2015年 · 第49卷第12期

Mucoid soft tissue tumors do not refer to a specific disease, but to a group of soft tissue neoplastic lesions characterized by containing a large amount of extracellular mucous matrix. In the 4th edition of the WHO classification of soft tissue and bone tumors^[1]Soft tissue tumors with the word "mucus" clearly in the nomenclature include myxoid liposarcoma, myxoinflammatory fibroblastic sarcoma, myxofibrosarcoma, low grade fibromyxoid sarcoma, dermal nerve sheath myxoma, acral fibromyxoma, intramuscular myxoma, juxta-articular myxoma, deep ("aggressive") angiomyxoma or aggressive angiomyxoma, ossifying fibromyxoid tumor, and extraskeletal myxoid chondrosarcoma, all of which are classified as myxoid soft tissue tumors. In addition to the above-mentioned tumors, although some soft tissue tumors do not have the word "mucus" in their names, they are often rich in extracellular mucus matrix or can undergo obvious mucus degeneration, so they are often classified as mucinous soft tissue tumors, including tendon sheath cyst, neurogenic tumors (schwannoma, perineurioma, neurofibroma, ganglioneuroma), nodular fasciitis, grape cluster rhabdomyosarcoma, leiomyosarcoma, etc.^[2,3]。

low-grade fibromyxoid sarcoma (LGFMS) is rare in clinical practice, and most of the relevant reports at home and abroad are case reports. Tumors mostly occur in the lower limbs and trunk, and their histomorphology is often benign, but they have the potential of local recurrence and distant metastasis^[1]。 The author retrospectively analyzed 6 cases of LGFMS confirmed by surgery and pathology in Nanfang Hospital of Southern Medical University from 2009 to 2015, and summarized their clinical manifestations, imaging features and pathological characteristics combined with literature review, in order to improve the understanding of this disease.

female urethral diverticulum (FUD) is a pocket-like structure that appears between the periurethral fibromuscular layer and the anterior vaginal wall. The prevalence of female urethral diverticulum is low, accounting for 0.6% ~6.0% of females^[1,2]It is more common in women aged 30 to 50. The clinical manifestations of FUD are not specific, the diagnosis is difficult, and the clinical misdiagnosis is easy. Imaging examination, especially MRI, has unique advantages in the diagnosis of pelvic diseases^[3,4]。 The MRI data of 10 patients with FUD diagnosed by surgery and pathology were retrospectively analyzed in order to explore the MRI characteristics of FUD.

Many diseases can affect the spleen, and the stiffness of the spleen is an important index to evaluate the degree of its lesions. Spleen palpation and ultrasound elastography are common clinical methods to evaluate spleen stiffness in vitro, but these two techniques have certain limitations. magnetic resonance elastography (MRE) is a technique to quantitatively detect the elastic properties of tissues through the conduction of mechanical waves^[1]。 Has been used to evaluate organs such as liver, brain tissue and prostate^[2,3,4], and scholars used to assess spleen stiffness in patients with portal hypertension^[5,6]Shown to have some value. By observing the manifestations of spleen MRE in healthy adults and patients with spleen enlargement caused by different lesions, the author aimed to explore the feasibility and value of MRE in diagnosing spleen lesions.

peritoneal dialysis (PD) is widely used worldwide as a treatment for end-stage renal disease^[1,2]。 Complications may occur in all aspects of PD, and in severe cases, patients can terminate PD treatment for a short or long time. Therefore, early and correct diagnosis of peritoneal dialysis-related complications is crucial. Some foreign scholars have applied CT peritoneography (CTp) to examine the complications related to peritoneal dialysis, and achieved very good results^[3,4]。 The author aimed to explore the value of CTp in the diagnosis of complications related to peritoneal dialysis.

malignant schwannoma (MS) is a rare soft tissue malignant tumor, with a clinical incidence of only 0.001%, accounting for 3% ~10% of soft tissue sarcomas. At present, no bulk cases of bronchopulmonary MS have been reported^[1,2,3]。 Because it is very rare in clinic, it is often misdiagnosed as lung cancer or other malignant tumors before surgery^[2]。 Common lung cancer generally requires lobe or one side pneumonectomy + regional lymph node dissection, some still need adjuvant radiotherapy and chemotherapy, and most of them have poor prognosis; However, the malignant degree of bronchopulmonary MS is relatively low, and the prognosis is good. There is no need for radiotherapy and chemotherapy after operation^[3]。 The CT and clinical data of 7 cases of bronchopulmonary MS were retrospectively analyzed, and the imaging features and their correlation with pathological features were summarized, aiming at improving the diagnostic level of this disease and providing help for clinical diagnosis and treatment.

