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Atypical presentation of Morgagni hernia: Bowel loops in the neck Morgagni疝的非典型表现:颈部的肠环
Q4 Medicine Pub Date : 2022-09-20 DOI: 10.29089/paom/151797
H. Akkaya, O. Dilek, Mustafa Sert, Cenk Parlatan, B. Gülek
Morgagni hernia is a rare congenital anomaly caused by the fusion defect between the septum transversum and the sternum. Patients may be asymptomatic or present with respiratory symptoms, abdominal pain, retrosternal pain, abdominal fullness, or gastrointestinal obstruction. Chest X-ray and thoracic computed tomography (CT) are the most commonly used modalities in imaging.We describe an adult case in which the transverse colon was herniated from the retrosternal area to the thyroid gland without a history of trauma or surgery.A 24-year-old female patient living in the countryside presented to our hospital with the complaints of indigestion and chest pain persisting for 2 years. In the thorax CT examination of the patient, it was observed that the transverse colon had herniated to the retrosternal region and then to the neck.Most acquired anterior diaphragmatic hernias are due to blunt or penetrating traumatic injury. However, there are also case reports describing iatrogenic diaphragmatic hernias following a sternotomy performed during thoracic or cardiac surgery. In Morgagni hernia, the most frequently herniated organs are the greater omentum and transverse colon. There are also reports, albeit rarer, describing the herniation of the stomach, liver and small intestines.Morgagni hernia is a very rare type of hernia, especially in adult patients. The diagnosis of these patients can be easily made based on thoracic CT findings.
Morgagni疝是一种罕见的先天性异常,由横隔与胸骨之间的融合缺陷引起。患者可能无症状或出现呼吸道症状、腹痛、胸骨后疼痛、腹部充盈或胃肠道梗阻。胸部x线和胸部计算机断层扫描(CT)是最常用的成像方式。我们描述了一个成人病例,横结肠从胸骨后区域疝到甲状腺,没有外伤或手术史。一名24岁的农村女性患者以消化不良、胸痛持续2年来我院就诊。在患者的胸部CT检查中,发现横结肠已经疝到胸骨后区,然后到颈部。大多数获得性前膈疝是由于钝性或穿透性创伤所致。然而,也有病例报告描述了胸或心脏手术中胸骨切开术后的医源性膈疝。在Morgagni疝中,最常见的器官是大网膜和横结肠。虽然比较罕见,但也有关于胃、肝和小肠疝的报道。Morgagni疝是一种非常罕见的疝类型,尤其是在成人患者中。这些患者的诊断很容易根据胸部CT表现做出。
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引用次数: 0
Female athlete triad and relative energy deficiency in sport – endocrine changes and treatment in women 女运动员三合会与运动相对能量缺乏——女性内分泌变化及治疗
Q4 Medicine Pub Date : 2022-09-20 DOI: 10.29089/paom/148215
J. Witkoś, Magdalena Hartman-Petrycka
Female athlete triad (FAT) it is a syndrome of three tightly interrelated components: amenorrhea, eating disorder, and osteoporosis. FAT syndrome has been re-evaluated and re-defined and the International Olympic Committee introduced a new relative energy deficiency in sport (RED-S) syndrome.The aim of the study was to review the knowledge on the issues of endocrine changes occurring in FAT and RED-S, and treatment of those conditions on a basis of available literature.This article was based on a review of the literature search in the electronic databases Medline (PubMed), EBSCO, ClinicalKey, and Willey Online Library, using the terms: ‘female athlete triad,’ ‘relative energy deficiency in sport,’ ‘FAT and RED-S and endocrine changes,’ ‘low energy availability (LEA) and endocrine changes,’ ‘FAT and RED-S and treatment and women’.LEA influences abnormal secretion of gonadotropin-releasing hormone (GnRH) and this leads to the disrupted follicle-stimulating hormone (FSH) and luteinising hormone (LH) secretion. Higher ghrelin levels inhibit secretion of GnRH and of adrenocorticotropic hormone (ACTH), growth hormone (GH), FSH and LH. A high peptide YY (PYY) results in a significant suppression of GnRH secretion. Hypercortisolemia occurring in athletes may directly affect reproductive functions. Lack of estrogen contributes both to disrupted mineralization of bones and to endothelial dysfunction.Low energy levels found in female athletes diagnosed with FAT or RED-S syndrome significantly influence hormonal pathways, disrupting the function of their reproductive system, and this noticeably affects the overall health of sportswomen, influencing endothelial dysfunctions and bone mineral density.
