肺软骨瘤样错构瘤二例误诊为肺癌

【例1】女,47岁。因反复右上腹及胸背部疼痛,B超检查示胆结石、胆囊炎入院行胆囊切除术,术前常规摄X线胸片示右肺下叶占位性病变?疑诊结核球或肺癌?行磁共振扫描示右肺下叶后基底段占位性病变,结合临床符合良性占位性病变表现;术前痰脱落细胞学检查阴性。临床拟诊为肺癌,行右下肺叶切除术。术后切除标本送病理检查,大体检查见:肺叶全切标本中央有一3cm×3cm×3cm的肿物,质较硬,似软骨样,边界清。病理诊断:右肺下叶中段软骨瘤样错构瘤。术后痊愈出院。【例2】男,59岁。因患矽肺病多年,常规体检摄X线胸片时发现左肺下叶占位性病变,提示肺癌…     

右上肺肺隔离症误诊为肺肿瘤

目的提高临床医生对肺隔离症的认识,减少误诊。方法对我院确诊1例右上肺肺隔离症的临床资料进行回顾性分析。结果本例因咳嗽、咳痰伴胸痛就诊,CT检查示右上肺阻塞性炎症伴肺不张,经抗感染治疗1周无效,以肺占位性病变性质待查行手术探查。术中见右肺上叶肿块与胸膜顶粘连,右肺上叶萎缩,右肺上叶支气管开口处未发现肺动脉分支、肺上叶静脉及支气管,行右肺上叶全切术。术后病理诊断:右上肺肺隔离症(叶内型)。结论肺隔离症临床表现无特异性,发生于右上肺者罕见,螺旋CT增强扫描三维重建可显示异常供血动脉,为诊断本病的首选方法。     

临床罕见的肺前肠囊肿病例报告

目的分析肺前肠囊肿的临床病理特点及影像学表现,提高诊断水平。方法对我院收治1例肺前肠囊肿临床资料进行分析总结。结果患儿因右胸疼痛并间断咯血查X线胸片及CT扫描示:右肺上叶可见大片高密度影,内有空洞影;纤维支气管镜检查示:右肺上叶开口有一息肉样物,软骨环破坏。活检病理报告:支气管黏膜呈慢性炎,另见胃黏膜。临床诊断:肺内囊性病变,胃黏膜异位。行右肺上叶切除术,术后病理检查诊断:支气管胃混合性前肠囊肿伴肺组织急慢性炎。结论前肠囊肿临床表现多与囊肿大小、周围器官受压程度有关,诊断主要依据CT和MR I检查,确诊需依靠手术病理检查。     

肺部平滑肌瘤5例分析

肺部平滑肌瘤是较罕见的肺良性肿瘤，我们两院30a间共经手术和病理确诊5例，报道如下。 1病历摘要 例1：女，10岁。主因咳嗽，痰中带血丝伴发热3个月人院。胸部X线示：右下叶薄壁囊性圆形阴影，内有块状阴影。支气管镜检查无阳性发现，行剖胸探查，右下肺叶切除术，术后病理证实诊断为右肺下叶平滑肌瘤。     

巨大肺错构瘤1例报告

1 病例报告 患者，男性，42岁，因胸闷、咳嗽3个月就诊。既往19年前体检时发现右肺下叶结节病灶约2cm×2cm，诊断肺良性肿瘤，未予治疗。每间隔几年行X线胸片检查，病灶进行性增大。本次住院后螺旋CT显示右下病灶11cm×10cm，增强后病灶不强化，CT值-2．9～64．9Hu，病灶内可见明显的“爆米花”样钙化灶。于2006年5月19日全麻下行开胸手术。术中见右胸腔广泛模样粘连，肿瘤位于右下叶背段肺表面，包膜完整，顺利地从肺组织中将其剥离，重量为360g。术后病理报告：肿瘤组织中由软骨、纤维、脂肪及支气管纤毛柱状上皮构成。病理诊断：软骨型错构瘤。     

喉癌合并肺癌的同时性多原发癌的治疗

目的探讨喉癌合并肺癌的同时性多原发癌(multiple primary cancers,MPC)的临床特点及诊治方法。方法对1例喉癌合并肺癌的同时性MPC的临床资料进行回顾性分析。结果本例因持续性声音嘶哑2个月入院。频闪喉镜检查示右侧声带见白色菜花状新生物;摄胸部正位X线片发现右下肺结节;胸部CT扫描示右下肺有一直径约1.5 cm的不规则软组织影,边缘可见毛刺,考虑恶性肿瘤可能性大。初步诊断:喉癌(T1N0M0),肺癌(T1N0M0),MPC。先后在全麻支撑喉镜下行CO2激光辅助右侧声带部分切除术和胸腔镜辅助下右肺下叶切除术,术后病理诊断:右侧声带鳞状细胞癌,右下肺中央型中-低分化鳞状细胞癌。术后恢复良好,现密切随访中。结论接诊喉癌患者应注意查找有无其他原发癌病灶,喉癌合并肺癌的MPC的治疗与第一原发癌相同,应及时行根治性手术治疗。     

