Different serum levels of IgG and complements and recurrence rates in IgG4-positive and negative lacrimal gland benign lymphoepithelial lesion

·AIM:To analyze the differences in immune indicators and prognosis between Ig G4-positive and negative lacrimal gland benign lymphoepithelial lesion(LGBLEL).·METHODS:This was a single-center retrospective clinical study including 105 cases of Ig G4-positive LGBLEL and 41 cases of Ig G4-negative LGBLEL.Basic information,related indicators of peripheral venous blood samples using immunoscattering turbidimetry,treatment(partial surgical excision and glucocorticoid therapy)and prognosis(recurrence and death)were collected.Survival curves for recurrence were created using the Kaplan-Meier analysis.Univariate analysis and multivariate regression analysis were used to analyze prognostic factors.·RESULTS:The mean age was 50.10±14.23y and 44.76±11.43y(P=0.033)in Ig G4-positive and negative group respectively.The serum C3 and C4 was lower in Ig G4-positive group(P=0.005,P=0.002),while the serum Ig G and Ig G2 was higher in Ig G4-positive group(P=0.000 and P=0.008).Twenty-one cases had recurrence in Ig G4-positive group and 3 cases recurrence in Ig G4-negative group.The 5-year recurrence-free cumulative percentages of Ig G4-positive group was 81.85%,and 83.46%in the Ig G-negative group(P=0.216).The history of preoperative glucocorticoid therapy,serum C4,Ig G1 and Ig G2 were the factors affecting recurrence in Ig G4-positive group,while serum C4,and Ig G1 were the factors affecting recurrence of LGBLEL.·CONCLUSION:Serum C4 and Ig G1 are the factors affecting recurrence of LGBLEL,while the Ig G4 does not affect recurrence of LGBLEL.

Association analysis of BclI with benign lymphoepithelial lesions of the lacrimal gland and glucocorticoids resistance

AIM:To evaluate the relationship between gene polymorphism(BclI,ER22/23EK,N363S)and the occurrence,progression and sensitivity to glucocorticoid of lacrimal gland benign lymphoepithelial lesion(LGBLEL).METHODS:Clinical peripheral blood samples of 52 LGBLEL patients and 10 normal volunteers were collected for DNA extraction and polymerase chain reaction sequencing to analyze single nucleotide polymorphism(SNP)genotypes.The lacrimal tissues of LGBLEL were surgically removed and made into paraffin sections for subsequent hematoxylin-eosin(HE)and Masson staining analysis.The duration of disease and hormone use of LGBLEL patients from diagnosis to surgery were also analyzed.The Meta-analysis follows PRISMA guidelines to conducted a systematic review of human studies investigating the relationship between the NR3C1 BclI polymorphism and glucocorticoids(GCs)sensitivity.RESULTS:There was no association between ER22/23EK or N363S and the occurrence of LGBLEL or GCs sensitivity(P>0.05);BclI GC genotype was closely related to GCs resistance(P=0.03)as is the minor allele C(P=0.0017).The HE staining and Masson staining showed that the GC genotype of BclI remarkably slowed down the disease progression and reduced fibrosis(P<0.05),especially for GCs-dependent patients(P<0.0001).Meta-analysis showed that BclI was not significantly associated with GCs responsiveness.CONCLUSION:The LGBLEL patients who carry the NR3C1 BclI allele C may be more sensitive to GCs and associated with lower fibrosis and slower disease progression.The results may guide the clinical treatment strategy for the LGBLEL patients.

Excision of malignant and pre-malignant rectal lesions by transanal endoscopic microsurgery in patients under 50 years of age

