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低回声，病灶范围较宽，内呈裂隙样无回声；(3)囊腔型，腹腔内病灶表现为腹587海南医学2023年2月第34卷第4期Hainan Med J,Feb.2023.Vol.34,No.4内囊性肿块。阴囊并殖吸虫病十分罕见，以儿童多见，其临床诊断方法包括：痰、粪检出并殖吸虫卵；并殖吸虫皮内试验和补体结合试验；嗜酸性粒细胞增多的检测，但缺乏特异性，其中约80%的患者中可以观察到外周血中嗜酸性粒细胞计数明显增高9。曹应海等10认为血小板计数的增高对肺吸虫病的诊断具有提示意义。该病需与结核鉴别，阴囊结核极为少见，多由附睾或睾丸结核直接蔓延。本病例由斯氏并殖吸虫病引起，属于皮肤型，表现为典型的游走性皮下结节，以形成相互连接的窦道和多房小囊肿为特征；超声表现呈浅表组织型，其特征为阴囊内结节，内可见小片状裂隙样无回声。由于成人型阴囊并殖吸虫病的罕见性，对于原因不明的阴囊肿块，若伴有下列情况之一者应高度怀疑阴囊并殖吸虫病：(1)在偏远山区或并殖吸虫病流行区的患者；(2)有食用半熟螃蟹或小龙虾者；(3)原因不明的嗜酸性粒细胞增多者；(4)游走或非游荡阴囊肿块的患者。而对疑似并殖吸虫病患者，应详细询问其病史，并进行相关辅助检查，必要时可对病灶进行穿刺活检和涂片细胞学检查。其中超声检查可明确病灶的部位，准确区分肿块的囊实性以及明确肿块与睾丸、附睾的位置关系，而阴囊壁病变中裂隙样无回声可能是疾病较为特异的超声表现。治疗以手术切除并规律服用抗寄生虫药物治疗为主。参考文献1 Blair D.Changing face of paragonimiasis J.Trop Parasitol,2020,10(2):168-171.2 Qian M,Li F,Zhang Y,et al.A retrospective clinical analysis of pedi-atric paragonimiasis in a Chinese childrens hospital from 2011 to2019 J.SciRep,2021,11(1):2005-2012.3Rosa BA,Cho YJ,Mcnulty SN,et al.Comparative genomics andtranscriptomics of 4 Paragonimus species provide insights into lungfluke parasitism and pathogenesis J.Gigascience,2020,9(7):73.4Curtis KC,Fischer K,Choi YJ,et al.Characterization and localiza-tion of antigens for serodiagnosis of human paragonimiasis J.Parasi-tol Res,2021,120(2):535-545.5Furst T,Sayasone S,Odermatt P,et al.Manifestation,diagnosis,andmanagement of foodborne trematodiasis J.BMJ,2012,344(73):35-42.6Zhou Y,Chen SH,Li H,et al.Cloning,expression of the thioredoxinperoxidase gene of Paragonimus westermani and its immunodiagnos-tic potential J.Chinese Journal of Parasitology and Parasitic Diseas-es,2021,39(1):20-26.周岩,陈韶红,李浩,等.卫氏并殖吸虫TPx基因的克隆、表达和免疫学诊断价值J.中国寄生虫学与寄生虫病杂志,2021,39(1):20-26.7 Cai DM,Li YZ,Zhang MZ,et al.Ultrasonic diagnosis of ectopic par-agonimiasis J.Chinese Journal of Medical Imaging Technology,2013,29(12):2055-2056.蔡迪明,李永忠,张明智,等.超声诊断异位肺吸虫病J.中国医学影像技术,2013,29(12):2055-2056.8Liu Y,Li ZX,Wu T,et al.Hepatic paragonimiasis diagnosed by liverhistopathology:A case report J.Journal of Clinical Hepatology,2022,38(5):1116-1118.刘洋,李朝霞,武彤,等.肝组织病理学诊断肝肺吸虫病1例报告J.临床肝胆病杂志,2022,38(5):1116-1118.9Mubang AC,Mwape KE,Phiri IK,et al.Progress on the develop-ment of rapid diagnostic tests for foodborne neglected zoonotic hel-minthiases:a systematic review J.Acta Trop,2019,19(4):135-147.10 Cao YH,Li S,Lei X,et al.A case of secondary subcutaneous para-gonimiasis misdiagnosed as pulmonary paragonimiasis J.ChineseJournal of Experimental and Clinical Infectious Diseases(ElectronicVersion),2020,14(2):172-175.曹应海,李姗,雷旭,等.肺型肺吸虫病误诊后又发生皮肤型肺吸虫病一例J/CD.中华实验和临床感染病杂志(电子版),2020,14(2):172-175.(收稿日期：2022-06-08)588