肺癌颈部、锁骨上下及腋下淋巴结针吸细胞学活检及应用价值

肺癌是我国北方最常见的恶性肿瘤,部分甚至以颈部淋巴结转移为首发症状.因此准确判断颈部淋巴结的转移情况,对肺癌诊断确定,指导化疗、放疗及估计预后等具有重要意义.本研究对随机选择的103例首诊肺癌患者行超声检查,并对243个可疑颈部淋巴结行细针穿刺针吸细胞学检查(fine needle aspiration cytopathology,FNAC),旨在探讨超声对肺癌颈部淋巴结转移的诊断价值.     

以卵巢囊肿为首发症状的肺小细胞癌1例并文献复习

目的:探讨l例以卵巢囊肿为首发症状的肺小细胞癌患者的临床病理特征.方法:对该患者的临床表现、病理特征及免疫组织化学表型进行观察、分析,并做相关文献复习.结果:该患者首发症状为卵巢囊肿,囊壁附一灰白结节,镜下为小细胞癌形态,术后结合临床表现及免疫组化表型结果,诊断为肺小细胞癌转移至卵巢子宫内膜异位囊肿.结论:肺小细胞癌转移至卵巢子宫内膜异位囊肿是一种极罕见的现象,其确诊依赖于临床资料及组织病理学检查.     

磁共振检查对中央型支气管肺癌的诊断价值

目的评价MRI在中央型支气管肺癌诊断中的价值.方法分析了27例中央型肺癌的临床与MRI资料,并与普通X线及CT扫描比较. 结果 MRI能清楚显示肿瘤的大体形态特征,并在显示肿瘤内部结构、区别肿块与肺不张、观察肿瘤侵犯纵隔和淋巴结转移方面可提供更多诊断信息. 结论 MRI对中央型肺癌的诊断具有重要价值.     

非小细胞肺癌脑转移分子诊断标志物的研究进展

非小细胞肺癌脑转移的发生率、病死率高,筛选操作简单、准确的分子标志物对其诊断及治疗具有重要意义。随着分子生物学的发展,许多肿瘤相关分子标志物被发现,在非小细胞肺癌脑转移诊疗中具有重要价值。该文主要对非小细胞肺癌脑转移分子标志物的研究进展及现状进行阐述,以期为非小细胞肺癌脑转移的临床和科研工作提供参考。     

磁共振检查对中央型支气管肺癌的诊断价值

目的：评价MRI在中央型支气管肺癌诊断中的价值。方法：分析了27例中央型肺癌的临床与MRI资料，并与普通X线及CT扫描比较。结果：MRI 能清楚显示肿瘤的大体形态特征，并在显示肿瘤内部结构、区别肿块与肺不张、观察肿瘤侵犯纵隔和淋巴结转移方面可提供更多诊断信息。结论：MRI对中央型肺癌的诊断具有重要价值。     

肺癌脑转移采用三维适形放射治疗的临床价值分析

目的：对肺癌脑转移采用三维适形放射治疗的临床价值进行评价分析，为今后的临床治疗工作提供可靠的参考依据。方法抽取在2011年7月~2013年8月我院收治的肺癌脑转移患者60例，将其按照治疗方法分成观察组和对照组，分别接受全脑放疗联合三维适形放射治疗和常规全脑放疗，而后对这两组患者的治疗效果进行对比分析。结果观察组患者肿瘤局部控制率较对照组发生显著升高(P<0.05)，中位生存期较对照组发生显著延长(P<0.05)。结论在对肺癌脑转移进行治疗时，合理实施三维适形放射疗法可有效改善肿瘤控制率，改善临床疗效，延长生存时间，临床价值显著，值得关注。     

56例脑转移性肿瘤临床病理分析

1　材料和方法收集我院 1985～ 1998年脑外科手术标本中脑转移性肿瘤 5 6例 ,标本均用 10 %中性福尔马林液固定 ,常规石蜡包埋切片 ,ＨＥ染色 ,其中部分病例作免疫组化染色 ,网状纤维染色 ,粘液染色。 11例做了电镜观察。2　结果2 1　各种脑转移性肿瘤的病理学特征2 1 1　肺癌　本组 40例 ,男 2 9例 ,女 11例 ,其中 16例已收稿日期 :1999 11 19作者单位 :南京军区南京总医院病理科 ,南京　 2 10 0 0 2 进修医生 ,现在盐城市第二医院病理科　 2 2 40 0 2作肺癌切除术而后出现脑转移 ,2 4例以颅内占位病变为首发症状 ,在术前或术后摄胸片时…     

