血管影像在乳腺癌诊断中的重要作用(附100例乳腺癌及200例良性乳腺增生对照分析)

[目的 ]提高对乳腺病血管像的认识 ,进而提高对乳腺良恶性病的诊断率。 [方法 ]选取经手术病理证实为乳腺癌的病例 1 0 0例 ,从乳腺体检中发现或经追踪观察为乳腺轻度增生的病例 2 0 0例乳腺 X线影像进行对照分析。 [结果 ]乳腺恶性与良性病变在血管像上有一定区别 :1血管像增粗。血管像横径大于2 .0 mm为增粗 ,乳腺恶性病变有 76例 ( 76.0 % ) ,良性病变有 40例 ( 2 0 .0 % ) ;2血管像增多。血管像条数多于 3条为增多 ,乳腺恶性病变有 61例 ( 61 .0 % ) ,乳腺良性病变有 46例 ( 2 3.0 % ) ;3血管像增大。弯曲度小于 1 5 0°血管像迂曲明显 ,乳腺恶性病变有 83例 ( 83.0 % ) ,乳腺良性病变有 42例 ( 2 1 .0 % ) ;4血管像走行特点。呈花瓣状 ,恶性病变有 33例 ( 33.0 % ) ,良性病变有 2例 ( 1 .0 % ) ;呈残端状 ,恶性病变有 34例 ( 34.0 % ) ,良性病变有 3例 ( 1 .5 % ) ;呈放射状 ,恶性病变有 1 3例 ( 1 3.0 % ) ,良性病变有 1例( 0 .5 % )。 [结论 ]掌握乳腺病血管像的特征 ,可以帮助确定乳腺病病变性质 ,提高对隐性癌和微小癌的诊断率和治愈率 ,从而延长生存期     

43例涎腺粘液表皮样癌的临床分析

目的：探讨涎腺粘液表皮样癌（MEC）的组织学分型和临床分期与手术预后的关系,为临床确定理想的治疗方案提供参考和依据。方法：对43例得到病理学证实的涎腺MEC的发病部位、临床表现及基组织学分型、TNM分类和临床分期与手术治疗预后的相关性进行分析。结果：在得到长期随访的36例中,6例出现局部复发或区域淋巴结转移,其中在组织学上属高分化型4例,低分化型2例;属临床Ⅰ、Ⅱ期1例,Ⅲ、Ⅳ期5例;现生存23例,死亡13例,其中死于MEC4例,死于其他疾病9例;死于MEC的4例均属临床Ⅲ、Ⅳ期。这表明MEC术后的复发转移率和病死率与其组织学分型无明显相关（P＞0．05）,而与临床分期关系密切（P＜0．01）,临床Ⅰ、Ⅱ期MEC的手术预后明显优于Ⅲ、Ⅳ期。结论：对于临床Ⅲ、Ⅳ期的MEC应高度重视原发灶手术切除的彻底性及相应区域的淋巴结清扫。对手术切除不彻底的病例,可考虑术后放疗。     

甲状旁腺肿瘤10例临床分析

目的 探讨甲状旁腺肿瘤的误诊原因,找出减少误诊的方法。方法 对1984－1998年我院收治的10例甲状旁腺肿瘤患者进行回顾性分析。结果 10例中8例患者临床表现为骨关节疾病和泌尿系结石,误诊率为80％。结论 临床医师应提高对该疾病的认识,对一些顽固的泌尿系结石和反复多次骨折的患者不仅要重视局部并发症的诊治,而且在考虑到诊断甲状旁腺肿瘤的可能性,并进行必要的血钙、血磷检测。     

