ObjectiveTo investigate the value of contrastenhanced ultrasonography in differential diagnosis between benign and malignant breast mass. MethodsTotally 65 patients with 70 breast masses were evaluated by general ultrasonography and contrastenhanced ultrasonography with contrast agent SonoVue. The related indexes, such as the degree and mode of contrast enhancement, the lesion boundaries and dissipation mode, were used to describe the difference between benign and malignant mass, which was also compared with pathological results. ResultsHistopathological examination revealed that benign mass was in 37 cases and malignant in 28 cases. The sensitivity, accuracy, positive predictive value, and negative predictive value of contrastenhanced ultrasonography with contrast agent SonoVue were significantly higher than that of general ultrasonography (Plt;0.05), while no significant difference in diagnostic specificity and misdiagnosis rate was observed between them (Pgt;0.05). All tumors showed contrast enhancement in various degrees. Of 28 patients with enhanced mass, hyperenhancement in 22 cases and nodular inhomogeneous enhancement in 21 cases were observed and the boundaries of malignant tumor were irregular with ill-defined and radial enhancement. Most of benign tumors were represented by weak, homogeneous enhancement, and the shape was regular with smooth and tidy boundary and intact capsule except seven cases with unclear boundary. These imaging characteristics of benign and malignant tumors were obviously different (P=0.000). In the resolution phase, both benign and malignant mass showed heterogeneous or homogeneous dissipation, which was not significantly different (P=0.791). ConclusionCompared with general ultrasonography, contrast enhanced ultrasonography may be more helpful for the differential diagnosis of benign and malignant breast tumors.
Objective To investigate clinical significance of serum VEGF-C level and C-erbB-2 protein expression in patients with breast cancer. Methods Sixty-two female patients with breast invasive ductal cancer and breast benign lesion were respectively selected. Serum VEGF-C level was detected by enzyme-linked immunosorbent assay (ELISA) before operation and at one month after operation, and C-erbB-2 protein expression in tissues of breast cancer was detected by immunohistochemistry. Then, the relationship between serum VEGF-C level and clinicopathologic characteristics and C-erbB-2 protein expressions wereas analyzed. Results The serum VEGF-C level before operation in breast cancer patients〔(279.65±17.34) pg/ml〕 was significantly higher than that in breast benign lesions patients 〔(167.26±12.15) pg/ml〕, P＜0.01. In breast cancer patients, the serum VEGF-C level before operation was higher than that at one month after operation 〔(209.45±15.23) pg/ml〕, P＜0.01. The serum VEGF level was related to tumor stage (P＜0.05) but not to patient age, tumor size, menopause status , lymph node metastasis or not and ER and PR expression (Pgt;0.05). The positive expression rate of C-erbB-2 protein in breast cancer patients (54.84%, 34/62) was significantly higher than that in breast benign lesion patients (11.29%, 7/62), P＜0.01. Moreover, the positive expression rate of C-erbB-2 protein in breast cancer patients with axilla lymph node metastasis (69.44%) was significantly higher than that without axilla lymph node metastases (34.62%), P＜0.05. The serum VEGF level increased with increasing expression intensity of C-erbB-2 protein and there was positive correlation between them (r=0.813，P＜0.05). Conclusions The serum VEGF-C level in breast cancer may be conducted as an assisted marker to differential diagnosis of breast tumor. C-erbB-2 is related to lymph node metastasis of breast cancer patients. There is synergistic effect between VEGF-C and C-erbB-2 in the lymph node metastasis way of breast cancer.
Objective To investigate differential points of clinical symptoms and pathology of solid-pseudopapillary tumor of the pancreas (SPTP) and islet cell tumor (ICT). Methods Fifteen cases of SPTP and twelve cases of ICT were studied in this retrospective research. Clinical symptom, pathologic feature and computed tomography (CT) image of patients with both tumors were analyzed, and the imaging features were compared with pathological results. Results The mean age of SPTP patients was 22.4 year-old. Twelve patients with SPTP presented a palpable abdominal mass as the initial symptom. It was observed that the tumor cells were located in a pseudopapillary pattern with a fibro-vascular core histologically. On the CT images, a mixture of solid and cystic structures could be seen in all the tumors. After taking enhanced CT scan, the solid portion was slightly enhanced in the arterial phase and the contrast intensity increased in the portal venous phase. On the other hand, the mean age of ICT patients was 39.3 year-old. The major symptom was due to the function of islet cell tumor, which was typical in 8 patients, presenting as Whipple triad. Histologically, cells demonstrated in trabecular, massive, acinar or solid patterns, and the blood supply of the tumor was abundant. On the CT images, most small tumors were difficulty to be detected. ICT could be markedly enhanced in the arterial phase and slightly enhanced in the portal venous phase on post-contrast CT scan. Conclusion Clinical symptom, pathologic feature and CT scanning are helpful to differentiate SPTP from ICT.
