Diagnosis and Treatment of Liver Cystadenocarcinoma:Report of 18 Cases

Objective： To discuss the diagnosis and treatment of liver cystadenocarcinoma. Methods： The clinical, imaging, and pathological data of 18 patients with liver cystadenocarcinoma between January 2000 and December 2004 in our hospital were retrospectively analyzed. Results： The liver cystadeno- carcinoma was seen in males and females （m/f： 9/9）; mean age was 51 years. Ultrasonography revealed cystic parenchymatous mass echoes of fluid predominance with uneven margins. Nonenhanced CT revealed intrahepatic low-density space occupying shadows with nodular protrusions on the margins in all cases. Enhancement CT revealed that part of the nodular protrusions and tissues around the lesions were enhanced and the delayed phase disappeared. 66.67% （12/18） of the lesions were more than 10 cm in diameter. The diagnosis of liver cystadenocarcinoma was confirmed by postoperative pathology in all cases. Of these patients, 12 lesions were in the left lobe, 3 in the right lobe, 1 in the mid lobe, 1 in the right and left lobe, and 1 in the caudate lobe. Of tile 18 patients, 6 had completely resect the cystadenocarcinoma, 2 were surgically explored, one received TAE＋fine needle aspiration cytology＋injection of chemotherapy drugs, and 9 underwent radical hepatectomy＋choledochostomy or T-tube drainage, in which, one patient underwent choledochostomy＋left hepatectomy＋radical gastrectomy for cancer＋lymphadenectomy; one patient underwent resection of the cystadenocarcinoma, who had relapse 20 months after the initial procedure. The patient received repeat reseet for the recurrent cystadenoeareinoma＋eholangio-jejunostomy. Six months later she had another relapse and received repeat reseet （only PMCT） for the recurrent cystadenoearcinoma. The patient died from eholangiopleural fistula after third time operation （PMCT） was attempted perioperatively. Seven patients died of metastatic disease after operation. The remaining 10 patients were alive without cancer recurrence or metastasis （mean follow-up 20 months）. Conclusion： Liver eystadenocarcinoma is rarely seen and grows slowly. It shows some typical clinical and imaging features. The crux for diagnosing and treating liver cystadenoeareinoma is how familiar the surgeon is with the pathology and clinical features of the condition. Prolonged survival can be achieved by radical resection of the tumor.

Obstructive jaundice due to hepatobiliary cystadenoma or cystadenocarcinoma

Hepatobiliary cystadenomas (HBC) and cystadenocarci- nomas are rare cystic lesions. Most patients with these lesions are asymptomatic, but presentation with ob- structive jaundice may occur. The first patient presented with intermittent colicky pain and recurrent obstructive jaundice. Imaging studies revealed a polypoid lesion in the left hepatic duct. The second patient had recurrent jaundice and cholangitis. Endoscopic retrograde cholan- giopancreatography (ERCP) showed a cystic lesion at the confluence of the hepatic duct. In the third patient with intermittent jaundice and cholangitis, cholangioscopy re- vealed a papillomatous structure protruding into the left bile duct system. In the fourth patient with obstructive jaundice, CT-scan showed slight dilatation of the intrahe- patic bile ducts and dilatation of the common bile duct of 3 cm. ERCP showed filling of a cystic lesion. All patients underwent partial liver resection, revealing HBC in the specimen. In the fifth patient presenting with obstructive jaundice, ultrasound examination showed a hyperecho- genic cystic lesion centrally in the liver. The resection specimen revealed a hepatobiliary cystadenocarcinoma. HBC and cystadenocarcinoma may give rise to obstruc- tive jaundice. Evaluation with cross-sectional imaging techniques is useful. ERCP is a useful tool to differentiate extraductal from intraductal obstruction.

