Tuberculoma of the liver

During the period 1973-76 2 patients, neither immigrants, were operated on and found to have tuberculoma of the liver. Both were successfully treated. Tuberculoma of the liver is an uncommon condition and is rarely encountered as a surgical problem. It can, however, present a surgical challenge as it must be distinguished from the more common types of right upper quandrant abdominal lesions such as biliary, gastroduodenal and other hepatic diseases. The occurrence of a tuberculoma of the liver without coexistent tuberculosis elsewhere in the body is extremely rare. Its presence in association with other tuberculous foci, whilst uncommon, has been recorded on a number of occasions.     

Isolated hepatic tuberculosis: report of five cases and review of the literature

Tuberculosis is one of the most common and well-described infectious diseases, with a worldwide distribution and a vast spectrum of clinical manifestations. Involvement of the liver alone by tuberculosis is, however, uncommon. It usually presents as a protracted illness frequently associated with jaundice and hepatomegaly. It can, therefore, mimic primary or metastatic liver malignancies. We report five cases of isolated hepatic tuberculosis, emphasizing the importance of obtaining a tissue diagnosis in all subjects with suspicious liver lesions to avoid missing the uncommon but curable hepatic tuberculosis.     

Computed tomography and angiography in hepatic tuberculosis mimicking liver tumor.

Tuberculosis is one of the most common and well-documented infectious diseases, with a vast variety of clinical manifestations. A case of isolated hepatic tuberculosis mimicking liver tumor is presented. The patient was a 44-year-old man who had suffered from intermittent epigastralgia for about 2 years. Abdominal computed tomography demonstrated a low density mass with internal calcification over the left lobe of the liver. Celiac angiography showed encasement of the hepatic propia and occlusion of the left hepatic artery. Abnormal tortuous vascular structures were found at the hepatic hilar region. The patient underwent surgical intervention under the impression of left liver tumor. Microscopically, the resected liver tissue specimen revealed tuberculosis.     

Hepatobiliary tuberculosis

Tuberculous involvement of the liver as part of generalized military tuberculosis is well known. It is said to be found in 50-80% of all cases dying from pulmonary tuberculosis (1). However, localized tuberculosis of the liver as a clinical entity and producing large nodules or abscesses have been considered exceedingly rare, even in areas where tuberculosis is relatively common. Leader (2), in an extensive review of the world literature in 1952, documented only 80 cases of hepatic tuberculosis with large abscesses or nodules. Other publications deal with localized tuberculous involvement of the hepatobiliary tract in isolated case reports (1-8). In order to learn more about the clinical manifestation and course of this disease, we therefore prospectively evaluated our total experience on hepatobiliary tuberculosis during the last two decades of our practice.     

Liver changes in reactive haemophagocytic syndrome.

Hepatomegaly and deranged liver functions are common findings in reactive haemophagocytic syndrome (RHS). We report the findings of 12 fatal cases of RHS in which histological materials of the liver are available for study. The underlying diseases of these patients included lymphoma/leukaemia (6 cases), disseminated undifferentiated carcinoma of the ovary (1 case), disseminated nasopharyngeal carcinoma complicated by tuberculosis (1 case), adenovirus pneumonia (1 case), pneumococcal pneumonia (1 case), typhoid fever (1 case), and possible drug intoxication (1 case). Ten patients had involvement of the liver by the underlying disease process which contributed to the marked hepatic derangement. Non-specific reactive hepatitis, sinusoidal dilatation and steatosis resulting from systemic or local effects of the associated diseases and the haemophagocytosis also added to the high incidence of liver abnormalities. A diffuse Kupffer cell hyperplasia with haemophagocytosis is characteristic of the syndrome, as all the cases showed increased numbers of bland-looking histiocytes within the hepatic sinusoids and haemophagocytosis which was moderate to marked in 8 cases and mild in 4. Thus the finding of Kupffer cell hyperplasia with prominent haemophagocytosis in liver biopsy is indicative of an element of RHS and warrants clinical monitoring. Differential diagnoses of haemophagocytosis in liver are also discussed.     

