胃肠间质瘤35例诊治体会

为了探讨胃肠间质瘤(GIST)的诊断和治疗,回顾性分析35例GIST的临床资料及预后.病变位于胃21例,小肠7例,直肠3例,十二指肠和小肠系膜各2例.临床主要表现为腹部疼痛不适、腹部包块及消化道出血.B超、CT检查示,腹腔肿瘤18例中,胃占位病变11例,直肠占位和盆腔肿瘤各2例,肝占位或转移8例.16例内镜检查示,胃黏膜下病变11例,直肠黏膜下病变1例;7例行超声内镜检查,5例提示胃间质瘤,1例提示直肠间质瘤.术前14例初诊为胃间质瘤,仅1例病理确诊.35例均行手术切除,其中姑息性切除9例,根治性手术26例,无手术死亡.33例患者获得随访3～128个月,中位随访时间27个月.全组死亡11例(33.3%),生存时间6～59个月,中位生存时间13个月;22例生存(66.7%),生存时间3～128个月,中位生存时间28个月.4例患者术后格列卫辅助治疗,仅1例带瘤生存.初步研究结果提示,GIST临床无特征性表现,超声内镜有助诊断,只有彻底切除肿瘤有望取得好的疗效,正规使用格列卫有助提高疗效.     

椎管内硬膜外占位病变的临床分析

椎管内硬膜外占位病变是指：良恶性肿瘤，血管畸形，炎性改变（脓肿、肉芽肿、结核瘤）和突出的椎间盘等，除椎间盘突出外，其它硬膜外占位病变均较少见，文献中多为个案报告。我科自８５年至９８年收治椎管内硬膜外占位病变１６例。均行手术治疗，无死亡，无恶化，疗效满意，报告如下：临床资料一般资料：本组１６例。男１３例，女３例，男女比为４．３∶１。年龄２１～６１岁，平均３６岁。病程１周至２５年。首发症状：神经根性痛８例，运动障碍４例，感觉异常３例，１例表现为腰骶部无痛性肿物。其它症状：膀胱和直肠功能障碍５例，性功…     

韩-薛-柯氏综合征放射治疗4例

韩-薛-柯氏综合征亦称黄色瘤性肉芽肿,临床上较少见。我院自1975年开院以来共收治4例,现报告如下。 临床资料:男女各2例,年龄4～6岁,病程6～18个月,平均13.5个月。症状体征:尿崩症4例,头颅肿块3例,其中1例B超发现单侧眼球后占位性病变,单发突眼1例,头痛、干咳、发育迟缓各1例。实验室检查血色素低于7g者2例,X线查,4例均有颅骨骨质缺损,单发和多发各2例,其中顶骨缺损3例,颞骨、额骨各2例,枕骨及蝶鞍各1例;缺损缘均清晰,1例出现强化缘,形如地图状者3例,不规则者1例。此外,1例胸片显示肺门     

CT 引导下食管占位穿刺活检的临床应用及安全性评估

目的：研究 CT 引导下穿刺活检在食管占位性病变中的临床应用价值及安全性。方法经 CT 引导下穿刺活检确诊的食管占位病变患者26例，影像学检查提示食管占位性病变，食管镜无法取材或取材不满意，均经 CT 引导下穿刺活检取材后送病理检查。结果26例患者均取得明确诊断，病理提示食管平滑肌瘤14例，食管癌患者11例，淋巴瘤患者1例。其中19例患者（平滑肌瘤14例，食管癌5例）明确诊断后行外科手术切除，穿刺病理与术后病理一致。安全性：26例患者中2例穿刺术后出现肺野内少量出血，对症药物治疗后稳定，无严重并发症出现。结论 CT 引导下食管占位穿刺活检在食管疾病的临床诊断中具有重要价值，且安全性较高。     

肾上腺少见占位性病变的CT表现

 目的 探讨肾上腺少见占位性病变的CT表现特点。方法 回顾性分析10例经病理证实的肾上腺少见占位性病变的CT资料。结果 10例中，右肾上腺皮质癌2例，右肾上腺神经鞘瘤1例，左肾上腺节细胞神经瘤1例，多发内分泌肿瘤Ⅰ型1例，左肾上腺区巨淋巴结增生症1例，肾上腺髓样脂肪瘤3例4个病灶，右肾上腺囊肿1例。结论 不同的肾上腺少见占位性病变，CT诊断难易不同，囊肿及髓样脂肪瘤，易于诊断；肾上腺皮质癌CT表现提示其为恶性；其他少见病变定性诊断困难。但均有一些价值大小不等的CT特点，CT平扫加动态增强扫描有重要价值     

