内镜超声引导下细针穿刺活检诊断上消化道壁外占位性病变的价值

目的 探讨内镜超声引导下细针穿刺活检(EUS-FNA)在上消化道壁外占位性病变(胰腺、纵隔、腹膜后占位)诊断中的应用价值.方法 回顾性总结行EUS-FNA检查的33例胰腺占位、25例纵隔占位和13例腹膜后占位患者的临床资料,以手术病理或6个月临床随访结果作为最终诊断,统计EUS-FNA对不同分类上消化道壁外恶性占位诊断的敏感度、特异度、阳性预测值、阴性预测值和准确率.结果 EUS-FNA诊断上消化道壁外恶性占位的总体敏感度、特异度、阳性预测值、阴性预测值、准确率分别为82.2％(37/45)、100.0％(26/26)、100.0％(37/37)、76.5％(26/34)、88.7％(63/71),且分别诊断胰腺、纵隔、腹膜后恶性占位的敏感度、特异度、阳性预测值、阴性预测值、准确率均较高.病灶直径＞3 cm恶性占位EUS-FNA诊断的敏感度、特异度、阳性预测值、阴性预测值及准确率分别为81.0％(17/21)、100.0％(13/13)、100.0％(17/17)、76.5％(13/17)、88.2％(30/34),病灶直径≤3 cm恶性占位的诊断敏感度、特异度、阳性预测值、阴性预测值及准确率分别为83.3％(20/24)、100.0％(13/13)、100.0％ (20/20)、76.5％ (13/17)、89.2％(33/37),两者比较差异均无统计学意义(P＞0.05).71例患者均未出现出血、穿孔、胰腺炎、胰瘘及感染、胸痛、气胸等并发症.结论 EUS-FNA是一种安全、准确、有效地诊断上消化道壁外占位性病变的方法,且诊断准确率不受病灶大小的影响.     

超声内镜下细针穿刺活检术对胰腺囊性病变的诊断价值

目的 探讨超声内镜引导下细针穿刺活检术(EUS-FNA)及细胞块对胰腺囊性病变的诊断价值.方法 回顾性分析2010年1月至2012年12月行传统影像学检查(CT、MRI、B超)、EUS-FNA的15例胰腺囊性病变的临床资料,其中8例行液基细胞学(LBC)、细胞块检查.同时,比较4种检查技术在胰腺囊性病变中的诊断价值.结果 假性囊肿7例,黏液性囊腺瘤2例,胰腺导管内乳头状黏液瘤(IPMN)1例,胰腺癌3例,囊腺癌2例.传统影像学、EUS-FNA、LBC、细胞块的诊断正确率为53.3％、86.7％、75.0％、100.0％,差异有统计学意义(P＜0.05).EUS-FNA较单纯传统影像学的灵敏度、特异度、约登指数均高(86.7％、75.0％、0.62与53.3％、58.3％、0.12),细胞块较LBC灵敏度高(100.0％与75.0％).结论 EUS-FNA及细胞块可提高诊断胰腺囊性病变的准确率.     

内镜超声引导下细针穿刺活检术对影像学拟诊肝脏恶性肿瘤的诊断价值

目的 评价内镜超声引导下细针穿刺活检术(EUS-FNA)在影像学拟诊为肝脏恶性肿瘤患者中的临床应用价值.方法 回顾29例经影像学拟诊为肝脏恶性肿瘤行EUS-FNA检查患者的临床资料,总结细胞学、组织学、病理学诊断结果以及随访并发症发生情况.结果 29例共穿刺29处肝脏占位(尾状叶8处、左叶19处、右叶深部2处),穿刺32处非肝脏占位(胰腺9处、胆囊2处、胃壁1处、肺1处、右肾上腺1处、淋巴结18处).61处(100.0％)均能行细胞学检查,56处(91.8％,56/61)能行组织学检查,48处(78.7％,48/61)能行免疫组化检查.病理学诊断为原发性肝癌8例,其中1例肝脏病灶细胞学和组织学均无阳性发现,经同时肝门淋巴结细胞学明确诊断,其余7例(87.5％,7/8)肝脏病灶细胞学和组织学均为阳性;病理学诊断为转移性肝癌21例,肝脏病灶细胞学、组织学和病理学阳性率分别为76.2％(16/21)、85.7％(18/21)和100.0％(21/21),所有病变部位(包括肝脏、原发病灶和肿大淋巴结)的病理学阳性率达98.0％(48/49).所有患者未发生明显的并发症.结论 基于深部肝脏与贲门、胃和十二指肠的局部解剖关系,EUS-FNA对于肝脏尾状叶、左叶和右叶深部的恶性肿瘤有肯定的诊断价值,是经皮肝脏穿刺活检的重要补充,应受到临床重视.     

