Tuberculoma hepático que simula metástasis de carcinoma neuroendocrino gástrico / Hepatic tuberculoma simulating metastasis of gastric neuroendocrine carcinoma

La tuberculosis es una de las enfermedades infecciosas más frecuentes de distribución mundial, con una amplia presentación clínica. La afectación hepática de la tuberculosis es poco frecuente, pero más infrecuente aún lo es el tuberculoma hepático. Se presenta el caso de una paciente con tuberculoma hepático solitario que simula metástasis hepática secundaria a tumor neuroendocrino

Tuberculosis is one of the most common infectious diseases, with worldwide distribution and ample clinical manifestations. Hepatic tuberculosis is rare but hepatic tuberculoma is even rarer. We report an unusual case of a solitary hepatic tuberculoma simulating hepatic metastasis of a neuroendocrine tumor

Primary Hepatic Tuberculosis Mimicking Hepatocelluar Carcinoma in Patient with Chronic Viral Hepatitis B and C / 계명의대학술지

Hepatic tuberculosis (TB) is usually associated with pulmonary or miliary TB, but primary hepatic TB is rare less than 1% of all cases of TB. Because hepatic TB lacks typical clinical manifestations as well as typical imaging findings, it is difficult to differentiate TB from the malignancies such as hepatic metastasis, intrahepatic cholangiocarcinoma and hepatocellular carcinoma. A 76-year-old woman was presented with single liver mass detected on routine examination. She was clinically diagnosed with hepatocellular carcinoma and underwent surgical excision of the lesion. However, histologic examination revealed caseous necrotizing granuloma and the PCR test for Myco-bacterium tuberculosis was positive. The final diagnosis was primary hepatic TB. Here we report the case with primary hepatic TB who was initially misdiagnosed with hepatocellular carcinoma and underwent surgical excision.

A Case of Single Mass Forming Hepatic Tuberculoma / 계명의대학술지

Tuberculosis mainly develops in the lung, but may also rarely invade other parts of the abdominal region. Abdominal tuberculosis is associated with pulmonary tuberculosis in approximately 15% of cases, and abdominal tuberculosis primarily develops in the terminal ileum and lymphatic gland. Moreover, hepatic tuberculosis is uncommon and is usually accompanied with active pulmonary or miliary tuberculosis. Hence, the development of primary hepatic tuberculoma as a single liver mass is very unusual. In the present report, we describe the case of a 63-year-old man with a solitary hepatic tuberculoma; the 6.4 cm mass was incidentally detected during abdominal computed tomography in the asymptomatic patient, and the diagnosis was confirmed by liver biopsy through ultrasonography-guided fine-needle aspiration.

Primary hepatic tuberculosis mimicking intrahepatic cholangiocarcinoma: report of two cases

Hepatic tuberculosis (TB) is usually associated with pulmonary or miliary TB, but primary hepatic TB is very uncommon even in countries with high prevalence of TB. The clinical manifestation of primary hepatic TB is atypical and imaging modalities are unhelpful for differential diagnosis of the liver mass. Image-guided needle biopsy is the best diagnostic method for primary hepatic TB. In the cases presented here, we did not perform liver biopsy because we believed the liver masses were cholangiocarcinoma, but primary hepatic TB was ultimately confirmed by postoperative pathology. Here we report two cases of patients who were diagnosed with primary hepatic TB mimicking mass-forming intrahepatic cholangiocarcinoma.

Hepatitis granulomatosa en paciente con tuberculosis miliar: presentación de un caso / Granulomatous hepatitis in a patient with Miliary Tuberculosis: presentation of a case

La hepatitis granulomatosa como elemento inicial de una enfermedad tuberculosa es muy poco frecuente. El rendimiento de las pruebas para el diagnóstico de tuberculosis hepática resulta baja, siendo las principales causas de granulomatosis hepática las infecciones (tuberculosis, brucelosis, hongos, parásitos, etc). En la tuberculosis miliar, durante la diseminación hemática, que ocurre en el desarrollo de la primoinfección, el hígado es capaz de recibir y albergar una carga considerable de bacilos por sus características anatomofuncionales que se agrupan en forma de granuloma, que es un patrón de reacción inflamatoria crónica en el que predomina un tipo especial de célula denominada macrófago. Esto es causa frecuente de síndrome febril prolongado de causa sistémica, puede debutar con manifestaciones clínicas poco precisas. Se presentó un caso del sexo masculino que ingresa en el servicio de Medicina del Hospital Militar Docente Dr Mario Muñoz Monroy, de Matanzas, que ingresa por cuadro de fiebre de origen desconocido, que resultó ser por esta causa.

