脂肪肉瘤PPT课件.ppt

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1、早读片2015-07-31女61岁PatientID：41721677主诉：体检发现左侧胸腔占位一月余入院情况：患者一月前因咳嗽地热于外院查体发现左侧胸腔占位。患者目前无明显不适，无胸闷憋气，无咳嗽咳痰，无胸痛。入院查体：左肺下叶呼吸音较对侧减弱。既往史：高血压十余年，药物控制满意。1971年急性阑尾炎，阑尾切除。肿瘤标记物：CA125：41.8U/ml（0-35.0）NSE(神经元特异性烯醇化酶):17.3ng/ml(0-16.3)ProGRP（血清胃泌素释放肽前体）:56.0pg/ml(0-50)诊断及鉴别诊断脂肪肉瘤畸胎瘤手术记录麻醉满意后，患者取右侧卧位

2、，常规消毒，铺巾。取左侧第5肋间外侧切口长约25cm，逐层切开进胸。探查胸腔少量淡黄清亮胸水，胸腔内无粘连，探查上、下肺未见明显异常，探查肿瘤约16*12*10cm大小，质稍软，有包膜，与肺无粘连，根部来源于左侧胸腺并与部分心包粘连紧密界限不清，挤压左侧膈神经，游离纵隔胸膜，显露并游离保护左侧膈神经，打开心包，在心包内游离切除受累及的心包，在肿物与胸腺连接部切断、移除巨大肿瘤。探查胸腺发现胸腺右叶内有直径2cm质硬肿物，累及右侧纵隔胸膜，遂打开右侧纵隔胸膜，保护右侧膈神经，完整切除胸腺及胸腺肿物满意，心包缺损予以涤纶补片修补满意，严密止血后彻底清洗胸腔，在第5、6

3、、7肋间神经靠近神经根处解剖出肋间神经予以冷冻治疗，查胸腔内无渗血，膨左肺满意无漏气。清点纱布、纱垫、器械无误后，放置胸腔引流管一根，逐层关闭胸腔。将患者转为仰卧位，于患者右侧腋前线第6肋间消毒铺巾后放置胸腔闭式引流一根顺利。病理结果AsimilarcaseintheliteratureAge：58yearsoldSex：MaleSymptoms：recentonsetofdysphonia,milddysphagiatosolids,dyspneaonexertionandcoughCTscanningoftheneckandchestdemonstrating

4、thelipoidmassdisplacingthetrachea,theoesophagusandgreatvesselswithoutdirectinvasionRenaO,DavoliF,PiaFetal.GiantCervico-mediastinalWell-differentiatedLiposarcoma.Heart,lung&circulation2015;24:e112-4.（well-differentiatedliposarcoma）BriefIntroductionLiposarcomaAmalignanttumorderivedfromp

5、rimitiveorembryonallipoblasticcellsAdult40~50yrsExtremities，retroperitoneumClassificationHistologically,liposarcoma（LS）isdividedintofivedistinctsubtypes:Well-differentiatedLSDedifferentiatedLSMyxoidLS/RoundcellLSPleomorphicLSMixed-typeLS12WorldHealthOrganizationClassificationofBoneand

6、SoftTissueTumors:ModificationsandImplicationsforRadiologistsMarkD.Murphey,M.D.ClassificationHistologically,liposarcoma（LS）isdividedintofivedistinctsubtypes:Well-differentiatedLSDedifferentiatedLSMyxoidLS/RoundcellLSPleomorphicLSMixed-typeLS14Well-differentiatedLiposarcoma（WDLS）Well-di

7、fferentiatedliposarcomarepresentsthemostcommontypeofliposarcoma,accountingforapproximately50%oflesions.Thetypicalclinicalpresentationofwell-differentiatedliposarcomaisthatofapainless,slowlyenlargingmass.Well-differentiatedliposarcomasmostfrequentlyaffectthedeepsofttissueoftheextremiti

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