Value of CT-guided core-needle biopsy in diagnosis and classification of malignant lymphomas using automated biopsy gun

AIM: To evaluate the value of CT-guided core-needle biopsy in diagnosis and classification of malignant lymphomas. METHODS: From January 1999 to October 2004, CT-guided core-needle biopsies were performed in 80 patients with suspected malignant lymphoma. Biopsies were performed with an 18-20 G biopsy-cut (CR Bard, Inc., Covington, GA, USA) needle driven by a spring-loaded Bard biopsy gun. RESULTS: A definite diagnosis and accurate histological subtype were obtained in 61 patients with a success rate of 76.25% (61/80). Surgical sampling was performed in 19 patients (23.75%) with non-diagnostic core-needle biopsies. The success rate of CT-guided core-needle biopsy varied with the histopathologic subtypes in our group. The relatively high success rates of core-needle biopsy were noted in diffuse large B-cell non-Hodgkin's lymphoma (NHL, 88.89%) and peripheral T-cell NHL (90%). However, the success rates were relatively low in ana plastic large cell (T/null cell) lymphoma (ALCL, 44.44%) and Hodgkin's disease (HD, 28.57%) in our group. CONCLUSION: CT-guided core-needle biopsy is a reliable means of diagnosing and classifying malignant lymphomas, and can be widely applied in the management of patients with suspected malignant lymphoma.     

Streptococcus bovis septic arthritis and osteomyelitis: A report of 21 cases and a literature review

BackgroundThe Streptococcus bovis group (SBG) is a well-known cause of endocarditis, but its role in osteoarticular infections (OAIs) has not been well described.MethodsWe analyzed all patients with OAIs by SBG diagnosed in our hospital (1988–2014). We selected those cases with septic arthritis and osteomyelitis, as defined according to clinical, microbiological, and imaging studies. Identification of the strains was performed by using the API 20 Strep and the GP card of the Vitek 2 system, and confirmed the identification by molecular methods. In addition, we reviewed the literature to select all cases of OAI by SBG during the period 1980–2015.ResultsFrom the 83 cases of OAI included in the analysis (21 from our center and 62 from the literature review), 59 were osteomyelitis (57 of them spondylodiscitis) and 24 were arthritis (2 with associated spondylodiscitis). The mean age was 66.9 years, and 79.2% of the patients were men. Endocarditis (IE) was associated with 59% of the cases and this association was greater for osteomyelitis than for arthritis (78.9% vs. 13.6%; P = 0.001). OAI was a presenting symptom in 63% of the cases of IE. Colonoscopy was performed in 64 cases, which detected colorectal neoplasm (CRN) in 46 patients (71.8%), almost all asymptomatic. Some 69.5% of these neoplasm were carcinomas or advanced adenomas. The blood cultures were positive in 78.3% cases. In 45 cases, the S. bovis species was identified; in 82.2% of the cases the cause was Streptococcus gallolyticus subsp. gallolyticus. The mortality was 7.2%, which in no case was attributable to the OAI.ConclusionsOAIs are frequently the initial manifestation of IE caused by SBG. S. gallolyticus causes most of these infections. Echocardiogram and colonoscopy are therefore mandatory, given the species’ close association with IE and CRN.     

