小儿肝间叶性错构瘤的CT诊断与鉴别诊断

目的：探讨小儿肝间叶性错构瘤的CT表现,提高对该病的诊断水平。方法：回顾性分析12例经手术病理证实的肝间叶性错构瘤患儿的CT资料,12例均行CT平扫及增强扫描。结果：12例中病灶位于肝右叶4例,位于肝左叶2例,同时累及肝左、右叶6例。瘤体直径7~17 cm,平均12.5 cm。CT表现取决于肿瘤囊实性成分比例和分布,表现为囊性型（2例）、囊实混合型（9例）和实性型（1例）,增强后肿瘤实性部分及分隔强化,囊性部分无强化,1例病灶内见点状钙化。结论：肝间叶性错构瘤的CT表现有一定特征性,结合临床特征并注意与肝脏其他囊实性肿瘤鉴别,术前大多能做出正确诊断。     

肝脏间叶性错构瘤的CT诊断价值

【摘要1目的分析肝脏间叶性错构瘤的CT表现,以增加对本病CT表现的认识,提高其诊断正确率。方法搜集已行CT检查并获得病理证实的3例肝脏间叶性错构瘤的CT图像及临床资料,分析并总结其CT表现。结果瘤体最大径分别为7．7cm、10．7cm、16．3cm,表现为肝内囊实性肿块,内见多个囊腔及分隔,增强后病灶囊性部分无强化,实性部分及分隔早期呈轻中度强化,延迟期密度进一步升高。结论肝脏间叶性错构瘤具有一定的特征性,认真分析其影像表现并结合患儿临床特征,术前大多能做出正确诊断。     

儿童肝脏未分化胚胎性肉瘤1例

女,9岁,主诉:持续性右上腹疼痛2周伴发热,抗感染治疗无效。体格检查:皮肤黏膜轻度黄染,右上腹压痛。实验室检查:甲胎蛋白正常,CA19-9>1000 U/ml。超声表现见图1A、B。上腹部三维CT(图1C、D)诊断:肝占位性病变,考虑为肝间叶性错构瘤。术中见实性肿物大小15 cm×15 cm×6 cm,囊壁厚1~2 cm,呈多房,囊内见灰褐色突起,呈分叶状,切面呈灰褐色、灰白色,质软,略呈胶冻样,肿物周围带少许肝组织,肿物边界不清。病理(图1E)诊断:未分化胚胎性肉瘤,肿瘤周边广泛水肿、出血、坏死及囊性变,部分区域呈间叶性错构瘤样结构。     

肾错构瘤合并结节性硬化的诊断与治疗(4例报告与文献复习)

目的　进一步提高对肾错构瘤合并结节性硬化的诊断和治疗水平。方法　对 4例肾错构瘤合并结节性硬化患者的临床资料和随访情况进行回顾性分析。结果　4例肾错构瘤合并结节性硬化患者均行手术治疗,术后病理结果明确诊断,术后定期复查B超,平均随访 30个月,均无复发。结论　肾错构瘤合并结节性硬化的患者多为双侧多发性病变,如一定要行手术治疗应慎重,必须要考虑肾功能的保留问题,肾部分切除和或选择性肾动脉栓塞术为首选。     

儿童肝脏间叶性错构瘤影像学和病理学表现

目的 探讨儿童肝脏间叶性错构瘤的影像学表现.方法 回顾性分析3例经手术病理证实的儿童肝脏间叶性错构瘤(HMH)的超声及CT影像学表现.男1例,女2例.3例均行B超和CT检查.结果 3例HMH均为单发肿瘤,CT及超声示1例为分隔囊型肿瘤,1例混合性囊实型肿瘤,1例实体型肿瘤.超声及CT显示分隔囊型肿瘤的囊隔较薄,混合型囊实性肿瘤的囊隔不规则增厚.注射造影剂后CT影像示肿瘤实性成分和分隔不均匀强化.结论 儿童肝脏间叶性错构瘤影像学表现有一定特征性.     

