胸内巨大淋巴结增生症的诊断与外科治疗预后分析

目的总结胸内巨大淋巴结增生症(Castleman disease,CD)的临床特点、诊断和外科治疗效果。方法分析1982～2008年收治的16例胸内巨大淋巴结增生症患者,男女各8例,年龄范围19～52岁,中位年龄(35.4±10.0)岁,包括局限型13例,多中心型3例。全组均行手术治疗,其中有2例行术前放疗。分析其临床病理、影像学诊断及外科治疗效果。结果随访6～318个月,所有病例术后均生存,其中13例局限型和2例多中心型术后无复发,1例多中心型患者于术后第4年、第9年各复发一次,均再次行手术治疗。结论胸内巨大淋巴结增生症的诊断主要依靠病理学,胸内巨大淋巴结增生症局限型可行外科手术治愈;部分胸内巨大淋巴结增生症中心型术后应辅助其他综合治疗手段。     

伴骨髓毛细胞增多的Castleman病一例并文献复习

目的　报道 1例伴骨髓毛细胞增多的Castleman病 ,对其临床特征进行探讨并复习文献。方法与结果　贫血伴左下腹包块患者 ,经骨髓常规和电镜检查提示毛细胞白血病。常规干扰素治疗无效 ,切除左下腹包块 ,病检确诊为透明血管型Castleman病。术后随访 12年血象及骨髓象正常。结论　Castleman病临床表现多样化 ,易误诊。该病常伴有成熟浆细胞增多 ,伴典型毛细胞增多者尚未见报道。其确诊主要依靠病理学检查。本病预后良好 ,手术治疗后一般不复发     

肺曲菌球病的诊断与手术治疗(附35例报告)

对手术治疗的35例肺曲菌球病患者的临床资料作回顾分析.本组均无手术死亡.1例因呼吸衰竭术后第13天死亡.34例随访6个月～10 a,平均36个月.失访7例,因其他疾病死亡2例.余25例术后积极治疗肺部基础疾病,肺曲菌球病未复发,患者生活质量良好.     

经肛门微创手术全层切除腹膜返折上直肠肿瘤26例报道

目的探讨经肛门内镜显微手术(TEM)全层切除治疗腹膜返折以上直肠肿瘤的经验。 方法回顾性分析采用TEM全层切除治疗的26例腹膜返折以上直肠肿瘤患者的临床资料。 结果本组手术均顺利完成,其中1例术中联合腹腔镜下创面缝合,无手术相关死亡。手术时间70～150min,住院时间5～7d。术后无肠瘘,术后发生少量便血2例。腹腔感染1例经抗生素治疗痊愈。术后病理显示了与术前临床评估存在差异。26例(其中2例pT2期的患者追加了腹腔镜Dixon术)均获得随访,随访时间6～72个月,随访发现：术后病理证实为pT1期伴淋巴浸润1例患者,术后6个月时出现肿瘤原发部位复发,余均无复发(包括追加根治性手术的两例pT2期病例)。 结论TEM全层切除腹膜返折上方直肠肿瘤是安全的,同时提供了更详尽的病理信息,并更遵守肿瘤根治原则,值得临床推广。     

腹部Castleman病(附16例国内文献复习)

目的探讨腹部Castleman病（CD）的临床和病理特征,旨在提高对该病的诊断、治疗水平.方法检索中国生物医学文献数据库光盘1995-2003,对8篇文献中共16例腹部CD病例进行统计分析.结果局灶性CD（LCD）9例,腹块、腹痛为主要表现,少有或仅有轻度系统症状;病理分型透明血管型4例,混合型3例,浆细胞型2例;局部手术切除预后良好.多中心CD（MCD）7例,腹痛为最常见症状（66.7%）,85.7%有系统症状,易误诊为淋巴瘤和腹腔淋巴结核;病理分型浆细胞型4例,混合型2例,透明血管型1例;广泛手术切除仍易复发.结论腹部CD临床表现缺乏特异性,剖腹探查是明确诊断的主要手段.MCD可予化疗和/或放疗.密切随访可早期发现复发和继发的恶性病变.     

