肝原发性平滑肌肉瘤1例

1 资 料 患者,男性,74岁,因腹胀不适1周入院,无畏寒、发热、恶心、呕吐等临床表现,食欲正常,睡眠良好,体重无变化,大小便正常.查体:右侧季肋区可触及肿大肝脏,无明显触痛;皮肤、巩膜无黄染.实验室检查:肿瘤标志物甲胎蛋白(α-fetoprotein,AFP)、癌胚抗原(carcinoembryonic antige...     

肝脏原发性平滑肌肉瘤1例报告并文献复习

目的：探讨肝脏原发性平滑肌肉瘤的诊断和鉴别诊断。方法：应用超声引导下自动活检技术、组织病理学、免疫组织化学观察1例肝脏原发性平滑肌肉瘤并复习相关文献。结果：组织学观察瘤细胞呈梭形．可见核分裂，免疫组织化学结果：CEA(-)、EMA(-)、vimentin( )、Myosin(Smooth Muscle)( )。结论：肝脏原发性平滑肌肉瘤是一种罕见的恶性间叶肿瘤．其诊断主要依靠免疫组织化学。     

膀胱平滑肌肉瘤3例报告并文献复习

目的探讨膀胱平滑肌肉瘤的临床病理和诊治方法。方法患者3例,肉眼血尿,膀胱镜检见肿瘤分别发生于膀胱左侧壁、左前壁和右后壁,直径2.0～3.5cm,以菜花样和乳头样为主,基底较宽,瘤体表面光滑。结果 3例均行全膀胱切除术,病理表现为上皮下间质富于黏液,黏液中可见散在或束状分布的细长梭形瘤细胞,其胞质淡染,核呈长梭形,有轻度异型,核分裂象易见。免疫组化SMA（＋）3例、MSA（＋）3例、Des（＋）2例、S-100（-）2例、CD34（-）3例,均诊断为膀胱低级别平滑肌肉瘤。随访6个月～8年,1例术后2.5年死亡,2例存活。结论膀胱平滑肌肉瘤临床罕见,确诊依赖病理及免疫组化检查,应与平滑肌瘤、横纹肌肉瘤、癌肉瘤、炎性肌纤维母细胞瘤等鉴别,治疗以手术为主,需根据肿瘤分级、分期决定手术方案及术后是否需行辅助治疗。     

低度恶性阴道平滑肌肉瘤一例报告并文献复习

1临床资料 患者，女，61岁。因发现盆腔包块5年余，阴道流液7d于2008年4月10日入院。患者曾于1993年行阴道平滑肌瘤切除术，2003年外院超声检查发现盆腔包块。入院查体（专科情况）：阴道狭窄，通而不畅，不能置入窥阴器，不能暴露宫颈。手指触摸：阴道后壁下包块，质中偏硬，活动度差，压痛不明显。肛诊示：直肠前方触及一临产胎儿头大小肿块，质硬、活动度欠佳，直肠黏膜光滑，无出血。     

骨原发性平滑肌肉瘤(1例报告并文献复习)

病例女,37岁,已婚。1年前无明显诱因左膝关节疼痛、跛行、功能受限等在我院摄片诊断为“左胫骨骨肿瘤,性质待定”。入院行病灶清除术,术后病理:大体观察送检组织为灰白碎组织,大小1.5cm×1.5cm×1.0cm。免疫组化检测:CD68灶性(+)、SM A(+)、S100(-)、溶菌酶灶性(+)。病理诊断:(左胫骨上段)富于细胞的平滑肌肿瘤(潜在低度恶性)。10天前患者再次渐感左膝关节疼痛,症状进行性加重,疼痛难忍,夜间难以入睡就诊。入院查体:左膝关节疼痛,主动活动受限,被动活动良好。左大腿肌肉群稍萎缩,左膝略肿胀。局部无明显叩压痛。左膝关节静脉充盈。头、颈…     

股骨原发性平滑肌肉瘤1例

病例 女,64岁,因“左髋部疼痛不适半年余,加重2月”入院.查体:无明显阳性体征.生化检查无明显异常.X线检查(图1)示左股骨转子间局部溶骨性破坏,破坏区形态不规则,部分边缘模糊,无硬化边,病灶内见散在小片状稍高密度影,未见软组织肿块.ECT全身骨显像(图2):左侧股骨上段局部异常放射性浓聚.     

