电视纵隔镜与CT 对胸部疾病诊断的运用研究

目的:探讨电视纵隔镜与CT对胸部疾病诊断中的运用.方法:对我院收治的59例胸部疑难疾病患者采用CT以及电视纵隔镜检查,并对两种方法对肺癌纵膈淋巴转移的诊断效果进行比较.结果:所有患者采用纵隔镜检查其确诊率为100％,CT诊断诊断符合率为525％;CT对肺癌纵隔淋巴结转移的灵敏度为55.26％、真实性为57.89％、特异度为60.53％、阳性预测值为44.74％以及阴性预测值为81.58％,而电视纵隔镜其分别为94.74％、97.37％、100.00％、100.00％、97.37％.电视纵隔镜在诊断肺癌纵膈淋巴结转移的各项指标中均优于CT.结论:电视纵隔镜对胸部疑难疾病具有较好的诊断效果,而且其具有并发症少等特点.     

Merkel cell carcinoma in a malignant pleural effusion: case report

BACKGROUND: Merkel cell (neuroendocrine) carcinoma is a small round blue cell malignant neoplasm that primarily presents in the skin. The diagnosis of Merkel cell carcinoma in a pleural fluid is challenging because of the morphological similarity to many other malignant neoplasms. Immunohistochemical stains can be essential to establish the diagnosis of Merkel cell carcinoma. CASE PRESENTATION: A 77 year-old woman presented with a mass in her right buttock thought clinically to be a boil or sebaceous cyst. Upon histopathologic review including immunohistochemical analysis, a diagnosis of Merkel cell carcinoma was rendered. Wide-excision and sentinel lymph node biopsy revealed negative margins and no evidence of metastasis. Ten months later she complained of bone pain and a bone scan revealed multiple lesions. An abdominal CT scan revealed a T4 vertebral mass and local radiotherapy was administered. Two months later the patient presented with shortness of breath. A chest radiograph showed an effusion and thoracentesis was performed. The fluid was confirmed to contain metastatic Merkel cell carcinoma by cytology and immunohistochemical analysis. CONCLUSIONS: Merkel cell carcinoma is an aggressive neoplasm that can, despite careful surgical management, occasionally present as a malignant pleural effusion in a relatively short time period. Immunohistochemical analysis can aid in confirming this rare outcome.     

Carcinoma of unknown primary in the head and neck: The evaluation of the effectiveness of 18F-FDG-PET/CT,own experience

AimThe aim of the present study was to estimate the clinical effectiveness of ¹⁸F-FDG-PET/CT in the detection of the primary tumor in patients with histologically proven squamous cell carcinoma cervical lymph nodes metastasis from an unknown primary.Background¹⁸F-fluorodeoxyglucose positron emission tomography combined with CT (¹⁸F-FDG-PET/CT) is believed to be very helpful in localization of primary tumor in CUP Syndrome patients.Material and method41 patients referred to Poznan Medical University Department of Head and Neck Surgery from January 2010 to December 2013 with CUP Syndrome were included in the study. All patients presented fine-needle biopsy proven squamous cell carcinoma metastasis of the upper-, or mid neck lymph nodes. The final results were obtained from the histopathologic reports of tissue samples from anatomical regions suspected for primary tumor, additional imaging exams as well as clinical follow-up data.ResultsThe ¹⁸F-FDG-PET/CT successfully detected primary tumor in 7 out of 41 patients (17%). In two more cases the primary tumor was indicated in the lung. 24 of 41 patients (58.5%) analyzed in our study remained without evidence of a primary tumor. In 4 cases (9.75%) we did not reveal any pathology within the localizations indicated by PET/CT on panendoscopy. In 4 cases we obtained histological confirmation of neoplasm on panendoscopy despite the negative results of PET/CT examinations.ConclusionWe may suppose a relatively high usefulness of ¹⁸F-FDG-PET/CT in the diagnosis process of CUP Syndrome patients. High NPV may indicate patients with no symptoms of primary tumor, which allows to avoid extensive resection or extra imaging.     