肺动静脉瘘2例报告

病例1男,23岁,因“胸闷,气紧13年,唇、手指发绀4年”入院,RBC 7·56×109/L,Hb 192 g/L。入院后胸片示右下肺大片斑片影,并有较粗血管影与之相通,右下肺动脉增粗,考虑右下肺动静脉瘘(PAVF)。98年7月在全麻下行右肺下叶切除术,术中见右下肺动脉增粗,外膜增厚,管壁变薄,并有较多小分支。术后病检:右肺下叶血管畸形符合动静脉瘘改变。术后胸闷、气紧,紫绀等症状消失。病例2男,56岁,因“体检发现双肺多发性结节影1周”入院。否认咳嗽,气紧,咯血等症状,入院考虑转移性肺癌,但全面检查无肿瘤证据。肺CT(平扫)见双肺散在分布多个大小不等圆及…     

肺韧带处理方式对单侧右部肺癌行胸腔镜下右肺上叶切除术患者余肺代偿性膨胀的影响

目的探讨肺韧带的处理方法对胸腔镜下行右肺上叶切除术的肺癌患者的术后余肺代偿性膨胀情况的影响。方法选取肺癌行胸腔镜下右肺上叶切除术的患者98例,随机分为2组。观察组患者术中松解下肺韧带,对照组患者则不松解。比较2组患者术后病理检查结果、手术时间与术后恢复情况、余肺膨胀情况。结果 2组患者手术时间、术后引流量、引流时间与平均住院时间比较,差异无统计学意义(P0.05)。观察组患者术后7 d内余肺膨胀情况优于对照组。结论胸腔镜下行右肺上叶切除的肺癌患者在手术中松解下肺韧带对术后余肺代偿性膨胀有积极影响。     

B超诊断大叶性肺炎1例

患者女 ,12岁。因高热、胸闷伴呼吸急促 3天就诊 ,查体 :体温 40 .5℃ ,呼吸 2 4次 /分 ,右下肺叩浊 ,呼吸音低 ,无罗音 ,临床疑诊为右侧胸腔积液 ,为穿刺抽水治疗行 B超检查。B超示右下肺组织内气体几乎消失 ,仅在大气管中有散在点状存留 ,右下肺呈实性回声 ,尚均匀 ,其回声光点较肝回声稍粗 ,可见有细的血管回声 ,整个图像类似肝回声 ,肺底及肺周有液性回声 ,最深处约 1.5 cm (图 1) ,B超诊断右肺下叶大叶性肺炎 ,右胸腔积液。次日拍 X线胸片 ,诊断为右下肺大叶性肺炎 ,右胸腔积液 (中量 )。讨论 :正常肺组织因含气而影响 B超诊断 ,但大…     

肺错构瘤误诊1例

男,70岁.主因膀胱癌术后2 a,胸部X线检查发现右肺占位1 d入院.查体：一般情况好,浅表淋巴结未及肿大,心肺无异常,小腹部正中见一长约10 cm的竖形手术瘢痕,肝、脾无肿大.胸部CT检查：右肺下叶背段见一类圆形高密度影,直径约2 cm,边界清楚,纵隔淋巴结无肿大.诊断考虑：（1）肺转移癌;（2）原发肺癌;（3）肺良性疾病.即给予CAP方案抗癌治疗1周期,3周后复查胸片,病灶无变化;又予静点青霉素同时口服三联抗结核治疗,2周后再次复查胸片,右肺病灶仍无变化.遂于2003-01-09剖右胸探查,发现肿瘤位于下叶背段内,质硬、光滑、界清、可推动,行肿瘤剔除术.术后病理诊断：右肺下叶错构瘤.     

Post‐partum blues among Korean mothers: A structural equation modelling approach

The objective of this study was to propose the post‐partum blues (PPB) model and to estimate the effects of self‐esteem, social support, antenatal depression, and stressful events during pregnancy on PPB. Data were collected from 249 women post‐partum during their stay in the maternity units of three hospitals in Korea using a self‐administered questionnaire. A structural equation modelling approach using the Analysis of Moments Structure program was used to identify the direct and indirect effects of the variables on PPB. The full model had a good fit and accounted for 70.3% of the variance of PPB. Antenatal depression and stressful events during pregnancy had strong direct effects on PPB. Household income showed indirect effects on PPB via self‐esteem and antenatal depression. Social support indirectly affected PPB via self‐esteem, antenatal depression, and stressful events during pregnancy.     

