检测血液中癌胚抗原信使核糖核酸诊断消化系统肿瘤血行转移

明确肿瘤有无转移对治疗决策的制订、预后评估等具有重要的指导意义。至今对肿瘤早期转移、微转移、血行转移等的诊断仍没有令人满意的方法。研究提示，癌胚抗原信使核糖核酸（CEA mRNA）指标在诊断肿瘤微转移方面具有较高的价值。检测血液中CEA mRNA指标，对诊断消化系统肿瘤血行转移有较大帮助，报道如下。     

三原发癌1例

患者,女性,48岁,于2002年6月25日因便血2个月而第3次入住我院。行纤维结肠镜检查示:距肛缘3 cm直肠前壁有一菜花状肿物,大小2.0 cm×2.0 cm,质脆,触之易出血。取活检病理报告为“直肠癌”。行经腹会阴联合直肠癌根治术。术后病理报告为“直肠高分化腺癌,未见转移淋巴结”。患者曾于1995年8月11日因发现左侧乳房肿物3个月而第1次入住我院。查体:于左乳外上象限可扪及实性质韧肿物,大小4.0 cm×3.0 cm,与皮肤及胸肌无粘连,双侧腋下淋巴结无肿大。肿物穿刺细胞学检查报告为“左乳癌”。行左乳癌跟治切除术。术后病理报告为“左乳腺单纯癌,淋巴…     

肺癌颅骨转移一例报告

[病例]男,57岁.因发现额顶部渐进性增大包块2个月入院.患者自述包块从发现至就诊期间生长迅速.有慢性支气管炎7年,近1个月咳血丝痰.查体:额部正中有一8 cm×8 cm×6 cm大小包块,包块处皮肤张力高,挤压无波动感,无触痛,包块周围皮肤正常.     

消化道肿瘤诊断中肿瘤标志物的检测应用与研究现状

近年来,我国消化系统肿瘤的发病率逐渐升高,并且发病人群日趋年轻化。全球癌症统计报告显示,我国癌症发病率较其他国家低,但病死率较高,其中36.4%的癌症相关死亡来自消化道肿瘤,且预后相对较差,原因可能与早期癌症的诊断率较低,以及不同地区实施的临床治疗策略不一致有关[1]。因消化系统肿瘤早期无明显不良症状,不易被察觉,发现时多濒临或处于中晚期,症状加重并伴有易转移、易复发的危险。故对于消化系统肿瘤的早期诊断显得尤为重要。相较于胃镜、肠镜、钡餐影像等检查技术,血清肿瘤标志物检测有着简便快捷、无创、准确等多种优势,在临床诊疗中发挥重要作用。     

肾癌骨髓转移1例

1病历摘要 患者，男，59岁，2007年11月6日入院。主诉：右肾癌术后3个月余，咳嗽、咳痰伴活动后喘憋1个月。现病史：3个月余前因右肾癌进行右肾切除术。术后3周开始进行膀胱灌注化疗。未出现特殊反应。1个月前无明显诱因出现咳嗽、咳痰，为白色黏痰，伴有活动后喘憋，休息后可缓解。无咯血、呕血，无腹痛、腹胀，无胸痛、心悸，无发热、黄疸等。     

肝、脾、肾脏多发性血管瘤1例报告

肝、脾、肾脏多发性血管瘤１例报告田华①王涛患者女，３６岁，因左上腹及左侧腰部疼痛３个月就诊，查体未发现阳性体征。Ｂ超首诊：肝脏大小形态正常，肝右后叶可见７．７ｃｍ×５．１ｃｍ的形态不规则的实性团块回声，边界清，边缘锐利，周围无声晕，内回声不均匀；脾脏...     

原发性肝细胞癌心脏转移1例

原发性肝细胞癌心脏转移１例首都医科大学附属北京同仁医院急诊料曹秋梅许政刚胡兵病例报告女，７６岁，乏力纳差１个月伴黄染两周，Ｂ超：胆管高位梗阻，肝门部实性占位，以“梗阻性黄疸”入院。入院前１个月开始无诱因乏力纳差并进行性加重，体重１个月内下降约５ｋｇ。...     

