原发性膀胱、前列腺印戒细胞癌（附3例报告并文献复习）

目的探讨原发性膀胱、前列腺印戒细胞癌的临床特征。方法回顾性分析2例原发性膀胱印戒细胞癌和1例原发性前列腺印戒细胞癌患者的临床资料，并结合文献进行复习。结果2例原发性膀胱印戒细胞癌患者行膀胱部分切除术，术后行化疗和定期膀胱腔内灌注化疗，1例随访9个月后失访，另1例术后7个月死于全身多发转移。原发性前列腺印戒细胞癌患者行双侧睾丸切除术和氟他胺口服治疗，免疫组织化学检查示前列腺特异抗原（VSA）（＋），黏液染色（PAs）（-）、癌胚抗原（CEA）（-）、白细胞共同抗原（LCA）（-）、高分子角蛋白（CKH）（-），术后1个月死于肺部转移。结论原发性膀胱、前列腺印戒细胞癌临床罕见，恶性程度高，预后较差,确诊依靠病理组织学和免疫组织化学检查。     

原发性精囊癌的诊断和治疗(附4例报告)

目的 探讨原发性精囊癌的临床表现、诊断及治疗.方法 回顾性分析4例原发性精囊癌患者的临床症状、体征、检查结果、手术方案及术后治疗.1例行双侧精囊连同膀胱、前列腺、直肠根治性切除术.2例行精囊、部分膀胱、前列腺切除术.1例行精囊、膀胱、前列腺、输尿管下段、直肠前壁切除术及回肠膀胱术.结果 2例患者术后随访5年未见复发与转移,1例术后2年死于结肠癌,1例术后随访3个月未见复发与转移.结论 原发性精囊癌的临床表现为血精或血尿,下尿路梗阻症状,大便性状与次数的改变,早期症状不明显,患者血清中前列腺特异抗原(PSA)、CEA阴性,细胞角蛋白(CK)阳性.治疗主要根据肿瘤侵及的范围采取相应的手术方式予以切除,术后应加以联合化疗.     

原发性阑尾肿瘤18例诊治分析

目的 探讨原发性阑尾肿瘤的临床特征、诊断及治疗要点.方法 回顾性分析18例原发性阑尾肿瘤的临床资料.结果 18例患者中良性肿瘤8例,均为黏液囊肿;恶性肿瘤10例,其中类癌7例,腺癌2例,黏液囊腺癌1例.18例患者首次均行阑尾切除术,其中4例(1例类癌,2例腺癌,1例黏液囊腺癌)术后2～3个月再次行二期右半结肠切除术,1例类癌患者术后4个月再次行二期回盲部切除术,其他13例均未行二期手术治疗.15例患者得到随访,其中13例患者随访6个月至23年未发现有阑尾肿瘤复发和转移者;1例黏液囊腺癌患者术后6个月死于全身转移,1例腺癌患者术后9个月死于全身转移.结论 原发性阑尾肿瘤缺乏特异性临床症状和体征,术前诊断困难,对术中可疑者应行快速冰冻切片明确诊断.手术为主要的治疗方法,而术式选择是影响预后的关键因素.     

皮质浸润型肾盂移行细胞癌的临床诊治

目的 探讨皮质浸润型肾盂移行细胞癌的临床特点,提高对皮质浸润型肾盂移行细胞癌的诊疗水平.方法 回顾性分析10例皮质浸润型肾盂移行细胞癌的临床病理资料.10例均行B超、静注肾盂造影(IVU)、CT检查,7例行MRI检查,6例行尿脱落细胞学检查.3例术前误诊为肾癌者行肾癌根治术后二期行输尿管残端及膀胱袖套状切除,5例术前确诊一期双切口行根治性肾输尿管及膀胱袖套状切除,1例误诊为肾上腺占位,1例疑诊肾盂癌者行姑息性肾及肾周肿块切除.结果 术后病理检查均为肾盂移行细胞癌Ⅲ级.1例术后3个月死于全身脏器功能衰竭,3例术后1年内死于肝、肺转移,3例术后2年内死于肝、肺、腹膜后转移,另3例分别为术后3个月、术后1年和术后3年,在随访中.结论 皮质浸润型肾盂移行细胞癌属高级、高期恶性肿瘤,易误诊为肾癌,临床上需提高认识,综合分析B超、IVU、CT、MRI及尿脱落细胞学资料进行诊断,对疑诊病例行术中快速病理检查.根治性患肾、输尿管及膀胱部分切除术为首选治疗手段,可结合放疗、化疗.此类肾盂癌恶性程度高,预后较差.     