Fine needle aspiration cytology of a skeletal metastasis of adult Wilms' tumor. A case report

BACKGROUND: Nephroblastoma (Wilms' tumor) is the most common malignant tumor of the kidney in children but is rare in adults. The stage and histopathology of the tumor are the most important prognostic indicators. The common sites of metastasis are lung, liver and lymph nodes. Skeletal metastasis is exceedingly rare in both pediatric and adult nephroblastoma. We report an unusual case of a skeletal metastasis of adult nephroblastoma that developed nine years after the diagnosis of a typical nephroblastoma of favorable histology and that was diagnosed by computed tomography (CT)-guided fine needle aspiration cytology. CASE: Following a right radical nephrectomy for adult nephroblastoma and two local recurrences two and three years later, a 74-year-old woman presented with low back pain. CT and magnetic resonance imaging revealed lytic lesions in the 10th and 12th thoracic vertebrae. Smears prepared from specimens obtained through CT-guided fine needle aspiration biopsy were moderately cellular, with small, round cells arranged singly and in loosely cohesive clusters. These cells had inconspicuous nucleoli and scanty to moderate amounts of cytoplasm. The cells were also positive for cytokeratin and vimentin and appeared similar to areas of blastema in the original tumor. CONCLUSION: A definitive diagnosis of metastatic adult nephroblastoma in thoracic vertebrae was made possible by CT-guided fine needle aspiration cytology in conjunction with clinical and radiologic findings and by using ancillary modalities, such as immunohistochemical studies.     

Simultaneous two organ metastases of the giant basal cell carcinoma of the skin

BACKGROUND: Basal Cell Carcinoma (BCC) is the most common carcinoma in humans. It accounts for 20% of carcinomas in men and 10-15% of carcinomas in women. Despite its high incidence, metastatic events are exceedingly rare. The reported frequency of metastatic dissemination is estimated at 0.0028-0.5 percent. Once metastasis is detected, there is a high mortality rate of 50% within 8 months. METHODS: In this study, we present a case of simultaneous lung and parotid metastases of giant BCC primary located on the right medial canthus of a 62 year old female. RESULTS: Examination of the tumor located on the medial canthus obtained showed "adenoid BCC". Computed tomography (CT) was performed to evaluate parotid region for evaluation of parotid gland and chest. Parotid and lung metastasis were detected in CT. Routine labarotory tests and radiological investigations were done. There was no abnormal finding. We also investigated this patient with a bone scan (normal), abdominal and cranial CT scans (also normal). CONCLUSION: Although metastasis of BCC is a very rare condition, this study reports a case of simultaneous parotid gland and lung metastasis originating from a giant BCC primary that was located on the right inner canthus of a 62 year old female.     

CT 扫描在食管癌淋巴结转移患者预后评估中的应用价值

目的:探讨CT扫描对食管癌淋巴结转移诊断的准确率及CT扫描对预测淋巴结转移患者预后的价值.方法:选择我院收入的行食管癌根治术患者共146例,患者均行CT及腹部彩超,检查者CT及腹部彩超对食管癌淋巴结转移检测的准确率及漏诊率,检测CT淋巴结转移数、CT三分区转移情况及CT最大病变直径等CT检测与食管癌淋巴结转移相关因素.结果:CT淋巴结总检出率显著高于彩超检出率,两组对比差异有统计学意义,P＜0.05.CT检测中胸上段、胸中段总检出率显著高于彩超检出率,结果对比差异有统计学意义,P＜0.05.所有患者自手术日起计算术后1、3年生存率分别为73.3％(107/146)、47.9％( 70/146),CT 转移数≥2枚、CT三分区转移＜2区、CT最大病变直径≤3cm患者术后生存率较高,结果对比差异有统计学意义,P＜0.05.结论:CT对食管癌淋巴结转移诊断率较高,CT转移数、CT三分区转移及CT最大病变直径检测可用于评估患者术后生存率情况.     

A case of Lymphoepithelioma-like carcinoma (LELC) developed in the rectum

Lymphoepithelioma-like carcinoma (LELC) is histologically similar in form to nasopharyngeal carcinoma (NPC) and is an epithelial tumor that is suggested to be involved in infection with Epstein-Barr virus (EBV), but it is rare to occur in the colon. A 35-year-old woman was found to have a rectal wall thickening by follow-up computed tomography (CT) image after sigmoidectomy and left salpingo-oophorectomy. Biopsy under colonoscopy revealed recurrence of ovarian cancer, and she underwent a low anterior resection. Pathological diagnosis was LELC. Although LELC of the stomach has been reported to have a high EBV infection rate as NPC, EBV infection was not detected in our case. Pelvic lymph node dissection was also performed, and metastasis was recognized around the iliac artery. There have been few reports of LELC occurring in the rectum, and there are no reports of distant metastasis only to the pelvic lymph node. We consider it a very valuable case, and report it with literature references.     

