女性盆腔结核性包块的诊断及治疗

女性盆腔结核性包块是临床上较常见的妇科疾病,容易与其他盆腔包块和肿瘤相混淆,造成误诊或漏诊。在临床工作中,为提高对女性盆腔结核性包块诊断的准确性,应全面、综合分析患者病史、症状,完善有关的辅助检查,包括结核菌素试验、病原学检查、诊断性刮宫、血清癌抗原125检测、腹腔积液及影像学检查;诊断方法上有结核病免疫学诊断、分子生物学检查,为肺外结核的诊断提供了快速检查技术;对诊断困难者进行腹腔镜或剖腹探查术也是必要的。女性盆腔结核性包块需要与盆腔炎性疾病、卵巢子宫内膜异位囊肿、卵巢良恶性肿瘤,尤其应与卵巢癌进行鉴别;也需要与腹腔其他恶性肿瘤以及其他发热性疾病鉴别。女性盆腔结核性包块治疗上主要是全身化学治疗,对临床高度怀疑生殖器结核患者可行诊断性治疗;必要时辅以手术治疗,术中注意防止损伤发生;对结核中毒症状严重者可考虑加用糖皮质激素治疗。     

Localization of insulinoma before surgery——119 cases report

目的 提高对胰岛素瘤术前定位诊断的准确率.方法 同顾性分析解放军总医院1985年1月至2008年4月入院的1 19例胰岛素瘤患者的临床资料.结果 全组病例共100例行手术治疗,98%(98/100)病例绛病理检查确诊为胰岛素瘤.术前各项定位检查的阳性率:B超22.9%(17/74),CT 55.2%(48/87),磁共振(MRI)58.8%(10/17),数字减影血管造影(DSA)76.6%(49/64),内镜超声(EUS)93.3%(42/45),超声造影(UC)94.7%(18/19).每项检查的准确率:B超88.2%(15/17),CT 87.5%(42/48),MRI 90.0%(9/10),DSA 100.0%(49/49),EUS 85.7%(36/42),UC 83.3%(15/18).术前有1～3项定位检查阳性,定位准确率分别为88.9%(24/27)、96.9%(32/33)及94.7%(18/19).手术组中,63例行CT和B超检查,阳性率47.6%(30/63);53例行CT和DSA检查,阳性率为75.5%(40/53);37例行CT和EUS检查,阳性率为89.2%(33/37);31例行EUS和DSA检查,阳性率为90.0%(28/31);14例行DSA和UC检查,阳性率为78.6%(11/14);13例行CT和UC检查,阳性率92.3%(12/13);11例行EUS和UC检查,阳性率90.9%(10/11).结论 术前有2项以上相符合的定位榆查,能大大提高胰岛素瘤术前定位诊断的准确率.以CT、DSA、EUS和UC中的两种组合阳性率较高.兼顾费用和检查的创伤,推荐采用CT、EUS和UC中的两种组合定位.     

Localization of insulinoma before surgery——119 cases report

目的 提高对胰岛素瘤术前定位诊断的准确率.方法 同顾性分析解放军总医院1985年1月至2008年4月入院的1 19例胰岛素瘤患者的临床资料.结果 全组病例共100例行手术治疗,98%(98/100)病例绛病理检查确诊为胰岛素瘤.术前各项定位检查的阳性率:B超22.9%(17/74),CT 55.2%(48/87),磁共振(MRI)58.8%(10/17),数字减影血管造影(DSA)76.6%(49/64),内镜超声(EUS)93.3%(42/45),超声造影(UC)94.7%(18/19).每项检查的准确率:B超88.2%(15/17),CT 87.5%(42/48),MRI 90.0%(9/10),DSA 100.0%(49/49),EUS 85.7%(36/42),UC 83.3%(15/18).术前有1～3项定位检查阳性,定位准确率分别为88.9%(24/27)、96.9%(32/33)及94.7%(18/19).手术组中,63例行CT和B超检查,阳性率47.6%(30/63);53例行CT和DSA检查,阳性率为75.5%(40/53);37例行CT和EUS检查,阳性率为89.2%(33/37);31例行EUS和DSA检查,阳性率为90.0%(28/31);14例行DSA和UC检查,阳性率为78.6%(11/14);13例行CT和UC检查,阳性率92.3%(12/13);11例行EUS和UC检查,阳性率90.9%(10/11).结论 术前有2项以上相符合的定位榆查,能大大提高胰岛素瘤术前定位诊断的准确率.以CT、DSA、EUS和UC中的两种组合阳性率较高.兼顾费用和检查的创伤,推荐采用CT、EUS和UC中的两种组合定位.     

