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。     

Analysis of indications and results of surgical treatment for patients with pulmonary metastasis

Ninety-three patients with pulmonary metastases (PM) were operated on between 1983 and 1997. Surgical complications occurred in 8 (9%) of patients. Two (3%) of patients died in hospital, 7 were operated on again due to further PM. An average survival after lung metastasis surgery was 40 months, median 22 months. 44% and 35% of patients survived respectively 3 and 5 years. Thanks to lung metastasis surgery the overall survival was longer; an average overall survival was 87 months (median 58 months). 58% and 38% of patients survived respectively 5 and 10 years. Time between treatment of primary tumour (PT) and lung metastasis surgery (disease free interval DFI) was on average 4 years, median 41 months. The patients who showed DFI-longer than 2 years had tendency to live longer (p = 0.086). Patients with PM are recommended to be operated on, even if further PM occur.     

"Cord formation" in smear specimen prepared from sputum for a more rapid method of presumptive identification of Mycobacterium tuberculosis

Cord formation of Mycobacterium tuberculosis complex is very uncommon in smear specimen prepared directly from sputum, although such a finding is well known in solid or liquid media and has recently been evaluated as a rapid method for presumptive identification in special liquid media (BACTEC or MGIT). We examined 308 (Mycobacterium tuberculosis 271 and Nontuberculous mycobacteria 37) positive smear specimens prepared directly from sputum in our hospital. These specimens all showed a "modified Gaffky scale" as +2 or more and this cord formation was found in four cases (five specimens). Each of these specimens was from a patient with severe lung tuberculosis showing cavity formation and each patient was complicated severe diabetes mellitus. The morphology of cord formation on smear specimens prepared directly from sputum was similar to that in liquid or solid media, and consequently the relevant bacilli were identified as Mycobacterium tuberculosis complex by PCR examination. In this study, we assessed "cord formation" in smear specimen prepared directly from sputum as a more rapid presumptive identification of Mycobacterium tuberculosis complex based on microscopic morphology, as well as cord formation in liquid or solid media.     

Metastatic adenoid cystic carcinoma of lung: a case report

A 48 year old male patient, operated five years back for sub mandibular swelling proved on histopathologic examination to be adenoid cystic carcinoma presented in the ENT department, I. G. medical hospital with pain on both sides of the chest. CT scan of the chest showed multiple lesions of variable sizes. CT guided FNAC as well as biopsy of the lung lesion was performed. Cytodiagnosis and histopathological examinations revealed features of cribiform type of adenoid cystic carcinoma. This case is reported here for its metastasis to the lungs and prolonged survival even with multiple metastasis.     

A case report: septicemia caused by Mycobacterium tuberculosis in a patient infected with the human immunodeficiency virus in Burundi]

The authors report a case of septicaemia due to Mycobacterium tuberculosis in one AIDS patient. This case arouse the interest of the clinicians for a systematic study on blood dissemination of Mycobacterium tuberculosis in all patients with HIV infections prolonged fever of unknown origin.     

Pathological studies on three cases of cancer treated with polysaccharides from human-type Mycobacterium tuberculosis. Antitumor activity through collagen fiber proliferation

Three cases of cancer treated with SSM (Special Substance, Maruyama: a polysaccharide extract from Mycobacterium tuberculosis) for a long period were studied pathologically following biopsies and autopsies. The most significant antitumor activity resulting from SSM treatment was found to be collagenation from stromal cells and the cancer cells themselves. Another significant finding was that collagenation was promoted by macrophages which had been stimulated non-specifically. However, it was apparent that SSM-A or B had to be used efficiently and quickly in order to prevent invasion or metastasis of cancer. Collagenation due to SSM treatment was more marked in metastatic cancer lesions in the liver than those in the lung. In a case of breast cancer reported in a previous investigation of SSM treatment, remarkable calcification was found in a metastatic cancer lesion which had become confined through collagenation, thus preventing cancer cell metastasis. The collagenation of cancerous lesions through SSM treatment resembled the healing of caseous tuberculosis lesions through a similar mechanism.     

