原发性肾滑膜肉瘤一例报告并文献复习

Objective To discuss the presentations, pathologic features, diagnosis and treatment of primary synovial sarcoma of the kidney. Methods One case of primary synovial sarcoma of the kidney was reported and the relevant literature was reviewed. A 55-year-old man was admitted with complaint of right abdomen and flank pain for 5 h. Computerized tomography revealed a 12.5 cm × 11.0 cm × 9. 0 cm mass located at the middle and lower pole of the right kidney. The patient was taken radical nephrectomy. Results The diagnosis of primary synovial sarcoma of the kidney in the patient was confirmed by postoperative pathology. Under microscope, tumor was typically mitotically active, monomorphic spindle cells growing in intersecting fascicles or in solid sheets with epithelial differentiation. In some areas a haemangiopericytoma-like pattern was found. Immunohistochemical staining showed that the tumor cells were positive for the markers Vimentin, CD99 and Bcl-2, but CK was negative. The patient died of local recurrence and multi-metastasis at 8 months after surgery. Conclusions Primary synovial sarcoma of the kidney is extremely rare with a high grade of malignancy,and its prognosis is poor. The diagnosis depends on pathological features, Immunohistochemical studies and RT-PCR detection. Radical resection combined with chemicaltherapy is considered to be the most reliable treatment so far.     

血管回声追踪技术评价T2DM及并发HUA病人颈动脉弹性功能

目的探讨应用血管回声追踪(ET)技术检测2型糖尿病(T2DM)及并发高尿酸血症(HUA)病人颈动脉弹性功能改变的临床意义。方法按照血尿酸水平将60例T2DM病人分为尿酸正常组(A组,30例)及HUA组(B组,30例),应用ET技术检测颈动脉弹性功能指标,包括僵硬度指数(β)、颈动脉压力-应变弹性系数(Ep)、顺应性(AC)、扩张指数(AI)及脉搏波传导速度(PWVβ),并与正常对照组(N组,30例)进行比较。结果与N组比较,A组及B组β、Ep、PWVβ均增高,AC减低(F=11.67~26.81,q=4.58~10.27,P<0.05);与A组比较,B组β、Ep、PWVβ均增高,AC减低(q=5.13~9.25,P<0.05)。各组间AI比较差异无统计学意义(P>0.05)。结论 ET技术能够发现T2DM及并发HUA病人早期颈动脉弹性改变,为临床早期干预和治疗T2DM病人动脉粥样硬化提供依据。     

经阴道超声检查对宫外孕的诊断价值

回顾分析我院2003年1月~2004年7月行阴道超声检查,并经手术和病理证实的宫外孕38例,以探讨经阴道超声对宫外孕的诊断价值。1临床资料1.1一般资料宫外孕病人38例,年龄18~43岁,平均28岁。38例均经手术和病理证实。33例有停经史,35例有下腹痛,23例有不规则阴道流血,37例尿妊娠试验     

原发性肾滑膜肉瘤一例报告并文献复习

目的 总结原发性肾滑膜肉瘤的临床表现、病理特点和诊治方法.方法 原发性肾滑膜肉瘤患者1例,男,55岁.因右腰背及上腹部疼痛5 h入院.无尿频、尿急、尿痛、血尿、发热等症状.CT检查示右肾中下极恶性占位可能,累及右肾门、肾动静脉及肝脏.行右肾肿瘤根治性切除术.结果 病理检查:肿瘤大小12.5 cm×11.0 cm×9.0 cm.镜下瘤细胞呈梭形、束状排列,细胞异型,可见核分裂相,部分区域见增生的薄壁血管,肿瘤呈浸润性生长,伴发炎症及大量坏死、出血.免疫组化染色示Vimentin、CD99、Bcl-2阳性,CK阴性.病理诊断为原发性肾滑膜肉瘤.患者术后2个月出现局部复发及肝肺转移,予异环磷酰胺、表阿霉素化疗1疗程,患者不能耐受.术后8个月死亡.结论 原发性肾滑膜肉瘤是一种罕见、高度恶性的肿瘤,预后不良,确诊需依赖病理检查、免疫组织化学及RT-PCR检测.根治性切除辅以化学治疗可行.     

直立体位超声检查对亚临床型精索静脉曲张的诊断价值

目的探讨直立体位超声检查对亚临床型精索静脉曲张（SVC）的诊断价值。方法彩色多普勒超声检测35例SVC患者,记录精索静脉在平静呼吸时最大内径及站立位时内径,在彩色多普勒超声引导下测量不同体位下精索内动脉血流峰值速度。结果 35例SVC患者,站立位后精索静脉内经（2.5mm）高于平卧位内径（1.7mm）,差异有显著性统计学意义（P〈0.05）站立位诊断阳性率（95.0%）高于平卧位诊断阳性率（65.0%）,差异有显著性统计学意义（P〈0.05）;精索内动脉血流峰值速度在平卧位与站立位无明显差别（P〉0.05）。结论站立位超声检查亚临床型精索静脉曲张诊断阳性率高于平卧位,对于亚临床型精索静脉曲张患者宜采用站立位检查。     

