摘要
背景原发性小肠淋巴瘤发病率较低,多发于回肠末端,与克罗恩病、肠结核、肠白塞病不易鉴别.临床以腹痛、腹部肿块多见,但症状缺乏特异性.诊断主要依靠病理.病例简介该患者因腹痛、腹泻数月伴黑便就诊,于当地医院多次行内镜、电子计算机断层扫描及病理检查诊断为克罗恩病,并先后予以抗炎、抑酸、营养支持,以及生物制剂(英夫利西单抗)治疗,但病情逐渐进展.入院后开腹探查,行小肠部分切除术,根据术后病理及免疫组化结果诊断为小肠淋巴瘤.结论小肠淋巴瘤和克罗恩病的临床表现、实验室检查、内镜及影像学表现相似,有时临床诊断困难,手术切除标本的组织病理可明确诊断.本文对此病例误诊的原因进行分析,旨在提高临床医生对两种疾病的认识和诊断水平,减少类似的误诊或漏诊.
BACKGROUND Primary intestinal lymphoma has a low incidence rate.It usually occurs at the end of the ileum and is thus difficult to distinguish from intestinal tuberculosis,Crohn’s disease,and Behcet’s disease.The common symptoms are abdominal pain and abdominal mass,but the clinical manifestations are not specific.The diagnosis mainly depends on pathological results.It is easy to cause misdiagnosis or missed diagnosis clinically.CASE SUMMARY A 43-year-old man was diagnosed as having Crohn’s disease by endoscopy,abdominal computed tomography,and pathological examination at a local hospital due to abdominal pain and diarrhea for several months followed by melena for one week.He was successively treated with anti-infection therapy,acid suppression,nutritional support,and biological agents(Remicade),which finally resulted in a worse condition.After admission to our hospital,open exploration and partial resection of the small intestine were performed.According to the results of postoperative pathology and immunohistochemistry,the patient was diagnosed as having intestinal lymphoma.CONCLUSION Small intestinal lymphoma and Crohn’s disease are similar in clinical manifestation as well as laboratory,endoscopic,and imaging findings.Sometimes it is difficult to distinguish small intestinal lymphoma from Crohn’s disease and make an accurate diagnosis.The histopathological characteristics of surgical specimens can be clearly diagnosed.This paper analyzes the causes of misdiagnosis of this case,in order to improve clinicians’understanding and diagnosis of the two diseases and reduce misdiagnosis or missed diagnosis.
作者
张冠群
吴维
王晓蕾
冯砅锦
赵玉洁
Guan-Qun Zhang;Wei Wu;Xiao-Lei Wang;Li-Jin Feng;Yu-Jie Zhao(Tongji University School of Medicine,Shanghai 200072,China;Department of Gastroenterology,Shanghai Tenth People’s Hospital,Shanghai 200072,China;Department of Pathology,Shanghai Tenth People’s Hospital,Shanghai 200072,China)
出处
《世界华人消化杂志》
CAS
2023年第1期35-40,共6页
World Chinese Journal of Digestology
关键词
克罗恩病
肠淋巴瘤
误诊
Crohn’s disease
Intestinal lymphoma
Misdiagnosis