PATHOLOGICAL STUDIES ON THREE CASES OF CANCER TREATED WITH POLYSACCHARIDES FROM HUMAN-TYPE MYCOBACTERIUIM TUBERCULOSIS Antitumor Activity through Collagen Fiber Proliferation

Three cases of cancer treated with SSM (Special Substance, Maruyama: a polysaccharide extract from Mycobacterium tuberculosis ) for a long period were studied pathologically following biopsies and autopsies. The most significant antitumor activity resulting from SSM treatment was found to be collagenation from stromal cells and the cancer cells themselves. Another significant finding was that collagenation was promoted by macrophages which had been stimulated non-specifically. However, it was apparent that SSM-A or B had to be used efficiently and quickly in order to prevent invasion or metastasis of cancer. Collagenation due to SSM treatment was more marked in metastatic cancer lesions in the liver than those in the lung. In a case of breast cancer reported in a previous investigation of SSM treatment, remarkable calcification was found in a metastatic cancer lesion which had become confined through collagenation, thus preventing cancer cell metastasis.
The collagenation of cancerous lesions through SSM treatment resembled the healing of caseous tuberculosis lesions through a similar mechanism.     

Reactivation of ancient joint tuberculosis of the knee following total knee arthroplasty after 61 years: a case report

The prevalence of pulmonary tuberculosis is increasing and is associated with a rise in skeletal tuberculosis. Even after appropriate anti-tuberculosis therapy, reactivation of the infection may occur, even after many years. In this case report we describe a patient who had a reactivation of tuberculosis in the knee after total knee arthroplasty. At the age of 14 years, the patient had isolated tuberculosis arthritis of the left knee. Reactivation occurred after total knee arthroplasty 61 years later, at the age of 75. The patient was treated with a combined therapy; first the joint was irrigated with povidine-iodine and saline solution, and gentamicin beads were left behind. When the cultures revealed Mycobacterium tuberculosis, drug therapy of isoniazid, rifampicin, ethambutol and pyrazinamide was started and was continued for 9 months postoperatively. At a recent follow-up, the patient is doing well, with good range of motion in the knee.     

Metastasis from small cell carcinoma of the lung producing acute appendicitis

A case of acute gangrenous appendicitis with perforation caused by metastatic small cell carcinoma of the lung in a 65 year old man is reported. The manifestation of appendicitis occurred more than 4 years after the diagnosis of the bronchogenic carcinoma. With longer survival of patients with disseminated tumors it is probable that new manifestations of those malignancies will be discovered. Acute appendicitis due to metastasis from a distant neoplasm should be considered in the differential diagnosis of right lower abdominal pain in the oncology patient.     

肺大细胞神经内分泌癌的预后影响因素：一项基于SEER数据库的研究

目的:探讨肺大细胞神经内分泌癌（LCNEC）患者的生存预后及其影响因素。方法:横断面研究。纳入监测、流行病学和最终结果数据库（SEER）2010年1月—2016年12月收录的2 504例肺LCNEC患者,其中男1 357例、女1 147例,<60岁633例、60～80岁1 664例、>80岁207例。采用Kaplan-...     

Bacteremias caused by Selenomonas artemidis and Selenomonas infelix.

We report two different cases of bacteremia caused by two recently described Selenomonas species, Selenomonas artemidis and Selenomonas infelix. Both species are normally found in human buccal flora. S. artemidis bacteremia appeared in a patient (number 1) who presented with an air-fluid pulmonary cavity and clinical conditions consistent with an anaerobic lung abscess. While the patient improved with antibiotic therapy, cultures of respiratory secretions yielded Mycobacterium tuberculosis. This case demonstrated a strong possibility of a coexisting lung abscess due to S. artemidis. S. infelix bacteremia appeared in a cancer patient (number 2) with heart disease during preterminal acute respiratory distress. It was more difficult in this case to assess the clinical impact of the Selenomonas organisms on the patient.     

