颅咽管瘤的MRI诊断及鉴别诊断颅咽管瘤的MRI诊断及鉴别诊断

目的:研究颅咽管瘤的MRI诊断及鉴别诊断。方法:回顾性分析经病理证实的13例颅咽管瘤的MRI表现。结果:9例呈圆形或类圆形,4例呈不规则形。平扫6例表现为长T1长T2信号,3例表现为等T1长T2信号,2例短T1长T2信号,1例等T1短T2信号,1例混杂T1混杂T2信号。其中囊内见出血1例,分层征象2例,钙化3例,壁结节4例,3例DWI弥散不受限呈低信号。增强后3例实性颅咽管瘤和5例囊实性颅咽管瘤实性部分明显均匀或不均匀强化,5例囊实性和4例囊性颅咽管瘤囊壁呈弧形或环形强化,4例囊性颅咽管瘤壁结节明显强化,1例囊性颅咽管瘤未见明显强化。结论:颅咽管瘤的MRI影像表现具有一定特征,但需注意与垂体腺瘤、Rathke囊肿、生殖细胞瘤等鉴别。     

肾上腺肿瘤的CT临床鉴别诊断

目的探讨肾上腺肿瘤CT表现及鉴别诊断要点.方法回顾性分析27例经手术及病理证实的肾上腺肿瘤CT资料.结果 27例肾上腺肿瘤中腺瘤15例,嗜铬细胞瘤4例,皮质腺癌2例,转移瘤3例,神经纤维瘤、节神经瘤及髓性脂肪瘤各1例.结论 CT对肾上腺肿瘤的检出率较高,在定性诊断上也具有重要的价值.     

Morphology, diagnosis and differential diagnosis of mesothelioma

Forty cases of mesothelioma biopsied and autopsied from 1961 to 1985 were studied and analysed as to their morphology, diagnosis and differential diagnosis. Mesothelioma had complex histologic types. The tumor cells varied in size and shape and were characterized morphologically by the coexistence of biphasic differentiation, adenoid and microvilli formation. The pathologic diagnosis is made according to the feature of biphasic differentiation, or coexistence of epithelioid and spindle tumor cells. It should be emphasized that the tissue sections are taken from multiple areas. Usually, the correct diagnosis is made in correlation to the clinical manifestations. For difficult cases of the diffuse mesothelioma, electron microscopy is needed to differentiate from metastatic adenocarcinoma and spindle cell sarcoma etc.     

上皮样肉瘤的病理诊断与鉴别诊断

目的探讨上皮样肉瘤的病理特点及鉴别诊断。方法13例上皮样肉瘤,男9例,女4例,年龄10～45岁。病变主要位于前臂、手掌和手指。行显微镜下观察组织形态特点并结合免疫组化染色结果进行分析。结果组织学表现为肿瘤细胞由恶性上皮样细胞和梭形细胞组成,呈结节样排列并伴有中心坏死。所有瘤组织CK、EMA和Vimentin均为阳性表达。结论上皮样肉瘤无特异性症状和体征,病理学特点及鉴别诊断应紧密结合临床表现和免疫组化结果。     

探讨粒细胞肉瘤的诊断与鉴别诊断

Objective: To discuss the diagnosis and differential diagnosis of granulocytic sarcoma (GS). Methods: Six cases were reported in this paper. They were assessed by pathologists. Immunohistochemistry (IHC) stain and routine hematoxylin and eosin (H&E) stain were applied. Results:All patients involved in different anatomic sites respectively including skin, lymph node, soft tissue, breast, cervix and penis. All cases were previously error diagnoses. Three of them were initially diagnosed as non-Hodgkin lymphoma (NHL). One case of cervical lymph node lesion was first considered as metastasized carcinoma by clinician. One biopsied skin sample was initially reported as Karposi's sarcoma. And one breast case was suspicious of the Iobular carcinoma with the frozen samples without antecedent clinical history information. GS was accompanied with acute myeloid leukemia (AML) in one case and with acute lymphocytic leukemia (ALL) in one case. Histopathologically, blastic, immature and differentiated variants were found in four, one and one, respectively. Immunohistochemistry (IHC) showed that myeloperoxidase (MPO) and lysozyme were both found to be positive in all cases, CD43 was found in 5 of 6 cases. Three of six cases were CD68, CD15 and LCA positive. CD34 and CD117 were positive in 1/5 and 1/6 cases, respectively. However, CD20 and CD3 were negative in all cases. Conclusion: GS was uncommon and it may be misdiagnosed easily in routine practice. Each area had its own character, but they had the common features too. It can be correctly diagnosed by combination of H&E stain, IHC stain, peripheral blood and bone marrow. MPO and Lysozyme were necessary for the nature of granulocytes. In addition, CD43, CD68 and CD15 were very helpful.     

