目的 通过学习1例少见的组织学特征与IgG4相关性淋巴结病类似的浆细胞型特发性多中心型Castleman病（PC-iMCD）,总结两种易误诊疾病的鉴别要点,提高病理诊断水平。方法 回顾性分析1例PC-iMCD患者临床资料,常规苏木素-伊红（HE）染色分析淋巴结组织结构及细胞形态,免疫组织化学染色及原位杂交分析免疫表型及EB病毒（EBV）感染状态,并结合文献分析讨论其与IgG4相关淋巴结病的鉴别诊断。结果 48岁女性患者,临床表现为口干、多饮、皮肤瘙痒伴全身多处淋巴结肿大。实验室检查血清IgG、IgA、IgM及IgE水平均升高,血清IgG4显著升高（14.7 g/L）,白介素- 6（IL-6）异常升高（150.84 pg/mL）。病理检查显示淋巴结生发中心萎缩,套区淋巴细胞呈“洋葱皮”样围绕生发中心排列,滤泡间区扩张,其内见大量成熟的浆细胞呈片状浸润,灶区见含铁血黄素沉积及血管增生;免疫组化染色显示IgG4阳性浆细胞数大于100/高倍视野,IgG4阳性细胞/IgG阳性细胞比值>40%,Kappa及Lambda轻链呈非限制性表达;EB病毒编码RNA原位杂交（EBER）阴性。结论 部分PC-iMCD与IgG4相关淋巴结病具有相似的组织病理学特征,单纯根据组织学及免疫表型难以将两者鉴别,正确诊断需结合IgG4相关病变诊断标准、排除性诊断标准、临床表现及实验室检查综合判断。

Objective By studying a rare case of the plasma cell type idiopathic multicentric Castleman disease（PC-iMCD）with histological characteristics similar to IgG4-related lymphadenopathy,the differential points of the two easily misdiagnosed diseases were summarized to improve the level of pathological diagnosis．Methods The clinical data of one patient with PC-iMCD were collected,the structure alteration and cell morphology were observed by hematoxylin-eosin（HE）stains．The immunophenotype of cells was marked by immunohistochemical staining and the infections status of EB virus was detected by in situ hybridization．Besides,the differential diagnosis between IgG4-RD and PC-iMCD were analyzed and discussed based on literature analysis．Results This article reported a 48-year-old female who was admitted to the hospital with dry mouth,polydipsia,skin itching and multiple lymphadenopathy．The levels of various classes of serum immunoglobulin were all increased,such as IgG,IgA,IgM and IgE．Specially,the serum IgG4 was also significantly increased（14.7 g/L）and interleukin 6（IL-6）was abnormally raised（150.84 pg/mL）．The pathological examination indicated that the lymph node germinal center was atrophied and mantle zones were expanded which were composed of concentric rings of lymphocytes in an “onion skinning” appearance．Besides,the interfollicular area was expanded in which mature plasma cells were infiltrated in sheet-like,hemosiderin was deposited as well as the vessels were proliferated．Immunohistochemistry showed that the number of IgG4-positive plasma cells was >100/HPF,IgG4/IgG-positive cells ratio was >40%,and Kappa and Lambda light chains were expressed unrestrictedly．In situ hybridization revealed that the expression of EBER was negative．Conclusions PC-iMCD and IgG4-related lymphadenopathy shares similar histopathological characteristics and it’s challenging to distinguish these two diseases by their histology and immunophenotype．In conclusion,the correct diagnosis should be combined with the diagnostic criteria,exclusion diagnostic criteria,clinical manifestations and related laboratory examinations．

目的 探讨胃癌误诊为环状胰腺并胰腺炎并十二指肠梗阻的原因和治疗。方法 对本院收治的1例由胃癌误诊为环状胰腺并胰腺炎以及十二指肠梗阻患者的临床情况加以总结,并总结复习和分析相关文献。结果 本例患者虽最终明确诊断为胃癌,但病理提示分化差,合并全身多处骨转移,疾病进展迅速,后续放化疗效果欠佳。早期诊断、早期治疗是影响胃癌患者预后的关键。结论 胃癌骨转移的发病率低,极少进行骨转移评估,易造成误诊。当出现胃十二指肠流出道梗阻时,虽患者合并环状胰腺,仍需警惕胃癌的可能,及早完善全身检查,明确诊断,采取正确的治疗措施。

