Bosworth骨折脱位1例并文献复习

踝关节骨折是四肢骨折中常见损伤,但Bosworth骨折脱位是踝关节罕见的骨折脱位,由Bosworth在1947年首先描述及报道^[1],其特点是腓骨骨折近端嵌入胫骨后侧而导致距骨脱位后难以闭合复位,需要切开复位。因其损伤机制及特点,容易出现漏诊,如未及时诊治,或按照一般踝关节骨折处理.     

创伤性睾丸交叉脱位1例并文献复习

目的：报道1例创伤性睾丸交叉脱位并文献复习,为临床医师提供参考.方法：回顾性分析1例创伤性睾丸交叉脱位的诊治经过 结合文献复习,对创伤性睾丸脱位的发病机制、分类、诊断、治疗等内容作一归纳总结.结果：该患者经阴囊区触诊和彩超检查诊断为创伤性睾丸交叉脱位.于伤后第25日手术探查,将双侧睾丸复位固定,修补阴囊纵隔.术后1.5月随访患者勃起功能正常,精液分析为外伤后死精.结论：对钝性暴力创伤性重症患者,应重视外生殖器的物理检查及双侧阴囊、睾丸的彩色Doppler超声检查 一旦睾丸脱位诊断确立,应尽早手法复位或手术治疗.     

胰母细胞瘤1例并文献复习

目的：探讨胰母细胞瘤( pancreatoblastoma, PBL)的临床病理学特点及鉴别诊断。方法回顾性分析1例PBL的病理组织学特征、免疫表型特点并进行临床随访,并对其进行文献复习。结果 PBL由纤维间隔形成上皮岛,并形成特征性的鳞状小体及腺泡样分化。免疫组化示肿瘤细胞表达多种细胞角蛋白, AFP、AACT 亦可表达,有腺泡分化区域PAS染色阳性,鳞状分化区域表达34βE12。结论 PBL是一种较少见的恶性肿瘤,目前报道甚少,需对其进行长期随访深入了解其临床、病理特征,以便更好的进行治疗。     

肾素瘤1例并文献复习

目的探讨肾素瘤的临床表现、病理特征、诊断及鉴别诊断、治疗及预后。方法回顾性分析1例经组织学诊断为肾素瘤患者的临床资料,并复习相关文献。结果患者女性,16岁,体检发现高血压1个月余,血压180/110 mmH g,血钾2.5 mol/L。腹部增强CT示左肾近下极附近见类圆形低密度影,边界尚清。肉眼见肾脏下极附近一大小3 cm×1.5cm×1.2 cm肿物,包膜完整,与周围肾组织分界清楚。镜下见均匀一致的圆形瘤细胞呈实片状、条索状排列,细胞间分界不清,胞质嗜酸性,核圆形、椭圆形,核仁、核分裂象罕见,间质血管丰富。免疫表型:CD34、vimentin和Syn均(+),SMA、CD117(散在+),Ki-67增殖指数约1%。术后患者血压及血钾水平恢复正常。结论肾素瘤是较为罕见的良性肿瘤,一般认为来源于肾小球旁细胞,主要临床表现为高血压及低血钾,确诊需结合临床表现、影像学资料和病理特征,保留肾单位的肿瘤切除即可治愈。     

脾脏错构瘤1例并文献复习

目的：探讨脾脏错构瘤的临床病理特征、诊断及鉴别诊断。方法对1例脾脏错构瘤行HE及免疫组化SP两步法染色,光镜观察,分析其临床病理特征并结合文献复习。结果脾脏错构瘤境界清楚,瘤组织主要由纤维组织构成,其间见巢状分布的裂隙状血窦和内含红细胞的小血管组成,内皮细胞呈胖梭形,未见坏死和核分裂象。免疫表型：内皮细胞CD8、CD31、CD34均阳性;纤维组织MSA、α-SMA、vim-entin均阳性,S-100、BCL-2、CD34均阴性;Ki-67增殖指数<1%。结论脾脏错构瘤属于罕见的良性肿瘤,应与脾脏血管瘤等鉴别,免疫组化检测有助于其鉴别诊断。     

外阴肌上皮癌1例并文献复习

目的 探讨外阴肌上皮癌的临床病理学特征。方法 回顾性分析1例外阴肌上皮癌的临床病理学特征、免疫表型、诊断及鉴别诊断等,并复习相关文献。结果 患者37岁,外阴见1枚界限清楚的无痛包块。镜下肿瘤组织呈实性排列,肿瘤细胞形态多样,由上皮样、浆细胞样及透明细胞样细胞组成。细胞核显著异形,核仁明显,核分裂象易见(12～15个/10 HPF),可见病理性核分裂象。免疫表型：EMA、vimentin均弥漫阳性,Calponin、SMA、CD99均阳性,CKpan、CD31、CD34均部分阳性,GFAP、S-100均局灶阳性,HMB-45、MyoD1、Myogenin、desmin均阴性,Ki-67增殖指数约15%。随访25个月,患者生存状况良好,未见复发或转移。结论 外阴肌上皮癌形态学广泛,结构有异质性,易误诊,具有较高的复发率和转移率,诊断时需结合临床病理学和免疫表型特征,必要时可行分子检测用以明确诊断。     

