胆囊息肉样病变恶性倾向的临床病理分析

目的探讨胆囊息肉样病变恶性倾向的危险因素、超声造影表现及其在鉴别良、恶性息肉样病变中的应用。方法收集356例胆囊息肉样病变的手术病理与术前超声的资料,回顾性分析其临床和病理特征。结果手术病理结果显示,假瘤样息肉是胆囊息肉的最主要病理类型335例(94.1%),其次为良性腺瘤和恶变息肉,分别是12例(3.4%)和9例(2.5%)。在胆囊息肉恶变组中,年龄>50岁居多(占88.9%),其息肉病理类型以乳头状或乳头管状腺瘤为主(OR=17.5,P<0.01)。随着息肉的增大,恶性率逐渐增加。息肉直径≥2cm时,恶性率≥50.0%。结合手术病理结果分析发现,合并胆囊结石是影响胆囊息肉超声诊断的重要因素,彩色多普勒血流显像(CDFI)指标是预测良恶性息肉的独立因素。结论年龄>50岁、胆囊直径增大以及CDFI指标是胆囊息肉恶性倾向的危险因素。     

足部骨肿瘤及瘤样病变的发病特点分析

目的分析足部骨肿瘤及瘤样病变的发病特点。方法分析1993～2008年收治的92例足部骨肿瘤及瘤样病变患者的临床资料,分析足部各种骨肿瘤及瘤样病变的发病特点。结果 92例足部骨肿瘤及瘤样病变患者占同期收治骨肿瘤患者（6 247例）的1.5%,其中良性骨肿瘤及瘤样病变79例,占同期收治所有良性骨肿瘤及瘤样病变患者（3 319例）的4.2%;原发恶性骨肿瘤11例,占同期收治原发恶性骨肿瘤患者（2 167例）的0.5%;2例转移癌患者,占同期收治骨转移癌患者（761例）的0.03%。肿瘤发病于跟骨37例、距骨21例、趾骨18例、跖骨11例、楔骨2例、舟骨2例、骰骨1例。结论足部骨肿瘤及瘤样病变发病率低,良性骨肿瘤及瘤样病变的发病率远高于恶性骨肿瘤。部位以跟骨发病率最高,其次为距骨、趾骨。     

肩关节区域肿瘤和肿瘤样病变的影像学诊断

目的探讨肩关节区域肿瘤和肿瘤样病变的影像学诊断及鉴别诊断思路。方法回顾分析我院经手术病理证实的患有肩关节区域肿瘤或肿瘤样病变42例患者的临床及影像学资料。结果42例患者中骨肿瘤25例，软组织肿瘤14例，关节病变3例。正确诊断29例，误诊5例，诊断不明但可明确良恶性8例。常见临床症状在辨别病变良恶性方面无显著性差异。结论肩关节区域肿瘤和肿瘤样病变来源复杂，种类繁多，部分病变仅可区分良恶性，合理的诊断及鉴别诊断思路有助病变的早期正确诊断。     

