中华病理学杂志
中華病理學雜誌
중화병이학잡지
Chinese Journal of Pathology
2013年
10期
683-686
,共4页
结核%结核,喉%结核,口腔
結覈%結覈,喉%結覈,口腔
결핵%결핵,후%결핵,구강
Tuberculosis%Tuberculosis,laryngeal%Tuberculosis,oral
目的 分析头颈部黏膜结核的临床特征、影像学表现及其病理学改变,探讨其诊断.方法 对2011年收集的47例经病理证实的头颈部黏膜结核病例的临床、影像学和病理学资料作回顾性分析,并进行随访.结果 47例头颈部黏膜结核感染患者发病年龄14～84岁,平均年龄47.1岁,中位年龄45岁,男女比例1.23∶1；其中鼻腔3例,鼻咽部19例,口咽部2例,喉部18例,中耳4例,腮腺1例；1例喉结核同时伴发喉癌；首发症状分别为鼻塞、流涕、鼻衄、嗅觉减退、头痛、眼球胀痛、回缩血涕、咽喉部干痛、灼热、咳嗽、声嘶、耳道流脓、听力下降等；影像学显示局部黏膜增厚,软组织占位伴相应骨质破坏,间有密度不均的钙化；病理学特征为黏膜间质内有团状分布的类上皮细胞和郎罕巨细胞,伴有干酪样坏死,其中13例找到抗酸杆菌.随访3～ 10个月,5例失访.结论 头颈部黏膜结核因临床表现无特征性,多数无肺部或其他部位结核病史,容易漏诊和误诊.组织内发现团状分布的类上皮细胞、郎罕巨细胞和干酪样坏死是病理形态诊断的三要素,抗酸染色能找到结核杆菌,但是阳性率较低.头颈部黏膜结核应及时给予规范的抗结核治疗及全身性支持治疗并注意随访.
目的 分析頭頸部黏膜結覈的臨床特徵、影像學錶現及其病理學改變,探討其診斷.方法 對2011年收集的47例經病理證實的頭頸部黏膜結覈病例的臨床、影像學和病理學資料作迴顧性分析,併進行隨訪.結果 47例頭頸部黏膜結覈感染患者髮病年齡14～84歲,平均年齡47.1歲,中位年齡45歲,男女比例1.23∶1；其中鼻腔3例,鼻嚥部19例,口嚥部2例,喉部18例,中耳4例,腮腺1例；1例喉結覈同時伴髮喉癌；首髮癥狀分彆為鼻塞、流涕、鼻衄、嗅覺減退、頭痛、眼毬脹痛、迴縮血涕、嚥喉部榦痛、灼熱、咳嗽、聲嘶、耳道流膿、聽力下降等；影像學顯示跼部黏膜增厚,軟組織佔位伴相應骨質破壞,間有密度不均的鈣化；病理學特徵為黏膜間質內有糰狀分佈的類上皮細胞和郎罕巨細胞,伴有榦酪樣壞死,其中13例找到抗痠桿菌.隨訪3～ 10箇月,5例失訪.結論 頭頸部黏膜結覈因臨床錶現無特徵性,多數無肺部或其他部位結覈病史,容易漏診和誤診.組織內髮現糰狀分佈的類上皮細胞、郎罕巨細胞和榦酪樣壞死是病理形態診斷的三要素,抗痠染色能找到結覈桿菌,但是暘性率較低.頭頸部黏膜結覈應及時給予規範的抗結覈治療及全身性支持治療併註意隨訪.
목적 분석두경부점막결핵적림상특정、영상학표현급기병이학개변,탐토기진단.방법 대2011년수집적47례경병리증실적두경부점막결핵병례적림상、영상학화병이학자료작회고성분석,병진행수방.결과 47례두경부점막결핵감염환자발병년령14～84세,평균년령47.1세,중위년령45세,남녀비례1.23∶1；기중비강3례,비인부19례,구인부2례,후부18례,중이4례,시선1례；1례후결핵동시반발후암；수발증상분별위비새、류체、비뉵、후각감퇴、두통、안구창통、회축혈체、인후부간통、작열、해수、성시、이도류농、은력하강등；영상학현시국부점막증후,연조직점위반상응골질파배,간유밀도불균적개화；병이학특정위점막간질내유단상분포적류상피세포화랑한거세포,반유간락양배사,기중13례조도항산간균.수방3～ 10개월,5례실방.결론 두경부점막결핵인림상표현무특정성,다수무폐부혹기타부위결핵병사,용역루진화오진.조직내발현단상분포적류상피세포、랑한거세포화간락양배사시병리형태진단적삼요소,항산염색능조도결핵간균,단시양성솔교저.두경부점막결핵응급시급여규범적항결핵치료급전신성지지치료병주의수방.
Objective To study the clinicopathologic features,histologic diagnosis and differential diagnosis of primary mucosal tuberculosis (TB) in the head and neck region.Methods Forty-seven cases of primary mucosal TB of the head and neck region were studied by hematoxylin-eosin and Ziehl-Neelsen stains.The clinical and pathologic features were analyzed with review of the literature.Results The patients included 26 male and 21 female,with mean age 47.1 years (range 14-84 years).There were three sinonasal TB,19 nasopharyngeal TB,two oropharyngeal TB,18 laryngeal TB,four middle ear TB,one salivary gland TB and one laryngeal TB complicating laryngeal cancer.The initial symptoms were nasal obstruction,mucopurulent rhinorrhea,epistaxis,snoring,hoarseness,dysphagia,odynophagia,serous otitis,hearing loss,tinnitus,and otalgia.Physical examination result was variable,from an apparently normal mucosa,to an evident mass,or a mucosa with an adenotic or swollen appearance,ulcers,leukoplakic areas,and various combinations thereof.CT and MRI findings included diffuse thickening,a soft-tissue mass,calcification within the mass and bone destruction resembling malignancy.Histologic examination showed granulomas with a central necrotic focus surrounded by epithelioid histiocytes and multinucleated Langhan's giant cells.Acid-fast bacilli were difficult to demonstrate but found in 13/45 cases.Follow-up data were available in 42 patients.Conclusions Primary TB arising in the head and neck mucosa is rare.It may mimic or co-exist with other conditions.The characteristic histopathology is a granuloma with central caseous necrosis and Langhans' giant cells.Identification of acid-fast bacilli and bacteriologic culture confirm the diagnosis of mycobacterial disease.