父子同患肝癌肺转移

例1,男,5 4岁,2 0 0 3年11月7日入院。上腹部不适2天伴头晕、胸闷1天。体检:意识清,消瘦,巩膜轻度黄染,双肺呼吸音粗,心率80次/min ,腹平软,肝脾肋下未触及,剑突下压痛。胸片示右侧肺3个小结节阴影,1.2cm×1cm ,1cm×1cm ,0 .5cm×0 .8cm ;左侧肺见2个小结节阴影1.3cm×1.1cm ,1cm×1cm ,考虑转移癌,乙型肝炎表面抗原(HBsAg)阳性,乙型肝炎表面抗体(HBsAb)阴性,乙型肝炎e抗原(HBeAg)和乙型肝炎e抗体(HBeAb)阴性,乙型肝炎核心抗体(HBcAb)阳性,肝功能正常。区人民医院胸部和腹部CT示肝癌、肺转移癌。对症治疗1周症状好转出院。例2 ,男,7…     

谷胱甘肽S-转移酶π在消化道恶性肿瘤研究中的应用

谷胱甘肽S-转移酶(glutathione S transferases,GSTs)是一类具有多种生理功能的同工酶,在保护机体免受毒性物质和致癌剂损伤方面具有重要意义.根据GSTs在细胞内定位不同分为胞浆型、胞膜型、线粒体酶和白细胞三烯合成酶等4型,前者又分为GST-α、μ、π、θ、δ等,其中GST-π分布最广泛,含量最丰富,普遍存在于胎盘、肺、肾、乳腺、前列腺等正常组织中,且与组织分化有关.随着对GST-π研究的深入及对GST-π检测方法灵敏度和特异性的提高,GST-π作为肿瘤标志物和肿瘤耐药性研究越来越受到临床重视[1].现将GST-π在消化道恶性肿瘤研究中的应用综述如下.     

膀胱癌前列腺癌共存1例

1 病例报告　男,83岁.20 d前B超发现膀胱三角区占位,性质待定.2005-07-24以膀胱占位待查入住我院.查体：t 36.8 ℃,R 20次/min,P 78次/min,BP 180/80 mm Hg.全身皮肤黏膜无黄染、出血.浅表淋巴结未扪及.双肺呼吸音清,未闻及干湿性罗音.     

子宫内膜癌腹膜后盆腔淋巴结转移相关因素分析

[目的]探讨子宫内膜癌患者腹膜后盆腔淋巴结转移的相关因素.[方法]选取43例于2000年1月至2001年8月行广泛性子宫加双附件切除加腹膜后盆腔淋巴结清扫的子宫内膜癌患者,分析腹膜后盆腔淋巴结(retroperitoneal lymph node,RLN)转移与临床病理和5年生存率的关系.[结果]RLN转移在病理分级,肌层浸润深度,宫颈浸润深度和宫旁血管浸润组间差异有显著性(P＜0.05);在腹腔冲洗液细胞学阴性组和阳性组间差异无显著性(P＞0.05);5年生存率在病理分级,肌层浸润深度,腹腔冲洗液细胞学检查,RLN转移和宫旁血管浸润组间差异有显著性(P＜0.05);宫颈浸润深度不同组间5年生存率差异无显著性(P＞0.05).[结论]RLN转移与病理分级,肌层浸润深度,宫颈浸润和宫旁血管浸润有关;5年生存率与病理分级,肌层浸润深度,腹腔冲洗液细胞学阳性,RLN转移和宫旁血管浸润有关.     

低张充水法螺旋CT扫描在食管、胃、结肠肿瘤中的临床应用

目的：为提高食管、胃、结肠癌的检出率,探讨食管癌、胃癌、结肠癌的ＣＴ检查方法。材料和方法：８０例消化管肿瘤（其中食管癌５例,贲门癌１９例,胃癌３４例,结肠癌２２例）,均经手术和病理证实。采用低张充水法行螺旋扫描及多体位扫描。结果：低张充水法可清楚地显示增厚的管壁和狭窄的管腔,有利于较早期病变的检出,增强后扫描有利于显示肿瘤向管壁侵犯的深度,以及向管壁外蔓延的范围,而多体位扫描则更有利于病变全貌的显     