2.77 以胃肠动力紊乱为首发症状的尿毒症

目的大多数尿毒症患者表现为与肾脏有关的症状,也有一部分患者伴有消化道症状,但以胃肠动力紊乱为首发症状者偶见.我们对北京天坛医院1991～2000年诊断明确的197例尿毒症患者进行分析,为了探讨胃肠动力紊乱在尿毒症患者首诊时的重要性.方法观察尿毒症患者首诊时胃肠动力紊乱的临床表现,比较首发与非首发胃肠动力紊乱尿毒症患者的发病年龄及肾功能血尿素、氮、肌酐的差异,并比较经血液透析治疗后首发与非首发胃肠动力紊乱尿毒症患者的临床表现.结果 197例尿毒症患者中以胃肠动力紊乱为首发症状为31例,占15.74%. 首发胃肠动力紊乱尿毒症患者的平均年龄(29.7)明显低于非首发胃肠动力紊乱者(54.3), 与年龄成反比.经血液透析治疗后,以胃肠动力紊乱为首发症状的尿毒症患者症状明显缓解或消失.结论以胃肠动力紊乱为首发症状的尿毒症临床虽不多见,但应引起高度重视.     

可手术性的非小细胞型肺癌脑转移的检查(CT和MRI的比较)

肺癌引起脑转移被认为是切除肺原发肿瘤的禁忌症。CT曾经认为是无神经症状非小细胞型肺癌术前检查分期的准确方法 ,最近研究发现增强 MRI对脑内小病灶的检出非常敏感。为此作者进行 CT、MRI两组比较。方法　 332例非小细胞型肺癌患者 ,无神经系统症状 ,并进行胸部 X线片、CT检查及腹部 CT、超声 ,血常规和骨扫描证实无远处转移 ,为可手术组。 15 5例 CT、177例 MRI检查颅脑 ,全部进行术前和术后随访。 CT组和 MRI组均进行平扫及静注造影剂后扫描。结果　原发性肺癌术后 12个月 CT组发现 11例脑转移 (7.1% ) ,MRI发现 12例 (6 .8…     

厄洛替尼一线治疗肺癌脑膜转移1例报告

肺癌脑膜转移是癌细胞脑转移弥漫性侵犯软脑膜和脑脊膜,无颅内占位性病灶。乳腺癌及黑色素瘤等也可脑膜转移^[1]。临床表现不典型,以颅内高压为主要表现。我院收治1例肺癌脑膜转移患者,采用厄洛替尼一线治疗获得满意效果,现报告如下。     

Diagnostic Efficacy of PET/CT Plus Brain MR Imaging for Detection of Extrathoracic Metastases in Patients with Lung Adenocarcinoma

We aimed to evaluate prospectively the efficacy of positron emission tomography (PET)/computed tomography (CT) plus brain magnetic resonance imaging (MRI) for detecting extrathoracic metastases in lung adenocarcinoma. Metastatic evaluations were feasible for 442 consecutive patients (M:F=238:204; mean age, 54 yr) with a lung adenocarcinoma who underwent PET/CT (CT, without IV contrast medium injection) plus contrast-enhanced brain MRI. The presence of metastases in the brain was evaluated by assessing brain MRI or PET/CT, and in other organs by PET/CT. Diagnostic efficacies for metastasis detection with PET/CT plus brain MRI and with PET/CT only were calculated on a per-patient basis and compared from each other. Of 442 patients, 88 (20%, including 50 [11.3%] with brain metastasis) had metastasis. Regarding sensitivity of overall extrathoracic metastasis detection, a significant difference was found between PET/CT and PET/CT plus brain MRI (68% vs. 84%; P=0.03). As for brain metastasis detection sensitivity, brain MRI was significantly higher than PET/CT (88% vs. 24%; P<0.001). By adding MRI to PET/CT, brain metastases were detected in additional 32 (7% of 442 patients) patients. In lung adenocarcinoma patients, significant increase in sensitivity can be achieved for detecting extrathoracic metastases by adding dedicated brain MRI to PET/CT and thus enhancing brain metastasis detection.     