Gastrointestinal tuberculosis--case report

Isolated tuberculosis of gastrointestinal tract is a very rare disease most commonly localized in the ileo-cecal region (over 85% of the cases). The main object of surgical therapy is intraperitoneal tuberculosis (IP-TB), which leads to complications such as bowel obstruction, perforation, fistulation and bleeding. Since gastrointestinal tuberculosis can mimic symptoms found in Crohns' disease and ileocecal cancer, definitive diagnosis can only be obtained by the finding of Mycobacterium tuberculosis in tissue and stool sample as well as by positive microbacterial cultivation. A 35 year old female patient was admitted to surgical ward with clinical and radiological signs of ileus. From personal medical history as well as previous medical documentation we learned that the patient had been treated in 1995 for lung and larynx tuberculosis at Jordanovac Hospital in Zagreb. After preoperative preparation, the patient underwent surgery during which we found numerous stenoses in the region of terminal ileum and cecum. Due to the patient's general condition, surgical treatment was performed in two acts. In the first we established an L-L ileotransverse anastomosis, and in the second we made the resection. The diagnosis was confirmed by histological findings of Mycobaterium tuberculosis in stool and tissue samples as well as in resection material during operation. The early postoperative period proceeded free from complications and after surgical treatment the patient was referred to the Klenovnik Special Hospital for Pulmonary Diseases. On follow up 18 months after the surgery, there were no signs of gastrointestinal involvement.     

Conservative Treatment of Prosthetic Valve Endocarditis due to Mycobacterium fortuitum

Described here is the case of a patient with infective endocarditis in a prosthetic valve due to a Mycobacterium fortuitum-group organism. The patient was treated medically and had a favorable clinical response. This is only the second report of survival after Mycobacterium fortuitum-group endocarditis, and the first of survival without surgical intervention. The duration of treatment is not well defined for this patient, but life-long suppressive therapy will likely be required. Electronic Publication     

Fatal pulmonary infection due to Mycobacterium fortuitum.

Environmental (atypical, opportunist, other) mycobacteria were first isolated nearly a century ago. The classification of these "other than Mycobacterium tuberculosis" organisms was initially chaotic until Runyon proposed a scheme of four groups in 1959. Mycobacterium fortuitum is a member of group IV: Rapid growers. These ubiquitous terrestrial and aquatic forms contaminate water supplies, reagents, and clinical samples. They may colonise the respiratory systems of patients whose local defence mechanisms have been impaired or those with congenital and acquired immune defects. They can also cause disease in immunocompetent individuals. There have been fewer than 20 published cases of pulmonary infection caused by M fortuitum. A further case is reported of fatal pulmonary infection in an elderly patient with long standing chronic obstructive airways disease (COAD). He had left upper zone shadowing on chest radiography and lung abscesses at post mortem examination yielded only M fortuitum.     

Fatal pulmonary infection due to multidrug-resistant Mycobacterium abscessus in a patient with cystic fibrosis

We report a case of fatal pulmonary infection caused by Mycobacterium abscessus in a young patient with cystic fibrosis, who underwent bipulmonary transplantation after a 1-year history of severe lung disease. Fifteen days after surgery he developed septic fever with progressive deterioration in lung function. M. abscessus, initially isolated from a pleural fluid specimen, was then recovered from repeated blood samples, suggesting a disseminated nature of the mycobacterial disease. Drug susceptibility testing assay, performed on two sequential isolates of the microorganism, showed a pattern of multidrug resistance. Despite aggressive therapy with several antimycobacterial drugs, including clarithromycin, the infection persisted, and the patient died.     

Successful treatment of Mycobacterium celatum pulmonary disease in an immunocompetent patient using antimicobacterial chemotherapy and combined pulmonary resection

Mycobacterium celatum is a nontuberculous mycobacterium that rarely causes pulmonary disease in immunocompetent subjects. We describe the successful treatment of M. celatum lung disease with antimicobacterial chemotherapy and combined pulmonary resection. A 33-year-old woman was referred to our hospital with a 3-month history of a productive cough. Her medical history included pulmonary tuberculosis 14 years earlier. Her chest X-ray revealed a large cavitary lesion in the left upper lobe. The sputum smear was positive for acid-fast bacilli, and M. celatum was subsequently identified in more than three sputum cultures, using molecular methods. After 1 year of therapy with clarithromycin, ethambutol, and ciprofloxacin, the patient underwent a pulmonary resection for a persistent cavitary lesion. The patient was considered cured after receiving 12 months of postoperative antimycobacterial chemotherapy. There has been no recurrence of disease for 18 months after treatment completion. In summary, M. celatum is an infrequent cause of potentially treatable pulmonary disease in immunocompetent subjects. Patients with M. celatum pulmonary disease who can tolerate resectional surgery might be considered for surgery, especially in cases of persistent cavitary lesions despite antimycobacterial chemotherapy.     