Asymptomatic adrenal tumor; 386 cases in Japan including our 7 cases

To clarify the indication of surgery in incidentally discovered asymptomatic adrenal masses, we analyzed 386 Japanese cases, 379 cases reported in Japan during the past 25 years (from 1964 to 1988) and 7 cases from our own experience. From a total of 460 patients, we carefully selected 379 patients satisfying our criterion of the absence of symptoms and signs suggestive of active hormone over-secretion as described in each case report. From the Japanese series, there was a high incidence of pheochromocytoma patients (20 of 37 patients) who had no symptoms and signs but had high plasma or urine catecholamines. Scintigraphy with 131I-meta-iodo-benzyl-guanidine was useful in the diagnosis of pheochromocytoma. For the other asymptomatic adrenal tumors, except for myelolipoma and adrenal cyst, differential diagnosis between malignant and benign adrenal lesions by imaging procedures such as whole body computed tomography (CT), ultrasonography (US), adrenocortical scintigraphy, and angiography was not always possible. In addition, among the 109 patients with cortical tumors whose hormonal data were reported, no clear-cut differentiation of malignant tumor from benign by means of these data could be obtained. Since 1980 whole body CT scanner and high resolution US scanner have become widely available, and there have been 283 cases of asymptomatic adrenal tumors who satisfied our criterion. Cortical carcinomas smaller than 3 cm and 6 cm in diameter account for 3.8% and 6.6%, respectively, of the total of 101 cases of cortical carcinoma, cortical adenoma, ganglioneuroma, and hemangioma during this period. The size of the smallest cortical carcinoma with metastasis was 2 cm in diameter in this series. Pre-operatively, an adrenocortical carcinoma 2.8 cm in diameter in our patient could not be diagnosed as such by imaging techniques and measurement of plasma hormones. These findings suggest that an adrenal mass larger than 3 cm should be removed and a patient with a smaller cortical tumor should be carefully followed up.     

CT联合DR对早期周围型肺癌的诊断价值

目的:分析数字X线摄片(DR)、CT及其联合应用对周围型肺癌的诊断价值。方法:选择该院2012年2月~2016年3月收治早期周围型肺癌患者90例为研究对象,分别进行数字化X线摄影和CT检查,以手术切除或病理结果为最终诊断的金标准,计算两种检查方法及其联合对早期诊断周围型肺癌的敏感度、特异度和准确率阳性预测值以及阴性预测值。结果:胸部DR检出空泡征者7例(7.8%),分叶征47例(52.2%),边缘有细小毛刺征36例(40%),胸膜凹陷征9例(10%);CT见病变边缘分叶征71例(78.8%),长短毛刺征57例(63.3%),空洞征27例(30%),胸膜凹陷征32例(35.6%)。DR诊断周围型肺癌的敏感性、特异性及准确性分别为85%、81%、85.6%,而CT则为90%,87.6%,90.5%,均高于DR。DR与CT两者联合诊断周围型肺癌的敏感性为98.4%,显著高于DR(85%)和CT(90%)。结论:在早期周围型肺癌的影像学诊断中,CT的临床价值显著优于DR,而两者联合诊断的临床价值明显优于单独检测。     

Fine needle aspiration of myelolipoma of the adrenal gland. Report of a case with computed tomography

Myelolipoma, a rare benign tumor of the adrenal gland composed of adipose tissue and hemopoietic elements, is usually asymptomatic and described as an incidental finding at autopsy. Computed tomographic (CT) body scans revealed radiographic evidence of myelolipoma, i.e., low-density masses with calcification, in a patient with a known squamous-cell carcinoma of the lung. These nonspecific findings, described in a variety of other tumors involving the adrenal gland, were confirmed by CT-guided fine needle aspiration (FNA) biopsy. While the routine use of FNA biopsies of the adrenal gland in patients who do not have cancer remains controversial, it is mandatory to biopsy any masses in the adrenal gland in patients who have cancer; this case illustrates the value of CT-guided FNA biopsy in rendering a diagnosis of myelolipoma of the adrenal gland.     

