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1.
肾脏原发性肿瘤种类繁多,多为恶性,且各病理亚型的影像表现均有不同。部分良性肿瘤如乏脂性血管平滑肌脂肪瘤、嗜酸细胞瘤难以与其区分,因此术前明确其组织学类型有助于治疗方案制定以及预后评估。CT是检查肾脏肿瘤的重要影像方法之一,除常规平扫、动态增强检查外,CT灌注成像、能量CT及PET-CT等亦提供了诸多信息。本文就其CT成像现状综述如下。  相似文献   

2.
目的:本研究探讨巨大浅表性脂肪瘤样痣(NLCS)的临床表现、病理特征及预后。方法:回顾性分析一例巨大NLCS的临床表现、病理学特征及预后情况,并结合文献进行复习。结果:本例患者皮损分布于腰臀部,呈群集状丘疹和结节。病理学特征为在真皮胶原组织内见成熟无包膜的脂肪组织。经手术切除后,取得了满意的效果。术后八个月,随诊复查未见异常,至今无复发。结论:巨大NLCS的确诊主要依靠组织病理检查,手术是治疗NLCS的首选方法。  相似文献   

3.
目的对一例膀胱平滑肌瘤合并子宫多发性平滑肌瘤患者诊疗进行回顾性分析。方法回顾分析一例膀胱平滑肌瘤合并子宫多发性平滑肌瘤患者临床资料,并结合相关文献进行复习。结果膀胱平滑肌瘤行局部切除,子宫多发性平滑肌瘤行全子宫切除,术后随访5年,未见肿瘤复发、恶变、侵袭转移及盆腔其他并发症。结论膀胱平滑肌瘤是一种少见的良性肿瘤,术前诊断主要依赖彩超、CT等影像学检查。手术探查能明确肿瘤部位,确诊依赖病理。手术治疗为主,预后良好。  相似文献   

4.
覃建雄  李修蕃  凌辉 《蛇志》2011,23(3):278-280
目的探讨结节性甲状腺肿的合理治疗方式。方法回顾性分析我院2005年3月~2010年7月收治的178例结节性甲状腺肿患者的临床资料。结果所有的患者均行手术治疗,术后病理证实均为结节性甲状腺肿,其中合并甲亢22例。全部患者术后症状均改善。结论结节性甲状腺肿要严格掌握手术指征,可减少不必要的手术;对需行手术治疗的患者应以全部切除病灶为原则,包括单侧或双侧腺叶切除。  相似文献   

5.
目的分析消化系统肉瘤样癌临床病理特点、诊断及鉴别诊断,探讨其治疗方法的进展。方法回顾性分析2012年1月~2018年12月我院12例消化系统肉瘤样癌的临床病理学特征、免疫染色特点、影像学特点,消化系统主要鉴别诊断及预后情况。查阅文献并结合患者临床资料进行分析。结果肉瘤样癌由多形性梭形细胞组成,癌细胞排列分散,呈束状、螺旋状或席纹状,浸润性生长。12例患者中细胞角蛋白阳性率为83.3%(10/12)、波形纤维蛋白阳性率为91.7%(11/12)。12例中仅有1例行术后化疗,其余均未给予术后辅助治疗。结论消化系统肉瘤样癌诊断主要依靠组织病理学检查,免疫组化对其诊断有重要价值。肿瘤恶性程度高,肿瘤切除后结果并不乐观。放化疗对预后无明显差异,基因靶向治疗仍可期待。  相似文献   

