恶性睾丸间质细胞瘤3例报告及文献复习

目的：探讨成人恶性睾丸间质细胞瘤的临床病理特点,明确适宜的治疗方式.方法：回顾性分析我院从1997年6月至2009年12月诊治的3例成年恶性睾丸间质细胞瘤患者,分析其临床资料包括症状体征、实验室检查、影像学检查、治疗方式、病理结果及随访情况.结果：3例患者均行睾丸根治性切除术.1例患者术后9个月出现淋巴结转移,13个月出现肺转移并于术后26个月死于肿瘤广泛转移;另2例患者术后即刻行腹膜后淋巴结清扫发现了CT未提示的腹膜后淋巴结转移,其中1例术后43个月出现肺转移.结论：部分成人睾丸间质细胞瘤呈恶性病程,需严密随诊.腹膜后淋巴结清扫术具有诊断价值,转移患者预后较差.     

放疗后硬皮病样改变的慢性放射性皮炎一例

患者男,62岁.精原细胞瘤放疗后腰部萎缩性斑块10天,于2010年1月13日来我科就诊.因左阴囊坠胀感1个月余,于2009年6月就诊于我院泌尿外科,B超、盆腔CT发现左侧睾丸增大.考虑精原细胞瘤.6月24日行根治性左睾丸切除术,术后组织病理证实为精原细胞瘤.     

睾丸精原细胞瘤的MRI诊断与鉴别诊断研究

目的:探讨睾丸精原细胞瘤MRI诊断与鉴别诊断,以期提高对此病认识度。方法:回顾性分析2010年3月至2013年3月14例经病理组织学证实为睾丸精原细胞瘤患者,均MRI检查,观察其影像学表现,并和病理形态学进行比较。结果:所有睾丸精原细胞瘤均位于睾丸实质内,未突破白膜,其中8例结节形,4例为不规则和分叶状且边界清楚,11例表现为均匀一致低信号,2例不均匀混合信号。增强扫描中,9例病灶边缘可见有纤维分隔样早期明显强化,TIC为平台型;5例肿瘤伴出血坏死,为不均匀强化,TIC为速升缓降型。病理表现为肿瘤细胞形态一致圆形或三角形,有胞膜,浆核丰富,核分裂常见。结论:睾丸精原细胞瘤的MRI特征性表现为T2WI病灶均匀低信号影并纤维血管间隔早期强化。     

显微镜下睾丸肿瘤剜除术治疗儿童睾丸畸胎瘤2例并文献复习

目的探讨显微镜下睾丸肿瘤剜除术治疗儿童睾丸畸胎瘤的临床价值。方法分析2018至2019年武汉科技大学附属普仁医院收治的2例儿童睾丸畸胎瘤的临床病例,研究其临床资料,包括症状体征、实验室检查、影像学检查、治疗方式、病理结果及随访情况,结合文献复习,探索儿童睾丸畸胎瘤的诊疗途径及显微镜下睾丸肿瘤剜除术的临床价值。结果2例患儿均行显微镜下睾丸肿瘤剜除术,患儿均治愈出院,术后随诊睾丸体积、睾酮水平未下降,肿瘤未复发。结论显微镜下睾丸肿瘤剜除术损伤小,可最大限度保留睾丸健康组织,值得临床应用和推广。     

转移性皮肤精原细胞瘤1例报告

转移性皮肤精原细胞瘤１例报告王为平，杨美清彭某，男，５９岁。于１９９１年４月出现双侧睾丸肿大，鸭蛋大小，以右侧为甚，曾被诊为＂睾丸积液＂，未治疗。入院前１月在外院诊为＂睾丸肿瘤＂，行双侧睾丸切除术，病理报告＂睾丸精原细胞瘤＂。近３月来双上臂、胸部、腹...     

睾丸扭转临床诊治体会

目的:提高睾丸扭转的早期诊断和治疗水平,降低急性睾丸扭转的误诊。方法:回顾性分析36例睾丸扭转患者的临床资料,结合文献进行总结。36例患者年龄3~32岁,平均11.6岁,左侧29例,右侧7例,无双侧同时发病者;发病至确诊时间6h~7d。结果:36例行手术探查,22例术中证实睾丸扭转坏死而行睾丸切除术,14例行睾丸复位术,除其中1例术后出现睾丸萎缩,其他均已治愈。结论:对于睾丸扭转,早期诊断及早期手术探查是提高睾丸存活率的重要手段。     

