肾上腺囊性病变的临床分析

目的 提高肾上腺囊性病变的诊治水平。方法 回顾性总结40例肾上腺囊性病变患者资料，经影像学检查、手术及病理证实非肿瘤源性囊性病变31例，肿瘤源性囊性病变9例。结果 非肿瘤源性患者31例，其中单纯性囊肿5例，囊肿内出血感染或自发性出血所致高密度囊肿26例，均无激素活性症状，超声检查肿物内无血管，CT、MRI增强扫描肿物无强化，内分泌检查正常。肿瘤源性患者9例，其中嗜铬细胞瘤6例，皮质腺癌1例，节细胞神经瘤1例，皮质腺瘤1例，CT、MRI增强囊壁可强化，4例有激素活性症状，内分泌检查部分有相应激素水平升高。手术治疗38例，仅1例术后20个月因肿瘤转移而死亡，37例效果满意。结论 B超、CT、MRI可帮助诊断肾上腺囊性病变。单纯性或单侧自发出血性囊肿，无症状较小者，可定期观察，余者应手术治疗。     

肾上腺囊性病变的诊断和外科治疗(附31例报告)

目的探讨肾上腺囊性病变的诊断和外科治疗方法，提高肾上腺囊性病变的诊治水平。方法回顾性分析31例肾上腺囊性变患者资料，经影像学检查，手术及病理证实非肿瘤源性患者21例，肿瘤源性患者10例。结果非肿瘤源性患者21例，其中单纯性囊肿15例，囊内出血感染或自发性出血所致的高密度囊肿6例。肿瘤源性患者10例，其中嗜铬细胞瘤9例，肾上腺神经节细胞瘤囊性变1例，8例嗜铬细胞瘤有激素活性症状。全部病例均行手术治疗，效果满意。结论B超、CT、MRI是诊断肾上腺囊性病变最可靠的定位诊断方法。强调在CT检查中有增强效应的囊性病变，要做内分泌功能检查。对直径〉4cm或有内分泌功能的肾上腺囊性病变应行外科治疗，〈4cm单纯性或单侧自发性出血性囊肿，无症状者可定期观察。     

肾上腺囊性占位性病变的诊治分析

目的:提高肾上腺囊性病变的诊治水平。方法:回顾性分析38例肾上腺囊性病变患者的临床资料,经影像学、手术及病理检查证实,其中非肿瘤源性囊性病变30例,肿瘤源性囊性病变8例。结果:囊肿内出血、感染或自发性出血所致高密度囊肿24例,单纯性囊肿6例。前者均有不同程度的腰、背、腹部胀痛,其中3例伴有贫血,2例伴有肝功能异常;后者均无临床症状。B超检查肿物内无血管,CT、MRI增强扫描肿物无强化,内分泌检查正常。肿瘤源性囊性病变患者中,嗜铬细胞瘤5例,皮质腺瘤2例,节细胞神经瘤1例。5例有激素活性症状,内分泌检查部分有相应激素水平升高。B超、CT、MRI显示囊壁>0.3 cm,且厚薄不均,CT、MRI增强扫描后,囊壁可有强化,以嗜铬细胞瘤囊壁强化最为显著。手术治疗36例,除1例因车祸、1例因脑血管意外死亡外,34例效果满意。结论:B超、CT、MRI可帮助诊断肾上腺囊性病变。无论是非肿瘤源性肾上腺囊性病变,还是肿瘤源性肾上腺囊性病变,只要条件允许,均应手术治疗。     

肾上腺囊肿的诊断与治疗(附15例报告)

目的:探讨肾上腺囊肿的诊断与治疗方法。方法:回顾性分析15例肾上腺囊肿的临床资料。结果:B超检查12例,9例显示肾上腺区为无回声液性囊性暗区, 3 例提示为低回声包块。14 例行CT检查为低密度肿块,其中7例提示囊壁有钙化影。MRI检查1例为包膜完整的占位病变。15 例均行手术治疗,其中行囊肿及同侧肾上腺切除6例,囊肿及肾上腺部分切除术7例,单纯囊肿切除术2例。9例行开放手术,6例经后腹腔镜手术。假性囊肿7例,内皮性5例,上皮性1例,2例未标明囊肿类型。结论:肾上腺囊肿临床上无特征性症状与体征,内分泌功能检查多数正常。B超与CT在诊断中占有重要的地位。注意与肝、胰、肾及脾囊肿,以及肾上腺肿瘤相鉴别。除直径<3 cm、内分泌功能正常、无症状、CT提示单纯性肾上腺囊肿外,均应采取积极手术治疗。建议囊肿切除加同侧肾上腺切除。后腹腔镜手术相对开放手术更有优越性。     

