距骨骨内脂肪瘤员例

患者,女,41岁,因右踝关节酸痛3个月入院.患者3个月前无明显诱因出现右踝关节酸痛,行走时明显,休息时能缓解,3个月来症状逐渐加重,遂来院就诊,无发热、消瘦、夜间痛等.既往体健,右踝关节无明确外伤史.体格检查:全身浅表淋巴结未触及异常肿大,心肺腹部检查未见异常,右踝无畸形,无明显肿胀,无浅表静脉怒张,皮温正常,右踝关节前方压痛,关节活动度正常.     

跟骨内脂肪瘤1例

患者,女,43岁。左踝外伤后发现左跟骨病灶9d入院。入院后查体：左外踝中度肿胀、无皮下淤血、青紫、无皮肤破溃,压痛（＋）,跟骨触之无包块,压痛（-）,叩击痛（-）,左踝关节活动好,左足背动脉搏动清晰,     

骨内脂肪瘤的影像学表现及其诊断价值

目的探讨骨内脂肪瘤的X线、CT及MRI的影像学表现特点及其诊断价值。方法收集经病理证实或影像学结合临床诊断的7例患者8个骨内脂肪瘤病灶资料,分析其影像学表现特征。结果 X线表现为边界清晰透亮区,形态不规则,1个病灶内可见钙化,2个病灶显示骨间隔,6个病灶边缘硬化。CT表现为单一脂肪密度2个病灶,以脂肪为主混杂密度5个病灶,4个病灶有轻度膨胀感,4个病灶显示骨嵴或分隔,5个病灶内见钙化或骨化,6个病灶边缘有硬化。MRI表现出脂肪组织特征性的短T1长T2信号,同时脂肪抑制序列呈低信号,合并钙化、纤维化、黏液样变及坏死则信号混杂。均未见骨皮质破坏、骨膜反应或软组织肿块。结论骨内脂肪瘤的影像学表现多种多样,但均含有特征性的脂肪成分,病灶内钙化和病灶边缘硬化是其重要征象,X线诊断价值有限,CT和MRI依据含有特征性的脂肪成分,能正确诊断,避免不必要的穿刺或手术。     

多发性骨脂肪瘤一例报告

患者男, 54岁。因双下肢肿痛不适、畸形 18年入院。 24年前患者因车祸撞伤腰部,当地医院诊断为 L 1骨折并不全瘫。经手术治疗,患者双下肢感觉恢复,运动功能渐改善,可扶双拐行走。 18年前患者出现左大腿及右小腿肿痛,经中医外敷药物等治疗无效,渐出现畸形,卧床至今。查体：神志清,被动半卧位。右膝至小腿中下段呈膨胀性肿大畸形,表面压痛,肿物质硬,皮温不高,无血管曲张,膝关节固定于屈曲 30°位,小腿中下段向前呈垂直成角畸形。左大腿明显肿胀,呈短缩外旋畸形,压痛,髋关节固定于屈曲 20°位,膝关节固定于伸直位,双下肢…     

骨斑点症合并“骨中骨”1例

<正>患者男,45岁,身高153cm,因"外伤摄胸片发现骨骼异常"入院,既往无骨、关节相关临床症状。X线检查:胸腰椎各椎体内均见相似比例小椎体,后缘与大椎体共线,上下缘与大椎体上下缘平行,小椎体终板致密骨厚度稍大于大椎体(图1A);双肱骨头内见与关节弧度一致的粗大致密带,见大小不等斑点及条纹状致密骨影;双肩胛骨见点条状致密骨影;双膝关节股侧与胫侧内见与骨端形态相似、轮廓清楚、具有内外髁及髁间棘的小骨端,其下缘止于骨骺线痕,小骨端内可见斑点影,左侧见边缘硬化的小囊样透明区,其下缘邻近骨干见纵横交错略模糊     

胃肠道脂肪瘤及其并发症MSCT表现

目的探讨胃肠道脂肪瘤及其并发症的MSCT表现。方法回顾性分析258例MSCT检查发现胃肠道脂肪瘤患者的临床、病理及影像学资料,患者均接受MSCT平扫+增强扫描。结果258例中,单发230例(230/258,89.15%),多发28例(28/258,10.85%),共发现脂肪瘤296个。单发肿瘤以空肠近段最常见(81/230,35.39%),其次是十二指肠(69/230,30.00%),直肠最少(1/230,0.43%)。病变体积0.000 9~198.59cm~3,中位数[0.71(0.31,1.75)]cm~3。肿瘤CT值-258~-35HU,增强扫描均无强化。296个脂肪瘤中,圆形147个(147/296,49.66%),椭圆形111个(111/296,37.50%),不规则形17个(17/296,5.74%),条状20个(20/296,6.76%),锥形1个(1/296,0.34%)。肿瘤并发肠梗阻18例(18/258,6.98%),其中重度梗阻6例,中度5例,轻度7例。并发肠梗阻、并发肠套叠及无并发症的脂肪瘤体积分别为(55.22±20.64)cm~3、(20.54±16.22)cm~3和(11.24±8.97)cm~3(F=140.200,P0.001)。结论胃肠道脂肪瘤体积和CT值可能是引起继发性肠套叠和肠梗阻的主要风险因素。MSCT能准确评估胃肠道脂肪瘤及其并发症。     

