目的報(bào)告8例肝血管平滑肌脂肪瘤的影像學(xué)特征及病理學(xué)特點(diǎn)，探討其診斷與治療方法。方法對(duì)8例經(jīng)手術(shù)及病理證實(shí)的肝血管平滑肌脂肪瘤的術(shù)前影像學(xué)表現(xiàn)（B超、CT、MRI、99mTcPMT）、手術(shù)情況及病理特點(diǎn)進(jìn)行分析。結(jié)果B超： 腫瘤呈強(qiáng)回聲光團(tuán)6例，低回聲光團(tuán)2例； 邊界清楚7例，血供豐富、內(nèi)部回聲不均勻4例，其中1例內(nèi)部呈分隔網(wǎng)狀結(jié)構(gòu)。彩色Doppler超聲示腫瘤血供豐富，均測(cè)及動(dòng)脈頻譜，阻力指數(shù)為0.4～0.5。靜脈造影示腫瘤內(nèi)血流信號(hào)明顯增加。CT： 平掃示腫瘤呈低密度影7例，不均勻5例，邊界清楚7例，腫瘤內(nèi)見(jiàn)軟組織影2例，脂肪成分2例。增強(qiáng)掃描示動(dòng)脈期明顯強(qiáng)化，門脈期及延遲期逐漸呈低密度。MRI: 腫瘤呈短T1、長(zhǎng)T2信號(hào)，增強(qiáng)后強(qiáng)化明顯，脂肪抑制后短T1變成長(zhǎng)T1。99mTcPMT示腫瘤呈放射性增強(qiáng)，5 min相腫塊區(qū)呈放射性缺損，2 h、5 h延遲相腫塊區(qū)未見(jiàn)放射性填充，肝血池相腫塊呈放射性填充。病理及免疫組化： 腫瘤由成熟的脂肪、血管及平滑肌組成，HMB45陽(yáng)性。術(shù)前確診3例。結(jié)論B超示強(qiáng)回聲光團(tuán)，CT呈低密度影中出現(xiàn)軟組織影、脂肪成分，增強(qiáng)明顯，MRI出現(xiàn)脂肪信號(hào)，脂肪抑制后短T1變成長(zhǎng)T1，增強(qiáng)明顯。99mTcPMT示腫瘤呈放射性增強(qiáng)，5 min相呈放射性缺損，延遲相未見(jiàn)放射性填充，肝血池相呈放射性填充。這些是肝血管平滑肌脂肪瘤的影像學(xué)特點(diǎn)，結(jié)合病史可作出診斷。此病應(yīng)盡早手術(shù)治療，行肝部分切除術(shù)。最后確診依靠病理檢查及免疫組化分析。
目的?應(yīng)用Meta分析方法對(duì)乏脂肪腎血管平滑肌脂肪瘤（renal angiomyolipoma，RAML）與腎細(xì)胞癌（renal cell carcinoma，RCC）鑒別診斷中主要CT征象的價(jià)值進(jìn)行評(píng)價(jià)。方法?電子檢索Cochrane圖書(shū)館、PubMed、MEDLINE（OVID）、EMbase數(shù)據(jù)庫(kù)以及中國(guó)期刊網(wǎng)（CNKI、CBM、VIP）的英文及中文文獻(xiàn)，檢索時(shí)間為2001年1月～2008年11月。按照Cochrane協(xié)作網(wǎng)推薦的診斷試驗(yàn)的納入標(biāo)準(zhǔn)篩選文獻(xiàn)，進(jìn)行文獻(xiàn)質(zhì)量評(píng)價(jià)和提取資料。采用RevMan 5、Meta-disc 1.4軟件檢驗(yàn)異質(zhì)性、進(jìn)行Meta分析及繪制SROC曲線。結(jié)果?共納入7篇文獻(xiàn)，包括482例患者和513個(gè)病灶。Meta分析結(jié)果顯示，平掃密度、病灶突出、病灶單發(fā)或多發(fā)、病灶內(nèi)有無(wú)鈣化、各征象對(duì)RAML和RCC的鑒別診斷均具有一定的價(jià)值，其中皮質(zhì)掀起征最高，均勻強(qiáng)化及延遲強(qiáng)化其次。結(jié)論?本系統(tǒng)評(píng)價(jià)結(jié)果顯示，除瘤內(nèi)測(cè)得脂肪成分外，尚有上述8種CT征象在鑒別RAML和RCC方面具有臨床應(yīng)用價(jià)值。
【摘要】 目的 探討頸部對(duì)稱性脂肪瘤的診斷和治療?！》椒ā?duì)2004年3月-2010年10月收治的5例頸項(xiàng)部脂肪瘤患者，其臨床癥狀、體征、術(shù)前術(shù)后處理及結(jié)果等臨床資料進(jìn)行回顧?！〗Y(jié)果 5例均為男性，以頸、項(xiàng)部大量皮下脂肪堆積為主要臨床表現(xiàn)，其中1例伴有胸部上分皮下脂肪堆積，呈對(duì)稱性隆起。3例患者伴阻塞性睡眠呼吸暫停低通氣綜合征，2例患者有睡眠打鼾但無(wú)明顯呼吸暫停。4例患者有脂肪肝和長(zhǎng)期酗酒史，但肝功能無(wú)異常改變，其中1例（1/4）有多次乙醇中毒史。1例患者無(wú)酗酒史，但訴經(jīng)常作頸部刮痧治療。5例均行外科手術(shù)切除，術(shù)中見(jiàn)腫瘤為白色無(wú)包膜脂肪組織。