肾上腺偶发瘤

本文报告了自１９９０－１９９５年收治经ＣＴ，Ｂ超检查发现的１０例肾上腺偶发瘤。其中肾上腺皮质腺瘤４例，肾上腺髓性脂肪瘤３例，肾上腺囊肿２例，肾上腺转移癌１例。全组有３例存在内分泌功能。肾上腺偶发瘤大部分是良性非功能性肿瘤。但也在相当部分为恶发表中具有内分泌功能。     

肾上腺囊肿的诊断和外科治疗(附22例报告)

目的：探讨肾上腺囊肿的诊断与外科治疗方法。方法：回顾性分析22例肾上腺囊肿的诊断与治疗资料。结果：22例中，上皮性囊肿1例，内皮性肿囊8例，假性囊肿13例，均行囊肿切除术。结论：B超与CT是诊断肾上腺囊肿最可靠的定位诊断方法；强调在CT检查中有增强效应的囊肿要作内分泌功能检测，对直径＞3cm或有内分泌功能的肾上腺囊肿应进行外科治疗。     

肾上腺囊肿19例报告

我院于 1989年至 1999年间手术治疗肾上肿囊肿 19例 ,报告如下。临床资料　本组 19例 ,男 9例 ,女10例。年龄 2 2～ 6 2岁 ,平均 40岁。其中左侧 8例 ,右侧 11例。 19例均在Ｂ超检查中发现 ,其中 13例Ｂ超显示肾上腺区为无回声液性暗区 ,包膜完整 ,壁薄 ,ＣＴ检查为低密度包块 ,ＣＴ值 3～11ＨＵ ,增强后无强化。 6例Ｂ超提示肾上腺区内回声欠均匀的低密度肿块 ,包膜完整 ,囊壁厚薄不均 ,ＣＴ值为 2 1～32ＨＵ ,增强后明显强化。包块大小 5ｃｍ× 5ｃｍ× 3ｃｍ～ 15ｃｍ× 11ｃｍ× 9ｃｍ。结　果　 19例均行囊肿切除术 ,16例经腰 11肋间切…     

肾上腺节细胞神经瘤4例报告

目的 提高肾上腺节细胞神经瘤的诊断和治疗水平。方法 回顾性分析４例肾上腺节细胞神经瘤患者临床资料。结果 ４例临床上均无典型症状,除１例２４ｈ尿３－甲氧－４羟苦杏仁酸检测值增高外,其余有关内分泌功能检测结果均正常。Ｂ超及ＣＴ检查及有阳性发现。肿瘤均经手术完整切除,并经病理检查证实为肾上腺节细胞神经瘤。结论 肾上腺节细胞神经瘤的诊断主要依靠Ｂ超、ＣＴ和ＭＲＩ,确诊需病理检查发现有神经节细胞的存在。手术     

肾上腺髓性脂肪瘤（附9例报告）

报告９例经手术、病理证实的肾上腺髓性脂肪瘤．常见的临床症状有腰或上腹部疼痛、腹部肿块。诊断主要依靠ＣＴ和Ｂ超，ＣＴ的特征是肾上腺区接近脂肪密度的类圆形肿块，边缘光滑锐利，ＣＴ值在－１２０～－１２ＨＵ，部分为团块状、条索状的软组织密皮，ＣＴ值为２０～３０ＨＵ，增强扫描无明显强化。Ｂ超显示肾上腺区不均质占位，声象图上为强回声反射．动脉造影在本病与肾肿瘤相鉴别时有较大价值．治疗仅需作单纯肿瘤切除。     

肾上腺淋巴管瘤的诊治分析

总结分析17例肾上腺淋巴管瘤的临床诊治经验,探讨该病的影像特点及病理类型。结果显示,肾上腺淋巴管瘤的影像学检查无特异性,表现与一般的囊肿相似,但囊腔密度略高于单纯性囊肿,部分病例囊壁可见钙化,少数可显示腺瘤样表现。本病确诊主要靠病理检查。对于肿瘤最大径≥4.0 cm、有内分泌功能、可疑恶性,或有明显临床症状者,推荐手术...     

Symptomatic Rathke's cleft cyst mimicking suprasellar arachnoid cyst

The authors report an atypical case of symptomatic entirely suprasellar Rathke's cleft cyst mimicking suprasellar arachnoid cyst. A 55-year-old male was introduced to our hospital complaining of bitemporal hemianopsia. CT and MRI demonstrated a cystic mass located entirely in the suprasellar cistern and to compress the optic nerve and mammillary body. The cystic wall was not enhanced in MRI. CT cisternography showed the suprasellar non-communicating cyst with cistern. The hormonal function was slightly disturbed by the pituitary compression. Under the diagnosis of suprasellar arachnoid cyst, a left front temporal craniotomy was performed to resect the suprasellar mass. The surgical specimen consisted ciliated epithelium and was diagnosed Rathke's cleft cyst. After operation, he recovered completely free.     

