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Objective To stuy the clinical value of combined DWI and PWI in diagnosis of cerebral infarction (CI) at different stages.Methods One hundred and sixty-eight elderly CI patients were divided into hyperacute phase group (n =32),acute phase group (n =64),subacute phase group (n=45) and chronic phase group (n=27).Their DWI and PWI parameters and abnormal brain regions were compared.Results The ADC on DWI for injured lateral brain tissue was significantly lower than that on DWI for unjured lateral brain tissue in hyperacute phase group and acute phase group (0.39±0.08 vs 0.83±0.03;0.32±0.07 vs 0.91±0.05,P＜0.01).However,the ADC on DWI for the injured lateral brain tissue was significantly higher than that on DWI for the uninjured lateral brain tissue in subacute phase group and chronic phase group (1.54±0.34 vs 0.85±0.07,2.01±1.29 vs 0.90±0.05,P＜0.01).The PWI showed that the CBV was smaller and the CBF was slower while the MTT and TTP were longer in CI patients at different stages.DWI＜PWI,DWI＞PWI,and DWI=PWI in abnormal signal region were more frequently detected in hyperacute phase,acute phase subacute phase and chronic phase respectively.Conclusion PWI can show ischemic penumbra while DWI can highlight infarct foci in CI patients.Combined PWI and DWI can display the CBF in CI patients at different stages,and can thus provide reference for the clinical treatment of CI.
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Purpose To analyze and summarize morphological characteristics, the immune phenotype, diagnosis and differential diag-nosis, clinical features and prognosis of epithelioid angiomyolipomas retrospectively, to deepen understanding of EAML and improve the diagnostic accuracy. Methods The pathological morphology was observed and immunohistochemistry of phenotypic characteristics were analyzed in 7 cases of epithelioid angiomyolipomas. Results Seven cases of epithelioid angiomyolipomas had similar morphology:larger tumor cells, ovoid, fusiform or polygonal, with abundant and eosinophilic cytoplasm, a big nucleus of different size with obvious nucleoli, polynuclear and gaint tumor cells, with a few mitotic figures. The tumor cells arranged in nests or sheets, cuff-shaped around the blood vessels. Immunohistochemistry showed that the tumor cells were positive for HMB-45, Melan-A, vimentin and SMA, but negative for EMA, CK, and CD10. All of them underwent radical surgery or surgical resection, and were followed up for 3~56 months after operation. 6 cases were alive, without recurrence and metastasis, while 1 case died of gastrointestinal stromal sarcomas 3 months later. Conclusion Epithelioid angiomyolipomas belong to mesenchymal tumors with malignant potential, pathological morphology would be easily misdiagnosed as malignant tumors. Immunohistochemistry plays an important role in the differential diagnosis. Surgical treatment is the main method at present, with possibility of recurrence or metastasis.
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Purpose To study the clinicopathologic feature, classification, benign or malignant histological features and differential diagnosis of extra-adrenal paraganglioma.Methods We performed a retrospective analysis of 21 cases of extra-adrenal (sympathetic and parasympathetic) paraganglioma. Histological, immunohistochemical findings, and follow-up data were reported with review of the relative literatures.Results There were 10 male and 11 female patients aged from 9 to 81 years (mean 46.5 years).Ten tumors occurred in the retroperitoneum, seven in the neck, and one case in the mediastinum, urinary bladder, spermatic cord and kidney, respectively.There were 3 cases of functional and 18 cases of non-functional paragangliomas.Histologically, the tumor was composed of chief cells and sustentacular cells. The chief cells were arranged in nests, alveolAR~-like and stereo-like structures.They were surrounded by sustentacular cells partly or completely.There was one malignant case, in which tumor cells had significant cell atypia and nuclear mitosis, and focal or diffuse necrosis, regional lymph node metastasis and blood vessel involvement were also observed.Immunohistochemical investigations revealed chief cells were intensely positive for neuroendocrine markers such as NSE, CgA, Syn and NF, but negative for CK, EMA and SMA.Sustentacular cells were positive for S-100 protein.The malignant cells were only positive for NSE and weakly positive for CgA.Eighteen cases were followed up.One patient developed to multi-organ metastasis and died.One patient was diagnosed as benign extra-adrenal paraganglioma that recurred and involved adjacent organs after 3 years.Conclusions It is generally considered that malignant potential, local invasiveness and distant metastasis are not correlated with the histological appearances of the extra-adrenal paraganglioma.So,further follow-up will be needed. It is necessary to emphasize the differential diagnoses of extra-adrenal paraganglioma from other pleiomorphic tumors.