胃弥漫大B细胞淋巴瘤合并小细胞肺癌的1例报道并文献复习

正多原发肿瘤是指同一患者同时或先后发生2种或2种以上的原发恶性肿瘤。弥漫大B细胞淋巴瘤是最常见的成人非霍奇金淋巴瘤(non-Hodgkin’s lymphoma,NHL)类型之一,40%的患者可有淋巴结外病灶,包括胃肠道、中枢神经系统、软组织以及肺部等脏器。淋巴瘤肺部浸润临床表现及影像学表现缺乏特异性,容易与肺部恶性肿瘤混淆。对于既往有淋巴瘤病史的患者,应鉴别淋巴瘤肺浸润、原发肺肿瘤及肺转移瘤。本文报道我院收治的胃弥漫大B细胞淋巴瘤合并小     

尿毒症肺的影像学诊断

目的探讨尿毒症肺的影像学诊断。方法回顾性总结经临床综合确诊的尿毒症肺42例影像学资料。结果肺水肿35例,其中间质性肺水肿23例,肺泡性肺水肿12例;肺内炎症感染7例,同时发现胸腔积液15例,小叶间胸膜增厚7例,Kedey’s B线5例,心包积液6例,42例均有不同程度心脏增大。结论尿毒症并发心、肺影像学的主要变化是肺水肿、肺内炎症感染及胸膜、心包、心脏等改变,间质性肺水肿是左心衰竭早期表现,肺泡性肺水肿是病情加重的征象。肺水肿短期复查变化迅速特点可与肺内炎症感染相区别。     

以心力衰竭发病的心脏原发性恶性淋巴瘤3例

作者10年间遇到心脏原发性恶性淋巴瘤3例。 例1,65岁,男性,因劳累性呼吸困难,意识消失入院,存在心影扩大,心包积液,室间隔肿瘤,房室传导阻滞。心包积液细胞学检查为T细胞性异常淋巴细胞浸润。~(67)Ga扫描仅在心脏异常处集聚,诊断为无淋巴结肿大的心脏原发性淋巴瘤。给予化疗后临床     

原发心脏淋巴瘤1例并文献复习

<正>心脏淋巴瘤是指累及到心肌或心包的淋巴瘤,包括原发心脏淋巴瘤(primary cardiac lymphoma,PCL)和继发心脏淋巴瘤(secondary cardiac lymphoma,SCL)。PCL较少见,约占所有原发心脏肿瘤的2%,结外淋巴瘤的0.5%[1]。SCL相对常见,晚期播散型淋巴瘤心脏累及率高达9%~20%。我院2000-01-2016-06期间收治淋巴瘤患者3 918     

心源性肺水肿的CT诊断

目的 探讨心源性肺水肿的CT特征,为心源性肺水肿的CT早期诊断提供一些有价值的依据.方法 回顾性分析87例心源性肺水肿患者的临床资料及CT表现.结果 87例胸部CT检查患者中发现胸腔积液两侧胸腔积液72例(占82.7%),间质性肺水肿51例(占58.61%),肺泡性肺水肿35例(42.2%),肺淤血改变17例(占19.5%),心脏外形改变87例,均可见心脏外形增大.结论 心源性肺水肿早期CT检查不仅可以发现合并感染,也可较好地显示心包及胸腔积液,具有早期诊断价值.     

冠状动脉穿孔导致心脏积血四例

回顾 1999年 3月～ 2 0 0 2年 9月在我院进行的 6 82例经皮冠状动脉介入性治疗 (PCI)手术 ,共出现 4例心包积液病例。 4例均为男性 ,年龄 5 6～ 81(6 8± 10 )岁 ,2例发生了心脏压塞。心脏压塞的原因均为冠状动脉穿孔。心包积液主要根据临床表现和超声心动图检查结果诊断。判断主要根据超声心动图 ,积液量分为少量 (≤ 0 5cm) ,中等量 (0 5～ 1 0cm) ,大量 (≥ 1 0cm )。根据影象学结果冠状动脉穿孔主要分为自由穿孔 (freeperforation ,造影剂直接渗入到心包 ) ,包裹性穿孔 (containedperforation ,造影剂充盈的冠状动脉腔外局限型包绕…     