Adenoid cystic carcinoma metastatic to the lung. Report of a case diagnosed by fine needle aspiration biopsy cytology

Cytologic examination of a fine needle aspiration (FNA) biopsy specimen served to diagnose a lung metastasis in a patient with an adenoid cystic carcinoma primary in a minor salivary gland of the hard palate. The aspiration cytologic features of the metastatic adenoid cystic carcinoma were similar to those of primary adenoid cystic carcinoma, including uniform tumor cells with scant cytoplasm surrounding transparent, mucoid spherical bodies. FNA biopsy cytologic diagnosis of metastatic adenoid cystic carcinoma is accurate, particularly if mucoid spherical bodies are present.     

Intraoperative cytologic diagnosis of symptomatic carcinoma (pulmonary small cell carcinoma) metastatic to the pituitary gland: a case report

BACKGROUND: Carcinoma metastatic to the pituitary gland is infrequent and has been reportedly detected in approximately 1% of pituitary surgical cases. It may masquerade as a pituitary adenoma both clinically and radiologically. CASE: A 49-year-old man presented with a 1-month history of severe headache, diplopia and blurred vision. Neurologic examination revealed bitemporal hemianopsia and left sixth nerve palsy. The initial radiologic diagnosis based on magnetic resonance imaging was pituitary adenoma. A biopsy of the lesion was performed. While intraoperative frozen section examination could not completely exclude an "atypical" pituitary adenoma, cytologic touch imprint findings were diagnostic of metastatic small cell carcinoma. Subsequently, additional workup revealed that the patient had a mass lesion in the right lung and right-sided mediastinal lymphadenopathy on chest computed tomography. This was a rare case of pituitary metastasis as the first manifestation of an occult malignancy. CONCLUSION: For intraoperative diagnosis at the time ofpituitary surgery, cytologic imprints can be used reliably to make a diagnosis not only of pituitary adenoma but also of metastatic lesions. It is appropriate in current neuropathology practice that the imprint method be used as the sole modality for intraoperative consultation for pituitary lesions.     

Pancreatic solitary and synchronous metastasis from breast cancer: a case report and systematic review of controversies in diagnosis and treatment

Background

Metastases from breast cancer cause the frequent involvement of lung, bone, liver, and brain, while the occurrence of metastases to the gastrointestinal tract is rare, and more frequently discovered after a primary diagnosis of breast cancer. Solitary pancreatic metastases from breast cancer, without widespread disease, are actually unusual, and only 19 cases have been previously described; truly exceptional is a solitary pancreatic metastasis becoming evident together with the primary breast cancer.

Case presentation

A 68-year-old woman reported general fatigue, lethargy, and jaundice. Abdominal ultrasound (US) and magnetic resonance imaging (MRI) showed an ampulloma of Vater’s papilla; moreover, a neoplastic nodule in the left breast was diagnosed. She underwent surgery for both breast cancer and ampulloma of Vater’s papilla. Pathological examination of pancreatic specimen, however, did not confirm primary carcinoma of the duodenal papilla, but showed a metastatic involvement of pancreas from lobular breast cancer. Immunohistochemistry has been essential to confirm the origin of the malignancy: hormone receptors and mammaglobin were expressed in both the primary breast tumor and the pancreatic metastasis.

Conclusions

This is one of the few reported cases in literature of an isolated and synchronous pancreatic metastasis from breast cancer, where the definitive diagnosis was obtained only after surgery. We discuss the controversies in this diagnosis and the choice of correct treatment. The surgical resection of solitary metastases can be performed in the absence of disseminated disease.     

