Computed tomography and magnetic resonance imaging findings of metastatic rectal linitis plastica from prostate cancer:A case report and review of literature

Linitis plastica is a rare condition showing circumferentially infiltrating intramural anaplastic carcinoma in a hollow viscus, resulting in a tissue thickening of the involved organ as constricted, inelastic, and rigid. While most secondary rectal linitis plastica(RLP) is caused by metastasis from stomach, breast, gallbladder, or bladder cancer, we report an extremely rare and unique case of secondary RLP due to prostate cancer with computed tomography(CT) and magnetic resonance imaging(MRI) findings, including diffusion weighted imaging(DWI). A 78-year-old man presented with approximately a 2-mo history of constipation and without cancer history. On sigmoidoscopy, there was a luminal narrowing and thickening of rectum with mucosa being grossly normal in its appearance. On contrast-enhanced CT,marked contrast enhancement with wall thickening of rectum was noted. On pelvic MRI, rectal wall thickening showed a target sign on both T2-weighted imaging and DWI. A diffuse infiltrative lesion was suspected in the prostate gland based on low signal intensity on T2-weighted imaging and restricted diffusion. A transanal full-thickness excisional biopsy revealed metastasis from a prostate adenocarcinoma invading the submucosa to the muscularis propria consistent with metastatic RLP. We would like to emphasize the CT and MRI findings of metastatic RLP due to prostate cancer.

Gastric linitis plastica with autoimmune pancreatitis diagnosed by an endoscopic ultrasonography-guided fine-needle biopsy: A case report

BACKGROUND Gastric linitis plastica(GLP)is a subset of gastric cancer with a poor prognosis.It is difficult to obtain a definitive diagnosis by endoscopic mucosal biopsies,and the usefulness of an endoscopic ultrasonography-guided fine-needle biopsy(EUSFNB)for GLP has been recently reported.Meanwhile,autoimmune diseases are occasionally known to coexist with malignant tumors as paraneoplastic syndrome.We herein report the usefulness of an EUS-FNB for detecting GLP and the possibility of paraneoplastic syndrome coexisting with GLP.CASE SUMMARY An 81-year-old man was admitted to our hospital for a 1-mo history of epigastric pain that increased after eating.His laboratory data revealed high levels of serum carbohydrate antigen 19-9 and immunoglobulin-G4.Endoscopic examinations showed giant gastric folds and reddish mucosa;however,no epithelial changes were observed.The gastric lumen was not distensible by air inflation,suggesting GLP.Computed tomography showed the thickened gastric wall,the diffuse enlargement of the pancreas,and the peripancreatic rim,which suggested autoimmune pancreatitis(AIP)coexisting with GLP.Because the pathological findings of the endoscopic biopsy showed no malignancy,he underwent an EUSFNB and was diagnosed with GLP.He received chemotherapy for unresectable gastric cancer due to peritoneal metastasis,after which both the gastric wall thickening and diffuse enlargement of the pancreas were improved.CONCLUSION An EUS-FNB for GLP with a negative endoscopic biopsy is useful,and AIP may develop as a paraneoplastic syndrome.

A Rare Case of Gastric Linitis Plastica Revealed by Isolated Vertebral Metastases in a Young Woman in a Less Developed Country

Aim: We report a rare case of gastric linitis plastica revealed by vertebral metastases without another digestive dissemination. Case presentation: The Benin native woman was hospitalized in rheumatology for inflammatory back pain without another signs. Rx ray showed vertebra metastasis. In the etiologic research, gastroscopy showed an infiltrating lesion of the antral area, indicating gastric linitis which was confirmed by biopsy. Short and medium-term evolution was favourable, characterized by a complete disappearance of the pains and a good physical condition. Conclusion: Vertebral metastases can reveal digestive cancer, although human gut is not among the most bone metastatic cancers.

