乳腺肉瘤50例临床分析

对50例乳腺肉瘤患者的临床资料进行回顾性分析。结果本组叶状囊肉瘤32例．恶性淋巴瘤4例，癌肉瘤6例，纤维肉瘤2例，恶性纤维组织细胞瘤2例，脂肪肉瘤2例，平滑肌肉瘤1例．恶性神经鞘瘤1例。予手术治疗加放、化疗的综合治疗方案。随访3个月～21a．5a生存率为84．2Vo（32／38）．10a生存率为81．8％（18／22）。认为对疑有乳腺肉瘤患者应常规行术中快速病理检查。乳腺叶状囊肉瘤等较少发生淋巴转移者，如瘤体较大宜行全乳腺切除术，瘤体较小者可行保乳手术。对癌肉瘤、恶性淋巴瘤等易发生腋窝淋巴结转移者，应行乳腺癌改良根治术。     

骨骼肌转移癌临床特点分析

目的探讨骨骼肌转移癌的临床表现、影像学特点、治疗及预后,避免与原发的软组织肉瘤相混淆,提高治疗效果。方法7例骨骼肌转移癌患者,原发部位明确5例,分别为纵膈低分化鳞癌、肝癌、肺癌、肾癌、结肠癌各1例;原发部位不明确2例,病理结果为小细胞末分化癌。首发症状：伴有疼痛的软组织肿物5例,仅有肿物不伴疼痛2例。发病部位：大腿3例、上臂3例、臀部1例。单发转移1例,伴肺转移的多发转移6例。6例患者术前局部行强化MRI检查,另1例行强化CT检查。结果MRI表现为骨骼肌内软组织肿物,伴明显强化,其中2例患者周缘明显强化,伴中心坏死。6例行局部手术切除治疗,1例放弃治疗。诊断骨骼肌转移癌后3—19个月死亡。结论骨骼肌转移癌临床罕见,易被误诊为软组织肉瘤。好发于肢体的近心端。治疗以手术治疗为主,可辅以放射治疗。患者预后差。     

原发性肾脏滑膜肉瘤1例并文献复习

目的 探讨原发性肾脏滑膜肉瘤的临床病理特征、诊断、治疗和预后.方法 报告1例原发性肾脏滑膜肉瘤诊治过程及临床病理资料,并结合文献分析其临床病理特征.结果 患者临床和影像学表现无特异性,行根治性肾切除术;术中冰冻病理诊断为尿路上皮细胞癌,行患侧输尿管全长切除术;术后常规病理诊断为后肾始基分化欠成熟的双向分化的癌肉瘤,经联合病理会诊及免疫组化检查确诊为肾脏原发性滑膜肉瘤（梭形细胞为主型）.术后生物治疗,随访1 a无复发.结论 原发性肾脏滑膜肉瘤是一种罕见的恶性程度高、进展迅速、侵袭性强的肿瘤,易发生于年轻成人,预后较差;确诊主要依据病理学检查、免疫组化、细胞遗传学,治疗需采取早期手术联合术后化疗、放疗或生物治疗的综合疗法.     

成人肾母细胞瘤的诊断及治疗（附8例报告）

目的探讨成人肾母细胞瘤的诊断和治疗方法。方法,对8例成人肾母细胞瘤患者的临床表现、分期、治疗及预后作回顾性分析。结果本组表现为单纯肉眼血尿1例、腰腹痛5例（伴血尿1例）、无症状2例,术前拟诊肾肿瘤5例、肾盂肿瘤2例、输尿管肿瘤2例。均于术后病理检查确诊为肾母细胞瘤。按照美国国家肾母细胞瘤研究组（NWTS）分期标准,本组8例分别为I期2例、Ⅱ期2例、Ⅲ期3例、Ⅳ期1例。8例均行手术治疗,术后辅以放疗和化疗。7例随访1—15a,3例存活。结论成人肾母细胞瘤是一种比较少见的恶性肿瘤,术前确诊困难。手术治疗、辅以放疗和化疗等可明显提高治愈率并改善其预后。     

原发性乳腺肉瘤的诊断与治疗

目的探讨原发性乳腺肉瘤的临床特点及诊治方法。方法回顾性分析1999年1月～2009年6月我院收治的26例原发性乳腺肉瘤患者的临床资料。结果 26例均行手术治疗,术后随访6个月～10 a,3例失访,4例死亡,8例复发,3、5、10 a生存率分别为90.5%、84.8%、77.1%。结论原发性乳腺肉瘤的诊断需病理证实,治疗方法以手术为主,辅助化疗及放疗疗效不确切。     