Localization of insulinoma before surgery——119 cases report

目的 提高对胰岛素瘤术前定位诊断的准确率.方法 同顾性分析解放军总医院1985年1月至2008年4月入院的1 19例胰岛素瘤患者的临床资料.结果 全组病例共100例行手术治疗,98%(98/100)病例绛病理检查确诊为胰岛素瘤.术前各项定位检查的阳性率:B超22.9%(17/74),CT 55.2%(48/87),磁共振(MRI)58.8%(10/17),数字减影血管造影(DSA)76.6%(49/64),内镜超声(EUS)93.3%(42/45),超声造影(UC)94.7%(18/19).每项检查的准确率:B超88.2%(15/17),CT 87.5%(42/48),MRI 90.0%(9/10),DSA 100.0%(49/49),EUS 85.7%(36/42),UC 83.3%(15/18).术前有1～3项定位检查阳性,定位准确率分别为88.9%(24/27)、96.9%(32/33)及94.7%(18/19).手术组中,63例行CT和B超检查,阳性率47.6%(30/63);53例行CT和DSA检查,阳性率为75.5%(40/53);37例行CT和EUS检查,阳性率为89.2%(33/37);31例行EUS和DSA检查,阳性率为90.0%(28/31);14例行DSA和UC检查,阳性率为78.6%(11/14);13例行CT和UC检查,阳性率92.3%(12/13);11例行EUS和UC检查,阳性率90.9%(10/11).结论 术前有2项以上相符合的定位榆查,能大大提高胰岛素瘤术前定位诊断的准确率.以CT、DSA、EUS和UC中的两种组合阳性率较高.兼顾费用和检查的创伤,推荐采用CT、EUS和UC中的两种组合定位.     

Localization of insulinoma before surgery——119 cases report

目的 提高对胰岛素瘤术前定位诊断的准确率.方法 同顾性分析解放军总医院1985年1月至2008年4月入院的1 19例胰岛素瘤患者的临床资料.结果 全组病例共100例行手术治疗,98%(98/100)病例绛病理检查确诊为胰岛素瘤.术前各项定位检查的阳性率:B超22.9%(17/74),CT 55.2%(48/87),磁共振(MRI)58.8%(10/17),数字减影血管造影(DSA)76.6%(49/64),内镜超声(EUS)93.3%(42/45),超声造影(UC)94.7%(18/19).每项检查的准确率:B超88.2%(15/17),CT 87.5%(42/48),MRI 90.0%(9/10),DSA 100.0%(49/49),EUS 85.7%(36/42),UC 83.3%(15/18).术前有1～3项定位检查阳性,定位准确率分别为88.9%(24/27)、96.9%(32/33)及94.7%(18/19).手术组中,63例行CT和B超检查,阳性率47.6%(30/63);53例行CT和DSA检查,阳性率为75.5%(40/53);37例行CT和EUS检查,阳性率为89.2%(33/37);31例行EUS和DSA检查,阳性率为90.0%(28/31);14例行DSA和UC检查,阳性率为78.6%(11/14);13例行CT和UC检查,阳性率92.3%(12/13);11例行EUS和UC检查,阳性率90.9%(10/11).结论 术前有2项以上相符合的定位榆查,能大大提高胰岛素瘤术前定位诊断的准确率.以CT、DSA、EUS和UC中的两种组合阳性率较高.兼顾费用和检查的创伤,推荐采用CT、EUS和UC中的两种组合定位.     

