肺淋巴管平滑肌瘤病1例及文献复习

病例 女，37岁，2003年10月因体检胸片示“右下肺阴影”就诊，患者无自觉不适，偶有咳嗽，咳少量白粘痰，体检及实验室检查均未发现异常，常规CT平扫在肺窗上右肺可见弥漫分布毛玻璃样密度影及粟粒状结节影（图1，2），纵隔窗于气管腔静脉后及主动脉弓旁可见多枚肿大淋巴结（图3），     

巨大子宫肌瘤的CT诊断2例并文献复习

子宫肌瘤多见于30～50岁妇女,一般认为肌瘤直径≥12cm或如4个月孕大小子宫诊断为巨大子宫肌瘤[1],较少见。今对我院2例证实的巨大子宫肌瘤的CT表现进行回顾性分析,并复习有关文献,以提高对其CT表现的认识。     

静脉内平滑肌瘤病超声与CT特征

目的 观察静脉内平滑肌瘤病(IVL)的临床、超声与CT特征表现.方法 回顾性分析55例经术后病理证实的IVL患者的临床及影像学特征,对比超声、CT诊断IVL的准确率.结果 Ⅰ期IVL超声多表现为子宫肿物呈“蠕虫”或条索串珠样向宫旁延伸,血流信号丰富;CT多表现为子宫或盆腔低密度肿物,伴子宫静脉或卵巢静脉内肿物.Ⅱ～Ⅳ期...     

膀胱平滑肌瘤1例

患者女,48岁,3年前无明显诱因出现尿急、尿频和间断性尿道刺痛症状,未见肉眼血尿.此后症状间断性出现,气温下降时明显.半个月前症状明显加重,当地医院B超提示膀胱占位病变.查体:无腰痛,肾、输尿管走行区及膀胱区无隆起,无叩击痛和压痛.实验室尿检:WBC(++),RBC(0～1/HP),脓细胞(-),隐血:阳性.B超:膀胱内壁可探及大小约7.6 cm×6.7 cm的实质性包块,边界清,形态规则,有完整包膜.包块内侧大部分向膀胱内突起,内部回声不均,可见少许无回声区.膀胱镜检查:膀胱黏膜未见充血,未见小梁.膀胱右侧顶部可见一大小约5.0 cm×5.0 cm肿块,似外压肿瘤.     

1例遗传性平滑肌瘤病和肾细胞癌综合征PET/CT表现

<正>患者女,29岁,1周前体检发现左肾占位;1年前因“子宫肌瘤”接受“腹腔镜下子宫肌瘤剔除术”;其母曾因“子宫肌瘤”接受“子宫全切术”。查体及实验室检查均未见明显异常。¹⁸FFDG PET/CT：左肾及腹膜后见异常高代谢灶,子宫代谢增高(图1A);左肾上极2.1cm×2.1cm肿物(图1B),腹膜后多发肿大淋巴结、彼此融合(图1C),子宫多发结节(图1D);考虑左肾恶性病变伴腹膜后多发淋巴结转移,子宫多发肌瘤。行全麻下腹腔镜下左肾切除+腹膜后肿物切除术,术中见左肾肿物最大径约3cm,质硬;腹膜后球形肿物最大径约5cm,与腹主动脉关系密切。     

盆部腹膜后平滑肌瘤1例

患者女,53岁,发现左下腹包块3月余.查体:子宫前倾位,略大,形态欠规则;肛门指诊未触及肿块,指套无血染.实验室检查:CA125、CA19-9、AFP及CEA均正常.B超:左下腹见6.3 cm×4.9cm低回声区,形态规则,边界清楚,肿块周边及内部均见血流信号,内部血流阻力指数0.77.CT:左下腹肿块约5.8cm×4.5 cm,密度均匀,增强后强化明显;部分小肠增宽(图1),拟诊小肠间质瘤.行左侧腹壁肿块切除术,术中于腹壁后鞘层探及8.0 cm×5.0 cm×4.0 cm肿块,腹膜完整覆盖,质中,边界清楚.术后病理示梭形细胞呈编织状密集排列,核呈纺锤形(图2);病理诊断:(腹膜)平滑肌瘤.     

