手术治疗胃肠间质瘤患者的预后分析

目的探究手术治疗胃肠间质瘤患者的预后影响因素。方法回顾性分析56例胃肠间质瘤术后患者的临床病理资料,采用Log-rank检验和Cox比例风险模型对其影响因素进行单因素分析和多因素分析。结果 56例患者随访时间为1~38个月,中位时间为17个月,其中4例复发,2例转移,8例死亡。1、3、5年生存率分别为94.6%(53/56)、89.3%(50/56)、82.1%(46/56)。单因素分析结果显示:年龄、肿瘤直径、核分裂象和肿瘤是否破裂与患者的预后相关(P均<0.05)。多因素分析结果显示:肿瘤直径大小(RR=6.600,95%CI=2.830~15.390)、核分裂象(RR=8.457,95%CI=2.855~25.049)和肿瘤是否破裂(RR=6.586,95%CI=1.792~24.202)是胃肠间质瘤术后患者预后的独立影响因素。结论肿瘤大小、核分裂象和肿瘤是否破裂是影响胃肠间质瘤术后患者预后的重要指标。     

胃肠道间质瘤患者预后的影响因素分析

目的探讨胃肠道间质瘤的临床病理因素对患者预后的影响。方法回顾性分析185例胃肠道间质瘤患者的临床资料,对患者不同病理因素1、3、5年无瘤生存率分布情况进行比较分析。结果 185例患者1年无瘤生存170例(91.89%),3年无瘤生存151例(81.62%),5年无瘤生存144例(77.84%);单因素分析显示肿瘤位置、肿瘤直径、核分裂数、ki-67指数均为影响胃肠道间质瘤无瘤生存率的因素(P<0.05);多因素分析显示肿瘤位置和核分裂数是影响胃肠道间质瘤无瘤生存率的独立因素(P<0.05)。结论肿瘤位置、肿瘤直径、核分裂数、ki-67指数均为影响胃肠道间质瘤无瘤生存率的主要因素,其中肿瘤位置和核分裂数为独立因素。     

核叉头转录蛋白3(Foxp3)在胃间质瘤组织中的表达及其临床病理意义

目的:利用免疫组化技术评估Foxp3在胃间质瘤组织中的表达,并进一步分析Foxp3的表达是否与胃间质瘤患者的临床病理因素和预后相关。方法:收集96例胃间质瘤患者肿瘤及瘤旁组织标本,采用免疫组化方法检测肿瘤及瘤旁组织中Foxp3的表达。进一步分析Foxp3表达水平与患者临床病理因素及预后的关系。结果:与瘤旁正常组织相比,Foxp3在胃间质瘤组织中呈高表达。Foxp3表达与核分裂象、肿瘤大小、肿瘤坏死以及肿瘤危险度分级呈正相关。单因素分析显示Foxp3高表达与总生存率呈负相关,多因素分析显示Foxp3是影响胃间质瘤患者预后的独立危险因素。结论:Foxp3高表达与胃间质瘤患者预后不良有关,Foxp3可能是胃间质瘤潜在的诊断标志物和治疗靶点。     

胃肠道间质瘤预后多因素分析

目的探讨胃肠道间质瘤的相关预后因素。方法复阅切片,重新诊断,从肿瘤的两点取材,构建组织微阵列。以免疫组织化学染色检测CD117、CD34、SMA、Desmin及S-100 5种蛋白的表达,分析各临床病理变量与预后的关系。结果194例患者1,3,5年生存率分别为93．5％、72．1％和63．2％;单因素分析显示,患者的预后与肿瘤大小、核分裂相数目、肿瘤坏死、肿瘤部位、肿瘤细胞密集程度、肿瘤细胞类型、核异型性、出血、手术方式、周围脏器组织有无侵犯、黏膜有无受侵、性别等因素有关（P〈0．05）;多因素分析显示,周围组织肿瘤侵犯、肿瘤坏死、肿瘤大小、核分裂相数目及性别是影响预后的重要因素。结论肿瘤大小及核分裂相数目是影响预后的重要因素,但准确判别预后尚应结合肿瘤坏死、性别、肿瘤部位及其他病理参数进行。     

