乳腺paget病的诊治:附33例分析

目的：通过探讨有关乳腺Paget病的临床特点、预后因素和手术处理原则,提高外科医生对乳腺Paget病的认识。方法：回顾性分析我院1975年至2002年收治的33例乳腺Paget患者的临床资料。结果：33例患者平均年龄57岁,29例行改良根治术,4例行单纯乳腺切除。23例患者（69.7％）合并有乳腺癌。26例（78.8％）主要表现为乳头乳晕区湿疹样改变,其中单纯乳腺paget病10例,导管内癌8例,浸润性导管癌8例（1例有腋窝淋巴结转移）;另外7例合并乳腺肿块（21.2％）的患者中,无1例为单纯乳腺paget病,1例为导管内癌,6例为浸润性导管癌（4例有腋窝淋巴结转移）。结论：大多数乳腺Paget病伴有导管内癌或浸润性导管癌,有乳腺肿块的患者合并浸润性导管癌的可能性更大,预后更差,治疗应更为积极。     

双侧原发性乳腺癌16例临床病理分析

目的 探讨双侧原发性乳腺癌的临床病理特征及其防治.方法 回顾性分析2001年1月至2009年12月江苏省肿瘤医院收治的确诊为双侧原发性乳腺癌16例的临床病理资料.结果 16例均为女性,占同期收治乳腺癌的0.47%,发病年龄41～69岁,中位年龄53岁.同时性双侧乳腺癌7例,发病年龄41～54岁,中位年龄47岁,5例为绝经前患者.异时性双侧乳腺癌9例,第2癌的发病年龄43～69岁,中位年龄58岁,1例为绝经前患者.异时性双侧乳腺癌第1癌与第2癌间隔14个月至196个月不等,中位间隔时间52个月.结论 同时性双侧原发性乳腺癌较异时性双侧乳腺癌发病年龄早,多见于绝经前.异时性双侧乳腺癌发生间隔时间不定,一侧发生乳腺癌后宜积极随访对侧乳腺,对雌激素受体阳性的患者应坚持内分泌治疗.     

膀胱憩室癌13例

目的 探讨膀胱憩室癌的临床特征和诊疗方法,以期提高其诊疗水平.方法 膀胱憩室癌患者13例,男11例,女2例;年龄59～86岁,平均年龄为(69.2±4.1)岁.13例患者均行膀胱B超、静脉尿路造影(IVU)、CT和膀胱镜检查,CT检查均发现膀胱憩室和憩室腔内软组织块.均行手术治疗,2例憩室内巨大肿瘤行根治性膀胱全切回肠膀胱术;膀胱部分切除术4例,其中1例行右侧输尿管膀胱移植术;切除膀胱憩室7例.术后,腺癌者仅予化疗.混合性癌者辅以放疗加化疗.结果 术后随访8～72个月,平均随访时间为(22.2±3.1)个月.4例移行细胞癌患者于术后6～10个月局部复发,行根治性膀胱切除加回肠膀胱术,术后1例死于肿瘤转移;另4例移行细胞癌患者随访6年无瘤存在.1例鳞癌患者术后18个月死于多脏器转移.1例腺癌患者术后13个月死于急性心肌梗死;另2例腺癌患者随访6年无瘤存在.1例混合性癌患者术后10个月无瘤存活.结论 CT和膀胱镜检查是确诊膀胱憩室癌的重要方法,膀胱憩窜癌的数目及大小、部位和形态诊断主要依靠膀胱镜和影像学检查.治疗应采取外科手术,对癌症广泛转移者应以根治性切除为主.     

Management of differentiated thyroid carcinoma

The study was done to determine the clinical, radiological and histopathological characteristics along with the management outcome of differentiated thyroid carcinoma. This Retrospective study included sixty patients with differentiated thyroid carcinoma presented to Department of Otolaryngology and Head-Neck Surgery at Dhaka Medical College Hospital and Apollo Hospitals Dhaka from June 2006 to December 2008. The data of each patient included age, sex, presenting symptoms and signs, provisional diagnosis, preoperative investigations, operation notes, histopathological examination and state at follow up. This study included 28 males and 32 females. The mean age was 42.7 years. Maximum patients presented at 4th decade. The commonest presentation was thyroid swelling followed by lateral neck swelling. Detailed clinical assessment before operative treatment has been done for all patients. Fifty five patients (91.66%) presented with single nodule. Distant metastasis was found in 2 cases. All patients underwent fine needle aspiration cytology which was conclusive in 38 patients (63.33%). All the sixty patients underwent surgical excision; either total thyroidectomy or completion thyroidectomy. Neck dissection was performed in 8 patients. All patients received postoperative radio-iodine. Fifty one cases were papillary carcinoma and 9 cases were follicular carcinoma. Except for one case with local recurrence the remaining cases were disease free on follow up (up to 10-40 months). One patient died with bone metastasis 2 years after operation. Of all thyroid cancers, majority cases are papillary cancer (85%). In contrast to other cancers, thyroid cancer is almost always curable. Most thyroid cancers grow slowly and are associated with a very favorable prognosis. Early diagnosis and treatment of the same is strongly advisable.     