肝脏感染性疾病的影像学诊断

肝脏感染性疾病包括化脓性、寄生虫性、真菌性、结核性、病毒性及其他罕见感染性疾病，如HIV感染和猫抓病。肝脏感染性疾病的早诊断、早治疗对改善预后具有重要价值。影像学检查是早期发现及鉴别诊断的重要手段。笔者就肝脏感染性疾病的计算机体层摄像及磁共振成像表现进行综述，希望对临床诊断有所帮助。     

Case of disseminated tuberculosis complicated with tuberculous meningitis while investigating an abdominal lymphadenopathy

In February 2005, a 33-year-old man visited A hospital complaining of fever. The blood screening test revealed the liver dysfunction, then computed tomography showed swelling of abdominal lymph nodes. In April, headache and disorientation appeared. He was diagnosed as disseminated tuberculosis and tuberculous meningitis based on chest X-ray and computed tomography findings and examination of cerebrospinal fluid. After admission to our hospital, anti-tuberculous drugs were prescribed, but the cerebral infarction happened. The disturbance of consciousness and the left half of his body paralysis appeared. They did not improve and hydrocephalus was complicated in August, though he was treated by steroids. He needed all helps because of the left half of his body paralysis and an advanced sequelae was left. It was thought that the abdominal lymph adenopathy preceded as one of symptoms of the disseminated tuberculosis in this case. It is said to be rare that abdominal lymph node swelling is seen in the early stage of disseminated tuberculosis. But, we think that it is necessary to keep in mind that the possibility of disseminated tuberculosis as one of the diseases in differential diagnosis, when we examine enlargement of abdominal lymph nodes with symptoms suggesting the presence of infection such as fever.     

Liver changes in reactive haemophagocytic syndrome

ABSTRACT— Hepatomegaly and deranged liver functions are common findings in reactive haemophagocytic syndrome (RHS). We report the findings of 12 fatal cases of RHS in which histological materials of the liver are available for study. The underlying diseases of these patients included lymphoma/leukaemia (6 cases), disseminated undifferentiated carcinoma of the ovary (1 case), disseminated nasopharyngeal carcinoma complicated by tuberculosis (1 case), adenovirus pneumonia (1 case), pneumococcal pneumonia (1 case), typhoid fever (1 case), and possible drug intoxication (1 case). Ten patients had involvement of the liver by the underlying disease process which contributed to the marked hepatic derangement. Non-specific reactive hepatitis, sinusoidal dilatation and steatosis resulting from systemic or local effects of the associated diseases and the haemophagocytosis also added to the high incidence of liver abnormalities. A diffuse Kupffer cell hyperplasia with haemophagocytosis is characteristic of the syndrome, as all the cases showed increased numbers of bland-looking histiocytes within the hepatic sinusoids and haemophagocytosis which was moderate to marked in 8 cases and mild in 4. Thus the finding of Kupffer cell hyperplasia with prominent haemophagocytosis in liver biopsy is indicative of an element of RHS and warrants clinical monitoring. Differential diagnoses of haemophagocytosis in liver are also discussed.     

肝结核5例诊治分析

[目的]分析肝结核的临床表现、影像学特点及治疗措施,提出诊治对策,提高诊断能力.[方法]回顾性 分析5例肝结核患者的病历资料,以期提高对肝结核的诊断及认识.[结果]5例中,以脐周痛、发热为主要表现1例,以右上腹痛表现1例,以右下胸痛为主要表现1例,以肝功能损害为主要表现1例,以腹胀、多浆膜腔积液为主要表现1例；其中3例经病理及影像学检查确诊,另2例为临床诊断考虑肝结核,给予抗结核治疗有效.[结论]肝结核可表现为腹痛、腹胀,也可无明显腹部症状,或仅有肝功能损害及表现为多浆膜病变；腹部CT表现为肝脏结节,增强后可强化,或有钙化表现；病理活检是金标准,表现为肉芽肿性炎.对于有肺结核病史,近期出现发热、纳差、腹痛、肝脏肿大伴触痛、血沉增高、肝功能异常尤其是γ-GT增高、贫血、甲胎蛋白正常,结合腹部CT及B超表现需考虑肝结核的可能.     

Hepatic vasculitis presenting with multiple sterile liver abscesses in a patient with systemic lupus erythematosus

Although biochemical evidence of liver disease is common in patients with systemic lupus erythematosus (SLE), clinical liver disease is uncommon. We report on a 26‐year‐old woman who presented with acute febrile illness, right upper abdominal pain and multiple hypo‐dense lesions in the liver in a computed tomographic study that mimicked multiple liver abscesses. Multiple necrotizing hepatic granulomas and old occlusive hepatic arteritis were observed in the surgical liver specimen. She was later found to have SLE. This patient represented a rare case of SLE that had hepatic vasculitis with hepatic infarction mimicking multiple liver abscesses as an initial manifestation.     

