经皮穿刺胸膜活检在胸腔积液诊断中的价值

目的探讨胸膜活检在胸腔积液病因诊断中的价值。方法对该院2009-01～2011-06行胸膜活检的120例胸腔积液患者的病例资料进行回顾性分析。结果 120例患者共行142次胸膜活检,1次成功检取组织105例,共197块;2次成功检取组织8例,共13块;3次成功检取组织7例,共10块。其中确诊结核性胸膜炎52例,胸膜转移瘤41例,间皮瘤2例,支气管黏膜淀粉样变合并胸腔积液1例,慢性嗜酸粒细胞增高症1例,慢性炎症12例,未取到胸膜者11例。出现的不良反应有胸膜反应3例,合并气胸6例,出血16例,术后发热17例,肿瘤细胞针道种植1例。结论胸膜活检操作简单,费用低,创伤小,患者易接受,对胸腔积液病因有较高的诊断价值。     

淀粉样变性病和胸膜

以往文献报告全身淀粉样变性病肺受累率为30～92%,肺受累的尸检传统分类为肺泡、支气管和/或血管改变,绝大多数报告都没有描述胸膜淀粉样变性病的组织学改变。本文报告5例全身淀粉样变性病合并胸膜腔积液者,均经经皮针刺胸膜活检确诊胸膜淀粉样变性病。     

经皮胸膜活检术在渗出性胸腔积液病因诊断中的应用

目的 探讨经皮胸膜活检术在渗出性胸腔积液病因诊断中的应用.方法 对我院2010年6月至2011年5月77例渗出性胸腔积液患者行经皮胸膜活检术,分析胸膜活检对胸膜疾病诊断的阳性率及注意事项.结果 确诊结核性胸膜炎37例,胸膜间皮瘤7例,胸膜转移癌26例,原因不明7例;术后无1例出现不良反应.结论胸膜活检术是一种操作简单、有效、安全的诊断胸膜疾病的方法.     

胸膜活检对原因不明的渗出性胸腔积液的诊断价值

目的观察胸膜活检术在渗出性胸腔积液诊断中的价值。方法对146例渗出性胸腔积液患者行胸膜活检，同时取胸水及痰送检抗酸杆菌及癌细胞。结果146例胸膜活检第一次活检成功率71．9％，特异性病理诊断92例，病理诊断阳性率63％。恶性胸腔积液胸膜活检阳性率58％，胸水细胞学检查阳性率22％，痰找癌细胞阳性率16％。结核性胸腔积液胸膜活检阳性率66．6％，痰找抗酸杆菌阳性率5．2％。结论胸膜活检是一项安全、简单、有效的胸膜疾病的重要的内科确诊手段。     

肺活检针在胸腔积液诊断中的应用价值

胸腔积液是常见病,多发病,包括渗出性与漏出性两类,病因多种多样,对原因不明的胸腔积液患者的胸膜行活检病理检查,具有重要的诊断价值。而常规的胸膜活检操作稍显复杂,所用活检针较粗钝,损伤大,且易并发气胸、出血等,我科于2003年3月-2004年3月对217例原因不明的胸腔积液患者以肺活检针（弹簧式自动切割针）代替常规胸膜活检针行胸膜活检,取得一定成绩,报道如下。     

胸膜活检诊断不明原因胸腔积液的临床分析

目的通过胸膜活检术提高不明原因胸腔积液的诊断率。方法用Cope针穿刺法采用多部位穿刺。结果139例胸腔积液患者中,胸膜活检病理诊断为肿瘤43例,结核59例,胸膜活检病理诊断阳性率为73.38%(102/139)。结论胸膜活检可明显提高胸腔积液的诊断率,且操作方便,操伤较小,无严重并发症,是安全有效的诊断手段之一。     

Raja胸膜活检针与Abrams针在实验性胸腔积液中的比较研究

经皮胸膜活检对原因不明的胸腔积液很有诊断价值。但现有的胸膜活检针尚不理想。新研制出的Raja 胸膜活检针由两个同心针管组成,其外径为3mm。用钛合金制作的活检勾安置在内管上,外管上有一活检孔的开口。本文比较了 Raja 针和 Abrams针作胸膜活检时的诊断率与安全性。方法与结果通过胸膜腔内滴入盐酸四环素溶液     