BACKGROUND The most common technique for treating benign and early malignant rectal lesions is transanal endoscopic microsurgery(TEM).Local excision is an acceptable technique for high-risk and elderly patients,but there are hardly any data regarding young patients.AIM To describe TEM outcomes in patients under 50 years of age.METHODS We collected demographic,clinical,and pathological data from all patients under the age of 50 years who underwent the TEM procedure at Hasharon Rabin Medical Center from January 2005 to December 2018.RESULTS During the study period,a total of 26 patients under the age of 50 years underwent TEM procedures.Their mean age was 43.3 years.Eleven(42.0%)were male.The mean operative time was 67 min,and the mean tumor size was 2.39 cm,with a mean anal verge distance of 8.50 cm.No major intraoperative or postoperative complications were recorded.The median length of stay was 2 d.Seven(26.9%)lesions were adenomas with low-grade dysplasia,four(15.4%)were high-grade dysplasia adenomas,two were T1 carcinomas(7.8%),and three were T2 carcinomas(11.5%).No residual disease was found following endoscopic polypectomy in two patients(7.8%),but four(15.4%)had other pathologies.Surgical margins were negative in all cases.Local recurrence was detected in one patient 33 mo following surgery.CONCLUSION Among young adult patients,TEM for benign rectal lesions has excellent outcomes.It may also offer a balance between the efficacy of complete oncologic resection and postoperative quality of life in the treatment of rectal cancer.In some cases,it may be considered an alternative to radical surgery.

Esophageal subepithelial lesion diagnosed as malignant gastrointestinal neuroectodermal tumor

A 21-year-old male visited our hospital with a complaint of aggravating dysphagia and odynophagia for a few days.Esophagogastroduodenoscopy showed huge bulging mucosa with an intact surface causing luminal narrowing at 35 cm from the incisor teeth.Endoscopic ultrasonography showed an about 35 mm sized irregular margined in-homogenous hypoechoic lesion with an obscure layer of origin.Endoscopic ultrasonography fine needle aspiration revealed spindle cell proliferation without immunoreactivity for CD117,SMA,and cytokeratin.The patient underwent excision of the subepithelial lesion at the distal esophagus.On pathologic examination of the specimen,the tumor was composed of short fascicles of oval to spindle cells with eosinophilic and clear cytoplasm and vesicular nuclei.The tumor cells were positive for S-100 and SOX10and negative for CD117,SMA,HMB-45,melan-A,cytokeratin,and CD99.The split-apart signal was detected in EWSR1 on FISH,suggesting a malignant gastrointestinal neuroectodermal tumor.At the time of writing,the patient is on radiation therapy at the operated site of esophagus and doing well,with no recurrence for three months.Malignant gastrointestinal neuroectodermal tumor is a rare gastrointestinal tumor with features of clear cell sarcoma,without melanocytic differentiation,and shows a poor prognosis.This is the first reported case of malignant gastrointestinal neuroectodermal tumor arising as subepithelial lesion in the esophagus.

Association of TCR-signaling pathway with the development of lacrimal gland benign lymphoepithelial lesions

·AIM: To identify the association of the T cell receptor(TCR) signaling with the development of benign lymphoepithelial lesions(BLEL) of the lacrimal gland.· METHODS: We collected affected lacrimal gland tissues from 9 patients who underwent dacryoadenectomy in the Capital Medical University Beijing Tongren Hospital Eye Center between August2010 and March 2013 and were confirmed to have lacrimal gland BLEL by histopathological analysis. Tumor tissues from 9 patients with orbital cavernous hemangioma were also collected and used as control.Whole genome gene expression microarray was used to compare gene expression profiles of affected lacrimal gland tissues from patients with lacrimal gland BLEL to those from of orbital cavernous hemangiomas.Differential expression of TCR pathway genes between these tissues was confirmed by polymerase chain reaction(PCR) and immunohistochemistry.·RESULTS: Microarray analysis showed that in lacrimal glands with BLEL, 32 signaling pathways were enriched in the upregulated genes, while 25 signaling pathways were enriched in the downregulated genes. In-depth analysis of the microarray data showed that the expression of 27 genes of the TCR signaling pathway increased significantly. To verify the differential expression of three of these genes, CD3, CD4, and interleukin(IL)-10, reverse transcription-PCR(RT-PCR)and immunohistochemistry assays were performed. RT-PCR analysis showed that CD3 and CD4 were expressed in the lacrimal glands with BLEL, but IL-10 was not expressed. Immunohistochemistry confirmed that CD3 and CD4 proteins were also present, but IL-10 protein was not. CD3, CD4, or IL-10 expression was not found in the orbital cavernous hemangiomas with either RT-PCR or immunohistochemistry.· CONCLUSION: TCR signaling pathway might be involved in the pathogenesis of lacrimal gland BLEL.