術(shù)后隨訪3個(gè)月~2年，1例術(shù)后1年復(fù)發(fā)，未行再次治療，其余未見(jiàn)明顯復(fù)發(fā)?！〗Y(jié)論 頸部對(duì)稱性脂肪瘤是脂肪組織彌漫性、對(duì)稱性沉積于頸胸部皮下淺筋膜間隙和（或）深筋膜間隙的良性疾病?；颊咭灾心昴行跃佣?，長(zhǎng)期的酗酒史及典型的臨床表現(xiàn)對(duì)于該病的診斷有一定幫助，但酗酒可能并非唯一病因。對(duì)于影響美觀及功能的患者，其手術(shù)療效較理想?！続bstract】 Objective To explore the diagnosis and treatment of symmetric lipomatosis in the neck. Methods We retrospectively analyzed the clinical manifestations, signs, preoperative and postoperative management, and the treatment outcome of five patients with symmetric lipomatosis hospitalized in the Department of Otolaryngology-Head and Neck Surgery of West China Hospital between March 2004 and October 2010. Results All the five patients are male with a large quantity of subcutaneous fat deposit in and around the neck. Among them, one patient demonstrated extending upper thorax mass in the form of symmetrical apophysis; three experienced obstructive sleep apnea hypoventilation syndrome, and two had the symptom of snoring without apnea. Four patients had a long history of alcohol abuse with fatty liver, but had no liver dysfunction. In these four patients, one had alcoholism for many times. One out of the five patients had no history of alcohol abuse, but said to have been treated by a traditional Chinese medical technique GUASHA. All the patients underwent resection surgery, during which a large amount of noncapsulated white adipose tissue was confronted. The duration of follow-up lasted from three months to two years. There was one case of recurrence one year after the surgery and the patient refused re-operation. No obvious recurrence was found in the rest of the group. Conclusions Symmetric lipomatosis is a benign lesion characterized by diffused and symmetric accumulation of adipose tissue in the superficial or deep fascia space in the cervico-thoracic region. It mainly takes place in the middle-aged people. Long history of alcohol abuse and typical clinical manifestations can help to reach the diagnosis, but alcoholism may not be the only cause in etiology. Surgery may be the feasible therapeutic modality up to now.
