超声评价子宫内膜癌肌层浸润深度及进展

肌层浸润深度是子宫内膜癌分期的重要依据之一。灰阶超声是子宫内膜癌的常规筛查方法。通过三维超声及多普勒超声可观察内膜的细微结构及血流分布情况,并进行血流动力学分析,可判断子宫内膜癌肌层浸润情况。子宫内膜癌超声造影呈特征性的血流灌注表现,有助于判断子宫内膜癌肌层浸润深度,对子宫内膜癌的诊断具有一定价值。利用三维经阴道超声对未受累肌层厚度进行测量,可较好地评估子宫内膜癌的肌层浸润情况,以指导临床治疗方案的选择。本文对子宫内膜癌肌层浸润深度的超声评价及进展进行综述。     

子宫内膜癌术中大体检查子宫肌层浸润的意义

目的：探讨子宫内膜癌术中大体检查子宫肌层浸润的价值。方法：选取116例1998年1月～2004年2月上海市第一妇婴保健院妇科收治的子宫内膜癌病例，术前经分段诊断性刮宫术证实为子宫内膜癌，且术前未予放疗、化疗或激素治疗。术中行子宫切除后，切开子宫标本，再沿病灶切下肌层，观察并记录癌灶浸润肌层小于1／2(浅肌层)还是大于1／2(深肌层)，术后与病理检查比较，计算出敏感度，假阴性(漏诊)率，特异度，假阳性(误诊)率，准确率，阳性预测值，阴性预测值。结果：术中大体检查子宫肌层浸润的准确率(AC)91．4％，敏感度(SN)78．9％，假阴性(漏诊)率21．1％，特异度(SP)93．8％，假阳性(误诊)率6．2％，阳性预测值(PPV)71．4％，阴性预测值(NPV)95．8％。结论：子宫内膜癌术中大体检查子宫肌层浸润是一种方便、经济、有效的方法，有助于手术医师决定是否进一步扩大手术范围。     

DWI-T2WI融合图像判断Ⅰ期子宫内膜癌肌层浸润深度

目的探讨DWI与T2WI融合图像在判定Ⅰ期子宫内膜癌肌层浸润深度中的价值。方法对28例Ⅰ期子宫内膜癌患者行常规MR及DWI检查。采用T2WI和T2WI-DWI融合图像分别测量肌层浸润深度及肌层厚度,计算二者比值,并将该比值与术后病理标本测量的肌层浸润深度进行比较。应用ROC曲线评价两种方法对肿瘤是否浸润肌层及是否浸润深肌层的诊断效能。结果术后病理诊断无肌层浸润3例,浅肌层浸润13例,深肌层浸润12例。对于评估肿瘤是否浸润肌层及深肌层,T2WI-DWI融合图像诊断效能优于T2WI,差异有统计学意义(P<0.05)。结论 MR对术前评估子宫内膜癌肌层浸润深度有一定价值;T2WI-DWI融合图像较常规T2WI判断更准确。     

子宫肌层的子宫内膜异位囊肿1例

患者女 ,38岁 ,G6 P+ 51 ,因腰骶部坠胀 2月于 2 0 0 4年 3月 8日入院。既往体健。患者平素月经规律 ,无明显痛经。 1 7年前行剖宫产一次 ,末次人流于 7年前。妇科查体 :外阴已婚未产式 ,阴道通畅 ,宫颈光滑 ,子宫前位 ,正常大小 ,活动度好 ,右宫角处可扪及一直径约 4厘米的包块突出。子宫后方偏右侧可扪及直径 8cm囊性包块 ,边界清 ,表面光滑 ,欠活动。B超示 :子宫形态规则 ,大小正常。子宫右后方查见大小约 7cm×6 5cm的无回声区。子宫底右侧查见大小约3cm× 2 5cm的囊性无回声团 ,与子宫关系密切。左附件区未见异常。于 3月 9日行剖腹…     