Granulomatous hepatitis as initial element of a tubercular disease is few frequent; the efficacy of the tests for diagnosing hepatic tuberculosis is low, being infections (tuberculosis, brucellosis, fungi, parasites, etc). The main cause of hepatic granulomatosis. during the hematic dissemination in the miliary tuberculosis, occurring in the development of primo-infection, liver is able of receiving and dwelling a considerable charge of bacilli due to its anatomic functional characteristics; they group in the form of granulomas, a pattern of chronic inflammatory reaction, in which there is a predomination of an special kind of cells called macrophages; it frequently causes a prolonged febrile syndrome and may start with little precise clinical manifestations. We present the case of a male patient entering the Medicine Service of the Military Hospital Dr Mario Muñoz Monroy of Matanzas, with a picture of unknown origin fever, resulting being originated by this cause.

Hepatic tuberculosis: a rare cause of fluorodeoxyglucose hepatic superscan with background suppression on positron emission tomography

Fluorodeoxyglucose (FDG) hepatic superscan refers to the diffuse intense uptake of 18F-FDG in the liver on positron emission tomography (PET), with reduced physiological activity in the brain and heart. The common causes include lymphoma and metastasis. In this case report, we describe the imaging features of tuberculosis as a rare cause of FDG hepatic superscan. PET imaging may be the only clue to a diagnosis of hepatic tuberculosis, as other imaging modalities may demonstrate only nonspecific hepatomegaly. It is important to consider this entity in the differential diagnosis of patients presenting with FDG hepatic superscan and proceed with liver biopsy for a definitive diagnosis.

Hepatic Tuberculosis Granuloma Mimicking Hilar Cholangiocarcinoma Confirmed by Endoscopic Ultrasound-Guided Fine-Needle Aspiration / 대한내과학회지

Hepatic tuberculosis is usually associated with active pulmonary or miliary tuberculosis. The occurrence of an isolated hepatic mass-forming tuberculosis with no evidence of tuberculosis elsewhere is rare. We report a case of a 31-year-old male with a solitary hepatic granuloma mimicking a mass-forming intrahepatic cholangiocarcinoma. Ultrasonography, computed tomography, magnetic resonance imaging, and positron emission tomography of the abdomen showed a malignant tumor-like lesion. We then conducted endoscopic ultrasonography (EUS) and EUS-guided fine-needle aspiration (EUS-FNA) for confirmation of the hepatic hilar mass, which was found to be a hepatic tuberculosis granuloma as the final diagnosis.

Hepatic Tuberculosis Granuloma Mimicking Hilar Cholangiocarcinoma Confirmed by Endoscopic Ultrasound-Guided Fine-Needle Aspiration / 대한내과학회지

Hepatic tuberculosis is usually associated with active pulmonary or miliary tuberculosis. The occurrence of an isolated hepatic mass-forming tuberculosis with no evidence of tuberculosis elsewhere is rare. We report a case of a 31-year-old male with a solitary hepatic granuloma mimicking a mass-forming intrahepatic cholangiocarcinoma. Ultrasonography, computed tomography, magnetic resonance imaging, and positron emission tomography of the abdomen showed a malignant tumor-like lesion. We then conducted endoscopic ultrasonography (EUS) and EUS-guided fine-needle aspiration (EUS-FNA) for confirmation of the hepatic hilar mass, which was found to be a hepatic tuberculosis granuloma as the final diagnosis.

Primary hepatic tuberculosis: a rare but fatal clinical entity if undiagnosed

Hepatic tuberculosis particularly in the absence of military tuberculosis is rare. It can occur as a primary case or due to reactivation of an old tubercular focus. We report case of a 24 year old married female who died of primary hepatic tuberculosis. She had no evidence of tuberculosis elsewhere. Appropriate treatment initiated early can result in marked recovery whereas failure to recognize this entity can prove to be fatal.

