肾上腺节细胞神经瘤CT表现:4例报告并文献复习

目的分析肾上腺节细胞神经瘤患者的CT表现。方法回顾性分析经手术病理证实的4例肾上腺节细胞神经瘤的CT表现。结果肾上腺节细胞神经瘤的CT表现主要为境界清楚、呈圆形或类圆形的肿块,平扫时肿瘤呈稍低密度影,密度较均匀,内部可见多发点状钙化;增强后病灶无强化或呈轻度强化。结论 CT检查能较好地显示肾上腺节细胞神经瘤的边缘、内部结构和血供方式等影像学特点,反映病灶的大体病理特征。     

后肾始基腺瘤的CT与病理学特点分析

目的:探讨后肾始基腺瘤的CT特征及病理特点。方法:回顾性分析经手术病理证实的18例后肾始基腺瘤患者的临床资料,其中男10例,女8例,年龄33~75岁(平均50岁),均为单侧发病,左肾8例,右肾10例。患者均行CT平扫及增强扫描。分析18例患者CT和病理特点以及两者之间的关系。结果:18例患者CT平扫肿物呈等密度或稍低密度软组织肿块,最大径1.5~7.0cm,平均3.6cm;呈类圆形12例,不规则形6例;边界清晰6例,欠清晰7例,边界不清晰5例;密度均匀及不均匀各4例,密度欠均匀10例;CT值27~45HU,平均39HU。CT增强扫描示肿物未强化2例,轻到中度强化16例,呈软组织密度肿物影,低于肾实质强化水平,CT值50~77HU,平均63HU。11例延迟期扫描示肾盂肾盏有造影剂充盈并显示受压移位。患者术后病理学均证实为后肾始基腺瘤,光镜下肿瘤细胞体积较小,均匀分布,紧密排列,大小一致,形成长管样结构,部分可见乳头状或肾小球样结构。结论:后肾腺瘤的CT检查特征与病理特点有一定的相关性;正确认识其CT及病理学特点,有助于指导手术方案的制定,避免不必要的全肾切除术。     

恶性纤维组织细胞瘤的CT表现及病理特征

目的探讨恶性纤维组织细胞瘤(MFH)的CT表现及病理特征。方法回顾性分析18例(男10例,女8例)经手术病理证实的MFH的CT和病理学资料。结果 MFH位于下肢8例,上肢1例,腹膜后3例,鼻部2例,肝脏2例,背部1例,肠道1例。CT示肿块密度与肌肉密度相似或略低,多不均匀,边界不清,病灶内见坏死15例,囊变9例,钙化3例,出血2例;增强后肿瘤多呈不均匀中等强化,以周边强化明显,并呈现"快进慢出"的特点。光镜下见肿瘤细胞成分复杂,大量成纤维细胞样细胞呈席纹状或轮辐状排列为其特征性病理表现。结论 CT对诊断MFH具有重要参考价值,但确诊仍需依靠病理学检查。     

颈部韧带样瘤1例

患者 女,27岁.因发现右肩肿块3个月入院.病程中无任何其他症状.体查:右颈后三角可扪及4 cm×4 cm大小肿块,质地硬,境界欠清,活动度差,无触痛.CT检查示:右颈部相当于右前斜角肌区域见35 cm×40 cm大小肿块,增强后病灶轻度强化.入院诊断:右肩肿块(性质特定).行手术切除.术中见肿块位于右侧前、中斜角肌间,肿块外侧邻副神经,下方邻臂丛神经,大小约4cm×4cm×3.5cm,无完整包膜,边缘不规则,质地硬,活动度差.病理检查:增生的梭形细胞呈束状排列,侵及周围横纹肌及脂肪组织.诊断:右颈部(腹壁外)韧带样瘤.     

