成人阴囊并殖吸虫病一例_杨光旭.pdf

海南医学2023年2月第34卷第4期Hainan Med J,Feb.2023.Vol.34,No.4J.Chest,1987,91(2):283-285.12 Chen L,Yang J,Wang WH,et al.Clinical study on the treatment ofairway leiomyoma by interventional bronchoscopy J.China Journalof Endoscopy,2020,26(11):65-70.陈磊,杨婧,王维红,等.经支气管镜介入技术治疗气道平滑肌瘤的临床研究J.中国内镜杂志,2020,26(11):65-70.13 Okada S,Yamauchi H,Ishimori S,et al.Endoscopic surgery with aflexible bronchoscope and argon plasma coagulation for tracheobron-chial tumors J.J Thorac Cardiovasc Surg,2001,121(1):180-182.14 Bugalho A,Oliveira A,Semedo J,et al.Argon-plasma treatment inbenign metastasizing leiomyoma of the lung:a case report J.RevPort Pneumol,2010,16(6):921-925.15 Tan JH,Takano AM,Hsu AA.Resection with preserved histologicmorphology of a rare tumour via bronchoscopic cryosurgery J.JThorac Dis,2016,8(10):2964-2967.16 Kwon YS,Kim H,Koh WJ,et al.Clinical characteristics and efficacyof bronchoscopic intervention for tracheobronchial leiomyoma J.Respirology,2008,13(6):908-912.17 Wu BQ,Liu YF.Immunohistochemistry for diagnostic pathologyM.Beijing:Science and Technology Press,2013:653.吴秉铨,刘彦仿.免疫组织化学病理诊断M.2版.北京:科学技术出版社,2013:653.18 Xuan LL,Wei JG,Liu HG.Pathological diagnosis and new progressof perivascular epithelioid cell tumor J.Chin J Pathol,2021,50(3):282-287.宣兰兰,魏建国,刘红刚.血管周上皮样细胞肿瘤的病理诊断及新进展J.中华病理学杂志,2021,50(3):282-287.19 Ogawa M,Hara M,Ozawa Y,et al.Benign metastasizing leiomyomaof the lung with malignant transformation mimicking mediastinal tu-mor J.Clin Imaging,2011,35(5):401-404.20 Li SY,He Y,Chi F,et al.Application of freezing method to removerefractory airway foreign body through flexible bronchoscope J.Chinese Journal of Tuberculosis and Respiratory Diseases,2006,29(9):641-642.李时悦,何颖,迟峰,等.经可弯曲支气管镜应用冷冻方法摘除难取性气道异物J.中华结核和呼吸杂志,2006,29(9):641-642.21 Bawaadam H,Ivanick N,Alshelli I,et al.Endobronchial Leiomyo-ma:A case report with cryoprobe extraction and review of literatureJ.Respir Med Case Rep,2021,33:101467.(收稿日期：2022-06-30)成人阴囊并殖吸虫病一例杨光旭1，李瑶2，彭格红1遵义医科大学附属医院超声科1、病理科2，贵州遵义563000【摘要】并殖吸虫感染发病隐匿，进展迅速，早诊断、早治疗是治愈该病的关键。并殖吸虫主要影响肺部而阴囊异位并殖吸虫病的报道较少，临床表现复杂多样，其诊断缺乏特异性。本文介绍1例成人型阴囊并殖吸虫病，以期提高对该病的认识。【关键词】成人；阴囊；并殖吸虫；超声；吸虫病【中图分类号】R383.2【文献标识码】D【文章编号】10036350（2023）04058603A case of adult paragonimiasis of scrotum.YANG Guang-xu1,LI Yao2,PENG Ge-hong1.Department of Ultrasound1,Department of Pathology2,the Affiliated Hospital of Zunyi Medical University,Zunyi 563000,Guizhou,CHINA【Abstract】Paragonimus infection is insidious and progressing rapidly.Early diagnosis and treatment are the keyto cure the disease.Paragonimus mainly affects the lungs,while there are few reports of heterotopic paragonimiasis ofscrotum.The clinical manifestations are complex and diverse,and the diagnosis is lack of specificity.This paper intro-duces a case of adult paragonimiasis of scrotum in order to improve the understanding of the disease.