成人原发性胃肠道Burkitt样淋巴瘤的诊治

目的:探讨成人原发性胃肠道Burkitt样淋巴瘤的流行病学、临床病理特点、诊断和治疗.方法:利用韩国延世大学图书馆平台在Medline/Pub Med、Web of Science、Directory of Open Access Journals(DOAJ)、Springer Link等15家英文文献数据库和中国知网中文期刊全文数据库中检索1995年以来发表的符合纳入条件的相关文献,共获得来自6篇文献的6例成人原发性胃肠道Burkitt样淋巴瘤的患者资料.结果:成人原发性胃肠道Burkitt样淋巴瘤主要分布在东亚的日本和中国(4例,66.7%);6例患者均为男性,平均年龄57.6岁;2例发生于回盲部,1例发生于胃,1例发生于结肠肝曲,1例发生于末端回肠,还有1例在胃和小肠同时发生;因发现腹部肿块就诊者4例,伴随B症状:体质量减轻4例;乏力2例;所有患者均行消化道内镜检查,行计算机断层扫描(computed tomography,CT)检查者5例,行B超检查者3例;行手术治疗者4例,行联合化疗者5例,行手术+术后化疗者3例;1例患者在1年内死亡;最长1例患者随访5年仍存活;6例患者中行CD20检测者4例,均为阳性;行C D10检测者6例,4例为阳性;行K i-67检测者3例,均为阳性;行B淋巴细胞瘤-2(B-cell lymphoma-2,Bcl-2)检测者3例,均为阴性;行CD23检测者2例,均为阴性;行CD5检测者2例,均为阴性.结论:成人原发性胃肠道Burkitt样淋巴瘤临床罕见,属于高度恶性的非霍奇金淋巴瘤,进展快,死亡率高.其临床表现缺乏特异性,在进行临床干预治疗之前,建议行全面的检查以明确诊断,最终诊断仍依赖于细针穿刺活组织检查或手术切除病理检查.治疗上应在诊断明确后尽早实施外科手术及术后的多药联合辅助化疗.临床医师应该提高对本病的认识,重视该病的临床诊治,以改善患者的预后.     

原发性中枢神经系统淋巴瘤临床分析

目的:探讨原发性中枢神经系统淋巴瘤(PCNSL)的临床特征.方法:回顾分析10例免疫功能正常的PCNSL患者的临床资料.结果:临床表现为颅内压增高及病灶所致的局部表现.病灶单发7例,多发3例,全经手术切除病灶,病理示B细胞型非霍奇金淋巴瘤.6例术后未行放化疗出院,失访1例,随访5例,平均生存4个月.1例CHOP方案化疗1周期,生存19个月.3例行大剂量甲氨蝶呤化疗+放疗;1例生存13个月,2例至今生存,平均生存24个月,复查无异常.结论:PCNSL预后不良,单纯手术不能延长患者生存期,手术结合放化疗是目前临床首选的治疗方案.     

原发性胃恶性淋巴瘤82例临床分析

对82例原发性胃恶性淋巴瘤患者的临床资料作回顾性分析。原发部位为胃窦66例。胃体10例，胃底贲门6例;临床分期为Ⅰ期50例，Ⅱ期26例，Ⅲ期6例。4例仅行化疗或化疗加放疗;78例接受手术治疗〈64例行根治术，14例行姑息性胃部分切除术），其中76例联合放疗和（或）化疗。全组患者的5、10a生存率分别为甲1．9％、54．5％，5、10a无瘤生存率分别为56．5％、48．7％。认为对原发性胃恶性淋巴瘤采用以手术为主加化疗或放疗的综合治疗效果较好。     

软组织肉瘤术后放疗的近期疗效观察

目的 观察软组织肉瘤术后放疗的近期疗效.方法 176例软组织肉瘤患者,均于局部扩大切除手术后行术后放疗.放疗开始时间为术后17～81 d,平均39 d;采用三维适形或调强放疗33例,常规放疗143例;大部分患者应用高能X射线,其中74例采用电子线照射或电子线与X射线混合照射;放疗剂量平均57.6 GY,常规分割.结果 本组13例未完成放疗,中断原因为放疗皮肤反应7例、非身体原因4例、放疗中放射野内复发1例、肺部感染1例;6例出现局部复发,复发率3.4％.急性反应包括皮肤黏膜急性损伤166例,白细胞减少37例,中性粒细胞减少15例;晚期反应包括皮肤黏膜慢性损伤139例,皮下组织纤维化107例,股骨颈骨折2例.结论 软组织肉瘤术后放疗的近期疗效较好.     

