副鼻窦腺泡型横纹肌肉瘤4例CT和MRI表现

目的分析副鼻窦腺泡型横纹肌肉瘤(ARMS)的CT、MRI表现,探讨其诊断要点。方法经手术病理证实的4例ARMS患者,其中男性3例,女性1例;年龄分别为3、9、15、17岁,平均年龄11岁。所有患者均行MRI平扫及增强扫描,同时行CT平扫扫描。分析其影像特点。结果肿瘤位于蝶窦1例,筛窦2例,上颌窦1例。3例骨破坏呈膨胀性、吸收性,1例骨破坏呈溶骨性。累及翼腭窝1例,颞下窝2例,眼下直肌受累3例,鼻腔受累3例。直径5 cm呈椭圆形,直径6 cm呈不规则分叶状。2例有囊变密度或信号,无钙化,1例含有黏液蛋白成分。T1WI以稍低信号为主,近似或低于正常脑实质信号,T2WI以不均匀高信号为主,与脑脊液信号近似,增强扫描呈中等~明显强化,强化不均匀,但程度较轻,可见线环状及菊花瓣样强化。结论 ARMS的CT和MRI有一定的特征性表现,在鉴别诊断上有着较高的临床应用价值。     

盆部孤立性纤维性肿瘤的多层螺旋CT和磁共振成像表现特征及其病理学基础

为了探讨盆部孤立性纤维性肿瘤(SFT)的多层螺旋CT(MDCT)和磁共振成像(MRI)表现特征及其病理学基础,收集手术病理证实的13例患者的临床资料,回顾分析其MDCT和MRI表现特征。13例中,6例仅行CT检查,5例仅行MRI检查,2例同时行CT和MRI检查。MDCT和MRI图像显示,病灶最长径为4.0~25.2cm(平均11.8cm);6例分叶状,7例圆形或卵圆形;所有病灶边界清晰,且均不同程度地压迫、推挤邻近的器官结构。行MDCT扫描者,平扫时表现为以等密度为主的软组织肿块,其中5例病灶内见片状低密度区。在MRI图像上,T1WI相主要表现为等信号,其中3例病灶内见片状低信号区,3例病灶中心见放射状低信号区,1例呈均匀等信号;T2WI相主要表现为混杂高信号,其中3例为不均匀高信号,3例病灶中心见放射状低信号区,1例均匀高信号。增强扫描时,13例中4例患者见粗大的供血血管。强化程度:1例轻度均匀强化;12例中-重度强化,其中7例病灶内见片状无强化区,3例病灶中心见放射状进行性强化区,2例均匀强化。病理组织学检查证实,放射状进行性强化区为胶原纤维成分。术后随访发现,2例患者存在局部复发,1例存在肝转移。总之,盆部SFT常表现为实性、边界清晰的富血供肿块,常伴不同程度的坏死和囊变,并推挤邻近的器官结构。病灶中心的胶原纤维在T2WI相表现为放射状低信号,增强时呈进行性强化,是该病变的重要特征,对诊断有重要价值。     

腔外型胃平滑肌瘤的CT诊断

目的探讨腔外型胃平滑肌瘤的CT表现.方法对经手术病理证实的30例腔外型胃平滑肌瘤行CT平扫及增强扫描,分析其特点.结果 30例腔外型胃平滑肌瘤,病变位于胃体部27例,胃窦部3例,CT平扫表现为与胃壁关系密切的圆形或椭圆形软组织肿块,边缘光滑,病变与胃壁呈钝角或锐角,19例密度均匀,11例内见低密度灶,增强扫描14例无强化,16例轻至中度强化,右侧卧位扫描肿块出现牵拉征14例,抱球征12例.结论 CT在显示腔外型胃平滑肌瘤较其他检查方法有明显优势,对病变的正确诊断有重大意义.     

