Sugito K, Suzuki K, Yamagishi F, Miyazawa H, Sasaki Y, Ihara S, Kawabata Y
Division of Thoracic Disease, National Chiba-Higashi Hospital, Japan.
Kekkaku. 1993 Dec;68(12):755-60.
After complaining of right hypochondrial pain, a 36-year old man was diagnosed as having a gastric submucosal tumor at a nearby hospital and admitted to Chiba Cancer Center Hospital. On admission, a hard and immobile mass was palpable on the right upper quadrant. Laboratory findings were within normal limits. A chest X-ray revealed bilateral pleural adhesions and streaking shadows in the bilateral lung area. These findings were assumed to be due to a prior tuberculous infection. Upper gastrointestinal series and endoscopic examination showed a protruding lesion on the stomach body. An abdominal CT showed another lesion adjacent to the stomach antrum. A resection was carried out under the presumptive diagnosis of multiple gastric submucosal tumors. Exploration of the abdomen revealed widespread fibrous adhesion suspected to be due to prior old tuberculous peritonitis. Two tumors were located here. One was adjacent to the stomach body, and the other was adjacent to the liver and abdominal wall. Pathologically, both were caseated necrotizing granulomas composed of mature epithelioid cells and Langhans giant cells. A close examination revealed that one originated from the serosa of the stomach and the other from the peritoneum. Both were believed to be relatively new lesions. Pus obtained from the tumors tested positive for acid-fast bacilli. A post-operative tuberculin skin test was given and checked highly positive. From these findings, this case was diagnosed as local reactivation of old tuberculous peritonitis. After antituberculous chemotherapy at our hospital, the patient was discharged and sent home without any symptoms. The reason for the local reactivation was unknown.
一名36岁男性在主诉右季肋部疼痛后，于附近医院被诊断为胃黏膜下肿瘤，并入住千叶癌症中心医院。入院时，右上腹可触及一个坚硬且固定不动的肿块。实验室检查结果均在正常范围内。胸部X线显示双侧胸膜粘连以及双侧肺野有条状阴影。这些表现被认为是既往结核感染所致。上消化道造影和内镜检查显示胃体部有一个突出病变。腹部CT显示胃窦部附近还有一个病变。在疑似多发性胃黏膜下肿瘤的诊断下进行了切除手术。腹部探查发现广泛的纤维粘连，怀疑是既往陈旧性结核性腹膜炎所致。此处有两个肿瘤。一个与胃体相邻，另一个与肝脏和腹壁相邻。病理检查显示，两者均为干酪样坏死性肉芽肿，由成熟的上皮样细胞和朗汉斯巨细胞组成。仔细检查发现，一个起源于胃浆膜层，另一个起源于腹膜。两者均被认为是相对较新的病变。从肿瘤中获取的脓液抗酸杆菌检测呈阳性。术后进行结核菌素皮肤试验，结果呈强阳性。根据这些发现，该病例被诊断为陈旧性结核性腹膜炎局部复发。在我院进行抗结核化疗后，患者出院回家，无任何症状。局部复发的原因不明。
