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1.
三原发性癌1例   总被引:2,自引:0,他引:2  
病案摘要 患者男 ,6 6岁 ,1 992年 5月因间歇性发热、腰痛伴肉眼血尿 ,初诊为右肾癌 ,在我院行右肾根治性切除术 ,术后病理报告为右肾透明细胞癌 ,周围组织未见转移。术后给予化疗及放疗 ,病情稳定 ,定期随访无复发。 1 998年7月因无痛性肉眼血尿在我院行CT及膀胱镜检查 ,诊断为膀胱癌 ,行手术治疗 ,术后病理为膀胱粘膜移行上皮细胞癌 ,用噻替哌行膀胱灌注化疗及生物治疗。 2 0 0 0年 9月复查未见复发。 2 0 0 1年出现咳嗽、咳痰、咯血症状 ,行胸部和头颅CT、全身骨显像、纤维支气管镜检查 ,病理活检报告为低分化腺癌 ,诊断为右肺腺癌 (…  相似文献   

2.
患者,男,33岁.因"尿急,尿频,尿痛伴间歇性血尿1年"入院.患者1年前无明显诱因反复多次出现尿急,尿频和尿痛.疼痛以左侧下腹部为主,呈阵发性钝痛.疼痛发作时伴有间歇性肉眼血尿.自行口服消炎类药物后症状有缓解.入院前1周腹痛和血尿症状加重,查体:左侧下腹部轻度压痛,无肌紧张和反跳痛.尿常规:肉眼血尿.膀胱镜检查因尿道狭窄失败.行盆腔B超:膀胱内不随体位改变的高密度回声影.X线片及盆腔CT检查均示左耻骨外生骨软骨瘤(图1,2).入院诊断:(1)左耻骨外生骨软骨瘤;(2)血尿原因待查.  相似文献   

3.
 病案摘要患者女,67岁,因不规则阴道出血2年,于1979年到武汉某医院行宫颈刮片及活检,诊断为“宫颈鳞状细胞癌”,临床分期为Ⅱb期(FIG0),并行体外放疗及腔内放疗;2001年患者因无痛性血尿1年,到我院行膀胱镜检查,诊断为“膀胱移行上皮癌”,并在我院行膀胱部分切除手术,术后行丝裂霉素膀胱内灌注化疗20次;2003年患者因颈部肿块半年到我院行肿块切除,病理检查为“甲状腺滤泡状癌”,2005年因全身疼痛半年到我院行CT及ECT检查,诊断为“全身多发骨转移”,并行131 I 内放射治疗,治疗后疼痛有所缓解,生存至今。  相似文献   

4.
目的探讨膀胱充盈度对宫颈癌术后放疗靶区照射剂量的影响。方法选择2013年6月至2014年6月间收治的宫颈癌术后需行调强放疗患者30例,在膀胱充盈状态和排空状态行计算机断层扫描(CT)检查,对膀胱不同状态下的临床靶体积(CTV)、计划靶体积(PTV)、膀胱、直肠、小肠及股骨头的体积变化及平均照射剂量进行比较。结果 (1)膀胱处于充盈状态的膀胱体积明显大于处于排空状态的体积,差异有统计学意义(P<0.05);而CTV、CPV、直肠、小肠及股骨头的体积相比较,差异无统计学意义(P>0.05)。(2)膀胱处于充盈状态时对膀胱及小肠的照射剂量明显低于膀胱排空时,差异有统计学意义(P<0.05);而CTV、CPV、直肠及股骨头照射剂量在膀胱处于充盈状态与排空状态时的差异无统计学意义(P>0.05)。结论在膀胱处于充盈状态下,对宫颈癌术后患者进行调强放疗,可明显减少膀胱及小肠的照射剂量,对膀胱及小肠产生一定的保护作用,有一定的临床应用价值。  相似文献   

