食管癌肉瘤X线诊断(附7例报告)

目的：探讨食管癌肉瘤的Ｘ线诊断。材料和方法：经手术病理证实的食管癌肉瘤７例，男５例，女２例。全部病例均行食管低张双对比造影检查。结果：根据Ｘ线表现将７例食管癌肉瘤分成息肉型和浸润型。息肉型６例，表现为腔内带蒂或宽基的肿物，呈分叶状，瘤基底周围的食管粘膜不规则破坏，呈颗粒状隆起或钡点。浸润型１例，表现为管腔狭窄、管壁僵硬、粘膜破坏，可见腔内外软组织肿块。食管癌肉瘤中癌全部为鳞癌、肉瘤中２例平滑肌肉瘤、４例纤维间质细胞肉瘤、１例恶性纤维组织细胞瘤。结论：具有上述Ｘ线表现，结合患者年龄偏大，症状相对较轻，应考虑食管癌肉瘤。     

腔内型食管癌的X线诊断－45例分析

食管癌的临床病理分型，经过吴英恺等（1）研究，提出分为髓质型，蕈伞型，溃疡型和缩窄型四型，这个分型方法经过实践证明基本上符合食管癌的临床病理表现，我院自1964年以来发现有少数肿瘤呈肿块状，息肉状，或香肠状窦入食管腔内，多数呈巨大型，与上述四型不同，经我院胸部肿瘤学组的共同研究，将其定为第五型，命名为“腔内型”（2，3），本文复习经病理证实的腔内型食管癌45例，以期提高其X线表现的认识。     

食和癌肉瘤X线诊断

探讨食管癌肉瘤的Ｘ线诊断。经手术病理证实的食管癌肉瘤７例，男５例，女２例。全部病例均行食管低张双对比造影检查。根据Ｘ线表现将７例食管癌肉瘤分成息肉型和浸润型。息肉型６例，表现为腔内带蒂或宽基的肿物，呈分叶状，瘤基底周围的食管粘膜不规则破坏，呈颗粒状隆起或钡占。     

食管恶性黑色素瘤1例报告

患者　男 ,6 5岁。饭后呃逆 2月 ,进食困难 1月。食管钡餐检查 :食管、胸中段可见 15ｃｍ长的不规则充盈缺损 ,粘膜破坏中断 ,表面呈颗粒样 ,钡剂通过明显受阻 ,但透视下病变食管尚能部分扩张。Ｘ线诊断 :食管癌肉瘤 (图 1)。ＣＴ检查 :食管腔内见软组织肿物 ,轻度均匀强化 ,肿块与管壁分界清楚 ,少部分有粘连 ,似腔内息肉状 (图 2 ) ,纵隔未见肿大淋巴结。ＣＴ诊断 :结合Ｘ线钡餐检查 ,考虑为食管癌肉瘤。食管镜检查 :食管中段有一肿物突向腔内 ,表面不光滑 ,颜色灰暗。活检病理 :恶性黑色素瘤。手术所见 :病变食管长 16ｃｍ ,粗 5ｃｍ。食…     

内镜下套扎治疗消化道息肉20例

消化道息肉是泛指消化道管腔黏膜表面向腔内突出的隆起性病变，内镜下治疗方法有高频电凝切除、微波及射频等，但对于直径〉3cm的粗蒂或广基息肉，镜下电切除易发生出血及穿孔等严重并发症。我科采用多环结扎器套扎消化道息肉，疗效满意，现报道如下。     

食道癌肉瘤的X线表现探讨及误诊原因分析

目的探讨食管癌肉瘤的X线学表现，提高对该病的认识。方法回顾性分析5例经病理证实的食管癌肉瘤，5例均行食管钡剂造影和电子纤维胃镜检查，并作病理检查和手术治疗。结果食管钡剂造影显示：病变位于食管中段2例，下段3例。食管腔扩张4例，狭窄1例。管壁柔软4例，僵硬1例。结论息肉型食管癌肉瘤有一定的X线特征性表现，浸润型食管癌肉瘤缺乏影像学特点。     

内镜下尼龙圈套扎治疗消化道巨大息肉50例临床分析

消化道息肉是泛指消化道管腔黏膜表面向腔内突出的隆起性病变，内镜下治疗方法有高频电凝切除、微波及射频等，但对于直径≥3锄的粗蒂或宽基息肉，镜下电切除易发生出血及穿孔等严重并发症。我科采用尼龙圈对消化道巨大息肉实施套扎治疗，疗效满意，现报道如下。     

浅谈食管癌的鉴别诊断

食管癌是来源于食管粘膜的恶性肿瘤，其主要特点就是破坏食管管壁，使管腔狭窄。因其不同的类型在不同的发展阶段都有其不同的X线表现，因此应于其他引起食管管壁及管腔改变的疾病相鉴别以达到对食管癌的正确诊断。在实践中本人总结了几种容易误诊为食管癌的疾病与食管癌的主要鉴别点，现浅述如下。     