隐匿性乳腺癌的诊治分析(附14例报告)

目的探讨隐匿性乳腺癌的诊断、治疗方法.方法回顾性分析1995年1月～2004年6月该科收治的14例隐匿性乳腺癌的诊断和治疗经过及随访结果.结果所有病例均为女性,占同期乳癌的0.86%,14例患者均行乳腺钼靶摄片,异常者6例,双乳B超,3例考虑乳癌.13例行改良根治术,1例保乳根治术.随访至今,2例死亡,12例生存,其中1例带瘤生存,最长1例存活5 a.结论临床对女性腋窝肿块应高度警惕隐性乳癌可能,提高认识,影像学检查及连续切片、免疫组化有助于乳腺原发灶检出.治疗予改良根治术或结合病情及自身愿望保留乳房手术综合化放疗.     

乳腺叶状肿瘤的诊断和治疗

目的探讨乳腺叶状肿瘤的临床病理特点、治疗原则,选择合理治疗方案。方法回顾性分析1997年3月至2006年6月收治的21例乳腺叶状肿瘤患者的临床资料,包括诊断年龄,临床症状,肿瘤大体及组织学特征,手术方式,术后放射及化学治疗,复发率,死亡率,比较良性、恶性、交界性肿瘤的不同。结果23例患者平均年龄38岁,按WHO分类标准,其中良性11例,交界性4例,恶性8例。14例行局部切除术,5例行乳腺单纯切除术,4例按乳腺癌改良根治术术式。随访18例,平均随访时间22个月(12～96个月),2例按乳腺癌改良根治术术后1年死于远处转移,4例行局部切除术后复发再次按乳腺癌改良根治术手术。结论保证1～2cm切缘的扩大局部切除术是治疗乳腺分叶状肿瘤的首选方案,局部复发的交界性和恶性肿瘤要选择乳房单纯切除术式或按乳腺癌改良根治术。     

Which patients are cured of breast cancer?

The clinical and pathological features of 51 patients who survived for more than 20 years after diagnosis of cancer of the breast were compared with those of 176 contemporaries who died within 20 years after diagnosis. Of those who survived, 18 (35%) had had pathologically affected axillary nodes compared with at least 86 (49%) of those who died. Also, 11 (21%) of the survivors had had small tumours compared with 10 (6%) of those who died. Pathological review of tumours in the survivors showed 40 (78%) to have been infiltrating ductal carcinomas, of which 13 (32%) were grade 3 lesions. These differences between the two groups were largely due to the prognostic value of these variables in the first five years after diagnosis. After a patient had survived five years the major prognostic variables were of little value in the prediction of which patients would be cured of breast cancer. Advanced age, which was of little prognostic value in the first five years after diagnosis, was of significant prognostic value in the longer term, partly due to the steep age gradient for mortality from other diseases. Nevertheless, seven of 19 deaths more than 20 years after first treatment were due to breast cancer. Late deaths from breast cancer may, however, have often been the result of metastases from second primaries rather than the late manifestation of micrometastases from the original primary carcinoma. Age, menstrual state, clinical stage, and axillary nodes being affected are thus of some prognostic value in cancer of the breast, but the present inadequacy of knowledge of the behaviour of the disease makes accurate prediction of which patients will be cured impossible.     

19例乳腺原位癌诊治及免疫组化分析

目的：探讨乳腺原位癌的诊断和治疗，分析其免疫组化特点。方法：回顾性分析我院2003年7月-2006年7月间诊治的19例乳腺原位癌的临床诊断及治疗，用免疫组化方法测定各抗体的表达率并进行分析。结果：19例乳腺原位癌占同期乳腺癌病例的6．6％，平均就诊时间12．4个月。其中18例乳腺原位癌的雌激素受体（ER）、孕激素受体（PR）、p53基因和人类表皮生长因子受体2（c-erbB-2）阳性表达率分别为66．7％、77．8％、38．9％、27．8％。结论：p53、c—erBb-2以及ER、PR表达状况有助于判断乳腺原位癌预后和选择适宜的治疗方案。乳腺原位癌手术预后较好，保乳术成为术式的选择之一。     

血清hsa-miR-486-5p在乳腺癌早期诊断中的价值

目的 探讨与乳腺癌早期诊断密切相关的血清microRNA(miRNA)的临床价值。方法 对乳腺癌发生发展4个阶段（正常-非典型增生-原位癌-浸润性癌）的组织进行miRNA高通量测序,以得到与疾病进展密切相关的目标miRNA,进而利用RT-qPCR技术分析目标miRNA在4个阶段血清中的表达情况。结果 hsa-miR-486-5P在乳腺癌发生发展4个阶段的组织和血清中均随疾病进展呈下调状态,在早期乳腺癌患者血清中呈明显低表达,与乳腺癌分子分型无关（P>0.05）。早期乳腺癌组低表达的血清hsa-miR-486-5p与正常对照组相比呈显著差异性（P<0.01）;ROC曲线分析结果显示ROC曲线下面积（AUC值）为81.2%（95%CI： 0.707～0.917）,灵敏度和特异度分别为62.5%和90.3%。结论 血清hsa-miR-486-5p可以作为诊断早期乳腺癌的生物标志物,具有较高的临床应用价值。     

Pericardiocentesis for symptomatic malignant pericardial effusion: a study of 36 patients.

