基于T2WI肿瘤最大层面直方图分析鉴别诊断子宫内膜间质肉瘤与变性子宫肌瘤

目的探讨基于T2WI肿瘤最大层面直方图分析鉴别诊断子宫内膜间质肉瘤(ESS)与变性子宫肌瘤的价值。方法回顾性分析20例ESS(ESS组)及24例变性子宫肌瘤(变性子宫肌瘤组)。采用MaZda软件于轴位脂肪抑制T2WI肿瘤最大层面勾画ROI,行灰度直方图分析,比较组间直方图参数差异;绘制受试者工作特征(ROC)曲线,评价直方图参数鉴别ESS与变性子宫肌瘤的效能。结果ESS组与变性子宫肌瘤组间轴位脂肪抑制T2WI肿瘤最大层面灰度直方图参数平均值、偏度及第1、10、50、90、99百分位数差异均有统计学意义(P均<0.05),方差及峰度差异无统计学意义(P均>0.05)。ROC曲线结果显示,上述组间差异有统计学意义的7个直方图参数中,以第50百分位数的曲线下面积(AUC)最大,为0.742(P=0.01),其鉴别诊断ESS与变性子宫肌瘤的敏感度为70.0%,特异度为83.3%。结论基于T2WI肿瘤最大层面直方图分析可鉴别ESS与变性子宫肌瘤。     

长可变回波链分段读出弥散加权成像表观弥散系数值全瘤直方图评估Ⅰ期子宫内膜癌肌层浸润深度

目的 观察长可变回波链分段读出弥散加权成像（RESOLVE-DWI）表观弥散系数（ADC）值全瘤直方图评估Ⅰ期子宫内膜癌肌层浸润深度的价值。方法 回顾性分析经病理证实的53例ⅠA期及25例ⅠB期子宫内膜癌患者的MR RESOLVE-DWI资料，采用全瘤ADC值直方图分析法获得肿瘤直方图参数，包括偏度、均匀度、中位数、最大值、第90百分位数、最小值、全距、变异度、第10百分位数、峰度和平均值，比较ⅠA期与ⅠB期子宫内膜癌间各参数的差异；绘制差异有统计学意义参数的受试者工作特征（ROC）曲线，计算曲线下面积（AUC），评价其鉴别ⅠA期与ⅠB期子宫内膜癌的效能。结果 ⅠB期子宫内膜癌ADC值直方图参数最小值及第10百分位数低于ⅠA期（P均<0.01）、全距高于ⅠA期（P<0.01），其他参数ⅠA与ⅠB期子宫内膜癌差异均无统计学意义（P均>0.05）。ROC曲线显示，第10百分位数鉴别ⅠA期与ⅠB期子宫内膜癌的效能较高，AUC为0.81，阈值取571.80×10^-6 mm²/s时，其敏感度为79.25%，特异度为80.00%，准确率为79.76%。结论 基于RESOLVE-DWI的ADC值全瘤直方图分析对评估Ⅰ期子宫内膜癌肌层浸润深度具有一定价值，其中直方图参数第10百分位数的诊断价值较高。     

基于灰度共生矩阵纹理特征分析鉴别胶质母细胞瘤与原发性中枢神经系统淋巴瘤

目的探讨基于灰度共生矩阵的纹理特征分析对胶质母细胞瘤(GBM)与原发性中枢神经系统淋巴瘤(PCNSL)的鉴别诊断价值。方法回顾性分析经病理证实的46例GBM患者(GBM组)和36例PCNSL患者(PCNSL组),利用MaZda软件于增强T1WI和ADC图像肿瘤最大层面手动绘制ROI,提取角二次矩能量(简称能量)、熵、对比、相关及逆差距纹理参数;以差异存在统计学意义的参数构建多变量Logistic回归模型,采用ROC曲线分析纹理参数及Logistic回归模型对GBM与PCNSL的鉴别诊断效能。结果GBM组与PCNSL组之间,增强T1WI参数中的能量、对比、相关、熵,ADC图像参数中的能量、相关、熵差异均有统计学意义(P均<0.01)。将以上参数纳入二元Logistic回归分析,ROC曲线结果显示,增强T1WI和ADC图像纹理参数中,均以熵的鉴别效能为最强,AUC分别为0.81、0.72,敏感度78.26%、56.52%,特异度为77.78%、80.56%;Logistic回归模型鉴别诊断GBM与PCNSL的AUC为0.92,敏感度为91.30%,特异度为83.33%。结论基于灰度共生矩阵的纹理特征分析有助于鉴别诊断GBM与PCNSL。     