皮质浸润型肾盂移行细胞癌的临床诊治

目的 探讨皮质浸润型肾盂移行细胞癌的临床特点，提高对皮质浸涧型肾盂移行细胞癌的诊疗水平。方法 回顾性分析10例皮质浸润型肾盂移行细胞癌的临床病理资料。10例均行B超、静注肾盂造影（IVU）、CT检查，7例行MRI检查，6例行尿脱落细胞学检查。3例术前误诊为肾癌者行肾癌根治术后二期行输尿管残端及膀胱袖套状切除，5例术胁确诊一期双切口行根治性肾输尿管及膀胱袖套状切除，1例误诊为肾上腺占位，1例疑诊肾盂癌青行姑息性肾及肾周肿块切除。结果 术后病理检查均为肾孟移行细胞癌Ⅲ级。1例术后3个月死于全身脏器功能衰竭，3例术后1年内死于肝、肺转移，3例术后2年内死于肝、肺、腹膜后转移，另3例分别为术后3个月、术后1年和术后3年，在随访中。结论 皮质浸润型肾盂移行细胞癌属高级、高明恶性肿瘤，易误诊为肾癌，临床上需提高认识，综合分析B超、IVU、CT、MRI及尿脱落细胞学资料进行诊断，对疑诊病例行术中快速病理检查。根治性患肾、输尿管及膀胱部分切除术为首选治疗手段，可结合放疗、化疗。此类肾盂癌恶性程度高，预后较差。     

膀胱颈口附近膀胱癌25例手术治疗的体会

目的 探讨膀胱颈口附近膀胱癌的治疗体会.方法 回顾性分析1997年3月～2005年12月经手术治疗的25例膀胱颈口附近膀胱癌患者的临床及随访资料.表浅性膀胱癌18例.行经尿道切除术13例,膀胱部分切除术4例,经尿道切除加膀胱部分切除术1例.浸润性膀胱癌7例,行根治性膀胱切除术4例,膀胱部分切除术2例,经尿道切除术1例.结果 随访16～96个月,平均61.3个月.表浅性膀胱癌术后复发4例,再行经尿道切除术后第2次复发1例;浸润性膀胱癌术后死于癌转移2例,复发2例.结论 膀胱颈口附近膀胱癌治疗应根据肿瘤大小、部位、分级、分期合理地拟订出手术方案才能提高疗效.     

脾脏原发性恶性肿瘤的诊断和治疗

目的 探讨脾脏原发性恶性肿瘤的诊断和治疗措施.方法 回顾性分析1995-2007年收治的11例脾脏原发性恶性肿瘤患者的临床资料.11例患者行超声、CT检查,诊断率为100%,11例均行脾脏切除术,其中3例行联合脏器切除术,术后病理10例为恶性B细胞淋巴瘤,1例为血管肉瘤.结果 术后随访8例,3例失访,恶性B细胞淋巴瘤患者最短生存期为16个月,死亡原因为肿瘤复发,4例生存期超过5年,血管肉瘤患者生存1年,死于复发转移.结论 脾脏原发性恶性肿瘤的诊断以CT为主,治疗方法采用以外科手术为主的综合治疗.     

膀胱鳞状细胞癌

目的　分析膀胱鳞状细胞癌 (SCC)的临床特点 ,提高对膀胱鳞状细胞癌的认识及诊治水平。方法　回顾性分析 10例该病患者的临床资料 ,结合国内外文献进行分析讨论。结果　 10例患者男 8例 ,女 2例 ,平均年龄 6 1岁。行膀胱全切术 2例 ,分别存活 18、2 5个月。膀胱部分切除 8例 ,2例术后 1年内出现膀胱内复发 ,1年以上无复发者4例 ,2例失随访 ,本组患者生存时间 6～ 72个月 ,平均生存 16 .4个月 ,1例膀胱鳞癌伴移行细胞癌 (TCC)患者生存 5年以上。结论　膀胱鳞癌在诊断时临床分期较高 ,预后差 ,对化疗不敏感 ,术前放疗和根治性膀胱切除可提高患者生存率。     

胃癌卵巢转移的临床诊疗(附21例分析)

目的探讨胃癌卵巢转移的临床特点、诊断及治疗方法。方法回顾分析我院2001年8月至2012年2月收治的21例胃癌卵巢转移临床资料。结果 21例患者年龄28-53岁,平均(39±11)岁,多为中青年女性。本组转移灶位于双侧卵巢者10例(48%),单侧者11例(其中右侧3,左侧8例);原发灶病理类型均为胃低分化腺癌,合并部分印戒细胞癌的15例;同时性转移14例(67%),异时性转移7例(34%,转移时间为2个月至2年)。结论胃癌卵巢转移具有特殊的临床特征,容易出现漏诊、误诊;确诊为胃低分化癌或伴有印戒细胞癌成分时应警惕卵巢转移可能,应及时行盆腔检查以排除;手术是胃癌伴单纯卵巢转移的首选治疗方式。     