【摘要】 目的 探討肝臟血管平滑肌脂肪瘤（hepatic angiomyolipoma，HAML）的多層螺旋CT影像學(xué)表現(xiàn)特征及其與病理學(xué)基礎(chǔ)的相關(guān)性，以進(jìn)一步提高CT診斷的準(zhǔn)確性?！》椒ā∈占?008年11月-2010年12月經(jīng)手術(shù)病理證實(shí)的16例HAML患者。所有患者均行螺旋CT平掃及動(dòng)脈期、門脈期增強(qiáng)檢查，重點(diǎn)觀察HAML的分型及其相應(yīng)CT表現(xiàn)及影像-病理的相關(guān)性?！〗Y(jié)果 16例患者共20個(gè)病灶，19個(gè)為稍低密度病灶，其中11個(gè)病灶內(nèi)可見(jiàn)明顯的脂肪密度影；1個(gè)為稍高密度病灶。動(dòng)脈期所有病灶均有不同程度的強(qiáng)化表現(xiàn)，15個(gè)病灶內(nèi)可見(jiàn)到較明顯條狀及扭曲的血管影。門脈期15個(gè)病灶有持續(xù)強(qiáng)化?！〗Y(jié)論 多層螺旋CT能準(zhǔn)確反映HAML的分型及其病理特征，對(duì)臨床表現(xiàn)不典型患者的診斷和鑒別診斷有較大診斷價(jià)值?！続bstract】 Objective To discuss the correlation between the features of multislice spiral CT results for hepatic angiomyolipoma (HAML) and their pathological basis, and to further improve the diagnostic accuracy through CT examination. Methods Sixteen HAML patients diagnosed pathologically between November 2008 and December 2010 in our hospital were enrolled in our study. All patients underwent multi-slice spiral CT scanning of pre-and post-contrast arterial phase, and portal venous phase. Focus was put on observation of HAML types and their corresponding manifestations, and the correlation between CT imaging and the pathologic basis. Results There were 20 lesions in the 16 patients. Among the 19 hypodense lesions, 11 were clearly seen with fat density shadow. One out of the 20 lesions showed as slightly hyperdense. On the arterial phase scanning, all lesions showed enhancement, and obvious vascular shadow could be seen in15 lesions. On the portal venous phase, 15 lesions continued to strengthen. Conclusions Multi-slice spiral CT can accurately reflect the classification of HAML and its pathological features. It has a great value in the diagnosis and differential diagnosis of patients without typical clinical manifestations.
【摘要】 目的 探討腎上腺髓樣脂肪瘤的彩色多普勒超聲表現(xiàn)和超聲診斷價(jià)值?！》椒ā』仡櫺苑治?005年3月-2010年9月58例61個(gè)經(jīng)手術(shù)及病理證實(shí)的腎上腺髓脂肪瘤病灶的彩色多普勒超聲表現(xiàn)，對(duì)病變的大小、內(nèi)部回聲特點(diǎn)及血流特點(diǎn)進(jìn)行分析?！〗Y(jié)果 在2005年3月-2007年12月的28個(gè)病灶超聲診斷出腎上腺病變23個(gè)，正確率82.1%；診斷為髓脂肪瘤2個(gè)，正確率7.1%；漏診1個(gè)，誤診4個(gè)。2008年1月-2010年9月，33個(gè)病灶超聲診斷出腎上腺病變30個(gè)，正確率90.9%；診斷為髓脂肪瘤19個(gè)，正確率57.6%；無(wú)漏診，誤診3個(gè)。52個(gè)病灶超聲表現(xiàn)為邊界清晰，形態(tài)基本規(guī)則，內(nèi)部呈均勻中等強(qiáng)回聲（與腎集合系統(tǒng)回聲相當(dāng)），內(nèi)部未測(cè)及血流信號(hào)， 另8個(gè)病灶表現(xiàn)為中等強(qiáng)回聲與低回聲相間。 結(jié)論 腎上腺髓樣脂肪瘤具有特征性的彩色多普勒超聲聲像圖表現(xiàn)， 可用于發(fā)現(xiàn)病變并對(duì)多數(shù)腎上腺髓樣脂肪瘤做出定性診斷。【Abstract】 Objective To evaluate the value of sonographic diagnosis of adrenal myelolipoma. Methods Sonographic findings from 58 patients with pathologically proved adrenal myelolipoma from March 2005 to September 2010 were retrospectively analyzed. The size of the lesion, internal echo features, and characteristics of blood flow were observed and analyzed. Results In 28 patients with pathologically proved adrenal myelolipoma from March 2005 to December 2007, adrenal lesions was diagnosed in 23 with an accurate rate of 82.1%; adrenal myelolipoma was diagnosed in two with an accurate rate of 7.1%; missed diagnosed in one; misdiagnosed was in four. In 33 patients with pathologically proved adrenal myelolipoma from January 2008 to September 2010, adrenal lesions was diagnosed in 30 with an accurate rate of 90.9%; adrenal myelolipoma was diagnosed in 19 with an accurate rate of 57.6%; no missed diagnosed occurred; misdiagnosed was in three. The sonographic features in 52 lesions were smooth borders and homogeneous hyperechoic; no color Doppler flow signal inside was detected. Conclusion Adrenal myelolipoma has special sonographic features. Ultrasonography is a reliable imaging method for the diagnosis of adrenal myelolipoma.
