超声和CT对胃肠道间质瘤的诊断分析

目的:探讨超声和CT对胃肠道间质瘤（gastrointestinal stromal tumors,GIST）的诊断价值。方法:回顾性分析经手术病理证实的28例胃肠道间质瘤的超声和CT表现。结果:28例胃肠道间质瘤中原发24例,复发4例。 6例位于胃,22例位于肠道。超声显示肿瘤内部回声分为实性低回声型与囊实混合回声型,彩色多普勒血流显示肿物内部和边缘部见彩色血流点条状或环形分布。CT表现为平扫肿块密度均匀或欠均匀,多数有坏死、囊变,增强扫描实性部分强化均匀或不均匀,静脉期强化较动脉期更明显。 结论:GIST 的CT和超声表现没有特异性,但两者联合应用对其定位准确,对肿瘤良、恶性的判别及预后的估计有重要价值。     

心脏黏液瘤48例外科治疗

 目的　探讨心脏黏液瘤的临床诊断与外科手术治疗的特点。方法　1997年1月至2007年12月收治的48例心脏黏液瘤患者在体外循环下接受手术治疗，同期施行三尖瓣成形术5例，房间隔缺损修补术6例，二尖瓣成形术2例，二尖瓣替换术1例。结果　所有患者术前均经彩色超声明确诊断。全部患者在体外循环下切除肿瘤，无死亡病例。其中左心房黏液瘤42例，右心房黏液瘤6例。经病理证实全部为黏液瘤。共获随访22例，2例黏液瘤患者术后12个月复发。结论　彩色超声心动图对心脏黏液瘤的确诊具有特殊价值，心脏黏液瘤有阻碍血流、栓塞和猝死的危险，一经确诊应尽快手术切除。     

5例未成年女性卵巢硬化性间质瘤影像学分析

目的:探讨未成年女性卵巢硬化性间质瘤的影像学特征。方法:收集5例未成年女性卵巢硬化性间质瘤患者的临床资料、CT及超声图像特征进行回顾性分析。结果:5例卵巢硬化性间质瘤肿瘤最大直径约4.3cm-16.2cm,轮廓清晰,形态多呈类圆形或卵圆形,2例内部呈实质性,3例呈囊实混合性(2例以实性为主,1例以囊性为主)。CT增强扫描后显示,实性部分明显强化,囊性部分无强化,多表现为动脉期实性部分自边缘开始强化,逐渐向内扩散,延迟扫描呈持续强化;超声图像显示瘤体实性部分呈中等回声,血流显示较丰富,以周边为主,囊性部分呈无回声或伴絮状弱回声,均无血流显示。结论:未成年女性卵巢硬化性间质瘤具有一定的CT和超声表现特征,可提高该病的诊断准确率。     

超声和CT在儿童神经母细胞瘤诊断、临床分期和治疗方案制定中的价值分析

目的:对比分析超声和CT对儿童神经母细胞瘤的诊断价值以及二者在该病临床分期和治疗方案制定中的价值。方法:筛选经病理证实的儿童神经母细胞瘤34例（其中术后证实瘤内钙化者26例）,分析其临床及影像资料。结果:本研究的34例患者中,有29例超声显示为大小不等、回声不均匀的实性肿块,其中20例肿块表现为跨中线生长,18例包绕腹部大血管,18例后腹膜淋巴结肿大,且有9例、8例和2例分别为肾脏、肝脏、脾脏受累患者。本研究中有28例患者在术前通过超声进行了确诊,其符合率高达82.4%,特征性瘤内钙化的检出率达88.5%（23/26）;CT示大小不等、密度不均匀的肿块34例,增强可见明显强化,包绕大血管者18例,跨中线生长者20例,侵犯椎管腔者8例,后腹膜淋巴结肿大者15例,肾脏、肝脏、脾脏受累者分别为9例、6例、1例,头颅转移者7例,30例术前做出正确诊断,术前CT诊断符合率为88.2%,瘤内钙化的检出率高达96.2%（25/26）。结论:儿童神经母细胞瘤有其典型的影像学表现,超声和CT对该病的诊断符合率都很高,且各具优势,二者联合应用对儿童神经母细胞瘤的诊断、临床分期和指导治疗有重要价值。     