胃间质瘤的CT诊断

目的探讨胃间质瘤的CT诊断价值,提高对GST的CT征象和临床表现的认识。方法回顾性分析14例经手术病理及免疫组化证实的GST的CT和临床表现资料,所有病例均行CT平扫及增强扫描。结果本组共检出病灶14个,均为单发,位于胃体部9例,胃底部3例,胃窦部2例,其中腔内生长3例,腔内外生长7例,腔外生长4例。良性5例,CT所见瘤体最大径均≤5.0cm,圆形或类圆形,密度均匀,明显均一强化;恶性或潜在恶性9例,CT表现为肿块较大,最大径均〉5.0cm,分叶状或不规则形,内见囊变坏死,不均一强化,其中2例发生肝脏转移。结论 CT对GST具有重要诊断价值。     

胰腺实性-假乳头状瘤的CT影像表现与病理对照

目的探讨胰腺实性-假乳头状瘤的影像学表现及临床病理特点,以提高对此类疾病的影像学诊断认识。方法回顾性分析经手术病理证实的12例胰腺实性-假乳头状瘤患者的临床资料、CT影像表现,将影像学表现与手术病理结果对照。结果 12例均为单发病灶。肿瘤体积较大,最大径为1.5～12 cm,平均5.2 cm。肿瘤位于胰头5例,胰颈3例,胰体2例,胰尾2例。术前CT检查6例可见完整包膜,3例可见不完整包膜,3例未见到包膜。12例患者中3例肿块边缘见点线状钙化,3例肿块中央见条片状钙化,1例肿块中央及边缘均见钙化,5例肿块内未见钙化。平扫主要表现为圆形或分叶状囊实性肿块,增强后实性部分动脉期轻度强化,延迟扫描呈渐进性强化,10例瘤体内出现乳头状或间隔状强化。7例伴有胰管轻度扩张。病理特征为肿瘤细胞围绕的血管轴心形成的假乳头状结构,外周伴纤维包膜。结论胰腺实性-假乳头状瘤的影像表现具有相对特征性,有助于术前诊断和手术方案的选择。     

腹膜后副神经节瘤的CT诊断3例及文献复习

目的探讨腹膜后副神经节瘤的CT表现和临床特点,提高对该病的认识、诊断及鉴别诊断水平。方法结合文献复习,回顾性分析3例经病理证实的腹膜后副神经节瘤的CT和临床表现资料。以腹部剧烈疼痛就诊者2例,无明显腹部症状、体检偶然发现腹部包块者1例,其中1例既往有高血压病史。结果本组3例病灶均为单发,大小约4.0cm×5.8cm×6.0cm～17.7cm×8.5cm×10.2cm。CT表现：肿瘤位于左侧腹膜后2例,右侧腹膜后1例,平扫呈圆形或类圆形不均质软组织肿块,内见囊变坏死,1例瘤灶内可见分隔样结构及沿囊壁分布的弧线样钙化,增强后肿瘤实质及间隔均明显强化。结论 CT对腹膜后副神经节瘤具有重要诊断价值。     

20例胸膜结核瘤临床分析

目的探讨胸膜结核瘤的临床和影像学特点。方法回顾性分析经细菌学和（或）病理学证实的20例胸膜结核瘤患者的临床及影像学资料。结果本组患者以咳嗽、发热、胸痛、盗汗为常见症状．无症状3例。合并肺结核5例,15例有明确的结核性胸膜炎病史,5例无明确病史。20例均行超声或CT引导下经皮穿刺活检,其中7例涂片找到抗酸杆菌,13例经病理检查证实。胸部X线片示：肿块多呈圆形或半圆形,有较均匀的密度增高影,不规则3例,内有钙化3例;有不完整的边缘、内缘清晰5例,其中2例有轻度的分叶。胸部CT示：病灶密度均匀8例,不均匀12例;7例伴钙化,3例病灶中心密度较低：注射对比剂后扫描胸膜结核瘤病灶往往无强化或呈现病灶周边强化。结论掌握胸膜结核瘤的临床和影像学特点,对诊断和鉴别诊断具有重要价值。     