不典型肝细胞癌的CT表现与分析

目的探讨原发性肝细胞癌(HCC)在螺旋CT扫描中的不典型表现及其产生原因。方法选择17例HCC患者,其中男性14例,女性3例;年龄29～71岁,平均年龄52岁。分析经手术病理组织证实的螺旋CT扫描中呈不典型表现的CT征像和病理学改变。结果17例共发现18个病灶为不典型表现,其中10个病灶在动脉期强化明显,门静脉期和延迟期为等密度或高密度;6个病灶在动脉期、门静脉期和延迟期均呈低密度;2个病灶动脉期病灶边缘有环形强化,门静脉期和延迟期仍有持续强化。结论肝癌在螺旋CT 3期增强扫描中有多种不典型表现,病灶的血液供应情况、病理学基础等是其常见原因。     

肝局灶性结节增生的CT表现

目的 研究肝局灶性结节增生（FNH）在螺旋CT上的表现,提高CT诊断准确性。方法 回顾性分析10例患者的临床、病理及影像学资料。5例行多层螺旋CT扫描;5例行单层螺旋CT扫描,其中3例只行增强扫描,2例只行平扫。结果 CT共发现18个病灶,2例患者为多发。平扫CT上15个病灶中10个为低密度,5个是等密度;增强扫描动脉期,除了中央瘢痕和纤维分隔外,所有病灶都明显均匀强化;门脉期和延迟期大部分病灶变为等密度或略高密度,2个病灶变为略低密度。2个FNH病灶中发现中央瘢痕,1个病灶于动脉期中央及外周发现异常增粗、扭曲的动脉,于延迟期可见强化的假包膜。结论 FNH在螺旋CT扫描上表现具有特征性,螺旋CT诊断FNH具有重要价值。     

多层螺旋CT在急诊胸腹部创伤中的评价

目的 探讨急诊CT扫描在胸腹部闭合性创伤中的应用价值.方法 收集我晓2012年9月～2013年8月经多层螺旋CT检查及手术证实急性胸腹部闭合性外伤99例行急诊CT检查的影像资料,进行回顾性分析,所有病例均只行CT平扫.结果 胸部闭合性创伤的急诊CT扫描主要表现为肋骨骨折、肺挫伤、液气胸、椎体骨折,腹部闭合性创伤的急诊CT扫描主要表现为混杂高低密度影像,多伴腹腔出血本组99例胸腹部闭合性创伤中,肋骨骨折43例,肺挫伤或撕裂伤55例,液气胸42例,颈椎骨折2例,胸椎骨折6例,腰椎骨折11例,骨盆环骨折7例,肝脏损伤12例、脾37例、肾13例,输尿管破裂1例,肠系膜与肠管损伤4例,膀胱破裂3例,复合性实质性脏器损伤9例.其中45例伴腹腔出血.结论 急症CT扫描对诊断胸腹部闭合性创伤具有很大的价值,能明确肺部的情况,腹部脏器损伤的部位、程度及复合性脏器损伤,肋骨骨折及椎体骨折等信息.随着现代医学影像学的快速发展,多层螺旋CT(MSCT)由于具有优秀的密度分辨率并可以进行快速的大范围扫描,容积扫描的CT图像进行多平面的重建具有良好空间分辨能力.     

输卵管妊娠的临床与CT表现特点(附六例)

目的探讨输卵管妊娠的临床和CT表现的特点。方法分析6例经手术病理证实的输卵管妊娠的临床资料和CT表现。结果 6例输卵管妊娠发生于壶腹部3例、峡部2例、伞部1例。CT表现为附件区不规则形囊实性混杂密度包快,内见高密度出血灶5例,孕囊1例,盆腔高密度血性积液4例。增强扫描软组织包快轻到中度不均匀强化,高密度出血灶基本无强化,1例孕囊边缘明显环形强化。2例子宫略增大。结论附件区不规则形囊实性混杂密度包快,内见高密度出血灶、孕囊,同时伴有腹盆腔高密度积液为输卵管妊娠的典型CT表现。     

腔外型胃平滑肌瘤的CT诊断

目的 探讨腔外型胃平滑肌瘤的CT表现。方法 对经手术病理证实的30例腔外型胃平滑肌瘤行CT平扫及增强扫描，分析其特点。结果 30例腔外型胃平滑肌瘤，病变位于胃体部27例，胃窦都3例，CT平扫表现为与胃壁关系密切的圆形或椭圆形软组织肿块，边缘光滑，病变与胃壁呈钝角或锐角，19例密度均匀，11例内见低密度灶，增强扫描14例无强化，16例轻至中度强化，右侧卧位扫描肿块出现牵拉征14例，抱球征12例。结论 CT在显示腔外型胃平滑肌瘤较其他检查方法有明显优势，对病变的正确诊断有重大意义。     

