直肠神经内分泌肿瘤的临床病理特点分析

Objective To analyze the clinicopathological characteristics of rectal neuroendocrine tumors (NETs) so as to improve their understanding and diagnosis. Methods The data of 62 rectal NETs patients were retrospectively analyzed to summarize their clinical characteristics. They were categorized into 3 types based on the level of histological differentiation. And the relationship of tumor size, histological type and metastases was examined. Results The clinical presentations of rectal NETs were atypical. The main clinical presentation was change in bowel habit (n = 43, 69.4%); Ten cases (16.1%) were asymptomatic. Nine cases were found during routine digital rectal examination. In 57 cases (91.9% ), the distance was within 8cm from anorectal line. All patients had single lesion without the presence of carcinoid syndrome. 25.8% ( 16/62 ) had colonic polyps while 16. 1% ( 10/62 ) synchronous colorectal adenocarcinomas. Except for synchronous colorectal adenocarcinomas (n = 10) , among 52 cases, there were 39 cases with tumor diameter ＜ 1 cm, the main type was type Ⅰ; 7 cases with tumor diameter ＞2 cm, the main types were types Ⅱ and Ⅲ. The metastatic rates in three groups with tumor diameter ＜ 1 cm, 1-2 cm and ＞2 cm were 0, 33.3% and 71.4% respectively. Conclusion The clinical presentations of rectal NETs are non-specific. Most cases are often single lesion without the presence of carcinoid syndrome. The clinical process and prognosis of rectal NETs are closely related to tumor size, histological type, the presence of lymph node metastases and liver metastases. The routine digital rectal examination is the simplest and most effectively way of diagnosing rectal NETs. Colonoscopy is important in diagnosing the synchronous cancers and conducting a follow-up.     

Ultrasonographic Characteristics of Intraductal Papillary Mucinous Neoplasm of the Pancreas

Objective To analyze the clinical and ultrasonographic imaging features of intraductal papillary mutinous neoplasm （1PMN） of the pancreas. Methods Twelve patients with IPMN underwent surgery between May 2005 and December 2008, including 4 （33.3%） with adenoma and 8 （66.7%） with adenocarcinoma. IPMN was classified preoperatively into 3 types based on sonographic findings of different sites： main duct, branch duct, and combined type. All clinical presentations and ultrasonographic findings of those paticnts were reviewed and the correlation be- tween ultrasonographic hndings and histopathological results was analyzed. Results There were 9 men and 3 women with a mean age of 60.1±9.6 years （range, 32-73）. OF all the 12 patients with IPMN, 9 （75.0%） had experienced some symptoms of epigastric discomfort and/or pain as cell as backache; 7 cases were with medical history of acute pancreatitis, 5 cases with diabetes, 4 cases with elevated CA19-9, and 2 cases with steatorrhea. All lesions of IPMN have been revealed by transabdominal ul- trasonography. The mean diameters of the lesions were 1.4±0.8 cm （range, 0.5-2.0） and 6.3±6.0 cm （range, 2.0-20.0） in adenomas and adenocarcinomas, respectively. And the mean diameters of the main duct in adelnomas and adenocarcinomas were 1.0±0.8 cm and 1.6±1.0 cm, respectively. Among the 4 adnomas, 3 （75.0%） cases were classified as branch type based on sonographic findings, and 2 were demonstrated as mural nodules in which no color signals was detected. Among the 8 adenocarcinomas, 5 （62.5%） cases were classifled as main duct type, and 3 （37.5%） as combined type. In 7 of the 8 adcnocarcinomas, mural nodules were detected within the dilated ducts or cysts of the lesions in which color flow signals were detected. Conclusions Transabdominal ultrasonography can reveal the pancreatic cystic lesions of IPMN as well as dilated pancreatic： ducts. Some characteristics should be noticed as suggesting the possibility of malignancy： clinical symptoms of pancreatic insufficiency, large tumor size, and mural nodules with color Doppler flow signals. Transabdominal ultrasonography could be a useful tool to help diagnose and make appropriate management of IPMN.     

