肿瘤样钙质沉着症临床病理分析

目的　加深对肿瘤样钙质沉着症 (TC)临床病理特征的认识 ,提高确诊率。方法　分析 9例TC的临床、影像学、组织病理学资料。结果　TC临床诊断误诊率较高 ,9例患者中仅有 1例术前诊断正确 ,余者分别误诊为良性肿瘤 4例、异物 3例、恶性肿瘤 1例 ;而且 9例钙化区均具有典型的影像学和组织病理学特征。结论　在诊断TC过程中 ,只要注意X线摄片检查或进行病理组织活检 ,完全可以避免漏诊或误诊 ,必要时可行特殊染色或偏振光显微镜检查     

TUMORAL CALCINOSIS A CASE REPORT

Tumoral calcinosis is a rare disease. Recent- ]y we found a typical case and thereby report it in the following. The patient was a 62-year old male admitted to this hospital on July l, 1982. Five months be- fore admission he found a mass of about half an egg size on the lateral side of the left knee. The mass was painful and the pain increased when the knee was flexed and decreased when it was stretched. The patient had been diagnosed as a case of "chondroma", "synovial chondromatosis", etc. by several other hospitals. Physical examination found a protrusion in the lateral side of the left knee and a hard pal- pable mass of about 3.5 X 4 cm. No distinct bor- derline between the mass and the surrounding tissue was seen. Radiographs showed a multi-nodular, calci- fied mass within the soft tissue of the lateral side of the left knee, which measured 3.5 x 4 cm and had a sharp margin. Bony structure of the knee joint was normal. An operation performed on July 10, 1982 found a mass with intact capsule which was re- moved from between the biceps femoris and vas- tus lateralis. It was a firm, rubbery tumor and covered by grayish-white to grayish-yellow fibrous tissue. Sectioning of the tumor revealed a multi- lobular structure with a fibrous connective tissue band separating the pasty, calcarenous deposits. Microscopically, multiple cystlike cavities were filled with blue-colored materials. The fibrous walls of the cysts consisted of numerous fibrous tissue in which there were multinucleated giant cells and histiocytes. Pathologic diagnosis was tumoral calcinosis.     

Clinical and roentgenographic aspects of pseudogout: a study of 50 cases and a review.

Pseudogout, defined as recurrent acute arthritis due to intrasynovial deposition of calcium pyrophosphate dihydrate crystals, is a relatively common arthritic disorder of the elderly. The clinical and roentgenographic aspects of 50 cases of pseudogout in hospitalized patients are reviewed in this paper. Oligoarticular and polyarticular episodes were observed in half of these patients. Antecedent problems included infection, trauma, surgery and vascular events. Consistent with previous reports, most patients had roentgenographic evidence of chondrocalcinosis. A third had asymptomatic capsular or periarticular calcific deposits or both, and a third had pyrophosphate arthropathy, a progressive, destructive, accelerated form of osteoarthritis. An attack of pseudogout may offer a clue to the presence of an unsuspected metabolic disease, such as primary hyperparathyroidism or idiopathic hemochromatosis.     

Primary pulmonary lymphoma. A case report and review of the literature

An 81-year-old non smoking patient is admitted with cough, fever and poor general status. The radiologic evaluation reveals a right parahilar mass, and trans-bronchic biopsy confirms its tumoral nature. Immunohistochemical analysis establishes the diagnosis of high grade primary pulmonary lymphoma. The rare nature of this disease, its non-specific clinical presentation and particular prognosis are discussed in this article.     

The tophus in calcium pyrophosphate deposition disease

A 61-year-old man had a tophus on the third finger of his right hand. There was no history of arthritis, no laboratory abnormality, and no chondrocalcinosis. Crystalline material from the tophus was identified as calcium pyrophosphate dihydrate by x-ray diffraction.     