R2^(*) value derived from multi-echo Dixon technique can aid discrimination between benign and malignant focal liver lesions

BACKGROUND R2^(*)estimation reflects the paramagnetism of the tumor tissue,which may be used to differentiate between benign and malignant liver lesions when contrast agents are contraindicated.AIM To investigate whether R2^(*)derived from multi-echo Dixon imaging can aid differentiating benign from malignant focal liver lesions(FLLs)and the impact of 2D region of interest(2D-ROI)and volume of interest(VOI)on the outcomes.METHODS We retrospectively enrolled 73 patients with 108 benign or malignant FLLs.All patients underwent conventional abdominal magnetic resonance imaging and multi-echo Dixon imaging.Two radiologists independently measured the mean R2^(*)values of lesions using 2D-ROI and VOI approaches.The Bland-Altman plot was used to determine the interobserver agreement between R2^(*)measurements.Intraclass correlation coefficient(ICC)was used to determine the reliability between the two readers.Mean R2^(*)values were compared between benign and malignant FFLs using the nonparametric Mann-Whitney test.Receiver operating characteristic curve analysis was used to determine the diagnostic performance of R2^(*)in differentiation between benign and malignant FFLs.We compared the diagnostic performance of R2^(*)measured by 2D-ROI and VOI approaches.RESULTS This study included 30 benign and 78 malignant FLLs.The interobserver reproducibility of R2^(*)measurements was excellent for the 2D-ROI(ICC=0.994)and VOI(ICC=0.998)methods.Bland-Altman analysis also demonstrated excellent agreement.Mean R2^(*)was significantly higher for malignant than benign FFLs as measured by 2D-ROI(P<0.001)and VOI(P<0.001).The area under the curve(AUC)of R2^(*)measured by 2D-ROI was 0.884 at a cut-off of 25.2/s,with a sensitivity of 84.6%and specificity of 80.0%for differentiating benign from malignant FFLs.R2^(*)measured by VOI yielded an AUC of 0.875 at a cut-off of 26.7/s in distinguishing benign from malignant FFLs,with a sensitivity of 85.9%and specificity of 76.7%.The AUCs of R2^(*)were not significantly different between the 2D-ROI and VOI methods.CONCLUSION R2^(*)derived from multi-echo Dixon imaging whether by 2D-ROI or VOI can aid in differentiation between benign and malignant FLLs.

Association of the macrophage migration inhibitory factor promoter polymorphisms with benign lymphoepithelial lesion of lacrimal gland

AIM： To identify the association of the macrophage migration inhibitory factor （MIF） gene polymorphism with the susceptibility of benign lymphoepithelial lesions （BLEL） of the lacrimal gland. METHODS： A total of 40 BLEL of lacrimal gland cases were matched with 40 healthy subjects （HS）. Extraction the plasma and whole blood DNA of patients of lacrimal gland BLEL and HS. Elisa and polymerase chain reaction was used to determine in plasma contents of MIF and MIF gene SNP-173G〉C and STR -794 CATT（8） polymorphism, respectively. RESULTS： The MIF levels in plasma were significantly higher in patients with lacrimal gland BI.EL versus HS （P〈0.001）. The -173 G〉C MIF polymorphism was significantly associated with lacrimal gland BLEL, with a significantly higher frequency of the C allele in lacrimal gland BLEL patients compared with HS （OR=2.38, 95% C1=1.07-5.31, P=0.032）, and the -173 C/x is more frequent in patients than in HS, P=0.037. Besides, we found that the carriage rate of the MIF -173C/x is associated with higher plasma levels of MIF in the BLEI. of lacrimal gland. CONCLUSION： MIF -173G/C variants play an insidious role in susceptibility of BLEL of lacrimal gland. Otherwise,there is no statistically significant correlation exists between MIF-794 CATT （） and BLEL of lacrimal gland.

Histochemical Patterns of Collagenic Fibers in the Benign and Malignant Breast Lesions