罕见表型的8p11骨髓增殖综合征的特征

目的:提高对罕见表型的8p11骨髓增殖综合征(eight p11 myeloproliferative syndrome,EMS)临床表现、实验室检查特征、诊断及治疗的认识.方法:总结1例罕见累及T/B/髓三系的EMS病例临床、实验室特征及接受异基因造血干细胞移植治疗过程,同时结合既往文献报道的2例类似病例进行讨论.结...     

血管瘤样纤维组织细胞瘤临床病理观察

目的探讨血管瘤样纤维组织细胞瘤(AFH)的临床病理特征。方法对1例发生于左肩的血管瘤样纤维组织细胞瘤的临床表现、组织形态、免疫组化等进行分析,并复习相关文献。结果患者男性,19岁。左肩部缓慢生长的无痛性肿块。镜检:瘤细胞为增生的组织细胞样细胞或肌样细胞,可见含铁血黄素颗粒和假血管样腔隙、较厚的纤维性假包膜和周围淋巴细胞浆细胞浸润。免疫组化:vimentin、CD57和CD99均(+),SMA、CD68和结蛋白部分(+),CD21、CD31、CD34、CD117、CKpan、S-100、calponin和synaptophysin均(-)。结论血管瘤样纤维组织细胞瘤是一种罕见的低度恶性中间型肿瘤,临床上易与血肿、血管瘤混淆。其诊断主要靠病理形态学特征,免疫组化标记有助于诊断与鉴别诊断;肿块局部扩大切除,必要时可局部放疗,术后随访尤其重要。     

Comparing self-report, clinical examination and functional testing in the assessment of work-related limitations in patients with chronic low back pain

Purpose. To compare the work-related limitations assessed using self-report, clinical examination and functional testing in patients with chronic low back pain (CLBP).

Methods. Work-related limitations of 92 patients were assessed using self-report, clinical examination and functional testing. To obtain the assessed limitations the patient (self-report), the physician (clinical examination) and a trained evaluator (functional testing) completed a scorings form about the work-related limitations of the patient. The Isernhagen Work Systems Functional Capacity Evaluation (IWS FCE) was used to obtain the functional testing results. A κ value of more than 0.60, absolute agreement of more than 80% and ICC of more than 0.75 were considered as acceptable.

Results. Little agreement and correlation among self-report, clinical examination and functional testing were found for the assessment of work-related limitations. Self-reported limitations were considerably higher than from those derived from clinical examination or functional testing. Additionally, the limitations derived from the clinical examination were higher than those derived from the IWS FCE.

Conclusion. Comparing self-report, clinical examination and functional testing for assessing work-related limitations in CLBP patients showed large considerable differences in limitations. Professional health care workers should be aware of these differences when using them in daily practice.     

特发性肾脏替代性脂肪瘤(附1例报告并文献复习)

目的探讨特发性肾脏替代性脂肪瘤(RRL)的临床特点、诊断和治疗方法。方法回顾性分析1例肾脏替代性脂肪瘤患者的临床资料。男性,48岁,体检发现左肾占位入院,超声提示左肾实质破坏,肾盂内强回声团伴声影,左肾被高回声软组织影包裹。CT提示左肾占位,可见明显负值,无明显强化,肾盂内可见高密度影,肾实质不均匀破坏。结果患者行手术治疗,术中探查见左肾被巨大脂肪组织包裹,行肾脏切除术。病理所见患肾皮质高度萎缩,肾脏体积明显增大,肾脏被过度增生的脂肪纤维组织所替代,光镜下可见到大量异常肥大的脂肪细胞。患者术后1周痊愈出院,随访18个月未见肿物复发转移。结论 RRL临床极为罕见,目前国内外文献仅见少数个案报道。RRL需要与慢性感染性肾脏疾病、脂肪瘤、脂肪肉瘤、血管平滑肌脂肪瘤和畸胎瘤等含有脂肪组织的肾脏肿瘤、黄色肉芽肿性肾盂肾炎、肥胖及Cushing综合征等疾病相鉴别。治疗以手术为主,通常需要行肾脏切除术。     

Comparing self-report,clinical examination and functional testing in the assessment of work-related limitations in patients with chronic low back pain

Purpose.?To compare the work-related limitations assessed using self-report, clinical examination and functional testing in patients with chronic low back pain (CLBP).

Methods.?Work-related limitations of 92 patients were assessed using self-report, clinical examination and functional testing. To obtain the assessed limitations the patient (self-report), the physician (clinical examination) and a trained evaluator (functional testing) completed a scorings form about the work-related limitations of the patient. The Isernhagen Work Systems Functional Capacity Evaluation (IWS FCE) was used to obtain the functional testing results. A κ value of more than 0.60, absolute agreement of more than 80% and ICC of more than 0.75 were considered as acceptable.