高频超声对系统性硬皮病皮肤厚度定量评估的初步研究

目的 探讨高频超声定量评估系统性硬皮病（systemic sclerosis, SSc）患者皮肤厚度的价值,为SSc患者皮肤厚度的临床评估寻找一种客观定量、简单可行的评价方法。方法 确诊为SSc患者82例（SSc组）,67例健康志愿者为对照组。对照组与SSc患者均行高频超声测量皮肤厚度,测量部位包括双侧手指、双侧前臂,胸壁,腹壁。SSc患者进行改良Rodnan皮肤评分（mRSS）。比较SSc组与健康对照组年龄、性别、身高、体质量、体质量指数（BMI）、皮肤厚度有无差异,采用受试者工作特征（ROC）曲线评价高频超声在SSc中的诊断效能,分析皮肤厚度与mRSS的相关性。结果 SSc组与健康对照组年龄、性别比、身高、体质量及BMI差异均无统计学意义(P>0.05)。SSc组皮肤厚度在手指及前臂均高于对照组,差异有统计学意义(P <0.05)。ROC曲线分析高频超声评估SSc皮肤厚度,在右、左手指,右、左前臂,胸、腹壁的ROC曲线下面积（AUC）分别为0.938、0.905、0.608、0.586、0.398、0.321;其中,右、左手指的AUC＞0.9,可用于诊断,其皮肤厚度诊断SSc阈值分别为1.35 mm、1.26 mm时,其敏感性分别为84.1%、86.6%,特异性分别为95.5%、89.6%。各检测部位mRSS评分越高,皮肤厚度值越大;皮肤mRSS评分之和（mRTSS）与皮肤厚度总和的相关性为r=0.599 (P<0.001),各部位mRSS评分与其皮肤厚度的相关性为0.400～0.623(P<0.001),相关性在腹壁最低,右侧手指最高。结论 高频超声能敏感反映SSc患者皮肤受累程度,其诊断SSc在手指具有较高的特异性和敏感性,高频超声有望成为评价SSc病情及治疗随访的有效定量指标。     

手指血管球瘤的MRI诊断

目的探讨手指血管球瘤的MRI诊断价值及技术方法。方法3例手指血管球瘤患者行MRI平扫，扫描序列包括：自旋回波序列（SET1WI，T1WI＋FS），快速自旋回波序列（TSET2WI），快速小角度单次激发梯度回波序列加脂肪抑制（FLASH＋FS）矢状位、冠状位、轴位以及增强扫描。结果3例患者的病程最短3年，最长9年。3例肿瘤均发生在环指，2例位于指骨远端掌侧面，1例位于甲床下。MRI上病变呈结节状，在T1WI上为等信号或稍低信号，在T2WI和FLASH上均为高信号。增强后病灶明显强化。结论MRI的T1WI、T2WI、FLASH＋FS及增强扫描可以很好地显示手指血管球瘤这种微小病变，对本病的诊断及手术前定位有较高的临床应用价值。     

A functioning pleomorphic carcinoma of the thyroid.

A metastasizing functioning pleomorphic carcinoma of the thyroid displayed a morphologic piture ranging from follicular to sarcomatous and carcinoid-like patterns. Spindle-cell elements were believed to be the result of metaplasia of the follicular epithelium. Development of carcinoid-like lesions in the secondary deposits of tumour supported the contention that so-called parafollicular or c-cells may be a phenomenon of metaplasia and not a histologic entity. The tumour was associated with a chromophobe adenoma of the pituitary and a benign schwannoma of the stomach. Clinically the patient did not show any other endocrinologic abnormalities and lived for 4 years from the time of diagnosis of the thyroid tumour.     

类风湿关节炎指关节病变的高频超声表现

目的：探讨高频超声（HFUS）对类风湿性关节炎（RA）患者指关节病变的超声特点。方法：对临床诊断为RA的32例患者双手指关节共640个关节进行高频超声检查，观察RA患者指关节声像图表现。结果：超声图像可清晰显示RA指关节积液26例共136个关节，关节周围炎性渗出15例共44个关节，关节骨质侵蚀28例共154个关节，滑膜增生28例共109个关节，同时彩色多普勒超声可显示RA指关节滑膜血管过度形成（血管翳）10例共33个关节。结论：高频超声能显示RA患者手指关节病变的各种表现，可为临床诊断提供依据。     

Mimicry in older patients: tophaceous pseudogout as a tumorlike lesion: a case report

Pseudogout is frequently seen in painful arthritis of larger joints, especially the knees and shoulders. This case report describes a rare clinical entity of soft-tissue calcium pyrophosphate dihydrate crystal deposition disease surrounding the second metatarsal bone of an 81-year-old man with moderate painful swelling of the right forefoot for 2 years. Diagnostic imaging demonstrated a calcified soft-tissue tumor adjacent to the second metatarsal bone by considering a neoplastic process in the differential diagnosis. Excisional biopsy revealed a chalklike material on the calcified soft tissue that was pathognomonic for chondrocalcinosis or pseudogout. The excisional biopsy findings led to stagnation of the clinical symptoms, and no recurrence of the initial tumor was seen during 12-month follow-up. In the literature, only 28 cases of tophaceous pseudogout tumors in the extremities have been described. In these cases, the lesions were suspected of being chondrosarcomas. For this reason, a correct diagnosis has to be pursued by performing a biopsy to treat the disease correctly.     