Endoscopic ultrasonographic features of gastric linitis plastica in fifty-five Chinese patients

The objective of this study was to investigate the endosonographic appearance of gastric linitis plastica(GLP) and to study the usefulness of endoscopic ultrasonography(EUS) for the T and N staging of GLP.EUS examinations of 55 patients with histologically proven GLP were retrospectively studied.In all patients,EUS showed that lesions involved at least one-third of the circumference of the stomach.Based on the findings of the EUS,the 55 patients were divided into two groups.There were 32(58.2%) patients in the first group.EUS of this group showed that the five sonographic layers had disappeared and had been replaced by a hypoechogenic thickening of the gastric wall.There were 23(41.8%) patients in the second group.EUS of this group showed that the first three sonographic layers were blurred and thickened,and the fourth layer was significantly thickened.The full thickness of the gastric wall was significantly thicker in first than in the second group of patients(P<0.01).The incidence of perigastric lesions was significantly higher in the first than in the second group of patients(P<0.01).Results for the 15 patients following preoperative EUS were compared postoperatively with histopathologic findings for T and N staging.The overall diagnostic accuracy of the T stage was 73.3% and of the N stage was 60.0%.In eight patients,we used EUS to assess a therapeutic response.No response was observed in five patients and a partial response in three.EUS images of GLP are characteristic.EUS is helpful in diagnosing GLP and for assessing the T and N stages.

皮革胃的新辅助治疗与辅助治疗研究进展

胃癌是最常见的消化系统恶性肿瘤之一。皮革胃是一种特殊类型的胃癌,大体上呈现为胃壁节段性或弥漫性增厚,镜下可见散在分布的低黏附性肿瘤细胞或印戒细胞,以及弥漫的纤维间质的增生和浸润。皮革胃进展迅速,预后不良。就诊时大部分患者处于进展期,同时伴有隐匿性的腹膜转移,术后中位生存期仅为6~14个月。根治性手术是皮革胃患者最重要的治疗方式,但超过50%的患者在就诊时已丧失根治性手术机会。近年来,以手术为中心的综合治疗模式,包括手术结合术前新辅助治疗、术后辅助治疗等已逐渐应用于皮革胃的治疗,相关分子通路的发现,也为进一步免疫和靶向治疗的研究提供了方向。

超声内镜在胃浸润性肿瘤诊断中的价值

目的 探讨超声内镜对胃浸润性肿瘤的诊断价值 ,提高其内镜诊断率。方法 分析 4 4例胃浸润性肿瘤 (皮革胃 4 1例 ,胃淋巴瘤 3例 )的内镜结果 ,对其中 2 9例行超声内镜检查 ,并分析其超声影像特征。结果 皮革胃和胃淋巴瘤内镜活检阳性率为 4 3.2 % (19/44)。超声内镜显示病变胃壁弥漫性增厚 ,以 2、3和 4层为主 ,回声减弱 ,胃壁层次尚可见 ,部分病例仅见 4层结构。超声内镜诊断准确率为 10 0 %。结论 超声内镜对胃镜活检阴性的胃浸润性肿瘤具有重要的诊断价值 。

皮革样胃肥大细胞增生症临床病理观察

目的探讨罕见的皮革样胃肥大细胞增生症的临床病理特点。方法报道1例皮革样胃肥大细胞增生症,回顾分析其临床表现、影像学、胃镜下表现及病理组织学特点,应用免疫组化方法及特殊染色进一步确认诊断,探讨诊断及鉴别诊断,同时随访患者。结果临床无特殊表现。影像学显示胃底后壁明显弥漫性均匀增厚。胃镜显示黏膜粗大。病理检查大体示胃呈皮革样改变;镜下胃壁全层见肥大细胞弥漫浸润并部分累及局部淋巴结。免疫组化示肿瘤细胞CD117、CD43、CD68和LCA(+);甲苯胺兰染色示瘤细胞胞质呈紫红色。随诊44个月,患者健康。结论胃肥大细胞增生症是罕见的系统性肥大细胞增生,胃呈皮革样改变和惰性生长是其特殊之处。

