Objective To evaluate and recognize the dynamic and morphological MRI charactristics of ductal carcinoma in situ (DCIS) of the breast and provide imaging information for the early detection and treatment planning Methods All MRI data in 71 patients with histollogically proved DCIS were analyzed retrospectively. The 71 patients were divided into two groups, NI ( pure DCIS, 44 patients) and N2 ( DCIS with microinvasion, 27 patients). According to the BI-RADS descriptors, all lesions were defined as a focus (smaller than 5 mm in diameter), mass and no-mass-like three enhancement types. The morphological features (M1 = focus, M2 = linear or linear-branched, M3 = branching-ductal, M4 = segmental, M5 = focal,M6 = regional, M7 = diffuse, M8 = mass) and the time-intensity curve (TIC) pattern [type l ( persistent enhancement curves), type Ⅱ( plateau), type Ⅲ(washout) and type Ⅳ (the same enhancement as glandular tissue)] were described. Chi-square test was used for the morphological characteristics of lesions.Results The 73 DCIS lesions were found in 71 patients, and 5.5% (n =4) were stippled lesions, 87.7%( n =64) were no-mass-like lesions, 6.8%(n=5) were mass-like lesions. In no-mass-like lesions (n=64), M3 was found in 15 cases, M4 in 34 cases, M5 in 9 cases and M6 in 6 cases, respectively, M3 and M4 were the most common distribution patterns. In N1 group(n =45) and N2 group (n =28), M3, M4,M5, M6 were found in 7 and 8, 21 and 13, 7 and 2, 3 and 3 cases, respectively. There were no statistic differences between two groups (P＞0.05). In 31 showed heterogeneous enhancement, both M3 and M4 were observed in 35.5% (11/31). In 26 clustered ring enhancement lesions, M4 was observed in 88.5% (23/26). Four lesions showed reticular enhancement,2 lesions showed a clumped enhancement and 1 lesion showed homogeneous enhancement. In 5 mass-like lesions, N1 group had 3 cases, N2 group had 2 cases.Four lesions showed lobulated margin, 4 lesions showed speculated margin, 1 mass showed smooth margin.Five mass showed heterogeneous enhancement. Type Ⅰ , type Ⅱ , type Ⅲ and type Ⅳ TIC ( n = 25) were demonstrated in 8, 11, 3 and 3 lesions, respectively. Conclusions M3, M4, especially segmental clustered ring enhancement, are the most common morphological characteristics of DCIS. Type Ⅰ and type Ⅱ TIC are the most common types.

Objective To investigate the diagnosis and treatment of active adrenal tuberculosis.Method The clinical data of 1 patients with adrenal tuberculosis was retrospectively analyzed and the related literatures were reviewed.The male patient,54 years old,complained abuot the dry cough and intermittent fever for 9 months.He was found the left adrenal gland tumor for 1 weeks and admitted to our hospital on November 1st,2016.The physical examination showed the obvious left kidney percussion tellderness.The local hospital,considered the left adrenal tumor.The pathological diagnosis of left adrenal tumor by biopsy was chronic inflammation.The patient accepted anti-inflammatory therapy,but his symptom was not relieved.In our hospital,blood bacterial culture and urine bacterial culture and PPD was negative.Blood tuberculosis antibody was positive.Triple acid-fast bacilli were negative in urine.Chest CT did not exclude the interstitial pulmonary tuberculosis.Adrenal contrast-enhanced CT showed mild enhancement,strip calcification shadow.Primary diagnosis was left adrenal tumor,which the abscess and tuberculosis could not to be excluded.Then,the patient accepted regularly anti-tuberculosis therapy (Isoniazid,0.3 g/d,rifampicin,0.45 g/d,ethambutol,0.6 g/d).Mter 3 days,his temperature returned to normal.Since the left adrenal mass was too large,which was about 6.8 cm × 5.5 cm,to distinguish with the tumor,the patient accepted successfully retroperitoneal adrenal tumor resection two weeks later.The left adrenal tumor surface was greyish and yellow,which was adherent with spleen and pancreas.After carefully separating,the tumor was successfully removed.Result The operation was successful,which last 85 min.Intraoperative blood loss was about 50 ml.Pathological report showed adrenal tuberculosis.The patients accepted regularly antituberculosis therapy(Isoniazid,0.3 g/d,rifampicin,0.45 g/d,ethambutol,0.6 g/d) for half a year,and followed up for 1 year after operation.No further hormone replacement therapy was used.No fever was noticed and his rhythm cortisol level was normal.Conclusions Adrenal mass associated with recurrent fever,should be suspected as adrenal tuberculosis if antibiotic therapy is not effective.If the adrenal CT showed adrenal calcification associated with the ectepic tuberculosis,patient should be diagnosised active adrenal tuberculosis.They should accept anti-tuberculosis treatment.However,if the volume of tuberculosis is large,or not to exclude tumor possibility,we recommend to proceed adrenal tumor resection for diagnosis.

