肺结核合并肺癌的临床及X线、CT影像分析

目的分析肺结核合并肺癌的临床特征及X线、CT影像,提高肺结核合并肺癌的诊断率。方法对经病理证实的57例肺结核合并肺癌患者的临床表现、X线及CT影像进行分析。结果57例病人除有结核病中毒症状外,尚有刺激性咳嗽,胸痛,咯血等表现。X线及CT表现以肿块影多见,占77．2％。病灶位于同侧同叶者30例（52．6％）,且上肺多于下肺,右肺多于左肺;同侧不同叶者16例（28．1％）,不同侧者11例（19．3％）。活动性肺结核合并的肺癌以周围型肺癌多见,陈旧性肺结核合并的肺癌以中央型肺癌多见。结论肺结核合并肺癌比较常见,应结合病史、年龄及影像学表现综合分析,早期诊断。     

周围型肺癌行X线平片与CT诊断的临床价值对照

目的 对比周围型肺癌行X线平片与CT诊断的临床价值.方法 回顾性分析本卫生院2012年7月～2014年7月收治的63例经病理学确诊的周围型肺癌患者X线平片与CT检查资料,并对比两种检查方式影像学表现.结果 本组患者行CT检查的毛刺、肿块、棘样突起、空泡、胸膜凹陷、支气管气象、肺门及淋巴结肿大、血管聚集及厚壁空洞等影像特征阳性检出率显著高于X平片检查,对比差异有统计学意义(P＜0.05);X线平片确诊周围型肺癌49例,确诊准确率为77.78％(49/63),CT确诊周围型肺癌60例,确诊准确率为95.24％(60/63),两者对比差异具有统计学意义(P＜0.05).结论 相较于X线平片,周围型肺癌行与CT检查可显著提升影像学特征检出率与诊断准确率.     

1109例乳腺癌X线影像病理学分型研究

目的 提高对乳腺癌X线征象的认识。方法 分析1109例经病理证实的乳腺癌X线特征。结果 1109例病例中，非浸润性癌66例（6．0％），早期浸润性癌74例（6．7％），浸润性特殊型癌96例（8．6％），浸润性非特殊型癌851例（76.7％），其他罕见癌22例（2％）。结论 乳腺X线检查对于乳腺癌，尤其是早期乳腺癌和隐性乳癌的诊断有重大价值。     

25例周围型小肺癌的CT诊断

目的 探讨CT对周围型小肺癌的诊断价值.方法 对25例周围型小肺癌病例的CT表现进行回顾性分析.结果 25例病例中,腺癌16例,鳞癌7例,细支气管肺泡癌1例,小细胞癌1例.深浅分叶征4例、毛刺征9例、空泡征5例、胸膜凹陷征5例、血管纠集征1例、蜂窝征1例.CT值增幅＞30Hu者为23例,占92%.结论 CT显示出现多种征象者,应高度怀疑为肺癌.增强扫描对于周围型小肺癌的诊断与鉴别诊断有着重要意义.     

早期股骨头缺血坏死核素骨显像与X线平片的对比分析

目的 探讨核素骨平面显像、断层显像压X线在早期股骨头缺血性坏死诊断及鉴别诊断中的价值。方法 对40例共52髋拟诊为股骨头缺血性坏死的患者行两髋关节平面厦断层显像，同时行两髋关节X线检查。结果 最后确诊为“股骨头缺血性坏死”的有37例患者48个髋关节，其中，平面显像诊断符舍率为60．4％（29／48），断层显像诊断符合率达93．75％（45／48）；X线诊断符合率为22．9％（11／48）。三者间存在显著性差异。结论 骨断层显像对股骨头缺血性坏死可以提供早期、准确的诊断厦鉴别诊断。     

早期周围型肺癌的X线动态观察和分析

目的 探讨X线动态观察对周围型肺癌进行早期诊断的价值.方法 对有X线随访资料的早期周围型肺癌14例资料进行回顾性分析.结果 病灶直径≤2cm,无局部、远处、肺门及纵隔淋巴结等转移者归为早期征象;病灶直径>2cm以上,有或无肺门,纵隔淋巴结、骨及胸膜转移者归为进展期征象.鉴别诊断中,除考虑形态学改变外,还要注意观察肿瘤的生长速度.结论 X线平片发现类似病灶,应进行动态观察,查看有无恶性征象,再结合临床资料进行鉴别诊断.     

