肝脏良性占位性病变误诊为肝癌分析

目的探讨肝脏良性占位性病变术前误诊原因,提高临床诊断的正确率。方法回顾性分析38例肝脏良性占位性病变患者的临床资料;分析误诊原因,总结诊断经验,以提高诊断率。结果 38例术前均误诊为肝癌,术后病理证实为良性占位性病变,其中肝局灶性结节性增生14例,肝血管平滑肌脂肪瘤8例,肝孤立性坏死结节7例,肝硬化再生结节3例,肝寄生虫性肉芽肿3例,肝结核瘤2例,肝结节病1例。结论肝脏良胜占位性病变术前易误诊为肝癌。提高认识并综合病史、化验和影像学检查可提高诊断率。对HBsAg（-）且AFP正常者尤应重视,术前怀疑者可行B超引导肝穿刺活检,术中怀疑者积极送冰冻切片检查提高诊断率。     

肝细胞腺瘤（附9例临床病理特征分析）

目的 研究分析肝细胞腺瘤临床病理学特征有助于提高临床诊治水平。方法 复阅所有病例临床病理资料,AFP、PCNA、P53蛋白检测采用免疫组化ABC法。结果 本组患者男性4例,女性5例,年龄20—58岁(平均34.5岁),肿瘤直径3.2—16.5cm(平均11.4cm),MRI提示肝脏有等高信号占位性病变,组织病理形态学呈良性改变,AFP、PCNA、P53蛋白染色均为阴性。结论 肝细胞腺瘤术前易误诊为原发性肝癌或海绵状血管瘤,如就诊患者为年轻女性,有或无腹痛,实验室检查指标正常,影像学提示肝脏占位性病变,临床应考虑肝细胞腺瘤的诊断,必要时行肝穿刺活检。     

胃腺癌伴非典型类癌合并间质瘤、胆管错构瘤的临床观察

目的探讨胃腺癌伴非典型类癌合并间质瘤、胆管错构瘤的临床病理特点。方法回顾性分析胃腺癌伴非典型类癌合并间质瘤、胆管错构瘤的临床病理资料。结果 CT及超声检查显示肝脏占位性病变经组织病理及免疫组化检查证实为胆管错构瘤,并证实肿瘤组织内腺癌及非典型类癌、间质瘤并存。结论胃腺癌伴非典型类癌合并间质瘤极为罕见,胆管错构瘤的正确诊断对手术方案的制定十分重要。     

CT引导下经皮肺穿刺活检临床应用分析

目的 探讨CT引导下经皮肺穿刺活检在肺内占位性病变临床诊断中的敏感性、特异性、准确率、并发症及其诊断价值.方法 回顾性分析140例行CT引导下经皮肺穿刺患者的临床病例资料,分析其敏感性、特异性、准确性,评价诊断价值,讨论其并发症.结果 140例肺部病变经手术病理或临床治疗、随访观察证实为恶性肿瘤90例,良性病变者50例;而CT引导下经皮肺穿刺活检诊断为恶性肿瘤者89例(鳞癌14例,腺癌57例,小细胞癌5例,转移癌3例),良性病变者51例,其中1例良性病变病例后行气管镜检查病理示癌.对恶性病变诊断敏感性98.9％,对良性病变诊断特异性98.0％,总的诊断准确率99.3％.并发症:痰中带血13例,少量气胸1例,并发症的发生率10.0％.结论 CT引导下经皮肺穿刺活检术非常安全有效,准确性高、并发症少,具有较高临床诊断价值,值得临床广泛应用及推广.     

脾占位性病变23例临床分析

目的探讨如何提高脾占位性病变的诊治水平。方法回顾性分析23例脾占位性病变的临床资料。结果本组良性病变16例,恶性病变7例。B超和CT是主要的检查方法,均行手术切除。良性病变疗效好,恶性病变预后差。结论影像检查是脾占位性病变的主要诊断手段,手术切除是主要治疗方法。     