双肾多发性错构瘤合并结节性硬化的诊断治疗

目的:提高双肾多发性错构瘤合并结节性硬化的诊断与治疗水平。方法:对4例双肾多发性错构瘤合并结节性硬化患者的临床资料和随访情况进行回顾性分析。结果:1例接受单侧肾切除手术治疗,术后10 d死于多器官功能衰竭;1例行肿瘤剜除术,术后恢复良好;2例随访24个月病情无进展。结论:双肾多发性错构瘤合并结节性硬化患者在无症状期,应严密观察;手术治疗应慎重,症状进展较快时,肿瘤剜除术为首选。     

结节性甲状腺肿合并慢性淋巴细胞性甲状腺炎22例临床分析

目的　总结结节性甲状腺肿 (结甲 )合并慢性淋巴细胞性甲状腺炎 (CLT)的诊治经验。方法　对 1989— 2 0 0 1年手术治疗的 2 2例结甲合并CLT的临床资料进行回顾性分析。结果　全部病例均经病理证实 ,术前诊断率为 4 0 .9%。根据不同术前诊断采取了不同手术方法。术后甲状腺功能减退 (甲减 )发生率为 15 .0 % ,甲状腺结节复发率为 9.1%。结论　应重视结甲合并CLT的诊断 ,甲状腺细针穿刺及术中冰冻切片有助于明确诊断。手术治疗是可行的 ,正确采取手术方法和切除范围能够有效防止术后甲减和结节复发。     

肾错构瘤自发性破裂出血的外科诊治（附14例报告）

目的：探讨肾错构瘤自发性破裂出血的诊断与治疗。方法分析手术治疗14例肾错构瘤自发破裂出血患者的临床资料,所有患者均有腰腹部疼痛病史就诊。术前检查均行彩超和CT检查,2例因有疑问行MRI检查。其中10例患者行患肾切除术,2例行肾部分切除术,2例行肿瘤剜除术。结果所有患者术后恢复良好,2例术后出现尿漏,延期痊愈后出院。随访8～48个月,无死亡病例,未发现肿瘤复发。结论彩超、CT及MRI是确诊肾错构瘤破裂出血简单而有效的方法。对于直径＞4 cm的肾错构瘤破裂出血患者,应积极行手术治疗,并尽可能保留有功能的肾组织。     

肝、双肾巨大血管平滑肌脂肪瘤的影像诊断及鉴别诊断(附1例报告及文献复习)

目的 探讨肝、肾血管平滑肌脂肪瘤即错构瘤的临床特点、影像诊断以及鉴别诊断.方法 回顾性分析1例51岁女性患者肝、肾错构瘤的临床资料,结合文献报道,对其临床表现、影像特点进行探讨.结果 腹部CT平扫示肝右叶一巨大低密度占位,增强扫描动静脉期自周缘向中心渐进性填充.两肾体积明显增大,呈大小不等、形态各异的蜂巢状混杂密度,可见斑块状、条索状的脂肪密度,增强扫描正常皮髓结构消失,蜂巢壁明显强化,其内见未强化区,双肾动静脉明显受压、移位.结论 肝、肾错构瘤与肝、肾其它良性、恶性病变相比,影像表现较典型,但确诊多数只能通过病理组织学方法.     

胆管错构瘤的CT及MRI表现

目的:分析胆管错构瘤的CT及MRI特点,以提高对该病的诊断水平。方法:回顾性分析我院经病理证实的肝内胆管错构瘤13例患者的CT或MRI资料,观察病变在CT及MRI图像上的分布、大小、形态及强化特点。结果:CT平扫主要表现为肝内低密度的囊状病变灶,病灶直径小于10mm,CT增强扫描无强化;MRI主要表现为T1WI上病变信号低于肝实质,T2WI病灶显示清楚,呈明显的高信号,增强扫描病灶未见强化,部分病灶出现边缘强化;MRCP显示肝内多发囊性病变与肝内胆管不相通。结论:胆管错构瘤的CT及MRI表现有一定的特征性,有助于对该病的诊断。     

Radiological spectrum of hepatic mesenchymal hamartoma in children.