多发性脑膜瘤1例并文献复习

患者,女性,27岁,出生4个月时发现右前额稍有隆起,随年龄增长,逐渐增大,在此期间无任何症状。1997年开始有时头痛,在当地医院就诊疑为颅内骨瘤,行头颅CT扫描,发现右大脑半球多发性病灶。伴右前额颅骨增生、隆起,考虑为“颅内转移性肿瘤”。1998年1月就诊我科,行MRI扫描发现“右大脑半球多发性病灶,大小不等,类圆形,边界清楚,     

阴囊海绵状血管瘤1例并文献复习

血管瘤比较常见,然而发生于生殖系统的血管瘤则较为少见,仅占1%,其中海绵状血管瘤 (cavernoushemangioma)更为罕见.至1998年日本共发现了37例[1,2].2010年我院诊治了1例阴囊巨型海绵状血管瘤,报告如下.     

原发性颅内绒毛膜癌1例并文献复习

目的：探讨原发性颅内绒毛膜癌的临床病理学特征。方法回顾性分析1例原发性颅内绒毛膜癌的临床病理学及免疫表型特征,并复习相关文献。结果原发性颅内绒毛膜癌的组织学改变与发生于性腺(睾丸和卵巢)的绒毛膜癌以及与妊娠相关的绒毛膜癌组织学表现相似。免疫表型：肿瘤细胞 PLAP、CK ( AE1/AE3)和β-HCG 均阳性, c-Kit 和OCT3/4均阴性。结论原发性颅内绒毛膜癌属于性腺外恶性非生殖细胞瘤性生殖细胞肿瘤,极其罕见。诊断必需排除性腺原发病灶以及转移性妊娠相关的绒毛膜癌。血清绒毛膜促性腺激素增高有助于诊断。因治疗原则和预后不同,应排除性腺和滋养层细胞来源的转移性绒毛膜癌,此外,还需与颅内其它组织学类型的生殖细胞肿瘤鉴别,免疫组化可辅助诊断。绒毛膜癌对放、化疗不敏感,预后极差。     

肺癌乳腺转移1例并文献复习

目的 提高对肺癌转移的认识. 方法 报告1例肺癌乳腺转移惠者并进行文献复习. 结果 肺癌总生存率较低的主要原因是肿瘤细胞的转移.目前认为肺癌细胞的转移是一个非常复杂的过程,主要包括肺癌细胞离开原发灶、进入淋巴系统和血液系统、远处生长等方面,与肿瘤的生物学特性密切相关.结论 肺癌转移的机理复杂,还有待于基因学的进一步研究.     

距下关节脱位伴距骨后突骨折一例及文献复习

目的 报道1例少见的距下关节内侧脱位伴距骨后突骨折病例的诊断和治疗,探讨距骨后突周围解剖、距下关节内侧脱位伴距骨后突骨折发生机制、诊断及治疗。方法 回顾性分析1例25岁男性距下关节内侧脱位伴距骨后突骨折患者的临床资料。在PubMed、中国知网、万方数据及维普数据库中,以“距下关节脱位/subtalar dislocation”和“距骨后突骨折/posterior process fracture of talus”为关键词,检索2017年10月前有关距下关节脱位伴距骨后突骨折的相关文献,共纳入6篇6例距下关节脱位伴距骨后突骨折的英文文献报道和1篇1例中文文献报道;结合本例诊治过程,总结该损伤临床及影像学表现、损伤机制、诊断及治疗方法。结果 本文1例青年男性因车祸伤致右足内翻畸形、疼痛、肿胀、活动受限,正侧位X线平片示右距下关节内侧脱位伴后踝游离骨块,急诊行右距下关节脱位闭合复位石膏固定术。急诊术后X线片示距骨外旋,CT平扫示距跟关节间隙增宽、距骨后突骨折、足舟骨撕脱骨折,择期行右距下关节脱位伴距骨后突骨折切开复位内固定术;择期手术后距下关节及距骨后突复位良好,随访6个月患者踝关节活动可,未诉疼痛。结合文献报道的7例,共8例距下关节脱位伴距骨后突骨折,男7例、女1例,年龄17~52岁,均表现为伤后足内翻畸形、肿胀、疼痛、活动受限;X线示距胫关节稳定,足内翻、距下关节内侧脱位,后踝存在游离骨折块;治疗以切开或闭合复位内固定为主要手术方式;距骨后突解剖复位并石膏固定者术后功能恢复好,无关节不稳、创伤性关节炎等相关并发症。结论 当足遭受跖屈内翻暴力时距下关节可发生内侧脱位,同时距骨后突遭受距跟韧带的牵拉暴力形成撕脱骨折。距下关节脱位合并无移位或移位≤2 mm的距骨后突骨折可保守治疗,合并距骨后突骨折移位＞2 mm应手术治疗,有症状的陈旧性骨折可在关节镜下切除骨折块。     