Localization of insulinoma before surgery——119 cases report

目的 提高对胰岛素瘤术前定位诊断的准确率.方法 同顾性分析解放军总医院1985年1月至2008年4月入院的1 19例胰岛素瘤患者的临床资料.结果 全组病例共100例行手术治疗,98%(98/100)病例绛病理检查确诊为胰岛素瘤.术前各项定位检查的阳性率:B超22.9%(17/74),CT 55.2%(48/87),磁共振(MRI)58.8%(10/17),数字减影血管造影(DSA)76.6%(49/64),内镜超声(EUS)93.3%(42/45),超声造影(UC)94.7%(18/19).每项检查的准确率:B超88.2%(15/17),CT 87.5%(42/48),MRI 90.0%(9/10),DSA 100.0%(49/49),EUS 85.7%(36/42),UC 83.3%(15/18).术前有1～3项定位检查阳性,定位准确率分别为88.9%(24/27)、96.9%(32/33)及94.7%(18/19).手术组中,63例行CT和B超检查,阳性率47.6%(30/63);53例行CT和DSA检查,阳性率为75.5%(40/53);37例行CT和EUS检查,阳性率为89.2%(33/37);31例行EUS和DSA检查,阳性率为90.0%(28/31);14例行DSA和UC检查,阳性率为78.6%(11/14);13例行CT和UC检查,阳性率92.3%(12/13);11例行EUS和UC检查,阳性率90.9%(10/11).结论 术前有2项以上相符合的定位榆查,能大大提高胰岛素瘤术前定位诊断的准确率.以CT、DSA、EUS和UC中的两种组合阳性率较高.兼顾费用和检查的创伤,推荐采用CT、EUS和UC中的两种组合定位.     

Localization of insulinoma before surgery——119 cases report

目的 提高对胰岛素瘤术前定位诊断的准确率.方法 同顾性分析解放军总医院1985年1月至2008年4月入院的1 19例胰岛素瘤患者的临床资料.结果 全组病例共100例行手术治疗,98%(98/100)病例绛病理检查确诊为胰岛素瘤.术前各项定位检查的阳性率:B超22.9%(17/74),CT 55.2%(48/87),磁共振(MRI)58.8%(10/17),数字减影血管造影(DSA)76.6%(49/64),内镜超声(EUS)93.3%(42/45),超声造影(UC)94.7%(18/19).每项检查的准确率:B超88.2%(15/17),CT 87.5%(42/48),MRI 90.0%(9/10),DSA 100.0%(49/49),EUS 85.7%(36/42),UC 83.3%(15/18).术前有1～3项定位检查阳性,定位准确率分别为88.9%(24/27)、96.9%(32/33)及94.7%(18/19).手术组中,63例行CT和B超检查,阳性率47.6%(30/63);53例行CT和DSA检查,阳性率为75.5%(40/53);37例行CT和EUS检查,阳性率为89.2%(33/37);31例行EUS和DSA检查,阳性率为90.0%(28/31);14例行DSA和UC检查,阳性率为78.6%(11/14);13例行CT和UC检查,阳性率92.3%(12/13);11例行EUS和UC检查,阳性率90.9%(10/11).结论 术前有2项以上相符合的定位榆查,能大大提高胰岛素瘤术前定位诊断的准确率.以CT、DSA、EUS和UC中的两种组合阳性率较高.兼顾费用和检查的创伤,推荐采用CT、EUS和UC中的两种组合定位.     