原发性乳腺肉瘤的诊断与治疗

目的探讨原发性乳腺肉瘤的临床特点及诊治方法。方法回顾性分析1999年1月～2009年6月我院收治的26例原发性乳腺肉瘤患者的临床资料。结果 26例均行手术治疗,术后随访6个月～10 a,3例失访,4例死亡,8例复发,3、5、10 a生存率分别为90.5%、84.8%、77.1%。结论原发性乳腺肉瘤的诊断需病理证实,治疗方法以手术为主,辅助化疗及放疗疗效不确切。     

副肿瘤性天疱疮伴发Castleman＇s病和间质性肺炎

目的总结首例伴发Castleman＇s病和间质性肺炎的副肿瘤性天疱疮（PNP）的诊治经验。方法结合患者临床表现和组织病理、免疫病理和影像学检查结果诊断为PNP伴Castleman＇s病和间质性肺炎。用大剂量丙种球蛋白中和抗体,手术切除肿瘤,用大剂量激素冲击疗法治疗间质性肺炎。结果患者临床症状均缓解,随访至今无复发。结论PNP不但与内脏肿瘤相关,也可累及呼吸系统;手术切除、大剂量丙种球蛋白及激素冲击疗法是该病的有效治疗方法。     

神经内镜微创手术治疗脑囊尾蚴病

目的 探讨应用神经内镜微创手术治疗脑囊尾蚴病的手术方法和治疗效果.方法 回顾分析11例行神经内镜微创手术治疗颅内脑囊尾蚴病患者的临床资料,分析总结应用神经内镜微创手术治疗脑囊尾蚴的手术方法和治疗效果.11例患者中有9例脑室内囊尾蚴,1例外侧裂池内脑囊尾蚴,1例脑实质囊尾蚴,其中l例行脑室腹腔分流,1例行三脑室底脚尖池造漏术,1例行立体定向辅助.结果 11例脑囊尾蚴病患者均取得较满意的疗效,无明显并发症.术后随访2～12个月,10例颅内压增高症状明显缓解,3例癫痫患者控制良好,有共济失调症的1例患者症状明显减轻,MRI复查未见囊尾蚴复发.结论 神经内镜微创手术治疗脑囊尾蚴病恢复快,并发症少,有较好的疗效.     

198例肺棘球蚴病的外科治疗效果分析

目的总结肺棘球蚴病的外科治疗经验,选择合适的手术方式避免手术后复发。方法回顾性分析新疆医科大学第一附属医院2000年1月～2010年10月手术治疗的198例肺棘球蚴病患者的临床资料,包括一般情况、病程、流行病学、临床表现、治疗和转归情况等。结果 198例肺棘球蚴病患者中,男性114例,女性84例,年龄2～68岁,平均25.5岁。绝大多数为农牧民(148例,74.7%)和未成年人(43例,21.7%)。手术方法以内囊完整摘除术和内囊穿刺摘除术为主。198例患者无手术死亡,均痊愈或好转出院,术后并发肺部感染9例(4.5%),切口裂开7例(3.5%),切口感染4例(2.0%),均经局部换药延期愈合,术后随访1～10年,随访率为83.3%(165/198),随访期间11例复发,复发率5.6%(11/198)。198例患者共行226次手术,复发病例均经手术治愈。结论内囊摘除术是治疗肺棘球蚴病常用手术方式,手术效果好,术后复发率低。     