Primary macronodular hepatic tuberculosis: US and CT appearances

Tuberculosis of the liver is uncommon except in association with miliary dissemination. Although hepatic involvement by tuberculosis tends to be diffuse, the macronodular or pseudotumor forms are rare. In addition, reports of actual imaging of tuberculous liver involvement are rare. A 5-year-old boy with a febrile illness due to macronodular hepatic tuberculosis, demonstrated by abdominal computed tomography (CT), and diagnosed by liver biopsy is presented.     

Hepatic tuberculosis in absence of disseminated abdominal tuberculosis

Liver involvement in tuberculosis in absence of miliary tuberculosis is rare. This study was performed to analyse the spectrum and response to treatment of hepatic tuberculosis in the absence of miliary abdominal tuberculosis. Retrospective analysis of seven cases of hepatic tuberculosis without miliary abdominal tuberculosis who presented at the single tertiary referral center were analyzed. All patients presented with fever and hepatomegaly. Five of them had pain in upper abdomen and vomiting. HIV serology was positive in one patient. All patients had normocytic normochromic anaemia, raised erythrocyte sedimentation rate (Mean 65). Mild elevation of liver enzymes and low albumin (Mean 2.4 gm%) with reversal of albumin globulin ratio (Mean 0.6) were seen in all. Two had jaundice. Prothrombin time was normal in all and lactate dehydrogenase values were elevated in all (Mean 794 IU/L). On ultrasonography, 2 had multiple hypodense lesion, 1 had coarse echotexture of liver, 1 had hyperechoic pattern and 3 had just hepatomegaly. Complete resolution of liver lesions on treatment with 4-drug anti-tuberculosis drug chemotherapy was seen. In conclusion, liver tuberculosis has protean manifestations with nonspecific alteration of liver function tests and is best diagnosed on liver biopsy. Overall response to therapy is satisfactory.     

Pseudotumoral hepatic tuberculosis. Atypical presentation and comprehensive review of the literature.

We describe a 40-year-old black North American woman with isolated hepatic tuberculosis and an incidentally elevated alkaline phosphatase. Imaging studies of the liver showed a lesion suggesting primary or metastatic disease, which turned out to be the so-called pseudotumoral form of hepatic tuberculosis. We believe this is the first case recorded in the English language literature of isolated hepatic tuberculosis manifesting first as an incidentally elevated alkaline phosphatase. It seems to be the third documented case in the English literature of a patient with this rare form of tuberculous involvement without systemic manifestations. The patient responded to antituberculous therapy and is healthy 4 years after treatment.     

Usefulness of Doppler blood flow ultrasonography in diagnosis of liver diseases]

The usefulness of Doppler blood flow ultrasonography in diagnosis of some liver diseases was investigated. Normal subjects and patients with AH and CPH had no blood flow signal on their abdominal wall and their femoral veins were normal. One (5%) of 20 patients with CAH was found to have blood flow signals on abdominal wall and the direction of the flow was normal, suggesting that collateral circulation has been established due to portal hypertension as a result of liver cirrhosis. 12 out of 20 cases of liver cirrhosis with no varices on abdominal wall had blood flow signals on their abdominal wall and the direction of the flow was normal. One case of Budd-Chiari syndrome with occlusion of hepatic vein and inferior vena cava showed blood flow signal on his abdominal wall and the direction of the flow was abnormal. One case of constrictive pericarditis showed abnormal blood flow in the femoral veins. In conclusion, this method is highly useful for the diagnosis and differential diagnosis of portal hypertension of cirrhosis and Budd-Chiari syndrome. It is also of help for the diagnosis of pericarditis and some other vascular deformity.     

抗结核药物对慢性肝病肺结核患者肝功能的影响

目的 探讨2HRZE/4HR方案对患不同慢性肝病的肺结核患者肝功能的影响.方法 回顾性分析2004年8月～2005年8月住院期间收治的1475例初治肺结核患者在化疗过程中发生肝功能损害的临床资料.B超检查提示同时患有慢性肝病者(脂肪肝、肝硬化等)为观察组(136例);未患肝病者为对照组(1339例).结果 观察组有57例(41.9%)出现了肝损害,其中脂肪肝12例(60.0%),肝硬化7例(87.5%),慢性酒精性肝病6例(35.7%),慢性乙型肝炎9例(45.0%),慢性血吸虫病肝8例(50.0%),肝血管瘤或肝囊肿10例(26.3%),肝内胆管结石5例(25.0%).对照组出现肝损害138例(10.3%).观察组肝功能损害比对照组严重.观察组经护肝治疗肝功能的恢复也比对照组慢.结论 2HRZE/4HR方案对各类慢性肝病的肺结核患者肝功能损害较大,发生较早,恢复较慢.应尽量选用对肝脏损害小的药物,并密切监测肝功能,同时给予有效的护肝治疗.     

