卵巢粘液性囊腺瘤伴肉瘤型附壁结节

卵巢粘液性肿瘤伴附壁结节罕见,复习文献至1990年得20余例,其中肉瘤型附壁结节不足10例,现报告2例如下:例1 24岁,未婚,13(5-6)/(28),1992年10月28 日主因下腹部肿物入院。11月6日临床以盆腔巨大占位病变行剖腹探查术,术中见肿物位于右卵巢、行右侧卵巢肿物切除。病理检查:灰白色囊性肿物30×20×11cm,内为棕黄色粘稠液体、壁厚0.1～0.5cm,囊壁一侧见一实性结节 4.5×2×2cm,边界欠清、切面细腻、棕黄及灰白色,质脆。镜下见囊壁内衬单层粘液柱状上皮、结节中瘤细胞弥漫分布、单核或双核多边形、圆形细胞与梭形细胞交织在一起。胎浆淡粉红色,核较大,异型明显,核分裂象10～22个/10高倍视野,并见较多病理性核分裂。嗜银染色瘤细胞间产生丰富的网状纤维。病理诊断:右卵巢粘液性囊腺瘤伴恶性纤维组织细胞瘤型附壁结节。例2 30岁,已婚,1992年8月因下腹肿物入     

囊性肾细胞癌的CT影像诊断和病理表现

目的：分析囊性肾细胞癌的CT特征及病理表现。方法：回顾分析9例经手术病理证实且临床和影像资料完整的囊性肾细胞癌。结果：9例患者中,女性2例,男性7例,病灶均为单发,多为外生性生长。CT平扫囊性2例,囊实性7例,5例囊内容物内见碎屑或絮状物,2例囊壁见小结节状钙化。增强后囊壁、分隔及附壁结节呈不同程度强化,囊内容物未见明确强化。9例病变大体病理显示肿瘤均有厚薄不等的假纤维包膜围绕,切面见单一或大小不等的囊腔,内含浆液性或血性液体。镜下见囊腔上皮被覆肿瘤细胞。结论：囊性肾细胞癌CT表现为单发,囊壁、分隔及附壁结节呈不同程度强化,具有一定的特征性。     

16例小脑毛细胞型星形细胞瘤MRI及病理分析

目的 探讨小脑毛细胞型星形细胞瘤的磁共振成像(MRI)影像特点和病理学特征.方法 回顾性分析16例小脑毛细胞型星形细胞瘤的术后病理、术前MRI资料.结果 16例小脑毛细胞型星形细胞瘤中,发生于小脑蚓部11例,小脑半球5例.小脑毛细胞型星形细胞瘤可呈单纯囊肿型、囊肿附壁结节型或瘤囊型.MRI平扫肿瘤境界清楚,无明显瘤周水肿;增强扫描囊壁瘤结节或瘤体部分明显强化,囊壁光滑、强化或不明显强化.显微镜下瘤组织内致密、疏松区双相交替,瘤细胞呈细长梭形,致密区见数量不等Rosenthal纤维,疏松区有微囊样结构、嗜酸性小体形成;肿瘤免疫组化GFAP强阳性.结论 小脑毛细胞型星形细胞瘤MRI影像表现和病理组织学具有特征性,把握其病理特点有助于术前影像诊断.     

肝胆管黏液性囊性肿瘤临床病理分析

 目的　探讨肝胆管黏液性囊性肿瘤的临床病理特点。方法　选取1993年5月至2007年5月间经手术病理证实的肝胆管黏液性囊性肿瘤9例,对其临床表现、影像学及病理特征进行回顾性分析。结果　肝胆管黏液性囊腺瘤6例,呈多房性,囊壁光整,厚薄一致,分隔均匀;囊腺癌3例,单囊性2例,多囊性1例,壁结节2例,乳头状突起及囊壁局部不均匀增厚1例,钙化2例,CT增强扫描动脉期囊壁及壁结节开始强化,门脉期及延迟期强化明显,呈"慢进慢出"特点,腹膜后淋巴结肿大1例。结论　肝胆管黏液性囊性肿瘤临床表现缺乏特异性,CT表现具有一定特征,单囊、囊壁不均匀增厚、壁上结节或乳头状突起及斑块状钙化者考虑为囊腺癌,但确诊需依靠病理。     

