原发性肺混合性恶性肿瘤的X线诊断(附四例报告及文献复习)

目的探讨X线对原发性肺混合性恶性肿瘤的诊断价值。方法回顾性分析经手术、病理证实的原发性肺混合性恶性肿瘤患者4例及收集文献报道的86例的X线表现。结果肺母细胞瘤39例，肺癌肉瘤51例。82例X线显示肺内肿块。结论原发性肺混合性恶性肿瘤的肿瘤体积大和病灶可多发是较有特点的X线征象，与肺癌鉴别较困难。     

肺原发性肉瘤的X线征象(附6例报告)

本文分析比较了6例肺原发性内瘤患者的x线表现、手术和病理所见,提出肺肉瘤块影以单侧单发、较大、类圆形、边缘光整等为基本x线征象,浅分叶征和边缘结节征则具有特征性诊断价值。     

原发性肺肉瘤的CT诊断

目的 探讨原发性肺肉瘤的CT表现及诊断价值。方法 回顾性分析3例经病理证实的原发性肺肉瘤的临床和CT检查资料。结果 3例均为男性,年龄分别为16、44、71岁。属平滑肌肉瘤、横纹肌肉瘤和滑膜肉瘤各1例,其中中央型1例,周围型2例。中央型表现为肺门结节,支气管壁增厚,管腔狭窄及阻塞性改变。周围型表现为肺内巨大肿块伴点状、斑片状钙化,增强明显强化,边界清楚,密度不均,无纵隔及肺门淋巴结转移。结论 原发性肺肉瘤中央型CT表现难与肺癌鉴别,周围型有一定的特征性,有助于临床诊断。     

原发性小肠恶性淋巴瘤临床及X线表现

目的:探讨原发性小肠恶性淋巴瘤的临床特点及X线诊断。方法:分析了10 例经活检手术病理证实的小肠原发性恶性淋巴瘤临床资料及X线征象。结果:10例中,原发 于回肠及回盲部共6例(6/10),空肠3例(3/10),空回肠交界处1例(1/10),X线表现为较 长范围的不规则管腔僵硬,结节息肉样多发腔内充盈缺损,粘膜中断破坏,少有肠管狭窄及 梗阻。临床表现以腹痛、腹块、腹胀、贫血、消瘦等为主。结论:原发性小肠恶性淋巴瘤X线表 现有一定的特点,若能结合临床表现观察X线征象,可望术前确诊。     

肾钙乳的X线诊断——附7例报告

结合7例肾钙乳,就x线诊断问题进行了讨论。肾钙乳积水型多于囊肿型,多数病例合并肾(或输尿管)结石。本病无特殊临床症状,术前确诊有赖于x线检查。x线特征性表现为“麻饼征象”与“含钙液面”。     

原发性骨上皮样血管肉瘤的影像学分析

目的探讨原发性骨上皮样血管肉瘤的影像特点,以提高其影像诊断水平。方法回顾性分析6例经病理证实原发性骨上皮样血管肉瘤的影像学表现。其中男2例,女4例,中位年龄51.7岁,病程1¹2个月。结果6例原发性骨上皮样血管肉瘤患者均行影像学检查,其中单独行X线平片检查1例,X线平片+CT 1例,X线平片+MR 2例,X线平片+CT+MR 2例。X线平片及CT表现:5例为单发病灶,1例为多中心发病;5例呈斑片状、地图样的溶骨性骨质破坏,呈轻度膨胀,无硬化边、钙化及骨膜反应;1例呈皂泡状明显膨胀生长,可见基本完整的硬化边,瘤内可见不规则钙化影。MR表现:肿瘤呈等T1、长T2信号影,增强扫描肿瘤呈明显不均匀强化,呈等、稍高或低T1WI信号,T2WT高信号,1例瘤内可见小片状长T1、T2区。结论原发性骨上皮样血管肉瘤是-种以肿瘤性内皮细胞呈上皮样形态为其特征的高度恶性血管源性肿瘤,影像表现缺乏特征性,确诊依靠病理检查。     