Intrahepatic biliary cystadenocarcinoma: clinical analysis of 4 cases

BACKGROUND: Intrahepatic biliary cystadenocarcinoma (IBC) is a low-incidence disease which is often misdiagnosed because of insufficient recognition. This study aimed to investigate the clinical features, diagnosis and treatment of the disease. METHOD: The clinical data of 4 IBC patients treated in the Second Affiliated Hospital of Sun Yat-Sen University were retrospectively analyzed. RESULTS: The 4 patients complained of right upper abdominal pain and mass or masses. One patient presented with moderate fever and chills, and two had moderately impaired liver function. The levels of carbohydrate antigens (CA125 and CA19-9) were significantly elevated and the level of carcinoembryonic antigen was slightly elevated in 3 patients. The level of serum transaminase was elevated in 2 patients, and the level of serum total bilirubin elevated in 2. Intrahepatic cystic masses ranging from 5.0 to 20.5 cm in diameter were found in all patients by ultrasound and CT/MR scan. Three of the 4 patients were misdiagnosed on admission as having hepatic cyst and one as having hepatic abscess. Radical removal of masses was performed in three patients after pathological diagnosis. One patient died from tumor recurrence 7 years after operation, 2 were followed up for 12 and 17 months without evidence of recurrence. The high risk patients who received palliative therapy were closely followed up. CONCLUSIONS: The diagnosis of IBC without specific clinical features mainly depends on imaging and pathological examination. Increased levels of serum CA125 and CA19-9 might contribute to the diagnosis and prognosis of some IBC patients. Radical excision is the only effective treatment.

Preoperative differential diagnosis between intrahepatic biliary cystadenoma and cystadenocarcinoma:A single-center experience

AIM: To investigate preoperative differential diagnoses made between intrahepatic biliary cystadenoma and intrahepatic biliary cystadenocarcinoma. METHODS: A retrospective analysis of patient data was performed, which included 21 cases of intrahepatic biliary cystadenoma and 25 cases of intrahepatic biliary cystadenocarcinoma diagnosed between April 2003 and April 2013 at the General Hospital of PLA. Potential patients were excluded whose diagnoses were not confirmed pathologically. Basic information (including patient age and gender), clinical manifestation, duration of symptoms, serum assay results (including tumor markers and the results of liver function tests), radiological features and pathological results were collected. All patients were followed up. RESULTS: Preoperative levels of cancer antigen 125 (12.51 +/- 9.31 vs 23.20 +/- 21.86, P < 0.05) and carbohydrate antigen 19-9 (22.56 +/- 26.30 vs 72.55 +/- 115.99, P < 0.05) were higher in the cystadenocarcinoma subgroup than in the cystadenoma subgroup. There were no statistically significant differences in age or gender between the two groups, or in pre- or post-operative levels of alanine aminotransferase, aspartate aminotransferase, total bilirubin (TBIL), and direct bilirubin (DBIL) between the two groups. However, eight of the 21 patients with cystadenoma and six of the 25 patients with cystadenocarcinoma had elevated levels of TBIL and DBIL. There were three cases in the cystadenoma subgroup and six cases in the cystadenocarcinoma subgroup with postoperative complications. CONCLUSION: Preoperative differential diagnosis relies on the integration of information, including clinical symptoms, laboratory findings and imaging results. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.

Improved early diagnosis of cystadenocarcinoma of the pancreas

BACKGROUND: Cystadenocarcinoma of the pancreas is insensitive to radiotherapy and chemotherapy, and surgery is at present the definitive treatment. Early and accurate diagnosis of cystadenocarcinoma is crucial for increasing the five-year survival rate and the resectable rate. There is no definitive and effective method of early diagnosis of cystadenocarcinoma of the pancreas in China and other countries. METHODS: We compared endoscopic ultrasonography-guided (EUS-guided) fine needle aspiration biopsy combined with cyst fluid carcinoembryonic antigen (CEA), CA19-9 examination with computed tomography (CT), B-ultrasonography (B-US) and serum CEA and CA19-9, to explore methods of early diagnosis of cystadenocarcinoma of the pancreas. Retrospective analysis was made on the clinical data of 126 cases of benign pancreatic lesion (90 cases) and cystadenocarcinoma (36). RESULTS: The sensitivity of B-US and CT for cystadenocarcinoma was 52.8% and 77.8%, while the specificity was 78.9% and 86.7%, respectively. When measurement of CEA and CA19-9 of cyst fluid was combined with EUS-guided fine needle aspiration biopsy, the sensitivity was 94.4%, higher than that of B-US and CT (P<0.05). The sensitivity of cyst fluid CEA, CA19-9 examinations was considerably higher than that of serum CEA, CA19-9 (P<0.05). Upper gastrointestinal barium meal and endoscopic retrograde cholangiopancreatography (ERCP) had low sensitivity and specificity. CONCLUSIONS: EUS-guided fine needle aspiration biopsy combined with examination of cyst fluid CEA, CA19-9 is a credible means for early diagnosis of cystadenocarcinoma of the pancreas. B-US, CT and serum CEA, CA19-9 measurements are in common use, their findings are also very important.

