肺部炎性假瘤13例

肺部炎性假瘤是肺部炎性增生性瘤样病变[1 ] 。由于其 X线形态与肺癌及肺结核球 (简称结核球 )的 X线形态相似 ,临床上误诊率较高。现将术后组织病理学证实的 13例分析如下。临床资料1.一般资料　本组男 8例 ,女 5例 ;年龄 2 4～ 6 5岁 ,平均4 9.3岁。咳嗽吐少量白粘痰 12例 ,低热 11例 ,胸痛 6例 ,痰中带血 3例 ,1例无症状查体时发现。2 . X线表现(1)形态 :团片影 3例 ,病灶浓淡不均 ,边缘模糊 ,病灶周围可见不规则的炎性浸润阴影 ;球形影 10例。其中圆形影 7,椭圆形影 2例 ,哑铃形影 1例 ,边缘光滑锐利 ,密度较高 ,但均匀一致 ;周围肺野…     

以肺脓肿为主要表现的肺部炎性假瘤1例

1　病史摘要　患者 ,男性 ,5 0岁 ;因咳嗽 2月 ,发热月余 ,痰中带血 5日入我院。查体 :37.7℃ ,P80次 / min,BP12 0 / 75mm Hg,右肺可闻及散在湿罗音。胸片示 :右肺下叶占位性病变伴感染 ,CT见右肺下叶后内基底段见大小约 7× 4× 3(cm) 3不均匀的高密度影 ,边缘毛糙。 PPD阴性 ,血沉 12 mm/ h,血常规正常 ,痰常规脓球 8～ 12、红血球 0～ 1、上皮 0～ 2 ;纤支镜见右肺下叶开口处大量黄绿色脓痰 ,给予局部冲洗、注药及吸引治疗 ,纤支镜术后拟右肺下叶背段支气管肺脓疡。 CT引导下穿刺病检为“炎性肌纤维母细胞瘤”,给抗炎及增强免疫机…     

肺部炎性假瘤伴血小板减少症一例

患者女性 ,6 2岁。因发现双下肢出血点 5个月于 2 0 0 1年 10月入院。患者入院前 5个月发现双下肢有散在出血点 ,无低热、盗汗。在外院检查血小板为 4 2× 10 9/L ;骨髓象 :细胞增生活跃 ,巨核细胞可见 ,分类有成熟障碍 ,颗粒型占 76 % ,有血小板形成的巨核细胞占 2 4 % ,血小板分布少。诊断为特发性血小板减少性紫癜 ,应用“泼尼松和丙种球蛋白”治疗后出血点消失 ,血小板短暂升高后又趋下降而收入我院。患者既往无结核病史。入院查体 :体温 36℃ ,全身皮肤未见瘀点、瘀斑 ;肺脏、心脏、肝、脾检查未见异常。入院后查血小板 2 8× 10 9/L…     

肺部炎性假瘤的X线诊断

20 0 0～ 2 0 0 2年 ,我院收治 2 5例炎性假瘤 ,均经手术病理证实 ,现就其 X线表现作一分析。临床资料 :本组男 18例 ,女 7例 ;年龄 6～ 74岁 ,平均 49岁。临床表现为咳嗽 2 1例 ,咳痰 9例 ,胸痛 5例 ,咳血 4例 ,发热 4例。X线表现示病变位于右肺 17例 ,左肺 8例。其中右肺上叶尖段 3例、后段 2例、前段 1例 ,右肺中叶 5例、下叶背段3例 ,后段 3例 ,左肺上叶尖后段 1例、下叶背段 6例、下叶后段 1例。病变形态多呈规则圆形或椭圆形肿块影 ,1例呈轻度分叶的肿块影 ,4例呈大小不等的片状影。病变最大 6cm×6cm ,最小 2 cm× 3 cm ,多数直径为…     

肺部炎性假瘤64例X线胸片及CT征象分析

目的探讨64例肺部炎性假瘤患者X线胸片及CT征象特征性改变及鉴别诊断意义。方法收集64例肺部炎性假瘤患者的临床资料,胸片及胸部CT扫描。结果肺部炎性假瘤的诊断极为困难、常误诊为肺癌,其症状与肺癌相似,表现最多的是胸痛伴血痰。根据病灶特点,可分为圆形／类圆形（46／64）和不规则形（18／64）两种基本类型;病灶显示多种X线胸片及CT形态学表现,包括浅分叶征、桃尖征、平直征、和钙化等．结论：肺部炎性假瘤具有多种X线胸片及CT表现,难与其他肺部疾患（尤其是支气管肺癌）鉴别．但某些存在征象,具有一定特异性。     