超声内镜引导下细针穿刺活检对胰腺实性占位定性诊断价值的Meta分析

目的:系统评价超声内镜引导下细针穿刺活检(EUS-FNA)在胰腺实性占位定性诊断中的价值.方法:计算机检索MEDLINE、Cochrane Library、中国生物医学文献数据库、万方数据库、中国学术期刊全文等数据库,检索时间均为建库至2011-10.全面查找有关EUS-FNA诊断胰腺实性占位的文献,按照诊断试验的纳入标准筛选文献,提取纳入文献的特征信息(研究背景、设计信息和诊断参数信息),根据QUADAS质量评价标准纳入文献的质量.采用Meta-Disc1.4软件进行Meta分析,检验异质性,并根据异质性结果选择相应的效应模型.对纳入文献予以加权定量合并,计算汇总敏感度、特异度、阳性似然比、阴性似然比和诊断优势比及其95%CI,绘制汇总受试者工作特征(SROC)曲线,并计算曲线下面积(AUC).结果:共检索出相关文献280篇,按照文献纳入标准,最终纳入18篇文献(均为英文文献).EUS-FNA对胰腺实性占位定性诊断价值分别为:汇总敏感度为0.90[95%CI(0.89-0.92)],汇总特异度为0.95[95%CI(0.93-0.97)],汇总阳性似然比为13.56[95%CI(8.31-22.15)],汇总阴性似然比为0.12[95%CI(0.10-0.15)],汇总诊断优势比为143.62[95%CI(93.98-219.46)],SROC曲线下面积AUC为0.9711,Q*=0.9215.另外,本研究还对有无病理医生在场指导进行了亚组分析,发现有病理医生在场的AUC为0.9757,Q*=0.9295.且汇总诊断优势比173.37[95%CI(98.09-306.44)],明显较无病理医生在场的113.64[95%CI(60.22-214.46)]高.结论:经SROC曲线证实,EUS-FNA活检在胰腺实性占位定性诊断中具有较高的灵敏度和特异度,尤其是有病理医生在场指导的情况下,可作为临床上胰腺实性占位定性诊断的重要检查手段.     

桥本甲状腺炎甲状腺细针穿刺两种细胞学亚型临床特点比较

回顾性分析397例经甲状腺细针穿刺细胞学(FNAC)确诊桥本甲状腺炎患者的临床特点.发现嗜酸细胞型(n=181)及淋巴细胞型(n=186)桥本甲状腺炎临床表现、抗甲状腺自身抗体(甲状腺球蛋白抗体、甲状腺过氧化物酶抗体)水平无差异.嗜酸细胞型较淋巴细胞型更倾向进展为甲状腺功能减退,可能为疾病进程中晚期阶段.     

Endoscopic ultrasound-guided fine-needle aspiration cytology diagnosis of solid pseudopapillary tumor of the pancreas： A case report and literature review

We describe the clinical, imaging and cytopathological features of solid pseudopapillary tumor of the pancreas (SPTP) diagnosed by endoscopic ultrasound- guided (EUS-guided) fine-needle aspiration (FNA). A 17-year-old woman was admitted to our hospital with complaints of an unexplained episodic abdominal pain for 2 mo and a short history of hypertension in the endocrinology clinic. Clinical laboratory examinations revealed polycystic ovary syndrome, splenomegaly and low serum amylase and carcinoembryonic antigen (CEA) levels. Computed tomography (CT) analysis revealed a mass of the pancreatic tail with solid and cystic consistency. EUS confirmed the mass, both in body and tail of the pancreas, with distinct borders, which caused dilation of the peripheral part of the pancreatic duct (major diameter 3.7 mm). The patient underwent EUS-FNA. EUS-FNA cytology specimens consisted of single cells and aggregates of uniform malignant cells, forming microadenoid structures, branching, papillary clusters with delicate fibrovascular cores and nuclear overlapping. Naked capillaries were also seen. The nuclei of malignant cells were round or oval, eccentric with fine granular chromatin, small nucleoli and nuclear grooves in some of them. The malignant cells were periodic acid Schiff (PAS)-Alcian blue ( ) and immunocytochemically they were vimentin ( ), CA 19.9 ( ), synaptophysin ( ), chromogranin (-), neuro-specific enolase (-), a1- antitrypsin and a1-antichymotrypsin focal positive. Cytologic findings were strongly suggestive of SPTP. Biopsy confirmed the above cytologic diagnosis. EUS- guided FNA diagnosis of SPTP is accurate. EUS findings,cytomorphologic features and immunostains of cell block help distinguish SPTP from pancreatic endocrine tumors, acinar cell carcinoma and papillary mucinous carcinoma.     

