整合原发性和继发性表现的多维痤疮综合分级系统

痤疮的严重程度分级对于常规的疾病诊疗和相应临床试验的开展均有着重要意义。目前虽然存在许多可用的分级系统,但均未得到广泛的认可。此外,目前的大部分痤疮分级系统都主要侧重于原发病灶(例如粉刺、丘疹和结节)的评估而忽略了对继发性改变的判断(如炎症后色素沉着、疤痕)。美国的Elena Bernardis等开发了一个新的痤疮综合分级系统。然后对痤疮图片进行分析进行验证,对比分级系统和个人经验分别得出的痤疮严重度评分,得到的均方误差(MSE)不到1(0.821)。说明该系统能够准确的反应临床医生对痤疮严重程度的判断,具有良好的标准性和可重复性。

Scirrhous hepatocellular carcinoma displaying atypical findings on imaging studies

We describe a 15-mm scirrhous hepatocellular carcinoma （HCC） in a 60-year-old man with B-type cirrhosis. Ultrasound disclosed a 15-mm hypoechoic nodule in segment 7. Contrast-enhanced US revealed heterogeneous, not diffuse, hypervascularity in the early phase and a defect in the Kupffer phase.Contrast-enhanced computed tomography （CT） revealed a heterogeneous hypervascular nodule in the early phase and a low-density area in the late phase.Magnetic resonance imaging （MRI） revealed iso- to hypointensity at T1 and high intensity at T2-weighted sequences. Contrast-enhanced MRI also revealed a heterogeneous hypervascular nodule in the early phase and washout in the late phase. Super-paramagnetic iron oxide-MRI revealed a hvoerintense nodule. CT during hepatic arteriography and CT during arterial portography revealed heterogeneous hyperattenuation and a perfusion defect, respectively. Based on these imaging findings the nodule was diagnosed as a mixed well-differentiated and moderately-differentiated HCC.Histologically, the nodule was moderately-differentiated HCC characterized by typical cytological and structural atypia with dense fibrosis. Immunohistochemically,the nodule was positive for heterochromatin protein 1 and alpha-smooth muscle actin, and negative for cytokeratin 19. From the above findings, the nodule was diagnosed as scirrhous HCC. Clinicians engaged in hepatology should exercise caution with suspected scirrhous HCC when imaging studies reveal atypical findings, as shown in our case on the basis of chronic liver disease.

Primary cardiac lymphoma:a case report and review of the literature

Primary cardiac lymphoma (PCL) is an extremely rare neoplasm and usually defined as a non-Hodgkin's lymphoma being exclusively located in the heart and/or the pericardium. It is particularly difficult to diagnose this rare disease due to its nonspecific clinical manifestations. The prognosis of this disease is poor. In this diffuse large B-cell lymphoma, the patient finally died of heart failure after 2 courses of chemotherapy with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone).

Imaging findings of primary hepatic leiomyoma

Objective： To investigate the imaging features of primary hepatic leiomyoma. Methods： 3 patients of primary hepatic leiomyoma confirmed by pathology without immunodeficiency were retrospectively analyzed about CT and MRI findings, clinical and pathological correlation. 2 cases had routine CT scan, 2 cases had routine MRI. Results： 2 case CT scans showed low-density lesions, 2 cases MRI showed lesions with long T1 and long T2 signal. One case of uniform density and signal showed homogeneous enhancement; two cases showed uneven density and signal, of which one case was inhomogeneous enhancement. 3 cases presented pseudocapsule without hepatic cirrhosis and venous tumor thrombus. Pathology showed spindle tumor cell proliferation and capillary hyperplasia; one case showed central hyalinization and one case central liquefaction necrosis. Conclusion： Primary hepatic leiomyoma is a hypervascular tumor, and CT and MRI help in the diagnosis.

Clinical analysis of primary central nervous system lymphoma with non-immune deficiency in 17 patients

Objective: The aim of this study was to investigate the clinical manifestations of primary central nervous system lymphoma (PCNSL) with non-immune deficiency and explore effective methods for its diagnosis and treatment. Methods: The clinical, imaging and pathological data from 17 cases with PCNSL in our hospital from March 2006 to April 2009 were analyzed. The immunologic function test for all 17 cases was confirmed as normal. Four of them received stereotactie brain biopsy while the other patients were given full or partial resection. Fifteen of them were given both radiotherapy and chemotherapy after surgery. High-dose Methotrexate (HD-MTX) (2.0g/m2) was used via intravenous infusion once per week for three times. From week 4, patients began radiotherapy. Six cases with abnormal cerebrospinal fluid were given whole central nervous system radiotherapy, and 9 cases with normal cerebrospinal fluid were given only whole brain radiotherapy. Two of them were without any additional treatment after surgery. Sixteen of 17 cases were followed up for 9-48 months. Therapeutic efficacy, toxic and side effect were investigated. Results: Six cases, who were given HD-MTX chemotherapy and whole central nervous system radiotherapy, had grade 3 leukopenia, but other toxic and side effect above grade 3 were not observed. Two patients having no chemotherapy and radiotherapy recurred in one month, but there was only one recurred case in three months among 15 cases who had both chemotherapy and radiotherapy. One of them lost fellow-up. The 2-year survival rate was 69.2%. Conclusion: There is no specific clinical manifestation for PCNSL. The pathological examination is a reliable method to confirm PCNSL. Recurrence may occur after surgery alone, however, the combination of HD-MTX chemotherapy and radiotherapy is an effective and safe therapeutic option, which might improve the treatment efficiency and survival rate.

淋巴水肿与干细胞移植治疗

淋巴水肿是淋巴管功能失调引起淋巴网流障碍造成，目前全世界约有1．4亿淋巴水肿患者，严重影响人类健康。根据病因分为原发性和继发性，原发性表现为先天性淋巴管数量减少或功能障碍，多存在遗传缺陷，如Milory病为m管内皮生长因子-C（VEGF-C）相关基因缺陷；继发性是指任何后天斟素所致的淋巴管完整性破坏和阻塞，在发达国家恶性肿瘤根治术后多见，据统计其在乳房全切的发生率为24％～49％，肿块切除为4％～28％^[1]；