食管梭形细胞鳞癌

食管梭形细胞鳞癌是一种既有癌瘤成份,又有肉瘤成份的罕见恶性肿瘤。作者报告了四例。X 线特征为:食管中1/3腔内巨大息肉样纵形肿块,伴局部管腔明显膨胀和扩张,肿瘤表面光滑,边缘呈分叶或扇具状,其构造类似圆盏形,量典型的“Cupola征”。不论肿块大小,它对流体造影剂不产生明显梗阻。可带蒂,并可有不同大小的粘膜溃疡。CT检查,两侧有食管壁增厚,仅一例伴有纵隔淋巴结肿大。作者指出,病理学早期研究中,提示肿瘤的肉瘤成份不转移,并具有良性的前景,这与后来报     

单钡双重造影法对老年食管癌的诊断价值分析

目的探讨“单钡双重造影法”对老年食道癌的诊断价值。方法对3l例经手术或病理证实的老年食道癌患者行单钡双重造影法食道吞钡检查。结果早期食管癌3例，x线表现为病变处管壁不光滑，有极轻微僵硬感。侧壁轻度凹陷，食管壁边缘毛糙，双对比片中病变部见不规则小钡斑。中晚期食道癌28例，局部粘膜皱襞中断、破坏和消失；食管腔内充盈缺损。其表面可见大小不等龛影形成；渍疡型则可见较大不规则龛影位于腔内，周边可有隆起环堤；食管壁局限性狭窄，管壁僵硬，不能扩张或蠕动，狭窄食管的近端不同程度扩张。结论食管“单钡双重造影法”简单、有效、老年人易于接受，容易配合；对诊断老年早期食管癌，观察中晚期食管癌纵向侵犯范围具有十分重要的价值。     

Polypoid epithelial malignancies of the esophagus

Polypoid epithelial malignancies of the esophagus are rare tumors. One hundred fifty cases of epithelial malignancy of the esophagus accessioned to the Registry of Radiologic Pathology at the Armed Forces Institute of Pathology were reviewed with respect to morphologic and pathologic characteristics. Only large intraluminal polypoid epithelial masses were analyzed. Criteria used to select cases were: (1) size greater than 4 cm, (2) expansion of the esophageal lumen by the bulky tumor, and (3) absence of constriction or wall infiltration. Twenty-two lesions met these criteria (15 spindle cell carcinomas, two carcinosarcomas, three squamous cell carcinomas, and two oat cell carcinomas). When an esophageal neoplasm is polypoid and bulky, creates a "cupola" effect, has scalloped edges, expands the lumen of the esophagus, and is pedunculated, one must consider spindle cell carcinoma as the primary diagnosis.     

食管癌肉瘤的X线表现(附5例报告)

目的:探讨食管癌肉瘤的X线表现,提高对该病的认识。方法:回顾性分析5例经手术病理证实的食管癌肉瘤影像资料。5例均行食管钡剂造影和电子纤维胃镜检查,5例均行手术治疗。结果:食管钡剂造影显示病变位于食管中段2例,下段3例。食管腔扩张4例,狭窄1例。管壁柔软4例,僵硬1例。结论:息肉型食管癌肉瘤有一定的X线特征性表现,浸润型食管癌肉瘤缺乏影像学特征。     

Early esophageal cancer

Early esophageal cancer (EEC) accounted for only seven (4.7%) of 148 cases of esophageal cancer diagnosed at the authors' hospital between 1977 and 1984. Two patients with EEC had squamous cell carcinoma and five had adenocarcinoma arising in Barrett's mucosa. All seven patients had associated clinical findings, including low-grade gastrointestinal bleeding (three cases), odynophagia (one case), and chronic reflux symptoms due to underlying reflux esophagitis and Barrett esophagus (three cases). Since Barrett esophagus is a premalignant condition, the high proportion of adenocarcinomas in this series presumably reflects the more frequent radiologic evaluation of symptomatic patients with Barrett esophagus. On esophagography, four patients had 3-4.5-cm polypoid intraluminal masses that could not be distinguished radiographically from advanced esophageal carcinoma. In the other three patients, esophagrams revealed secondary achalasia, irregular flattening of the esophageal wall, and diffuse nodularity of the mucosa. The authors conclude that "early" esophageal cancers are not necessarily small cancers, since they may undergo considerable intraluminal or intramural growth and still be classified histologically as EEC. Radiologists should be aware of these findings, since EEC has an excellent prognosis with a 5-year survival approaching 90%.     

