原发性腹膜后软组织肉瘤的诊断与治疗

原发性腹膜后软组织肉瘤是一类临床上比较罕见的局部侵袭性肿瘤，其治疗效果远比四肢软组织肉瘤差。为了提高本病的临床诊断符合率，影像学的检查是必不可少的，尤其是Ｂ超、ＣＴ以及ＭＲＩ的检查，对于确定肿瘤大小、部位、与邻近器官的关系和有无肝脏及腹腔的转移，具有特殊的价值。主张通过开放活检，获取组织学诊断。手术是治疗本病的主要手段，提高本病疗效的关键是手术彻底切除肿瘤。因此，我们主张在明确本病诊断后，尽可能完全或大部分切除肿瘤，对术后复发者，也要争取再次、多次手术切除，并于术后酌情辅加放疗。     

原发性腹膜后肿瘤的诊断和治疗：附24例临床分析

本文对２４例原发性腹膜后肿瘤的诊断治疗进行了讨论。本病早期缺乏症状，多数病人就诊较晚，常以腹部肿块或肿块压迫邻近组织脏器出现症状时才确诊。因此早期诊断对提高原发性腹膜后肿瘤的切除率很重要。运用各种影象学检查技术，尤其是Ｂ超，在诊断中应视为首选检查方法。在治疗上，应对肿瘤尽可能彻底切除，并广泛切除受累邻近组织，不能完整切除可作包膜内切除或肿瘤部分切除及活检。对术后复发者，应争取再次手术切除。     

原发性腹膜后软组织肉瘤20例临床分析

原发性腹膜后软组织肉瘤是一类临床上比较罕见的局部侵袭性肿瘤。本文对１９７６～１９９３年收治２０例病人作回顾性分析：首次诊断符合率仅３０％，结合影像学检查，诊断符合率达８５％，Ｂ超和ＣＴ在诊断中价值极大。手术是治疗本病的主要手段。手术完整切除肿瘤占４５％，部分切除占２０％，活检占３５％，指出提高本病治愈率关键是完全切除肿瘤，对切除后复发者，强调再次、多次手术，以提高生存率。     

腹膜后肿瘤手术治疗探讨（附26例临床分析）

对２６例腹膜后肿瘤的手术治疗结果表明，腹膜后肿瘤所在部位以及选择合适的手术径路，是肿瘤能否彻底切除的前提。对已不能一期切除的较大恶性肿瘤，采取肿瘤的包膜内切除术或减量手术，可取得良好的临床效果。术后病人应缩短复查时间，争取复发时早期手术，并切除邻近受累器官。     

腹腔肉瘤的治疗进展

腹腔肉瘤系临床较难治疗的一类肿瘤，由于累及部位不同，与其它癌肿处理有所区别。现将此类肿瘤近期治疗现状予以介绍。1腹膜后软组织肉瘤腹膜后肿瘤约80％为恶性，而软组织肉瘤占其中40％－50％。目前腹膜后肉瘤的治疗仍存在许多难点，由于肿瘤体积较大，常累及邻近器官，外科手术如何确定切缘，是否行联合脏器切除，如何控制术中大出血，术后防止复发等均系临床考虑的问题。1．l手术切口腹膜后肉瘤的手术切口应以充分暴露肿瘤，便于解剖、易于止血及减少肿瘤细胞扩散和避免创面污染为原则。应认识到切口选择是决定肿瘤是否能彻底切除的保…     

101例原发性腹膜后肿瘤外科治疗

目的探讨原发性腹膜后肿瘤的外科治疗。方法回顾性分析1992年来原发性腹膜后肿瘤手术切除101例，总结提高手术治疗效果的策略。结果其中良性肿瘤38例，恶性肿瘤63例，均经术后病理证实。肿瘤完整切除率71．29％。良性肿瘤的手术完整切除率高于恶性肿瘤，术中失血少，需要合并切除的脏器少，术后复发率相对低。全部病人无一例术中死亡。术后复发33例，再次手术19例。结论手术完整切除是腹膜后肿瘤治疗首选的方法，术前准备非常重要，对复发的肿瘤应该争取再次手术。     

