肝脏上皮样血管内皮瘤三例

肝脏上皮样血管内皮瘤 (ｅｐｉｔｈｅｌｉｏｉｄｈｅｍａｎｇｉｏｅｎｄｏｔｈｅ ｌｉｏｍａ,ＥＨＥ)是一种极为罕见的血管源性肿瘤。 1998年1月～ 2 0 0 1年 8月 ,我院共收治 3例 ,现报告如下。例 1　患者男 ,5 7岁。右上腹胀痛 ,向腰背部放射 1个月。ＣＴ示肝脏体积缩小 ,肝裂增宽。右肝 5 .7ｃｍ× 5 .3ｃｍ低密度占位 ,内部密度不均 ,增强后不均匀强化。ＡＦＰ(- ) ,ＣＥＡ(- ) ,ＣＡ19- 9(- ) ,ＨＢｓＡｇ( ) ,ＨＢｃＡｂ( ) ,肝功能正常。手术及病理可见右肝近膈面探及肿瘤 ,与大网膜粘连明显 ,肝内无子灶 ,行右肝肿瘤切除术。肿瘤切…     

肺及胸膜上皮样血管内皮瘤一例

患者女 ,38岁。因乏力伴胸闷气促 2个月 ,右侧胸痛半月余而入院。 3年前体检发现两肺多发性结节。查体 :右侧胸廓塌陷 ,脊柱侧弯 ,右肺中下野叩浊 ,呼吸音减低。B超示右侧胸水伴机化。纤维支气管镜示右中开口狭窄。CT示两肺多发性结节伴右侧胸腔积液。对比前后CT ,发现两肺结节较前略有增大。胸膜活检示少量炎性肉芽组织及纤维疤痕组织。行开胸探查。术中见右胸病灶广泛侵犯右胸壁、右肺、右侧纵隔及心血管 ,黏连致密 ,分界不清 ,病灶质地坚硬 ,无法切除 ,遂行胸膜活检后即关胸。病理检查 :镜下见增生纤维结缔组织中单个或成巢排列的上皮…     

肝上皮样血管内皮瘤1例

患者, 女, 15 岁。因上腹部胀痛、 食欲不振 9 个月入院。无肝炎病史。查体: 生命征平稳, 腹平软, 未触及肝脾, 肝区无叩痛。胃肠镜无异常。     

纵隔多发恶性上皮样血管内皮瘤1例

患者,女,38岁.胸闷、气短5个月。查体:右前胸第4前肋以下触觉语颤减弱,叩诊实音,纵隔右界叩诊增宽。CT示右前纵隔,隆突下、气管、上腔静脉周围均可见低密度灶,CT值25Hu,右侧胸腔积液。B超示右前上纵隔气管前方见9.4×4.9cm弱光团,边界模糊,无包膜,内部回声不均,右侧胸腔积液。1994年4月行剖胸探查术,术中见右胸腔积液约1000ml,部分呈胶胨状,右前纵隔见多个肿物,表面光滑,基底界限不清,质硬韧,大小不等部分融合,最大者6×8cm,侵     

脾上皮样血管肉瘤 1例

患者 , 女 , 61岁 , 间歇性左上腹隐痛 1月余 , 于 2000年 10月 18日入院治疗 (住院号 : 288041). 查体 : 全身状况好 , 腹平坦 , 左上腹轻压痛 , 脾区轻微叩痛 . B超示脾占位 , 内有多个无回声暗区 ; CT示脾肿大 , 以脾后极更明显 , 外缘凹凸不平 , 可见多个较小的不规则类圆形低密度病灶 , 边界不清 . 强化 3 min后 , 脾脏显示出多个充盈缺损区 , 边缘清晰 . 临床诊断 : 脾脏恶性肿瘤 , 考虑为恶性淋巴瘤或血管肉瘤 . 2000年 10月 25日在全身麻醉下行脾切除手术 . 术后病理检查 (病理号 : 20008986): 切除全脾一个 , 大小为 12 cm× 8.5 cm× 4 cm, 切面见一大小为 3.5 cm× 5 cm× 4 cm的灰红色结节 , 呈分叶状 , 质软 , 可见出血及坏死区 ; 镜下见脾脏部分区域为瘤组织所代替 , 可见瘤细胞与脾血窦内皮细胞有移行 . 瘤细胞圆形、卵圆形 , 呈上皮样 , 胞体大 , 边界清楚 ; 胞浆丰富、嗜酸性 , 呈空泡状 , 偶见含有单个红细胞 ; 胞核大、淡染 , 核仁突出 , 多紧贴于核膜下 . 瘤组织中可见大量单核及多核瘤巨细胞 , 核分裂相约 15个 /10HPF. 瘤细胞弥漫呈片状排列 (图 1A), 局部见有裂隙状、管状及乳头状结构 . 瘤组织内有大片出血及坏死 , 间质有炎症细胞浸润 . 免疫组化染色 : CD34(+ )(图 1B), FVIII R(+ )(图 1C), Pan Keratin(+ ), CK8(+ ), EMA(+ ), Vimentin(+ ). 网状纤维染色 : 清晰显示大小不一的血管腔 , 瘤细胞分布成巢 , 巢周绕以网状纤维 . 病理诊断 : 脾上皮样血管肉瘤 .     

