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.
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 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.
ObjectiveTo investigate the value of ultrasound contrast in the differential diagnosis for hepatocellular carcinoma (HCC) and hepatic focal nodular hyperplasia (FNH). MethodsTwenty-three HCC patients and 23 cases hepatic FNH patients from January 1, 2012 to January 1, 2014 in our hospital were selected, all of them were underwent ultrasound contrast examination before operation. The ultrasound contrast results of 2 groups patients were comparative analyzed. ResultsIn HCC group, the contrast arrival time was (3.8±1.9) s, peak time was (21.8±11.9) s, and peak strength was (28.8 ±3.1) dB; in hepatic FNH group, these indicators was (2.3±1.4) s, (35.3±14.8) s, and (22.3±7.9) dB, respectively. These indicators of HCC group was longer or shorter or higher than those of hepatic FNH group, respectively (P < 0.05). The sensitivity, specificity, and accuracy of ultrasound contrast diagnosed HCC was 91.3% (21/23), 87.0% (20/23), and 95.7% (22/23), and diagnosed hepatic FHN was 87.0% (20/23), 91.3% (21/23), and 91.3% (21/23), respectively, the difference were not statistically significant between the two groups (P > 0.05). ConclusionUltrasound contrast has very important application value in the differential diagnosis of HCC and hepatic FNH, can be used in clinical application.
ObjectiveTo evaluate the differential diagnosis and treatment of nonfunctional parathyroid cyst. MethodsThe data of 6 patients with nonfunctional parathyroid cyst, who underwent operation in general surgical department of China Medical University Shengjing Hospital between January 2003 and April 2013 were retrospectively analized. ResultsNo patient got definite diagnosis before operation.Preoperative diagnosis were thyroid cyst in 4 patients, neck mass in 1 patient, and thyroid cancer in 1 patient.All patients received operation, included parathyroid cystectomy in 5 patients and thyroid cancer radical resection plus parathyroid cystectomy in 1 patient.Two patients were lost to follow-up, 4 patients were followed-up for 9-24 months, average 19 months, there were no parathyroid cyst and thyroid cancer recurrence or metastasis. ConclusionsNonfunctional parathyroid cyst is true cyst, it is rare lesion in neck, and preoperative definite diagnosis rate is low.The cystectomy is a safe and effective treatment method.
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 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.
【Abstract】ObjectiveBy using multidetector row spiral CT (MDCT) to investigate the CT imaging findings of gallbladder abnormalities caused by hepatic parenchymal diseases and those of inflammatory cholecystitis. MethodsCT and clinical data of 80 patients with gallbladder abnormalities were retrospectively reviewed. Fifty patients were in hepatic disease group, including 20 chronic hepatitis, 25 liver cirrhosis, and 5 cirrhosis with hepatocellular carcinoma. Thirty patients were in inflammatory group, including 19 chronic cholecystitis, 6 acute cholecystitis, 3 cholecystitis with acute pancreatitis, 1 gangrenous cholecystitis, and 1 xanthogranulomatous cholecystitis. All patients underwent MDCT plain scan and contrastenhanced dualphase scanning of upper abdomen. ResultsIn hepatic disease group, 48 cases had evenly thickened gallbladder wall (96%) with mean thickness of (3.67±0.49) mm; 38 cases had clear gallbladder outlines (76%); 38 cases had gallbladder wall enhancement of various degree (76%); 14 cases had gallbladder bed edema and localized nondependant pericholecystic fluid collection (28%). In inflammatory cholecystitis group, 28 cases had obscuring gallbladder outlines (93%) ; 26 cases had gallbladder wall evenly thickened (87%), 4 cases showed unevenly thicked wall (13%), the mean thickness being (4.54±1.14) mm; 30 cases had inhomogenous enhancement of the gallbladder wall (100%); 9 cases had highattenuation bile (30%); 4 cases had dependant pericholecystic fluid collection (13%); 5 cases had transient enhancement of adjacent hepatic bed in arterial phase (17%); microabscess and gas in the gallbladder wall was observed in 1 case respectively. ConclusionMDCT can offer imaging findings useful for differentiating abnormal gallbladder changes caused by hepatic parenchymal diseases from those due to inflammatory cholecystitis.
Diagnosis and treatment of solitary pulmonary nodule (SPN, less than 30 mm in diameter) has been a formidable problem in clinical work. It is often detected in medical examination or other disease examinations by chance. There are no corresponding signs and symptoms of SPN except those on the imaging, so it is difficult to make a correct diagnosis as early as possible. Literature shows that there is a certain probability of malignant SPN, so early correct diagnosis is the key factor in deciding the prognosis and appropriate treatment. With the accumulation of clinical experiences, the development of new fiberoptic bronchoscopy, highresolution CT, and videoassisted thoracoscopic surgery, as well as the evolution of some invasive examination technologies, it is less difficult in distinguishing benign from malignant SPN than ever before. In this article, we will make a comprehensive review on the development in the aspect of differential diagnosis of SPN.
ObjectiveTo evaluate the diagnostic value of ultrasound for gallbladder carcinoma (GA), in order to improve the ability of early ultrasonic and clinical diagnosis of GA. MethodsWe analyzed and compared the clinical data and ultrasonic results of 42 GA cases confirmed by surgery and pathology between January 2008 and December 2013, and summarized the classification, ultrasonographic features, and diagnosis of GA. ResultsAmong the 42 cases, 25 were correctly diagnosed by ultrasound (59.5%), among which 9 were thick-wall type, 11 were protrusion type and 5 were solid type. Seventeen cases were misdiagnosed (40.5%). Pathological results showed 14 cases of highly-differentiated adenocarcinoma, 16 of moderately differentiaed adenocarcinoma, 9 of poorly-differentiated adenocarcinoma, 2 of squamous adenocarcinoma and 1 of neuroendocrine carcinoma. ConclusionUltrasound is the preferred method for the diagnosis of GA because of its convenience, although the diagnostic accuracy is still not good and more efforts should be done.