Investigation of lacrimal sac space-occupying lesions using color doppler ultrasound, computed tomography, and computed tomography dacryocystography

AIM:To observe the imaging features of color Doppler ultrasound(CDU)and computed tomography(CT)or computed tomography dacryocystography(CT-DCG)in different types of lacrimal sac space-occupying lesions(SOLs).METHODS:This retrospective case series study included 21 patients with lacrimal sac SOLs who underwent lacrimal sac surgery between January 2018 and March 2022.The imaging features of CDU and CT or CT-DCG in these patients were extracted from the examination cloud system.The images were observed and analyzed.RESULTS:The detection rate of lacrimal SOLs between CDU(21/21,100%)and CT or CT-DCG(20/21,95.2%)had no statistically significant difference(P=1.0).CDU could detect the blood flow signals in all SOLs except mucocele and mucopeptide concretion.Among them,polyps had characteristic imaging changes on CDU and CT-DCG.The mucoceles and mucopeptide concretions had characteristic imaging changes on CDU,which could provide more information for differential diagnosis.CONCLUSION:The morphology and internal blood flow signals of lacrimal sac SOLs can be observed using CDU.CT or CT-DCG has advantages in observing structural damage around the lacrimal sac mass.Therefore,CDU may be used as a routine examination to exclude lacrimal sac SOLs before dacryocystorhinostomy in the absence of preoperative CT or CT-DCG.

Assessment of optic nerve and optic tract alterations in patients with orbital space-occupying lesions using probabilistic diffusion tractography

AIM: To investigate the diffusion changes in both the optic nerve and optic tract in orbital space-occupying lesion patients with decreased visual acuity, and its clinical significance using probabilistic diffusion tractography(PDT). METHODS: Twenty patients with orbital space-occupying lesions and 25 age-and gender-matched healthy persons were included. All patients and controls underwent routine orbital magnetic resonance imaging and diffusion tensor imaging(DTI), using a 3.0 T magnetic resonance scanner(Trio Tim Siemens). After the image data were preprocessed, each DTI parameters of the optic nerve and optic tract was obtained by PDT, including fractional anisotropy(FA), mean diffusivity(MD), axial diffusivity(AD) and radial diffusivity(RD). The asymmetry index(AI) of each parameter was calculated. Compared the parameters of the affected side optic nerve and ipsilateral optic tract with the contralateral side by paired sample t-test;compared AI of parameters of optic nerve and optic tract between the patient group and the control group by independent sample t-test. Patients were divided into threesubgroups according to the low vision grade standard of WHO, compared the FA and AI of FA between the three subgroups by single factor variance analysis. RESULTS: The affected side optic nerve presented significantly decreased FA, increased MD, AD, and RD values compared to the unaffected side(P<0.05). The AI of FA, MD, AD, and RD of optic nerve in the patients was significantly higher than that of the controls(P<0.05). The comparison results of the optic tract showed that there was no significant difference between the patient group and control group in terms of the bilateral optic tracts in patients(P>0.05). The AIs of the FA value of the optic nerve in the eyesight <0.1 subgroup was significantly higher than that in the other groups(P<0.05). CONCLUSION: FA, MD, AD, and RD of the affected side optic nerve of the orbital space-occupying lesions have significantly changed, the FA value is the most sensitive. The PDT could be a useful tool to provide valid quantitative markers of optic nerve injuries and evaluate the severity of orbital diseases, which other examinations cannot be acquired.