Oinical study on thymomas and thymomas with myasthenia gravis

Objective To present the clinical experience in treating thymomas and thymomas with myasthenia gravis (MG). Methods Between 1975 to 1997,285 patients with thymoma were surgically treated. 168 cases of thymus tumor (TT,Group Ⅰ ) were compared to 90 cases of thymus tumor with myasthenia gravis (TTMG, Group Ⅱ ). Results In group Ⅰ , the average age was 38. 4 years, the youngest was 4 years old. In 93. 4%, the diameter of tumors was 5 cm. 61. 2% were in stages Ⅲ and Ⅳ of clinical pathology. In group Ⅱ ,the average age was 46.2 with the youngest of 20 years old,the diameter of tumor under 3 cm and 5 cm was 34.6 % and 65.6 % . 55.2 % was in stage Ⅰ of clinical pathology. Conclusion Many cases of thymoma in early stage received early treatment. The diagnostic standard of thymoma in early stage is: (1) the diameter of tumor is below 3 cm. (2) In stage I of clinical pathology. The clinical characteristics of TTMG are: short history, the rapid progress, serious MG symptoms,and the high incidence of thymus-     

Preliminary Study of the Lectin Receptor Expression in Adenocarcinomas of the Gastrointestinal Tract

Ten cases of gastrointestinal adenocarcinomas were histochemically investigated fortheir lectin receptors by avidin—biotin-peroxidase complex(ABC)method.Results showed thatgastric adenocarcinomas expressed more types of lectin receptors than large boweladenocarcinomas.Positive rates of Glc/Man-and GlcNAc-specific lectin receptors in these tu-mors were kigher than those of Gal/GalNAc-and Fuc-specific lectin receptors.From the stom-ach to rectum,the spectrum of the lectin receptors in pericarcinomatous tissues graduallychanged from the gastric type to the rectal type.The expression of lectin receptors ingustrointestinal adenocarcinomas was obviously different Jrom that in their correspondingpericarcinomatous tissues.The increase and decrease of lectin receptor expression,theappearance and disappearance of some types of lectin receptors as well as the change of thereceptor distribution are indirectly regulated by cellular genome.     

Clinical and CT histological diagnosis of orbital tumors

Preoperative histological diagnosis of orbitaltumors is the key to decide the necessity of the operation or to choose right surgery. This paper reviewed 117 cases of orbital tumor in our hospitalfrom Feb. 1980 to May 1995. Emphasis was puton CT presentations of the tumors and clinical value of CT in the histological diagnosis of orbital tumors.1 SUBJECTS AND METHODSIn 117 patients with orbital tumor, there were56 males (47. 9 %) and 61 females (52. 1 %). Thediagnosis of 108 cases (92…     

Application of 18F-FDG PET/CT imaging in diagnosing bladder tumor metastasis lesions

Bladder tumor is the most common malignant tumor in urinary system and always companied with lymph node metastasis. The accurate staging plays a significant role in treatment for bladder tumor and prognostic evaluation, and the distant metastasis predicts worse prognosis. The objective of this study was to assess the clinical significance of 18 F-FDG PET/CT imaging in diagnosing bladder tumor metastasis lesions. A retrospective analysis of 60 patients with bladder tumor from October 2008 to May 2010 was done. The patients were stratified based on the imaging technique. Among all 60 cases, besides the primary lesion, 81 suspected lesions were spotted and 73 confirmed as metastasis, including 50 lymph node metastases, 22 distant metastases, and 1 bone metastasis. For PET/CT imaging, its sensitivity was 94.5%, specificity 87.5%, positive predictive value 98.6%, negative predictive value 63.6% and accuracy 93.8% respectively. For CT, its sensitivity was 82.2%, specificity 50%, positive predictive value 93.8%, negative predictive value 23.5% and accuracy 79% respectively. PET/CT imaging was superior to CT in sensitivity, specificity and accuracy. In conclusion, 18 F-FDG PET/CT imaging is more significant in diagnosing bladder tumor metastasis lesions.     