Inferior vena cava obstruction and collateral circulation as unusual manifestations of hepatobiliary cystadenocarcinoma

BACKGROUND: Hepatobiliary cystadenocarcinoma represents a rare epithelial malignant tumor derived from the intrahepatic bile duct. METHODS: A 71-year-old woman, who had undergone laparoscopic drainage of a cystic lesion of the right hepatic lobe, was misdiagnosed as having hepatic echinococcal disease, and received intracystic infusion of 95% ethanol four years ago. She was admitted to our hospital for further treatment. RESULTS: Physical examination revealed dilated superficial veins across the right abdominal wall. After mapping the direction of blood flow in these vessels, we assumed that this was a sign of inferior vena cava obstruction. Abdominal ultrasound, computed tomography, magnetic resonance imaging combined with magnetic resonance angiography showed a large cystic mass in the right upper quadrant and epigastrium, displacing the adjacent structures, adherent to the inferior vena cava, which was not patent, resulting in dilation of superficial epigastric veins. The patient underwent an exploratory laparotomy. Total excision of the huge mass measuring 16×15 cm was possible under selective vascular exclusion of the liver. Removal of the tumor resulted in immediate restoration of flow in the inferior vena cava. On the basis of the pathology and findings of immunohistochemical analysis, a hepatobiliary cystadenocarcinoma was diagnosed.CONCLUSIONS: In the present case, hepatobiliary cystadenocar-cinoma was accompanied by dilated superficial venous collaterals due to inferior vena cava obstruction. Selective vascular exclusion of the liver allowed a safe oncological resection of the tumor.

Clinical diagnosis and management of pancreatic mucinous cystadenoma and cystadenocarcinoma:Single-center experience with 82 patients

BACKGROUND Mucinous cystic neoplasm(MCN)of the pancreas is characterized by mucinproducing columnar epithelium and dense ovarian-type stroma and at risk for malignant transformation.Early diagnosis and treatment of MCN are particularly important.AIM To investigate the clinical characteristics of and management strategies for pancreatic mucinous cystadenoma(MCA)and mucinous cystadenocarcinoma(MCC).METHODS The clinical and pathological data of 82 patients with pancreatic MCA and MCC who underwent surgical resection at our department between April 2015 and March 2019 were retrospectively analyzed.RESULTS Of the 82 patients included in this study,70 had MCA and 12 had MCC.Tumor size of MCC was larger than that of MCA(P=0.049).Age and serum levels of tumor markers carcinoembryonic antigen(CEA),carbohydrate antigen(CA)19-9,and CA12-5 were significantly higher in MCC than in MCA patients(P=0.005,0.026,and 0.037,respectively).MCA tumor size was positively correlated with serum CA19-9 levels(r=0.389,P=0.001).Compared with MCC,MCA had a higher minimally invasive surgery rate(P=0.014).In the MCA group,the rate of major complications was 5.7%and that of clinically relevant pancreatic fistula was 8.6%;the corresponding rates in the MCC group were 16.7%and 16.7%,respectively.CONCLUSION Tumor size,age,and serum CEA,CA19-9,and CA12-5 levels may contribute to management of patients with MCN.Surgical resection is the primary treatment modality for MCC and MCA.

Biliary cystadenocarcinoma diagnosed with real-time contrast-enhanced ultrasonography:Report of a case with diagnostic features

Biliary cystadenocarcinoma is a very rare malignant cystic tumor of the liver,which is often misdiagnosed due to a poor recognition of it.We report a case of a 60-year-old man with biliary cystadenocarcinoma with his real time contrast enhanced ultrasound(CEUS)characteristics compared to those of computed tomography(CT)and magnetic resonance imaging(MRI),which were correlated with the surgical and pathologic findings.Cystic wall enhancement,internal septations and intra-cystic solid portions in the arterial phase were observed on CEUS after contrast agent injection.The enhancement was washed out progressively and depicted as hypo-enhancement in the portal and late phases.CT revealed a large irregular cystic lesion in the left liver lobe with no clear septations and solid components.MRI showed an irregular cystic occupying lesion with septations.

