Daniel Tyrell, Sweeney Ryan, Haag Aaron, Morrissey Suzanne
Medicine Institute, Allegheny Health Network, Pittsburgh, USA.
Department of Gastroenterology and Hepatology, Allegheny Health Network, Pittsburgh, USA.
Cureus. 2023 Feb 7;15(2):e34750. doi: 10.7759/cureus.34750. eCollection 2023 Feb.
Newly discovered liver lesions have a broad differential ranging from malignancy to infection. While tissue biopsy is the gold standard diagnostic modality, imaging can also aid in diagnosis. Hepatocellular carcinoma (HCC) can be diagnosed via imaging alone; however, masses suspicious for infection ultimately require biopsy and culture. We report a case of a 72-year-old male who presented with subjective fever, nausea, decreased appetite, dark urine, elevated liver function tests, and CT evidence of an exophytic liver mass. Differentials included infections such as hepatobiliary actinomycosis, abscess, solid malignancy, or lymphoma. Obtaining a definitive diagnosis with tissue biopsy endoscopically and percutaneously was quite difficult due to the location of the lesion around the porta hepatis. Subsequent laparoscopic biopsy revealed diffuse large B cell lymphoma (DLBCL).
新发现的肝脏病变鉴别诊断范围广泛，从恶性肿瘤到感染性疾病均有可能。虽然组织活检是诊断的金标准，但影像学检查也有助于诊断。肝细胞癌（HCC）仅凭影像学检查即可诊断；然而，怀疑为感染性的肿块最终需要活检和培养。我们报告一例72岁男性患者，其表现为自觉发热、恶心、食欲减退、尿色加深、肝功能检查指标升高，CT显示有一外生性肝脏肿块。鉴别诊断包括肝胆放线菌病、脓肿、实体恶性肿瘤或淋巴瘤等感染性疾病。由于病变位于肝门周围，通过内镜和经皮组织活检获得明确诊断相当困难。随后的腹腔镜活检显示为弥漫性大B细胞淋巴瘤（DLBCL）。
