骨外骨肉瘤1例并文献复习

骨外骨肉瘤(Extraskeletal osteosarcoma,EOS)是一种在软组织内生长的恶性肿瘤,较罕见,占骨肉瘤病例的4%～5%,占软组织肉瘤的1%[1.2].该病多发于中老年人.原发于腹部的EOS国内报道不超过10例.临床病例少见,临床医生对该病的认识及鉴别困难.同时,各医疗中心对于该病的诊断及治疗等方面仍存在着较多的争议.2007年我科收治了1例老年女性EOS患者.在此做一总结及探讨.     

黄甲综合征一例并文献复习

目的 提高对黄甲综合征（YNS）的认识。方法 报道1例YNS，并结合国内文献中报道的9例YNS患者的临床资料进行分析。结果 YNS是一种罕见的疾病，临床主要表现黄甲、淋巴水肿、胸膜肺疾病三联征。病理机制可能是淋巴回流障碍。结论 在胸腔积液的鉴别诊断中应考虑到黄甲综合征的可能。YNS大多预后良好，目前尚无有效的治疗方法，对胸腔积液可反复胸穿排液或行胸膜固定术。     

多种特殊临床表现并存的淋巴瘤一例并文献复习

目的 提高对淋巴瘤患者临床表现复杂件的认识.方法 分析广州医学院第一附属医院广州呼吸疾病研究所2007年9月6日收治的1例多种特殊临床表现并存(皮下结节、胸腔积液及眼眶肿物)的淋巴瘤患者的临床和病理资料,并复习相关文献.结果 患者男,60岁,以皮下结节为首发表现,因胸腔积液首次就诊,合并眼眶肿物,胸腹部CT提示全身多发性淋巴结肿大,病理结果 证实为淋巴瘤.结论 淋巴瘤临床表现复杂,町并发多系统、多器官受累;当以淋巴结外表现为首发症状时,极易误诊.     

胸膜淀粉样病变1例并文献复习

目的 提高胸膜淀粉样病变的诊断率.方法 报道1例原发性淀粉样病变,主要累及胸膜、心脏,并复习相关文献,对其病因、发病机制、临床表现、诊断、治疗及预后进行分析.结果 本例原发性系统性淀粉样病变患者无家族史及慢性疾病史,胸膜病理诊断原发性淀粉样病变AL型,其他组织如皮下脂肪、骨髓未见淀粉样物质沉淀.结论 对于反复出现不明原因的顽固性胸腔积液的鉴别诊断,应考虑本病的可能;为治疗大量顽固性胸腔积液,可行胸膜腔黏连术缓解症状.     

椎管内包虫病一例报告并文献复习

１临床资料患者女性,１６岁,学生。一年前其弟弟因肝包虫病手术治疗。患者于１９９７年１０月起后背部及腰骶部疼痛并呈进行性加重,逐渐出现颠跛及休息痛,翻身困难,双下肢无力感,无感觉障碍,无午后低烧,盗汗,纳差及消瘦史。心、肺、腹无阳性发现。胸腰段右侧饱满...     

Gorham-Stout综合征五例临床分析并文献复习

目的 探讨Gorham-Stout综合征(GSS)患者的临床、骨影像及组织病理特点及其诊断、治疗和预后.方法 回顾性分析1980年1月至2008年1月北京协和医院收治的5例GSS患者的临床资料并进行文献复习.结果 (1)5例患者中男2例,女3例;年龄15～37岁,平均30.2岁.(2)5例患者均有不同部位、不同程度的骨破坏,3 例合并大最胸腔积液,均为血性渗出液;其中2 例为乳糜性胸腔积液.所有患者均无恶性肿瘤的依据.4 例接受骨组织活检,其中2例接受局部穿刺及切开活检,有典型的骨病理表现.(3)采用二膦酸盐、钙剂+活性维生素D3、病变部位的放疗、胸导管结扎等治疗方法.(4)转归:5例患者中,仅有骨病变的2例病情平稳,合并胸腔积液的3例患者中,1例骨病变相对稳定,但需间断放胸腔积液,2例失访.结论 GSS是一以渐进性溶骨性改变为主要表现的罕见病,临床表现取决于受累部位.目前没有确切的治疗方法;合并胸腔积液时预后差.     