Localization of insulinoma before surgery——119 cases report

目的 提高对胰岛素瘤术前定位诊断的准确率.方法 同顾性分析解放军总医院1985年1月至2008年4月入院的1 19例胰岛素瘤患者的临床资料.结果 全组病例共100例行手术治疗,98%(98/100)病例绛病理检查确诊为胰岛素瘤.术前各项定位检查的阳性率:B超22.9%(17/74),CT 55.2%(48/87),磁共振(MRI)58.8%(10/17),数字减影血管造影(DSA)76.6%(49/64),内镜超声(EUS)93.3%(42/45),超声造影(UC)94.7%(18/19).每项检查的准确率:B超88.2%(15/17),CT 87.5%(42/48),MRI 90.0%(9/10),DSA 100.0%(49/49),EUS 85.7%(36/42),UC 83.3%(15/18).术前有1～3项定位检查阳性,定位准确率分别为88.9%(24/27)、96.9%(32/33)及94.7%(18/19).手术组中,63例行CT和B超检查,阳性率47.6%(30/63);53例行CT和DSA检查,阳性率为75.5%(40/53);37例行CT和EUS检查,阳性率为89.2%(33/37);31例行EUS和DSA检查,阳性率为90.0%(28/31);14例行DSA和UC检查,阳性率为78.6%(11/14);13例行CT和UC检查,阳性率92.3%(12/13);11例行EUS和UC检查,阳性率90.9%(10/11).结论 术前有2项以上相符合的定位榆查,能大大提高胰岛素瘤术前定位诊断的准确率.以CT、DSA、EUS和UC中的两种组合阳性率较高.兼顾费用和检查的创伤,推荐采用CT、EUS和UC中的两种组合定位.     

Localization of insulinoma before surgery——119 cases report

目的 提高对胰岛素瘤术前定位诊断的准确率.方法 同顾性分析解放军总医院1985年1月至2008年4月入院的1 19例胰岛素瘤患者的临床资料.结果 全组病例共100例行手术治疗,98%(98/100)病例绛病理检查确诊为胰岛素瘤.术前各项定位检查的阳性率:B超22.9%(17/74),CT 55.2%(48/87),磁共振(MRI)58.8%(10/17),数字减影血管造影(DSA)76.6%(49/64),内镜超声(EUS)93.3%(42/45),超声造影(UC)94.7%(18/19).每项检查的准确率:B超88.2%(15/17),CT 87.5%(42/48),MRI 90.0%(9/10),DSA 100.0%(49/49),EUS 85.7%(36/42),UC 83.3%(15/18).术前有1～3项定位检查阳性,定位准确率分别为88.9%(24/27)、96.9%(32/33)及94.7%(18/19).手术组中,63例行CT和B超检查,阳性率47.6%(30/63);53例行CT和DSA检查,阳性率为75.5%(40/53);37例行CT和EUS检查,阳性率为89.2%(33/37);31例行EUS和DSA检查,阳性率为90.0%(28/31);14例行DSA和UC检查,阳性率为78.6%(11/14);13例行CT和UC检查,阳性率92.3%(12/13);11例行EUS和UC检查,阳性率90.9%(10/11).结论 术前有2项以上相符合的定位榆查,能大大提高胰岛素瘤术前定位诊断的准确率.以CT、DSA、EUS和UC中的两种组合阳性率较高.兼顾费用和检查的创伤,推荐采用CT、EUS和UC中的两种组合定位.     

Localization of insulinoma before surgery——119 cases report

目的 提高对胰岛素瘤术前定位诊断的准确率.方法 同顾性分析解放军总医院1985年1月至2008年4月入院的1 19例胰岛素瘤患者的临床资料.结果 全组病例共100例行手术治疗,98%(98/100)病例绛病理检查确诊为胰岛素瘤.术前各项定位检查的阳性率:B超22.9%(17/74),CT 55.2%(48/87),磁共振(MRI)58.8%(10/17),数字减影血管造影(DSA)76.6%(49/64),内镜超声(EUS)93.3%(42/45),超声造影(UC)94.7%(18/19).每项检查的准确率:B超88.2%(15/17),CT 87.5%(42/48),MRI 90.0%(9/10),DSA 100.0%(49/49),EUS 85.7%(36/42),UC 83.3%(15/18).术前有1～3项定位检查阳性,定位准确率分别为88.9%(24/27)、96.9%(32/33)及94.7%(18/19).手术组中,63例行CT和B超检查,阳性率47.6%(30/63);53例行CT和DSA检查,阳性率为75.5%(40/53);37例行CT和EUS检查,阳性率为89.2%(33/37);31例行EUS和DSA检查,阳性率为90.0%(28/31);14例行DSA和UC检查,阳性率为78.6%(11/14);13例行CT和UC检查,阳性率92.3%(12/13);11例行EUS和UC检查,阳性率90.9%(10/11).结论 术前有2项以上相符合的定位榆查,能大大提高胰岛素瘤术前定位诊断的准确率.以CT、DSA、EUS和UC中的两种组合阳性率较高.兼顾费用和检查的创伤,推荐采用CT、EUS和UC中的两种组合定位.     