子宫阔韧带平滑肌瘤2例报告

病例例1,女,46岁,因B超检查发现盆腔包块20余天入院。无腹痛、发热,大小便正常,无白带增多及阴道流血,既往健康。查体:下腹稍隆起,外阴发育正常,阴道通畅,未见分泌物,宫颈肥大,子宫大小正常,无压痛,左附件区扪及肿块大小如小儿头,质实,无压痛,边界清楚,无凹凸不平,活动     

青春期复发性黏膜下子宫肌瘤一例

子宫肌瘤是最常见的子宫良性肿瘤,多见于30~50岁的女性,在青少年中较为少见。该文报道了1例16岁青少年女性复发性黏膜下子宫肌瘤的诊治经过,患者因异常子宫出血行宫腔镜下子宫肌瘤切除术,术后未规律随访,患者于术后18个月再次因异常子宫出血入院,经阴道超声检查见宫腔5.2 cm×4.6 cm×3.8 cm占位,再次行宫腔镜下子宫肌瘤部分切除术,术后病理活组织检查提示为黏膜下子宫肌瘤。该病例的诊治经过提示,在青少年子宫肌瘤复发的诊治过程中,需与肌瘤肉瘤变鉴别,同时需尽可能保留患者生育能力,重视术后随访。     

宫颈癌合并大量宫腔积脓1例

病例 女,67岁,腹痛腹胀半月.入院查体:生命体征平稳,腹部膨隆,压之胀满不适,双下肢无明显水肿.妇科检查:外阴已婚已产式,阴道畅,壁光滑,宫颈萎缩变小,双合扪及盆腔包块,囊性欠活动,扪诊不满意.血常规:WBC 14.56×109 L-1,N 12.86×109 L-1.肿瘤标志物:CA125 99.9 U/mL(正常≤35 U/mL),CA199 95.7 U/mL(正常≤37 U/mL).尿常规及便常规未见明显异常.     

Recurrent atypical leiomyoma in bladder trigone,confused with uterine fibroids: A case report

BACKGROUNDTumors originating from the posterior bladder wall can be challenging to diagnose because they may mimic a mass from the uterine cervix. Atypical leiomyoma of the bladder trigone is extremely rare, with few reported cases, and requires caution during surgery to avoid damage to the adjacent ureter. Diagnostic surgery and confirmational pathology are essential to assess whether the tumor is malignant and relieve clinical symptoms. Herein, we describe a case of recurrent leiomyoma with focal atypia in the bladder trigone.CASE SUMMARYA 29-year-old woman with a uterine fibroid incidentally found at a regular checkup was referred to our hospital. Based on magnetic resonance imaging, either urinary bladder leiomyoma or protrusion of pedunculated uterine cervical fibroid into the bladder was suspected. This leiomyoma in the trigone of the bladder was completely excised by laparotomy, and the patient was discharged without complication. Follow-up outpatient ultrasonography identified tumor recurrence after four years. As focal atypia was identified previously, laparotomy was performed to confirm the pathology. A round solid mass was resected from the posterior bladder wall without injuring either ureteric orifice. This tumor was pathologically diagnosed as a leiomyoma without atypia. Three-year follow-up ultrasonography has revealed no recurrence.CONCLUSIONAtypical leiomyoma in bladder trigone is rare and could be easily mistaken for fibroid in the uterine cervix. To confirm histopathology, surgical excision is mandatory and regular follow-up is necessary to detect recurrence.     

子宫黏膜下肌瘤致子宫内翻1例

病例女,43岁,子宫肌瘤病史一年余,入院前3h上厕所时自觉阴道有肿物脱出,同时伴下腹部剧烈疼痛及阴道流血,由当地医院转入我院.查体:一般状态欠佳,神志清,表情痛苦,贫血貌.T 36.8℃,P 82次/min,Bp 130/70mmHg,腹软,下腹压痛及反跳痛(+).妇科检查:阴道口外见一超手拳大肿物,暗红色,触痛明显.超声所见:盆腔未探及正常子宫体回声,可见子宫底上端中间呈凹陷样,其前后壁向内折于子宫腔内,呈套筒样改变,大小约7.0cm×9.4cm×8.2cm(图1,2),宫体周围可见液性暗区,最大径1.0cm,双侧卵巢未见异常.超声提示诊断:子宫内翻,盆腔积液.     