自发性气胸术后复发的治疗及再次手术时机的选择

目的探讨自发性气胸术后复发的治疗方法、再次手术时机的选择、适应证及治疗效果。方法回顾分析1994年1月至2005年1月485例自发性气胸手术后患者中28例复发患者的临床资料和随访结果。结果28例中1例留院观察，12例行胸腔闭式引流，15例再次手术治疗。28例患者肺完全膨胀，1例出现胸腔积液，1例术后漏气时间延长。无术后死亡病例。手术时间为80～315（115±43）min，出血量50～350（115±54）ml，停留胸管时间为1～7（4±2）d，住院时间为7～18（11±5）d。成功随访28例，随访时间为1～107个月，中位随访期为（55．4±32．5）个月。随访期内无气胸复发。结论CT薄层扫描是选择治疗方法的主要依据。术后首次复发，特别是术后2年内复发且CT未见肺大疱等病变、粘连不影响肺膨胀者可考虑保守治疗。再次手术的指征：术后复发3次以上；首次复发且有明确肺大疱；首次复发后有效引流仍持续漏气2周以上；局部纤维板形成影响肺膨胀的局限性气胸；粘连带牵拉限制肺膨胀者。既往手术和胸膜处理等虽增加胸腔镜手术的难度，但不影响再次手术的效果。     

Type A dissection following endovascular thoracic aortic stent-graft repair.

PURPOSE: To describe our experience with endovascular stent-graft repairs in the thoracic aorta focusing on the secondary complication of type A dissection. METHODS: Between January 1996 and April 2004, 73 patients were treated for traumatic thoracic aortic rupture (n=15), type B dissection (n=22), or atherosclerotic descending thoracic aortic aneurysms (TAA, n=36). A retrospective review of the records found 5 (6.8%) patients (3 men; median age 64 years, range 43-87) who experienced a type A dissection at a median 20 days (range 2-124) after thoracic stent-graft repair for 3 type B dissections, 1 TAA, and a late type I endoleak that appeared 28 months after initial stent-graft repair of a traumatic dissection. RESULTS: In 3 patients (2 dissections, 1 endoleak), a tear in the aortic wall at the proximal stent-graft was responsible for a retrograde type A dissection. Underlying disease was the cause of the type A dissection in the 2 other patients (1 dissection, 1 TAA) and was unrelated to the stent-grafts. Three patients underwent open surgery at 3, 26, and 124 days after stent-graft placement; 2 procedures were successful, but the third patient died 3 months later due to multiorgan failure. Two type A dissections were untreated: one patient died from cardiac tamponade 14 days after successful stent-graft exclusion of the type I endoleak; the other patient refused further treatment and survived. The procedure-related mortality following acute retrograde type A dissection was 40%. CONCLUSIONS: Endovascular stent-graft repair of the thoracic aorta is associated with lower morbidity and mortality rates than surgical repair, although potentially lethal complications, acute or delayed, may occur.     

胸部受累的巨淋巴结增生症10例临床分析

目的 提高对少见胸部受累的巨淋巴结增生症的认识,减少误诊,延长患者的生存期.方法 2000年1月至2006年5月对10例胸部受累的巨淋巴结增生症患者的临床表现、影像学、病理学、鉴别诊断、治疗及预后进行研究.结果 10例胸部受累的巨淋巴结增生症患者均为女性,其中5例多中心型患者的年龄为29～49岁,临床表现多样,外周淋巴结多处肿大伴多系统损害,影像学表现为间质性肺炎和纵隔淋巴结肿大,病理分型均为浆细胞型,给予糖皮质激素或化疗后4例部分缓解,1例死于心肺衰竭.5例局灶型患者的年龄为13～49岁,均无症状体征,实验室检查无异常,病灶均位于右侧纵隔,直径6～9 cm,病灶呈均匀显著强化,病理分型均为透明血管型,经手术切除肿块,5例随访均存活.结论 胸部受累的巨淋巴结增生症易误诊,有多发淋巴结肿大或局灶巨大淋巴结者应警惕该病的发生.诊断的关键在于早期多次、多部位淋巴结病理检查,与血管同步显著强化的影像学表现具有诊断价值.     

