肺癌合并血嗜酸性粒细胞增多临床特点

目的 探讨肺癌合并血嗜酸性粒细胞增多的临床特点及意义.方法 结合我院收治的1例肺癌合并嗜酸性粒细胞增多的临床资料及国外文献报道的实体肿瘤合并嗜酸性粒细胞增多的病例报道进行综合分析.结果 患者男,80岁,表现为右侧胸痛,呈持续性钝痛,胸部CT示右肺上叶后段厚壁空洞,伴邻近骨质破坏,右肺动脉及右主支气管受侵,右侧少量胸腔积液.血嗜酸性粒细胞增多,比例为0.169,绝对值2.15×109/L,痰及支气管灌洗液中嗜酸性粒细胞比例也明显增高.CT引导下穿刺活检显示为鳞癌.患者发现合并嗜酸性粒细胞时,肺癌已有转移,预后差,与文献报道一致.结论 肺癌等恶性肿瘤通过分泌嗜酸性粒细胞克隆刺激因子引发血嗜酸性粒细胞增多,为较少见的副癌综合征,提示肿瘤已有转移,预后差.     

肺肉瘤样癌2例并文献复习

目的提高对肺肉瘤样癌（lung sarcomatoid carcinoma,LSC）的诊断、治疗及预后方面的认识。方法通过对2例LSC患者的诊治进行分析,结合相关文献复习。结果患者表现为咳嗽、咯血、胸痛,其症状与其它类型肺癌相似,增强CT示环形强化为其特征。肺组织活检确诊肺肉瘤样癌（病理及免疫组化）。手术联合化/放疗可延长患者生存时间。结论肺肉瘤样癌罕见,较一般肺癌更具侵袭性,预后差。本病缺乏特异性临床表征,增强CT扫描示环形强化为其特征,但诊断主要依靠手术病理。手术是LSC的首选治疗方法。     

肺肉瘤样癌21例临床分析

目的 探讨肺肉瘤样癌的临床病理特征、化疗疗效及预后.方法 回顾性分析21例肺肉瘤样癌患者的临床资料.结果 多形性癌是最常见病理亚型,占85.7％(18/21).肺肉瘤样癌好发于中老年、男性患者,起病症状、胸部CT影像学特征与其他类型非小细胞肺癌无明显差别.合并有腺癌成分的患者共有8例,其中3例行EGFR基因检测均为野生型,另有3例EGFR状态不明患者接受EGFR-TKIs治疗均无效.共有16例复发或转移患者接受一线化疗,缓解率为6.25％、疾病控制率为25％,中位生存期为6.2个月,1年生存率为6.25％.结论 与其他类型非小细胞肺癌相比,肺肉瘤样癌的临床表现无特殊,但预后差且对化疗高度耐受,对EGFR-TKI治疗可能不敏感.     

以乳房发育起病的肺癌1例

患者男 ,39岁。因两侧乳房肿大 1个月 ,两眼上视、四肢抽搐 4小时入院。查体 :T37.2℃ ,R2 4次 /min,Bp17/11k Pa(1k Pa=7.5 mm Hg)。神志清 ,双瞳孔等大等圆 ,对光反射存在。颈软 ,双乳房明显发育增大 ,未扪及包块。左肺底呼吸音低 ,颅神经检查 (- )。颅脑 CT示左额顶叶 2 .0 cm× 2 .5 cm高密度灶 ,密度欠均 ,周围水肿明显。 X线胸片示双肺布满数个大小不等密度均匀球形病灶 ,提示左肺癌并双肺内转移。入院诊断为左肺癌、肺内转移、脑内转移并症状性癫痫。后经支气管镜活检 ,病理报告为小细胞未分化癌。讨论 :以咳嗽性质改变、咯血、…     