多发性内分泌腺瘤综合征-Ⅳ型1例

病例男,24岁.体检时发现胰腺及双肾上腺肿块1周入院.既往十二指肠球部溃疡史4年余,发病时饥饿痛明显,偶有心慌、出汗.查体:双肾区未触及明显包块,无叩击痛,血压162～120/96～75mmHg.实验室检查:CEA 5.32ng/mL,空腹血糖5.68mmol/L,尿香草苦杏仁酸14.3mg/24h.CT示胰头部类圆形稍低密度肿物,大小约2.7cm×2.4cm,CT值为35HU,边界较清,突出于胰腺边缘,增强早期明显均匀强化,程度与主动脉类似,而后强化程度逐渐减低,延迟期仍稍高于周围胰腺实质(图1,2);双肾上腺椭圆形稍低密度肿物,右侧大小约6.7cm×4.4cm,左侧约3.0cm×2.8cm,二者内部均可见液性密度区,边界欠清,皮质期实性成分明显强化,周围似有包膜,中心液化区未见强化(图3,4).     

超声诊断子宫肌壁间脉管内平滑肌瘤病1例

患者女,48岁,体检发现子宫占位;5年前接受子宫肌瘤剔除术,平素月经规律.妇科查体:子宫大小如妊娠4个月,质中,表面凹凸不平,活动度差,无压痛.实验室检查未见明显异常.     

超声诊断静脉内平滑肌瘤病(附7例报告)

目的 回顾性分析静脉内平滑肌瘤病(IVL)的超声表现,提高对IVL的认识和诊断水平.方法 回顾性分析7例经手术病理证实确诊为IVL临床资料,总结所累及脏器的超声表现.结果 7例均为女性,6例有子宫肌瘤病史,5例已行子宫切除手术,1例超声见子宫肌壁间多发结节及盆腔多发肿物.7例血管彩色多普勒超声均发现一侧髂内静脉伴髂外静脉或髂总静脉占位,并见下腔静脉不同段实性中等回声占位:4例累及下腔静脉下段;3例累及下腔静脉全程,其中2例向上延伸至右心房.结论 IVL的临床表现复杂多样,超声表现有一定的特点,掌握IVL超声特点有助于提高诊断正确率.     

累及右侧心腔的子宫静脉内平滑肌瘤病的影像学诊断

目的：探讨累及右侧心腔的子宫静脉内平滑肌瘤病（IVL）的影像学征象,以提高该病的影像学认识。方法：回顾4例经手术病理证实累及右侧心腔的IVL的临床及影像学资料,结合文献分析其影像学特点。结果：在4例累及右侧心腔的IVL中,均有子宫肌瘤病史,1例子宫切除。胸片心影增大2例。超声检查,于髂静脉至右心腔探及连续性低回声区,其中右心腔内低回声团块,随心脏搏动而移动。CT平扫表现为下腔静脉增粗2例,右心房增大2例。增强后髂静脉至右心腔见连续性充盈缺损,其中子宫静脉受累3例,以右心腔内病灶为最大,最大径在3.0~9.8 cm之间,其与管壁分界清,轻中度不均匀强化,其中3例静脉内病灶见条状血管影。重建后表现为游离于管腔内的充盈缺损,呈“萝卜根”样改变。结论：累及右侧心腔的IVL具有一定的影像学特征,有助于诊断和鉴别诊断。     

Ventral hernia after high-intensity focused ultrasound ablation for uterine fibroids treatment: A case report

BACKGROUNDHigh-intensity focused ultrasound (HIFU) ablation is a minimally invasive approach in gynecology that is used to manage uterine fibroids. Although this procedure is safe and effective, adverse outcomes are becoming a major problem.CASE SUMMARYWe present a case of ventral hernia that occurred as a rare and delayed complication of HIFU ablation for uterine fibroids treatment. The patient came to the hospital with abdominal bloating that occurred 6 mo after ultrasound-guided HIFU ablation for managing uterine fibroids. The ventral hernia, which occurred due to atrophied muscle layers following the procedure, was confirmed by imaging studies and intraoperative findings. She required a hernia repair with mesh and hysterectomy for definitive treatment of uterine fibroid. CONCLUSIONHigh-intensity ultrasound ablation should be performed only on appropriate candidates. Patients should be educated about potential complications of the procedure and the possibility of subsequent treatment. Post-procedural long-term follow-up for detecting delayed adverse effects is important.