息肉样节细胞神经瘤合并幼年性息肉一例

患者男,17岁。因大便带血半年于2003年1月外院肠镜检查示乙状结肠、直肠多发性息肉。病理诊断为炎性息肉。2003年7月16日因大便带血1年余入本院,无其他伴随症状。无家族遗传性疾病。体检:血压正常,甲状腺未扪及,无皮肤脂肪瘤或皮赘。肠镜示乙状结肠及直肠广泛息肉样增生;回盲瓣处1个2·5cm×2·5cm带蒂息肉,表面欠光滑。组织学检查见该息肉黏膜上皮部分脱落,固有腺体弯曲、扩张,部分呈明显的潴留性扩张,或呈囊性改变,内衬上皮不完整,腔内可见多少不一的分泌物,间质纤维组织增生,较多淋巴细胞、浆细胞浸润伴淋巴滤泡形成,灶性区域中性粒细胞…     

Sarcomatoid combined hepatocellular-cholangiocarcinoma: a case report and review of literature

Sarcomatoid combined hepatocellular-cholangiocarcinoma is an extremely rare primary hepatic malignancy and only a few cases have been reported. Herein, we report a case of combined hepatocellular-cholangiocarcinoma with sarcomatoid changes in a 52-year-old man, who had a history of liver cirrhosis and transarterial chemoembolization. The resected liver revealed a mass of 4.5×3.5 cm. Microscopically, the tumor was composed of adenocarcinoma intermingled with poorly differentiated hepatocellular carcinoma, which contained atypical spindle cells. We also present a short review of reported cases of sarcomatoid combined hepatocellular-cholangiocarcinoma.     

Traumatic transverse fracture of sacrum with cauda equina injury--a case report and review of literature

Fractures of the sacrum are rare and generally associated with fracture of the pelvis. Transverse fractures of the sacrum are even less frequent and neurological deficit may accompany these fractures. A case of transverse fracture sacrum with cauda equina injury treated by sacral laminectomy and root decompression, is reported.     

输尿管子宫内膜异位症1例并文献复习

目的:提高对输尿管子宫内膜异位症(ureteral endometriosis)的认识.方法:分析1例输尿管子宫内膜异位症,并结合文献复习讨论.结果:本案例中患者以"腰酸背痛2月余"入院,全身麻醉下行输尿管活检术及输尿管镜检查术,术中见输尿管内息肉样生长新生物,参考临床病史诊断为输尿管子宫内膜异位症,行输尿管部分切除术及输尿管吻合术.结论:输尿管子宫内膜异位症虽不常见,且临床表现缺乏特异性,诊断明确时常常已经造成肾功能损害,所以应提高对输尿管内膜异位症的认识,对于有不明原因痛经、血尿、腰腹部坠胀或有子宫内膜异位症病史的患者,应结合影像学检查考虑输尿管内膜异位症,确诊后予以积极的手术和药物治疗,长期预后良好.     

Endometrial carcinoma on continuous combined HRT: case report and literature review

BACKGROUND: Continuous combined hormone replacement therapy (HRT) has been introduced in an attempt to increase patient compliance by eliminating withdrawal bleeding which is one of the most significant and troublesome side effects of sequential HRT. Moreover, when given on a daily basis, progestin is thought to be more protective against the development of endometrial carcinoma. CASE REPORT: We describe the case of a 59-year-old woman, diagnosed with endometrial carcinoma while on continuous combined HRT. Her last menstrual period was 7 years ago and she had been on HRT ever since. Initially, she tricycled her preparation using transdermal gel 17beta-estradiol 1.5 mg daily along with vaginal micronised progesterone 200 mg daily from day 1 to 12 every 3 months for the first 5 years and she had regular withdrawal bleeding. She was then moved on to continuous combined HRT (transdermal gel 17beta-estradiol 2.25 mg daily plus dydrogesterone 10 mg per os daily) and started to be amenorrhoeic. A routine transvaginal ultrasound showed an increased endometrial echo (10 mm). She was completely asymptomatic. Further investigations resulted in a report of a well differentiated grade II endometrial carcinoma with squamous differentiation. A review of literature confirms endometrial cancer to be rare while on continuous progesterone and difficulties posed in diagnosing it.     

Severe valgus deformity of the knee with permanent patellar dislocation associated with melorheostosis: A case report and review of the literature

We present a case of an 8-year-old boy diagnosed with melorheostosis who was suffering from severe genu valgum, permanent dislocation of the patella, knee flexion contracture and leg length shortening. Soft tissue contracture of the limb and subsequent joint deformities were reported to represent clinical manifestations of pediatric melorheostosis. As the epiphyseal plate had not closed, patellar reduction was achieved by soft tissue surgical stabilization, including lateral retinacular release, medial retinaculum plication, and transfer of the lateral half of the patellar tendon. At 4 years postoperatively, as a result of improved limb alignment and knee flexion contracture, the leg length shortening has improved, and the patient does not limp and participates in sports activities. Surgical intervention should be performed as early as possible, because genu valgum and external rotation of the tibia may deteriorate with age, rendering the patellar dislocation irreversible in patients with melorheostosis before epiphyseal closure.