隐源性机化性肺炎7例分析

目的提高对隐源性机化性肺炎(COP)的诊治水平。方法对7例诊断明确的病例进行总结,探讨COP的临床、病理、影像学特点及治疗和预后。结果 7例中女性5例,男性2例,肺功能6例显示限制性通气功能障碍,1例患者为混合型通气功能障碍。7例患者均被误诊,影像学示"五多一少"特点,使用抗生素治疗无效,肺活检而明确诊断,糖皮质激素治疗有效,随访示预后好。结论临床表现及影像学特征和诊疗经过,对诊断有一定的提示作用,确诊依靠肺活检病理检查。     

肺透明细胞癌1例并文献复习

目的 分析肺透明细胞癌的临床特征、影像学表现及病理诊断要点.方法 报告1例经肺活检病理确诊的肺透明细胞癌病例,并结合文献资料对该病的临床特征、影像学表现及病理诊断要点进行分析.结果 本例患者为女性,45岁,以反复咳嗽2个月为首发症状,胸部CT示两肺多发结节灶合并肺门及纵隔淋巴结肿大,胸腔镜下肺活检病理确诊为原发性肺透明细胞癌.近20年国内外文献报道肺透明细胞癌病例仅27例,其中男性18例,女性9例,平均年龄(55±11)岁.临床表现主要为咳嗽(16/27)、胸痛(12/27)、咯血(10/27).影像学表现以周围型单发结节或团块影多见(22/27),病灶直径0.5～11 cm.该病罕见,属大细胞癌的变异型;确诊多依赖开胸肺组织病理活检,免疫组织化学染色有助于鉴别.结论 肺透明细胞癌的临床表现无特异性;影像学表现以肺部单发结节或团块影多见,亦可为两肺多发和弥漫型;确诊依赖肺组织病理活检,免疫组织化学染色有助于鉴别.     

CT引导下经皮肺穿刺活检在管外型中央型肺癌中的诊断价值

目的 研究CT引导下经皮肺穿刺活检在管外型中央型肺癌中的诊断价值.方法 101例在纤维支气管镜检查镜下示管外型占位没有明确病理诊断的患者行CT引导下肺穿刺活检.结果 101例,活检阳性率为100%.鳞癌48例,小细胞癌12例,腺癌29例(其中肺泡细胞癌5例),大细胞癌2例,腺鳞癌4例,神经内分泌癌4例,表皮样癌2例.其中22例行EGFR突变位点检测,突变率为54.5%(12/22).结论 CT引导下肺穿刺活检诊断管外型中央型肺癌阳性率高,为临床提供的病理诊断可靠完整,为后继的临床治疗提供了可靠的依据.     

骨骼肌转移癌临床特点分析

目的探讨骨骼肌转移癌的临床表现、影像学特点、治疗及预后,避免与原发的软组织肉瘤相混淆,提高治疗效果。方法7例骨骼肌转移癌患者,原发部位明确5例,分别为纵膈低分化鳞癌、肝癌、肺癌、肾癌、结肠癌各1例;原发部位不明确2例,病理结果为小细胞末分化癌。首发症状：伴有疼痛的软组织肿物5例,仅有肿物不伴疼痛2例。发病部位：大腿3例、上臂3例、臀部1例。单发转移1例,伴肺转移的多发转移6例。6例患者术前局部行强化MRI检查,另1例行强化CT检查。结果MRI表现为骨骼肌内软组织肿物,伴明显强化,其中2例患者周缘明显强化,伴中心坏死。6例行局部手术切除治疗,1例放弃治疗。诊断骨骼肌转移癌后3—19个月死亡。结论骨骼肌转移癌临床罕见,易被误诊为软组织肉瘤。好发于肢体的近心端。治疗以手术治疗为主,可辅以放射治疗。患者预后差。     

以鼻尖皮肤转移瘤为首发表现的支气管肺癌1例

患者,男性,53岁,于20天前无明显诱因发现鼻尖部肿大,无发热及疼痛,自服抗生素7天效果不佳,在当地诊所静滴菌必治治疗8天效果仍不佳,肿物生长迅速,已增长至5cm,遂来我院诊治,拍胸片示：左中肺团块状影,经纤维支气管镜检查发现左肺中叶背段口管腔外压迫性狭窄,局部粘膜不光滑。取病理活检示肺鳞癌。取鼻尖部肿物活检,术后病理示：鳞状细胞癌,诊为支气管肺癌（鳞癌）,皮肤转移癌。经CAP方案化疗三周期,患者鼻尖部肿物渐缩小。     