睾丸扭转的时间与角度对睾丸挽救率的影响研究

目的：分析睾丸扭转时间与角度的选择对睾丸挽救率的影响。方法：选择在本院接受治疗的45例睾丸扭转患者为研究对象,根据其扭转时间及角度不同进行分组,比较不同的睾丸扭转时闻、扭转角度与最终睾丸挽救结局的影响。结果：随着睾丸扭转时间的增加、睾丸扭转角度的增加,睾丸切除率明显增加（P〈0．05）;所有患者经病理检查后显示,随着睾丸扭转时间的增加、睾九扭转角度的增加,睾丸挽救率明显降低（P〈O．05）。结论：睾丸扭转角度的增加、时间的延长将直接导致睾丸救治成功率降低,睾丸梗死切除的几率大幅上升。     

自制套管钩取式睾丸活检针在睾丸活检及取精中的应用（附234例报告）

目的：探讨自制套管钩取式睾丸活检针在睾丸活检及取精术中的应用价值。方法：对234例无精子症患者使用自制套管钩取式睾丸活检针行睾丸活检及取精。结果：234例,共294次（60例为双侧）睾丸活检及取精全部取材成功,术中及术后疼痛轻微,1例出现阴囊轻度血肿,一周后自行吸收。结论：应用自制套管钩取式睾丸活检针行睾丸活检及取精,具有微创、简便快捷、易操作、及一次穿刺可反复取材、多点取材的特点,可以在临床推广。     

睾丸性生殖障碍——曲细精管界膜病变

自Deviretser和Baker提出了新的称为男性不育症的逻辑性分类法。该分类法已为我国学者采纳与接受[2]。其主要是将男性不育症原因分睾丸前、睾丸后和睾丸等因素。笔者前文[3]已就睾丸生精障碍,生殖细胞的生成,功能以及有害因素对睾丸生殖细胞的影     

汽化电切联合内分泌疗法治疗老年晚期前列腺癌临床观察

目的：探讨汽化电切联合内分泌疗法治疗老年晚期前列腺癌的临床效果。方法：选择2008年2月至2009年2月我院收治的老年晚期前列腺癌患者48例（研究组）,对其采用经尿道前列腺汽化电切术,病理确诊为前列腺癌后加行双侧睾丸切除术;对照组行常规治疗,每2个月交替口服氟他胺、康士得的联合内分泌疗法,比较术后两者相关指标的变化。结果：两组手术时间、切除前列腺重量、术后2年及以下和2年以上生存率、死亡率比较,差异均有显著意义（P＜0.05）。与对照组相比,研究组血清PSA、IPSS分、残余尿量均下降,尿流率、膀胱压力均升高,差异有高度统计学意义（P＜0.01或P＜0.001）。结论：对老年晚期前列腺癌患者行经尿道前列腺汽化电切术,能解除下尿路梗阻,联合内分泌疗法明显抑制肿瘤生长而延长生命,提高患者生活质量。     

New diagnostic procedures in assessing male fertility

In 160 patients with normal and pathological semen samples, we studied the penetration of human spermatozoa in standardized bovine cervical mucus (assay Penetrak). Our results indicate that Penetrak can detect those dysfunctions of sperm motility which cannot be diagnosed by conventional semen analysis - The toluidine blue-pyronine staining is an easy way to differentiate between spermatozoa within an hour. The reliability of this technique is comparable to that of conventional methods and therefore appropriate for routine diagnostics. - As case studies on 140 patients proved, the level of carnitine in the seminal plasm can be regarded as a parameter of epididymal function. In combination with the examination of FSH serum levels, this method may be helpful in the differential diagnosis of azoospermia due to obstruction, Sertoli-cell-only syndrome, or spermatogenic arrest. - In severe oligozoospermia, testicular biopsy using semithin sections may be of high diagnostic and prognostic value. In contrast to paraffin sections, this technique is particularly appropriate for the detection of cytological characteristics of germ cells. The type and number of pathological germ cells are decisive regarding the prognosis. Furthermore, a carcinoma in situ (CIS) can be definitely identified by means of semithin sections. - In a study on 2047 patients, we found seminoma cells in 15 cases (0.73%); 5 of these patients already had a solid seminoma in the testicular rete. Risk-patients are those showing oligozoospermia of less than 10 million spermatozoa per ml or azoospermia associated with unilaterally or bilaterally subnormal testicular volume. In these cases, the testicles are inconspicuous, both palpatorically and sonographifically.     