原发心房肿瘤超声心动图像特征及规律研究--附128例病理对照和术后随访

目的探讨原发心房肿瘤超声心动图(ECG)图像特征及规律性,观察心房肿瘤ECG图像特征与病理和愈后关系.方法应用ECG检查128例原发心房肿瘤,寻找心房肿瘤ECG图像特征及规律性,所有病例均经手术和病理证实,术后ECG随访.结果根据ECG图像特征对128例心房肿瘤所在心腔的部位、附着点位置、形态、大小和运动状态作出正确诊断.ECG显示(1)左房肿瘤多见,右房肿瘤少见,双房肿瘤罕见.(2)左房肿瘤以黏液瘤多见,ECG图像表现单一,其他肿瘤少见;右房肿瘤虽然少见,但病理类型多,ECG图像表现多样.(3)黏液瘤与心房壁界限明显,都绝大多数通过短蒂与房间隔相连,极少数与心房壁相连,瘤体以蒂为固定点随心脏收缩、舒张往返运动;其他肿瘤与心房壁接触密切,接触范围广泛,无蒂,瘤体不随心脏收缩、舒张运动.手术和病理证实前者多为良性肿瘤,后者多为恶性肿瘤.(4)心房黏液瘤可致房室瓣相对性狭窄和关闭不全,但一般不引起瓣膜器质性病变,瘤体摘除后ECG随访绝大多数房室瓣功能即恢复正常.(5)术后ECG随访黏液瘤术后复发率很低,复发间隔时间较长;其他肿瘤复发率很高,复发间隔时间很短.结论原发心房肿瘤ECG图像特征及规律性明显,ECG是诊断原发心房肿瘤简便、快捷、准确的检查方法,ECG可提供心房肿瘤的部位、形态、大小和运动状况,最后确定肿瘤性质必需依靠病理诊断.     

肺内神经鞘瘤七例临床分析并文献复习

目的通过临床病例分析,了解肺内神经鞘瘤的临床和影像表现,提高鉴别诊断能力. 方法对1979年1月～2001年10月期间收治的7例肺内神经鞘瘤的临床、影像学表现及诊断依据进行分析. 结果主要症状:小量咯血、咳嗽、发热、气促、胸痛.纤维支气管镜检查:支气管腔内见新生物3例,外压性狭窄2例.影像表现:左总支气管腔内见结节阻塞2例 ;肺内单发肿块4例;多发肿块1例(2个病灶).肿块边缘光整3 个(良性2个,恶性1个) ,毛糙 3个(恶性).CT增强扫描,表现为网格样强化1个(良性)、周边强化1个(恶性) 、不均质强化4个(良性1个,恶性3个).伴支气管和肋骨受压2例.恶性神经鞘瘤中见胸膜浸润伴胸液 1例、血管受侵2例. 结论肺内神经鞘瘤罕见,临床及影像学表现缺乏特异性 .肿瘤大小和密度对良恶性鉴别无特征意义,肿瘤边界不光整提示恶性可能,相邻结构侵犯是提示恶性病变的重要征象.     

163例心脏肿瘤临床分析

目的 :总结心脏肿瘤的临床特征 ,提高对心脏肿瘤的认识。方法 :回顾性分析了 163例心脏肿瘤的临床表现、肿瘤发生部位及肿瘤性质等。结果 :心脏肿瘤最常见临床表现是心悸和气短。心脏肿瘤可发生于心脏任何部位 ,左心房最常见 ,且多为粘液瘤 ,其次是右心房。右心肿瘤除粘液瘤外 ,多为恶性肿瘤。 163例心脏肿瘤中原发性肿瘤 15 9例 (97.5 % ) ,其中粘液瘤 12 8例(78.5 % ) ,非粘液良性肿瘤 17例 (10 .4% ) ,恶性肿瘤 18(11.0 % )。结论 :原发心脏肿瘤中左心房粘液瘤最多见 ,良性心脏肿瘤手术治疗效果好 ,恶性心脏肿瘤预后差。     