微小肝癌的诊断和处理

通过通肝脏实质性小占位的临床研究，探讨微不肝癌的诊断及处理原则。方法１９８３－１９９６年２８例结节直径≤２ｃｍ的肝脏实质性小占位病变，共３４个病灶。首诊后行手术切列，１９９个病灶；ＴＡＥ治疗６例，７个病灶；首诊后未治行ＡＦＰ＋Ｂ眼随访８例。     

上颌窦占位病变的CT诊断

目的　评价上颌窦占位病变的 Ｃ Ｔ 表现,探讨其 Ｃ Ｔ 诊断与鉴别诊断的价值。方法　收集手术病理诊断的上颌窦占位病变１０２ 例。术前经 Ｃ Ｔ 平扫加增强,全部病例行轴位扫描,部分病例加用冠状位扫描。结果　上颌窦囊肿３４ 例,息肉增生 ２９ 例,恶性肿瘤 ２０ 例（鳞癌 １５ 例、囊腺癌４ 例、恶性淋巴瘤 １ 例）,乳头状瘤 １２ 例,骨化性纤维瘤３ 例,骨瘤和曲菌感染各２ 例。与病理对照, Ｃ Ｔ 诊断正确率为８５．３％ （８７／１０２）,误诊率为１４．７％ （１５／１０２）。结论　上颌窦占位病变由多种疾病引起,对大多数有典型 Ｃ Ｔ 表现者能够作出定位、定性诊断,对部分不同病变而 Ｃ Ｔ表现相似者定性困难,除轴位扫描外,应加用冠状位扫描,穿刺活检也是必不可少的。     

少见成人腹部淋巴管瘤的CT表现及临床特点

目的:对成人腹部淋巴管瘤的临床资料、CT表现进行分析,结合文献对其进行总结、讨论,以提高其术前诊断正确率。方法:回顾性分析5例经手术病理证实的罕见腹部淋巴管瘤的CT表现及临床资料,总结其诊治要点。结果:5例病变中,女性4例,男性1例,发病年龄37～59岁（平均51.6岁）。2例患者无明显临床症状而在体检时发现,其余3例均以腹部包块伴或不伴腹痛、腹胀为首发症状。3例患者存在腹部手术史,2例分别伴有外伤及输血史。病变体积均较大,最大径从4.3～33cm不等。呈爬行性或塑形生长,边界尚清,表现为不同程度的占位效应致使临近组织结构受压移位。病变呈囊性者2例;囊实性者1例,其内可见线样钙化影;实质性者2例,病变周围可见清晰的包膜结构环绕。增强扫描病变部分示病灶囊壁及包膜轻度强化,部分病灶未见明显强化成分。病理证实4例为囊性淋巴管瘤,1例为海绵状淋巴管瘤,其中1例来源于脾脏,3例位于腹腔,1例位于腹膜后。确诊后均经手术完整切除,术后3年未见复发。结论:淋巴管瘤是成人腹部极少见的占位性病变,CT平扫及增强检查能够提供较多的诊断信息,根据其CT图像及临床资料特点,尤其是当患者有明确手术及外伤史,且病变为囊性并呈“爬行性生长”、临床出现巨大占位与轻微占位效应不相称时,首先考虑囊性淋巴管瘤的诊断,并在与腹部其他病变甄别后常可做出正确诊断。     

后颅凹占位性病变CT影像学探讨

收集１１７例经手术和病理证实的后颅凹占位病变病例，其中肿瘤１１４例，囊肿３例。髓母细胞瘤、星形细胞瘤及室管膜瘤多发生于青少年。小脑桥脑角好发听神经瘤、脑膜瘤、胆脂瘤，往往有四脑室侧移和后移。小脑蚓部好发髓母细胞瘤，占８２．４％，可引起四脑室前移。四脑室好发室管膜瘤，占８０％，引起四脑室扩大。小脑半球好发血管母细胞瘤、星形细胞瘤及多胶母细胞瘤、转移瘤，往往引起四脑室侧移及前移。后颅凹各种占位性病变都有ＣＴ影像学特征。可依据症状，与四脑室之间的关系，多可准确定位及定性诊断，本文定位诊断符合率为８９．７％。定位诊断准确率提高，可进一步提高定性诊断准确率。     