肺部炎性假瘤78例临床分析

目的探讨肺炎性假瘤临床特征和诊断要点。方法回顾性分析78例肺炎性假瘤住院患者的临床资料。结果男性多于女性,男女之比1.9∶1。年龄以青壮年为多占71.8%。临床无症状表现者占20.5%,有症状表现者占79.5%,以常见呼吸道症状为主与其他肺部疾病症状相似,无特异性。X片及CT片影象表现缺乏特异性,但增强CT为环形强化。术前确诊率低,本组资料术前确诊18例(23.1%),术前误诊60例(76.9%),其中肺癌45例,肺良性肿瘤6例,肺结核球5例,肺囊肿4例。本组71例外科手术治疗,术后良好。结论肺炎性假瘤内科治疗效果不佳,首选外科治疗。有7例内科治疗症状有好转,病灶变化不明显,拒绝手术出院。     

肝脏炎性假瘤伴血清甲胎蛋白强阳性1例

1.临床资料:患者,男,60岁。因体检B超发现右肝占位。CT:肝右后叶低密度占位,肝癌可能,局灶性增生有待排出;MRI:肝右后叶占位,肝癌可能;血清甲胎蛋白(AFP)16709.14μg/L,于2002年12月入院。患者无不适症状及其它阳性体征,有乙型肝炎病史30年。入院检查HBsAg( )、HBcAb( );B超显示肝右叶包膜下见一个略低回声区,内回声不均,边界不清,大小24.1mm×29.9mm。于2002年12月27日手术治疗。术中见肝脏Ⅶ段表面有一绿豆大小灰白色结节,质中,未能触及明确肿瘤,应用B超反复探查,历时90min,未见明显肿瘤影像。根据CT、MRI片,确认肿瘤解剖位置,行肝脏     

肝脏炎性假瘤二例

肝脏炎性假瘤(IPL)是肝内以局限性纤维组织增生和慢性炎性细胞浸润为特点的增生性炎症,该病缺乏临床和影像学特征,常不易与恶性肿瘤鉴别.为提高对本病的认识,笔者将曾诊治的2例报道如下:     

53例肺部炎性假瘤的外科治疗

目的 探讨肺炎性假瘤的临床特点、诊断和治疗。方法 对临床资料回顾分析。结果 全组病人均行手术治疗并痊愈出院。结论 肺炎性假瘤是肺实质内的增生性肉芽肿,组织结构复杂、细胞成分多样化是其显微镜下特点。由于此病的临床表现和影像学检查缺乏特征,术前误诊率高,有必要提高对本病的认识。该瘤虽属良性,亦应尽早手术,手术方式以肿块切除或肺叶切除为主,术中病理检查是决定术式的重要依据。     

IgG4-related Diaphragmatic Inflammatory Pseudotumor

A 71-year-old man underwent surgery for a pancreatic neuroendocrine tumor. Follow-up imaging showed swelling of the remnant pancreas, and he was histologically diagnosed with autoimmune pancreatitis based on endoscopic ultrasonography-guided fine-needle aspiration specimens. After two years, a tumor appeared on the liver surface. Although we planned to perform laparoscopic partial hepatectomy, the intraoperative findings showed that the tumor was located in the diaphragm. Partial resection of the diaphragm was performed, and the final diagnosis was an immunoglobulin G4-related inflammatory pseudotumor in the diaphragm. To our knowledge, this is the first reported case of an immunoglobulin G4-related diaphragmatic inflammatory pseudotumor.     

Inflammatory pseudotumor of the trachea in a ten-month-old infant

Inflammatory pseudotumors occur through a non-neoplastic process that involves abnormal proliferation of spindle cells (myoblasts and fibroblasts) with an inflammatory cell infiltrate. Clinically, radiographically, and grossly these lesions mimic malignant neoplasms but are readily distinguished histologically. We report an infant who presented with an inflammatory pseudotumor of his trachea that caused severe stridor. Pediatr Pulmonol. 1997; 23:307–309. © 1997 Wiley-Liss, Inc.     

