鞍区颗粒细胞瘤1例的病历分析及相关文献复习

目的：探讨伴有临床症状的鞍区颗粒细胞瘤（granular cell tumour,GCT）的病理组织学起源及其治疗方法。方法：回顾性分析我院收治的1例具有临床症状的GCT患者的治疗状况和病理结果,并结合近20年来关于GCT病理和治疗的相关文献报道,探讨GCT肿瘤病理组织起源和治疗要点。结果：该患者影像学报告怀疑鞍区炎性肉芽肿,给予抗生素治疗后复查MRI显示鞍区占位较前次无改变,增强MRI可见占位明显强化,诊断良性肿瘤,并采取翼点入路手术切除。术后病理证实为神经垂体颗粒细胞瘤。术后患者头痛缓解,尿量、尿比重、垂体内分泌激素等相关指标相继恢复至正常值。结论：GCT很可能起源于神经组织,伴有临床症状的GCT的治疗首选开颅手术,肿瘤残存的患者,术后不必放射治疗,定期复查即可。     

鞍区常见肿瘤影像学诊断现状

鞍区占位包括垂体起源的和非垂体起源的占位性病变,其中以垂体腺瘤最为常见。由于鞍区其他占位性病变在颅内的解剖位置与垂体腺瘤十分接近,因此垂体腺瘤的诊断与鞍区其它肿瘤的鉴别诊断,是影像科医师所面临的挑战。将鞍区其它少见的占位性病变与垂体腺瘤相鉴别,给出正确的诊断对于指导临床手术入路和避免术中和术后出现并发症(如脑脊液漏、颅内感染),具有重要意义。其中鞍区占位性病变常需要将垂体腺瘤与Rathke囊肿、颅咽管瘤、鞍区脑膜瘤、脊索瘤、颅内转移瘤相鉴别。本文总结了目前垂体腺瘤等其他占位性病变的影像学表现以及影像学特征,以便于鞍区常见肿瘤的诊断和鉴别诊断。     

不同术式治疗早期卵巢颗粒细胞瘤的预后分析

目的：探讨不同术式对早期卵巢颗粒细胞瘤初治患者预后的影响。方法：收集2000年1月～2008年12月我院收治的39例早期卵巢颗粒细胞瘤患者的临床资料,分析不同术式对肿瘤复发和预后的影响。结果：39例患者中,行全面分期手术者20例,其中7例仅予盆腔及腹主动脉旁淋巴结活检而未予淋巴结清扫,所有淋巴结术后病理皆提示无淋巴转移;19例行非全面分期手术。随访期间,全面分期手术组皆无复发,而非全面分期手术组4例复发,两组患者术后3年的复发率分别为0和21%,具有统计学差异（P〈0.05）;非全面分期手术组有1例患者于术后29月死亡,死亡年龄为72岁,全面分期手术组无死亡病例,两组患者的死亡率不具有统计学差异（P〉0.05）。结论：原发性卵巢颗粒细胞瘤罕有淋巴结转移,早期卵巢颗粒细胞瘤行全面分期手术对于明确肿瘤分期、治疗及预后有重要意义,而全面分期手术中行盆腔及腹主动脉旁淋巴结清扫对于肿瘤的复发意义有限,初治患者全面分期手术时可不予淋巴清扫。     

额底纵裂入路手术对鞍上第三脑室底垂体瘤的疗效分析

目的：分析经额底纵裂入路治疗鞍上第三脑室底垂体瘤的疗效,探讨其临床适用性。方法：选择从2011年1月~2013年1月与我院行额底纵裂入路手术治疗的30例鞍上第三脑室底垂体瘤的患者,术中行单侧额或双侧额弧形切口,根据术中所见肿瘤位置,由终板、视神经一颈内动脉等存在的生理间隙处切除肿瘤,观察所有患者的手术疗效。结果：所有患者术中可见肿瘤位于鞍内鞍上,部分或全部突入第三脑室底,其中有6例患者伴有脑积水。术中肿瘤全切23例,次全切5例,大部切除2例,无手术死亡病例。术前25例患者视力减退,术后23例患者视力均获得不同程度改善,仅1例暂无明显变化。术后19例出现电解质紊乱,患者经治疗后均已纠正;12例出现不同程度的尿崩症,给予患者药物治疗后,病情得到缓解。术后随访6个月,23例肿瘤全切患者病灶无复发,另外4例次全切者病灶也无明显变化,仅1例次全切和2例大部切除患者于术后行伽马刀再次治疗。结论：经额底纵裂入路治疗鞍上第三脑室底垂体瘤可以达到视野清晰,直观下进行肿瘤切除,手术效果好,并发症较少,适合临床长期推广应用。     

