液氮冷冻治疗骨肿瘤132例体会

2006年1月～2007年11月,我科采用液氮冷冻疗法治疗骨肿瘤132例,效果满意.现报告如下.临床资料:本组132例骨肿瘤患者,男92例,女40例;年龄10～67(45.8±6.3)岁.骨良性或肿瘤样病变51例,骨低密度恶性病变68例,恶性肿瘤13例.     

乙醇灭活非离体瘤段骨重建治疗骨干部恶性骨肿瘤

目的观察非离体瘤段骨乙醇灭活后行骨重建术在骨干部恶性骨肿瘤治疗中的应用。方法对6例骨干部原发或继发恶性骨肿瘤患者,术中充分暴露瘤体,于肿瘤近端距瘤体2—3cm正常骨干处截骨,向另一端分离,将瘤体提起,稍离开创面,彻底切除瘤段骨上的肿瘤组织。用自制橡皮袋从骨断端将瘤段骨套人。注入95％乙醇,注满为止。封闭橡皮袋30min后将瘤段骨复位,给予内固定,修复骨缺损。术后观察肢体功能、患者生活质量及存活时间。结果6例平均随访时间为23个月（8—42个月）,元复发,肢体功能均满意。结论非离体瘤段骨乙醇灭活后用于治疗骨干部恶性骨肿瘤是一种控制肿瘤局部复发的较理想方法。     

骨巨细胞瘤40例分析

骨巨细胞瘤为青壮年人较多见的原发骨组织肿瘤之一,其发生率约占骨肿瘤的5%,占良性骨肿瘤的15%左右。具有易复发、恶变倾向和一开始就具有恶性的特点。在外科疗法中以病骨彻底切除或大块植骨的效果最为理想。我科收治骨肿瘤345例,经手术和病理证实骨巨细胞瘤40例,现作简要分析讨论。一、临床资料40例中,男22例,女18例,年龄13～49     

电子结肠镜检查回盲部病变12328例分析

目的探讨皖南地区回盲部病变的发病情况及内镜下特点。方法回顾总结分析皖南医学院附属医院内窥镜中心近4年来肠镜检查中发现的回盲部病变发病情况及内镜下特点。结果 2009年9月至2013年6月共行电子结肠镜检查12 328例,发现回盲部病变225例。其中回盲部息肉76例,恶性肿瘤40例,慢性炎症37例,憩室20例,溃疡18例,外压隆起9例,阑尾病变5例,间质瘤4例,克罗恩病3例,肠结核2例,血管病变2例,血吸虫肠病2例,囊肿1例,脂肪瘤1例,未明确诊断的隆起灶5例。在肠镜检查中,回盲部发病率较低,发病率为1.83%,但回盲部病变的种类繁多,总体上以良性病变为主,良性病变占80.00%,恶性病变占17.78%,未明确的隆起病灶占2.22%。良性病变中主要以息肉为主,占良性病变的42.22%;恶性病变主要以腺癌为主,占恶性病变的77.50%。结论常规结肠镜加上病理组织学检查是诊断回盲部病变的主要手段,结合超声肠镜可提高诊断准确率。     

骨肉瘤的分类

在骨肿瘤中,55.7%为良性,27.7%为恶性。在原发恶性骨肿瘤中,骨肉瘤(OS)占44.6%,软骨肉瘤占14.2%,纤维肉瘤占6.6%,骨髓瘤占6%,尤文氏瘤占4.6%。骨肉瘤和原发性骨肿瘤好发年龄为11～30岁。以股骨和胫骨多见,占51.3%。次为肱骨、骨盆、颌骨和椎骨。     

骨转移瘤的诊断及外科治疗

骨转移瘤是指所有恶性肿瘤发生的骨骼转移病灶的总称。骨转移瘤作为一组疾病,单从数量看,远远超过任何一种原发恶性骨肿瘤。这其中,癌所发生的骨转移占绝大多数（90％以上）。骨在人类恶性肿瘤转移的易感器官中,位列第3,仅排在：肺、肝之后（亦有认为第4,第3为脑）。     

