32p胶体联合地塞米松治疗甲状腺囊肿的疗效

目的:探讨32p胶体联合地塞米松治疗甲状腺囊肿的疗效及临床价值.方法:采用32p胶体联合地塞米松治疗甲状腺囊肿患者103例,患者按甲状腺囊肿的直径大小分为三组,甲状腺囊肿＜2 cm患者45例,2～ ＜3 cm患者38例,3～ ＜4cm患者20例.患者治疗前后均查FT3、FT4、TSH、TG(甲状腺球蛋白)、TM(甲状腺微粒体)及血常规.用超声及甲状腺显像测量囊肿大小.用药1个疗程之后,经医学影像资料未发现囊肿,则判定治愈;经医学影像资料发现囊肿直径缩小超过1/2,则判定有效;囊肿缩小不到治疗前1/2或无变化,则判定无效.采用卡方检验对结果进行统计.结果:三组的治疗效果比较有显著差异,P ＜0.05.三组治疗前后甲状腺激素及血常规检查未发现异常变化,穿刺液未检出癌细胞.治愈病例随访2年未复发.结论:32p胶体联合地塞米松治疗甲状腺囊肿安全,疗效确切,治愈率高,易被患者接受,具有重要的临床价值.     

Orbital hydatid cyst — A rare case report

We present a rare case of cystic hydatid disease of orbit and its endoscopic management. A 35-year-old female patient presented with unilateral progressive nonpulsatile proptosis of the right eye. Ophthalmological examination revealed proptosis of right eye with complete visual loss. Hydatid cyst of the orbit is a rare cause of proptosis, which can be safely managed endonasally in selected cases and by albendazole chemotherapy.     

Subperiosteal aneurysmal bone cyst with associated bone marrow oedema: An unusual appearance

A case of a subperiosteal aneurysmal bone cyst with adjacent bone marrow oedema is presented. Aneurysmal bone cysts have been well documented in the published literature; however, relatively few have been observed in a subperiosteal location, and associated bone marrow oedema in the absence of a demonstrable pathological fracture is a rare finding. Aneursymal bone cyst should be considered in the differential diagnosis of subperiosteal bone lesions and may be associated with bone marrow oedema.     

Upright stereotactic vacuum-assisted needle biopsy of suspicious breast microcalcifications

Stereotactic core needle biopsy is a useful technique for evaluation of suspicious breast microcalcifications. The development of the 11-G vacuum-assisted biopsy system offers another method of minimally invasive biopsy carried out on a conventional mammography unit. We evaluate its usefulness, efficacy and safety in Asian women. Vacuum-assisted biopsy was carried out through the lateral approach using an add-on stereotactic device attached to a mammography unit. One hundred and five lesions were sampled in 97 patients. Excisional biopsy was subsequently Carried out for diagnosis of atypical ductal hyperplasia or carcinoma in high-risk patients. Patients with benign diagnosis underwent mammographic follow up. The technical success rate was 97%. An average of 13.5 tissue cores were retrieved for each lesion. The histopathological result obtained from mammotome was benign in 84.8% and malignant in 15.2%. The benign microcalcifications were predominantly fibrocystic change (n = 42) whereas the malignant microcalcifications included ductal carcinoma in situ (n = 15) and invasive carcinoma (n = 1). Twenty-two patients underwent subsequent open surgical biopsy but no underestimation of disease was seen. Only two patients had vasovagal syncope and three others felt unwell during the biopsy. Nine patients had small haematomas, which resolved spontaneously. Vacuum-assisted biopsy carried out on an upright stereotactic mammography unit is a safe and effective method for evaluation of suspicious microcalcifications.     