女性肺癌463例纤支镜肺活检结果分析

回顾性分析463例在我科经纤支镜肺活检的女性肺癌患者病理组织诊断结果。结果活检前临床诊断为肺部原发或转移癌与病理诊断符合率61．99％,误诊率38．01％。463例女性肺癌患者中,腺癌158例（34．13％）,小细胞癌132例（28．51％）,鳞癌112例（24．19％）,可疑癌33例（7．13％）,不易定型癌11例（2．35％）,其它癌17例（3．67％）。同期女性鳞癌、腺癌的检出率分别为24．19％、34．13％,男性分别为46．57％、21．45％,女性肺癌的病理类型与男性比较差异显著（P〈0．01）。认为经纤支镜肺活检是女性肺癌确诊的诊断方法之一,女性肺癌病理分型不同于男性肺癌患者。     

Fulminant ulcerative colitis in a healthy pregnant woman

This case report concerns a 25-year-old patient with6-7 bloody stools/d, abdominal pain, tachycardia,and weight loss occurring during the third trimester of pregnancy. Severe ulcerative colitis complicated by toxic megacolon and gravidic sepsis was diagnosed by clinical evaluation, colonoscopy, and rectal biopsy that were performed safely without risk for the mother or baby. The patient underwent a cesarean section at28+6 wk gestation. The baby was transferred to the neonatal intensive care unit of our hospital and survived without complications. Fulminant colitis was managed conservatively by combined colonoscopic decompression and medical treatment. Although current European guidelines describe toxic megacolon as an indication for emergency surgery for both pregnant and non-pregnant women, thanks to careful monitoring, endoscopic decompression, and intensive medical therapy with nutritional support, we prevented the woman from having to undergo emergency pancolectomy. Our report seems to suggest that conservative management may be a helpful tool in preventing pancolectomy if the patient's condition improves quickly. Otherwise, surgery is mandatory.     

ACTH-independent Cushing's syndrome in pregnancy with spontaneous resolution after delivery: control of the hypercortisolism with metyrapone

A 25-year-old primigravid woman presented with Cushing's syndrome at 23 weeks gestation; serum Cortisol was 1090 nmol/l at 0900 h, 1230 nmol/l at 2200 h; basal urinary free Cortisol excretion was 3680 nmol/24 h, and 8830 nmol/ 24 h after dexamethasone 8 mg daily for 48 hours; plasma ACTH was <1.1 pmol/l. CT scan of the adrenal glands showed bilateral adrenal hyperplasia. The hypercortisolism was controlled with metyrapone until elective delivery of the fetus by Caesarian section at 34 weeks gestation because of a decline in growth. No adverse fetal effects of metyrapone treatment were apparent, maternal outcome was uncomplicated and wound healing was unimpaired. Maternal adrenocortical function had returned to normal within 4 weeks of the cessation of pregnancy and biochemical remission has been maintained up to 9 months post-partum. Metyrapone therapy is effective in controlling the hypercortisolism in certain cases of Cushing's syndrome complicating pregnancy.     

Acute fatty liver of pregnancy -- an underlying condition for herpes simplex type 2 fulminant hepatitis necessitating liver transplantation

The infrequent occurrence of herpes simplex virus (HSV) hepatitis in healthy women in comparison with the high prevalence of HSV infections suggests that, in addition to deranged immunity, an underlying condition in the liver might be necessary to develop HSV hepatitis. We report the case of a 28-year-old pregnant woman in the 28 (th) week of gestation. Following HSV type 2 infection of the uterine cervix, acute liver failure developed, necessitating urgent liver transplantation. In addition to fulminant HSV type 2 hepatitis, the explanted liver also showed the histological features of acute fatty liver of pregnancy. The presented case suggests a possible pathogenetic role of acute fatty liver of pregnancy in the development of fulminant HSV hepatitis following recurrent infection with HSV in healthy pregnant women. We believe that early histopathological diagnosis, followed by specific antiviral treatment and liver transplantation in selected patients may improve the clinical outcome of otherwise almost uniformly fatal HSV hepatitis.     