Presentation and Outcome of Castleman’s Disease in Immunocompetent Hosts

Castleman’s disease (CD) is a heterogeneous lymphoproliferative disorder of unknown aetiology. Mostly, this disorder is seen in immunocompromised hosts. It is known to be associated with systemic disorders like HIV, HHV-8, lymphoma, and Kaposi sarcoma. As of today, the clinical behaviour and outcome of CD in immunocompetent host remains suboptimally studied. We analyzed consecutively treated cases of CD presented to our centre in last 12 years. Case record files were studied for patient’s characteristics, clinical presentation, baseline laboratory and pathologic parameters, therapy and outcome. This study describes presentation and treatment outcome of CD in immunocompetent patients. Total 16 patients of CD were treated during the study period. The median age of patients at the time of presentation was 40.5 years (range 13–72 years). An equal number of patients (8 each) had unicentric and multicentric CD. Sixty-three percent patients had hyaline vascular subtype while 37 % patients had plasma cell or mixed variant. Majority of the patients had good performance status (ECOG PS 0, 1 in 10 (62.5 %) patients; PS2-4 in 6 (37.5 %) patients). The median duration of symptoms was 6 months (range 2–36 months). None of the patients in our study had associated HIV infection. Six patients presented with fever, out of which four had plasma cell variant of CD and three of them had multicentric involvement. In comparison to unicentric CD, patients with multicentric CD had lower albumin levels (4.15 vs. 3.38 g/dl, p = 0.006), haemoglobin levels (11.3 vs. 9.8, p = 0.06), and lower complete remission rates (62.5 % vs. none). Patients were treated according to the stage and clinical status with surgery, chemotherapy or combination of both modalities. Surgery was the predominant treatment for unicentric CD while multicentric CD was treated with various chemotherapy regimens. Eight patients were treated with chemotherapy (CHOP-based regimen-5, melphalan-prednisolone thalidomide-1, chlorambucil-prednisolone-1, and only corticosteroids-1). In the entire study group, ORR was 72 % (CR 36 %, PR 36 %), one patient died of progressive disease during chemotherapy. Two patients lost to follow-up before assessment of treatment response. Five-year overall survival was 100 and 87 % for unicentric and multicentric CD respectively. Castleman’s disease is a rare lymphoproliferative disorder amongst Indian patients. It more commonly presents as hyaline vascular variant and affects middle-aged individuals. The most remarkable fact in our analysis was a lack of HIV positivity in any of the patient that is in contrast to the majority of the published literature. With multimodality therapy, high response rates and long-term survival were noted in the entire study group.     

Original article: Surgical management for small cell carcinoma of the esophagus

Esophageal small cell carcinoma (SmCC) has been regarded as a rare and aggressive tumor with early metastasis. The optimal treatment has not yet been established, and the role of surgery has remained controversial. In this retrospective study, we report seven cases studies of SmCC of the esophagus and analyze the clinical outcomes after surgery. Between 1986 and 2007, there were seven patients with esophageal SmCC treated surgically in our institution. All the patients with clinically limited disease underwent transthoracic esophagectomy with lymphadenectomy. Lymph node involvement was found in all cases irrespective of the depth of tumor invasion. Three of the seven patients were diagnosed as having an extensive disease on pathological examination after esophagectomy. Five patients received postoperative chemotherapy. Two patients are alive with no recurrence at 16 months and at 45 months after surgery. Another one without chemotherapy survived 93 months and died of another disease. The remaining four patients died of recurrent disease or another disease. The median overall survival to date of these patients was 16 months (range 12–93 months). Esophagectomy with lymphadenectomy resulted in a relatively better survival in some patients with esophageal SmCC. We concluded that surgery may be helpful as part of multimodality treatment in selected patients with esophageal SmCC.     