胰腺导管内黏蛋白性乳头状瘤CT、MRI诊断及鉴别诊断（附6例报告)

目的:探讨胰腺导管内黏蛋白性乳头状瘤CT、MRI表现特点及诊断价值。方法:6例经手术和病理证实的胰腺导管内黏蛋白性乳头状瘤均行CT平扫及增强检查。4例行MRI检查,其中2例行MRI增强扫描。结合文献,回顾性分析其临床表现及CT、MRI征象表现。结果:本组患者主胰管型5例,混合型1例。CT表现:主要表现为胰腺主胰管或分支胰管不规则扩张,呈分叶状囊性表现,其中4例显示壁结节。增强扫描肿瘤实性部分轻度强化。MRI扫描:胰腺导管不规则扩张,T1WI扩张胰管呈均匀低信号,2例扩张囊壁上见结节样隆起呈等信号。T2WI扩张胰管呈高信号,壁结节显示不清。压脂T1WI扫描肿瘤结节显示清楚。增强扫描肿瘤结节中度强化。结论:CT、MRI对胰腺导管内黏蛋白性乳头状瘤的诊断具有重要价值。     

螺旋CT增强扫描和超声造影对多房囊性肾透明细胞癌的诊断价值

目的 分析多房囊性肾透明细胞癌(MCRCC)影像学征象和病理特点,提高其诊断准确性.方法 回顾性分析术前行螺旋CT(SCT)多期增强扫描和超声造影(CEUS)检查并经手术病理证实的18例MCRCC影像特征.结果 所有肿瘤呈圆形或类圆形,囊壁薄,边缘光整,囊内液性成分密度略高于水,间隔边缘毛糙.MCRCC间隔菲薄型6例,间隔增厚型8例,间隔结节型4例.SCT动态增强和CEUS均显示菲薄间隔多呈轻到中度强化,结节表现为明显均匀强化,增厚型间隔则有上述两种形式强化;肿瘤间隔的SCT强化程度与CEUS的峰值强度有明显相关性.结论 MCRCC的典型影像特征为多囊液性密度、分隔毛糙和壁结节,囊壁薄而规则,多有轻到中度以上强化.充分结合CEUS和SCT的多期增强扫描可以提高对MCRCC的诊断率,为临床治疗提供有力指导.     

超声在肝脏囊性恶性肿瘤诊断中的应用

目的 探讨灰阶及彩色多普勒超声对肝脏囊性恶性肿瘤的临床诊断价值。方法 分析了16例肝脏囊性恶性肿瘤的灰阶及彩色多普勒特征。其中肝脏原发肿瘤8例,转移性肝肿瘤8例。灰阶超声观察肿瘤的大小、形态、数目、囊壁的厚度及内部回声,多普勒超声观察肿瘤的供血状况并测定其流速。结果 原发肿瘤以单发病灶多见,转移性肿瘤以多发病灶多见。肿瘤直径为1.9-13.6cm。8例呈类圆形,5例为不规则形,3例呈分叶状。15例表现为囊壁不规则增厚,7例内有厚分隔,6例可见向囊腔内突起的乳头样结节。彩色多普勒显示14例于壁内、乳头结节内或分隔上引出血流信号,其中13例为搏动性血流信号。结论 肝脏囊性恶性肿瘤的灰阶超声表现为厚壁不规则的囊性病变,彩色多普勒能够较好地反映其囊壁、分隔及乳头内的血流信号,为肝脏囊性恶性肿瘤的诊断提供了重要依据。     

