肺透明细胞癌2例报告

例1,男,57岁,因咳嗽、胸痛2月入院。胸部X线片见左肺上叶肿物,痰细胞学检查找到鳞癌细胞。行左上肺叶切除术,术中见肿物位于左肺上叶,约8×8×7cm大小,已侵及脏层脑膜,纵隔中见多枚3×2×1cm大小淋巴结,术后病理报告为左肺透明细胞癌,淋巴结阳性。术后给予胸部放疗及VP16＋PDD方案化疗1疗程。肺切除术后12月复诊时发现肿物复发,伴有胸腔积液,3月后死亡。例2,女,44岁,因咳嗽、痰中带血1月入院。胸部X线片示左下肺结核球可能,给予抗房治疗1月无效,痰细胞学检查未见恶性细胞,做胸腔CT考虑左下肺癌,行左下肺叶切除术。术…     

原发性卵巢类癌6例及文献复习

目的:探讨卵巢类癌的临床和病理特点、治疗及预后.方法:回顾性分析中国医学科学院中国协和医科大学肿瘤医院1975年9月～2008年9月治疗的6例原发性卵巢类癌临床病理资料,并进行文献复习.结果:6例患者中5例(83.3%)发生下腹痛症状,检查发现盆腹腔肿物;2例(33.3%)发生类癌综合征表现;2例合并卵巢畸胎瘤.全部患者接受手术治疗,术后均无辅助治疗.病理组织学类型分别为:岛状型4例,小梁型1例,粘液型1例.手术病理分期:Ⅰ A期3例,Ⅰ C期3例.1例Ⅰ C期患者术后1个月发生肿瘤复发转移,行全身化疗后肿瘤未控.术后5个月死于本病.其余54例患者随诊9个月至33年,除1例死于原发肺癌外,4例均无瘤生存.结论:原发卵巢类癌非常罕见,诊断需除外转移性类癌.本病为低度恶性,早期患者可单纯手术治疗.多数预后良好.本组复发病例化疗疗效差.     

乳腺间质肉瘤6例

目的:探讨乳腺间质肉瘤(Stromal sarcoma of the breast,SSB)的临床病理特征、诊治方法及预后.方法:对天津医科大学附属肿瘤医院1954年5月～2007年9月收治的6例SSB患者的临床病理资料进行回顾性分析.结果:患者均为女性,1例绝经.发病年龄20～55岁,中位年龄38岁.患者均以乳腺肿物为首发症状,3例位于乳腺外上象限,肿物中位最大直径6cm(3～15cm),3例有肿块短时间内迅速增大的病史,1例伴间断性疼痛.按美国肿瘤联合会(AJCC)制定的临床及病理分期(第六版)标准:ⅡA期1例,ⅡB期2例,ⅢB期2例,1例无法评估.4例患者首次治疗采用乳腺肿物局部切除术,复发后采用全乳切除或改良根治术,侵犯胸大肌者则行根治术.最终2例行全乳切除术,2例行乳腺根治术,2例行乳腺改良根治术.术后病理证实均为乳腺间质肉瘤,其中1例伴灶性骨化,1例伴粘液变性.4例患者首次行腋窝淋巴结清扫,均未见淋巴结转移.术后3例患者行辅助化疗,所有患者均未行放疗.术后中位随访36.5个月(8～204个月)间,4例行肿物局部切除术的患者均复发,其中3例患者2次以上复发,首次复发中位时间为2.5个月(1～4个月).1例患者于术后7个月出现双肺转移,未治疗,余5例患者均无瘤生存.结论:乳腺间质肉瘤术前诊断困难,肿物局部切除术后易复发,保证切缘阴性的局部扩大切除术或全乳切除术是治疗乳腺间质肉瘤的合适手段,腋淋巴结清扫是不必要的.术后辅助化疗、放疗的疗效尚不明确.     