Results.?Little agreement and correlation among self-report, clinical examination and functional testing were found for the assessment of work-related limitations. Self-reported limitations were considerably higher than from those derived from clinical examination or functional testing. Additionally, the limitations derived from the clinical examination were higher than those derived from the IWS FCE.

Conclusion.?Comparing self-report, clinical examination and functional testing for assessing work-related limitations in CLBP patients showed large considerable differences in limitations. Professional health care workers should be aware of these differences when using them in daily practice.     

超声误诊为乳腺Paget病的乳头腺瘤的诊断学特征并文献复习

目的探讨超声不典型表现的乳头腺瘤(NA)的临床误诊原因及诊断学特征。 方法回顾性分析2020年7月17日皖南医学院第一附属医院普外科收治的1例NA患者的临床资料，并进行文献复习。 结果患者女性，29岁，2个月前因左乳头肿物行"左乳头肿物切除术"，术后病理示左乳头乳头状瘤病，术后因切口反复破溃入院，体格检查发现左侧乳头皮肤破裂，无明显渗出，双侧腋窝未见肿大淋巴结。超声检查显示左侧乳头增大，血流信号丰富，考虑乳腺Paget病。术后病理诊断为NA，病理镜下：肿瘤为腺性结构且位于真皮内，导管上皮呈乳头状或腺瘤样增生。免疫组织化学染色示腺上皮低分子质量细胞角蛋白(CAM 5.2)阳性，p63阳性，基底细胞角蛋白5/6(CK 5/6)阳性，肌上皮平滑肌肌动蛋白(SMA)阳性，Ki-67阳性，人类表皮生长因子受体2(HER-2)阴性，抑癌基因p53阴性。 结论NA极易被误诊为乳头乳头状瘤病和乳腺Paget病。超声检查可以为诊断NA提供帮助，但在某些情况下，单纯通过超声检查很难做出正确诊断，应通过病理检查和免疫组织化学染色确诊。     

血液常规检测幼稚粒细胞的临床价值

目的通过1例急性非淋巴细胞白血病病例,探讨血常规检测幼稚粒细胞（IG）对临床诊断的重要性。方法通过血常规检测IG升高或仪器有IG报警信息,对其进行推片染色镜检,观察是否有幼稚细胞存在。结果患者3次检查血常规,仪器均提示患者IG的计数、比例升高,同时该患者外周血白细胞计数减少,但淋巴细胞比例呈进行性上升趋势。患者经临床普通抗病毒治疗病情一直未见缓解,检验员根据患者IG持续升高的表现做了外周血涂片检查,镜检观察到大量IG,后建议临床行骨髓穿刺,查骨髓象确诊患者为急性非淋巴细胞白血病,及时避免了误诊。结论通过血常规检测有效筛选IG升高或有IG报警的样本,可及时发现白血病,对诊断白血病有重要作用。     

罕见的肾管状囊性癌一例临床分析

目的探讨肾管状囊性癌的临床及病理特征。方法对1例肾管状囊性癌的诊治过程进行回顾性分析，并复习相关文献。结果患者因体检发现右肾占位3周入院。以“右。肾占位性质待查”收住泌尿外科，行右肾肿瘤剜除术，完整切除肿瘤，术后病理检查确诊为。肾管状囊性癌；免疫组织化学染色：CK7（＋＋＋），Ckpan（＋＋＋），P504S（＋＋＋），Vim（＋＋＋），Ki-675％（＋）。术后予干扰素及白细胞介素治疗，随访10个月无复发及转移。结论肾管状囊性癌是一种罕见的肾脏肿瘤，无特异性临床表现，主要依靠病理学及免疫组织化学检查确诊。手术切除为其主要治疗方法。     

颅内结核误诊为颅内转移性恶性肿瘤一例

目的 探讨颅内结核的临床特点,分析其误诊原因并提出防范措施.方法 回顾性分析颅内结核误诊为颅内转移性恶性肿瘤1例的临床资料.结果 本例因低热、腹痛3个月,右侧肢体无力、言语不清1个月入院.外院正电子发射计算机断层显像（PET）-CT提示右半结肠癌伴双肺转移、脑转移.予相应治疗后无好转来我院,经影像学检查、脑脊液检查、结核杆菌DNA检测后确诊为结核性脑膜炎、肺结核、肠结核,予全身抗结核、脑脊液置换及对症治疗后,病情好转出院.结论 对于颅内结核,临床医生应认真仔细询问患者病史和细致查体,并及时行脑脊液检查和结核分枝杆菌DNA检测,以避免误诊的发生.