OBJECTIVE: To summarize the clinical and spiral computed tomography (CT) features of undifferentiated embryonic liver sarcoma (UELS) in adults. METHODS: Clinical and CT findings of four adult patients with pathology‐approved UELS were retrospectively analyzed with a literature review. All patients were examined using a plain and enhanced spiral CT scan. RESULTS: The participants were two men and two women with a mean age of 36.5 years. The clinical manifestations were the right upper quadrant mass, pain ( n = four) and intermittent fever ( n = three). Laboratory tests showed a mild elevation of alpha‐fetoprotein in one patient and mildly abnormal liver function in two. Liver cirrhosis was present in one patient coexistent with hepatocellular carcinoma. CT findings indicated a huge well‐defined cystic‐solid mass with varying degrees of enhancement of the solid component. Irregular high‐density lesions showing hemorrhage occurred in three patients and the inferior vena cava was compressed in one. CONCLUSION: UELS showed a solitary and predominantly cystic or multicystic appearance on CT imaging compared with ultrasound (US) from the medical literature, which shows a predominantly hypoechoic mass. The laboratory tests were normal or mildly abnormal despite the presence of the large mass. The combination of these clinical features and CT findings together with those of US are helpful in making a prospective diagnosis.
Objective To analyse shifts patient′s clinical material and the treatment research to 63 example lung cancer bone.Methods 63 consecutive cases were analyzed with bone scanning and compared with other radioiogical examinations(MRI,CT and X-ray).All cases were confirmed by cytology and / or histological.They were randomly divided into two groups: Group A :30 cases(the same period of radiotherapy and chemotherapy plus pamidronate;) and group B:33 cases(Sequential radiotherapy and chemotherapy + pamidronate).All patients were followed up more than 1 year.Results The most cases were adenocarcinoma(65.1%).27 cases of 63 cases were single bone metastasis(42.9%).36 cases were multiple bone metastasis(57.1%).The rib bone was the most frequent metastatic sites(17.5%).The pain relief rate(CR+PR) was 86.7% in group A,39.4% in group B.There was significant difference between group A and group B(χ2= 5.416 7,P=0.02).The total effective rate of partial lesion(CR+PR) was 60.0% in group A,and 33.3% in group B.There was significant difference between group A and group B(χ2=4.498 2,P=0.034).Conclusion Adenocarcinoma has the highest rate of osseous matastasis,By sends the bone to shift sees.The comprehensive treatment based on radiotherapy and chemotherapy can significantly reduce the symptoms.
Objective To evaluate contrast enhanced subtraction dynamic MRI in the diagnosis of breast diseases.Materials and Methods MRI of breast was performed in 40 patients with mammographic or clinically palpable abnormalities before surgery. Fat suppressed T 2WI was followed by FLASH 3D sequences with which dynamic images data were obtained. With a bolus injection of Gd DTPA (0.1mmol/kg), digital subtraction was performed on selected images. MIP was carried out for enhanced lesions. Subtraction images were compared with the relevant conventional images.Results Subtraction images alone could reveal 87.5% (35/40) of total lesions, and 100% of all malignant lesions (21/21), with the extent and features of the lesions being better demonstrated. Abnormal blood vessels were displayed well on MIP images.Conclusion Digital subtraction is an effective and simple postprocessing technique, and dynamic contrast enhanced subtraction studies are very useful in the diagnosis of breast diseases.
Objective To investigate CT features of focal nodular hepatic fatty infiltration (FNHFI).Materials and Methods This study included 23 patients with CT diagnosed FNHFI. Follow up observation for 6～28 months (mean 8.5 months) was carried out in all patients. CT findings on both plain and enhanced scans, as well as additional CTA in 3 cases, were retrospectively analyzed.Results A total 25 lesions was found in 23 cases. Of the 25 lesions, 24 were situated at the medial segment of the left lobe, of which 19 were located by the side of falciform ligament and 5 at the posterior border of medial segment. The another lesion was located in the lateral segment of the left lobe by the side of falciform ligament. The lesions took the form of round, oval or triangular shape, with sharp (n=14) or blurred (n=11) margin and a diameter of 0.8～3.5 cm (mean 1.6 cm). No marked space occupying effect was seen. After intravenous injection of contrast, the lesions showed slight enhancement. Vanishing of the lesion was seen in one case during follow up checkups.Conclusion The medial segment of the left lobe, nearby the falciform ligament or porta hepatis, is the site of prediction in FNHFI. Familiar with its prediction site and CT features is of great importance for the diagnosis of FNHFI.