以胸部病变为主的淋巴管瘤病1例并文献复习

目的 提高对淋巴管瘤病在胸部病变的认识.方法 对1例以胸部病变为主的淋巴管瘤病患者的临床资料进行分析,并结合文献复习.结果 淋巴管瘤病是一种少见的由淋巴管组成的良性过度增生性错构瘤.结论 患者的主要受累组织为肺、纵隔和胸壁,如此广泛胸部病变在以前文献少有报道.此患者血凝分析呈现出血倾向,既往文献未见报道.     

A case report of rib osteosarcoma and literature review

About half of osteosarcomas occur near the knee joint, but other sites such as the humerus, upper femur, fibula, spine, and ilium can also occur. However, rib osteosarcoma is rarely reported. Here, we report the case of a 17-year-old female who was found to have a left dorsal mass on physical examination. Computed tomography (CT) revealed bone destruction in the seventh rib, leading to surgery for mass excision. Pathological results suggested chondroblastic osteosarcoma. After surgery, the patient was treated with chemotherapy and is doing well.     

特发性乳糜心包积液一例并文献复习

目的介绍1例特发性乳糜心包积液并进行文献复习,以提高对该病的认识。方法对1例特发性乳糜心包积液患者的诊治过程进行分析,并检索Medline及万方中文数据库近55年国内外报道的特发性乳糜心包积液病例,分析总结其临床表现、病因、诊断和治疗的特点。结果共检出89例特发性乳糜性心包积液的患者。男性49例、女性40例,患病无性别差异,年龄6周至68岁,平均(25.5±15.8)岁。其中无症状者22例(24.7%)。常见临床表现包括:呼吸困难48例(53.9%),咳嗽23例(25.8%),胸背痛或上腹痛6例(6.7%),发热6例(6.7%),心慌3例(3.4%),水肿3例(3.4%),乏力1例(1.1%),并可以晕厥、心脏压塞为首发症状。多数通过心包积液乳糜试验阳性、心包积液三酰甘油>12.9 mmol/L而诊断,淋巴管核素显像以及淋巴管造影有助于发现淋巴漏出部位及病因,本研究中阳性率分别为80.8%(21/26)和74.1%(20/27)。常见病因包括胸导管闭塞或发育不良、胸导管/淋巴管异常扩张,其他局部异常和发育异常等。特发性乳糜心包积液保守治疗包括低脂饮食、中链脂肪酸饮食、全胃肠外营养等,但效果差,70.8%(46/65)的患者转而行手术治疗。最常用、有效的术式为胸导管低位结扎及心包开窗术,治愈率可达92.4%(61/66)。89例患者中70例有随访资料:88.6%(62/70)无复发,10%(7/70)未愈,其中1例发生缩窄性心包炎。随访期内无死亡病例。结论特发性乳糜心包积液发病率很低,临床表现缺乏特异性,心包积液检查可以确诊。淋巴管影像学检查有助于确定病变部位及病因。手术是有效的治疗方法,预后良好。     

恶性胸膜间皮瘤致嗜酸细胞性胸腔积液1例报告并文献复习

目的提高对嗜酸细胞性胸腔积液的认识。方法对一例由恶性胸膜间皮瘤所致嗜酸细胞性胸腔积液的临床资料进行分析,并结合文献复习。结果嗜酸细胞性胸腔积液首次报道于1984年,其病因很复杂,由肿瘤引起的并不多见,机理也不十分清楚,大多预后良好。结论虽然嗜酸细胞性胸腔积液的病因大多数是良性的,但我们不能忽略恶性的情况,应尽可能查找原因,以免贻误病情。     

Pseudoachalasia: A peculiar case report and review of the literature

Pseudoachalasia is a rare secondary achalasia, which accounts for only a small subgroup of patients. We describe a 77-year-old woman with recent onset of dysphagia and typical esophageal manometric findings of achalasia. Moreover, esophageal manometric findings of vascular compression at 36 cm from the nose were associated with dysphagia. An upper endoscopy showed the absence of lesions both in the esophagus and gastro-esophageal junction, whilst a 15-mm ulcer on the gastric angulus was detected. The gastric ulcer resulted in being a diffuse signet ring cell carcinoma at histology, suggesting pseudoachalasia. An abdominal computed tomography scan showed an irregular concentric thickening of the gastro-esophageal junction wall extending for 7 cm and a dilated ascending thoracic aorta with no presence of the inferior vena cava, with an enlarged azygos as the source of vascular compression of esophagus. Moreover, cardia involvement from diffuse signet ring cell carcinoma of the gastric angulus was also recognized as the cause of dysphagia. The cancer was not suitable for a surgical approach in an old patient with cardiovascular comorbidities and support therapy was started. In our ambulatory series, pseudoachalasia was eventually diagnosed in 4.7% of 234 consecutive patients with esophageal manometric finding suggestive of achalasia. We also reviewed cases in the literature and aimed to evaluate the reported causes of pseudoachalasia.     