弹簧式自动切割针胸膜活检在诊断胸腔积液病因的价值

目的探讨弹簧式自动切割针胸膜活检在良恶性胸腔积液诊断的临床应用价值。方法对2006年1月-2009年5月对279例原因不明的胸腔积液患者随机分为观察组肺活检针（意大利制造的弹簧式自动切割针）168例和对照组常规胸膜活检针（上海制造的改良Cope钝头胸膜活检针）111例,行针刺胸膜活检并对结果进行回顾性分析。结果弹簧式自动切割针观察组取材成功率与活检的确诊率均与对照组相似（95.2%对95.5%,35.1%对36.9%）。结核性病变阳性率与恶性病变阳性率在观察组均高于对照组（31.4%对30.6%,44%对41.9%）。并发症观察组低于对照组（5.4%对20.7%）。结论使用弹簧式自动切割针较使用改良Cope钝头胸膜活检针行针刺胸膜活检,既可提高诊断率又能显著减少并发症发生,值得推广使用。     

胸膜活检对胸腔积液病因诊断的价值

胸腔积液是临床的一种常见病，其病因复杂。我院自2000年以来收治了200例胸腔积液患，逐一进行经皮针刺胸膜活检。现总结报告如下：     

支气管镜代替内科胸腔镜检查在胸腔积液诊断中的价值

胸腔积液是呼吸系统常见疾病,其病因的诊断和鉴别有时非常困难,以往采用胸腔穿刺抽出积液进行常规、生化,标志物等检查,但其敏感性、特异性较低,多数只能做参考[1]。确诊胸膜疾病最可靠的方法是对病变部位取活检作病理诊断。经皮闭式胸膜活检对胸腔积液病因诊断具有简单、易行、损伤小的优点,但胸膜活检也具有一定的盲目性,阳性率较低。内科胸腔镜(medical thoracoscopy,或     

Pleural amyloidosis in a patient with intractable pleural effusion and multiple myeloma

Pleural involvement of systemic amyloidosis has been rarely reported. We report a case with multiple myeloma presenting an intractable right pleural effusion, in which pleural amyloidosis was diagnosed through pleural biopsy using a Cope needle. The diagnosis of pleural amyloidosis is important, because its refractory pleural effusion should be treated with pleurodesis. Since closed pleural biopsy using a Cope needle is much less invasive than thoracoscopy, the former should be attempted first whenever pleural amyloidosis is suspected.     

Pseudotumoral adenopathies, an unusual means of detecting systemic amyloidosis

INTRODUCTION: It is uncommon that lymph node enlargement is diagnostic of systemic amyloidosis as found in the case reported in this study. EXEGESIS: This study examined the case of a 49-year old male with chronic bronchitis in whom in 1990 the presence had been detected of an isolated cervical lymphadenopathy, 2 cm in diameter, and which had previously remained unnoticed. In 1993, a significant number of other peripheral adenopathies also appeared in various locations, i.e., cervical, axillary, inguinal. Chest and abdominal CT-scans revealed several mediastinal and abdominal lymphadenopathies. The histological study with Congo red stain of a cervical lymph node biopsy determined the diagnosis of amyloidosis. The patient was at that time asymptomatic. In September 1997, upon physical examination the following were found: lower limb edema, superior vena cava syndrome, and several cervical lymphadenopathies. Abdominal ultrasonography showed enlarged kidneys, and homogeneous splenomegaly. Biological examination determined the existence of a nephrotic syndrome with renal failure and creatinemia of 350 mumol/L. Due to superior vena cava syndrome worsening, cervical lymph node removal was performed. However, the patient died after rapid renal failure. CONCLUSION: Although it is a rare occurrence, amyloidosis should be taken into consideration in the differential diagnosis of isolated lymphadenopathy. Congo red stain amongst others, and an immunohistochemical study should be performed in cases of uncertain diagnosis.     