197例嗜铬细胞瘤临床分析

目的提高嗜铬细胞瘤的诊治水平。方法回顾性分析郑州大学第一附属医院1986～2005年所有病理诊断为嗜铬细胞瘤的197例患者的临床资料。结果197例患者均经手术治疗。良性嗜铬细胞瘤184例,恶性13例;肾上腺原发肿瘤171例,异位嗜铬细胞瘤24例,多发内分泌腺瘤（MEN）Ⅱ（嗜铬细胞瘤伴甲状腺髓样癌）2例。结论完善检查手段可提高嗜铬细胞瘤的检出率,确诊需病理检查,手术是根本的治疗方法。     

2型糖尿病患者高发胆囊息肉样病变原因分析

目的探讨2型糖尿病患者胆囊息肉样病变的发病率及其临床意义。方法选取2003年1月至2006年12月本院住院的625名糖尿病患者。对照组选择本院同期健康体检者625例。依据腹部B超检查结果对上述资料进行统计学分析。结果625例糖尿病患者合并胆囊息肉样病变144例,占23%(其中:1型糖尿病患者132例,胆囊息肉样病变者9例,占6.8%;2型糖尿病患者493例,胆囊息肉样病变者135例,占27%);健康体检者625例,其中胆囊息肉样病变者36例,占5.8%。结论2型糖尿病患者胆囊息肉样病变的发现率显著高于健康人(P<0.01)和1型糖尿病患者(P<0.01);1型糖尿病患者胆囊息肉样病变的发病率与健康人无差别。2型糖尿病患者脂代谢异常是其发生胆囊息肉样病变的主要原因,而胆囊的植物神经病变、胆囊壁超微结构的改变亦是其可能发病的机制。因而在强调降血糖治疗的同时,积极地调脂治疗,则可降低糖尿病患者胆囊息肉样病变的发病率,进而减少急性胆囊炎及胆囊癌的发生率,具有重要的临床意义。     

髋臼骨样骨瘤2例报告

骨样骨瘤是一种良性骨肿瘤，常发生在股骨、胫骨和肱骨的骨干和干骺端。2000年以来，本院收治髋臼骨样骨瘤患者2例。现报告如下。     

长骨病理性骨折56例手术治疗体会

1995年 2月～ 2 0 0 0年 2月 ,我院骨科手术治疗长骨病理性骨折患者 5 6例 ,现报告如下。一般资料 :本组男 33例 ,女 2 3例 ;年龄 16～ 6 9岁 ,平均 2 4岁。均为一个长骨病理性骨折。骨折位于股骨 35例 ,胫骨 11例 ,肱骨 7例 ,桡骨 3例。病因 :良性骨肿瘤及瘤样病变 30例 (骨巨细胞瘤 14例 ,孤立性骨囊肿 8例 ,非骨化性纤维瘤 3例 ,骨纤维异样增殖症 5例 ) ,恶性肿瘤 2 6例 (骨肉瘤 16例 ,骨转移瘤 4例 ,纤维肉瘤 2例 ,软骨肉瘤 3例 ,尤文肉瘤 1例 )。5 6例患者之诊断均经术后病理检查证实 ,均为闭合性骨折。手术方法 :良性骨肿瘤和瘤样病损…     

Immunohistochemical analysis of nm23 protein expression in malignant bone tumors

Expression levels of nm23 protein in 72 malignant bone tumors comprising 41 osteosarcomas, 22 chondrosarcomas, 6 Ewing's sarcomas, and 2 malignant fibrous histiocytomas were examined immunohistochemically, using anti-nm23 protein polyclonal antibody, and compared with 51 cases of benign bone tumors or tumor-like lesions. Malignant bone tumors showed significantly higher nm23 protein expression than benign bone tumors or tumor-like lesions (P<0.0001). In chondrosarcoma, nm23 expression increased in high-grade tumors (grade I versus grade II and III:P=0.0229). In the cases of osteosarcoma, however, grade IV osteosarcomas showed decreased expression of nm23 compared with grade III tumors (P=0.0122). There was no significant relationship between nm23 expression and histological type. nm23 expression had no correlation with metastatic potential in osteosarcoma, although the therapy was not uniform in our cases. Furthermore, in 6 cases of osteosarcoma and 1 case of Ewing's sarcoma, there was no clear tendency for a decrease of nm23 in the metastatic sites compared with primary sites, as reported in breast cancer. These results showed that, in contrast to reports on breast cancer and experimental models, nm23 protein expression in human bone tumors may be associated with malignant potentiality, except in cases of osteosarcoma.     