Surgical treatment of Peyronie＇s disease： choosing the best approach to improve patient satisfaction

Aim： To discuss important points on medical history, preoperative evaluation, real expectations, and selection of the appropriate surgical procedure to improve patient satisfaction after surgical procedures for Peyronie＇s disease. Methods： Recent advances in approaches to Peyronie＇s disease are discussed based on the literature and personal experiences. Issues concerning surgical indication, patient selection, surgical techniques, and grafting are discussed. Lengthening procedures on the convex side of the penile curvature by means of grafting offer the best possible gain from a reconstruction standpoint. Penile rectification and rigidity are required to achieve a completely functional penis. Most patients experience associated erectile dysfunction （ED）, and penile straightening alone may not be enough to restore complete function. Twenty-five patients were submitted to total penile reconstruction on length and girth with concomitant penile prosthesis implant. The maximum length restoration was possible and limited by the length of the dissected neurovascular bundle. The mean age was 55.4 years （32-69 years） and the mean angle of curvature 74.2± 22.4° （0-100°）. Pericardial grafting was used to cover the defect. The mean follow-up time was 11.2 ± 5.9 months （3-22 months）. Results： Mean functional penile length gain was 3.40 ＋ 0.73 cm （2-5 cm）. Penile prosthesis maintained the penis straight. No infections occurred. Sexual intercourse was restored in all patients and all reported recovered self-esteem. Conclusion： Improving patient satisfaction with the surgical treatment includes proper preoperative evaluation on stable disease, penile shortening, vascular and erectile status, patient decision and selection as well as extensive discussion on surgical technique for restoring functional penis （length and rigidity）. Length and girth restoration is very important for self-esteem and patient satisfaction.

Endoscopic ultrasound-guided cutting of holes and deep biopsy for diagnosis of gastric infiltrative tumors and gastrointestinal submucosal tumors using a novel vertical diathermic loop

AIM To report on a more accurate diagnostic possibility offered by endoscopic ultrasound-guided cutting of holes and deep biopsy(EUS-CHDB) for pathologic diagnosis of gastric infiltrative tumors and gastrointestinal submucosal tumors.METHODS Ten consecutive patients who were suspected of having gastric invasive tumors or gastrointestinal submucosal tumors underwent EUS-CHDB with a novel vertical diathermic loop. We reviewed their medical data and analysed the effectiveness and safety of this new method. The final diagnosis was based on the surgical pathology or clinical/imaging follow-up. RESULTS EUS-CHDB was performed successfully in all the ten patients. Neither severe haemorrhage nor perforation occurred in any patient. Among the ten patients, there were three cases of gastric linitis plastica, one case of gastric lymphoma, five cases of gastrointestinal stromal tumors(GISTs), and only one case of chronic non-atrophic gastritis. That is, nine(90%) of the cases treated by EUS-CHDB showed positive findings.CONCLUSION EUS-CHDB may be a technically feasible and safe option for patients with gastric infiltrative tumors or gastrointestinal submucosal tumors. EUS-CHDB may be used as a remedial or even preferred biopsy method for submucosal lesions.