Computer-aided diagnosis

The evolution of logic thought in relation to the predominant recent advances in technology is analyzed. In fact, the computer was the prime mover of this major change. At present the use of sophisticated software has allowed to attain increasingly accurate levels of simulation of human reasoning. The computer has determined profound transformations in many sectors of work, study and research. Among these, it is extremely relevant how the computer has completely transformed medicine and the medical role, especially in the field of radiology. Expert systems are the most interesting and futuristic applications of artificial intelligence. These systems are able to reproduce on a computer the behavior of an expert human being. Some of the recent innovations introduced in the field of breast, thoracic and mainly neural pathology are illustrated.     

The Diagnosis and Differential Diagnosis of Umteral Fibroepithelial Polyps

OBJECTIVE To study the clinical pathologic characteristics and differential diagnosis of ureteral fibroepithelial polyps. METHODS One case of ureteral fibroepithelial polyps was studied by clinical data analysis and light microscopy. RESULTS The tumor was located in the lower ureter. Histologically, the polyp was composed of expanded blood vessels and fibrous connective tissue under normal or proliferous transitional epithelium. CONCLUSION Benign ureteral fibroepithelial polyps are extremely rare, recognition of it＇s precise histological features can facilitate its correct diagnosis.     

卵巢原发恶性淋巴瘤的诊断与鉴别诊断

目的:研究卵巢原发恶性淋巴瘤的诊断、鉴别诊断及临床特点.方法:用免疫组织化学及组织病理学方法观察39例卵巢恶性肿瘤,包括初次病理诊断的2例恶性淋巴瘤和37例具有小圆形细胞为主要特征的卵巢恶性肿瘤.结果:发现5例组织病理学特点、免疫组织化学标记符合卵巢原发恶性淋巴瘤,所有病例临床均诊断为畸胎瘤或腹部包块,临床特点以腹痛,腹部包块为主或无症状.结论:卵巢原发恶性淋巴瘤罕见、起病隐袭、症状不典型,临床及病理诊断很困难,单凭组织化学方法很难与其它小圆形细胞肿瘤鉴别,免疫组织化学标记有重要价值.     

侧脑室肿瘤的MRI诊断及鉴别诊断

目的:分析侧脑室肿瘤的MRI影像特点,提高侧脑室肿瘤诊断的准确性。方法:回顾性分析28 例经手术病理证实的侧脑室占位性病变的MRI影像学表现。 结果:大多数侧脑室肿瘤具有年龄和性别特征。如脑膜瘤好发于30~50岁,女性多见;中枢神经细胞瘤发病年龄在20~40岁;转移瘤均大于40岁。不同的侧脑室肿瘤,其好发部位不同。室间孔区好发中枢神经细胞瘤,侧脑室体部好发星形细胞瘤,脑膜瘤和转移瘤好发于侧脑室三角区。不同侧脑室肿瘤的MRI表现有所不同,部分具有特征性表现。脑膜瘤增强后呈明显均匀强化。星形细胞瘤,邻近脑组织受侵伴水肿,增强扫描可见不均匀强化。中枢神经细胞瘤,围绕透明隔生长,周围可见多发囊变,增强可见不均匀强化。少突胶质细胞瘤内可见多发钙化灶。转移瘤,增强扫描大多数可见环形强化。室管膜瘤,增强扫描明显强化,容易侵犯邻近脑实质。结论:MRI影像学表现结合肿瘤的部位、发病年龄、强化程度和磁共振波谱(MRS)表现等可以提高侧脑室肿瘤的术前诊断准确率。     