胫骨骨内脂肪瘤1例

正患者,男,21岁,因"无明显诱因出现左小腿下段间歇性疼痛4年余"入院。患者于4年前长时间站立后出现左小腿下段疼痛,当时未行治疗,后症状逐渐加重,就诊于当地医院,行X线、MRI等检查,当时考虑病变较小,建议定期复查。2018年2月26日患者在剧烈运动后疼痛加重就诊我院。入院查体:左小腿远端前内侧压痛阳性,未触及肿块,局部皮肤无红肿、发热、破溃等异常,肢体远端足趾颜色红润、毛细血管反应良好,足背动脉可扪及。     

肾上皮样血管平滑肌脂肪瘤一例报告并文献复习

目的 探讨肾上皮样血管平滑肌脂肪瘤(EAML)的病理及影像学特点.方法 患者,男,47岁.左上中腹疼痛不适1年入院.查体左上腹部可扪及巨大质韧肿块,叩痛(+).CT检查左肾见一最大径约28 cm肿块伴腹主动脉旁多枚肿大淋巴结,增强后呈不均性中等度强化.平扫相对高密度;乏脂肪;强化方式呈"快进慢出".全麻下行根治性左肾切除及周围淋巴组织清扫术.检索Ovid和CBM数据库相关文献复习讨论. 结果病理检查:肿瘤包膜完整,来源于左肾中上部,不能与左肾完全分离;切面为鱼肉样组织,伴灶性坏死组织;镜下:密集分布的上皮样细胞,无脂肪组织;免疫组化染色黑色素瘤相关抗原(HMB-45)强阳性、上皮膜抗原(EMA)阴性.病理报告:左肾EAML伴腹腔淋巴结转移,输尿管残端、血管残端及肾周组织未见肿瘤浸润.术后随访1年肿瘤未见复发转移.结论 EAML是一种罕见的、有恶性潜能的问叶肿瘤,有一定的病理及影像学特点,预后相对较好.     

Intraosseous lipoma of the calcaneus

Abstract Intraosseous lipoma is rare and often misdiagnosed. A patient with intraosseous lipoma in the calcaneus is presented with conventional radiography, bone scintigraphy, magnetic resonance imaging and histological findings. The intention of this work is to show the diagnostic procedure of a rare bone tumor. Despite its benign nature, the tumor is often salvaged by surgery. However, a simple observation can avoid unnecessary surgical intervention and complication.     

Intraosseous lipoma: a clinical study of 12 patients

We studied 12 patients (13 bones) with intraosseous lipoma to elucidate the clinical features of this disease. The patients ranged in age from 14 to 54 years. Eleven patients were men and 1 was a woman. The involved bones were the calcaneus in 6 patients (7 bones), humerus in 3, ischium in 2, and sacrum in 1. Three bones were in Milgram's stage I, 8 were in stage II, and 2 were in stage III. On plain radiographs, all bones showed a well-circumscribed radiolucent area. Nine bones showed calcification or ossification. Computed tomography or magnetic resonance imaging showed low density or high signal intensity, respectively, identical to the findings in normal adipose tissue. The tumor was curetted in 3 patients (3 bones), in whom local recurrence was not seen thereafter. In the remaining 9 patients (10 bones), we observed the natural course; in 1 of these patients, incisional biopsy was performed. During the follow-up period, only 1 patient showed slight enlargement of the lesion, while the findings in the others remained unchanged. Three patients had pain, which disappeared after the surgery or during the course of the observation. Partly because intraosseous lipoma tends to undergo spontaneous involution, and partly because diagnosis is easy from the radiological findings, surgery does not seem to be necessary in most patients. Received: August 6, 2001 / Accepted: October 30, 2001     

Intraosseous lipoma: retrospective analysis of 29 patients

We reviewed 29 patients with intraosseous lipoma treated between 1985 and 2002. Mean patient age was 48 (20–75) years. According to Milgrams classification, ten cases were classified as stage I, 14 as stage II, and three as stage III. All patients were initially treated by curettage. In 11 cases an additional phenolization was performed. The average follow-up was 32 (6–208) months. At the last follow-up, none had any clinical or radiological signs of recurrence. The adequate treatment of a symptomatic intraosseous lipoma is curettage and bone grafting. In the current study, phenolization showed no added benefit. An asymptomatic intraosseous lipoma without impending pathological fracture can be treated conservatively.