影像引导下经皮胰腺占位性病变穿刺活检临床实践

目的:探讨CT或B超图像引导下经皮胰腺占位性病变穿刺活检的临床应用价值。方法:194例经B超或核磁共振/CT检查发现胰腺占位的患者接受CT或B超影像引导下经皮胰腺占位性病变穿刺活检。对取得的组织标本进行病理学检查。结果:CT引导下穿刺90例,平均穿刺次数为2.8次;B超引导下穿刺104例,平均每例穿刺2.3次。总的穿刺活检诊断准确率为97.9%(190/194)。病理诊断为胰腺恶性病变172例(90.5%),其中导管腺癌160例、囊腺癌和黏液腺癌各4例、恶性间质瘤和非霍奇金淋巴瘤各2例;良性病变18例(9.5%,18/190),其中浆液腺瘤4例、黏液腺瘤和结核各2例、慢性炎性疾病和假性囊肿各5例。术后,40例(20.6%)患者出现上腹痛(中度10例,轻度30例),160例(82.5%)患者出现过性血淀粉酶升高;未发生其他严重并发症。结论:CT或B超图像引导下经皮胰腺占位性病变穿刺活检是种准确率较高的临床诊断方法,定位精确且安全性较高。     

Recurrent orbital space-occupying lesions: a clinicopathologic study of 253 cases

Objective

To analyze the clinical features, histopathologic classification and frequencies of various types of recurrent orbital space-occupying lesions.

Methods

A retrospective study was carried out in 253 consecutive patients with recurrent orbital space-occupying lesions treated by surgical excision in the Institute of Orbital Diseases, the General Hospital of the Armed Police Force from January 2009 to December 2010.

Results

The patients included 123 males and 130 females aged 2 to 78 years (mean, 36.2 years), and the last recurrence interval after operation ranged from 1 month to 40 years (median, 4.75 years). Of all the cases, 159 (62.8%), 65 (25.7%), 20 (7.9%), 8 (3.2%) and 1 (0.4%) had previously experienced once, twice, three, four and six times of surgeries, respectively. Among them, 29 (11.5%) cases had recurred 3 times or over, and 37 (14.6%) cases got recurrence in 10 or more years postoperatively. Most of the patients with local recurrence presented with various clinical manifestations, while 31 (12.3%) cases were symptom-free. Two hundred and thirty-one (91.3%) cases underwent surgical removal of the recurrent orbital lesions, and another 22 (8.7%) cases had to receive the exenteration of orbit. Categories of these recurrent orbital lesions after operation were as follows: lacrimal gland tumors, 65 (25.7%) cases; vasogenic diseases, 54 (21.3%) cases; neurogenic tumors, 42 (16.6%) cases; secondary tumors, 24 (9.5%) cases; orbital inflammation, 21 (8.3%) cases; myogenic tumors, 14 (5.5%) cases; fibrous and adipose tumors, 12 (4.7%) cases; lympho-hematopoietic tumors, 7 (2.8%) cases; bone or cartilage tumors, 7 (2.8%) cases; orbital cysts, 6 (2.4%) cases; and indefinitely differentiated tumor, 1 (0.4%) case. The 10 top histopathologic diagnoses were lacrimal gland pleomorphic adenoma, hemangiolymphangioma, lacrimal gland adenoid cystic carcinoma, meningioma, inflammatory pseudotumor, neurofibroma, sebaceous gland carcinoma, vascular malformation, rhabdomyosarcoma and hemangioma.

Conclusions

The variety of recurrent orbital lesions after operation includes mainly of tumors except for vascular malformation and orbital inflammatory lesions. The lacrimal gland epithelial tumor is most prone to relapse after resection, and early and longer-term postoperative follow-up is needed.Key Words: Orbital space-occupying lesions, recurrence, lacrimal gland epithelial tumor, vascular malformation, orbital inflammatory lesions     

Comparison of 18FDG-PET with CT scans in the evaluation of patients with residual and recurrent Hodgkin's lymphoma

