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肝门部结核与 Klatskin 肿瘤:诊断难题。

Hilar tuberculosis versus Klatskin tumour: a diagnostic challenge.

机构信息

General Medicine, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India.

Critical Care Medicine, St John's Medical College Hospital, Bangalore, Karnataka, India.

出版信息

BMJ Case Rep. 2022 Nov 4;15(11):e252511. doi: 10.1136/bcr-2022-252511.

Abstract

Hepatobiliary tuberculosis is a rare condition causing obstructive jaundice either by enlarged lymph nodes around the bile ducts or involvement of biliary epithelium by the tuberculous process. Since a tissue diagnosis is not mandatory to proceed with the resection or initiation of a liver transplant protocol, benign lesions are occasionally misdiagnosed as hilar cholangiocarcinoma. Here, we present a case of hepatobiliary tuberculosis which presented as obstructive jaundice due to hilar obstruction. The mass causing the obstruction was then later found to be a pseudotumour, typical of tuberculosis. This diagnosis meant that extensive surgical resection as a protocol for cholangiocarcinoma was avoided. The patient recovered completely after a course of antitubercular therapy.

摘要

肝胆结核是一种罕见的疾病,可导致胆管周围淋巴结肿大或结核过程累及胆管上皮,从而引起阻塞性黄疸。由于进行切除或启动肝移植方案并不一定需要组织学诊断,因此良性病变偶尔会被误诊为肝门部胆管癌。在这里,我们报告了一例肝胆结核病例,其表现为肝门部阻塞引起的阻塞性黄疸。导致阻塞的肿块后来被发现是一个典型的结核性假肿瘤。这一诊断意味着避免了广泛的手术切除作为胆管癌的治疗方案。患者在接受抗结核治疗后完全康复。

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本文引用的文献

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Tuberculous common bile duct stricture mimicking a cholangiocarcinoma: A case report.酷似胆管癌的结核性胆总管狭窄:一例报告
Radiol Case Rep. 2021 Apr 1;16(6):1311-1314. doi: 10.1016/j.radcr.2021.03.001. eCollection 2021 Jun.
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Hepatobiliary tuberculosis.肝胆结核
Ann Gastroenterol. 2014;27(3):207-211.
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Hepatobiliary tuberculosis in western India.印度西部的肝胆结核
Indian J Pathol Microbiol. 2008 Apr-Jun;51(2):175-81. doi: 10.4103/0377-4929.41644.
6
Differential diagnosis of stenosing lesions at the hepatic hilus.肝门部狭窄性病变的鉴别诊断。
World J Surg. 2004 May;28(5):466-70. doi: 10.1007/s00268-004-7034-z. Epub 2004 Apr 19.
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Primary miliary tuberculosis of the liver.原发性肝粟粒性结核
J Am Med Assoc. 1957 May 11;164(2):150-7. doi: 10.1001/jama.1957.02980020030007.
9
Treatment of tuberculosis.结核病的治疗。
MMWR Recomm Rep. 2003 Jun 20;52(RR-11):1-77.

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