Recurrent orbital space-occupying lesions:a clinicopathologic study of 253 cases

Objective：To analyze the clinical features,histopathologic classification and frequencies of various types of recurrent orbital space-occupying lesions.Methods：A retrospective study was carried out in 253 consecutive patients with recurrent orbital spaceoccupying lesions treated by surgical excision in the Institute of Orbital Diseases,the General Hospital of the Armed Police Force from January 2009 to December 2010.Results：The patients included 123 males and 130 females aged 2 to 78 years（mean,36.2 years）,and the last recurrence interval after operation ranged from 1 month to 40 years（median,4.75 years）.Of all the cases,159（62.8%）,65（25.7%）,20（7.9%）,8（3.2%） and 1（0.4%） had previously experienced once,twice,three,four and six times of surgeries,respectively.Among them,29（11.5%） cases had recurred 3 times or over,and 37（14.6%） cases got recurrence in 10 or more years postoperatively.Most of the patients with local recurrence presented with various clinical manifestations,while 31（12.3%） cases were symptom-free.Two hundred and thirty-one（91.3%） cases underwent surgical removal of the recurrent orbital lesions,and another 22（8.7%） cases had to receive the exenteration of orbit.Categories of these recurrent orbital lesions after operation were as follows：lacrimal gland tumors,65（25.7%） cases;vasogenic diseases,54（21.3%） cases;neurogenic tumors,42（16.6%） cases;secondary tumors,24（9.5%） cases;orbital inflammation,21（8.3%） cases;myogenic tumors,14（5.5%） cases;fibrous and adipose tumors,12（4.7%） cases;lympho-hematopoietic tumors,7（2.8%） cases;bone or cartilage tumors,7（2.8%） cases;orbital cysts,6（2.4%） cases;and indefinitely differentiated tumor,1（0.4%） case.The 10 top histopathologic diagnoses were lacrimal gland pleomorphic adenoma,hemangiolymphangioma,lacrimal gland adenoid cystic carcinoma,meningioma,inflammatory pseudotumor,neurofibroma,sebaceous gland carcinoma,vascular malformation,rhabdomyosarcoma and hemangioma.Conclusions：The variety of recurrent orbital lesions after operation includes mainly of tumors except for vascular malformation and orbital inflammatory lesions.The lacrimal gland epithelial tumor is most prone to relapse after resection,and early and longer-term postoperative follow-up is needed.

Application of endoscopic submucosal dissection in duodenal space-occupying lesions

BACKGROUNDEndoscopic submucosal dissection (ESD) has been advocated by digestiveendoscopists because of its comparable therapeutic effect to surgery, reducedtrauma, faster recovery, and fewer complications. However, ESD for lesions of theduodenum is more challenging than those occurring at other levels of thegastrointestinal tract due to the thin intestinal wall of the duodenum, narrowintestinal space, rich peripheral blood flow, proximity to vital organs, and highrisks of critical adverse events including intraoperative and delayed bleeding andperforation. Because of the low prevalence of the disease and the high risks ofsevere adverse events, successful ESD for lesions of the duodenum has rarelybeen reported in recent years.AIM To investigate the efficacy and safety of ESD in the treatment of duodenal spaceoccupyinglesions.METHODS Clinical data of 24 cases of duodenal lesions treated by ESD at the DigestiveEndoscopy Center of the Affiliated Hospital of Qingdao University from January2016 to December 2019 were retrospectively analyzed.RESULTS All of the 24 cases from 23 patients underwent ESD treatment for duodenal spaceoccupyinglesions under general anesthesia, including 15 male and 8 femalepatients, with a mean age of 58.5 (32.0-74.0) years. There were 12 lesions (50%) inthe duodenal bulb, 9 (37.5%) in the descending part, and 3 (12.5%) in the ball descending junction. The mean diameter of the lesion was 12.75 (range, 11-22)mm. Thirteen lesions originated from the mucosa, of which 4 were low-gradeintraepithelial neoplasia, 3 were hyperplastic polyps, 2 were chronic mucositis, 2were adenomatous hyperplasia, 1 was high-grade intraepithelial neoplasia, and 1was tubular adenoma. Eleven lesions were in the submucosa, including 5neuroendocrine neoplasms, 2 cases of ectopic pancreas, 1 stromal tumor, 1leiomyoma, 1 submucosal duodenal adenoma, and 1 case of submucosal lymphfollicular hyperplasia. The intraoperative perforation rate was 20.8% (5/24),including 4 submucosal protuberant lesions and 1 depressed lesion. The meanlength of hospital stay was 5.7 (range, 3-10) d, and the average follow-up time was25.8 (range, 3.0–50.0) mo. No residual disease or recurrence was found in allpatients, and no complications, such as infection and stenosis, were found duringthe follow-up period.CONCLUSION ESD is safe and effective in the treatment of duodenal lesions;however, theendoscopists should pay more attention to the preoperative preparation,intraoperative skills, and postoperative treatment.

