Benign Leydig cell tumour and germ cell carcinoma in situ in a young man with gynaecomastia.

A 21-year-old man presented with a 16-year history of recurrent pyrexial episodes and a 5-year history of gynaecomastia. Blood and urinary oestrogen levels were elevated and a mass was found in the upper pole of a retractile right testis. After orchidectomy, oestrogen levels fell, gynaecomastia regressed and the pyrexial episodes ceased. Histological examination of the right testis showed a benign Leydig cell tumour in the upper pole and a germinal cell carcinoma in situ in the remaining part of the testis. Thus a potentially lethal condition was detected at an early pre-malignant phase by virtue of a benign, endocrinologically active tumour. This would seem to be the first report of the co-existence of a Leydig cell tumour and germ cell carcinoma in the same testis.     

Clinics in diagnostic imaging (93)

A 63-year-old woman was found to have pathological fracture of the right lower tibia through a brown tumour, hypercalcemia, and a soft tissue mass at the lower pole of the right lobe of thyroid gland. US scan of the neck showed a well-circumscribed heterogeneously-hypoechoic mass with displacement of the right lobe of thyroid gland. Diagnosis of parathyroid adenoma was confirmed on histopathological examination of the excised specimen. The cause and clinical manifestations of primary hyperparathyroidism are discussed. Imaging methods of parathyroid gland are presented.     

Examining the anterior right kidney. Frequent lack of appreciation in examination of the right upper quadrant.

An anteriorly positioned lower pole of the right kidney is often unappreciated on physical examination. Yet, on review of a large number of abdominal sonograms, more than 12% of the patients had a right kidney with a lower pole sufficiently anterior in position so as to lie at the same depth as the anterior surface of the liver. In a group of patients referred for ultrasound evaluation of hepatomegaly, 20% proved to have a normal liver and an anteriorly positioned lower pole of the right kidney.     

腹膜后间隙向外侧通连的应用解剖

连续观察３０具经福尔马林固定的成人腹部横断面标本，结果显示肾筋膜向外侧延伸和附着在肾门及其以下平面可分为四种类型：Ⅰ型在肾门平面左右侧出现率分别为２３．３３％和３０．００％，肾下极平面分别为３０．００％和３３．３３％；Ⅱ型在肾门平面的出现率左右侧分别为４０．００％和２６．６７％，肾下极平面分别为１０．００％和３．３３％；Ⅲ型在肾门平面的出现率左右侧分别为３３．３３％和４３．３３％，肾下极平面分别为６０．００％和６３．３３％；Ⅳ型少见，仅见于左肾门平面，出现率为３．３３％。肾门以上平面，肾前、后筋膜在肾外侧愈着。熟悉肾筋膜向外侧延伸和附着的情况，对腹膜后间隙积液扩散途径的认识和积液的定位鉴别诊断及临床处理具有重要意义。     

用改良的5/6肾切除法制作的大鼠慢性肾衰竭模型

目的:改进5/6肾切除大鼠慢性肾衰竭动物模型的手术方法。方法:游离肾动脉夹闭其中1～2个分支30秒,解除夹闭,根据缺血范围选择性切除左肾上、下极及左肾外侧缘约2/3肾组织。1周后切除右肾。结果:5/6肾切除后的大鼠出现尿蛋白增多、血清肌酐、尿素氮升高、内生肌酐清除率下降;肾脏病理检查出现肾小球硬化、肾小管萎缩、间质纤维化。结论:用改良的5/6肾切除法成功制作了大鼠慢性肾衰竭动物模型。     