彩超诊断附睾腺瘤样瘤2例报告并文献复习

目的提高临床医生对超声诊断附睾腺瘤样瘤的认识。方法报告2例彩超诊断附睾腺瘤样瘤的患者,并结合文献复习其解剖、临床、病理和超声特征。首先2例患者术前使用二维超声观察记录肿块大小、形态、部位、边界、内部回声,并用彩色多普勒(CDFI)检查,记录其彩色血流信号分布,将取样容积置于血流信号最丰富处,获取频谱,使声束和血流的夹角<60°,测定收缩期血流速度、阻力指数等参数。后经手术顺利切除附睾肿瘤。结果2例附睾肿块均呈等回声、边界规则的肿块,内部回声均匀。1例位于右附睾头的肿块,内部未探及明显彩色血流信号;1例位于左附睾头的肿块,内部探及少量彩色血流信号,最大流速16cm/s,RI:0.62。术后病理诊断为附睾腺瘤样瘤。结论附睾腺瘤样瘤临床少见,超声检查可在附睾头或尾部见到等回声,形态规则,边界清晰完整,内部回声均匀,CDFI示无或有少量彩色血流信号的肿块,腺瘤样瘤可能性大。     

彩色多普勒超声检测对肠间质瘤与肠癌的鉴别诊断

目的 探讨经腹彩色多普勒超声检测对肠间质瘤和肠癌的鉴别诊断价值.方法 回顾性分析比较经手术病理证实的肠道间质瘤（25例）和肠癌（30例）患者术前彩色多普勒超声诊断资料.结果 92%的肠道间质瘤患者肿瘤发生于小肠,超声表现为内部呈低回声的实质性肿块,部分内部可出现无回声区,边界清,血流信号丰富,不包绕肠腔生长.30例肠癌患者全部为结直肠肿瘤,超声表现为均匀的低回声肿块,边界不清,多探不到丰富的血流信号,包绕肠腔生长呈＂假肾样改变＂;1例患者发现肿块周边有淋巴结肿大.肠间质瘤超声检测显示的内部回声、肿块与肠腔关系、血流信号等表现与结直肠癌比较,差异有统计学意义（P＜0.05）.结论 经腹彩色多普勒超声能够准确地鉴别肠道间质瘤和肠癌.     

Desmoid tumors in three patients

Desmoids are rare tumors of the connective tissue. It develops about 1:1000 times more in patients with familial adenomatous polyposis (FAP, Gardner syndrome) compared to normal population. It has been shown in molecular genetic examinations, that different mutations of the APC gene are responsible for desmoid tumors in FAP. It means, that this disease is one of the extraintestinal manifestations of Gardner syndrome. This tumor has high recurrence rate and is growing rapidly, and as a result it is the second most common cause of death in FAP patients. That is why genetic examination for FAP patients is advised to decide if the patient has higher risk for desmoid formation. If the result of the genetic test is positive, it is advisable to try to slow the progression of polyposis with medical treatment, and so to delay the date of the colectomy because the surgical intervention--and connective tissue damage--can induce desmoid formation in these patients. At the same time it is reasonable to examine and regularly control patients with sporadic desmoid tumors searching for other manifestations of Gardner syndrome (colon, stomach and duodenum polyposis, tumor of papilla Vateri, retinopathy, etc.). Palliative surgery is not indicated in patients with inoperable intraabdominal desmoid tumors, because partial resections (R1, R2, debulking) result in further tumor progression. In these patients medical treatment (sulindac, tamoxifen), chemotherapy (doxorubicin, dacarbazin) and radiotherapy or combination of them can result tumor remission. We describe our three patients (an abdominal wall desmoid four years following Cesarean section; a desmoid tumor in the retroperitoneum and in the pelvis diagnosed three years after total colectomy; and a retroperitoneal and abdominal wall desmoid one year after total colectomy) and etiology, diagnosis and therapy of desmoid tumors are discussed.     