Distant failure after treatment of postoperative locoregional recurrence of non-small cell lung cancer

BACKGROUND: The standard treatment for patients with locoregional recurrence of non-small cell lung cancer (NSCLC) after complete resection has not been established. The aim of this study was to evaluate clinicopathologic characteristics, type of locoregional recurrence, pattern of subsequent failure, and survival after the recurrence. METHODS: Of 743 patients undergoing pulmonary resection for NSCLC in the National Cancer Center Hospital between 1990 and 1995, we retrospectively reviewed the medical charts of the 43 patients (5.8 %) found to have locoregional recurrence without distant metastasis or pleural or pericardial involvement. RESULTS: The median time to locoregional recurrence was 13.6 months (range: 1.6 - 85.8 months). The most frequent site of recurrence was the mediastinal nodes in 21 of 43 patients (49 %). 33 patients (77 %) received further treatment for the recurrence: thoracic irradiation in 26, surgery in two, systemic chemotherapy in two, and a combination of the above in 3 patients. Subsequent distant failure was detected in 26 (68 %) of the 38 patients assessable for the analysis of failure pattern: lung in 11, brain in 6, bone in 5, and others in 13. The median interval from the recurrence to distant failure was 8.4 months (range: 1.7-56.4 months). The median survival time after diagnosis of the locoregional recurrence was 10.5 months (range: 0-74.0 months). A multivariate analysis showed that local therapy for the locoregional recurrence had no significant impact on postrecurrent survival or distant failure-free survival. CONCLUSIONS: Many patients with postoperative locoregional recurrence developed distant metastases early after the first recurrence. Systemic chemotherapy in addition to local therapy may be of benefit in this population.     

Reactive lymphoid hyperplasia – A case of castlemans disease reviewed

Reactive lymphoid hyperplasia is a common pathological finding from lung biopsy. It is frequently the original pathologic interpretation from FNA or core biopsies of lesions that are ultimately determined to be non-neoplastic pulmonary lymphoid disorders. One of these disorders is Castleman's Disease. We present a case of a 35-year-old male who underwent multiple procedures to diagnose a posterior mediastinal mass. This was eventually diagnosed as Castleman's Disease. We review the pathology of reactive lymph node hyperplasia and the spectrum of non-neoplastic pulmonary lymphoid disorders. We also review the Unicentric hyaline vascular variant form of Castleman's disease.     

2 -Chloro-deoxyadenosine therapy for giant lymph node hyperplasia

Summary. Giant lymph node hyperplasia (GLNH) or Castle- man disease is a heterogenous group of atypical lympho- proliferative disorders. Two main histologic variants, the hyaline vascular variant and the plasma cell variant, have been recognized. Although localized GLNH can often be managed successfully with surgery, optimal therapy for multifocal disease has yet to be identified. We report two cases of GLNH treated with 2-chloro-deoxyadenosine (2- CDA), a synthetic purine analogue. 2-CDA was utilized based on its relative lymphocytic toxicity and the putative pathophysiologic process in GLNH being either hamarto- matous overgrowth (hyaline-vascular variant) or immune dysfunction and lymphoproliferation (plasma cell variant). One patient with unresectable localid hyaline-vascular GLNH has had a 9-month continuous complete remission following two courses of 2-CDA therapy followed by radiation therapy. The second patient with disseminated plasma cell type had a partial response to two cycles of 2- CDA therapy; however, further cycles were not given due to development of possible early neurotoxicity. Although the optimal management of non-resectable GLNH is yet to be determined, 2-CDA appears to be a viable therapeutic option for patients with this disease process.     

