147例原发灶不明颈部转移癌的随访结果

目的 为探讨早期发现原发灶不明颈淋巴结转移癌之原发灶的方法。方法 对147例原发灶不明颈淋巴结转移癌患者的随访观察。结果 63例发现原发灶，其中2年内发现原发灶58例。原发于头颈部者以鼻咽、下咽、甲状腺多见；原发于锁骨以下者以肺、食管、纵膈多见。结论 认为严格随访，注意每一轻微症状，全面查体，利用必要的辅助检查，有助于发现原发灶。     

原发灶不明的颈部转移癌200例临床研究

本文报告200例原发灶不明的颈部转移癌跟踪检查临床研究结果。经过不同时间的检查,能查出原发灶者143例,占71.5％;3年以上仍未查出原发灶者57例,占28.5％。原发灶不明颈转移癌的发病率,本组用因颈转移灶就诊的患者为基数统计,占41.8％。年龄50～69岁的患者占68.5％,以男性为多。上颈部转移灶主要来自头颈部,以鼻咽癌、甲状腺癌为多;下颈部转移灶主要来自锁骨以下部位,以食管癌、肺癌,胃癌为多。原发于头颈部者,主要向同侧上颈转移;原发于锁骨以下者主要向左侧下颈转移。转移灶的病理类型对寻找原发灶有一定帮助,尤其对甲状腺癌等较有意义。     

原发灶不明颈淋巴结转移癌42例临床分析

目的探讨原发灶不明颈淋巴结转移癌的诊断、治疗方法与预后的影响因素。方法回顾分析我院1992年2月～1999年2月收治的42例原发灶不明颈淋巴结转移癌患者的临床资料。结果全组的1、3、5年生存率分别为71．4％(30／42)，45．2％(19／42)，33．3％(14／42．)。随诊中有14．3％(6／42．)的原发灶不明颈淋巴结转移癌患者发现了原发灶。结论影响原发灶不明颈淋巴结转移癌预后的主要因素是组织学类型，N分期，转移癌的部位，原发灶是否找到。对颈部转移性低分化癌、未分化癌或鳞癌应采用放射治疗，位于中上颈者应采用面颈联合野放射治疗，转移性腺癌应以手术治疗为主，晚期颈转移癌应采用化疗、放疗为主的综合治疗。锁骨上区转移癌应以化疗为首选。     

颈部原发不明转移癌的胃镜检查结果分析

不明来源的转移癌占实体瘤的10%～15%,常发生于淋巴结,尤以颈部淋巴结最多见.其原发灶部位是否明确与临床治疗及预后密切相关.我科1994～2001年间有104例颈部原发不明转移癌患者行胃镜检查,其中47例明确了原发灶来源,为探讨胃镜检查在颈部转移癌原发灶寻找中的诊断价值,我们对胃镜明确来源者进行分析,现报告如下.     

颈部原发不明转移癌的治疗

目的 探讨颈部原发不明转移癌的合理治疗方式。方法 回顾分析６８例颈部原发不明转移癌患者的临床资料。结果 中上颈低分化转移癌最好的治疗方式是放疗,转移性鳞癌则采用手术后加放疗,转移性腺癌中的乳头状腺癌治疗应采用甲状腺癌联合根治术。其５年生存率分别为５０．０％（２／４）、６６．７（８／１２）、６６．７（８／１２）和８５．７％（１２／１４）。锁骨上区转称癌尤其右侧者应力争手术切除,辅之以化疗。随访中有１５．２％颈部原发不明转移癌患者发现原发病灶。结论 对颈部原发不明转移癌的治疗方式,应根据淋巴结的病理性质、部位、局部和全身情况进行综合考虑。     

原发灶不明的颈部淋巴结转移癌

临床上原发灶不明的颈部淋巴结转移癌并非鲜见。据Winegar(1973)7,600例颈转移癌资料,原发灶不明者占4～9％,平均5.5％。本文就其诊断标准,寻找原发灶的方法、治疗措施及预后等进行综述。诊断标准诊断标准不一。Comess等103例的诊断标准为:1.无恶性病变或性质不明病变手术切除史,2.无与某器官明确有关的症状,3.无原发病变临床或实验室症状,3.无原发病变     