Inflammatory pseudotumor of the lung following invasive aspergillosis in a patient with chronic graft-vs.-host disease

Inflammatory myofibroblastic tumor (IMT) is an uncommon cause of solitary or multifocal lung nodules and can also be rarely found in various other extrapulmonary sites. Although this pseudotumor is benign, it can be locally very aggressive. The pathogenesis of IMT remains unclear; autoimmune or infectious origins have been hypothesized, so far. Here, we report a case of inflammatory pseudotumor of the lung secondary to invasive pulmonary aspergillosis in a patient with chronic graft-vs.-host disease. The 42-year-old patient presented with coughing and hemoptysis as major clinical signs 1 yr after successful HLA-identical stem cell transplantation. Aspergillus fumigatus was cultured from the bronchoscopic lavage, but intensive antifungal treatment could only initially improve the clinical situation. Diagnostic re-evaluation by open-chest biopsy surprisingly revealed an inflammatory pseudotumor responsible for clinical and radiographical deterioration. Both clinical and radiographical signs resolved under long-term steroids and secondary antifungal prophylaxis.     

Inflammatory pseudotumor of the pancreas

Summary We describe a rare example of inflammatory pseudotumor of the pancreas in a 42-yr-old woman, which developed following chemotherapy for lymphoma of the uterine cervix. The patient had developed fatigue, weight loss abdominal pain, and anemia; abdominal CT scan showed a large mass in the pancreas. Examination of the resected specimen revealed a fleshy, well-circumscribed, 7-cm mass., Histologically, there was a hypocellular to moderately hypercellular, bland spindle-cell proliferation admixed with a prominent infiltrate of lymphocytes, histiocytes, and plasma cells. The spindle cells were vimentin positive but negative for muscle markers; electron microscopy revealed only fibroblastic cells. DNA analysis revealed a diploid population with low S-phase fraction. The patient was well at 6-mo follow-up. It is important for the pathologist to be aware of the existence of this entity in unusual locations such as the pancreas so as to avoid a mistaken diagnosis of malignancy.     

Inflammatory pseudotumor of the liver revealing gynecological Corynebacterium infection

Inflammatory pseudotumor (IPL) of the liver is a rare benign clinicopathologic entity, which has been associated with infectious conditions, including alimentary, digestive tract and mouth infections. We report a new case, where a patient developed hepatic IPL that revealed endometritis related to Corynebacterium infection; the patient had a favorable outcome of hepatic IPL after appropriate antibiotic therapy initiation. Our findings therefore confirm that antibiotic therapy may be effective in patients with hepatic IPL associated with underlying infections, avoiding unnecessary surgery. Our data also indicate that when hepatic IPL is observed, a complete clinical evaluation, including gynecological evaluation, should be systematically performed.     

Inflammatory myofibroblastic tumor of the liver

Inflammatory myofibroblastic tumor is a rare benign entity formerly known as inflammatory pseudotumor. Involvement of the liver is extremely rare. There are controversies about the optimal treatment of this benign entity. Newer reports suggest an association with autoimmune sclerosing pancreatitis and primary sclerosing cholangitis. We present a case of an 18-year-old patient with biliary obstruction from a perihilar mass of the liver requiring hepatic resection. Division of the hepatic bile duct resulted in drainage of yellow, thick, gelatinous material in the presence of benign margins and absence of cholangitis. Histological examination showed a mass with fibroblastic and myofibroblastic cells set in a loose myxoid matrix containing scattered lymphocytes, consistent with an inflammatory myofibroblastic tumor. One-year recovery was uneventful. This report discusses the presentation, diagnosis, and controversies in management of this disease.     

Inflammatory pseudotumor of the liver: report of eight cases, including three unusual cases, and a literature review

BACKGROUND: Inflammatory pseudotumor (IPT) of the liver is a rare but increasingly recognized tumor-like lesion. This condition is becoming an important differential diagnosis in patients with hepatic space-occupying lesions. This study reports the clinical features of eight cases of IPT of the liver, including the first report of three cases with an unusual associated disease or clinical course. METHODS: The study sample included cases of IPT diagnosed based on the histopathology in our institution from 1995 to 2004. Clinical events were reported and compared with reports in the literature. RESULTS: The age of the patients ranged from 28 to 78 years. The most common symptoms were abdominal pain, fever and bodyweight loss. Three patients were diagnosed incidentally. The initial clinical diagnoses were hepatocellular carcinoma in three cases, liver abscess in two cases, metastasis in one case and uncertain nature in two cases. Two cases were associated with preceding endophthalmitis and cholangiocarcinoma, respectively. Two patients had spontaneous lesion regression, but one of these had possible recurrence 10 months later. The other two patients experienced resolution of their lesions following antibiotic treatment. Four patients underwent surgical resection with subsequent recovery. CONCLUSIONS: The clinical and imaging features of IPT in this small series were found to sometimes mimic those of malignant liver tumors or abscess. Surgical resection was performed in half of the cases. However, IPT of the liver could resolve spontaneously or following antibiotics treatment.