CTA对小肠间质瘤的诊断价值

目的 评价螺旋CT与螺旋CT血管造影(MSCTA)对小肠间质瘤的诊断价值.方法 回顾性分析19例经手术病理证实小肠间质瘤的螺旋CT扫描与MSCTA结果.结果 19例中良性12例,恶性7例;肿瘤大小约2～15 cm.19例中CT及MSCTA发现病灶有16例,即定性诊断准确率为84.21%.根据手术中探查结果,CT及MSC...     

Abdominal wall reconstruction with intraperitoneal prosthesis in desmoid tumors surgery

Desmoid tumor (DT), also known as aggressive fibromatosis, is a rare soft tissue neoplasm. For those tumors localized in the anterior abdominal wall, radical resection and reconstruction with mesh are indicated. Due to the rarity of this disease, there have been no randomized trials, but in reported retrospective series, although it is considered a benign lesion, it is clear that local recurrence is not uncommon. Records from seven consecutive patients (1 man, 6 women; mean age 35 years, range 25-60 years) presenting with desmoid tumors of the anterior abdominal wall were analyzed. In all cases the surgical strategy was the same: wide surgical excision and immediate plastic reconstruction with ePTFE mesh after intraoperative confirmation by frozen section of disease-free margins >1 cm. No immediate postoperative complications were recorded, and no patients developed recurrence after a median follow-up period of 60 months. The long-term mean of global health status recorded was 100%. Radical resection aided by intraoperative margin evaluation by frozen sections, followed by immediate mesh reconstruction, is a safe procedure and can provide a definitive cure without functional limitations for patients with desmoid tumors of the anterior abdominal wall.     

Desmoid tumors of the abdominal wall.

Four cases of desmiod tumors of the anterior abdominal wall recently treated at the University of Chicago Hospitals and Clinics are presented. From our experience we conclude: 1. Inadequate excision of desmoid tumors results in local recurrence. 2. Adequate excision of desmoid tumors ot the abdominal wall sometimes necessitates creation of an abdominal wall defect too large for primary closure. 3. Marlex mesh has been used successfully in reconstruction of the abdominal wall following adequate excision of desmoid tumors. 4. One patient (Case 4) with an abdominal wall desmoid tumor associated with familial polypisis and mesenteric fibromatosis has benefited greatly following wide excision of abdominal wall and reconstriction using Marlex mesh, despite the fact that the mesenteric fibrous tumor was unresectable.     

Computed Tomographic Demonstration of a Fish Bone in Abdominal Actinomycosis: Report of a Case

A 53-year-old man who had the habit of consuming fish bones was referred to our clinic because of a suspected malignant abdominal wall tumor. Computed tomography (CT) showed a mass (10 × 5 cm) in continuity with the transverse abdominal muscle, containing a small calcification. A laparotomy was performed with a preoperative diagnosis of an inflammatory mass due to fish bone penetration from the sigmoid colon. A fish bone, measuring 2.3 cm in length, was detected within the tumor by specimen radiography. The pathological findings demonstrated actinomycotic colonies. We herein present the first case of a CT demonstration showing a fish bone in an abdominal mass which was pathologically confirmed to be actinomycosis. Evidence of the presence of a foreign body is valuable for diagnosing inflammatory nodules such as actinomycosis and differentiation from malignancies.     

Desmoid tumor: a case of mistaken identity

Desmoid tumors are rare tumors accounting for only 0.03% of all neoplasms. Mainly occurring in the fourth and fifth decades of life, these tumors originate in musculoaponeurotic tissues of the limbs, neck, trunk, abdominal wall, and mesentery. We present a rare case of a chest wall desmoid tumor that was mistaken for breast cancer on both physical examination and mammography, which highlights the unique risk these tumors present for confusion with other malignant processes. Although past literature contains numerous reports of other misdiagnoses, this case is unique in reporting the potential for misdiagnosis between chest wall desmoid tumors and breast cancer. In cases where suspicious breast findings do not correlate to usual diagnostic measures, such as fine-needle aspiration or core needle biopsy, the possibility of another pathology such as a chest wall desmoid tumor mimicking breast cancer should be considered in the differential diagnosis.     