不同扩散模型对Ⅰ期子宫内膜癌肌层浸润深度的诊断价值

目的评估单指数、双指数、拉伸指数模型各参数对诊断Ⅰ期子宫内膜癌肌层浸润深度的价值。材料与方法收集Ⅰ期子宫内膜癌53例,行常规MRI和多b值扩散加权成像(diffusion weighted imaging,DWI)扫描,在各参数伪彩图上测量表观扩散系数(apparent diffusion coefficient,ADC)、真扩散系数(D)、假扩散系数(D*)、灌注分数(f)、分布扩散系数(distribution diffusion coefficient,DDC)、水扩散异质性指数(α)值。根据子宫全切术后病理结果分为Ⅰa期和Ⅰb期。使用两独立样本t检验进行两组间差异性比较。绘制受试者工作特征(receiver operating characteristic,ROC)曲线,评价各参数对诊断Ⅰ期子宫内膜癌肌层浸润深度的效能。结果Ⅰb期D、f、DDC、ADC值小于Ⅰa期,且差异均有统计学意义(P<0.05),Ⅰb期D*值大于Ⅰa期,差异无统计学意义(P>0.05),Ⅰb期α值小于Ⅰa期,差异无统计学意义(P>0.05)。D、f、DDC、ADC值对诊断Ⅰ期子宫内膜癌肌层浸润深度的曲线下面积(area under curve,AUC)分别为0.867、0.762、0.794、0.774。结论单指数模型对诊断Ⅰ期子宫内膜癌肌层浸润深度有一定帮助,双指数、拉伸指数模型较之价值更高。     

子宫内膜浆液性乳头状腺癌30例临床病理分析

【目的】探讨子宫内膜浆液性乳头状腺癌（UPSC）的临床及病理特点。【方法】回顾性分析30例UPSC患者的临床资料,对其临床及病理特点做统计学分析。【结果】30例UPSC患者中,53．33％（16／30）的病例肌层浸润深度超过1／2肌层,60．00％（18／30）的病例有子宫外转移,淋巴转移率为43．33％（13／30）,p53阳性率达到56．67％,雌激素受体（ER）和孕激素受体（PR）的阳性率分别为26．67％和30．30％。【结论】UPSC病期晚,易浸润深肌层和向子宫外扩散;p53的高表达及ER、PR的低表达预示患者预后不良。     

MRI及超声评估子宫腺肌病患者子宫内膜-肌层交界区研究进展

子宫腺肌病(AD)为临床常见妇科疾病,可影响子宫内膜容受性(ER),致子宫内膜-肌层交界区(EMI)发生改变,破坏子宫环境,影响临床妊娠率(CPR)甚至造成不良妊娠结局。MRI及超声等影像学方法可综合评估AD患者EMI形态、容积、血流及弹性改变,有望有效预测CPR及判断胚胎植入最佳时机。本文就MRI及超声评估AD患者EMI研究进展进行综述。     

胰腺神经内分泌肿瘤、肺转移性腺癌、肺梗死1例

<正>肺梗死是一种常见病,近年来越来越受到人们的重视,但因其临床表现多种多样以及临床医生对其认识不足,尤其当患者的高危因素不太明显时,肺梗死往往容易被漏诊。本文拟对1例因肺部阴影待查就诊而最终诊断为肺梗死的病例作一介绍及分析,以提高临床医师对肺梗死的警惕性。     

胰腺粘液性囊腺癌（MCAC）诊治探讨

目的　探讨胰腺粘液性囊腺癌的诊治。方法　分析 3例 MCAC患者资料。结果　 2例由于误诊为胰腺囊肿 ,术后均死亡 ,1例由于确诊 ,及时手术而存活。结论　胰腺粘液性囊腺癌无典型症状 ,与良性胰腺囊性病变区分困难 ,影像学与血清学检查无特异性 ,囊肿穿刺常引起严重并发症并导致肿瘤细胞种植 ,因此对胰腺囊腺瘤应尽早手术。     

子宫内膜癌经阴道超声表现与肌层浸润深度的相关性研究

目的探讨子宫内膜癌经阴道超声表现与病理诊断肌层浸润深度的相关性。方法46例子宫内膜癌术前均经阴道超声观测子宫三径之和、宫内膜厚度、彩色血流分布特点及血流阻力指数。根据病理检查肌层浸润深度分为Ⅰa期9例,Ib期22例,IC期15例。结果子宫三径之和为12．9～27．4cm,宫内膜厚度为4．7～65．0mm,在Ⅰa期、Ⅰb期、Ⅰc期的子宫三径之和、宫内膜厚度逐渐增大,差异有统计学意义（P〈0．05）。37例探及血流信号,血流显示率80．4％;Ⅰa、Ⅰb期、Ⅰc期血流显示率逐渐增大,差异有统计学意义（P〈0．05）。肌层浸润越深,阻力指数越低,各期比较无统计学差异（P〉0．05）。结论子宫内膜癌经阴道超声表现与病理诊断肌层浸润深度相关,经阴道超声检查可作为子宫内膜癌的术前检查方法。     

Composite pheochromocytoma masquerading as solidpseudopapillary neoplasm of pancreas

