f*********1
发帖数: 189 | 1 Re: 【征文活动】图文并茂，一天一个病例
响应futurehw and Aplusplus 提议, 参加【征文活动】.
History: 67 y/o patient with frequent urination since 3 months ago.
CT KUB was ordered.
CT KUB Findings:
1. Left kidney 5cm upper pole mass: most concerning for primary renal cell
carcinoma.
2. Bladder wall thickening with mild bilateral hydronephrosis and
hydroureter, concerning for chronic inflammation of the bladder wall.
Neoplasm such as TCC is not excluded.
3. A left adrenal nodule with HU of 9, most consistent with adrenal adenom... 阅读全帖 |
|
n*******c
发帖数: 501 | 2 Thanks for sharing.This is a very interesting case.
To present the case for discussion we need more details because it is the
critical thinking during diagnosis process really matters. The picture is
just there to prove you are right:)
My questions for this case would be:
1.Why did we choose to do CT rather than Ultrasound KUB in the first place?
What is the pros and cons of these 2 imaging in their contributions to
diagnosis of urinary tract problems. I must say I always want good reasons
to gi... 阅读全帖 |
|
R*******t
发帖数: 367 | 3 Usually people do CTs. The reason the MRI was done in this case is to
further characterize the adrenal lesion as well as hepatic lesions. Rads are
very comfortable calling TCCs and RCCs on CT. For adrenal adenomas, you
need three phase CTs or MR. Also for the liver lesion, CT liver protocol or
MR are better to tell most of the lesions.
MRI |
|
R*******t
发帖数: 367 | 4 3 . It is a lipid-rich adrenal adenoma. It is benign. Clinicians can do
follow ups on their own protocol if they want, especially if it is functional.
4. As I said the purpose of the MR is to further delineating the adrenal
lesion and hepatic lesion. Furthermore, it will provide us more info on RCC
invasion, to adjacent Gerota fascia or renal vein and IVC etc. so is for the
bladder TCC for staging purpose.
The bladder mass and left renal mass themselves are pretty diagnostic on CT. |
|
f*********1
发帖数: 189 | 5 thank you.
1. U/S can miss lesions, especially those hiden between organs.
2. It is diffuse, symmeterical thickening, so it is more on the inflmmaion
or obstruction caused hypertrophy side, than TCC.
3.4. It is adenoma, as the HU 9 on CT and MRI out-of phase images further
confirmed signal drop out.
Thank you again.
?
, |
|
l*h
发帖数: 4124 | 6 there is no 奇迹 here at all.
based on what you showed, there had never been evidence she had 卵巢早衰.
rather, plenty of evidence argued against the diagnosis of 卵巢早衰. 卵巢早
衰 is permanent and irreversible: something is dead, and is simply dead.
this does not directly prove it was a pituitary adenoma, but it is
consistent with a pituitary adenoma. Pituitary adenomas are well known to
have spontaneous remission. The one with the highest spontaneous remission
rate is prolactin adenoma with a spontaneous ... 阅读全帖 |
|
z****o
发帖数: 368 | 7 An asymptomatic 56-year-old woman has occult blood in her stool. Barium
studies of her transverse colon show an intraluminal mass. The surgical
specimen is shown. Which of the following is the most likely diagnosis?
A. Adenocarcinoma
B. Carcinoid tumor
C. Polypoid leiomyoma
D. Tubular adenoma
E. Villous adenoma
病例图片请见附上的文件。是不是因为出现隐血，所以一定就是恶性了？或者adenoma
会不会出血？ |
|
d****y
发帖数: 2180 | 8 Adenocarcinoma: crater-like(象火山口的）, reddish, irregularly-shaped tumor
Tubular adenoma: most common polyp, the head of the stalked polyp has a
lobulated, mushroom-like appearance.
This is consitent with the figure presented in the question. The stalk of
the polyp is just under the mushroom-like head.
