目的 分析隐匿性乳腺癌(OBC)的超声声像图特征,为临床筛检OBC提供早期诊断依据.方法 回顾性分析22例隐匿性乳腺癌患者乳腺、腋窝及锁骨上窝肿块超声声像图表现,观察肿块大小、数目、形态、回声、血流分布等.乳腺肿块按照BI-RADS分级,并与活检及术后病理结果对照.结果 超声显示22例OBC患者均可见单侧腋窝淋巴结肿大,4例伴同侧锁骨上窝淋巴结肿大.声像图显示病变淋巴结形态不规则,皮质回声增厚,结门不清或偏移,血流分布以混合型和周围型为主,符合乳腺癌转移性淋巴结超声特征.超声引导下穿刺活检病理检查腋窝及锁骨上淋巴结内查见转移性癌,肿瘤细胞呈实性巢团状或腺管状排列,细胞异型性明显,形态学结合免疫组化结果符合来源于乳腺.22例患者术后与术前病理诊断均一致.22例患者术前体格检查、影像检查及术后病理均未在乳腺发现原发病灶.结论 超声检查可较敏感检出OBC转移性腋窝肿大淋巴结,并提示临床良、恶性趋向,超声引导下淋巴结活检结合免疫组化染色可推测肿瘤来源,对制定治疗方案具有指导作用.

有研究表明,下肢曲张静脉管壁的改变先于瓣膜功能不全之前[1].细胞凋亡参与曲张静脉管壁重塑过程,两者之间关系密切[2-3].我们通过原位细胞凋亡(TUNEL)法和免疫荧光法对3组下肢静脉管壁细胞凋亡进行定量分析. 一、资料与方法 1.一般资料:选取解放军第89医院普外科2009年10月至2011年10月行高位结扎剥脱加旋切治疗的大隐静脉曲张患者44例,并分为浅表血栓性静脉炎(血栓组)22例和单纯静脉曲张(曲张组)22例.对照组为创伤行截肢术而大隐静脉无损伤者13例.血栓组为慢性血栓性静脉炎(血栓形成时间＞30 d).曲张组按CEAP分类选取C2 ～ C3.

患者,女性,35岁,因"痛经进行性加重伴月经量增多6年,查体发现子宫肌瘤5年"人院,欲行全子宫切除术.B超示右侧卵巢区一6.5 cm×2.7 cm混合性包块,内透声差,可见条带状分割,未见血流信号.诊断:右卵巢区混合性包块.

<正>患者女,22岁。右腋窝皮下多个绿豆大结节,界限清楚,互不融合,活动,质地较硬,伴局部淋巴结肿大、压痛。患者近期无发热、咳嗽等感染症状,局部无外伤史,血常规检查正常。故取病患处皮肤活检。病理检查结果示:皮肤组织1块,

<正>患者,女,39岁。1年前发现左上腹鸡蛋大小肿物,平躺后消失,触之疼痛。肿块逐渐增大且疼痛向右上腹转移,出现恶心、呕吐、发热;发病以来体重减轻10kg,闭经。专科查体:腹部膨隆,可触及一45cm×35cm×25cm大小肿块,质硬,活动差,右上腹触痛明显。CT扫描示:胰腺体尾部巨大囊实性占

目的 探讨纤维结构不良(Fibrous dysplasia,FD)临床、X线和病理的诊断、鉴别诊断及误诊原因.方法 对36例FD的临床、X线和病理三者的诊断进行对照.标本采用10%甲醛固定,常规石蜡切片,HE染色,光镜观察,.结果 36例FD中有20例临床、X线和病理的诊断结果一致(55.5%),其余的分别被临床、X线误诊为骨囊肿、病理性骨折、纤维瘸、硬化性骨髓炎等.误诊牢高达44.5%,其中1例75岁男性的肋骨病变,因穿刺细胞学诊断的影响,而被临床、X线误诊为软骨瘤恶变.结论 典型FD临床、X线和病理的诊断并不困难,难的足形态学变异的FD,特别足继发性形态学变异,是临床、X线和病理误诊的主要原因.因此熟悉FD形态学变异特点,寻找病灶中典型FD结构是至关重要的.

Objective To investigate the diagnosis, the differential diagnosis and misdiagnosis causes of clinic, X-ray, pathology in fibrous dysplasia (FD). Methods The clinic, x-ray and pathological diagnosis of 36 FD cases were set off. Specimen were fixated with 10% Formalin. The routine paraffin section were stained with HE and observed under light microscope. Results In all the 36 cases, 20 cases were identified by clinic, X-ray, pathology (55.5%). The other cases of FD were misdiagnosed as solitary bone cysts, pathologic-fracture, fibroma, sclerosteomyelitis and so on by the clinic and X-ray,including one case of 75 old age male whose rib alteratic lession was misdiagnosed as chondroma deterioration followed the puncturatiocytodiagnostics. The rate of misdiagnosis was so high up to 44.5%. Conclusions The diagnosis of typical FD by the clinic, X-ary, pathology is easyly made, but the FD with morphological variant usually are misdiagnosised and leaked out by the clinic,x-ary or pathology. On that score, it is important to be familiar with morphological variant of FD and to search for typical area of FD for the diagnosis.

