16层螺旋CT诊断单侧上尿路多发癌

目的 探讨16层螺旋CT扫描对单侧上尿路多发癌的诊断价值.方法 回顾性分析10例经病理证实的单侧上尿路多发癌患者的16层螺旋CT影像表现.结果 单侧肾盂、输尿管多发癌同时累及膀胱6例,肾盂及输尿管同时受累3例,输尿管中下段癌累及膀胱1例.CT图像上表现为病变肾盂及输尿管管壁不规则增厚和(或)腔内软组织肿块,管腔变窄,累及膀胱者表现为膀胱壁不规则增厚或软组织肿块,大范围的曲面重建可全程清晰显示上尿路病变累及范围,直观显示上尿路腔内外改变.发现腹膜后淋巴结肿大3例,2例经病理证实为转移癌,影像所见与手术、病理完全符合.结论 16层螺旋CT容积扫描能清楚显示单侧上尿路多发癌发生的部位、累及范围.     

CT诊断双肾癌1例

患者男,53岁,当地CT体检发现双肾占位.平素体健.CT增强扫描:左肾和右肾分别见大小约7.0 cm×6.8 cm×6.0 cm和2.5 cm×2.0 cm×1.8 cm的肿块影,边界欠清,双肾肿块在肾实质明显增强的对比下呈不均匀轻度增强,诊断为双肾占位.先后2次在全麻下进行右肾癌剜除术和左肾癌根治术.术后病理:双肾透明细胞癌.     

原发性肺淋巴上皮瘤样癌的CT表现

目的 探讨原发性肺淋巴上皮瘤样癌的CT特征。方法 回顾性分析经手术和病理证实的39例肺淋巴上皮瘤样癌的临床病理及CT资料。结果 39例均为肺内单发病灶,最大径1.12~9.55 cm,其中17例中央型、22例外周型,肿瘤好发于右肺中叶及左肺下叶,共27例（27/39,69.23%）。31例CT平扫表现为均匀等密度肿块,2例见小斑片状低密度区,3例可见细点样钙化,3例出现空洞;增强扫描示均匀强化28例,出现小斑片状坏死8例,出现血管或支气管包埋征15例。肿块呈分叶状25例,边缘可见细毛刺23例,胸膜凹陷征8例。23例出现淋巴结转移。结论 原发性肺淋巴上皮瘤样癌CT表现既具有淋巴瘤的特征,也具有与其他类型肺癌相似之处。     

单期相与多期相CT扫描在常见上尿路梗阻性疾病中的应用

上尿路梗阻性疾病临床较常见,CT平扫加增强后肾皮质期、实质期及分泌期多期扫描[1-2]对诊断本病具有较高的敏感度和特异度,但X线有效剂量(effective dose, ED)较大.多期扫描是否有必要、较少期相扫描是否也可获得相似的诊断效果是本研究的目的.     

Lymphoepithelioma-like carcinoma of the upper urinary tract: A systematic review of case reports

BACKGROUND Lymphoepithelioma-like carcinomas(LELCs)are rare,malignant epithelial tumors,generally considered a subtype of squamous cell carcinoma.LELCs are undifferentiated and can occur in multiple tissues,although LELCs in the urinary tract are extremely rare.As such,evidence does not provide clinicians with guidelines for the best practices.Even though this is a rare disease,it is associated with high morbidity and mortality.Therefore,we must learn to differentiate LELC types and identify risk factors for early identification.AIM To develop an evidence base to guide clinicians treating primary LELCs of the upper urinary tract(UUT-LELC).METHODS We performed a systematic review of all reports on UUT-LELC from the first published case in 1998 until October 2019,according to the PRISMA.A database was then developed by extracting data from previously published reports in order to analyze interactions between clinical characteristics,pathological features,interventions and outcomes.Survival was analyzed using Kaplan–Meier estimates,which were compared using log rank tests.RESULTS A total of 28 previously published cases were identified for inclusion.The median age was 72 years with a male to female ratio of 4:3.Pure type LELCs were most common with 48.3%(n=14),followed by 37.9%(n=11)predominant LELCs and 3.4%(n=1)focal LELCs.Epstein-Barr virus testing was negative in all cases.Fourteen patients received radical nephroureterectomy(RNU)-based intervention.Twenty-three patients survived with no evidence of further metastasis,although six died before the median 18 mo follow-up point.Survival analysis suggests pure histological subtypes,and patients who receive complete tumor resection have more favorable prognoses.As always in cancer care,early identification generally increases the probability of interventional success.CONCLUSION The most effective treatment for UUT-LELC is RNU-based therapy.Since cases are few in number,case reporting must be enhanced and publishing encouraged to both save and prolong lives.     

