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病例信息性别: | 男 | 年龄: | 7 |
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临床诊断: | |
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一般病史: | |
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标本名称: | |
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大体所见: | |
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![1](https://a1.cdn.91360.com/bbsattachment/forum/201608/26/110325wp6o4rs6epzpfr8p.jpg.thumb.jpg) 1 ![2](https://a1.cdn.91360.com/bbsattachment/forum/201608/26/110329ls7zkolhs82727cj.jpg.thumb.jpg) 2 ![3](https://a1.cdn.91360.com/bbsattachment/forum/201608/26/110331yqlqqwnw1qqciqeg.jpg.thumb.jpg) 3 ![4](https://a1.cdn.91360.com/bbsattachment/forum/201608/26/110339jsoyzkeez5o5i3g5.jpg.thumb.jpg) 4 ![5](https://a1.cdn.91360.com/bbsattachment/forum/201608/26/110342z7edn4nrr6bm6b9j.jpg.thumb.jpg) 5 ![6](https://a1.cdn.91360.com/bbsattachment/forum/201608/26/110347z226nax20zn2a75g.jpg.thumb.jpg) 6 ![7](https://a1.cdn.91360.com/bbsattachment/forum/201608/26/110612e9rdz9erkkehft2r.jpg.thumb.jpg) 7 ![8](https://a1.cdn.91360.com/bbsattachment/forum/201608/26/110620rprqygjwo00g3jwm.jpg.thumb.jpg) 8 ![9](https://a1.cdn.91360.com/bbsattachment/forum/201608/26/110626bj0guwsghgj3jzgu.jpg.thumb.jpg) 9 ![10](https://a1.cdn.91360.com/bbsattachment/forum/201608/26/110630ted5ge95wppplmpp.jpg.thumb.jpg) 10 ![11](https://a1.cdn.91360.com/bbsattachment/forum/201608/26/110635e881q4mozvt1oi36.jpg.thumb.jpg) 11 ![12](https://a1.cdn.91360.com/bbsattachment/forum/201608/26/110642q0vupme1mmtdteav.jpg.thumb.jpg) 12 ![13](https://a1.cdn.91360.com/bbsattachment/forum/201608/26/110644dlmiftbbwbc773b8.jpg.thumb.jpg) 13 ![14](https://a1.cdn.91360.com/bbsattachment/forum/201608/26/110648b4k40vl5z35k8jxj.jpg.thumb.jpg) 14 ![15](https://a1.cdn.91360.com/bbsattachment/forum/201608/26/110650wxaraltrrx0rjlk0.jpg) 15 ![16](https://a1.cdn.91360.com/bbsattachment/forum/201608/26/110652epnf2bsspx8ehiuh.jpg) 16 ![17](https://a1.cdn.91360.com/bbsattachment/forum/201608/26/110656cg229lk0d50igygg.jpg) 17 ![18](https://a1.cdn.91360.com/bbsattachment/forum/201608/26/110659c5bo7bjoyijf6jeb.jpg) 18
曾弘
患儿男,7岁,主 诉:右髋疼痛伴间歇性跛行1月余。现病史:患儿1月余前无明显诱因出现左髋部疼痛,疼痛发作时行走不便出现跛行。疼痛反复发作,程度可忍受,运动后可稍加重,持续十数分钟后即可自行消失。无向他处放射,无伴双下肢麻木、疼痛感。患儿家长携患儿就医,2016-07-29我院骨髓细胞检查报告:未见明显异常细胞骨髓象。2016-08-03我院MR:L5、S1椎体及右侧髂骨多发病灶,考虑嗜酸性肉芽肿可能性大。2016-08-04解放军昆明总医院PET-CT:L5、S1椎体、右侧髂骨病变,代谢增高,考虑恶性肿瘤,骨髓瘤、转移瘤、淋巴瘤相鉴别,骨髓瘤可能性大。
曾弘
各位老师好,非常抱歉昨天发的图片不清楚,再次上传患者详细资料,请各位专家会诊一下,多谢
曾弘
免疫组化:CD68(+)、CD3(+)、CD20(+)、CD99(±)、Ki67(-)、CK(-)、CD1a(-)、S-100(-)、Syn(-)、CD34(-)、TdT(-)、Langerin(-)。
蒋智铭
@曾弘 你发的图片分二部分,前半部分都是软骨,你必须分清楚这些软骨是肿瘤还是小孩骶髂关节面或椎间关节面的正常软骨,这需要与手术医生联系。如果是正常关节面软骨你就可以不去管它了。后半部分图片都是组织细胞和淋巴细胞,对儿童来说多骨受累当然先考虑朗格罕,但是你三个朗格罕的标记全阴,而病变累及的L5,S1和髂骨都围绕骶髂关节。因此你下一个诊断应该是骶髂关节结核。因为病变中除了组织细胞淋巴细胞还有朗罕氏巨细胞,可以做抗酸染色找结核杆菌,並让临床查血沉抗0等相关检查。
曾弘
@蒋智铭 多谢蒋老师,前面的软骨是正常的,病变主要是纤维组织增生,血管周较多炎症细胞浸润,有淋巴细胞,中性粒细胞,多核巨细胞,巨细胞胞浆内有吞噬的含铁血黄素,您看象郎罕氏巨细胞还是异物巨细胞呢?我做下抗酸染色,再和临床,放射科沟通一下。
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