Objective To explore the clinicopathological features of the ductal adenoma of the breast. Methods The clinical presentations,histological features,immunophenotype and differential diagnosis were studied retrospectively in one case of ductal adenoma of the breast,and related literature was reviewed. Results The tumor had a definite predilection for elderly female patients(60 yr.). The lesion consists of a single nodule and presents as a palpable lump without nipple discharge. It was composed by tubular glands lined by epithelium and myoepithelium. Fibrous sclerosis sometimes results in distortion with apparent invasion of surrounding tissue. It could be seen that glandular epithelium appeared metaplasia apocrine and myoepithelium taked place squamous metaplasia. The tumor also showed focal chondromyxoid change. Despite often showing worrying pseudoinfiltration and cytologic atypia,the immunohistochemical demonstration of a myoepithelial layer and intact basement membrance around the tubules was clear evidence of benign nature of the lesions. Conclusion Ductal adenoma is a uncommon tumor,which results from medium-and small-sized breast ducts.It is considered suspicious of malignancy at the clinical and laboratory preoperative investigation. Fine-needle aspirations from breast lesions are now daily routine and preoperative recoginition of this benign lesion is desirable. It has microscopic affinities with many breast diseases.

<正>患者男,37岁。发现左侧颈前肿物16年入院。查体:左侧颈部可触及一个大小约3cm×3cm×3cm大小肿物,边界清楚,无结节,表面光滑,质韧,无压痛,可随吞咽上下活动。患者无声音嘶哑、饮水呛咳、食欲亢进等其他伴随症状。彩超示:左甲状腺叶内有一2.8cm×2.2cm低回声光团,内部回声不均匀,考虑甲状腺腺瘤。手术切除甲状腺肿物。

患者男性,44岁.于10年前发现右腮腺区黄豆大小肿物,无疼痛及其他不适,肿物缓慢增大,6个月前在当地卫生院行"粉瘤"切除术,术中见肿物深在,即停止手术.术后肿物迅速增大,并伴有轻微疼痛.查体:颌面部不对称,右腮腺区可见一球形肿物,大小约4 cm×4 cm,边界清楚,表面呈结节状,质地中等,可活动,触压疼痛,肿物与皮肤瘢痕相连;无面瘫症状,颈部未触及明显肿大淋巴结,胸片阴性.临床诊断:腮腺肿瘤(良性可能性大).行"右腮腺浅叶及肿物切除和面神经解剖术",术中见肿物位于腮腺浅叶,与表面皮肤粘连,浅面有瘤芽形成,与深面的面神经分支无粘连,肿物实性、结节状,完整切除肿物及右腮腺浅叶,梭形切除与肿瘤粘连的皮肤.

对T淋巴母细胞性淋巴瘤胸水漏诊1例分析如下. 1病历摘要 女,72岁.无明显诱因咳嗽、咳痰10个月,加重并发热1个月,体温最高39.8 ℃,RBC 3.19×1012/L,Hb 90 g/L,ESR 93mm/h,体检轻度贫血貌,周身浅表淋巴结肿大,脾肿大,B超示双颈部、锁骨上窝、颌下、腹股沟淋巴结肿大,活动度好,不融合,脾厚6.2 cm,CT示纵隔淋巴结肿大,双侧胸腔积液,心包积液.

睾丸原发淋巴瘤较为罕见,且预后较差.现对我院收治的2例患者其临床表现、病理组织学特征和误诊原因进行分析,并结合相关文献回顾总结.

患者男,60岁.因下腹部包块2周入院行盆腔肿瘤部分切除术,术后1月行放疗治疗.于术后10个月入院复查.查体:右下腹可触及约6cm×5cm包块,质地中等,边界不清,表面光滑,不活动,无压痛.辅助检查:B超、CT均提示膀胱后方巨大占位性病变.再次行盆腔肿瘤切除术.

患者女性,41岁.2001年B超发现盆腔囊性包块,3年后渐大入院.妇检:宫体前位,不规则增大,如妊娠50天大小,质硬,左附件区触及约6 cm×3 cm大小包块,轻压痛.术中见子宫肌层多个肌瘤,左输卵管系膜有一约8 cm×5 cm×4 cm大小囊肿,行子宫全切+左输卵管囊肿切除.

患者男,59岁.6年前右颌下无明显诱因出现一花生米大肿物,无疼痛不适,肿物渐增大,且反复肿胀、流脓.临床检查:右颌下皮肤内收性皱缩,伸舌左偏,口角右偏,右侧颌下皮肤深处触及4cm×3cm大小不规则肿块,固定不活动.术中切开皮肤见颌下腺区3cm×3cm大小肿块,边界不清,颌下淋巴结、咬肌前淋巴结、颈深上淋巴结肿大,质地较硬.

患者男,18岁.左睾丸进行性无痛性肿大3月入院.入院查体:左侧睾丸约8cm×5cm×4cm,有明显沉重感,表面光滑,质韧,触之无明显疼痛,透光试验阴性,与附睾界限不清,双腹股沟区淋巴结未触及肿大;检验AFP 379.9ng/ml,HCG＜50mIU/ml;阴囊B超示左侧睾丸占位性病变,其内回声不均质,右睾丸未见异常.

Objective To explore the expression status of ubiquitin in hepatocellular carcinoma and its clinicopathologic significance.Method Ubiquitin was detected in tissue microarray by immunohistoche-mistry,in addition, the relativity between ubiquitin expression and clinicopathologic indexes was analyzed. Results Ubiquitin expression not only was remarkably enhanced in hepatocellular carcinoma, but also correlated with tumor grade, type and HBV infection (P0.05, 0.01, 0.05, respectively). No relativity was found between ubiquitin expression and age, gender, tumor size, surrounding tissue, AFP level (P0.05). Conclusion A important mechanism in hepatocellular carcinoma occurrence and development is the elevation of proteasome function. Ubiquitin detection would direct clinic therapy in the near future.

本文報告3例在罕見部位發生的軟骨樣副脊索溜,因光鏡下HE染色與粘液樣軟骨肉瘤或其它原發或轉移性粘液性腫瘤很難區分,現結合免疫組化表型,對其臨床病理學特征,診斷與鑒别診斷進行討論.