The patient was a 21-year-old female. He was admitted to hospital for 3 months due to nasal congestion with purulent discharge for 1 year, occasional headache, stuffy ear, hearing loss and bloodshot nasal discharge. Nasal examination: There is no deformity in the external nose, the nasal septum is centered, the nasal mucosa is slightly congested, and all nasal passages are accumulated with pus. Gray, soft new organisms were seen in bilateral lower nasal passages without ulceration. Nasal ventilation was poor, tenderness in each sinus area was positive, and rough sense of smell was poor.

A 10-year-old male was seen on January 29, 2015 due to weakness of both lower limbs for 2 years. Two years ago, the child developed weakness of both lower limbs, which was manifested as a fall when walking, and the movement up and down the stairs and squat was acceptable, but the weakness of the left leg was obvious. 16 months ago, there was no obvious inducement to aggravate the weakness of both lower limbs, accompanied by difficulty in moving up and down the stairs and squatting, gradually appearing clumsy hands, incoherent speech, occasionally choking and coughing after drinking water and dysphagia. Three months ago, I was struggling to lift my left leg and could not stand and walk. Since the onset of the disease, the ability to control urination has been weakened, bedwetting at night, and stool control is acceptable. The past history and family history were not special, and there was no obvious history of psychomotor development retardation. Physical examination of the nervous system after admission: clarity, poor fluency in language, poor computational ability, bilateral knee reflex, Achilles tendon hyperreflex (+ + + +), bilateral Babinsky sign (+). The results of out-of-hospital genetic testing showed that one site heterozygous missense mutation was found in the glial fibrillary acidic protein (GFAP) gene, and one site heterozygous deletion mutation was found in the 3 '-5' exonuclease DNase Ⅲ (three-prime repair exonuclease 1, TREX1) gene. Cranial MRI after admission (5 February 2015) showed diffuse lesions of bilateral subcortical white matter, bilateral internal capsule, bilateral brachiopontine, dentate nucleus, and bilateral dorsal medulla oblongata with multiple symmetrical T₂WI hyperintensity, bilateral lateral paraventricular white matter showed symmetric T₁WI high signal, T₂WI Low Signal (Figure 1，Figure 2，Figure 3), mild atrophy of the brainstem and cerebellum (Figure 4）。 Combined with the out-of-hospital genetic test results and the characteristics of cranial MRI, the diagnosis of juvenile Alexander disease (AXD).

The 52-year-old female was seen on January 10, 2015 due to headache and nausea for 3 days. She had no other special signs. She had undergone retinal detachment surgery in a foreign hospital 8 years ago. Imaging examination: CT plain scan showed a round-like high-density shadow in the fourth ventricle, about 1.8 cm in diameter, with a CT value of about 55 HU (Figure 1), uniform density and smooth edges; MRI plain scan T₁WI showed a slightly low signal (Figure 2), T₂WI and water inhibition showed a slightly high signal (Figure 3), the edge signal is higher; No enhancement was observed on enhanced scan lesions (Figure 4）。 Eyeball imaging manifestations: CT plain scan showed a uniform high density shadow in the right vitreous body, with a CT value of about 65 HU (Figure 1), uniform density; MRI plain scan of the right vitreous body showed a slightly longer T₁Slightly longer T₂Signal, water inhibition showed high signal, and no enhancement was seen in the enhancement scan. According to the surgical history, the initial diagnosis was that silicone oil was implanted into the ventricle in the vitreous body. Subsequently, CT and MRI scans were performed with silicone oil stock solution, and the imaging findings were similar, thus confirming the diagnosis.