Malignant giant cell tumor in the left upper arm soft tissue of an adolescent: A case report

BACKGROUNDGiant cell tumor of soft tissue (GCT-ST) is an extremely rare low-grade soft tissue tumor that is originates in superficial tissue and rarely spreads deeper. GCT-ST has unpredictable behavior. It is mainly benign, but may sometimes become aggressive and potentially increase in size within a short period of time.CASE SUMMARYA 17-year-old man was suspected of having a fracture, based on radiography following left shoulder trauma. One month later, the swelling of the left shoulder continued to increase and the pain was obvious. Computed tomography (CT) revealed a soft tissue mass with strip-like calcifications in the left shoulder. The mass invaded the adjacent humerus and showed an insect-like area of destruction at the edge of the cortical bone of the upper humerus. The marrow cavity of the upper humerus was enlarged, and a soft tissue density was seen in the medullary cavity. Thoracic CT revealed multiple small nodules beneath the pleura of both lungs. A bone scan demonstrated increased activity in the left shoulder joint and proximal humerus. The mass showed mixed moderate hypointensity and hyperintensity on T1-weighted images, and mixed hyperintensity on T2-weighted fat-saturated images. The final diagnosis of GCT-ST was confirmed by pathology.CONCLUSIONGCT-STs should be considered in the differential diagnosis of soft tissue tumors and monitored for large increases in size.     

肾脏囊性成熟性畸胎瘤1例

患者，男，42岁。2个月前出现阵发性右上腹疼痛不适，查体发现右上腹一拳头大小包块，质中，无压痛，不能推动。CT平扫：右肾上极见一大小约18cm×18cm×20cm的类圆形占位，以脂肪密度为主．内见软组织密度及团块钙化灶，包膜呈条状及弧形钙化（图1、2）。手术：肿块位于右肾上极．为囊实性。囊内为黄白色黏稠液体约600ml，有大量毛发，囊壁钙化。病理诊断：右肾上极囊性成熟性畸胎瘤（图3）。     

胰腺间变性癌1例

患者女,85岁。因上腹部不适、腹泻入院。CT:左上腹胰尾、脾脏、胃后壁间见大小约6.6 cm×4.5 cm的软组织肿物,平扫密度略不均匀(图1),CT值33~43 HU;增强后不均匀强化(图2),CT值66~100 HU;病灶与脾脏及胰尾分界不清,脾门受压,脾静脉局部显示不清,胰管未见异常扩张。腹腔及腹膜后未见明显肿大淋巴结。CT诊断:左上腹恶性肿瘤,考虑来     

小细胞肺癌误诊为恶性间皮瘤1例

患者男,33岁,因干咳、活动后呼吸困难20天入院.于当地医院接受消炎治疗20天,效果欠佳.入院查体:一般状况良好,右侧肩胛下区触觉语颤减弱,叩诊呈浊音,呼吸音减弱.痰结核菌涂片阴性.CT示右侧肺内可见多发大小不等的团块状阴影沿胸膜分布,右肺上叶可见不规则形实变影,其内可见支气管充气征,纵隔向左移位,纵隔、肺门未见明显肿大淋巴结(图1、2).右侧大量胸腔积液.考虑右侧胸膜恶性间皮瘤,伴右肺上叶肺不张.入院后反复抽取胸水为血性,胸水常规以淋巴细胞为主,胸水中LDH升高875 IU/L,蛋白定量＞3 g/L.CT引导下穿刺病理证实为小细胞癌(图3).     

多房囊性肾瘤1例

患者女,48岁.数年前曾有腹部不适感,近日查体未见异常.实验室检查:血、尿常规及肝、肾功能均无异常.超声示左肾体积增大,肾门区探及液性回声区域,其内条状实质回声,诊断囊性占位病变.     