The protective effect of the Mycobacterium bovis BCG vaccine is increased by coadministration with the Mycobacterium tuberculosis 72-kilodalton fusion polyprotein Mtb72F in M. tuberculosis-infected guinea pigs

A tuberculosis vaccine candidate consisting of a 72-kDa polyprotein or fusion protein based upon the Mtb32 and Mtb39 antigens of Mycobacterium tuberculosis and designated Mtb72F was tested for its protective capacity as a potential adjunct to the Mycobacterium bovis BCG vaccine in the mouse and guinea pig models of this disease. Formulation of recombinant Mtb72F (rMtb72F) in an AS02A adjuvant enhanced the Th1 response to BCG in mice but did not further reduce the bacterial load in the lungs after aerosol challenge infection. In the more stringent guinea pig disease model, rMtb72F delivered by coadministration with BCG vaccination significantly improved the survival of these animals compared to BCG alone, with some animals still alive and healthy in their appearance at >100 weeks post-aerosol challenge. A similar trend was observed with guinea pigs in which BCG vaccination was boosted by DNA vaccination, although this increase was not statistically significant due to excellent protection conferred by BCG alone. Histological examination of the lungs of test animals indicated that while BCG controls eventually died from overwhelming lung consolidation, the majority of guinea pigs receiving BCG mixed with rMtb72F or boosted twice with Mtb72F DNA had mostly clear lungs with minimal granulomatous lesions. Lesions were still prominent in guinea pigs receiving BCG and the Mtb72F DNA boost, but there was considerable evidence of lesion healing and airway remodeling and reestablishment. These data support the hypothesis that the coadministration or boosting of BCG vaccination with Mtb72F may limit the lung consolidation seen with BCG alone and may promote lesion resolution and healing. Collectively, these data suggest that enhancing BCG is a valid vaccination strategy for tuberculosis that is worthy of clinical evaluation.     

Skin test performed with highly purified Mycobacterium tuberculosis recombinant protein triggers tuberculin shock in infected guinea pigs

Tuberculin shock due to inoculation of Mycobacterium tuberculosis antigens in patients with tuberculosis is a serious syndrome originally described over 100 years ago by Robert Koch. Here, we present experimental evidence that a single M. tuberculosis recombinant protein, CFP-10, triggers this syndrome. Intradermal inoculation of CFP-10 elicits in M. tuberculosis-infected mice high levels of serum tumor necrosis factor alpha and causes tuberculin shock in infected guinea pigs characterized by hypothermia and death within 6 to 48 h after the antigen inoculation. Autopsies of these animals revealed intense polycythemia and hemorrhagic patches in the lung parenchyma, a pathological observation consistent with tuberculin shock. These results point to the possible occurrence of tuberculin shock in sensitive individuals inoculated with highly purified M. tuberculosis recombinant proteins as vaccine candidates or skin test reagents.     

Leiomyosarcoma of the pulmonary vein

A case of a 74-year-old man with leiomyosarcoma of the pulmonary vein is reported. The patient felt transient chest oppression while playing golf 1 week before he visited a clinic with a common cold. He underwent an ultrasonographic examination of the heart, which showed a mass lesion in the left atrium. The preoperative clinical diagnosis was myxoma of the left atrium. Cardiac surgery revealed the mass to be a leiomyosarcoma, probably extending from the left inferior pulmonary vein. The patient underwent a left lower lobectomy of the lung, and the tumor was confirmed to have originated from the wall of the left inferior pulmonary vein. Although the patient had a metastatic lesion in the right axillary lymph node 11 months later, which was excised, he remained free of disease 14 months after the initial operation. Histologically, the tumors were composed of pleomorphic cells with bizarre nuclei and spindle cells with blunt-ended nuclei with 1-4 mitotic figures in 10 high power fields. Immunohistologically, the tumor cells were positive for alpha-smooth muscle actin and desmin. We reviewed 17 cases of leiomyosarcoma of the pulmonary vein (six males and 11 females with a mean age of 50 years in each group). The present case was the oldest in age and to our knowledge was the first reported case with metastasis in a distant lymph node.