原发灶不明的颈部转移癌的治疗和预后：附51例分析

临床上原发灶不明的颈部转移癌比较少见 ,约占颈部转移癌的 5 .5 % [1 ] 。对原发灶不明的颈部转移癌应积极治疗 ,密切随访 ,持续寻找原发灶 ,以取得一定的远期疗效 [2 ] 。我们回顾性分析了 5 1例原发灶不明的颈部转移癌患者的临床资料 ,以探讨原发灶不明的颈部转移癌患者的治疗和预后。1　临床资料1.1　一般资料　原发灶不明的颈部转移癌须具备下列四个条件 :(1)颈部肿物经病理检查确诊为淋巴结转移癌 (不包括恶性淋巴瘤 ) ;(2 )未找到原发肿瘤 ;(3)既往无恶性肿瘤病史 (包括不明性质的肿块切除史 ) ;(4)治疗过程中无颈部以外的转移灶。 1…     

18 F-脱氧葡萄糖PET显像在原发灶不明转移癌中的应用

目的：探讨^18F-脱氧葡萄糖（FDG）正电子发射型体层摄影术（PET）全身显像在原发灶不明转移癌中的作用。方法：对29例原发灶不明转移癌患者行EDG PET全身显像，并与临床随诊、组织活检和手术病理结果对照。结果：29例原发灶不明转移癌患者，FDG PET发现可疑原发灶15例，其中13例为病理结果所证实，2例病理结果为阴性，FDG PET对原发灶的检出率为44．8％（13／29）。FDG PET全身显像另外检检出淋巴结转移和远地转移灶26个，CT和MRI只检出13个。14例FDG PET未确定原发灶者，经随访3－13个月,死亡率42．9％（6／14）。13例FDG PET确定原发灶者，经过有针对性的治疗，经随访2－13个月，死亡率为15．4％（2／13）。结论：FDG PET全身显像对原发灶不明转移癌原发灶的确定、临床分期、治疗方案的制定以及预后的改善均有一定的价值。     

涎腺腺样囊性癌的复发转移因素分析

通过６０例涎腺腺样囊性癌的随诊，结果发现：局部复发率为２１．７％。复发主要与原发部位、病理类型、局部扩散及切除范围有关。腺样囊性癌局部侵袭性强，切除范围不易确定，对术后切缘有癌残留者，应追加术后放疗。本组淋巴结转移少见（３％），转移部位多在原发灶周围。在广泛切除原发灶后，一般无需行预防性颈清扫术。血行转移较多见（２１．７％），常发生于肺部。但出现血行转移的病人经治疗后仍可长期带瘤生存，故血行转移并非切除原发灶的手术禁忌证。     

原发部位不明的颈部转移癌

 原发部位不明的颈部转移癌是指颈部转移癌经病理证实而原发灶不明者。 在临床上并非偶见,病人常经过几个医院、多个科室、多个医生、多次检查仍不能发现原发灶, 所以作出恰当的诊断、治疗是比较困难的。     

Diagnosis and management of neoplastic lesions of the submandibular triangle

Review of submandibular triangle neoplasms (benign and malignant) treated at a tertiary referral centre in the United Kingdom (1986-2004). One hundred and seven cases identified via computerised search of histopathology records over the 18 year review period. Retrospective review clinical notes and collation with data maintained prospectively by the senior author. Forty nine benign and 58 malignant neoplasms of the submandibular triangle were reviewed. Definitive diagnosis was by excision and pathological examination. Pleomorphic adenoma (n=37) were the most common benign neoplasms. For malignant lesions (n=58), 48 were primary malignancies and 10 metastatic lesions. The most frequent primary lesions were malignant non-Hodgkin lymphoma (n=22), adenoid cystic carcinoma (n=9) and mucoepidermoid carcinoma (n=9). The mainstay treatment for both benign and malignant lesions was surgical either by extracapsular excision of the gland/lesion or selective levels I, IIa and III neck dissection. The main post-operative complication was temporary weakness of the marginal mandibular nerve (13%). Submandibular triangle neoplasms are rare and pose many diagnostic and therapeutic challenges. There is a relatively high incidence of malignant neoplasms in this region (54%). Benign tumours manifest a mild course of disease and have an excellent prognosis following adequate excision. Malignant tumours have a poor symptomatology that can result in late (often post-operative) diagnosis. The adequacy of primary surgery is crucial and would support the approach of a more radical excision primarily with a selective levels I, IIa and III neck dissection; ensuring a definitive operation for benign lesions, avoiding the risks of tumour spillage associated with a more limited excision; and removing the primary echelon of lymph nodes at risk of metastasis if the pathology in fact turns out to be malignant; without a significantly higher morbidity in comparison with an extracapsular gland/lesion excision.     