彩色多普勒超声介导周围型肺占位穿刺活检的临床应用

目的 观察彩色多普勒超声介导下穿刺活检对肺周围型占位性病变的安全性及诊断准确性,探讨该方法在临床中的应用价值。方法 在彩色多普勒超声引导下,应用自动活检装置对97例经CT检查显示为周围型肺占位病变患者进行穿刺活检。结果 取材成功率98.9%;93例获得正确诊断,组织病理学符合率95.9%;恶性71例,良性25例,其中假阴性3例,假阴性率4.1%(3/74);1例因取材量不足而无法做出病理诊断。结论 彩超介导下周围型肺占位病变的穿刺活检具有操作简便,成功率高,安全性好等优点,值得临床推广应用。     

儿童肝脏炎性假瘤：附6例报告

报告6例儿童肝脏炎性假瘤.患者年龄4～13岁,男4例,女2例.主要症状有间断性发热、上腹部疼痛及肿块.影像学检查提示肝脏边界清楚的占位性病变,临床上均误诊肝脏恶性肿瘤.病理组织学均呈炎性增生性肿块.讨论了发病原因和诊断.     

多层螺旋CT及相关肿瘤标志物水平检测对肝细胞癌的诊断价值

目的:探讨肝细胞癌(HCC)多层螺旋CT(MSCT)影像特点及肿瘤标志物水平变化.方法:以本院2013年3月至2016年3月就诊的115例肝脏病变患者为研究对象,病理证实肝细胞癌60例,良性病变55例.所有患者均接受MSCT检查及血清高尔基体蛋白73(GP73)、磷脂酰肌醇蛋白聚糖3(GPC3)水平检测,观察HCC患者CT表现,以病理结果为金标准,分析MSCT诊断肝细胞癌敏感度、特异度及准确度,同时比较良恶性病变血清GP73、GPC3水平及其阳性检出率.结果:HCC患者血清GP73、GPC3水平均显著高于良性病变(P<0.05),血清GP73、GPC3单独及联合检测阳性检出率均显著高于良性病变(P<0.05).MSCT平扫图像多为低密度,增强扫描动脉期多为高密度影,门脉期多为低密度影或以低密度影为主,延迟期多为低密度影.MSCT对HCC诊断敏感度、特异度、准确度分别为85.00%、90.91%、87.83%.结论:MSCT对HCC特征清晰显示,诊断准确率较高,血清GP73、GPC3也可作为HCC诊断重要辅助手段,两者联合检测能有效提高HCC阳性检出率.     

弹性成像与超声造影联合应用诊断甲状腺微小乳头状癌的价值

目的：探讨弹性成像（UE）与超声造影（CEUS）联合应用诊断甲状腺微小乳头状癌（PTMC）的价值。方法：对常规超声检测出确定性困难的73例80个甲状腺微小结节进行 UE 及 CEUS 检查,所有结节均经手术病理证实。结果：80个结节中 UE5分法诊断正确率为92．5％（74／80）,其中3例恶性结节误诊为良性结节,3例良性结节误诊为恶性。CEUS 诊断正确率为85．0％（68／80）,其中6例 PTMC 误诊为良性病变,6例良性结节误诊为 PTMC;UE 诊断甲状腺微小癌的敏感性94．0％,特异性90．0％,准确性92．5％;CEUS 诊断甲状腺微小癌的敏感性88．0％,特异性80．0％,准确性85．0％。联合应用 UE 和CEUS 诊断甲状腺微小癌的敏感性96．7％,特异性92．7％,准确性94．9％。结论：UE 和 CEUS 对于诊断 PTMC 方面均有较高的诊断价值,二者联合应用大于任意单项检查的诊断效能。     

肝脏肿瘤的CT诊断与鉴别

目的　探讨肝脏肿瘤的CT表现及鉴别诊断。方法　收集病理或临床证实的 10 0例肝脏肿瘤的螺旋CT平扫及增强资料。结果　 10 0例肝脏肿瘤中 ,3 9例肝细胞肝癌 ,3 1例肝血管瘤 ,2 0例肝转移瘤 ,10例肝胆管细胞癌。定性总准确率 94%。结论　肝细胞肝癌、肝血管瘤、肝转移瘤、肝胆管细胞癌各自具有特征性CT表现 ,CT检查具有诊断和鉴别诊断价值。     

Benign tumors and tumor-like lesions of the lung

We detail an investigation of the diagnosis and operative method for benign tumors and tumor-like lesions of the lung. In benign tumors, the preoperative diagnosis was almost the same as the postoperative one. In tumor-like lesions, the correlation of preoperative and postoperative diagnosis was poor. Since 1986, no patient with benign tumors has undergone invasive methods, but this has been required in some tumor-like lesions. Malignant tumors are easily distinguished from benign tumors but difficult from tumor-like lesions, preoperatively. Therefore, open biopsy is necessary in cases of suspicious malignancy. Then small invasive procedure should be selected due to the possibility of benign tumors.     