53例涎腺腺样囊性癌MMP—2和MMP—9表达与神经浸润和淋巴结转移的关系

目的研究涎腺腺样囊性癌MMP-2和MMP-9表达情况,评估其与涎腺腺样囊性癌神经浸润和淋巴 结转移的关系。方法选取53例涎腺腺样囊性癌,以抗MMP-2和MMP-9单克隆抗体用Envision法进行免疫 组织化学染色和半定量分析。结果MMP-2和MMP-9在涎腺腺样囊性癌中的表达率分别为67.92％和 79.25％;有神经浸润的腺样囊性癌其MMP-2和MMP-9的表达水平远高于无浸润者(P＜0.05,P＜0.05);随 着MMP-2和MMP-9的表达水平增高,淋巴结转移率也增高(P＜0.05,P＜0.05)。结论提示MMP-2和 MMP-9的高表达与涎腺腺样囊性癌易侵犯神经的特性及发生淋巴结转移密切相关。     

Salivary Intraductal Carcinoma Arising within Intraparotid Lymph Node: A Report of 4 Cases with Identification of a Novel STRN-ALK Fusion

Intraductal carcinoma (IDC) is a rare salivary gland tumor that is considered analogous to ductal carcinoma in-situ of the breast, demonstrating a complex neoplastic epithelial proliferation surrounded by a continuous layer of presumed non-neoplastic myoepithelial cells. It is subcategorized into intercalated duct, apocrine, and hybrid subtypes based on morphologic and immunohistochemical features, with frequent NCOA4-RET and TRIM27-RET fusions, respectively, seen in intercalated duct and hybrid tumors. However, as an expanding clinicopathologic spectrum of IDC has been documented, controversy has emerged as to whether this tumor type is best defined by its intraductal growth pattern or distinctive molecular and immunophenotypic differentiation. Here, we further explore the nature of IDC by evaluating four cases that arose within intraparotid lymph nodes. These intercalated-duct phenotype tumors with diffuse S100 protein expression demonstrated a crowded and complex epithelial proliferation arranged in cystic, cribriform, and micropapillary architecture, surrounded by an intact myoepithelial cell layer, and were completely intranodal. Of two tumors with tissue available for molecular analysis, one demonstrated a NCOA4-RET fusion and one harbored a STRN-ALK fusion that is novel to IDC. Not only does the intranodal presence of IDC present a challenging differential diagnosis, but the complex nature of this proliferation within lymph node tissue raises questions as to whether the myoepithelial component of IDC is actually non-neoplastic in nature. Furthermore, identification of a STRN-ALK fusion expands the genetic spectrum of IDC and adds to evidence of an emerging role for ALK in salivary gland tumors. Further attention to the nature of the myoepithelial cells and documentation of alternate fusion events in IDC may inform continued discussion about its appropriate classification.     

Case report of Brunner’s gland hyperplasia: A rare “mimic” of malignant pathology

IntroductionBrunner’s gland hyperplasia is a rare, benign lesion of the duodenum. The symptomology can range from asymptomatic (as an incidental finding on endoscopy) to gastrointestinal obstruction or haemorrhage.Case presentationWe report a case of a 60-year-old man presenting with post-prandial vomiting and weight loss. Inpatient evaluation led to the likely diagnosis of a duodenal malignancy for which the patient underwent a laparotomy and proximal duodenectomy.Clinical discussionBrunner’s gland hyperplasia is a rare, benign condition that can be overtreated due to the difficulty in obtaining an accurate pre-operative diagnosis. The literature has been reviewed to discuss the approach to diagnosis.ConclusionThis case highlights the potential for Brunner’s gland hyperplasia mimicking a malignancy.     

