肝恶性淋巴瘤伴高钙血症1例

1.病例资料:男性患者,69岁,农民.因发热伴呕吐1周,外院抗炎治疗后,症状缓解,但近2日精神逐渐变差,于2008年3月24日转入我院急诊内科进一步诊治.入院时体检结果:体温37.5℃,呼吸22次/min,脉搏84次/min,血压170/90 mm Hg(1 mm Hg=0.133 kPa),平侧卧位,神清,精神萎靡,口唇不绀,双肺呼吸音稍低,右下肺可闻及少许湿音,心率84次/min,心律齐,未闻及杂音,腹平软,脐周轻压痛,无反跳痛,肝脾肋下未及.     

非霍奇金淋巴瘤并发高钙血症5例临床报告

目的:探讨非霍奇金淋巴瘤(NHL)并发高钙血症患者的发病机制及临床特点。方法:回顾性分析5例伴高钙血症的NHL患者的临床病历资料。结果:5例患者中,伴骨髓侵犯4例,其中2例已达白血病期;血钙浓度3.5~4.93 mmol/L,乳酸脱氢酶(LDH)441~6 470 mmol/L,血β2微球蛋白3.86~7.71 mg/L,Ki67(增殖细胞核抗原)70%~95%,甲状旁腺激素(PTH)降低4例,多发骨破坏1例,骨质疏松1例。所有患者均给予降钙治疗,1例顽固性高钙血症在加用糖皮质激素后血钙降至正常,1例出现急性肾功能不全行血液透析。所有患者均给予原发病的治疗,未再出现高钙血症,其中1例外周T细胞淋巴瘤患者共完成8个疗程化疗,但出现病情进展,生存期仅9个月;另1例弥漫大B细胞淋巴瘤患者已完成6个疗程免疫化疗,但疗效仅达部分缓解(PR)。结论:NHL并发高钙血症常见于中高度NHL,临床分期常较晚期,常伴有血清LDH升高、肿瘤细胞高负荷及高增殖活性,对化疗疗效欠佳,生存期短,预后不良。     

恶性淋巴瘤伴骨髓纤维化1例

淋巴瘤是淋巴网状组织的恶性肿瘤,随着病情的发展,常侵犯任何器官和组织,但引起骨髓重度纤维化临床上少见,现将我院收治的1例报告如下:患者,男,35岁,农民,因头晕、乏力、发热20天,颈部肿块1周于1994年3月14日入院.患者既往健康.检查:39.2℃,神清,中度贫血外观,全身皮肤及粘膜无出血点及紫癜,颈部、腋窝、腹股沟均可触及数个鸽蛋及黄豆大的淋巴结,无触痛,境界清楚,质偏硬,与周围组织无粘连,胸骨无压痛,心肺(一),腹软,肝脏在右肋缘下3cm,剑突下5cm,质中,无触痛,脾脏肿大平脐,有触痛,质偏硬,NS(一).周围血象:Hb70g/L,WBC 5.2×10~9/L,N80,L20,BPC70×10~9/L.两侧髂后3次穿刺均干抽.后做骨髓活检.病理报告:骨髓重度纤维化.颈部淋巴结活检病理报告:非霍奇金淋巴瘤(T细胞性).T细胞亚群:CD_3 48.9%、CD_4 44.6%,CD_8 22.5%.胸片报告:中上纵隔影增宽,肺门影增宽呈多个团块状影,考虑为纵隔淋巴瘤.入院确诊为:非霍奇金淋巴瘤Ⅳ期并重度骨髓纤维化.给予COBP方案1疗程,患者临床症状明显好转,无发热,全身浅表淋巴结明显缩小,脾脏缩至左肋缘下1cm,目前仍在治疗中.骨髓纤维化是一种骨髓增殖性疾病,可原发,也可继发于其它疾病.     

