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find Keyword "鉴别诊断" 69 results
  • 可疑肾上腺内异位甲状腺1例报道并文献复习

    目的总结肾上腺内异位甲状腺的影像学表现、病理特征、临床诊断、鉴别诊断以及治疗方法和预后。方法回顾性分析2023年3月广东医科大学附属医院收治的1例可疑肾上腺内异位甲状腺的临床表现、病理特征、治疗及预后情况,并结合国内外相关文献报道的26例肾上腺内异位甲状腺的病例资料进行分析。结果本例66岁女性患者,术前检查提示左侧肾上腺占位(考虑嗜铬细胞瘤)并行手术完整切除,术后根据病理学检查和免疫组织化学检查最终考虑诊断为肾上腺内异位甲状腺并腺瘤样增生,术后随访6个月未见复发。复习国内外文献报道的26例肾上腺内异位甲状腺患者资料,亚洲中老年女性多见(22例),左侧多发(17例),大部分(19例)由体检发现,通常表现为无痛性囊性肿块,大体呈类圆形,镜下可见甲状腺样组织,并见甲状腺样滤泡,滤泡腔内见嗜酸性胶质样物,部分区域可见滤泡与肾上腺皮质混杂,通常无肾上腺髓质成分,囊壁被覆扁平上皮细胞或甲状腺滤泡样细胞、可见核重叠,偶见核沟和包涵体,类似甲状腺乳头状癌细胞核,但未见砂粒体。免疫组织化学表现为PCK、EMA、TTF-1、Tg、Vimentin阳性,提示甲状腺分化,BRAFV600E、KRAS基因突变阴性。治疗以完整切除肿瘤为主,预后良好。结论肾上腺内异位甲状腺罕见,确切发生机制有待研究,临床术前不易辨识,应与肾上腺肿瘤、转移性甲状腺滤泡癌、乳头状癌等鉴别,免疫组织化学染色及基因检测有助于明确诊断,治疗以完整切除肿瘤为主,预后良好。

    Release date:2024-05-28 01:54 Export PDF Favorites Scan
  • 老年肝脏未分化胚胎性肉瘤伴囊内出血1例报道

    Release date:2024-02-28 02:42 Export PDF Favorites Scan
  • 肝后下腔静脉狭窄导致术中呼气末二氧化碳降低一例

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  • 神经衰弱的鉴别诊断模式

    【摘要】为探讨神经衰弱鉴别诊断的规范化方法,提高其准确性。 将必备组合症状、病因、内在关系、严重程度、病程、排除症状和非器质性病变基础七方面做为神经衰弱鉴别诊断模式的要素,用神经症二重辩证施治进行临床验证。验证表明,神经衰弱与伴发神经衰弱症状的其他疾病相比,具有明显的差异。其中必备组合症状、病因和内在关系,是鉴别诊断的核心;排除症状、非器质性病变基础是重要参考标准,但在某些特定情况下是否成为鉴别诊断的依据,应视情况而定;严重程度和病程仍有意义。神经衰弱的鉴别诊断模式具备了更加缜密规范准确的优点。

    Release date:2016-09-08 09:51 Export PDF Favorites Scan
  • Comparison of airspace consolidation in thoracic CT between organizing pneumonia and community acquired pneumonia

    ObjectiveTo explore the differential diagnosis value of airspace consolidation in thoracic CT between organizing pneumonia (OP) and acquired community pneumonia (CAP).MethodsA retrospective study was taken by retrieving the patients CT database from October 2010 to August 2016. Fifty-six consecutive patients with OP and 99 consecutive patients with CAP whose CT showed airspace consolidation were enrolled and their clinical characteristics and radiological characteristics were analyzed.ResultsThe percentage of patients whose CT image showed various amount of air bronchogram (ABG) with different shapes is higher in OP group than that in CAP group (87.5% and 72.7% respectively, χ2=4.558, P=0.033). The median and interquartile range amount of ABG in the OP patients were significantly higher than those in CAP group [4 (ranged from 2 to 8) and 2 (ranged from 0 to 4) respectively, z=3.640, P=0.000]. Morphologically, 58.9% of the OP patients showed entire air bronchogram (EABG) on the thoracic CT, significantly higher than that in CAP group (21.2%) (χ2=22.413, P=0.000). Interrupted ABG was found in 26.3% of CAP patients, while 16.1% of OP patients shared same features and the difference was not statistically significant (χ2=2.125, P=0.148). Traction bronchiectasis and ground glass opacity (GGO) were more likely to be found in the OP patients rather than CAP patients with 26.8% and 39.3% respectively, while they were found in 1.0% and 11.1% in the CAP patients (P<0.05). Reversed halo sign was found only 1.0% of the CAP patients, significantly lower than that in OP group, 26.8% (χ2=25.671, P=0.000). Pleural effusion and bronchial wall thickening were more commonly found in the CAP group with 56.6% and 35.4% respectively. By multivariate logistic analysis, EABG (OR=5.526, P=0.000), traction bronchiectasis (OR=21.564, P=0.010), GGO (OR=4.657, P=0.007) and reversed halo sign (OR=13.304, P=0.023) were significantly associated with OP, while pleural effusion (OR=0.380, P=0.049) and bronchial wall thickening (OR=0.073, P=0.008) were significantly associated with CAP. Other features in thoracic CT coexisting with ABG all reach significance statistically between the OP and CAP group (all P<0.05).ConclusionsAirspace consolidation in thoracic CT may be valuable for the differential diagnosis between OP and CAP. EABG is more commonly found in OP patients than in CAP patients. When EABG exists or ABG coexists with traction bronchiectasis, GGO and reversed halo sign, a diagnose of OP should be considered.