Association between the fMRI manifestations of activated brain areas and muscle strength in patients with space-occupying lesions in motor cortex

BACKGROUND ： Functional magnetic resonance imaging （fMRI） studies have disclosed the changes of the motor function in the motor cortex of ipsilateral and contralateral hemispheres of tumor, which have special significance for making the surgical planning and most greatly minimizing the postoperative functional damages. OBJECTIVE： To analyze the association between the manifestation characteristics of hand functional area and motor dysfunction using fMRI in patients with space-occupying lesions of tumor in motor cortex. DESIGN ： A case-controlled observation SETTING： Department of Radiology, Second Affiliated Hospital, Shantou University Medical College .PARTICIPANTS： Twenty-three patients （13 males and 10 females） with space-occupying lesions of central sulcus area, aged 21-53 years with a mean age of （47±1） years were selected from the Second Affiliated Hospital of Shantou University Medical College. All the patients were diagnosed by MR scanning as space-occupying lesions of motor area, and pathologically confirmed that the lesions involved central sulcus and central Iobule; Lesions occurred in left and right hemispheres in 13 and 10 cases respectively. The tumor types were astrocytoma （n =8）, metastatic tumours （n =7）, meningiomas （n =5） and oligodendroglioma （n =3）. The muscle strength was normal in 11 cases （grade 5） and obviously decreased in 12 cases （grade 2-3 in 3 cases and grade 4 in 9 cases）; muscle strengths of both upper and lower limbs were decreased in 7 cases, and only that of upper limbs was decreased in 5 cases. Informed consents were obtained from all the subjects. Meanwhile, 9 healthy physical examinees （5 males and 4 females） of 20-56 years old with an average of （34±1） years were taken as controls. All the patients and healthy subjects were right-handed. METHODS： All the enrolled subjects were examined with MR scanning and functional imaging. Twenty cases whose clinical symptoms were mild in the patient group and 9 healthy volunteers adopted simple active finger-tapping movements, and for the 3 cases whose clinical symptoms were severe in the patient group, the simple passive finger-tapping movements were used. The manifestations in the activated brain areas were analyzed in the patients with brain tumor of different muscle strength and the controls. The motor deficit and activation of contralateral primary motor cortex （M1） in simple finger-tapping movements were observed in the patient group. MAIN OUTCOME MEASURES： （1） Brain areas activated by finger-tapping movements in each group： （2） Activated volumes in hemisphere by finger-tapping movements between groups. RESULTS： The contralateral M1 area could not be activated in 1 case in the patient group,, all the other 22 patients and 9 healthy subjects were involved in the analysis of results. （1） In the control group, unilateral finger tapping movement activated the contralateral primary motor cortex （M1）, bilateral SMA and bilateral PMC. The activation volume was the largest in contralateral primary motor cortex （M1）, smaller in the SMA, and the smallest in PMC. The finger tapping movement in healthy subjects could activate contralateral primary motor cortex （M1）, bilateral SMA and bilateral PMC, which had no obvious differences from the manifestations of brain functional area activated by active finger tapping. There was no significant difference in the volume of activated functional areas between right and left hands. In the patient group, the central sulcos around the tumor in the activated M1 area displaced towards dorsal or ventral side, also extended. The distance of displacement in the functional area was determined as compared with the contralateral central sulcus, and the results suggested the M1 displacement, including that there were 10 cases with the M1 displacement larger than 10 mm in the patients with motor deficit, which were obviously more than in those without motor deficit （n =1, P 〈 0.01）, and the activated volume in contralateral M1 area was obvious smaller in the patients with motor deficit than in those without motor deficit （P 〈 0.01）. （2） The M1 activation and changes were observed in contralateral hemisphere in the patient group, and the activated volume was obviously larger than that in the control group （P 〈 0.01）. The activated volumes of M1 and PMC in ipsilateral hemisphere were obviously larger than those in the control group （P 〈 0.05）, but that of SMA had no obvious difference between the two groups （P 〉 0.05）. CONCLUSION： fMRI can be used to observe the activation of the brain motor functional areas of patient with space-occupying lesions in motor area, and evaluate the state of their motor function. The larger the distance of displacement of M1 compressed by tumor, the more obviously the muscle strength decreases in the patients.