腮腺混合瘤的超声诊断及其价值

目的：探讨腮腺混合瘤的声像图特征及其临床价值。方法：应用彩色多普勒超声对22例经病理证实的腮腺混合瘤进行观察。结果：实性不均匀12例，实性4例，囊实性5例，囊性1例。彩色多普勒显示：8例表现为0级血流信号，14例表现为Ⅰ级--Ⅲ级血流信号。结论：腮腺混合瘤有显著的声像图特点，彩色多普勒超声有助于提高诊断的正确性。     

胆囊癌的超声表现

目的分析胆囊癌的二维声像图和彩色多普勒超声表现.方法经手术病理证实的胆囊癌28例,将其超声表现分三型Ⅰ型胆囊壁局灶肿块型;Ⅱ型胆囊形态完全消失,胆囊窝实性肿物型;Ⅲ型胆囊壁弥漫增厚型.分析胆囊癌对邻近器官侵犯、肝转移、淋巴结转移的彩色多普勒超声表现.结果超声诊断准确率89.3%.Ⅰ型7例肝转移2例,腹腔腹膜后淋巴结转移1例;Ⅱ型8例肝受侵6例,肝转移2例,腹腔淋巴结转移3例;Ⅲ型10例肝受侵7例,肝转移5例,腹腔淋巴结转移6例,腹膜后淋巴结转移6例.28例胆囊癌血流显示率为28.6%(8/28),最大流速14.7～28.8 cm/s,RI 0.65～0.83.结论Ⅱ型与Ⅲ型肝受侵率较Ⅰ型高,Ⅲ型肝转移和淋巴结转移率较Ⅰ型和Ⅱ型高,超声扫描不仅能检出原发肿瘤,而且能显示肿瘤的侵犯范围、有无转移,为判断能否手术及合理制订综合治疗方案提供帮助;彩超扫描有血流信号时能增强对胆囊癌的诊断信心,但在没有血流信号时,不能完全除外胆囊癌的诊断.     

超声心动图诊断26例心脏黏液瘤

应用经胸二维超声心动图（2DE）、彩色血流显像（CDFI）及频谱多普勒显像（Doppler）诊断26例心脏黏液瘤（27个瘤体）,对团块的位置、数目、大小、形状、瘤蒂附着点和活动度、心腔内及瓣膜口血流等进行探查及分析．认为心脏超声检查是心脏黏液瘤的首选检查方法,具有实时、经济、简便易行等优点。     

巨大腹膜假性黏液瘤1例

<正>腹膜假性黏液瘤是一种比较罕见的低度恶性肿瘤,其发病率约为百万分之一至百万分之三。其主要来源于阑尾黏液瘤或卵巢黏液瘤破裂,导致胶冻状样肿瘤在腹腔内播散增殖而形成。我科收治了1例巨大腹膜假性黏液瘤患者,现将诊治经过报告如下。1病案摘要患者女性,40岁。因腹部持续性胀痛20天,于2021年4月8日至我院门诊就诊。查腹部彩超示:肝周及腹腔内大量积液,较深处150 mm。患者腹部胀痛与饮食无关,排便后未见明显缓解。患者既往因卵巢黏液性囊腺瘤行双侧卵巢、     

乳腺导管内乳头状瘤的高频彩色多普勒超声检查

目的：探讨高频彩色多普勒超声对乳腺导管内乳头状瘤的诊断价值。方法：回顾性分析54例经手术和病理学证实的乳腺导管内乳头状瘤的声像特征和彩色多普勒频谱表现。结果：54例乳腺导管内乳头状瘤的声像图特征可分为4型。导管扩张伴导管内乳头状回声型35倒，不规则液性暗区中实质回声型4例，单纯性导管扩张型6例，实质结节回声型9例。超声诊断符合率为72．2％。彩色血流和多普勒频谱对导管内乳头状瘤良、恶性病变的鉴别无显著差异性。结论：高频彩色多普勒超声能显示乳腺导管内乳头状瘤的直接或间接声像特征，是诊断该病的一种有效检测方法。     