超声内镜联合凿洞式活检对皮革胃的临床诊断价值研究

目的:探讨超声内镜联合凿洞式活检对皮革胃的临床诊断价值。方法:选取医院收治的86例疑似皮革胃患者,所有患者先行胃镜活检,再行超声内镜联合凿洞式活检,以手术组织病理确诊的结果作为标准,比较胃镜活检、超声内镜联合凿洞式活检对皮革胃的诊断价值。结果:86例皮革胃患者中病变部位位于胃窦部12例,胃体部20例,胃窦、体17例,胃体、底23例,累及全胃14例。在超声内镜下病变处胃壁表现为不同程度的增厚(7.5~21.3 mm),平均增厚(16.41±4.18)mm,胃壁层次结构比较模糊或者消失。86例疑似皮革胃患者中18例病灶侵犯至黏膜下层,38例病灶侵犯至固有肌层,30例病灶侵犯至浆膜层。86例疑似皮革胃患者中均匀低回声49例,不均匀低回声21例,中等回声改变16例。弹性成像主要以蓝色为主,弹性应变率为44~81。超声内镜发现胃周淋巴结转移8例,腹水18例。86例疑似皮革胃患者经过病理检查确诊,其中80例为皮革胃,4例为胃平滑肌,2例为原发性胃肠淋巴瘤。以病理检查结果为标准,超声内镜联合凿洞式活检对皮革胃的检出灵敏度为91.25%,显著高于胃镜活检的38.75%,差异有统计学意义(x^(2)=48.462,P<0.05),特异度为66.67%,高于胃镜活检的33.33%,但差异无统计学意义;误诊率为33.33%低于胃镜活检的66.67%,但差异无统计学意义,漏诊率为8.75%低于胃镜活检的61.25%,差异有统计学意义(x^(2)=10.895,P<0.05);诊断符合率为87.21%高于胃镜活检的43.02%,差异有统计学意义(x^(2)=36.960,P<0.001)。结论:相比于胃镜活检,超声内镜联合凿洞式活检有助于获得黏膜下层病变组织,显著提高皮革胃的诊断阳性率,与病理诊断符合率高,且该操作创伤小、安全性高。

色素性扁平苔藓并发皮革样胃癌伴转移1例

患者男,68岁,维吾尔族。全身起黑褐色皮疹伴瘙痒1年。查体见躯干及四肢近端散在分布米粒至手掌大黑褐色扁平丘疹和斑块,界清,表面有蜡样光泽,可见wickham纹。消化道钡透示:瀑布型胃,胃腔缩小,黏膜粗乱—皮革胃样改变。皮损组织病理示:表皮轻度角化过度,色素增多,灶状基底细胞液化变性,真皮浅层较多淋巴组织细胞浸润,可见较多嗜色素细胞。IHC:HMB-45阴性,CK5/6表皮阳性,LCA阴性,S-100阴性,Ki-67阴性。诊断:色素性扁平苔藓;皮革样胃癌(胃小弯处淋巴结转移)。

共聚焦显微内镜对临床难以确诊的皮革胃的诊断价值

目的探索共聚焦显微内镜(CLE)对临床难以确诊的皮革胃病例的诊断价值。方法收集2009年～2011年因胃黏膜病变行CLE检查的患者317例。CLE检查过程中使用经静脉注射的10%荧光素钠溶液作为荧光剂,术后行导向病理活检。对CLE无法确诊的病例行腹部薄层增强CT扫描,对符合手术指征者行外科手术。将普通胃镜、CLE检查及活检病理结果进行比较分析。结果总共13例临床确诊为皮革胃的患者接受了CLE检查,所有患者术前均曾接受包括常规内镜及活检病理在内的辅助检查,病理均未确诊胃癌。单纯根据CLE图像诊断皮革胃的准确率为76.9%(10/13),CLE导向活检阳性率84.6%(11/13)。对皮革胃患者的CLE图像分析显示,腺体排列紊乱伴明显炎症反应、荧光素钠大量渗出、高度异型腺体或成片排列的大型暗色细胞、腺上皮或间质中大型浅色细胞、间质中异常扭曲异型的阳性率分别为84.6%、76.9%、76.9%、46.1%与7.7%。结论 CLE检查及CLE导向活检术是提高皮革胃诊断正确性的有效方法。

以活检后溃疡不愈合为特征的皮革胃1例报道

皮革胃发病率低,临床表现不典型。现将我院收治的1例皮革胃患者报道如下。

AN ANALYSIS OF THE LARGE DEFLECTION OF AN ELASTIC-PLASTIC CANTILEVER SUBJECTED TO AN INCLINED CONCENTRATED FORCE

Based on the Plastica theory (see ref. [12]), the large deflection of an elastic-perfectly plastic cantilever subjected to an inclined concentrated force at its tip, before the unloading in the plastic region occurs, is analyzed in this paper. The emphasis of the analysis is put on the effects of the angle of inclination of the concentrated force upon the deformed shape, the load-deflection relationship and the length of the plastic region. Both analytical and computed results are given.