Molecular discrimination between alpha-fetoprotein from patients with hepatocellular-carcinoma and nonneoplastic liver-diseases by their carbohydrate structures (review)

Serum alpha-fetoprotein (AFP) is a good marker of HCC. However, this protein also increases moderately in non-neoplastic liver diseases. The serum concentration of AFP in HCC at the time of initial diagnosis has become lower thanks to the advancement of imaging modalities. These clinical circumstances have lead to the need of molecular discrimination of AFP between HCC and benign liver diseases. This has been attained by taking advantage of the reactivity of AFP with various lectins. The relative amount of the Lens culinaris agglutinin (LCA)-reactive species of AFP is significantly greater in HCC than in benign liver diseases. Molecular basis of this variation is the fucosylation of sugar chain at innermost N-acetyl-glucosamine. On the other hand, the concanavalin A (Con A)-nonreactive species of AFP increases in AFP-producing gastrointestinal carcinoma as compared with HCC and benign liver diseases. Molecular basis of Con A-nonreactive variants is the N-acetylglucosaminylation of the mannose residue at the trimannosyl core, although the position to be modified can be different. Therefore, the terms 'fucosylation and glucosaminylation indices' have been introduced to express the percentages of LCA-reactive and Con A-nonreactive species of AFP, respectively. The reactivity of AFP to erythroagglutinating phytohemagglutinin of Phaseolus vulgaris (E-PHA) also provides useful information for discrimination between HCC and benign liver diseases. These indices together with the measurement of E-PHA molecular variants are useful to detect HCC even if the disease is at an early stage. Furthermore, they seem to serve the prediction of HCC in the follow-up course of chronic liver diseases. Thus, not only qualitative but also quantitative measurements of lectin-based molecular variants of AFP provide us valuable information for the differential diagnosis of various liver diseases.     

Comparison of cytosol estrogen and progestin receptor status in malignant and benign tumors and tumor-like lesions of human ovary

Some human ovarian malignancies respond favorably to hormone therapy. In order to obtain more information about the endocrine properties of these malignancies, we measured estrogen (ER) and progestin (PR) receptors in 21 malignant ovarian tumors, and compared the findings with those in 29 benign tumors and 28 tumor-like ovarian lesions. There were marked differences in steroid receptor distributions between the three groups. Only 38% of the malignant tumors simultaneously contained measurable amounts of both receptors, whereas the corresponding figure was 76% for the benign tumors. Malignant tumors were more often (29%) receptor-negative than the benign ones (7%). The major difference in the tumor-like lesions was the high frequency (43%) of samples containing PR only, as compared with the two other groups. The respective concentrations (fmol/mg cytosol protein, mean ± SEM) of ER and PR were 114 ± 42 and 148 ± 76 (malignant tumors), 71 ± 34 and 132 ± 32 (benign tumors) and 19 ± 16 and 251 ± 88 (tumor-like lesions). Of the malignant tumors, endometrioid carcinoma was characterized by a relatively high mean PR content (330 ± 262), whereas in undifferentiated carcinoma a high ER content (149 ± 97) was associated with a low PR concentration (26 ± 15). Steroid receptor content was very similar in benign epithelial tumors with different histological properties. The two main groups of tumor-like lesions, endometriosis and luteal cysts, typically contained little or no ER and a relatively high amount of PR. Hormone dependency of malignant and benign ovarian tumors and tumor-like lesions does not seem similar. These data support the notion that receptor determinations from malignant ovarian tumors could aid in selection of patients for endocrine therapy in a manner similar to that already established for certain other hormone-dependent cancers.     