女运动员三联征(FAT)是一种由三个密切相关的组成部分组成的综合征:闭经、饮食失调和骨质疏松。FAT综合征已被重新评估和定义,国际奥委会引入了一种新的运动相对能量缺乏综合征(RED-S)。本研究的目的是在现有文献的基础上,回顾FAT和RED-S中发生的内分泌变化问题以及这些疾病的治疗。本文基于对电子数据库Medline(PubMed)、EBSCO、ClinicalKey和Willey Online Library中的文献检索的综述,使用术语:“女运动员三联征”、“运动中的相对能量缺乏”、“FAT和RED-S与内分泌变化”、“低能量可用性(LEA)和内分泌变化”,LEA影响促性腺激素释放激素(GnRH)的异常分泌,从而导致卵泡刺激素(FSH)和黄体生成素(LH)分泌紊乱。较高的胃促生长素水平会抑制GnRH和促肾上腺皮质激素(ACTH)、生长激素(GH)、FSH和LH的分泌。高肽YY(PYY)导致GnRH分泌的显著抑制。运动员出现的高皮质醇血症可能直接影响生殖功能。雌激素缺乏会破坏骨骼矿化,并导致内皮功能障碍。在被诊断为FAT或RED-S综合征的女运动员中发现的低能量水平会显著影响激素途径,破坏其生殖系统的功能,这会显著影响女运动员的整体健康,影响内皮功能障碍和骨密度。
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引用次数: 0
A cadaveric analysis of anatomical variations of the musculocutaneous nerve 肌肉皮神经解剖变异的尸体分析
Q4 Medicine Pub Date : 2022-09-20 DOI: 10.29089/paom/152136
Ewa Toruńska, Mikołaj Konopka, Jerzy Gielecki, Łukasz Klepacki
Variations within musculocutaneus nerve (MCN) are very frequent. Such cases should be discussed extensively to reduce the risk of iatrogenic damage during surgery.In this paper, we wanted to present the unusual variability within the brachial plexus, which is the double MCN.We present a case of accesory MCN found during the cadaveric dissection.In this paper we encountered two musculocutaneous nerves, of which MCN proper runs as standard innervating the biceps brachii and the coracobrachialis muscle, while MCN accessory extending distally from MCN proper and innervates the brachialis.The case analysed by us is rare in the literature. Brachial plexus variations are very common and clinically important.
肌间神经(MCN)的变异是非常常见的。此类病例应广泛讨论,以减少手术中医源性损伤的风险。在本文中,我们想要呈现臂丛内不寻常的变异性,即双MCN。我们报告一例在尸体解剖过程中发现的辅助MCN。在本文中,我们遇到了两种肌肉皮神经,其中MCN固有神经作为标准运行,支配肱二头肌和喙肱肌,而MCN副神经从MCN固有神经向远端延伸,支配肱肌。我们所分析的病例在文献中是罕见的。臂丛神经变异很常见,在临床上很重要。
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引用次数: 1
The dilemma in management of desmoid tumour: A case report 结缔组织样肿瘤的治疗困境:一例报告
Q4 Medicine Pub Date : 2022-09-20 DOI: 10.29089/paom/150516
F. Y. Lee, A. Jagwani, Mohamad Fairuz Mohamad Sharin, Andee Dzulkarnain Zakaria, F. Hayati, I. Sagap
Desmoid tumours are rare benign tumours. The tumours may develop sporadically or they may be linked to familial adenomatous polyposis (FAP) in Gardner’s syndrome.This article highlights a young lady with an intra-abdominal desmoid tumour that manifested as an acute abdomen and we discuss our management strategy.A 24-year-old lady with a known FAP who had undergone a panproctocolectomy with an ileal pouch-anal anastomosis and total thyroidectomy, later was complicated with acute abdomen for symptomatic desmoid tumour. Computed tomography of the abdomen showed a large intraperitoneal heterogenous mass with small bowel displacement and was confirmed by magnetic resonance imaging. An exploratory laparotomy and en-bloc resection of the tumour with an end ileostomy were performed.Intra-abdominal desmoid tumours usually present as a painless slow-growing mass, however, in severe form, it can cause bowel ischemia, intestinal obstruction, or deterioration of function in the ileoanal anastomosis, among post total colectomy. Surgery is indicated upfront in specific clinical scenarios namely complications (occlusion, perforation, or bleeding) or major cosmetic issues.Desmoid tumour, despite being benign, is challenging to manage due to its compressing nature. As a key point, the diagnosis of a desmoid tumour should be suspected and followed up closely in patients with a previous history of FAP in combination with extracolonic manifestation.