头颅磁共振成像引导幕上病变活检103例*

  目的  探讨磁共振成像（magnetic resonance imaging,MRI）引导下微钻钻孔立体定向活检术在颅内占位性病变的应用。  方法  回顾性分析2009年11月至2013年12月就诊于首都医科大学三博脑科医院103例因脑幕上病变行MRI引导微钻钻孔立体定向活检手术的患者,分析病变的病理结果及患者术后情况。  结果  102例患者均获取明确的病理诊断,活检阳性率99.0%,其中胶质瘤66例（65.0%）,淋巴瘤27例（26.5%）,横纹肌肉瘤1例（1.0%）,生殖细胞肿瘤3例（2.9%）,炎性病变3例（2.9%）,脑灰质异位2例（2.0%）,脑梗塞1例（1.0%）。3例患者术后出现穿刺部位出血（2.9%）,1例（1.0%）需行手术清除血肿,无死亡病例,无术后感染病例。  结论  磁共振引导微钻钻孔脑立体定向活检术是一种安全、可靠、微创的手术方法,对颅内病变的诊断与治疗具有重要意义。      

Multilocular cyst of the kidney: a case report

A 69-year-old female was referred to Roswell Park Memorial Institute for management of a right kidney tumor. Her evaluation included excretory urography, ultrasound, computerized axial tomography (CT scan), and selective renal angiography. Fine needle aspiration cytology was felt to be consistent with primary renal cell carcinoma. In spite of the radiological appearance of a benign lesion, a right radical nephrectomy was performed because of the positive cytology on fine needle aspiration. The pathological diagnosis was a solitary multilocular cyst of the kidney.     

Recurrent Glioependymal Cyst of the Posterior Fossa: An Unusual Entity Containing Mixed Glial Elements. Case report

Reports of glioependymal cysts in the posterior fossa are uncommon. There are only a few documented cases of posterior fossa glioependymal cysts and, to our knowledge, this is the first documented case of a recurrent posterior fossa glioependymal cyst. We discuss the clinical presentation, pathological features, and treatment options for this lesion. A 55-year-old woman with a 10-year history of a recurrent cytic lesion in the left cerebellar hemisphere, which required two operations, presented with diplopia, dizziness, and ataxia. Magnetic resonance imaging revealed a multiloculted cytic lesion in the left cerebellar hemisphere. Resection, through a suboccipital craniectomy, resulted in improvement of the patient's neurologic status. Microscopic examination of a surgical specimen revealed complex cysts lined by a single layer of ependyma-like cells and underlying gliotic parenchyma with florid reactive changes. Glioependymal cysts of the posterior fossa may present with symptoms of increased intracranial pressure and compression of local structures. Recurrence in this case may be partly explained by subtotal resection in the previous two operations and may also be associated with a florid, proliferative ependymal element. Definitive diagnosis is by microscopic examination of surgically resected specimens. Total extirpation of these cystic lesions is recommended.     

儿童颅内皮样囊肿合并感染1例并文献复习

目的:探讨颅内皮样囊肿的临床表现、诊断、治疗及并发症。方法:回顾性分析我院1例颅内皮样囊肿合并感染患儿的临床资料,并结合文献复习,总结其临床表现、诊断及治疗。结果:本例患儿出现了囊内感染,经手术切除后患儿预后良好。结论:儿童颅内皮样囊肿发病率低,一般预后良好,可出现囊内感染、无菌性脑膜炎、脑积水等并发症,核磁共振在诊断中起重要作用,手术是其主要治疗方式。     

Mucinous adenocarcinoma arising from a tailgut cyst: A case report

BACKGROUNDRetrorectal hamartomas or tailgut cysts (TCs) are rare. In most cases, they are asymptomatic and benign; however, rarely, they undergo malignant transformation, mainly in the form of adenocarcinoma.CASE SUMMARYA 55-year-old woman presented to our hospital with lower back pain. On magnetic resonance imaging, a large pelvic mass was found, which was located on the right of the ischiorectal fossa, extending to the minor pelvis. The patient underwent extensive surgical resection of the lesion through the right buttock. Histological examination confirmed the diagnosis of a retrorectal mucinous adenocarcinoma originating from a TC. Surgical resection of the tumour was complete, and the patient recovered without complications. The pilonidal sinus was then excised. One year later, semi-annual positron emission tomography-computed tomography and magnetic resonance imaging scans did not reveal any evidence of local recurrence or metastatic disease.CONCLUSIONPreoperative recognition, histological diagnosis, and treatment of TCs pose significant challenges. In addition, the possibility of developing invasive mucinous adenocarcinoma, although rare, should be considered.     