5.
放疗后宫颈癌根治术中输尿管梗阻的处理   总被引:1,自引:0,他引:1  
目的 探讨经术前放疗后宫颈癌根治术中输尿管梗阻的处理。方法  1978年 5月~ 1996年 6月 ,我院对171例中晚期宫颈癌 (行放疗、手术治疗 171例 )术前放疗后行宫颈癌根治术 ,术中发现输尿管梗阻 3 2例 ,占 18.7% ,双侧 9例、左侧 16例、右侧 7例。手术行子宫广泛切除术加盆腔淋巴结清扫术 ,同时对输尿管的梗阻进行手术处理 ,现对其进行回顾性分析总结。结果 手术 3 1例 ,放弃手术 1例 ,其中松解输尿管与周围组织粘连 2 7例 ,切除压迫输尿管转移淋巴结 2例 ,因癌性浸润输尿管而行部分输尿管切除 ,输尿管端端吻合术及输尿管膀胱吻合术各 1例。术后 2周输尿管引流通畅 ,肾功能明显好转 2 9例。经随访 ,2例患者 1年后因肾功能衰竭死亡 ,5年生存率为 48.3 9%。结论 中晚期宫颈癌放疗后出现输尿管梗阻 ,可考虑手术处理 ,可预防肾功能衰竭 ,能有效的提高患者的生存率  相似文献   

6.
目的探讨原发膀胱ALK阴性间变大细胞淋巴瘤(ALK-ALCL)的临床特点、诊断、治疗和预后.方法回顾性分析1例原发膀胱ALK-ALCL患者临床资料,并进行文献复习.结果该例患者反复肉眼血尿,影像学检查结果提示膀胱多发肿块,膀胱外无明显病灶,后经膀胱肿物活组织病理检查明确诊断为ALK-ALCL.化疗及局部放疗后完全缓解,患者维持无事件生存持续至今.结论原发膀胱ALK-ALCL临床罕见,发病率低,患者病变首发并局限于膀胱,放化疗联合治疗效果显著.  相似文献   

7.
崔悦  王俊杰 《癌症进展》2018,16(5):546-549
宫颈癌是女性常见的妇科肿瘤之一,宫颈癌患者治疗后肿瘤出现复发或未获得局部控制是导致患者死亡的主要原因.复发性宫颈癌的治疗一直是临床上一个具有挑战性的难题,无论是常规放疗、立体定向放射治疗、术中放疗,还是放射性粒子组织间近距离治疗,均被证明是可行、有效且安全的,对于部分患者甚至可以达到根治的目的,具体的治疗方式及预后取决于初始治疗方式、病灶复发形式和病变程度等.对于之前接受过放疗的宫颈癌患者,手术是最佳选择,不能进行手术的患者可以接受姑息化疗;而对于之前从未接受过放疗的患者,应对其进行根治性补救放化疗.此外,还应向宫颈癌患者充分说明不同治疗方案的利弊,在制定治疗策略时充分考虑患者的风险偏好.本文就近几年放射治疗复发性宫颈癌的研究进展作一综述.  相似文献   

8.
脐尿管癌14例临床分析   总被引:2,自引:0,他引:2  
Chen ZF  Wang F  Qin ZK  Dai YP  Zhou FJ  Han H  Liu ZW  Yu SL  Li YH  Ye YL 《癌症》2008,27(9):966-969
背景与目的:脐尿管癌临床少见.本研究旨在探讨脐尿管癌的诊断与治疗方法,以提高其疗效.方法:回顾性分析中山大学肿瘤防治中心及中山大学附属第一医院1994年5月至2007年4月收治的14例脐尿管癌临床资料.结果:本组患者最常见的临床症状为血尿和膀胱刺激症状,膀胱镜检查主要表现为膀胱顶部宽基底肿物,影像学检查征象常见膀胱顶前壁与腹壁之间质软组织肿块影,常浸润膀胱壁.本组病例腺癌13例,恶性间质细胞瘤1例.7例行扩大性膀胱部分切除术患者中,1例术后24个月局部复发,6例随访14~120个月,中位随访42个月无复发:3例行全膀胱切除 尿流改道术,其中2例分别随访16个月和84个月无复发,1例术后3个月死于手术并发症;1例在外院行膀胱部分切除术,术后10个月局部复发;3例晚期未切除者行化疗,2例肿瘤无进展生存7个月和8个月,1例化疗后6个月死于肿瘤.本组病例1年、5年生存率分别为85.7%和61.2%.结论:扩大性膀胱部分切除术是值得推荐的手术方式.首次手术彻底切除肿瘤及对晚期及术后复发转移患者积极的综合治疗,是提高脐尿管癌疗效的关键.  相似文献   