MRI灰度直方图分析在髓母细胞瘤复发风险评估中的应用

目的探讨MRI灰度直方图分析在髓母细胞瘤复发风险评估中的应用价值。方法回顾性分析我院经手术病理证实的28例后颅窝髓母细胞瘤患者资料,根据术后随访3年内肿瘤是否复发将其分为复发组及未复发组,各14例。选取肿瘤MR增强矢状位图像最大层面,采用Mazda软件勾画ROI并进行灰度直方图分析,对2组肿瘤直方图参数特征进行统计学分析,获得2组肿瘤间差异有统计学意义的参数特征,并绘制ROC曲线,评价其对髓母细胞瘤复发的诊断效能。结果利用直方图提取出的9个参数特征中,2组间峰度的差异有统计学意义(P=0.018),其ROC曲线下面积为0.776(P=0.018),最佳临界值为1.268,峰度鉴别肿瘤复发风险的敏感度、特异度分别为64.3%、71.4%。结论 MRI灰度直方图分析可作为评估髓母细胞瘤复发风险的重要辅助手段。     

腮腺肿瘤的CT诊断价值探讨

目的:探讨螺旋CT在腮腺肿瘤诊断方面的价值.方法:回顾性分析81例腮腺病变的资料,将CT表现与手术病理结果进行对比分析,进而分析不同病理特征腮腺肿瘤的CT表现特点.结果:良性肿瘤表现形态规则,边界清晰;多形性腺瘤多呈进行性、延迟强化;腺淋巴瘤强化方式表现为“快进快出”;基底细胞腺瘤肿瘤实性部分动脉期强化显著,静脉期持续强化.恶性肿瘤多表现形态不规则、边界不清,并伴邻近组织浸润.结论:螺旋CT对腮腺肿瘤的诊断及鉴别诊断具有重要参考价值.     

腮腺浅叶肿瘤手术方式的探讨

腮腺浅叶良性肿瘤临床上十分常见，尤以腮腺多形性腺瘤为多，根据传统的手术方法，在切除肿瘤时需将腮腺浅叶切除，同时结扎腮腺导管。笔者在做肿瘤切除时，根据肿瘤的部位、大小，试保留部分腮腺浅叶和腮腺导管。1995年以来笔者采用此法对63例腮腺浅叶肿瘤施行手术，现报告如下。     

MRI对腹膜后良性神经源性肿瘤的诊断价值

目的 探讨MRI常规T1WI、T2WI、弥散加权成像（DWI）结合增强扫描对腹膜后良性神经源性肿瘤的诊断价值。方法 回顾性研究34例腹膜后良性神经源性肿瘤的MRI常规T1WI、T2WI、DWI及增强表现,所有病变均经手术病理证实,包括神经鞘瘤15例,副神经节瘤11例,节细胞瘤8例。结果 神经鞘瘤、副神经节瘤、节细胞瘤患者发病年龄、肿瘤大小无统计学差异（P>0.05）,均易产生囊变,神经鞘瘤囊变多位于病灶中心,副神经节瘤囊变多位于病灶周边,神经鞘瘤出血明显多于其他两者（P<0.05）,神经鞘瘤及副神经节瘤呈类圆形或椭圆形,节细胞瘤在形态上呈不规则形;三种病例在DWI上均呈稍高信号,部分囊变出血呈混杂信号,DWI信号强度及ADC值差异无统计学意义（P>0.05）。副神经节瘤强化最明显,神经鞘瘤其次,节细胞瘤轻度强化。结论 MRI增强扫描对腹膜后良性神经源性肿瘤的鉴别诊断具有重要作用,常规T2WI及T1WI对病灶形态、大小显示较好,T2WI对显示囊变、T1WI对显示出血具有优势,DWI鉴别价值不高。     

内镜下治疗声门下巨大多形性腺瘤1例报告

多形性腺瘤又称混合瘤,是源于涎腺最常见的良性肿瘤,约85%发生于腮腺,10%发生于鼻腔、口腔、咽、喉和气管的小涎腺,5%发生于下颌下腺[1].发生于小涎腺的多形性腺瘤主要位于软腭及硬腭,其次为上唇[2].国内外报道多形性腺瘤可发生在少见部位,如泪腺、咽旁间隙、会厌甚至副鼻窦、鼻中隔,但发生于声门下的巨大多形性腺瘤较少见,国内外文献[7]有零星报道.因声门下多形性腺瘤患病率低,肿瘤破溃出血更为罕见,2013年1月我科收治1例,现报道如下.     

