AIM: To investigate the incidence of abrupt visual loss and its associated factors, during anti-vascular endothelial growth factor(VEGF) treatment for type 3 neovascularization.METHODS: This retrospective study includ...AIM: To investigate the incidence of abrupt visual loss and its associated factors, during anti-vascular endothelial growth factor(VEGF) treatment for type 3 neovascularization.METHODS: This retrospective study included 137 eyes that were newly diagnosed with type 3 neovascularization. All eyes were treated with anti-VEGF therapy. Abrupt visual loss was defined as loss of 5 or more lines in best-corrected visual acuity(BCVA) in comparison to the previous visit. The incidence and timing of abrupt visual loss as well as the factors associated with it, were determined. In addition, the BCVA at the final follow-up was compared between the eyes with and those without abrupt visual loss.RESULTS: The mean follow-up period was 42.4±18.9 mo after diagnosis, and abrupt visual loss was noted in 22 eyes(16.1%) at a mean of 19.6±13.9 mo. Abrupt visual loss was found to be associated with subretinal hemorrhage in 11 eyes(50.0%), development of or increase in the height of pigment epithelial detachment with fluid in 8 eyes(36.4%), and tears in the retinal pigment epithelium in 3 eyes(13.6%). The logarithm of minimum angle of resolution(logMAR) mean BCVA at the final follow-up was 2.07±0.67(Snellen equivalents: 20/2349) and 1.00±0.55(20/200) in eyes with and without abrupt visual loss, respectively. BCVA was significantly worse in the eyes with abrupt visual loss(P<0.001).CONCLUSION: Abrupt visual loss is noted in 16.1% of patients with type 3 neovascularization and is associated with poor visual outcome. Additional studies are needed to determine how abrupt visual loss can be prevented.展开更多
Meningiomas are classified into three types according to the World Health Organization classification system which is based on morphologic criteria. Type 1 is the benign variant, in which meningothelial is the most co...Meningiomas are classified into three types according to the World Health Organization classification system which is based on morphologic criteria. Type 1 is the benign variant, in which meningothelial is the most common subtype. Angiomatous also belongs to the same subtype but comprises only 2.1% of all meningiomas. Although most meningiomas are asymptomatic, some may present with varying symptoms ranging from seizures to focal deficits. Often, large meningiomas can also manifest as neuropsychiatric symptoms ranging from depression to overt psychosis. Here, in this case, we have further elaborated the importance of the organic cause of psychiatric symptoms as our patient initially presented with symptoms of depression. Regarding the diagnosis of meningiomas, nowadays excellent neuro-imaging methods are available, however, histological examination and immunohistochemistry remain the gold standard tools for a definite diagnosis. In our patient, the histological examination showed well-formed sinusoids and vascular channels which were consistent with the diagnosis of an angiomatous variant. Gross total resection of the lesion remains the treatment of choice with radiation therapy being used for residual tumors postoperatively. Being a type 1 variant, these meningiomas have a very small risk of recurrence. Here, we have presented a rare variant of meningioma initially presenting with prominent psychiatric symptoms of depression advancing to focal deficits.展开更多
BACKGROUND Cutaneous epithelioid angiomatous nodules(CEAN) are rare, benign, vascular lesions characterized by benign proliferation of endothelial cells with prominent epithelioid features, which can be easily confuse...BACKGROUND Cutaneous epithelioid angiomatous nodules(CEAN) are rare, benign, vascular lesions characterized by benign proliferation of endothelial cells with prominent epithelioid features, which can be easily confused with benign and malignant vascular tumors. However, the etiology of CEAN remains unclear, and no association with infection, trauma, or immunosuppression has been described.This case study indicated that CEAN is closely related to the patient’s impaired immune status and may be induced by cyclosporine.CASE SUMMARY A 19-year-old boy with nephrotic syndrome(NS) developed large CEAN on the left foot during treatment for NS. He had repeated relapses of edema in the past 6 years and different types of immunosuppressants were administered including methylprednisolone, mycophenolate mofetil, tacrolimus and cyclosporine;the dosages of these drugs were frequently adjusted. The patient had been receiving cyclosporine and methylprednisolone for 7 mo before he developed CEAN.Cyclosporine was discontinued due to its side effects on skin. After cessation of cyclosporine and 16 mo follow-up, the nodules gradually disappeared without any other treatment for the CEAN.CONCLUSION Impaired immune status is proposed to be a risk factor for CEAN, which may be induced by cyclosporine.展开更多