艾滋病合并肺癌、肺结核合并肺癌与单纯肺癌的病理特征及肺内占位CT特征的比较

目的分析艾滋病合并肺癌、肺结核合并肺癌与单纯肺癌的病理特征及肺内占位CT特征。方法选择2021年11月~2022年6月我院收治的36例艾滋病合并肺癌、36例肺结核合并肺癌及36例单纯肺癌患者为研究对象,收集其一般资料、临床症状、病理特征、肺内占位CT特征等临床资料,并将3组患者上述资料进行对比分析。结果艾滋病合并肺癌组、肺结核合并肺癌组发热、纳差比例均高于单纯肺癌组(P<0.05),艾滋病合并肺癌组贫血、真菌感染比例高于肺结核合并肺癌、单纯肺癌组(P<0.05),3组其他临床症状差异无统计学意义(P>0.05)。艾滋病合并肺癌组腺癌比例高于肺结核合并肺癌组、单纯肺癌组(P<0.05),鳞癌比例低于肺结核合并肺癌组、单纯肺癌组(P<0.05),肺结核合并肺癌组病理分型与单纯肺癌组的差异均无统计学意义(P>0.05),3组TNM分期差异均无统计学意义(P>0.05)。艾滋病合并肺癌组肺内占位CT表现中纤维条索影比例均高于肺结核合并肺癌组和单纯肺癌组(P<0.05);肺结核合并肺癌患者肺内占位CT表现中长毛刺征、空洞、纵膈淋巴结增大、胸腔积液均高于单纯肺癌组(P<0.05),粟粒性阴影、卫星灶比例高于艾滋病合并肺癌组和单纯肺癌组(P<0.05)。结论艾滋病合并肺癌、肺结核合并肺癌与单纯肺癌的病理特征及肺内占位CT特征存在不同之处,临床可结合患者病理特征及肺内占位CT特征对不同类型肺癌患者病情予以评估。

DIFFERENTIAL ULTRASONIC DIAGNOSES OF PULMONARY BENIGN AND MALIGNANT SPACE-OCCUPIED LESIONS OF THE PERIPHERAL TYPE

87 patients with pulmonary space-occupied lesions of the peripheral type which were either adhesive of close to pleura were examined using ultuasonography.Of them,64 cases of lung cancers and 23 of bening lesions were then confirmed by

多层螺旋CT多平面重建后处理技术对肺内占位良恶性的鉴别诊断意义

目的:探讨多层螺旋CT多平面重建后处理技术对肺内占位良恶性的鉴别诊断意义。方法:2016年5月到2018年6月选择在我院进行诊治的肺内占位病变患者194例,所有患者均给予常规多层螺旋CT与CT多平面重建后处理技术检查,记录影像学特征,并判断鉴别诊断良恶性的效果。结果:在194例患者中,病理诊断为良性病变100例(良性组),诊断为恶性病变94例(恶性组),恶性组与良性组CT常规特征中的分叶征、锯齿征、毛刺征、血管聚集征、空泡征等比例差异显著(P<0.05)。所有患者CT多平面重建后处理图像均可清晰显示肺动脉,不同重建方法显示肺部血管有高度一致性,重建评分对比差异无统计学意义(P>0.05)。多层螺旋CT多平面重建后处理鉴别诊断肺内占位病变良恶性的阳性预测值、阴性预测值、灵敏度以及特异度分别为90.5%、91.9%、91.5%和91.0%。结论:多层螺旋CT多平面重建后处理技术在肺内占位病变中的应用获取图像清晰,重建区域自由,能有效鉴别诊断良恶性状况。

Surgical treatment of a patient with peliosis hepatis: A case report

This report describes a case of a space-occupying lesion in the right liver in a 38-year-old man who was found to have peliosis hepatis. Clinical data of this patient were presented, including medical history, laboratory test and imaging results, and postoperative pathological findings (hematoxylin and eosin staining). Review of his medical history showed that the patient had been bitten by a dog three years earlier. B-mode ultrasonography revealed an uneven echo mass in the right hemiliver, and magnetic resonance imaging scans also showed a mass in the anterior segment of the right liver. Upon surgical removal, the mass was found to be 4.0 cm × 3.8 cm × 3.8 cm in size and located in segment Ⅵ. The mass had a dark and soft appearance, with an irregular edge on intraoperative ultrasonography. Postoperative pathological findings revealed many small capsules filled with blood cells. The patient was diagnosed with peliosis hepatis based on his medical history of having been bitten by a dog, presence of mild anemia, and lack of characteristic symptoms, including fever of unknown origin, abdominal pain, and hepatosplenomegaly, combined with intraoperative and postoperative pathologic findings. The operation was successful, and after being treated with anti-infection agents, the patient had a good recovery.