Concomitant adenosquamous carcinoma and cystadenocarcinoma of the extrahepatic bile duct: A case report

BACKGROUND Infiltrative adenosquamous carcinoma(ASC) of the extrahepatic bile duct is reported infrequently, which is an unusual variant of the ordinary adenocarcinoma. The simultaneous development of ASC and cystadenocarcinoma in the extrahepatic biliary tree is rare. In addition, the accurate preoperative diagnosis of concomitant carcinoma in the multiple biliary trees at an early stage is often difficult. Thus, awareness of the risk of the multiplicity of biliary tumors is perhaps the most important factor in identifying these cases.CASE SUMMARY Here, we report a case of a 63-year-old female with jaundice, who was referred to Shuguang Hospital because of abdominal pain for 1 mo. An abdominal contrastenhanced computed tomography revealed a type I choledochal cyst and intraluminal masses suggestive of adenoma of the common bile duct. In addition,a preoperative diagnosis of a concomitant Klatskin tumor and type I choledochal cyst was made. The patient underwent anti-inflammatory therapy, followed by radical surgery due to hilar cholangiocarcinoma and resection of the choledochal cyst. Examination of the surgical specimen revealed a papillary tumor of the common bile duct, which arose from the malignant transformation of a preexisting cystadenoma. Histologic examination confirmed a special type of cholangiocarcinoma; the tumor in the hilar bile duct was an ASC, whereas the tumor in the common bile duct was a moderately differentiated cystadenocarcinoma. The patient showed rapid deterioration 8 mo after surgery.CONCLUSION Although concomitant ASC and cystadenocarcinoma of the extrahepatic bile duct is difficult to diagnose before surgery, and the prognosis is poor after surgery,surgical resection is still the preferred treatment.

Cystadenocarcinoma of the liver:a case report

Biliary cystadenocarcinoma as a very rare hepatic neoplasm may be difficult to distinguish from simple hepatic cysts, especially in the unilocular form. Although diagnosis of cystadenocarcinoma during open hepatic surgery demands a complete surgical resection, few reports described the correct approach to such lesions revealed by laparoscopic approach. Five cases of incidental cystadenocarcinoma after laparoscopic surgery for hepatic cystic lesions were presented with discussion of diagnostic and management implications. METHODS:Clinical records of 5 patients who had undergone operation and histological examination at our hospital from 1993 to 2002 were analyzed retrospectively. RESULTS:In all patients who received liver lobectomy, primary hepatic cystadenocarcinoma was diagnosed. Primary biliary cystic neoplasm was difficult to diagnose and the management of both benign and malignant tumors was similar in the 5 patients. CONCLUSIONS:Cystadenocarcinoma is often difficult to diagnose because its clinical manifestations are similar to those of hepatic cysts and other cystic lesions. Imagining examination is helpful in evaluating the disease. Complete excision of cystadenocarcinoma with a wide margin is the best treatment.

Pancreatic mucinous cystadenocarcinoma in a patient harbouring BRCA1 germline mutation effectively treated with olaparib: A case report

BACKGROUND Pancreatic mucinous cystadenocarcinoma(MCAC)is a rare malignancy with a poor prognosis when it presents metastases at diagnosis.Due to its very low incidence,there are no clear recommendations for the treatment of advanced disease.Olaparib(an oral PARP inhibitor)has been approved for the maintenance treatment of patients with metastatic pancreatic adenocarcinoma harbouring germline BRCA1/2 mutations.Herein,we report the first case of a germline BRCA1 mutated unresectable MCAC which was effectively treated with olaparib.CASE SUMMARY A 41-year-old woman,without personal or family history of cancer,was diagnosed with ovarian and peritoneal metastases of MCAC.She underwent 12 cycles of gemcitabine plus oxaliplatin(GEMOX)obtaining a partial response and allowing radical surgery.One year later,local recurrence was documented,and other 12 cycles of GEMOX were administered obtaining a complete response.Seven years later,another local recurrence,not amenable to surgical resection,was diagnosed.She started FOLFIRINOX(oxaliplatin,irinotecan,leucovorin and fluorouracil),obtaining a partial response after 8 cycles.Given the excellent response to platinum-based chemotherapy,BRCA testing was performed,and a BRCA1 germline mutation was detected.She was switched to maintenance olaparib due to chemotherapy-related toxicities and achieved an almost complete metabolic response,with a reduction in the diameter of the lesion,after three months of therapy.CONCLUSION The current case suggests the beneficial effect of olaparib in BRCA mutated MCAC.However,further studies are required.

