肿瘤细胞治疗研究
英文原题：Infection as a Differential Diagnosis of Solid Retroperitoneal Masses: A Case Series and Review of the Literature.
Infection as a Differential Diagnosis of Solid Retroperitoneal Masses: A Case Series and Review of the Literature.
腹膜后肿块的鉴别诊断包括多种良性和恶性病变，其中感染构成一个重要亚组。
腹膜后肿块的鉴别诊断包括多种良性和恶性病变，其中感染构成一个重要亚组。熟悉这些感染性假瘤有助于及时诊断。在本报告中，我们描述了三位感染性假瘤患者，其临床和影像学高度提示肿瘤。第一位患者是一位62岁女性，有Richter综合征病史，在接受无关供者异基因造血干细胞移植七个月后出现肾脏肿块。当时的肾脏活检显示坏死组织。该患者表现出Richter综合征的多次复发（为此她还接受了CAR-T 细胞治疗挽救性化疗）和淋巴瘤的缓解，以及一次曲霉菌肺炎，为此她接受了静脉注射安必素治疗，之后口服泊沙康唑。由于肾脏肿块持续存在且为排除恶性肿瘤，进行了肾切除术，结果显示存在真菌菌丝。第二位患者是一位51岁男性，有低级别非肌层浸润性膀胱尿路上皮癌病史，在灌注Mycobacterium bovis Calmette-Guerin后出现发热和可疑肾脏肿块。进行了部分肾切除术。术中冰冻切片分析和常规组织学提示Mycobacterium bovis相关病变，经聚合酶链反应（PCR）分析证实。第三位患者是一位85岁男性，表现为食欲减退、疲劳和显著体重减轻（不到一年减轻24 Kg）以及旅行史。实验室检查显示低钠和高钾水平。CT扫描显示右肺有一个孤立性病灶、一个小肝脏病灶以及双侧肾上腺病灶。CT引导下活检显示存在荚膜组织胞浆菌，并经PCR分析证实。对所有参数的回顾性分析表明，这三名患者均存在一些危险因素，如免疫抑制、旅行史或临床病史，这些因素可提高对感染的怀疑，从而将其纳入鉴别诊断，为及时诊断提供了额外的工具。
The differential diagnosis of retroperitoneal masses includes a variety of benign and malignant conditions, among which infections constitute a significant subgroup. Familiarity with these infectious pseudotumours could facilitate prompt diagnosis. In this report, we describe three patients with an infectious pseudotumour, which was clinically and radiologically highly suggestive of a neoplasm. The first patient was a 62-year-old woman with a history of Richter syndrome, who seven months after allogeneic haematopoetic stem cell transplantation from an unrelated donor presented with a renal mass. A renal biopsy at that time revealed necrotic tissue. The patient displayed multiple relapses of Richter syndrome (for which she received also chimeric antigen receptor T-cell therapy salvage chemotherapy) and remissions of the lymphoma as well as an Aspergillus pneumonia for which she was treated with intravenous ambisome and afterwards oral posaconazole. Since the renal mass persisted and to exclude malignancy, nephrectomy was performed which revealed the presence of fungal hyphae. The second patient was a 51-year-old man with a history of a low-grade non-muscle-invasive bladder urothelial carcinoma, who after Mycobacterium bovis Calmette-Guerin instillation presentedwith fever and a suspicious renal mass. A partial nephrectomy was performed. Intraoperative frozen section analysis and routine histology suggested a Mycobacterium bovis -associated lesion, which was confirmed by polymerase chain reaction (PCR) analysis. The third patient was an 85-year-old man who presented with loss of appetite, fatigue, and significant weight loss (24 Kg in less than a year) as well as a travel history. The laboratory tests showed a low sodium and a high potassium level. CT scans revealed a solitary lesion in the right lung, a small liver lesion as well as bilateral adrenal lesions. A CT-guided biopsy revealed the presence of Histoplasma capsulatum, which was confirmed by PCR analysis. A retrospective review of all parameters indicates that all three patients presented with some risk factors, such as immunosuppression, travel, or clinical history that could raise the suspicion of infection in order to be included in the differential diagnosis, thus providing an additional tool for timely diagnosis.
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