复发性腹膜后肉瘤的手术治疗探讨

背景与目的：腹膜后肉瘤是罕见的恶性肿瘤,彻底手术切除是最有效的治疗方法,但是其术后复发率很高。复发性腹膜后肉瘤通常在复查时被发现,治疗方法仍是手术切除,但由于其解剖层次不清,因此手术难度大,出血多。该研究旨在探讨复发性腹膜后肉瘤的诊断及手术方式。方法：回顾性分析2007年10月—2016年10月收治的25例复发性腹膜后肉瘤,根据手术情况分组后使用log-rank检验对完整切除组与部分切除或活检组两者进行单因素预后分析,并使用Kaplan-Meier法计算生存率。结果：全组25例完整切除16例,占64.0%(16/25),部分切除6例,占24.0%(6/25),未切除活检为3例,占12.0%(3/25)。完整切除中联合脏器切除8例,占完整切除的50.0%(8/16)。24例获随访,完整切除和部分切除两者5年生存率为56.3%(9/16)和20.0%(1/5),差异有统计学意义(P<0.05)。结论：手术切除是治疗复发性腹膜后肉瘤最有效的方法,联合脏器切除能提高肿瘤完整切除率。本病术后复发率高,术后需密切随访。     

腹膜后黏液样脂肪肉瘤1例及文献复习

<正>腹膜后脂肪肉瘤(retroperitoneal liposarcoma,RPLS)是罕见的间叶细胞来源的恶性肿瘤,发病率占全部恶性肿瘤的1%以下,但在腹膜后软组织肉瘤中则是最常见的类型。因其症状隐匿,发现时多数肿瘤体积巨大且与邻近脏器关系复杂,手术难度大,彻底切除较困难,往往需要联合脏器切除,术后复发率高,化疗效果不佳,因此是临床亟待解决的难点。现就本院收治的1例腹膜后黏液样脂肪肉瘤,     

原发性腹膜后恶性肿瘤17例诊治体会

原发性腹膜后恶性肿瘤有别于腹膜后器官发生的肿瘤，是独立发生的，绝大部分为恶性。肿瘤早期可无症状，不易发现，当有症状时肿瘤已达到较大体积，血供较丰富，且大部分已侵犯周围器官，切除较困难，术中出血多，不易完整切除，术后易复发，故预后较差。我院1987至2002年收治经手术治疗及病理证实原发性腹膜后恶性肿瘤17例，现结合文献将其诊治体会报告如下。     

复发性和转移性腹膜后脂肪肉瘤的治疗

目的探讨复发性和转移性腹膜后脂肪肉瘤的治疗方法。方法回顾性分析２５例复发性和转移性腹膜后脂肪肉瘤作积极外科治疗，辅以放疗和化疗的临床资料。结果除６例仍在２年内治疗中，余１９例中１８例生存３年以上，１０例生存５年以上，５年生存率为５２．６％。手术的次数和有无合并脏器切除与生存无明显关系。完全切除能得到较好的预后，而部分切除结合放疗和化疗能也得到较满意的效果。手术加放疗是最满意的结合。结论复发性和转移性腹膜后脂肪肉瘤的预后差与完全切除肿瘤及部分切除的肿瘤辅以放疗和化疗有关     

From cytogenetics to cytogenomics of adipose tissue tumors: 2. Malignant adipose tissue tumors

