支气管内脂肪瘤二例报道并文献复习

目的 了解支气管内脂肪瘤临床特征.方法 复习国内发表的有病理证据的支气管内脂肪瘤的病例,结合近期北京医院收治的2例支气管内脂肪瘤病例进行分析.结果 40例患者中,男31例,女9例,平均年龄(53±11)岁,其中37例瘤体位于气管、主支气管及叶支气管.主要症状包括咳嗽、胸闷、发热、咯血等.30例胸部CT可见脂肪或软组织密度气道内肿物影,仅9例经气管镜活检诊断.32例患者最终选择外科手术治疗,7例行气管镜介入治疗.结论 胸部CT和气管镜介入检查均为诊断支气管内脂肪瘤的有效手段,支气管内脂肪瘤首选经气管镜进行气管、支气管腔内治疗.     

肺母细胞瘤1例并文献复习

目的提高对肺母细胞瘤的认识。方法结合1例肺母细胞瘤患者的临床资料和文献复习,详细分析该病的组织起源、临床病理特点、分类、诊断、鉴别诊断、治疗及预后等。结果该病临床症状少且轻微,影像学提示“良性肿瘤”;病理学检查主要特征是镜下瘤组织由胎儿型腺管样的上皮成分和原始的肉瘤样间质成分混杂存在。免疫组化示瘤组织由上皮和间叶两种成分构成。目前尚无有效治疗措施,预后差。结论肺母细胞瘤罕见,极易误诊,应予重视。     

原发性肺黑色素瘤1例报道并文献复习

目的 分析原发性肺黑色素瘤(PMML)的流行病学及临床、病理特点,提高临床医师对PMML的诊断水平.方法 报道了济宁市第一人民医院呼吸科1例经病理确诊的PMML,并对其病理特点及32例PMML患者的治疗进行回顾分析.结果 患者,男,22岁,主因“反复咯血8个月,加重3d”于2011年3月31日在我院呼吸科住院治疗.肺CT是多发结节灶,后行胸腔镜肺活检病理示黑色素瘤.迄今为止,国外诊断PMML 32例,国内报道22例,主要症状为咯血,咳嗽.影像学为孤立性病灶多见.结论 本例肺内多发结节的PMML患者在国内外都是首例报道.手术是目前最好的方法,晚期可以给予放化疗.     

罕见乏脂纵隔血管平滑肌脂肪瘤1例并文献复习

目的探讨乏脂纵隔血管平滑肌脂肪瘤的临床、病理特征和鉴别诊断。方法1例纵隔乏脂血管平滑肌脂肪瘤,同时结合国内外文献复习。结果1例46岁术前诊断为纵隔肿瘤,全麻下行纵隔肿瘤切除术。术后诊断为纵隔乏脂血管平滑肌脂肪瘤,组织学特征与其他部位血管平滑肌脂肪瘤相似,免疫组化表达HMB45、S-100、Des。结论本例罕见,诊断依靠临床、病理学特征及免疫组化三方面结合。乏脂纵隔血管平滑肌脂肪瘤必须经过全面思维和细致检查,以求正确诊断,为决策正确治疗提供科学依据。     

支气管肺淀粉样变1例报道并文献复习

目的探讨支气管肺淀粉样变的临床表现、诊断、治疗和预后。方法对我院确诊的1例和国内报道的47例支气管肺淀粉样变进行回顾性总结。结果①常见症状为咳嗽,咳痰,咯血,呼吸困难等,大部分肺部无异常体征。②胸片或CT常见表现为气管或支气管肥厚、狭窄,斑片浸润影,结节或肿块,肺不张等,亦可有正常胸片。③纤支镜常见表现为支气管黏膜结节、隆起或息肉。④48例患者中有37例经纤支镜取得病理标本。⑤治疗方法有激素等免疫抑制剂、激光、微波和手术治疗等,但无特效疗法。⑥易复发但病程多为良性经过。结论该病临床表现无特异性,纤支镜活检是确诊最有效的方法,无特效疗法,预后与病理类型有关,多数较好。     

支气管脂肪瘤1例报道并文献复习

正病例资料患者男性,54岁,系"咳嗽、咳痰、气喘伴发热二十余日,加重一周"入院。患者在广东打工并从事建筑搬运工作。二十余日前开始,患者无明显诱因下出现咳嗽、咳痰伴气喘,痰量不多,多为白色粘痰,未见痰中带血,呼吸时自觉可闻及"拉风箱"音,体温偏高,曾多次自测体温达39℃。开始仅口服"头孢类"抗生素治疗,但效果欠佳。2015.01.07日患     

肺组织细胞增多症1例并文献复习

目的探讨肺组织细胞增多症的发病特点、诊断和治疗方法。方法结合收治的1例肺组织细胞增多症患者的临床资料,对该病的发病特点,诊断和治疗方法进行综合分析。结果肺组织细胞增多症好发于吸烟人群,临床上多表现为活动后呼吸困难以及反复气胸。X线表现为中上肺野多发小结节状改变,晚期表现为多发囊状以及纤维化改变。病理表现为嗜酸性肉芽肿。约一半病人经激素或不经任何治疗后症状缓解,三分之一病人病情急性加重,导致呼吸衰竭。结论肺组织细胞增多症是一种罕见疾病,容易误诊,HRCT对诊断很重要,确诊需要病理。治疗以激素治疗为主。     