保乳手术后放疗可以消除复发

早期乳腺癌试验者协作组（EBCTCG）对10801例妇女进行乳房保守外科手术后的放疗试验。中位随访时间9．5a,25％的患者随访时间为10a以上。在放疗后的第1年内癌症复发明显减少,并持续到第1个10a内。在乳腺癌诊断10a后,与接受放疗的妇女相比（复发率19％）,没有接受放疗的妇女复发率为35％,即绝对风险降低15．7％。15a内接受放疗的乳腺癌死亡的绝对风险降低3．8％。     

Surgical treatment outcomes of primary hepatic sarcomas: A single-center experience

BACKGROUNDPrimary hepatic sarcoma is a rare tumor originated from mesenchymal tissue. There are various pathologic types of primary hepatic sarcoma and the treatment outcome of this tumor was usually disappointing. Unlike hepatocellular carcinoma, outcome of primary hepatic sarcoma is not well-known due to it’s rarity. However, with development of medical technology, surgical treatment may lead to better survival.AIMTo investigate the surgical outcomes of primary hepatic sarcoma, we gathered and analyzed the cases of a single institute.METHODSFrom August 2001 to September 2016, a total of nine patients were surgically treated for primary hepatic sarcoma after exclusion of cases with open and closure, early loss to follow-up and sarcomatoid hepatocellular carcinoma and sarcomatoid cholangiocellular carcinoma. Baseline characteristics, tumor characteristics such as tumor pathology, size and number, surgical and adjuvant treatments were reviewed. Tumor recurrence, and patient survival were analyzed with retrospective approach.RESULTSThe enrolled participants included five patients with angiosarcoma and four patients with undifferentiated sarcoma. All patients experienced tumor recurrence at a median of 52 post-operative days. Only two patients survived and the 5-year survival rate was 29.6%. One patient with angiosarcoma who received central hepatectomy for primary tumor and received radiofrequency ablation for recurrent tumor still lives for 11 years. One patient with undifferentiated sarcoma received Rt. lobectomy for primary tumor followed by chemotherapy and radiation therapy still lives around 30 mo even though she got additional operation for recurrent tumor. Two patients who received living donor liver transplantation due to angiosarcoma died. Only adjuvant therapy was associated with survival gain (P = 0.002).CONCLUSIONPatients with primary hepatic sarcoma may gain survival benefit with surgical resection followed by adjuvant therapy, even though the outcome remains relatively poor.     

Pancreaticoduodenectomy for metastatic ampullary and pancreatic tumors

BACKGROUND/AIMS: To report the clinical presentation, diagnosis and results of aggressive surgical management in patients with metastatic ampullary and pancreatic tumors. METHODOLOGY: Twelve patients underwent pancreaticoduodenectomy for ampullary or pancreatic metastases from January 1, 1987, to June 30, 1998, in 2 institutions. The primary cancer was renal cell carcinoma (n = 5), melanoma (n = 2), venous leiomyosarcoma (n = 1), carcinoid tumor (n = 1), colon carcinoma (n = 1), breast carcinoma (n = 1) and small-cell lung carcinoma (n = 1). The mean interval between primary treatment and metachronous pancreatic metastasis was 88 months. In 3 cases, pancreatic metastases were synchronous with the primary tumor. The main symptoms were jaundice (n = 8) and upper gastrointestinal tract bleeding (n = 2). The principal investigations were computed tomography scan (n = 9), arteriography (n = 7), duodenoscopy (n = 6) and fine-needle aspiration (n = 4). A correct preoperative diagnosis was made for 8 patients. RESULTS: In all cases, the pancreatic tumor was resected with intention to cure or provide useful palliation, using pancreaticoduodenectomy for isolated tumors (n = 11) or total pancreatectomy for multiple lesions (n = 1). Three out of 12 patents had positive lymph nodes, and the resection margin was free of disease in all cases. There was no postoperative mortality. Survival after pancreaticoduodenectomy averaged 26 months. Overall survival of patients undergoing pancreaticoduodenectomy was 35% at 2 years and 17% at 5 years. One patient is still alive more than 10 years after pancreaticoduodenectomy. CONCLUSIONS: Pancreaticoduodenectomy can be performed safely, representing a suitable option for resection in patients with symptomatic or late isolated pancreatic metastases in the absence of widely metastatic disease. The best indications are solitary metastases from renal cell carcinoma, sarcoma and neuroendocrine tumors. However, there is no evidence of survival benefit after pancreaticoduodenectomy for synchronous tumors or metachronous tumors from melanoma or colon carcinoma.     