多层螺旋CT引导下经皮穿刺肺内非特征性占位病变活检术的临床应用价值

目的探讨多层螺旋CT(MSCT)引导下经皮穿刺肺内非特征性占位病变活检术的临床应用价值。方法回顾68例肺内非特征性占位病变患者行MSCT引导下穿刺活检术的操作方法和过程,分析检查结果和并发症发生情况。结果 68例MSCT引导下经皮穿刺活检术均顺利成功,无严重并发症发生,仅10例术后出现少量气胸等轻度并发症,经简单保守治疗后全部恢复。全组68例肺内非特征性占位病变的病理结果中非恶性病变38例,占55.9%。结论肺内非特征性占位病变经病理确诊为非恶性者不在少数,该类病变及时确诊并正确治疗尤为重要,而利用MSCT的功能优势引导经皮肺穿刺活检术易于操作、结果可靠、并发症少,具有较高的临床应用价值。

Incontinentia pigmenti with intracranial arachnoid cyst: A case report

BACKGROUND Incontinentia pigmenti(IP)is a rare X-linked dominant genetic disorder that can be fatal in male infants.It is a disease that affects many systems of the human body.In addition to characteristic skin changes,patients may also have pathological features of the eyes,teeth,and central nervous system.Therefore,the lesions in these systems may be the first symptoms for which patients seek treatment.To date,no cases of IP complicated by intracranial arachnoid cyst(IAC)have been reported.This paper aims to report a case of IP with IAC in order to share the diagnosis and treatment experience of this rare case with other clinicians.CASE SUMMARY An 11-year-old female patient suffered intermittent limb convulsions for five months and was sent to hospital.In the initial stage,the patient was considered to have primary epilepsy.Further investigation of the patient's medical history,physical examination and imaging examination led to the diagnosis of IP combined with intracranial space-occupying lesions,and secondary epilepsy.The patient was treated with craniotomy,and postoperative pathology revealed an IAC.The patient recovered well after craniotomy and had no obvious surgeryrelated complications.During the follow-up period,the patient did not have recurrent epilepsy symptoms.CONCLUSION IP is a multi-system disease that presents with typical skin lesions at birth,but the long-term prognosis of this disease depends on the involvement of systems other than the skin,especially nervous system and ocular lesions.

肺内非特异性球块状炎性病变的X线诊断

目的 为了进一步提高肺内球块状炎性病变的认识和诊断正确率。方法 3 3例肺内球块状炎性病变 ,18例经手术病理证实 ,15例经抗炎治疗完全吸收而确诊。本文对其进行了回顾性分析。结果 肺内球块状炎性病变可见于炎性假瘤 ( 18例 ) ,球形肺炎 ( 15例 )。病灶边缘有毛刺者 11例 ,有浅分叶者 8例 ,有“桃尖”征者 12例。病灶内或其周围有“条索”征者 9例。结论 抗炎治疗观察及寻找“条索”征和“桃尖”

临床鉴别困难的肺内多发实性病灶的外科治疗分析

目的探讨临床鉴别困难的肺内多发实性病灶的临床病理特征及外科处理前景。方法回顾性分析2012—2019年湖南省肿瘤医院胸部肿瘤外科中心二区连续完成的临床鉴别困难的肺内多发实性病灶行手术治疗97例患者的临床资料,其中男72例、女25例,年龄(58.1±9.0)岁。其中病灶位于一侧78例、双侧19例,分析主病灶与次病灶的临床病理特征及多发实性病灶外科处理的围术期风险。结果同侧及双侧病灶患者均同期完成手术,手术顺利。主病灶以肺叶切除为主(71.1%),电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)完成率69.1%(67/97)。次病灶以楔形切除为主(80.4%),VATS完成率71.1%(69/97)。单侧或双侧手术后3级以上并发症发生率为12.8%及5.3%。术后病理证实主病灶恶性65例(67.0%),以腺癌为主(63.1%),其中Ⅰ期43.1%;良性32例,以结核瘤为主(56.3%)。次病灶恶性29例,良性67例,良恶性均有1例。主次病灶的病理一致率为54.6%[肺癌肺内转移及均为良性者(含不同类型良性病灶者)]。主病灶为恶性时,其直径在<3 cm、3~<5 cm、5~7 cm、>7 cm时,次病灶为转移瘤的比率依次为42.5%、15.8%、20.0%、0。主病灶为恶性且伴有淋巴结转移时,次病灶为转移灶的几率有高于不伴淋巴结转移者的趋势(46.7%vs.30.0%,P>0.05)。当主病灶为恶性,主次病灶位于同叶时,次病灶转移可能性大(54.5%),而位于同侧不同叶及不同侧时,次病灶为良性可能性大(58.1%、72.7%),转移可能性小(32.6%、9.1%);当主病灶为良性,临床鉴别诊断困难时,次病灶均为良性。结论鉴别诊断困难的肺内多发实性病灶,主病灶直径越大,次病灶为转移瘤的比率有降低趋势;主次病灶位于同叶和/或伴淋巴结转移者,次病灶为转移可能性大;次病灶位于对侧时转移的可能性小;双侧同期手术不明显增加手术风险。