结节病易误诊,据王洪武等~([1])收集国内18篇关于此病误诊的文献,误诊率高达63.2%,当然有误诊就会有误治,如孙永昌等~([2])报道26例结节病在影像学检查诊断的第一印象中拟诊结核5例,其中就有2例完成规范的抗结核治疗,为此应引起临床对本病诊治的重视。

Sarcoidosis

Strumal carcinoid of the ovary is a type of germ-cell tumor characterized by an intimate mixture of thyroid tissue and carcinoid Fifty patients with this type of tumor ranged in age from 21 to 77 years The tumors measured up to 26 cm in diameter and were always unilateral In 10% of the cases, the contralateral ovary contained another type of neoplasm, usually a dermoid cyst Three-fifths of the strumal carcinoids arose in dermoid cysts or in mature solid teratomas Birefringent calcium oxalate monohydrate crystals were commonly identified in the thyroid colloid, and argentaffin granules, in the carcinoid cells, thus substantiating the identity of the neoplastic components Although 31% of the tumors were accompanied by focal stromal luteinization, only 8% of the cases exhibited clinical signs of steroid hormone production (endometrial hyperplasia, hirsutism, or virilism) In 8% of the cases, there was evidence suggesting functioning of the thyroid component, but no patient had the carcinoid syndrome Only one woman died of tumour; five others died of unrelated causes The remaining patients remained alive and well; 23, for at least five years, and 15, for at least ten years postoperatively Although the carcinoid component of the strumal carcinoid has been considered a malignant transformation of struma ovarii, it is almost always benign, and treatment with a simple oophorectomy or salpingo-oophorectomy is effective

Strumal carcinoid of the ovary: An analysis of 50 cases of a distinctive tumor composed of thyroid tissue and carcinoid

BACKGROUND

Few studies of patients with esophageal small cell carcinoma (SCC) have been conducted. Choice of treatment remains controversial.



METHODS

The authors analyzed data on 199 evaluable esophageal SCC patients, selected from among 230 patients found in the literature, and a data extraction form that recorded 11 features was completed. To allow for the evaluation of prognostic factors that influenced survival, the patients were grouped according to limited stage (LS), which was defined as disease confined to the esophagus, or extensive stage (ES), which was defined as disease that had spread beyond locoregional boundaries. Univariate and multivariate analyses were performed. Treatment was categorized as either local or local with systemic; for the ES cases, the categories were defined as treatment versus no treatment.



RESULTS

The tumor site was described in 178 cases (89%). Mean tumor size was 6.1. Pure SCC was found in 137 cases (68.8%), whereas 62 cases (31.2%) showed mixed SCC; 93 (46.7%) were LS, whereas 95 (47.7%) were ES. In 11 cases (5.5%), the stage was not determined. There was a significant difference in survival between patients with LS and those with ES (P 60 years, the median survival was 6 months), tumor size (for those with tumors ≤5 cm, the median survival was 12 months, whereas for those with tumors >5 cm, the median survival was 4 months), and type of treatment (with local plus systemic treatment, the median survival was 20 months, whereas with local it was 5 months). In multivariate analysis, tumor size (P = 0.007) and type of treatment (P < 0.001) were shown to be independent predictive variables.



CONCLUSIONS

Esophageal SCC is an aggressive type of tumor. This study shows that there are significant differences between LS and ES and that in LS, both tumor size and type of treatment are possible prognostic factors. Cancer 1997; 80:1366-72. © 1997 American Cancer Society.

Primary small cell carcinoma of the esophagus: a review of the literature with emphasis on therapy and prognosis.

Background. Small cell carcinoma of the esophagus is regarded as having a poor prognosis with frequent systemic dissemination.



Methods. A review of the records and histologic sections of 11 patients with primary small cell carcinoma of the esophagus seen in 11 years was undertaken. They were analyzed and compared with the more common squamous cell carcinomas and adenocarcinomas.



Results. Small cell carcinoma of the esophagus constituted 1% of all esophageal tumors and was mainly located at the middle and lower thirds (90%) of the esophagus. Primary treatment consisted of tumor resection in five patients (46%), chemotherapy and radiotherapy in two (18%); surgical bypass in one (9%), radiotherapy after exploratory laparotomy in one (9%), intubation in one (9%), and no active intervention in one (9%). Two of the five resected tumors were Stage IIB disease, and three were Stage III disease. Five of the six patients in the nonresection group had distant metastases at presentation (45% of all patients). The median survival of patients who had chemotherapy (three of whom also had radiotherapy) was 16.7 months (range, 2.8–72 months) and was 2.2 months (range, 4 days to 9.1 months) for those with no chemotherapy. The overall median survival was 3.1 months for all patients. The prognosis was not significantly different from those with squamous cell carcinomas or adenocarcinomas.