Ruptured abdominal aortic aneurysms presenting to a general hospital.

Fifty-six patients with a ruptured abdominal aortic aneurysm presented to an acute general hospital over six years from 1968 to 1973. Twelve patients died before operation, while 19 of 44 patients (43%) survived replacement of the aneurysm with a Dacron graft. Patients aged under 70 years and not shocked on admission to hospital had the best chance of survival. It is suggested that survival rates can be significantly raised only by a decrease in the time between the onset of symptoms and an operation. A correct diagnosis may be made more often if it is remembered that the classical clinical triad of pain, shock and an abdominal mass is seen is less than half of the cases presenting to hospital.     

Pancreaticocolonic fistula: a complication of pancreatitis.

In three cases of pancreaticocolonic fistula presenting before the stage of exsanguinating hemorrhage of severe sepsis the problem was diagnosed on the basis of the clinical history, visualization of the terminal part of the fistula by roentgenography after a barium enema had been given and, in two cases, demonstration of the communication with the pancreatic ductal system by endoscopic retrograde pancreatography. The lesions were repaired surgically. Pancreaticocolonic fistula should be suspected in a patient with upper abdominal pain who has a history of abdominal pain and excessive alcohol consumption and in whom diarrhea and fever, hematochezia or a disappearing abdominal mass develops. Characteristically barium will collect in the terminal part of the fistula and thus permit a tentative diagnosis; the diagnosis can then be confirmed by endoscopic retrograde pancreatography. With this approach surgical treatment can be carried out earlier and the often fatal course of the disorder can be averted.     

Fine needle aspiration cytology in tumoral calcinosis cases ＆ review of literature

Objective:To investigate them by the non-invasive technique of fine needle aspiration cytology(FNAC).Methods: In this study cases were described in which FNAC was indicative of tumoral calcinosis.Total numbers of cases studied were 18.Male to female ratio was 1∶8.11 cases(61.11%) were less than 20 years of age.3 cases had history of trauma in the past(16.67%).8 cases had lesions located in the hip region(44.44%).Results:The size of lesion varied from 2.5 to 4 cm.In none of the case diagnosis of tumoral calcinosis was considered clinically.All other investigations were normal and no significant family or medical history was present.Cytology in all cases showed only abundant acellular calcium.The patients on follow up were clinically well with no changes.Conclusion:The cases are interesting,since the cytohistological findings in the aspirate sample are strongly indicative of tumoral calcinosis.     

Ollier's disease treated with grafting using alpha-tricalcium phosphate cement. A case report

Ollier's disease is a rare disorder characterized by multiple enchondromas with a unilateral predominance, especially in fingers in early childhood. We experienced a case of Ollier's disease treated four times with simple curettage from the age of 2 years and alpha-tricalcium phosphate cement grafting at the age of 21 years. The forth curettage was performed when the patient was 15 years old and preoperative X-rays had shown remarkable finger deformities. Postoperative casting of the involved joints was necessary to prevent fractures but led to some finger contractures. Following X-rays demonstrated incredible improvement of the appearance. This suggests that simple curettage alone at an early stage of Ollier's disease provide cosmetic improvement. At the age of 21 years our patient showed enlargement of the intramedullary finger lesions again. Some lesions seemed to be impending pathological fractures. This time we chose alpha-tricalcium phosphate cement to fill the cavities after curettage had been carried out. Harvesting a large amount of autologous bone was not required. All activities of daily life could be resumed immediately after surgery and none of the finger joints showed further restriction of motion. X-rays taken three years after the operation showed new bone ingrowth surrounding the material with little evidence of absorption. To our knowledge, this may be the first case of Ollier's disease treated with artificial bone grafting reported in the English literature.     

Ollier's Disease Treated with Grafting Using Alpha-tricalcium Phosphate Cement. ACase Report

Ollier's disease is a rare disorder characterized by multiple enchondromas with a unilateral predominance, especially in fingers in early childhood. We experienced a case of Ollier's disease treated four times with simple curettage from the age of 2 years and alpha-tricalcium phosphate cement grafting at the age of 21 years. The forth curettage was performed when the patient was 15 years old and preoperative X-rays had shown remarkable finger deformities. Postoperative casting of the involved joints was necessary to prevent fractures but led to some finger contractures. Following X-rays demonstrated incredible improvement of the appearance. This suggests that simple curettage alone at an early stage of Ollier's disease provide cosmetic improvement.