Malignant adipose tissue tumors, also called liposarcomas, are the most common sarcoma of adult life. They may be hard to distinguish from benign adipose tissue tumors as well as from other types of sarcomas. Well-differentiated liposarcomas and myxoid liposarcomas are the two histological subtypes that have been best characterized at the genetic level. The defining genetic features of well-differentiated liposarcoma cells are supernumerary circular ("ring") and giant linear rod chromosomes. These rings and giant chromosomes contain amplification of the 12q14-15 region, including the MDM2 gene, associated with coamplification of various other chromosomal regions. In addition, they most often lack alpha-satellite centromeric sequences. The detection of MDM2 amplification is a valuable tool for the differential diagnosis between well-differentiated liposarcomas and lipomas. Dedifferentiated liposarcomas usually present with patterns of MDM2 amplification similar to those observed in well-differentiated liposarcomas. In addition, recent CGH-array studies suggest that co-amplification of MDM2 with the 6q23-25 region might be a specific feature. Myxoid and round-cell liposarcomas are characterized by a translocation t(12;16)(q13;p11) that fuses the DDIT3 and FUS genes. A rare variant translocation t(12;22) that fuses DDIT3 with EWS has also been described. The genetics of pleomorphic liposarcoma is still obscure. Pleomorphic liposarcomas show complex karyotypes with many numerical and structural chromosomal aberrations. To date, no specific molecular abnormality has been identified.     

Cytogenetic findings in liposarcoma correlate with histopathologic subtypes.

The cytogenetic findings in 31 liposarcomas from 26 patients are reported. Four other tumors did not grow. Three histologic types are represented in this analysis. The well-differentiated liposarcomas were characterized by telomeric associations, large marker chromosomes and ring chromosomes, and in some cases, double minutes. The pleomorphic liposarcomas contained very high clonal chromosomal numbers with near-tetraploid modes and numerous variable, often unidentifiable, chromosomal abnormalities. The myxoid liposarcomas were characterized primarily by a t(12;16)(q13;p11) as the sole abnormality or additional changes. These results indicate that cytogenetic findings may provide a new criterion, not only for establishing the diagnosis of liposarcoma, but also for differentiating confusing histologic types of liposarcoma and these lesions from other types of sarcomas.     

The characterization of biological features in dedifferentiated liposarcomas by means of principal components and discriminant analyses of 25 computer-generated variables from Feulgen-stained nuclei and histological slides

Several groups of lipomatous tumors are not yet clearly characterized on the biological level. In order to attempt to classify the dedifferentiated liposarcomas with respect to other types of malignant liposarcomas, 80 adipose tumors were submitted to the combination of two computer-assisted methodologies. These two methodologies consisted of i) the determination of 25 variables, and ii) the analysis of the diagnostic information contributed by these 25 variables by means of two complementary techniques, i.e. principal components and discriminant analyses. The 25 variables were computed by means of image cytometry on Feulgen-stained nuclei and histological slides, quantitatively describing distinct biological characteristics relating to morphonuclear (chromatin pattern) features (14 variables), nuclear DNA content distribution (9 variables), and tissue architecture pattern (2 variables). The 80 adipose tumors included 21 typical lipomas, 7 atypical lipomas (defined as extremity adipose tumors with a histopathological pattern of well-differentiated liposarcomas), 16 retroperitoneal and 5 non-retroperitoneal abdominal well-differentiated liposarcomas, 9 dedifferentiated liposarcomas, 8 myxoid (intermediate-grade tumor) and 14 pleomorphic (high-grade tumor) liposarcomas. The data strongly suggest that the dedifferentiated liposarcomas exhibit biological characteristics which are distinct from those of low- and high-grade liposarcomas, but similar to those of intermediate ones. The results also show that typical and atypical lipomas are two distinct biological entities. In contrast, the atypical lipomas and the well-differentiated retroperitoneal and non-retroperitoneal liposarcomas exhibited a high number of similar biological characteristics. Computer-assisted methods contribute valuable information to characterize lipomatous tumor biology.     

GDF15在肿瘤骨转移中的作用及机制的研究进展

恶性肿瘤患者常常死于肿瘤转移所造成的并发症而非原发灶,在我国,居民防癌意识不强,大量的患者在就诊时已处于肿瘤的晚期阶段,因此恶性肿瘤的死亡率持续升高。肿瘤常转移到骨组织,一旦发生骨转移,SREs等并发症将严重降低患者生活质量。然而,现阶段对于肿瘤骨转移的诊疗水平却十分有限,其相关机制更是知之甚少。GDF15在肿瘤中的作用被我们逐渐认识,而它同时又在包括骨转移在内的几种骨相关疾病中被报道,因此GDF15极有可能在肿瘤骨转移中扮演重要角色。本文将对GDF15在肿瘤骨转移及相关疾病中的争议作用和机制作一综述。     