乳腺癌的超声造影表现

目的:探讨SonoVue实时超声造影在乳腺癌诊断中的表现。方法:选用SonoVue超声造影剂,对21例经手术病理证实的乳腺癌常规超声及超声造影声像图进行回顾性分析。常规超声观察乳腺肿瘤部位,大小、形态、边界、内部回声、彩色血流分布情况。超声造影观察病灶的增强时相和方式,包括起始时间、达峰值时间、开始减退时间、完全廓清时间及病灶内部结构的增强表现。结果:常规超声显示21肿块最大直径范围1.1cm-6.0cm,实质回声团块21个,伴钙化5个。18个肿块边界清楚,3个边界尚清楚,均未见明显包膜。19个肿块发现较丰富或丰富彩色血流信号,2个显示周边少量血流信号,21个肿块测及动脉血流信号,平均Vmax 37.5cm/s(范围15.1-95.4 cm/s),RI 0.63-0.83。术前常规超声诊断符合率为85.71%(18/21)。超声造影时21个肿块平均增强起始时间(14.54±3.24)s、达峰值时间(22.64±4.15)s、开始消退时间(59.09±10.25)s、完全廓清时间(115.45±16.70)s乳腺癌造影后内部表现:16例(乳腺浸润性导管癌15例,乳腺神经内分泌癌1例)表现为不均匀增强,其中5例周围见放射状血管;3例(乳腺浸润性导管癌)表现为不完全增强;1例(乳腺浸润性筛状癌)周边不均匀增强,内部始终未见造影剂进入;1例(乳腺黏液腺癌)周边环状增强,边缘显示一穿支血管进入肿块内,走行弯曲,其余部分显示零星增强。乳腺癌造影后边界表现:18例乳腺肿瘤边界模糊,造影后肿块测值均大于常规超声大小,1例(乳腺黏液腺癌)边界清楚;2例(1例乳腺浸润性筛状癌,1例乳腺神经内分泌癌)边界尚清楚,呈分叶状。超声造影后诊断符合率为95%(20/21)。结论:实时超声造影有助于提高乳腺癌诊断的准确性。     

Pseudomyxoma peritonei: a review of 62 cases.

AIM: Pseudomyxoma peritonei (PMP) is a rare disease characterized by the abundance of mucus in the abdomen without extra-peritoneal growth. METHODS: Our patients with PMP have been treated with cytoreduction and hyperthermic intraperitoneal chemotherapy since 1996. The clinical and histopathological features of PMP and the relation of these features with disease-free interval and survival were assessed. RESULTS: Sixty-two patients with PMP (24 M/38 F) were studied. Adenomatous mucosal changes were present in 31 patients. In females, the ovaries were normal in 5 patients and pseudomyxoma ovarii was present in 20 patients. Patients with minimal atypia and with 1% focal proliferation or less (n=38) had a better survival (p=0.0008) than those with more focal proliferation (n=14). CONCLUSION: In most patients with PMP the appendix is affected; in females the ovaries are usually also involved. Focal proliferation appears to be a prognostic factor.     

卵巢来源腹膜假黏液瘤临床病理分析

  目的  探讨卵巢来源腹膜假黏液瘤（pseudomyxoma peritonei,PMP）的临床病理学特征及免疫组织化学表型。  方法  回顾性分析2010年1月至2019年1月272例于首都医科大学附属北京世纪坛医院确诊为PMP患者的临床资料,研究PMP肿瘤来源,复阅病理切片并行免疫组织化学标记,标记抗体包括CK7、CK20、CEA、Villin、CDX2、SATB2、CA125、ER、PR、PAX8、MUC1、MUC2等。  结果  272例PMP中阑尾来源245例（90.1%）、非阑尾来源27例（9.9%）。卵巢来源PMP仅5例（1.8%）,其中4例为黏液性囊腺瘤、1例为交界性黏液性囊腺瘤,均发生在单侧,5例中2例合并成熟性囊性畸胎瘤;腹膜播散肿瘤中2例为无细胞性黏液、2例为低级别腹膜黏液癌、1例为高级别腹膜黏液癌。免疫组织化学法检测显示,5例PMP患者组织中CK20、CEA、Villin、CDX2均阳性,2例黏液性囊腺瘤合并畸胎瘤患者的SATB2部分阳性、2例SATB2阴性、1例SATB2灶状阳性。  结论  卵巢来源PMP罕见,需对阑尾全部取材或对可疑组织块行连续切片,以排除阑尾黏液性肿瘤,并结合临床症状体征、影像学表现、手术所见、组织学特征及免疫组织化学法检测进行综合分析。      

