MRI在腮腺上皮性良性肿瘤定性诊断价值及其病理基础

目的探讨MRI在腮腺上皮性良性肿瘤定性诊断中的作用.方法收集腮腺上皮性良性肿瘤72例80个病灶的MRI资料,其中70例经手术病理证实,2例活检证实.77个手术切除病灶行病理逐层切片检查并与MRI影像进行对照分析.MRI平扫采用T1WI、T2WI,其中61例共67个病灶同时行平扫和增强扫描.结果超过一半的腺淋巴瘤瘤灶(26个)T2WI表现为低、等信号,所有经过增强的42个腺淋巴瘤均轻度增强;31例混合瘤T2WI表现为高而不均匀信号,经过增强的24例混合瘤均中等或显著强化.结论常见腮腺上皮性良性肿瘤在MRI表现上各有特点,对大多数病例进行定性诊断是可能的.     

原发性脑淋巴瘤的MRI表现特点与诊断

目的：分析颅内原发性淋巴瘤的MRI表现特点，为临床诊断与治疗提供资料。方法：回顾分析28例经病理证实颅内原发性淋巴瘤的MRI资料，所有病例均行平扫及增强扫描。结果：病灶单发6例，多发22例，分布于幕上14例，幕下4例，幕上幕下同时存在10例，大多位于深部脑白质，病灶多呈圆形或不规则形，T1WI呈低信号，T2WI呈等或高信号，瘤周水肿较轻，增强扫描病灶均呈团块状显著强化。结论：颅内淋巴瘤的MRI表现缺乏特异性，需手术或活检才可作出定性诊断。     

颅内皮样囊肿破裂4例的MRI诊断

目的分析颅内皮样囊肿破裂的MRI表现。方法搜集4例经手术病理证实颅内皮样囊肿破裂病例资料,均行MRI平扫及增强检查,对其MRI表现、病因、病理和临床特征进行分析。结果病灶位于鞍旁2例,位于后颅窝及第三脑室后各1例。3例MRI表现T1WI与T2WI均为高信号,1例MRI表现T1WI为不均匀稍低信号,T2WI为高信号影。结论颅内皮样囊肿破裂有较典型的MRI影像学和临床特征性表现,可实现术前正确诊断。     

免疫状态正常人原发性脑淋巴瘤的CT及MRI诊断

目的探讨免疫状态正常人原发性脑淋巴瘤的CT及MRI影像特点。方法回顾性分析16例经病理证实原发性脑淋巴瘤的CT和MRI影像表现。结果老年男性多见,病灶多发多见,近中线室管膜周围脑白质及脑表面多见。CT平扫病灶呈等或稍高密度,MR平扫T1WI呈等或稍低信号,T2WI呈等或稍高信号,病灶信号多较均匀,少见囊变、坏死,周围水肿及占位效应多较轻,T2-FLAIR及DWI多呈均匀性稍高或高信号,病灶多均匀性强化,可呈"握拳状"、裂隙状分叶改变。结论免疫状态正常人原发性脑淋巴瘤的CT及MRI影像表现具有一定特征性,影像诊断具有重要临床意义。     

应用MRI技术对肝脏局灶结节性增生的诊断

目的 评估磁共振成像（magnetic resonance imaging,MRI）技术对肝脏局灶结节性增生（focal nodular hyperplasia,FNH）的诊断价值.方法 回顾性分析齐齐哈尔市第一医院2008年1月至2010年4月经手术切除或穿刺活检病理证实的10例26灶FNH 磁共振平扫、动态增强表现,由3名有经验的医师做MR表现诊断.结果 对于10例中的26个病灶,平扫T1WI上23个病灶为稍低或等信号、3个病灶为稍高信号;T2WI上23个病灶呈稍高信号、1个病灶等信号,2个病灶呈稍低信号.在动脉期5个病灶明显不均匀增强、19个病灶显著均匀增强,门静脉期和延迟期13个病灶呈稍高信号,11个病灶呈等/稍低信号,2个病灶无强化.11个病灶检出瘢痕,T1WI呈低信号,T2WI呈低或高信号,动脉期无增强、门静脉期或延迟期增强.8例诊断正确,1例诊断为良性病变（定性困难）,1例误诊为恶性肿瘤.结论 MRI能显示单发或多发FNH的特征性改变,并在术前正确诊断大部分FNH.     