Case of lung carcinoma revealed by vulvar metastasis associated with systemic scleroderma and literature review

Metastatic carcinoma to the vulva is rare, where the incidence is believed to be between 5% and 8%.However, malignant tumors have been described in 3–11% of systemic scleroderma (SSc) cases.We report the case of one patient, a 66-year-old postmenopausal woman, whose medical history was marked with rheumatic vascular disease (systemic scleroderma) since 1993 without muscular, renal, cardiac lesions or HTA (arterial hypertension) and without tobacco history.The woman presented with a new vulvar mass of the right labia in December 2011 that had progressively enlarged in size.CT scan of the abdominopelvic region demonstrated a lobular mass of the right labia with central necrosis, 7 cm on the wide axis, and the rectum and the vaginal wall were normal. No inguinal or iliac lymphadenopathy was noted.An outpatient excisional biopsy revealed a poorly differentiated malignant tumor suggestive of carcinoma.IHC: CK7+/CK20−, estrogen receptors−, AE 1 AE 3+, vimentine+, S100−, Desmina−, CD34−, KI 67: 20%.The thoracic scan revealed a large mass of 4 cm × 3 cm in the right lung base with right paratracheal lymphadenopathy 3 cm × 2 cm.A bronchoscopy revealed discrete stenosis of the mediastinal portion of the right bronchial tree.The bronchial biopsy also revealed poorly differentiated lung carcinoma, non-small cell, which was identical with the vulvar tumor.

Conclusion

The presence of the single lung lesion with only one lymphadenopathy paratracheal with pathological and immunohistochemical (IHC) profile similar to the vulvar lesion, and a particular IHC profile with CK7+ and CK20− was detected – that is more specific to the primitive pulmonary cancer, and the presence of only one sarcoma marker vementine+, desmine and actine−. Also the presence of KI 67: 20%, predicted the proliferative and great metastatic power of the lung tumor was observed.Additionally, lung cancer was the most frequent type and may develop in scleroderma as reported in most studies.This allows to conclude for primitive lung carcinoma revealed with vulvar metastasis after elimination of the possibility of vulvar sarcoma.The patient was treated by chemotherapy (Taxol/Platin) with partial response from the lung after 3 cycles and palliative radiotherapy in the vulva with a good response.This case described primary lung carcinoma associated with scleroderma, revealed by a vulvar metastasis, which may be related to the aggressiveness of lung cancer when the lung fibrosis follow-up is not performed well to detect early the development of lung tumors in the patient with systemic scleroderma.     

Renal cell -like carcinoma of the nasal cavity: a case report and review of the literature

Background

Sinonasal renal cell-like carcinoma (SRCLC) is an extremely rare low malignant tumor arising in the sinonasal tract, with histological mimicry of renal cell carcinoma.

Case presentation

We present a case of sinonasal renal cell-like carcinoma in a 63-year-old male patient. Computer tomography(CT) scanning revealed a soft tissue mass at the left nasal cavity and choana. Histologically, the predominant tumor architecture was follicular to glandular with intervening fibrous septa. The tumor cells were uniform cuboidal to polyhedral with abundant clear or eosinophilic cytoplasm. Immunohistochemically, the tumor cells were strongly positive for CK7, EMA, vimentin, SOX10, S-100, and focally positive for CA9. During 6 months of follow-up, there was no clinical or radiological evidence of recurrence or metastasis.

Conclusion

SRCLC has microscopic features which overlap with tumors that contain clear cells. Thus, several other tumors must be considered in the differential diagnosis of a tumor of the sinonasal region with clear cells, especially metastatic renal clear cell carcinoma. SRCLC is an indolent tumor and none of the reported SRCLC patients had metastatic disease.

     

Involvement of highly sulfated chondroitin sulfate in the metastasis of the Lewis lung carcinoma cells

The altered expression of cell surface chondroitin sulfate (CS) and dermatan sulfate (DS) in cancer cells has been demonstrated to play a key role in malignant transformation and tumor metastasis. However, the functional highly sulfated structures in CS/DS chains and their involvement in the process have not been well documented. In the present study, a structural analysis of CS/DS from two mouse Lewis lung carcinoma (3LL)-derived cell lines with different metastatic potentials revealed a higher proportion of Delta(4,5)HexUA-GalNAc(4,6-O-disulfate) generated from E-units (GlcUA-GalNAc(4, 6-O-disulfate)) in highly metastatic LM66-H11 cells than in low metastatic P29 cells, although much less CS/DS is expressed by LM66-H11 than P29 cells. This key finding prompted us to study the role of CS-E-like structures in experimental lung metastasis. The metastasis of LM66-H11 cells to lungs was effectively inhibited by enzymatic removal of tumor cell surface CS or by preadministration of CS-E rich in E-units in a dose-dependent manner. In addition, immunocytochemical analysis showed that LM66-H11 rather than P29 cells expressed more strongly the CS-E epitope, which was specifically recognized by the phage display antibody GD3G7. More importantly, this antibody and a CS-E decasaccharide fraction, the minimal structure recognized by GD3G7, strongly inhibited the metastasis of LM66-H11 cells probably by modifying the proliferative and invading behavior of the metastatic tumor cells. These results suggest that the E-unit-containing epitopes are involved in the metastatic process and a potential target for the diagnosis and treatment of malignant tumors.     