颅底脊索瘤的影像学诊断及治疗研究（附26例报告）

目的：探讨颅底脊索瘤的CT、MRI表现及治疗措施。方法：回顾性分析经病理证实的26例脊索瘤患者的临床资料。肿瘤位于鞍区及鼻咽部者9例,位于中颅窝者5例,位于后颅窝者8例,混合型4例。手术入路：额颞入路一翼点开颅9例,鼻内镜下经蝶入路5例,颞下、颞枕及扩大中颅窝入路8例,4例未手术行放射治疗。结果：肿瘤全切8例,大部及次全切14例,围手术期未见死亡病例。25例患者获得随访;3例于术后1年内复发,其中2例死亡,余者颅神经损伤及肢体症状均有改善。结论：脊索瘤无典型临床表现,现多可通过术前影像学检查得以诊断,少数位于特殊位置者需与垂体瘤,颅咽管瘤,三叉神经鞘瘤等鉴别;肿瘤全切较为困难,根据需要选择相应的手术入路可明显提高手术效果;放疗可作为术后辅助治疗。     

肾脏巨大血管平滑肌脂肪瘤合并结节性硬化1 例报告并文献复习

目的:总结肾脏巨大血管平滑肌脂肪瘤合并结节性硬化的临床及组织病理特点,探讨其诊疗方法及预后情况.方法:回顾性分析1例罕见的肾脏巨大血管平滑肌脂肪瘤合并结节性硬化的临床特征、组织病理学特点以及诊断、治疗方法,同时复习近年来的国内外相关文献.结果:患者于我院行剖腹探查,右肾巨大肿瘤切除术,术后病理示血管平滑肌脂肪瘤.手术后患者恢复良好,症状明显改善,肝肾功能正常.术后3个月复查CT:左肾区与术前比无变化,右肾区未见肿瘤复发.结论:对于巨大肾脏血管平滑肌脂肪瘤合并结节性硬化的患者,手术治疗仍可作为可选择的治疗方法,但其远期预后仍待观察.     

鞍区HRCT扫描在单鼻孔蝶窦入路切除垂体腺瘤中的作用

目的:探讨术前鞍区HRCT扫描在单鼻孔蝶窦入路切除垂体腺瘤中的作用.方法:回顾性分析42例经单鼻孔蝶窦入路垂体腺瘤切除病人鞍区薄层HRCT检查的结果和经验.结果:蝶窦呈鞍彤35例,鞍前形7例,鞍底骨质破坏19例.术后鞍底骨窗均小于1.5 cm × 1.5cm.肿瘤全切除28例,次全切除10例,部分切除4例.术后视力及视野改善者31例,内分泌指标恢复正常者35例.术后脑脊液鼻漏5例.本组无死亡病例,没有出现因骨窗咬除而出现的视神经损伤、海绵窦出血等并发症.结论:鞍区薄层HRCT检查有利于指导手术入路的设计和术中手术方位的判断.     

胶质母细胞瘤术后MRI特征及其意义

目的:探讨胶质母细胞瘤术后瘤周梗塞的MRI特征,并评价其临床意义.方法:收集54例胶质母细胞瘤患者的临床、病理及影像学资料,全部患者于术后72小时内进行了MRI检查,并在6个月内进行MRI随访复查,回顾性分析术后临床及MRI表现.结果:术后72小时内MRI研究发现39例存在DW1局灶性弥散受限,病变位于肿瘤切除后空穴区附近.随访MRI研究发现90%的弥散受限病灶已发展成为囊性脑软化,提示原来的局灶性弥散受限为脑梗塞表现,增强扫描44%的梗塞区有异常强化.9例手术后并发神经功能缺失,其中6例与MRI梗塞的分布区域密切相关.结论:恶性胶质瘤术后DWI弥散受限是一种脑梗塞表现,并具有一定临床意义,MRI随访观察中梗塞区异常强化容易误诊为肿瘤复发.     