6.
为了探讨磁共振成像(MRI)和计算机X线断层扫描(CT)肝对血管平滑肌脂肪瘤的诊断价值,本研究选择了我院收治的肝脏血管平滑肌脂肪瘤患者43例作为研究对象,分别采用MRI和CT对患者进行检查,比较CT和MRI单独诊断及CT+MRI联合诊断时的检出率和误诊率。43例肝脏血管平滑肌脂肪瘤患者中女性占74.4%,平均年龄为(44.3±9.8)岁。65.1%的患者无明显临床症状,有症状的患者主要为腹痛。患者的肿瘤直径为(4.76±2.3) cm,肿瘤部位主要为肝右叶(67.4%)。经病理结果证实,血管瘤型、肌瘤型、脂肪瘤型和混合型依次为5例、7例、11例和20例。CT和MRI的联合诊断检出率(72.09%)高于CT (48.84%)或MRI(46.51%)单独诊断,然而差异不显著(p0.05)。误诊类型主要包括肝细胞癌、腺瘤、血管瘤和肝脏局灶性结节增生。CT+MRI联合诊断时的误诊率(23.26%)显著低于CT (48.84%)和MRI (46.51%)单独诊断。CT和MRI联合诊断有助于降低误诊率,然而,仍需要做进一步的病理检查。  相似文献   

7.
目的:探讨应用彩超在肾脏恶性肿瘤诊断及治疗中的应用效果。方法:回顾分析2006年1月~2010年12月在我院采用彩超确诊的肾脏恶性肿瘤138例,所有患者均采用LOGIQ-7彩色多普勒超声诊断仪进行检测并行手术治疗,术后均行病理检查。结果:138例患者彩超影像显示瘤体内具有丰富的动静脉血流信号,诊断为肾脏恶性肿瘤,与病理诊断完全相符。结论:彩超检查可以明确肾脏肿瘤的性质和范围,以供临床决定手术方式,也可用于术后复查。  相似文献   

8.
目的探讨肝脏上皮样血管平滑肌脂肪瘤的临床病理特征、免疫组织化学表型、鉴别诊断及预后情况。方法回顾性分析厦门大学附属第一医院2014年1月至2019年12月10例肝上皮样血管平滑肌脂肪瘤,并复习相关文献。结果本院收治10例患者,其中9例为女性,1例为男性,年龄35~61岁,中位年龄47.9±10岁。8例患者肿瘤位于肝右叶,1例位于左叶,1例位于尾状叶。肉眼观肿瘤最大径2.1cm~14.5cm,平均直径7.93±4.2cm,10例均为单发,境界较清楚,实性,灰白、灰黄或灰褐色,质地中等或质软,部分病例切面伴出血。镜下见多边形或类圆形的上皮样细胞弥漫成片排列,胞浆丰富,胞质嗜酸或透亮,可见核仁,部分病例可见多核或奇异形核,核分裂像少见,部分区域可见肿瘤细胞围绕血管排列。免疫组化结果显示HMB-45和Melan-A均弥漫性阳性,SMA部分阳性,CK、Hepar1、glypican-3、desmin、CD34均阴性,其中仅1例(1/10)肿瘤细胞TFE3弱阳性,Ki-67指数(3%~10%)。结论肝脏上皮样血管平滑肌脂肪瘤是一种具有恶性潜能的间叶性肿瘤,没有典型的临床症状和影像学征象,与发生在肝的其他良恶性肿瘤较难鉴别,需结合病理形态及免疫组织化学表型确诊。  相似文献   

9.
目的:探讨长链非编码RNA PVT1 (lncRNA-PVT1)在肝癌组织中的表达以及在肝癌诊治中的临床意义。方法:采用qRT-PCR法检测肝癌组织和癌旁肝组织中lncRNA-PVT1的表达情况,通过x2检验分析lncRNA-PVT1的表达水平与肝癌患者临床病理指标之间的相关性,采用Kaplan-Meier法绘制患者术后生存曲线,Log-rank检验比较生存率的差异,单因素和多因素分析评估影响肝癌患者预后的独立危险因素。结果:肝癌组织中lncRNA-PVT1的表达水平显著高于癌旁肝组织(P0.05)。肝癌组织lncRNA-PVT1的表达水平与其Edmondson分级、TNM分期、分化程度和是否发生血管转移具有显著相关性(P0.05),而与患者的年龄、性别、血AFP水平、肿瘤直径、肿瘤数目以及是否有肝炎病史无关(P0.05)。lncRNA-PVT1高表达组患者的术后生存率明显低于lncRNA-PVT1低表达组患者,高表达水平的lncRNA-PVT1、Edmondson分级、TNM分期、分化程度和是否发生血管转移均是影响肝癌患者预后的独立危险因素。结论:lncRNA-PVT1在肝癌组织中呈高表达,高表达水平的lncRNA-PVT1与肝癌患者的临床预后不良密切相关,有望成为今后肝癌治疗的新靶点。  相似文献   