肝癌螺旋CT双期增强扫描影像学特征及CT假阳性病灶的病理分析

背景与目的:肝细胞癌(简称肝癌)螺旋CT双期增强扫描"快进快出"的特点与其它病变存在交叉重叠的现象,为进一步提高螺旋CT对肝细胞癌诊断的准确性,探讨与肝癌螺旋CT双期扫描特点类似的病变,分析出现假阳性病灶的原因,并阐明它们与病理之间的关系.方法:收集自2000年12月至2002年12月中山大学肿瘤防治中心行螺旋CT双期增强扫描发现肝内病灶,并经手术切除、病理证实的病例52例(男性49例,女性3例),CT扫描共发现56个病灶.分析、总结肝癌病灶动脉期与门脉期增强特点,螺旋CT所见假阳性(false positive)病灶与病理结果对照分析.结果:本组52例的56个病灶中,癌灶51个,其中49个为肝细胞癌病灶,另有2例为肝细胞与胆管细胞的混合癌;假阳性灶5个.全部肝癌病灶动脉期明显不均匀强化;门脉期不均匀低密度;巨块型肝癌癌灶内可见不同程度坏死,小肝癌与结节性肝癌病灶内坏死较少见.病灶大部分边缘清楚,可见包膜.另外5个为CT扫描的假阳性病灶(8.9%),假阳性病灶病理诊断包括肝硬化结节增生、再生结节,肝硬化合并胆管增生、胆管结石合并胆管壁的炎性反应、纤维增生.假阳性病灶的螺旋CT征象与肝癌灶类似.结论:螺旋CT双期增强扫描对肝癌典型病灶可以明确诊断.假阳性病灶与典型的肝癌病灶双期螺旋扫描的CT征象差别不大,应结合临床资料进行分析,行随诊观察或病理活检证实.     

肝脏瘤样病变的临床特点与治疗探讨

背景与目的：肝脏瘤样病变是一类肝脏良性病变,其中以局灶性结节性增生（focal nodular hyperplasia,FNH）、炎性假瘤（inflammatory pseudotumor,IPT）、腺瘤性结节性增生、局灶性脂肪变较为多见,易与原发性肝癌相混淆。本文旨在探讨这4种瘤样病变的临床特点与治疗方法。方法：对12年来中山大学肿瘤防治中心确诊的4种肝脏瘤样病变共70例的临床及随访资料进行分析和总结。结果：34例（48．6％）瘤样病变的患者有临床症状,以腹部隐痛为主。手术前检查乙型肝炎病毒抗原阳性22例（31．4％）;肝功能轻度异常21例;甲胎蛋白〉25μg／L6例。瘤样病变的B超及CT表现多种多样,仅8例FNH术前能确诊。61例瘤样病变行手术切除．术后无并发症。随访发现1例FNH及1例IPT复发。复发后采用非手术方式治疗效果好。结论：肝脏瘤样病变容易与原发性肝癌相混淆,性质不明者应手术探查。     

成人肝脏少见肿瘤或肿瘤样变18例临床观察

【摘 要】目的 探讨成人肝脏少见肿瘤或肿瘤样变的诊断和治疗。方法 收集2009年6月至2015年5月收治的18例肝脏少见肿瘤或肿瘤样变患者的临床资料,回顾性分析临床诊治过程。结果 18例患者中,纤维瘤2例,腺瘤3例,局灶结节性增生4例,癌肉瘤2例,错构瘤2例,梭形细胞瘤1例,原发性肝恶性间质瘤1例,肝结核1例,炎性假瘤2例。8例影像学诊断出现误诊,良恶性诊断准确率为50%。1例炎性假瘤术前CA19-9为246.4 kU／L,其他病例肿瘤标志物均正常。除1例肝结核因术中见胃小弯多发肿大淋巴结和膈肌硬结未行肝脏肿块切除及1例腺瘤患者行射频消融外,其他病例均行肝脏病灶完整切除（包括局部切除、肝叶肝段切除）。结论 肝脏少见肿瘤或肿瘤样变术前难以确诊,检查误诊率较高,主要依靠病理诊断,治疗以手术切除为主。     

Assessment of Glut-1 expression in cholangiocarcinoma,benign biliary lesions and hepatocellular carcinoma

Hepatocellular carcinoma (HCC), cholangiocarcinoma (Chca) and benign bile ductule proliferations represent uncommon but important differential diagnoses in liver masses, especially if the patient has no known primary malignancy. The glucose transporter protein Glut-1 is commonly expressed in adenocarcinomas but its expression in HCC, Chca, and benign bile ductules has not been systematically investigated. Forty-two cases of Chca, 27 cases of benign bile ductule proliferations and 19 cases of HCC were stained with Glut-1. Cases were evaluated for a membranous staining pattern in tumor cells and the results compared. Twenty-one of 42 (50%) Chca stained with Glut-1 while no HCC or benign bile ductule proliferations did, neither did benign hepatocytes or portal triad structures. Glut-1 is a highly specific but insensitive stain for Chca. It may prove to be a helpful part of a diagnostic panel used to evaluate liver lesions.     