小肾透明细胞癌的CT表现与病理组织对照研究

目的分析小肾透明细胞癌的CT表现及其与病理组织的关系。方法选择小肾透明细胞癌患者42例,其中男性27例,女性15例;年龄34~68岁,平均年龄50.6岁。对42例经手术后病理组织证实的小肾透明细胞癌病例进行CT征象及病理组织结果对照分析。结果 CT平扫32例为低密度,8例为等密度,2例为高密度;增强CT扫描皮质期,肿瘤实性部分明显强化,强化峰值≥100 Hu,排泄期迅速下降,低于正常肾实质,呈快进快出特点;不均匀强化26例,均匀强化16例。病理组织36例可见出血、坏死,细胞呈实性排列,6例呈囊性排列;出现小泡样结构2例,出现不规则钙化2例,出现假包膜38例。结论小肾透明细胞癌的CT表现与病理组织类型及肿瘤结构有关,动态增强扫描对小肾透明细胞癌的诊断及制定手术方案有重要意义。     

小于2cm肺内炎性假瘤的HRCT诊断

目的探讨肺内2cm以下炎性假瘤的高分辨率CT(HRCT)表现.方法24例经手术或穿刺活检病理证实的肺内直径2cm以下炎性假瘤的患者行HRCT检查,其中16例同时行增强扫描.结果24例中,出现浅分叶征8例,棘状突起6例,晕征8例,血管集束征5例,空泡征1例;增强扫描16例,其中6例有轻度强化,10例无明显强化.所有病灶边缘均较光整.结论HRCT在诊断肺内小于2cm炎性假瘤有很大价值,各种征象综合分析可提高诊断的正确性.     

腭瓣的应用解剖

解剖了44侧硬腭的软组织,观察了软组织的层次持点和腭大动脉的定位。硬腭软组织外侧厚于正中,后部厚于前部。腭大动脉恒定地分布于硬腭半宽的内中2/3,外径约1.2mm。讨论了腭瓣手术的取材范围和腭大动脉的保护问题。     

Regional regulation of palatal growth and patterning along the anterior-posterior axis in mice

Cleft palate is a congenital disorder arising from a failure in the multistep process of palate development. In its mildest form the cleft affects only the posterior soft palate. In more severe cases the cleft includes the soft (posterior) and hard (anterior) palate. In mice a number of genes show differential expression along the anterior-posterior axis of the palate. Mesenchymal heterogeneity is established early, as evident from Bmp4-mediated induction of Msx1 and cell proliferation exclusively in the anterior and Fgf8-specific induction of Pax9 in the posterior palate alone. In addition, the anterior palatal epithelium has the unique ability to induce Shox2 expression in the anterior mesenchyme in vivo and the posterior mesenchyme in vitro. Therefore, the induction and competence potentials of the epithelium and mesenchyme in the anterior are clearly distinct from those in the posterior. Defective growth in the anterior palate of Msx1-/- and Fgf10-/- mice leads to a complete cleft palate and supports the anterior-to-posterior direction of palatal closure. By contrast, the Shox2-/- mice exhibit incomplete clefts in the anterior presumptive hard palate with an intact posterior palate. This phenotype cannot be explained by the prevailing model of palatal closure. The ability of the posterior palate to fuse independent of the anterior palate in Shox2-/- mice underscores the intrinsic differences along the anterior-posterior axis of the palate. We must hitherto consider the heterogeneity of gene expression and function in the palate to understand better the aetiology and pathogenesis of non-syndromic cleft palate and the mechanics of normal palatogenesis.     

