艾滋病合并眼、胰腺和脾结核误诊为肿瘤3例临床与病理分析

AIDS complicated with eye,pancreas and spleen tuberculosis misdiagnosed as tumors:Clinical and pathological analysis of 3 cases

目的:探讨艾滋病合并少见部位结核患者的临床及病理特征,并通过分析其临床资料及误诊原因,提高艾滋病合并结核的诊断水平。方法:收集2010年10月至2013年8月进行手术切除的3例艾滋病患者组织标本(包括眼、脾和胰腺),分别进行HE和抗酸染色,在光学显微镜下观察,并结合患者临床资料及文献复习,对其误诊原因进行综合分析。结果:3例患者的影像学检查结果均提示为实性占位,分别考虑为眼黑素瘤、胰腺癌、脾淋巴瘤的可能;术后病理形态学显示眼部组织除炎细胞浸润、坏死、少数巨噬细胞、类上皮细胞外,未见典型结核病变;胰腺、脾组织内炎细胞浸润,上皮样肉芽肿形成,脾脏见干酪样坏死灶。3例患者的病理标本抗酸染色均为阳性,病理诊断均符合结核。结论:艾滋病合并结核多以不规则发热为主要表现,影像学检查不具备特异性,易造成临床误诊,确诊主要依靠病理检查和特殊染色技术,光学显微镜下观察应重视鉴别诊断。

Objective： To explore the clinical and pathological characteristics of AIDS complicated with tuberculosis, and to analyze the clinical data and misdiagnosing reasons for improving the diagnosis of HIV complicated with tubercu losis. Methods： Tissue specimens from AIDS patients＇ eye, spleen nd pancreas were collected during Oct. 2010 to Aug. 2013, and H.E. and acid fast staining were performed. Specimens were observed under light microscope, and clinical data, literature review amt misdiagnosing reasons were analyzed. Results： The 3 patients were previously diagnosed as eye melanoma, pancreatic cancer and splenic lymphoma by radiologic imaging, respectively. Pathological changes under microscopy showed tissue necrosis, inflammatory cell infiltration, a few macrophages and epithelioid cells in eye tissue, but no typical TB lesion. In pancreas and spleen, tissues were full of inflammatory cells, and epithelioid granulomas were formed; spleen showed caseous necrosis. Fast stain was positive in all these 3 cases. The three patients were confirmed pathologically as AIDS complicated with TB. Conclusions： AIDS patients complicated with tuberculosis mainly present as irregular fever. Radiologic imaging has no specificity and thus is easy to result in misdiagnosis. The definite diagnosis relies on pathological examination and special staining; differential diagnosis by microscopy should be emphasized.