Objective To investigate the clinicopathologic features, diagnosis and differential diagnosis of pulmonary selerosing pneumocytoma (PSP). Methods A total of 13 cases of PSP were enrolled, and the clinical and imaging findings, pathologic features, and immunophenotype were collected and analyzed, with review of the literatures. Results Thirteen patients were all female, aged from 27 to 69 years old by first discovered, the average age was 53 years old. The maximum diameter ranged from 0.8 - 6 cm. It was mainly discovered accidentally by physical examination. According to the CT findings of 13 cases, all lesions were round or round-like, with a well-circumscribed mass. The “welt vessel sign” was suggestive to the diagnosis of PSP. Microscopically, the tumor was composed of two types of cells (surface epithelial cells and round mesenchymal cells), and four histological patterns (papillary, solid, hemorrhagic and sclerotic zone). Immuophenotype: thyroid transcription factor-1 (TTF-1) and epithelial membrane antigen were expressed on both epithelial cells and mesenchymal cells. Pan cytokeratin (PCK) and cytokeratin 7 were only expressed on epithelial cells, and vimentin on mesenchymal cells. Conclusion PSP is a rare lung benign tumor, preoperative and intraoperative freezing diagnosis are difficult, the diagnosis depends on the morphologic characteristics of paraffin-embedded tissue sections and immunohistochemical staining. The identification of mesenchymal cells with TTF-1 positive and PCK negative is the key to PSP diagnosis.
ObjectiveTo investigate the clinical features, differential diagnosis and treatment for chromophobe cell renal carcinoma (CRCC) and renal oncocytoma.
MethodsFrom December 2009 to May 2013, we selected 41 cases of CRCC and 22 cases of renal oncocytoma, retrospectively analyzed their clinical features, ultrasonography and CT findings and performed immunohistochemical staining for CK7, CD10, PAX-2, and Ksp-cadherin.
ResultsCRCC could be associated with lower back pain or hematuria, and renal oncocytoma generally did not have clinical symptoms. Ultrasonography and CT examination were not specific for the differentiation between the two diseases. The expression rates of CK7, CD10, PAX-2, and Ksp-cadherin in CRCC were 66% (21/32), 22% (7/32), 23% (3/13) and 93% (14/15), respectively. In patients with oncocytoma, 7% (1/15) were positive for CK7, 7% (1/15) were positive for CD10, 86% (13/15) were positive for PAX-2, and 31% (4/13) were positive for Ksp-cadherin. Pearson chi-square analysis was performed with a significant P value set at <0.05. The results of CK7(-)CD10(-)PAX-2(+) and CK7(-)CD10(-)Ksp-cadherin(-) immunohistochemistry were integrated, which also showed the differences.
ConclusionThe combination of CK7(-)CD10(-)PAX-2(+) and CK7(-)CD10(-)Ksp-cadherin(-) immunohistochemistry may be useful for differentiating between CRCC and oncocytoma. Combined with imaging examination, it can further improve the differential diagnosis of the two diseases.
ObjectiveTo elucidate the relationship between clinical characteristics and pathology findings of solitary pulmonary nodules (SPN).
MethodsA retrospective cohort study was carried out on 231 SPN patients pathologically confirmed between January 2009 and December 2013 in Nanjing General Hospital of Fuzhou Military Command and Fuzhou Second Hospital. Using pathological results as reference standard, the sex, age, smoking history, smoking amount, quit smoking history, and extrapulmonary malignant tumor history were compared between the SPN patients with different pathological type.
ResultsFemale and age were positively correlated with the probability of malignancy in SPN with correlation coefficients as 1.090 and 0.063 respectively. Extrapulmonary malignant tumor history, smoking history, smoking amount, quit smoking history did not show significant relationship. Gender was a factor that affects pathological types of SPN. Female patients were in higher risk than male patients to have precancerous lesions, pulmonary aspergillosis, pulmonary sclerosing hemangioma, adenocarcinoma. Male patients had higher risk suffering from pulmonary tuberculosis, pulmonary cryptococcosis, squamous cell carcinoma, adenosquamous carcinoma, inflammatory pseudotumor and metastases. Distribution of SPN pathologic types in each age group was similar. Most patients who had precancerous lesions, pulmonary hamartoma, pulmonary aspergillosis, pulmonary sclerosing hemangioma, adenocarcinoma and inflammatory pseudotumor were not smokers.
ConclusionsGender and age are valuable in distinguishing benign SPN from malignant SPN. Pathologic types of SPN are related to patients' gender and smoking history.