103例原发性心脏肿瘤的外科治疗

目的:回顾性总结原发性心脏肿瘤103例的外科治疗效果。方法:根据病检结果分类,103例中良性肿瘤97例,占94.2;恶性肿瘤6例,占5.8。本组病例术前均行心脏彩超,怀疑恶性者行CT或核磁共振检查。所有良性肿瘤中,除1例平滑肌瘤由下腔静脉延伸至右房,仅部分切除外,其余均完全切除。同期行Dacron补片房间隔修补74例,三尖瓣瓣膜置换1例,二尖瓣整形6例,三尖瓣整形1例,同期行冠状动脉搭桥2例。恶性心脏肿瘤患者中,2例血管肉瘤患者,1例完全切除肿瘤,同期行右房-房间隔重建并行右房-上腔静脉人工血管连接术,并在术后接受局部放疗,另1例行部分切除及自体心包右心房修补;2例右室横纹肌肉瘤患者,行部分肿瘤切除术;2例肺动脉恶性间皮瘤累及肺动脉患者,在体外循环下经肺动脉切口清除肿瘤,疏通肺动脉直至肺门水平。结果:住院期间,全组仅死亡1例,其余患者均顺利出院。良性肿瘤在(2±1.7)年随访期内未发现复发者。6例恶性肿瘤患者中5例术后6个月内早期复发。结论:原发性心脏肿瘤的治疗应根据其恶性程度、来源、侵犯范围、大小来决定手术时机和方式;心脏良性肿瘤中最常见的是黏液瘤,手术应及时进行。发热及血沉增快并不是手术禁忌;术中应防止瘤体破碎,避免遗留肿瘤组织,应切除瘤蒂附着的房壁、房间隔甚至部分瓣膜,防止复发;心脏原发恶性肿瘤预后不良,往往难以完全切除,术后应辅以化疗或放疗。     

孤立性肺结节的临床分析

目的研究孤立性肺结节(SPN)的临床特征,探讨SPN诊断与治疗。方法胸腔镜手术治疗肺结节64例,分析年龄、性别、症状、吸烟史、肺内结节的影像学表现、手术情况、术后病理等因素。结果 SPN的恶性病变与吸烟史,肿瘤直径,肿瘤的边界,肿瘤钙化有关。64例患者中诊断为恶性病变36(56.25%)例。28(43.75%)例术中快速病理诊断为良性病变,其中错构瘤4例,结核球14例,炎性假瘤10例。结论 SPN的良恶性与吸烟史,结节大小,肿瘤边界,是否钙化有关;胸腔镜手术有助于SPN病理诊断与治疗。     

老年眼眶内肿瘤及肿瘤样病变的影像学特点

目的探讨老年患者眼眶内肿瘤及肿瘤样病变的发病情况及影像学表现特征。方法回顾性分析经病理证实的39例年龄≥60岁的老年眼眶内肿瘤及肿瘤样病变患者的临床、影像学及病理资料,分析病变的发病情况及影像学表现特点。结果 39例眼眶内肿瘤及肿瘤样病变中良性27例(69.2%),最常见的为海绵状血管瘤;恶性12例(30.8%),最常见的为恶性淋巴瘤。结论老年眼眶内肿瘤及肿瘤样病变中恶性比例较大,CT及MRI能准确地显示眼眶内肿瘤的部位和累及范围,对病变术前的定位及定性诊断具有重要意义。     

Ki-67在胰岛素瘤中的表达及其意义

胰岛素瘤是最常见的胰腺内分泌肿瘤。Ki-67作为一种细胞增殖标志，与多种肿瘤的分化、浸润、转移和预后密切相关。目的：研究Ki-67在胰岛素瘤中的表达情况。探讨其作为胰岛素瘤良恶性鉴别和预后判断标志物的可能性。方法：选取45例胰岛素瘤组织和9例配对瘤旁正常胰腺组织，以免疫组化方法检测Ki-67的表达。并分析其表达与胰岛素瘤临床病理特征的关系。结果：45例胰岛素瘤组织中18例Ki-67表达阳性，阳性率为40．0％，9例配对瘤旁正常胰腺组织均不表达Ki-67。5例（11．1％）胰岛素瘤组织Ki-67指数≥2％。除术前血糖〈2．8mmol／L者Ki-67表达阳性率显著低于术前血糖≥2．8mmol／L者（P=0．025）外，Ki-67表达阳性与否和Ki-67指数与胰岛素瘤的临床病理特征，包括性别、年龄、症状出现至确诊时间、肿瘤原发部位、大小、是否多发、良恶性、有无转移和术后是否治愈均不相关。结论：根据本研究结果尚不能确定Ki-67能作为鉴别胰岛素瘤良恶性和预后判断的标志物。     