毛细胞型星形细胞瘤的临床特点和外科治疗

背景和目的：毛细胞型星形细胞瘤是一特殊病理类型的星形细胞瘤，本文结合我们的临床病例，探讨毛细胞型星形细胞瘤的临床特点、病理学和影像学特点以及治疗方法。方法：回顾性分析我院近7年来18例经手术病理证实的毛细胞型星形细胞瘤临床资料。结果：18例患者平均发病年龄20岁，大多位于小脑，临床表现主要为颅内压增高症和共济失调，CT和MRI可分为囊性伴囊壁结节、假囊性伴囊壁结节、实质性3种影像学表现。病理以镜下见到大量Rosenthal氏纤维为特征性改变。预后与手术切除程度有关，全切组(11例)无肿瘤复发；部分残留组(6例)肿瘤易复发(2例)和恶性变(1例)，未放疗组1例肿瘤复发，为次全切除组。结论：毛细胞型星形细胞瘤好发于年轻人和小脑，有较典型的影像学和病理学特点，应争取外科全切除。对未全切病例术后应行放疗，化疗可作为预防肿瘤复发的一种辅助治疗方法。     

毛细胞型星形细胞瘤的MRI诊断与病理分析

目的:回顾性分析颅内毛细胞型星形细胞瘤（pilocytic astrocytoma,PA）的MRI表现,并与病理结果对照研究,以提高该病的影像学诊断。方法:分析本院2014年至2017年经病理证实的10例该病患者的临床及影像学资料。结果:10例毛细胞星型细胞瘤中,5例呈囊实性改变,4例呈实性改变,1例呈囊性伴壁结节改变且结节明显强化。术后病理显示,镜下可见疏松区与致密区双极性分布,且比例各不相同,部分可见血管增生及嗜酸性小体。结论:毛细胞型星形细胞瘤在影像学上有一定的特征性,肿瘤多为囊性壁结节型或实性肿块,不同类型的肿瘤镜下显示疏松区与致密区比例不同,强化程度与其毛细血管通透性密切有关,熟悉影像学表现及鉴别诊断,并与相关病理联系,可为临床手术方案的制订提供重要的参考价值。     

卵泡膜细胞瘤的超声表现和病理对照研究

目的 探讨卵泡膜细胞瘤的超声声像图特征,并分析其病理学基础.方法 回顾性分析45例卵泡膜细胞瘤的超声表现,按肿瘤内部及后方回声的不同,分为实性后方回声衰减型、实性低回声型及囊实性回声型.卵泡膜细胞瘤组织病理学表现按肿瘤细胞的组成,分为卵泡膜细胞为主型、成纤维细胞为主型及混合型,并记录玻璃样变性及黄素化情况,比较各超声类型的组织病理学差异.结果 45例卵泡膜细胞瘤中,有34例(75.6%)为实性肿瘤,其中后方回声衰减型15例,即肿瘤前部呈低回声或强回声弧形带,后方伴回声衰减;实性低回声型19例,即肿瘤内部呈较均匀低回声,无后方回声衰减.另11例(24.4%)呈囊实混合性肿瘤,即囊实性回声型.各超声类型患者的病理学细胞组成差异无统计学意义(P>0.05),5例合并玻璃样变性和1例黄素化肿瘤后方伴回声衰减,囊实性回声型肿瘤病理可见不同程度的囊性变及出血.结论 实性卵泡膜细胞瘤具有特征性表现,超声表现的差异性可能与肿瘤变性有关,而与肿瘤细胞的组成无关.     

Clinical Value and Pathologic Basis of Cystic Airspace Within Subsolid Nodules Confirmed as Lung Adenocarcinomas by Surgery

Purpose. To investigate the clinical value and pathologic basis of cystic airspace within lung adenocarcinomas manifesting as subsolid nodules.Patients and Methods. A retrospective study was conducted on a total of 541 surgically confirmed lung adenocarcinomas manifesting as subsolid nodules in computed tomography images, including 87 cases with cystic airspace and 454 cases without cystic airspace. The pathologic characteristics of the cases with and without cystic airspace were compared. The investigation of the pathologic structure of cystic airspace was attempted on the postoperative paraffin sections.Results. There was a significant difference in the containing of cystic airspace between preinvasive and invasive adenocarcinomas (10.5 vs 26.6%; P < .001). Multivariate analysis indicated that cystic airspace is an independent predictor of invasive adenocarcinomas (odds ratio, 3.220; 95% confidence interval, 1.822-5.687). Nodules containing multiple cystic airspaces are more likely to be invasive adenocarcinomas than nodules with a single cystic airspace (47.1 vs 72.2%; P < .05). On paraffin sections, the walls of the cystic airspace seemed to be mainly composed of atypical hyperplasia and/or tumor cells on the surface and the remaining smooth muscle cells and stroma below, which is similar to the structure of bronchi.Conclusions. Cystic airspace may be a reliable predictor of invasive adenocarcinomas, the classification method based on the number of cystic airspaces might be suitable for the computed tomography-based typing of cystic airspace within subsolid nodules. Cystic airspace may derive from the destroyed and enlarged bronchi owing to the growth or infiltration of atypical hyperplasia and/or tumor cells.     