Breast adenoid cystic carcinoma arising in microglandular adenosis: A case report and review of literature

BACKGROUNDBreast adenoid cystic carcinoma (AdCC) is a rare invasive carcinoma composed of epithelial and myoepithelial cells. Microglandular adenosis (MGA) is a rare benign proliferative lesion consisting of small, uniform, and round glands formed by a single layer of epithelial cells and basement membrane without a myoepithelial cell layer. MGA may progress to atypical MGA and carcinoma arising in MGA. Among various invasive carcinomas from MGA, AdCC has been rarely reported. Here, we report a case of AdCC arising in MGA.CASE SUMMARYA 59-year-old woman was diagnosed with a newly developed density on a routine mammogram. The density was similar to or slightly lower than that of the breast parenchyma. Sonography showed an irregular mass with a slightly higher echo than that of fat. Magnetic resonance imaging showed an irregular mass with a similar T1 signal intensity and a slightly higher T2 signal intensity compared to muscles or the breast parenchyma. The lesion showed heterogeneous internal enhancement with an initially slow and delayed persistent enhancing pattern. Microscopically, the tumor was composed of invasive AdCC, in situ AdCC, and MGA. AdCC is composed of basaloid and ductal epithelial cells forming cribriform or solid sheets, or haphazardly scattered small cribriform or tubular glands. MGA showed small glands with a single epithelial lining and retained lumen. S-100 staining was strongly positive in MGA area. The patient underwent breast-conserving surgery with sentinel lymph node biopsy. CONCLUSIONBreast AdCC arising in MGA showed unique imaging findings that was different from usual invasive cancer.     

富含脂肪结构的不典型肝细胞肝癌1例

患者,男,67岁,右腹部胀痛6月余,袖珍室检查:AFP112.5ng/ml(正常值≤7.0ng/ml).超声检查见肝脏增大,右肝前后径15.9cm.表面欠光滑,实质回声不均匀,肝内见多发高回声,较大的病灶大小约为15.2cm×13.6cm,边界不规则,其内回声不均匀.     

胰腺实性-假乳头状瘤1例

患者女,28岁,半月前无意发现右上腹包块,偶有便秘,无其他不适.体检:右上腹扪及大小约8 cm×8 cm质中包块,包块表面光滑活动度欠佳,无触痛.实验室检查:ALT增高为79 U/L、AST增高为224 U/L,胃肠癌相关抗原增高64.83 U/ml.术前DSA检查,考虑包块性质为良性,ERCP结果为十二指肠降部外压变形,胆总管下段狭窄(外压性)并胆总管显著扩张,未见管壁有充盈缺损.CT检查:右中下腹见一大小约为8.6 cm×8.3 cm肿块,平扫呈等、低密度,密度不均匀,其内可见液化坏死,病灶与周围胰腺组织分界欠清(图1),增强扫描病灶呈不均匀强化,胰周围组织界面不清,胆总管扩张,胆囊、胰管、肝内及肝门区胆管明显扩张(图2).CT诊断:右中下腹占位,考虑为神经源性或间叶组织肿瘤.术后病理结果:(胰头部)实性-假乳头状瘤.     

胃黏膜下巨大纤维脂肪瘤1例

患者,女,47岁,因“中上腹疼痛伴黑便4天”入院。查体:腹平软,未见胃肠型及蠕动波,中上腹部轻压痛,无反跳痛,余腹部未及压痛、反跳痛,Murph’s征阴性,移动性浊音阴性。实验室检查:大便潜血试验( ),血常规:白细胞WBC5.11×109/L,N74.8%,其他各项实验室检查均正常。胃镜检查:胃     

肺巨细胞癌1例

患者女,72岁,以"胸部不适半年,咳嗽、咯血5天"为主诉入院.查体:左肺呼吸音低,叩诊实音.双肺可闻及湿啰音.余未见异常.CT平扫见左胸腔巨大软组织团块影,其内密度不均匀,周边CT值44.3 HU,双侧胸腔积液,左肺膨胀不全;增强扫描见病灶呈不均匀明显强化,其内见低密度影,周边CT值达76.1 HU.CT诊断:左肺癌.