欠发达地区结核性腹膜炎40例

目的:总结结核性腹膜炎(tuberculous peritonitis,TBP)临床特点,进一步提高临床医生对TBP的认识水平.方法:收集40例TBP患者的病例资料,对其发病情况、临床表现、实验室和辅助检查、诊疗经过等方面进行回顾性分析并复习文献.结果:本组TBP患者年龄以20-40岁为高发(57.5%),仅22.5%的病例既往有结核病史或慢性疾病史.发病以慢性起病多见(85.0%),症状以腹胀(85.0%)、食欲减退(67.5%)、发热(52.5%)、腹痛(47.5%)常见.体征以腹水(67.5%)、腹痛(65.0%)多见,腹壁柔韧感少见(35.0%).血清学检查特异性低,腹水多呈渗出液的特点,但腹水ADA>33U/L,单核细胞占优势等有助于诊断TBP的特点较少见(16.0%-34.0%).腹水抗酸杆菌涂片和结核菌培养阳性率低(4.75%,0%).PPD实验和胸部X线的阳性率均为37.5%.CT和B超检查多数表现为腹水、腹膜增厚、粘连等(78%),女性患者子宫、附件受累常见(72.7%).本组TBP患者误诊5例,误诊率为12.5%,最常见是误诊为妇科肿瘤(n=3).仅4例患者(10%)获病原学或病理确诊,其余90%依靠试验性抗结核治疗获得诊断.结论:在欠发达地区,目前依靠腹腔镜、B超引导下活检等手段获得病理标本,确诊TBP的比例仍很低.绝大部分TBP病例诊断主要依靠试验性抗结核治疗及对疗效的动态观察.临床医生能够怀疑到TBP的可能并积极试验性抗结核治疗是TBP诊断的关键.对2wk试验性抗结核治疗效果不好的病例,要动员患者接受更积极的腹腔镜检查,以免贻误病情.     

The Princess Margaret Hospital study of ovarian cancer: stages I, II, and asymptomatic III presentations.

An analysis of 231 patients with stages I, II, and asymptomatic III ovarian cancer, studied in a prospective randomized-stratified trial, is presented. None of the stage IA patients with well-differentiated tumors have had disease relapses; one fourth of the patients with poorly differentiated tumors have had disease relapses throughout the peritoneal cavity. There is therefore little justification for pelvic radiation alone as postoperative therapy for stage IA ovarian carcinoma. For stage IB, II, and asymptomatic III presentations, patients with an incomplete initial pelvic operation had poor survival characteristics with all tested therapies. For patients in whom the operation was completed, abdominopelvic radiation was superior to pelvic radiation alone or followed by chlorambucil, with respect to long-term survival and control of abdominal disease. The effectiveness of abdominopelvic radiation was independent of stage or histology. The value of abdominopelvic radiation was most strikingly seen in patients with no visible residual tumor.     

Tuberculous peritonitis in an endemic area

BACKGROUND: Tuberculous peritonitis is a fatal disease if not diagnosed in time. AIMS: To identify the clinical, laboratory, and diagnostic features of tuberculous peritonitis in Iranian patients. PATIENTS: Included in the study were all cases of tuberculous peritonitis with a definite diagnosis confirmed by pathology in four referral University Hospitals in Tehran between 1989 and 1999. METHODS: All clinical, laboratory, and radiological findings as well as invasive procedures were reviewed. RESULTS: A total of 50 patients (30 female, 20 male), mean age 33.5 years were studied. Main presenting symptoms included abdominal pain (84%), weight loss (72%) and fever (50%). In 24% of patients a positive tuberculin test was found. Erythrocyte sedimentation rate >50 mm/h was detected in 60% of patients and 4.4% had an Erythrocyte sedimentation rate >100 mm/h. Laparoscopy or laparotomy showed peritoneal seeding in 74% of patients. CONCLUSIONS: Exudative ascites should give rise to clinical suspicion of tuberculous peritonitis in endemic areas or in immigrants from endemic areas. Laparoscopy is the most sensitive and specific diagnostic method.     