At the age of 21 years our patient showed enlargement of the intramedullary finger lesions again. Some lesions seemed to be impending pathological fractures. This time we chose alpha-tricalcium phosphate cement to fill the cavities after curettage had been carried out. Harvesting a large amount of autologous bone was not required. All activities of daily life could be resumed immediately after surgery and none of the finger joints showed further restriction of motion. X-rays taken three years after the operation showed new bone ingrowth surrounding the material with little evidence of absorption. To our knowledge, this may be the first case of Ollier's disease treated with artificial bone grafting reported in the English literature.     

超声造影在泌尿系肿瘤中的临床应用分析

目的探讨泌尿系肿瘤超声造影声像图特点及超声造影对泌尿系良恶性肿瘤鉴别诊断的价值与造影剂的用量。方法对38例疑似泌尿系（包括肾脏、输尿管及膀胱）肿瘤的患者行超声造影检查,分析声像图表现特征、诊断准确率及造影剂用量。所有纳入病例结果均经活检或手术证实。结果纳入的38例患者中,6例肾脏恶性肿瘤,15例良性病变,1例常规超声诊断为肾癌,经造影证实为肾上腺癌;1例输尿管恶性肿瘤;12例膀胱癌,3例膀胱良性病变;超声诊断与手术病理结果对比,超声诊断准确率为97．4％（37／38例）。泌尿系肿瘤的超声造影表现有其特征性,由于血供特点不同,肾脏肿瘤造影剂用量1～1．5m1,而输尿管及膀胱肿瘤则需要1．5～2．0ml。结论超声造影能精确显示肿块的血供及微血管循环,提高了泌尿系肿瘤的定性诊断及良恶性鉴别的准确率。     

不同类型锤状指的诊断治疗

目的探讨不同类型锤状指的诊断与治疗方法。方法根据15例锤状指患者不同的损伤类型选择相应的手术方法进行治疗。结果术后随访3个月~2年,所有患者锤状指畸形均矫正,手术切口均Ⅰ期愈合,无皮缘坏死。远指间关节屈曲良好,关节活动度(TAM)评分优良率达100%。结论根据不同原因引起的锤状指选择适合的治疗方法,可以获得良好的手指外观和功能。     

Herpetic whitlow.

Three cases of herpetic whitlow are reported. This occupational hazard of medical and paramedical personnel caused by finger infection by ther herpes simplex virus is often confused with bacterial (pyogenic) infection of the pulp of the finger or thumb. Unnecessary surgical drainage may then be carried out, with prolongation of morbidity. Wider recognition of this entity should enable a correct clinical diagnosis to be made in every case. The treatment is conservative as the condition is self-limiting. Topical application of idoxuridine appears to be beneficial.     

活动期瘤样钙质沉着症13例分析

目的:探讨活动期瘤样钙质沉着症的临床表现、组织病理学改变.方法:对13例活动期瘤样钙质沉着症临床资料和病理特征进行回顾性分析.结果:13例活动期瘤样钙质沉着症中,男7例,女6例;年龄16～65岁.病程1～11年.多发肿块3例;单个肿块10例.结论:活动期瘤样钙质沉着症临床表现为无痛性包块,发生于骨旁或关节周围,不累及骨或关节.X线摄片呈特征性的钙化阴影.组织学表现呈多囊性或实质性硬结节;囊壁内衬肉芽组织,囊腔内为无定形的钙盐颗粒.     

左肾上腺囊性成熟性畸胎瘤1例报告

目的探讨肾上腺畸胎瘤的诊断、鉴别诊断、临床表现及治疗方法。方法分析1例老年女性合并糖尿病患者,体检时B超
发现左肾多发囊性占位,腹部CT平扫及增强检查显示左侧肾上腺区混杂密度肿块影,直径约9.0 cm,密度欠均匀,遂待血糖水
平控制尚可后行手术切除,术后病理报告可见肿物呈多房性,囊内有少量油脂样,囊壁厚0.2~0.4 cm,切面见骨骼,表面有脂肪组
织,考虑为囊性成熟性畸胎瘤。临床表现及治疗方法通过查询国内外文献获得。结果最终诊断为左侧囊性成熟性畸胎瘤,手
术切除后随访半年,效果良好,未见局部复发及转移。结论肾上腺成熟畸胎瘤是较为罕见的一种生殖细胞来源肿瘤,有恶变风
险,可通过B超及CT检查特点初步诊断,应注意与其它肾上腺源性肿瘤的鉴别,及早诊断及手术切除是治疗关键,不能手术切
除或潜在恶性者则行联合化疗,病理检查确定诊断,需要终身随访。