99mTc-MDP SPECT/CT联合血清碱性磷酸酶和钙离子诊断单发骨转移瘤

Objective To investigate the clinical value of 99mTc methylene diphosphonate (MDP) SPECT/CT bone imaging combined with serum alkaline phosphatase (ALP) and calcium ion (Ca2+) in the diagnosis of benign and malignant nature of single bone tumors. Methods 106 patients with confirmed malignant tumors and single bone tumors in our hospital from January 2021 to December 2022 were included. After admission, 99mTc MDP SPECT/CT whole body and local bone imaging was completed and serum ALP and Ca2+levels were detected. Routine follow-up for at least 6 months, based on the pathological or comprehensive imaging (CT and MRI) findings of bone tumors, the diagnosis of benign and malignant bone tumors should be made. Results There were 44 confirmed cases of bone metastases and 62 negative cases, the gender, age, and primary tumor types of the two groups were comparable (P>0.05). Bone imaging diagnosed 53 cases of bone metastases and 53 cases were negative. The accuracy of bone imaging in diagnosing bone metastases was 78.3% [(37+46)/106], sensitivity was 84.1% (37/44), specificity was 74.2% (46/62), positive predictive value was 69.8% (37/53), and negative predictive value was 86.8% (46/53). The serum ALP and Ca2+levels in the bone metastasis group were significantly higher than the negative group (P<0.05). ROC showed AUC of bone imaging combined with ALP+Ca2+for the diagnosis of bone metastases was 0.876 (95% CI=0.823~0.924, P<0.001), sensitivity of 88.6% and specificity of 90.5%. Conclusion 99mTc MDP SPECT/CT bone imaging could provide structural changes and functional metabolic characteristics of single bone metastases, with good sensitivity, but limited specificity and accuracy. Combining serum ALP and Ca2+can furtherly improve diagnostic performance and has important clinical potential.     

DIAGNOSIS AND TREATMENT OF THE PITUITARY METASTASES

Three cases of pituitary metastases were reported. They all had operations and the pathological examination confirming the diagnosis. The clinical features of diabetes insipidus and extraocular nerve palsy were presented. In two cases, the original tumors were bronchioloalveolar carcinoma; in the other one, the original tumor was unknown. All three cases had poor outcome. These cases illustrate the fact that a pituitary metastasis can closely mimic a pituitary benign tumor, such as pituitary adenoma. Especially in the presence of suggestive symptoms such as diabetes insipidus and/or cranical nerve paralysis, the possibility of metastatic disease in the differential diagnosis of a pituitary mass should always be considered.     

Diagnosis and treatment of intramedullary hemangioblastoma of cervical spinal cord

ObjectiveTo investigate the diagnosis and surgical techniques of intramedullary hemangioblastoma of the cervical spinal cord.MethodsMR imaging and the methods and results of surgery were analyzed in 21 patients.ResultsThe tumors were divided into three types on MR imaging. ① Syringeal type, where the tumor varied in size and was accompanied by syringobulbia and syringomyelia; ② Cystic type, where the tumor presented as a cyst with a small mural node; and ③ Solid type, where the tumor was revealed as a huge solid mass. All tumors were totally removed and diagnosis was confirmed by histological study. Post-operative neurological status was improved in 20 patients and aggravated in 1.Conclusions The localization and the nature diagnosis of the tumor can be made by cervical MR imaging. Operative methods vary with tumor types. It is the most important that the tumor is dissected along the right interface and removed after devascularization.     

COMPARATIVE OBSERVATIONS ON THE TYPES OF ATROPHIC GASTRITIS AND BIOPSY PATHOLOGY OF GASTRIC MUCOSA

300 cases of chronic atrophic gastritis were classified into 3 types of qi-dificiency of spleen and stomach, yang-deficiency of spleen and stomach, and yin-deficiency of spleen and stomach according to syndrom differentiation of traditional Chinese medicine. The biopsy specimens of gastric mucosa were examined histopathologically and for the presence of pyloric spirobaeteria. The results showed that the type of yin-deficiency was the most seri-ous in the degree of pathologic changes, or the glandular atrophy and the interstitial inflam-matory cellular infiltration, while the rate of pyloric spirobacteria presence was comparable in all types.