三位被“误诊”的晚期癌症病人

在大多数人的眼里，癌症就是“绝症”，因为毕竟直到今天．仍有许多癌症还没有实现真正意义上的根治。尤其像肺癌、肝癌、胰腺癌等发病率较高的癌种生存率更是低得可怜。而这类病种一旦进入晚期，更是生机渺茫，病人往往在被确诊后的几个月，甚至更短的时间里就走掉了。有人曾比喻说，拿到晚期肿瘤的诊断书，就等于拿到了死刑判决书!那么，事实真的如此吗?患了晚期肿瘤就彻底没救了?

癌症 不可不防的“误诊”

肺癌“误诊”为肺结核：四十岁的陈女士，一段时间以来咳得比较厉害，还伴有低烧。刚开始，她以为是患了感冒，去药店买了一盒感冒药回来服用，但是一盒感冒药吃完了，咳嗽的症状一点缓解的趋势都没有，没办法，陈女士就去附近一个诊所看医生。

A MISDIAGNOSED CASE OF SACROILIAC JOINT INJURY AND MALPOSITION

Sacroiliac joint malposition is one of the main causes evoking lumbocrural pain. Because its clinical symptoms are similar to those induced either by lumbar intervertebral disc protrusion or by ankylosing spondylitis （AS） at the early stage, and because X-ray results taken at its early stage were not evident for differentiating the diseases,

Laparoscopic Partial Splenectomy for Giant Hemangioma Misdiagnosed as Splenic Cyst:a Case Report

ALTHOUGH unusual, hemangioma is the most common type of primary splenic neoplasm.1 Usually, splenic hemangioma appears as solid mass, but sometimes it presents cystic corn-ponent as well, which is difficult to discriminate from some other lesions, such as abscess, simple cyst, parasitic cyst, and lymphangioma.2 Preoperative diagnosis of splenic hemangioma mainly depends on imaging study （e.g. ultrasonography, CT, MRI）.

A clinicopathological analysis in unsuspected gallbladder carcinoma: A report of 23 cases

AIM： To study the clinicopathological characteristics of unsuspected gallbladder carcinoma （UGC）. METHODS： We retrospectively studied 23 cases of UGC in Tongji Hospital, and compared their clinicopathological characteristics with 33 cases of preoperatively diagnosed gallbladder carcinoma （PDGC）. RESULTS： The proportion of UGC coexisting with cholecystolithiasis was significantly higher than that of PDGC （x^2 = 13.53, P 〈 0.01）. The infection rate of hepatitis B virus was 21.74% （5/23） in UGC and 30.30% （10/33） in PDGC. Nine （39.13%） of 23 patients with UGC and 8/33 （24.24） PDGC had contact with schistosome pestilent water. The rate of multiple pregnancies was 56.52% （13/23） in the patients with UGC and 42.42% （14/33） in PDGC. The primary location of the UGC was mostly in the neck and body of the gallbladder, and that of the PDGC was often in the body and bottom. The incidence of Nevin stage I and 11 UGC was significantly higher than that of PDGC （x^2 = 4.44, P 〈 0.05 and 2 = 4.96, P 〈 0.05） while that of Nevin stage V UGC was significantly lower than that of PDGC （x^2 = 7.59, P 〈 0.01）. According to the grading of carcinoma, the incidence of well-differentiated UGC was significantly higher than that of PDGC （2 = 4.16, P 〈 0.05）, and that of poorlydifferentiated UGC was significantly lower than that of PDGC （x^2 = 4.48, P 〈 0.05）.CONCLUSION： There are different characteristics between UGC and PDGC, such as in primary location, malignant degree and incidence of coexistence with cholecystolithiasis. Cholecystolithiasis, hepatitis B, schistosome and multiple pregnancies were high risk factors for gallbladder carcinoma.

