ObjectiveTo study the clinical features,pathogenesis and differential diagnosis,and explore the imaging characteristics of congenital cystic adenomatoid malformation of the lung (CCAM) in children,in order to improve the knowledge of imaging findings of the disease. MethodsWe retrospectively analyzed the clinical data and imaging characteristics of three patients proven to have CCAM of the lung both by surgery and pathology between March 2011 and March 2013.Related literature was also reviewed,and two out of the three patients were followed up for two years. ResultsAll CCAM lesions in this study involved unilateral lower lobe,including two left lung and one right.Two patients had multiple large cysts containing gas,and one had multiple honeycomb-shaped vesicles.Histopathological examination showed that two cases were classified as Stocker type I and one as type Ⅱ,without type Ⅲ cases.Surgeries proved that the malformation was unilateral in all patients without connection with the bronchia.All patients with CCAM got complete cure by operation.The two-year postoperative follow-up showed an excellent recovery in all the patients. ConclusionImaging examination is the main basis for discovery and diagnosis of CCAM.The CT manifestations of CCAM are featured,and according to CT examination,pathological subtypes of the disease can be predicted.Being familiar with these characteristics is helpful for its diagnosis.
目的 探讨胰腺囊腺瘤和囊腺癌的临床病理特点及其诊治。 方法 回顾性分析山东省菏泽市立医院及曹县人民医院1996年6月至2007年3月共收治的17例患者的临床病理资料。结果 本病临床表现无特征性。B超和CT检查能发现囊肿但不能确定类型。浆液性囊腺瘤7例均行肿瘤局部切除； 黏液性囊腺瘤6例，行胰十二指肠切除1例，胰体尾切除5例； 囊腺癌4例，行胰十二指肠切除加淋巴结清扫1例，胰体尾切除术2例，胰体尾加脾切除1例。光镜下浆液性囊腺瘤囊壁由扁平或立方上皮细胞组成； 黏液性囊腺瘤囊壁由高柱状上皮细胞组成，可见乳头状突起； 囊腺癌囊壁细胞核异形明显，可见核分裂象及间质浸润。15例获得B超随访，中位随访时间为42个月（1～129个月），除1例行胰体尾切除加脾切除的老年囊腺癌患者术后6个月死于营养衰竭和 1例胰十二指肠切除患者并发糖尿病外，其余患者生存满意，未见肿瘤复发。结论 B超和CT是本病的主要影像检查方法。加强对本病临床病理特征的认识是提高诊治率的关键。手术切除治疗本病疗效满意。
ObjectiveTo explore the effectiveness of the usage of artificial bone of tricalcium phophate in sellar floor reconstruction after transsphenoidal microsurgery for pituitary adeoma. MethodsBetween January and December 2014, 85 patients with pituitary adema underwent transsphenoidal microsurgery, and the clinical data were retrospectively analyzed. "Sandiwich" was used for sellar floor reconstruction in 46 cases (control group), and "sandiwich" combined with the artificial bone of tricalcium phophate in 39 cases (trial group). There was no significant difference in gender, age, disease duration, size of tumor, invasiveness, and the degree of damage to the sellar floor between 2 groups (P>0.05). ResultsTotal removal and subtotal removal of tumors were achieved in 39 cases and 7 cases of the control group, and in 33 cases and 6 cases of the trial group, showing no significant difference between 2 groups (Z=-1.303, P=0.193). Cerebrospinal leakage occurred in 8 cases of the control group and in 10 cases of the trial group during operation, showing no significant difference (Z=-1.748, P=0.080). The case number of cerebrospinal leakage in the control group (4 cases) was significantly more than that in the trial group (0) after operation (P=0.020). The time of gauze removal in the trial group (3 days) was significant shorter than that in the control group[(4.3±1.6) days] (t=2.236, P=0.033). The patients were followed up 3-14 months in the control group and 5-13 months in the trial group. No cerebrospinal leakage occurred during follow-up. ConclusionSellar floor reconstruction with artificial bone of tricalcium phophate is safe, and it can reduce cerebrospinal leakage and shorten the time of gauze removal.
ObjectiveTo investigate the correlation between tumor-vessel signs on 64-slice spiral CT (MSCT) and malignant change of tubulovillous adenoma in the colon and rectum. MethodsA retrospective study of the image and the clinical data of 16 patients with tubulovillous adenoma or malignant change proved by pathologies from February 2010 to October 2012 was conducted. The tumor-vessel signs were analyzed by multiplanar reformation (MPR) and maximum intensity projection (MIP) on picture archiving and communication systems workstation. ResultsAmong the 16 cases of tubulovillous adenoma or malignant change, 2 cases of tumor diameter≤2 cm had no tumor-vessel sign; and in the 14 cases of tumor diameter >2 cm, 13 were observed to bear tumor-vessel signs. The size of the tumor and tumor-vessel signs showed a certain correlation (r=0.618, P=0.002). And the manifestation of tumor-vessel signs had obvious differences between benign and malignant tumor. For the adenoma group, it showed venous blood vessel involvement, and downy and natural contour; for the adenocarcinoma group, it showed arterial blood vessel involvement, blood vessels with uneven thickness, visible expansion and irregular defect manifestations. No obvious difference was detected among tumor-vessel signs of adenocarcinoma with different malignant degree. ConclusionMSCT combined with image reconstruction techniques (such as MPR and MIP) can clearly demonstrate tumor blood supply, and tumor-vessel in the arterial phase may suggest a high risk of malignant change of tubulovillous adenoma in the colon and rectum.
目的 探讨结直肠腺瘤的诊断及外科治疗方法。方法 对我院1994年10月至2003年5月收治的323例结直肠腺瘤患者行外科手术治疗的临床资料进行回顾性分析。结果 在直肠镜下行直肠腺瘤局部切除86例，开腹行肠壁楔形及肠段切除202例，行肠段及其系膜的根治性切除35例，治愈率达95.7%(309/323)，本组术后有276例获得1～5年随访，其中术后复发14例，恶变3例。结论 结直肠腺瘤作为癌前病变，一经发现均应完整切除，外科手术治疗可明显减少复发及恶变率，是结直肠腺瘤的最彻底治疗的方法。
目的 探讨十二指肠腺瘤并大出血的诊断和治疗。方法 对2例十二指肠腺瘤并大出血患者进行回顾性分析，并结合文献进行讨论。结果 2例术前均行X线气钡双重造影、胃镜及肿块活检，但未确诊。2例均行十二指肠切开、肿瘤切除术而痊愈。结论 十二指肠腺瘤早期多无临床症状，随着肿瘤的增大可并发肠梗阻或肿瘤溃疡出血而出现相应症状； X线钡餐和胃镜可发现肿瘤，但难于确诊，经内窥镜或十二指肠切开、肿瘤切除术是治疗本病的常用方法。
National Comprehensive Cancer Network (NCCN) has updated and released the latest content of NCCN guidelines version 1. 2023 thymomas and thymic carcinomas (known as "guidelines"). The guideline sets standards for the diagnosis and treatment of thymoma and thymic carcinoma based on high quality clinical evidence and the latest advances in research. There have been some updates and revisions in the latest two versions of the guidelines, mainly focusing on the principles of radiotherapy, the principles of systematic therapy, multidisciplinary participation and the improvement of some footnotes, compared with the first version of the guidelines in 2022. In this paper, the contents of the new guideline will be interpreted in order to provide reference for the work of thymoma and thymic carcinoma in our country at the present stage.