Hepatic Actinomycosis after Radical Gastrectomy Mimicking Metastatic Hepatic Tumor: A Case Report

肝放線菌症為罕見之傳染病，約佔放線菌症5%。由於其非特定性症狀，易造成誤診，常須以細針抽取病灶標本或手術切除後才能以病理確切診斷。治療以長期給與高劑量青黴素為主。本文報告一肝放線菌症之病例。一位59歲男性病患因胃癌作根冶性胃次全切除，六年後，病人感覺食慾不振約兩個月，影像檢查意外發現有葉肝臟有一腫瘤，血液與生化檢驗及血清腫瘤指數並未超出正常範圍，手術前懷疑為轉移性癌或肝原發性癌。經肝葉部分切除後，病理報告為放線菌病。術後不須長期使用抗生素，且追蹤二年並未有再發現象。對此肝病灶之成因尚未明，推斷應與前次術後免疫力降低及某處腹內感染有關。在肝癌盛行率高之地區如臺灣，肝放線菌病仍須被考慮，若適合手術切除，經皮穿肝細針切片應盡量避免，審慎地手術切除此類單一不具活性之病灶亦可達成治癒目標。

關鍵字

肝放線菌病；胃切除

並列摘要

Hepatic actinomycosis is a rare infectious disease which accounts for 5% of all actinomycotic diseases. It is easily misdiagnosed due to nonspecific symptoms and signs. Accurate diagnosis is usually made from pathological findings of sulfur granule after fine needle aspiration or surgical resection. Long-term and high dose of penicillin is treatment of choice with satisfactory results. A 59 year-old male presented with poor appetite for two months, 6 years after receiving radical subtotal gastrectomy. A liver mass was noted on imaging studies. Metastatic liver tumor was first impressed preoperatively for normal tumor marker and normal laboratory examinations. After partial hepatectomy for the lesion, liver actinomycosis was reported by pathological findings. No antibiotic was given post-operatively and no recurrence was found in a period of 2 years follow-up. The etiology of this liver lesion remains uncertain. W presume that the lesion was due to mucosal barrier destroyed by previous surgery. It should be kept in mind that even in areas of high prevalence rate of hepatocellular carcinoma, such as Taiwan, liver actinomycosis is still a possible cause of liver masses. Fine-needle aspiration should be held if surgery is indicated. A delicate and careful surgical resection for this inactive solitary and consolidation lesion can cure this disease.

並列關鍵字

liver actinomycosis ； gastrectomy

國際替代計量

Hepatic Actinomycosis after Radical Gastrectomy Mimicking Metastatic Hepatic Tumor: A Case Report

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