原发性肝癌致高钙血症五例报告

原发性肝癌所致高钙血症,临床报告较少。我院对32例原发性肝癌作了血清钙测定,其中有5例呈高钙血症,今报告如下。临床资料由临床、AFP、B超或CT及病理确诊的32例原发性肝癌进行血清钙测定,其中呈高钙血症者5例,发生率为15.6%。5例中男4例,女1例。发病至出现高钙血症时间为43～72天,平均57.6天。1例血钙高达4mmol/L,临床上表现便秘、食欲不振、恶心呕吐、腹胀、易疲劳、肌张力降低,但无转移性钙化和骨骼改变。余4例为2.9～     

左肺癌伴高钙血症一例

患者,男性,60岁,因消瘦、乏力6个月,咳嗽1个月,加重1周于2005年12月12日入院.既往体健.吸烟大于600支/年,体重下降约10公斤.入院体检:体温37 ℃,脉搏86次/分,呼吸22次/分,血压100/65 mm Hg.意识清,精神萎靡,表情淡漠,他人搀扶入院,消瘦貌,双侧瞳孔等大等圆,为0.25 cm,对光反射灵敏,双侧锁骨上等处浅表淋巴结未及肿大,颈静脉无怒张,颈软,甲状腺无肿大,气管居中,胸廓无畸形,两肺叩诊呈清音,两肺呼吸音低,以左下肺明显,闻及少量哮鸣音.     

多发性骨髓瘤伴恶性淋巴瘤1例

多发性骨髓瘤伴恶性淋巴瘤,临床上较少见,我院收治1例,报告如下。1 病例介绍 患者,男,56岁,农民。1992年12月因乏力、头昏、胸前骨痛在某地区医院就诊。体检无特殊。血象:Hb 85g/L,WBC 11×10~9/L,plt 68×10~9/L,血沉145mm/h。蛋白电泳:A 0.461,α_10.067,α_20.067,β0.081,γ0.324。骨髓检查示:浆细胞系统显著增多,原浆0.31、幼浆0.18,成浆0.20。胸片示:部分肋骨虫蚀样破坏。诊断:多发性骨髓瘤。给予COP方案化疗1疗程,住院45天,好转出院。以后自觉仍有乏力、头昏,能自理生活及轻微劳动。至1993年5月发现左腹股沟有一肿块,逐渐增大,1993年10月来我院。体检:贫血貌,左腹股沟可及5cm×5cm大小淋巴结2枚,左下腹腹壁可及6cm×6cm肿块,均质中,活动度差,无压痛。心肺无殊,肝未及,脾肋下1.5cm、质软、无压痛。血象:Hb 80g/L、WBC 17×10~9/L,N 0.66,E 0.05,M 0.07,L 0.24,plt 31×10~9 L,ESR 112mm/h。尿蛋白（+）,本周蛋白（-）。     

甲状腺功能亢进症伴高钙血症一例

患者,女性,69岁。因“怕热、心慌、消瘦40余天”入院。患者40余天前开始出现怕热、心慌、多汗、消瘦等不适,起初未予重视。1个月前患者跌倒,在当地医院诊断为“左股骨颈骨折”,予以局部牵引治疗。近1个月来,患者出现乏力、纳差,自觉消瘦明显,体重降低约20公斤,行甲状腺功能检查示甲状腺功能亢进（简称甲亢）,收住我院。既往无其他疾病史和特殊用药史。     

原发性肝淋巴瘤1例

原发性肝淋巴瘤(PLL)临床罕见,发病率仅占肝脏恶性肿瘤的0.1%.2007年10月我院收治1例原发性肝脏非霍奇金结外边缘带B细胞淋巴瘤.现报告如下.     

肝源性淋巴瘤一例

患者,女性,45岁.因乏力、发热1月余住院.不明原因间断发热,最高达39℃,无厌油、腹胀和腹痛等不适.体格检查:贫血貌,皮肤、巩膜未见明显黄染,颈部、锁骨上下、腋窝及腹股沟淋巴结均未触及肿大.     

Liver cell adenoma with malignant transformation： A case report

A 57-year-old woman was referred to our hospital because of a liver mass detected by computed tomography. She had taken oral contraceptives for only one month at the age of thirty. Physical examination revealed no abnormalities, and laboratory data, including hepatic function tests, were within the normal range, with the exception of elevated levels of those serum proteins induced by the absence of vitamin K or by raised levels of the antagonist (PIVKA)-II (3,502 AU/ml). Abdominal ultrasonography revealed a hyperechoic mass measuring 10 X 10 cm in the left posterior segment of the liver. Because hepatocellular carcinoma could not be completely excluded, this mass was resected. The tumor consisted of sheets of uniform cells with clear cytoplasm, perinuclear eosinophilic granules and round nuclei. These histological findings were consistent with liver cell adenoma. Background hepatic tissue appeared normal. After resection of the tumor, serum PIVKA-II fell to within the normal range. An area of hepatocellular carcinoma (HCC) with a mid-trabecular pattern was immunohistochemically found, which was positive for PIVKA-II. Sinusoidal endothelial cells were CD34-positive, containing scattered PIVKA-II positive cells. This tumor was therefore finally diagnosed as liver cell adenoma with focal malignant transformation to HCC.     