Xanthogranulomatous cholecystitis misdiagnosed as gallbladder carcinoma: retrospective analysis of 10 cases

Objective: To investigate the reasons for misdiagnosing xanthogranulomatous cholecystitis (XGC) as gallbladder carcinoma, and to provide differential points between these two diseases. Methods: Thirty-three patients with the final diag- nosis of XGC in our hospital over a period of 10 years (1996–2005) were reviewed, among which 10 (6 males and 4 females) were misdiagnosed as having gallbladder carcinoma either preoperatively or intraoperatively. Results: 10 misdiagnosed cases were examined preoperatively by B-ultrasound (BUS) and computed tomography (CT). BUS and CT revealed 5 cases of gallbladder carcinoma and 1 of chronic cholecystitis; 2 cases were diagnosed as gallbladder carcinoma on BUS but chronic cholecystitis on CT; other 2 cases were diagnosed as chronic cholecystitis on BUS but as gallbladder carcinoma on CT. Intra- operatively, thickening of the gallbladder wall was found in all of the patients; xanthogranulomatous tissue was found invading into other tissues including gallbladder bed and omentum majus. Intraoperative frozen section investigation was performed on 1 patient revealing that no tumor cell was found. Open cholecystectomy + partial hepatic wedge resection were performed on 3 patients; cholecystectomy + partial hepatic wedge resection + regional lymphadenectomy in the liver duodenum ligament on 6 patients; cholecystectomy + cholecystoenterostomy + colocolic anastomosis after partial resection of transverse colon on 1 patient. Postoperative pathological findings revealed XGC in all these patients. Conclusion: XGC is an uncommon variant of chronic cholecystitis of which clinical and imaging presentations closely resemble gallbladder carcinoma. Thus differentiation is essential by means of intraoperative frozen section investigation to ensure optimal surgical treatment since XGC has its pathological distinctions, which are not that of a precancerous change.

A case of idiopathic colonic varices: A rare cause of hematochezia misconceived as tumor

Colonic varices are a very rare cause of lower gastrointestinal bleeding. Fewer than 100 cases of colonic varices, and 30 cases of idiopathic colonic varices （ICV） have been reported in the English literature. Among these 30 cases of ICV, 19 cases were diagnosed by angiography, and 7 operated cases were diagnosed later as ileocecal vein deficit, hemangioma, and idiopathic in 1, 1, 5 cases, respectively. We report the case of a 24-year-old man who suffered from multiple episodes of hematochezia of varying degree at the age of 11 years. He had severe anemia with hemoglobin of 21 g/L. On colonoscopy, tortuously dilated submucosal vein and friable ulceration covered with dark necrotic tissues especially at the rectosigmoid region were seen from the rectum up to the distal descending colon. It initially appeared to be carcinoma with varices. Mesenteric angiographic study suggested a colonic hemangioma. Low anterior resection was done due to medically intractable and recurrent hematochezia. Other bowel and mesenteric vascular structures appeared normal. Microscopic examination revealed normal colonic mucosa with dilated veins throughout the submucosa and serosa without representing new vessel growth. Taken all of these findings together, the patient was diagnosed as ICV. His postoperative course was uneventful.

Data fusion for fault diagnosis using multi-class Support Vector Machines

Multi-source multi-class classification methods based on multi-class Support Vector Machines and data fusion strategies are proposed in this paper. The centralized and distributed fusion schemes are applied to combine information from several data sources. In the centralized scheme, all information from several data sources is centralized to construct an input space. Then a multi-class Support Vector Machine classifier is trained. In the distributed schemes, the individual data sources are proc-essed separately and modelled by using the multi-class Support Vector Machine. Then new data fusion strategies are proposed to combine the information from the individual multi-class Support Vector Machine models. Our proposed fusion strategies take into account that an Support Vector Machine (SVM) classifier achieves classification by finding the optimal classification hyperplane with maximal margin. The proposed methods are applied for fault diagnosis of a diesel engine. The experimental results showed that almost all the proposed approaches can largely improve the diagnostic accuracy. The robustness of diagnosis is also improved because of the implementation of data fusion strategies. The proposed methods can also be applied in other fields.