异位甲状旁腺肿瘤合并原发性甲状旁腺功能亢进症的研究进展

甲状旁腺肿瘤是引起原发性甲状旁腺亢进症的主要因素。异位甲状旁腺肿瘤较为少见,多数肿瘤无典型的临床症状,隐匿性高而在临床中易被忽视。对异位性肿瘤的定性、定位是目前临床诊治难点,99Tcm-MIBI闪烁扫描术是诊断甲状旁腺肿瘤的金标准,通常与其他影像方法联合应用。手术治疗是最有效也是唯一可以治愈的方式。     

Diagnosis and management of lipomatous tumors

Lipomatous tumors range from benign lipomas to high-grade liposarcomas. Liposarcomas are classified into five histologic subtypes: well-differentiated, dedifferentiated, myxoid, round cell, and pleomorphic, which differ in outcomes and patterns of recurrence. Surgical resection is the mainstay of curative treatment; however, large, high grade liposarcomas may benefit from multimodality treatment with chemotherapy and radiation. A histologic-subtype specific nomogram provides accurate survival predictions. Prospective randomized clinical trials will continue to improve our care of patients with liposarcoma.     

代谢组学及其在肿瘤研究中的应用

代谢组学是继基因组学、蛋白质组学、转录组学后出现的新兴"组学",常用于疾病诊断、医药研制开发、营养食品科学、毒理学、环境学、植物学等与人类健康密切相关的领域.自20世纪以来,每年发表的代谢组学研究的文章数量不断增加,特别是代谢组学在肿瘤方面的研究亦在不断增多.从表面上看代谢组学的发展很迅速,但是仍然远远落后于基因组学和...     

Liposarcomas of the head and neck: a review of the literature and addition of four cases.

Liposarcomas of the head and neck are rare. There have been 25 previously reported patients in the literature. Four patients with head and neck liposarcomas, recently treated by the Head and Neck Surgery Service, Walter Reed Army Medical Center, are presented. Less than half of reported patients were noted to be living without evidence of disease. Prognosis generally corresponds to the cell type of the tumor. Intraoral, cheek and orbital tumors seem to have a worse prognosis compared to neck tumors. Wide local excision remains the treatment of choice. Advances in surgical techniques have allowed adequate therapy for most head and neck liposarcomas. Advanced lesions should be managed by conservative surgery and radical radiation therapy.     

Genomic investigation of dedifferentiated liposarcoma suggests a role for therapeutic targeting of the tumor epigenome

A comprehensive genetic analysis of dedifferentiated liposarcomas suggests that epigenetic modifications are common and may alter the differentiation capacity in these tumors. Furthermore, these data suggest that treatment strategies aimed at altering histone acetylation and/or DNA methylation are worthy of further study.     

Telomeric lengths and telomerase activity in liposarcomas

To assess the role of telomerase in the development of liposarcomas, we measured telomerase activity in 36 malignant and seven benign lipomatous neoplasias from 34 patients. A sensitive polymerase chain reaction-based telomerase assay (the telomeric repeat amplification protocol) was applied. Shortening or elongation of telomeric repeat fragment lengths, as measured by using hybridization with a telomere-specific oligonucleotide probe, was correlated with the presence of telomerase activity. The latter was demonstrable in 69% of malignant tumors. Benign tumors can be distinguished from malignant neoplasias on the basis of telomerase activity. However, telomerase expression seems to be characteristic of poorly differentiated liposarcomas. Myxoid/round cell liposarcomas exhibited a higher telomerase activity level than the classical low-grade variants. Telomerase activity was not correlated with age at the time of diagnosis or with sex. In most cases, telomerase-positive tumors showed higher proliferation indices than did neoplasias lacking telomerase. All eight recurrences expressed telomerase activity, reflecting a close association of telomerase with the biological behavior of liposarcomas. Our findings suggest that telomerase may play a key role in the establishment and progression of malignant lipomatous tumors.