9.
例1 患女,50岁.2年前因患“宫颈癌”在本院行全宫切除术,术后行常规放疗及化疗;4月前患者出现头痛,血压增高,双下肢浮肿,夜尿增多;BUN 31mmol/L,Scr 649μmol/L.拟诊为化疗后肾损害,肾功能不全收入院.入院后B超示双肾盂分离1.4cm,双输尿管轻度扩张;妇科检查:盆腔左后有一个4cm×5cm包块,阴道残端增厚,表面不平,突入阴道内;膀胱镜检查:三角区隆起,双侧输尿管开口处占位性狭窄,未见喷尿,导管不能插入.诊断:(1)宫颈癌术后复发;(2)梗阻性肾病.经血液透析5次后行手术切除盆腔包块及双附件,同时予双输尿管膀胱再植术.术后患者BUN7.9mmol/L,Scr 183umol/L肾功能恢复出院.例2 患男,53岁.2年前因直肠癌行直肠根治术.术后  相似文献   

10.
目的 探讨宫颈癌根治性调强放疗时膀胱直肠体积与其吸收剂量之间的关系。方法 随机选取行根治性调强放疗的50例宫颈癌患者,采集初始放疗计划CT图像前告知患者中等程度充盈膀胱(喝500~800 ml水,30~60 min后采集图像),排空直肠。分析膀胱直肠体积与各自平均吸收剂量及V45之间的关系。结果 膀胱直肠体积变化较大,与其各自平均吸收剂量、V45及D2cm3之间无显著相关性,但膀胱直肠和PTV相交体积与各自体积的比值(Vob/Vb、Vor/Vr)与各自平均剂量和PTV处方剂量的比值(Dmb/Dp、Dmr/Dp)以及V45之间存在显著正相关性,并利用matlab软件拟合出二者之间的相关公式。结论 宫颈癌根治性调强放疗期间患者膀胱与直肠体积变化较大,对于个体化的放疗患者,可根据本研究所拟合出的相关公式对放疗前及分次间膀胱与直肠的平均剂量和V45进行预测,及时分析剂量限制超标的患者相关原因并进行修正。  相似文献   

11.
目的:评估以5-氨基乙酰丙酸(5-aminolevulinic acid, 5-ALA)作为荧光剂的荧光膀胱镜检查对非肌层浸润性膀胱癌的诊断价值。方法:按照筛除纳入标准,纳入97名研究对象,膀胱灌注50 mL浓度为3%的5-ALA溶液,保留1小时后,排空膀胱后置入膀胱镜,分别在普通白光和荧光下观察,对白光和/或荧光下显示阳性或可疑区域取组织做病理活检,同时行电切术。结果:97例患者中,19例患者普通白光膀胱镜及荧光膀胱镜下检查均为阴性,剩余78例患者取156处组织进行活检,平均每例患者取2块组织。结果显示97处病理报告为尿路上皮癌。经计算得出荧光膀胱镜的敏感性为91.75%(89/97),特异性为64.41%(38/59);普通白光膀胱镜的敏感性为71.13%(69/97),特异性55.93%(33/59);P<0.05,差异具有统计学意义。结论:荧光膀胱镜在诊断尿路上皮膀胱癌上的敏感性和特异性均显著高于普通白光膀胱镜,具有较高的临床应用价值。  相似文献   

12.
Objective: To determine the diagnostic performance of hematuria as a screening test for urinary bladderinfiltration in cervical cancer patients with a prospective study design. Materials and Methods: Newly diagnosedcervical cancer patients at Srinagarind hospital from 14 June 2011 to 30 April 2012 were enrolled in this study.We collected midstream urine samples for urinalysis from every patient before routine cystoscopic exam forclinical staging. The presence of 3 or more red blood cells (RBCs) per high power field was defined as positivefor hematuria. A two-by-two table was used to determine the diagnostic performance of hematuria to detecturinary bladder mucosal infiltration using cystoscopy and biopsy as the gold standard. Result: A total of 130 werepatients included, 54 of which (41.5%) had hematuria. Of these, four patients (3.08%) had pathological reportfrom cystoscopic biopsy confirmed metastatic squamous cell carcinoma. The sensitivity, specificity, PPV, NPV,and accuracy of hematuria as a screening test to detect urinary bladder mucosal infiltration of cervical cancerwere 100%, 60.3%, 7.4%, 100%, and 61.5%, respectively. There was no single case of urinary bladder mucosalinfiltration in patients initially staged less than stage III. Conclusions: Hematuria can be used as a screening testto detect urinary bladder mucosal infiltration of cervical cancer. This can reduce the number of cervical cancerpatients who really need to undergo cystoscopy as a staging procedure to less than half and to less than 20% ifstage III or more were included without missing a single case of urinary bladder mucosal infiltration.  相似文献   

