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青少年肝门部肿块:罕见的肝胆结核病例。

Hepatic hilar mass in an adolescent: a rare case of hepatobiliary tuberculosis.

机构信息

Department of Biliary and Minimally Invasive Surgery, China Medical University Shengjing Hospital Shenyang, No. 36, San Hao Street, Shenyang, 110004, Liaoning, China.

出版信息

BMC Infect Dis. 2019 Mar 4;19(1):217. doi: 10.1186/s12879-019-3850-5.

Abstract

BACKGROUND

Hepatobiliary tuberculosis is a rare manifestation of Mycobacterium tuberculosis infection, especially in younger patients. The non-specific symptoms and signs as well as the lack of definite imaging characteristics often impedes diagnosis. Definite diagnosis of tuberculosiscan be obtained through histopathological examination; conventional anti-tuberculosis drugs and surgery are the most commonly recommended treatments.

CASE PRESENTATION

A previously healthy 15-year-old rural adolescent male presented with a 2-month history of weight loss and fatigue. We strongly suspected a Klatskin tumor; therefore, exploratory laparotomy was performed. However, the microscopical findings revealed a granuloma consisting of epithelioid cells, caseous necrosis, and lymphocytic infiltration, indicating caseating granulomatous inflammation and yielding a final diagnosis of hepatic hilar tuberculosis.

CONCLUSION

Hepatic hilar tuberculosis is an extremely rare case; few physicians may have actually treated a case. This report therefore aims to improve the overall understanding of lymphatic tuberculosis of the hepatic hilum.

摘要

背景

肝胆结核是结核分枝杆菌感染的一种罕见表现,尤其是在年轻患者中。非特异性症状和体征以及缺乏明确的影像学特征常常妨碍诊断。通过组织病理学检查可明确诊断结核,通常推荐使用常规抗结核药物和手术治疗。

病例介绍

一名既往健康的 15 岁农村青少年男性,因体重减轻和乏力就诊,病程 2 个月。我们强烈怀疑为 Klatskin 肿瘤,因此进行了剖腹探查术。然而,显微镜下的发现显示为上皮样细胞、干酪样坏死和淋巴细胞浸润的肉芽肿,提示干酪样肉芽肿性炎症,最终诊断为肝门部结核。

结论

肝门部结核极为罕见,可能很少有医生实际治疗过此类病例。因此,本报告旨在提高对肝门部淋巴结结核的整体认识。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/40c2/6398219/d17d7ee0d41c/12879_2019_3850_Fig1_HTML.jpg

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