目的 探讨小于4 cm的胃神经鞘瘤（GS）的CT误诊与漏诊原因,从而加深影像科医师对GS的认识,提高其CT检出率及诊断准确率。方法 回顾性分析2019年3月—2022年10月经手术切除及病理证实的10例小于4 cm的GS患者的临床、CT及病理资料。在CT图像上评估肿瘤的位置、大小、形态、密度、强化特点及周围淋巴结等情况。结果 术前CT误诊7例,漏诊2例,仅1例正确诊断;10例病灶均起源于胃黏膜下;9例为圆形或类圆形;7例发生于胃体;平扫密度均低于肌肉组织,均呈渐进性强化。结论 小于4 cm的GS术前误诊率很高,且可发生漏诊。当CT检查提示胃体部黏膜下圆形或类圆形占位病变,平扫呈均匀稍低密度,增强呈渐进性强化时应考虑GS的可能,最终确诊需病理及免疫组化检查。

Objective To investigate the causes of CT misdiagnosis and missed diagnosis of gastric schwannomas（GS）smaller than 4 cm in size,and to improve radiologists’ awareness of GS and increase the detection rate and diagnostic accuracy．Methods Clinical,pathological and CT data of ten surgically and pathologically confirmed GS patients were retrospectively reviewed between March 2019 and October 2022．The location,size,shape,attenuation,enhancement features and surrounding lymph nodes of each tumor on CT were analyzed．Results Of the 10 patients,7 cases were misdiagnosed in preoperative CT examination,two cases were missed diagnosed and only one case was correctly diagnosed．All tumors originated from the submucosa in ten cases,and nine cases showed a round or oval shape．Seven lesions were located in the gastric body,and all tumors had homogeneous low attenuation compared to muscle on plain CT images．All cases displayed mild-moderate to obvious enhancement．Conclusions GS smaller than 4 cm have a high rate of misdiagnosis and missed diagnosis preoperatively．When CT examination indicates a submucosa tumor with a round-like shape in the gastric body and homogeneous mild hypoattenuation on plain CT,the possibility of GS should be raised．Pathological and immunohistochemical examinations are necessary to confirm the final diagnosis．

目的 回顾性分析支气管肺泡细胞癌(bronchioloalveolar carcinoma,BAC)临床特点,提高早期BAC的确诊率,减少误诊。方法 对2013年—2014年间在我院确诊的BAC病例5例的临床资料进行回顾性分析。结果 5例患者中男4例,女1例,年龄在50～73岁之间,在社区医院均曾误诊为肺炎,所有患者均在我院经支气管镜肺活检后确诊为BAC。结论 BAC是一种较为特殊的肺癌,临床上症状无特异性,极易误诊为普通肺炎。由于BAC预后差,误诊后果严重,对初诊为普通肺炎的患者经常规抗感染治疗后临床症状及影像学表现改善不明显时,应及时进行各项检查、明确诊断,以便有效改善患者预后。

Objective To elevate the clinical diagnosis of BAC (bronchioloalveolar carcinoma) so as to reduce misdiagnosis by using retrospective analyses. Methods Retrospective analyses were used to study the five BAC patients, who were diagnosed in our hospital from 2013 to 2014. Results 4 of 5 male, and 1 female, age between 50 and 73, were diagnosed as pneumonia. All of them were made a definite diagnosis as BAC after performing transbronchial lung biopsy. Conclusion BAC is an exceptional lung adenocarcinoma and there is no specific clinic symptom. BAC was easily misdiagnosed as common lung pneumonia. There will be serious consequences after misdiagnosis of BAC due to its poor prognosis. Those patients who were misdiagnosed as common lung disease, but there was no obvious improvement after accepting long anti-infective therapy and there was negatively detection of pathogenic bacteria in them, are needed to perform all other clinical examination to clarify a diagnosis, and to further improve the prognosis of the patients.