Genetic imbalances in benign bone tumors revealed by comparative genomic hybridization

There have been no reports on choromosomal aberrations of benign bone tumors revealed by comparative genomic hybridization (CGH). CGH analysis of benign tumors may be useful in understanding the mechanism of tumorigenesis with comparisons to malignant tumors. There were 4 tumors (2 enchondromas, one chondromyxoid fibroma, and one osteoid osteoma) and 8 tumor-like conditions (4 aneurysmal bone cysts (ABCs), one eosinophilic granuloma, one fibrous dysplasia, one solitary bone cyst, and one Rosai-Dorfman disease) available for analysis. One of 2 enchondromas and one of 4 ABCs exhibited rapid growth. Six lesions showed chromosomal aberrations, while 6 others did not. The most frequent aberrations were the loss of a whole chromosome-19 in 6 cases, the loss of chromosome-arm 22q in 4 cases, and the loss of chromosome-arm 17p in 3 cases. Gains were seen in 13q21 in 2 cartilaginous tumors and at 12q15-q21 in eosinophilic granulomas. Therefore, in benign bone tumors or tumor-like lesions, chromosomal aberrations are not frequent; however, some clear tendencies of clustering of aberrations can be observed.     

Differential diagnosis of benign tumors and tumor-like lesions in the spine. Own cases and review of the literature

Although benign tumors and tumor-like lesions of the spine are shown in every orthopedic teaching book, it is often surprising how little attention is paid to the differential diagnosis and diagnostic investigations, respectively, since surgical treatment and postoperative control depends on exact diagnosis. Clinically the importance of this fact can not be over-emphasized. The most common complaint is pain, either local or radicular in nature. Bone deviations are diagnosed radiologically. Different types of benign bone tumors and tumor-like lesions of the spine including osteochondroma, osteoblastoma, osteoid osteoma, aneurysmal bone cyst, eosinophilic granuloma, hemangioma, and giant cell tumor, their appearance relation to the age and location in the spine were reviewed and the common histologic subtypes described. Clinical, laboratory and histopathologic findings, radiologic inclusive MRT and scintigraphic features are evaluated. Diagnostic investigations including the invasive techniques of CT guided needle biopsy, Yamshidi needle biopsy and costotransversectomy for biopsy are shown. Treatment including radiation, chemotherapy and the surgical procedure as well as the postoperative treatment of patients with benign tumors and tumor-like lesions of the spine are discussed.     

Resistance index in differential diagnosis of liver lesions by color doppler ultrasonography

AIM: To investigate the specific value of resistance index (RI) in color Doppler ultrasonography in the diagnosis of focal hepatic lesions. METHODS: Eight hundred patients with 893 hepatic solid lesions were studied with color Doppler flow imagimg (CDFI) and pulsed Doppler, induding 644 malignant cases (596 primary malignant liver tumors, and 48 metastatic liver tumors), 156 benign cases. All were confirmed by operation and pathology. RESULTS: The detection rate of arterial flow in malignant tumors was 92%, and 52% in benign lesions. Doppler spectrum analysis showed that the resistance index in primary malignant tumors was 0.75&#177;0.12, 0.73&#177;0.09 in metastatic tumors, and was below 0.6 in benign lesions. The difference was significant (P&lt;0.001). This difference was related with its histopathologic structure. CONCLUSION: The arterial flow with RI≥0.6 identified by CDFI within the liver lesion can be regarded as a criterion of malignant tumors, RI&lt;0.6 can be regarded as benign disorders. RI is useful in differential diagnosis of liver neoplasms.     