A Case of Multi-Organ Macronodular Tuberculosis / 결핵및호흡기질환

A 37 year old female presented with epigastric pain and weight loss over a period of 3 months. Her abdominal CT finding showed a 4.5 cm size hepatic mass and 4.3 cm size pancreatic head mass with multiple macronodules in the liver. At the same time, her chest CT revealed a 5 cm size necrotic mass in the left lower lobe of the lung with multiple bilateral pulmonary nodules. We diagnosed these lesions as tuberculosis through multiple biopsies. She was treated with anti-tuberculous medication. After taking the medications, her symptoms were improved. Twelve months later, imaging studies indicated an improvement in the patient's health. Here we report a case report of multi-organ macronodular tuberculosis in lung, liver and pancreas.

Primary Hepatosplenic Tuberculosis in an Immunocompetent Adult and Domestic Literature Review

Hepatic or splenic involvement of tuberculosis without other disseminated lesions is a very uncommon form of extrapulmonary tuberculosis, especially in an immunocompetent adult. We report a case of a 25 year-old-man who developed primary hepatosplenic tuberculosis not associated with the lung or other distant organs. He was initially diagnosed with esophageal candidiasis in local clinic. A computed tomographic scan of the abdomen showed hepatosplenomegaly and multiple microabscesses in the spleen. Our initial diagnosis, based on the clinical feature and radiologic findings, was hepatosplenic candidiasis. However, histopathology of the liver specimens revealed chronic granuloma with central caseous necrosis, strongly suggestive of tuberculosis. Although rare, splenic tuberculosis should be considered in the differential diagnosis of splenic abscess, especially in countries where tuberculosis is endemic.

Causes of hepatic granuloma: a 12-year single center experience from Southern Iran

Hepatic granuloma is reported in 2 - 15% of liver biopsy specimens. It is relatively easy for the pathologist to diagnose, but sometimes arriving at a specific etiology is quite difficult. Until now, there are few published studies about the etiology of hepatic granuloma in Iran. In this study, we attempt to determine the causes of hepatic granuloma from one of the largest referral centers in this country. In a retrospective study over 12 years, a hepatopathologist reviewed all liver biopsies with granuloma. The medical records, including clinical findings, autoantibodies, viral markers, imaging studies, drug histories, and all other specialized tests, such as molecular studies, were reviewed to reach a definite diagnosis. During 12 years, there were 72 cases diagnosed with liver granuloma. The most common cause of hepatic granuloma was infectious, with Mycobacterium tuberculosis [52.8%]. The second most common cause was visceral leishmaniasis in 8.3% of biopsies. Other less common causes were fungal infections, visceral larva migrans, primary biliary cirrhosis, and hepatitis C, each in 4.2% of cases. Autoimmune hepatitis was diagnosed in 2.8% of patients. Lymphoma, drug induced, disseminated BCGitis, CMV infection, foreign body reaction and sarcoidosis, were each found in 1.4% of the liver biopsies. After all investigations, there were 12.5% idiopathic hepatic granulomas. According to this study, the most common cause of hepatic granuloma in Iran is tuberculosis. This finding is completely different from western countries and very similar to the results of countries such as Saudi Arabia

Imágenes en tuberculosis abdominal / Imaging in tuberculosis abdominal

En este artículo se discuten e ilustran las características por imagen de la afectación abdominal por tuberculosis. Se presenta un grupo de pacientes evaluados a través de diferentes modalidades diagnósticas con síntomas abdominales y hallazgos imaginológicos sugestivos de infección granulomatosa. Este diagnóstico fue confirmado posteriormente en la evolución clínica y con estudio histológico. Se incluyen casos de afectación en diferentes órganos abdominales, como sistema linfático, peritoneo, órganos pélvicos, hígado, bazo, riñones y uréteres.

In this article we illustrate and discuss imaging features resulting from Tuberculosis abdominal affectation. We present patients evaluated with several imaging modalities who had abdominal symptoms and findings suggestives of granoulomatous disease. Diagnosiswas confirm including hystopatology and clinica outgoing. Cases involved presented many affected organs such as lymphatic system, peritoneum, liver, spleen, pancreas, kidneys, ureters, adrenal glands and pelvic organs.