COX-2 expression in pseudomyxoma peritonei

COX-2 expression was studied using an immunohistochemical method in 75 patients with pseudomyxoma peritonei (PMP). Twenty-five patients presented with disseminated peritoneal adenomucinosis (DPAM) and 50 with peritoneal mucinous carcinomatosis (PMCA). COX-2 was expressed in neoplastic mucinous epithelium of 30 cases (40%): 20 in PMCA (40%), 10 in DPAM (40%). Weak COX-2 expression was also noted in four of five patients with appendiceal mucinous neoplasms without peritoneal dissemination. In addition, COX-2 was detected in stromal, endothelial, inflammatory cells and reactive mesothelium. This preliminary information indicates a potential for the use of COX-2 inhibitors in patients with PMP.     

深部热疗联合5-Fu及顺铂腹腔化疗辅助治疗腹膜假黏液瘤的安全性及初步有效性研究

目的:研究深部热疗联合5-Fu及顺铂(DDP)腹腔化疗辅助治疗腹膜假黏液瘤(pseudomyxoma peritonei,PMP)的安全性和初步有效性.方法:回顾性分析2018年1月至2019年12月航天中心医院接受深部热疗联合腹腔化疗患者的临床资料及随访结果,分析血常规、肝肾功、Karnofsky评分及并发症发生情况...     

腹腔热灌注化疗在非根治性阑尾来源低级别腹膜假黏液瘤中的应用价值CSCD

目的探讨腹腔热灌注化疗(HIPEC)在非根治性阑尾来源低级别腹膜假黏液瘤(PMP)中的应用价值。方法回顾性分析300例非根治性阑尾来源低级别PMP患者的临床资料,分析其预后影响因素及HIPEC对其治疗价值。结果237例接受术中HIPEC治疗的患者10年生存率显著高于未接受HIPEC治疗的患者(52%vs.26%,P<0.001);同时接受术中及术后HIPEC治疗的患者10年生存率显著高于单纯接受术中HIPEC治疗的患者(57%vs.44%,P=0.004)。单因素分析显示HIPEC、根治程度、减瘤前PCI>30、减瘤后PCI>30、CA19-9异常为预后影响因素。多因素分析结果提示未接受术中HIPEC治疗以及CA125异常为预后不良的独立危险因素。结论对于无法达到完全减瘤的阑尾来源低级别PMP患者,姑息性减瘤术联合HIPEC治疗仍可显著改善远期预后。     

Case report - cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for pseudomyxoma peritonei complicated with long-term persisting intestinal pneumonitis

A 62-year-old woman had suffered from interstitial pneumonitis caused by collagen disease and had received steroids and immunosuppressants for twenty years. She was diagnosed as pseudomyxoma peritonei by CT examination and underwent palliative cytoreduction two years ago, but peritoneal relapse occurred one year later. At her first visit to our office, she complained of abdominal distension and respiratory distress of Hugh-Jones classification 2-3. CT showed interstitial pneumonitis and a massive intra-abdominal mucinous tumor. Complete cytoreduction by peritonectomy procedures, combined with intraperitoneal chemotherapy with 50 mg of cisplatin, was performed. The duration of the operation was 860 minutes and the blood loss was 7, 000 mL. Postoperative steroidal replacement was performed and neither acute exacerbation of interstitial pneumonitis nor any other severe complication occurred. Today, in the 3-year follow-up period, she is doing well without any sign of recurrence of pseudomyxoma peritonei.     

