肝上皮样血管平滑肌脂肪瘤2例

目的:探讨肝上皮样血管平滑肌脂肪瘤的病理诊断及鉴别诊断.方法:收集武钢总医院病理科2007-2009年手术切除肝上皮样血管平滑肌脂肪瘤标本2例,对2例肝上皮样血管平滑肌脂肪瘤相关临床资料、病理学特征及免疫组织化学进行观察分析并复习相关文献.结果:2病例均为女性,巨检境界较清楚,镜下见肿瘤主要由弥漫的上皮样细胞构成,排列...     

超声内镜诊断老年食管黏膜下肿瘤的准确性

目的探讨超声内镜诊断老年食管黏膜下肿瘤（SMTs）的准确性及价值。方法选择胃镜检查中存在食管黏膜下肿物的老年患者116例进行内镜超声检查（EUS），其中29例通过超声内镜引导细针穿刺（EUS—FNA）对肿瘤实施针吸活检，获得穿刺物临床病理珍断；14例通过手术获得术后临床病理诊断；将EUS诊断与病理诊断进行同一样本对照。结果在43例具有明确病理诊断的老年食管黏膜下肿物中，EUS诊断平滑肌瘤27例，平滑肌肉瘤4例，脂肪瘤3例，纵隔肿瘤6例，转移性淋巴结2例，淋巴结结核1例；病理诊断平滑肌瘤25例，平滑肌肉瘤6例，脂肪瘤3例，肺癌4例，淋巴瘤1例；转移性淋巴结3例，淋巴结结核1例。二者总符合率74．42％，其中食管壁内肿瘤诊断符合率94．12％，纵隔病变诊断符合率33．33％。结论通过EUS超声影像能够准确诊断老年食管壁内肿物的性质，纵隔肿瘤需根据EUS—FNA进行诊断。     

磁共振弥散加权成像对肾癌与肾血管平滑肌脂肪瘤的诊断价值

目的探讨磁共振弥散加权成像对肾癌和肾血管平滑肌脂肪瘤的诊断价值。方法选取85例肾肿瘤患者（包括肾癌54例,肾血管平滑肌脂肪瘤31例）,术前行常规MRI平扫检查及弥散加权成像,并在取b值为800 s/mm2时直接测量肾脏肿瘤实性部分的平均表观弥散系数（ADC）值。结果 54例肾癌肿瘤实性部分在弥散加权成像上表现为高信号;31例肾血管平滑肌脂肪瘤表现为边界清楚的混杂信号,其中软组织部分呈等、稍高信号,脂肪部分呈低信号。在b值取800 s/mm2时,肾癌、血管平滑肌脂肪瘤的ADC值比较差异具有统计学意义（P〈0.05）。结论通过弥散加权成像及ADC值,可以更多了解肿瘤的内部结构,有助于肾脏良恶性肿瘤的诊断和鉴别诊断。     

肝血管平滑肌脂肪瘤1例报道

血管平滑肌脂肪瘤(Angiomyolipoma,AML)为少见病,多见于肾脏,发生在肝脏者罕见且成分复杂,术前诊断困难,因此,误诊率较高.作者通过1例较典型的肝血管平滑肌脂肪瘤完整病例的介绍及相关文献复习,以期提高对肝血管平滑肌脂肪瘤的认识及诊断水平.     

MRI与CT诊断肝血管平滑肌脂肪瘤的价值及影像表现

目的探讨MRI与CT检查对诊断肝血管平滑肌脂肪瘤的应用价值,总结其影像学特征。方法选取我院2015年10月至2017年1月收治的16例肝血管平滑肌脂肪瘤患者,分别进行MRI检查,CT检查,MRI联合CT检查。对比患者的临床资料及总结MRI和CT检查的影像学特征。结果患者一般资料比较中,MRI检测出脂肪瘤型5例(31.25%)、肌瘤型3例(18.75%)、血管瘤型1例(6.25%);CT检测出脂肪瘤型4例(25.00%)、肌瘤型2例(12.50%)、混合型2例(12.50%);MRI联合CT检测出脂肪瘤型2例(12.50%)、肌瘤型2例(12.50%)、血管瘤型1例(6.25%)、混合型1例(6.25%)。在对患者影像学检查的检出率比较中,MRI检查检出例数9例(56.25%),CT检查检出例数8例(50.00%),MRI联合CT检查检出例数6例(37.50%)。结论 MRI能够对肝脏内脂肪组织进行检测,而CT能够对患者的病灶密度进行检测,因此MRI联合CT检查能够对肝血管平滑肌脂肪瘤的类型和各类型的病理特征进行诊断,具有较好的临床推广价值。     