免疫学标记在甲状腺细针抽吸细胞学诊断中的应用

目的探讨免疫学标记在甲状腺细针抽吸细胞学诊断中应用的价值。方法用免疫细胞化学方法观察938例甲状腺细针抽吸标本涂片中各种甲状腺疾病的细胞形态及HLA-DR、S-100和CD44蛋白表达。结果诊断或提示可能性诊断为良性病变(慢性淋巴细胞性甲状腺炎、结节性甲状腺肿、临床甲状腺功能亢进、甲状腺腺瘤、亚急性甲状腺炎)约占80%。不能诊断或不能提示可能性诊断的各种疾病(含陈旧性出血)约占16%。恶性肿瘤的诊断比例不足4%。提示可能性诊断为慢性淋巴细胞性甲状腺炎、临床甲状腺功能亢进涂片的甲状腺滤泡上皮胞浆中HLA-DR表达阳性率分别为47.9%和15.8%。而S-100蛋白在良、恶性病变中均有程度不同的表达。CD44棕黄色免疫阳性反应物见于提示可能性诊断为恶性病变中92%的异形细胞胞膜,未见于其他细胞中。结论HLA-DR抗原表达在弥漫性毒性甲状腺肿、桥本甲状腺炎有助于与其他有淋巴细胞浸润疾病的鉴别诊断,CD44阳性表达在高分化滤泡癌,在与腺瘤的鉴别诊断中有一定的参考价值。     

CT引导下经皮穿刺胰腺病变的诊断价值

目的:探讨CT引导下经皮腹腔穿刺胰腺病变的诊断价值.方法:经由B超、CT或MRI等影像检查发现的33例胰腺病变进行CT引导下穿刺活检.结果:33例病例中,30例取得阳性病理结果,阳性率占92.1%;其中胰腺癌20例,占66.7%;慢性胰腺炎4例,占13.3%;结核2例,占6.7%;恶性间质瘤2例,占6.7%;平滑肌瘤1例,占3.3%;恶性生长抑素瘤1例,占3.3%.结论:CT引导下胰腺穿刺活检术是一种安全、准确的微创影像学诊断技术.     

化脓性革兰阴性杆菌性脊柱炎患者的手术治疗效果分析(附13例报告)

目的 分析化脓性革兰阴性杆菌性脊柱炎(Gram-negative bacterial vertebral osteomyelitis,GNB VO)的手术治疗效果。方法 收集2007年1月至2016年12月首都医科大学附属北京胸科医院诊断为化脓性GNB VO并行手术治疗的13例患者的临床资料,13例化脓性GNB VO患者均有感染史或高危感染因素(高龄、并发糖尿病、其他慢性感染、长期使用抗生素、免疫抑制剂等);其中,感染大肠埃希菌9例,肺炎克雷伯杆菌2例,铜绿假单胞菌1例,阴沟肠杆菌1例。对手术前后痛觉视觉模拟评分(visual analogue scale score,VAS)、白细胞计数(WBC)、中性粒细胞比率、血红细胞沉降率(ESR)、C-反应蛋白(CRP)等水平进行比较,同时观察末次随访(第12个月末)时术后患者病椎的骨性融合、治愈等情况。计数资料以“ \bar{x} ±s”表示,采用t检验,以P<0.05为差异有统计学意义。结果 13例化脓性GNB VO患者末次随访VAS评分[(1.46±0.78)分]、WBC[(7.14±1.20)×10 ⁹/L]、中性粒细胞比率(0.69±0.03)、ESR[(10.29±4.82)mm/1h]、CRP[(3.57±2.07)mg/L]较术前[分别为(7.38±1.19)分、(15.93±2.82)×10 ⁹/L、(0.08±0.02)、(72.71±18.45)mm/1h、(53.20±18.25)mg/L]均明显改善(t值分别为33.34、8.99、6.40、9.21、6.67,P值均=0.000)。13例患者经敏感抗生素联合手术治疗12~16周后均治愈,其中1例肺炎克雷伯杆菌感染患者术后2周因刀口破溃,行3次负压封闭引流治疗后刀口延期愈合。全部患者末次随访时均获得骨性融合,无复发。结论 化脓性GNB VO患者经过敏感抗生素联合手术治疗12~16周后,VAS评分、WBC、中性粒细胞、ESR、CRP水平均较术前明显改善,可达到骨性融合的治愈目的。     