Arterial occlusion of pelvic bone tumors.

Arterial occlusion of the internal iliac artery was successful in the relief of pain due to primary and secondary neoplasms of the bony pelvis in 8 of 9 patients. These included 3 giant cell tumors, 1 aneurysmal bone cyst, 1 recurrent chondrosarcoma, 3 metastatic renal cell carcinoma and 1 metastatic clear cell sarcoma. Calcification of the margin of the lesion occurred in 3 of 4 primary neoplasms after infarction. The transcatheter arterial occlusion was accomplished utilizing Gelfoam and stainless steel coils. Although most patients experienced pain and fever for several days following the procedure, no permanent sequelae or complications were encountered.     

Merkel cell carcinoma of the head and neck

Merkel cell carcinoma (MCC) is a rare neuroendocrine neoplasm of the skin. The tumor most frequently affects elderly patients, with a preference for the head and neck. Incidence rates increase with sun exposure and after immunosuppression and organ transplantation. A significant proportion of MCC have been reported to occur in intimate association with malignant epithelial neoplasms. The genetic mechanisms underlying the development and tumor progression of MCC are poorly understood, sharing pathogenetic mechanisms with other neoplasms of neural crest derivation. MCC has a propensity for spreading to regional lymph nodes, either at presentation or as a first site of relapse. Sentinel lymph node positivity is helpful in predicting the risk of recurrence or metastasis in patients with MCC. Complete surgical resection is the mainstay of treatment of the primary tumor. Tumor resections are recommended to include a 2-3-cm tumor-free margin around the primary lesion when possible, but this is often difficult to achieve in the head and neck, where Mohs micrographic surgery has proved to be effective. The role of adjuvant radiation therapy is controversial. The role of adjuvant chemotherapy in diminishing the risk of subsequent systemic recurrence in patients with positive nodes remains undefined. Overall response rates to combination chemotherapy for surgically unresectable distant metastatic disease are generally high, although responses are transient. Overall survival of head and neck MCC at 5 years postoperatively ranks between 40% and 68%. MCC has a high incidence of locoregional recurrences, but even after a locoregional failure, a substantial proportion of patients achieve long-term disease-free survival. Finally, factors generally associated with survival are the stage of disease at presentation, distant recurrence usually being the most adverse predictor of survival.     

Neoplasms in skin and subcutis over the breast, simulating breast neoplasms: case reports and literature review

Twenty cases of neoplasms in skin and subcutaneous tissue over the breast were reviewed. There were 17 women, from 15 to 70 years of age, and three men, from 25 to 66 years of age. Among the benign skin neoplasms, superficial leiomyoma, granular cell tumor, and eccrine acrospiroma were misdiagnosed clinically as primary breast carcinoma. Among the malignant neoplasms in subcutaneous tissue, there were three metastatic malignant melanomas, one metastatic epidermoid bronchogenic carcinoma, and two malignant lymphomas. It is interesting that four of these six patients had no prior history of malignant lesion, the subcutaneous nodule presenting as the first manifestation of an occult primary. It is concluded that histological diagnosis of such tumors may lead to avoidance of unnecessary radical surgery.     

前哨淋巴结阳性早期乳腺癌非前哨淋巴结的组织学检测及临床意义

目的：研究早期乳腺癌患者前哨淋巴结(SLN)阳性时非前哨淋巴结(NSN)转移的可能性及其临床意义。方法：对84例SLN阳性接受乳癌根治术的早期乳腺癌患者的NSN及HER-2免疫组化等进行检测，分析NSN转移的发生率及相关临床因素。结果：SLN阳性患者NSN转移的检出率是48．8％(41／84)，NSN转移与原发肿瘤的大小、SLN转移灶的大小及HER-2的表达状况有关，原发肿瘤直径小于1cm及SLN转移灶小于1mm时NSN无转移，NSN的阳性率随原发肿瘤及SLN转移灶直径的增大而提高，HER-2蛋白阳性者NSN转移率高。结论：原发肿瘤直径小于1cm且SLN转移灶小于1mm时的早期乳腺癌患者可免于腋窝清扫，反之亦然；HER-2阳性患者NSN转移率较高，应考虑腋窝清扫。     