穿刺活检诊断肝上皮样血管内皮瘤一例并文献复习

1病例报告患者女,55岁。因乏力、纳差15d,发现肝脏占位10d于2010-07就诊于北京302医院。查体:无慢性肝病面容,巩膜无黄染,心肺未见异常,腹部平坦,触软,无压痛、反跳痛及肌紧张,肝脾未触及,无移动性浊音,双下肢无水肿。甲、乙、丙、戊型肝炎病毒标志均阴性,肝脏自身抗体阴性,血清肝功能、铜蓝蛋白、甲胎蛋白均在正常范围     

原发性肾脏上皮样血管内皮瘤1例报道及文献复习

[目的]探讨肾脏上皮样血管内皮瘤的诊断、鉴别诊断及治疗。[方法]结合文献对1例原发性肾脏上皮样血管内皮瘤的临床资料、病理特征、免疫表型及治疗预后进行分析。[结果]右肾下极肿物,光镜下肿瘤细胞排列成巢状、短梁状、部分区域灶性实性片状;肿瘤细胞呈圆形、多边形和较少的短梭形,瘤细胞胞浆丰富,粉红色,核呈空泡状,有一个不明显的核仁。肿瘤细胞形成小的细胞内管腔,表现为丰富的胞浆内空泡,偶尔含有红细胞,似原始血管管腔;部分区域几个短梭形细胞围成一个小腔隙,为发育较好的血管管腔。免疫表型:VIM、CD34、CD31血管内皮细胞弥漫阳性。随访11个月无复发。[结论]肾脏上皮样血管内皮瘤属罕见的低度恶性肿瘤,具有特征性的组织学结构,其形态学和免疫表型与发生于肾外者相同。治疗上应局部切除并随访。     

骨上皮样血管内皮瘤3例临床病理分析

目的 探讨骨上皮样血管内皮瘤 (epitheliod hemangioendothelialoma, EHE)的临床病理特征、诊断及鉴别诊断。方法 观察了3例骨的EHE形态学及免疫组织化学染色特点并复习相关文献。结果3例患者中,女性2例、男性1例。年龄14、35、36岁,平均28.3岁。病变均发生于下肢且呈多灶性。最常见的临床表现为局部疼痛。影像学显示边界清楚或模糊的溶骨性病变伴有硬化边。大体显示肿瘤呈卵圆形,切面灰褐色,质韧,出血明显。形态学上,肿瘤由大的多边形上皮样细胞及梭形细胞组成。两种细胞具有嗜酸性胞质、圆形或拉长的核及显著的核仁,分布于玻璃样变或黏液样基质中。在高分化区域,肿瘤细胞排列成条索或巢状伴随狭窄的小管或裂隙。但在分化差的区域,一些细胞呈弥漫实性或片层状,缺乏血管源性肿瘤的组织学表现。一些细胞出现代表原始血管的胞质内空泡,其内包含红细胞或碎片。免疫组织化学检查肿瘤细胞同时表达CD31、CD34(或FⅧRAg)及CK。辅以放、化疗的扩大切除术是治疗骨EHE的首选方法。结论 骨的上皮样血管内皮瘤是一种罕见的恶性血管源性肿瘤,需与转移癌、骨上皮样血管瘤和上皮样血管肉瘤等鉴别。     

容易误诊的纵隔上皮样血管内皮瘤1例

<正>患者女性,37岁,因体检CT发现左前上纵隔软组织肿块于2019年11月7日入院治疗。患者无眼睑下垂,无胸痛。实验室检查无特殊。影像表现：于2019年11月8日行胸部CT平扫增强（图1）及MRI增强（图2）扫描示：左前上纵隔见一类圆形软组织肿块,边界尚清,大小约为35 mm×25 mm,肿块可见多发结节状钙化（CT值约为546 HU,图1红箭）及小片状脂肪成分（CT值约为-72 HU,图1蓝箭）,     