腹腔脏器结核57例临床分析

目的 探讨腹腔脏器结核的临床特点、诊治方法,以提高对腹腔脏器结核的诊断水平。方法 回顾性分析1958年1月～2004年12月间在北京协和医院收治并经病理诊断的57例腹腔脏器结核病例的临床资料。结果 肝结核39例,脾结核5例,胰腺结核8例,胃结核3例,肝结核并胃结核1例,肝结核并脾结核1例。男性26例,女性31例,年龄17～68岁。41例（71．9％）患者并存腹腔以外脏器结核或既往有结核病史。主要临床表现有发热（75．4％）,结核中毒症状（82．5％）,肝脾肿大（57．9％）。多数患者（59．6％）有血沉增快,肝、脾或胰腺占位病变者占64．9％。结论 不明原因长期发热伴有肝脾肿大、血沉增快、影像学提示有腹腔脏器占位病变的病例应警惕结核可能,穿刺取活组织病理检查有助诊断,必要时需剖腹探查,及早抗结核治疗预后良好。     

结核性多发浆膜炎45例临床分析

目的　探讨结核性多发浆膜炎的临床特点,提高结核性多发浆膜炎的诊断治疗水平。方法对45例结核性多发浆膜炎的临床资料进行回顾性分析。结果 (1)40岁以下的中青年多见。(2)发热、腹胀为常见临床症状。(3)均并发胸膜炎,且单侧胸腔积液并发腹腔积液最为常见。(4)近半数三腔同时出现积液患者肺内发现血行播散型肺结核。(5)含RFP治疗组的临床效果较为满意。高龄、并发心包炎、并发低蛋白血症是影响疗效的相关因素。结论 对于发热伴有胸闷、腹胀的中青年患者,应进行胸片及B超检查以除外结核性多发浆膜炎,对已发现浆膜腔积液的患者亦应注意其它浆膜腔的相关检查,血播型结核应进行各浆膜腔的相关检查。早期诊断并采用含RFP方案治疗,效果较好。     

腹腔置管注药并引流治疗干酪型结核性腹膜炎的疗效观察

目的 探讨腹腔置管注药并引流治疗干酪型结核性腹膜炎的临床疗效.方法 选择符合诊断条件的干酪型结核性腹膜炎患者60例,分为两组,对照组应用抗结核药物全身化疗;实验组应用腹腔置管注药并引流＋全身化疗.观察两组患者发热、腹痛、腹胀、呕吐、便秘等症状缓解时间;腹腔分房及包裹性积液消退程度;腹部包块及腹腔淋巴结肿大消退程度.结果 治疗4周时,病人症状缓解时间、腹腔分房及包裹性积液消退程度和腹部包块及腹腔淋巴结肿大消退程度,两组比较差异有统计学意义（P＜0.01）.结论 腹腔置管注药并引流治疗技术可减轻腹腔粘连包裹,缓解患者症状,减少肠梗阻及结核性化脓性腹膜炎的发生机会,提高好转率及治愈率.且安全简便、无明显并发症,值得临床推广应用.     

A 41 year-old female with abdominal pain and fever of 24 hours

A 41 year-old female with intrauterine contraceptive device (ICD) from 8 year ago that complained fever and abdominal pain during 24 hours and leucocytosis. The radiology examination tests showed cegal, appendiceal, and right ovary enlargement with swollen of fat adjacent. In the differential diagnosis should be include: appendicitis, diverticulitis, chronic inflammatory digestive disease or mesenterical adenitis. In the differential diagnosis included: ovarian neoplasm, endometriosis, ectopic pregnancy, ovarian torsion and pelvic inflammatory diseases. From pelvic infections, it is import consider pelvic inflammatory disease, genital tuberculosis and pelvic actinomycosis. With the antecedent of ICD, the clinic and the radiological finding as abdominal mass with invasion of adjacent structures and absence of adenopathy; the first diagnosis is a abdominopelvic actinomycosis and the second is a genital tuberculosis.     