颅底脊索瘤的影像学诊断及治疗研究(附26例报告)(英文)

目的:探讨颅底脊索瘤的CT、MRI表现及治疗措施。方法:回顾性分析经病理证实的26例脊索瘤患者的临床资料。肿瘤位于鞍区及鼻咽部者9例,位于中颅窝者5例,位于后颅窝者8例,混合型4例。手术入路:额颞入路-翼点开颅9例,鼻内镜下经蝶入路5例,颞下、颞枕及扩大中颅窝入路8例,4例未手术行放射治疗。结果:肿瘤全切8例,大部及次全切14例,围手术期未见死亡病例。25例患者获得随访;3例于术后1年内复发,其中2例死亡,余者颅神经损伤及肢体症状均有改善。结论:脊索瘤无典型临床表现,现多可通过术前影像学检查得以诊断,少数位于特殊位置者需与垂体瘤,颅咽管瘤,三叉神经鞘瘤等鉴别;肿瘤全切较为困难,根据需要选择相应的手术入路可明显提高手术效果;放疗可作为术后辅助治疗。     

神经内镜与显微镜下经鼻蝶入路手术切除垂体腺瘤的临床疗效比较及术中出现脑脊液漏的危险因素分析

摘要 目的：对比垂体腺瘤患者采用显微镜或神经内镜下经鼻蝶入路手术切除后的临床疗效,分析术中出现脑脊液漏的危险因素。方法：回顾性分析2018年3月~2022年2月期间来我院接受手术治疗的178例垂体腺瘤患者的临床资料。根据采用手术器械的不同将178例患者分为A组（显微镜,n=91）和B组（神经内镜,n=87）。比较两组的肿瘤有效切除率、临床指标、术中脑脊液漏发生率及术后并发症发生率。根据术中是否发生脑脊液漏分为脑脊液漏组和无脑脊液漏组。经单因素和多因素Logistic回归分析患者术中发生脑脊液漏的危险因素。结果：B组的手术时间、住院时间短于A组,术中出血量少于A组（P<0.05）。A组、B组的肿瘤有效切除率组间对比,无统计学差异（P>0.05）。B组术中脑脊液漏发生率、术后并发症发生率低于A组（P<0.05）。垂体腺瘤患者术中发生脑脊液漏与再次手术、肿瘤大小、年龄、肿瘤质地、美国麻醉医师协会（ASA）分级有关（P<0.05）。肿瘤大小为巨大腺瘤、再次手术、肿瘤质地为韧是垂体腺瘤患者术中发生脑脊液漏的危险因素（P<0.05）。结论：显微镜与神经内镜下经鼻蝶入路手术切除垂体腺瘤,治疗效果相当,但神经内镜下手术可缩短手术时间、住院时间,减少术中出血量,降低术中脑脊液漏发生率、术后并发症发生率。此外,肿瘤大小为巨大腺瘤、再次手术、肿瘤质地为韧是垂体腺瘤患者术中发生脑脊液漏的危险因素。     

MRI在喉癌术前分期中的临床应用价值

目的:探讨MRI在喉癌术前诊断、分期中的临床应用价值。方法:对114例行电子喉镜检查并经病理学证实为喉癌的患者行术前MRI扫描,根据图像资料判断肿瘤侵及范围及判断有无淋巴结转移;同时进行术前分期、分型,并与术后病理分期、分型对照研究。结果:术前MRI T1期27例,其中25例经病理证实为T1期,2例为T2期,准确率为92.6%;术前MRI T2期39例,其中经病理证实35例为T2期,3例T1期,1例T3期,准确率为89.7%;术前MRI T3期29例,其中经病理证实25例为T3期,4例T2期,准确率为86.2%;术前MRI T4期17例,其中经病理证实15例为T4期,2例T3期,准确率为88.2%;MRI术前T分期总准确率为87.7%。N1期准确率为81.8%,N2期准确率为94.1%。结论:MRI图像能很好地显示喉癌肿块的侵及范围及淋巴结转移等,对喉癌的术前分期、分型及制定合理的手术方案具有指导意义。     