筛状瘤是罕见的良性肿瘤。肿瘤可能是偶发性发展的,也可能与Gardner综合征中的家族性腺瘤性息肉病(FAP)有关。这篇文章重点介绍了一位患有腹内硬纤维瘤的年轻女士,表现为急腹症,我们讨论了我们的治疗策略。一位患有已知FAP的24岁女性接受了全结肠切除术、回肠袋-肛门吻合术和甲状腺全切除术,后来因症状性硬纤维瘤并发急腹症。腹部的计算机断层扫描显示腹腔内有一个巨大的不均匀肿块,伴有小肠移位,并经磁共振成像证实。进行了剖腹探查和肿瘤的整体切除,并进行了末端回肠造口术。腹部硬纤维瘤通常表现为无痛的缓慢生长的肿块,然而,在严重的情况下,它会导致全结肠切除术后的肠缺血、肠梗阻或回肠-oanal吻合功能恶化。在特定的临床情况下,即并发症(闭塞、穿孔或出血)或重大美容问题中,手术是预先指示的。Desmoid肿瘤虽然是良性的,但由于其压迫性,其治疗具有挑战性。作为一个关键点,对于有FAP病史并伴有结肠外表现的患者,应怀疑并密切随访硬纤维瘤的诊断。
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引用次数: 0
Calcified gliomatosis peritonei in a post-menopausal woman with mature ovarian teratoma 绝经后妇女伴成熟卵巢畸胎瘤腹膜钙化胶质瘤病一例
Q4 Medicine Pub Date : 2022-09-20 DOI: 10.29089/paom/152443
N. Sapiai, W. A. Wan Ahmed, S. Saminathan
Gliomatosis peritonei (GP) is characterized by the presence of benign, mature glial implants in the peritoneum or omentum.Understanding unusual findings with clear knowledge of pathological comparisons makes diagnosis more reliable and guides future treatment.This is a case of a 70-years-old lady, post-menopausal, who presented with abdominal mass which progressively increased in size for the past 40 years. She also had constipation requiring laxatives and occasional lower abdominal pain. Her abdomen was clinically distended with a large hard central mass.Computed tomography of the abdomen showed features of left ovarian teratoma with multiple gliomatosis peritonei. Histopathology of the mass post-surgery revealed a left ovarian mature cystic teratoma and the peritoneal deposits to be heavily calcified and fibrotic mature implants with no evidence of malignancy.Gliomatosis peritonei (GP) is a rare finding associated with ovarian teratoma and rare in postmenopausal women. It is important to appreciate a variety of radiological presentations of this condition to establish an accurate diagnosis.
腹膜胶质瘤病(GP)的特点是存在良性,成熟的胶质植入物在腹膜或网膜。了解异常的发现与病理比较清楚的知识,使诊断更可靠,指导未来的治疗。这是一个70岁的妇女,绝经后,谁提出了腹部肿块,在过去的40年逐渐增加的大小。她也有便秘需要泻药,偶尔下腹部疼痛。临床表现为腹部膨胀,中央有一大块硬肿块。腹部电脑断层显示左侧卵巢畸胎瘤合并腹膜多发性胶质瘤。术后肿块的组织病理学显示左侧卵巢成熟囊性畸胎瘤,腹膜沉积物严重钙化和纤维化成熟植入物,无恶性肿瘤证据。腹膜胶质瘤病(GP)是一种罕见的发现与卵巢畸胎瘤和罕见的绝经后妇女。重要的是要了解这种情况的各种放射表现,以建立准确的诊断。
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引用次数: 0
The significance of race-related differences in anaesthesiological setting 麻醉学环境中种族相关差异的意义
Q4 Medicine Pub Date : 2022-09-20 DOI: 10.29089/paom/151914
Katarzyna Szymonek, B. Kędziora, H. Tomczyk, I. Podlińska, Onichimowski Dariusz
The human species shows a great variability. The differences involve culture, customs, appearance but they also come to include some biological or physiological aspects which have a potential bearing on the course of diseases and the effects of treatment. Over the recent years, the increasing globalisation and improved travel opportunities have resulted in a growing mass mobility. The arrival of people representing other ethnicities may pose a challenge to doctors traditionally offering treatment to individuals within ethnically homogenous societies.The paper aims to present a comprehensive summary of state-of-the-art knowledge on race-related differences which may be of great importance for patient management in anaesthesiological setting.This paper is based on the available literature.A literature review reveals a number of anatomical, pharmacokinetic and pharmacodynamic differences between the races. Moreover, particular ethnic groups show dissimilarities in the prevalence of some diseases requiring modifications in anaesthesiological management.Prior to the commencement of treatment, patient’s ethnicity and the consequent differences in terms of physiology should be recognised and considered in the treatment to ensure it is conducted appropriately and safely.