Fine-needle aspiration of intrapancreatic accessory spleen: cytomorphologic features and differential diagnosis

BACKGROUND:

Intrapancreatic accessory spleen (IPAS) is a rare benign lesion of the pancreas that frequently clinically and radiographically mimics a solid neoplasm. Very rarely, epidermoid cysts may form in IPAS and be mistaken for a cystic neoplasm of the pancreas on radiographic imaging. IPAS and epidermoid cyst involving intrapancreatic cyst (ECIPAS) are benign, and, if recognized, do not require surgical intervention. There are few reports of the cytopathologic features of IPAS diagnosed by fine‐needle aspiration (FNA).

METHODS:

Here we report a series of 6 cases of endoscopic ultrasound (EUS)‐guided FNA of IPAS, 3 of which had histological confirmation, including 1 case of histologically confirmed ECIPAS.

RESULTS:

Cytomorphologic features of IPAS include a polymorphous population of hematopoietic cells, including lymphocytes, eosinophils, histiocytes, plasma cells, and red blood cells, admixed with numerous small blood vessels representing splenic sinusoids. CD8 immunostaining of cell block or core biopsy material highlights splenic endothelial cells and confirms the diagnosis. FNA of ECIPAS reveals predominantly macrophages and proteinaceous debris.

CONCLUSIONS:

Diagnostic pitfalls include pancreatic neuroendocrine tumor. If IPAS is recognized as a diagnostic consideration on EUS‐FNA, unnecessary surgical resection may be avoided. Cancer (Cancer Cytopathol) 2012. © 2012 American Cancer Society.     

Radiation-induced Tumor after Stereotactic Radiosurgery and Whole Brain Radiotherapy: Case Report and Literature Review

Radiation-induced neoplasms are extremely rare after stereotactic radiosurgery. To date, only 3 cases meet Cahan's criteria in the world literature. We present a fourth case of a radiation-induced neoplasm arising after radiosurgery. The patient is a 43-year-old woman who presented with a right cerebellar anaplastic astrocytoma 64 months after radiosurgery for metastatic melanoma. Initially, 3 brain metastases involving the inferior right temporal (2 tumors) and right frontal regions were treated. Following radiosurgery, the patient underwent whole brain radiotherapy (37.5 Gy). Twenty-two months later, a second radiosurgical procedure was performed for a recurrent right temporal lobe metastasis. The area of cerebellum where the glioma developed received a maximum dose of 7.7 and 1.5 Gy during the 2 procedures, respectively. Support that radiosurgery contributed to the development of this glioma are the tumor's location and the rarity of adult cerebellar astrocytomas. The risk of radiation-induced tumors after radiosurgery is unknown. To better define the incidence of radiation-induced neoplasms after radiosurgery, all potential cases should be presented and discussed in an open, candid fashion.     

穿刺加三苯氧胺治疗乳腺囊肿的疗效观察(附36例)

目的：比较乳腺可扪及囊肿穿刺抽液后服用三苯氧胺和单纯穿刺抽液两种治疗方法的疗效.方法：将临床可扪及乳腺囊肿根据乳腺B超检查结果入组68例,随机分为穿刺抽液治疗组32例和穿刺抽液后服三苯氧胺治疗组36例,两组患者穿刺抽液后中位随访13个月观察疗效.结果：68例可扪及乳腺单纯囊肿,平均囊肿大小23mm,36例穿刺服三苯氧胺组复发率13.89%（5/36）,32例穿刺抽液组复发率37.50%（12/32）,两组相比较（P＜0.05）有显著性差异.乳腺囊肿病史＞1年的患者,穿刺服三苯氧胺组和穿刺组复发率分别是36.36%（4/11）和77.78%（7/9）,两组相比较（P＜0.05）差异有显著性.对单个囊肿,多发囊肿,囊肿病史＜1年患者,两种治疗方法不影响复发率（P＞0.05）.结论：临床可扪及乳腺单纯囊肿可根据B超检查筛选适合穿刺患者,穿刺抽液加服三苯氧胺治疗可减少复发,囊肿病史＞1年者复发率较高.     

