ObjectiveTo improve the diagnosis and treatment of multiple systemic sarcoidosis (MSS) and avoid misdiagnosis. MethodsTo analyze the diagnosis and treatment of a MSS patient misdiagnosed as lymphoma. Related literatures were also reviewed. ResultsThe patients' clinical manifestations were not specific including cough and stethocatharsis. Lung and thoracic lymph nodes were most commonly involved in MSS. MSS was characterized by symmetrical lymph nodes enlargement in the bilateral lung hilus and/or mediastinum. The enlarged lymph nodes had a clear boundary and showed homogeneous enhancement. Symmetrical fluorodeoxyglucose (FDG) uptake in the hilar and/or mediastinal node was a typical finding of sarcoidosis on FDG PET/CT. Mucosal inflammation and mucosal nodules could be seen in the bronchoscope. Sarcoidosis was characterized by the presence of noncaseating groanulomas histologically. Hormonal therapy was effective for MSS. ConclusionSarcoidosis is a kind of disease involving multiple systems and organs with unknown etiology. The clinical manifestation of sarcoidosis is nonspecific,so it's likely to be misdiagnosed. Imaging examination and laboratory examination are helpful to the diagnosis of MSS. The definitive diagnosis depends on the pathologic biopsy.
目的：评价CT引导下经皮穿刺活检肺内小结节病灶的诊断价值。方法：在CT导向下穿刺活检肺内直径≤2 cm的孤立性的小结节病灶51例，作细胞学和组织学的检查。结果:本组51例共行58次穿刺活检，24例获得细胞学涂片检查，39例获得组织学检查。诊断准确率82.3%（42/51）。并发症主要为肺出血和气胸，其发生率分别为21.6%（11/51）和13.7%（7/51）。结论：CT导向下穿刺活检肺内小结节病灶的诊断确诊率高，并发症轻。可作为一种常规检查手段。
Objective To investigate the association between preoperative serum TSH concentration and thyroid carcinoma in patients with nodular goiter.Methods Data of 632 patients with nodular goiter from January 2004 to December 2010 were analyzed retrospectively.Results Preoperative serum TSH in nodular goiter with thyroid carcinoma was higher than that without thyroid carcinoma，which was （2.10±1.38）mU/L and （1.51±0.98）mU/L，respectively （P＜0.000 1）.The risk of malignancy increased as serum level of TSH rose in nodular goiter patients （P=0.023 5），the ratios were 9.91% （0.3-0.9mU/L），12.37% （0.9-1.7mU/L）， 20.09% （1.7-4.8mU/L），and 27.27%（＞4.8mU/L）.The TSH level of stageⅢ-Ⅳ patients higher than that stageⅠ-Ⅱ patients （P=0.030 6）.The diameter of tumor ＞4 cm had highest mean TSH level， and which ≤ 2cm had lowest mean TSH level（P=0.018 6）. Conclusion Preoperative serum TSH level perhaps is a risk predictor for nodular goiter with thyroid carcinoma.
目的 探讨结节性甲状腺肿与甲状腺癌并存时的诊治方法。 方法 回顾性分析我院1961～2000年手术治疗的4 622例结节性甲状腺肿病例中169例并存甲状腺癌患者的临床资料。 结果 患者平均年龄（42.71±12.96）岁，病程平均19.15年； 43例出现短期内颈部肿块快速长大，32例有气管受压症状，27例出现声音嘶哑； 行超声检查105例，提示甲状腺癌者52例； 行放射性核素扫描检查38例，24例显示甲状腺内凉结节或冷结节； 行术前细针穿刺细胞学检查18例，找到癌细胞11例。术前确诊率为12.43%。术中行快速病理检查57例，55例诊断为甲状腺癌。 结论 在结节性甲状腺肿临床表现的基础上出现颈部肿块增长迅速、气管受压、声音嘶哑等症状时应高度怀疑结节性甲状腺肿与甲状腺癌并存； 甲状腺彩色超声多普勒、甲状腺核素扫描、细针穿刺细胞学等检查对诊断本病有重要意义； 术前检查怀疑甲状腺癌者术中应行快速冰冻切片病理检查，可有效避免再次手术。
ObjectiveTo explore the clinical features and sum up the laws of the hepatic focal nodular hyperplasia (FNH) in its diagnosis and treatment. MethodsFNH was an uncommon benign hepatic tumor that often posed diagnostic dilemmas. We analyzed retrospectively the clinical, imaging of ultrasound, imaging of computed tomography (CT) and magnetic resonance images (MRI), and pathological materials of 21 patients with FNH proven by the pathological diagnosis during 5 years from April 1996 through April 2001 in two hospitals. ResultsThe diagnosis of FNH remained a challenge for clinicians and surgeons. Rate of correct diagnosis of FNH was low preoperatively (19.0%). The lesions of FNH were seen in males and females (m/f: 14/7). Only three female patients (3/7) had the history of taking oral contraceptive. Patients with FNH were largely young and middle age persons (81.0% under 50 years), discovered by accident (57.1%), without infection of the hepatitis B virus (95.2%) and with normal liver functions (100%) and serum AFP levels (100%). Color Doppler ultrasound showed blood vessels passing through the lesion (80.0%) and there was abundant in blood (66.7%). CT scan showed that the lesion had transient immediate enhancement in 60.0% of patients and had homogeneous signal in 60.0% after bolus injection. MR imaging demonstrated early vigorous enhancement (64.3%), homogenous signal (57.1%) and having central scar (35.7%) in the lesion. The demonstration of a central scar in the lesion was very helpful for the diagnosis of FNH. MRI was more helpful for the diagnosis of FNH using liver specific contrast agents: superparamagnetic iron oxide（SPIO）. All patients underwent focus resection (18 cases) or segmentectomy (2 cases), except one having no treatment. ConclusionFNH shows some typical clinical and imaging features. We could increase the rate of correct diagnosis by comprehensively analyzing the clinical and imaging materials. It is very important and necessary to determine a definite diagnosis of FNH, hepatic adenoma (HA) and primary liver cancer (PLC) preoperatively, because the HA and PLC must be surgically resected, FNH can only be followed up.