腮腺区肿块临床分析与文献复习

目的分析目前腮腺区肿块构成现状及诊疗方法,为临床诊治提供帮助。方法对自1995年至2003年住院手术且经病理确诊的120例腮腺区肿块病例,按其性质、组织类型、性别及年龄等进行回顾性统计分析。结果120例患者中,腮腺肿瘤92例(76.67%);腮腺炎症15例(12.50%);瘤样病变13例(10.83%)。良恶性比例为5.57∶1.00。肿瘤病例中,以多形性腺瘤为最多见,其次为Warthin瘤。腮腺肿块男女比例为1.07∶1.00,以40~69岁患病最多。腮腺区肿块临床误诊率为22.50%(27/120),均误诊为腮腺良性肿瘤。其中炎症病例占大多数。术后随访良性肿瘤及瘤样病变2~5年未见复发;恶性肿瘤1例2年内复发。结论腮腺区肿块好发于中老年人,以良性肿瘤为绝大多数,临床上要注意炎性肿块与肿瘤的鉴别,可根据肿块的病理类型及部位,来确定以手术为主的综合治疗方案。     

腮腺区肿块临床分析与文献复习

目的分析目前腮腺区肿块构成现状及诊疗方法,为临床诊治提供帮助.方法对自1995年至2003年住院手术且经病理确诊的120例腮腺区肿块病例,按其性质、组织类型、性别及年龄等进行回顾性统计分析.结果 120例患者中,腮腺肿瘤92例(76.67%);腮腺炎症15例(12.50%);瘤样病变13例(10.83%).良恶性比例为5.57∶1.00.肿瘤病例中,以多形性腺瘤为最多见,其次为Warthin瘤.腮腺肿块男女比例为1.07∶1.00,以40～69岁患病最多.腮腺区肿块临床误诊率为22.50%(27/120),均误诊为腮腺良性肿瘤.其中炎症病例占大多数.术后随访良性肿瘤及瘤样病变2～5年未见复发;恶性肿瘤1例2年内复发.结论腮腺区肿块好发于中老年人,以良性肿瘤为绝大多数,临床上要注意炎性肿块与肿瘤的鉴别,可根据肿块的病理类型及部位,来确定以手术为主的综合治疗方案.     

Carcinosarcoma (malignant mixed tumor) of the parotid: Report of a case with a pure rhabdomyosarcoma component

Background. Carcinosarcoma or true malignant mixed tumor of the parotid gland is extremely rare, accounting for <1% of all salivary gland malignancies. Methods. A 63-year-old woman presented with a 5-cm right parotid mass which was resected with a radical parotidectomy and infratemporal fossa dissection. Results. The tumor contained two distinctive histologic patterns, that of a poorly differentiated ductal carcinoma and a pleomorphic rhabdomyosarcoma. Additionally, a residual focus of pleomorphic adenoma was present peripherally, Immunohistochemical and electron microscopic studies confirmed the skeletal muscle differentiation. Conclusions. The pattern of combined rhabdomyosarcoma and ductal carcinoma has not been previously reported and adds further evidence to the myoepithelial derivation of these tumors. © 1994 John Wiley & Sons, Inc.     

Salivary Gland Tumor: A Review of 599 Cases in a Brazilian Population

Salivary gland tumors consist of a group of heterogeneous lesions with complex clinicopathological characteristics and distinct biological behaviors. Worldwide series show a contrast in the relative incidence of salivary gland tumors, with some discrepancies in clinicopathological data. The main aim of this study was to describe demographic characteristics of 599 cases in a population from Central Brazil over a 10-year period and compare these with other epidemiological studies. Benign tumors represented 78.3% of the cases. Women were the most affected (61%) and the male:female ratio was 1:1.6. Parotid gland tumors were the most frequent (68.5% of cases) and patient age ranged from 1 to 88 years-old (median of 45 years old). The most frequent tumors were pleomorphic adenomas (68.4%) and benign tumors were significantly more frequent in the parotid (75.9%), while malignant tumors were more frequent in the minor salivary glands (40%) (P < 0.05). In conclusion, women and the parotid gland were the most affected and pleomorphic adenoma was the most frequent lesion, followed by adenoid cystic carcinoma and Warthin’s tumor.     

