Wee Jason, Sobhi Salar, De Boer Bastiaan, Xu Dan
Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia.
Anatomical Pathology, PathWest Laboratory Medical WA, Murdoch, Western Australia, Australia.
BMJ Case Rep. 2020 Dec 16;13(12):e234366. doi: 10.1136/bcr-2020-234366.
We describe a case of a 61-year-old man with a background of rheumatoid arthritis who presented to the emergency department with a single-reported episode of haemoptysis on the background of an upper respiratory tract infection. A CT scan revealed an incidental 40 mm mass in upper right lobe of the liver abutting the diaphragmatic surface. A subsequent positron emission tomography scan confirmed the mass and raised the possibility of another lesion in the liver raising the suspicion of malignancy. The case was complicated by the inability to perform a fine needle aspiration biopsy due to the mass' proximity to the diaphragm. After discussion with the patient, it was decided to resect the affected liver segment. Histological analysis of the mass revealed localised necrotising granulomatous inflammation suggestive of a rheumatoid nodule, which is seldom reported in the literature.
我们描述了一例61岁男性患者，他有类风湿关节炎病史，因上呼吸道感染出现单次咯血后就诊于急诊科。CT扫描显示肝脏右叶上部有一个偶然发现的40毫米肿块，紧邻膈面。随后的正电子发射断层扫描证实了该肿块，并发现肝脏可能存在另一个病变，怀疑为恶性肿瘤。由于肿块靠近膈肌，无法进行细针穿刺活检，使该病例变得复杂。与患者讨论后，决定切除受影响的肝段。肿块的组织学分析显示为局限性坏死性肉芽肿性炎症，提示为类风湿结节，这在文献中鲜有报道。