小肠间质瘤临床、影像及病理学特征与预后的相关性分析

目的:分析小肠间质瘤临床、影像及病理学特征与术后转移复发和死亡的相关性。方法:回顾性分析2013年01月至2016年12月北京友谊医院及北京市房山区良乡医院普外科收治的经手术治疗且病理检查确诊的61例小肠间质瘤患者,术后对其进行为期3年的随访。观察指标包括患者的临床特征、影像学特征、临床病理特征以及预后情况。结果:单因素分析结果提示,小肠间质瘤患者术后复发或转移与肿瘤直径、CT肿瘤密度不均匀改变、核分裂象计数、是否浸润、改良NIH危险度分级、切除分级、是否服用伊马替尼相关;小肠间质瘤患者术后死亡与年龄、肿瘤直径、核分裂象计数、是否浸润、改良NIH危险度分级和切除分级相关。多因素分析提示肿瘤直径>5 cm和核分裂象＞5/50高倍镜视野是小肠间质瘤患者复发或转移的独立危险因素;肿瘤直径>5 cm和改良NIH危险度中高危组是小肠间质瘤患者死亡的独立危险因素。结论:肿瘤大小、核分裂象计数以及改良NIH危险度分级是影响小肠间质瘤患者预后的独立相关因素。     

内脏肿瘤的皮肤表现

内脏肿瘤的皮肤表现可以分为副肿瘤性皮肤病及皮肤转移瘤.本文首先复习了3种比较特异性的副北肿瘤性皮肤病:皮肌炎、坏死松解性游走性红斑和副肿瘤性天疱疮,这些皮肤病对某些肿瘤有一定的提示作用.并综述了非特异性副肿瘤性皮肤病及皮肤转移瘤的主要表现.     

肝癌合并微血管侵犯的相关因素分析北大核心

目的:探讨肝癌合并微血管侵犯(microvascular invasion,MVI)的临床危险因素,为肝癌术前预测、诊断治疗以及判断预后提供依据。方法:回顾性分析165例确诊为肝癌患者的临床、影像以及病例资料,依据术后病理报告有无微血管侵犯分为MVI阳性组(42例)和MVI阴性组(123例)。比较分析两组间年龄、性别、乙型肝炎病毒感染情况、甲胎蛋白(alpha fetoprotein,AFP)水平(AFP>400 ng/mL、AFP≤400 ng/mL)、肝功能指标、肿瘤大小(>5 cm、≤5 cm)、肿瘤数目、包膜是否完整、有无瘤内动脉形成、肿瘤边缘是否光滑、有无瘤内组织坏死以及肿瘤分化程度与MVI形成的关系。结果:单因素分析结果显示,MVI阳性组与MVI阴性组相比,AFP水平、白蛋白水平、肿瘤最大直径、存在瘤内动脉以及瘤内坏死有统计学差异(P<0.05)。将其纳入多因素Logistic回归分析,两组间AFP水平、肿瘤最大直径、存在瘤内动脉以及瘤内坏死有统计学差异(P<0.05)。结论:AFP水平、肿瘤最大直径、存在瘤内动脉以及瘤内坏死是MVI发生的独立危险因素。     

胃肠道间质瘤的临床病理特征和预后相关因素分析

目的探讨胃肠道间质瘤（gastrointestinal stromal tumor，GIST）的临床病理特征和预后相关因素，评价Fletcher等推荐的GIST生物学行为分级法的应用价值。方法复阅切片，以免疫组化方法检测CD117、CD34和S—100蛋白的表达。结合患者临床病理特征和GIST生物学行为分级分析影响GIST患者预后的相关因素。结果确诊44例GIST患者。患者中位生存时间41．7个月，1、3和5年总体生存率分别为80．2％、57．2％和39．8％。单因素分析显示，肿瘤最大径〉5cm、肿瘤性坏死、组织学类型混合型、肿瘤细胞高密集度、核分裂象计数≥5／50HPF、手术未完整切除、复发或转移瘤以及浸润性生长显著降低生存（P〈0．05）。44例GIST生物学行为分级：极低度侵袭危险性7例，低度侵袭危险性8例，中度侵袭危险性10例，高度侵袭危险性19例。单因素分析显示，不同侵袭危险性组患者生存率差异有显著性（X^2=28．376，P=0．000）。结论准确判断GIST患者预后有赖于综合分析患者临床病理特征。Fletcher等推荐的GIST生物学行为分级法能够准确评价GIST患者的预后，具有较好的临床应用价值。     