含脂肪肾上腺肿瘤的CT图像分析

目的 探讨含脂肪肾上腺肿瘤的CT图像特征.方法 对18例经病理检查证实含脂肪肾上腺肿瘤(髓样脂肪瘤13例,脂肪瘤及成熟畸胎瘤各2例,血管平滑肌脂肪瘤1例)的CT图像(18例均行CT平扫,其中9例行增强扫描)作回顾性分析.结果 18例CT图像上均表现为边缘清楚含脂肪混杂密度影.13例髓样脂肪瘤中,11例以脂肪密度为主,2例以骨髓组织为主;其中3例内见点状钙化影,6例增强扫描髓样组织呈轻度强化,2例表现为边缘清楚均匀一致脂肪密度影.2例成熟畸胎瘤内含有多发钙化灶、软组织及脂肪密度影,其中软组织呈轻度强化.1例肾上腺血管平滑肌脂肪瘤的部分实性成分增强扫描明显强化.结论 含脂肪肾上腺肿瘤种类繁多,其CT图像上具有一定的特征.     

肝脏血管平滑肌脂肪瘤的诊治分析

目的 总结肝脏血管平滑肌脂肪瘤( hepatic angiomyolipoma,HAML)的临床、影像及病理特点,提高对HAML的诊治水平. 方法 收集新疆医科大学附属肿瘤医院3例经手术切除和术后病理确诊的HAML患者,结合相关文献,分析肝HAML的临床表现、典型影像及病理学特点.结果 1例术前确诊,另2例误诊为肝脏其他肿瘤.3例术后随访32～39月,均未见肿瘤复发及转移.临床上,HAML与其他肝良性肿瘤相比无特异性.因3种组织比例差异,影像学表现呈现多样性,在众多影像检查中以CT诊断率最高.常规病理检查加免疫组化可确诊及分型,其中免疫组化标记HMB-45阳性具有重要诊断意义. 结论 HAML是一种少见的肝脏良性肿瘤,术前诊断率低,但只要掌握其影像特点,结合临床病史及实验室检查,术前确诊已成为可能.积极手术治疗,预后良好.     

肝血管平滑肌脂肪瘤的MRI及临床病理特征

目的探讨肝血管平滑肌脂肪瘤(hepatic angiomyolipoma,HAML)的MRI表现及临床病理特征。方法回顾性分析经病理证实的9例HAML的MRI特征及临床表现。结果 9例均为单发肿块,中位直径4.0 cm(1.4~15.3 cm)。7例无不适症状,2例上腹部不适,均行手术切除,中位随访10个月(2~24个月),无复发。组织学上分为混合型4例和肌瘤型5例。免疫组化均HMB-45(+)、SMA(+)、CD34(+)。5例MRI回波序列见大量脂质成分。增强MRI分两种类型:Ⅰ型,动脉期明显强化,门脉期和延迟期仍强化(混合型和肌瘤型各1例),其对应病理为肿瘤组织含较少血管;Ⅱ型,动脉期强化,门脉期和延迟期消退,其病理为肿瘤富含血管(混合型3例及肌瘤型4例)。结论 HAML临床表现无特异性,HAML的增强MRI特征与肿瘤组织富含血管多少有关。确诊需病理及免疫组化检测HMB-45、SMA、CD34阳性。     

肝血管平滑肌脂肪瘤一例报道

肝血管平滑肌脂肪瘤属罕见肿瘤,到1993年为止国外文献报道仅36例,国内尚未见报道。我院通过B超、CT、病理检查及手术,诊疗了一例肝血管平滑肌脂肪瘤,报道如下。 临床资料 彭某,男,50岁,因右上腹隐痛不适,自己扪     