对比增强磁敏感加权成像序列与肺癌脑转移瘤检出的相关性

目的:研究对比增强磁敏感加权成像（CE-SWI）与肺癌脑转移瘤检出的相关性。方法:病例组选取肺癌脑转移瘤病例50例,对照组选取高血压病例50例,分析SWI与CE-SWI检出微出血的病例数、病灶个数、最大直径,采用[χ2]检验分析两组检出的差异,采用Logistic回归分析CE-SWI与肺癌脑转移瘤、高血压微出血的相关性。结果:CE-SWI在病例组检出患者45例,病灶数127个,最大直径5.428（3.663, 11.405） mm;在对照组检出患者28例,病灶数121个,最大直径3.259（2.206, 4.325） mm,[χ2]检验得出两组病例检出均有统计学差异（P<0.05）。相关性检验中,病例组发生微出血的优势比高于高血压组,差异有统计学意义（P<0.05）。结论:CE-SWI对于微出血和脑转移瘤的检出敏感,肺癌脑转移、高血压都是微出血的危险因素,但肺癌脑转移瘤引起的微出血发生率显著增加。     

Brain metastases from breast cancer: lessons from experimental magnetic resonance imaging studies and clinical implications

Breast cancer that has metastasized to the brain presents difficult clinical challenges. This diagnosis comes with high mortality rates, largely due to complexities in early detection and ineffective therapies associated with both dormancy and impermeability of the blood–brain barrier (BBB). Magnetic resonance imaging (MRI) is the current gold standard for diagnosis and assessment of brain tumors. It has been used clinically to investigate metastatic development as well as monitor response to therapy. Here, we describe preclinical imaging strategies that we have used to study the development of brain metastases due to breast cancer. Using this approach, we have identified three subsets of metastatic disease: permeable metastases, nonpermeable metastases, and solitary, dormant cancer cells, which likely have very different biology and responses to therapy. The ability to simultaneously monitor the spatial and temporal distribution of dormant cancer cells, metastatic growth, and associated tumor permeability can provide great insight into factors that contribute to malignant proliferation. Our preclinical findings suggest that standard clinical detection strategies may underestimate the true metastatic burden of breast cancer that has metastasized to the brain. A better understanding of true metastatic burden in brains will be important to assist in the development of more effective chemotherapeutics—particularly those targeted to cross the BBB—as well as detection of small nonpermeable metastases.     

肺肠型腺癌6例诊疗分析并文献复习

目的：肠型腺癌是非小细胞肺癌的一种少见病理类型,本文主要讨论肺肠型腺癌的临床和病理特征,诊断和治疗方法。方法：回顾性分析2013年至2016年5月间诊治的6例肺肠型腺癌患者的临床资料。结果：男2例,女4例,发病年龄25~78岁,以“咳嗽胸闷”起病4例,伴“颈部包块”4例,以“头晕恶心呕吐”起病1例;影像学主要表现为肺部、锁骨上及纵隔占位,病理形态及免疫组化均提示肿瘤来自于结直肠癌,但胃肠镜均未见异常占位;根治性和姑息性手术各1例,其中1例根治术后复发转移;1例行脑单发转移灶射波刀治疗后未再接受治疗,余5例患者均接受了全身化疗。截止随访结束,4例患者死亡,生存时间最短9个月,最长32个月。结论：肺肠型腺癌易与结直肠癌肺转移相混淆,确诊需要排除肠道病变,早期治疗以手术治疗为主,关于系统治疗方案有待临床进一步研究。     