Benign hemorrhagic renal cyst: a case report

A case of benign hemorrhagic renal cyst in a 64-year-old man is reported. The patient was admitted to our hospital for further evaluation of left upper abdominal mass. CT scan and ultrasonic sonography showed a left giant renal cystic mass. The characteristic findings were thick and irregular wall and heterogeneous contents of the cystic mass. Selective renal arteriography showed a hypervascular area in a part of the cyst wall and hemorrhagic cyst was suspected by MR imaging. The presence of a malignant tumor in the cyst wall was suspected, and radical nephrectomy was performed. The specimen measured 18 x 12 x 8 cm and weighed 1,170 g. The cyst contained bloody fluid and a hemorrhagic degenerating mass. Pathohistological examination showed no evidence of malignant tumor at any site of the cyst wall.     

Thymoma arising in a thymic cyst.

We present a case of thymoma arising in the wall of the thymic cyst. A 77-year-old asymptomatic woman demonstrated an approximately 3.5 cm sized cystic mass in the left anterior mediastinum in the CT scan. The tumor was extirpated by a total thymectomy. Histologically, the cyst wall was lined by low cuboidal cells, but a markedly thickened wall was observed at the upper site of the mass, which was found to be thymoma. These findings may suggest that the thymoma originated from the wall of the thymic cyst.     

囊腔类肺癌CT特征分析

目的分析囊腔类肺癌的CT特征。方法回顾性分析经病理证实的24例囊腔类肺癌的CT表现。所有患者均接受平扫,其中4例同期接受增强扫描。结果 24例均为单发病灶。4例病灶CT表现为单纯囊腔,8例表现为囊腔伴周围磨玻璃密度影,7例表现为囊腔伴周围实性密度影,5例囊腔周围同时伴有磨玻璃及实性密度影;囊腔形态呈圆形或类圆形9例,不规则形15例;22例囊壁不光整,2例囊腔壁光整。4例接受CT增强扫描者囊腔周围实性密度影可见中度强化。13例囊腔内可见壁结节,20例囊腔内可见粗细不均的分隔;出现分叶征18例,毛刺征12例,血管集束征9例,胸膜凹陷征10例。结论囊腔类肺癌CT表现具有一定特征性,对囊腔及其周围CT表现进行综合分析有助于进一步明确诊断。     

Cystic thymoma without solid mass lesions on diagnostic imaging —A case report—

A 68-year-old man was referred to our hospital because of an abnormal shadow on a chest X-ray film. A chest CT scan snd MRI demonstrated a cystic mass without solid lesions on the anterior mediastinum. The CT scan also showed that it was a well-defined and homogenous mass without contrast enhancement effect. ⁶⁷Ga and ²⁰¹T1 scintigrams showed no uptake in the mass. Needle aspiration cytology was performed, and there was no evidence of neoplasms. A thymic cyst was diagnosed, and then an operation was performed. At the operation, the cystic tumor was removed along with thymic tissues by a median sternotomy. On the cut section of the resected specimen, the tumor was found to be a cyst with small solid nodules on the wall. Pathologic examination revealed that the tumor was a cystic thymoma. We consider that patients with cystic tumors on the onterior mediastinum should obtain histopathologic diagnosis because of the difficulty in excluding neoplasms such as thymoma.     

Retrorectal epidermoid cyst in an elderly woman: Report of a case

An epidermoid cyst is a common occurrence in the skin. Such a cyst occurring in the retrorectal space, however, is extremely rare. We herein present a case of retrorectal epidermal cyst in a 67-year-old Japanese woman. She reported no symptoms and a perirectal mass behind the lower rectum was accidentally detected by computed tomography (CT). Contrast CT and magnetic resonance imaging revealed a cystic mass (76 x 70 x 63 mm) with a slightly enhanced thin wall which was attached to the lower rectum. The patient underwent surgery via a posterior approach. The mass was exposed after an excision of subcutaneous fat and was firmly adhered to the anal sphincter muscle. The cystic mass was completely removed without a proctectomy. Histologically, the cyst was diagnosed to be an epidermoid cyst. The postoperative course was uneventful, and the patient was discharged on postoperative day 9. A diagnosis of retrorectal cystic tumor is difficult, and a complete resection is necessary for the treatment of such tumors.     