Epidemiological feature,diagnosis and treatment of pancreatic cystadenoma and cystadenocarcinoma:a meta-analysis of 1865 cases

Objective:To study the epidemiological features of pancreatic cystadenoma and cystadenocarcinoma in China during the last 10 years and to analyze the diagnosis and treatment.Methods:Reports on pancreatic cystadenoma and cystadenocarcinoma published from 2000 to 2009 were retrieved from various databases,such as WANFANG data,VIP web and China National Knowledge Infrastructure(CNKI).The epidemiological features of pancreatic cystadenoma and cystadenocarcinoma and its diagnosis and treatment were analyzed.Results:Totally 1 865 patients with pancreatic cystadenoma and cystadenocarcinoma were reported in China during the last 10 years.The male to female ratio was approximately 1:2.1.The accurate ages were reported in 1 536 cases,the average age of them was 50.8 years,whose average age from 40 to 60 years old accounted 75.9% of the patients.65.3% of the cases were located in East China and Central China.Abdominal pain was the main clinical manifestation and was found in 54.9% of the patients.Pancreatoduodenectomy and resection of body and tail of the pancreas were the main procedure for the treatment of pancreatic cystadenoma and cystadenocarcinoma.Conclusion:Pancreatic cystadenoma and cystadenocarcinoma were mainly found in older women in East and Central China.Preoperative diagnosis is difficult.Pancreatoduodenectomy and resection of pancreatic body and tail were the main procedure for the treatment of pancreatic cystadenoma and cystadenocarcinoma.

Hepatic abscess caused by esophageal foreign body misdiagnosed as cystadenocarcinoma by magnetic resonance imaging:A case report

BACKGROUND Foreign bodies stuck in the throat and esophagus can be discharged through the digestive tract.Esophageal-lodged foreign bodies can cause secondary injury or detrimental response,with hepatic abscess being one such,albeit rare,outcome.Review and discussion of the few case reports on such instances will help to improve the overall understanding of such conditions and aid in differential diagnosis to improve patient outcome.CASE SUMMARY A 51-year-old female patient with pre-existing diabetes visited our hospital following a 15-d experience of chills and fever.Both plain and enhanced magnetic resonance imaging and color Doppler ultrasound examination of the liver and gallbladder revealed a space-occupying lesion in the caudate lobe of the liver(7.8 cm×6.0 cm×5.0 cm).Initially,a malignant tumor was suspected,but differential diagnosis was unable to exclude the possibility of hepatic abscess.Conservative anti-infection therapy produced a less than ideal outcome.Additional examination by hepatobiliary imaging with computed tomography suggested a foreign body present in the upper abdomen and hepatic abscess,and subsequent endoscopy revealed a sinus tract in the anterior wall of the duodenal bulb.Therefore,surgery was performed to remove the object(fishbone)and drain the abscess.After a 2-wk uneventful recovery,the patient was discharged.The final diagnosis was foreign body-induced hepatic abscess of the caudate lobe.CONCLUSION Differential diagnosis is important for hepatic masses,and systematic examination and physician awareness can aid in diagnosing and curing such rare conditions.

Primary Serous Cystadenocarcinoma of Broad Ligament: A Case Report with Laparoscopic, Histopathologic and Immunohistochemical Findings

An 86-year-old Japanese woman underwent an examining laparoscopy for removing the huge pelvic tumor. At laparoscope examination, the cystic tumor was found within the left broad ligament, while the ovaries, fallopian tubes and uterus showed almost normal appearance. The tumor was removed together by total laparoscopic hysterectomy and bilateral salpingo-oophorectomies after the suction of serous content in the broad ligament. Cytological findings of the ascites suggested serous carcinoma. The resected ovaries and fallopian tubes were grossly and histologically normal. Histological examination of the solid part of broad ligament tumor, closely next to the fallopian tube, revealed a serous adenocarcinoma. Immunohistochemically, the tumor cells were strongly positive for CK7, WT-1, estrogen receptor, AE1/AE3 and EMA, and negative for CK20, D2-40 and calretinin. Also, they were negative for progesterone receptor and p53. The authors diagnosed the primary tumor as being a serous cystadenocarcinoma of the broad ligament [pTIC3NxM0, as modified and adapted to post-surgical staging of ovarian cancer (FIGO 2014)]. The patient has been receiving 6 cycles of adjuvant chemotherapies with one course with paclitaxel (PTX) and carboplatin (CBDCA) and five with PTX, CBDCA and Bevacizumab, and has no signs of recurrence and metastasis six months after the operation.