Phenol Congo red staining enhances the diagnostic value of abdominal fat aspiration biopsy in reactive AA amyloidosis secondary to rheumatoid arthritis

OBJECTIVE: Systemic reactive AA amyloidosis is an intractable complication in patients with a long history of rheumatoid arthritis (RA). To help to more easily and reliably detect the presence of this form of amyloidosis in patients with RA and start intensive treatment as early as possible, we examined the sensitivity and usefulness of abdominal fat aspiration biopsy with phenol Congo red staining in the diagnosis of AA amyloidosis. PATIENTS AND METHODS: Ten patients were diagnosed with systemic reactive AA amyloidosis secondary to RA (all women; mean age, 70.2 +/- 6.4 years; mean disease duration of RA, 20.3 +/- 11.2 years) based on histopathological examinations of biopsied specimens mainly from the gastroduodenal mucosa. Abdominal fat aspiration biopsy was performed in these patients, and the specimens were treated with both classical alkaline and phenol Congo red staining. RESULTS: Phenol Congo red staining revealed amyloid deposits in all 10 patients, while conventional alkaline Congo red staining showed a positive result in 7 patients. In the patients with a positive result with alkaline Congo red staining, reactivity of one grade or two higher was demonstrated by the phenol Congo red method. CONCLUSION: Phenol Congo red staining is superior to the classical alkaline Congo red staining with respect to the detection of AA-amyloid deposits in biopsied abdominal fat tissue specimens. In addition to easy access and procedural safety, abdominal fat aspiration biopsy might contribute reliably to the diagnosis of systemic reactive AA amyloidosis secondary to RA when phenol Congo red staining is employed.     

The association of Hashimoto disease and Congo red negative amyloidosis

Systemic amyloidosis which is characterized by extracellular deposition of monoclonal immunoglobulin light chains in various organs may be difficult to diagnose at an early stage, especially when the Congo red stain is negative. We describe herein a case of Congo red negative primary amyloidosis associated with Hashimoto thyroiditis. The patient presented with multiple organ involvement suggestive of amyloidosis including heart failure, renal failure, and macroglossia. Serum and urine immunofixation studies were positive for monoclonal chains. Even though a biopsy taken from the enlarged tongue of the patient was negative when stained with Congo red, electron microscopy showed ultrastructural features of amyloid deposition. In conclusion, we are reporting a rare case of primary amyloidosis with a negative Congo red stain associated with Hashimoto thyroiditis.     

Diagnosis of systemic amyloidosis and amyloidosis mediated cardiomyopathy by VATS pleural biopsy for chronic pleural effusion

Amyloidosis is a family of diseases characterized by the extracellular accumulation of amyloid protein, causing altered physiology based on its abnormal deposition in an organ. The etiology of persistent pleural effusions in patients with systemic amyloidosis is unknown. Endomyocardial biopsy is the gold standard of diagnosis for patients with cardiac involvement in systemic amyloidosis. We present the case of a patient with systemic amyloidosis whose diagnosis was made by pleural pathology collected via video-assisted thoracic surgery after a false negative endomyocardial biopsy.KEY WORDS : Pleural effusion, amyloidosis, cardiac amyloidosis, video assisted thoracic surgery     

Nodular lung disease with five year survival and unilateral pleural effusion in AL amyloidosis

A 67-year-old female patient with biopsy proven AL systemic amyloidosis developed rapidly progressive dyspnea. Chest roentgenogram and CT scan revealed a large right pleural effusion in addition to nodular lesions with bilateral hilar lymphadenopathy. The patient's serum showed IgG λ type monoclonal gammopathy and she also had Bence Jones proteinuria. The pleural effusion was an exudate that contained many mononuclear cells and a high concentration of protein. Cardiac function was not seriously disturbed Except for amyloidosis, no other causes for the severe pleural effusion were found. This patient was treated with chemical pleurodesis using Picibanil and a low dose of prednisolone. Eighteen months after this treatment, her right pleural effusion did not recur. Bronchopulrnonary tissues are known to be frequently involved by AL systemic amyloidosis, but a nodular pattern of pulmonary amyloid deposition and a unilateral large pleural effusion are rare clinical manifestations in this disease.     

Labial salivary gland biopsy is a reliable test for the diagnosis of primary and secondary amyloidosis. a prospective clinical and immunohistologic study in 59 patients

Objective. Reports of the detection of amyloidosis by labial salivary gland (LSG) biopsy have been mostly anecdotal. The aim of this study was to assess the value of this method in the diagnosis of amyloidosis. Methods. LSG biopsy tissues were studied with a combination method using Congo red stain and immunohistologic characterization using an antibody directed against the serum amyloid P (SAP) component. Electron microscopy was performed in all cases. In a prospective study, we evaluated 30 patients with biopsy-proven AA or AL amyloidosis. We compared these patients with a control group of 29 age-matched patients without clinical or biologic evidence of amyloid disease (14 had rheumatoid arthritis and 15 had plasma cell dyscrasia). Results. In 26 of the 30 patients with known systemic amyloidosis, amyloid deposits were identified on LSG biopsy (sensitivity of 86%). In 1 of the remaining patients, amyloid deposits were identified on LSG biopsy and systemic amyloidosis was confirmed by abdominal fat biopsy and ¹²³I-labeled SAP scintigraphy. Conclusion. This study emphasizes the high sensitivity of LSG biopsy in the diagnosis of amyloidosis, even in the absence of oral symptoms.     