13.
目的:评估以盐酸吡柔比星作为荧光剂的荧光膀胱镜检查对非肌层浸润性膀胱癌的诊断价值。方法:本次研究共63例患者,膀胱灌注盐酸吡柔比星溶液40 mg,保留30 min后排空置入膀胱镜,分别在普通白光及荧光下观察,对白光和/或荧光下显示阳性或可疑区域进行活检,同时行电切术。结果:63例患者中,18例患者普通白光膀胱镜及荧光膀胱镜检查均阴性;其余45例患者共取活检92处,平均每例患者取活检2.04处。其中53处病理报告为尿路上皮癌,荧光膀胱镜敏感性为90.57%(48/53),特异性为64.10%(25/39);普通白光膀胱镜敏感性为71.70%(38/53),特异性为56.41%(22/39)。结论:吡柔比星荧光膀胱镜诊断非肌层浸润性膀胱癌的敏感性和特异性均显著高于普通白光膀胱镜,具有较高的临床应用价值。  相似文献   

14.
膀胱偶发肿瘤的的诊断与治疗   总被引:2,自引:0,他引:2  
背景与目的:膀胱偶发肿瘤的国内外报道较少,有必要总结一下膀胱偶发肿瘤的临床特点,以提高膀胱偶发肿瘤的诊治水平。方法:回顾性分析11例膀胱偶发肿瘤的临床资料。常规体检B超发现6例,膀胱镜下置放或拔双J管发现3例,经尿道前列腺电切(TURP)术中发现2例,肿瘤直径0.2~1.5cm。结果:11例均行经尿道膀胱肿瘤电切(TURBT)术,术后病理:乳头状瘤1例,内翻性乳头状瘤2例,乳头状低度恶性倾向的尿路上皮肿瘤3例,低级别的乳头状尿路上皮癌5例。所有膀胱癌患者TURBT术后接受即刻单剂膀胱灌注化疗,术后定期膀胱镜复查。随访半年至10年,复发1例。结论:膀胱偶发肿瘤中膀胱癌多见,但恶性程度低,肿瘤表浅,预后良好,术后复发率低。  相似文献   

15.
Loss of heterozygosity (LOH) and alterations in microsatellite DNA markers have been reported in bladder-cancer tumors. We have studied, in a blinded fashion, using PCR-based microsatellite analysis, genetic alterations of cells exfoliated in urine of 59 Caucasian patients and control patients; 31 with initially confirmed bladder transitional-cell carcinoma (TCC), 17 with signs and symptoms suggestive of bladder cancer, 6 control patients who underwent renal transplantation, and 5 control patients with urolithiasis. Microsatellite analysis of cells exfoliated in the urine allowed the diagnosis of 83% (10/12) of patients with bladder TCC recurrence confirmed by cystoscopy, while 100% of patients followed up for transitional-cell carcinoma of the bladder for up to 12 months without evidence of tumor recurrence upon routine cystoscopy showed no microsatellite alterations. None of the patients without neoplasia (negative controls) had any microsatellite alterations, whereas all patients who underwent renal transplantation had additional new alleles corresponding to contamination with donor's renal and urothelial cells (positive controls). No control patients had any evidence of transitional-cell carcinoma by cystoscopy. Our results provide objective evidence that non-invasive molecular detection of bladder TCC by microsatellite analysis is reproducible with a sensitivity of 83% and a specificity of 100% in Caucasian patients. This non-invasive procedure represents a potential clinical tool for the detection and the screening of bladder TCC. Int. J. Cancer (Pred. Oncol.) 79:629–633, 1998. © 1998 Wiley-Liss, Inc.  相似文献   