新生儿先天性巨结肠的X线诊断分析

目的分析新生儿先天性巨结肠的X线表现,探讨新生儿先天性巨结肠的X线诊断,重视影像学检查的作用,提高对本病的认识,提高早期诊断水平。方法对21例新生儿先天性巨结肠的临床表现和腹部平片、钡灌肠的X线表现进行回顾分析。结果本组病例21例,腹部平片X线表现中结肠梗阻征10例,结肠淤张征8例,阴性X线征3例。钡剂灌肠X线表现中短段型1例,常见型16例,长段型2例,全结肠型2例。结论 X线检查是诊断新生儿先天性巨结肠最简单、最常用、确诊率较高的检查方法。只要密切结合临床,注意检查注意事项,检查中仔细观察,并坚持24 h复查,即可提高早期诊断正确率。     

纵隔型肺癌的X线CT诊断分析

目的分析纵隔型肺癌的影像学表现，提高诊断及鉴别诊断能力，为临床提供准确的信息。方法回顾性总结分析13例经临床手术或／和病理证实的纵隔型肺癌的X线和CT资料。13例病人均行胸部正侧位平片和CT平扫检查，6例病人做了强化扫描。结果13例纵隔型肺癌病人中有右上肺4例，左上肺2例，右肺门5例，左肺门2例。平片表现气管测移位，纵隔不规则块影，纵隔增宽，2例胸腔积液。CT表现肿块位于纵隔胸膜下，与纵隔分界清楚或模糊，显示分叶征、毛刺征、血管纠集征及支气管完全或不完全阻塞、纵隔淋巴结肿大，增强后肿块轻度不均匀强化。结论密切结合临床症状及体征，深入观察影像学表现，全面综合分析，对纵隔型肺癌可以做出准确的影像学诊断。     

肺炎性假瘤与周围型肺癌的CT征象鉴别诊断

目的研究肺炎性假瘤与周围型肺癌的CT征象特征,探讨二者的影像鉴别诊断。方法回顾分析30例经手术和病理证实的肺炎性假瘤的CT征象,并与30例经手术和病理证实的周围型肺癌CT征象对照。结果肺炎性假瘤多呈圆形,主要表现有平直征(86.7%)、含气支气管征(50.0%)和空泡征(40.0%),无纵隔淋巴转移;周围型肺癌多呈结节状,主要表现分叶征(90.0%)、毛刺征(83.3%)、血管集束征(76.7%)和胸膜凹陷征(80.0%),常见纵隔淋巴转移。肺炎性假瘤与周围型肺癌发生部位、大小、空泡征、含气支气管征对鉴别诊断意义不大。结论肺炎性假瘤与周围型肺癌CT征象的不同有助于二者的鉴别诊断。     

肺内孤立结核瘤在X线胸片中的诊断

目的：讨论在X线胸片中肺内孤立结核瘤与球形肺炎、肺癌等其它孤立病变易误诊的鉴别诊断。方法分析109例肺内孤立结核瘤在X线胸片的表现，分析其诊断及鉴别诊断。结果在结核瘤等其它肺野内孤立结节的诊断与鉴别诊断中，孤立结节的边缘特征(分叶、毛刺)、内部结构(空泡征、空气支气管征、结节内透亮影)、周围改变(卫星灶)等表现。结论对X线胸片影像表现的细心观察，结合临床诊疗与实验室结果，对肺内孤立结节病变不难诊断与鉴别诊断。     

30例肺鳞癌纤支镜与胸片检查结果对比分析

目的 对肺鳞状上皮细胞癌（肺鳞癌）用纤维支气管镜（纤支镜）和X线胸片检查结果进行比较。并作临床分析。方法 于1989年7月至1999年11月对30例肺鳞患者进行纤支镜检查，将结果与胸片所见进行比较分析。结果 肺鳞癌占肺癌40%，与吸烟密切相关。男性多于女性，50岁-65岁高发，中央型多见，易形成空洞，右上肺多见。结论 纤支镜检查是目前肺鳞癌主要诊断方法，必要时需复查，阳性率可达86.7%，X线胸片对肺鳞癌诊断也提供了很有价值的资料。     