Conclusions. Small cell carcinoma of the esophagus should be regarded as a systemic disease, and multimodality treatment, including chemotherapy, should be used. Surgery may be offered in selected patients to manage local disease as part of a chemotherapy-based treatment program. Cancer 1994; 73:2894–9.

https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.1002/1097-0142%2819940615%2973%3A12%3C2894%3A%3AAID-CNCR2820731204%3E3.0.CO%3B2-M

Small cell carcinoma of the esophagus.

Complications of acute pancreatitis : Clinical and CT evaluation

Pancreatic pseudocyst involving the splenic parenchyma itself is an unusual complication of pancreatitis. The diagnosis is best established by arteriography, isotopic studies, and sonography. Once confirmed, surgical intervention is mandatory because of the danger of secondary hemorrhage.

Pancreatic pseudocysts involving the spleen

An exceedingly rare ovarian neoplasm composed of mixed thyroid and Brenner tumor is reported. Review of the literature yielded only one well-documented case previously described. Although the possibility of a "collision" of two different tumors cannot be completely discarded, a possibility of an endodermal teratoma (thyroid-urothelium) is also proposed.

Mixed ovarian tumor composed of Brenner and thyroid elements.

Background/Aims: Standard triple therapy (STT; proton pump inhibitor [PPI]+clarithromycin+amoxicillin) used for Helicobacter pylori (H. pylori) eradication has shown low treatment success rates in recent years, which is most likely attributable to increased clarithromycin resistance. In this study, we compared treatment success rates of tailored therapy (TT) using real-time polymerase chain reaction (RT-PCR) and empirical STT.Methods: This retrospective study included 650 patients with H. pylori infection, who visited Eunpyeong St. Mary’s Hospital in Korea; 343 patients received TT based on RT-PCR assays, and 307 patients received STT. Eradication success was defined as a negative &lt;sup&gt;13&lt;/sup&gt;C-urea breath test result 4~8 weeks after treatment completion. Patients who failed first-line therapy and those with clarithromycin resistance received bismuth-containing quadruple therapy (BQT; PPI+bismuth+metronidazole+tetracycline).Results: Intention-to-treat analysis showed that H. pylori eradication rates were higher in patients who received RT-PCR–based TT than in those who were treated using empirical STT (80.5% [190/236] vs. 70.4% [216/307], P=0.069). Per-protocol (PP) analysis showed similar results (84.4% [190/225] vs. 74.7% [216/289], P=0.007). PP analysis showed that 7-day TT treatment was associated with a higher eradication rate than that observed with 10- to 14-day STT (85.2% [178/209] vs. 73.8% [59/80], P=0.029). The clarithromycin resistance rate was 27.9% (87/312). The eradication success rate was 89.2% (74/83) in patients with clarithromycin resistance, who received BQT as first-line therapy.Conclusions: The treatment success rate was higher in patients who received 7-day RT-PCR–based TT than in those who were administered 10- to 14-day empirical treatment. 

/pdf/eradication-of-helicobacter-pylori-infection-using-7-day-pcr-2juzgwxx.pdf

Eradication of Helicobacter pylori Infection Using 7-day PCR-based Tailored Therapy

A case of small cell anaplastic epidermoid carcinoma of the esophagus is reported. The morphology of this rare esophageal neoplasm simulates that of oat cell carcinoma. Four similar cases have been previously reported. The finding of epidermoid differentiation in two of these tumors, including the present one, raises considerable doubt that any are truly oat cell carcinomas of the esophagus. Although it is theoretically possible that an oat cell carcinoma may arise in the esophagus, there is as yet no conclusive evidence for the existence of such an entity.

Small cell epidermoid carcinoma of the esophagus. An oat-cell-like carcinoma.

Discrepancies were observed between functional (PFT), chest roentgenographic, and open lung biopsy findings (granulomata, interstitial pneumonitis, angiitis, and fibrosis) in 81 patients with clinical diagnosis of sarcoidosis. A combination of normal PFT and Type 1 roentgenographic findings (hilar lymphadenopathy) was associated with minimal lung lesions without fibrosis. Type 1 findings alone did not preclude extensive lesions or fibrosis. Advanced roentgenographic and PFT abnormalities correlated with the presence of extensive lung lesions. The pulmonary diffusing capacity correlated best with specific and overall lung pathology, and roentgenographic types. Only this test differentiated the extent of granulomata and the roentgenographic types. Moderate degrees of other pathologic changes were not distinguished by any other PFT. Degrees of overall lung pathology correlated with an individual PFT and most significantly with overall PFT (p less than 0.001). Serial studies of PFT are a practical and valuable means for assessment of the disease process in sarcoidosis.

Pulmonary sarcoidosis: roentgenographic, functional, and pathologic correlations.

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