Epithelioid haemangioendothelioma of the lung： one case report with positive pulmonary hilar lymph nodes

Pulmonary epithelioid hemangioendothelioma (PEH) is a rare tumor that occurs among young women and typically presents as bilateral multiple nodules. In this report, we described an unusual case of PEH presented as a single mass in a 46-year-old man, with 6 positive pulmonary hilar lymph nodes. Histologic findings were compared with conventional PEH, except those features such as round to oval-shaped nodules, hypocellular/cellular peripheral zone, hyaline, myxomatous intercellular stroma and intracellular vacuoles, and we found the patient’s pulmonary hilar lymph nodes were metastasis and cholesterol crystal were discovered in the focal infarction areas. Immunohistochemically, the tumor cells were strong positive for CD34, CD31, factor VIII related endothelial antigen and vimentin. The patient died 3 and half months after the surgery without receiving any radiotherapy or chemotherapy. This report may contribute to the data on clinical and histological finding of this rare tumour.     

原发性肾上皮样血管内皮瘤一例报告并文献复习

上皮样血管内皮瘤(hepatic epithelioid hemangioendothelioma,EHE)是罕见低度恶性血管肿瘤,其临床和组织学介于血管瘤和血管肉瘤之间.可在全身各部位发病,以软组织居多,也可原发于肺脏、肝脏、骨骼等器官,其中肾脏原发的报道罕见.本研究结合青岛大学附属青岛市市立医院收治的1例EHE患者...     

Intracerebral haematoma formation in Herpes simplex encephalitis: A case report

Acute viral encephalitides have a high mortality and morbidity in all age groups. Early institution of appropriate medical treatment can alter the prognosis dramatically. Imaging studies may be normal or may show a wide variety of subtle findings in the initial stages. Knowledge of the extremely varied clinical as well as radiological expression of the disease is essential to enable timely diagnosis. A case is presented here of histopathologically proven Herpes simplex encephalitis (HSE), wherein a large intracerebral haematoma was seen on imaging studies. Observation of the accompanying subtle findings and knowledge of the variability of expression of this disease helped in reaching the correct diagnosis.     

Pseudotumour due to surgical sponge: Gossypiboma

The plain-film, ultrasonography and computed tomography findings of retained surgical sponges (gossypibomas) are described in three patients. When a mass with hyperechoic wavy structures and posterior acoustic shadowing is seen on ultrasonography, the history of previous surgery must be questioned. Gossypiboma should be included in the differential diagnosis of such cases with a previous surgery. Plain film and computed tomography examinations should be obtained for correct pre-operative diagnosis.     

The clinical value of combined use of MR imaging and multi-slice spiral CT in limb salvage surgery for orthopaedic oncology patients: initial experience in nine patients

Background

The purpose of this prospective study was to evaluate the value of the combined use of MR imaging and multi-slice spiral CT for limb salvage surgery in orthopaedic oncology patients.

Patients and methods

Nine consecutive patients with lower/upper limb malignant bone tumours (7 osteosarcomas and 2 chondrosarcomas) were treated with limb-salvaging procedures. Preoperative planning including determination of the osteotomy plane and diameters of the prosthesis was performed basing on the preoperative CT and MR images. The histopathology was performed as golden diagnostic criteria to evaluate the accuracy of CT and MR-based determination for tumour’s boundary.

Results

The tumour extension measured on MRI was consistent with the actual extension (P>0.05, paired Student’s t test), while the extension measured on CT imaging was less than the actual extension. The length, offset and alignment of the affected limb were reconstructed accurately after the operation. An excellent functional outcome was achieved in all patients.

Conclusions

In the present study, MRI was found to be superior to CT for determining the tumour extension, combined use of MRI and CT measurement provided high precision for the fit of the prosthesis and excellent functional results.     

小肠系膜Kaposi型血管内皮瘤致消化道出血一例及文献回顾

Kaposi型血管内皮瘤是一种定义为中间型的血管肿瘤。本文对1例发生于小肠系膜Kaposi型血管内皮瘤患者的组织病理学、免疫表型及临床资料进行回顾性分析并文献复习。该例患者以消化道出血为主要症状,影像学示肠系膜巨大软组织肿块并侵犯回肠,临床未见卡梅诺现象(Kasabach-merritt phenomenon,KMP),光镜下可见海绵状脉管样结构,部分区域间质伴淋巴细胞聚集灶,其间散在较多由短梭形细胞瘤构成的结节,结节内瘤细胞呈纵横交错排列并形成条索或裂隙样血管。免疫组化:CD31(+),CD34(+),D2-40(+),C-Kit(-),SMA(-),Ki-67(1%)。     