结直肠癌浸润尿路的诊断与治疗

目的 探讨结直肠癌合并泌尿系浸润或转移的诊断与手术疗效.方法 回顾性分析1997年1月至2008年12月收治的197例原发性结直肠癌合并泌尿系浸润或转移患者的诊断与治疗经过.197例结直肠癌根治术中,发现浸润尿路且有盆腔及后腹膜癌肿转移不能切除14例,双侧肾积水行输尿管皮肤造瘘术8例,行肾造瘘术10例.结果 197例患者中185例得到随访,随访时间3～72个月.术后膀胱肿瘤复发2例,行再次膀胱部分切除1例,膀胱造瘘1例.术中无死亡病例,术后31例死于广泛转移.结论 对原发性结直肠癌合并泌尿系浸润或转移的患者积极实施盆腔联合脏器切除是可行的,可以选择性应用.     

Krukenberg tumor: a clinico-pathological study of 5 cases

BACKGROUND: Krunkenberg tumor is defined as the ovarian metastases of a primary digestive tumor composed of a signet ring cells. AIM: Describe the different characteristics of Krukenberg's tumor to improve diagnostic criteria and the therapeutic approche. METHODS: Five cases of Krukenberg tumor are diagnosed in 5 year period between 2002 and 2005. The clinico-pathological feature are reported. RESULTS: The patient age was ranged from 31 to 58 years. Most ovarian tumors were diagnosed synchronously (3 cases). It was a gastric carcinoma in 3 cases and a colonic carcinoma in 2 patients. Histological diagnosis wass easy. We found in 2 cases a metastasis of colonic mucinous adenocarcinoma with signet ring-cell, in 2 other cases it was a gastric adenocarcinoma with exclusively signet ring cell and in the later case it was a gastric moderately differentiated adenocarcinoma with signet ring cell component. Surgical treatment was given in only 3 patients. CONCLUSION: Prognosis is always unfavourable. The only hope for improved prognosis is to search for ovarian metastasis in all cases of digestive tumor.     

前列腺恶性纤维组织细胞瘤1例报告并文献复习

目的探讨前列腺恶性纤维组织细胞瘤（MFH）的临床和病理特征。方法我科收治的1例前列腺MFH患者,经尿道前列腺肿瘤部分切除术,并结合文献进行讨论。结果术后2个月肿瘤复发,6个月死于全身衰竭。结论前列腺MFH为高度恶性、预后差,早期手术切除加长期化疗可提高生存率。     

Squamous cell carcinoma arising in a papillary carcinoma of the thyroid: a case report

BACKGROUND: primary squamous cell carcinoma (scc) of the thyroid is a rare malignant tumor that needs to be distinguished from other neoplasms. Cases of papillary carcinoma merging in association with squamous cell carcinoma are extremely rare. AIM: the characteristics of such association will be studied herein through a review of literature. CASE REPORT: we report a case of an 87-year-old patient presented with an enlarged right lobe of the thyroid. Thyroid scintigraphy revealed a cold nodule. Clinically, malignancy was suspected. Histopathologic diagnosis was a well-differentiated scc associated with areas of papillary carcinoma. Exhaustive clinical, endoscopic and radiological examinations did not reveal any primary site of scc or any contiguous spread from neighboring structures. Surgery was followed by radiotherapy, but the patient died 6 months later. CONCLUSION: the coexistence of epidermoide and papillary carcinomas in the thyroid gland must be known because of its prognostic impact.     

Lateral pelvic lymphadenectomy and total nerve sparing for locally advanced rectal cancer in Western patients.

BACKGROUND: In an attempt to improve the results of locally advanced rectal cancer treatment, we performed an extended surgical technique consisting of total mesorectal excision (TME), lateral pelvic lymphadenectomy (LPL) and total nerve sparing (NS). Resection of the autonomic nerves was realized only when these fibres were involved by the tumour. METHODS: Nine cases (9.2%) of a personal series of 98 western patients with rectal carcinoma operated on between January 1992 and December 1997 at Third Department of Surgery, University La Sapienza, Rome, underwent TME, LPL and NS procedures for locally advanced extraperitoneal disease. RESULTS: Two out of seven patients in stage II/III suffered postoperatively from urinary retention with mild irregular flow as tested on urodynamics, but no long-term urinary disturbances persisted. Retrograde ejaculation occurred postoperatively in one of two patients who experienced urinary disturbances. Another patient had erection dysfunctions. These sexual dysfunctions did not improve during the long-term follow-up. Seven patients with stage II or stage III disease achieved a 5-year survival rate of 80.0% and a 5-year disease-free survival rate of 68.6% after a mean follow-up period of 64.7 months. None of them experienced local recurrence, but one patient died of diffuse metastatic disease 50 months after surgery. Two patients with stage IV rectal carcinoma died of local and distant disease 13 months and 35 months after operation. One patient underwent liver resection for solitary metastasis 25 months after primary operation. CONCLUSIONS: TME, LPL, and NS with resection of autonomic nerves only when these fibres are involved by the disease can achieve satisfactory results in terms of survival and functional outcome in selected western patients with locally advanced rectal cancer.     