食管、贲门癌X线钡餐造影与CT检查的对照研究

目的：提高影像技术对诊断食管癌、贲门癌重要性的认识。方法：回顾性地分析经手术、病理证实食管癌22例和贲门癌17例，全部病例均有X线钡餐及CT检查。结果：22例食管癌及17例贲门癌主要X线表现为粘膜破坏、中断、壁僵硬、充盈缺损及溃疡。主要CT表现为壁增厚、软组织肿块及周围组织器官累及及淋巴结转移情况。结论：X线钡餐是检查食管癌和贲门癌的首选方法，CT检查对食管癌和贲门癌的术前分期有重要意义。因此合理地应用X线和CT检查有助于全面观察食管癌和贲门癌的影像表现。     

An unusual presentation of endometrial polyp

A 33-year-old woman was incidentally found to have a polypoid adenofibroma on MR imaging during the evaluation of carcinoma in situ of the cervix. The position of the polypoid lesion was variable from time to time. Although the lesion was a benign pedunculated one, T2-weighted MR images showed disruption of "junctional zone" in the posterior myometrial wall of the uterus, mimicking myometrial invasion of endometrial carcinoma. Electronic Publication     

Esophagogram and CT vs endoscopic and surgical specimens in the diagnosis of esophageal carcinoma

PURPOSE: Aim of our study was to assess the accuracy of diagnostic imaging in establishing site, morphology and size of the neoplasm comparing surgical specimens or endoscopic examination with esophagograms and CT in patients with esophageal cancer. CT accuracy in defining TNM staging was also evaluated. MATERIAL AND METHODS: From 1993 to 2000 we examined 39 patients with esophageal cancer: 30 males (77%) and 9 females (23%), age range 41-85 years. All patients underwent esophagogram, digestive endoscopy, and chest and abdominal CT. In 22 patients who underwent surgery, we evaluated the correlation between diagnostic imaging and surgical specimens. Patients were divided into 3 groups on the basis of discrepancy between pathological and radiological measurements: =/<1 cm (considered as no discrepancy); 1 to 3 cm; > 3 cm. RESULTS: Esophagogram identified neoplasm in 38 patients out of 39, while CT identified neoplasm in all patients. Location and morphology of the neoplasm established at endoscopy were confirmed in all patients. Lesion length measured at esophagogram corresponded to length of surgical specimens in 13 of the 22 surgically treated patients (59%). In this group there was a dominance of polypoid and stenotic tumor forms. In the remaining 9 cases there was a dominance of ulcerative tumor forms. CT measurement corresponded in 7 patients (32%) with a dominance of polypoid and stenotic tumor forms. T staging performed with CT corresponded to surgical specimens in 12 patients (54%, T3-T4). N staging correlated in 19 patients (86%). CT identified distant metastases in 6 patients (27%). DISCUSSION AND CONCLUSIONS: Our study proves a high sensitivity of esophagogram and CT in the diagnosis of esophageal carcinoma. Esophagogram presented a higher accuracy in establishing tumor length (59% of cases, as compared to CT 32%). Tumor morphology influenced the accuracy of the esophagogram, and highest accuracy was obtained in polypoid and stenotic tumors. T staging performed with CT corresponded to surgical specimens in advanced stages (T3-T4), while accuracy was poorer in smaller superficial lesions (T1-T2) due to the inability of CT to differentiate the layers of the esophageal wall. N understaging in 14% of cases did not modify surgical management. CT presented a high sensitivity in the identification of loco-regional lymph nodes and identified distant metastases in 6 patients. In conclusion, these techniques are accurate and non-invasive and their role in establishing the correct management is therefore important.     

胆囊癌的超声诊断(附25例分析)

目的 :探讨不同类型的胆囊癌B超特征性表现。方法 :按胆囊癌常规扫查方法仔细观察其声像图 ,并作回顾性分析。结果 :2 5例胆囊癌中 ,包括胆囊局部性向腔内隆起型 (3例 ) ,胆囊壁弥漫性或局限性不规则增厚型 (8例 ) ,胆囊实块型改变 (12例 ) ,胆囊壁乳突状结节突入腔内 (2例 )。本文分析了各型的声像图特征。结论 :B超可以帮助检出胆囊癌 ,尤其在帮助检出没有临床症状的早期胆囊癌时 ,有重要的临床意义。     

Fundic adenomyomatosis bulged with the subserosal excessive fat of the gallbladder mimicking polypoid carcinoma: a case report with unusual imaging and morphological features.

This report describes a 41-year-old female who presented with adenomyomatosis of the gallbladder mimicking polypoid carcinoma, on the diagnostic imaging findings and revealing unusual histologic features for such a localized adenomyomatosis. The mass was located on the gallbladder liver-side wall at the fundus and papillary hyperechoic growth showed no clear ultrasonographic features of adenomyomatosis. The patient underwent a laparoscopic cholecystectomy with a tentative diagnosis of superficial polypoid carcinoma. Histologically, the tumor bulged due to subserosal excessive fat tissue.     

食管癌X线钡餐造影与CT检查的对比研究

目的提高影像技术对诊断食管癌重要性的认识。方法回顾性分析经手术、病理证实食管癌34例，全部病例均有X线钡餐造影与CT检查。结果34例食管癌主要X线表现为管壁僵硬、充盈缺损、龛影及黏膜中断、破坏。主要CT表现为管壁增厚、软组织肿块、周围组织器官受累及淋巴结转移。结论X线钡餐检查是诊断食管癌的首选方法，CT检查对食管癌的分期有重要意义。