A model of using magnetic resonance imaging in osteoarticular tumor lesion in case of giant cell tumors

Fifty-eight patients with giant cell tumors (GCT) underwent a comprehensive radiation diagnosis involving X-ray study and magnetic resonance imaging (MRI). The obtained MR images indicated the high efficiency of this combination of radiation diagnostic techniques in solving the problems in the visualization of osteoarticular tumor lesions. GCT is characterized by well-known primary X-ray semiotics; MR images are also rather pathognomonic of these tumors and they illustrate the process of morphogenesis of these masses. MRI made it possible to solve the specific problems facing a physician (a radiation diagnostician), to determine the site, shape, sizes, volume, and local extent of a tumor, which permitted the planning of surgical treatment policy; to assess its results, to reveal possible inflammatory complications; and to visualize a local recurrence and on-going growth of a tumor, including the signs of GCT malignancy.     

富亮氨酸胶质瘤失活1蛋白抗体脑炎的病理特征及临床分析（附1 例案例报道）

目的:探索富亮氨酸胶质瘤失活1蛋白(LGI1)抗体相关自身免疫性脑炎的临床特点及治疗。方法:报道l例LG I1抗体阳性相关自身免疫性脑炎的临床资料,并结合相关文献讨论该病的临床病理特点。结果:老年男性,亚急性起病,反复多次发作并进行性加重,以近记忆下降、癫痫、认知和睡眠障碍为主要表现;头颅MRI示脑萎缩;LGI1抗体阳性。结论:本病患者具有认知功能、睡眠障碍及癫痫等,血清和脑脊液中抗LGI1抗体阳性,但无低钠血症,头颅影像学检查正常;急性发作期给予免疫抑制剂治疗后可获良好效果。     

Presentation of two patients with malignant granulosa cell tumors, with a review of the literature

ABSTRACT: Granulosa cell tumors (GCTs) of the ovary account for 2 to 5 of ovarian malignancies. We present two patients with malignant ovarian adult GCT. In one patient, a combination of bleomycin, etoposide, and cisplatin was effective after initial surgery for malignant GCT. In the other, an aromatase inhibitor was effective for recurrent malignant GCT. We also review the literature for further management of this tumor. Because GCT of the ovary is rare, it will be necessary to elucidate the clinical phenotype and establish treatment protocols by accumulating and analyzing more patients.     

Granular cell tumor of the parotid gland. A case report

BACKGROUND: Granular cell tumor (GCT) is a relatively uncommon soft tissue tumor of putative Schwann cell origin. This tumor can occur in multiple sites as a small, nontender nodule, but the parotid gland is unusual, and only several cases have been reported. CASE: A 46-year-old woman presented with a slowly growing mass in the left preauricular region for three years. Imaging studies confirmed a nodular lesion in the superficial lobe of the left parotid gland. Fine needle aspiration (FNA) cytology revealed scattered cellular clusters and single cells with abundant granular cytoplasm and indistinct cell borders. Background exhibited eosinophilic, granular, cytoplasmic material, and some scattered naked nuclei were also noted. Histologic examination with supportive immunohistochemical and ultrastructural studies confirmed GCT. CONCLUSION: GCT of the parotid gland is very unusual. Recognition of this tumor is important to make a definitive diagnosis before an operation. FNA is useful procedure in GCT of parotid gland for a preoperative diagnosis and proper treatment.     

Giant cell carcinoma of the lung. Report of a case with cytohistologic and clinical correlation

BACKGROUND: Giant cell carcinoma (GCC) of the lung is an unusual tumor characterized by an aggressive outcome. CASE: A peripheral lung tumor was observed in an elderly male. At presentation the clinical symptoms were cough, thoracic pain and hemoptysis. Chest roentgenography showed a left pleural effusion and neutrophilia in the blood. Bronchoscopic examination showed a peripheral tumor mass that could not be biopsied. Bronchoalveolar lavage was negative. The patient underwent a cerebrovascular accident and died. The autopsy showed a peripheral giant cell tumor of the left lung that involved regional and mediastinal lymph nodes. Touch imprints showed tridimensional clusters of pleomorphic and large cells, some of which were multinucleated, containing leukocytes in their cytoplasm. CONCLUSION: This case illustrates the typical cytohistologic features of GCT of the lung, which should be considered in the differential diagnosis of any peripheral lung tumor composed of large cells. Clinical correlation is helpful in reaching the correct diagnosis.     