Background Eccrineangiomatoushamartoma(EAH)is a rare benign disease that comprises vascular and eccrine malformations.Pain is one of the most common symptoms and surgical resection is generally required.Objective To r...Background Eccrineangiomatoushamartoma(EAH)is a rare benign disease that comprises vascular and eccrine malformations.Pain is one of the most common symptoms and surgical resection is generally required.Objective To report a novel surgical technique that can alleviate severe pain caused by a large lesion in an EAH patient.Methods On magnetic resonance imaging(MRI),a subcutaneous abnormal signal was detected in the right hip and groin area of an 18-year-old male.The lesion was carefully elevated from the normal tissue above the plane of the deep fascia and was sutured in situ.Additionally,a small sample of the central lesion tissue was collected for histological examination.Results The visual analog scale score of pain decreased from 9 points to 2 points at 1week and to 0 points at 2 weeks after the surgery.The only complication observed was local numbness,which recovered spontaneously.No recurrence of pain was observed after 1 year of surgery.Histological findings demonstrated that the numbers of eccrine sweat glands and abnormal vessels decreased post-surgery.Conclusion The surgical procedure used in our case may represent a novel,easy,safe,and effective option for the treatment of a large,severely painful EAH.展开更多
目的探讨基于多参数MRI影像组学特征鉴别颅内Ⅱ级孤立性纤维瘤/血管外皮细胞瘤(solitary fibrous tumor/hemangiopericytoma,SFT/HPC)与血管瘤型脑膜瘤(angiomatous meningioma,AM)的价值。材料与方法回顾性分析经手术或病理证实的两个...目的探讨基于多参数MRI影像组学特征鉴别颅内Ⅱ级孤立性纤维瘤/血管外皮细胞瘤(solitary fibrous tumor/hemangiopericytoma,SFT/HPC)与血管瘤型脑膜瘤(angiomatous meningioma,AM)的价值。材料与方法回顾性分析经手术或病理证实的两个中心共68例Ⅱ级SFT/HPC患者及41例AM患者的术前磁共振成像资料,按7∶3的比例将患者随机分为训练组(n=77)和验证组(n=32)。图像进行标准化后,利用3D slicer软件于T1WI、FLAIR及T1WI增强轴位图像勾画感兴趣区(region of interest,ROI)并进行特征提取;采用最小冗余最大相关(minimum redundancy maximum relevance,mRMR)和最小绝对收缩和选择算子(least absolute shrinkage and selection operator,LASSO)算法进行降维,筛选最具诊断价值的影像组学特征,构建二元Logistic回归模型,并绘制受试者操作特征(receiver operating characteristic,ROC)曲线,评估其鉴别诊断效能。结果从T1WI、FLAIR和T1WI增强序列中各提取16、13、12个影像组学特征,从多参数MRI序列中提取9个影像组学特征进行模型建立,4种模型的ROC曲线下面积(area under the curve,AUC)分别为:T1WI模型为0.98(敏感度100%,特异度92.86%);FLAIR模型为0.92(73.47%,100%),T1WI增强模型为0.89(79.59%,85.19%),多参数模型为0.99(98.04%,96.15%),在验证组中的准确率分别为87.50%、75.00%、68.75%和90.63%。结论多参数MRI影像组学特征对Ⅱ级SFT/HPC与AM的鉴别效能优于单一序列,其中单序列中T1WI影像组学特征鉴别效能最高。展开更多
文摘AIM: To investigate the incidence of abrupt visual loss and its associated factors, during anti-vascular endothelial growth factor(VEGF) treatment for type 3 neovascularization.METHODS: This retrospective study included 137 eyes that were newly diagnosed with type 3 neovascularization. All eyes were treated with anti-VEGF therapy. Abrupt visual loss was defined as loss of 5 or more lines in best-corrected visual acuity(BCVA) in comparison to the previous visit. The incidence and timing of abrupt visual loss as well as the factors associated with it, were determined. In addition, the BCVA at the final follow-up was compared between the eyes with and those without abrupt visual loss.RESULTS: The mean follow-up period was 42.4±18.9 mo after diagnosis, and abrupt visual loss was noted in 22 eyes(16.1%) at a mean of 19.6±13.9 mo. Abrupt visual loss was found to be associated with subretinal hemorrhage in 11 eyes(50.0%), development of or increase in the height of pigment epithelial detachment with fluid in 8 eyes(36.4%), and tears in the retinal pigment epithelium in 3 eyes(13.6%). The logarithm of minimum angle of resolution(logMAR) mean BCVA at the final follow-up was 2.07±0.67(Snellen equivalents: 20/2349) and 1.00±0.55(20/200) in eyes with and without abrupt visual loss, respectively. BCVA was significantly worse in the eyes with abrupt visual loss(P<0.001).CONCLUSION: Abrupt visual loss is noted in 16.1% of patients with type 3 neovascularization and is associated with poor visual outcome. Additional studies are needed to determine how abrupt visual loss can be prevented.