不同分割剂量同步推量调强放疗治疗肺癌脑转移瘤的安全性分析

目的:分析不同分割剂量同步推量调强放疗治疗肺癌脑转移瘤的安全性及生存情况。方法:选取肺癌脑转移瘤患者75例,随机分为3组,均实施同步推量调强放疗,其中A组放疗方案为全脑40 Gy/20f（2.0 Gy/f）+瘤区同步推量46 Gy/20f（2.3 Gy/f）,B组方案为全脑40 Gy/20f（2.0 Gy/f）+瘤区同步推量52 Gy/20f（2.6 Gy/f）,C组方案为全脑40 Gy/20f（2.0 Gy/f）+瘤区同步推量58 Gy/20f（2.9 Gy/f）。放疗开始后,对3组患者危及器官（眼球、晶体、视神经、脑干）平均剂量及最大剂量和3组患者放疗相关不良反应进行比较。治疗结束后定期复查颅脑MRI评价疗效,观察3组患者1年生存率。结果:A、B、C组危及器官平均剂量及最大剂量差异不显著（P>0.05）;A、B、C组急性放疗不良反应发生率差异不显著（P>0.05）,晚期神经系统不良反应发生率亦差异不显著（P>0.05）,3级放疗不良反应低于5%,无4级放疗不良反应发生。随访1年,C组生存率高于A、B组（P<0.05）。结论:同步推量调强放疗治疗肺癌脑转移瘤是一种安全有效的方法,随着放疗剂量增加,疗效有增加趋势。     

Screening of brain metastasis with limited magnetic resonance imaging (MRI): clinical implications of using limited brain MRI during initial staging for non-small cell lung cancer patients

The purpose of this prospective study was to determine whether using magnetic resonance imaging (MRI) for early screening for brain metastases (BM) can improve quality of life, survival in patients with non-small cell lung cancer (NSCLC). The study group comprised 183 patients newly diagnosed with NSCLC. All patients underwent limited brain MRI and routine workups. The control group comprised 131 patients with NSCLC who underwent limited brain MRI only if they had neurologic symptoms. The incidence of BM was 20.8% (38/183) in the study group and 4.6% (6/131) in the control group. The rate of upstaging based on the MRI data was 13.5% (15/111) overall and 15.9% (11/69) in patients that had been considered initially to be resectable surgically. There was no significant difference in survival outcome between the groups. Patients who had BM alone had a greater overall survival time (49 weeks) than those who had multiple systemic metastases (27 weeks; p=0.0307). In conclusions, limited brain MRI appears to be a useful, cost-effective method to screen for BM at the time of initial staging. And it may facilitate timely treatment of patients with NSCLC and improve their survival and quality of life.     

Salivary-type amylase producing lung cancers examined clinically and pathologically in 260 Japanese patients of lung lobectomy or segmentectomy

The causative mechanisms of lung cancers producing salivary-type amylase (S-Amy) were hypothesized from clinical and pathological analysis of lung cancers. A total of 260 Japanese patients who received lung lobectomy or segmentectomy during the last 4 years at Hamamatsu University Hospital, Japan, were objective patients in this study. Among the 260 patients, 212 patients were operated on for lung cancers. Of the 212 patients, 132 (62%) had adenocarcinoma and 38 (18%) had squamous cell carcinoma (SCC), of which 32 adenocarcinoma, and 8 SCC patients had metastatic lung cancers. Twenty-five (78%) of the 32 adenocarcinoma patients showed metastatic cancers from colon cancers to the lungs, especially from rectal and sigmoid colon cancers. Twenty-one (21%) of 100 primary adenocarcinoma patients and 8 (27%) of 30 primary SCC patients had double cancers coexisting with the lung cancers during the last 7 years. Among the 29 patients of double cancers, 4 lung cancer patients showed coexisting gastric cancers. The mortality rate of 79 adenocarcinoma and 22 SCC patients with primary lung cancer but not double cancer was 14% during the 4 years of this study. In 12 (12%) patients of the 101 patients with primary lung cancers, bone metastases were confirmed by bone scintigraphy. All the nine (9%) patients with brain metastases were adenocarcinoma, which was confirmed by brain magnetic resonance imaging (MRI). Serum amylase levels of the 79 adenocarcinoma and 22 SCC patients were 232 ± 343 (SD) and 156 ± 161 (SD) (IU/l), respectively, 1 day post-operation. Diabetes mellitus (DM) or borderline DM were found in 34 (43%) of the 79 adenocarcinoma and 16 (73%) of the 22 SCC patients. Of the 14 patients who died of lung cancers, 11 (79%) had DM. From these clinical and pathological findings, more than 70% of Japanese lung cancers were hypothesized to have developed from the oncogene of a retrovirus inserted into the 5' promoter of S-Amy genes (AMY1) in 60–70 age groups.     