16.
The combination of a noninvasive, quantitative immunoassay, NMP22, with voided urinary cytology prior to cystoscopy was evaluated in patients with urothelial transitional cell carcinoma. Fifty-six patients with a history of transitional cell carcinoma were evaluated. Voided urine was obtained for NMP22 and cytology prior to cystoscopy. One hundred and twenty-three NMP22 assays, 124 cytologies, and 124 cystoscopies were performed. The type of anesthesia used for cystoscopic evaluation was determined by the NMP22 value in 30 patients. Cystoscopy results were considered positive on biopsy-confirmed malignancy. The reference value used for NMP22 was 10.0 U/ml. NMP22, cytology, and the combination of NMP22 and cytology were compared to cystoscopy and to pathologic grading and staging. Thirty-four recurrent transitional cell carcinoma episodes occurred; 22 were low-grade (I-II), and 12 were high-grade (III-IV). Twenty-seven were stage Ta; four were T1; and three were T3b or 4. Within this group, NMP22 detected low- and high-grade tumors equally, as compared to cytology, which was sensitive only to high-grade tumors. Nineteen patients were NMP22-negative and underwent cystoscopy under topical anesthesia; 17 were tumor-free. Eleven patients were NMP22-positive and had anesthesia, and all had visible lesions, which were subjected to biopsy and were resected. Six lesions were tumors, five were inflammatory. Overall sensitivity of combined NMP22 and cytology was 70%; specificity was 72%; positive predictive value was 54%; and negative predictive value was 77%. An accurate assessment of the risk of a bladder cancer can be obtained with NMP22, cytology, and cystoscopy in patients with a history of bladder cancer. NMP22 values can be used to determine the level of anesthesia for cystoscopy in patients with a history of bladder cancer.  相似文献   

17.
BACKGROUND: It has been shown that microsatellite analysis (MA) is able to detect bladder carcinoma in urine. Relatively small groups of patients often with high stage and grade disease were investigated. However, greater than 85% of cystoscopies are performed for follow-up of superficial bladder carcinoma. The authors evaluated this DNA-based method in a group of consecutive patients in follow-up after transurethral resection of superficial disease. METHODS: Matched blood and urine samples from 109 patients were obtained before cystoscopy and subjected to MA. The BTA stat test (Bard Diagnostic Sciences, Inc., Redmond, WA) and cytology were used for comparison. RESULTS: Sixteen patients were excluded: the DNA was of insufficient quality for 7 patients and leukocyte abundance rendered the result of MA unreliable for 9 patients. For the remaining 93 patients, MA detected 18 of the 24 recurrent tumors. The six undetected tumors were small pTaG1 lesions for which immediate surgery was not necessary. Conversely, 5 of 9 patients with a positive MA and a negative cystoscopy had a tumor recurrence within 6 months after urine collection. In contrast, a recurrence occurred in only 7 of 60 patients who were negative in both MA and cystoscopy (P = 0.006). The MA (74%) appeared more sensitive than the BTA stat test (56%) or urine cytology (22%). CONCLUSIONS: Microsatellite analysis is a DNA test in urine that reliably signals the presence of recurrent bladder carcinoma, sometimes even before cystoscopic evidence of the disease. This noninvasive diagnostic tool has the potential to replace cystoscopy in many cases. The authors' results warrant the need for randomized trials.  相似文献   