基于增强CT影像组学及基因组学模型预测卵巢浆液性囊腺癌预后

目的探讨基于治疗增强前动脉期CT构建的影像组学模型和影像-基因组学模型预测卵巢浆液性囊腺癌(OSC)患者预后的价值。方法回顾性收集2个中心及癌症影像档案馆(TCIA)共110例OSC增强动脉期CT图像,提取其影像组学特征,建立影像组学Cox回归预后预测模型;于癌症基因组图谱(TCGA)数据库获取399例OSC(TCGA-OV)转录组数据,以Pearson相关系数筛选与预测模型纳入特征相关的基因,进行关联基因富集分析。以Cox回归及蛋白质互作网络(PPI)对57例同时具有完整影像学及转录组学资料的OSC患者(TCGA-TCGA-OV)筛选连接度最高的预后枢纽基因,建立影像-基因组学模型。观察上述模型预测OSC预后的效能。结果基于5个OSC预后相关影像组学特征的建立影像组学模型在相应训练集和测试集的C指数(C-index)分别为0.782和0.735;纳入30个预后枢纽基因建立的影像-基因组学模型在相应训练集和测试集的C-index分别为0.673和0.659。以上述模型分层后,不同层次患者间生存率差异有统计学意义(P均<0.05)。与影像组学模型相关联的1135个mRNA基因涉及细胞黏附等生物学行为和PI3K-Akt、细胞外基质受体互作通路及1型糖尿病通路等信号通路。结论影像组学模型能较好地预测OSC预后;分析OSC mRNA生物信息学可为影像组学模型提供生物学可解释性。

Clinicopathological Characteristics and Prognostic Factors of Intrahepatic Biliary Cystadenocarcinoma

Background：Surgical resection is generally considered the main curative treatment for intrahepatic biliary cystadenocarcinoma （IBCA） or suspected IBCAs,but controversy exists regarding the prognosis for IBCAs.This study aimed to describe the clinicopathological characteristics of IBCA and identify prognostic factors that may influence the survival of patients treated with surgical procedures.Methods：Thirty-four patients with histologically confirmed IBCA treated between January 2000 and June 2014 were included.The clinical characteristics of patients with IBCA were compared with those of 41 patients with intrahepatic biliary cystadenoma （IBC）;factors that significant difference were analyzed for prognosis analysis of IBCA using multivariate/univariate Cox proportional hazards regression models.Survival curves were constructed using the Kaplan-Meier method and compared using the log-rank test.Results：IBCAs had a strong female predominance,and the most common presenting symptoms were abdominal pain or discomfort.Compared with IBCs,IBCAs occurred in older patients,in more male patients,and were associated statistically significant abnormal increase in alanine aminotransferase （P =0.01） and total bilirubin （P =0.04）.Mural nodules were more frequently seen with IBCAs and may associate with malignancy.It was difficult to differentiate between IBC and IBCA based on laboratory examination and imaging findings.Although complete resection is recommended,enucleation with negative margins also achieved good outcomes.Median overall patient survival was 76.2 months;survival at 1,3,and 5 years was 88.0％,68.7％,and 45.8％,respectively.Radical resection and noninvasive tumor type were independent prognostic factors for overall survival.Conclusions：It remains difficult to distinguish between cystadenomas and cystadenocarcinomas based on laboratory examination and image findings.Complete resection is recommended for curative treatment,and patients should be closely followed postoperatively,particularly those with invasive tumors.