人类表现出很大的多样性。这些差异包括文化、习俗、外貌,但也包括一些生物或生理方面的差异,这些差异对疾病的进程和治疗效果有潜在的影响。近年来,日益全球化和旅游机会的改善导致了日益增长的大规模流动性。代表其他种族的人的到来可能会对传统上为种族单一的社会中的个人提供治疗的医生构成挑战。本文的目的是提出一个全面的总结国家的最先进的知识对种族相关的差异,这可能是非常重要的病人管理在麻醉设置。本文是在现有文献的基础上编写的。一篇文献综述揭示了种族之间的解剖学、药代动力学和药效学差异。此外,在某些需要修改麻醉管理的疾病的患病率方面,特定的族裔群体表现出差异。在治疗开始之前,应认识到患者的种族和由此产生的生理差异,并在治疗中加以考虑,以确保治疗的适当和安全进行。
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引用次数: 0
Frequency of polymorphic loci of GSTM1 and GSTT1 modifier genes in the genotype of children with pyelonephritis and congenital urinary malformations 儿童肾盂肾炎和先天性尿路畸形基因型中GSTM1和GSTT1修饰基因多态位点的频率
Q4 Medicine Pub Date : 2022-09-20 DOI: 10.29089/paom/149242
N. Lukyanenko, A. Spaska, E. Lenha, I. Marazha
The growing number, prevalence, numerous complications, and deaths in patients with congenital anomalies of the kidney and urinary tract (CAKUT) indicate the high relevance of the declared topic. Currently, clinical medicine is actively engaged in research on the cellular and molecular mechanisms that cause the appearance of these diseases.The aim of the work is to study genetic markers of CAKUT and the tendency to a more severe course of pyelonephritis in young children.Using the multiplex polymerase chain reaction method, 50 children with pyelonephritis were examined for the presence of deletion alleles of the glutathione S-transferase mu 1 (GSTM1) and glutathione S-transferase theta 1 (GSTT1) genes.As a result, 35 children were diagnosed with certain CAKUT. A statistically significant associative relationship between the development of pyelonephritis in a child and the presence of a null allele GSTM1 0/0 in its genotype and a high probability of CAKUT with quantitative and positional anomalies and impaired formation and differentiation of renal tissue in carriers of null alleles GSTT1 0/0, GSTM1 0/0 in their combination was revealed.The fact that different forms of abnormalities are detected in members of the same family suggests that certain genetic mutations can potentially lead to CAKUT syndrome, but the final phenotype of the renal system depends either on the genetic background or on environmental factors.