    Release date:2018-05-28 09:22 Export PDF Favorites Scan
  • Comparative Study of Clinical Pathology of Solid-Pseudopapillary Tumor of The Pancreas and Islet Cell Tumor

    Objective To investigate differential points of clinical symptoms and pathology of solid-pseudopapillary tumor of the pancreas (SPTP) and islet cell tumor (ICT). Methods Fifteen cases of SPTP and twelve cases of ICT were studied in this retrospective research. Clinical symptom, pathologic feature and computed tomography (CT) image of patients with both tumors were analyzed, and the imaging features were compared with pathological results. Results The mean age of SPTP patients was 22.4 year-old. Twelve patients with SPTP presented a palpable abdominal mass as the initial symptom. It was observed that the tumor cells were located in a pseudopapillary pattern with a fibro-vascular core histologically. On the CT images, a mixture of solid and cystic structures could be seen in all the tumors. After taking enhanced CT scan, the solid portion was slightly enhanced in the arterial phase and the contrast intensity increased in the portal venous phase. On the other hand, the mean age of ICT patients was 39.3 year-old. The major symptom was due to the function of islet cell tumor, which was typical in 8 patients, presenting as Whipple triad. Histologically, cells demonstrated in trabecular, massive, acinar or solid patterns, and the blood supply of the tumor was abundant. On the CT images, most small tumors were difficulty to be detected. ICT could be markedly enhanced in the arterial phase and slightly enhanced in the portal venous phase on post-contrast CT scan. Conclusion Clinical symptom, pathologic feature and CT scanning are helpful to differentiate SPTP from ICT.

    Release date:2016-09-08 11:07 Export PDF Favorites Scan
  • Clinical Significance of Serum VEGF-C Level and C-erbB-2 Protein Expression in Patients with Breast Cancer

    Objective To investigate clinical significance of serum VEGF-C level and C-erbB-2 protein expression in patients with breast cancer. Methods Sixty-two female patients with breast invasive ductal cancer and breast benign lesion were respectively selected. Serum VEGF-C level was detected by enzyme-linked immunosorbent assay (ELISA) before operation and at one month after operation, and C-erbB-2 protein expression in tissues of breast cancer was detected by immunohistochemistry. Then, the relationship between serum VEGF-C level and clinicopathologic characteristics and C-erbB-2 protein expressions wereas analyzed. Results The serum VEGF-C level before operation in breast cancer patients〔(279.65±17.34) pg/ml〕 was significantly higher than that in breast benign lesions patients 〔(167.26±12.15) pg/ml〕, P<0.01. In breast cancer patients, the serum VEGF-C level before operation was higher than that at one month after operation 〔(209.45±15.23) pg/ml〕, P<0.01. The serum VEGF level was related to tumor stage (P<0.05) but not to patient age, tumor size, menopause status , lymph node metastasis or not and ER and PR expression (Pgt;0.05). The positive expression rate of C-erbB-2 protein in breast cancer patients (54.84%, 34/62) was significantly higher than that in breast benign lesion patients (11.29%, 7/62), P<0.01. Moreover, the positive expression rate of C-erbB-2 protein in breast cancer patients with axilla lymph node metastasis (69.44%) was significantly higher than that without axilla lymph node metastases (34.62%), P<0.05. The serum VEGF level increased with increasing expression intensity of C-erbB-2 protein and there was positive correlation between them (r=0.813,P<0.05). Conclusions The serum VEGF-C level in breast cancer may be conducted as an assisted marker to differential diagnosis of breast tumor. C-erbB-2 is related to lymph node metastasis of breast cancer patients. There is synergistic effect between VEGF-C and C-erbB-2 in the lymph node metastasis way of breast cancer.