Pathogenicity for rats of a strain of chicken sarcoma virus

The RBI rat tumor, induced with cell suspensions from chicken sarcoma B77, is pathogenic for chicks as well as for rats. Cell suspensions from RBI tumors induced sarcomas in 100 percent of inoculated chicks. Cell suspensions of this chicken sarcoma induced early RBA sarcomas in 50 percent of 171 rats. Most of these rats died within 4 weeks after inoculation. The early tumors regressed in 15 of the 85 tumor-bearing rats, and the animals died of cystic hemorrhagic disease. The sarcoma was induced in 9 animals within 50 to 70 days after inoculation, and cystic hemorrhagic disease developed in 117. None of the 171 rats remained free from either tumor or cyst and only 12 survived for 3 months or longer. The tumors induced in rats were transplantable into rats and after transplantation of early-appearing tumors, tumors and cysts developed. Virus strongly infective in chicks was demonstrated by cell-free filtrates and virus preparations from RBI and RBA rat sarcomas induced by chicken sarcoma cells. Cell suspensions from the wall of small cysts induced tumors in chicks and cystic hemorrhagic disease and tumors in rats.     

高频超声对甲状腺囊实性结节良恶性鉴别的效果

目的 探讨高频超声对甲状腺囊实性结节良恶性鉴别的效果.方法 选取甲状腺囊实性恶性结节患者47例以及甲状腺囊实性良性结节患者47例.所有患者均予以高频超声检查,观察对比良、恶性结节图像特征.结果 高频超声诊断恶性结节的误诊率为8.51％(4/47),高于病理诊断的0.00％(0/47),差异有统计学意义(P<0.05).良性结节高频超声的病灶内部结构、内部回声、边界、形状、钙化与恶性结节对比,差异有统计学意义(P均<0.05).良性结节RI值<0.7人数占比为85.11％(40/47),高于恶性结节的14.89％(7/47),差异有统计学意义(P<0.05).结论 高频超声诊断甲状腺囊实性良性结节的准确度高,有利于鉴别甲状腺囊实性结节良恶性.     

Ovarian mucinous tumors with sarcoma-like mural nodules: a report of seven cases.

Seven cases of mucinous ovarian tumors with sarcoma-like nodules in their walls are reported. The age of the patients ranged from 18--81 years. Each of them had a large abdominal mass which proved on exploration to be a Stage Ia cystic ovarian tumor. All the specimens contained one or more discrete nodules in their walls, most of which were soft, dark brown, and hemorrhagic. On microscopical examination the epithelial component of four of the tumors was of borderline malignancy and of three was well-differentiated carcinoma. Three patterns were encountered in the nodules: pleomorphic and epulis-like in four cases, pleomorphic and spindle-celled in one case, and giant cell-histiocytic in two cases. These patterns simulated those of malignant giant cell tumor of soft parts, spindle cell sarcoma, and well-differentiated rhabdomyosarcoma, respectively. Postoperative follow-up ranging from 1 to 11 1/2 years (average 7 1/2 years) revealed no evidence of recurrence. Reports of seven similar tumors were found in the literature. Although follow-up has been less complete in these cases, none of the tumors is known to have spread beyond the ovary. These data suggest that mural nodules of the types described are not sarcomatous but could represent a reactive process that has no effect on the prognosis of the patient.     