Quantitation of human melanoma, carcinoma and sarcoma tumor cell adhesion to lymphatic endothelium

We have used an in vitro adhesion assay to study the interaction of tumor cells with lymphatic endothelium, a dynamic event that leads to tumor metastasis in vivo. 3H-thymidine-labeled human tumor cells from: one primary Ewing sarcoma, two established melanoma cell lines, two colon and two breast carcinomas (one established line and one primary culture of each) were added to 24-well culture dishes containing confluent monolayers of bovine lymphatic endothelium. Radioactivity associated with either the cells in suspension or the attached cells was assessed and compared at frequent intervals up to 360 minutes. Generally, tumor cell attachment increased as a function of time reaching a plateau between 180 and 360 minutes. the modular media system described here facilitates the primary and secondary culture (or co-culture) of a variety of normal and transformed cells. Primary cultures with a rounded morphology (one breast and one colon carcinoma) showed the lowest preferential attachment for lymphatic endothelium. All established cell lines and the primary Ewing sarcoma cell line displayed a more fibroblastic morphology and achieved the highest adhesion profiles. There was a correlation between the malignancy and attachment potential for the melanoma and breast carcinoma cell lines. Collectively, these data show that established tumor cell lines with fibroblastic-like morphology exhibit more rapid adhesion than primary tumor cell cultures with more rounded morphologies. While this property may reflect in vitro selection and/or adaptation, it does correlate with the metastatic propensity for some human tumor cells.     

Associations Between Elastography Findings and Clinicopathological Factors in Breast Cancer

This study aimed to explore the clinical significance of breast tumor tissue stiffness based on ultrasound elastographic evaluation in clinical breast cancer.Tumor tissue stiffness is mainly regulated by interactions among tumor cells, stromal cells, and extracellular matrix and was recently regarded as a representative feature of tumor microenvironment. Basic research has already revealed that the tumor stiffness can lead to tumor progression; however, little is known about its clinical significance because thus far, no useful modality is available in the clinical setting.We investigated the tumor stiffness by strain elastography in 503 consecutive patients with invasive breast cancer. Correlations between stiffness and clinicopathological factors, including tumor size, lymph node involvement, tumor subtypes, and stromal-related genes’ expressions in primary breast tumor, were statistically examined.We identified that clinical tumor stiffness significantly correlated with lymph node involvement and invasive tumor size but not with hormonal receptor expressions, human epidermal growth factor receptor type 2 status, and ki67 labeling index by analyses of both categorical and continuous variables of stiffness. On multivariate analyses, axillary lymph node metastasis was an independent factor that influenced the stiffness of primary breast tumor. In the gene expression analyses, relatively hard tumors had a significantly high gene expression of lysyl oxidase compared with soft tumors.Our study showed a close relationship between primary tumor stiffness by elastographic evaluation and lymph node involvement in clinical breast cancer. Further investigations on tumor-related tissue stiffness are required.     

成人乳腺干细胞中乳腺癌相关基因表达的研究

目的 探讨成人乳腺干细胞的分子特点。方法 应用RT-PCR和免疫印记杂交方法，检测从乳腺癌旁正常组织中分离培养的具有乳腺干细胞特点的乳腺上皮细胞（SHMEc）及同源癌组织中乳腺癌相关基因C-myc，C-jun、Ras，C-erbB2的转录和表达。结果 SHMEC不转录癌基因C-myc和c-jun，不表达C-erbB2及Ras癌基因蛋白，而其同源癌组织中可检测出癌基因的转录或表达。结论 成人乳腺干细胞SHMEC，不具有恶性转变的分子基础，有重要的研究价值及临床意义。     

Invasiveness and ploidy of human mammary carcinomas in short-term culture.