侵袭性纤维瘤病的影像分析及组织病理学分析

目的 分析侵袭性纤维瘤病的影像特点,以及组织病理学特征。方法 回顾性分析2013年1月～2018年3月湖北省荆门市第一人民医院经术后病理证实的 15例AF患者的 CT 和 MRI表现,及MR与组织病理对照分析。结果 15 例患者全部行 CT 平扫,8例行CT增强;9例行 MRI平扫,6例行MRI增强。CT 平扫示13 例呈不均匀等、低密度,2 例呈较均匀稍低密度;12例边界不清,3例边界清楚;CT 增强8例均呈渐进性不均匀明显强化。MRI平扫提示T1WI、T2WI、压脂、DWI等序列肿瘤均为不均匀信号,夹杂不规则低信号,肿块边缘呈爪形浸润或边缘不清。MRI增强 6例均呈不均匀明显强化。结论 CT和MRI 都能从不同方面为AF的诊断提供信息,MRI能更好地显示肿瘤的形态、范围及边缘,且可推断肿瘤的大致成分,对AF的诊断更有帮助。     

Thickness of Palatal Masticatory Mucosa and Its Relationship with Different Parameters in Turkish Subjects

Background: The aim of the study was to clinically investigate the mucosal variations in different parts of hard palate subject to soft tissue harvesting and its relationship with selected parameters in patients with gingival recessions.Materials & Methods: Fifty periodontally healthy, dentate subjects (13 males) with gingival recessions were enrolled into the study. After initial periodontal therapy they were scheduled for surgical procedures. Palatal masticatory mucosa of five teeth was evaluated at five different points from the gingival margin and two points on the buccal gingival mucosa were evaluated on the day of surgical intervention via bone sounding method. Totally 27 assessments were performed for each patient.Results: The overall mean thickness of palatal masticatory mucosa (PMM) was 2.55±0.49mm. The mean mid-facial gingival thickness was 1.11±0.39mm. The PMM showed an increase towards the posterior and raphe palatina. No difference was observed between genders, and no association of body mass index (BMI) and age with PMM was determined. An association was observed between the thicknesses of mid-facial gingival and palatal masticatory mucosa.Conclusion: The thickness of PMM in this study seems to be less than other reports possibly due to ethnicity or measurement design. Canine and premolar region reveals higher thickness values, and the increase in the tissue thickness towards the midline should also been taken into consideration. Clinicians planning soft tissue harvesting from the palate should take this variation into consideration. In this regard transmucosal probing of the donor site may provide valuable information where considerable variation exists.     

上呼吸道结外Rosai-Dorfman病临床病理学观察

目的 探讨上呼吸道结外Rosai-Dorfman病的临床病理特征及鉴别诊断.方法 采用光镜及免疫组织化学LSAB法结合临床资料,对10例发生于上呼吸道的结外Rosai-Dorfman病进行临床病理学分析.结果 10例患者中,男性3例,女性7例,发病年龄20 ～61岁,平均38岁.肿瘤分别位于鼻腔鼻窦(7例)、鼻咽(2例)和硬腭气管(1例).患者多以鼻塞、鼻衄或鼻腔鼻咽新生物就诊.CT显示鼻腔鼻窦等相应部位占位性病变,无骨质破坏.组织学显示肿瘤由相互交错的淡染区与暗染区组成,淡染区见大圆形或多边形的组织细胞,部分组织细胞见吞噬现象;暗染区由聚集的淋巴细胞和浆细胞组成.免疫组织化学染色显示组织细胞弥漫强阳性表达S-100蛋白,部分表达CD68等.随访6例,经手术治疗均健在,无复发.结论 上呼吸道结外Rosai-Dorfman病较为少见,多发生于鼻腔鼻窦,形态学上易与鼻硬结病相混淆,常需免疫组织化学染色加以鉴别.     

腹膜后恶性纤维组织细胞瘤的 MSCT 表现及诊断价值简

目的分析腹膜后恶性纤维组织细胞瘤（MFH）的多层螺旋CT（MSCT）表现,探讨MSCT对该病的诊断价值。方法经手术病理证实的15例腹膜后MFH患者,其中男性11例,女性4例：年龄21～79岁,平均年龄46.5岁。回顾性分析其临床及MSCT表现.并与病理组织学改变相对照。结果15例腹膜后MFH主要临床表现为腹部肿块和疼痛。15例MSCT平扫表现为腹膜后软组织肿块.肿瘤呈圆形或类圆形10例。不规则形5例,肿瘤平均直径为12.5cm,瘤内坏死9例,出血7例,钙化6例。增强扫描肿瘤不均匀强化,13例见分隔状强化。组织学上呈明显多形性,其中车辐状一多形型MFH 11例,巨细胞型MFH 3例,炎症型MFH 1例。结论腹膜后MFH的MSCT表现具有一定特征,对其诊断及鉴别诊断有重要价值。     