恶性淋巴瘤的胸部表现16例

目的 恶性淋巴瘤常累及胸部。74例恶性淋巴瘤中，16例出现胸部病变，发生率为21．6％。霍奇金淋巴瘤38例中有7例，非霍奇金淋巴瘤36例中有9例。恶性淋巴瘤常常侵犯纵隔、肺及胸膜，主要表现为纵隔或肺门淋巴结肿大，肺野均匀一致性浸润及胸腔积液等。经联合化疗与放疗，伴随淋巴瘤的缓解，胸部病变消退。     

恶性淋巴瘤心脏侵犯的临床病理研究

已有报道恶性淋巴瘤心脏转移,占整个恶性肿瘤的9%以上,而死于淋巴瘤的病人有20%发现心脏侵犯。由于心肌被肿瘤浸润的程度,心脏功能障碍的临床症状和体征可能不典型,而且心脏受侵犯在死前不易被发现。因此,对恶性淋巴瘤心脏侵犯的知识,大部分从尸体解剖中得来。本文报道1960～1980年150例经尸解的何杰金氏病(53例)或非何杰金氏淋巴瘤(97例),其中13例(8.7%)有淋巴瘤心脏或心包壁侵犯的组织学证据。     

42例HIV感染/艾滋病患者的心脏表现

目的　总结 42例人免疫缺陷病毒 ( HIV)感染 /艾滋病患者的心脏表现。方法　对 42例 HIV感染 /艾滋病患者进行回顾性分析。结果　 42例 HIV感染 /艾滋病心脏表现有 :心律失常 5 0 .0 % ( 2 1/ 4 2 ) ,感染性心内膜炎 4.8% ( 2 / 4 2 ) ,心包积液 2 .4% ( 1/ 4 2 ) ,扩张型心肌病合并心功能不全 14 .3% ( 6 / 4 2 )。结论　心脏亦为 HIV感染 /艾滋病的受累器官之一。艾滋病患者可因自身突出的全身症状掩盖而使心脏病变隐匿 ,心电图、胸片、超声心动图有助早期诊断并指导治疗     

心电图初步诊断恶性心包积液的临床价值

目的：探讨心电图在恶性心包积液初步诊断中的临床价值。方法回顾性观察149例恶性肿瘤患者心包积液的病因分布,并分析其心电图改变情况。结果恶性肿瘤合并心包积液患者以肺癌、乳腺癌及恶性淋巴瘤占多数。恶性心包积液患者窦性心动过速、胸／全导联低电压及 ST-T 改变的检出率显著高于良性心包积液患者,且差异有统计学意义（P ＜0．01）。结论当原发肿瘤患者出现上述心电图改变时,应高度怀疑合并恶性心包积液,可结合心脏彩超或 CT 等其他影像学资料进一步诊断。     

Gastrointestinal Malignancy in Patients with AIDS

To clarify the prevalence and characteristics of gastrointestinal malignancy in patients with AIDS, we reviewed the demographics and clinical features of patients with AIDS and gastrointestinal neoplasms seen at North Central Bronx Hospital and Montefiore Medical Center during the past 8 yr. Malignant neoplasia complicated AIDS in 108/869 (12%) of the cases in our study. Most common was Kaposi's sarcoma (KS) (60%), followed by lymphoma (35%) and miscellaneous tumors (6.5%). The gastrointestinal tract was involved in 35/108 (32%) of patients with AIDS and neoplasia. Gastrointestinal tract involvement with KS usually was silent, although present, in every patient with KS who underwent autopsy. Lymphoma was most commonly non-Hodgkin's, and often produced symptoms. Uncommonly, the gastrointestinal tract was the primary site of neoplasms other than KS or lymphoma.     

内镜黏膜下剥离术(ESD)治疗消化道病变

目的探讨内镜下黏膜剥离术(endoscopic submucosal dissection,ESD)治疗消化道病变的疗效、安全性及并发症防治。方法回顾性分析ESD方法治疗29例(共31块)消化道病变的内镜下手术情况、并发症及治疗、预后情况。结果术中出血2例,1例创面小动脉出血,内镜下钛夹止血,另1例胃黏膜下持续出血,形成血肿,中转开腹行胃窦切除术;1例直肠管状腺瘤ESD术后7天大出血,经肛门缝扎止血;术中发现肠壁穿孔1例,中转开腹行肠壁修补术。29例患者均痊愈出院,无1例留下后遗症,平均住院时间5 d。随访2～27个月未见复发。结论 ESD治疗消化道病变是安全的,可以一次性完整切除较大病变,提供完整的病理学资料,且术后不易复发。缺点是操作时间长,技术难度较大,并发症较EMR多。     