The reliable assessment of residual masses after treatment as well as of new lesions suspected for relapse remains a diagnostic problem in patients with Hodgkin's disease (HD). The current study compares the results obtained by CT scan to FDG-PET imaging in a blind analysis with respect to the viability of residual masses and in case of suspected relapse. Between 1/94 and 10/99, 47 comparisons of PET and corresponding CT scans - 26 comparisons in 24 patients with residual tumors and 21 comparisons in 20 patients with suspected relapse of HD - were evaluated by independent reviewers blinded to he results of each other. Patients with primary diagnosis had been treated within trials of the German HD Trial study group. Relapsed patients received intensified salvage chemotherapy regimens. PET was assessed visually and by quantifying glucose uptake (SUV). Changes in size of tumor lesions as well as contrast medium enhancement served as criteria for assessment by CT scans. Results were validated either by histologic examination of a resected mass or biopsy (n=17) or by a clinical follow-up over 6 months following treatment (n=30). In 26 cases with residual lesions FDG-PET showed an increased tracer uptake in 8, 7 of which were true positive (TP) and 1 false positive (FP). Eighteen cases were classified as being negative (no viable HD), 17 true negative (TN) and 1 FN. In the blinded reading of the corresponding CT scans, 10 cases with residual lesions were considered to contain vital lymphoma (2 TP, 8 FP). Sixteen CT scans were classified as negative (10 TP, 6 FN). The resulting sensitivity and specificity of PET were 87.5% and 94.4% in contrast to only 25% and 56% for CT scans. The positive and negative predictive values of PET and CT scans were 87.5% and 94.4% and 20% and 62.5%, respectively. In patients with suspected relapse, sensitivity and positive predictive value for the diagnosis of the relapse were 100% and 86%, respectively, yielding the same results for both methods. FDG-PET performed in HD patients with residual masses appears to offer important additional information regarding the presence of viable HD in these residual lesions. In patients with suspected relapse of HD, FDG-PET seems not to offer any information over CT scans. Using SUVs is not superior to visual assessment of PET alone.     

CT导引经胸壁穿刺活检的临床研究(附55例分析)

对５５例患者的ＣＴ导引经胸壁穿刺活的方法学和临床价值进行评估。方法采用２０ｇ改良抽吸针和１８ｇ自动切割针两种活检针在ＣＴ导下行活检,所有５５例均作了病理组织学检查,其中２５例作了细胞学检查。     

眼眶淋巴瘤的CT和MR影像特点

目的:探讨眼眶淋巴瘤的CT和MR影像特点,为临床提供更多有价值的影像学信息。方法:　回顾性分析9例（共10眶）经病理诊断明确的眼眶淋巴瘤的CT及MR影像学表现,包括病变的位置、形态、密度及信号,强化方式及其与邻近结构的关系。 结果:　纳入10眶病例的临床表现主要以眼球突出、眼睑肿物为主;纳入10眶病变中跨越2个区域或以上的有7眶;7眶为弥漫型,3眶为局限型;CT密度以同层面眼外肌密度为参照均为均质稍高密度,增强扫描呈均质（1眶）或不均质（3眶）中等强化;MR同样以同层面眼外肌为参照,病变为均质T1WI呈等、稍低信号,T2WI呈稍高信号;眼外肌有两个或以上受累者有6眶。结论:　眼眶淋巴瘤影像学表现有一定的特征性,好发于眶隔前区及泪腺区,病变密度及信号均匀,增强扫描呈轻至中度强化,可以为临床诊断及治疗提供重要的参考价值。     

PET/CT显像在妇科恶性肿瘤术后复发及转移中的临床应用价值

目的:探讨正电子发射断层显像(PET/CT)在诊断妇科恶性肿瘤术后复发与转移中的临床应用价值。方法:回顾性分析2015年1月至2016年12月,在我中心行PET/CT检查的56例妇科恶性肿瘤术后患者的全身PET/CT的显像结果,确诊依据为术后病理结果、血糖类抗原125（CA125）持续升高水平和临床随诊结果,评价PET/CT对妇科恶性肿瘤术后复发、转移的诊断效能。结果:56例患者中,经病理结果、血CA125持续升高水平、临床随诊结果证实,肿瘤复发及转移者25例,没有复发、转移者26例,假阳性者3例,假阴性者2例,PET/CT显像在妇科恶性肿瘤术后复发及转移的灵敏度、特异性、准确率分别为92.6%（25/27）、89.7%（26/29）、91.1%（51/56）;转移灶分为阴道残端、全身淋巴结、远处器官转移,PET/CT显像对各转移灶的灵敏度及特异性分别为87.5%(7/8)和97.9%(47/48)、95.0%（19/20）和91.7%（33/36）、91.3%（21/23）和90.9%（30/33）;PET/CT显像发现全身多部位、多器官转移的6人,改变了临床分期及治疗方案。结论:PET/CT显像对妇科恶性肿瘤术后复发及转移的诊断,具有较高的灵敏度和特异性,对肿瘤术后复发及转移的临床分期及治疗方案的确定具有非常大的指导意义。     