:目的:探討腎上腺髓樣脂肪瘤的臨床、影像學(xué)及病理特點(diǎn)。方法:回顧性分析28例腎上腺髓樣脂肪瘤患者的臨床資料,結(jié)合文獻(xiàn)分析其特點(diǎn)。結(jié)果:28例患者腫瘤均經(jīng)手術(shù)切除,并經(jīng)病理檢查證實(shí)為腎上腺髓樣脂肪瘤,隨訪至今未見(jiàn)復(fù)發(fā)。結(jié)論:腎上腺髓樣脂肪瘤的診斷主要依靠B超、CT和MRI,術(shù)前診斷困難,確診需經(jīng)病理學(xué)檢查,手術(shù)切除是有效的治療方法。
目的 探討肝血管平滑肌脂肪瘤（HAML）的CT表現(xiàn)及相關(guān)臨床特點(diǎn)。方法 回顧性分析3例經(jīng)手術(shù)病理確診的HAML患者的臨床、CT及病理資料，分析其影像學(xué)表現(xiàn)及特點(diǎn)。結(jié)果 3例患者均為女性，其中2例有腹痛表現(xiàn)，1例無(wú)任何癥狀。2例實(shí)驗(yàn)室檢查均正常，1例除乙肝標(biāo)志物（+）外，其余正常。CT表現(xiàn): 腫瘤位于肝右葉前上段1例，右葉后下段1例，左內(nèi)葉1例; 腫塊內(nèi)可見(jiàn)脂肪成分及軟組織成分，其中脂肪成分CT值為-80～-20 HU（平均-50 HU）; 增強(qiáng)后均有不同程度強(qiáng)化，可見(jiàn)強(qiáng)化血管影。術(shù)中見(jiàn)均為外生性包塊。免疫組化染色HMB45（+）、αSMA（+）、S100（+），符合血管平滑肌脂肪瘤的診斷。結(jié)論 HAML是一種少見(jiàn)的良性腫瘤，其影像學(xué)表現(xiàn)有一定特征性，確診有賴于免疫組化檢測(cè)HMB-45。
【摘要】目的探討肝血管平滑肌脂肪瘤的臨床病理特點(diǎn)、診斷及鑒別診斷。 方法對(duì)3例肝血管平滑肌脂肪瘤患者有關(guān)病理檢查結(jié)果進(jìn)行回顧性分析。 結(jié)果腫瘤位于肝右葉2例，肝左葉1例。腫瘤直徑為2～10 cm，平均6.2 cm。3例腫瘤內(nèi)均見(jiàn)平滑肌、脂肪、畸形厚壁血管，但未見(jiàn)髓外造血灶。對(duì)黑色素瘤（HMB45）、結(jié)合蛋白（desmin)及肌動(dòng)蛋白（actin)檢查均呈陽(yáng)性反應(yīng)。術(shù)后隨訪6～36個(gè)月，未見(jiàn)腫瘤復(fù)發(fā)。結(jié)論肝血管平滑肌脂肪瘤由3種成分組成，病理形態(tài)變化多樣，必須與多種肝腫瘤相鑒別。平滑肌細(xì)胞HMB45表達(dá)呈強(qiáng)陽(yáng)性反應(yīng)是診斷肝血管平滑肌脂肪瘤較可靠的依據(jù)。