Cancer is one of the leading causes of death worldwide and breast cancer is the most commonly diagnosed cancer among women. An increased incidence of different types of breast cancer has been reported. This study was designed to evaluate the different types of breast cancer and its possible risk of neoplasmic transformation to an advanced malignant stage from a benign tumor. The histochemical patterns of collagen fibers in the benign and malignant breast lesions were evaluated. From the 50 tissue samples, 25 were malignant breast lesions and 25 were benign breast tumor. Hematoxylin and Eosin (HE), Van Gieson staining were performed to detect a benign and malignant tumor as well as collagen fibers. We found that significant cases after age of 35 were associated with ductal carcinoma while most of the cases within the age of 25 years were associated with fibrocystic changes. The intensity of collagen fiber was higher to Ductal Carcinoma while negative and less intense for Fibroblastic changes. Furthermore, a consistent association of other lesions, such as Lobular Carcinoma, Fibroadenoma, Papilloma and Fat necrosis and noticeable staining for collagen was observed for the different lesion. Our study suggested that women with age of 25 with benign lesion of fibrocystic change and ductal carcinoma are highly susceptible to develop advanced malignant tumor with age. Therefore, quantitative measurement of collagen fiber and regular follow-up are recommended to avoid the possible risk of developing advanced malignant lesions.

Lymphoepithelial cysts and cystic lymphangiomas: Underrecognized benign cystic lesions of the pancreas

AIM: To identify their diagnostic and prognostic clinical characteristics in a large series.METHODS: Retrospective review of clinicopathologic and imaging characteristics of patients diagnosed with lymphoepithelial cysts and cystic lymphangiomas of the pancreas at Massachusetts General Hospital.RESULTS: Twelve patients were identified between 1/1/1997 and 8/1/2007. Their median age was 55.5 years(range 19-78 years), and 6 were females. The le-sion was incidentally discovered in half of the patients.Contrast enhanced computed tomography demonstrat-ed that the cysts had thin walls, without calcifications, pancreatic duct dilation or pancreatic parenchyma inva-sion. Endoscopic ultrasound with fine needle aspiration(EUS/FNA) confirmed the diagnosis of a lymphoepithe-lial cyst in 3 patients, one of whom was spared an op-eration and continues to do well after 6 years. Eleven patients had a resection: 3 pancreaticoduodenecto-mies, 7 distal pancreatectomies, and 1 enucleation. The median size of the cysts was 3 cm(range 2-20 cm). At a median follow-up of 57 mo no recurrences or other pancreas-related conditions occurred.CONCLUSION: Lymphoepithelial cysts and cystic lymphangiomas of the pancreas can be diagnosed with a combination of contrast-enhanced computed tomog-raphy scans and EUS/FNA. If the lesion is asymptom-atic, an operation might be avoided.

Radiological Mimics of Popliteal Cysts: An Algorithmic Approach Using US and MRI to Identify the Potentially Malignant Lesions: Case Series

Background: Popliteal cysts are common and present as asymptomatic lumps in the medial popliteal fossa. Some have complex internal characteristics such as septa and loose-bodies. However, not all are popliteal cysts and can be aggressive. These lesions need to be differentiated by the absence of the communicating neck with the joint on ultrasound. Presence of Doppler flow of non-communicating cysts requires further evaluation on MRI, prior to performing a biopsy. Using a case series, we propose an algorithmic approach that is simple and will help identify the malignant lesions and institute appropriate management. Case-Presentation: Popliteal Cyst: On ultrasound: characteristic neck communicating with knee joint. Synovial Sarcoma: Gadolinium enhancement, with areas of low-, iso- and hyper-intense signal to fat on T2. Synovial-Osteochondromatosis: Non-mineralized: T1-low/intermediate intensity;T2-high intensity. Mineralized type: low intensity on T1 & T2. Thrombosed Popliteal Aneurysm: Lamellated appearance-high/low signal intensity on T2. Myxoid-Liposarcomas: Inhomogeneous appearance;homogenous with gadolinium. Usually require a biopsy for diagnosis. Conclusion: The cystic lesions in the medial aspect of the popliteal fossa can be misdiagnosed. Our article reiterates the importance of the communicating neck that separates popliteal cysts from other mimics. We have proposed an algorithm to identify these mimics.