Pheochromocytoma and ganglioneuroma form rare composite tumours of the adrenal medulla comprising less than 3% of all sympathoadrenal tumours. We present a case of intraoperatively detected adrenal medullary tumour of composite pheochromocytoma and ganglioneuroma diagnosed on histopathology, in a normotensive patient. A 50-year-old male with a past history of chronic obstructive pulmonary disease presented with abdominal pain and significant weight loss since one month. Ultrasound and contrast-enhanced computed tomography abdomen revealed a large lobulated lesion in the distal body and tail of pancreas suggestive of solid and papillary neoplasm of body and tail of pancreas. Intra-operatively, a 15 cm × 10 cm solid lesion with cystic areas was seen arising from the left lower pole of the adrenal gland pushing the pancreas which appeared unremarkable. In our case, exploratory laparotomy with tumour excision was done. Extensive sectioning and microscopic examination of this adrenal tumour confirmed a diagnosis of composite Pheochromocytoma with Ganglioneuroma on histopathology. Immunophenotyping with S-100 further supported the diagnosis. The goal of this report is to increase the awareness of this rare disease and to further identify its variable presentation.     

Endometriosis of the pancreas presenting as a cystic pancreatic neoplasm with possible metastasis

The authors report a case of endometriosis that presented as a cystic mass in the tail of the pancreas, leading to extensive evaluation and ultimately a major surgical resection. The diagnosis was made by histopathological evaluation, revealing endometrial glands and stroma in the wall of the mass with hemorrhagic fluid in the cystic lumen, compatible with pancreatic involvement by an endometrial cyst.     

Azygos continuation of the inferior vena cava masquerading as neoplasm

The two cases we have reported demonstrate that dramatic enlargement of the azygos vein may occur in patients with azygos continuation of the inferior vena cava. Awareness of this phenomenon can prevent unnecessary procedures. The diagnosis should be established by dynamic CT scan.     

Transvaginal ultrasonography with and without saline infusion in assessment of myometrial invasion of endometrial cancer.

OBJECTIVE: The purpose of this study was to determine the diagnostic accuracy of saline infusion ultrasonography (SIUS) compared with transvaginal ultrasonography (TVUS) in the assessment of myometrial invasion of endometrial cancer. METHODS: A total of 53 patients with endometrial cancer were examined preoperatively with TVUS and SIUS with respect to myometrial invasion. All patients were postmenopausal. Ultrasonographic findings were compared with histopathologic findings of the surgical specimens. RESULTS: The median age of the patients +/- SD was 64 +/- 7 years (range, 51-77 years). In all patients, the procedure was well tolerated. The median thickness of malignant endometria was 17 +/- 9 mm (range, 2-51 mm). The specimens consisted of 40 endometrioid adenocarcinomas, 2 serous papillary carcinomas, 5 clear cell adenocarcinomas, 2 adenosquamous carcinomas, 3 mixed types, and 1 undifferentiated carcinoma. There were 18 grade G1, 24 G2, and 11 G3 cases. On histopathologic examination, superficial myometrial invasion (50% of the myometrium) was present in 28 (52.8%). For superficial myometrial invasion, evaluation by TVUS was accurate in 19 (76.0%) of 25 cases, and evaluation by SIUS was accurate in 18 (72.0%) of 25. For deep myometrial invasion, evaluation by TVUS was accurate in 24 (85.7%) of 28 cases, and evaluation by SIUS was accurate in 27 (96.4%) of 28. CONCLUSIONS: Transvaginal ultrasonography is a reliable method for assessing myometrial invasion of endometrial cancer. Saline infusion ultrasonography showed slightly better accuracy in the assessment of myometrial invasion than TVUS, but the differences were not statistically significant.     

Combined 5-fluorouracil, adriamycin and mitomycin C in the management of adenocarcinoma metastasizing to the liver from an unknown primary site

A combination of 5-fluorouracil, adriamycin and mitomycin was used to treat patients with adenocarcinoma metastasizing only to the liver from an unknown primary site. Of the 29 evaluable patients, only three (10.3%) achieved short partial remission for 6-12 weeks and two (6.9%) patients were stabilized for 4 weeks. The partial responders demonstrated a short survival time of 10-22 weeks and the median survival of non-responders was 8 weeks, which was not significantly different from that of responders. It is concluded that, although treatment of patients with metastatic adenocarcinoma of unknown primary site should be individualized, in general systemic chemotherapy for patients presenting with liver metastases is probably not justified.     

Duodenocolic fistula due to adenocarcinoma of the pancreas

A case of duodenocolic fistula due to pancreatic adenocarcinoma is presented. The causes and clinical and radiographic features of duodenocolic fistulae are discussed.