原发性肺滑膜肉瘤2例并文献复习

目的：通过探讨原发性肺滑膜肉瘤的临床症状,病理学及影像学表现,提高对本病的认识。方法总结2例资料完整的原发性肺滑膜肉瘤的临床表现,病理学特征及影像学表现,2例患者均行胸部X线及CT检查,均手术切除肿物及病理学检查。结果临床表现为咳嗽、咳痰或胸痛。病理学检查提示为梭形细胞恶性肿瘤,瘤细胞呈流水状排列,核分裂象易见,免疫组化EMA、Bcl-2、Vimentin等阳性。影像学表现为肺部肿块影,边缘清楚或呈分叶状,病灶密度不均匀,增强扫描呈不均匀强化,可伴纵隔淋巴结肿大及胸腔积液。结论肺的滑膜肉瘤临床表现及影像学表现上无特异性,不易与其他肺或胸膜原发性肉瘤相鉴别,需要结合病理及免疫组化结果进行诊断。     

4例原发性肺肉瘤样癌的影像表现(附文献复习)

目的探讨原发性肺肉瘤样癌（PLSC）的影像表现,提高对该病的认识。方法对经病理证实的4例PLSC的临床、X线胸片、CT和病理资料进行回顾性分析。结果 4例PLSCX线胸片和CT均表现为肺内直径3.0cm～7.5cm团块状实质性病灶;肿块均为周围型;2例肿块边界清楚,密度均匀;2例病灶呈浅分叶状,有短毛刺;4例肿块均侵犯邻近胸膜;2例纵隔淋巴结肿大;1例左侧肾上腺转移。病理及免疫组化检查显示3例单一肉瘤样癌,1例多形性癌为肉瘤样癌伴腺癌Ⅱ～Ⅲ级;4例波形蛋白（Vim）及细胞角蛋白（CK）均阳性,1例上皮膜抗原（EMA）阳性,1例S-100阳性。结论周围型PLSC在CT上具有相对特征性表现,免疫组织化学Vimentin、CK有助于确诊。     

肋骨原发性尤文氏肉瘤——附4例报道及文献复习

目的报道4例肋骨原发性尤文氏肉瘤井结合文献复习,对其临床表现、X线特征、组织发生、治疗和预后进行讨论。力法收集4例肋骨原发性尤文氏肉瘤,复习临床和病理资料以及X线照片,对其标本蜡块进行免疫组织化学检测。结果患名年龄17岁-34岁,中位年龄21岁。4例均有胸部肿块及疼痛,x线主要表现为肋骨溶骨性破坏,手术所见4例均有肋骨骨质破坏和周围软组织浸润。结论肋骨原发性尤文氏肉瘤少见,诊断上要与肋骨化脓性骨髓炎、结核病及继发性骨肿瘤等鉴别,最后确诊要依靠病理学检查并与临床表现和x线表现相结合来证实。     

原发性骨内滑膜肉瘤的X线表现(附23例分析)

滑膜肉瘤是一种少见的恶性肿瘤,最常见于关节附近的软组织,原发于骨内者非常罕见。本文报告23例经手术、病理证实的原发性骨内滑膜肉瘤。作者认为,尽管骨内滑膜肉瘤在X线上并无特征性表现,但某些征象对诊断有一定帮助。这些征象是:X线表现的多     

滑膜肉瘤影像学表现的再探讨

目的: 再次探讨滑膜肉瘤的影像学特征.方法: 回顾性分析手术后病理确诊的16例滑膜肉瘤的临床及影像学资料,同时收集发生于躯干、四肢的22例其它软组织恶性肿瘤的影像学资料做对照研究.统计学方法采用四格表的确切概率法.结果: 87.5%(14/16)的滑膜肉瘤邻近关节,对照组中13.6%(3/22)的肿瘤邻近关节,两组比较有统计学差异(P《0.05);37.5%(6/16)的滑膜肉瘤有钙化,对照组中1例钙化,两组比较有统计学差异(P《0.05);31.25%(5/16)的滑膜肉瘤出现相邻骨质囊状破坏,对照组中无1例出现囊状骨质破坏,两组比较有统计学差异(P《0.05);磁共振T2WI/STIR像上62.5%(5/8)的滑膜肉瘤肿瘤内呈"卵石"状稍高信号结节,其间有低信号间隔,对照组中无1例类似表现,两组比较有统计学差异(P《0.05).结论: 滑膜肉瘤的一些影像学特点对其在软组织恶性肿瘤中的定性诊断有重要的价值.     

Primary sarcoma of the ovary: clinicopathological characteristics, prognostic factors and evaluation of therapy

Background  The primary ovarian sarcoma is a very rare malignancy. The objective of this study was to further investigate the clinicopathologic features and outcome in patients with primary sarcoma of the ovary.

