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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 investigate the clinical and pathological features of tuberculosis in patients with AIDS complicated with rare sites and to improve the diagnosis of AIDS complicated with tuberculosis by analyzing the clinical data and causes of misdiagnosis. Methods: Tissue specimens (including eyes, spleen and pancreas) from 3 AIDS patients who underwent surgical resection from October 2010 to August 2013 were collected. HE and acid-fast staining were performed respectively. The specimens were observed under a light microscope and combined with the clinical data And literature review, a comprehensive analysis of the causes of misdiagnosis. Results: The imaging findings of 3 patients were all suggestive of solid mass, which were considered as the possibility of ocular melanoma, pancreatic cancer and splenic lymphoma respectively. Pathological examination showed inflammatory cell infiltration and necrosis in the ocular tissues, A small number of macrophages, epithelial cells, no typical tuberculosis; pancreatic, spleen inflammatory cell infiltration, epithelial-like granuloma formation, see the spleen case-like necrosis. The pathological specimens of 3 patients were all positive for acid-fast staining and the pathological diagnosis was consistent with tuberculosis. Conclusion: The majority of AIDS complicated with tuberculosis are irregular fever. The imaging examination does not have specificity. It is easy to cause clinical misdiagnosis. The diagnosis depends mainly on pathological examination and special staining techniques. The observation under light microscope should pay attention to differential diagnosis.