Diffuse large cell lymphoma with spontaneous regression in the lung and lymph nodes. Case report]

An 84-year-old woman was admitted to our hospital because of swelling of the cervical lymph nodes and multiple tumorous lesions observed on radiographic studies. Transcutaneous lung biopsy was performed, but necrosis of the tissue was too marked to make a diagnosis. The diagnosis of diffuse large-cell lymphoma was made based on a biopsy of the pretracheal lymph node. During the first two months after admission, the left cervical lymph nodes and most of the pulmonary lesions regressed not withstanding of special treatment for lymphoma. The patient eventually died of generalized peritonitis. At autopsy, metastasis of systemic organs by malignant lymphoma was observed. Most of the lung regions were cicatrized, but clusters of atypical lymphocytes were observed in the necrotic tissue. The tumor in the mucosa of the small intestine showed necrosis, which accounted for the intestinal perforation. The total clinical course after admission was about six months. Spontaneous regression of diffuse large cell lymphoma is rare, and this is the second reported case in Japan.     

32例重症肝病者多器官功能衰竭的临床与病理特征

本文以同期死亡并行尸检的非老年重症肝病多器官功能衰竭（ＭＯＦ）患者８６例为对照，总结了３２例老年重症肝病患者ＭＯＦ的临床及尸检病理特点。结果表明，发生ＭＯＦ的主要诱因为感染及消化道出血。器官衰竭发生的顺序为肝、脑、肾、胃肠道、血液、心肺等。同时，肝脏有不同程度的肝细胞坏死，其他脏器可出现不同的病理改变，其中肺出血、心内膜及心外膜下出血、心肌断裂等发生率明显低于非老年组（Ｐ＜０．０５），而肾小球硬化、间质性肾炎的发生率明显高于非老年组（Ｐ＜０．０５）。老年重症肝病并发ＭＯＦ，应加强肝病的治疗，及时消除感染、消化道出血等诱发因素。     

Isolated primary hepatic lymphoma in a patient with acquired immunodeficiency syndrome.

Non-Hodgkin lymphoma (NHL) of the B-cell type is the second most common neoplasm in patients with human immunodeficiency virus (HIV) infection after Kaposi sarcoma (KS). The majority of cases of NHL in patients with acquired immunodeficiency syndrome (AIDS) involve extranodal sites; most frequently the gastrointestinal tract (GIT) and the central nervous system (CNS). Hepatic NHL in patients with AIDS was first described by Reichert et al in 1983 in an autopsy series. It usually presents with multiple large hepatic masses and involvement of other abdominal organs or lymph nodes. The authors present a case of primary hepatic NHL in a patient with AIDS, presenting with innumerable small intrahepatic masses without the involvement of any other organs.     

Primary Lymphoma of the Colon

Primary lymphoma of the colon is a rare tumor of the gastrointestinal (GI) tract and comprises only 0.2-1.2% of all colonic malignancies. The most common variety of colonic lymphoma is non-Hodgkin''s lymphoma (NHL). The GI tract is the most frequently involved site, accounting for 30-40% of all extra nodal lymphomas, approximately 4-20% of which are NHL. The stomach is the most common location of GI lymphomas, followed by the small intestine. Early diagnosis may prevent intestinal perforation; however, the diagnosis is often delayed in most cases. Therapeutic approaches described in two subsets include: Radical tumor resection (hemicolectomy) plus multi-agent chemotherapy (polychemotherapy) in early stage patients, biopsy plus multidrug chemotherapy in advanced stage patients. Radiotherapy is reserved for specific cases; surgery alone can be considered as an adequate treatment for patients with low-grade NHL disease that does not infiltrate beyond the sub mucosa. Although resection plays an important role in the local control of the disease and in preventing bleeding and/or perforation, it rarely eradicates the lymphoma by itself. Those with limited stage disease may enjoy prolonged survival when treated with aggressive chemotherapy.     