胃肠道间质瘤临床特征及预后影响因素分析

目的:探讨胃肠道间质瘤临床特征及预后影响因素。方法:回顾性分析我院2011年3月至2014年1月收治的653例胃肠道间质瘤患者临床资料,归纳临床特征,采用统计学方法分析影响预后的危险因素。结果:男女性别比为1.17∶1,年龄分布以40岁以上人群为主(84.07%)。首发症状以消化道出血(37.98%)、腹痛及腹胀(32.01%)、消化道症状(14.85%)为主,部分患者无明显症状(4.44%)。肿瘤发生部位以小肠(20.06%)和胃部(58.35%)为主。581例(88.97%)患者行根治性切除,72例(11.03%)患者行姑息性切除。根治性手术患者中,137例(20.98%)患者行联合脏器切除。112例(17.15%)患者行淋巴结清扫,淋巴结清扫数平均为(23.45±6.12)枚。63例患者术后采用伊马替尼（400 mg/d）口服治疗。371例(56.81%)患者核分裂象≤5个/50 HPF,282例(43.18%)患者核分裂象＞5个/50 HPF。CD117阳性581例(88.97%),S-100阳性61例(9.34%),CD34阳性568例(86.98%)。患者1年、3年及5年总体生存率为96.71%、76.52%和61.83%。单因素分析发现核分裂象、肿瘤最大径、手术根治性及改良NIH危险度分级与胃肠道间质瘤患者5年生存率有关,多因素回归分析证实以上因素是影响患者5年生存率的独立危险因素(P＜0.05)。结论:胃肠道间质瘤主要分布在40岁以上人群,但临床症状不典型,可通过核分裂象、肿瘤最大径、手术根治性及改良NIH危险度分级评估预后。     

恶性孤立性纤维性肿瘤的临床病理特征分析并文献复习

目的:探讨恶性孤立性纤维性肿瘤的临床病理特征及鉴别诊断。方法:对9例恶性孤立性纤维性肿瘤进行光镜及免疫组织化学研究,并复习相关文献。结果:男性6例,平均年龄为49.7岁;女性3例,平均年龄为48.3岁;平均肿瘤直径为9.39 cm。镜检:细胞稀少区和细胞丰富区交替分布,两者之间有粗的玻璃样变胶原纤维分隔。密集区肿瘤细胞丰富,呈束状、旋涡状排列,可见血管外皮瘤样结构;瘤细胞呈梭形,异型性明显,有肿瘤性坏死,核分裂均大于4个/10 HPF。免疫表型:肿瘤细胞STAT6和Vimentin一致阳性表达,CD34、BCL-2、CD99不同程度阳性表达。结论:恶性孤立性纤维性肿瘤确诊依据形态学及免疫组化,需与形态学表现相似的其他恶性梭形细胞肿瘤鉴别,其预后不良,易复发和转移,根治性切除是主要治疗手段,必要时辅助放化疗。     

Prognostic Evaluation of Proliferative Activity and DNA Content in the Phyllodes Tumor of the Breast: Immunohistochemical and Flow Cytometric Study of 118 Cases

The goal of this study was the prognostic evaluation of histology, mitotic rate, S-phase fraction (SPF) and expression of proliferative antigen Ki67 and p53 protein in phyllodes tumor of the breast. The study was performed in the group of 118 patients with phyllodes tumor treated by surgery from 1952 to 1998. Mitotic rate was assessed on the representative histological specimens. Expressions of Ki67 and p53 were evaluated by immunohistochemistry on a section from the corresponding paraffin blocks which were also used for flow cytometric DNA evaluation. Histologically, 52 tumors were benign (LGM), 24 borderline malignancies (BM) while among 42 malignant tumors, 20 were monomorphous (HGM) and the remaining 22 revealed heterologic elements (HGH). Tumor recurrencies occurred in 17 patients, predominantly during the first three years after surgery, and 13 patients died of the tumor (1 BM, 12 both malignant variants). Multivariate analysis demonstrated mitotic rate, SPF and p53 expression as independent prognostic parameters for the disease-free survival. Histological tumor type and expression of Ki67 influenced independently the overall survival. In conclusion, the histological type of tumor phyllodes forms the basis for the prognosis of clinical outcome, but the indicators of the proliferative activity, especially Ki67 index, are valuable prognostic factors among patients with malignant variant of phyllodes tumor of the breast. Expression of the p53 protein in tumor cells could be also useful when the percentage of cells and intensity of expression are considered.     

Jejunal intussusception due to malignant phyllodes tumor of the breast

Phyllodes tumors are rare fibroepithelial neoplasms of the breast; classified as benign, borderline, or malignant based on the mitotic activity, cellular atypia, and stromal overgrowth. Wide surgical excision is the treatment of choice. The most common locations for metastasis are lung, bone, and liver; small intestinal metastasis is extremely rare. Here we present the first patient with jejunal metastases and intussusception due to malignant phyllodes tumor of the breast. Adjuvant treatment of malignant phyllodes tumor needs to be investigated.     

