后纵隔巨大甲状腺乳头状癌一例

患者女,48岁。两年前无明显诱因出现轻微进食梗噎感,抬头时加重,未予治疗。近半年,梗噎感加重,并出现胸闷、咳嗽,痰中带血,遂来我院就诊。胸部CT显示:左后纵隔食管后方见一长条形低密度影,密度不均,其上方见环形斑     

Neuroblastoma of the Anterior Mediastinum in an 80-Year-Old Woman

A 7-cm anterior mediastinal tumor in an 80-year-old woman was found by light and electron microscopy to be a neuroblastoma. Immunoreactivity for neuron-specific enolase, synaptophysin, and chromogranin supported the diagnosis. Neuroblastoma is an uncommon tumor in adults and we are not aware of a previous report of such a tumor in a patient of this age.     

MRI visualization of the aortic nipple

The aortic nipple, a small “pseudotumor” adjacent to the aortic arch, is the left superior intercostal vein. In our series of 40 patients it was demonstrated in six; all had a right upper thoracic mass and four had a superior vena caval syndrome. Coronal magnetic resonance, images (MRI) of the thorax were superior to all other imaging methods in demonstrating the nipple. It is concluded that in patients with masses in the right upper chest, coronal MR chest examinations are valuable in demonstrating an aortic nipple, a sign of impending present superior vena caval or innominate, vein obstruction.     

原发纵隔囊肿影像学表现

目的探讨原发纵隔囊肿影像表现特征,提高影像诊断的准确率。方法回顾性分析经手术病理证实且资料完整的42例原发纵隔囊肿的影像学表现。所有病例均摄胸部后前位与侧位片,胸部CT平扫29例,其中15例行增强扫描,胸部MRI平扫6例。观察病变的部位、大小、形态、密度(信号)、边缘、壁及其厚度、邻近结构。每一病种均分为影像征象典型与不典型2类。结果病变位于前纵隔28例,中、后纵隔各7例。上纵隔9例,中纵隔24例,下纵隔9例。支气管囊肿9例,囊性淋巴管瘤4例,胸腺囊肿11例,心包囊肿5例,成熟性囊性畸胎瘤13例。影像征象典型38例,不典型4例。结论90%的纵隔囊肿,根据CT、MRI显示的病变部位与内部密度、信号特征,可做出正确的影像诊断;不典型者确诊仍依靠手术病理。     

纵隔软组织肿瘤23例临床病理分析

本科手术治疗纵隔软组织肿瘤２３例，占同期手术治疗纵隔肿瘤３９０例的５．９％，年龄３５岁以下者１７例，占７３．９％。男女之比为４．８：１（１９／４），本病的临床及Ｘ线表现缺乏特异性，确诊有赖于术后病理学检查。本组中良性肿瘤１５例（６５．２％），恶性肿瘤８例（３４．８％），手术治疗２４例次，肿瘤切除率为９１．７％（２２／２４），手术为首选的治疗方法。     

Case of double superior vena cava

A 23-year-old male patient who had no history of any previous medical illness was noted to have a widened mediastinum on chest X-ray undertaken as part of a routine medical evaluation. A computer tomographic (CT) scan confirmed the widened mediastinum to be due to a double superior vena cava (SVC). No further investigations were undertaken. The patient was noted to be well when re-assessed 3 years later.     

Atypical Glomus Tumor in the Mediastinum: A Case Report with Immunohistochemical and Ultrastructural Studies

A case is reported of atypical glomus tumor occurring in the posterior inferior mediastinum of a 26-year-old woman complaining of severe back pain. The tumor was composed of atypical small, round tumor cells with scattered mitotic figures. In addition to sheet-like, diffuse proliferation of the tumor cells, some areas of the tumor contained small “glo-moid” cells arranged in organoid and hemangiopericytoma-like patterns. Immunohistochemically, many tumor cells were positive for muscle-type actins and a few cells were focally positive for desmin. Ultrastructural studies revealed smooth muscle features of tumor cells, that is, pinocytotic vesicles, external laminas, dense plaques, and occasional thin filaments with dense bodies. The patient remained well for 5 years and 4 months after the operation without additional radiation and chemotherapy. The tumor was diagnosed as an atypical, or low-grade malignant, glomus tumor morphologically. It seems important to recognize the presence of this type of tumor in sites other than extremities and to differentiate it from other malignant small, round cell tumors.     

Malignant peripheral nerve sheath tumor of small round cell type with pleomorphic spindle cell sarcomatous areas

An unusual case of malignant peripheral nerve sheath tumor (MPNST) arising in the posterior mediastinum of a 59-year-old man is reported. Histopathologically, the tumor showed an admixture of a dense proliferation of small round cells resembling a primitive neuroectodermal tumor (PNET) and a pleomorphic spindle cell sarcomatous area. Abortive rosettes, primitive neural tube-like structures, and a few glandular structures were found in the small round cell area. Small round cells were immunoreactive for neural cell adhesion molecule and synaptophysin, but were not immunoreactive for MIC2 and neuron-specific enolase. Pleomorphic spindle cells were occasionally arranged in a storiform pattern and were diffusely immunoreactive for S-100 protein. The MPNST of small round cell type is distinguishable from PNET by its negative immunoreactivity for MIC2, and the present tumor is assumed to be derived from primitive neuroectodermal cells in the peripheral nerve capable of bidirectional (neuron and Schwann cell) differentiation.     

Mediastinal lymph node metastasis of colon cancer: Report of a case

We herein describe a patient with mediastinal lymph node metastases which occurred after both a primary sigmoid colon cancer and metachronous ovarian metastasis had been resected. The most likely route of metastases to the mediastinum in this case is the paravertebral venous plexus probably connected to the ovarian metastasis, or so-called remetastasis. This case illustrates that the mediastinum is thus a possible metastatic site in patients with colon cancer. Surgeons should therefore pay attention to the mediastinum as well as the lung fields when checking chest X-ray films during a follow-up of patients after a resection of colon cancer.     

儿童纵隔神经母细胞瘤临床特征分析

  目的  探讨纵隔神经母细胞瘤临床特征。  方法  收集2008年3月至2012年9月中国医科大学附属第四医院儿科收治的神经母细胞瘤110例, 其中26例肿瘤位于纵隔, 其他部位84例。将纵隔神经母细胞瘤的临床表现、肿瘤标志物、生物学预后因素与其他部位对比。  结果  纵隔组平均年龄25.5个月, 与其他部位组相近。初诊时纵膈组88.5%有症状, 高于其他部位组60.7%（P < 0.05）; 早期病例（Ⅰ、Ⅱ期）34.6%, 高于其他部位组8.3%（P < 0.05）; 血清NSE>100 ng/L者达21.4%, 低于其他部位组86.1%（P < 0.001）。纵隔组N-myc基因拷贝数均 < 10, 其他部位组N-myc基因拷贝数>10者为23.1%（P < 0.05）。纵隔组4年总生存率为80.0%, 其中局限性肿瘤（Ⅰ、Ⅱ、Ⅲ期）达100%, 分别高于其他部位组44.0%、82.0%。  结论  多数纵隔神经母细胞瘤表现出临床分期早（Ⅰ、Ⅱ期）和良好的生物学预后因素, 这些特征可能与纵隔神经母细胞瘤良好的预后相关。