涎腺淋巴上皮癌的影像学与病理学特点分析

目的：探讨涎腺淋巴上皮癌(lymphoepithelial carcinoma,LEC)的CT、MRI及病理学特点。方法：回顾性分析22例涎腺LEC患者的影像学资料及病理组织学表现,其中18例行CT平扫及增强扫描,4例行MRI平扫及增强扫描。结果：22例患者中共检出22个病灶,位于腮腺16例,颌下腺6例。边界清楚6例,边界不清16例。CT上密度均匀16例,不均匀2例,MRI上信号均匀4例,T1WI上为低信号, T2WI上呈稍高信号,增强扫描中度强化12例,明显强化10例。8例侵犯周围结构,10例颌下及颈动脉鞘区见肿大淋巴结。组织学均表现为肿瘤性上皮细胞伴淋巴细胞间质浸润及免疫组织化学CK阳性表达。结论：涎腺LEC的影像学表现具有一定的特征性,肿块常密度或信号均匀,增强扫描中度至明显强化,坏死较少见,多伴有同侧颈部淋巴结肿大。病理学上改变符合组织学特点和免疫组织化学检测,结合影像学CT、MRI的定位,排除鼻咽癌转移,即可诊断为原发性涎腺LEC。     

腮腺腺淋巴瘤与多形性腺瘤的CT对比分析

目的分析腮腺腺淋巴瘤与多形性腺瘤的CT特点,探讨CT对鉴别腮腺腺淋巴瘤与多形性腺瘤的价值。方法经手术病理组织证实的15例腮腺腺淋巴瘤患者,其中男性14例,女性1例;年龄55～77岁,平均年龄62岁。经手术病理组织证实的30例多形性腺瘤患者,其中男性9例,女性21例;年龄25～55岁,平均年龄45岁。回顾性分析腮腺腺淋巴瘤和腮腺多形性腺瘤CT表现。结果 15例腮腺腺淋巴瘤中多发9(60%)例,双侧同时发现病灶12例,共发现42个病灶,39(92.9%)个病灶位于腮腺后下象限,双期增强动脉期CT值平均上升(38.5±12.8)Hu。30例腮腺多形性腺瘤中多发1/30(3.3%)例,仅1/30(3.3%)个病灶位于腮腺后下象限,双期增强动脉期CT值平均上升(15.5±9.2)Hu。结论对于中老年男性,发生于腮腺后下象限,病灶多发,内密度不均,增强后动脉期明显强化,应首先考虑为腮腺腺淋巴瘤。     

脑内海绵状血管瘤的CT和MRI诊断

目的探讨脑实质内海绵状血管瘤（CA）的CT、MRI表现及其诊断价值。方法回顾性分析经手术病理证实的CA12例,8例行CT平扫,4例行CT增强扫描,12例均行MR检查,5例行Gd-DTPA增强扫描。结果12例CA共检出14个病灶。CA可发生于脑内任何部位,单发多见（10/12）。海绵状血管瘤CT平扫表现为类圆形高或稍高密度病灶,多数为不均匀,常伴钙化、出血。MRI平扫大部分表现为T1WI呈等信号或稍高信号,T2WI呈高、低混杂信号,11个病灶周围可见低信号环影,大多数病灶周围无水肿带及占位效应。CT和MRI增强后均呈轻度强化或无明显强化。结论CT和MRI检查对CA具有重要的诊断价值,MRI优于CT,是诊断本疾病最佳的影像学方法。     

术前磁共振成像在垂体囊性病变诊断中的价值

目的探讨磁共振成像技术在垂体囊性病变中的诊断价值,提高垂体囊性病变的MRI影像诊断水平。方法回顾分析我院2013年1月至2016年11月经手术病理证实的31例垂体囊性病变患者的MRI检查资料,其中囊性垂体瘤16例,垂体脓肿6例,Rathke’s囊肿9例。所有病例全部行MRI平扫,22例行GD-DTPA增强检查。结果 16例囊性垂体瘤,其中垂体大腺瘤12例,微腺瘤4例。12例大腺瘤表现为在实性瘤体中出现囊变,T1WI呈低信号,T2WI呈高信号。囊壁为等信号,厚薄不等,增强后明显强化,其中3例合并出血,T1WI呈高信号,并见液平。4例囊性微腺瘤,TIWI呈稍低信号,T2WI呈高信号,增强后边缘轻度强化,其中1例术前误诊为Rathke’s囊肿,1例漏诊。6例垂体脓肿,T1WI呈低或等低信号,T2WI呈等、高信号或不均匀信号,多数边界不清楚,大部分病灶为环状强化或分隔状强化,部分为不均匀强化,邻近颅底脑膜、海绵窦区可见强化。2例T2WI表现为高低混杂信号影,术前误诊为垂体瘤并瘤卒中。9例Rathke’s囊肿,5例表现为稍长T1长T2信号,边界清楚,增强后边缘轻微强化,4例T1WI、T2WI均呈高信号影,其中2例误诊为颅咽管瘤。囊性垂体瘤、垂体脓肿、Rathke’s囊肿的诊断准确率分别为87.5%、66.7%、77.8%。结论磁共振成像技术可以很好地显示鞍区内垂体囊性病变部位、形态及信号特点,并能较大程度地做出定性诊断,对手术治疗有一定指导意义。     

局灶型Castleman病的MDCT和MRI表现特征及其病理学基础

为了探讨局灶型Castleman病(CD)的多层螺旋CT(MDCT)和磁共振成像(MRI)表现特征及其病理学基础,收集经手术病理证实的13例患者的临床资料,回顾分析其MDCT和MRI表现特征。所有患者均行MDCT平扫,11例行MDCT增强扫描,而另外2例行MRI平扫和增强扫描。13例患者共有14个病灶且均为透明血管型,MDCT平扫病灶均为等密度软组织肿块影;4个病灶中心有钙化,其中斑点状钙化2个,分支放射状钙化及分支放射状钙化伴病灶边缘弧形钙化各1个。MDCT增强扫描均有明显强化,其中均匀强化11个,另外3个为不均匀强化,表现为中心有星芒状低密度无强化区2个,局灶性无强化影1个;病灶周围显示较多迂曲血管影8个。行MRI扫描者T1WI信号稍高于肌肉,T2WI为明显高信号,增强亦有明显强化;同时右肩部病灶中心显示流空血管影,增强显示粗大的供血动脉及周边许多小血管影。总之,局灶透明血管型CD在MDCT或MRI上多表现为孤立性软组织肿块,以明显均匀强化为主、少数伴有不规则钙化或星芒状瘢痕为特征。     

Fine-needle aspiration cytology of lymphangioma of the parotid gland in an adult

Lymphangioma or cystic hygroma is an uncommon benign congenital tumor of lymphatics that is seen in children and, rarely, adults. Lymphangioma primarily involving the parotid gland is an extremely uncommon occurrence in adults. We report on the cytologic findings of a parotid lymphangioma in a 34-yr-old man which showed 13 cc of yellow fluid with red blood cells, lymphocytes, and rare fragments of benign-appearing salivary gland epithelium. The differential diagnosis of cystic parotid gland lesions in adults may include Warthin's tumor, lymphoma, benign lymphoepithelial lesions, branchial cleft cysts, chronic sialadenitis, cystic low-grade mucoepidermoid carcinoma, and cystic pleomorphic adenoma. In this case, the fine-needle aspiration findings along with the magnetic resonance imaging (MRI) findings of a multiloculated cystic mass in the parotid gland allowed the diagnosis of lymphangioma.     