Prospective study on the expression of cancer testis genes and antibody responses in 100 consecutive patients with primary breast cancer

To determine the expression of cancer testis (CT) genes and antibody responses in a nonselected population of patients with primary breast cancer, we investigated the composite expression of 11 CT genes by RT-PCR in fresh biopsies of 100 consecutive cases of primary breast carcinoma and by immunohistology in selected RT-PCR-positive cases. Antibody responses against 7 CT antigens were analyzed using recombinant antigen expression on yeast surface. In 98 evaluable cases, SCP-1 and SSX-4 were expressed most frequently (both 65%), followed by HOM-TES-85/CT-8 (47%), GAGE (26%), SSX-1 (20%), NY-ESO-1 (13%), MAGE-3 (11%), SSX-2 (8%), CT-10 (7%), MAGE-4 (4%) and CT-7 (1%). One CT gene was expressed by 90% of the cases; 79% expressed > or =2, 48% > or =3, 29% > or =4, 12% > or =5, 6% > or =6, 3% > or =7, 2% > or =8 and one case coexpressed 9 antigens. Of 100 serum samples screened for CT antigen-specific antibodies, antibodies against NY-ESO-1 were detected in 4 patients, against SCP-1 in 6 patients and against SSX-2 in 1 patient, while no antibodies were detected against MAGE-3, CT-7 and CT-10. Expression of CT genes or antibody responses was not correlated with clinical parameters (menopausal status, tumor size, nodal involvement, grading, histology and estrogen receptor status) or the demonstration of CT gene expression at the protein level, by immunohistology. Our results show that breast carcinomas are among the tumors with the most frequent expression of CT antigens, rendering many patients potential candidates for vaccine trials.     

18 F-FDG PET/CT、CT评价肝细胞肝癌TACE治疗后密实碘油病灶的价值

目的：探讨18 F-FDG PET/CT、CT在肝细胞肝癌TACE治疗后密实碘油病灶的临床价值。方法：经临床或病理确诊的26例肝细胞肝癌,TACE治疗后,分析18 F-FDG PET/CT对密实碘油病灶的判断结果,并与同期常规CT对比。结果：26例共112个碘油密实病灶,经病理、临床随访、动脉造影证实存活病灶11个,肿瘤坏死或抑制101个。常规CT诊断全部112个病灶为肿瘤抑制、肿瘤存活为0个病灶,准确率90．2%。18 F-FDG PET/CT诊断肿瘤坏死或抑制103个病灶、肿瘤存活为9个病灶,准确率97．3%。2组比较差异有统计学意义（ P〈0．01）。结论：评价肝细胞肝癌TACE治疗后密实碘油区肿瘤状态,18 F-FDG PET/CT优于常规CT,能为进一步联合治疗提供依据,有重要的临床价值。     

原发性胆囊癌误诊分析

目的分析原发性胆囊癌误诊原因,探索有效的预防措施。方法我院1995年1月至2006年5月共收治原发性胆囊癌患者46例,对其临床资料进行回顾性分析。结果术前明确诊断14例(占30.4%)。误诊32例(占69.6%),术中误诊6例(占13.0%)。合并胆囊结石者18例(占39.1%),胆囊息肉样病变8例(占17.4%)。术前诊断为胆囊结石、胆囊炎21例(占45.7%)。超声检查阳性率43.5%,CT检查阳性率66.7%,螺旋CT增强检查阳性率83.3%。结论误诊原因并发胆囊其它疾病;缺乏特异性临床表现,对发病情况认识不足;过分依赖影像学检查;术中对可疑病灶未做冰冻病理检查。预防措施熟悉胆囊癌的临床特点;可疑病例术前需完善检查;积极手术治疗癌前病变;术中可疑病灶应做冰冻病理检查。     

多排螺旋CT血管造影对冠状动脉-肺动脉瘘的诊断价值

目的:探讨冠状动脉CT血管造影(CCTA)对冠状动脉-肺动脉瘘(CPAF)的诊断价值.方法:回顾性分析21例CPAF患者的CCTA影像学表现和临床资料.结果:21例CPAF患者,其中2例行64排CT、19例行256排CT检查.CPAF单一瘘管15例、多发瘘管6例.CPAF起自右冠状动脉4例、左冠状动脉12例、起自两者5例.伴有动脉瘤形成7例.结论:CCTA可无创、准确地显示CPAF的起源血管及走行、动脉瘤和瘘口大小等重要信息,可作为诊断CPAF的首选方法.