Methods  Between 1988 and 2007, 24 patients with primary ovarian sarcoma who underwent treatment at Peking Union Medical Hospital were reviewed retrospectively. Response to treatment, progression and overall survival were analyzed.

Results  Patients with ovarian sarcoma had a mean age of (54.3±10.3) years, and 16 of them were postmenopausal. The most common symptom was abdominal pain, present in 14 patients. Of the 24 patients, 16 patients were pathologically diagnosed as carcinosarcoma (known as malignant mixed mesodermal tumor (MMMT)), 2 as ovarian leiomyosarcoma (LS) and 6 patients as ovarian endometrial stromal sarcoma (ESS). The patients in optimal debulking group had a median survival period of 28 months and 1-year survival rate of 71%. The patients in suboptimal debulking group had a significantly lower median survival of 6 months (P=0.02) and 1-year survival rate of 29%. Among the patients, 23 patients received chemotherapy and most of regimens were based on platinum, 3 patients received chemoradiation. The mean number of courses of combined chemotherapy was 6.6±5.0, and the response was unsatisfactory. The median survival for the entire group was 18.7 months. The one-year survival rate was 58%, and two-year survival rate only 29%.

Conclusions  Ovarian primary sarcoma has a poor overall prognosis. Optimal debulking surgery appears to be of prognostic significance. There is a clear need for further study to explore the role and the regimen of platinum-based chemotherapy in primary ovarian sarcoma.

     

前列腺肉瘤的临床表现与MRI诊断

目的:探讨前列腺肉瘤的临床表现及MRI影像特征,提高诊断水平。方法:3例前列腺肉瘤,年龄23-45岁,中位数年龄25岁,3例均做快速自旋回波序列T1WI和T2WI轴位、矢状位和冠状位平扫,2例做增强扫描。结果:腺泡性横纹肌肉瘤2例,间质来源无法分类肉瘤1例。从始发症状到确诊约5-18月,临床症状为进行性排尿困难(2例),尿频(1例),下腹胀痛(2例),血尿(1例)。3例术前行血清酸性磷酸酶(PAP),碱性磷酸酶(AKP)及前列腺特异性抗原(PSA)检查均正常。2例2期均行手术及放化疗,1例3期未行手术,仅做化疗。术后随访2例生存8-15月,1例失访。MRI显示前列腺显著增大,呈榨菜分叶状占据盆腔的大部分,最大病灶为8.5 cm×8.3 cm×10.4 cm。T1WI信号不均,呈等或稍低信号,T2WI呈中高混杂信号,正常前列腺结构消失,中央带和外周带分界不清。1例精囊腺侵犯。增强扫描病灶明显强化,部分出现局灶性坏死区。结论:前列腺不规则显著增大及异常强化,中央带与外周带分界不清。病人年龄较轻,临床以排尿困难、下腹坠胀、尿频、血尿为主,血清PSA在正常范围,提示前列腺肉瘤。前列腺肉瘤恶性程度高,发展快,死亡率高。     

子宫肉瘤165例临床病例探讨

目的：分析探讨子宫肉瘤165例临床病例。方法研究对象为在2000年6月—2014年6月期间内,该院一共收治的165例子宫肉瘤患者。回顾性分析诊断病例结果。结果①在165例子宫肉瘤患者当中：癌肉瘤、平滑肌肉瘤、子宫内膜间质肉瘤、腺肉瘤各为70例、56例、35例、4例;②各类I期病理一共为101例,II期一共为44例,III期一共为20例;③针对患者病理期级手术方法共分为全子宫切除术、全子宫切除+盆腔淋巴结清扫术、全子宫切除术+盆腔淋巴结清扫术+化疗、全子宫切除术+盆腔淋巴结清扫术+化疗+放疗几种,不同手术方法治疗效果差异有统计学意义(P<0.05)。讨论在165例子宫肉瘤患者以癌肉瘤居多,其次是平滑肌肉瘤。期级以I期患者居多,阴道不规则流血是子宫肉瘤患者最主要的临床表现症状。掌握患者病理类型,采取对应治疗方案,有利于改善预后。     

低度恶性肌纤维母细胞性肉瘤

目的 探讨低度恶性肌纤维母细胞性肉瘤的临床病理学特征、免疫学表型及鉴别诊断.方法 对1例发生于后腹膜的低度恶性肌纤维母细胞性肉瘤进行光镜观察、免疫组化标记并结合文献进行复习.结果 肿瘤细胞呈梭形,排列成束,显示中度异型性,可见核分裂像(3～4个/10HPF).免疫表型:瘤细胞弥漫性广泛表达Vim、SMA,不表达MSA、Des、和S100蛋白.结论 低度恶性肌纤维母细胞性肉瘤是一种少见的软组织肉瘤,组织学形态及免疫表型显示瘤细胞具肌纤维母细胞性分化.应与纤维瘤病、纤维肉瘤和平滑肌肉瘤相鉴别.     

