Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of peripancreatic tuberculous lymphadenitis
Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of peripancreatic tuberculous lymphadenitis
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DOI：
10.1007/s00535-006-1913-z
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发表时间：
2007-01-01
影响因子：
6.3
通讯作者：
Yamada, Kinya
中科院分区：
文献类型：
--
作者：
Itaba, Soichi;Yoshinaga, Shigetaka;Yamada, Kinya
患有非典型肺外结核病的患者比例一直在增加。在肺外结核病例中，胰腺和胰周淋巴结结核是一种罕见的临床疾病。在这里，我们介绍一例通过内镜超声引导下细针穿刺活检（EUS-FNA）从细胞学和微生物学角度诊断的胰周结核性淋巴结炎病例。一名23岁男性，有1周上腹痛和低热病史。随后，他的腹部超声检查发现异常。腹部计算机断层扫描显示一个孤立的肿块，由多个囊性成分组成，邻近胆囊的胰周部分有边缘强化。进行内镜超声引导下细针抽吸以确认诊断。细胞学检查发现上皮样细胞干酪样坏死，提示结核。经聚合酶链反应（PCR）分析和结核分枝杆菌培养，抽吸液体呈阳性。根据PCR和细胞学结果，开始使用异烟肼、利福平、乙胺丁醇和吡嗪酰胺进行抗结核治疗，并注意到治疗反应良好。内镜超声引导下细针抽吸细胞学检查结合PCR分析对于胰周结核的诊断非常有用。
The percentage of patients with atypical extrapulmonary forms of tuberculosis has been increasing. Among extrapulmonary tuberculosis cases, tuberculosis of the pancreas and peripancreatic lymph nodes is a rare clinical entity. Here, we present a case of peripancreatic tuberculous lymphadenitis diagnosed by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) both cytologically and microbiologically. A 23-year-old man had a 1-week history of epigastralgia and low-grade fever. Subsequently, he was found to have an abnormality on abdominal ultrasound. A computed tomography scan of the abdomen showed a solitary mass consisting of multiple cystic components with rim enhancement in the peripancreatic portion contiguous to the gall bladder. Endoscopic ultrasound-guided fine-needle aspiration was performed to confirm the diagnosis. The cytological examination revealed epithelioid cells with caseous necrosis, indicating tuberculosis. The aspirated fluid was positive by polymerase chain reaction (PCR) analysis and culture for Mycobacterium tuberculosis. Antituberculosis therapy with isoniazid, rifampicin, ethambutol, and pyrazinamide was started based on the PCR and cytology results, and a good response to the treatment was noted. Endoscopic ultrasound-guided fine-needle aspiration cytology with PCR analysis is very useful for the diagnosis of peripancreatic tuberculosis.