儿童Xp11.2易位/TFE3基因融合相关性肾癌的影像学表现

目的 探讨儿童Xp11.2易位/TFE3基因融合相关性肾癌（Xp11.2 tRCC）的影像学表现。方法 回顾性分析我院2015年1月—2020年12月经手术病理证实为Xp11.2 tRCC的5例患儿临床及影像学资料,其中4例行CT平扫及增强检查,1例行MRI平扫、增强及DWI检查。观察分析肿瘤的部位、大小、形态、边界、性质及成分、强化方式及程度、与肾门及邻近大血管关系以及转移情况。结果5例病灶均为皮髓质型。实性/囊实性病灶4例,CT平扫主要为等或稍高密度,均可见钙化及坏死,部分可见出血及囊变,增强扫描主要为轻-中度强化,延迟期可见假包膜强化。囊性病灶1例,囊液表现为低密度及长T1长T2信号,DWI序列可见弥散受限。增强扫描囊性部分未见明显强化,囊壁及分隔影可见强化,分隔影厚度欠均,MRI增强见强化壁结节影。结论 儿童Xp11.2易位/TFE3基因融合相关性肾癌具有一定特征性,实性/囊实性病灶中心或周围出现点状、斑片状钙化以及延迟期“假包膜征”,囊性病灶出现囊壁分隔不均匀增厚及强化壁结节,应考虑Xp11.2 tRCC的可能。     

Association of insulin-like growth factor-1 with thyroid nodules

The aim of the present study was to investigate the relationship between insulin-like growth factor-1 (IGF-1) and thyroid nodules. A total of 56 patients with thyroid nodules confirmed by physical examination and ultrasound screening were randomly selected. The patients were divided into three groups by radionuclide scan: the hot nodule group (group 1, n=18); the cold and solid nodule group (group 2, n=18); and the cold and cystic nodule group (group 3, n=20). Cystic fluid samples from patients with cystic cold thyroid nodules were defined as group 4. A control group of 18 healthy adults matched for age, gender and body mass index (group 0) was also included. For all participants, levels of the thyroid hormones, TT3, TT4, TSH and IGF-1, were determined by radioimmunoassay. The measurement data were expressed as the mean ± standard deviation (SD). The analysis of variance was performed by the t-test and the correlation analysis was performed by linear regression. The serum levels of IGF-1 in the solid cold nodule group were significantly higher than those in the hot nodule group (P<0.05). Serum levels of IGF-1 in the cystic cold nodule group were significantly lower than those in the control group (P<0.05). The serum IGF-1 levels in the cystic fluid were significantly lower than those in the cystic cold nodule (P<0.05) and the control groups (P<0.05). Additionally, the mean serum IGF-1 level in patients with thyroid adenoma was significantly higher than that in the control group (P<0.05). The serum IGF-1 level may not be involved in the pathogenesis of hot thyroid nodules and cold and cystic thyroid nodules; however, it may play a significant role in the pathogenesis of certain solid cold thyroid nodules.     

Spontaneous massive hemorrhage within a malignant tumor of the liver: diagnostic features in sonography and CT.

Computed tomography (CT) and sonography performed on four patients with histopathologically proven massive intratumoral hemorrhages in the liver were compared with pathological findings. Unenhanced CT showed a round low-density mass, and enhanced CT produced slight enhancements in the peripheral portions of the masses in two patients which corresponded to histopathologically viable cancerous portions. In contrast, sonography showed multilocular cystic masses with variously shaped septa, assuming a honeycomb appearance. Histopathologically, the septa were made up of blood clots with or without granulation tissue, scar and viable tumor, and the cystic spaces were filled with exudate and erythrocytes. Combined study by CT and sonography could be useful in differentiating massive hemorrhagic malignancies from cystic and necrotic masses and/or simple hemorrhagic lesions. The danger of malignant tumors with massive hemorrhage possibly being diagnosed as benign lesions, such as hematomas and abscesses, is also stressed.     