18.
Objective: UroVysion (Abbott Molecular, Inc., Illinois, USA) is based on multicolor fluorescence in situ hybridization(FISH). It has been used successfully in the USA following its Food and Drug Administration approval in 2001. However,the technology was not approved for use in Japan until 2017. Cystoscopy and urine cytology are the most frequentlyused examinations to detect bladder cancer in Japan, and there are only a few reports regarding the performance ofUroVysion. Therefore, the aim of this study is to examine the diagnostic accuracy of UroVysion FISH in Japanesepatients whose tumors are detected by cystoscopy before transurethral resection of bladder tumor (TURBT). Methods:From April 2018 to July 2018, a total of 40 patients who were diagnosed as having bladder tumors by cystoscopy, andtherefore underwent TURBT were registered in this study. One day before TURBT, urine cytology and UroVysionFISH were used in order to compare the accuracy with which they could detect bladder carcinoma, as confirmed bypathological results of TURBT. Results: The pathological results of TURBT showed urothelial carcinoma in 33 cases.Urine cytology showed positive results for 0 cases (0%), suspicious results for 10 cases (30.3%), and negative resultsfor 23 cases (69.7%). On the other hand, UroVysion FISH indicated 9 positive cases (27.3%) and 24 negative cases(72.7%). There were 19 cases of urothelial carcinoma (57.6%) that were not detected by either method. Conclusion:We conclude that UroVysion FISH alone is insufficient to detect bladder cancer and that cystoscopy is essential for theoptimum detection or follow up of bladder cancer cases in our hospital.  相似文献   

19.
BACKGROUND AND OBJECTIVES: It is not uncommon for colorectal carcinomas to invade the urinary bladder. However, the actual incidence of urinary bladder invasion of colorectal carcinomas and the common sites of the original tumors are still unclear. METHODS: The clinical records of 580 patients diagnosed with colorectal carcinoma were retrospectively reviewed. A further review of patients with urinary bladder invasion was performed. RESULTS: Of the 580 patients, 17 (2.9%) had a diagnosis of urinary bladder invasion intraoperatively. The incidence of bladder involvement was significantly higher in carcinomas of the sigmoid and rectum than in carcinomas of other colon segments (4.1 vs. 0.5%, P = 0.017). Although a combination of computed tomography (CT) and cystoscopy predicted 80% of the bladder involvement, preoperative diagnostic modalities could not provide information for the differentiation between macroscopic and pathological invasion or the necessity for total cystectomy. CONCLUSIONS: The sigmoid colon and rectum were common sites of the original tumors invading the urinary bladder compared with other colon segments. CT and cystoscopy are recommended for preoperative screening of the bladder involvement of sigmoid colon and rectal cancer. However, it appeared to be difficult to predict the pathological invasion of malignant cells and the necessity for total cystectomy preoperatively.  相似文献   

20.
BACKGROUND: The objective of the current study was to comparatively analyze the sensitivity and specificity of flow cytometric DNA/cytokeratin 8/18 measurements and the urinary bladder carcinoma antigen (UBC) enzyme linked immunoabsorbent assay (ELISA) test for the detection of bladder carcinoma in voided urine samples. METHODS: Eighty-one fresh urine voided samples, preserved frozen for a maximum period of 3 months, belonging to patients with an active bladder carcinoma (n = 37), patients who were free of disease as confirmed by cystoscopy (n = 19), patients receiving intravesical therapy (n = 17), and individuals with other benign and malignant conditions (n = 8), were collected. Flow cytometry measurements of thawed samples were based on the detection of cytokeratin (CK) 8+ and CK18+ cells using the 3F3 and 6D7 monoclonal antibodies alone or in combination with the measurement of cell DNA contents, after propidium iodide staining. Urinary bladder carcinoma antigen test was measured by ELISA. RESULTS: Patients were grouped according to the presence (n = 44) or absence (n = 29) of bladder carcinoma as confirmed by cystoscopy, and taking cutoffs of 9.7 microg/L for UBC-ELISA, 75% for the percentage of 3F3 (+) and 6D7 (+) cells, and 10.6% for the proportion of hyperdiplod cells that suggested a specificity of 83%, the individual sensitivity obtained for each parameter was 77%, 5%, 9%, and 77%, respectively. The presence of DNA aneuploid populations showed a relatively low sensitivity (36%) although it was the most specific parameter (93%). Combining UBC antigen test with the proportion of cells showing DNA content higher than 2n increased to 89% the sensitivity of the UBC antigen alone. However, false-positive results for both techniques were found in individuals with urologic diseases other than bladder carcinoma and in patients receiving intravesical therapy. CONCLUSIONS: The authors' results suggest that the combined use of the UBC antigen test and DNA/cytokeratin flow cytometry double stainings for the analysis of freshly obtained urine voided samples, cryopreserved to assure cellular integrity, is of great clinical utility for the detection of tumor recurrence in patients with bladder carcinoma.  相似文献   

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