Primary hepatic diffuse large B cell lymphoma: A case report: Primary hepatic diffuse large B cell lymphoma

In this report we describe a rare case of primary hepatic diffuse large B cell lymphoma in a 67-year-old man who presented with abdominal pain, deteriorated liver function, elevated lactate dehydrogenase. He was found to have diffuse nodular intrahepatic space-occupying lesion with normal α-fetoprotein and carcino-embryogenic antigen. The final diagnosis was made by percutaneous biopsy of the liver as the clinical manifestation not consistent with common liver diseases. The patient was treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) without surgical resection with a favorable response. However, serious complication was occurred after 4 cycles of chemotherapy, and the patient finally died of concurrent acute respiratory distress syndrome.     

Colonic and peritoneal tuberculosis associated with coloduodenal fistula

We report a very rare case of tuberculous colitis that showed relatively long-segment involvement of the colon near the hepatic flexure with coloduodenal fistula that caused severe malnutrition. The formation of fistula in abdominal tuberculosis is very rare. This is the eighth reported case of abdominal tuberculosis with fistula and the first reported case with a coloduodenal fistula.     

Contrast uptake in primary hepatic angiosarcoma on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging in the hepatobiliary phase

Primary hepatic angiosarcoma is the most common malignant mesenchymal tumor of the liver. It has a poor prognosis and various appearances on magnetic resonance(MR) images. We report a case of hepatic angiosarcoma with a characteristic appearance on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)-enhanced MR imaging in the hepatobiliary phase. A 72-year-old man was admitted with a complaint of abdominal pain. Gd-EOBDTPA-enhanced MR imaging revealed a liver tumor that showed slight hyperintensity in the hepatobiliary phase. These findings suggested Gd-EOB-DTPA uptake in the tumor. An autopsy revealed the solid proliferation and sinusoidal spreading of hepatic angiosarcoma cells. Immunohistochemistry indicated that the tumor was negative for OATP1B3. Gd-EOB-DTPA uptake in the liver tumor in the hepatobiliary phase suggested sinusoidal tumor invasion with residual normal hepatocytes.     

A case of primary hepatic epithelioid hemangioendothelioma mimicking metastatic carcinoma]

Epithelioid hemangioendothelioma is a rare vascular origin tumor which usually occurs in soft tissues, liver, and lung. It usually affects adult women and presents as multiple hepatic nodules with mainly peripheral distribution. It is difficult to diagnose and treat because of non-specific clinical manifestations and findings on the imaging study. Moreover, pathological misdiagnosis is common. We report a case of this rare tumor that was detected incidentally. Final diagnosis was based on histological evidence. A 52-years old man suffered from right upper quadrant abdominal pain for 3 months, and was initially misdiagnosed as a metastatic carcinoma. Physical examination revealed superior cervical lymphadenopathy with mild hepatomegaly. Finally, hepatic epithelioid hemangioendothelioma was diagnosed on the basis of positive immunohistochemical staining for factor VIII, CD34, and VEGF. Our case highlights the importance of a histological diagnosis to avoid misdiagnosis.     

肝结核20例临床分析

目的 探讨肝结核的诊断和治疗措施.方法 对20例肝结核患者的临床资料进行回顾性分析.结果 20例患者中表现为发热、盗汗、纳差、腹痛、腹胀和腹泻分别为10例(50%)、4例(20%)、12例(60%)、8例(40%)、12例(60%)、4例(20%)和无症状3例(15%).腹部B超及CT检查发现肝内占位性病变15例,肝内有钙化灶2例,肝脏肿大3例.手术及病理诊断肝结核15例,2例因肝内有钙化灶诊断为肝结核,另3例采用诊断性抗结核治疗有效诊断为肝结核.20例患者中有16例合并肝外结核.所有患者均经过1.5年以上的抗结核治疗,经随访预后良好.结论 肝结核患者的临床和影像学表现多样,且无特异性,误诊误治率高.确诊的主要手段是肝脏病理学检查及诊断性治疗,系统的抗结核治疗及选择性手术治疗是肝结核患者的有效治疗手段.