Giant submandibular gland tumor: mucoepidermoid carcinoma within the pleomorphic adenoma (mixed tumor)

Pleomorphic adenoma (mixed tumor) is the most common type of salivary gland tumors, most often involving the parotid glands. The study presented a case of a giant pleomorphic adenoma of the submandibular gland in a 78-year old woman. Due to the initially slow and progressive growth (during a period of 25 years) without treatment, the tumor attained a size of 25×19×16 cm and a weight of 4 kg. The patient underwent surgery. The histopathological examination showed that the tumor was subject to malignant transformation: within the pleomorphic adenoma one observed mucoepidermoid carcinoma lesions of high-degree malignancy. In spite of the good postoperative esthetic and functional effect the patient was diagnosed with distant metastases to the lungs.     

MRI增强灰度直方图鉴别诊断胶质母细胞瘤、脑淋巴瘤和单发转移瘤

目的探讨MRI增强灰度直方图鉴别诊断胶质母细胞瘤(GBM)、原发性中枢神经系统淋巴瘤(PCNSL)和单发脑转移瘤(SMT)的价值。方法回顾性分析29例GBM(GBM组)、38例PCNSL(PCNSL组)和28例SMT(SMT组)患者的MRI资料。分析肿瘤增强全域灰度直方图分布参数均值、方差、偏度、峰度及第1、10、50、90、99百分位数(Perc.01%、Perc.10%、Perc.50%、Perc.90%、Perc.99%),比较3组间参数差异。结果除Perc.99%外,3组间均值、方差、偏度、峰度、Perc.01%、Perc.10%、Perc.50%、Perc.90%差异均具有统计学意义。GBM组与PCNSL组、GBM组与SMT组、PCNSL组与SMT组间偏度差异有统计学意义,其鉴别诊断GBM与PCNSL、GBM与SMT、PCNSL与SMT的曲线下面积分别为0.97、0.70和0.87(P均0.05)。结论MRI增强肿瘤全域灰度直方图参数可作为鉴别GBM、PCNSL和SMT的辅助方法,以偏度鉴别GBM和PCNSL的效能最高。     

Benign metastasizing pleomorphic adenoma of the parotid gland: a clinicopathologic puzzle

BACKGROUND: Pleomorphic adenoma constitutes the most common benign parotid gland tumor. Local recurrence after surgical treatment (lateral or total parotidectomy) has been described in 1% to 5% of cases. Malignant degeneration has been reported in 2% to 9% of cases of pleomorphic adenoma of salivary gland origin. Metastasizing pleomorphic adenomas without histologic evidence of malignancy have rarely been reported. Metastatic lesions have been discovered in bone, lymph nodes, the lung, oral cavity, pharynx, skin, liver, retroperitoneum, kidney, calvarium, and central nervous system. To the best of our knowledge, we hereby report the first case of pleomorphic adenoma of the parotid gland metastasizing to the ipsilateral maxilla. METHODS: We simultaneously examined apoptosis-related protein expression and markers of cell-proliferation activity in our case of benign pleomorphic adenoma metastasis and compared outcome with a control group of primary parotid pleomorphic adenomas. RESULTS: Analysis of p53, Bcl-2, MIB1, CD 105, p27, and p21 expression did not reveal significant differences between metastasizing pleomorphic adenoma of the salivary gland and the control group of primary parotid pleomorphic adenomas. CONCLUSIONS: Clinical rather than pathologic evidence seems to justify inclusion of metastasizing salivary pleomorphic adenoma in the group of low-grade malignant salivary tumors.     

Familial mixed tumors of the parotid gland

BACKGROUND: The most common neoplasm of the parotid gland is the pleomorphic adenoma. The familial occurrence of such tumors arising within the parotid gland is rare, with only 3 previous reports in the literature. Bilateral synchronous pleomorphic adenomas of the parotid gland are also uncommon. We report 2 siblings with pleomorphic adenomas of the parotid gland, 1 of whom had bilateral synchronous mixed tumors. Patients and Methods Chromosomal analysis of tumor cells from the sibling with bilateral adenomas revealed the translocation t(3;12)(p21;q15). Chromosome 12q breakpoints have previously been identified in a wide variety of solid tumors including pleomorphic adenomas of the parotid gland. CONCLUSIONS: We discuss bilateral mixed tumors, familial parotid tumors, and the potential for a genetic predisposition for the recurrence of such parotid tumors, as suggested by characteristic chromosomal translocations associated with mixed tumors.     