Le fibroélastome valvulaire, une cause cardiaque rare d’accident vasculaire cérébral : à propos de deux cas

Cardiac papillary fibroelastomas are very rare and benign tumors, usually involving heart valves. They are sometimes asymptomatic. However, they become serious illnesses when associated with clinical events, as systemic embolism. Diagnosis is evoked by echocardiography and confirmed by histopathological examination. The only curative treatment consists of the excision of the tumor under cardiopulmonary bypass. This approach is safe and prevents the risk of embolism recurrence. We report the cases of two patients suffering from acute cerebral embolism. Transthoracic and transoesophageal echocardiography detected tumors of the mitral and aortic valve in the first and second patients, respectively. Preserving the valve integrity, both masses were surgically excised and pathological findings confirmed the diagnosis. As surgical management is curative, we believe that these lesions should be always removed.     

Coinciding anomalous coronary artery and papillary fibroelastoma

The primary cardiac tumors are extremely rare tumors that arise from the normal cardiac tissues. There are benign variants (mostly myxoma) and malignant tumors. Fibroelastoma (FE) is the most common primary tumor, of which myxoma is the most common subtype followed by papillary fibroelastomas (PFE). They account for the majority of primary heart valvular tumors that mainly involve the left (mitral and aortic) valves, and only few cases reported pulmonary valve PFE [1]. We present a case of 61 year old female who had incidental pulmonary valve papillary fibroelastoma finding on echo along with anomalous coronary arteries.     

Papillary fibroelastoma of the pulmonary valve

A papillary fibroelastoma is rare, but it is the most common primary tumor of the cardiac valves. Most papillary fibroelastomas affect the left-sided heart valves, such as the aortic and mitral valves; however, they also rarely affect the pulmonary valve. Generally, surgical removal is strongly recommended to prevent its potential thromboembolic risks, especially in cases of left-sided cardiac involvement. However, there are few reports on the treatment of asymptomatic, small, right-sided cardiac fibroelastomas. We present a rare case of an asymptomatic papillary fibroelastoma occurring on the pulmonary valve, which was detected by transthoracic echocardiography, transesophageal echocardiography, and a 64-slice cardiac computed tomography scan, and which was surgically removed.     

Cardiac Papillary Fibroelastoma: case report and review of the literature

Primary cardiac tumors are very rare. Cardiac Papillary Fibroelastoma (CPF) is the third most common primary tumor of the heart and most commonly affects cardiac valves. Those tumors appear like a "sea anemone" with multiple papillary fronds attached to the endocardium by a short stalk. It generally occurs as a single structure and is typically found on the atrial aspect of atrioventricular valves or either side of the semilunar valves. We report a case of aortic valve papillary fibroelastoma which was found on autopsy in a patient with normal coronary artery with evidence of myocardial and cerebral ischemic damage and sudden death.     

Papillary fibroelastoma: report of seven cases

The papillary fibroelastoma (PFE) is a benign heart tumor, mainly found in the valves. Most tumors are asymptomatic, but when present, they are nonspecific or related to embolic phenomena. They are usually diagnosed at routine imaging studies or valve surgery and autopsies. Its treatment is controversial, due to its rarity. We describe seven PFE cases diagnosed and treated at our institution between 1989 and 2010, which constitutes the largest national case series study of this pathology to date.     