先天性肾和泌尿道异常(CAKUT)患者的数量、患病率、并发症和死亡人数不断增加,表明该主题具有高度相关性。目前,临床医学正在积极研究导致这些疾病出现的细胞和分子机制。这项工作的目的是研究CAKUT的遗传标志物和幼儿肾盂肾炎更严重病程的趋势。采用多重聚合酶链式反应方法,对50例肾盂肾炎患儿进行谷胱甘肽S转移酶μ1(GSTM1)和谷胱甘肽S转移因子θ1(GSTT1)基因缺失等位基因检测。结果,35名儿童被诊断出患有某种CAKUT。儿童肾盂肾炎的发展与其基因型中存在无效等位基因GSTM1 0/0之间存在统计学上显著的关联关系,以及在GSTT1 0/0、GSTM1 0/0及其组合的携带者中CAKUT与数量和位置异常以及肾组织形成和分化受损的高概率。在同一家族的成员中检测到不同形式的异常这一事实表明,某些基因突变可能导致CAKUT综合征,但肾系统的最终表型取决于遗传背景或环境因素。
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引用次数: 0
Spontaneus pneumomediastinum and subcutaneus emphysema in nonventilated COVID-19 patient 非通气COVID-19患者纵隔自发性肺炎和皮下肺气肿
Q4 Medicine Pub Date : 2022-09-09 DOI: 10.29089/paom/152734
Beata Moczulska, M. Żechowicz, L. Gromadziński, P. Nowek
The most common complications of COVID-19 infection are: pneumonia, acute respiratory distress syndrome, pulmonary fibrosis, pulmonary embolism, pneumothorax and pneumomediastinum.We would like to highlight the rarity of pneumomediastinum and subcutaneous emphysema in nonventilated COVID-19 patient.A 50-year-old man was addmitted to the COVID-19 Department with SARS-CoV-2 pneumonia. The patient wasn’t vaccinated against COVID- 19. Upon admission the general condition was quite good with mild dyspnea.Upon admission a CT scan was performed in which there were bilateral infiltrates consistent with COVID-19 infection, covering approximately 50% of the lungs. On the 5th day of hospitalization the general condition deteriorated and a drop in saturation was observed. A follow-up CT scan revealed progression of lung inflammatory changes that spanned approximately 60%–70% of lung parenchyma; there was pneumomediastinum and subcutaneous emphysema in the neck, left subclavian, and axillary area. High flow nasal oxygen therapy (60 L/min) was administered. On the 13th day the general condition of the patient further deteriorated and blood saturation continued to drop which prompted the decision to escalate treatment. Initially, noninvasive ventilation was used, however, shortly after the patient was intubated. Immediately after intubation the patient went into cardiac arrest that ultimately led to his death.The development of spontaneus pneumomediastinum in the patient can be mainly attributed to the intense cough and rapidly developing acute respiratory distress syndrome in the course of SARS-CoV-2 infection despite aggressive treatment with steroids, tolicizumab, and antibiotics for staphylococcal pneumonia.
新冠肺炎感染最常见的并发症是:肺炎、急性呼吸窘迫综合征、肺纤维化、肺栓塞、肺气肿和纵隔气肿。我们想强调非通气性新冠肺炎患者中纵隔气肿和皮下气肿的罕见性。一名50岁男子因严重急性呼吸系统综合征冠状病毒2型肺炎被送入新冠肺炎科。该患者未接种新冠肺炎疫苗-19。入院时,总体情况良好,伴有轻度呼吸困难。入院后进行CT扫描,发现双侧浸润与新冠肺炎感染一致,覆盖约50%的肺部。住院第5天,全身情况恶化,观察到饱和度下降。后续CT扫描显示,肺部炎症变化的进展范围约为肺实质的60%-70%;颈部、左锁骨下和腋窝有纵隔气肿和皮下气肿。给予高流量鼻内氧疗(60L/min)。第13天,患者的总体情况进一步恶化,血氧饱和度持续下降,这促使决定升级治疗。然而,最初使用的是无创通气,在患者插管后不久。插管后,患者立即出现心脏骤停,最终导致死亡。患者自发性纵隔气肿的发展主要归因于严重急性呼吸系统综合征冠状病毒2型感染过程中的剧烈咳嗽和快速发展的急性呼吸窘迫综合征,尽管对葡萄球菌肺炎进行了积极的类固醇、托西珠单抗和抗生素治疗。
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引用次数: 0
Uncommon series of subclavian vein thrombosis in Emergency Department 急诊科罕见系列锁骨下静脉血栓形成
Q4 Medicine Pub Date : 2022-05-20 DOI: 10.29089/paom/147912
R. Jalali, Agata Pypkowska, Weronika Szwed, Magdalena Fadrowska, G. Wasilewski, A. Zawadzki, J. Manta
Deep vein thrombosis (DVT) is one of the two possible clinical manifestations of venous thromboembolism (VTE), and the other one is the pulmonary embolism. The most common reasons behind the upper limb DVT can be central venous catheterization, compression of subclavian vein or anatomical abnormalities.The aim of this study is to stress the importance of accurate diagnosis of the relatively rare subclavian vein thrombosis (SCVT). Due to low specificity of the clinical signs and symptoms, a careful risk assessment of VTE is extremely helpful in successfully reaching a diagnosis.Authors are presenting a series of 4 cases of diagnosis and initial treatment in Emergency Department (ED) of the patients presenting with common symptoms of upper limb with uncommon SCVT. All patients presented to ED, of which 3 were seen in ED of our hospital and 1 patient, who is co-author of the publication, had the same diagnosis in other ED allocated in another city.Among the 4 patients only 1 has reached high risk in Caprini’s score and moderate in Wells score. In Padua scale patient did not reach high risk. In other patients risks in each score were low.In most cases, the Wells, Padua, Caprini scores can be used to evaluate the risk of VTE; this diagnostic tool cannot be efficiently utilized in patients with local anatomical anomalies, which can lead to problems with diagnostics and treatment of such patients.