Diagnosis of malignant granular cell tumor by fine needle aspiration cytology:.

BACKGROUND: Malignant granular cell tumors (GCT) are the rarest of all sarcomas, and the histologic differentiation from their benign counterpart may be extremely difficult or impossible unless metastatic disease is demonstrated. To our knowledge, this is the first report of a malignant GCT diagnosed by fine needle aspiration (FNA) cytology. CASE: A 70-year-old, Caucasian female presented with a progressively enlarging left supraclavicular mass. FNA of the mass revealed a metastatic tumor cytologically consistent with GCT. With this diagnosis, a search for other metastatic sites was initiated. Computed tomography (CT) scan revealed several tumor nodules in the lungs and liver. CT-guided FNA and tru-cut needle biopsy of a liver mass confirmed the diagnosis of metastatic GCT. In searching for a primary site, the patient revealed a clinical history of having had a tumor removed from her back two months before; it was reported to be an atypical GCT. Comparison of the three tumors revealed similar histologic, cytologic and immunohistochemical features. CONCLUSION: Evidence of mild to moderate cytologic atypia; increased mitotic activity; locally aggressive growth; increased proliferative activity as demonstrated by immunohistochemical evaluation of proliferation markers; and DNA ploidy analysis, as reported for this case, may be helpful in predicting malignant behavior of GCTs.     

Reduction of pituitary tumor size with clinical and biochemical improvement with bromocriptine in a normoprolactinemic Cushing's disease

We report a 37-year old Japanese female patient with Cushing's disease who was treated with a large daily dose of bromocriptine, which resulted in the reduction of the pituitary tumor size with clinical and biochemical improvements. On admission, the pituitary tumor size detected by magnetic resonance imaging (MRI) was 12.4 x 11.1 x 6.2 mm. Both the basal plasma prolactin level and its response to TRH test were normal. The patient was treated with bromocriptine at 5 to 35 mg/day. With 35 mg daily, 24-h urinary free cortisol started to decrease and eventually became normal. Four months after initiation of treatment with the drug, there was clinical remission with normalization of suppressibility of plasma cortisol with 1 mg dexamethasone. Repeated examination of the pituitary fossa by MRI showed a marked reduction in the tumor size (6.3 x 6.2 x 2.4 mm). This is a very rare case in which treatment with bromocriptine resulted in a reduction of the pituitary tumor size as well as clinical and biochemical improvements in a patient with normoprolactinemic Cushing's disease.     

Potentialities of low-field magnetic resonance tomography in the diagnosis and treatment of invasive cancer of cervix uteri

The aim of the study was to evaluate the efficiency of low-field (0.14 T) magnetic resonance imaging (MRI) in the diagnosis and treatment of cancer of the cervix uteri. MATERIALS AND METHODS: Low-field MRI was performed in 39 patients with cancer of the cervix uteri to define the stage of the tumor and to follow up the outcomes of their treatment. Particular emphasis was laid on the determination of the size of the tumor and the presence of parametral invasion and on metastatic lesions of lymph nodes. MRI data were compared with clinical, morphological, and surgical staging results. In detecting the stage of cancer of the cervix uteri, the accuracy of MRI was 72% whereas that of clinical study was 51%. In determining parametral invasion, the accuracy of clinical study and low-field MRI was 71 and 90%, respectively. The sensitivity and specificity of MRI were 83 and 92%, respectively. The anterioposterior tumor size was an important prognostic factor in following up the outcomes of treatment as there was its close association and the incidence of tumor recurrences. The present study has indicated that the high efficiency of low-field MRI in detecting the stage of invasive cancer of cervix uteri makes it the method of choice in planning treatment and monitoring the outcomes of combined radiation therapy.