結核性肝肉芽腫の1切除例と本邦報告例の検討

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  • A CASE OF SOLITARY TUBERCULOMA OF THE LIVER AND A REVIEW OF THE JAPANESE LITERATURE

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A case of solitary tuberculoma of the liver is presented with a review of 18 cases reported in the Japanese literature.<br> A 60-year-old female was admitted, complaining of fever and right hypochondriac discomfort. Abdominal CT and ultrasonographic imaging revealed a tumor located in S4 and S8 of the liver. Hepatic angiography also demonstrated a tumor shadow with mild vascularity and tumor stain, suggestive of hepatoma. Hepatic resection of S2, S3, S4, and S8 was performed. Pathological examination of the resected specimen disclosed non-caseous granuloma and acid-fast bacilli with Ziehl-Neelsen staining.<br> A survey of the 18 cases revealed the following features: The age distribution was biphasic with peaks at 20 and 40 years. The sex distribution was equal. Fever, abdominal pain, and mass were commonly encountered as clinical manifestations. Only three of the 18 cases were diagnosed correctly and two of these three cases underwent echo-guided needle biopsy. In 15 cases, surgical resection was performed and in only one was chemotherapy alone administered. Recovery was good and neither recurrence nor death was reported.<br> Difficulties in the imaging diagnosis and the efficacy of echo-guided needle biopsy were emphasized.

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