OBJECTIVE: A hepatic mesenchymal hamartoma is an uncommon benign tumor in children and little is known about the spectrum of its radiological features. The purpose of this study is to describe the spectrum of radiological features of a hepatic mesenchymal hamartoma in children. MATERIALS AND METHODS: Thirteen children with a pathologically confirmed hepatic mesenchymal hamartoma (M:F = 7:6; mean age, 3 years 2 months) were included in our study. Ultrasonography (US) was performed in nine patients including color and power Doppler US (n = 7). CT scans were performed in all patients. We evaluated the imaging findings of the hepatic mesenchymal hamartomas and the corresponding pathological features. RESULTS: Each patient had a single tumor (mean diameter: 13 cm [1.8-20 cm]). On CT and/or US, four patients (31%) had a "multiseptated cystic tumor", five patients (38%) had a "mixed solid and cystic tumor", and four patients (31%) had a "solid tumor." The septa of the cystic portion were thin in the multiseptated cystic tumors and irregularly thick in the mixed solid and cystic tumors as seen on US. On a post-contrast CT scan, solid portions or thick septa of the tumors showed heterogeneous enhancement. The amount of hepatocytes was significantly different among the three tumor groups according to the imaging spectrum (p = 0.042). CONCLUSION: A hepatic mesenchymal hamartoma in children can show a wide spectrum of radiological features, from a multiseptated cystic tumor to a mixed solid and cystic tumor, and even a solid tumor.     

Mesenchymal hamartoma of the liver.

We present a multiseptated mesenchymal hamartoma of the liver in a 10-year-old male patient, a rare benign tumor of childhood. The characteristic ultrasound and CT appearances of this unusual tumor are reviewed. A single septal calcification associated with this tumor was demonstrated, an association which has not previously been reported. The differential diagnosis for cystic liver lesions is discussed in detail.     

A case of mesenchymal hamartoma of the chest wall of a child

Mesenchymal hamartoma of the chest wall is a rare benign tumor that usually occurs in infants and children. The clinical presentations and imaging features are atypical and difficult to differentiate from malignant tumors. In this article, we present a case with a large mesenchymal hamartoma tumor of the chest wall. A large right-sided chest wall mass was discovered in a 6-month-old boy by his mother. Chest X-ray revealed a thoracic mass with well-defined margins on the right side that expanded into the right ribs. Chest computed tomography showed that the mass originated from the thoracic wall. The patient underwent complete removal of the mass, and histopathology results confirmed a mesenchymal hamartoma.     

超声引导经皮肺穿刺活检在肺外周型病变诊断中的价值

目的探讨超声引导下经皮肺穿刺活检对肺外周型病变定性诊断的应用价值。方法在超声引导下对80例胸部影像学检查显示的肺周边型肿块需明确诊断者行超声引导下经皮肺穿刺活检术。结果 80例病人均穿刺成功,成功率100%。病理诊断结果:恶性肿瘤64例,其中鳞癌38例,腺癌20例,大细胞癌2例,小细胞癌2例,恶性淋巴瘤1例,恶性间皮瘤1例;良性病变16例,其中良性错构瘤1例,结核8例,炎症7例。并发气胸、咯血各1例,并发症发生率为3%。结论超声引导下经皮肺穿刺活检术具有定位准确、操作简便、安全性好、并发症少及重复性强等优点,可作为肺外周型病变定性诊断的首选诊断方法。     

Mesenchymal hamartoma of the chest wall in infants and children: a clinicopathological study of five patients

Mesenchymal hamartoma of chest-wall is a rare benign lesion that has varied histological characteristics and usually occurs during early infancy. We report the histological characteristics of mesenchymal hamartoma found in five patients aged respectively 25 days, 5 months, 8 months, and 4 and 8 years at presentation. Two patients presented with respiratory distress, two with an asymptomatic chest-wall mass, and one with a deformity of the left chest wall. Surgical resection was performed on four patients and a biopsy only in one patient. Overall, the tumors were well delineated, lobulated, tan to reddish in color, and on section showed bloodfilled cystic spaces with interspersed small islands of cartilage and fibrous tissue. Histological analyses demonstrated mixtures of bone trabeculae with spindle-cell stroma, chondroblast-like proliferation, mature and immature hyaline cartilage, and aneurysmal bone cyst formation. All patients are alive and well without evidence of disease. Despite the alarming clinical and histologic presentation, mesenchymal hamartoma of the chest wall is a non-neoplastic benign lesion.     