Aortoesophageal fistula:A case misdiagnosed as esophageal polyp

Aortoesophageal fistula(AEF)is a rare and fatal disorder. It is also a life-threatening cause of massive upper gastrointestinal hemorrhage.Thoracic aortic aneurysm is the most common cause of AEF.Management of a patient with this disorder requires rapid diagnosis and immediate intervention,which is considered the best way to save the patient's life.We report a case of AEF misdiagnosed as esophageal polyp.

ENDOPHTHALMITIS INDUCED BY MYCOBACTERIUM TUBERCULOSIS BEING MISDIAGNOSED AS NON-INFECTIOUS UVEITIS

ENDOPHTHALMITIS induced by mycobacterium tuberculosis （TB） was rarely reported. Here we present and characterize this typical case to establish the diagnosis.

The development of a knowledge base in an expert system based on the four-layer perceptron neural network

Owing to continuous production lines with large amount of consecutive controls, various control signals and huge logistic relations, this paper introduced the methods and principles of the development of knowledge base in a fault diagnosis expert system that was based on machine learning by the four-layer perceptron neural network. An example was presented. By combining differential function with not differential function and back propagation of error with back propagation of expectation, the four-layer perceptron neural network was established. And it was good for solving such a bottleneck problem in knowledge acquisition in expert system and enhancing real-time on-line diagnosis. A method of synthetic back propagation was designed, which broke the limit to non-differentiable function in BP neural network.

Synthetic Intelligent Fault Diagnosis Technology for Complex Process

A fault diagnosis method of knowledge based fuzzy neural network is proposed for complex process, which is hard to develop practical mathematical model. Fault detection is performed through a knowledge based system, where fault detection heuristic rules have been generated from deep and shallow knowledge of the process. The fuzzy neural network performs the fault diagnosis task. This method does not need practical mathematical models of objects, so it is a strong implement for complex process.

Multicentric Gliomas Misdiagnosed as Metastatic Tumors： One Case Report and Literature Review

Multicentric gliomas are considered to be well recognized but uncommon; often scatter widely in different lobes or hemispheres; and cannot be attributed to a definite pathwayEll. A patient diagnosed as multicentric gliomas is presented in this paper. He was firstly misdiagnosed as cerebral metastatic tumors, but later the histopathological examination revealed them to be glioblastoma （WHO grade IV）. Additionally, the aim of the paper was to describe the case history of the patient and the problems encountered in the pathogenesis, pathophysiology, diagnosis and treatment.

Pneumonia,Multiple Pulmonary Infarction and Abscess Caused by a Bamboo Stick Accidentally Piercing into Chest:a Case Misdiagnosed as Pulmonary Tuberculosis

Computed tomography(CT)examination is the major measure for detecting and diagnosis of foreign bodies in human body.Although CT has high sensitivity in diagnosis of foreign body,some interference factors may still lead to missed diagnosis or misdiagnosis.Here we report a rare case that a bamboo stick accidentally pierced into the left chest of a young man who was drunk and unware of this hurt.The patient experienced cough,chest pain,fever,hemoptysis,and was misdiagnosed as primary and secondary tuberculosis based on chest CT examinations at a local hospital,although no tubercular bacillus detected by sputum smear.He subsequently received anti-tuberculous treatments in the following three years,but no improvement of his symptoms was observed.Until one month before his death,the bamboo stick was detected by spiral CT examination as well as three-dimensional image reconstruction at another hospital.Postmortem examination revealed pneumonia,pulmonary infarction,and abscess as the causes of his death.We analyze the potential reasons of misdiagnosis in this case,aiming to provide reference for the diagnosis and treatment of pulmonary inflammation associated with foreign body in the future.