【Key words】Adults;Scrotum;Paragonimiasis;Ultrasound;Fluke disease 个案报道 doi:10.3969/j.issn.1003-6350.2023.04.027第一作者：杨光旭(1987)，男，主治医师，硕士，主要研究方向为浅表器官超声诊断。通讯作者：彭格红(1967)，女，主任医师，三级教授，主要研究方向为心血管疾病，E-mail：。并殖吸虫病在亚洲、非洲和美洲的动物中广泛分布，以亚洲为主，并殖吸虫属包含50多个种属，其中7种可引起人类感染，在我国以卫氏并殖吸虫和斯氏并殖吸虫常见，是对人畜危害极大的食源性寄生虫病之一1-2。并殖吸虫病起病隐匿，早期诊断较为困难，尤其对异位并殖吸虫感染的者常被误诊，目前国内外关于阴囊并殖吸虫病多以个案的形式被报道，其临床表现不一，现对1例成人阴囊并殖吸虫病的病例报道如下：1病例简介患者男性，21 岁，2020 年 6 月 5 日因“发现右侧586Hainan Med J,Feb.2023.Vol.34,No.4海南医学2023年2月第34卷第4期图1阴囊肿物超声表现Figure 1Ultrasonographic findings of scrotal masses注：A，二维超声示右侧阴囊内探及不均质回声结节，大小约1.2 cm1.0 cm，结节内可见小片状无回声区，病灶累及同侧精索；B，彩色多普勒血流显像示病灶内见点状血流信号；C，弹性成像示病灶硬度较周围组织增强。Note:A,Two-dimensional ultrasound showed an inhomogeneous echoic nodule in the right scrotum,about 1.2 cm1.0 cm in size.The nodule hadunclear boundary and irregular shape;B,Color Doppler flow imaging showed punctured blood flow signal in the lesion;C,Elastography showedthat the hardness of the lesion was enhanced compared with the surrounding tissue.脐周肿块3个月，逐渐增大并向阴囊迁移”收入遵义医科大学附属医院泌尿外科，无发热盗汗、阴囊肿胀瘙痒等症状，既往无外居史，饮食、睡眠与二便排便均正常，否认有肝炎、结核和其他传染病。查体显示心、肺、腹部及双侧睾丸未见异常，右侧睾丸头部区域触及包块，可移动，表面光滑，质地有弹性。辅助检查血常规显示患者的嗜酸性粒细胞-T 淋巴细胞比率升高，胸部 CT、纯化蛋白衍生物试验阴性；超声检查提示：右侧阴囊壁不均质低回声结节(图 1)。术中发现右侧睾丸顶部阴囊鞘层内大小约1.5 cm1.0 cm 肿块，与精索和睾丸鞘膜黏连，呈灰色。病理证实为阴囊并殖吸虫病并嗜酸性脓肿形成，未见虫体和虫卵。其主要病理学特征见图2。术后患者透露，以往有食用生河蟹的病史，予以服用抗寄生虫药治疗一个疗程出院；随访两年，阴囊超声显示正常。图2阴囊肿物病理检查Figure 2Pathological examination of scrotal mass注：A，镜下见大量炎症反应致实质细胞大片破坏、崩解，形成窦道(箭)(HE，40)；B，局部窦道可见夏科-莱登晶体(箭)(HE，400)；C，实质细胞周围浸润大量的嗜酸性粒细胞(箭)、淋巴细胞、浆细胞和单核巨噬细胞(HE，400)。Note:A,microscope showed that a large area of parenchymal cells was destroyed and disintegrated,forming sinus tract(arrow)due to inflammatoryreactions(HE,40);B,Charko-lydon crystal(arrow)is seen in local sinus(HE,400);C,Numerous eosinophil(arrow),lymphocytes,plasmacells,and mononuclear macrophages infiltrated around parenchymal cells(HE,400).2讨论人类并殖吸虫病是通过食用含有囊蚴的生或未煮熟的甲壳类(小龙虾或螃蟹)而引起感染，并殖吸虫病是一种肺吸虫病，同时也可以异位在其他部位，大脑是肺外受累最常见的部位3-4。发病的原因是囊蚴在小肠中滋生，从肠道迁移至肺部，以及蠕虫异位迁移到大脑、生殖器官及四肢皮下部位，因虫体在迁移过程中毒素和部分介质的释放而引起5-6。异位并殖吸虫病的症状因吸虫的位置而异，临床上可分为内脏型和皮肤型，表现为脏器游走性皮下包块或结节，多见于胸腹部、腰背部、头颈及腹股沟等处，少见于阴囊。以往研究根据超声图像将肺外型并殖吸虫病分为以下几种7-8：(1)肝内型，背景肝脏实质回声均匀，病灶多以低回声、不均匀为主；(2)浅表组织型，局部浅表组织病灶呈片状