The adenoma has a great chance to develop into maglinant carcinoma since the
adenoma >2cm. |
|
d****y
发帖数: 2180 | 9 adenoma也会出血的。 有些adenoma也是会癌变的。
http://emedicine.medscape.com/article/172674-overview
History of present illness
Most patients with colonic polyps are asymptomatic.
In symptomatic patients, the most common presenting symptom is rectal
bleeding. Other symptoms include diarrhea or constipation, often with
decreased stool caliber.
Villous adenomas of the rectum and distal colon can occasionally manifest as
a syndrome of severe diarrhea with massive fluid and electrolyte loss.
Chronic bleeding from c |
|
d****y
发帖数: 2180 | 10 adenoma can be larger than 2cm.
The big adenoma is viewed as premaglinant, but it's not adenocarcinoma yet.
And clearly the outlook, shape, and texture is more like adenoma, not
adenocarcinoma. If you have seen the real one, you can tell they're
different. |
|
g*****j
发帖数: 1211 | 11 Thyroid adenoma is a benign tumor. About 5% of thyroid nodule are actually
malignant tumor. The pathology report is key and tells you the type of
tumor you have. If adenoma is what you had, patients do great here in US
without the benefit of 中医调理. |
|
l*h
发帖数: 4124 | 12 does she still have menstrual cycles?
the hormone results don't support premature ovarian failure. she still had
sufficiently high estrogen level. the results were either a reduced
steroid suppression at pituitary level or primary hypergonadotropism.
diagnosis of POF requires hypogonadism (low estrogen levels).
i am not trained in gynecological endocrinology. but in neuroendocrinology,
there is a condition fitting this very well: gonadotroph adenoma (a type of
pituitary adenomas) that is secreti... 阅读全帖 |
|
l*h
发帖数: 4124 | 13 in a short summary, her fertility hormone panel said it was a pituitary
disease, not an ovarian disease. the most likely would be a gonadotroph
adenoma that is secreting. the size of the adenoma would be, i guess, about
1cm in diameter or even larger, so typically called macroadenoma just
because of the size. she should not delay much in doing the studies i
mentioned since the macroadenoma compresses on normal pituitary gland.
if she had been seen in more than one hospitals, this says this is a
... 阅读全帖 |
|
A*****a
发帖数: 52743 | 14 typo. 应该是pleomorphic adenoma, 或者multiform adenoma. |
|
k**n
发帖数: 6198 | 15 Don't worry, more than likely you got a lactating adenoma.It won't go away
when you are breast feeding. I had the same situation before and I took a
biopsy of it. It got smaller after the biopsy, but didn't went away. I
followed up after I quit breast feeding. it's still there but not getting
changed. My surgent told me to follow up after another half year. According
to him, it might take two-three years to go away. It's not that common to
have lactating adenoma, but not necessary not to happen.... 阅读全帖 |
|
n********t
发帖数: 1079 | 16 40个老鼠在哪呢？另外您还得把这个SD母鼠自发肿瘤发生率就是80%甚至更高的地洗了
。。。
http://www.ncbi.nlm.nih.gov/pubmed/11381627
Neoplastic lesions were observed in untreated aged Sprague Dawley (SD) rats
throughout their lifespan starting at 5 weeks. Their mean survival times
were 89 to 105 weeks of age. The total tumor incidences were 70 to 76.7% and
87 to 95.8% in males and females, respectively. The common neoplasmas were
pituitary adenoma and adrenal pheochromocytoma in both sexes, testicular
Leydig cell tumor in males and mamma... 阅读全帖 |
|
b***e
发帖数: 108 | 17 NBMESTEP1 FORM 1 SECTION 1 QUESTION 15
A 27-YEAR -OLD MAN IS FOUND TO HAVE A SOLITARY THYROID NODULE DURING A
ROUTINE HEALTH MAINTENANCE EXAMINATION. A THYROID Scintiscan shows uptake of
radiioactive by the nodule. which of the following is the most likely
diagnosis?
A. Chronic autoimmune(Hasimoto's)thyroiditis
B. Follicular adenoma
C.Granulomatous thyroiditis
D.Medullery carcinoma
E. Papillary carcinoma
参考答案是B.