肺透明细胞癌1例并文献复习

<正>肺透明细胞癌(CLCC)是肺原发性恶性肿瘤中非常少见的一类,2004年WHO关于肺癌最新分类中CLCC属于大细胞癌中的变异型,因发病率低,临床症状无特异性,目前对肺透明细胞癌的认识尚不十分清楚,关于诊断、治疗亦缺乏足够的临床经验,且误诊率较高。我院2015年5月收治1例老年男性CLCC的患者,现作一综述并进行国内外文献复习。1临床资料老年男性,78岁,主因咳嗽、咳痰伴痰中带血4 d入院。     

胃脂肪瘤一例报告并文献复习

患者男,60岁,因上腹间歇性疼痛15d并胃占位1周收入我院。患者15d前出现间歇性上腹疼痛,在某诊所行针灸治疗无效后,于1周前至当地某医院行胃镜检查发现胃占位性病变,经治疗临床症状无明显改善后转入我院。患者发病以来,饮食、睡眠良好,无恶心、呕吐及黑便,无消瘦。入院查体：腹平软,未见胃肠型及肠蠕动波,全腹无压痛及反跳痛,未触及肿物,无移动性浊音,肠鸣音4次／min。     

肺淋巴管平滑肌瘤病1例并文献复习

患者女,34岁。因活动后呼吸困难3a,加重3月余,于2005年3月9日入院。3a前患者无明显诱因出现呼吸困难,月经期后症状略有加重。3月前因受凉后咳嗽、吐黏痰,罗红霉素治疗无效。胸部CT示双肺纹理增多,散在小点状高密度影,拟诊为问质性肺病,给予抗感染、激素治疗。20d后呼吸困难稍有缓解出院。近1d来因症状加重伴咳吐大量脓痰收住本院。     

Parosteal lipoma of the forearm: A case report and a literature review

Rationale:Parosteal lipomas are rare neoplasms comprising mature adipocytes situated in a proximity to bone. Although these tumors follow a benign course, the reactive osseous changes that may occur with such lesions might raise the suspicion of malignancy.Patient Concerns:Here we present a case of a 33-year-old male patient complaining of pain and swelling in the right anterior forearm without history of trauma.Diagnosis:An magnetic resonance imaging of the region revealed a lobulated intramuscular fat intensity mass within the supinator muscle. Bony projection inseparable from the anterolateral radial diaphyseal cortex and periosteum was also seen. The radiological features suggested the diagnosis of parosteal lipoma.Intervention:After the radiological diagnosis of a parosteal lipoma, the patient was offered a total surgical excision of the mass.Outcomes:The mass was removed successfully. Histopathology showed mature benign adipose tissue bordered by thin fibrous septa confirming the diagnosis of parosteal lipoma. Follow-up magnetic resonance imaging after 6 months did not reveal any signs of complications or recurrence.Lessons:Distinction of the features of parosteal lipomas is needed to establish the accurate diagnosis, discriminate it from malignant lesions, predict potential neurovascular compromises, and follow up until a curative action is planned.     

回盲部脂肪瘤致肠套叠1例

肠道脂肪瘤是一种较少见良性肿瘤。其临床表现缺乏特异性,因此难以在术前明确诊断。我院收治1例结肠肿块导致肠套叠患者,经外科手术后病理诊断为结肠脂肪瘤。复习文献后对关于结肠脂肪瘤的临床表现、诊断以及治疗进行总结。     

Submucous colon lipoma： A case report and review of the literature

Colon lipoma is remarkably rare in clinical practice. We reported a case of ascending colon lipoma in an 83-year-old woman. She was asymptomatic with a lipoma of 35 mm×30 mm×24 mm in size which was found by routine colonoscopy. Right hemicolectomy was performed uneventfully. The diagnosis was made by histological examination. Reviewing the literature and combining with our experience, we discussed the clinical features, diagnosis and treatment of this uncommon disease.     

