肝结核伪装为恶性肿瘤。
Hepatic tuberculosis masquerading as malignancy.
机构信息
Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr Ernest Borges road, Parel, Mumbai, Pin: 400012, India.
Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India.
出版信息
Hepatol Int. 2022 Apr;16(2):463-472. doi: 10.1007/s12072-021-10257-9. Epub 2021 Oct 23.
BACKGROUND AND AIMS
Hepatic tuberculosis (HTB) is rare and mimics neoplastic liver lesions clinico-radiologically leading to misdiagnosis and even unnecessary surgery.
METHODS AND MATERIAL
We analysed 43 cases of HTB diagnosed at a referral cancer centre over 10 years. Clinical details, investigations and treatment received were noted.
RESULTS
The median age was 46 years with a female preponderance (58%). HTB was diagnosed incidentally in 28% cases during surveillance imaging for a previous cancer. Constitutional symptoms (31, 72%), abdominal pain (25, 58%), fever (12, 28%), hepatomegaly (22, 51%), elevated alkaline phosphatase (34, 79%), elevated aminotransferases (18, 42%) and hypoalbuminemia (19, 45%) were common features. All cases had negative HIV serology and normal tumor markers. Twenty-two (52.5%) had solitary liver lesion and lesions > 2 cm in 28 (65%). Ultrasound showed hypoechoic lesions in 31 of 33 cases. Computed tomography showed hypodense lesions (43,100%) with mild peripheral enhancement (32, 74%). Calcifications (5, 12%) and capsular retraction (8, 19%) was uncommon. MRI was performed in seven cases commonly showed T1 hypointense, T2 hyperintense lesions with restricted diffusion. Histopathology showed granulomatous inflammation (42, 97.5%), Langhan's giant cells (41, 95%) and caseation necrosis (35, 85%). Acid-fast stain and PCR positivity was uncommon. Extrahepatic organs were involved in 20 (46.5%). HTB mimicked cholangiocarcinoma (25, 58%), liver metastasis (11, 26%) and lymphoma (3, 7%). Six patients underwent liver resection with a presumptive diagnosis of cancer without a preoperative biopsy. All patients received antitubercular therapy, 37 had clinico-radiological response, there were 3 deaths and 3 patients were lost to follow-up.
CONCLUSION
HTB is rare and can mimic a malignancy clinico-radiologically. Calcifications and pseudocapsule appearance on multiphase CT scan may help in differentiating HTB from hepatic malignancy. Tumor markers are normal while histopathology is generally diagnostic. A high index of suspicion is required to avoid unnecessary surgery as the patients respond well to ATT.
TRIAL REGISTRATION
This is a retrospective and observational study hence clinical trial registration is not applicable.
背景与目的
肝结核（HTB）较为罕见，临床上常与肝脏占位性病变相混淆，导致误诊甚至不必要的手术。
方法和材料
我们分析了在转诊癌症中心诊断的 43 例 HTB 患者，记录了其临床资料、检查结果和治疗方法。
结果
中位年龄为 46 岁，女性居多（58%）。28%的患者是在因先前癌症进行的监测影像学检查中偶然发现的。常见的临床表现有：全身症状（31 例，72%）、腹痛（25 例，58%）、发热（12 例，28%）、肝肿大（22 例，51%）、碱性磷酸酶升高（34 例，79%）、氨基转移酶升高（18 例，42%）和低蛋白血症（19 例，45%）。所有患者 HIV 血清学均为阴性，肿瘤标志物正常。22 例（52.5%）患者仅有单个肝脏病变，28 例（65%）患者的病变直径大于 2cm。33 例中有 31 例超声显示低回声病变。CT 显示低密度病变（43 例，100%），边缘轻度增强（32 例，74%）。钙化（5 例，12%）和包膜回缩（8 例，19%）不常见。7 例行 MRI 检查，常显示 T1 低信号、T2 高信号病变，弥散受限。组织病理学显示肉芽肿性炎症（42 例，97.5%）、朗格汉斯巨细胞（41 例，95%）和干酪样坏死（35 例，85%）。抗酸染色和 PCR 阳性不常见。20 例（46.5%）患者合并肝外器官受累。HTB 主要与胆管细胞癌（25 例，58%）、肝转移瘤（11 例，26%）和淋巴瘤（3 例，7%）相混淆。6 例患者接受了肝切除术，术前未行活检，诊断为癌症。所有患者均接受抗结核治疗，37 例患者临床和影像学表现有反应，3 例患者死亡，3 例患者失访。
结论
HTB 较为罕见，临床上常与恶性肿瘤相混淆。多期 CT 扫描上的钙化和假性包膜外观有助于将 HTB 与肝脏恶性肿瘤相鉴别。肿瘤标志物正常，而组织病理学通常具有诊断意义。由于患者对 ATT 反应良好，因此需要高度警惕，避免不必要的手术。
注
这是一个回顾性和观察性研究，因此不需要临床试验注册。
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