Evaluation of Diagnostic Value of Ultrasound and Magnetic Resonance Imaging for Malignant and Benign Breast Lesions

Objectives:To investigate diagnostic value of ultrasound and magnetic resonance imaging(MRI)for malignant and benign breast lesions.Methods:Retrospective analysis of treatment data of 48 patients diagnosed with malignant and benign breast lesions in our hospital,collected from December 2017 to November 2018.A total number of 56 breast masses were examined by both ultrasound and MRI,and were compared with postoperative pathological biopsy results.Results:Postoperative pathological biopsy results showed that there were 26 and 30 malignant and benign lesions respectively.Comparison of MRI curve type of malignant and benign lesions showed statistical significance(P<0.05).By comparison with pathological biopsy results,specificity and sensitivity of ultrasound diagnosis were 83.33%(25/30)and 84.61%(22/26)respectively;specificity and sensitivity of MRI diagnosis were 96.66%(29/30)and 92.30%(24/26)respectively.Conclusions:Ultrasonographic examination of malignant and benign breast lesions is straight-forward,simple and inexpensive.Accuracy,specificity and sensitivity of MRI are significantly higher than ultrasound in examining malignant and benign breast lesions,this can reduce misdiagnosis.

Expression Analysis of p53, Ki-67 and bcl-2 in Pre-Malignant Lesions of the Cervix

Objectives: The present study has tried to analyze the individual and combined expression of the three markers—p53, Ki-67 and bel-2-in HPV associated pre-malignant lesions of the cervix. Methods: Thirty-four cases of high-grade lesions, 21 low-grade cases and 18 normal cases were histologically assessed. HPV-DNA presence and the viral types were determined through PCR and RFLP, respectively. Marker expression was performed by immuno-histochemistry.Results: With regards to viral types, HPV with high oncogenic potential represented the majority, with just one case reporting the low oncogenic potential for viral infection (HPV 6). HPV was the most frequent and could be associated with the high-grade lesion group, however, no significant associations were found between the viral ones and the marker expression. When the expression location, beyond the basal layer, was taken into account, the three markers proved to be good indicators of the lesion grade. The markers’ combined expression: p53(-), Ki-67(+), bcl-2(-) and p53(-), Ki-67(+), bcl-2(-) was statistically significant when associated with the lesion grade.Conclusions: The results suggest that the p53, Ki-67 and bel-2 markers can contribute to differentiate the lesion grades, whether in its isolate form or in combined form.

Main duct-first approach:A potential expansion of indications for pancreatic enucleation in benign and low-grade malignant lesions

To the Editor:Pancreatoduodenectomy(PD),distal pancreatectomy(DP),and central pancreatectomy(CP)usually lead to an undesirable loss of functional pancreatic parenchyma,disruption of the continuity of the digestive tract,and high incidence of complications.In recent years,traditional pancreatic enucleation(TPE)has been increasingly performed for small benign and lowgrade malignant pancreatic lesions>2 mm away from the main duct(MD)as it can maximize the preservation of functional pancreatic parenchyma and retain the continuity of the digestive tract.Cases with a too short distance(≤2 mm)are not good candidates,as a too short distance may damage the MD when TPE is performed.[1]Herein,a novel pancreatic enucleation procedure,the main-ductfirst approach pancreatic enucleation(MDFAPE),was introduced for small benign and low-grade malignant lesions≤2 mm away from the MD.

Malignant transformation of hepatocellular adenoma in a young female patient after ovulation induction fertility treatment:A case report

BACKGROUND Hepatocellular adenoma(HCA) is a rare benign liver tumor usually affecting young women with a history of prolonged use of hormonal contraception.Although the majority is asymptomatic, a low proportion may have significant complications such as bleeding or malignancy. Despite responding to the hormonal stimulus, the desire for pregnancy in patients with small HCA is not contraindicated. However, through this work we demonstrate that intensive hormonal therapies such as those used in the treatment of infertility can trigger serious complications CASE SUMMARY A 33-year-old female with a 10-year history of oral contraceptive use was diagnosed with a hepatic tumor as an incidental finding in an abdominal ultrasound. The patient showed no symptoms and physical examination was unremarkable. Laboratory functional tests were within normal limits and tests for serum tumor markers were negative. An abdominal magnetic resonance imaging(MRI) was performed, showing a 30 mm × 29 mm focal lesion in segment VI of the liver compatible with HCA or Focal Nodular Hyperplasia with atypical behavior. After a total of six years of follow-up, the patient underwent ovulation induction treatment for infertility. On a following MRI, a suspected malignancy was warned and hence, surgery was decided. The surgical specimen revealed malignant transformation of HCA towards trabecular hepatocarcinoma with dedifferentiated areas. There was non-evidence of tumor recurrence after three years of clinical and imaging follow-up.,CONCLUSION HCAs can be malignant regardless its size and low-risk appearance on MRI when an ovultation induction therapy is indicated.

