Extrahepatic cholestasis associated with paracoccidioidomycosis:Challenges in the differential diagnosis of biliopancreatic neoplasia  

作　　者：Jose Sebastiao dos Santos Vitor de Moura Arrais William Jose Rosseto Ferreira Ricardo Ribeiro Correa Filho Mariangela Ottoboni Brunaldi Rafael Kemp Ajith Kumar Sankanrakutty Jorge Elias Junior Fernando Bellissimo-Rodrigues Roberto Martinez Edson Zangiacomi Martinez Jose Celso Ardengh 

机构地区：[1]Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo(FMRP-USP),Departamento de Cirurgia e Anatomia,Ribeirao Preto 14049-900,Sao Paulo,Brazil [2]Universidade de Sao Paulo,Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo(FMRP-USP),Departamento de Patologia,Ribeirao Preto 14048900,Sao Paulo,Brazil [3]Universidade de Sao Paulo,Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo(FMRP-USP),Departamento de Imagens Médicas,Hematologia e Oncologia Clínica,Ribeirao Preto 14048900,Sao Paulo,Brazil [4]Universidade de Sao Paulo,Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo(FMRP-USP),Departamento de Medicina Social,Ribeirao Preto 14015-010,Sao Paulo,Brazil [5]Universidade de Sao Paulo,Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo(FMRP-USP),Departamento de Clínica Médica,Ribeirao Preto 14015-010,Sao Paulo,Brazil [6]Universidade de Sao Paulo,Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo(FMRP-USP),Departamento de Cirurgia e Anatomia,Ribeirao Preto 14049-900,Sao Paulo,Brazil and Hospital Moriah,Servico de Endoscopia Digestiva,Sao Paulo 04084-002,Sao Paulo,Brazil

出　　处：《World Journal of Gastrointestinal Oncology》2024年第6期2531-2540,共10页世界胃肠肿瘤学杂志（英文版）（电子版）

摘　　要：BACKGROUND Paracoccidioidomycosis(PCM)may involve the hepatic pedicle and peripan creatic lymph nodes,cause damage to the bile duct and manifest,exceptionally,in combination with extrahepatic cholestasis(EHC),making investigation and treatment challenging.AIM To investigate the management of patients with visceral PCM admitted with EHC.METHODS All patients diagnosed with PCM treated in a public,tertiary teaching hospital between 1982 and 2020 were retrospectively evaluated.Those also identified with EHC were allocated to two groups according to the treatment approach for the purpose of comparing clinical,laboratory,and imaging findings,resources used for etiological diagnosis,treatment results,and prognosis.Statistical analyses were performed using the linear mixed-effects model(random and fixed effects),which was adjusted using the PROC MIXED procedure of the SAS®9.0 software,and Fisher’s exact test.RESULTS Of 1645 patients diagnosed with PCM,40(2.4%)had EHC.Of these,20(50.0%)lived in the rural area and 29(72.5%)were men,with a mean age of 27.1 years(3-65 years).Jaundice as first symptom and weight loss of at least 10 kg were observed in 16 patients(40.0%),and a mass in the head of the pancreas was observed in 8(20.0%).The etiological diagnosis was made by tissue collection during surgery in 4 cases(10.0%)and by endoscopic methods in 3 cases(7.5%).Twenty-seven patients(67.5%)received drug treatment alone(Group 1),whereas 13(32.5%)underwent endoscopic and/or surgical procedures in combination with drug treatment(Group 2).EHC was significantly reduced in both groups(40.7% in Group 1,with a mean time of 3 months;and 38.4% in Group 2,with a mean time of 7.5 months),with no statistically significant difference between them.EHC recurrence rates,associated mainly with treatment nonadherence,were similar in both groups:37% in Group 1 and 15.4% in Group 2.The mortality rate was 18.5% in Group 1 and 23% in Group 2,with survival estimates of 71.3% and 72.5%,respectively,with no statistically significant difference.CONCL

关 键 词：CHOLESTASIS JAUNDICE Obstructive BLASTOMYCOSIS Paracoccidioides Diagnosis Treatment 

分 类 号：R735.2[医药卫生—肿瘤]