2例儿童肝血管平滑肌脂肪瘤的影像学表现

肝血管平滑肌脂肪瘤是起源于肝间叶组织的良性肿瘤，儿童极为少见，其影像学报道少见。近年来，笔者搜集了2例经病理证实的儿童肝血管平滑肌脂肪瘤，现结合文献总结其影像学特征。     

Malignant Perivascular Epithelioid Cell Neoplasm of the Mediastinum and the Lung: One Case Report

A perivascular epithelioid cell neoplasm (PEComa) in the chest is rare, let alone in the mediastinum and lung.A 63-year-old man was admitted to our hospital with chest pain for more than 2 months and was found to have an opacity in his mediastinum and lung for 3 weeks. Enhanced chest computed tomography (CT) revealed a mass in both the left upper lobe and central anterior mediastinum. To identify the disease, a CT-guided percutaneous transthoracic needle biopsy of the upper left lung lesions was performed. The pathology result was consistent with epithelioid angiomyolipoma/PEComa. After a standard preparation for surgery, the neoplasms in the mediastinum and left lung were resected. The operative findings revealed extensive mediastinal tumor invasion in parts adjacent to the pericardium, including the mediastinal pleura, left pulmonary artery and vein, and phrenic nerve. The left lung tumor had invaded the lung membranes. The final pathologic diagnosis was malignant epithelioid angioleiomyoma in the left upper lung and mediastinum. Later, the mediastinal tumor recurred. The radiography of this case resembles left upper lobe lung cancer with mediastinal lymph node metastasis. Because this tumor lacks fat, the enhanced CT indicated that it was malignant but failed to identify it as a perivascular epithelioid cell neoplasm.This case reminds clinicians that, although most PEComa are benign, some can be malignant. As the radiology indicated, chest PEComas lack fat, which makes their preoperative diagnosis difficult. Therefore, needle biopsy is valuable for a definitive diagnosis.     

Timolipoma gigante: presentación de un caso de tumor mediastínico inusual

Thymolipoma is an uncommon benign neoplasm of the thymus composed of mature adipose and thymic tissue. The diagnosis of thymolipoma should be considered in the case of a mediastinal mass with fat density, especially if it is interspersed with strands of soft tissue attenuation on computed tomography scans. However, it is sometimes difficult to differentiate radiologically between a thymolipoma and other mediastinal fatty tumors.Here we present a patient with a huge mediastinal mass that proved to be a thymolipoma.     

A case of posterior mediastinal ganglioneuroma with fat tissue]

We present a rare case of posterior mediastinal ganglioneuroma with fat tissue. A 50-year-old man visited our Department of Internal Medicine because of hypertension and fatty liver. On screening with abdominal CT a soft tissue tumor was found in the posterior mediastinum. CT and MRI revealed that the tumor appeared to have an abundant fatty component. To obtain a definitive diagnosis, the tumor was resected thoracoscopically. The histological diagnosis was ganglioneuroma. A ganglioneuroma containing a fat component has rarely been reported after cross-sectional imaging. We infer that the tumor may have resulted from spontaneous regression, with subsequent infiltration of adipose tissue from the posterior mediastinum.     

A case of Morgagni's foramen hernia difficult to differentiate from lipoma]

A 61-year-old woman was admitted for chest discomfort. She had been admitted before, in March 1995, because of a lesion detected on chest roentgenograms. At that time, she was given a diagnosis of mediastinal lipoma based on the findings of chest computed tomography (CT) and magnetic resonance imaging (MRI), but was discharged without active intervention due to lack of subjective symptoms. During follow-up, the patient again reported chest discomfort beginning in March 1998. Because chest radiography disclosed. The tumor had enlarged, the patient was admitted to the hospital by our department. Chest MRI disclosed a mass with a signal intensity equal to that of subcutaneous fat in the pericardial space on both T1-weighted and T2-weighted images. Although sagittal images demonstrated continuity of the mass into intraperitoneal fat, a conclusive diagnosis of diaphragmatic hernia could not be made at that time. On April 30, 1998, a thoracotomy was performed on the basis of a preoperative diagnosis of mediastinal lipoma. During surgery, a hernial ring was observed slightly to the right and behind the sternum. The hernia consisted only of greater omentum, and was diagnosed as Morgagni's foramen hernia.     