原发性颅内外沟通平滑肌肉瘤1例

患者女,74岁,1年前摔伤后出现右额部皮下血肿并进行性增大,无头晕、头痛、恶心、呕吐;既往高血压10年余.入院查体:神志清,右额部触及7 cm×7 cm肿块,整体质软、部分基底部稍硬,触之略有波动感,无压痛,移动度差.实验室检查未见明显异常.     

原发性骨平滑肌肉瘤的临床、影像学和病理分析及文献复习

目的分析原发性骨平滑肌肉瘤(PLB)的临床、影像学和病理学表现。方法回顾性分析6例PLB的临床资料,结合1980—2010年相关国内文献,观察其临床、影像学表现和病理学特点。结果 6例PLB中,病变位于胫骨上段2例,股骨下段1例,股骨干1例,肱骨远端1例,骶骨1例,均未见骨膜新生骨;4例表现为边界不清的溶骨性骨质破坏,2例表现为边界较清的囊状骨质破坏;3例MR T1WI呈等信号,T2WI稍高信号,增强扫描有明显强化;免疫组化Vim、Actin和SMA均阳性,S-100阴性。复习文献中的53例PLB,单骨受累50例,多骨受累3例;39例有X线片资料,37例可见边界不清的溶骨性骨质破坏,2例见边界较清的囊状骨质破坏,其中2例可见病理性骨折伴骨膜新生骨。结论 PLB罕见,多表现为单骨溶骨性骨质破坏,无骨膜新生骨,但其临床和影像学表现并不典型,术前诊断需要依赖免疫组化。     

Primary leiomyosarcoma of the middle ureter: A rare case report with literature review

Leiomyosarcoma is a rarely seen neoplasm of the ureter. Malignant tumors of smooth muscle of the ureter are extremely rare, and about 22 cases of leiomyosarcoma of ureter have been reported to date. A 57‐year‐old diabetic Pakistani man presented with a dull ache pain in the right flank. Past surgical history was three ureteroscopic surgeries for a ureteric stricture. Computed tomography showed a stricture with a peri‐ureteral soft tissue mass of 11 mm x 5 mm at the middle third of the ureter at the level of common iliac vessels. laparoscopic excision with safety margin and right ureterovesical reimplantation is performed. Diagnosis of leiomyosarcoma of the right ureter was made, and one iliac lymph node was excised and was positive for tumor by pathologic examination. Although leiomyosarcoma is rarely seen in urinary tract, it should be considered in the differential diagnosis of ureteral stricture disease and retroperitoneal tumors.     

Rapidly growing esophageal leiomyosarcoma: case report and review of the literature

We evaluated a 72-year-old woman who was experiencing dysphagia. Esophageal leiomyosarcoma was diagnosed by barium meal study, upper gastrointestinal endoscopy, endoscopic ultrasonography (EUS), by computed tomography (CT). A barium meal study and esophagoscopy performed 3 months before the diagnosis of esophageal leiomyosarcoma showed no abnormalities. Therefore, the tumor appeared to have grown rapidly during the 3-month period.     

原发性骨淋巴瘤1例报告及文献复习

目的:探讨1例原发性骨淋巴瘤(PLB)的诊断、治疗及患者预后。方法:报告1例PLB患者,并结合国内外相关文献进行分析。结果:该例患者依据病变局灶活检及免疫组化结果被确诊为"弥漫大B细胞型非霍奇金淋巴瘤"。予患者常规化疗,结合单克隆抗体治疗及自体造血干细胞移植后,14个月后达到完全缓解,随访36个月,未出现新发病灶。结论:PLB的实验室检查结果和影像学表现均无特异性,早期确诊十分困难,易误诊。目前,确诊PLB依靠病理组织形态学和免疫组化检查。早期诊断、积极治疗可改善PLB患者的预后。     

颅内原发性绒毛膜癌1例报告并文献复习

目的提高对男性颅内原发性绒毛膜癌的认识。方法对1例经开颅手术病理确诊为颅内原发性绒毛膜癌男性患者的临床资料进行分析,并结合国内外文献进行复习。结果男性颅内原发性绒毛膜癌是临床少见病例,恶性程度高,临床除颅内占位性病变外常无其他特异性表现,如患者不及时治疗可在短期内死亡。结论影像学发现青少年颅内占位性病变且有出血倾向,血或尿β-HCG升高的患者应考虑到该疾病,应尽早给予包括手术和放化疗为主的综合治疗。     