Objective To summarize the clinical characteristics of polyarteritis nodosa which begin with pulmonary lesions, so as to make early diagnosis and treatment possible. Methods Clinical data of three patients of polyarteritis nodosawhich began with pulmonary lesions were summarized includingmode of onset, evolvement of symptom and sign, data of laboratory test. The results of vascular ultrasound and histopathology examination were analyzed for their diagnostic value.Results Cough, sputum productive cough, and irregular high fever were present in the earlier period. Increases of C-reactive protein ( CRP) , erythrocyte sedimentation rate ( ERS) , white blood cell count ( WBC) , and anemia were main laboratory findings. Computed tomography revealed scattered infiltration in the lung. Anti-infective treatment was ineffective. Involvement of skin, kidney, gastrointestinal tract, nerve and muscle was present in sequence. Two of the three cases were confirmed by pathological biopsy. The symptoms were improved by the treatment with glucocorticoid. Conclusions Polyarteritis nodosa which begin with pulmonary lesions is easy to misdiagnose due to atypical symptoms. It is important for diagnosis of polyarteritis nodosa to collect evidence of systematic involvement through taking careful history and physical examination. Further angiography and biopsy can confirm the diagnosis. Cytotoxic drugs and/ or glucocorticoid are effective for the treatment of polyarteritis nodosa.
Objective To improve the knowledge of pulmonary sclerosing hemangioma ( PSH)especially with bilateral multiple lesions of the lung. Methods The clinical data of 3 cases of PSH ( 1 case with bilateral multiple lesions in the lung) were analyzed, and the related literatures were reviewed. Results All of the 3 cases were females. A 22-year-old female patientwith bilateral multiple nodules in the lungs was complicated with thyroid multiple nodular goiter ( with hypothyroidism) , dysfunctional uterine bleeding ( with anemia) , nodular hyperplasia of the breast, and arteriovenous malformation over forearm. Thoracoscopicbiopsy of left lung and resection of the right pulmonary mass were performed and both the lesions were confirmed as PSH. The clinical manifestations of multiorgan diseases and the presence of PSH suggested Cowden syndrome in this patient. The other 2 cases aged 50 and 53 were asymptomatic with solitary pulmonary nodules identified incidentally. The accessory examinations for malignancies, infections, and autoimmune diseases showed no specific findings. Resection of the lesions were performed by thoracoscopic surgery and thoracotomy respectively, and the histopathological results proved to be PSH. Literature review showed that PSH typically occurred in middle-aged women without clinical symptoms and signs, often presenting as a pulmonary solitary nodule/mass identified incidentally. The differential diagnosis should include peripheral carcinoma, hamartoma, inflammatory pseudotumor and tuberculoma. Multiple PSH, which mainly presented as multiple well-defined nodules /masses of different size in the lungs, was rather rare, but easily confused with metastatic neoplasm. Lung biopsy by surgical operation was a common way to confirm the diagnosis, while FDP-PET and fine needle aspiration biopsy showed some defects. Surgical resection was an effective method of treatment, the residual lesions of multiple PSH should be monitored. Cowden syndrome may be considered if a PSH coexisting with abnormity of multiple organs such as thyoid, breast and vessels. Conclusions PSH should be considered during the differential diagnosis for solitary or multiple nodules /masses in the lung. Surgical biopsy is a common way to confirm the diagnosis. Local excision andnecessary follow-up are effective methods of treatment.