Cystic falx meningioma: report of a case with difficulty in radiologic diagnosis]

A case of cystic falx meningioma in the frontal region in which preoperative neuroradiologic diagnosis was difficult is reported. This 33-year-old man had suffered from epileptic seizures three times in one month. Physical and neurological examinations on admission were normal. A cystic mass with a small nodule was found on CT in the frontal region. Thin wall was enhanced smoothly and the nodule attached to the falx was enhanced heterogeneously. The mass was considered to be an extra-axial lesion on MRI. The right anterior falcine artery seemed to feed the mass. Bifrontal craniotomy was performed. Cyst was evacuated, and a soft reddish mass was subtotally removed. Cyst fluid was yellowish and protein content was 3.5 g/dl. Histopathological diagnosis was a meningotheliomatous meningioma and tumor cells were present also in the thin cyst wall. At the second operation the mass was completely removed, cyst wall inclusive. When we encounter a cystic mass in the sites of predilection of meningiomas, we have to consider the possibility of a cystic meningioma. If the mass has meningeal vascularization, a correct diagnosis is not difficult. Taking the location of the mass into consideration, an accurate interpretation of CT and MRI findings indicating extra-axial nature of the mass is indispensable.     

Rathke's cleft cyst--report of three cases

Three cases of symptomatic Rathkes' cleft cyst are described. Case 1. A 51-year-old man was admitted to the hospital for evaluation of intermittent headache, in April, 1985. He was neurologically free, but skull films disclosed a ballooning of the sella with thinning of the dorsum sellae. CT scan showed enlargement of the sella, but no abnormal density area in the sellar region. MRI revealed a round mass with high signal intensity located just posteriorly to the pituitary body. By a transsphenoidal approach, a thin-walled cyst was found at the posterior portion of the sella. Turbid mucinous fluid and the capsule of the cyst were subtotally removed. Histologic section of the specimen demonstrated that its wall was composed of a loose fibrous tissue lined by a single layer of ciliated cuboidal epithelium containing some goblet cells. Electron microscopy showed ciliated cuboidal cells, cells with microvilli, cells with light and large granules, and basal cells abutting on the basal lamina. Case 2. A 33-year-old female was referred to the hospital with complaints of severe headache and decreased visual acuity 0.02 in the left and 0.1 in the right, in July, 1985. Visual field examination revealed bitemporal hemianopsia. She had amenorrhea, galactorrhea and polyuria. CT scan and metrizamide CT cisternography detected a low density mass in the suprasellar region. Endocrinological studies disclosed hyperprolactinemia with partial hypopituitarism. She had a right frontal craniotomy and a suprasellar cyst was subtotally removed. Histologically, a cystic wall was lined by pseudostratified columnar epithelium supported by a loose fibrous tissue.(ABSTRACT TRUNCATED AT 250 WORDS)     

Evaluation of complicated renal cyst: a comparison of CT and MR imaging]

We report 12 cases of renal cystic lesions that could not be diagnosed preoperatively. Sonography, computed tomography (CT), magnetic resonance (MR) imaging, and angiography were performed in all cases. Angiography was not helpful in evaluating cystic lesions, because all cystic lesions were hypovascular or avascular within the cystic mass. CT was useful in depicting the fine structural abnormalities, and especially bolus-contrast CT study was useful in the differentiation of cystic renal cell carcinoma from simple renal cyst. However, there were 5 false positive cases. MR imaging is superior to CT in distinguishing a hemorrhagic cyst or multiloculated cystic mass. In conclusion, CT is currently the primary imaging modality for evaluating complicated renal cysts, and surgical exploration is warranted for the undiagnosed cystic lesion by CT. However, MR imaging also has an important role in detecting the benign complicated cyst. Therefore if complicated cyst is thought to be benign by MR imaging, parenchyma-sparing surgery should be considered preoperatively.     

Ciliated foregut cyst of the gallbladder: report of a case

We report the rare case of a gallbladder cyst arising from the foregut remnants. A 36-year-old woman was referred to our hospital after screening ultrasonography (US) detected a tumor in the gallbladder. On admission, she was well and her blood analyses were all normal. US showed a cystic mass with internal high-echoic lesions, and computed tomography (CT) demonstrated a protruding tumor with slight enhancement in the gallbladder. Angiography provided no additional information; however, sequential CT-arteriography (CTA) clearly demonstrated that this tumor was a cystic lesion. Surgical exploration was performed, first because of the difficulty in establishing a definite diagnosis, and also because the patient wanted the tumor removed. The resected specimen contained a unilocular cystic tumor that looked like a submucosal tumor. Histologically, the wall of the cyst was lined by ciliated stratified columnar epithelium with interspersed goblet cells and underlying smooth muscle fibers. The mass was finally diagnosed as a congenital ciliated foregut cyst of the gallbladder. Cysts of the gallbladder are uncommon and the majority are acquired. To our knowledge, this represents only the fourth report of a ciliated foregut cyst of the gallbladder in the literature. Although rare, an awareness of this entity could allow a preoperative diagnosis to be made, whereby surgical exploration may be avoided. CT-A is a very useful diagnostic tool, especially when the nature of the tumor presents a difficult differential diagnosis.