Ovarian carcinoma diagnosis

BACKGROUND: Ovarian carcinoma often is called the "silent killer" because the disease usually is not detected until an advanced stage. The authors' goal was to evaluate preoperative symptoms and factors that may contribute to delayed diagnosis for women with ovarian carcinoma. METHODS: A two-page survey was distributed to 1500 women who subscribe to CONVERSATIONS!, a newsletter about ovarian carcinoma. Because the survey could be copied and given to other patients, 1725 surveys were returned from women in 46 states and 4 Canadian provinces. RESULTS: The median age of the surveyed women was 52 years, and 70% had Stage III or IV disease (International Federation of Gynecology and Obstetrics). When asked about symptoms before the diagnosis of ovarian carcinoma, 95% reported symptoms, which were categorized as abdominal (77%), gastrointestinal (70%), pain (58%), constitutional (50%), urinary (34%), and pelvic (26%). Only 11% of women with Stage I/II and 3% with Stage III/IV reported no symptoms before their diagnosis. Women who ignored their symptoms were significantly more likely to be diagnosed with advanced disease compared with those who did not (P = 0.002). The time required for a health care provider to make the diagnosis was reported as less than 3 months by 55%, but greater than 6 months by 26% and greater than 1 year by 11%. Factors significantly associated with delay in diagnosis were omission of a pelvic exam at first visit; having a multitude of symptoms; being diagnosed initially with no problem, depression, stress, irritable bowel, or gastritis; not initially receiving an ultrasound, computed tomography, or CA 125 test; and younger age. The type of health care provider seen initially, insurance, and specific symptoms did not correlate with delayed diagnosis. CONCLUSIONS: This large national survey confirms that the majority of women with ovarian carcinoma are symptomatic and frequently have delays in diagnosis.     

Molecule based diagnosis

Based on reviews of the concept of diagnostics and in general and in specific tumour areas it was clear that development of diagnostic procedures involving genomics will allow for much better targeted and tailored treatments in the future. This will result in better efficacy and better tolerability of cancer treatments, but will also allow for progress in prediction, diagnosis and dose selection. Large collaborative projects studying the efficacy and safety of drugs on the genome level is promising to bring important benefits to both patients and the national economy by reducing useless drug therapy. In colorectal cancer there are several genetic defects identified that can act as the target for directed therapy in the future. Expressions of tumour specific antigens open the way for immunological targeted therapies. Developments in the understanding of the genomic basis for resistance to anti-tumour therapy is promising to help targeting patients likely to respond and not develop resistance. A Japanese model is being developed to determine the relative risk of breast cancer of Japanese women. Based on this prevention therapies can be instigated. The last four years have seen the introduction of four novel targeted therapies. If this model should become a standard in the future, much stronger collaboration between academic research and pharmaceutical industry need to develop.     

Familial cancer diagnosis

Familial clustering of cancer is well known from epidemiologic studies. This can be due to chance, shared environmental influences, shared genes and chance-environmental-genetic interactions. Family studies are a key to the understanding of the environmental and genetic etiology of chronic disease. Cancer families are human models of susceptibility to neoplasia. More and more people are aware of, and anxious about, their cancer risk. High-risk individuals can benefit from prevention and early detection programs. In medical practice the patient workup should include a carefully obtained family history. This low technology method has the potential for reduction of cancer morbidity and mortality. Every person should create his/her own family tree and discuss it with his/her doctor. This is a step each individual can take for his/her health.     