Cystic lesions of the salivary glands: cytologic features in fine-needle aspiration biopsies

A variety of neoplastic and nonneoplastic lesions of the salivary glands have a predominantly cystic architecture. Fine-needle aspirates of these lesions yield watery or mucoid material, frequently of low cellularity. Such aspirates may be obtained from mucus retention cysts, lymphoepithelial cysts, cystadenomas, Warthin's tumors, cystic pleomorphic adenomas, low-grade mucoepidermoid carcinomas, cystadenocarcinomas, and examples of polycystic disease of the parotid gland. The cellular component within the fluid obtained from these lesions may be exceedingly scant or absent, making cytologic diagnosis difficult and, at times, impossible. We studied a series of 56 cystic lesions of the salivary glands, including 38 Warthin's tumors, 6 benign cysts, 2 lymphoepithelial cysts, 5 low-grade mucoepidermoid carcinomas, 1 cystic pleomorphic adenoma, 2 cystadenomas, and 2 cystadenocarcinomas. Careful attention to the cellular elements present often allowed definitive cytologic diagnosis, with an overall accuracy rate of 84%. The presence of atypical squamous metaplasia in oncocytic lesions was a significant cause of false-positive diagnoses of carcinoma (4 cases, 7%). Aspirates of low-grade mucoepidermoid carcinoma may contain no epithelial cells and result in false-negative diagnoses (1 case, 2%).     

Fine-needle aspiration cytology of salivary gland: a review of 341 cases

Three hundred and forty-one salivary gland fine-needle aspiration (FNA) cytology specimens taken over a 6-yr period were reviewed and correlated with clinical and/or histological findings. The aspirates were derived from parotid gland (212 cases), submandibular gland (124 cases), and minor salivary gland (5 cases). The major diagnostic categories were unsatisfactory (10 cases), normal (100 cases), sialadenitis (74 cases), cyst (34 cases), lipoma (5 cases), pleomorphic adenoma (55 cases), Warthin's tumor (36 cases), and malignancy (27 cases). The latter included 14 primary salivary neoplasms (4 lymphomas of mucosa-associated lymphoid tissue (MALT) type, 3 adenocarcinomas, 2 squamous carcinomas, 2 adenoid cystic cacinomas, and one case each of carcinoma ex pleomorphic adenoma, undifferentiated carcinoma, and high-grade mucoepidermoid carcinoma), and 13 metastases, 9 of which were derived from squamous carcinomas of head and neck origin. Clinicopathological review showed that 88 of 91 (97%) benign epithelial tumors and 27 of 31 (87%) malignant neoplasms with adequate FNA sampling were accurately diagnosed cytologically. False-negative results were caused by sampling error (7 cases), most notably in cystic tumors, or were due to misinterpretation of uncommon neoplasms (3 cases). The overall sensitivity, specificity, and accuracy were 92%, 100%, and 98%, respectively. FNA cytology provides accurate diagnosis of most salivary gland lesions and contributes to conservative management in many patients with nonneoplastic conditions.     

Immunoreactive somatostatin in Warthin''s tumor.

The presence of somatostatin (SRIF) in the neoplastic epithelial cells of certain Warthin's tumors arising in the human parotid gland was found immunohistochemically, whereas the other parotid gland tumors, such as pleomorphic adenoma, oxyphilic adenoma, mucoepidermoid tumor, adenocarcinoma, and adenoid cystic carcinoma, did not show positive immunoreactivity for SRIF. The SRIF-positive Warthin's tumor had dense core granules immunoreactive with anti-SRIF serum. Moreover, a comparatively high concentration of immunoreactive SRIF was detected by radioimmunoassay in an SRIF-positive Warthin's tumor, although the other tumors also contained low levels of immunoreactive SRIF.     