Fine-needle aspiration biopsy in a pediatric population. Report of 64 consecutive cases

Fine-needle aspiration biopsy for diagnosis of mass lesions has seldom been used in pediatric patients. Sixty-four aspirations from pediatric patients have been reviewed in order to determine the adequacy of this technique in the pediatric age group. There were 38 benign diagnoses, 19 malignant diagnoses, and 7 unsatisfactory specimens. The benign diagnoses included inflammatory lesions, benign tumors, cystic lesions, and miscellaneous lesions. The malignant diagnoses included neuroblastomas, leukemias or lymphomas, small cell or poorly differentiated tumors, Wilms' tumors, rhabdomyosarcomas, a Ewing's sarcoma, and a postirradiation fibrosarcoma. Correlation of histologic and cytologic diagnoses was possible in 53 cases. The diagnostic sensitivity and specificity for the detection of malignant disease were 76% and 100%, respectively. These results suggest that fine-needle aspiration biopsy is a useful technique in the diagnosis of pediatric mass lesions.     

The usefulness of simultaneous determinations of glucosaminylation and fucosylation indices of alpha-fetoprotein in the differential diagnosis of neoplastic diseases of the liver.

The degrees of glucosaminylation (glucosaminylation index) and fucosylation (fucosylation index) of alpha-fetoprotein (AFP) were determined in serum samples of 351 patients with hepatocellular carcinoma (HCC), 47 with carcinoma metastatic to the liver from digestive organs, five with mixed cholangiocellular and HCC, and 176 with benign liver diseases. The glucosaminylation index of AFP in patients with carcinoma metastatic to the liver (42 +/- 23%, mean +/- SD) was significantly higher than that in patients with HCC (5 +/- 7%, P less than 0.001) or that in patients with benign liver diseases (2 +/- 4%, P less than 0.001). The fucosylation indices of AFP in patients with carcinoma metastatic to the liver, with HCC, and with benign liver diseases were 76 +/- 25%, 42 +/- 30%, and 4 +/- 6%, respectively. Thus, the fucosylation indices of AFP were high in two neoplastic liver diseases (carcinoma metastatic to the liver and HCC) and low in benign liver diseases, whereas the glucosaminylation indices were high in carcinoma metastatic to the liver but low in HCC and benign liver diseases. When the values of 30% and 80% were used as the level of the glucosaminylation and fucosylation indices, respectively, to discriminate carcinoma metastatic to the liver from HCC, 40 of 47 patients with carcinoma metastatic to the liver (85%) were able to be discriminated from HCC (sensitivity). The specificity, the positive predictive value, and the overall accuracy were 86% (302/351), 45% (40/40 + 47 + 3 - 2) and 86% (40 + 302/47 + 351), respectively. These data suggest that the combined information in these two indices provides a potent criterion for the diagnosis of neoplastic diseases of the liver.     

CT检查对原发性骨肿瘤或肿瘤样病变的诊断价值研究

目的 探讨CT检查对原发性骨肿瘤或肿瘤样病变的诊断价值.方法 收集97例原发性骨肿瘤或肿瘤样病变患者的临床资料进行回顾性分析,对其X线、CT等影像学单独及联合检查结果进行分析,并与病理诊断结果进行比较,对诊断符合率进行考察.结果 97例患者中包括良性骨肿瘤35例,恶性骨肿瘤28例,肿瘤样病变34例,病变均具有不同的影像学特征.与病理诊断结果相比,CT诊断符合率为83.51%,X线诊断符合率为68.04%,CT符合率高于X线,差异有统计学意义(P<0.05).联合检测诊断符合率为95.88%,远高于单项检测(P<0.05).结论 CT对于原发性骨肿瘤及肿瘤样病变的诊断具有较高的临床价值,与X线平片结合可有效提高疾病检出率,值得临床进行推广应用.