A case of horseshoe kidney with surplus renal arteries

During a gross anatomy course at Kurume University School of Medicine in 2001, an anomaly of the kidneys was found. The lower ends of the kidneys were fused by a renal substance and formed a horseshoe kidney located ventral to the abdominal aorta and inferior vena cava. Both renal hila opened very widely in the ventral direction, with the left hilum being larger than the right. This horseshoe kidney had original left and right renal arteries that branched from the abdominal aorta. As well, there were four surplus renal arteries. The first surplus artery branched from the right renal artery and was distributed to the upper pole of the right kidney. The second arose from the abdominal aorta and was distributed to the inferior pole of the right kidney. The third arose from the abdominal aorta and was distributed to the inferior pole of the left kidney and part of the isthmus. The fourth branched from the abdominal aorta and was distributed to the upper pole of the left kidney. The incidence of horseshoe kidneys in Japanese anatomical dissections has been reported as 0.15-0.48%. This was the sixth such case for our laboratory, representing a frequency of 0.1% (6 of 1902 dissections) from 1952 to 2001.     

睾丸嗜铬细胞瘤并多发淋巴结及肺转移18F-FDG PET/CT特征1例并文献复习

目的：探讨睾丸异位嗜铬细胞瘤的18F-氟-2-脱氧葡萄糖(18F-fluroro-2-deoxyglucose,18F-FDG)正电子发射断 层成像-计算机断层成像(positron emission tomography and computed tomography,PET/CT)特点,以提高对其诊断水平。 方法：报告1例病理确诊为异位嗜铬细胞瘤并多发淋巴结及肺转移的患者资料。结果：患者有典型的血压升高症状, 血儿茶酚胺及尿香草扁桃酸值显著升高。PET/CT检查发现患者右侧睾丸糖代谢增高的软组织结节,邻近伴1个子 灶,右侧精索可见糖代谢增高的肿块,双侧腹股沟区及腹膜后多发糖代谢增高的淋巴结,右肺下叶后基底段糖代谢 增高的结节,全身多处可见糖代谢弥漫性增高的棕色脂肪影;右侧睾丸异位嗜铬细胞瘤原发灶与转移灶切除后PET/ CT检查则可见棕色脂肪组织糖代谢增高表现消失。结论：PET/CT检查对异位嗜铬细胞瘤原发灶的定位诊断、临床分 期与疗效评估有着较好的价值,而棕色脂肪组织的18F-FDG摄取增高对异位嗜铬细胞瘤的定性诊断具有一定的提示作用。     

True hermaphrodite - a rare case for hysterectomy

One apparently healthy male patient reported at the Urology outpatient department, Bangabandhu Sheikh Mujib Medical University, Bangladesh, with the history of cyclical bleeding per urethra. He started bleeding from the age of 10. The bleeding lasted for 2-3 days. He also had cyclical lower abdominal pain, which remained unexplained. Menstruation occurred every 3-4 months. Left testis was normal but there was a separate soft palpable mass from its lower pole. Chromosomal analysis showed translocation of X and Y chromosome 45(t X/Y). Ultrasonography revealed normal kidneys with well-filled urinary bladder that appeared regular in outline. Left testis was normal in size, measuring about 2.73 × 1.72 cm. Its echotexture was finely homogenous with no evidence of collection or mass. There was a multiloculated cystic mass in the right half of scrotum. Right testis was not visualised along the line of descent. Surprisingly, uterus was found to be present and normal in size and anteverted in position. Fluid collection was noted in the uterine cavity. No ovarian outline was noted. FSH level was almost four times the normal level for males (31.74 IU). The LH level was slightly raised (16.17 IU). The testosterone, Estradiol and Prolactin level were within normal male range, being 3.5 microgram/L, 24 pg/L, and 13.54 microgram/L respectively. Semen analysis revealed azoospermia but the amount of semen was normal. After discussion with the patient, a total abdominal hysterectomy with right-sided salpingo-oophorectomy and left salpingectomy was performed under general anaesthesia. True hermaphrodites must be distinguished from a false one, they have both male and female gonadal tissue, false hermaphrodites are unisexual, but their sex organs resemble those of the opposite sex. This particular patient raised great interest because true hermaphrodites are rare. Attempts were made to make his life normal as a male. If he had the opportunity to have easy access to medical treatment, would he be raised as a female? Controversies are paramount. In this patient, subsequent surgery was done by urologists to correct the chordee and the hypospadias. The overall life of this patient is still a dilemma to us. It was a rare case of hysterectomy done, from the gynaecologist's point of view.     