但GOLJAN 第500页说 FOLLICULAR ADENOMA IS A COLD NODULE,WHICH DOESN'T TAKE UP
RADIOACTIVE |
|
f****i
发帖数: 129 | 18 34.
A 57-year-old woman is brought to the emergency
department because of
abdominal pain for 12 hours. Over the past 3 hours,
the pain has become
severe and generalized. Over the past month, she has
had mild upper
abdominal discomfort that is relieved by eating. She
has a history of
recurrent migraines treated with sumatriptan as
needed. Her temperature
is 38.2 C (100.8 F), blood pressure is 170/95 mm Hg,
and pulse is
110/min. Abdominal examination shows mild distention;
there is marked
rigidity... 阅读全帖 |
|
h*******y
发帖数: 1220 | 19 Steps are:
1. Low dose dex (sensitive but not specific) to exclude; if (-), stop; if (+
):
2. 24 h cortisol / urine (expensive but specific); if (-): look for other
reasons such as stress...; if (+):
3. High dose dex:
positive: adrenal or puituitary adenoma
--high ACTH = pituitary = MRI;
--low ACTH = adenoma of adrenal gland;
Negative high dose = small cell carcinoma (high ACTH) or adrenal Ca (low
ACTH). |
|
f*********1
发帖数: 189 | 20 Your symptoms sound like neuroendocrine tumor.
Differentials based on limited CT images are broad: GIST; prior granuloma
disease such as TB or sarcoidosis; pheo especially your symtoms fit well
with it and sounds
like you also have some family history which makes it fit even better,
however pheo usually enhance well with contrast while yours do not enhance
much with contrast, although necrotized pheo may not enhance; adrenal
cortical adenoma especially hyper functioning adenoma, with adrenal cor... 阅读全帖 |
|
h********n
发帖数: 4079 | 21 腺瘤叫做adenoma, 良性.
腺癌叫adenocarcinoma, 恶性. |
|
n***p
发帖数: 7668 | 22 破学校没有这个杂志，本版卧虎藏龙，来碰碰运气
Title: Genetics of familial pituitary adenomas
Author(s): Beckers A, Jaffrain-Rea ML, Daly AF
Source: BULLETIN DE L ACADEMIE NATIONALE DE MEDECINE Volume: 193
Issue: 7 Pages: 1557-1570 Published: OCT 2009
Please email to: a*******[email protected].
Thanks. |
|
d*******c
发帖数: 14 | 23 Adenoma是腺瘤，良性的。
他所说的应该是恶性的，——〉adenocarcinoma |
|
g***r
发帖数: 285 | 24
depnds on the size of the polyp, in general, more than 20mm the chance is of
being malignant is high and should be removed,
polyp can be either a benign tumor like adenoma, or cholesterol deposit
which if breaks off might or might not cause inflammation/obstruction,
the malignant potential is quite low if the size is very small,
another interesting fact, though females are more prone to have gallbladder
disease, but during a study of autopsy the prevalence of gallbladder stones/
polyps are equa |
|
y*****g
发帖数: 193 | 25 There is a surgery called transsphenoidal resection of pituitary adenoma. It
's a relative easy surgery done by neurosurgery team. Patient checks in on
the same operation day, surgery about 1 or 2 hours, stays in ICU for one day
, then stay in regular floor for one or two days, then go home.
We had a lot of patients like this, it's piece of cake in ICU. I have never
seen patients failed the surgery in my hospital. |
|
c********e
发帖数: 496 | 26 transsphenoidal resection of pituitary adenoma is good one, minor, no scar,
less invasive and less complication, but only indicated in the treatment of
small tumor.
roughly the indications include
if small and non functional, obeserve.
if small and functional, transsphenoidal resection or chemo
if big, surgery, but this is a tough one. there are many important
anatomical structure around pituitary gland.
if reoccur after operation, radiotherapy. |
|
c********e
发帖数: 496 | 27 first, the imaging test of choice for pituitary adenoma is MRI, instead of
CT.