A case report of a rare nasopharyngeal myoepithelial dominant pleomorphic adenoma

IntroductionPleomorphic adenoma is the most common benign salivary gland neoplasm. The majority of cases occur in the major salivary glands; however, they can also originate from the minor salivary glands. The nasopharynx is an uncommon site, but it has been reported in the literature. The characteristic difference of our report from the literature is the young age of our patient and his previous unremarkable medical or surgical history.The objective of this report is to present a case of salivary gland pleomorphic adenoma, discuss radiological and histopathological findings and treatment options.Case presentationHerein we report a case of a 25-year-old male patient presenting with a long-term history of snoring, mouth breathing, and progressive left nasal obstruction. After examining the patient and confirming the diagnosis, patient successfully underwent tumor resection using a combined transnasal/transoral endoscopic approach with no complications following surgery and significant improvement of the previously reported symptoms.DiscussionPleomorphic adenoma of the minor salivary glands can occur anywhere throughout the distribution sites of these glands such as: along the upper aerodigestive tract, parapharyngeal fat spaces, soft palate, the sinonasal, and nasopharyngeal areas.ConclusionThe occurrence of pleomorphic adenoma in uncommon sites has been reported in the literature, and the nasopharynx is considered to be one of these uncommon sites. The mainstay of treatment for nasopharyngeal pleomorphic adenoma is surgical excision as they can grow to giant sizes if left untreated.     

The superior laryngeal nerve loop and its surgical implications

Summary Based upon findings from 60 cadavers (120 sides), the incidence of superior laryngeal nerve loop, connecting the cervical sympathetic chain and the superior laryngeal nerve and its branches, the external and internal laryngeal nerve, was 98.3% (118 out of 120 sides). In most cases the loop connected the sympathetic chain and the external laryngeal nerve. The external laryngeal nerve was looped, and not linear as traditionally thought. The loop could be divided into three categories, V-shaped, U-shaped and mixed, and subdivided into 5 types and 17 subtypes according to morphological variation. The loop without exception innervated not only the cricothyroid muscle, but also the thyroid gland. The loop is one of the origins of the thyroid nerve. It seems that for thyroid surgery the loop, when lower in position, should be carefully separated from the superior thyroid vessels before the latter are ligated, in order to preserve a normal nerve supply to the muscle as well as to the part of the gland that remains after surgery.

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L'anse du nerf larynge supérieur, étude anatomique et applications chirurgicales

Résumé La fréquence d'une anse du nerf laryngé supérieur réalisant une anastomose entre la chaine sympathique cervicale et le nerf laryngé supérieur et/ou ses branches (rameau laryngé externe et ingerne), est de 98,3 % (118/120). Ce résultat s'appuie sur l'étude de 60 cadavres. Dans la plupart des cas, l'anastomose se fait entre la chaine sympathique cervicale et le rameau laryngé externe. Ce rameau laryngé externe a un trajet curviligne et non linéaire conformément aux données classiques. Il existe trois catégories d'anses : en "V", en "U" et mixte ; on peut également les subdiviser en 5 types et 17 sous-types en fonction des variations morphologiques. Cette anse innerve constamment non seulement le muscle cricothyroïdien mais aussi la glande thyroïde dont elle fournit une partie de l'innervation. Lors de la chirurgie thyroïdienne, si l'anse est en position basse, les nerfs doivent être soigneusement disséqués et séparés des vaisseaux thyroïdiens supérieurs avant ligature de ces derniers de façon à conserver l'innervation normale du muscle et de la partie restante de la glande.

     

自发性高血压大鼠甲状旁腺的异常表现

观察自发性高血压大鼠（ＳＨＲ）的甲状旁腺。发现在其腺体中除大量正常的主细胞外，还具有一种特殊的新型细胞。这些细胞的形态不规则，边界不清。ＨＥ染色后胞浆比主细胞着色深，核的形态不规则且染色更暗。此种细胞在甲状旁腺中成团状分布，与主细胞形成鲜明的对比。另外，经实验证实在ＳＨＲ的血浆中存在一种特殊的高血压因子（ＨＦ），可以使正常大鼠的血压产生延迟性升高，其高峰在４５ｍｉｎ出现，此特点与血中已知的增压物质的即刻效应和延期出现的效应有本质的不同。因此，推论这种具有独特的理化性质和生理功能高血压因子的来源与甲状旁腺有密切关系。