Ontogeny and innervation of taste buds in mouse palatal gustatory epithelium

We investigated the relationship between mouse taste bud development and innervation of the soft palate. We employed scanning electron microscopy and immunohistochemistry using antibodies against protein gene product 9.5 and peripherin to detect sensory nerves, and cytokeratin 8 and α-gustducin to stain palatal taste buds. At E14, nerve fibers were observed along the medial border of the palatal shelves that tracked toward the epithelium. At E15.5, primordial stages of taste buds in the basal lamina of the soft palate first appeared. At E16, the taste buds became large spherical masses of columnar cells scattered in the soft palate basal lamina. At E17, the morphology and also the location of taste buds changed. At E18–19, some taste buds acquired a more elongated shape with a short neck, extending a variable distance from the soft palate basal lamina toward the surface epithelium. At E18, mature taste buds with taste pores and perigemmal nerve fibers were observed on the surface epithelium of the soft palate. The expression of α-gustducin was demonstrated at postnatal day 1 and the number of pored taste buds increased with age and they became pear-shaped at 8 weeks. The percent of pored fungiform-like papillae at birth was 58.3% of the whole palate; this increased to 83.8% at postnatal day 8 and reached a maximum of 95.7% at 12 weeks. The innervation of the soft palate was classified into three types of plexuses in relation to taste buds: basal nerve plexus, intragemmal and perigemmal nerve fibers. This study reveals that the nerve fibers preceded the development of taste buds in the palate of mice, and therefore the nerve fibers have roles in the initial induction of taste buds in the soft palate.     

Malignant hemangiopericytoma and other sarcomas with hemangiopericytoma-like pattern

This clinicopathologic study concerns 19 cases of malignant hemangiopericytoma among 755 cases of soft tissue sarcomas. The age of the patients ranged from 18 to 76 years, with a median of 43 years. Tumors occurred on the trunk in 8, lower extremities in 5, the head in 3, and the retroperitoneum in 3. According to follow-up information, nine of the 19 patients had died. Histologically the tumor was characterized by its homogeneous vascular pattern, its uniform cell population and a wide range of cellular anaplasia. After extensive sampling of the tumors, a comparative light microscopy revealed differences in diagnostic histology between malignant hemangiopericytoma and other soft tissue sarcomas with a hemangiopericytoma-like vascular pattern. The frequency of appearance of such pericytoma pattern in different soft tissue sarcomas was as follows: 4/4 cases (100%) in extraskeletal mesenchymal chondrosarcoma, 11/14 (79%) in infantile fibrosarcoma, 27/45 (60%) in synovial sarcoma, 62/201 (30%) in malignant fibrous histiocytoma, 9/37 (25%) in malignant schwannoma and 6/72 (8%) in liposarcoma.     

Reflex control of cat extrinsic and intrinsic tongue muscles exerted by intraoral receptors

The effects of mechanical and noxious stimulation of the palatal and lingual surfaces on the activity of the extrinsic and intrinsic tongue muscles have been studied in cats. Stimulation of the hard palate produced mainly activation of extrinsic tongue muscles while inhibition was elicited by stimulating the soft palate. Longlasting pressure on the hard palate caused rhythmic tongue flapping by intermittent genioglossal activity. The intrinsic tongue muscles, m. transversus and m. verticalis, were activated by noxious stimuli applied to the hard palate, the effects apparently being mediated by high-threshold afferents. Mechanical and noxious stimulation applied to the dorsal and ventral lingual surfaces of the tongue either activated or inhibited the extrinsic tongue muscles depending on the reflex area stimulated. The intrinsic tongue muscles were activated by noxious stimuli applied to the tongue surfaces. The anastomoses running between the hypoglossal and lingual nerves were found to mediate mainly nociceptive afferent impulses travelling from the hypoglossal to the lingual nerve. The intrinsic muscles were found to be controlled by anastomosal nociceptive afferents.