乳腺肉瘤28例诊断治疗分析

目的探讨乳腺肉瘤的临床特点和治疗方法。方法回顾性分析1972年1月～2006年9月收治的28例乳腺肉瘤患者的临床资料。结果术后随访10个月至32年，1例失访，随访率为96％。6例死亡，7例复发。5年生存率为80．3％，10年生存率为71．0％。结论乳腺肉瘤的治疗方法以手术治疗为主。对于肿块较小，无淋巴结转移的患者可行单纯乳腺切除术；对于有腋窝淋巴结转移的患者需行乳腺癌根治术。对局部复发的患者不应放弃再次手术的机会。     

上尿路移行上皮细胞癌根治术后复发膀胱肿瘤的高危因素分析

目的 探讨肿瘤部位与上尿路移行上皮细胞癌根治术后复发膀胱肿瘤风险的关系.方法 对行根治手术并获随访的168例上尿路移行上皮细胞癌患者的临床资料进行回顾性总结,比较不同部位上尿路移行上皮细胞癌根治术后复发膀胱肿瘤的风险,采用Cox回归分析术后复发膀胱肿瘤风险的独立影响因素.结果 168例患者术后1、3、5年的无复发膀胱肿瘤的生存率分别为88%、76%和63%.观察期内,共有49例术后发生膀胱肿瘤复发,中位首次复发时间为20个月.肾盂癌术后复发率为30.8%(28/91);输尿管中段癌术后复发率为8.3%(2/24),输尿管下段癌术后复发率为48.7%(19/39).肾盂癌与输尿管癌患者术后无复发膀胱肿瘤生存率比较差异无统计学意义(P>0.05).多因素分析结果显示输尿管下段癌为影响上尿路移行上皮细胞癌根治术后复发膀胱肿瘤风险的独立变量(P<0.01).结论 输尿管下段癌患者术后复发膀胱肿瘤的风险高于其他部位上尿路移行上皮细胞癌.

Abstract：

Objective To investigate the relationship between tumor location and the risk of developing bladder cancer in pafients treated by nephroureterectomy(NU)for upper urinary tract transitional cell carcinoma(UUT-TCC).Methods The clinical data of 168 UUT-TCC patients who underwent NU were reviewed.Univariate and multivariate analysis were carried out to determine the risk factors for intravesical recurrence after NU.Results The recurrence-free survival rate at 1,3 and 5 years after NU were 88%, 76%and 63%.All patients were followed up for a median period of 45(12-107)months During this period, a total of 49 patients developed bladder tamors after surgery,of which 28 cases were renal pelvic carcinoma, 2 cases were rniddle ureter carcinoma and 19 cases were distal ureter carcinoma.The recurrence-free survival of renal pelvic carcinoma and ureter carcinoma had no significant difference by Log-Rank test(P>0.05).On multivariate analysis,only locating in distal ureter carcinoma was the independent risk predictor for intravesical recurrence after NU (P<0.01).Conclusion Pafients with UUT-TCC at distal ureter carry a higher risk for intraeesieal recunerrce after NU than those with TCC at other location of upper urinary tract.     

动脉化疗栓塞对膀胱癌组织中Ki-67表达的影响

目的 探讨术前动脉化疗栓塞对膀胱癌组织中核增殖相关抗原(gi-67)表达的影响.方法 对30例动脉化疗栓塞前后的膀胱癌组织,应用免疫组化方法测定Ki-67的表达,并分析Ki-67与膀胱癌病理分级和临床分期的关系.结果 动脉化疗栓塞前后Ki-67阳性和强阳性表达率分别为70.00%、26.67%,差异有统计学意义(P＜0.01).30例患者平均随访24.6个月,复发率为16.67%.Ki-67阳性表达及动脉化疗栓塞前后降低幅度与膀胱癌的病理分级、临床分期和患者术后复发率关系密切.结论 Ki-67的表达可作为膀胱癌预后评估的指标.     

Primary duodenal signet-ring cell carcinoma presenting as gastric outlet obstruction

Small bowel tumors occur rarely. We present an unusual case of a 68 year old man with gastric outlet obstruction secondary to a non-ampullary primary duodenal signet ring cell carcinoma. A review of the literature of small bowel malignant tumors is presented along with the case.