多发性骨髓瘤伴胸膜浸润1例

1病历资料患者女,77岁。2010年2月起反复出现胸闷、气急,无发热、咳嗽、盗汗、胸痛、心悸等不适,夜间尚可平卧。既往有"高血压"病史20余年,血压最高达180/110 mmHg(1 mmHg=0.133 kPa),平素服用降压药,血压控制良好。入院体检:神志清楚,消瘦,全身皮肤无黄染,无皮下出血点,球结膜无水肿,颈     

Valproic acid-induced eosinophilic pleural effusion: a case report and review of the literature

OBJECTIVE: To report a case of valproic acid-induced eosinophilic pleural effusion and to review the existing literature. CASE SUMMARY: A 25-year-old African-American man receiving valproic acid, 250 mg/d, had a moderate-sized right pleural effusion. Pleural fluid analysis revealed 75% eosinophils. The patient had no evidence of parasitic infection, hemothorax, or pneumothorax. One month after valproic acid was discontinued, there was no evidence of a pleural effusion by both chest radiography and thoracic ultrasonography. DISCUSSION: Valproic acid-induced pleural effusions have been reported in the medical literature in 5 case reports. Pleural fluid eosinophilia is almost always related to pneumothorax, hemothorax, parasitic infection, or drug toxicity; therefore, when the first 3 causes have been eliminated, a drug should be suspected. Only a few medications are known to cause pleural fluid eosinophilia, one being valproic acid. The Naranjo probability scale rated this adverse reaction as probably drug-related. CONCLUSIONS: In all 6 patients discussed in this review, the pleural effusions resolved after discontinuation of the valproic acid. None of these patients had associated pulmonary infiltrates. Valproic acid eosinophilia may be associated with peripheral blood eosinophilia. Valproic acid should be added to the list of medications that can cause an eosinophilic pleural effusion.     

结核性脓胸并发胸膜血管肉瘤一例并文献复习与分析

目的 总结分析结核性脓胸并发胸膜血管肉瘤的临床特点,提高临床诊疗水平。方法 对2016年11月山东大学附属山东省胸科医院收治的1例结核性脓胸并发胸膜血管肉瘤患者的临床表现、实验室检查结果、治疗及预后进行分析,并复习国内外文献资料。以“pleural angiosarcoma”为检索词检索PubMed数据库;以“胸膜血管肉瘤”为检索词检索万方医学网和中国知网数据库,检索时间为1995年1月至2018年11月;收集患者的一般情况、既往病史、影像学表现、病理免疫组织化学检测结果、治疗方法、预后及病程时间。结果 患者,男,56岁。因“胸闷、咳嗽超过1个月,痰中带血20d”入院,住院期间多次行胸部手术,病理诊断为结核性脓胸并发胸膜血管肉瘤。患者发病17个月后因病死亡。通过文献复习与筛选共获得相关文献31篇,包含32例胸膜血管肉瘤患者,加上本例患者共计33例;其中男23例,女10例,年龄24~87岁,平均(64.12±13.90)岁。33例患者中有结核性脓胸病史者9例,有脓胸病史者1例;有放化疗病史者2例,单纯放疗病史者1例;有粉尘接触史者1例。病灶位于右侧胸腔14例,左侧胸腔12例,双侧胸腔7例;发病时单纯胸腔积液者4例,胸膜增厚、胸膜肿物者12例,胸腔积液并发胸膜增厚、胸膜肿物者17例;明确有血胸者16例;发生转移病灶5例;CD31阳性者27例,CD34阳性者17例,Vimentin阳性者15例,Ⅷ因子相关抗原阳性者9例。33例患者均为病理确诊。治疗方法有手术(14例)、化疗(10例)、放疗(6例)、介入动脉栓塞(2例)、微波消融(1例)、胸膜固定(3例)、血管靶向药物治疗(5例)。患者病程为2个月至15年,中位时间为7个月;最终24例患者死亡,预后不详、失访和末次随访时存活者各3例。结论 胸膜血管肉瘤临床表现缺乏特异性,结核性脓胸易导致胸膜血管肉瘤的发生,当结核性脓胸患者并发不明原因的渗血性病变时,应考虑到本病的可能,防止误诊、漏诊。