2528例原发性肝癌细针穿刺细胞学检查及其并发症

目的评价超声引导细针穿刺在原发性肝癌诊断中的价值及其相关并发症。方法回顾性分析1985年6月1日至2005年5月31日复旦大学附属肿瘤医院2528例临床疑诊原发性肝癌患者肝穿刺细胞学检查及随访结果。结果经肝穿刺细胞学证实为恶性肿瘤者2061例（81.53%,其中肝脏原发肿瘤1704例,转移性肿瘤41例,原发不明恶性肿瘤316例）、阴性431例（17.05%）、疑癌或异形36例（1.42%）。临床随访发现2061例恶性患者最终均被证实为恶性肿瘤;431例阴性中,37.82%（163/431）最终被证实为恶性（其中原发性肝癌136例）;36例疑癌或异形中,28例最终被证实为恶性（均为原发性肝癌）。946例AFP≥400μg/L患者全部证实为恶性,其中原发性肝癌942例、肝母细胞瘤1例、转移性肝癌3例。AFP〈400μg/L的1582例患者中,最终诊断原发性肝癌1154例,其中81.89%（945例）可通过肝穿刺直接确诊。本研究结果显示,细针穿刺细胞学检查用于肝脏肿瘤定性诊断（良、恶性鉴别）敏感性91.52%、特异性100.00%、阳性预测值100.00%、阴性预测值59.10%,总准确性为92.44%。肝穿刺可直接确诊原发性肝癌达81.01%。77.49%的患者可通过肝穿刺明确原发或继发。穿刺后并发症主要为：出血11例（0.44%）,针道种植转移5例（0.2%）。结论经皮细针穿刺细胞学检查可有效确定肝脏肿瘤的性质,且对原发性肝癌诊断准确性高。穿刺相关并发症发生少,易于推广。     

Non-tuberculous mycobacterial osteomyelitis: an unusual cause of hip pain in immunocompetent children

Non-tuberculous mycobacteria (NTM) are an unusual cause of osteomyelitis in immunocompetent children. Diagnosis is often difficult due to the paucity of clinical symptoms and a subtle course of the disease. NTM comprise a group of about 91 identified species of environmental mycobacteria that cause infections most frequently in immunocompromised individuals or in patients with predisposing factors. Cervical lymphadenitis is the most common presentation of NTM infection in children. Invasive and recurrent infections with these organisms have been associated with a genetic defect of the interferon γ-receptor. We report a 3-year-old immunocompetent girl who presented a NTM osteomyelitis of the left femur. Four months before she had been treated with medical and surgical therapy for a mycobacterium avium complex cervical lymphadenitis. Polymerase chain reaction assay on bone aspirate specimens confirmed the diagnosis of mycobacterium avium osteomyelitis. The patient was treated successfully with clarithromycin and rifampicin for 6 months.     