小肠间质瘤的CT诊断

目的探讨小肠间质瘤的CT诊断价值,提高对小肠间质瘤CT征象和临床表现的认识。方法回顾性分析14例经手术病理及免疫组化证实的小肠间质瘤患者的临床资料。临床主要症状为黑便、贫血、腹部不适、腹痛、呕吐、发热及腹部包块等。所有病例均行CT平扫及增强扫描。结果本组病例中,CT共检出病灶14个,均为单发,发生于十二指肠3例,回肠7例,空肠4例。良性9例,CT平扫表现为类圆形软组织块影,瘤体最大径均≤4.0cm,密度均匀,明显均一强化。恶性5例,分叶状或不规则形,瘤体最大径均〉4.0cm,多为腔外生长,肿瘤内可见囊变坏死,不均一强化,其中肝脏及肺转移各1例。结论 CT对小肠间质瘤具有重要诊断价值;以瘤体最大径4.0cm为界值对肿瘤的良恶性判断有一定参考价值。     

腹壁韧带样瘤16例临床分析

目的 探讨腹壁韧带样瘤的临床特点和治疗方法.方法 回顾性分析1998年1月至2010年10月收治的16例腹壁韧带样瘤患者的临床资料,全组患者均经手术治疗.结果 本组16例患者均行广泛切除术,复发2例,复发率12.5%(2/16).结论 腹壁韧带样瘤呈侵袭性生长的特性,治疗应按低度恶性软组织肿瘤处理.治疗首选外科手术.     

阑尾类癌13例诊断和治疗

目的探讨阑尾类癌的生物学特性、诊断和外科治疗经验,提高首次手术治愈率。方法回顾性总结1985年至2002年我院收治的13例阑尾类癌患者的临床和病理资料。结果全组无一例术前确诊,均经术后病理确诊。肿瘤直径小于1cm 9例,1～2cm 3例,大于2cm 1例。8例肿瘤浸润深度限于黏膜下或肌层,3例浸及浆膜。有2例患者显示肿瘤浸润至阑尾系膜,其中有1例患者肿瘤大于2cm伴局部淋巴结转移。分别采用单纯性阑尾切除术9例,回盲部切除术1例,右半结肠切除2例,姑息性手术1例。获随访的11例患者中,10例患者无复发和远处转移,1例死亡。结论阑尾类癌少见且多无症状,难以做出术前确诊。宜根据肿瘤大小、部位及浸润深度决定手术方式和切除范围。     

Abdominal wall and foot reconstruction after extensive desmoid tumor resection with free tissue transfer

BACKGROUND: Desmoid tumors are rare connective tissue tumors, also referred to as deep, aggressive fibromatosis. Although histologically benign, they show an invasive growth behavior and have a high local recurrence rate. METHODS: The treatment of choice is surgical resection with wide negative margins, while the use of radiotherapy remains controversial. Wide resection of greater desmoid tumors may result in considerable defects and functional impairment. Few papers discuss different options for defect coverage after desmoid tumor resection. Two cases of extensive desmoid tumors, one at the trunk, one at the foot, both with compromised wound margins due to multiple previous surgeries, are presented. To achieve a stable and functional soft tissue cover, the defects were treated with microvascular soft tissue transfer (one free latissimus dorsi, one free radial forearm flap). RESULTS: Both flaps healed uneventfully and patients regained full function of the abdominal wall and foot, respectively. CONCLUSIONS: The presented cases demonstrate the efficacy of free flap coverage as an ultimate therapeutic option in selected cases of critical defects after extra-abdominal desmoid tumor resection. Furthermore, free flaps provide a well vascularized ground for adjuvant radiotherapy.