Le schwannome malin du grêle: cas rare

Introduction

Primary malignant schwannoma of the small bowel is an extremely rare pathology, with only 24 cases described in English language literature. We report a case of this rare occurrence with a review of the literature. Observation: The case involves a 63-year-old female patient presenting with an abdominopelvic mass. An abdominopelvic scan showed a bulky abdominopelvic mass, which appeared to originate in the uterus, with hepatic metastasis. The patient was treated by surgical excision despite the presence of a diffuse carcinoma. She died three months later.

Discussion

The clinical signs of small bowel schwannoma are not obvious. Radiological examinations reveal a tumoral syndrome. Diagnosis is generally by histological analysis after laparotomy. Surgery is the basic treatment. The role of chemotherapy is not well defined as yet.

Conclusion

Primary malignant schwannoma is an extremely rare pathology. The treatment is primarily surgical. Chemotherapy probably has a beneficial role to play.     

A case of tuberculous endometritis detected by cytology of mass screening for gynecologic cancer

A 55-year-old infertile woman was referred to our clinic for further investigation on extragenital tuberculosis, as tuberculous endometritis was strongly suspected by cytology of her vaginal smear carried out on the occasion of the mass examination for gynecologic cancer screening. Her vaginal smear revealed epithelioid cell clusters which are characteristic for tuberculosis, and cultures of her vaginal discharge were positive for M. tuberculosis consecutively. Moreover, she was exposed for tuberculosis infection from her father who died of active pulmonary tuberculosis when she was ten years old. Her tuberculin test was strongly positive, and her chest radiography showed no abnormality, but a small nodular shadow evaluated as primary focus of tuberculosis located beneath the pleura of the right lower lung field was confirmed by chest CT. In addition, calcification of her para-aortic abdominal lymphnode was detected by simple abdominal X-ray. Based on these data, she was diagnosed as tuberculous endometritis via abdominal cavity, and three antituberculous drugs, namely RFP, INH and EB, were administrated. The mycobacterial cultures of vaginal discharge converted to negative, and chemotherapy was terminated after 9 months treatment. A risk factor leading to the onset of gynecologic tuberculosis, in this case was an exposure to infection from her father. In order to evaluate risk factors relating to the development of gynecologic tuberculosis, bibliographic studies were made on 19 cases of tuberculous endometrites reported recently in Japan regarding their age, its pathogenesis and immuno-suppressive conditions, and the summarized results were as follows. 1. approximately 80% of them were elderly, namely 79% were above 50 years, 63% above 60 years, and 26% above 70 years. 2. 50% of them were caused by endogenous reactivation. 3. 25% of them were immuno-compromised host. It can be concluded that more than 70% of the patients with tuberculous endometritis had risk factors on the host side to develop tuberculosis.     

Pancreatic pseudotumor due to peripancreatic tuberculous lymphadenitis

Peripancreatic tuberculous lymphadenitis is a very rare and difficult diagnosis. We report herein a patient with a clinically solitary abdominal tuberculoma. A 68-year-old woman was admitted to our hospital with moderate-level obstructive jaundice due to a mass located between pylorus and head of the pancreas. There were no clinical signs or symptoms of tuberculosis in lungs or abdomen. After the diagnosis of a neoplasm of the pancreas was made, exploratory laparotomy was performed which revealed a conglomerated mass penetrating into the pancreas. Since an exact diagnosis could not be reached on the basis of frozen sections prepared during the operation, a standard Whipple procedure was performed. After the histopathological examination of the resected specimen revealed tuberculous lympadenitis, the patient was given antituberculous medication. The patient recovered well. An abdominal tuberculoma is often mistaken for a malignant neoplasm, and nonsurgical diagnosis and treatment of this entity continues to be a challenge.