A case report of osteomyelitis pubis in a hemodialysis patient with diabetes mellitus

Osteomyelitis pubis is a rare form of osteomyelitis. Known risk factors are urogynecologic surgery, trauma caused by sport activities, pelvic malignancy and intravenous drug use. Immunocompromised patients, including hemodialysis patients, and those with diabetes are also susceptible to infection. Particularly in the hemodialysis population, the use of intravenous catheters frequently results in bacteremia and metastatic infectious complications such as osteomyelitis. We describe the first case of osteomyelitis pubis in a woman on chronic maintenance hemodialysis with diabetes mellitus.     

When amputation is not the end of the challenge: A successful therapy for osteomyelitis and soft tissue infection in a patient with type 1 diabetes

Infection is a common complication in patients with diabetic foot ulcer, leading to lower extremities amputation and healing failure. In this article, we report the case of a 39‐year‐old man with diabetes who developed a severe soft tissue infection and osteomyelitis after experiencing a major amputation for wet gangrene of both the foot and the ankle.     

Colonic ameboma: Its appearance on CT: Report of a case

Ameboma is an uncommon manifestation of amebiasis, occurring in 1.5 percent of cases. It can mimic both carcinoma and inflammatory bowel disease. The first known report of the CT appearance of ameboma is presented. This entity should be considered in any patient with a colon mass, history of travel to an endemic area, and symptoms of amebiasis.The views expressed in this article are those of the author and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. Government.     

Characteristics of common solid liver lesions and recommendations for diagnostic workup

Due to the widespread clinical use of imaging modalities such as ultrasonography, computed tomography and magnetic resonance imaging （MRI）, previously unsuspected liver masses are increasingly being found in asymptomatic patients. This review discusses the various characteristics of the most common solid liver lesions and recommends a practical approach for diagnostic workup. Likely diagnoses include hepatocellular carcinoma （the most likely; a solid liver lesion in a cirrhotic liver） and hemangioma （generally presenting as a mass in a non-cirrhotic liver）. Focal nodular hyperplasia and hepatic adenoma should be ruled out in young women. In 70% of cases, MRI with gadolinium differentiates between these lesions. Fine needle core biopsy or aspiration, or both, might be required in doubtful cases. If uncertainty persists as to the nature of the lesion, surgical resection is recommended. If the patient is known to have a primary malignancy and the lesion was found at tumor staging or follow up, histology is required only when the nature of the liver lesion is doubtful.     

气管支气管骨化症2例并文献复习

目的 提高对气管支气管骨化症的认识,提高疾病诊断率.方法 收集经郑州大学第一附属医院呼吸与危重症医学科确诊的气管支气管骨化症2例,对患者的临床症状,胸部CT、纤维支气管镜下表现、组织病理、治疗及效果进行回顾性研究,并复习相关文献对气管支气管骨化症进行分析.结果 2例患者均为女性,分别为55岁和33岁,均表现为咳嗽、咳痰,纤维支气管镜下可见结节样隆起突出气管、支气管管腔,质硬.1例患者经气道内结节高频电、氩气刀及冷冻治疗,另1例患者给予糖皮质激素口服治疗.2例患者治疗后患者临床症状较前均有所改善.结论 气管支气管骨化症临床症状各异,临床医师、影像学医师对气管支气管骨化症认识不足,导致该病诊断率低,易被误诊、漏诊,对原因不明的慢性咳嗽患者应行支气管镜检查排除气管支气管骨化症.     

A case of malignant thymoma mimicking thyroid carcinoma: a pitfall in fine-needle aspiration

A case of malignant thymoma presenting as an anterior neck mass is reported. The tumor extended from the thyroid gland to the superior mediastinum. It did not accumulate Tc-99m pertechnetate, but continued to accumulate Tl-201 at the late phase. A fine-needle aspiration cytology from the tumor showed tight clusters of epithelial cells with crowded ovoid nuclei. The tumor was initially diagnosed as thyroid carcinoma, clinically and cytologically. A thymoma with a dominant epithelial component has to be considered in the differential diagnosis of a suspected papillary carcinoma of the thyroid.     

Non-imaging-guided fine-needle aspiration of liver lesions: a retrospective study of 279 patients

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