雷替曲塞用于腹膜假黏液瘤肿瘤细胞减灭术后腹腔热灌注化疗的短期疗效及安全性分析

目的:观察雷替曲塞用于腹膜假黏液瘤(pseudomyxoma peritonei,PMP）肿瘤细胞减灭术(cytoreductive surgery,CRS)后腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC）的短期疗效及安全性。方法:回顾性分析我院自2019年01月至2020年03月接受CRS联合HIPEC治疗的PMP患者,根据术后灌注药物方案是否应用雷替曲塞分为观察组和对照组。观察组术后第1次灌注药物为雷替曲塞(4 mg),第2~5次灌注药物为5-氟尿嘧啶（5-FU）(1 g);对照组术后5次灌注药物均采用5-FU(1 g)。比较两组患者术后一般情况、手术并发症发生率、排气时间、住院时间及两组患者手术前后血常规(WBC、PLT)、肝功能(ALT、AST)、肾功能(Cr)变化情况。结果:研究期间接受CRS及HIPEC治疗的患者共86例,其中观察组和对照组分别为39例和47例。两组基线资料一致(P＞0.05)。两组间术后出血、肠瘘、胸腔积液、切口感染等并发症发生率比较无统计学差异（P＞0.05）。化疗相关不良反应显示对照组腹痛发生率较观察组多(P=0.044),其余不良反应如恶心、呕吐、乏力、发热3日以上等两组比较均无统计学差异（P＞0.05）。两组患者手术前后血液学检查结果变化无统计学差异（P＞0.05）。结论:雷替曲塞用于PMP CRS后HIPEC,不增加术后并发症,不良反应可耐受,治疗过程安全性良好。     

Short-term complications in elderly patients undergoing CRS and HIPEC: A single center's initial experience

IntroductionCytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a well-established curative treatment for patients with peritoneal carcinomatosis (PC) from colorectal cancer (CRC) and pseudomyxoma peritonei (PMP). The study's aim was to present a single center's initial experience with CRS and HIPEC and report the postoperative morbidity in elderly patients.MethodsA retrospective observational study was conducted of all patients with peritoneally disseminated colorectal cancer or pseudomyxoma peritonei undergoing CRS and HIPEC between March 2014 and March 2017. Patient characteristics and the peri- and postoperative course were reviewed. Elderly patients were defined as those aged ≥ 65 years. Postoperative complications were classified according to the Serious Adverse Event (SAE) grading system.Results122 patients undergoing CRS and HIPEC were split into two groups based on age (< 65 years versus ≥ 65 years) at the time of surgery. Both groups were comparable for ASA score, Peritoneal Cancer Index (PCI), procedure time and blood loss. Serious Adverse Event (SAE) grade > 3 morbidity was 26.7% in the elderly group as opposed to 10.4% in the younger group (p = 0.034). Both univariate and multivariate logistic regression analysis demonstrated that age was a significant risk factor (OR = 3.2, 95% CI 1.1–9.4, p = 0.033) for severe postoperative morbidity (SAE > 3).ConclusionThis retrospective study showed advanced age to be a significant risk factor for SAE > 3, after undergoing CRS and HIPEC. The initial institutional experience resembles previously published literature in terms of severe postoperative morbidity in elderly patients.     

Congenital pleuroperitoneal communication in a patient with pseudomyxoma peritonei

BACKGROUND AND OBJECTIVES: Pseudomyxoma peritonei syndrome is a rare disease arising from a perforated appendiceal adenoma. The syndrome is characterized by progressive accumulation of mucinous ascites and tumor within the peritoneal cavity. Direct extension of pseudomyxoma peritonei to the pleural cavity is uncommon and has been associated with surgical penetration of the diaphragm at the time of cytoreduction. METHODS: We review the case of a patient who presented with mucoid peritoneal and pleural fluid consistent with spontaneous pleural spread of pseudomyxoma peritonei. RESULTS: Surgical exploration confirmed direct pleuroperitoneal communication by macroscopic diaphragmatic fenestration. CONCLUSIONS: This is a rare phenomenon. We outline a therapeutic approach to be applied when pleural involvement is suspected in patients with pseudomyxoma peritonei syndrome.     

Review: Pathology and Its Clinical Relevance of Mucinous Appendiceal Neoplasms and Pseudomyxoma Peritonei

Until recently, many classifications existed for the terminology and histopathologic classification of appendiceal mucinous neoplasms, mucinous appendiceal adenocarcinomas, and pseudomyxoma peritonei (PMP). A major accomplishment was achieved by consensus-based histopathologic classifications on behalf of the Peritoneal Surface Oncology Group International regarding mucinous appendiceal tumours and PMP. As different classifications were used over the years and also owing to the rare nature of these tumors, many clinicians are not familiar with the terminology and the impact on patient management. Hence, an overview concerning mucinous appendiceal neoplasms, mucinous appendiceal adenocarcinomas, and PMP is provided to serve as an introduction into the basic morphology of these tumors with tentative recommendations for management.