To determine the value of contrast-enhanced ultrasonography (CEUS) in the diagnosis of renal occupying lesions.Seventy-eight patients with a preliminary diagnosis of renal masses in West China Hospital, Sichuan University were examined by CEUS. The characteristics of enhancement, phase of enhancement/decline, pseudocapsule sign, and time-intensity curve (TIC) were compared between the malignant and benign lesions.Of the 78 renal occupying lesions, 50 were malignant and 28 were benign. Malignant lesions showed enhanced signs to various degrees. The renal clear cell carcinoma mainly presented as "fast wash-in and fast wash-out", while the other malignant lesions presented as " slow wash-in and fast wash-out" Pseudocapsule signs were found mostly in renal clear cell carcinoma. No enhancement was found in renal cyst. Renal angiomyolipoma presented as diffuse hypo-enhancement characterized with "slow wash-in and slow wash-out". The time-to-peak (TTP) in malignant lesions appeared earlier than benign lesions. Higher levels of peak intensity (PI) and area under the curve (AUC) were found in malignant lesions compared with the benign lesions (P<0. 05).CEUS plus time-intensity curve can provide evidence for identifying different kinds of renal occupying lesions.
Objective:To evaluate CT in the diagnosis and staging of prostate cancer.Methods:40 cases of prostate cancer,of which 24 cases were confirmed by pathology and biopsy and 16 by clinical data,were performed CT scanning.12 of 40 cases were processed with 3D MPR.A comparative study of CT staging and clinical staging referred to JW criteria was subsequently made. Results:In 40 cases of prostate cancer,their CT appearances were as following:the prostate was normal in size in 2 cases and enlarged in 38 cases;the lesion was limited in the prostate in 17 cases and extended over the prostate in 23;the density of mass was lower than the normal prostate in 27 cases(67.5%) and there was mixed density with equal to and lower than normal in 3 cases (7.5%).The density of mass in 10 cases (25%) appeared equal to normal on non enhanced CT but turned lower on enhanced.Patchy calcification was seen in 13 cases. Involvement of seminal vesicle,bladder and rectum,pelvic lymph nodes enlargement and distant metastasis were shown in 11,19,9,5,6 cases respectively.The comprehensive CT signs were demonstrated in 23 cases (57.5%).The accuracy of CT staging in stage C,D and overall accuracy was 90%, 66.7% and 82.5%,respectively.The sensitivity of CT was 90% for distinction between stage A/B and C/D.Conclusion:The comprehensive CT signs may be specific in diagnosing prostate cancer which together with 3D MPR are helpful to locate tumor. CT can accurately distinguish prostate cancer with the stage A/B from C/D,and make an accurate diagnosis of prostate cancer with the stage C/D.
Vesical paragonimiasis is an extremely rare form of ectopic infestation caused by <i>Paragonimus</i> spp. We reported a case of vesical paragonimiasis associated with urinary symptoms but without history of respiratory symptoms or cercarial dermatitis. The diagnosis was made by histopathological examination of the surgical specimens of the vesical masses. Identification of the species by morphometric analysis of the fluke body sections indicated that the vesical lesion was caused by<i> Paragonimus. </i>Postsurgical medication with the antiparasitic drug praziquantel was applied regularly, and the patient experienced a stable recovery.
Objective
To explore the safety and efficacy of a new trans-lumbar-and-peritoneally joint (TLPJ) approach for treating renal cell carcinoma by laparoscopic operation.
Methods
From January, 2007 to December, 2013, one hundred patients with renal tumor were divided into 4 groups according to the size of tumors and operative approaches. And the clinic information was compared retrospectively. Group A (TLPJ laparoscopic partial nephrectomy) included 17 male and 13 female with average age (49.7±14.5) years old and average weight (65.2±14.1) kg. The location of tumor included 16 in left kidney and 14 in right kidney. The mean size of tumor was (4.2±0.9) cm. Group B (trans-peritoneal laparoscopic partial nephrectomy) included 16 male and 14 female with average age (48.5±13.9) years old and average weight (63.9±15.0) kg. The location of tumor included 17 in left kidney and 13 in right kidney. The mean size of tumor was (4.3±1.0) cm. Forty patients with tumor size over than 7cm were divided into group C and group D. Group C (TLPJ laparoscopic radical nephrectomy) included 11 male and 9 female patients, with average age (52.3±13.1) years old and average weight (64.4±13.5) kg. The mean tumor size was (8.5±0.9) cm. 12 tumors were located in the left kidney and 8 in right kidney. average tumor size. Group D (trans-peritoneal laparoscopic radical nephrectomy) included 12 male and 8 female patients with average age (53.5±12.8) years old and average weight (65.0±13.6) kg. 10 tumors were located in the left kidney and 10 in right kidney. The average tumor size was (8.7±0.9) cm. General anesthesia was applied in all groups. The body position and the surgical approach in group A and C were similar to the retroperitoneal approach. However, the entire side peritoneum was opened to connect the retroperitoneal space with the abdominal space, which largely extended the operative space and was particularly appropriate for the manipulation of the tumors with large size or in special location.