转移性肾上腺癌的临床治疗（附15例报告）

目的:分析我院收治的15例肾上腺转移性恶性肿瘤的临床资料，结合文献复习，总结临床诊治体会。方法:回顾性分析我院2011年1月至2019年5月收治的15例肾上腺转移性恶性肿瘤患者的临床资料。男12例，女3例；平均年龄为63岁(53～73岁)。肾上腺转移瘤的最大径中位值为4.4 cm（2.0~9.8 cm），左侧11例，右侧3例，双侧1例。原发恶性肿瘤来源:肺7例，肝3例，肾2例，子宫1例，胰腺1例，腹膜后肿物1例。本研究中15例肾上腺转移恶性肿瘤为原发肿瘤确诊后诊断，距离原发肿瘤诊断的中位时间为15.6个月(5~28个月)。15例患者均行手术切除治疗。结果:术后病理细胞类型:腺癌4例，肝细胞癌3例，透明细胞癌2例，弥漫性大B细胞瘤2例，神经内分泌癌1例，癌肉瘤1例，肺小细胞癌1例，肺大细胞癌1例。术后定期随访患者，15例患者生存4~78个月。患者最终死于肿瘤广泛转移。结论:我院肾上腺转移性恶性肿瘤的原发肿瘤以肺癌最为常见，多数转移瘤在定期复查中无意发现。我院肾上腺转移瘤以左侧多见。肾上腺转移瘤治疗方式有手术治疗、介入治疗、经皮肿瘤消融、免疫治疗、放疗和化疗等。     

鼻腔、颞骨神经内分泌癌的生物学特征及诊治

目的:报道2例原发于鼻腔鼻窦、颞骨小细胞神经内分泌癌,并探讨其临床生物学特征及诊治。方法:回顾性分析2例头颈神经内分泌癌的临床资料,并复习文献。结果:1例为女性,68岁,临床表现为进行性左鼻塞、鼻腔暗红色肿物。鼻窦CT示左鼻腔占位性病变,行手术加放化疗、靶向治疗,带瘤生存。1例为女性,70岁,临床表现为右耳流脓、耳痛、面瘫。先后行两次手术和两次放疗。第二次手术及放疗后1个月死于肺转移、全身多器官功能衰竭。结论:鼻腔鼻窦和颞骨神经内分泌癌极为罕见。该瘤具有临床表现不典型、生长迅速、侵犯广、转移率高、预后差、差异大等特点。诊断依靠病理及免疫组化。治疗应根据不同的临床分期和病理分型,实施以手术为主的综合治疗。     

眼眶受累的鼻型NK/T细胞淋巴瘤一例报告

1 病例报告 患者男性,56岁,因双眼红肿、视力下降10 d于2008-03-20入院.患者2007-01因右鼻前庭肿物、上腭正中溃疡行肿物切除术,病理为鼻腔T细胞淋巴瘤,免疫组化:CD3+,CD20-,CD43+,CD56-,CD79-;虽CD56-,但临床考虑鼻腔NK/T细胞淋巴瘤(NHL)可能性大;经CHOP方案化疗6个周期、放疗1个周期后,肿物消失,溃疡缩小,病情评估为完全缓解.     

直线加速器治疗鼻咽癌的疗效观察

我院于1984年4月开始使用直线加速器对鼻咽癌进行放射治疗。现对同年收治的71例进行回顾性分析如下: 资料与方法 1984年4月至1984年12月共收治符合本文收集标准的鼻咽癌71例,使用直线加速器9MV-X线治疗。 病例收集标准:1、鼻咽活检病理证实为癌;2、未曾放疗、化疗者;3,鼻咽部单纯使用9MV-X线照射,肿瘤量≥60Gy;4,收治时无远地转移。     

原发于鼻腔、鼻窦多形T细胞淋巴瘤临床分析

目的:探讨原发于鼻腔、鼻窦多形T细胞淋巴瘤(polymorphic T-cell lymphoma)的治疗方法.方法:回顾分析1997年1月～2003年1月间天津市第一中心医院耳鼻咽喉科诊治的14例原发于鼻腔、鼻窦多形T细胞淋巴瘤患者的临床资料.对所有的患者行全面的检查及临床分期,分别采用单纯放疗,化疗 放疗 化疗的治疗方法.结果:14例中ⅠE期2例采用单纯放疗完全缓解(CR)随访19、77个月无复发;ⅡE期8例其中3例采用化疗50天～2个月内死亡,5例采用化疗 放疗 化疗,完全缓解(CR),随访20、32、63、63、76个月无复发,ⅣE期4例,其中3例采用化疗分别于1～4个月内死亡,1例采用化疗 放疗 化疗,部分缓解(PR),随访64个月无复发.结论:原发于鼻腔和鼻窦的多形T细胞淋巴瘤,ⅠE期可采用单纯放疗,ⅡE期～ⅣE期应采用化疗 放疗 化疗的综合治疗.CHOP仍是首选的标准化疗方案.     