深静脉血栓形成(DVT)是静脉血栓栓塞症(VTE)的两种可能的临床表现之一,另一种是肺栓塞。上肢DVT最常见的原因可能是中心静脉插管、锁骨下静脉受压或解剖异常。本研究的目的是强调准确诊断相对罕见的锁骨下静脉血栓形成(SCVT)的重要性。由于临床体征和症状的特异性较低,对VTE进行仔细的风险评估对成功诊断非常有帮助。作者介绍了4例在急诊科(ED)诊断和初步治疗的患者,这些患者表现为上肢常见症状和罕见的SCVT。所有就诊于急诊科的患者,其中3例在我院急诊科就诊,1例患者是该出版物的合著者,在另一个城市的其他急诊科也有相同的诊断。在4名患者中,只有1名患者的Caprini评分达到高风险,Wells评分达到中等风险。在帕多瓦量表中,患者没有达到高风险。在其他患者中,每个评分的风险都很低。在大多数情况下,Wells、Padua、Caprini评分可用于评估VTE的风险;这种诊断工具不能有效地用于具有局部解剖异常的患者,这可能导致此类患者的诊断和治疗问题。
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引用次数: 0
Myeloid sarcoma (chloroma) a rare tumour of the chest wall 髓样肉瘤(氯瘤)是一种罕见的胸壁肿瘤
Q4 Medicine Pub Date : 2022-05-20 DOI: 10.29089/paom/147732
S. Skrzyniarz, M. Wojtyś, Janusz Wójcik, Darko Gajić, K. Ptaszyński
Myeloid sarcoma (previously chloroma or granulocytic sarcoma) is a very rare malignant neoplasm associated with myeloproliferative neoplasms. This type of tumour can be located anywhere outside the bone marrow.To describe the successful treatment and diagnostic of myeloid sarcoma.Retrospective case review.This paper presents a case of myeloid sarcoma in a 50-year-old male. Patient presented due to pain lasting for 2 months in the left anterior axillary line region and a rapidly growing nodular lesion on the anterior chest wall. The lesion involved an extensive area of the ribs, causing rib destruction. Surgery was performed causing patients relief and chance of collecting histopathological tissue.In myeloid sarcoma patients, surgical treatment does not only bring relief in symptomatic patients but also provides material for histopathological examination, which is necessary to confirm the diagnosis. An important part of the diagnosis is the implementation of a wide panel of immunohistochemical tests.
髓样肉瘤是一种非常罕见的与骨髓增殖性肿瘤相关的恶性肿瘤。这种类型的肿瘤可以位于骨髓外的任何地方。描述骨髓肉瘤的成功治疗和诊断。回顾性病例审查。本文报告一例50岁男性髓系肉瘤。患者表现为左腋窝前线区域疼痛持续2个月,胸壁前方有快速生长的结节性病变。病变涉及肋骨的广泛区域,导致肋骨破坏。手术使患者缓解,并有机会收集组织病理组织。在髓系肉瘤患者中,手术治疗不仅使患者症状得到缓解,而且为组织病理学检查提供了材料,这是确认诊断所必需的。诊断的一个重要部分是实施广泛的免疫组织化学测试。
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引用次数: 0
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Polish Annals of Medicine
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