Department of Gastroenterology, Lishui Hospital of Zhejiang University, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, Zhejiang Province, China.
Department of Internal Medicine, People's Hospital of Lishui Liandu District, Lishui, Zhejiang Province, China.
J Int Med Res. 2023 Jul;51(7):3000605231182270. doi: 10.1177/03000605231182270.
Retroperitoneal tuberculosis is a rare disease that can mimic many conditions and lacks specific clinical manifestations, which makes it difficult to diagnose. As a consequence, it can be misdiagnosed as a malignant tumour. Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) can obtain specimens of the lesion site from areas that might be inaccessible using more traditional biopsy methods. A 60-year-old female patient was admitted with a 3-month history of intermittent upper abdominal pain accompanied by nausea. Imaging found pancreatic uncinate process and retroperitoneal lymph nodes at the horizontal part of the duodenum. EUS-FNA found necrotic matter, multinucleated giant cells and epithelioid cells consistent with the signs of tuberculosis bacilli infection, although typical noncaseous granuloma and were not observed. Retroperitoneal tuberculosis was considered as the diagnosis. After anti-tubercular therapy, the signs and symptoms quickly improved and a repeat computed tomography scan found that the space-occupying lesion had reduced in size. By using EUS-FNA, the cytological and histopathological findings can be obtained in a timely manner to facilitate an earlier diagnosis and avoid unnecessary procedures such as laparotomy or surgery.
腹膜后结核是一种罕见疾病，可模拟多种疾病，且缺乏特定的临床表现，这使得诊断变得困难。因此，它可能被误诊为恶性肿瘤。内镜超声引导下细针抽吸（EUS-FNA）可以使用传统活检方法难以到达的病变部位获取标本。一名 60 岁女性患者因间歇性上腹痛伴恶心 3 个月入院。影像学检查发现胰钩突和十二指肠水平部的腹膜后淋巴结。EUS-FNA 发现坏死物质、多核巨细胞和上皮样细胞，符合结核杆菌感染的迹象，尽管未观察到典型的干酪样肉芽肿。考虑诊断为腹膜后结核。抗结核治疗后，症状迅速改善，重复计算机断层扫描发现占位病变缩小。通过使用 EUS-FNA，可以及时获得细胞学和组织病理学发现，从而有助于更早地诊断，并避免不必要的手术，如剖腹手术或手术。