Objective:To explore the influencing factors of postoperative chronic kidney disease (CKI) in patients with primary aldosteronism (PA).Methods:The clinical data of 103 patients who underwent adrenalectomy for PA in our center from August 2018 to August 2019 were analyzed retrospectively. There were 53 males and 50 females, aged (47.02±10.06) years old, including 27 diabetes patients (26.2%). The body mass index (BMI) were (24.47±3.24) kg/m 2, tumor maximum diameter were (15.61±5.66) mm, preoperative systolic blood pressure were (166.93±12.22) mmHg(1 mmHg=0.133 kPa), preoperative blood potassium were (3.35 ± 0.48) mmol/L, plasma aldosterone concentration (PAC) were (55.75±8.56)ng/dl, aldosterone-renin ratio(ARR) were (165.13±38.21) and preoperative glomerular filtration rate (GFR) were (77.96±14.77) ml/(min·1.73m 2). All patients underwent laparoscopic adrenalectomy. The operation time and bleeding volume were recorded. The GFR, blood potassium, PAC and ARR were recorded at the third month after surgery. The paired sample t test was used to compare GFR before and after surgery. Pearson correlation analysis was used to evaluate the correlation between the parameters and GFR after surgery. The independent predictors of GFR≤60ml/(min·1.73 m 2) were analyzed by univariate and multivariate logistic regression. Results:The surgery time were (85.37±21.66) min, and the bleeding volume were (10.54±4.84) ml. GFR (62.66±8.53) ml/(min·1.73 m 2) at 3 months after surgery was significantly different from that before surgery ( P<0.01). Univariate analysis showed that age ( OR=1.36, P<0.01), preoperative GFR ( OR=0.81, P<0.01), preoperative blood potassium ( OR=2.95, P=0.02), preoperative PAC ( OR=1.28, P<0.01) and preoperative ARR ( OR=1.08, P<0.01) were significantly correlated with postoperative CKI. In Pearson analysis, older age ( r=-0.51, P<0.01), lower preoperative GFR ( r=0.62, P<0.01), lower preoperative blood potassium( r=0.41, P=0.02), higher preoperative PAC ( r=-0.49, P<0.01) and higher preoperative ARR ( r=-0.56, P<0.01) increased the risk of CKI. Multivariate logistic regression analysis showed that age ( OR=1.26, P=0.05), preoperative GFR ( OR=0.79, P=0.02) and preoperative PAC( OR=1.29, P=0.01) were independent risk factors for postoperative CKI. Conclusions:CKI may occur in PA patients after adrenalectomy. PA patients with older age, higher preoperative PAC, higher preoperative ARR, lower preoperative blood potassium and lower preoperative GFR are more likely to have CKI. Age, preoperative GFR and preoperative PAC were independent predictors of CKI.

