肝脏孤立性坏死结节的临床病理分析(附20例报告)

目的 分析肝脏孤立性坏死结节的病理、影像学表现,以提高其诊断正确率.方法 收集20例手术病理证实的肝孤立性坏死结节,对照病理,分析其在超声、CT及MRI上的表现.结果 肝孤立性坏死结节超声表现为内部回声欠均匀的低回声结节;CT表现为边缘清楚、无强化的低密度灶,在MRI的T1WI及T2WI分别呈低信号及等信号,增强后病灶内部不强化,有细环状轻度延迟强化的包膜.组织病理显示全部为凝固坏死结节,外周薄层纤维包膜中有淋巴细胞、浆细胞、嗜酸性粒细胞及少数的中性白细胞浸润.结论 平扫加动态增强MRI能良好反映孤立性坏死结节的病理特征,其表现具有高度的诊断特异性,据此可以与炎性假瘤、原发性或继发性小肝癌区分开来.     

肝脏孤立性坏死结节十例

目的 探讨肝脏孤立性坏死结节的临床表现、治疗方法和预后.方法 回顾性分析经手术治疗的10例肝脏孤立性坏死结节患者的临床资料.结果 该病好发于男性(7/10),中位年龄47岁.患者多无临床症状(8/10);多不合并肝炎病毒感染,肿瘤标记物CA199,AFP,CEA等正常.本组9例患者为单发病灶,l例为2个病灶,其中7个病灶位于肝左叶,4个病灶位于肝右叶.结节大小为(2.9±1.1) cm.MRI检查T1WI扫描肿瘤呈低信号或中信号,T2WI扫描肿瘤呈低或稍高信号,增强扫描无强化或有周边强化,MRI有较高的诊断准确率,达66.7％ (4/6).术前穿刺活检较难定性.术后病理检查提示病灶结节中心由坏死的肝细胞组成,周边为增生的纤维细胞、炎性细胞及多核巨细胞,5例患者存在肝组织脂肪变性.10例患者病灶均经手术切除,经随访6～67个月,无复发.结论 该病病因尚未达成共识,由于临床少见,临床医师认识不足,容易误诊,如能诊断准确,可随访观察,本病预后良好.     

肝脏孤立性坏死结节15例诊治分析

目的探讨肝脏孤立性坏死结节的诊断和治疗方法。方法回顾性分析1999年6月至2005年12月收治的15例肝脏孤立性坏死结节患者的临床资料,结合文献对其临床症状、影像学特点、诊断和治疗方法进行总结。结果15例患者中右上腹隐痛不适者7例（46．7％）,乏力1例（6．7％）,低热1例（6．7％）。B超检查肝孤立性坏死结节显示为边界尚清、回声欠均的低回声结节。CT平扫呈相对肝实质的低密度病灶,增强后在动脉、门静脉期均无强化。磁共振成像检查T1W1上病变呈边界清楚的相对于肝实质的低信号,在T2WI上病灶为等或相对低信号。组织病理学检查示病灶内为大片凝固性坏死,无组织细胞结构,周边有纤维组织包绕,其中含淋巴细胞、浆细胞和单核细胞。实验室检查提示肝功能轻度异常3例,甲胎蛋白定量定性均为阴性。术前正确诊断4例（26．7％）。15例均行手术切除,经3个月～6年的随访,无复发。结论结合临床特点和影像学表现的综合分析有助于术前诊断肝脏孤立性坏死结节。手术切除是主要的治疗方法。     

肝脏孤立性坏死结节的诊断与治疗:附76例报告

目的探讨肝脏孤立性坏死结节（SNN）的准确诊断及合理治疗方法。方法回顾性分析近3年来收治的76例SNN病人的临床、病理、影像学资料及治疗效果。结果大多数SNN病人无明显症状，血清学检查正常。病理显示病灶内部为凝固性坏死，周边纤维组织包绕，并可见炎细胞浸润。大多数病灶超声为内部欠均匀的低回声结节，CT平扫为低密度，T1W、T2W为等或低信号，CT、MRI增强扫描后病灶无强化，少数病灶可见轻度延迟强化的包膜。手术切除疗效确切，术后随访无复发。结论肝脏孤立性坏死结节无特异性临床表现，CT、MRI增强扫描对SNN有较高的诊断价值；手术切除是SNN首选的治疗方法，但对诊断明确而瘤体较小者，可密切随访及定期观察。     