Spontaneous rupture of the esophagus presenting with unilateral proptosis

An unusual case of spontaneous rupture of the esophagus (Boerhaave syndrome) presented initially with only unilateral proptosis secondary to orbital emphysema, without significant chest or abdominal symptoms. The classical signs of chest pain and cardiovascular collapse were absent. The diagnosis was suggested by the presence of mediastinal emphysema on chest roentgenogram. Boerhaave syndrome was seen after a barium swallow, and the patient was taken immediately to surgery and he survived without further complications. The presence of subcutaneous or mediastinal emphysema with or without other classical signs or symptoms should prompt an aggressive search for its origin. Because a decrease in mortality and morbidity occurs with early detection of this syndrome, a brief review of common and uncommon symptoms is presented.     

Mediastinal emphysema in mountain climbers: report of two cases and review

Two cases of mediastinal emphysema occurring in healthy individuals climbing to the summit of Mount Rainier (4,393 m.) are described. In both, the condition was probably attributable to a voluntary, forced pressure breathing technique--a modified Valsalva maneuver. The various circumstances in which mediastinal emphysema may occur are discussed, along with its possible serious complication of cardiorespiratory compromise. The means of diagnosis are presented, emphasizing that cases in which the important finding of subcutaneous emphysema is absent may be those in which the danger is greatest. Therapeutic measures that occasionally may be necessary are outlined, though the condition is usually a benign one that subsides without specific treatment.     

Totally robotic-assisted non-circumferential tracheal resection and anastomosis for leiomyoma in an elderly female

We describe a novel technique of totally robotic-assisted non-circumferential tracheal resection and running anastomosis with coverage of anastomosis with anterior mediastinal fat flap. A 71-year-old female presented with cough and CT scan revealed a mass at the intra-thoracic trachea. A complete robotic-assisted tracheal resection and anastomosis was performed. The postoperative course was uneventful. The final pathologic examination confirmed the diagnosis of primary tracheal leiomyoma.     

A case of bilateral Bochdalek hernia in an adult]

A 71-year-old male was found to have bilateral posteromedial masses on routine roentgenogram during admission for treatment of traffic accident related injuries. These masses were initially considered to be posterior mediastinal tumors, however, CT scan demonstrated a left diaphragmatic defect and the adipose nature of the bilateral masses (CT number: left -29, right -132). MRI also demonstrated a large amount of fat accumulation in the abdomen. CT scan and MRI are therefore very useful for the diagnosis of Bochdalek hernia in adults.     

Primary myelolipoma in posterior mediastinum

Myelolipoma in posterior mediastinum is indeed rare. As a benign tumor, it consists of mature fat with scattered foci of haematopoietic elements resembling bone marrow. The computed tomography (CT) and magnetic resonance imaging (MRI) are effective methods to detect them, while the definite diagnosis still depends on pathological diagnosis. Up to now, there is no standard treatment for this disease. Surgery is thought to be the best choice in some literatures reports. In this paper, two patients with primary posterior mediastinal tumor are reported, both of whom were underwent Video-assisted thoracoscopic surgery (VATS). Postoperative pathological diagnosis was myelolipoma.     

经气管镜超声引导针吸活检术在定性诊断不明原因肺门及纵隔肿块、纵隔淋巴结肿大中的应用价值

背景 不明原因肺门及纵隔肿块、纵隔淋巴结肿大是胸外科常见的一种疾病,尽管纵隔镜或胸腔镜检查是临床诊断纵隔病变良恶性的"金标准",但因对机体损伤较大、检查费用高昂、可重复性差等导致其临床应用受限,故寻找一种安全、有效的诊断方法一直是临床医师面对的难题.目的 探讨经气管镜超声引导针吸活检术(EBUS-TBNA)在定性诊断不...