10.
目的:总结复杂胸壁肿瘤的临床特点与外科治疗经验。方法:回顾性分析上海交通大学医学院附属新华医院心胸外科2011年1月至2015年12月期间行复杂胸壁肿瘤切除重建手术患者的临床病理学资料,对患者临床特点、诊治方法及随访结果进行分析研究。结果:共入组25例患者,其中男16例,女9例。对25例患者均行完整肿瘤切除、胸壁重建术。4例上腔静脉或头臂静脉受侵者行人工血管置换术,2例胸骨受侵者行部分或完全胸骨切除术,1例因上腔静脉内癌栓形成行体外循环辅助胸壁肿瘤切除。术后病理诊断:恶性19例,良性6例;骨肉瘤6例(其中1例体外循环下行肿瘤切除),胸腺癌3例(均行人工血管置换术),浆细胞瘤2例,孤立性胸膜纤维瘤2例,横纹肌肉瘤2例,神经母细胞瘤2例,神经纤维瘤2例,梭形细胞癌2例,纵膈恶性间皮瘤1例(血管置换),纵膈脉管瘤1例,纵膈慢性炎性病变1例(侵犯胸骨),胸骨去分化软骨肉瘤1例(侵犯胸骨)。结论:完整切除肿瘤、一期胸壁重建是复杂胸壁肿瘤治疗的主要治疗方法。对大血管侵犯患者行新辅助放化疗后行血管置管术,对癌栓形成者行体外循环辅助取栓,对巨大胸壁肿瘤患者行肿瘤切除后钛板胸壁重建,必要时辅以手术前后放化疗,有助于提高肿瘤切除率并改善患者预后。  相似文献   

11.
Renal angiomyolipomas (AMLs) are often associated with tuberous sclerosis. These tumors are predominantly benign, although malignant forms do exist and are known to be associated with renal cell carcinoma. This case report describes a patient with tuberous sclerosis and massive bilateral AML. Total right nephrectomy was performed; histopathologic examination revealed the coexistence of AML and clear cell renal carcinoma in the same kidney. Because differentiation between renal cell carcinoma and AML with minimal or no fat component can be difficult, an accurate diagnosis is critical in the management of renal AML.Key words: Angiomyolipoma, Renal cell carcinoma, Tuberous sclerosisApproximately 80% of patients with tuberous sclerosis complex (TSC) develop renal angiomyolipoma (AML). Although often benign,1,2 malignant AML and renal cell carcinoma (RCC) have also been reported in patients with TSC. The concurrence of renal AML and RCC in the same kidney has also been reported in patients with TSC and has been revealed on pathologic examination.Several criteria can be used to help predict malignancy in renal AML, such as tumor size, tumor size and necrosis, and atypical mitotic figures. We report a case of associated massive bilateral AML and RCC. We discuss the diagnosis and treatment of renal AML and emphasize the possibility of concurrent renal malignancies in patients with TSC.  相似文献   

12.
Angiomyolipoma is a well described but relatively uncommon benign renal neoplasm composed of varying admixtures of mature adipose tissue, smooth muscle, and thick-walled blood vessels. The incidence of angiomyolipoma is about 0.3% overall. It frequently occurs in patients with tuberous sclerosis. Even more uncommon is the simultaneous occurrence of angiomyolipoma and renal cell cancer in the same kidney in a patient without tuberous sclerosis.  相似文献   