精索静脉曲张对青春期大鼠生精细胞凋亡相关基因Bcl-2和Bax表达的影响

目的 研究精索静脉曲张(VC)对青春期大鼠睾丸生精细胞凋亡相关基因Bcl-2／Bax表达的影响,探索精索静脉曲张致不育的机理。方法 通过部分结扎左肾静脉建立青春期大鼠实验性精索静脉曲张模型,分别于术后2周、4周、8周取双侧睾丸,用免疫组化SABC法检测Bcl-2／Bax基因表达。结果 随着精索静脉曲张时间的延长,Bcl-2表达呈下降趋势,曲张组比对照组低,左侧睾丸比右侧睾丸低;而Bax表达呈增加趋势,曲张组比对照组高,左侧睾丸比右侧睾丸高。结论 实验性精索静脉曲张可明显改变青春期大鼠睾丸组织生精细胞凋亡相关基因与Bcl-2／Bax表达。     

精索脂肪肉瘤的诊断和治疗(附1例报告并文献复习)

目的总结对精索脂肪肉瘤的诊断及治疗。方法对1例右侧阴囊肿块患者体检,检测α- 甲胎蛋白、β-HCG和卵泡刺激素;行B超和CT检查。行根治性右侧精索及肿块高位切除加右侧睾丸、附睾切除。并结合文献复习。结果阴囊右侧大小约5 cm×6 cm×5 cm肿块,质硬,表面欠光滑,有结节感,与右侧附睾、睾丸精索位置固定,透光试验阴性。α-甲胎蛋白、β-HGG和卵泡刺激素均正常。B超提示右侧精索实质性肿物,非均质性强回声,与附睾、睾丸边界清淅;CT示右侧精索实质性肿瘤,未见明显肿大淋巴结。病理诊断为右侧精索硬化型脂肪肉瘤。结论精索脂肪肉瘤罕见,其诊治及预后的标准难以确定;手术切除为主的综合治疗为首选治疗方法。     

Clinics in diagnostic imaging (135). Cystic renal cell carcinoma

A 45-year-old man presented with right flank pain and haematuria for one month. Computed tomography showed a large, well-circumscribed exophytic complex cystic mass with enhanced, irregular thickened walls arising from the upper pole of the right kidney, which was associated with bilateral renal stones. Partial right nephrectomy with removal of the right renal stones was performed. Histopathology revealed papillary cell carcinoma confined to the kidney. The patient made good postoperative recovery. The Bosniak classification system of renal cystic lesions and cystic renal cell carcinoma are discussed. Various cases of renal cystic lesions and cystic renal cell carcinoma are shown.     

Sarcomatoid renal cell carcinoma with huge retroperitoneal metastasis

Sarcomatoid Renal Cell Carcinoma (SRC) is a very rare form of renal neoplasm with very poor prognosis. A case of sarcomatoid renal cell carcinoma (SRC) is reported herein at the National Institute of Kidney Diseases and Urology (NIKDU), Dhaka. A 40 year old man presented with swelling in right loin with dragging abdominal pain and intermittent low grade fever. A huge, fleshy and highly vascular retroperitoneal mass was found peroperatively. Tumor affected the lower pole of right kidney invading the renal capsule, perinephric fat and continued to grow as a large tumor mass in the right retroperitoneal space Histologically, it revealed the features of sarcomatoid renal cell carcinoma.     