婴儿型肝血管内皮细胞瘤的影像学诊断价值

目的 探讨婴儿型肝血管内皮细胞瘤的影像学表现及诊断价值.方法 回顾性分析15例婴儿型肝血管内皮细胞瘤的影像学表现,所有病例均行超声检查,10例行CT检查,7例行MRI检查.结果 15例中,单发病灶9例,多发病灶6例.影像学特点：肝内单发、多发及弥漫性结节或肿块,边界多清晰,病灶内或周围可见丰富血管影.超声以低回声为主,也可为高回声或混杂回声,多普勒超声检查示病灶血供丰富.CT平扫呈低密度灶,伴有斑点、斑片、条索状钙化.增强扫描示小病灶动脉期均匀明显强化或环行强化,延迟期持续强化;大病灶动脉期边缘呈环形及花瓣样强化,延迟期持续向心性强化,中心区域可见条索状血管样强化及未强化区域.MRI表现为不均匀长T1长T2信号,混杂出血、坏死及迂曲流空血管.结论 婴儿型肝血管内皮细胞瘤影像学表现具有一定特征.超声应作为筛查和随访的重要手段,CT和MR对早期定性诊断有帮助.     

CT和MRI对胰岛素瘤的诊断价值

目的　探讨胰岛素瘤的多层螺旋CT(MSCT)和磁共振成像(MRI)的影像学特征。方法　回顾性分析18例经手术病理证实的胰岛素瘤的MSCT及MRI表现。结果　18例胰岛素瘤除1例为多发外其余均为单发,最大径0.3～2.0 cm。MSCT平扫多呈等密度或稍低密度结节,MRI平扫病灶呈T1WI为低或稍低信号,T2WI为高或稍高信号。MSCT及MRI动态增强扫描动脉期明显强化,实质期和门脉期强化降为等密度。 结论 胰岛素瘤的影像学表现具有一定的特征性,反映了胰岛素瘤的病理特点。MSCT动态增强应作为胰岛素瘤首选筛查手段,合理使用MSCT动态增强与MRI检查能显著提高诊断胰岛素瘤的检出率。     

CT及MRI在肝脏局灶性结节增生中的诊断价值

目的评价螺旋CT和MRI在肝脏局灶性结节增生(focal nodular hyperplasia,FNH)中的临床诊断价值。方法收集18例(24灶)经手术切除或病理活检确诊为FNH的患者的CT、MRI资料并分析,13例行CT扫描,11例行MRI扫描,6例同时行CT及MRI扫描。结果 13例CT检查出15个病灶,平扫呈低密度12个、等密度3个,其中9个可见中央更低密度瘢痕;增强扫描动脉期所有病灶均明显强化,中央瘢痕组织无强化,病灶边界均显示清晰,无明显包膜;门脉期病灶密度较前降低,呈稍高密度或等密度;延迟期病灶以等密度为主,6个瘢痕组织出现强化。11例MRI检查出14个病灶,平扫T1WI呈等或稍低信号,T2WI呈稍高或等信号;11个见瘢痕组织,在T1WI呈低信号,T2WI呈明显高信号;增强扫描动脉期病灶均匀强化呈高信号,中央瘢痕呈低信号;门脉期及延迟期病灶强化下降呈稍高或等信号,瘢痕组织可见延迟强化。结论 CT及MRI能显示FNH的特征性改变,具有较高的敏感性、准确性,是临床诊断FNH的有效方法。     

胰腺神经内分泌肿瘤的CT和MRI表现

目的探讨胰腺神经内分泌肿瘤的影像特征。方法分析43例经手术后病理证实的胰腺神经内分泌肿瘤的CT和MRI资料,并与手术病理结果对照。结果 43个病灶平均大小为(25.00±1.82)mm,23个病灶出现坏死囊变;CT平扫15个病灶呈等密度,28个病灶呈稍低密度;43个病灶T1WI均呈低/稍低信号,27个病灶T2WI呈高/稍高信号,16个病灶T2WI呈等信号;26个病灶见包膜;30个病灶显示清晰轮廓;24个病灶增强扫描动脉期病灶即明显强化,8个呈延迟强化,5个呈向心性强化,6个呈轻度强化。结论胰腺神经内分泌肿瘤形态及CT和MRI动态增强扫描具有特征性表现,影像学检查对诊断其具有重要价值。     