13.
BACKGROUND: Angiomyolipoma composed predominantly of epithelioid cells has been referred to as epithelioid angiomyolipoma. As this subtype shows considerable cellular atypia, it may be erroneously diagnosed as malignant epithelioid tumor, such as renal cell carcinoma and hepatocellular carcinoma. So far, only one report describing the cytologic findings of epithelioid angiomyolipoma has been documented, and epithelioid angiomyolipoma occurring in the peritoneal cavity has not been reported. CASE: Eleven years after resection of a renal epithelioid angiomyolipoma in a 34-year-old male with tuberous sclerosis, a tumor appeared in the peritoneal cavity and three masses in the liver. The intraoperative smears imprinted from part of the peritoneal mass revealed many large, atypical cells. The well-preserved atypical cells showed abundant, round to polyhedral, granular cytoplasm. Bizarre, giant nuclei with hyperchromasia and huge nucleoli were occasionally seen. Intranuclear cytoplasmic inclusions and mitotic figures were occasionally observed. As the epithelioid cells were markedly pleomorphic, we could not rule out hepatocellular carcinoma, cytologically and histologically, in the intraoperative consultation. In permanent sections the tumor was composed predominantly of epithelioid cells showing an alveolar pattern or sheetlike arrangement. Mitotic counts were zero to one per 10 high-power fields. Immunohistochemically, the epithelioid tumor cells were positive for vimentin, alpha-smooth muscle actin and HMB-45, consistent with epithelioid angiomyolipoma. MIB-1-labeling index was 1.6%. CONCLUSION: When one sees atypical epithelioid tumor cells in a tuberous sclerosis patient during an intraoperative consultation, one must consider epithelioid angiomyolipoma.  相似文献   

14.
BACKGROUND: Angiomyolipoma is a rare benign neoplasm, commonly involving the kidney. Preoperative diagnosis on fine needle aspiration cytology can confirm the diagnosis, reducing the chances of unnecessary surgery. CASES: We studied cases of renal angiomyolipoma (AML) presenting within 1 year with palpable renal masses confirmed on ultrasound to be of renal origin. Fine needle aspiration cytology (FNAC) smears showed a few cohesive syncytial fragments with adipocytes, spindle cells and isolated single cells with foamy cytoplasm; a diagnosis of AML was made. The diagnosis was confirmed on histopathology, which showed mature adipose tissue, tortuous and thick-walled blood vessels lacking elastic tissue lamina and bundles of smooth muscles that seemed to emanate from the blood vessels. CONCLUSION: A preoperative diagnosis of renal AML is of great importance for correct management. In fact, when the lesion is small and asymptomatic, a conservative approach may be considered. Partial nephrectomy is possible with masses < 5 cm. Preoperative FNAC along with computed tomographic findings and immunocytochemical analysis of FNAC smears with HNB-45 can confirm the diagnosis of AML, thus preventing unindicated nephrectomy.  相似文献   

15.
Angiomyolipomas are benign tumors of the kidney which express phenotypes of smooth muscle, fat, and melanocytes. These tumors appear with increased frequency in the autosomal dominant disorder tuberous sclerosis and are the leading cause of morbidity in adults with tuberous sclerosis. While benign, these tumors are capable of provoking life threatening hemorrhage and replacement of the kidney parenchyma, resulting in renal failure. The histogenesis of these tumors is currently unclear, although currently, we believe these tumors arise from "perivascular epithelioid cells" of which no normal counterpart has been convincingly demonstrated. Recently, stem cell precursors have been recognized that can give rise to smooth muscle and melanocytes. These precursors have been shown to express the neural stem cell marker NG2 and L1. In order to determine whether angiomyolipomas, which exhibit smooth muscle and melanocytic phenotypes, express NG2 and L1, we performed immunocytochemistry on a cell line derived from a human angiomyolipoma, and found that these cells are uniformly positive. Immunohistochemistry of human angiomyolipoma specimens revealed uniform staining of tumor cells, while renal cell carcinomas revealed positivity only of angiogenic vessels. These results support a novel histogenesis of angiomyolipoma as a defect in differentiation of stem cell precursors.  相似文献   