Computed direct magnification radiography of bone tumors

The purpose of this study was to assess the diagnostic performance of computed direct magnification radiography in diagnosing bone tumors as compared with conventional radiography. Ninety-one patients with primary bone tumors and tumor-like lesions were radiographed with conventional and magnification techniques. All radiographs were analyzed by one orthopedic surgeon and two radiologists and the findings were correlated with histopathology. Two microfocal X-ray units were used for computed direct magnification radiography with a focal spot size of 20–130 μm. Using magnification versus conventional radiography, the diagnosis of benign and malignant lesions as well as the individual tumor diagnosis was obtained with higher accuracy (85% versus 71% and 69% versus 51%, respectively, P < 0.01). Margins of destruction, periosteal reactions, and matrix patterns were evaluated with higher accuracy by all observers (P < 0.01). We conclude that computed direct magnification radiography may improve evaluation and diagnosis of bone tumors. Received: 28 September 1999 / Accepted: 30 June 2000     

Benign tumors of the liver

Benign tumors of the liver, less commonly encountered than metastatic or primary liver tumors, may present clinically with symptoms due to mass effect, or may be discovered incidentally during radiographic evaluation or surgical exploration for other clinical indications. Many of the lesions that result in a benign liver mass are true neoplasms, while others result from reactive proliferation of hepatocytes, biliary cells, mesenchymal or inflammatory cells. The premalignant nature or potential for malignant transformation is of concern in some of the benign tumors or tumor-like masses of the liver. In this article, benign tumors and tumor-like masses involving the adult liver are discussed with a focus on histopathology, histogenesis, and clinical significance of these interesting and unusual lesions.     

Klatskin-mimicking lesions--a case series and literature review

Obstruction of the hepatic hilum in patients without prior surgery is generally due to hilar adenocarcinoma (Klatskin tumor). However, not all the hilar strictures are malignant. Although uncommon, benign strictures of the proximal bile duct should be taken into consideration in differential diagnosis of Klatskin tumors, since the incidence could reach up to 25% of patients with presumed Klatskin tumor diagnosis. This group of benign proximal bile duct strictures (Klatskin-mimicking lesions) is usually represented by segmental fibrosis and non-specific chronic inflammation. The clinical and imaging features can not differentiate between benign and malignant strictures. Herein, we present a case series of three patients with benign proximal bile duct strictures (representing 4.1% of 73 patients resected with presumptive preoperative diagnosis of Klatskin tumor) and literature review. There are presented the clinical and biochemical features, imaging preoperative workup, surgical treatment and histological analysis of the specimen, along with postoperative outcome. For benign strictures of the hilum limited resections are curative. However, despite new diagnosis tools developed in the last years, patients with hilar obstructions still require unnecessary extensive resections due to impossibility of excluding the malignancy. In all cases of proximal bile duct obstruction presumed malignant, they should be managed accordingly, even with the risk of over-treatment for some benign lesions.     

Accuracy of endoscopic ultrasonography in upper gastrointestinal submucosal lesions: a prospective multicenter study

BACKGROUND: Endoscopic ultrasonography (EUS) is commonly agreed to be the best imaging method for diagnosing and differentiating between submucosal lesions in the gastrointestinal tract. However, most of the current evidence for this derives from retrospective multicenter studies. A prospective multicenter analysis of the performance of EUS in diagnosing submucosal lesions in everyday practice was therefore conducted. METHODS: Over a 2-year period, this study included 150 patients (52% men, mean age 59.8 years) from 23 centers who had a presumptive diagnosis of a submucosal lesion on upper gastrointestinal endoscopy. The patients' symptoms and EUS results were recorded. Endoscopic and endosonographic findings regarding lesion size, layer of origin, and the presumptive diagnosis (benign or malignant) were recorded. The reference methods used were surgery, biopsy, other imaging tests, and a follow-up period of 6 months. RESULTS: Of the 150 patients, 102 had an intramural lesion (84 tumors, 18 other lesions such as cysts, aberrant pancreas, etc.), and 48 had an extraluminal compression--in most cases (n = 35) by normal organs or structures. For differentiating between a submucosal and an extraluminal compression, the sensitivity and specificity of endoscopy were 87% and 29%, whereas those of EUS were 92% and 100%. However, the sensitivity and specificity of EUS for differentiating between malignant and benign submucosal tumors were only 64% and 80%, respectively. CONCLUSIONS: The accuracy of EUS in differentiating between submucosal tumors and extraluminal compressions is substantially superior to that of endoscopy, but EUS is still inadequate for differential diagnosis between benign and malignant submucosal tumors. However, EUS is still the best method of visualizing submucosal lesions precisely. The influence of EUS on the further management in these patients remains to be examined in subsequent studies.