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鼻咽结核的临床病理分析。

Clinicopathological analysis of nasopharyngeal tuberculosis.

机构信息

Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Medicine Center, Seoul National University Hospital, Seoul, South Korea.

Department of Pathology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea.

出版信息

Ann Med. 2024 Dec;56(1):2406440. doi: 10.1080/07853890.2024.2406440. Epub 2024 Sep 25.

Abstract

BACKGROUND

The aim of this study is to examine the clinical and pathological attributes of nasopharyngeal tuberculosis.

METHODS

We conducted a retrospective analysis of the clinicopathologic characteristics of nasopharyngeal tuberculosis in 14 patients. The medical records and imaging data obtained between March 2004 and February 2023 were scrutinized. During the pathological review, we classified the types of granulomatous inflammation and graded the extent of caseation.

RESULTS

Results indicate a 100% female predominance, with chief complaints including hearing loss, postnasal drip, and nasal obstruction. Cervical lymphadenopathy occurred in 21.4% of patients. Chest radiograph abnormalities were found in 58.3%, with three showing active pulmonary tuberculosis. Endoscopic examination revealed three types of lesions, and CT/MRI findings correlated with gross lesions. A statistically significant association was found between lesion characteristics (bulging, ulcerative, necrotic) and pathology patterns (sarcoidosis-like, caseation). Bulging masses exhibited sarcoidosis-like patterns, while ulcerative/necrotic lesions were often associated with caseation. All lesions responded well to over six months of anti-tuberculosis medication, leading to favourable outcomes.

CONCLUSION

We studied 14 cases of nasopharyngeal tuberculosis, mostly in females, with common ear and nose symptoms. Lesions were typically visible on nasopharyngeal endoscopy, and endoscopically bulging mass-like lesions had pathologically sarcoidosis-like granulomas. All patients had favourable outcomes.

摘要

背景

本研究旨在探讨鼻咽结核的临床和病理特征。

方法

我们对 14 例鼻咽结核患者的临床病理特征进行了回顾性分析。分析了 2004 年 3 月至 2023 年 2 月期间获得的病历和影像学资料。在病理复查中,我们对肉芽肿性炎症的类型进行分类,并对干酪样坏死的程度进行分级。

结果

结果显示,女性患者占比 100%,主要症状包括听力下降、后鼻滴注和鼻塞。21.4%的患者出现颈部淋巴结肿大。58.3%的患者胸部 X 线片异常,其中 3 例显示活动性肺结核。内镜检查发现三种病变类型,CT/MRI 结果与大体病变相关。病变特征(隆起、溃疡性、坏死性)与病理模式(类肉瘤样、干酪样坏死)之间存在统计学显著关联。隆起性肿块表现为类肉瘤样模式,而溃疡性/坏死性病变常与干酪样坏死相关。所有病变均在接受抗结核药物治疗超过 6 个月后得到良好反应,预后良好。

结论

我们研究了 14 例鼻咽结核病例,主要发生在女性,常见的耳部和鼻部症状。病变通常在鼻咽内镜下可见,内镜下隆起的肿块样病变具有病理上的类肉瘤样肉芽肿。所有患者均有良好的预后。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5ea1/11425682/f596ba834a82/IANN_A_2406440_F0001_C.jpg

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