Bromocriptin is not a steroid, it is Dopamine receptor agonist.
Could you make it more clear, you want pregnancy or not? |
|
u*******r
发帖数: 2855 | 28 似乎是parathyroid adenoma,中国人不太常见,看来要做手术,似乎LA有几个好医生 |
|
l*h
发帖数: 4124 | 29 germinoma? or NGGCTs? or even gonadotroph adenomas of the pituitary? |
|
h******g
发帖数: 65 | 30 第一次在这里发贴， 不知道这样可以不
7月份b超是这样的，大家看看像不像恶性? 甲状腺双侧叶及峡部大小形体正常，被膜光
滑，腺体组织回声欠均匀，稍增粗，甲状腺左叶内见多处大小不等低等回声结节，较大
者位于腺体浅层，大小2.4*1.0cm,边界清晰。右叶中部深面似见0.7*0.4等回声结节，
边界欠清晰,CDFI上述结节周边可采集散在血流信号。左颌下见1.7*0.8淋巴结回声，左
颌下见2.1*0.9淋巴结回声。
8月份在国内另一家做的，想看一下那个大的变大没，没想到不同医院仪器不一样，没
法比较：甲状腺右叶1.79cm,峡部厚0.32cm,左叶厚1.89cm,实质回声增粗欠均，甲状腺
左叶可见中等回声结节，大小约2.36*1.15cm,边界尚清CDFI:期内可见血流信号显示，
左叶可见多个囊状回声及中强回声结节，较大者约1.1*1.0cm,甲状腺弥漫性改变。国内
这两个看着也不一样.
10月份回美国:
US THYROID OR NECK OR SOFT TISSUE
CLINICAL HISTORY: Palpable left thyroid nodule
TECHNIQUE: S... 阅读全帖 |
|
A*****a
发帖数: 52743 | 31 pleomrophic adenoma
可以去看otolaryngologist, oncologist |
|
k**n
发帖数: 6198 | 32 I also got lactating adenoma with my first baby. I have it moved when she is
1 and half years old. People can get it, not a big problem.
You may need to make an appoitment with a surgeon, not just your OB and have
ultra-sound check. After the ultra-sound, most of them are likely to
suggest you to follow up in half a year. I have it moved after my followup
as the surgeon said the shape is changing and it's suggesting it is
degrading, but "I will have it removed." It's an out patient operation and... 阅读全帖 |
|
k**n
发帖数: 6198 | 33 我是lactating adenoma,手术因该和纤维瘤差不多,outpatient, 大概一个小时,当天不
开车,后来也不是很疼.医生也会把组织切片的结果告诉你,没什么大事的一个手术 |
|
a**e
发帖数: 5094 | 34 你那个朋友估计是pituitory adenoma, 这东西不长在小脑上 ：D |
|
g***r
发帖数: 22 | 35 It is extremely important to have a diagnosis before jumping into surgery.
Some adrenal tumors are benign and do not need treatment, for example
functionally inactive adrenal adenomas. Some tumors, such as
pheochrsmocytomas, need medical treatment to control blood pressure before
surgery to prevent side effects of the operation. Malignant tumors and
metastasis need different appoaches in management.
Both adrenal CT and MRI are very helpful to confirm the diagnosis or point
to some differential d... 阅读全帖 |
|
g*******n
发帖数: 1188 | 36 有点多，找到几篇是几篇，都没access。。。大包子
//bow
Standard pharmacological treatment and new therapies for overactive bladder
Repeat intradetrusor injections of onabotulinum toxin a for refractory
idiopathic overactive bladder patients: a single-center experience.