周围型肺腺癌和周围型肺鳞癌的能谱CT表现

目的:观察周围型肺腺癌和周围型肺鳞癌的能谱CT表现。方法:回顾性分析经病理证实并行能谱CT扫描的周围 型肺腺癌122 例和周围型肺鳞癌89 例。测量病灶在动脉期及静脉期下的CT40 keV值、CT70 keV值、CT100 keV值、碘（水）浓度 （IC）、水（碘）浓度（WC）和有效原子序数（Zeff）,并计算能谱曲线斜率（K70 keV）。比较两组之间各能谱参数之间的差异。结 果:两组之间性别差异有统计学意义（P<0.05）,而其他临床特征和临床症状在两组之间差异无统计学意义（P>0.05）。动 脉期和静脉期,周围型肺腺癌的CT40 keV、CT70 keV、K70 keV、IC及Zeff均大于周围型肺鳞癌,差异具有统计学意义（P<0.05）;而 两组之间的WC和CT100 keV无统计学意义（P>0.05）。ROC曲线分析显示,动脉期各定量参数联合较静脉期各定量参数联 合的诊断效能好,曲线下面积、敏感性和特异性分别为86%、77%、83%。结论:周围型腺癌和周围型鳞癌的能谱CT表现 存在一定差异,可为二者的鉴别提供参考。     

Bronchogenic squamous cell carcinomas with invasion along alveolar walls

In bronchogenic squamous cell carcinoma, a growth pattern along the alveolar walls of the peripheral lung parenchyma is unusual. In order better to understand the way tumour cells invade the peripheral lung parenchyma, we studied two cases of squamous cell carcinoma with invasion along the alveolar walls (in 30% to 40% of the area surrounding the tumour). We used immunohistochemical staining with antibodies against pulmonary surfactant, apoproteins (PE-10) and collagen type IV, and electron microscopy. Tumour cells invading the peripheral lung tissue were located between one layer of type II alveolar epithelial cells and the basement membrane of the alveolar walls. These results suggest that the cells of a squamous carcinoma (unlike an adenocarcinoma) have the ability to spread along the basement membrane of the alveolar walls without destroying pre-existing normal peripheral lung parenchyma.     

What can we learn from the errors in the frozen section diagnosis of pulmonary carcinoid tumors? An evidence-based approach

The intraoperative diagnosis of pulmonary neuroendocrine tumors can be difficult. Frozen section diagnosis was requested on 87 neuroendocrine tumors including 58 typical carcinoids, 8 atypical carcinoids, 18 large cell neuroendocrine carcinomas, and 3 small cell carcinomas from 2405 patients that underwent frozen section diagnosis at Cedars-Sinai Medical Center from 2002 to 2007. The deferral and error rate for carcinoid tumors was 4.13% and 7.5%, respectively, and resulted in 4 unnecessary lobectomies and 2 second thoracotomies. The most common errors included misdiagnoses as lymphoma, squamous carcinoma or metastasis from breast carcinoma. Thirty one pathologic features were evaluated in the 66 carcinoid tumors and 10 frozen sections each of lymphoma, squamous cell carcinoma, and metastatic breast carcinoma. Seven pathologic features were significant by chi square test at P > .05. Positive likelihood ratios identified 11 pathologic features that were useful for the diagnosis of carcinoid tumor from other neoplasms. The applicability of the 11 pathologic features was tested with a group of pathologists, resulting in significant improvement in diagnostic accuracy as measured by pre and posttests. The value of evidence-based pathology and Bayesian statistics to evaluate complex differential diagnoses in pathology is discussed.     

HPV L1 capsid protein detection and progression of anal squamous neoplasia

Three cases of pulmonary squamous cell carcinoma (SCC) are described displaying a prominent microcystic pattern closely resembling microcystic adnexal carcinoma of the skin (MAC). The patients were 2 women and 1 man aged 72 to 83 years. Histologically, in addition to conventional SCC, all tumors showed striking microcystic changes characterized by nests and strands of basaloid squamous cells with central cystic spaces, peripheral palisading, and cytoplasmic clearing of the central tumor portions. Follow-up available for 2 patients revealed that 1 was alive at 76 months and 1 had died 38 months after diagnosis. Microcystic SCC is an unusual variant of SCC of the lung histologically mimicking tumors with glandular or adnexal differentiation and a particularly striking resemblance to MAC of the skin. The importance of the recognition of this growth pattern lies in the separation from other often less aggressive pulmonary neoplasms or metastatic disease from a cutaneous tumor.     