Minimal deviation hepatoma. A new entity.

The term minimal deviation hepatoma has been applied to a specific clinical, pathological, and angiographic entity. It is a tumor, composed of atypical cells, which is neither frankly malignant nor so well organized as a benigh tumor. This lesion occurs in females with otherwise normal livers and has a relatively benign course, although life threatening hemorrhage may occur. The diagnosis may be strongly suggested in the presence of hypervascularl or hypovascular discrete masses without evidence of frank malignancy, with a defect in the colloid liver scan and with normal liver function tests. Surgical resection when possible and aggressive chemotherapy may be corrective in many cases.     

Diffusion and magnetization transfer MRI of brain infarct, infection, and tumor in children

The purpose of this study was to determine the efficacy of diffusion-weighted imaging (DWI) and magnetization transfer imaging (MTI) in the differential diagnosis of brain infarct, infection, hamartoma, and tumor in 106 children. The apparent diffusion coefficients (ADCs) and magnetization transfer ratios (MTRs) of the lesions were compared using nonparametric tests. There was an inverse relationship between ADC and MTR in subacute/chronic infarct, infection, hamartoma, arachnoid cyst, and tumor relative to normal brain parenchyma. Both ADC and MTR were reduced in acute infarct. DWI and MTI had a complementary role in the differential diagnosis of acute infarct from infection with lower MTR, from hamartoma with higher ADC, and from low-grade gliomas and benign tumors that had higher ADCs and lower MTRs. ADCs increased and MTRs decreased with the duration of infarct and lower tumor grade.     

非功能胰岛细胞瘤诊治分析

目的　探讨非功能胰岛细胞瘤的诊断和治疗方法。　方法　对 7例非功能胰岛细胞瘤患者的临床资料进行回顾性分析。　结果　肿瘤位于胰头部 3例 ,胰体部 2例 ,胰尾部 2例。胰十二指肠切除术 3例 ,胰体胃切除 脾切除 3例 ,局部切除1例。病理证实恶性 4例 ,良性 3例 ,其中 4例行免疫电镜检查。 7例全部一期治愈出院。　结论　体症、B超、CT是发现本病的主要手段 ,将病理学检查和肿瘤生物学行为结合起来判定良恶性 ,手术切除肿瘤是治疗本病的有效方法。     

乳腺错构瘤的钼靶X线诊断

目的:评价乳腺错构瘤的X线征象及病理学基础,以期从影像学角度提高对该病的认识。方法:回顾性分析18例经手术病理证实的乳腺错构瘤的X线片与病理。结果:X线表现分3型:混合型11例,致密型3例,脂肪型4例。结论:乳腺错构瘤的X线表现与其病灶内的低密度脂肪及高密度的腺体组织、纤维组织所占的比例有关。混杂密度改变是本病的特征性X线表现。X线检查是发现本病的好方法,确诊需临床、X线及病理相结合。     

腹膜后孤立性纤维瘤的影像诊断进展

腹膜后孤立性纤维瘤是一种罕见的肿瘤,位置隐匿,临床征象出现较晚且无特异性。但其影像表现具有一定特征性,在超声、CT、MRI等影像检查中可被发现,有利于临床诊断及治疗,但也需要与腹膜后边界较清楚的良性肿瘤及个别边界相对清楚的恶性病变鉴别,最终确诊需要病理学检查。对腹膜后孤立性纤维瘤的临床、病理表现及影像表现作一综述。