Conventional Ultrasonography and Real Time UltrasoundElastography in the Differential Diagnosis of DegeneratingCystic Thyroid Nodules Mimicking Malignancy and PapillaryThyroid Carcinomas

Background: To evaluate the diagnostic utility of conventional ultrasonography and real time ultrasoundelastography in differentiating degenerating cystic thyroid nodules mimicking malignancy from papillarythyroid carcinoma. Methods: We retrospectively analyzed conventional ultrasonographic and elastographiccharacteristics of 19 degenerating cystic thyroid nodules mimicking malignancy in 19 patients, with 30 surgicallyconfirmed PTCs as controls. Based on size, the nodules had been grouped into less than 10mm (group A) andgreater than 10 mm (group B). We evaluated conventional parameters and elasticity pattern. Color-scaledelastograms were graded as to stiffness of nodules using an elasticity pattern from I (soft) to IV (stiff). Results:Degenerating cystic thyroid nodules were similar to PTCs in conventional ultrasonographic findings, but theformer frequently showed oval to round in shape (group A, 69.2% vs 18.8%, P=0.017; group B, 66.7% vs7.14%, P=0.017) and punctuate hyperechoic foci (group A, 61.5% vs 0, P<0.001; group B, 50% vs 0, P<0.001).On real time ultrasound elastography, 7 of 13 degenerating cystic thyroid nodules in group A were pattern I,5 were pattern II, 1 was pattern III. One degenerating cystic thyroid nodule in group B was pattern II, 5 werepattern III. The area under the curve for elastography was 0.98 in group A (sensitivity 92.3%, specificity 100%,P = 0.002), and 0.88 in group B (sensitivity 16.7%, specificity 100%, P = 0.014). Conclusions: As a dependableimaging technique, elastography helps increase the performance in differential diagnosis of degenerating cysticthyroid nodule and malignancy.     

Brain metastases in renal cell cancer: diagnostic and therapeutic aspects

A 67-year-old patient with metastatic renal cell cancer was treated with fractionated stereotactic radiotherapy to a hemorrhagic pons metastasis. He then developed multiple cystic brain lesions, suggestive of diffuse metastatic spread. However, further work-up revealed abscesses from bronchopneumonia. Diagnostic and therapeutic aspects as well as potential pitfalls in the management of patients with brain metastases are discussed.     

Minimally-invasive treatments for benign thyroid nodules: a Delphi-based consensus statement from the Italian minimally-invasive treatments of the thyroid (MITT) group

Benign thyroid nodules are a common clinical occurrence and usually do not require treatment unless symptomatic. During the last years, ultrasound-guided minimally invasive treatments (MIT) gained an increasing role in the management of nodules causing local symptoms. In February 2018, the Italian MIT Thyroid Group was founded to create a permanent cooperation between Italian and international physicians dedicated to clinical research and assistance on MIT for thyroid nodules. The group drafted this list of statements based on literature review and consensus opinion of interdisciplinary experts to facilitate the diffusion and the appropriate use of MIT of thyroid nodules in clinical practice. (#1) Predominantly cystic/cystic symptomatic nodules should first undergo US-guided aspiration; ethanol injection should be performed if relapsing (level of evidence [LoE]: ethanol is superior to simple aspiration = 2); (#2) In symptomatic cystic nodules, thermal ablation is an option when symptoms persist after ethanol ablation (LoE = 4); (#3) Double cytological benignity confirmation is needed before thermal ablation (LoE = 2); (#4) Single cytological sample is adequate in ultrasound low risk (EU-TIRADS ≤3) and in autonomously functioning nodules (LoE = 2); (#5) Thermal ablation may be proposed as first-line treatment for solid, symptomatic, nonfunctioning, benign nodules (LoE = 2); (#6) Thermal ablation may be used for dominant lesions in nonfunctioning multinodular goiter in patients refusing/not eligible for surgery (LoE = 5); (#7) Clinical and ultrasound follow-up is appropriate after thermal ablation (LoE = 2); (#8) Nodule re-treatment can be considered when symptoms relapse or partially resolve (LoE = 2); (#9) In case of nodule regrowth, a new cytological assessment is suggested before second ablation (LoE = 5); (#10) Thermal ablation is an option for autonomously functioning nodules in patients refusing/not eligible for radioiodine or surgery (LoE = 2); (#11) Small autonomously functioning nodules can be treated with thermal ablation when thyroid tissue sparing is a priority and ≥80% nodule volume ablation is expected (LoE = 3).