    Release date:2016-09-08 11:05 Export PDF Favorites Scan
  • Analysis of a case of primary squamous cell carcinoma of liver

    ObjectiveTo investigate misdiagnosis of primary squamous cell carcinoma of liver (PSCCL) as cholangiocarcinoma before operation and its clinical manifestations, imaging manifestations, etiology, histological origin, pathological characteristics, diagnosis and differential diagnosis, selection of treatment methods, and prognosis, so as to improve understanding and reasonable diagnosis and treatment of disease.MethodThe clinicopathologic data of a case of PSCCL misdiagnosed as cholangiocarcinoma in the West China Hospital of Sichuan University were analyzed retrospectively.ResultsThe patient was admitted to the West China Hospital of Sichuan University with the right hepatic space occupying. The preoperative imaging examination showed that the patient had the imaging characteristics of hepatic cholangiocarcinoma, then the right hemihepatectomy was performed. The postoperative pathological diagnosis was the PSCCL.ConclusionsPreoperative diagnosis of PSCCL is extremely difficult and it is difficult to differentiate it from primary liver cancer, and it is easy to overlook liver metastasis’s occurrence in other parts of the squamous cell carcinoma, which leads to liver metastasis. It is usually diagnosed by pathological diagnosis after operation, and then original lesions in other parts are excluded by various examinations. PSCCL is treated in a variety of ways, but it’s prognosis is not good. At present, there is no unified treatment principle, most of which are surgery, followed by postoperative radiotherapy and chemotherapy. In most cases, because PSCCL’s etiology is unknown and mechanism is not clear, clinicians can only implement individualized treatment according to patient’s condition.

    Release date:2020-02-24 05:09 Export PDF Favorites Scan
  • Villoglandular Carcinoma of Cervix: A Clinicopathological Analysis

    ObjectiveTo investigate the clinicopathological features, diagnosis and differential diagnosis of villoglandular carcinoma of the uterine cervix. MethodsThe clinical data of a 34-year-old patient diagnosed with villoglandular carcinoma of cervix on April 6, 2010 was retrospectively analyzed. Surgical excision samples were analyzed by means of hematoxylin-eosin and immunohistochemical staining. ResultsThe gross appearance of the tumor mass showed cauliflower-like pattern of growth. Histologically, it was similar to colorectal villoglandular adenoma, and was composed of branching papillae shaped like villous glandular tube structure, and the surface was coated with pseudostratified or stratified columnar cells which showed mild atypia and uncommon mitotic figures. Immunohistochemically, tumor cells were positive for carcinoma embryonic antigen, CK7 and CA125, and negative for estrogen receptor, progesterone receptor, P16, p53 and vimentin. This patient was subjected to a follow-up of 48 months, and was alive without recurrence or metastasis. ConclusionsVilloglandular carcinoma of the uterine cervix is rare and has a favorable prognosis. The diagnosis of villoglandular carcinoma depends on pathological morphology, and meanwhile, it is necessary to distinguish villoglandular carcinoma from other benign and malignant tumors which exhibited papillary growth pattern.

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  • Gallbladder Abnormal Changes Caused by Liver Parenchymal Diseases Versus Inflammatory Cholecystitis: Differential Diagnosis by MultiDetector Row Spiral CT

    【Abstract】ObjectiveBy using multidetector row spiral CT (MDCT) to investigate the CT imaging findings of gallbladder abnormalities caused by hepatic parenchymal diseases and those of inflammatory cholecystitis. MethodsCT and clinical data of 80 patients with gallbladder abnormalities were retrospectively reviewed. Fifty patients were in hepatic disease group, including 20 chronic hepatitis, 25 liver cirrhosis, and 5 cirrhosis with hepatocellular carcinoma. Thirty patients were in inflammatory group, including 19 chronic cholecystitis, 6 acute cholecystitis, 3 cholecystitis with acute pancreatitis, 1 gangrenous cholecystitis, and 1 xanthogranulomatous cholecystitis. All patients underwent MDCT plain scan and contrastenhanced dualphase scanning of upper abdomen. ResultsIn hepatic disease group, 48 cases had evenly thickened gallbladder wall (96%) with mean thickness of (3.67±0.49) mm; 38 cases had clear gallbladder outlines (76%); 38 cases had gallbladder wall enhancement of various degree (76%); 14 cases had gallbladder bed edema and localized nondependant pericholecystic fluid collection (28%). In inflammatory cholecystitis group, 28 cases had obscuring gallbladder outlines (93%) ; 26 cases had gallbladder wall evenly thickened (87%), 4 cases showed unevenly thicked wall (13%), the mean thickness being (4.54±1.14) mm; 30 cases had inhomogenous enhancement of the gallbladder wall (100%); 9 cases had highattenuation bile (30%); 4 cases had dependant pericholecystic fluid collection (13%); 5 cases had transient enhancement of adjacent hepatic bed in arterial phase (17%); microabscess and gas in the gallbladder wall was observed in 1 case respectively. ConclusionMDCT can offer imaging findings useful for differentiating abnormal gallbladder changes caused by hepatic parenchymal diseases from those due to inflammatory cholecystitis.

    Release date:2016-08-28 04:30 Export PDF Favorites Scan
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