Ultrastructural contributions to the study of morphological differentiation in malignant mixed (pleomorphic) tumors of salivary gland

Ultrastructural studies of pleomorphic adenoma have shown a coordinated differentiation of luminal epithelial and modified myoepithelial cells with the latter cells related to processes resulting in the myxochondroid stroma. Five examples of various histologic types of malignant mixed tumor of parotid origin were examined by electron microscopy to see if underlying patterns of tumor cell differentiation and organization matched those of pleomorphic adenoma. Whether they were intracapsular tumors (with or without identifiable pleomorphic adenoma), carcinomas ex pleomorphic adenoma, or a true malignant mixed tumor, all lesions had cell types and organizations either identical to those in pleomorphic adenoma or, as in less-differentiated examples, displayed features suggesting origin from luminal cells, myoepithelial cells, or both. Even the chondroid cells in the true malignant mixed tumor expressed ultrastructural features indicating their epithelial derivation. On the basis of these findings, some alterations to the classification and terminology of the subtypes of malignant mixed tumor are suggested.     

Disseminated Carcinoma Ex Pleomorphic Adenoma in an Adolescent Confirmed by Application of PLAG1 Immunohistochemistry and FISH for <Emphasis Type="Italic">PLAG1</Emphasis> Rearrangement

A 16-year-old previously asymptomatic boy presented with complaints of fatigue, weight loss, and back pain for several months. Imaging studies revealed a large superior mediastinal mass, numerous bilateral pulmonary nodules, and multiple lytic bone lesions. A needle biopsy from a sternal lesion showed a poorly differentiated carcinoma, immunoreactive for cytokeratins and EMA and immunonegative for various organ/tissue-specific markers. His past medical history was significant for excision of a parotid gland tumor 5 years earlier. Histologic review of the salivary gland tumor revealed a pleomorphic adenoma containing a microscopic focus of invasive carcinoma (carcinoma ex pleomorphic adenoma). By immunohistochemistry, both the salivary gland tumor and the disseminated carcinoma expressed PLAG1 with a strong nuclear pattern. Fluorescence in situ hybridization (FISH), using dual-color, break-apart probes for PLAG1, showed rearrangement of the gene in both the salivary gland and the disseminated tumors. FISH demonstrated additional cytogenetic aberrations in the carcinoma, including polysomy for chromosome 8 (in both the primary salivary gland and the metastatic tumors) and PLAG1 amplification (in the metastatic tumor). We conclude that in the proper clinicopathologic setting, application of PLAG1 immunohistochemistry and FISH for PLAG1 gene rearrangement may be valuable in establishing the diagnosis of carcinoma ex pleomorphic adenoma as the source of a cancer of unknown primary site.     

Myoepithelial Carcinoma Ex Pleomorphic Adenoma of the Maxillary Sinus: A Case Report and Review of Literature

Myoepithelial carcinoma ex pleomorphic adenoma is defined as a malignant epithelial neoplasm arising from a primary or recurrent benign pleomorphic adenoma. This type of tumor comprises 3.6% of all salivary gland tumors and 12% of malignant ones. Clinically, it most commonly presents as a firm mass in the parotid gland. The development of this neoplasm in the sinonasal and nasopharyngeal regions is extremely rare and only few cases are reported in the literature. The prognosis of myoepithelial carcinoma is variable. Marked cellular pleomorphism, high mitotic rate, and high proliferative activity correspond to a poor prognosis. In this article, the authors report the histopathological features of a clinical case of a 64-years-old patient with a large median maxillary neoplasm diagnosed as myoepithelial carcinoma/ex-pleomorphic adenoma. The tumor was resected and subjected to secondary reconstruction using a revascularized free fibula flap. The myoepithelial derivation of neoplastic cells was demonstrated by immunohistochemical positivity for S-100 protein (strong and diffuse), cytokeratin 14 (strong and diffuse), and GFAP (focal).