Intravascular proliferating anaplastic lymphoma kinasepositive anaplastic large-cell lymphoma

An 82-year-old Japanese man visited our emergency unit complaining of dyspnea. Laboratory data showed 15% atypical lymphocytes in peripheral blood which expressed the T-cell phenotype. Chest/abdominal computed tomography depicted hepatosplenomegaly and swelling of systemic lymph nodes. The patient died of advanced respiratory failure 5 d after the first occurrence of his dyspnea. At autopsy, the pathological features revealed a diffuse infiltration of large atypical lymphocytes to systemic organs including the spleen and lung. In immunohistochemical staining, these cells expressed CD30, TIA-1, anaplastic lymphoma kinase(ALK), CD5 and CD3. An advanced surface molecule analysis revealed a lack of CD54(intercellular cell adhesion molecule-1) and CD56(neural cell adhesion molecule). We observed the proliferation and infiltration of these lymphoma cells specifically at the intravascular lesions similar to intravascular lymphoma(IVL). T-cell IVL is not established as an independent clinical entity in the World Health Organization classification, and our patient's ALK-positive T-IVL in lung appears to be the first reported case.     

Nutrition in systemic sclerosis

Systemic sclerosis is a connective tissue disease characterized by inflammation and fibrosis of multiple organs (skin, gastrointestinal tract, lung, kidney and heart). After the skin, the organ most affected with a frequency of 75 to 90%, the gastrointestinal tract is more often involved. Gastrointestinal tract involvement is manifested by the appearance of oropharyngeal dysphagia, esophageal dysphagia, gastroesophageal reflux, gastroparesis, pseudo-obstruction, bacterial overgrowth and intestinal malabsorption, constipation, diarrhea and/or fecal incontinence. These effects influence food intake and intestinal absorption leading to the gradual emergence of nutritional deficiencies. About 30% of patients with systemic sclerosis are at risk of malnutrition. In 5-10%, gastrointestinal disorders are the leading cause of death. Therapeutic strategies currently available are limited and aimed at reducing clinical symptoms. The multidisciplinary management of these patients, including nutritional intervention, helps improve gastrointestinal symptoms, and avoid malnutrition, morbidity and improve quality of life.     

黏膜相关淋巴组织淋巴瘤的临床研究

目的为提高对黏膜相关淋巴组织淋巴瘤（ＭＡＬＴ淋巴瘤）临床特征的认识。方法经我院确诊的ＭＡＬＴ淋巴瘤２４例,进行回顾性的临床分析研究。结果按原发部位可分为胃肠（ＧＩ）和非胃肠（ＮＯＮＧＩ）两组。ＧＩ组１８例（７５０％）,ＮＯＮＧＩ组６例（２５０％）,后者包括涎腺３例、肺２例和膀胱１例。手术治疗２１例,其中单用手术治疗１３例,术后合用化、放疗７例,合用放疗１例。单用化疗３例。随访１７例,失访７例,随访率为７０．８％。生存期４～１２１个月,平均３３个月,中位数１９个月。１７例随访病人中１６例已存活１～１０年,其中存活１年以上者占５８．８％、＞３年以上者占３５．３％、５年以上者占２９．４％、１０年以上者占５．９％。对临床分期和治疗措施与生存率比较显示差异无明显性（Ｐ＞０．０５）。结论ＭＡＬＴ淋巴瘤是非霍奇金淋巴瘤的一种独特亚型,具有起病隐匿、病程长、进展慢及患病率低、好发于中老年男性、Ｂ症状少见、易误诊为假性淋巴瘤、治疗疗效和预后良好等特征。     

韦格纳肉芽肿病23例临床分析

目的分析韦格纳肉芽肿病(Wegener granulomatosis，WG)的临床和病理特点，提高对本病的认识。方法对23例确诊的WG病人的临床表现、辅助检查及病理特点进行回顾性分析。结果发病年龄20．57岁，平均37．2岁，平均病程5．8个月。首发症状以上呼吸道为主(48％)，可累及多个系统或器官，肺脏受累87％，肾脏受累78%。胞质型抗中性粒细胞胞质抗体(cANCA)阳性率100%，病理表现为坏死性肉芽肿性炎症、炎细胞浸润的血管炎。结论WG的临床表现复杂多样，有多系统或器官病变的症候群，以上、下呼吸道及肾脏受累最多见：病理特点为坏死性肉芽肿和血管炎。