Objective To establish the overall diagnostic accuracy of the measurements of vascular endothelial growth factor (VEGF) for malignant ascites. Methods After a systematic review of current studies, sensitivity, specificity, and other measures of the value of ascites concentrations of VEGF in the diagnosis of malignant ascites were pooled by using random effects models. Qualified studies on evaluation of VEGF in diagnosis of malignant ascites in English and Chinese published from January 1990 to December 2009 were retrieved from The Cochrane Library, Cochrane Central Register of Controlled Trials, MEDLINE, EMbase, China National Knowledge Infrastructure (CNKI) databases, WanFang Data, and VIP Information. Two reviewers independently assessed the methodological quality of each study with the tool of QUADAS. Statistical analyses were performed by employing Meta-Disc 1.4 software. Meta-analyses of the reported sensitivity and specificity of each study and Summary Receiver Operating Characteristic (SROC) curve were performed. Results Seven studies met the inclusion criteria for the analysis. After testing the heterogeneity of the included studies, a random effect model was selected to calculate the pool weighted sensitivity and specificity with 95% confidence interval: the sensitivity was 0.81 (95%CI 0.75 to 0.85), the specificity was 0.90 (95%CI 0.86 to 0.94), the DOR was 50.45 (95%CI 28.37 to 89.73), and the AUC of SROC was 0.9507 (SE=0.013 0). The subgroups were analyzed to identify the sources of heterogeneity according to race and agent sources. There was homogeneity among the three studies with agents from Ramp;D company (χ2=0.05, P=0.9750; I2=0.0%), and the AUC of SROC were 0.9675 (SE=0.016 7). Conclusion VEGF has a highly accurate sensitivity and specificity with a b ROC curve, which makes it a new marker to differentiate malignant ascites from the benign.
Abstract： Sarcoidosis is a common systemic disease with noncaseating granulomatous epithelioid nodule and coexisting granulomatous inflammation. Although sarcoidosis can affect any organ of the body， more than 90% of the patients demonstrate thoracic involvement， which is often confusing with lung cancer and other diseases. Therefore, thoracic surgeons must have a clear understanding of sarcoidosis. Moreover， due to the special role of surgery in obtaining pathological specimens， thoracic surgeon plays an important role in the diagnosis and treatment of sarcoidosis. It is not difficult to make diagnosis for patients with typical clinical features of sarcoidosis. However， the majority of patients do not have specific manifestations of sarcoidosis. The cause of sarcoidosis remains unknown， and there is also no specific treatment strategy for it. But recent research has shown that annexin A11 gene may be involved in the pathogenesis of sarcoidosis， and tumor necrosis factor （TNF） inhibitor is effective in the treatwent of sarcoidosis.
Idiopathic intracranial hypertension (IIH) is a neurological disorder characterized by an unexplained increase in intracranial pressure that primarily affects obese women of childbearing age, but individuals of any age, gender, or weight may also be affected. Its signature symptoms include disc edema, headache, visual disturbance, and throbbing tinnitus. Due to potentially serious complications, such as vision loss, accurate diagnosis and appropriate treatment management are critical to improving patients' quality of life. Ophthalmologists play a key role in the treatment process, as about half of patients first visit the eye department. Diagnosis of IIH depends not only on clinical presentation, but also on the exclusion of other diseases that may cause similar symptoms, and imaging and other tests to ensure an accurate diagnosis. In order to improve diagnostic accuracy and treatment efficiency, multidisciplinary collaborative diagnosis and treatment mode is advocated, especially in the face of patients with complex trauma or systemic diseases, which can effectively shorten the treatment time and ensure patient safety. Future research directions include establishing China's IIH epidemiological database, exploring clinical diagnosis and treatment methods and basic scientific research, aiming at forming diagnosis and treatment standards suitable for China's national conditions, improving medical level and improving patient prognosis. At the same time, a deeper understanding of the different forms of IIH will better serve the affected populations.
ObjectiveTo summarize the clinical features of infection with Staphylococcus intermedius and its differential diagnosis.
MethodsA clinical case of Staphylococcus intermedius infection was analyzed and Chinese literatures about Staphylococcus intermedius infection were reviewed.The literatures were derived from domestic medical journals in CNKI Digital Library and Wanfang Databases from 1998 to 2015.
ResultsThe patient was a 35-year-old male.The chief complaints were cough and sputum associated with fever for three days.Chest CT scan showed cuneate and flocculent shadow with high density and unclear margin in the posterior segment of the right upper lobe and aerated bronchus sign was seen.Fuzzy shadow under the pleural was observed in the right lower lobe; On the right side of the chest, a little curved liquid density was seen.Sputum culture in Columbia blood agar plate and chocolate agar plate was done and Staphylococcus intermedius was identified.The final diagnosis of this patient was pneumonia caused by Staphylococcus intermedius.Fleroxacin 0.4 g per day was given by intravenous drip.Two weeks later, chest CT scan showed cuneate and flocculent shadow in the right upper lobe decreased obviously.Fuzzy shadow under the pleural the right lower lobe and pleural effusion on the right side of the chest disappeared.Four cases with Staphylococcus intermedius infection were reported and 3 were children.Two patients had open wound with infection.The involved organs included brain, joints, lungs, and one patient developed septicemia.Staphylococcus intermedius was identified from blood, sputum, cerebrospinal fluid, and pus from the open wound.By treatment with sensitive antibiotics three patients were cured but one patient with meningoencephalitis died of circulatory failure.
ConclusionsStaphylococcus intermedius infection can occur in many organs and its clinical manifestations are dependent on the infected location.Specimen culture for pathogen is necessary and blood, sputum, cerebrospinal fluid, and pus from the open wound are optional candidates.Cultivation of Staphylococcus intermedius is similar to that of Staphylococcus aureus and should be differentiated carefully.Early treatment with high sensitive antibiotics is effective with good prognosis.