悬臂梁在倾斜载荷作用下的弹塑性大挠度分析

作为Plastica理论的应用,本文分析了理想弹塑性矩形截面梁在自由端承受倾斜集中力作用时塑性区扩展阶段的大挠度变形.着重讨论了集中力的倾角对弯曲形状、载荷—挠度关系及塑性区长度的影响.结果用解析解和数值解同时给出.

铜精矿中金的ICP-AES法测定

本文介绍了用ICP－AES法测定铜精矿中金．研究了试样的前处理，方法简便、快速、易操作．准确度和精密度均符合GB3884．2—83和GB3884．14－86中的误差要求。

革袋胃诊治现状及进展

革袋胃是一种特殊型胃癌,呈弥漫性生长,恶性度高、进展快,通常预后差,属于弥漫浸润型(BorrmannⅣ型)胃癌,好发于女性。随着诊疗技术的提高,为部分革袋胃患者的诊治提供了新的希望。革袋胃的具体发病机制及疾病进展尚未完全明确,该文就近年来的革袋胃的诊治现状及进展进行综述。

塑料模塑品及其涂装

涂装塑料可以弥补塑料本身性能的不足。随着塑料品种的多样化，用于涂装塑料的涂料品种也在不断增加。文中介绍了塑料模塑品、适应不同性能塑料所应使用的涂料及其涂装工艺。

内镜超声对皮革胃的诊断价值

目的 探讨内镜超声检查 (EUS)对皮革胃的诊断价值。方法 对 2 1例皮革胃患者行EUS检查 ,并将其结果与内镜、胃肠道钡餐、CT检查及术后病理结果进行对照研究。结果 皮革胃的EUS声像图表现为 (1 )病灶处胃壁第 2、3、4层明显增厚 ,所侵犯胃壁层次结构消失 ,胃壁增厚处平均 (1 6 8± 0 37)cm ;(2 )大多数 (95 2 4 % )呈低回声改变 ;(3)EUS下病灶范围超过内镜所见异常区域 ;(4 ) 85 7%的患者病变沿胃的横轴生长呈连续性分布 ;(5 )病灶边界较容易分辨 ,但图像放大观察交界处模糊 ,是皮革胃浸润生长的标志。EUS对皮革胃的诊断符合率为 90 4 8% ,显著高于常规内镜检查的 5 2 38% (P =0 0 0 95 )、胃肠道钡餐的 6 1 1 1 % (P =0 0 396 )及CT检查的 35 2 9% (P =0 0 0 5 9)。术前EUS对皮革胃的T、N分期诊断的准确性分别为 80 95 %、85 71 % ,EUS对皮革胃可切除性判断的准确率为 71 4 3%。

超声内镜对胃黏膜增厚性疾病的诊断价值

目的探讨超声内镜对胃黏膜增厚性疾病的诊断价值,提高其诊断准确率。方法对25例胃镜检查发现的胃黏膜增厚的患者行超声内镜检查,分析其内镜表现及超声影像特征。结果超声内镜可以清楚显示胃壁的厚度及回声变化,对胃黏膜增厚疾病良恶性诊断的符合率为100%,对皮革胃的诊断符合率为94.8%;内镜活检病理对恶性胃黏膜增厚诊断率为47.6%。超声内镜对恶性胃黏膜增厚疾病的诊断符合率与内镜活检比较有统计学意义(P<0.01)。结论超声内镜对胃黏膜增厚性疾病良恶性的鉴别具有重要的诊断意义,对于皮革胃和淋巴瘤,超声内镜是除手术病理鉴别外最重要鉴别诊断手段。