肝脏局灶性结节性增生的临床及影像学诊断

目的 探讨肝脏局灶性结节性增生(FNH)的临床及影像学特征从而提高其诊断率.方法 回顾性分析17例术后病理证实为FNH的临床表现及影像学资料.结果 男4例,女13例,年龄23 ～ 52岁,平均34.8岁.无明显临床症状或轻微腹胀.单病灶15例,多发病灶2例;多位于肝包膜下,直径小于5 cm,形态不规则,边缘分叶多见,边界清晰.MSCT及MRI检查,13例病灶密度或信号欠均匀,增强动脉期呈快速明显强化,中央星状纤维瘢痕无强化,而于延迟期明显强化.4例病灶无明显中央纤维瘢痕,而明显均匀强化.10例病灶在DWI上呈稍高信号,其内中央纤维瘢痕为低信号;17例病灶均无明显包膜或假包膜结构.结论 FNH多见于青中年女性,多数无明显症状,CT和MRI检查呈星状纤维瘢痕延迟性强化是其特征性影像表现,可为临床正确诊断提供重要帮助.     

附睾结核的MRI 诊断价值

目的 分析附睾结核的MRI 表现,总结其MRI 的诊断要点.方法 对8 例经病理确诊为附睾结核的MRI 进行回顾性分析,重点分析其部位、形态、MRI 信号、强化方式及泌尿生殖系其他部位的情况.结果 8 例患者中2 例为局限于附睾附睾头的单发实性圆形小结节灶,6 例累及整个附睾弥漫性或多发形态不规则结节灶;4 例为实性病灶,2 例为囊实性病灶;8 例病灶实性部分T1WI 均呈等信号,T2WI 均呈低信号,囊性部分T1WI 呈低信号,T2WI 呈高信号.增强扫描8 例病灶中T2WI 呈低信号实性部分均明显强化.8 例患者中伴有泌尿系、睾丸、前列腺、精囊腺、肺结核分别为4 例、4 例、2 例、1 例及1 例.结论 附睾结核常伴发其他泌尿生殖系结核,典型的附睾结核多累及整个附睾,表现为在T2WI 呈低信号的实性病灶,且增强扫描明显强化,此MRI 特异性表现可以对附睾结核进行准确定位和早期诊断.     

睾丸良性肿瘤的诊断和治疗——附8例临床病例报告及文献复习

目的探讨睾丸良性肿瘤的临床特点以提高诊治水平。方法回顾性分析我院20年间诊治的8例睾丸良性肿瘤患者的临床资料。结果患者年龄9个月～47岁,病理诊断为单侧睾丸畸胎瘤3例,单侧睾丸纤维瘤、表皮样囊肿、腺瘤样瘤、多房性囊肿各1例,双侧皮样囊肿1例。对其中5例行睾丸肿瘤切除术,3例行睾丸根治性切除术。随访9个月至23年,平均8.37年,均无复发。结论睾丸良性肿瘤并不罕见,值得重视,保留睾丸的肿瘤切除手术是有益的。     

脾脏淋巴管瘤临床特点分析(附6例报告)

目的 探讨脾脏淋巴管瘤的临床、影像及病理学特点.方法 回顾性分析于2006年1月～2009年12月在我院进行手术治疗的6例脾脏淋巴管瘤患者,包括一般情况、临床表现、体检资料、实验室及影像学检查结果,并通过电话方式进行随访.结果 6例患者中,男3例,女3例,年龄18～57岁,平均40.5岁.3例患者为体检发现,另3例有...     

先天性胆总管囊肿手术治疗体会

目的 总结先天性胆总管囊肿手术治疗的经验体会.方法 回顾分析我院自1998年1月至2006年7月收治先天性胆总管囊肿76例的临床资料.结果 65例接受根治性手术治疗,术后胰漏2例,均经保守治疗痊愈,无胆管损伤,随访期内未见吻合口狭窄.结论 先天性胆总管囊肿的治疗要充分注意病史和临床表现的多样性特点,选择合适的手术时机及手术方式,手术中根据具体病人的解剖病理情况,结合影像学及病史特点,合理处理关键细节,是手术取得完美效果的关键.     

Apocrine Metaplasia Found at MR Biopsy: Is There Something to be Learned?

