Rationale: The diagnosis of pyloric gland adenoma (PGA) can be challenging when a small lesion grows in an uncommon site, which has no characteristic imaging manifestations. However, radiological examination has specific value in the diagnosis of complications. PGA has a clear malignant potential, and its treatment depends on the size, shape, and location of the lesion. Minimally invasive endoscopic resection is an effective treatment option for this condition. This report aims to raise awareness among clinicians regarding such clinical scenarios. Patient concerns: In the current report, we present the case of a 28-year-old male patient with a duodenal pyloric adenoma with a long pedicle of >8 cm, causing intestinal obstruction and intermittent gastrointestinal bleeding. Finally, the tumor was completely removed endoscopically. Diagnoses: The pathological diagnosis result was (duodenum) pyloric gland adenoma, with some glands exhibiting mild to moderate dysplasia. Interventions: The patient underwent a hot trap resection of duodenal long-pedunculated polyps combined with nylon ropes and titanium clips. The operation was carried out under general anesthesia and lasted approximately 40 minutes, excluding the waiting time for anesthesia recovery. The tumor was discolored due to ischemia and was resected using high-frequency electrical resection. Outcomes: The patient was discharged on the 7th day after polyp resection. The patient recovered well after surgery and no recurrence was observed during follow-up. Lessons: PGAs are usually solitary in the gastric body and rarely occur in the duodenum, and the appearance of a long pedicle have rarely been reported. Considering that PGA has definite malignant potential and may cause intestinal obstruction, early diagnosis and minimally invasive endoscopic resection are conducive to good prognosis.

Successive current trials using immune response checkpoint blockade, the systemic therapy for progressive hepatocellular carcinoma (HCC) has shifted dramatically towards targeting the tumor microenvironment (TME). Locoregional therapies (LRTs) like radiofrequency ablation (RFA)/rhizotomy, trans-arterial chemoembolization (TACE) and surgical resection in the initial stages are critical. LRTs perform the crucial task of modulating the immune system surrounding the tumor, which is of great importance in the prevailing era of developing immuno-oncology treatments and their direct effect on tumor cells. Significant efforts are needed in exploring the mechanisms of latest combinational approach to boost clinical advantage with tolerable side effects. The present review highlights the tumor microenvironment of HCC followed by current immunotherapeutic approaches for HCC. Next, we discussed the concealed mechanisms of LRTs given in combination with immunotherapy and their utilization in clinical practice.

Background Solitary fibrous tumor of the pleura (SFTP) is a rare mesenchymal tumor that arises at various sites and typically originates from the pleura. Most patients with SFTPs are asymptomatic, unless the tumor is large. Approximately 20% of SFTP cases are malignant. There are few reports on imaging diagnoses and interventional treatments of SFTP. Here, we report a case of a giant SFTP that exhibited malignant behavior and underwent successful resection after embolization of the main supply artery of the tumor. Case presentation We report a clinical case of a giant SFTP in a 66-year-old Chinese female patient complaining of chest tightness and cough for more than 2 months. Ten years ago, the patient had undergone a chest CT scan at a local hospital for cough. Computed tomography (CT) had revealed a mass in the right thoracic region, which was misdiagnosed as a pulmonary abscess by CT-guided biopsy. Therefore, the patient did not receive appropriate/complete treatment at that time. She was hospitalized again, because CT showed significant enlargement of the right thoracic mass, which caused her obvious symptoms of discomfort. The pathological results of CT-guided biopsy at our hospital confirmed SFTP. Considering the large size of the tumor and the rich blood supply, some of the main blood vessels were treated with embolization before surgical resection. A large tumor, about 23 cm × 16 cm × 15 cm in size, was then successfully removed by thoracic surgery. The diagnosis of malignant SFTP was confirmed by surgical pathology and immunohistochemistry. Conclusion Imaging findings of SFTPs are not characteristic, especially when a tumor is large, the diagnosis is difficult, and the final diagnosis still depends on histological and immunohistochemical examinations. The two-stage surgical treatment described here, which involves first embolization of the main supplying artery of the large tumor and then complete surgical resection, is effective and safe for SFTPs. Whether needle biopsy or vascular embolization is performed, intervention plays a crucial role in the diagnosis and treatment of patients with SFTPs.

目的 探讨金属内固定拆除部位出现金属伪影的原因.方法 收集29例内固定拆除后患者临床资料,均行X线摄片或CT、MRI影像检查.结果 29例患者行X线摄片或CT平扫,在内固定拆除区域均未发现金属致密影,14例在MRI检查图像中出现少许点状金属伪影,基本上分布在内固定拆除后遗留骨道区域或周围骨痂形成区域.结论 MRI检查对内固定拆除术后出现金属伪影有较高敏感性,对于金属伪影产生的原因分析有重要意义,可以避免不必要的医疗纠纷.

目的:探讨动态对比增强MRI(DCE-MRI)三维直方图定量参数鉴别肝细胞癌(Hepatocellular carcinoma,HCC)和结直肠腺癌肝转移瘤异质性的价值.方法:回顾性分析经病理证实且术前均行腹部常规MRI和DCE-MRI检查的HCC或肝转移瘤病例59例,其中HCC 41例,肝转移瘤18例.运用肝脏双血供双输入Extended Tofts模型,三维全病灶勾画ROI,获得DCE-MRI灌注参数,包括转运常数(Ktrans)、速率常数(Kep)、血管外细胞外间隙容积分数(Ve)、血管(血浆)间隙容积分数(Vp)和肝动脉供血比例(HPI).进行三维Histogram分析,获得上述参数的中位数、平均数、偏度、峰度、能量、熵、10％位数、90％位数.采用独立样本t检验和Mann-Whitney U检验比较各参数间差异.绘制ROC曲线,分析各参数鉴别诊断HCC和肝转移瘤的效能.结果:HCC和肝转移瘤的三维直方图定量参数中,Ktrans、Kep(中位数、平均数、10％位数、90％位数),Kep能量、熵,Ve中位数、偏度、10％位数、90％位数,Vp偏度、峰度、能量、熵、90％位数和HPI中位数、平均数、90％位数的差异有统计学意义(P<0.05),余参数差异均无统计学意义(P>0.05).其中Kep 90％位数的ROC下面积(AUC)最大(0.930).结论:DCE-MRI三维直方图定量参数可用于鉴别HCC和结直肠腺癌肝转移瘤的异质性,其中Kep 90％位数具有较高诊断效能.

骨脂肪瘤是起源于成熟脂肪组织的良性肿瘤,根据发生部位可分为骨内脂肪瘤和骨旁脂肪瘤,但发生于颅骨的骨旁脂肪瘤十分罕见.骨脂肪瘤瘤体由成熟的脂肪组织构成,而脂肪组织具有明显的影像学特征.骨内脂肪瘤CT表现为骨内脂肪性透亮影或骨质缺损区,MRI上病灶为脂肪信号;骨旁脂肪瘤虽仍具典型表现,但因位置特殊,需要与其它疾病鉴别,且骨脂肪瘤也存在着继发或者转变为恶性的可能.本文报道1例手术确诊病例,复习其影像特点、临床诊疗经过,以期提高对颅骨骨旁脂肪瘤的认识.