甲状腺转移癌(附9例报告)

目的：探讨甲状腺转移癌的发病特点、诊断及治疗。方法：分析甲状腺转移癌9例，中住年龄51岁．原发食管癌3例，肺癌3例，肾透明细胞癌、恶性黑色素瘤、喉癌各1例。针吸穿刺确诊5例，手术切除及确诊4例．其中1例肾透明细胞癌行部分切除及术后放疗，单纯放疗2例，化疗3例。由原发癌至转移间隔1个月～4年。中位时间8个月。患者均以颈前肿物就诊，1例伴声音嘶哑。结果：B超检查为甲状腺内多发弥漫性低回声团块．部分患者表现为结节性甲状腺肿。1例肾透明细胞癌患者存活7．5年，其余均在10个月内死于广泛转移。结论：甲状腺转移癌罕见．但有恶性肿瘤既往史伴有甲状腺肿块的患者应考虑转移癌的可能，诊断依靠B超、针吸活检、免疫组化染色。甲状腺转移预后不良，但肾透明细胞癌甲状腺转移积极治疗仍有望长期生存。     

鼻腔类癌复发并心包转移1例

病案摘要　患者男性 ,34岁。 1995年 10月 18日因双侧鼻塞在山东省省立医院行双侧鼻腔肿物切除术 ,术后病理为鼻腔类癌。 1995年 11月 7日入住我院给予PF(PDD 4 0mgd1 5 ,5 FU 5 0 0mgd1 5 )方案化疗两周期 ,随后给予局部放疗 695 9cGy ,患者于 1996年 3月 18日出院。出院后病情稳定。2 0 0 0年 1月 2 0日发现前额部一 1cm× 1cm的肿块 ,并有涕血 ,在山东省省立医院行颅底及鼻腔肿瘤清扫术 ,术中见肿瘤位于双侧额窦 ,前额前板见 3cm× 3cm骨质破坏 ,颅内正常 ,鼻中隔中后段及硬腭均见新生物 ,病理为复发性类癌。 2 0 0 3年 1月出现咳嗽…     

9例原发性食管小细胞癌临床分析

目的：探讨原发性食管小细胞癌的临床特点、治疗及预后。方法：回顾分析9例原发性食管小细胞癌患者的临床资料。结果：1年生存为3／9，死于肝转移4例、肺转移3例、骨转移1例及肝、脑同时转移1例。结论：对于原发性食管小细胞癌应采用以化疗为主的综合治疗，局限期以手术联合化疗，广泛期以放疗联合化疗为宜。     

Clinical report of the treatment of locally advanced lung cancer.

This paper discusses the results of the treatment of 345 patients entered in the Veterans Administration Lung Group Protocol 13L. The study was activated March 1972, and closed for the patient accesion March 1975. All patients had a histological diagnosis of primary lung cancer considered clinically non-resectable or inoperable. Patients were equally randomized into two groups, radiotherapy alone or radiotherapy with chemotherapy. The analysis of the data included: treatment regimen, radiation dose, initial performance status, performance status change, cell type, duration of survival, quality of survival and age. The strongest influence on median survival was the level of radiation dose. The small cell carcinoma patients treated with radiotherapy and chemotherapy showed significant improvement in the median survival (38.2 weeks) over the patients treated with radiotherapy alone (20.6 weeks). The patients treated with radiotherapy and chemotherapy also showed improvement in performance status more frequently than the patients treated with radiotherapy alone. Other parameters of the analysis will be presented.     