远外侧入路骨性标志及相关神经血管的显微解剖研究

目的 为了充分了解中下斜坡和颅颈交界区解剖结构,探明颅骨表面标志与其周围重要结构的对应关系,为安全、合理地运用远外侧入路提供显微外科解剖学依据.方法 通过对10例(20侧)经甲醛固定的国人成人带颈尸体头颅(不分性别)和干性颅骨10例(20侧)(不分性别)进行解剖、测量拍摄获取相关资料.结果 ①枕髁、颈静脉孔、舌下神经管、环椎、枕骨大孔、乳突是枕下远外侧入路的重要骨性标志;②枕下三角和头外侧直肌、二腹肌是保护深部重要血管、神经的重要肌学标志;③舌下神经管后缘至枕髁后极距离(9.91±0.93)mm(左),(9.99±0.85)mm(右);舌下神经管下缘至枕裸下极距离(8.77±1.07)mm(左),(8.80±1.11)mm(右);舌下神经管上缘至颈静脉孔下缘距离(9.48±0.87)mm(左),(9.28±1.04)mm(右);舌下神经管长度(10.68±1.07) mm(左),(10.40±1.03)mm(右);舌下神经管与正中矢状面角度(48.3±4.7°)(左),(47.9±4.5°)(右).结论 远外侧入路可以以最短的距离到达脑干和颈延髓的腹侧和外侧,直接的显露下斜坡和颈延髓的腹侧和外侧,为颅神经和椎动脉提供了良好的显露,易于利用颅神经的自然间隙;避免对脑干和颅神经的牵拉,提高手术切除率,降低手术损伤及术后并发症.     

胎儿肾的大小及位置测量分析

目的:观测和分析7～9个月胎儿肾的大小和位置。方法:使用经防腐处理的7个月和9个月胎儿,胎龄从末次月经后两周计算,选出7个月胎儿40例(男19例、女21例),9个月胎儿40例(男19例,女21)。从背部暴露肾上、下极。用游标卡尺(精确度为0.2 mm)测量肾的位置。继后清除肾筋膜并游离肾,测量肾的大小,逐一记录。结果:(1)测得了左、右肾的长度、宽度和厚度,左肾长度和厚度稍大于右肾,右肾的宽度稍大于左肾。(2)肾的位置,以左肾高于右肾为多见,其中7个月左肾高于右肾的出现率为76.3%,9个月为71.0%。(3)测得了左、右肾上极、下极至后正中线距离。左、右肾上极距后正中线距离近于左、右肾下极。(4)肾下极至髂嵴的距离,左侧大于右侧。结论:胎儿肾的大小及位置测量分析,在临床上特别是产科有重要的意义。     

环孢素对大鼠睾丸生精功能自身免疫反应损伤的保护作用

目的：探讨环孢素对大鼠单侧睾丸扭转后对侧睾丸生精功能自身免疫反应损伤的保护作用。方法：42只健康雄性SD大鼠随机均分为假手术组、安慰剂组和环孢素组。建立左侧睾丸扭转模型并作相应的药物处理。三组大鼠分别于术后1周时处死7只,即刻采集各组大鼠未扭转侧睾丸标本,进行组织病理学观察以及MHC肽-四聚体复合物流式细胞仪分析;术后2个月时处死余下7只,即刻采集各组大鼠未扭转侧睾丸标本,进行组织病理学观察。结果：术后1周时,环孢素组MHC肽-四聚体复合物含量为0.21±0.06,与安慰剂组（0.58±0.10）比,差异有显著性（P〈0.05）;术后2个月时,病理学示生精上皮层数、MSTD、结构评分分别为3.2±0.7、（242±44）μm、2.9±0.9,与安慰剂组[分别为32.3±0.9、（206±25）μm、3.6±0.5]比,差异有显著性（P〈0.05）。结论：环孢素通过抑制自身免疫反应,从而对大鼠单侧睾丸扭转后对侧睾丸生精功能起到保护作用。     

Clinics in diagnostic imaging (88). Gynaecomastia of the right breast and carcinoma of the left breast

An 83-year-old man presented with a painless lump in his left breast for one year. Mammograms showed an ill-defined uncalcified high-density subareolar mass in the left breast and minimal fibroglandular density radiating beneath the nipple into the fatty tissue of the right breast. US showed an irregular, heterogeneously-hypoechoic mass with mild posterior transmission. The differential diagnosis of breast enlargement in men is discussed. Mammographical and US features of gynaecomastia and male breast carcinoma are presented.     