肺周边部肿块的声像图与病理分析

目的 分析肺周边部病灶的声像图与病理学特征。方法 回顾性分析76例X光胸片及CT片显示的肺周边部肿块影在彩超引导下自动活检病理学结果，声像图分析包括肿块形态，边缘，内部回声，支气管相血流分布情况。结果 介入超声下自动活检病理结果为恶性病变62例，良性病变14例，诊断的准确率为93％。结论 肺周边部肿块的声像图与病理改变有一定的特征性；超声与介入超声可为肺周边中肿块提供准确的诊断依据。     

肺癌细胞外基质的表达与临床病理的关系

目的探讨原发性肺癌层粘蛋白（Ｌａｍｉｎｉｎ,ＬＮ）、纤维连接蛋白（ｆｉｂｒｏｎｅｃｔｉｎ,ＦＮ）和Ⅳ型胶原的表达与临床病理的关系。方法采用免疫组化ＬＳＡＢ法检测１８４例肺癌标本中ＬＮ、ＦＮ和Ⅳ型胶原的表达。结果ＬＮ及Ⅳ型胶原在中、高分化的肺鳞癌中的表达均明显强于低分化组（Ｐ＜００１）,在有无淋巴结转移两组间的表达差异均具显著性（Ｐ＜００５）;肺鳞癌５年以上生存组ＬＮ、Ⅳ型胶原的表达明显高于０５年内死亡组（Ｐ＜００１）,ＦＮ的表达亦有差异（Ｐ＜００５）。肺腺癌的５年以上生存组中ＦＮ、Ⅳ型胶原的表达均强于０５年内死亡组（Ｐ＜００５,００１）。结论ＬＮ和Ⅳ型胶原的表达与肺鳞癌的组织学分级和淋巴结转移有关;ＬＮ、ＦＮ、Ⅳ型胶原的表达均可作为评估肺鳞癌预后的指标,而腺癌的预后仅与ＦＮ、Ⅳ型胶原的表达有关。     

Sperm protein 17, MAGE-C1 and NY-ESO-1 in hepatocellular carcinoma: expression frequency and their correlation with clinical parameters

This study is dedicated to investigate the expression patterns of sperm protein 17 (Sp17), melanoma-specific antigen (MAGE)-C1 and New York esophageal squamous cell carcinoma-1 (NY-ESO-1), to explore the correlation between these cancer-testis antigens and clinical parameters, and to evaluate their values in diagnosis and differentiation of hepatocellular carcinoma. Methods: Immunohistochemical staining was performed in 45 paraffin-embedded hepatocellular carcinoma specimens. 45 normal peripheral hepatic tissues collected from adjacent non-cancerous areas were used as controls. Results: Positive results of immunohistostaining were obtained in 16 (35.6%), 7 (15.6%) and 36 (80.0%) samples using MAGE-C1, NY-ESO-1 and Sp17 antibodies, respectively. The immunoreactivity of Sp17 was also found in 7 (14.0%) control samples. A statistical correlation between the frequency of Sp17 expression and tumor differentiation grade in hepatocellular carcinoma was confirmed. Conclusions: Sp17 is highly expressed in hepatocellular carcinoma cells. The frequency of Sp17 expression is closely related to the pathologic differentiation in hepatocellular carcinoma.     

Frequency of occurrence of diagnostic cytologic parameters in basal cell carcinoma. A retrospective review of 25 cases

Twenty-five cases of cytologic preparations from basal cell carcinomas documented by subsequent tissue material were obtained. The cases were retrospectively analyzed to evaluate the frequency of occurrence of various features that could either be helpful or misleading in the diagnosis. These features included peripheral palisading, Bowenoid nuclei, and keratinized cells. Results from the study include the fact that a major criterion for the histologic diagnosis of basal cell carcinoma (peripheral palisading) could seldom be appreciated in the cytology preparations. Large clusters of cells with crowded nuclei were found in every case and thus represent a useful cytologic parameter. However, because of the frequent absence of peripheral palisading, the study suggests there could be diagnostic confusion with lesions of small cell squamous carcinoma.