Hepatic tuberculosis presenting as a large liver mass / 대한간학회지

No abstract available.

Primary nodular hepatic tuberculosis mimicking hepatic neoplasia in an immunocompetent host

We present and describe a case of nodular primary hepatic tuberculosis mimicking hepatic neoplasia in an immunocompetent host. This particularly rare presentation, associated with unspecific imaging, laboratory andclinical findings and relatively unspecific microbiological results make diagnosis extremely difficult, usually requiring surgical intervention.

Tuberculosis hepática pseudotumoral: reporte de caso / Hepatic Tuberculosis pseudotumoral: case report

El compromiso hepático por tuberculosis es una presentación rara de la enfermedad. Su espectro clínico es variado; siendo una de las formas el tuberculoma hepático o tuberculosis pseudotumoral entidad poco frecuente que no muestra sintomatología específica, por lo que es difícil diagnosticarla. Se reporta el caso de un paciente con tuberculosis hepática pseudotumoral, cuyos síntomas de presentación fueron dolor en hipocondrio derecho y pérdida de peso. La tomografía computarizada mostró presencia de una lesión hepática sólida hipodensa que captaba sustancia de contraste de forma heterogénea. Fue sometido a hepatectomia segmentaria con la sospecha clínica de neoplasia maligna, sin embargo el estudio anatomopatológico confirmó el diagnóstico de tuberculosis. No se encontró foco primario en otras localizaciones. El paciente posteriormente recibió tratamiento antibiótico específico y evolucionó clínicamente bien.

Clinical features of hepatic tuberculosis in biopsy-proven cases / 대한간학회지

BACKGROUNDS/AIMS: Hepatic involvement is frequently observed in patients with miliary tuberculosis, but primary hepatic tuberculosis with no clinical extrahepatic manifestations of tuberculosis is uncommon. With the ever-increasing number of immunocompromised patients, it is expected that hepatic tuberculosis will occur more frequently. The aim of the present study was to establish the clinical manifestations and course of the disease. METHODS: From January 1989 to September 2008, 12 patients were diagnosed with hepatic tuberculosis by liver biopsy at Seoul National University Hospital. We retrospectively evaluated their clinical, laboratory, and imaging findings by medical record review. RESULTS: Four patients had primary hepatic tuberculosis, and eight patients had hepatic tuberculosis secondary to pulmonary or miliary tuberculosis. Three patients were immunocompromised, and six patients had no previous medical problem. An elevated serum level of alkaline phosphatase was the most frequently observed finding in laboratory tests. Imaging studies showed variable findings, including hepatosplenomegaly, multiple hepatic nodules, abscess formation, and even normal findings. Ten patients responded to antituberculosis drugs, and two cases with tuberculous liver abscess had persistent disease despite prolonged therapy. CONCLUSIONS: In patients with a protracted illness, hepatosplenomegaly and/or abnormal liver function tests, hepatic tuberculosis should be suspected, even in healthy young patients or patients with normal imaging findings. Patients with tuberculous abscess formation tend to respond poorly to antituberculosis therapy, and surgery could be considered in these patients.

A case of tuberculosis hepatitis diagnosed in a patient presenting with acute hepatitis / 대한내과학회지

Involvement of the liver is very common in military tuberculosis, but despite this fact, jaundice and hepatocellular dysfunction very rarely occur in this disease. Here, we report the case of a 59-year-old male patient who presented with acute hepatitis. After being admitted for fever and right upper quadrant pain for a 3-day period, military tuberculosis was diagnosed and treated with antituberculosis medication. Despite treatment, which was based on laboratory results and radiologic findings suggestive of acute hepatitis, fever persisted, jaundice developed, and hepatic enzyme levels increased. Percutaneous liver biopsy was performed to assist in the differential diagnosis of acute hepatitis and findings from the biopsy specimen revealed typical hepatic tuberculosis. Antituberculosis treatment was initiated, and the fever gradually subsided and hepatic enzyme levels decreased.