The 5-year-old child was seen on October 2, 2014 due to a reduction in speech for half a month and weakness in her right limb for 2 days and gradually aggravated. Neurological examination showed: less speech, adduction of the left eye, incomplete abduction and inflexibility of the left eye; Right lower limb muscle strength grade 4; Wide step base, spastic gait; Positive Babinsky sign in both lower limbs. Blood routine: platelets 497×10⁹/L (normal reference value 100~300×10⁹/L); Cerebrospinal fluid routine: Immunoglobulin G (IgG) 64.1 mg/L (normal reference value 10~40 mg/L), IgG production index 0.9 (normal reference value 3~8).

A 33-year-old female was found to have pulmonary nodules during physical examination in November 2014, without cough and sputum, chest tightness, breathlessness, and general bone and joint pain. A plain chest CT scan was performed on 5 Dec 2014 (Figure 1) shows that both lungs can be seen in nodular shadows of different sizes, with clear boundaries and uniform density. The patient did not have an enhanced chest CT scan. After medical history, the patient discovered uterine fibroids in 2004, and underwent laparoscopic myomectomy in November 2005. Postoperative pathology showed uterine leiomyoma, rich cell type. In March 2010, a pelvic mass was discovered, and exploratory laparotomy was performed. Intraoperative findings were as follows: the uterus was enlarged at 2 months of pregnancy, uneven, and multiple fibroids were seen. Fibroids were seen on the bladder surface, mesileum, omentum, and mesappendix. Uterine fibroidectomy + bladder fibroids, omentum fibroids, mesenteric fibroids, mesappendix fibroidectomy + cervical polypectomy were performed. Postoperative pathology: peritoneal disseminated leiomyoma, endometriosis and cyst formation. Thoracoscopic wedge resection of right middle lung and right lower lung was performed on 6 December 2014. Postoperative pathology: The tumor cells were spindle-shaped, bundle-shaped, vortex-shaped, slightly abnormal, occasionally mitotic, no necrosis, and residual bronchial epithelium was seen in the tumor nodule (Figure 2）。 Immunohistochemical findings: tumor cells smooth muscle agonist protein (SMA), Desmin (Desmin), estrogen receptor (ER) (+), CD117, CD34, S-100 (-), Ki-67 10%, bronchial epithelial thyroid transcription factor-1 (TTF-1) (+). Combined with the medical history and immunohistochemical examination results, it was consistent with benign metastatic leiomyoma (right middle lobe, right lower lobe) (benign metastasizing leiomyoma, BML). Pelvic MRI examination was performed on 8 December 2014, and it was found that the left common iliac artery was round and isoteric₁Long T₂Signal mass shadow, considering uterine fibroid metastasis (Figure 3）。

The patient was a 40-year-old male. Right limb weakness for 23 d, paroxysmal right lower limb twitching for 20 d, right lower limb twitching for several minutes after eating on December 13, 2014, and then loss of consciousness, closed teeth, tongue bite, foaming at the mouth, and incontinence. The patient had undergone head CT examination in another hospital, which revealed abnormal low-density shadow in the left central area, and was transferred to our hospital after treatment of dehydration, anti-inflammation and improvement of microcirculation. Physical examination: clear consciousness, reasonable questions and answers, and cooperation with physical examination. The muscle strength and muscle tone of the left limb were normal, the muscle strength of the right upper limb was about grade 3, and the muscle strength of the right lower limb was about grade 2, and the muscle tone was increased. The tendon reflex of the right lower limb was active, the ankle clonus (+), and the remaining pathological signs were negative.

At present, palliative treatment is the main treatment for malignant superior vena cava occlusion at home and abroad. Superior vena cava stent implantation is a commonly used non-surgical treatment at present. However, restenosis of superior vena cava stent often occurs after operation due to tumor growth and other reasons.¹²⁵The therapeutic effect of I particles in malignant tumors has been confirmed. A patient with lung cancer complicated with superior vena cava obstruction was treated with particle strip combined with stent in our hospital, and good curative effect was achieved, as reported below.

hypertrophic cardiomyopathy (HCM) is the most common monogenic autosomal dominant disease involving the heart and a common cause of sudden death in adolescents^[1], genetic mutations at more than 1 400 loci may cause HCM. HCM not only has genetic diversity, but also has great heterogeneity in clinical phenotype and prognosis^[2]。 Some patients with HCM will have serious cardiovascular events such as sudden cardiac death, heart failure and malignant arrhythmia. Therefore, early diagnosis, prognosis and risk stratification of HCM are of great significance in clinical practice.