颅内生殖细胞瘤的MRI影像表现及诊断

目的 探讨颅内生殖细胞瘤的MRI表现,旨在提高对本病的影像诊断准确率。方法 回顾性分析2014年12月~2019年5月我院经手术病理或临床诊断性放射治疗确诊的13例颅内生殖细胞瘤患者的MRI影像资料,分析其临床表现、影像表现及诊断。结果 病变位于松果体区患者9例,MRI检查肿瘤实质部分T1WI呈稍低信号,T2WI和FLAIR 呈高或稍高信号,DWI呈等或稍高信号,增强扫描呈明显强化;肿瘤伴有囊变者1例,伴有钙化者3例,4例患者伴脑积水;3例患者出现转移灶,累及三脑室、侧脑室等,其MRI信号及强化方式与原发灶相似。病变位于鞍区患者3例,肿瘤形态、大小不一,T1WI 呈稍低信号,T2WI和FLAIR 呈稍高信号,增强扫描呈明显强化。1例患者的病变位于右侧基底节区,形态不规则,T1WI呈等信号,T2WI、FLAIR及DWI均呈稍高信号,增强扫描无强化,同侧大脑脚较对侧萎缩。结论 MRI对颅内生殖细胞瘤的影像诊断与鉴别诊断具有重要价值。     

43例腮腺Warthin 瘤的细针穿刺细胞学分析

目的：探讨腮腺腺淋巴瘤的细针穿刺细胞学特点。方法：收集并复习43例腮腺腺淋巴瘤，每例均备有巴氏染色、HE染色涂片及细胞块。结果：43例均发现嗜酸性细胞及淋巴细胞，40例发现细胞碎屑，9例发现带有淋巴间质的嗜酸性细胞乳状结构，35例发现巨噬细胞，5例出现鳞状上皮化生，3例发现肥大细胞。结论：腺淋巴瘤是腮腺的常见肿瘤，细针穿刺一般可以作出准确诊断，但应注意与多形性腺瘤、腺样囊腺癌、腺泡细胞癌、慢性腮腺炎、淋巴上皮囊肿、鳞癌鉴别。     

Carcinoma ex pleomorphic adenoma

Carcinoma ex pleomorphic adenoma is an epithelial malignant neoplasm arising from a primary or recurrent pleomorphic adenoma and is a diagnostic challenge for cytopathologists. Diagnosis requires that elements from the benign pleomorphic adenoma and the malignant component need to be seen. We report a case of carcinoma ex pleomorphic adenoma in a patient presenting with left facial nerve palsy and a painless left parotid lump. Ultrasound imaging revealed a suspicious parotid mass and FNA cytology showed background benign myoepithelial and ductal cells, chondro-myxoid stroma, and overtly malignant epithelial and myoepithelial cells; features consistent with carcinoma ex pleomorphic adenoma. A radical parotidectomy was performed and histology confirmed the diagnosis of invasive salivary duct carcinoma ex pleomorphic adenoma. Early diagnosis of carcinoma ex pleomorphic adenoma is important and cytology plays a key role; however, findings should be correlated with radiology and clinical history and the potential limitations of cytology should be appreciated.     

Benign metastasizing pleomorphic adenoma of salivary gland: diagnosis of bone lesions by fine-needle aspiration biopsy.

Two cases of benign salivary gland pleomorphic adenomas metastatic to bone (benign-metastasizing pleomorphic adenomas) diagnosed by fine-needle aspiration biopsy are presented. Both primary tumors were slightly atypical cytologically but neither case demonstrated features of carcinoma. The metastatic lesions contained benign epithelial, myoepithelial, and stromal components. In both cases the clinical history was either not known by the radiologist or not communicated to the cytopathologist interpreting the case, and a primary tumor of bone was the leading clinical diagnosis. Obtaining pertinent clinical history and comparing the cytomorphology of the bone aspirate with the primary parotid tumor allowed for an accurate diagnosis in both cases. The differential diagnosis with primary bone tumors is discussed and the importance of clinical history is emphasized.