原发性卵巢平滑肌肉瘤及纤维肉瘤临床病理分析

目的:探讨原发性卵巢肉瘤的临床特点、诊断、治疗及预后。方法:分析我院2例原发性卵巢肉瘤患者的病例资料,并复习相关文献。结果:本组2例原发性卵巢肉瘤患者均未能早期确诊,病情发展快,手术难度大,预后差(1例已死亡)。结论:原发性卵巢肉瘤的早期诊断困难,主要依靠病理,核分裂像多见,病理性核分裂像可见,免疫组化显示Vimentin( )。该病恶性程度高,治疗效果及预后均差,可辅助化疗及放疗。     

Monitoring of endogenous interferon-alpha and human herpesvirus 8 in HIV-infected patients with Kaposi's sarcoma

The incidence of AIDS-associated Kaposi's sarcoma has declined since the mid-nineties due to the availability of potent antiretroviral therapy including protease inhibitors. However, Kaposi's sarcoma is still the most common neoplasia in HIV-infected patients. In the pathogenesis of the HIV-associated as well as other forms of this disease an infectious agent seems to play a role, namely the human herpesvirus 8. Even before the discovery of the HIV virus, high levels of an unusual acid-labile form of endogenous interferon alpha were found in patients with AIDS-associated KS. The administration of recombinant interferon alpha evolved as standard therapy for Kaposi's sarcoma in HIV-infected patients with a moderate immunodeficiency in addition to antiretroviral therapy. This investigation monitored the levels of HHV 8 and endogenous interferon in 4 patients with and without Kaposi's sarcoma during the course of HIV-disease. The results of our experiments lead us to two hypotheses: First of all, the pre-therapeutic level of endogenous interferon may be a predictor of the response to an interferon-alpha therapy for HIV-associated Kaposi's sarcoma. Secondly, the determination of HHV 8 DNA in blood of HIV-positive patients may allow conclusions about the risk for the development of Kaposi's sarcoma. However these hypotheses should be tested by monitoring the levels of endogenous interferon and HHV 8 DNA in clinical studies of a greater number of HIV-infected patients.     

A case of generalised cutaneous granulocytic sarcoma in an elderly patient with myelodysplastic syndrome

Granulocytic sarcoma is a rare extramedullary malignant mass composed of primitive cells of the granulocytic lineage. It can arise from any part of the body and is frequently associated with haematological diseases, commonly acute myeloid leukaemia. Rarely, it has been found in conjunction with myelodysplastic syndrome. We report a case of cutaneous granulocytic sarcoma in a 73-year-old lady. The patient presented with a two-month history of multiple skin nodules which were confirmed by skin biopsy to be granulocytic sarcoma. Bone marrow examination was consistent with myelodysplastic syndrome. Localised radiotherapy to the skin lesions were given. She died from septicaemia six months after presentation. The management of this condition presents a diagnostic and therapeutic dilemma for both the pathologist and physician. In cases which are poorly differentiated as in this case, histological diagnosis is particularly difficult. Its definitive diagnosis would then require the additional use of a broad panel of immunohistochemical and cytochemical stains.     

滤泡树突状细胞肉瘤临床病理观察

目的探讨滤泡树突状细胞肉瘤的临床病理特点及鉴别诊断。方法运用组织病理学、免疫组织化学染色,回顾性分析2例滤泡树突状细胞肉瘤的特点,并结合相关文献进行讨论。结果2例分别发生于颈部及腹股沟,瘤组织HE镜检为梭形或卵圆形肿瘤细胞,呈结节状浸润性生长方式,瘤细胞胞质丰富、嗜酸,合体状,呈片束状、编织状或旋涡状结构,有多少不等的淋巴细胞浸润。免疫组化示瘤细胞特异性表达CD21、CD35,部分表达的抗体有EMA、CD68、CD34、$100。结论滤泡树突状细胞肉瘤是一种少见的梭形或卵圆形细胞肿瘤,恶性度较低,结节状生长方式及淋巴细胞浸润对诊断可能有提示意义,CD21及CD35的表达对其确诊有重要意义。