跟骨肿瘤及肿瘤样病变的影像学诊断价值

目的:探讨跟骨肿瘤及肿瘤样病变的影像学特征,提高跟骨病变的影像诊断水平。方法:回顾性分析经手术和病理确诊的30例跟骨病变的影像学表现,其中30例行X射线平片检查,19例平片后不能确诊再行CT检查,3例仍然诊断困难再行MR检查。结果:良性肿瘤10例,恶性肿瘤7例,肿瘤样病变13例;骨囊肿在跟骨体部与前部交界处发生率最高,且有特征性。动脉瘤样骨囊肿有分隔,可有钙化。恶性骨肿瘤骨质破坏明显,往往为全跟骨骨质破坏。硬化缘、骨嵴及破坏区密度对鉴别诊断有意义。结论:X射线平片、CT及MR综合表现结合病变部位,可以对跟骨肿瘤及肿瘤样病变提出准确的影像学诊断和鉴别诊断。     

放射性核素显像在巨大肝血管瘤诊断与鉴别诊断中的意义

目的:评价放射性核素显像诊断巨大肝血管瘤的临床应用价值.方法:肝内巨大占位病变23例病人37个病灶,同时行肝胶体断层和肝血池断层显像.手术病理证实为肝巨大血管瘤24个病灶.结果:核素显像诊断巨大肝血管瘤都有典型表现:肝血池延迟相放射性过度填充,明显高于正常肝组织.结论:肝胶体断层显像联合肝血池断层显像诊断巨大肝血管瘤有良好诊断价值,对巨大肝血管瘤与肝癌有重要的鉴别诊断意义.     

淋巴组织反应性增生的病理诊断与鉴别诊断

淋巴组织反应性增生(RH)的临床表现、病理组织学、免疫表型与鉴别诊断.RH的主要特点为:(1)临床表现为急性发热,淋巴结轻度肿大,致病因子消除后可以痊愈;(2)病理组织学分为单纯性与特异性两类,共同改变为淋巴或T区细胞增生而导致正常组织结构紊乱,大细胞及核分裂象增多(称为假恶性组织象);(3)免疫表型呈现以淋巴滤泡为主的B细胞免疫表型和以T细胞为主的免疫表型保持正常.鉴别诊断最主要的是RH特点为组成细胞量的增多产生假恶性组织象,缺乏细胞的异型性与单克隆性,并且会出现正常组织结构的侵蚀破坏.     

The diagnosis and management of pre-invasive breast disease: radiological diagnosis

Pre-invasive disease is most frequently diagnosed in asymptomatic women following detection of microcalcification at mammography. The vast majority is ductal carcinoma in situ. This article summarizes the radiological features of pre-invasive disease and indicates which features are helpful in differentiating between benign and malignant conditions. The value of finding ductal carcinoma in situ at screening, predicting the presence of an invasive focus and methods of percutaneous biopsy of calcification are also addressed.     

乳腺小肿块的诊断、鉴别诊断及误诊原因分析

目的探讨乳腺小肿块高频超声图像的异同点,对照病理结果,提高超声对乳腺小肿块的诊断和鉴别诊断.方法取112例乳腺小肿块患者的高频超声声像图与病理结果对照分析.结果超声诊断均为纤维化,病理诊断间质纤维化1例,间质胶原化7例,囊肿21例,乳腺导管扩张17例,瘤样病变15例,单纯性小叶增生14例,囊性增生症12例(其中1例伴大汗腺化生),硬化性乳腺病9例,纤维腺瘤形成趋势9例,脂肪瘤6例,浸润性导管癌1例.本组诊断符合8例,符合率7.14%.结论高频超声在乳腺小肿块诊断中须抓住细小的特征性表现,以提高诊断符合率.     

Vimentin and tumor diagnosis

Vimentin was isolated and purified from the pig eye lens by homogenization, ultracentrifugation, extraction in urea buffer and preparative eletrophoresis. It was identified with SDS-PAGE and rabbit anti-vimentin was raised against the purified vimentin. The specificity of anti-vimentin was examined with immunohistochemical technique and double immune diffusion. Results showed that the vimentin antibody possessed good specificity for mesenchyme-derived cells. Tumor tissue sections from 151 cases were stained with anti-vimentin, anti-keratin, anti-desmin, anti-S-100 protein, anti-Factor-FV III related anti-gen, and anti-lysozyme. Positive staining was obtained in mesenchyme-derived cells, while the epithelial tumor cells did not react with anti-vimentin. It indicated that vimentin anti-body is effective for tumor differential diagnosis in surgical pathology.