Incidental Papillary Fibroelastoma Multimodal: Imaging and Surgical Decisions in 2 Patients

Papillary fibroelastoma is a rare, benign cardiac tumor typically found on the heart valves. It is usually discovered incidentally on echocardiography. The clinical presentation of cardiac papillary fibroelastoma varies from no symptoms to severe embolic sequelae. We report the incidental finding of papillary fibroelastoma in 2 patients. In each, we chose to excise the tumor. The relevant medical literature provides little guidance regarding whether to excise a small papillary fibroelastoma in an asymptomatic patient. Multimodal imaging, which we discuss in the context of our patients'' cases, aids the cardiologist and cardiovascular surgeon in more accurately evaluating papillary fibroelastoma preoperatively.Key words: Chordae tendineae/pathology/ultrasonography, echocardiography, fibroma/epidemiology/pathology/surgery, heart neoplasms/diagnosis/epidemiology/pathology/surgery/ultrasonography, heart valves/pathology, incidental findings, tomography, x-ray computedPapillary fibroelastoma is the third most common primary tumor, and it usually involves the cardiac valves. It can be asymptomatic, or it can cause major thromboembolic sequelae. Factors in deciding to proceed with surgery can be complex, because of difficulties in evaluating the tumor and predicting the patient''s prognosis. Multimodal imaging enables a more accurate evaluation of papillary fibroelastoma. We report our incidental discovery of papillary fibroelastoma in 2 patients, discuss the role of multimodal imaging in our surgical decisions, and review ideas for managing these tumors in asymptomatic patients.     

Primary failure of Hancock porcine bioprosthetic valves: two dimensional echocardiographic assessment

To reveal the process of primary failure of the Hancock porcine bioprosthetic heart valve, a real-time two-dimensional echocardiography was undertaken. There were 75 cases (84 valves) with 26 in the aortic valve position, 39 in the mitral valve position, 9 in both the aortic and mitral valve positions, and 1 in the tricuspid valve position. The subjects comprised 35 males and 40 females, whose ages ranged from 18 to 65 years with a mean of 44.7 years. Valvular changes such as thickened valve cusps or abnormal valve movement were observed in 27 (32%) of the 84 valves; more specifically, in 5 (14.3%) of the 35 aortic valves and in 22 (45.8%) of the 48 mitral valves, indicating that valvular changes occurred most frequently in the mitral valve position (p less than 0.01). In the period between valve replacement surgery and the appearance of valvular changes, no significant difference was noted between aortic and mitral valve bioprostheses. The duration ranged from 14.5 to 74.5 months with a mean of 50.2 months. Valvular changes were evident in more than 50% of the valve bioprostheses implanted 6 or more years ago. In the mitral valve position, valve cusp changes appeared more frequently at the anterior cusp than at the inner and outer cusps. The frequency was 17 cases at the anterior cusp, 6 at the inner and 9 at the outer. In 7 of the 11 cases followed up after the appearance of valvular changes, an increase in the changes was recognized 7.5 to 29.5 months (a mean of 16.4 months) later.(ABSTRACT TRUNCATED AT 250 WORDS)     

Papillary Fibroelastoma of the Aortic Valve as a Cause of Transient Ischemic Attack

Diagnostic evaluation of embolic neurologic events requires the consideration of cardiac causes. We recently encountered a case that emphasizes the importance of cardiac tumor as a source of embolic events. We present herein the case of a 42-year-old woman who suffered a transient ischemic attack caused by a papillary fibroelastoma that originated from the aortic valve.Key words: Aortic valve/pathology, echocardiography, transesophageal, heart neoplasms/pathology, heart valve diseases/ultrasonography, heart valves/pathology, fibroma/complications/diagnosis/therapy/ultrasonography, transient ischemic attackDiagnostic evaluation of embolic neurologic events requires the consideration of cardiac causes. We recently encountered a case that emphasizes the importance of cardiac tumor as a source of embolic events. Primary cardiac tumors are rare: their prevalence in a series of multiple autopsies¹ was only 0.02%. Cardiac papillary fibroelastoma, the 2nd most common primary benign cardiac tumor after cardiac myxoma, accounts for 10% of all cardiac tumors and is the most common tumor of the heart valves. Papillary fibroelastoma occurs slightly more often in men than in women (55% vs 45%), and the mean age of patients is 60 years.² Although some authors associate papillary fibroelastoma with an underlying risk of heart disease, no risk factors have been established, and the histogenesis of these tumors remains a controversial topic.^3,4 Concomitant valvular dysfunction is attributed only rarely to these tumors.⁵ Clinical manifestations of papillary fibroelastoma include cerebrovascular accidents, myocardial infarction, pulmonary embolism, congestive heart failure, and sudden cardiac death. Most patients, however, remain asymptomatic or display symptoms incidental to the tumor itself.^2,3     

Surgical pathology of the mitral valve: gross and histological study of 1288 surgically excised valves.

