背景:胆囊结核(GBTB)是一种罕见的疾病,具有非特异性表现,模拟胆囊炎和胆囊恶性肿瘤。我们描述了一名年轻女性中罕见的浸润性GBTB伴胆道狭窄的病例,该女性最初被诊断为转移性胆囊癌。
方法:一名33岁女性患者出现反复发作的梗阻性黄疸,显著的体重减轻,疲劳,和少月经。影像学研究显示局部晚期胆囊癌伴近端和远端胆总管狭窄的特征。然而,胆囊肿块周围的肝组织活检证实了坏死性肉芽肿性炎症,颈部淋巴结细针穿刺发现类似。连同组织病理学发现,肺结核的放射学证据证实了浸润性GBTB的诊断。患者在胆道减压的同时使用抗结核药物成功治疗。
结论:GBTB的稀有性归因于胆汁和胆汁酸的高碱度,提供对结核杆菌的保护。患者通常表现为腹痛,发烧,腹部肿块,厌食症,和减肥。胆道狭窄,虽然罕见,已在GBTB中描述并模拟胆管癌。由于术前实验室和放射学检查的非特异性发现,大多数患者接受手术治疗,术后组织学分析诊断为TB.
结论:胆囊结核是一种罕见的疾病,由于它缺乏任何病理特征,因此对诊断提出了挑战。在确认胆囊和胆道恶性肿瘤之前,必须进行组织诊断。结核病流行地区的医生应该对诊断GBTB有很高的怀疑指数。
BACKGROUND: Gallbladder TB (GBTB) is a rare disease with a non-specific presentation, simulating cholecystitis and gallbladder malignancies. We describe a rare case of infiltrative GBTB with biliary strictures in a young female who was initially diagnosed with metastatic gallbladder carcinoma.
METHODS: A 33-year-old female presented with recurrent episodes of obstructive jaundice, significant weight loss, fatigue, and oligomenorrhoea. Imaging studies revealed features of locally advanced gallbladder carcinoma with proximal and distal common bile duct strictures. However, biopsy of the liver tissue surrounding the gallbladder mass confirmed necrotizing granulomatous inflammation with similar findings from fine needle aspiration of the cervical lymph node. Along with the histopathological findings, radiological evidence of pulmonary tuberculosis confirmed the diagnosis of infiltrative GBTB. The patient was successfully managed with anti-tubercular drugs along with biliary decompression.
CONCLUSIONS: The rarity of GBTB is attributed to the high alkalinity of bile and bile acids, which afford protection against tubercle bacilli. Patients commonly present with abdominal pain, fever, abdominal lump, anorexia, and weight loss. Biliary strictures, though rare, have been described in GBTB and simulate cholangiocarcinoma. Due to the non-specific findings of pre-operative laboratory and radiological investigations, most patients are taken up for surgery and diagnosed with TB on post-operative histological analysis.
CONCLUSIONS: Gallbladder TB is a rare disease which poses a diagnostic challenge because it lacks any pathognomonic features. A tissue diagnosis must be carried out before confirming gallbladder and biliary tract malignancies. Physicians in TB-endemic regions should possess a high index of suspicion for diagnosing GBTB.