北京部分地区直肠癌与结肠癌、左侧与右侧结肠癌、青年与老年大肠癌的对比研究

目的初步探讨北京部分地区的直肠癌与结肠癌、左侧与右侧结肠癌、青年与老年性大肠癌的临床及病理特征的区别。方法回顾性调查首都医科大学宣武医院2002年9月至2012年9月行结肠镜检查并经病理组织学证实且随访资料完整的北京部分地区880例大肠癌患者,分析其直肠癌与结肠癌、左侧与右侧结肠癌、青年与老年大肠癌患者的临床及病理特征的差异。结果直肠癌与结肠癌患者在出现症状时间、肿瘤直径、Dukes分期、组织分化程度、手术性质方面差异有统计学意义（P＜0.05）;左侧与右侧结肠癌患者在肿瘤直径、组织分化程度方面差异有统计学意义（P＜0.05）;青年与老年大肠癌患者在Dukes分期、组织分化程度、是否化疗方面差异有统计学意义（P＜0.05）。结论直肠癌与结肠癌、左侧与右侧结肠癌、青年与老年大肠癌有其各自的发病特点,准确了解其临床特征并早期诊断及治疗是对大肠癌诊治的关键。     

Hepatic mesenchymal sarcoma: MRI findings

Hepatic undifferentiated mesenchymal sarcoma is a rare pediatric malignant neoplasm. We present three children, aged 7, 8, and 12 years, with this tumor. Clinical presentation was abdominal pain, palpable mass, asthenia, anorexia, and weight loss. One had jaundice. All three lesions were detected on ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). MRI localized the lesions more accurately than the other methods, with good resectability correlation. On MRI, these tumors were markedly hyperintense on long TR/TE spin-echo (SE) and short-time inversion recovery (STIR) sequences. This was due to the cystic areas with myxoid material and necrosis. The internal septations were hypointense on these sequences. On short TR/TE SE sequences the lesions presented a fibrous pseudocapsule (two cases), and internal hyperintense areas representing hemorrhage (two cases). MRI also detected vascular invasion (one case), biliary obstruction (one case), and biliar adenopathies (one case). The combination of hemorrhage (hyperintense on short TR/TE SE) and cystic or myxoid components (markedly hyperintense on long TR/TE SE and STIR sequences) is common in this tumor.     

消化系统多原发癌临床分析

目的：探讨消化系统多原发癌的临床特点，诊治原则及预后。方法：回顾性分析本院1992年1月--2001年12月10年间经术后病理证实的消化系统多原发癌。结果：经计算机病案管理系统检索出39例消化系统多原发癌，其中双原发癌37例，三原发癌2例；同时癌20例，异时癌19例；累及病灶数以结肠、胃居多，占48．8％；消化系统多原发癌的术前漏诊30％；异时癌3年以内发生为68．4％；5年生存率33．3％，均为异时性结肠多原发癌。结论：消化系统多原发癌多发于结肠，异时癌的第二癌多发生于第一癌治疗后的1．3年内；消化系统多原发癌术前漏诊率高，应行综合性诊断方法；异时性结肠多原发癌患的预后较好。     

Intraoperative sonography of hepatocellular carcinoma: Detection of lesions and validity in surgical resection

Eighty-six hepatocellular carcinomas (HCCs) in 67 patients were examined by intraoperative sonography. Sensitivity for detecting tumors with intraoperative sonography was compared with sonography, computed tomography (CT), hepatic angiography, and CT after intraarterial injection of iodized poppy-seed oil (Lipiodol-CT). The overall sensitivities were 76% with sonography, 86% with CT, 89% with angiography, 96% with Lipiodol-CT, and 98% with intraoperative sonography. The differences in sensitivity between intraoperative sonography and sonography (p < 0.01), CT (p < 0.01), and angiography (p < 0.05) were significant. In 35 lesions smaller than 2 cm, the sensitivities of Lipiodol-CT and intraoperative sonography were high (91 and 94%, respectively). In operating field, tumors were invisible in 36 (42%) and nonpalpable in 31 of 86 cases (36%). In 35 tumors smaller than 2 cm, invisible tumors were 66% and nonpalpable tumors were 63%. However, 84 of 86 cases (98%) could be localized with intraoperative sonography.These results suggest that intraoperative sonography is the final diagnostic imaging procedure before surgical resection of tumors and in cases of invisible and nonpalpable tumors in the operating field, this procedure is mandatory to improve surgical results.     