Management of non metastatic phyllodes tumors of the breast: review of the literature

Phyllodes tumors of the breast are rare tumors, accounting for less than 0.5% of all breast tumors. These tumors are comprised of both stromal and epithelial elements; and traditionally they are graded by the use of a set of histologic features into benign, borderline, and malignant subtypes. Unfortunately, the histologic classification of phyllodes tumors does not reliably predict clinical behavior.The mainstay of treatment of non metastatic phyllodes tumors of the breast is complete surgical resection with wide resection margins. Lumpectomy or partial mastectomy is the preferred surgical therapy. However, despite the complete surgical resection, local failure rate may be high; and 22% of malignant tumors may give rise to haematogenous metastases. The most frequent site of distant metastases is the lungs. Several predictive factors of recurrence and metastases have been described in the literature, such as positive surgical margins, increased stromal cellularity, stromal overgrowth, stromal atypia and increased mitotic activity.Nevertheless, the role of adjuvant therapies (radiotherapy and chemotherapy) is presently undefined and should be tested in multicenter, prospective, randomized trials.     

Primary breast sarcoma: A review of 33 cases with immunohistochemistry and prognostic factors

The clinical and pathological features of 33 previously untreated patients with primary breast sarcoma were retrospectively analysed to evaluate the prognostic significance of histologic variables on survival. The series comprised 17 cystosarcomas phyllodes and 16 stromal sarcomas (excluding angiosarcomas).All tumors were reviewed and classified in similar fashion to extramammary soft tissue sarcomas. In addition, immunohistochemical studies were performed on paraffin sections with a panel of several antibodies directed against cytoskeletal filaments and cellular enzymes; five cases were also examined by electron microscopy.Most tumors were malignant fibrous histiocytoma (21 cases) and fibrosarcoma (6 cases) types. Surgery was the main therapy. Metastasis-free survival rate was significantly correlated only with histological grade, consisting of tumor differentiation, tumor necrosis, and mitotic activity. Courses and survivals of the cystosarcoma and stromal groups were identical, questioning the clinical value of this pathologic distinction. All local recurrence, metastasis, or death occurred within 30 months, though follow-up was much longer.Immunohistochemistry was disappointing for identification of specific histologic sub-types.     

Proliferating activity in differential diagnosis of benign phyllodes tumor and cellular fibroadenomas: Is it helpful?

Benign phyllodes tumors and fibroadenomas are two types of fibroepithelial tumors of breast that are usually difficult to differentiate. The purpose of this study is to evaluate the proliferative activity of these tumors and to find out if it helps in differential diagnosis. Thirty-one benign phyllodes tumors and twelve cellular fibroadenomas were retrieved from the archives of Pathology Department of Akdeniz University, School of Medicine. Proliferating activity of epithelial and stromal cells were evaluated by using labeling index (LI) of proliferating cell nuclear antigen (PCNA) and Ki-67 antigen by immunohistochemistry. The results were compared with other clinicopathologic findings. There was not any significant difference between the proliferating activity of phyllodes tumor and cellular fibroadenomas. Mean LI of PCNA was 28.01 (+/-22.85) in stromal cells and 56.57 (+/-30.98) in epithelial cells of phyllodes tumor where it was 28.92 (+/-24.02) and 62.53 (+/-32.56) in fibroadenomas. Ki-67 indices were 0.05 (+/-0.19) in stromal cells, 2.65 (+/-12.53) in epithelial cells of phyllodes tumors and 0.0 (+/-0) in stromal cells, 0.43 (+/-0.63) in epithelial cells of fibroadenomas. There was no correlation between the diameter of tumors and proliferating activity in both groups. Proliferating activity, determined by immunohistochemistry with PCNA and Ki-67 antibodies did not reveal significant difference between phyllodes tumor and fibroadenoma.     