The purpose of this study was to determine (a) the frequency of apocrine metaplasia (ApoM) found on MR core biopsy of suspicious findings, and (b) to determine if there are specific MR imaging features that might obviate the need for biopsy. This HIPAA‐compliant retrospective study was performed under IRB exemption for quality assurance studies. Patient demographics, MR imaging features, and pathology were reviewed. Breast lesions which underwent MR‐guided biopsy, yielding ApoM on pathology analysis were included. Retrospective review of MR imaging features of these lesions was performed by two radiologists blinded to pathology results except for the presence of ApoM. Imaging features on MR assessed included location, size, morphology, T1 and T2 signals, and enhancement kinetics. Full pathology results were subsequently reviewed during data analysis. The pathology slides and imaging was subsequently reviewed by two fellowship trained radiologists and a breast pathologist to categorize the finding of ApoM into target lesion (imaging corresponds to size of lesion on pathology) versus incidental lesion. Target lesion characteristics were assessed to determine specific MRI features of ApoM. Between January 2011 to November 2012, 155 distinct breast lesions suspicious for malignancy successfully underwent MR‐guided biopsy. Of the 155 lesions biopsied, 123 (79%) were benign and 32 (21%) were malignant. Of the 123 benign biopsies, ApoM was found in 57 (46%), of which 35 (61%) had no associated atypia and 22 (39%) had associated atypia. Of the 32 malignant biopsies, three (9%) had associated ApoM (DCIS in two cases and DCIS/LCIS in one case). Of the 60 cases with ApoM, only 11 (18.3%) were target lesions and 49 were incidental lesions (81.7%). Of the 60 cases with ApoM, 35 (58%) were masses (average size 0.8 cm for both with or without atypia) and 25 (42%) were nonmass enhancement (NME) (average size 2.1 cm with and 1.0 cm without atypia). Only five (14%) of 35 masses demonstrated spiculated margins, of which four were associated with atypia (80%). Of 22 lesions with atypia or other high‐risk lesion, 14 (64%) were masses, most commonly with irregular margins (64%). Of the 12 T2 hyperintense lesions, only two (1.7)% had associated atypia or high‐risk lesion, and none were associated with malignancy. Of the 11 target lesions, seven were T2 hyperintense. Enhancement kinetics were variable: 30 (50%) showed mixed persistent and plateau kinetics, eight (13%) persistent delayed enhancement, 10 (17%) plateau kinetics, four (7%) washout kinetics, and eight (13%) were below threshold for kinetic analysis. ApoM is a common benign pathologic result at MR‐guided core biopsy for both masses and NME accounting for 39% of all biopsy results in this series. Although there is considerable variability in imaging characteristics on MR, our results suggest biopsy may be safely obviated for lesions that are subcentimeter T2 hyperintense areas of NME and short term follow‐up imaging may be a reasonable alternative for these lesions.     

Hepatic pseudotumor in long-standing biliary atresia patients undergoing liver transplantation.

A pseudotumor, giant regenerative nodule, or macroregenerative nodule is an unusual benign hepatic lesion in biliary atresia (BA) patients. This tumor may mimic malignant transformation and may preclude liver transplantation (LT). The clinical and imaging surveillance of patients after the Kasai procedure is therefore an important aspect of management of BA patients. Our objective is to report our experience and describe the incidence, imaging, and pathologic features of pseudotumors in BA patients awaiting LT. From August 1990 to December 2006, 133 LTs for BA were performed. Five (3.8%; 4 female, 1 male) patients were diagnosed with pseudotumor. The patients' records were reviewed. The diagnostic imaging modalities used were abdominal ultrasound (US), computed tomography (CT) scan, and magnetic resonance imaging (MRI). Histologic confirmation of the lesions was obtained in all cases. All underwent the Kasai operation in early infancy. Six of 7 lesions in 4 of 5 patients were demonstrated by pretransplant imaging. Two of 7 tumors were detected by US. Five of 7 lesions were detected by CT, and 5 of 7 lesions were demonstrated by MRI. In 1 patient, the lesion was not seen in the US, CT, or MRI but was found during surgery and confirmed by histology. An additional tumor was found incidentally during histologic examination in a patient previously diagnosed to have 2 tumors by CT and MRI. In another patient diagnosed to have 2 tumors on imaging, pathology revealed only a single tumor. In conclusion, although unusual, pseudotumor should be included in the differential diagnosis of liver masses in BA children.     