Successful thrombolysis of prosthetic mitral valve thrombosis in early pregnancy

Prosthetic valve thrombosis occurring during pregnancy is a life-threatening complication. Surgical treatment requires clot removal or valve replacement under cardiopulmonary bypass, and carries a high mortality. We report successful thrombolytic therapy with streptokinase for prosthetic valve thrombosis in a pregnant, 28-year-old woman. The patient, who had undergone mitral valve replacement (St. Jude Medical prosthesis) two years previously for restenosis after closed mitral valvotomy, was successfully thrombolyzed during the first trimester (6-8 weeks) for prosthetic valve thrombosis, and without any complication. The patient delivered a normal healthy child at nine months' gestation. Although thrombolysis in pregnancy has been reported previously, this is the first case in which it was performed during the first trimester for prosthetic valve thrombosis.     

Ruptured sinus of valsalva aneurysm in a pregnant woman

A ruptured sinus of Valsalva aneurysm is a rare cardiac anomaly, usually of a congenital nature. There are few documented cases of this condition during pregnancy, which renders unclear the therapeutic options. We report the case of a 35-year-old pregnant woman who presented at the hospital for cardiac evaluation due to the presence of a heart murmur. The patient was asymptomatic and in her 4th month of pregnancy. Transthoracic echocardiography revealed a ruptured sinus of Valsalva aneurysm and a fistula to the right ventricle with evidence of a continuous left-to-right shunt.     

Acute aortic dissection in a 34 year old pregnant woman--a case report

A case of a 34 year old pregnant woman at 38 weeks gestation, who was admitted to the hospital with acute chest pain, is presented. Electrocardiogram showed ST segment changes suggestive of acute myocardial infarction. Echocardiography, however, revealed acute aortic dissection. The patient was transferred to another hospital where caesarean section followed by cardiac surgery were successfully performed. A subsequent one-year follow-up period was uneventful, both for mother and child. Diagnosis and treatment of acute aortic dissection during pregnancy are discussed.     

A case of well-tolerated and safe deferasirox administration during the first trimester of a spontaneous pregnancy in an advanced maternal age thalassemic patient

In this report, we present a case of a spontaneous pregnancy in a 42-year-old thalassemic woman referred to our Microcythemic Unit while she was on deferasirox (DFX) therapy. The patient had been on treatment with DFX since March 2008 and in March 2009 realized that she was pregnant at 12 weeks of gestation. The conception was spontaneous and the baby was born at full term without complications or malformations.     

Clopidogrel treatment during pregnancy: a case report and a review of literature

Management of ischemic heart disease in pregnant women is still difficult, as there is little experience with many of the newer treatments such as clopidogrel. The safety of clopidogrel in pregnancy is unknown, especially in combination with aspirin. Its use during gestation has been described in a few case reports. We describe the case of a 36-year-old woman in her 9th week of pregnancy with a history of chronic hypertension, dyslipidemia and CAD, who required antiplatelet treatment. Clopidogrel and aspirin were administrated until one week before delivery and a healthy child was born at 36 weeks of pregnancy by caesarean section, without any complication.     

Moderate mitral stenosis in pregnancy: the haemodynamic impact of diuresis

A case of asymptomatic, newly diagnosed, moderate mitral stenosis in a 27 year old pregnant woman is described. A conservative management strategy with regular cardiac assessment was adopted and the patient remained well. Routine transthoracic echocardiography at 36 weeks' gestation showed the development of severe pulmonary hypertension with right ventricular pressure overload, which was successfully treated with oral diuretics resulting in rapid normalisation of pulmonary pressure. Mitral stenosis in pregnancy and its management in pregnancy are briefly discussed.