Analyses of the clinical characteristics of 49 cases of malignancy with multiple bone lesions as the first manifestation

Objective To investigate the clinical features of several cases of malignancy with multiple bone lesions as the first manifestation.Methods Forty-nine cases of malignancy with multiple bone lesions as the first manifestation were retrospectively analyzed from May 2018 to July 2019.All patients complained of“pain at the site of bone lesion”upon admission.Baseline patient information,such as age,gender,location of bone lesions,etiology,diagnosis method,time of onset was collected.Results The median age of the patients was 56 years old,of which 83.7%(41/49)were aged≥50 years.The median time of onset was 2 months.Among the cases,40 were confirmed as solid tumor bone metastasis,whereas the remaining 9 cases as hematological system tumor.Lung cancer and multiple myeloma were the main tumor types,accounting for 40.8%(20/49)and 16.3%(8/49),respectively.Other common causes were seven cases of cancer affecting the digestive system(three cases of liver cancer,three cases of gastric cancer,and one case of esophageal cancer),as well as seven cases of unknown primary cancer.Half of the solid tumors had only multiple bone metastases but no other distant metastasis.Conclusion Multiple bone lesions accompanied by pain may be the first clinical manifestation in various malignant tumors.The common tumor types were lung cancer,multiple myeloma,and digestive system tumor.It is more common in people aged 50 years and older.Multiple bone lesions might be the only metastasis site of some solid tumors,and its mechanism needs further investigation.

基于瘤体及瘤周多参数MRI对乳腺病变良恶性诊断列线图预测模型的构建与评价

目的:建立基于瘤体及瘤周多参数MRI的乳腺病变良恶性鉴别诊断的列线图模型,并验证其预测效能。方法:纳入经病理学检查明确乳腺病变性质的100例患者作为研究对象,所有患者均行核磁共振(MRI)检查和病理检查,根据病理检查结果分为乳腺良性病变组(n=62)和乳腺恶性病变组(n=38)。收集患者临床资料、瘤体各参数、瘤周各参数以及乳腺病变良恶性情况。多因素Logistic回归分析筛选乳腺恶性病变的危险因素并构建列线图预测模型,采用受试者工作特征(ROC)曲线和Hosmer-Lemeshow拟合优度检验验证模型的预测效能及拟合优度;内部验证采用Bootstrap。结果:乳腺恶性病变组病灶直径、平均扩散峰度(MK)、MDp/t、瘤周与瘤体MKp/n高于乳腺良性病变组(均P<0.05);乳腺恶性病变组表观扩散系数(ADC)值、平均扩散率(MD)、非对称磁化转移率(MTRasym)、MKp/t、MDp/n低于乳腺良性病变组(均P<0.05)。多因素分析结果显示,病灶直径、MK、MDp/t、MKp/n升高,ADC值、MD、MTRasym、MKp/t、MDp/n降低是乳腺恶性病变的独立影响因素(均P<0.05)。基于上述独立影响因素构建乳腺恶性病变的列线图预测模型,曲线下面积(AUC)为0.827。Hosmer-Lemeshow拟合优度检验显示P值为0.004。采用Bootstrap法,生成的校准曲线拟合良好。结论:瘤体及瘤周多参数MRI对乳腺病变良恶性鉴别诊断具有重要预测价值,基于乳腺恶性病变的独立影响因素构建的列线图预测效果良好,能直观预测乳腺发生恶性病变的概率。