A consecutive series of 1288 mitral valves surgically excised from 1981 through 1989 were studied macroscopically and histologically. The explanted valves were affected by: chronic rheumatic disease (1179, 91.5%), floppy mitral valve (84, 6.5%), bacterial endocarditis (19, 1.5%), and post-ischemic mitral incompetence (6, 0.5%). Among 1179 post-rheumatic cases, mixed mitral stenosis and incompetence was the most frequent malfunction (747, 58%). Isolated mitral incompetence was diagnosed in 72 (6.11%) cases only, and isolated stenosis in 360 cases. In 52 valves, excised because of chronic rheumatic disease, the histology showed unexpected signs of acute rheumatism of the leaflets and the papillary muscles. In these patients clinical symptoms and blood tests were negative for rheumatic disease. Mitral incompetence, possibly due to papillary muscle dysfunction, was the prevalent lesion (61.5%). A total of 181 patients (14.05%) with pure mitral incompetence underwent surgery. In 84 patients (46.4%), the floppy mitral valve was the most frequent cause of valve dysfunction, 72 (39.8%) had rheumatic disease, 19 (10.5%) infective endocarditis, and 6 (3.4%) ischemic heart disease. In the group with floppy mitral valve, males were more prevalent than females (51:33). The mean age of the 4 patients with Marfan's syndrome and non-Marfan patients was noticeably different (17 vs 49 yr). Moreover leaflet deformation, tendinous cord elongation and annulus dilatation were the most common causes of valve incompetence. Floppy mitral valve and infective endocarditis were the cause of cordal rupture in 43.5% of the cases. This was a severe complication which always required emergency surgery.     

Mitral valve prolapse: an atypical variation of the anatomy

BACKGROUND: The mitral valve apparatus is a complex structure composed of an annulus, mitral leaflets, chordae tendinae, papillary muscles and left ventricular, atrial and aortic walls. Deficiency or degeneration of one or more of these structures may result in dysfunction of the valvular apparatus leading to mitral valve prolapse during systole. OBJECTIVE: To review the chordal attachment of surgically resected mitral valve tissue from cases of mitral valve incompetence. METHODS: The clinical and morphological features of 135 surgically resected posterior mitral valve leaflet specimens were reviewed for mitral valve prolapse from January 1999 to June 1999. Four mitral leaflets removed either surgically or at autopsy served as controls. RESULTS: Excised posterior mitral leaflets from two patients had segments containing free margin and rough zone chordae that lacked attachment to larger 'strut' or 'stem' chordae or to either papillary muscle. These chordae were observed in otherwise normal mitral valves with adjacent areas that had normal chordal arrangements. Such chordae of the posterior leaflet were termed 'atypical chordae tendinae'. There was no good gross or histological evidence of chordal rupture, and this atypical arrangement appears to be congenital in origin. Grossly and histologically, these atypical variants otherwise exhibited characteristics similar to those of leaflet tissue from typical cases of mitral valve prolapse, with shiny, grey-white and "edematous" tissue that contained increased mucopolysaccharides in the zona spongiosa and chordae tendinae. CONCLUSIONS: This review found atypical attachment of mitral valve chordae tendinae such that isolated segments of the posterior leaflet congenitally lack chordal support, likely leading to mitral valve prolapse. Review of the literature suggests that this is a heretofore unreported cause of mitral valve incompetence.