Primary leiomyosarcoma of the thyroid gland with prior malignancy and radiotherapy:A case report and review of literature

BACKGROUND Leiomyosarcoma(LMS) of the thyroid gland is a rarely presented tumor that offers poor prognosis. To the best of the authors' knowledge, there currently exist only 28 known cases described in the literature(limited to English).CASE SUMMARY Herein a case is reported of a 60-year-old female patient who had an LMS of the thyroid, which was accompanied by periodic dysphonia and breathing disorder as well as the feeling of pressure in the chest and neck. At the time the disease was diagnosed, no metastases were detected. Prior to the diagnosis, the patient experienced a uterine adenocarcinoma that had been treated by surgical procedure and radiotherapy. For the LMS, a total thyroidectomy was performed,followed by radiotherapy. Since metastases were also discovered in the lungs,sternum, and femur, chemotherapy was administered as well.Immunohistochemically, the tumor cells in the thyroid indicated positively for alpha smooth muscle actin, calponin, and H-caldesmon, but were negative for CD34, p63, estrogen receptor, progesterone receptor, and Epstein-Barr virus.CONCLUSION Although the etiology of the LMS is as of yet unknown, prior malignancy and radiation should be considered as risk factors.     

Primary paraganglioma of the lung: a case report and literature review

Only 22 cases of primary pulmonary paraganglioma have been reported previously. This report presents a case of paraganglioma that arose in the lung of a 38-year-old woman who presented with chest pain and paroxysmal cough with little sputum. Positron emission tomography-computed tomography scan demonstrated two homogeneous masses in the left lower lobe accompanied by multiple mediastinal lymph node metastases. After resection, gross pathological examination confirmed two solid masses, which had a yellow-grey complexion and decreased blood supply and that invaded the mediastinum. Immunohistochemical analysis confirmed the presence of several biological tumour markers. This is the first known report to describe the computed tomography imaging characteristics of a paraganglioma, thereby improving understanding of its morphological features and helping in the differential diagnosis of lung tumours.     

微小病变样原发性肾淀粉样变性1例误诊报告并文献复习

目的 探讨微小病变样原发淀粉样变肾病的临床病理特点及电镜检查在老年肾病中的诊断价值.方法 1例报道结合文献复习.结果 早期轻微病变样淀粉样变肾病可以没有明显的临床特征,光镜下可以表现为微小病变样,确诊必须依赖电镜诊断.结论 对中老年肾病综合征患者治疗前一定要做病理诊断,即使光镜检查为微小病变,也应做电镜检查是否存在淀粉样变.电镜检查对早期淀粉样变肾病而言可能是惟一可靠的诊断手段.     

Venous invasion in renal vein leiomyosarcoma: case report and review of the literature

Tumors arising from veins are rare, usually present with nonspecific clinical and imaging findings and almost universally show histology of leiomyosarcoma. This twentieth reported case of primary renal vein leiomyosarcoma demonstrates invasion of the renal vein with endoluminal propagation of tumor into the infrahepatic inferior vena cava (IVC), an unreported manifestation. The combination of CT, ultrasound, and angiographic studies allowed differentiation from renal cell carcinoma by suggesting a tumor arising from the renal vein.     

Primary tuberculous liver abscess: a case report and review of the literature

A 48-year-old diabetic man was admitted to our hospital with abdominal pain in the right upper quadrant, weight loss, night sweats, fatigue, and anorexia. Ultrasonography, computed tomography, and magnetic resonance imaging of the abdomen revealed multiple hemangiomas and a hypodense mass lesion in the posterior segment of the right hepatic lobe. Histopathologic examination of the specimens obtained by ultrasonography-guided percutaneous needle biopsy revealed caseating granulomas with epithelioid histiocytes and giant cells. Systemic antituberculous therapy led to improvement of the lesion in the liver without necessitating surgery or percutaneous drainage. Tuberculosis should be considered in the differential diagnosis of hepatic mass lesions, especially in the presence of immune-compromised states. Ruling out tuberculosis may avoid delay in initiation of specific therapy in some cases. A greater awareness of this rare clinical entity may prevent needless surgical interventions.