16.
Tuberous sclerosis is an autosomal dominant trait characterized by the development of hamartomatous growths in many organs. Renal cysts are also a frequent manifestation. Major genes for tuberous sclerosis and autosomal dominant polycystic kidney disease, TSC2 and PKD1, respectively, lie adjacent to each other at chromosome 16p13.3, suggesting a role for PKD1 in the etiology of renal cystic disease in tuberous sclerosis. We studied 27 unrelated patients with tuberous sclerosis and renal cystic disease. Clinical histories and radiographic features were reviewed, and renal function was assessed. We sought mutations at the TSC2 and PKD1 loci, using pulsed field- and conventional-gel electrophoresis and FISH. Twenty-two patients had contiguous deletions of TSC2 and PKD1. In 17 patients with constitutional deletions, cystic disease was severe, with early renal insufficiency. One patient with deletion of TSC2 and of only the 3' UTR of PKD1 had few cysts. Four patients were somatic mosaics; the severity of their cystic disease varied considerably. Mosaicism and mild cystic disease also were demonstrated in parents of 3 of the constitutionally deleted patients. Five patients without contiguous deletions had relatively mild cystic disease, 3 of whom had gross rearrangements of TSC2 and 2 in whom no mutation was identified. Significant renal cystic disease in tuberous sclerosis usually reflects mutational involvement of the PKD1 gene, and mosaicism for large deletions of TSC2 and PKD1 is a frequent phenomenon.  相似文献   

17.
Apoptosis - Tuberous sclerosis, angiomyolipoma and lymphangioleiomyomatosis are a group of diseases characterized by mutation in tuberous sclerosis genes (TSC 1-2). TSC mutation leads to continuous...  相似文献   

18.
目的:分析肾嗜酸细胞腺瘤的临床特征,指导并提升诊疗水平。方法:回顾性分析47例肾嗜酸细胞腺瘤的临床资料,包括临床特点、影像表现、病理特征、治疗方法及预后等方面。结果:47例患者中43例因查体偶然发现,仅4例表现为患侧腰痛症状。术前影像诊断中1例考虑嗜酸细胞腺瘤,1例考虑腺瘤,2例CT与MRI报告不一致(CT与MRI各有1例诊断良性,具体类型不确定),其余43例均诊断为肾细胞癌(1例囊性肾癌)。27例行肾癌根治性切除术,16例行肾部分切除术,4例行微波或射频消融术。所有患者术后病理均诊断为肾嗜酸细胞腺瘤,随访4~179月,均无转移或复发。结论:肾嗜酸细胞腺瘤作为一种与肾细胞癌难相鉴别的良性肿瘤,因缺乏特异性表现,极易误诊为肾细胞癌,因此对肾肿瘤患者应尽可能选择保肾治疗方案。  相似文献   

19.
Pulmonary tuberous sclerosis produced interstitial disease in a woman with normal-sized lungs; numerous hemosiderin-laden macrophages were found in the fluid obtained through bronchoalveolar lavage. The pathological changes seen in the lungs were identical to those of pulmonary lymphangiomyomatosis, in which the constellation of clinical signs usually found in tuberous sclerosis is absent. The two conditions are sufficiently similar in clinical presentation, pathological changes and prognosis to be considered variants of the same disease. The recent findings of progestin receptors in lung tissue from patients with pulmonary lymphangiomyomatosis will likely direct future management towards hormonal manipulation.  相似文献   

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