经阴道超声联合血清CA125、CEA鉴别卵巢囊腺瘤和囊腺癌的价值

目的探究经阴道超声(TVS)联合血清糖类抗原125(CA125)、癌胚抗原(CEA)检测在卵巢囊腺瘤和囊腺癌鉴别诊断中的应用价值。方法选取2019年11月至2022年3月马鞍山市人民医院161例卵巢囊腺肿瘤患者的临床资料,根据病理结果分为囊腺瘤130例、囊腺癌31例,所有患者均进行了经阴道超声检查及血清CA125、CEA测定。阴道超声观察肿块直径、形状、边界、内部实性组织回声、血流阻力指数(RI)、搏动指数(PI)值,分析经阴道超声联合血清CA125、CEA检测在卵巢囊腺瘤及囊腺癌鉴别诊断中的敏感性、特异性及ROC曲线下面积(AUC)。结果囊腺瘤组患PI与RI均大于囊腺癌组,差异有统计学意义(P<0.05);囊腺癌组肿块直径大于囊腺瘤组,肿瘤形状规则、边界清晰比例低于囊腺瘤组,肿瘤内部实性回声、内壁伴乳头、有腹水比例高于囊腺瘤组,差异有统计学意义(P<0.05);囊腺癌组CA125、CEA水平高于囊腺瘤组,差异有统计学意义(P<0.05)。经阴道超声、血清CA125、CEA检测及三者联合对鉴别卵巢囊腺瘤及囊腺癌囊的敏感性分别为0.839、0.807、0.772、0.936,特异度分别为0.808、0.685、0.654、0.939,ROC曲线下面积(AUC)分别为0.839、0.790、0.742、0.973。经阴道超声联合血清CA125、CEA对卵巢囊腺瘤及囊腺癌鉴别诊断的敏感性、特异性、AUC均较单项检查高(P<0.05)。结论高CA125、CEA与低PI、RI可作为卵巢癌诊断依据,经阴道超声联合血清CA125、CEA检测可以提高卵巢囊腺瘤和囊腺癌的鉴别诊断效能。

肝内胆管囊腺瘤和囊腺癌的MRI鉴别诊断

目的分析肝内胆管囊腺瘤和囊腺癌之间的MRI表现差异,以提高对两种疾病的诊断准确率。方法分析经病理证实的24例囊腺瘤及10例囊腺癌患者的MRI表现,包括肿瘤部位、大小、瘤周胆管扩张,囊壁结节和强化方式等征象,并进行数据分析。结果24例囊腺瘤中单囊型5例,多囊型19例,多囊型病灶内有分隔,分隔菲薄且均匀;囊壁平均厚度(1.7±0.5)mm,伴瘤周胆管轻度扩张8例;增强后囊壁及囊隔中度强化5例,轻度强化19例。10例囊腺癌中单囊型6例,多囊型4例;10例均见囊壁不同程度增厚,平均厚度(2.2±0.7)mm;9例病灶囊壁见菜花状结节,伴瘤周胆管扩张8例;增强后囊壁中度强化8例,轻度强化2例。结论囊腺瘤和囊腺癌的分房、大小,瘤周胆管扩张,囊壁厚度,囊壁结节和强化方式的差异有统计学意义,MRI扫描及结合MRCP有助于诊断与鉴别诊断。

Endoscopic trans-pterygoid resection of a low-grade cribriform cystadenocarcinoma of the infratemporal fossa

This article presents a case of low-grade cribriform cystadenocarcinomas(LGCCC),a rare salivary gland tumor manifesting in the infratemporal fossa(ITF).The lesion in this case is unique in its location,histopathology,and management in that the tumor resection was performed using an exclusively endoscopic,endonasal approach.This case highlights the expanding application of endoscopic skull base techniques to address an indolent,slow-growing malignancy of the ITF.

肝胆管囊腺瘤和囊腺癌的CT、MRI表现及其与病理对照分析

目的 探讨肝胆管囊腺瘤和囊腺癌的CT及MRI表现,并与病理对照分析,以提高对该病的术前影像诊断准确性及鉴别诊断水平。方法 回顾性分析经手术病理证实的11例肝胆管囊腺瘤及囊腺癌患者的影像学征象及病理学特点,其中9例均行CT平扫及三期增强扫描,5例同时行MRI平扫及动态增强扫描。结果 在11例患者中,囊腺瘤8例,囊腺癌3例:11例均为单发,肝左叶7例,右叶3例,肝多叶受累1例;1例囊腺瘤为单囊性病灶,囊壁光整,CT见囊内主要表现为水样密度;1例囊腺癌以实性成为主,其余9例囊腺瘤及囊腺癌呈多发囊状,5例囊腺瘤囊壁光整,厚薄一致,部分分隔均匀增厚,增强扫描无强化或轻度强化;2例囊腺瘤有囊壁钙化;2例囊腺癌囊壁及其内分隔厚薄不一,增强扫描可见实性结节强化,门静脉期强化减退,呈“结节”状或“菜花状”,部分断面锯齿状改变。结论 肝胆管囊腺瘤及囊腺癌的CT、MRI表现,充分反映其病理学特点,注意病变的一些影像学特征性表现,如分隔不均匀增厚,囊壁“结节”或“菜花样”突起及伴有粗大钙化,在囊腺瘤及囊腺癌的鉴别诊断上具有重要意义。