Objective To analysis the clinical features,diagnosis,treatment and prognosis of adrenal eosinophilic tumor with low testosterone levels.Methods The clinical data of a 22 years old male patient with adrenal eosinophilic tumor and low testosterone levels was analyzed.Blood pressure was 151/88 mmHg.The patient got bilateral gynecomastia.His bilateral testicular was soft and became smaller,with short penisr.Endocrine examination results showed:Estradiol 666 pg/ml,Prolactin 19.08 ng/ml,Testosterone 0.18 ng/ml,follicle stimulating hormone ＜ 0.2 U/L.The CT showed the mass density of soft tissue in the left adrenal region with diameter 7 cm,which was inhomogeneous and enhanced.There were many small vessels enhanced in the CT arterial phase,and the blood flow in the tumor was abundant.Clinical diagnosis of left adrenal tumor was pheochromocytoma.The patient underwent laparoscopic left adrenal tumor resection.The left adrenal gland was located in the superior pole of the left kidney,and there was an independent supply of the artery.Results Pathological result showed the tumor weigh was 60 g,7 cm in diameter and brown in section.The tumor cells were arranged in solid nests or acini,with more eosinophilic granules in cytoplasm.The nuclei was round and the nucleoli was located in the center,had clusters of pleomorphic and clustered cells.The tumor was wrapped in a thick fibrous envelope,mainly consisted of eosinophils,granulation tissue.There was no necrosis,mitosis,and vascular invasion.Immunohistochemical staining showed that the expression of CD56 and syn protein was positive.Pathological diagnosis was left adrenal eosinophilic tumor.After 4 months,the blood testosterone levels rose to 3.90 ng/ml,the blood pressure returned to normal (118/75 mmhg).The estradiol (21 pg/ml) was significantly inhibited.The patient began to appear beards and breasts became smaller.There were no signs of clinical or imaging recurrence.After 16 months follow-up,serum testosterone was 4.68 ng/ml and serum estrogen levels dropped to 33 pg/ml.Semen routine showed no sperm.Conclusions The clinical morbidity of functional adrenocortical oncocytoma with low testosterone levels and high estradiol levels is low.The pathological components are mainly eosinophilic granulation tissue.The adrenocortical oncocytoma are rare and preoperative diagnosis is difficult.Clinical manifestation,imaging examination and adrenal biochemistry examination should be considered to determine the localization and qualitative of tumor.Minimally invasive surgery is an effective treatment.The close follow-up after operation is essential.

Objective To realize the distribution and characteristics of Mycobacterium leprae (M.leprae) species and its single nucleotide polymorphisms (SNPs) spreading currently in China.Methods A total of 171 cutaneous lesion specimen of leprosy patients from 22 provinces were collected.The 16S rRNA conservative region of Mycobacterium leprae was amplified by nest PCR and the positive products were sequenced directly and aligned by BLAST.The SNPs of M.leprae were genotyped by restricted fragment length polymorphism for the PCR products.Results The 171 specimen were all Mycobacterium leprae since the amplified fragments of DNA samples were 99％ similar to the Br4923 of M.leprae from Brazil.No new species (M.lepromatosis) was found.Among the 85 samples genotyped for SNPs,SNP3,SNP1 and SNP2 accounted for 78.8％ (67/85),20％ (17/85) and 1.2％ (1/85) respectively.There was no sample with SNP4 genotype to be detected.Among the 171 sequencing specimen,130 showed mutation C-T at 251 bp of 16S rRNA.There was no difference for mutant rate of 16S rRNA gene and SNP genotype among the samples with different clinical pathological types.Certain associations between 16S rRNA C251T mutation and SNP genotype were found.Most of the samples with C251T mutations of 16S rRNA sequence were SNP3,only a few were SNP1 but not SNP2.There was significant difference of SNP genotype distribution among the patients from different regions.The distribution rate of SNP3 genotype in the samples from inland region (97.1％,34/35)was significantly higher than that from coastal region (66％,33/50) (x2 =11.96,P ＜ 0.01) . There was significant difference of the gene mutation rate of 16S rRNA sequence among the patients from different regions.The mutation rate of 16S rRNA in the samples from inland region (94.8％,92/97) was significantly higher than that from coastal region (51.4％,38/74) (x2 =43.56,P ＜0.01).Conclusion C251T mutation in 16S rRNA gene sequence of M.leprae may associate with SNP type suggesting that the characteristics of geographical distribution presented in different genotypes of M.leprae.No new species of M.leprae was found in this study.