肝硬化脾功能亢进合并感染性心内膜炎一例

<正>1病例资料患者男性,45岁。因呼吸困难、发热2个月余于2011年3月14日入院。患者2个月前劳累后开始出现呼吸困难,并逐渐加重,伴有全身乏力,头晕,黑矇,两次行走中出现晕厥,休息后症状可缓解。体温间断升高,波动于37.0℃～38.5℃,无寒战、盗汗、胸痛、咳嗽、咳痰,无皮疹、红斑、肌肉     

肝血色病1例报道并文献复习

肝血色病又称肝血色素沉着症或肝铁过度沉积症,是一种罕见的因铁代谢紊乱,肠道铁被过度吸收导致体内铁过量的疾病。现将我院收治的1例肝血色病及相关文献复习报道如下。     

Primary cervical epidural malignant lymphoma with rheumatoid arthritis: a case report

We report a case of primary cervical epidural malignant lymphoma with rheumatoid arthritis. Because of the acute progression of paralysis in both legs, surgical decompression and stabilization of the cervical spine were performed. The resected specimen showed proliferation of lymphoblastic cells diagnosed as malignant lymphoma. Four series of chemotherapy were administered after surgery, and the patient recovered from paralysis.     

Liver cell adenoma： A case report with clonal analysis and literature review

We report a case of liver cell adenoma (LCA) in a 33-year-old female patient with special respect to its clonality status, pathogenic factors and differential diagnosis. The case was examined by histopathology, immunohistochemistry and a clonality assay based on X-chromosomal inactivation mosaicism in female somatic tissues and polymorphism at androgen receptor focus. The clinicopathological features of the reported cases from China and other countries were compared. The lesion was spherical, sizing 2 cm in its maximal dimension. Histologically, it was composed of cells arranged in cords, most of which were two-cell-thick and separated by sinusoids. Focal fatty change and excessive glycogen storage were observed. The tumor cells were round or polygonal in shape, resembling the surrounding parenchymal cells. Mitosis was not found. No portal tract, central vein or ductule was found within the lesion. The tumor tissue showed a positive reaction for cytokeratin (CK) 18, but not for CK19, vimentin, estrogen and progesterone receptors. Monoclonality was demonstrated for the lesion, confirming the diagnosis of an LCA. Clonality analysis is helpful for its distinction from focal nodular hyperplasia.     

Primary malignant liver mesenchymal tumor: a case report

Primary malignant liver mesenchymal tumor is a rare condition defined as a tumor with vascular, fibrous, adi-pose, and other mesenchymal tissue differentiation. We report a case of primary malignant liver mesenchymal tumor in a 51-year-old male with anemia, weight loss and hepatomegaly. Finally unconventional liver biopsy and histological manifestation led to the definitive diag-nosis.     

Liver lesions in cryoglobulinemia associated with gastric non-Hodgkin lymphoma: a case report

ABSTRACT: Liver lesions in cryoglobulinaemia, associated with gastric non-Hodgkin lymphoma, are described in a 67-year-old woman. Histological examination showed capillaropoiesis in some portal tracts with vessels containing amorphous, eosinophilic and PAS-positive material, which immunohistochemically was shown to contain IgM and k light-chains.     

Primary malignant melanoma of the liver： A case report

Primary malignant melanoma of the liver is an exceedingly rare tumor. Only 12 cases have been reported in the worldwide literature. We present a case of isolated malignant melanoma of the liver occurring in a 36-year-old Chinese male patient. Comprehensive dermatologic and ophthalmologic examinations revealed no evidence of a cutaneous or ocular primary lesion. Other lesions in brain, respiratory tract, lung, gastrointestinal tract and anus, were not demonstrated by serial position emission tomography （PET）. Microscopic examination of the resected specimen revealed a malignant melanoma, which was confirmed by immunohistochemical staining for HMB-45, S-100 protein, melanoma-pan and vimentin. Moreover, electron microscopy demonstrated melanosomes in tumor cell cytoplasm. Our case shows that primary malignant melanoma may occur in the liver and should be considered when the histopathological appearance is not typical for other hepatic neoplasm.