Extrapulmonary Small Cell Carcinoma - a Case Series of Oropharyngeal and Esophageal Primary Sites Treated with Chemo-Radiotherapy

Background: The optimal sequence and extent of multimodality therapy remains to be defined forextrapulmonary small cell carcinoma because of its rarity. The purpose of our study was to assess the responseto neoadjuvant chemotherapy followed by chemoradiation/radiation in patients with extrapulmonary smallcell carcinoma. Materials and Methods: Four consecutively diagnosed patients were included in this study.The primary tumor site was oropharynx in three patients and esophagus in one. The patients with the limiteddisease were treated with chemotherapy followed by concurrent chemoradiation (n=2) or radiotherapy (n=1).The patient with the extensive disease with the primary site in vallecula was treated with chemotherapy andpalliative radiotherapy to the metastatic site. Results: The median follow-up was 22.5 months (range, 8-24months). Three patients with the limited disease (base of tongue, n=2; esophagus, n=1) were in completeremission. The patient with the extensive disease died of loco-regional tumor progression at 8 months from thetime of diagnosis. Conclusions: The combination of chemotherapy and radiotherapy is the preferred therapeuticapproach for patients with extrapulmonary small cell carcinoma. Induction chemotherapy followed by concurrentchemoradiation or radiation provides a good loco-regional control in patients with limited disease.     

Small-cell carcinoma of the head and neck. A novel treatment regimen.

Four patients with small-cell carcinoma (SCC) of the head and neck were treated in a pilot Phase I-II study to evaluate the response rate and toxicity of weekly non-cross-resistant combination chemotherapy administered as primary therapy in small-cell carcinomas. All four patients had locoregional disease without evidence of distant metastasis. The treatment regimen consisted of dose-intensive chemotherapy administered for 16 weeks. One or two of six cytotoxic agents (cisplatin, vincristine, methotrexate, Adriamycin, cyclophosphamide, and etoposide) were used weekly in different combinations followed by radiotherapy and/or surgical resection. To date, three of the four patients have completed therapy and achieved a complete response. The fourth patient is currently receiving chemotherapy and has achieved a partial response. Our treatment regimen appears effective in producing high initial response rates in SCC of the head and neck.     

原发性食管小细胞癌临床分析

目的探讨原发性食管小细胞癌的临床特点、治疗及预后.方法回顾性分析20例原发性食管小细胞癌患者的临床资料.结果局限期患者单纯手术、单纯化疗、单纯放射治疗、手术 化疗、化疗 放射治疗的中位生存时间分别为14,14,6,18,16个月;广泛期患者单纯化疗(2例)、化疗 放射治疗(2例)中位生存时间分别为6和8个月.全组的中位生存期为12个月,生存最长者已达72个月.而未治疗的广泛期患者仅存活2个月.结论对于原发性食管小细胞癌,应采用以化疗为主的综合治疗.     

Primary malignant lymphoma of the parotid gland report of three cases.

AIMS AND BACKGROUND: To document the clinicopathologic features and treatment modalities of primary malignant parotid gland lymphoma, based on three cases diagnosed and treated at Oldchurch Hospital, Romford, UK. METHODS: Three patients, two with stage II and one with stage IV disease, received primary treatment consisting of chemotherapy following surgical biopsy. RESULTS: All three patients obtained rapid complete remission during their scheduled chemotherapy. One patient is alive without evidence of disease 12 months from the end of treatment. One patient, a frail, elderly gentleman, died due to massive pneumonia while in complete remission for two months. The third patient, who developed local recurrences in both parotid glands without transformation of his low-grade histology, achieved a second complete remission following chemo- and radiotherapy. All side effects were of a mild nature. CONCLUSION: Malignant lymphoma of the parotid gland is a chemo- and radiosensitive disease.     

50例原发性食管小细胞癌的临床特点和综合治疗

目的：探讨原发性食管小细胞癌（PESC）的临床特点和综合治疗方法．方法：分析50例PESC的临床资料，其中放、化疗16例，单纯手术11例，术后联合放、化疗17例，术前化疗6例，分析其中位生存时间、结果：全组手术根治切除率为85．2％，手术死亡2例。放、化疗的中位生存时间7．2个月，单纯手术的中位生存时间为11个月．术后联合放、化疗的中位生存时间为16个月，术前化疗的中位生存时间为22个月。结论：PESC是一种全身性疾病．恶性程度较高，应采用综合治疗以达到延长生存的目的，特别是采用术前化疗的方法值得重视。     