经口入路和乳晕入路腔镜手术对甲状腺恶性病变患者术后美观满意度及生活质量的影响

目的 分析经口入路和乳晕入路腔镜手术对甲状腺恶性病变患者术后美观度满意度及生活质量的影响,为甲状腺疾病患者寻求更加有效且安全美观的手术治疗方式。方法 选取2022年1月至2023年3月甲状腺恶性病变手术患者120例,按照手术入路将患者分为经口腔前庭组55例和经乳晕组65例,经口腔前庭组采用经口腔前庭入路腔镜手术治疗,经乳晕组采取乳晕入路腔镜手术方法,对比2组患者的手术相关指标、美观满意度以及治疗后生活质量水平和术后并发症发生情况。结果 2组患者手术时间、住院时间以及术后SIS评分和VHI评分差异无统计学意义(P>0.05),经口腔前庭组的手术出血量及术后引流量低于经乳晕组,且经口腔前庭组术后VAS评分显著低于经乳晕组(P<0.05);经口腔前庭组的VSS、OSAS和PSAS评分均较经乳晕组低,其美观满意度较高(P<0.05);经口腔前庭组的治疗后SF-36各维度评分均较经乳晕组高(P<0.05);2组并发症发生率差异无统计学意义(P>0.05)。结论 甲状腺恶性病变患者手术治疗中,经口腔前庭入路腔镜手术治疗相较于经乳晕入路治疗方式更具安全性,患者术中损伤及术后疼痛均较为轻微,且无瘢痕美观性更强,有助于促进患者身心状态和生活质量提升,属于安全且有效的手术治疗方法。

自身免疫性胰腺炎患者少见的影像表现

自身免疫性胰腺炎(autoimmune pancreatitis,AIP)是一种特殊类型的胰腺炎症,其常见的影像学特征已被影像科医师熟知,成为诊断AIP的影像学依据。然而在临床工作中我们也发现,除了常见的影像表现,AIP还可出现主胰管扩张、胰腺囊性病变、胰腺周围血管受累、胰腺钙化与胰管结石、类固醇治疗后短期内显著胰腺萎缩、合并恶性肿瘤等少见的影像表现。为进一步提高对AIP影像表现的认识,本文介绍这些AIP少见的CT和MRI表现。

孤立性肺结节患者恶性病变相关因素分析

目的探讨分析孤立性肺结节(SPN)患者恶性病变相关因素。方法选取2021年10月至2023年10月本院收治的100例SPN患者,根据病理检查结果分为良性组(n=46)、恶性组(n=54)。收集患者基本资料,分析影响恶性SPN的因素。结果恶性组年龄、结节直径、咳嗽、咯血、分叶征、血管集束征、胸膜凹陷征、边界不清、CEA阳性、CYFRA21-1阳性、CA125阳性占比均高于良性组(P<0.05)。Logistic多因素分析显示年龄、结节直径、分叶征、CYFRA21-1阳性为影响恶性SPN的独立危险因素(P<0.05)。结论年龄、结节直径、分叶征、SYFRA21-1为影响恶性SPN的独立危险因素,SPN患者出现上述因素应怀疑恶性病变的可能。

多模态高场MRI乳腺扫描对乳腺良恶性病变的诊断价值

目的 分析多模态高场磁共振成像(MRI)乳腺扫描诊断乳腺良恶性病变的临床价值。方法 收集2022年1月至2023年12月于河南科技大学第二附属医院进行乳腺MRI检查的79例乳腺患者的临床资料,所有患者入院后均接受高场MRI轴位T1加权成像(T1WI)、压脂T2加权成像(fs-T2WI)、扩散加权成像(DWI)、表观弥散系数(ADC)、动态对比增强(DCE),并将扫描的图像传至配套的后处理软件工作站建立病灶感兴趣区的动态增强曲线(DCE-TIC)及最大强度投影(MIP)图像、分析多模态高场MRI乳腺扫描在诊断乳腺良恶性病变方面的临床价值。结果 以组织病理学检查结果作为金标准,79例患者中发现81个病灶,其中良性病变44个,恶性病变37个,有2例患者存在2个病变并存的情况,1例是左乳纤维腺瘤,右乳微小粘液癌,1例是左乳发现2个病变,血管平滑肌瘤和叶状肿瘤并存。磁共振平扫、动态对比增强扫描和多模态高场MRI乳腺扫描诊断恶性病变的灵敏度分别为72.97%、86.49%、94.59%,特异度分别为54.55%、59.09%、81.82%,准确度分别为62.96%、71.60%、87.65%,约登指数分别为0.28、0.46、0.76。其中多模态高场MRI乳腺扫描诊断乳腺恶性病变效能最高,灵敏度、特异度、准确度及约等指数分别为94.59%、81.82%、87.65%,0.76,高于单一做乳腺磁共振平扫或单做动态对比增强成像。结论 多单一做乳腺平扫或DCE检查都有一定的不足,多模态高场MRI乳腺扫描诊断乳腺良恶性病变的诊断效能较好,对乳腺恶性病变诊断的准确性较高,对乳腺良恶性病变的诊断具有较高的临床价值。