MRI findings of malignant transformation of epidermoid cyst: case report

Malignant transformation of epidermoid cysts into squamous cell carcinoma (SCC) rarely occurs. A 67-year-old man initially presented with an 8-year history of right trigeminal neuralgia. His symptoms had changed into right facial anesthesia with right-ear hearing impairment 8 months before first consulting a neurosurgeon at our hospital. Results obtained using MRI suggested an epidermoid cyst in the right cerebellopontine angle, but showed atypical findings of a small enhancing nodule in the periphery and surrounding edema in the cerebellum and pons. Surgery was performed to remove the mass, but a small nodule was not reached. Despite stereotactic radiosurgery, the patient’s clinical course deteriorated; he died 13 months after the first MRI examination. Autopsy revealed SCC originating from the epidermoid cyst. We present serial MRI and pathologic findings in the early and terminal phases of this patient.     

Dose discrepancy between planning system estimation and measurement in spine stereotactic body radiation therapy: A case report

Stereotactic body radiation therapy (SBRT) to treat spinal metastases has shown excellent clinical outcomes for local control. High dose gradients wrapping around spinal cord make this treatment technically challenging. In this work, we present a spine SBRT case where a dosimetric error was identified during pre‐treatment dosimetric quality assurance (QA). A patient with metastasis in T7 vertebral body consented to undergo SBRT. A dual arc volumetric modulated arc therapy plan was generated on the Pinnacle treatment planning system (TPS) with a 6 MV Elekta machine using gantry control point spacing of 4°. Standard pre‐treatment QA measurements were performed, including ArcCHECK, ion chamber in CTV and spinal cord (SC) region and film measurements in multiple planes. While the dose measured at CTV region showed good agreement with TPS, the dose measured to the SC was significantly higher than reported by TPS in the original and repeat plans. Acceptable agreement was only achieved when the gantry control point spacing was reduced to 3°. A potentially harmful dose error was identified by pre‐treatment QA. TPS parameter settings used safely in conventional treatments should be re‐assessed for complex treatments.     

Hydatid cyst of thyroid: An unusual cause of stridor

A rare case of hydatid cyst of the thyroid is reported, which presented with slow growing swelling of weck in thyroid region since two years and severe dyspmoea and stridor since S days. She was posted for emergency tracheostomy with provisional diagnosis of multimodular thyroid goitre. During surgery multiple hydatid cysts in left lobe of thyroid were found and all cysts were removed. Dyspnoea and stridor were relieved post-operatively. Pre-operative diagnosis of this condition is difficult; diagnosis is usually made at the time of Surgery.     

An international multicenter matched cohort analysis of incidental meningioma progression during active surveillance or after stereotactic radiosurgery: the IMPASSE study

BackgroundThe optimal management of patients with incidental meningiomas remains unclear. The aim of this study was to characterize the radiologic and neurological outcomes of expectant and stereotactic radiosurgery (SRS) management of asymptomatic meningioma patients.MethodsUsing data from 14 centers across 10 countries, the study compares SRS outcomes to active surveillance of asymptomatic meningiomas. Local tumor control of asymptomatic meningiomas and development of new neurological deficits attributable to the tumor were evaluated in the SRS and conservatively managed groups.ResultsIn the unmatched cohorts, 727 meningioma patients underwent SRS and were followed for a mean of 57.2 months. In the conservatively managed cohort, 388 patients were followed for a mean of 43.5 months. Tumor control was 99.0% of SRS and 64.2% of conservatively managed patients (P < .001; OR 56.860 [95% CI 26.253-123.150]). New neurological deficits were 2.5% in the SRS and 2.8% of conservatively managed patients (P = .764; OR 0.890 [95% CI 0.416-1.904]). After 1:1 propensity matching for patient age, tumor volume, location, and imaging follow-up, tumor control in the SRS and conservatively managed cohorts was 99.4% and 62.1%, respectively (P < .001; OR 94.461 [95% CI 23.082-386.568]). In matched cohorts, new neurological deficits were noted in 2.3% of SRS-treated and 3.2% of conservatively managed patients (P = .475; OR 0.700 [95% CI 0.263-1.863]).ConclusionsSRS affords superior radiologic tumor control compared to active surveillance without increasing the risk of neurological deficits in asymptomatic meningioma patients. While SRS and active surveillance are reasonable options, SRS appears to alter the natural history of asymptomatic meningiomas including tumor progression in the majority of patients treated.