Small cell carcinoma of the esophagus: a multicentre Rare Cancer Network study

Small cell carcinoma of the esophagus (SCCE) is a rare and aggressive malignant tumor with a poor prognosis. The aims of this retrospective study were to analyze the epidemiology, clinical characteristics, and treatment outcomes of these patients. Between 1994 and 2004, 24 patients with SCCE from several centers were reviewed for data on demographics, presenting symptoms, diagnosis, disease stage, type of treatment, and outcome. SCCE occurs in the sixth decade: median age (interquartile range [IQR]): 65 (59–69) years with a male predominance (63%). The most common complaining symptoms were rapidly progressive dysphagia (79%), weight loss (54%), and retrosternal/epigastric pain (46%). The tumor arises primarily in the middle (52%) or in the lower (35%) third of the esophagus. History of tobacco and alcohol exposure was present in 90% and 70% of case, respectively. Extensive disease was present in 13 cases (54%) at initial diagnosis. The overall median survival (IQR) was 11 (8–20) months for all 24 patients, and the 2‐year overall survival was 25.1%. Four patients were alive more than 2 years after treatment. Chemotherapy increased the survival compared with symptomatic management in extensive disease (median survival [IQR]: 9.5 [6–14] vs. 6 [4–7] months, P= 0.05). In limited disease, concurrent chemo‐radiotherapy was more effective than non‐concurrent treatment (median survival [IQR]: 36 [14–93] vs. 11 [9–15] months, P= 0.04). Two patients were treated by surgery and chemoradiation therapy with a survival of 35 and 66 months. Chemotherapy is the cornerstone of treatment of SCCE in all stage. For limited disease SCCE, concurrent chemo‐radiotherapy is the primary choice compared with sequential approach. The role of surgery was not assessable in our study.     

Primary gastric non-Hodgkin's lymphoma: a clinicopathological study of 41 patients

Pathological findings in 41 patients (male/female ratio: 1.3/1) with primary localized gastric non-Hodgkin's lymphoma (NHL) were retrospectively studied and correlated with survival. The median observation period after diagnosis was 32 (0–189) months. Nineteen patients were low-grade NHL, all but one B-cell lymphomas of the mucosa-associated lymphoid tissue (MALT) type. Twenty-two patients had primary (n-7) or secondary (n=15) high-grade lymphomas; Musshoff stage IE was found in 29 and II E in 12 cases. The median age at diagnosis was 61 years (range, 26–88 years), and proliferation, measured by the number of mitosis and Ki-67 antigen positivity (MIB-1), was high or moderately high in 24 cases and low in 17 cases. Follicular lymphatic hyperplasia could be found in 25 of 34 evaluable cases, more often in low-grade than in high-grade NHL. Most of the patients were treated by resective surgery and additional ratio- or chemotherapy. Thirteen patients (31%) died (median survival: 10 months), 5 of them within 3 months after surgery owing to postoperative complications. Survival was superior, though not statistically significant, in low-grade lymphomas. Our retrospective anlysis of heterogeneously treated gastric lymphomas reveals that gastric lymphomas, especially of the low-grade MALT type, often remain a localized disease with a good long-term prognosis. Our study confirms previous reports indicating that lymphomas of the MALT type represent a specific clinicopathological entity.     

氩等离子体凝固联合冷冻治疗恶性气道梗阻的临床分析

目的：探讨经支气管镜介入氩等离子体凝固(APC)联合冷冻治疗中央型肺癌导致的恶性气道梗阻的临床意义及对肿瘤血管的抑制作用。方法对2005年1月至2015年1月我科收治的400例发生气道梗阻的肺癌患者,根据自愿原则分为治疗组(在全身化疗基础上联合支气管镜下 APC及冷冻介入治疗)和对照组(只接受化学治疗),对上述不同治疗方案的患者均在治疗后进行长期随访,分析2组患者的中位生存期,并对接受支气管镜下 APC联合冷冻治疗的患者在治疗前后进行组织病理学分析和CD31免疫组化染色,了解肿瘤细胞凋亡情况及肿瘤微血管破坏情况。结果治疗组的中位生存期为14个月,而对照组的中位生存期为10个月,差异有统计学意义(t =0.032,P <0.05)。经支气管镜下 APC及冷冻治疗后肿瘤细胞凋亡明显,肿瘤微血管密度为18.31±4.42,治疗前为26.42±6.13,差异有统计学意义(t=0.601,P<0.01)。结论在全身化疗基础上使用支气管镜下APC联合冷冻治疗中央型肺癌不但能够迅速减除梗阻症状,促进肿瘤细胞凋亡,而且能够破坏肿瘤血管,阻断肿瘤营养供应,从而抑制肿瘤生长,延长患者生存期。