Nodular lung disease with five year survival and unilateral pleural effusion in AL amyloidosis.

A 67-year-old female patient with biopsy proven AL systemic amyloidosis developed rapidly progressive dyspnea. Chest roentgenogram and CT scan revealed a large right pleural effusion in addition to nodular lesions with bilateral hilar lymphadenopathy. The patient's serum showed IgG lambda type monoclonal gammopathy and she also had Bence Jones proteinuria. The pleural effusion was an exudate that contained many mononuclear cells and a high concentration of protein. Cardiac function was not seriously disturbed. Except for amyloidosis, no other causes for the severe pleural effusion were found. This patient was treated with chemical pleurodesis using Picibanil and a low dose of prednisolone. Eighteen months after this treatment, her right pleural effusion did not recur. Bronchopulmonary tissues are known to be frequently involved by AL systemic amyloidosis, but a nodular pattern of pulmonary amyloid deposition and a unilateral large pleural effusion are rare clinical manifestations in this disease.     

Sensitive and rapid assessment of amyloid by oligothiophene fluorescence in subcutaneous fat tissue

Systemic amyloidosis (SA) is often diagnosed late. Combining clinical and biochemical biomarkers is necessary for raising suspicion of disease. Fine needle aspiration (FNA) of subcutaneous fat enables SA detection by Congo red staining. The luminescent conjugated probe heptameric formic thiophene acetic acid (h-FTAA) is a sensitive alternative to Congo red-staining of tissue samples. Our objective was to compare h-FTAA fluorescence with the Congo red stain for amyloid detection in FNA-obtained fat tissue. Herein, we studied samples from 57 patients with established SA (19 with AA, 20 with AL, and 18 with ATTR) and 17 age-matched controls (34–75 years). Positivity for h-FTAA was graded according to a Congo red-based grading scale ranging from 0 to 4+. Amyloid grading by both methods correlated strongly (r?=?0.87). Here h-FTAA was positive in 53 of 54 Congo red-positive cases (sensitivity 98%) and h-FTAA was negative in 7 of 17 Congo red-negative controls (specificity 41%), but was also positive for 3 Congo red-negative SA cases. We conclude that h-FTAA fluorescence is more sensitive than Congo red staining in this small exploratory study of fat tissue samples, implicating potential sensitivity for prodromal amyloidosis, but is less specific for clinical amyloidosis defined by Congo red positivity. Given its simplicity h-FTAA staining may therefore be the most appropriate method for rapid screening of fat tissue samples but should presently treat grade 1+ as only suggestive, whereas 2+ or higher as positive for amyloidosis. Parallel assessment of h-FTAA and Congo red staining appears highly promising for clinical applications.     

Pulmonary amyloidosis and non-amyloid immunoglobulin deposits

The amyloidoses are characterised histopathologically by the tissue deposition of fibrillar amyloid, specifically stained by Congo red and birefringent under polarised light. This characteristic is linked to a beta-folded structural configuration that is the common denominator of the amyloidoses which may have more than twenty distinct protein precursors. The most common is AL amyloidosis which is of immunoglobulin origin. It may be organ limited, or systemic (with predominant cardiac involvement). Limited bronchopulmonary amyloidosis, usually AL, may manifest itself as either tracheobronchial deposits or parenchymal nodules or masses. Diffuse interstitial pulmonary amyloidosis with clinical manifestations is rare and usually associated with systemic AL amyloidosis and deposits involving the alveolar-capillary gas exchange zone. Amyloidosis may also manifest itself as pulmonary hypertension, amyloid hilar and mediastinal adenopathy or pleural involvement. AL amyloidosis may be associated locally with pulmonary lymphoma. Occasionally, non-fibrillar, Congo red-negative, immunoglobulin deposits may occur, presenting as parenchymal pulmonary nodules or cysts. Exceptionally immunoglobulin deposits may show a cellular or extra-cellular crystalline structure.