The Great Imitator:Atypical Cutaneous Manifestations of Primary Syphilitic Chancre

Objective To analyze the reasons of misdiagnosis of primary syphilitic chancre and strengthen the understanding of atypical features of this disease.Methods A case series of twenty-seven challenging primary syphilis patients who were not immediately recognized as chancre was included in our study.The clinical data including the patients’age,sex,skin lesions,HIV status,syphilis serologic test results,treatment,and follow-up results were collected.Hematoxylin-eosin and immunohistochemistry staining of skin biopsy sections were reviewed.Results Four female cases with extragenital chancres presenting as erythema or erosive skin lesions on the nipple were misdiagnosed as Paget’s disease or eczema.The disorder of missed or misdiagnosed male cases manifested as syphilitic balanitis or multiple chancres on the penis root and adjacent pubis rather than coronal sulcus or frenum.Patients with nonreactive nontreponemal tests at initial presentation were also easily missed or misdiagnosed.Conclusion Primary syphilis presenting as multiple lesions rather than a single chancre,at atypical locations,or with a nonreactive nontreponemal test result,tends to be missed or misdiagnosed.

Spontaneous regression of pancreatic cancer: Real or a misdiagnosis?

Spontaneous tumor regression has been subject of numerous studies and speculations for many years. This phenomenon is exceptional, but well reported, in some types of tumors, but not in pancreatic cancer. Pancreatic cancer has the worst five-year survival rate of any cancer. Despite numerous molecular studies and clinical approaches, using several mouse models, this cancer responds poorly to the existing chemotherapeutic agents and progress on treatment remains elusive. Although pancreatic cancer tumors seldom undergo spontaneous regression, and some authors take that with skepticism, there are some cases reported in the literature. However, the variability in the description of the reports and technical details could make this process susceptible to misdiagnosis. Distinguishing between different types of pancreatic carcinoma should be taken with caution as they have wide differences in malignant potential. Diseases such as pancreatic benign tumors, insulinomas, or autoimmune pancreatitis could be responsible for this misdiagnosis as a pancreatic cancer. Here we review different cases reported, their clinical characteristics, and possible mechanisms leading to spontaneous regression of pancreatic cancer. We also discuss the possibilities of misdiagnosis.

Fault diagnosis in neutral point indirectly grounded system basedon information fusion

In neutral point indirectly grounded systems, phase-to-ground fault is putting new demands on fault diagnosis technology. Information fusion is applied to detect the phase-to-ground fault, which integrates several sources of information, including line current, line voltage, zero sequence current and voltage, and quintic harmonic wave component. This method is testified through the simulation of Matlab. Simulation results show that the precision and reliability of the detection has been greatly increased.

Esophageal tuberculosis misdiagnosed as esophageal carcinoma

Esophageal tuberculosis （ET） is a rare clinical entity; the clinical features of this infection may be similar to the esophageal carcinoma. The differential diagnosis is very difficult and some cases may result in an unnecessary esophagectomy. We reported herein a 48-year-old man with symptoms of dysphagia and pectoralgia for one month. Our primary diagnosis was established as esophageal carcinoma and the patient underwent surgical therapy. Histopathological examination of the excised tumor lesion and lymph nodes showed epithelioid granulomas, Langhans＇ giant cells, caseous necrosis. No evidence of malignancy has been found. The Mantoux test revealed a positive reaction with 20 mm in diameter. Antituberculous treatment was given alter operation. Clinicians should aware the features of ET and this rare disease should be considered in the differential diagnosis of esophageal lesions.

An Iranian male with syringoid eccrine carcinoma misdiagnosed as basal cell carcinoma:a case report

Syringoid carcinoma (syringoid eccrine carcinoma,or eccrine epithelioma) is a rare cutaneous tumor with some controversy regarding its correct definition.This tumor shows a slow growth and has often been for many years,some decades before diagnosis.It may also be difficult to differentiate from its benign counterpart (syringoma) or other adnexal carcinoma and cutaneous metastasis.There have been limited case reports of syringoid carcinoma in foreign literatures but none from Iran.Here we report a case of syringoid carcinoma in a 52 year-old Iranian man.Syringoid eccrine carcinoma is a very rare and uncommon diagnosed tumor thought to be derived from eccrine sweat apparatus.It locally invasive,destructive and often shows recurrence.It may also be difficult to differentiate from metastatic adenocarcinoma.