Hypopharyngeal spindle cell lipoma: A case report and review of literature

Rationale:Spindle cell lipoma is a rare, uncommon type of benign lipomatous tumor, a distinct group of lipomas composed of mature adipocytes, uniform spindle cells, and multinucleated giant cells associated with ropey collagen. Immunohistochemically, spindle cell lipoma is characterized by the diffuse expression of CD34.Patient concerns:We present a rare case of a 56-year-old man who complained of vomiting out of a smooth and giant mass in the oral cavity provoked by an intra-abdominal pressure increase. Oral examination revealed an elongated mass protruding from the mouth. Computed tomography of the patient showed a mass from left pyriform to oral cavity, with 2.38 × 2.78 × 16.86 cm in size. The flexible fiberscope showed that the pedicle of the elongated mass originated from the posterior wall of the hypopharynx, corresponding to the left pyriform fossa.Diagnosis:Histopathologically, the tumor was mainly composed of hyperplastic adipocytes, admixed with small blood vessels, and scattered inside adipose tissue spindle cells. The immunohistochemical profile revealed positivity of spindle cells for CD34, negativity for S100, and low proliferation with Ki67, which confirmed the diagnosis of spindle cell lipoma and revealed its benign behavior.Interventions:The patient underwent hypopharyngeal mass resection using transoral suspension laryngoscopy.Outcomes:No recurrence was found after 5 months of follow-up.Lessons:Spindle cell lipoma is difficult to diagnose early because of slow growth and subtle symptomatology. This entity should be differentiated from several benign or malignant subtypes of lipomas, including liposarcomas. In this case, the spindle cell lipoma is large and originates from the hypopharynx, which is a rare entity and presents with atypical symptoms. This case gave rise to further studies on the clinical and pathologic characteristics of this tumor in the future.     

Cecal lipoma with pseudomalignant features： A case report and review of the literature

Colonic lipoma is a well-documented benign neoplasia, endoscopically appearing as a smooth round yellowish polyp with a thick stalk or broad-based attachment. We describe a 63-year old woman with persistent abdominal pain, in whom colonoscopy revealed a cecal mass with malignant features. Based on the colonoscopy findings, right hemicolectomy was laparoscopically performed for a presumptive diagnosis of a cecal adenocarcinoma, but histological examination revealed a colonic lipoma with overlying mucosal ulceration.     

经皮椎体成形术后合并骨水泥肺栓塞:1例报道并文献复习

目的 提高对经皮椎体成形术后合并骨水泥肺栓塞的认识.方法 对1例骨水泥肺栓塞患者的临床资料进行分析,并结合文献复习.结果 经皮椎体成形术可合并骨水泥肺栓塞,临床表现为胸痛、呼吸困难、呼吸衰竭等,X线胸片示肺内射线不能透过的管状影.给予吸氧、抗凝及相关支持治疗,病情可好转.结论 应提高对经皮椎体成形术后骨水泥肺栓塞的认识,通过积极预防可能减少发生率,确诊后积极治疗可改善预后,对于大的骨水泥肺栓塞应行手术取栓.     

肺静脉堵塞病:1例报道及文献复习

目的 提高对肺静脉堵塞病(PVOD)的认识.方法 对1例PVOD患者的临床资料进行分析,并结合文献复习.结果 PVOD是一种临床少见病,临床表现为进行加重的劳力性呼吸困难和肺动脉高压.影像学特征为肺水肿、Kerley B线、肺动脉高压和右心房室扩大等征象,左心房正常.血流动力学表现为肺动脉压升高,肺动脉楔压(PAWP)和左房压正常.组织病理学可见弥漫性的肺小静脉管腔狭窄和闭塞.结论 重度肺动脉高压、肺水肿和PAWP正常(或左心房内径正常)被称为PVOD三联征,可作为PVOD的临床诊断标准.血管扩张剂可诱发急性肺水肿和猝死,应谨慎使用.PVOD预后不良,肺移植是惟一确定有效的治疗方法.     

Pulmonary embolism with acute pancreatitis: a case report and literature review

Acute pancreatitis is an inflammatory disease characterized by local tissue injury which can trigger a systemic inflammatory response. So vascular complications of pancreatitis are a major cause of morbidity and mortality. Pulmonary embolism in acute pancreatitis has been reported to be very rare. We reported a case of pulmonary embolism with acute pancreatitis. A 38-year-old woman broke out upper abdomen pain without definite inducement. She had no nausea and vomiting, fever, dyspnea, cough and expectoration, chest pain. The patient had been diagnosed with acute pancreatitis in local hospital. The patient was treated with antibiotics and proton pump inhibitors, and the abdomen pain was alleviated slightly. But the patient came forth cough and expectoration with a little blood, progressive dyspnea. A computed tomographic scan of the abdomen revealed pancreatitis. Subsequent computer tomography angiography of chest revealed pulmonary embolism (both down pulmonary arteries, left pulmonary artery and branch of right pulmonary artery). Dyspnea of the patient got well with thrombolytic treatment and anticoagulation therapy. Pulmonary embolism is a rare but potentially lethal complication of pancreatitis. Familiarity with this complication will aid in its early diagnosis, therapy and prevent pulmonary embolism, a rare but catastrophic phenomenon.     

肺玻璃样变肉芽肿病一例报告并文献复习

目的：提高对罕见病肺玻璃样变肉芽肿（PHG）的认识。方法：对1例经尸体解剖证实的PHG患者的临床资料进行分析,并结合文献复习。结果：PHG是一种罕见的肺疾病,临床表现为咳嗽、气短、胸痛、咯血、发热、疲劳、若病灶融合扩大可导致呼吸衰竭,胸部X线片特征是双肺多发肺结节,显微镜下结节的特点是由涡轮状或席纹状方式排列的胶原纤维组成,周围有炎性细胞浸润,病因及发病机制可能与免疫有关。结论：在双肺多发肺结节的鉴别诊断中应想到PHG的可能,PHG大多预后良好,目前尚无有效的治疗方法。