Adjuvant high-dose rate brachytherapy after chemoradiation for treatment of early T-stage nasopharyngeal carcinoma

The local control of nasopharyngeal carcinoma after conventional radiotherapy has historically been suboptimal. Recently, investigators have reported improved outcomes for this patient population with the use of combined chemoradiotherapy. The purpose of this analysis of our prospective treatment protocol was to evaluate the additional value of high-dose rate intracavitary brachytherapy (HDRIB) on the disease response, local control, and survival. Between March 1999 and January 2001, 16 patients with newly diagnosed locally advanced (stage III and IV) nasopharyngeal carcinoma were treated prospectively at the Radiation Oncology Department of the National University Hospital of Singapore. All patients were staged according to the AJCC (1997) Staging System and had early T stages (T1 and T2). Treatments included concurrent external beam radiotherapy (EBRT) and chemotherapy as follows: 66 Gy to the primary tumor in conventional fractionation with cisplatin based concurrent chemotherapy followed by adjuvant cisplatin and 5-fluorouracil (5-FU) chemotherapy. Ten Gy of HDRIB in 2 weekly fractions were delivered after the completion of EBRT to all 16 patients. All patients were evaluable for treatment response, local control, survival, and toxicity analysis. The median follow-up for the whole group of patients was 18 months (range: 10-34 months). All patients obtained pathologic complete response at the primary site at 4 months after the completion of the treatment. At the time of this analysis, 15 (93.8%) patients are alive with no evidence of disease. One patient (6.2%) developed locoregional recurrence in the neck at 9 months, and distant metastasis at 11 months after the completion of treatment. Our experience has shown adjuvant HDRIB after concurrent chemoradiation offers encouraging disease response, local control, and survival. A prospective study is being planned to further evaluate the role of adjuvant HDRIB after concurrent chemoradiation on treatment outcome.     

Nasopharyngeal carcinoma in children review of 16 cases

Of fifty two children with nasopharyngeal tumors who were registered and treated at Memorial Sloan-Kettering Cancer Center (MSKCC), from 1961 through 1977, 16 had carcinoma. The results of retrospective analysis of these patients are presented here. There were 7 girls and 9 boys between 12 and 16 years of age. One patient had a Stage I tumor; one had a Stage II tumor and 14 had Stage IV tumors. The histology was poorly differentiated epidermoid carcinoma in all patients. All patients had radiotherapy to the primary site. Six patients received chemotherapy for distant metastases, and 2 had adjuvant chemotherapy. Of the 13 patients who were treated initially with radiation alone, 2 were alive and free of disease at 12 and 14 years respectively. Of the 3 patients who had chemotherapy at initial treatment, one was alive and free of disease 18 months from diagnosis and one patient died of treatment without tumor. Bone was the most common site of distant metastases. While radiation therapy alone appears to be adequate treatment for early tumors, adjuvant chemotherapy should be tried to improve results in advanced tumors.     

Haemangiopericytoma of the central nervous system

The records of four patients presenting with a histological diagnosis of haemangiopericytoma of the central nervous system, in Auckland, New Zealand, between 1970 and 1990 were reviewed retrospectively, with the aim of determining the natural history of the disease and response to various treatment modalities. Three out of the four patients reviewed presented with primary cerebral disease and the fourth with a primary spinal cord tumour. All three cerebral primary patients were initially treated with local surgical excision. All three patients received radical radiotherapy following local recurrence. The first two patients remained disease-free locally although one patient developed a solitary liver metastasis 5 years after radiotherapy. The third patient was referred with multiple cerebral metastases and failed to respond to radiotherapy. The patient with the primary lesion in the spinal cord was treated with local excision followed by postoperative radiotherapy and remains disease-free 17 years after treatment. One patient failed to respond to chemotherapy, prescribed to treat a local recurrence adjacent to the previous radiotherapy field. This was successfully excised subsequently. The patient presenting with multiple cerebral metastases was the only patient to die of this disease. Results suggest that local recurrence is avoidable with adequate wide excision of the primary tumour followed by local radical radiotherapy. The role of chemotherapy remains controversial and no conclusion could be drawn regarding the role of palliative radiotherapy from this study. Active treatment and long-term follow-up are necessary because of the relative aggressiveness of this disease and the propensity for late relapses.