Multiple primary malignant neoplasms of the head and neck

This report analyzed the 7,763 cases treated at T.W.M.C., where radiotherapy has been mainly used, between 1968 and 1984. Of these, 258 cases (3.3%) had multiple primary malignant neoplasms, among which 88 cases involved head and neck cancer. The incidence averaged 1.6% during the first 5 years, but increased to an average of 5.7% during the last 5 years. Among head and neck cancer the incidence of multiple primary malignant neoplasms was 8.5% (88/1,033) and the incidence has been gradually increasing annually. Cancers of the head and neck were frequently combined with another primary lesion in the head and neck area or in the digestive tract, especially esophagus and stomach, followed by one in the both cases. The great majority of cancers in the head and neck occurred as the first cancer at age 60-70. The head and neck region is where the respiratory system and digestive system, including lymphatic organs originate and where the external carcinogenic factors enter into the body. These data suggested that multiple primary malignant neoplasms have been increasing in number and becoming an increasing problem. The possibility of multiple primary malignant neoplasms should not be forgotten in routine cancer related clinical work.     

原发灶不明的颈部转移癌49例临床分析

目的:探讨原发灶不明的颈部转移癌的诊断及治疗方法。方法:我院自1980年～1990年共收治原发灶不明的颈部转移癌49例,最终发现原发灶21例(42.9％),以鼻咽、肺最常见。对单纯放疗、放疗加化疗、手术加放疗和/或化疗综合治疗三种方法进行比较。结果:3、5年总生存率分别为55.1％和18.4％。手术加放疗和/或化疗综合治疗优于其他两种方法。结论:随着颈部转移癌部位的下移,其治疗效果越差。     

Multi-Analysis of Non-Thyrogenous Masses of the Neck

OBJECTIVE To systematically analyze and summarize non-thyroge-nous masses of the neck(NTMN)by consideration of new areas,a large sample size and multiple-aspect analysis.METHODS Our research involved 3,125 NTMN cases.We summarized the proportion of various NTMN and the distribution of the neck diseases based on the new international classification.The clinical traits such as sexual proportion and age,etc,were analyzed along with the unknown pri-mary cervical metastatic carcinomas(UPCMC),multiple nodular NTMN and tubercular lymphadenitis.RESULTS There were 68 different diseases identified.Among all the NTMN,the percentage of metastatic carcinomas was 63.3%.The neck masses with a focus above the clavicle comprised 62.3% of the metastatic carcinomas whose focuses were clear.Moreover,other results almost sup-ported the “rule of 80%”.There was an obvious distribution of traits at every sub level.For example,there were 23 different diseases in level III,of which the most common was lymphoma.UPCMC made up 12.3% of all metastatic carcinomas.Multiple NTMN were composed of lymphoma,metastatic car-cinoma and tubercular lymphadenitis,etc.For tubercular lymphadenitis pa-tients,the patients without tubercular toxic symptoms comprised 77.1% of all tubercular lymphadenitis patients.CONCLUSION NTMN are complex and various,with a definite distribu-tion in each neck level.Data relating the sex ratio,UPCMC,multiple nodular NTMN and tubercular lymphadenitis to the clinical traits of NTMN will provide support for clinical applications.     

Thyroid cancer and multiple primary malignancies in Israel

The exact risk of multiple primary neoplasms in patients with thyroid cancer is difficult to ascertain from the data available in the literature. Three thousand seventy-two patients with thyroid cancer, listed in the Israel Cancer Registry during a 16-year time span, were studied to determine the true incidence of another primary cancer. Ninety-two cases were reported as having an additional primary cancer. The prevalence of multiple primary malignancies was 3%. The frequency was higher among patients of European rather than of Asian or African origin. The second primary cancers in order of decreasing frequency were of the breast, lung, colorectum, head and neck, and lymphoma/myeloma. Most of the deaths were due to the additional cancer. The 5-year survival rate was highest for head and neck and lowest for lung cancer patients. These results emphasize the need for greater awareness of the possibility of developing additional cancers, and indicate the need to incorporate strategies for the prevention, early detection, and treatment of multiple primary neoplasms.     

Clinical implications of expression of vascular endothelial growth factor in metastatic lesions of ovarian cancers

Vascular endothelial growth factor (VEGF) has been identified as an important factor for tumour angiogenesis, which is essential for the growth, invasion and metastasis of solid tumours. Significantly increased VEGF level from the primary tumour to the metastatic lesion of ovarian cancers was found in 8 of 30 cases. The 24-month survival rate of the patients with significantly increased VEGF level was extremely poor (0/8 = 0%) in comparison with that of patients with no change in the level (15/22 = 68%) from the primary tumour to the metastatic lesion. This indicates that VEGF may contribute to the advancement of metastatic lesions, and that VEGF level in metastatic lesions may be a prognostic indicator.