吡柔比星联合维拉帕米膀胱灌注对膀胱癌术后复发的预防效果分析

目的:探讨吡柔比星联合维拉帕米膀胱灌注治疗应用于膀胱上皮癌术后复发的效果及安全性。方法:将本院收治的54例膀胱上皮癌行经尿道膀胱肿瘤电切术(TURBT)或膀胱部分切除术患者随机分为实验组和对照组,实验组患者给予吡柔比星联合维拉帕米膀胱灌注治疗,对照组患者给予吡柔比星膀胱灌注治疗。随访观察5年,比较两组患者1年、3年、5年的累计复发率,以及治疗过程中膀胱刺激征、血尿、化学性膀胱炎等不良反应发生率。结果:实验组1年、3年、5年的累计复发率分别为3.7%、7.4%、11.1%,不良反应发生率为51.9%;对照组1年、3年、5年的累计复发率分别为14.8%、29.6%、37.0%,不良反应发生率为48.1%。实验组3年、5年累积复发率显著低于对照组(P<0.05),不良反应发生率无显著差异(P>0.05)。结论:在吡柔比星膀胱灌注的基础上,联合应用维拉帕米能够显著降低膀胱上皮癌术后复发率并保留患者的性功能,且安全性较高,值得临床推广应用。     

32例子宫肉瘤的临床病理分析及其与预后之间的关系

目的探讨子宫肉瘤的临床病理分析及其与预后之间的关系,为子宫肉瘤患者的预后改进提供参考。方法选择2006年12月至2013年12月嘉兴市妇幼保健院诊治的32例子宫肉瘤患者为研究对象。对其子宫肉瘤的病理类型、病理分期和手术方式等进行观察,以此判断其与患者预后之间的关联。结果不同病理类型子宫肉瘤患者的3年生存率比较,其差异具有统计学意义;子宫肉瘤病理类型与疾病复发风险之间存在重要关联,不同手术方式患者的3年与5年生存率比较,其差异均具有统计学意义;相比之下,手术联合放疗与手术联合放化疗患者的3年生存率相对较高,两者5年生存率和绝经前后复发率比较,其差异均无统计学意义。结论子宫肉瘤患者在发病初期没有特异性的症状表现,将会极大地影响到临床诊断的精准度,而在手术前借助子宫内膜刮诊可以辅助确诊。不同病理类型子宫肉瘤与预后之间存在一定关联,制定治疗方案时应当综合考虑子宫肉瘤的病理类型。     

化疗对高危因素子宫内膜癌患者预后及生活质量的影响

目的：分析化疗在子宫内膜癌预后及生活质量的影响.方法：将116例具有子宫内膜癌患者按照患者知情自愿原则分为对照组（n =69例）与观察组（n=47例）.对照组患者进行单独手术治疗,观察组患者在手术治疗基础上进行化疗,观察两组患者术前、术后3个月的CA-125水平、随访5年生存率及比较两组患者术前及术后6个月时的生存质量状况.结果：观察组术后3个月时的CA125水平为（21.4±8.9 U/mL vs 46.17±11.3U/mL）,术后1年时的CA-125水平为（22.60±9.3 U/mL vs 42.19±14.21U/mL）P＜0.05,观察组的5年生存率为87.2％,对照组为66.7％,两者比较,x2=4.766,P=0.029;观察组与对照组患者术后6个月时的FACT-G生存质量评分（64.89±8.60分vs 48.61±8.24分）,术后1年的FACT-G生存质量评分（61.89±7.03分vs 46.78±6.42分）,P＜0.05.结论：化疗对于具有高危因素的子宫内膜癌具有提升5年生存及改善生活质量作用,临床上对于高危因素的子宫内膜癌应尽可能推荐使用辅助化疗.     

Hauterkrankungen bei organtransplantierten Patienten

In Germany 3273 visceral organs were transplanted in the year 2000. Together with patients grafted abroad, it is estimated that between 70,000 and 100,000 organ transplant patients are currently living in Germany. With the provision of lifelong immunosuppression the survival-time of these patients can exceed more than 20 years. In the first year following transplantation special emphasis is given to the prevention of viral, bacterial and fungal infections. Regular dermatological screening can provide early diagnosis of even systemic infections. An increased incidence of skin cancer parallels the extended survival rates of grafted patients. Within the first 5 years of immunosuppression 40% of these patients develop pre-malignant skin tumors such as actinic keratoses, dysplastic nevi, squamous cell carcinomas and basal cell carcinomas. Squamous cell carcinomas show an aggressive biology and an uncommon clinical morphology. The increased incidence of cancer is now responsible for a mortality rate of 5-8% in grafted patients. Against a background of lifelong immunosuppression, other risk factors include sun exposure and infections with oncogenic viruses. The rapidly growing numbers of allograft recipients as well as the rising long term survival rates of these patients demand the provision of high quality interdisciplinary and dermatological care in this field.     

Programmed cell death protein 4 expression in renal cell carcinoma,penile carcinoma and testicular germ cell cancer

AIM:To investigate the expression of programmed cell death 4(Pdcd4)tumor suppressor gene in tissue specimen of renal cell carcinoma(RCC),testicular germ cell cancer and penile cancer.METHODS:Pdcd4 expression was studied using immunohistochemistry in 188 cases of RCC and 28 controls(including 9 oncocytoma);in 74 cases of penile carcinoma(including 17 metastatic tissue samples)and26 controls;in 11 cases of seminoma,in 14 cases of non-seminoma and 5 controls.RESULTS:Control tissues exhibited strong core and cytoplasmatic Pdcd4 staining.In contrast,core and cy-toplasmatic Pdcd4 levels were significantly decreased in cancer tissues.CONCLUSION:Our data support a role for Pdcd4(down-)regulation in urologic tumors.Interestingly,Pdcd4 expression seem to be a potential diagnostic marker for renal or penile tumors.     

Primary cutaneous B‐cell lymphoma in Nottinghamshire U.K.: prognosis of subtypes defined in the WHO‐EORTC classification

Background Primary cutaneous B‐cell lymphomas (PCBCL), with the exception of large B‐cell lymphoma of leg type and intravascular large B‐cell lymphoma, are associated with an excellent prognosis. These lymphomas have become much better understood in recent years leading to the publication in 2005 of the World Health Organization–European Organisation for Research and Treatment of Cancer classification. Objectives To determine the relative frequency of occurrence of subtypes of PCBCL in a defined population, and the survival of patients with these subtypes. Methods During the period 1987–2009, 61 consecutive patients with PCBCL were identified from the Nottingham Lymphoma Registry (population 1·1 million). After histological review, the number of patients with each subtype was as follows: marginal zone, 18; follicle centre, 14; diffuse large B cell, leg type, 16; diffuse large B cell, other sites, 12; and intravascular large B cell, one. Results The 5‐ and 10‐year lymphoma‐specific survival for patients with marginal zone lymphoma was 100%. The only patient with intravascular large B‐cell lymphoma died from widespread disease in spite of chemotherapy. The 4‐year lymphoma‐specific survival for follicle centre cell lymphoma was 90%. Patients with the other subtypes had the following 5‐year lymphoma‐specific survival rates: diffuse large B cell, leg type, 61% and diffuse large B cell, other, 40%. The median age at diagnosis for patients with diffuse large B‐cell lymphoma, leg type was 82 years and as a consequence the 5‐year overall survival was only 15%. There was a 3·4‐fold increase in the incidence of PCBCL from the period 1987–1997 to the period 1998–2009. Conclusions PCBCL is a rare disease (incidence around three per million population per year). It is, in our view, essential that it is diagnosed by a pathologist with an interest in cutaneous lymphoma and that the very different prognosis of the individual subtypes is appreciated by the treating clinician.     

Improved survival for melanoma in Northern Ireland: a comparison of two 5-year periods (1984-88 and 1994-98)

BACKGROUND: The incidence of cutaneous malignant melanoma has been rising steadily in Caucasian populations for several decades, with a doubling time of 10-14 years. An increase in incidence of about 5% per year has been reported in most Caucasian populations since the early 1960s. OBJECTIVES: This study was designed to determine the changing incidence of primary cutaneous malignant melanoma in Northern Ireland and to examine changes in survival rates from cutaneous malignant melanoma in two 5-year periods, 1984-88 and 1994-98. METHODS: One thousand three hundred and twenty-six patients with invasive primary cutaneous melanoma were included in the study. RESULTS: The age standardized rate of melanoma rose from 4.3 per 100,000 population per year in men and 8.6 per 100,000 population per year in women to 7.7 and 11.8, respectively, per 100,000 population per year in the 1994-98 period. Overall, the absolute 5-year survival for the 1984-88 period was 71.0% [95% confidence interval (CI) 66.9-75.1%] and 77.4% (95% CI 73.4-81.4%) for the 1994-98 period. Women consistently showed better survival at all ages and within almost all categories of thickness of primary tumour. Younger patients of both sexes showed better survival rates. CONCLUSIONS: When survival rates between the 1984-88 and 1994-98 periods were compared using multivariate analysis, we found that patients diagnosed in the second period had a one-third lower risk of dying than those in the earlier period. Much of this reduction was explained by changes in the number of melanomas of thin Breslow depth and ulcerated melanomas.