文摘Meningiomas are classified into three types according to the World Health Organization classification system which is based on morphologic criteria. Type 1 is the benign variant, in which meningothelial is the most common subtype. Angiomatous also belongs to the same subtype but comprises only 2.1% of all meningiomas. Although most meningiomas are asymptomatic, some may present with varying symptoms ranging from seizures to focal deficits. Often, large meningiomas can also manifest as neuropsychiatric symptoms ranging from depression to overt psychosis. Here, in this case, we have further elaborated the importance of the organic cause of psychiatric symptoms as our patient initially presented with symptoms of depression. Regarding the diagnosis of meningiomas, nowadays excellent neuro-imaging methods are available, however, histological examination and immunohistochemistry remain the gold standard tools for a definite diagnosis. In our patient, the histological examination showed well-formed sinusoids and vascular channels which were consistent with the diagnosis of an angiomatous variant. Gross total resection of the lesion remains the treatment of choice with radiation therapy being used for residual tumors postoperatively. Being a type 1 variant, these meningiomas have a very small risk of recurrence. Here, we have presented a rare variant of meningioma initially presenting with prominent psychiatric symptoms of depression advancing to focal deficits.
文摘BACKGROUND Cutaneous epithelioid angiomatous nodules(CEAN) are rare, benign, vascular lesions characterized by benign proliferation of endothelial cells with prominent epithelioid features, which can be easily confused with benign and malignant vascular tumors. However, the etiology of CEAN remains unclear, and no association with infection, trauma, or immunosuppression has been described.This case study indicated that CEAN is closely related to the patient’s impaired immune status and may be induced by cyclosporine.CASE SUMMARY A 19-year-old boy with nephrotic syndrome(NS) developed large CEAN on the left foot during treatment for NS. He had repeated relapses of edema in the past 6 years and different types of immunosuppressants were administered including methylprednisolone, mycophenolate mofetil, tacrolimus and cyclosporine;the dosages of these drugs were frequently adjusted. The patient had been receiving cyclosporine and methylprednisolone for 7 mo before he developed CEAN.Cyclosporine was discontinued due to its side effects on skin. After cessation of cyclosporine and 16 mo follow-up, the nodules gradually disappeared without any other treatment for the CEAN.CONCLUSION Impaired immune status is proposed to be a risk factor for CEAN, which may be induced by cyclosporine.
基金This work was supported by the Clinical Research Plan of SHDC(16CR1007A),the Clinical Research Program(JYLJ001)and the Fundamental research program(JYZZ083B)of the Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine。
文摘Background Eccrineangiomatoushamartoma(EAH)is a rare benign disease that comprises vascular and eccrine malformations.Pain is one of the most common symptoms and surgical resection is generally required.Objective To report a novel surgical technique that can alleviate severe pain caused by a large lesion in an EAH patient.Methods On magnetic resonance imaging(MRI),a subcutaneous abnormal signal was detected in the right hip and groin area of an 18-year-old male.The lesion was carefully elevated from the normal tissue above the plane of the deep fascia and was sutured in situ.Additionally,a small sample of the central lesion tissue was collected for histological examination.Results The visual analog scale score of pain decreased from 9 points to 2 points at 1week and to 0 points at 2 weeks after the surgery.The only complication observed was local numbness,which recovered spontaneously.No recurrence of pain was observed after 1 year of surgery.Histological findings demonstrated that the numbers of eccrine sweat glands and abnormal vessels decreased post-surgery.Conclusion The surgical procedure used in our case may represent a novel,easy,safe,and effective option for the treatment of a large,severely painful EAH.
文摘目的探讨基于多参数MRI影像组学特征鉴别颅内Ⅱ级孤立性纤维瘤/血管外皮细胞瘤(solitary fibrous tumor/hemangiopericytoma,SFT/HPC)与血管瘤型脑膜瘤(angiomatous meningioma,AM)的价值。材料与方法回顾性分析经手术或病理证实的两个中心共68例Ⅱ级SFT/HPC患者及41例AM患者的术前磁共振成像资料,按7∶3的比例将患者随机分为训练组(n=77)和验证组(n=32)。图像进行标准化后,利用3D slicer软件于T1WI、FLAIR及T1WI增强轴位图像勾画感兴趣区(region of interest,ROI)并进行特征提取;采用最小冗余最大相关(minimum redundancy maximum relevance,mRMR)和最小绝对收缩和选择算子(least absolute shrinkage and selection operator,LASSO)算法进行降维,筛选最具诊断价值的影像组学特征,构建二元Logistic回归模型,并绘制受试者操作特征(receiver operating characteristic,ROC)曲线,评估其鉴别诊断效能。结果从T1WI、FLAIR和T1WI增强序列中各提取16、13、12个影像组学特征,从多参数MRI序列中提取9个影像组学特征进行模型建立,4种模型的ROC曲线下面积(area under the curve,AUC)分别为:T1WI模型为0.98(敏感度100%,特异度92.86%);FLAIR模型为0.92(73.47%,100%),T1WI增强模型为0.89(79.59%,85.19%),多参数模型为0.99(98.04%,96.15%),在验证组中的准确率分别为87.50%、75.00%、68.75%和90.63%。结论多参数MRI影像组学特征对Ⅱ级SFT/HPC与AM的鉴别效能优于单一序列,其中单序列中T1WI影像组学特征鉴别效能最高。