Musculoskeletal desmoid tumours: Diagnostic imaging appearances

This study aimed to discuss the role medical imaging has on diagnosis of musculoskeletal desmoid tumours and to describe their radiological appearances on various imaging modalities. Imaging of histologically proven cases of desmoid tumours at St. Vincent's Hospital Melbourne were obtained via picture archiving communication system (PACS) and then assessed by two musculoskeletal radiologists. Suitable imagings were obtained from PACS. All imaging chosen was de‐identified. Desmoid tumours can occur in many areas of the body. Imaging plays an important role in the diagnosis of these tumours and magnetic resonance imaging has been the gold standard for imaging and is the most accurate in terms of assessing tumour margins and involvement of surrounding structures.     

Molecular imaging in oncology: Current impact and future directions

The authors define molecular imaging, according to the Society of Nuclear Medicine and Molecular Imaging, as the visualization, characterization, and measurement of biological processes at the molecular and cellular levels in humans and other living systems. Although practiced for many years clinically in nuclear medicine, expansion to other imaging modalities began roughly 25 years ago and has accelerated since. That acceleration derives from the continual appearance of new and highly relevant animal models of human disease, increasingly sensitive imaging devices, high-throughput methods to discover and optimize affinity agents to key cellular targets, new ways to manipulate genetic material, and expanded use of cloud computing. Greater interest by scientists in allied fields, such as chemistry, biomedical engineering, and immunology, as well as increased attention by the pharmaceutical industry, have likewise contributed to the boom in activity in recent years. Whereas researchers and clinicians have applied molecular imaging to a variety of physiologic processes and disease states, here, the authors focus on oncology, arguably where it has made its greatest impact. The main purpose of imaging in oncology is early detection to enable interception if not prevention of full-blown disease, such as the appearance of metastases. Because biochemical changes occur before changes in anatomy, molecular imaging—particularly when combined with liquid biopsy for screening purposes—promises especially early localization of disease for optimum management. Here, the authors introduce the ways and indications in which molecular imaging can be undertaken, the tools used and under development, and near-term challenges and opportunities in oncology.     

Evolution of imaging in rectal cancer: multimodality imaging with MDCT,MRI, and PET

Magnetic resonance imaging (MRI), multidetector computed tomography (MDCT), and positron emission tomography (PET) are complementary imaging modalities in the preoperative staging of patients with rectal cancer, and each offers their own individual strengths and weaknesses. MRI is the best available radiologic modality for the local staging of rectal cancers, and can play an important role in accurately distinguishing which patients should receive preoperative chemoradiation prior to total mesorectal excision. Alternatively, both MDCT and PET are considered primary modalities when performing preoperative distant staging, but are limited in their ability to locally stage rectal malignancies. This review details the role of each of these three modalities in rectal cancer staging, and how the three imaging modalities can be used in conjunction.     

Using CT or MRI to assess locoregional spread to determine the radiotherapy target of hypopharyngeal carcinoma

Aim: To identify the locoregional extension of hypopharyngeal carcinoma (HPC), particularly the invasion of the nasopharynx and skull base, and metastasis of level VI and retropharyngeal lymph node (RPLN) by investigating computed tomography (CT) and magnetic resonance (MR) images; together with the radiotherapy target of HPC. Methods: CT and MR images of 186 patients with pathologically confirmed HPC between Aug 2000 and Dec 2010 were analyzed retrospectively. We used the χ² test and logistic regression to analyze local invasion and regional spread and to determine their relationships. Results: Of the 186 patients, there was only one case of invasion of the nasopharynx without skull base involvement. The rate of regional node metastasis was 79%. There was no significant relationship between T stage and lymph node metastasis (P = 0.1). Level IV metastasis (P = 0.001), RPLN metastasis (P = 0.041) and esophageal invasion (P = 0.003) were significantly correlated with level VI metastasis. Primary tumor subsite (P = 0.024), bilateral cervical node metastasis (P < 0.001) and size of cervical nodes (P = 0.01) significantly contributed to the occurrence of RPLN metastasis. Conclusion: The locoregional spread of HPC occurs via certain routes. It is potentially unnecessary to routinely and prophylactically irradiate the nasopharynx and skull base. Patients with early stage HPC should receive bilateral cervical prophylactic irradiation. The decision regarding the administration of prophylactic irradiation to the level VI and RPLN areas should be according to the relative risk factors.