CA19-9、增强MRI和PET/CT在胰腺癌诊断及分期中的价值

目的探讨CA19-9、增强MRI和PET/CT在胰腺癌诊断及分期中的价值。方法回顾性分析沈阳军区总医院普外科2013年1月至2014年1月间收治的92例手术治疗的胰腺占位患者资料。患者术前均行CA19-9检查、腹部增强MRI扫描及全身PET/CT扫描,以术后病理或临床综合评价诊断为标准,比较CA19-9、增强MRI和PET/CT在胰腺癌诊断及分期中的价值。结果 92例患者中,确诊胰腺癌82例,非胰腺癌10例。CA19-9检查、腹部增强MRI及全身PET/CT对胰腺癌诊断的灵敏度分别为78.0%、86.6%和92.7%。PET/CT具有较高灵敏度,显著优于CA19-9,差异有统计学意义（P=0.008）;PET/CT优于增强MRI,差异无统计学意义（P=0.200）;在胰周淋巴结转移判断方面,增强MRI和PET/CT的灵敏度分别为46.9%、81.6%,二者差异有统计学意义（P〈0.001）;在肝转移判断方面,增强MRI和PET/CT诊断的灵敏度分别为54.5%、72.7%,二者差异无统计学意义（P=0.66）。结论PET/CT对胰腺癌诊断有较高灵敏度,优于CA19-9、增强MRI;PET/CT有助于发现淋巴结和远处器官转移病灶,获得更加准确的术前分期,从而避免诊断性剖腹探查手术。由于仍然存在假阴性、假阳性,应该综合其他检查方法对疾病作全面分析来提高临床诊断准确性。     

立体定向活检在颅内疑难病变诊断中的临床应用

目的 探讨立体定向活检在颅内疑难病变诊断中的临床应用价值。方法 选取我院2011年3月~2017年3月20例患者全部行立体定向活检术,术前均因临床症状或体征多次接受过CT 、MRI 或MRS等影像学检查, 已明确患者颅内病变, 但未对病理性质确诊, 无法采取有效的治疗方法而接受立体定向活检手术。结果 行立体定向活检术确诊病理诊断,星形细胞瘤Ⅲ级6例,星形细胞瘤Ⅱ级2例,淋巴瘤2例,肺癌脑转移瘤2例,肿瘤放射性坏死灶2例,其它5例（胶质母细胞瘤１例,转移性小细胞恶性肿瘤1例,炎细胞１例,脱髓鞘1例,脑梗塞1例）,性质不明1例,手术活检阳性率95.00%。结论　立体定向活检术具有准确性高、创伤小、并发症少等优点,能够有效的诊断颅内疑难病变,并为下一步治疗提供病理学依据。     

Markers of bone turnover in patients with lung cancer

INTRODUCTION: Bone metastases may change the primary treatment modality, especially if the bone is the only site of metastasis in patients considered to be in the early stage of lung cancer. It is usually diagnosed by imaging techniques. However, the diagnostic yields of imaging methods are limited. Some bone markers such as propeptides of type-1 collagen, pyridinoline cross-links and deoxypyridinoline (D-PYD) cross-links, serum osteocalcin, alkaline phosphatase are thought to be useful in the detection of bone metastasis in lung cancer. Thus, we aimed to determine the clinical usefulness of bone turnover markers in the assessment of bone metastases in patients with lung cancer. MATERIAL AND METHODS: Urinary D-PYD, calcium, and serum osteocalcin, calcium and total alkaline phosphatase (T-ALP) were measured in 60 lung cancer patients. Patients were evaluated by technetium 99 (99Tc) bone scintigraphy. The comparisons of measured values in patients with and without bone metastasis were done by using appropriate statistical methods. RESULTS: Fifty-four males and six females were included into study. Twenty-two patients had bone metastases, while 38 did not. Forty-two patients were nonsmall-cell lung cancer, whereas 18 were small-cell carcinoma. Urinary D-PYD level was the unique value that was statistically significantly higher in patients with bone metastases than that level in patients without bone metastasis (p < 0.05). CONCLUSION: Our study suggests that urinary measurement of D-PYD might be helpful in detecting bone metastasis in lung cancer. The high urinary D-PYD level may be an early sign of occult metastases in patients with no bone metastasis assessed by scintigraphic techniques.