的罕见性，明确诊断往往会延迟。我们在此报告一例79岁男性病例，该患者左前臂出现一个红斑且发热的肿块。X线检查显示腕部掌侧有钙化，磁共振成像显示病变处有镶嵌图案。怀疑为腕部软组织肉瘤，遂进行了切开活检，结果发现大量黄色米粒体。快速病理评估显示干酪样坏死和朗汉斯巨细胞，组织学评估确诊为结核瘤。所有米粒体均被切除，患者术后接受了吡嗪酰胺、异烟肼、利福平和乙胺丁醇的抗结核治疗。然而，患者在治疗期间出现肝功能不全，治疗方案被迫中断。治疗1年后患者未出现复发。总之，在鉴别诊断类似炎症性软组织肿瘤的腕部肿块时，应考虑结核瘤。