Use of Combined Anticholinergic Medication and Sacral Neuromodulation in the
Treatment of Refractory Overactive Bladder
Posterior Tibial Nerve Stimulation in Patients Who Have Failed
Anticholinergic Therapy: Efficacy and Time to Response
Environmental ... 阅读全帖 |
|
n**e
发帖数: 2026 | 37 今年初，美国科学促进会（AAAS）和皮尤研究中心（Pew Research Center）联合公布
的一项调查显示，88％的科学家认为转基因食品可安全食用，持这一看法的公众只有37
％。报告认为差距如此之大的一个可能原因是，三分之二的公众认为科学家对转基因食
品的健康后果没有清晰认识。这就是真正的原因吗？
根据报告全文，皮尤中心给19，984名科学家发出了调查问卷，3748人（18.8%）完成了
问卷调查。其中生物医学学科背景的科学家占50%。报告没有说明50%的生物医学背景是
否能够代表科学家总体的学科构成。更大问题是在这50%的科学家人群中，有多少人的
工作是与转基因作物的研究有关，以什么样的方式相关。报告没有提供任何信息。
由于这些关键信息缺失，88%的科学家相信转基因安全的说法毫无意义。在一个没有代
表性并且无法排除偏向性的样本中调查，科学家相信转基因安全从1%到99%与88%没有任
何不同。好消息是超过半数的美国民众认为转基因不安全。
2012年10月，美国科学发展协会以官方名义（Board of Directors ）抛出了一个反对
转基因标识声明（附录1）。目的就是诱导民... 阅读全帖 |
|
i****x
发帖数: 17565 | 38 认英文的话，随便读读这些权威机构的报告吧。注意，别拿”没有证据证明辐射有害“
说话，再解释一遍，统计学的假设检验理论根本不可能给出辐射无害的证明，只能要么
证明辐射有害要么无法证明辐射有害。
In 2006 a large Danish group's study about the connection between mobile
phone use and cancer incidence was published. It followed over 420,000
Danish citizens for 20 years and showed no increased risk of cancer.[21] A
2011 follow-up confirmed these findings.[22]
The authors reported the following conclusion:
Overall, no increase in risk of glioma or meningioma was observed with use
of mobile phones. ... 阅读全帖 |
|
i****x
发帖数: 17565 | 39 你那个国内烂校学报的”科研“结论跟以下所有结论矛盾的时候，你说我们该信谁呢？
In 2006 a large Danish group's study about the connection between mobile
phone use and cancer incidence was published. It followed over 420,000
Danish citizens for 20 years and showed no increased risk of cancer.[21] A
2011 follow-up confirmed these findings.[22]
The following studies of long time exposure have been published:
The 13 nation INTERPHONE project – the largest study of its kind ever
undertaken – was published in 2011 and did not find a solid li... 阅读全帖 |
|
s******y
发帖数: 28562 | 40 David Venet from the Université Libre de Bruxelles 用胡乱挑选的基因组合
和已经发表的所谓的癌基因的marker 用在未知的病人的数据上，发现胡乱挑选
的基因的准确率比那些所谓的marker 还要好。
文章结尾直接点了几个杂志的名：Cell, Nature Genetics, PNAS, 认为这些杂志
过分鼓吹所谓的 gene marker 的意义。从文章里面的行文来看，估计这些也是
把这个文章据掉的杂志 （lol)
文章最后发表在
PLoS Comput Biol. 2011 Oct;7(10):e1002240. Epub 2011 Oct 20.
http://blog.f1000.com/2012/01/10/random-gene-sets-can-predict-b
Random gene sets can predict breast cancer survival better than cancer-
related signatures
And top-tier journals did not want to pu... 阅读全帖 |
|
s******y
发帖数: 28562 | 41 David Venet from the Université Libre de Bruxelles 用胡乱挑选的基因组合
和已经发表的所谓的癌基因的marker 用在未知的病人的数据上，发现胡乱挑选
的基因的准确率比那些所谓的marker 还要好。
文章结尾直接点了几个杂志的名：Cell, Nature Genetics, PNAS, 认为这些杂志
过分鼓吹所谓的 gene marker 的意义。从文章里面的行文来看，估计这些也是
把这个文章据掉的杂志 （lol)
文章最后发表在
PLoS Comput Biol. 2011 Oct;7(10):e1002240. Epub 2011 Oct 20.
http://blog.f1000.com/2012/01/10/random-gene-sets-can-predict-b
Random gene sets can predict breast cancer survival better than cancer-
related signatures
And top-tier journals did not want to pu... 阅读全帖 |
|
h********n
发帖数: 4079 | 42 像教科书一样, 可以上去查各种老鼠的正常和疾病的病例切片?
