Search

伴胸水的结节病一例报告

结节病并发后葡萄膜炎一例

结节病四例诊治体会

目的 探讨结节病的临床特点和诊断方法。 方法 回顾性分析我院2012年4月至2015年9月经病理学确诊的4例结节病患者的临床及影像学资料。 结果 4例结节病患者中，男3例， 女1例，年龄23~70岁。3例患者临床表现为咳嗽、胸闷和气促，其中1例以腮腺肿大为主要表现；另1例无明显临床症状。胸部CT均显示肺门及纵隔淋巴结肿大。患者均经淋巴活检、腮腺外科活检。给予糖皮质激素治疗效果良好。 结论 结节病较少见，临床表现无特异性，临床易误诊。对肺门及纵隔淋巴结肿大病例，应尽早行病理学检查以明确诊断。结节病治疗首选糖皮质激素。

Sarcoidosis-A Disease Needs to Be Differentiated from Lung Cancer

Abstract：　Sarcoidosis is a common systemic disease with noncaseating granulomatous epithelioid nodule and coexisting　granulomatous inflammation. Although sarcoidosis can affect any organ of the body， more than 90% of the patients　demonstrate thoracic involvement， which is often confusing with lung cancer and other diseases. Therefore, thoracic surgeons　must have a clear understanding of sarcoidosis. Moreover， due to the special role of surgery in obtaining pathological specimens， thoracic surgeon plays an important role in the diagnosis and treatment of sarcoidosis. It is not difficult to make diagnosis for patients with typical clinical features of sarcoidosis. However， the majority of patients do not have specific manifestations of sarcoidosis. The cause of sarcoidosis remains unknown， and there is also no specific treatment strategy for it. But recent research has shown that annexin A11 gene may be involved in the pathogenesis of sarcoidosis， and tumor necrosis factor （TNF） inhibitor is effective in the treatwent of sarcoidosis.

Multiple Systemic Sarcoidosis Misdiagnosed as Lymphoma: One Case Report and Literature Review

ObjectiveTo improve the diagnosis and treatment of multiple systemic sarcoidosis (MSS) and avoid misdiagnosis. MethodsTo analyze the diagnosis and treatment of a MSS patient misdiagnosed as lymphoma. Related literatures were also reviewed. ResultsThe patients' clinical manifestations were not specific including cough and stethocatharsis. Lung and thoracic lymph nodes were most commonly involved in MSS. MSS was characterized by symmetrical lymph nodes enlargement in the bilateral lung hilus and/or mediastinum. The enlarged lymph nodes had a clear boundary and showed homogeneous enhancement. Symmetrical fluorodeoxyglucose (FDG) uptake in the hilar and/or mediastinal node was a typical finding of sarcoidosis on FDG PET/CT. Mucosal inflammation and mucosal nodules could be seen in the bronchoscope. Sarcoidosis was characterized by the presence of noncaseating groanulomas histologically. Hormonal therapy was effective for MSS. ConclusionSarcoidosis is a kind of disease involving multiple systems and organs with unknown etiology. The clinical manifestation of sarcoidosis is nonspecific,so it's likely to be misdiagnosed. Imaging examination and laboratory examination are helpful to the diagnosis of MSS. The definitive diagnosis depends on the pathologic biopsy.

以葡萄膜炎首诊的结节病1例

结节病伴乳糜胸一例并文献复习

目的观察分析结节病伴乳糜胸的临床特征、诊断、治疗，以提高临床医生对该病的认识。方法分析南京医科大学第一附属医院病理确诊的首例结节病伴乳糜胸患者的临床资料，并检索复习 PubMed 的 10 例结节病伴乳糜胸患者的发病年龄、性别、临床表现、实验室检查、治疗和预后。结论本例为年轻男性患者，以胸痛、咳嗽为首发症状；胸部 CT 示全身多发淋巴结肿大，多发肺结节影，胸膜增厚，左侧胸腔积液及肺间质改变；胸腔闭式引流示乳糜胸；颈部淋巴结和支气管黏膜活检病理为非干酪样肉芽肿；经泼尼松治疗 9 个月预后佳。分析检索的 10 例结节病并发乳糜胸患者，以右侧乳糜胸为主，患者大多通过肺组织、淋巴结及胸膜活检确诊，治疗包括糖皮质激素、生长抑素、中链甘油三脂饮食、胸膜固定术及胸导管结扎术。对Ⅱ、Ⅲ期患者以糖皮质激素为基础的内科治疗大多数预后良好，Ⅳ期结节病伴并乳糜胸患者糖皮质激素治疗效果差，并发心肺功能不全可致死亡。结论乳糜胸是结节病的一种罕见并发症，与肉芽肿侵犯淋巴组织引起淋巴管阻塞有关，内科治疗大多预后好。

以双眼葡萄膜炎伴面瘫首诊的眼结节病1例

The Expression of Th17 Cells in Peripheral Blood of Patients with Sarcoidosis

Objective To investigate the expression of Th17 cells in peripheral blood of patients with sarcoidosis at different stage. Methods Flow cytometry was used to detect the Th17 cells in peripheral blood of 38 patients with sarcoidosis, including 18 cases of newly diagnosed active patients with obvious symptoms such as cough, fever, fatigue and weight loss, and 20 stable cases who were followed up regularly.15 cases of healthy volunteers were enrolled as control. Serumangiotensin-converting enzyme ( SACE) of the patients with sarcoidosis was detected by ultraviolet spectrophotometry. The cell classification and CD4 + /CD8 + T in the BALF of the newly diagnosed active patients were calculated. Results The expression of Th17 cells in peripheral blood in the patients with active sarcoidosis were higher than that in the sable patients and the controls [ ( 1. 59 ±0. 44) % vs. ( 0. 56 ±0. 32) % and ( 0. 49 ±0. 23) % , all P lt; 0. 05] . Th17 cells in peripheral blood in the patients with stable sarcoidosis and the controls were not different significantly ( P gt;0. 05) . The levels of SACE in the patients with active sarcoidosis were higher than that in the patients with stable sarcoidosis [ ( 56. 6 ±14. 6) IU/L vs. ( 35. 8 ±18. 3) IU/L, P lt; 0. 05) . There was not significant correlation between the Th17 cells in peripheral blood and SACE in the patients with sarcoidosis ( P gt;0. 05) . In the patients with active sarcoidosis, the Th17 cells in peripheral blood were not significantly correlated with lymphocyte percentages in BALF( P gt; 0. 05) , but significantly correlated with CD4 + /CD8 + in BALF ( r=0. 63, P lt;0. 05) .Conclusion In patients with active sarcoidosis, the increased expression of Th17 cells in peripheral blood may correlate with the activity of sarcoidosis.

不典型胸部结节病影像诊断研究

结节病是一种原因未明的多系统肉芽肿性疾病，其特征是发生广泛的非干酪性上皮肉芽肿，可累及全身各个器官，90％可累及肺部[1]。其诊断依赖于组织学活检证实有非干酪性坏死性肉芽肿，且抗酸染色阴性，临床表现，以及影像学表现。由于组织学活检不易获得，且临床表现无特异性，故影像诊断则成为诊断该病的关键。影像学表现典型者，结节病的诊断较易，但也不乏误诊者；影像学表现不典型者，极易误诊。现回顾分析28例胸部结节病患者的相关资料，探讨结节病的影像诊断，尤其是不典型者的影像诊断，以提高结节病的诊断准确率。