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Résumé Nous avons examiné 29 malades avec un lipome intraosseux traité entre 1985 et 2002. Lâge moyen des malades était de 48 ans (20–75). Daprès la classification de Milgram, dix cas ont été classés comme stade I, 14 comme stade II, et trois comme stade III. Tous les malades ont été traités initialement par curetage. Dans 11 cas une phénolisation supplémentaire a été faite. Le suivi moyen était de 32 mois (6–208). Àu dernier examen aucun navait de signe clinique ou radiologique de récidive. Le traitement adéquat dun lipome intraosseux symptomatique est un curetage avec greffe osseuse. Dans cette étude, la phénolisation na montré aucun avantage supplémentaire. Un lipome intraosseux asymptomatique sans menaçe de fracture pathologique peut être traité dune manière conservatrice.

     

Intraosseous lipoma of the fifth metatarsal: a case report

Intraosseous lipomas are benign tumors of bone. Although the tumor may affect many different locations, small bone involvement is quite rare. The authors report a case of an intraosseous lipoma of the fifth metatarsal treated with curettage and packing with allograft. The clinical and laboratory features of the case are also discussed.     

Mediastinal lipoma: Report of a case

We experienced a case of mediastinal lipoma, which is considered to be a relatively rare disease. A 3-year-old girl was referred to Gifu University hospital because of fever and an abnormal shadow on her chest X-ray. The chest X-ray clearly showed a well-delineated tumor shadow which seemed to oppress the diaphragm and the right atrium in the right lower lung area. A computed tomogram (CT) of the chest showed a homogeneous mass localized on the right diaphragm and adjoining the right anterior chest wall and heart. The mass showed a fat density measuring about-100 HU. Magnetic resonance imaging (MRI) showed a high-intensity mass which was almost the same level as the subcutaneous fat on both the T₁-weighted and T₂-weighted images. Thoracotomy was performed and a fatty tumor was found. It arose from the right side of the pericardium and adjoined the diaphragm, the anterior chest wall, and the thymus. There was no adhesion between the tumor and the surrounding organs. It was resected easily and its contents were yellowish and homogeneous. The patient made an uneventful recovery and was discharged 10 days after the operation. Light microscopy showed a lipoma consisting of mature adipose tissue and no malignancy was found.     

脾脏单发肿瘤或肿瘤样病变的CT表现

目的探讨脾脏单发肿瘤或肿瘤样病变的CT表现。方法回顾性分析18例经手术病理证实的脾脏单发肿瘤或肿瘤样病变的临床表现及CT特点。结果 18例单发脾脏肿瘤或肿瘤样病变中,血管瘤2例,其中1例明显强化,1例边缘结节状强化;3例淋巴管瘤边缘及分隔轻度强化;3例较大窦岸细胞血管瘤动脉期明显强化,门静脉期逐渐均匀强化,延迟期强化与周围组织相仿,另2例边缘轻度强化;3例较大硬化性血管瘤结节样转化病灶内见"辐轮状钙化"及"辐轮状强化",另1例病灶内见液化坏死;1例上皮样血管内皮瘤平扫及增强无特征性改变;1例巨块型淋巴瘤动脉期可见"血管漂浮"征;2例淋巴瘤呈轻度均匀强化。结论 CT可较清晰地显示脾脏病灶的大小、形状、密度、边界及强化程度,对脾脏单发肿瘤或肿瘤性病变有较高的诊断价值。     

多层螺旋CT辅助术中判断胃癌浆膜侵犯的价值

目的探讨多层螺旋CT辅助术中判断胃癌浆膜侵犯的价值。方法回顾性分析2009年8月至2011年6月间中国医科大学附属第一医院收治的206例胃癌患者的临床资料。将术前CT和术中判断胃癌浆膜侵犯情况与术后病理对照．以比较术前CT与术中判断胃癌浆膜侵犯的诊断价值。结果术前CT和术中判断胃癌浆膜侵犯的敏感性分别为88．5％和98．9％,特异性分别为81．5％和61．3％．CT判断浆膜侵犯的准确率高于术中判断．但差异未达到统计学意义（84．5％比77．2％,P=0．060）。术中判断胃癌浆膜面为正常型、反应型、结节型、腱状型和多彩弥漫型者浆膜侵犯率分别为0（0／29）、2．5％（1／40）、40．5％（15／37）、59．2％（29／49）和82．4％（42／51）。对于浆膜呈腱状型表现者,术中判断胃癌浆膜侵犯的准确率为61．2％．明显低于术前CT的87．8％（P=0．002）。结论术前CT检查能够辅助术中判断胃癌浆膜有无侵犯．对浆膜呈腱状型的胃癌．手术医生应重视术前CT诊断。