声辐射力脉冲成像技术对正常肾脏的定量研究

目的确定正常肾脏各部位弹性系数参考值范围并探讨其影响因素.方法选取380名健康体检者共760个正常肾脏,应用声辐射力脉冲成像技术(ARFI)于不同取样深度下测量正常肾脏皮质、髓质、肾窦剪切波传播速度(Vs)并进行比较,分析受试者性别、年龄、身高、体重、取样深度及取样角度对Vs值的影响.结果垂直取样时正常肾脏皮质、髓质、肾窦Vs值参考值范围分别为(3.33±0.56)、(2.29±0.20)、(1.06±0.19)m/s,且差异有统计学意义(F=29451.58,P<0.05);不同侧别、性别、年龄、体重指数(BMI)、健康体检者正常肾脏皮质、髓质、肾窦同一部位Vs值差异均无统计学意义;不同取样深度测量正常肾脏肾皮质Vs值差异也均无统计学意义;取样线与垂直方向呈30°角时测得正常肾脏皮质、髓质、肾窦Vs值分别为(3.01±0.51)、(2.03±0.21)、(0.96±0.15)m/s,各部位比较差异有统计学意义(F=16033.17,P<0.05);与垂直取样时比较差异也均有统计学意义(t值分别为7.588、2.821、3.946,P均<0.05).结论 ARFI技术可较客观地测量正常肾脏不同部位Vs值,且影响因素较少,可定量评价正常肾脏不同部位组织弹性顺应性.     

超声诊断膀胱壁间型平滑肌瘤1例

病例男,38岁,4天前健康查体时发现膀胱占位,为求进一步诊断遂人我院。患者自诉无肉眼血尿,无尿频、尿急、尿痛,无发热。化验：血、尿常规等未见明显异常。2013年1月18日超声检查：膀胱充盈良好,右侧壁近三角区见椭圆形低回声肿块（图1）,大小3．2cm×3．5cm×2．3cm,边界清,向膀胱内、膀胱外隆起,似位于膀胱肌层,膀胱黏膜层、     

骨性膝关节炎超声检查的临床意义

目的观察引发骨性膝关节炎疼痛症状的超声影像学改变,为临床治疗提供依据。方法选择骨性膝关节病人32例41个膝关节,根据VAS评分将患膝分为两组,P组：VAS评分大于3,共23个膝关节;NP组：VAS评分为0,共18个膝关节。将43个患膝关节纳入超声检查,记录检查结果,并将两组患膝所记录的髌上囊积液、髌下滑囊炎、半月板损伤、腘窝囊肿发生率进行统计学分析。结果P组超声检查阳性率发现显著高于NP组,其中髌上囊积液及腘窝囊肿组间比较差异有统计学意义（P〈0．01）。P组患膝中有8例显示髌骨下滑囊炎,而NP组未发现髌骨下滑囊炎。结论骨性膝关节炎疼痛患者多伴发髌上囊、髌下滑囊积液以及elgy腘窝囊肿,提示髌周炎性渗出性改变可能为引发患膝疼痛的重要因素之一;超声检查对骨性膝关节炎疼痛患者的病因诊断具有一定的临床参考价值,可在临床推广应用。     

原发性肾滑膜肉瘤一例报告并文献复习

Objective To discuss the presentations, pathologic features, diagnosis and treatment of primary synovial sarcoma of the kidney. Methods One case of primary synovial sarcoma of the kidney was reported and the relevant literature was reviewed. A 55-year-old man was admitted with complaint of right abdomen and flank pain for 5 h. Computerized tomography revealed a 12.5 cm × 11.0 cm × 9. 0 cm mass located at the middle and lower pole of the right kidney. The patient was taken radical nephrectomy. Results The diagnosis of primary synovial sarcoma of the kidney in the patient was confirmed by postoperative pathology. Under microscope, tumor was typically mitotically active, monomorphic spindle cells growing in intersecting fascicles or in solid sheets with epithelial differentiation. In some areas a haemangiopericytoma-like pattern was found. Immunohistochemical staining showed that the tumor cells were positive for the markers Vimentin, CD99 and Bcl-2, but CK was negative. The patient died of local recurrence and multi-metastasis at 8 months after surgery. Conclusions Primary synovial sarcoma of the kidney is extremely rare with a high grade of malignancy,and its prognosis is poor. The diagnosis depends on pathological features, Immunohistochemical studies and RT-PCR detection. Radical resection combined with chemicaltherapy is considered to be the most reliable treatment so far.     

肌间血管瘤误诊淋巴结1例

1病例资料患者,女,57岁。因"右侧颈部肿物1年,加速生长伴疼痛十余天"入院。查体:右侧颈部下颌角下方胸锁乳突肌后缘可触及一1.5 cm×2 cm肿物,圆形,压痛(+),活动度好,与周围组织界限清,表面皮肤完整,肤色同正常皮肤。初诊:颈部肿物,性质?淋巴结或纤维瘤。超声检查示: