食管错构瘤的影像学特征

目的 总结食管错构瘤的影像学特征.方法 回顾性分析2010年10月吉林大学第一医院收治的1例食管错构瘤患者的临床资料,给予X线钡剂造影、多排螺旋CT平扫及二期增强扫描、食管镜、EUS检查,完善检查后行内镜下肿瘤切除术.术后复查X线钡剂造影.结果 X线钡剂造影检查示食管上段分叶状充盈缺损,表面光滑,食管黏膜连续,局部食管蠕动正常.食管CT检查示食管腔内见分叶状软组织密度影,大小约4.2cm×1.6 cm×1.5 cm,其内密度不均,中间密度近似脂肪样密度;二期增强扫描未见明确强化.食管镜检查示距门齿16 ～ 23 cm处见纵行隆起型粉白色肿瘤,近侧有蒂起源于食管后壁,远端呈结节样隆起,表面颗粒样粗糙,触之柔软,无出血,病变局部管腔狭窄.EUS检查示病灶呈不均质低回声,固有基层增厚明显,外膜边缘粗糙.患者行内镜下肿瘤切除术,术后病理学诊断为错构瘤.术后随访12个月,患者状况良好,复查X线钡剂造影,未见肿瘤复发.结论 食管错构瘤是一种极罕见的良性肿瘤,以进食固体食物出现哽咽感为主要临床表现.CT增强扫描及EUS检查对诊断、鉴别该病变具有重要的意义.     

髓外食管浆细胞瘤1例

病人男,56岁.进行性吞咽困难2个月.查体未见明显阳性体征.上消化道造影见食管胸段长约5.6 cm充盈缺损.2009年2月行左胸入路食管癌根治,颈部食管胃侧侧吻合术.术中见肿瘤位于食管中段,约5 cm×4cm×9cm大小,浸润食管全层,无明显外侵,瘤体凸入腔内.     

食管原发性非霍奇金淋巴瘤1例

病人 男,53岁.进食梗噎感1个月.查体:消瘦,浅表淋巴结未触及.上消化道钡餐检查示食管中段见一充盈缺损,食管黏膜中断,管腔狭窄,管壁僵硬,钡剂通过受阻(图1).胃镜检查距门齿29～35 cm处食管左后壁紫红色新生物凸出,约4 cm×5 cm大小,基底处黏膜唇样隆起,质脆.活检病理报告为低分化腺癌.     

原发性食管恶性黑色素瘤二例

病例 1 男,62岁.患者进行性吞咽障碍伴哽噎、胸骨后疼痛1个月,行上消化道X线钡餐检查示:食管下段可见一4 cm×4 cm的充盈缺损,伴桥行黏膜,病灶表面可见龛影,食管下段有占位性病变.胃镜检查示:距门齿34～37 cm处食管前壁见一肿物,表面有结节状突入腔内,占据近食管半边.病理检查提示:食管低分化恶性肿瘤.于2007年8月21日,在全身麻醉下行食管下段恶性肿瘤根治术,术中探及食管下段肿块,长约4.0 cm,食管旁见大小为0.5 cm×0.5 cm的淋巴结数枚,质韧.切下肿块后,食管内有一3.5 cm×2.5 cm×2.5 cm息肉样物突入食管腔.术后病理检查示:食管恶性黑色素瘤已侵入肌层,食管旁6枚淋巴结均未见肿瘤细胞转移.     

原发性食管小细胞未分化癌一例

患者女,63岁.进食哽噎2个月.食管X线钡餐检查示食管中段有一3 cm黏膜充盈缺损,诊断食管中段癌.食管镜检查示距门齿30 cm处黏膜有小溃疡,其边缘呈菜花样隆起,活组织病理检查为恶性肿瘤.1992年1月行手术治疗,术中见肿瘤位于食管距主动脉弓下方1 cm处,约2 cm×3 cm×2 cm大小,食管病变处肌层水肿,无明显外侵.行食管癌切除、食管胃左胸顶部吻合术.     

食管鳞腺癌合并平滑肌肉瘤一例

患者　女 ,6 0岁。因进行性吞咽困难 6个月入院。食管 X线钡餐造影示食管中段有长约 5 cm黏膜中断 ,钡剂通过受阻 ,并有不规则充盈缺损 ,管壁僵硬。胃镜示距门齿线 2 5 cm食管左侧壁有 3cm× 3cm黏膜糜烂 ,边缘不整齐 ,有轻微凹陷 ,向下 3cm处食管左侧壁有 1cm× 0 .8cm肿物 ,黏膜无破坏。于1998年 6月 2 0日在全身麻醉下行食管大部分切除、胃食管左颈部吻合术。术后肉眼见食管长 16 cm,直径 1.5～ 2 .5 cm,表面有 2枚直径分别为 0 .5 cm和 0 .3cm大小的淋巴结 ,食管腔内有 2个肿物 ,分别距食管上缘 6 cm和 8cm,大小分别为3cm× 2 cm× 2 c…     

原发性食管淋巴瘤一例

患者女,57岁。因吞咽不利3个月,加重10 d入院。查体未见阳性体征。食管内窥镜显示:距门齿26 cm至贲门见条状隆起,考虑血肿可能。上消化道X线钡餐造影显示:食管中下段息肉样增生;胸部CT示:食管中下段右侧壁见一大小约14 cm×5 cm长梭形软组织团块影,CT值60～80 Hu,边界清晰,病变通过贲门延伸至胃底;并提示食管平滑肌瘤(图1)。血常规检查白细胞计数正常,消化道肿瘤标记物―),B超检查肝脾无异常。初步临床诊断为食管占位。     

成人管状食管重复畸形一例

1临床资料患者男,37岁.因胸闷、气短、胸骨后疼痛伴吞咽困难1个月,于2011年4月25日收治入院.CT检查提示:胸廓入口处食管旁及后纵隔内见囊实性病变,食管及气管受压,与病变分辨小清,后纵隔病灶与食管并行呈条状;增强后扫描囊壁强化明显,囊内无强化(图1).双肺纹理增强,多发片状磨砂玻璃样改变.胃镜检查见距门齿27 cm、32 cm、36 cm处各一充盈缺损,梭状,前2个在黏膜下相通(图2).贲 门及胃十二指肠未见异常.诊断为后纵隔占位,双肺炎症.患者于2011年5月3日行右侧开胸探查,胸廓入口至膈肌上方,沿胸内全段食管均见包块并行,病变与周围组织界限不清.遂行右胸、腹正中和左颈部切口,行食管大部切除、管状胃颈部吻合术.大体标本显示管状重复食管与主食管外壁共壁,将其剖开显示主、副食管间存在一结缔组织薄膜.     

原发性食管小细胞癌二例

例 1　男 ,47岁。进食不畅 3个月。食管 X线钡餐造影示 :食管中段有一 3cm充盈缺损 ,诊断为食管中段癌。于 1997年 5月入院。食管镜示 :距门齿 31cm食管后壁见一菜花样新生物 ,活组织检查 :小细胞恶性肿瘤 ,神经内分泌颗粒 ( )。胸腹腔CT均未见转移征象。行食管癌切除、食管胃弓上吻合术。术中见肿瘤位于奇静脉下 2 cm,约 2 .5 cm× 2 .0 cm,边界不清 ,病理诊断 :食管小细胞癌 (附图 ) ,淋巴结无转移。术后采用依托泊甙 顺铂 (EP方案 )和环磷酰胺 阿霉素 长春地辛 (CAO方案 )各 2次 ,已存活 43个月。例 2　男 ,72岁。进行性吞咽困难 …     

双原发食管癌、肺癌一期根治术一例

患者男,60岁。因吞咽困难伴呕吐3 d入院。食管X线钡餐造影示:食管中下段交界处长约3cm黏膜中断,壁僵硬。胃镜检查示:距门齿28cm处见食物残渣(肉块)嵌顿,取出后见距门齿3234 cm食管前壁黏膜呈息肉状隆起凸入腔内,活组织检查诊断:鳞状细胞癌。胸部CT示:左肺上叶后段有4.5cm×4.3cm大小阴影,呈分叶状,多数短小毛刺,增强后病灶明显强化。肺门、纵隔未见异常增大的淋巴结。纤维支气管镜检查未见异常。头颅CT、肝、胆B超、双侧肾上腺彩色超声波检查均未见异常。肺功能第1秒用力呼气容积(FEV1):1·98L,占预计值67·7%,肺弥散功能正常。临床诊断…     

Invasive carcinoma of prostate presenting as rectal carcinoma

Prostate carcinoma occasionally can present with rectal obstructive symptoms and an annular constricting lesion of the rectum. Discriminating between primary rectal carcinoma and prostate carcinoma locally invasive to the rectum is of obvious importance because of the different treatments and prognoses. History and physical examination play only a marginal role in differentiating between these two lesions. The diagnosis of prostatic malignancy in patients in this circumstance can be supported by an elevated serum acid phosphatase as well as a bone scan that demonstrates a pelvic/vertebral distribution of bony metastases. The rectal mucosa is usually spared, and a barium enema often will demonstrate tapered margins as opposed to a tumor edge in primary rectal malignancy. Excretory urography often demonstrates hydronephrosis. Rectal biopsy with immunohistochemical staining for prostate specific antigen can direct the origin of a poorly differentiated adenocarcinoma to the prostate. Treatment involves hormonal manipulation with estrogen therapy or orchiectomy. Radiation therapy to the obstructed rectum has provided satisfactory palliation when hormonal manipulation fails.     

Oat cell carcinoma of lung masquerading as prostatic carcinoma

We believe this is the second case of oat cell carcinoma metastatic to the prostate to be reported. The patient was treated for prostatic carcinoma diagnosed by rectal examination. Subsequent biopsy confirmed oat cell carcinoma and led to the discovery of pulmonary carcinoma. Tumors metastatic to the prostate are rare and are identified when they result in urologic symptoms. A review of tumors metastatic to the prostate is presented.     

Immunohistochemical differentiation of high-grade prostate carcinoma from urothelial carcinoma

The histologic distinction between high-grade prostate cancer and infiltrating high-grade urothelial cancer may be difficult, and has significant implications because each disease may be treated very differently (ie, hormone therapy for prostate cancer and chemotherapy for urothelial cancer). Immunohistochemistry of novel and established prostatic and urothelial markers using tissue microarrays (TMAs) were studied. Prostatic markers studied included: prostate-specific antigen (PSA), prostein (P501s), prostate-specific membrane antigen (PSMA), NKX3.1 (an androgen-related tumor suppressor gene), and proPSA (pPSA) (precursor form of PSA). "Urothelial markers" included high molecular weight cytokeratin (HMWCK), p63, thrombomodulin, and S100P (placental S100). TMAs contained 38 poorly differentiated prostate cancers [Gleason score 8 (n=2), Gleason score 9 (n=18), Gleason score 10 (n=18)] and 35 high-grade invasive urothelial carcinomas from radical prostatectomy and cystectomy specimens, respectively. Each case had 2 to 8 tissue spots (0.6-mm diameter). If all spots for a case showed negative staining, the case was called negative. The sensitivities for labeling prostate cancers were PSA (97.4%), P501S (100%), PSMA (92.1%), NKX3.1 (94.7%), and pPSA (94.7%). Because of PSA's high sensitivity on the TMA, we chose 41 additional poorly differentiated primary (N=36) and metastatic (N=5) prostate carcinomas which showed variable PSA staining at the time of diagnosis and performed immunohistochemistry on routine tissue sections. Compared to PSA, which on average showed 18.8% of cells with moderate to strong positivity, cases stained for P501S, PSMA, and NKX3.1 had on average 42.5%, 53.7%, 52.9% immunoreactivity, respectively. All prostatic markers showed excellent specificity. HMWCK, p63, thrombomodulin, and S100P showed lower sensitivities in labeling high-grade invasive urothelial cancer in the TMAs with 91.4%, 82.9%, 68.6%, and 71.4% staining, respectively. These urothelial markers were relatively specific with only a few prostate cancers showing scattered (相似文献   

乳腺癌相关多原发癌

目的 探讨乳腺多原发癌诊断、治疗及预后。方法 回顾性分析乳腺癌相关多原发癌6例资料。第一、二原发乳腺癌均经根治性手术或加故疗及化疗。结果 随访其中3例(50％)有转移性复发。结论 免疫功能抑制和肿瘤生物学行为，可能是乳腺原发癌复发及第二原发癌发生的原因之一。     

Primary ureteral carcinoma composed of both transitional cell carcinoma and mucinous carcinoma: a case report

We present a case of primary ureteral carcinoma composed of both transitional cell carcinoma and mucinous carcinoma. A 79-year-old woman visited her home doctor with the chief complaint of right lower abdominal pain. Abdominal computed tomographic scan (CT) disclosed a tumor measuring about 5 cm in diameter at the right lower quadrant of the abdomen. Percutaneous nephrostomy was performed for hydronephrosis and pyonephrosis. The urinary cytology revealed class V, transitional cell carcinoma. Re-abdominal CT showed further enlargement of tumor diameter, but the primary site of the tumor was not identified. Her general condition worsened, and she died 42 days after her initial complaint. Pathologic examinations upon autopsy revealed both mucinous carcinoma and transitional cell carcinoma in the right ureter. Pathogenesis and management of this rare condition are discussed.     

Simultaneous renal cell carcinoma and squamous cell carcinoma of kidney

A unique case of a collision tumor of the kidney composed of a renal cell carcinoma and a squamous cell carcinoma is reported. Although a few cases of combined tumors of the kidney have been reported previously, we were unable to find any similar case in the literature. Squamous cell carcinoma of the kidney usually behaves aggressively. Early diagnosis and surgical treatment before the tumor has extended beyond the capsule offer the best hope of cure.     

Development of upper tract carcinoma after cystectomy for bladder carcinoma

Two hundred twenty patients who underwent a radical cystectomy and en bloc pelvic lymph node dissection with urinary diversion were reviewed to define the incidence of upper tract carcinoma developing after cystectomy. Each patient was followed for at least five years or until death. In 5 of 220 (2.4%) upper tract lesions developed, with a disease-free interval from cystectomy of twenty-two to fifty-four months. All patients died within two to twenty-seven months of diagnosis. Common pathologic features included the presence of high-grade multifocal lesions or carcinoma in situ (CIS) in the cystectomy specimen, tumor invasion of the intramural ureter, and positive findings on urethrectomy specimens. Although the incidence of this disease process is low, heightened surveillance of the upper urinary tracts would seem appropriate in patients displaying these pathologic features.     

Low-grade adenosquamous carcinoma. A variant of metaplastic mammary carcinoma

The prognostic significance of metaplasia in mammary carcinoma has not been well defined. Pseudosarcomatous metaplasia reportedly has an unfavorable impact on survival. Squamous metaplasia may have less effect on outcome except for the high-grade spindle cell form, which is particularly aggressive. This report describes 11 patients with a low-grade variant of adenosquamous metaplastic carcinoma which has a distinctive combination of glandular and squamous differentiation. The average age of the patients was 59 years (range 42-76). The tumors measured 1.5-3.4 cm (average 2.3) and were grossly hard, tan-yellow, and infiltrative. Follow-up in seven cases treated at least 1 year ago averages 3.5 years (range 1-6 years). Four of eight patients treated by local excision alone developed recurrence in the breast in 1-3.5 years. Negative lymph nodes were found in five axillary dissections. There have been no recurrences after mastectomy performed as primary therapy or for recurrence in seven cases. These findings suggest that patients with the low-grade adenosquamous variant of metaplastic carcinoma have a favorable prognosis. They may be good candidates for breast conservation therapy, but this will require adequate excision followed by primary radiotherapy.     

Metastatic carcinoma of the gallbladder after a renal cell carcinoma

The gallbladder is rarely the site of distant metastases and in most cases malignant melanoma is the primary tumor. We report a case of a 64-year-old man with a gallbladder metastasis secondary to a renal cell carcinoma. Renal cell carcinoma has a tendency toward metastatic disease, the most notable features of this tumor being its unusual pattern of metastatic disease. Pre-operative imaging studies are often futile in the differentiation between primary and secondary tumors of the gallbladder. Since primary tumors of the gallbladder often coexist with gallstones, a polypoid lesion in an acalculous gallbladder is more consistent with metastasis than a primary tumour. If feasible, surgical resection of the gallbladder is mandatory because it could guarantee better chances of survival for patients with metastatic renal carcinoma.