Primary testicular lymphoma--A case report

Primary lymphoma of the testis is more commonly seen in the elderly age group. A 45-year-old Hindu male with histopathological diagnosis of non-Hodgkin's lymphoma of the right testis presented after orchiectomy of the right testis. The patient was put on two cycles of chemotherapy consisting of cyclophosphamide, vincristine, adriamycin and prednisolone at 3- weekly interval followed by external radiation therapy. During follow-up after 7 years he developed left facial nerve palsy and left sided haemiparesis. On CT scan of the brain multiple space occupying lesions were seen in both the hemispheres of the brain. He was put on cranial radiation therapy with intrathecal methotrexate injections. He responded favourably with the treatment.     

Pure choriocarcinoma of testis with rare gingival and skin metastases

A 22-year-old man presented with complaints of gingival and skin lesions. Physical examination revealed the presence of two nodular lesions, one over the sternum, 3 cm in size, and another, on the right side of chin, 1 cm in size. There was another fleshy soft tissue deposit over the left lower gingiva, in the oral cavity. He had noticed these lesions ten days prior to his visit to the hospital. In addition, there was left testicular non-tender swelling which had been present for two months, but was not investigated. Fine-needle aspiration cytology from skin and gingival lesions was suggestive of metastatic deposits. Patient underwent left high orchidectomy, and histopathological examination was consistent with the diagnosis of pure choriocarcinoma. Although rare, cases of testicular neoplasms and especially choriocarcinoma of the testis leading to skin metastases have been reported, but case reports of choriocarcinoma of testis metastatic to gingiva have been reported exceptionally in the English literature. We report this unique case of a young man with pure choricarcinoma of testis with unusual gingival and skin metastases.     

Clinics in diagnostic imaging (134). Testicular lymphoma

A 55-year-old man presented with a painless right scrotal mass for the past three months. Scrotal ultrasonography showed a large circumscribed hypoechoic mass with marked hypervascularity occupying almost the entire right testis. The epididymis and scrotal skin were normal. Right radical orchiectomy was performed. Histopathology revealed lymphoma, diffuse large B-cell type confined within the tunica albuginea. The patient made a good postoperative recovery. No evidence of lymphoma in other organs was demonstrated. We discuss the differential diagnosis of ultrasonographic intratesticular masses and highlight various cases of intratesticular lesions in this article.     

多发性硬化网络节点改变的基于体素度中心度的fMRI研究

目的：利用度中心度（DC）探索复发缓解型多发性硬化（RRMS）患者脑网络的功能异常。方法：选择26例RRMS患者为RRMS组,27例性别、年龄匹配的正常人为对照组。所有患者完成扩展残疾状况评分量表（EDSS）。DC和功能连接方法评估RRMS的脑功能改变。Pearson相关评估差异脑区与行为学的相关性。ROC曲线评估差异脑区对2组的区分能力。结果：DC差异不随相关系数r值的不同而变化。相比对照组,RRMS组DC值增加脑区主要包括右侧小脑后叶、左侧枕中回、左侧背侧前额叶和双侧顶上小叶,减低脑区主要包括左侧扣带回和双侧颞极突入岛叶。ROC曲线显示这些脑区能较好的区分2组（AUC=0.943,敏感度为96.3%,特异度为88.5%）。在RRMS组,病程与左侧颞极呈负相关（r=-0.483,P=0.020）,EDSS得分与右侧顶上小叶呈正相关（r=0.485,P=0.019）,与右侧颞极呈负相关（r=-0.430,P=0.041）。功能连接显示DC减低的颞极和扣带回存在网络间和网络内的功能连接减低。结论：扣带回和颞极在RRMS患者中存在功能异常,这些关键网络节点可以预测疾病进展和残疾状态。