Invasiveness and ploidy were examined in cultures of human epithelial cells derived from nonmalignant breast tissue, primary breast carcinomas, and breast cancer effusion metastases. Successful short-term culture was achieved from approximately 70% of the primary breast cancers. These primary cancers were essentially diploid by flow cytometry and karyotype in contrast to the effusion metastases, which were mostly aneuploid. The diploid tumor cells retained their malignant phenotype in culture as demonstrated by invasion into a denuded human amnion basement membrane. In contrast, epithelial cells cultured from nonmalignant mammary tissue did not invade the amnion. We suggest that the diploid carcinoma cultures may be useful for investigating the essential differences between normal and malignant cells and may complement information derived from studies of tumor cell lines with grossly aberrant karyotypes.     

Direct esophageal metastasis from a distant primary tumor is a submucosal process: a review of six cases

Malignant esophageal stricture secondary to invasion from a tumor arising in a contiguous organ is a relatively rare finding; even more uncommon is a direct metastasis to the esophagus from a distant primary carcinoma. We present six cases, the largest current series, of esophageal strictures secondary to metastases from a separate primary cancer. We reviewed the records of 20 patients treated at Virginia Mason Medical Center between 1972 and 2000 with a diagnosis of malignant esophageal stricture secondary to an extraesophageal primary carcinoma. Patients whose stricture appeared to be secondary to esophageal invasion or compression from a contiguous tumor or lymph nodes were excluded. The remaining six patients who had metastases to the esophagus itself were reviewed with respect to the nature of the primary tumor, presentation, radiologic and endoscopic findings, and treatment. Among the 20 patients reviewed, 14 were excluded owing to either contiguous involvement from a nearby primary malignancy, regional nodal involvement, or complications of external beam radiation treatment. Six patients were considered to have direct metastasis to the esophagus from distant primary malignancies. The mean age of these patients was 72 years (range 68-74). Two of the primary lesions were lung carcinoma, while four primaries were breast cancers. The average time interval from the diagnosis of a primary tumor to esophageal involvement was 7 years in patients with breast cancer and 5 months in patients with lung cancer. Three patients were palliated with endoscopic dilation and stent placement. The other three patients have died secondary to upper gastrointestinal bleeding. Metastatic cancer to the esophagus is a rare occurrence. The process is usually submucosal and can be difficult to diagnose. The diagnosis should be considered when a patient presents with malignant dysphagia and has a background of distant carcinoma.     

Metastatic tumors to the upper gastrointestinal tract: endoscopic experience.

Metastatic tumors to the upper gastrointestinal tract were identified by esophagogastroduodenoscopy in 14 patients. Malignant melanoma, breast cancer, and lung cancer were the most common primary cancers in four, three, and three patients, respectively. Osteogenic sarcoma, renal cell carcinoma, Meckel cell carcinoma of the skin, and germ-cell tumor were the primary cancer in the remaining four. The esophagus was involved in three patients, the stomach in 13, duodenum in four, and papilla of Vater in one. Upper gastrointestinal bleeding and anemia were the most common presenting features. There was correlation between symptoms and endoscopic findings in all patients. Involvement of gastrointestinal tract at endoscopy was the initial and only evidence of metastases in all patients without evidence of metastases elsewhere, as evidenced by other diagnostic tests in any of these patients. Endoscopic biopsies and/or brush cytology provided histologic diagnosis in all 14 patients. The endoscopic and nonendoscopic literature regarding metastases to the upper gastrointestinal tract is reviewed.     

外科诊治原发性气管腺样囊性癌11例

目的 探讨原发性气管腺样囊性癌的临床特征、诊断及治疗方法。方法 11例原发性气管腺样囊性癌患，年龄30～49岁。病灶位于气管上1／3段7例，其中2例侵及喉，1例侵及环状软骨；气管中、下段各2例。11例患均采取手术治疗，行气管袖状切除端端吻合术5例，其中环状软骨部分切除、气管环状软骨端端吻合1例；气管肿瘤局部刮除术4例；颈段气管及全喉切除气管造口术2例。结果 11例患无手术死亡，术后均痊愈出院，远期并发症有气管造口狭窄1例，复发1例。结论 对原发性气管腺样囊性癌患应力争早期诊断，积极手术治疗。