多层螺旋CT后处理技术在下咽癌及喉癌术前评估中的应用

目的探讨多层螺旋CT（MSCT）各种后处理技术在下咽癌和喉癌术前评估中的价值。方法收集45例手术病理证实的下咽癌及喉癌病例,术前行16层螺旋CT检查,并行矢、冠状位多平面重建（MPR）、仿真内镜（CTVE）、表面遮盖显示（SSD）及透明重建（Raysum）等后处理技术,综合对喉癌术前分期进行评估,并与手术病理进行对照。结果16层螺旋CT术前对下咽癌及喉癌TNM分期与临床最终手术病理结果对照,其中T1期符合率为81.2%,T2期为88.9%,T3期为84.6%,T4期为75.0%。总体分期符合率为84.4%。结论下咽癌及喉癌术前MSCT各种后处理技术的综合应用,可明确肿瘤的范围、周围组织受侵及颈部淋巴结转移情况,在下咽癌及喉癌术前评估中具有很高的实用价值。     

超声造影在鉴别诊断腹部良恶性占位病变中的应用价值

目的探讨实时超声造影对腹部良恶性占位病变的鉴别诊断价值。方法对250例腹腔脏器占位性病变进行实时超声造影研究,其中包括肝脏良恶性肿瘤196例,胆囊癌及胆囊良性病变39例,胰腺良恶性病变15例,所有病例均经过手术或其他影像学检查方法证实。结果造影剂Sono Vue2.4ml静脉注射后,肝癌动脉相表现为整体快速增强,并在门脉相快速消退,在实质相显示为低回声;血管瘤呈周围向心性环状或结节状增强,门脉相及实质相进一步增强,持续较长时间;局灶性结节增生表现为中央扩散型快速整体增强,部分病例显示为车轮状;肝硬化增生结节的造影增强特征与肝实质一致;胆囊癌快速不均匀增强,胆囊壁连续性中断,胆囊良性病变及慢性胆囊炎胆囊壁连续;胰腺癌造影剂快速进入,消退时间早于胰腺实质,胰腺炎性肿块造影后回声与胰腺一致,或造影剂不进入。结论实时超声造影能显示肿瘤内微小血管的血流灌注情况,对腹部良恶性占位病变的定性诊断具有重要的意义。     

Application of the breast imaging reporting and data system final assessment system in sonography of palpable breast lesions and reconsideration of the modified triple test.

OBJECTIVE: The purpose of our study was to evaluate the utility of the American College of Radiology's Breast Imaging Reporting and Data System (BI-RADS) sonographic final assessment system and palpation-guided fine-needle aspiration (FNA) for evaluation of palpable breast lesions. METHODS: Our computerized database identified 160 palpable lesions of the breast in which follow-up palpation-guided FNA, targeted sonography, and pathologic confirmation were performed. We used BI-RADS sonographic data on all lesions. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of malignancy were calculated for sonography and palpation-guided FNA. Two-sample binomial proportion tests were used as the statistical analysis (P<.05). RESULTS: The FNA results were defined as benign, atypical cells, suspicious for malignancy, malignancy, and insufficiency. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 90.9%, 82.7%, 84.3%, 57.7%, and 97.2%, respectively, on sonography and 75.8% to 90.9%, 82.7% to 98.4%, 84.3% to 94.4%, 57.7% to 92.6%, and 93.9% to 97.2% on FNA. There was no statistically significant difference for sensitivity and negative predictive value between the two examinations. CONCLUSIONS: The diagnostic accuracy of sonography was similar to that of palpation-guided FNA for not missing the malignancy. Clinical application of FNA results can be difficult, especially when the result is insufficiency or atypical cells. Moreover, FNA is invasive and overlaps other procedures. Therefore, we conclude that sonography can replace palpation-guided FNA for diagnosis of palpable lesions of the breast when the BI-RADS sonographic final assessment system is used appropriately.