最近在看老鼠肺上面 adenoma vs carcinoma, 烦死了.
谢谢 |
|
r*****m
发帖数: 3619 | 43 Results: 46
Select item 25597018
1.
Exome-wide Sequencing Shows Low Mutation Rates and Identifies Novel Mutated
Genes in Seminomas.
Cutcutache I, Suzuki Y, Tan IB, Ramgopal S, Zhang S, Ramnarayanan K, Gan A,
Lee HH, Tay ST, Ooi A, Ong CK, Bolthouse JT, Lane BR, Anema JG, Kahnoski RJ,
Tan P, Teh BT, Rozen SG.
Eur Urol. 2015 Jan 14. pii: S0302-2838(14)01396-7. doi: 10.1016/j.eururo.
2014.12.040. [Epub ahead of print]
PMID: 25597018 [PubMed - as supplied by publisher] Free Article
Related citations... 阅读全帖 |
|
n**e
发帖数: 2026 | 44 【 以下文字转载自 WaterWorld 讨论区 】
发信人: nile (nile), 信区: WaterWorld
标 题: 美国科学促进会《科学》大旗下的转基因谎言
发信站: BBS 未名空间站 (Fri Oct 30 10:18:45 2015, 美东)
今年初，美国科学促进会（AAAS）和皮尤研究中心（Pew Research Center）联合公布
的一项调查显示，88％的科学家认为转基因食品可安全食用，持这一看法的公众只有37
％。报告认为差距如此之大的一个可能原因是，三分之二的公众认为科学家对转基因食
品的健康后果没有清晰认识。这就是真正的原因吗？
根据报告全文，皮尤中心给19，984名科学家发出了调查问卷，3748人（18.8%）完成了
问卷调查。其中生物医学学科背景的科学家占50%。报告没有说明50%的生物医学背景是
否能够代表科学家总体的学科构成。更大问题是在这50%的科学家人群中，有多少人的
工作是与转基因作物的研究有关，以什么样的方式相关。报告没有提供任何信息。
由于这些关键信息缺失，88%的科学家相信转基因安全的说法毫无意义。在一个没有代
表性并且无法排除... 阅读全帖 |
|
n***a
发帖数: 1373 | 45 B is the best answer. a small percentage of follicular adenomas are hot
nodules. Other answers are simply even less possible. |
|
W******g
发帖数: 143 | 46 1: Hermiston ML, Gordon JI. Inflammatory bowel disease and adenomas in mice
expressing a dominant negative N-cadherin. Science. 1995 Nov 17;270(5239):
1203-7.
PubMed PMID: 7502046.
2: Hermiston ML, Gordon JI. In vivo analysis of cadherin function in the
mouse
intestinal epithelium: essential roles in adhesion, maintenance of
differentiation, and regulation of programmed cell death. J Cell Biol. 1995
Apr;129(2):489-506. PubMed PMID: 7721948; PubMed Central PMCID: PMC2199905.
3: Gordon JI, Hermist |
|
d****y
发帖数: 2180 | 47 我第1个反应就是carcinoma，不过看了图后觉得这个肿块不象那么恶性的。
刚好在看RRP，查了一个Gastrointestinal disorders,嘿嘿，有个图跟这个几乎一样，
是D; Tubular adenoma. |
|
z****o
发帖数: 368 | 48 多谢多谢，:)
我也看到了那个图，果然很像。应该就是D了。只是有点不清楚，出血是不是也可以发
生在adenoma上啊？以为只有恶性才会出血呢 |
|
|
s******t
发帖数: 579 | 50 If you look at the pitcure carefully, you will find that it is an adenomatous
polyp (tubular adenoma) attached to the lumen by a stalk. It is round and w
/ a smooth surface. Polyps can cause rectal bleeding too.
I go with daisy. |
|