Biologic significance of false-positive magnetic resonance imaging enhancement in the setting of ductal carcinoma in situ

BACKGROUND: Imaging patterns of benign proliferative processes often complicate the assessment of ductal carcinoma in situ (DCIS) by magnetic resonance imaging (MRI). We investigated the pathologic and biologic characteristics of false positive enhancement by breast MRI. METHODS: DCIS (n = 45), benign (n = 5), and false-positive (MRI enhancement and nonmalignant pathology) (n = 10) cases were characterized by immunohistochemistry and MRI features. RESULTS: For DCIS cases, images that overestimated pathologic size had heterogeneous enhancement on MR, were estrogen receptor positive, and were low grade by pathology. False-positives had higher rates of proliferation, angiogenesis, and inflammation compared with benign tissue but lower values than DCIS. Benign proliferative processes accounted for all false-positive and size overestimated cases. CONCLUSIONS: Lesions that enhance on MRI have higher proliferation, angiogenesis, and inflammation compared with nonproliferative breast tissue. Benign proliferative processes often enhance on MRI and are difficult to differentiate from low-grade, ER+ DCIS lesions. False-positive MRI enhancement may reflect a spectrum of change within high-risk tissue.     

Tumor like swellings arising from Hoffa's fat pad: A report of three patients

We report three rare cases of tumor-like conditions arising from Hoffa''s fat pad (HFP). Patients were having persistent knee pain, the cause of which was not diagnosed by the general physician, and then were referred to us for knee pain. Magnetic resonance imaging revealed the lesions to be arising from HFP (ganglion cysts and hemangioma), as was suggested by clinical findings. Anatomy, pathology, and radiological features of the Hoffa''s disease are described here to increase awareness in orthopedic community of this rare but interesting disease which is often misdiagnosed as meniscal pathology. These cases illustrate that increased cognizance can facilitate timely intervention which will prevent morbidity of the patient.     

Association between intravascular microthrombosis and cerebral ischemia in traumatic brain injury

OBJECTIVE: To determine the association between traumatic cerebral ischemia and intravascular thrombosis, a common finding after traumatic brain injury (TBI). METHODS: We reviewed samples of the frontal cortex and hippocampus from individuals who had sustained a fatal TBI. Sections stained with hematoxylin and eosin were reviewed and rated for severity of selective neuronal necrosis (SNN). Because intravascular fibrin microthrombi may lyse within a few days of TBI, we restricted our analysis to patients who had died within 48 hours of injury. Medical records in all cases were reviewed to rule out severe or prolonged hypotension or hypoxemia. Eleven patients with severe or global SNN were compared with 11 patients in whom SNN was mild or absent. Slides adjacent to the hematoxylin and eosin sections were stained with an immunofluorescent antibody to antithrombin III and were reviewed for intravascular microthrombosis. The number of microthrombi on each slide was counted by an investigator blinded to the hematoxylin and eosin findings, and density of intravascular microthrombi was calculated. RESULTS: Intravascular microthrombi were noted in every section, excluding control (non-TBI) brain tissue. However, the density of microthrombi varied with the degree of SNN. We found a highly significant difference in the mean density of microthrombi between patients with severe SNN (7.74 +/- 3.7/cm(2)) and those with little or no SNN (2.58 +/- 1.0/cm(2)). Furthermore, a good correlation was noted between the location of intravascular microthrombi and that of SNN. CONCLUSION: These data support a strong link between intravascular microthrombosis and neuronal death after brain trauma in humans and may have important implications for new therapeutic approaches.     

三例胆囊神经内分泌癌的病理特点及诊疗体会

目的 探讨胆囊神经内分泌癌（gallbladder-neuroendocrine carcinomas,GB-NECs）的病理特点及诊疗预后。方法 收集2015年5月至2019年5月期间湖南师范大学附属第一医院收治的3例GB-NECs,回顾性分析该3例患者的病史、实验室检查、影像学检查、治疗方案,探讨患者术后病理特点及其预后。结果 3例患者中男1例,女2例,年龄52～68岁,2例行根治性手术,1例仅行穿刺活检术,术后病理均证实为GB-NECs。术后病理及免疫组化：2例由腺癌和神经内分泌肿瘤（neuroendocrine tumours,NETs）两种成分组成,1例NETs呈弥漫片状生长。免疫组化：Syn、CgA联合阳性率100%,Ki-67阳性指数为75%～85%。3例GB-NECs均为G3级,且恶性程度较高。2例行根治性手术患者未行进一步辅助化疗,1例行穿刺活检术患者仅行进一步姑息化疗。3例患者生存时间分别为8个月、大于10个月、3个月。结论 GBNECs的确诊主要是通过术后病理及免疫组化。手术是主要的治疗手段,手术治疗能明显延长患者生存期。