MRI与CT检查对卵巢癌病理分期及复发转移的诊断价值对比研究

摘要 目的：对比磁共振成像（MRI）与计算机断层扫描（CT）检查对卵巢癌病理分期及复发转移的诊断价值。方法：纳入2017年1月～2019年1月于我院接受诊治的卵巢癌患者100例进行研究。所有患者术前均进行MRI与CT检查,并以术后病理组织活检结果为金标准,对比MRI与CT诊断卵巢癌与卵巢癌病理分期的准确率。所有患者均于首次检查6个月后进行复诊,对比MRI与CT诊断卵巢癌复发转移的准确率。结果：MRI诊断卵巢癌的确诊率为94.00%（94/100）,高于CT诊断的81.00%（81/100）;漏诊率为2.00%（2/100）,低于CT诊断的10.00%（10/100）（均P＜0.05）。MRI诊断卵巢癌Ⅰ期、Ⅱ期、Ⅲ期的准确率分别为93.33%（14/15）、95.00%（19/20）、93.33%（28/30）,高于CT诊断的60.00%（9/15）、65.00%（13/20）、73.33%（22/30）（均P＜0.05）。MRI诊断肠管及周围、盆腔淋巴结、腹膜后淋巴结、肝脏等远处侵袭和转移中的准确率分别为100.00%（26/26）、88.89%（24/27）、75.00%（18/24）、95.00%（19/20）,高于CT诊断的76.92%（20/26）、48.15%（13/27）、41.67%（10/24）、45.00%（9/20）（均P＜0.05）。结论：相较于CT检查,MRI检查诊断卵巢癌的准确率更高,漏诊率更低,且在卵巢癌病理分期以及复发转移的诊断准确率更高,具有较好的临床应用价值。     

Metastasis of bronchogenic carcinoma to the thumb

Bone metastasis in the hand is rare. The etiology is quite different from that of metastasis to other bones; bronchogenic carcinoma is by far the most frequent case. Distal phalanges are mainly involved with irregular osteolysis and cortical destruction. Differential diagnosis of phalangeal metastasis includes osteomyelitis, rheumatoid arthritis and gout. The prognosis is always that of metastatic bronchial cancer with an average survival of three months. Treatment may involve distal digital amputation or antalgic radiotherapy. A case of bronchogenic carcinoma with metastasis to the thumb is presented. The metastasis was located in the distal phalanx of the left thumb. The primary tumor was located in the lung. Treatment consisted of amputation. The overall survival was five months.     

Roles of circulating carcinoembryonic antigen and calcitonin in diagnosis of medullary thyroid carcinoma: a comparative study.

Carcinoembryonic antigen (CEA) and calcitonin (CT) were simultaneously determined in sera and tumor tissues from 15 patients with medullary carcinoma of the thyroid (MCT). Serum CEA was increased in all but one patient, and CT did in all of them. Both levels were significantly related to the weight of excised tumor, but not to the presence of metastasis. Furthermore, a significant correlation was noted between the basal levels of CT and CEA. Both levels fell to normal after a radical operation had been performed. Tissue concentrations of CEA and CT in the MCT were more than 100 times those in hyperthyroidism, and the ratios of tissue over serum levels averaged 770 in CEA and 1000 in CT. In the calcium infusion test, CEA levels were not significantly changed in contrast with a distinct increase in CT levels. The results indicate that CEA and CT represent separate activities of the tumor cells, and that circulating CEA together with CT is a useful indicator in the diagnosis and follow-up of the disease.