Results
All patients experienced successful operation without the open approach conversion. For patients in group A and B, the operative duration were (109.5±22.5) and (110.7±23.6) mins. The time of warm ischemia were (24.0±2.5) and (24.8±2.4) min. The estimated blood loss (EBL) were (61.0±17.0) and (70.0±15.5) ml with one patient and two patients needed blood transfusion, respectively. The time for gastrointestinal function restoration were (41.3±6.4) and (53.7±5.2) h. There were no significant differences between the two groups in comparing those parameters mentioned above (P>0.05). For patients in group C and D, the operative duration were (100.8±21.4) and (106.4±20.5) min. The EBL were (40.0±9.5) and (48.5±9.0) ml without any case needed blood transfusion. The time for gastrointestinal function restoration were (39.7±6.2) and (52.3±5.8) h. There were no significant differences between the two groups in comparing those parameters mentioned above (P>0.05). All patients gained a satisfactory recovery after a hospital stay of 3.5 to 6.3 days, without any severe postoperative complications, such as intra-abdominal organ injury and intestinal obstruction. During a follow up from 3 to 84 months, one patient was found recurrence in group A and a new occurrence of renal tumor appeared in one patient in group B. Both of them presented survivals of non-neoplasm after an immediately radical nephrectomy. In group C, no recurrence was reported.2 cases were diagnosed as pulmonary metastases, in which one died due to this disease. The other one survived with tumor after 6 months therapy of targeted drugs. Two cases died due to the pulmonary metastases in group D.
Conclusions
Partially or radically laparoscopic nephrectomy could be completed safely and efficiently with TLPJ approach. This approach is especially suitable for large renal neoplasms or the neoplasms nearby peritoneum.
Key words:
Laparoscope; Renal neoplasm; Trans-lumbar-and-peritoneally joint approach; Operation
Abstract Background: Tumor regression grade (TRG) correlates with prognosis in patients with locally advanced rectal cancer (LARC), but there is controversy regarding the use of magnetic resonance imaging (MRI) for determining TRG. This study to evaluate the diagnostic value of change rate in signal intensity (SI) and volume (V) from MRI to TRG following preoperative chemoradiotherapy (CRT) in patiens with LARC. Materials and methods: This retrospective analysis examined 82 LARC patients who were admitted to our institution between Oct 2017 and Oct 2019. Patients underwent pre- and post-CRT T2-weighted (T2W), diffusion-weighted (DW)/apparent diffusion coefficient (ADC), and contrast-enhanced T1-weighted (ceT1W) MRI. Change rate of volume and relative SI ratio(%△V and %△SIR) from each sequence were determined. All LARCs were confirmed pathologically and classified into TRG 0, 1, 2 and 3. Descriptive statistics and receiver operating characteristic (ROC) analysis, with calculation of area under the curve (AUC), were used to compare the diagnostic performances. Results: Sixteen patients had TRG-0, 15 had TRG-1, 35 had TRG-2, and 16 had TRG-3. Except for ADC-%△SIR, the remaining%△V and %△SIR on T1W, DWI, and ceT1W had significant differences among the four groups. %△V and/or %△SIR did not distinguish TRG-1 from TRG-2 nor TRG-2 from TRG-3, but differences between other TRGs were identified by %△V and/or %△SIR on T2W, DWI, and ceT1W. The combined use of DW-%△V and T2W-%△SIR provided the best diagnostic performance in distinguishing of TRG-0 from TRG-2 (AUC: 0.954) and from TRG-3 (AUC: 1.000). Conclusions: Preoperative MRI of LARC patients can determine TRG and may improve selection of the preoperative therapy.
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