Phyllodes tumors of the breast diagnostic and therapeutic dilemmas

BACKGROUND: This article compares experiences in the diagnosis and treatment of phyllodes tumors from 2 regional institutions with the relevant literature. PATIENTS AND METHODS: From 1991 to 2005, 2,848 breast cancer patients were treated in our institutions, 36 (1.44%) for phyllodes tumors. The average tumor size was 5.1 cm (range 1.4-19.6). Triple assessment was the standard diagnostic algorithm. Wide excision with tumor-free margins was carried out in 29 (80.5%) cases and mastectomy in 7 (19.4%) cases. Axillary lymphadenectomy was performed in patients with positive lymph nodes. RESULTS: Histology showed the phyllodes tumors to be benign in 27 (75.0%), malignant in 6 (16.6%), and borderline in 3 (8.3%) cases. Follow-up was from 5 months to 16 years. In this period, recurrences of 3 (8.3%) malignant and 2 (5.6%) benign phyllodes tumors were diagnosed and treated. 10 (27.7%) patients treated with wide local excision showed deformities in the form of scarring. The steroid receptor status was of no prognostic value in our patients, and chemotherapy was used in only 1 (2.7%) patient. 5-year survival was 86.2%. CONCLUSION: Our study shows that tumor size, margin infiltration, mitotic activity and degree of cellular atypia are important prognostic factors. Problems in diagnosing this condition arise from its similarity to fibroadenoma. Although wide local excision is usually the treatment of choice, tumor recurrence is common. Axillary lymphadenectomy in malignant phyllodes tumors is, in our opinion, still controversial.     

Phyllodes tumor of the breast: a clinicopathologic study of 34 cases

Thirty-four cases of phyllodes tumor of the breast were studied to evaluate the clinical and pathological features, which correlate with local recurrence. Histologically, local recurrence correlated with the finding of more than ten mitotic figures per ten high-power fields, marked cellularity, prominent nuclear pleomorphism, and stromal overgrowth. Older patients and patients with larger tumors had a higher probability of local recurrence. Stromal overgrowth correlated with the other histological parameters, with rapid tumor growth, a tumor diameter of over 10 cm, and with local recurrence. It was thus considered to be a histological indicator of the malignant potential of phyllodes tumor of the breast.     

Le sarcome stromal périductal : une nouvelle observation d’une tumeur rare

Periductal stromal sarcoma is an extremely rare malignant fibroepithelial breast tumor, long confused with phyllodes tumors. This confusion is justified by its biphasic histology comprising two components: ductal or epithelial benign, surrounded by a sarcomatous periductal stroma made of spindle cells. Currently, it is a distinct pathological entity. Wide surgery with free margins is enough and is the only treatment currently validated, the value of adjuvant therapy based on radiation and/or chemotherapy remains to be demonstrated. The prognosis is marked by local recurrence sometimes as phyllodes tumors or specific soft tissue sarcoma more aggressive, which requires close monitoring based on clinical examination.     

Prognostic factors in cystosarcoma phyllodes. A clinicopathologic study of 77 patients.

The authors studied prognostic factors in 77 patients with primary cystosarcoma phyllodes (CSP) of the breast. Median patient age was 50 years of age, and the median follow-up time was 8 years. Sixteen patients (21%) had distant metastases and subsequently died of CSP. Clinical variables such as age, symptom duration, clinical tumor size, and type of surgery were not of prognostic value. Local recurrence was more common among patients treated with breast-conserving surgery than among those treated with mastectomy. However, there was no significant difference between these two subgroups in terms of distant metastasis-free survival or overall survival. The prognostic significance of several histopathologic parameters was also assessed, e.g., stromal cellularity, stromal cellular atypism, mitotic activity, atypic mitoses, stromal overgrowth, tumor contour, tumor necrosis, and heterologous stromal elements. In a multivariate Cox analysis, the only features that were found to be independent prognostic factors were tumor necrosis (P less than 0.05) and presence of stromal elements other than fibromyxoid tissue (P less than 0.01). In summary, additional studies of prognostic factors in CSP are warranted because of the conflicting results in published reports.     

乳腺叶状肿瘤的诊断及治疗

目的探讨乳腺叶状肿瘤的诊断和治疗.方法对经手术和病理诊断的48例乳腺叶状肿瘤的临床病理资料进行回顾性分析.结果48例中平均年龄为43.2岁.根据肿瘤生长方式,瘤细胞异型,核分裂和肿瘤坏死进行乳腺叶状肿瘤分级,良性26例,交界性12例,恶性10例.全部病例采用手术治疗,肿瘤单纯切除术23例,良性、交界性、恶性复发分别为3/18、2/3、2/2;肿瘤扩大切除术15例,良性、交界性、恶性复发分别为0/8、1/5、1/2;乳房切除术10例,交界性、恶性复发转移分别为0/4、2/6.结论乳腺叶状肿瘤可分良性、交界性和恶性三种类别,确诊和分级主要依靠病理组织检查.提示首次肿瘤彻底切除是治疗的关键,应根据组织分级及肿瘤大小决定手术方式.