We reviewed 36 cases of symptomatic malignant pericardial effusion managed with pericardiocentesis at our institution from 1982 to 1989. There were 13 men and 23 women, aged 49 +/- 12 years (range, 33-76 years). The commonest underlying tumours were lung cancer (12 cases, 33%) and breast cancer (11 cases, 30%). Pericardiocentesis was successful as the initial management in 34 of 36 patients (94%); one patient died as a result of the procedure and another required subxiphoid incision and tube drainage of the effusion. When intrapericardial sclerotherapy was performed, only three of 28 patients required repeat pericardiocentesis, and when sclerotherapy was not performed initially, four of seven patients had recurrent symptomatic effusions. Median survival following pericardiocentesis in breast cancer patients was 10 months (range, 0-36 months) and in all other malignancies was four months (range, 0-12 months). We conclude that pericardiocentesis with intrapericardial sclerotherapy provides good local control for symptomatic malignant pericardial effusion in the majority of patients. In spite of this, the median survival of such patients is poor, especially in patients with malignancies other than breast cancer, with few patients surviving more than a few months.     

单中心16年青年膀胱尿路上皮癌患者的诊治

目的：研究40岁及以下青年膀胱尿路上皮癌患者的临床表现、临床分期、病理分级、治疗及预后等情况。方法：选择 2001年1月至2016年12月北京大学第三医院泌尿外科收治的43例40岁及以下的膀胱癌患者临床资料进行回顾性分析。结果：本组病例占同期科室收治的膀胱癌患者的2.2%,男性35例,女性8例,平均年龄33岁（23~40岁）。初诊时以无痛性肉眼血尿为主要症状者27例（62.8%）, 体检发现异常者9例（20.9%）,以膀胱刺激症状或排尿异常起病者7例（16.3%）。肿瘤单发者34例（79.1%）,多发者9例（20.9%）,且多发者均在31~40岁亚组。根据患者临床分期采用相应的手术方式治疗。 术后病理分级：低级别乳头状尿路上皮癌29例（67.4%）,高级别乳头状尿路上皮癌14例（32.6%）。Ta期31例（72.1%）,T1期7例（16.3%）, T3期1例（2.3%）, T4期3例（7.0%）,T1期合并Tis 1例（2.3%）。术后3例失访,另40例随访5~165个月,随访患者中有5例复发,复发率12.5%（5/40）, 平均复发时间39个月（3~105个月）, 2例患者进展,进展率5%（2/40）。多发患者组复发率33%（3/9）,单发患者组复发率5.9%（2/34）,两组差异具有统计学意义（P=0.000 3）。结论：青年膀胱癌的发病比例呈增长趋势, 无痛性肉眼血尿是青年膀胱癌的主要临床表现,但青年患者的下尿路刺激症状同样需警惕肿瘤的发生,术后的复发情况可能与多发病变有关。     

立体定位法对乳腺微小病灶的治疗意义

目的介绍钼靶片引导下立体穿刺定位,美蓝标记加小手术活检方法。方法153例乳腺微小病变患者接受术前钼靶片引导下立体穿刺定位,美蓝标记加手术活检。其中93例微小钙化,60例可疑肿块和局部结构紊乱。将标本进行钼靶摄片,确认病灶取下。如病理结果为良性病灶,则随访。如为恶性病灶,则作进一步处理。结果153例中,恶性病灶113例(73．9％),其中浸润性导管癌和小叶癌62例(40．5％),原位癌23例(15％),粉刺样癌21例(13．7％),筛状癌4例(2．7％),粉刺样癌21例(13．7％),筛状癌4例(2．7％),微小乳头状癌3例(2％);良性病灶40例(26．1％),其中13例是非典型导管增生。112例(73．2％)手术完全切除,切缘阴性。结论钼靶片引导下立体穿刺定位,美蓝标记乳腺可疑病灶和微小钙化加手术活检方法是一种有效而安全的方法。对于无肿块型可疑病灶,该方法可作为常规检查。     

乳腺恶性肿瘤的病理类型和年龄分布比较分析

目的:探讨乳腺恶性肿瘤的病理类型及年龄分布,不同病理类型的乳腺癌在发病年龄上的差异.方法:统计分析温州医学院附属第一医院2006年1月至2011年12月乳腺恶性肿瘤1512例,按WHO乳腺肿瘤组织学分类(2003)进行病理分类.按年龄进行分组,30 ～ 69岁以10岁为一个年龄组,＜30岁和＞70岁分别为一个年龄组.将病理分类前5位乳腺癌的高发年龄及年龄分布进行比较分析.结果:确诊的乳腺恶性肿瘤病理类型共14种,以浸润性导管癌居首位,占总病例数的71.1％,其次为导管原位癌、浸润性小叶癌、黏液癌及髓样癌.高发病年龄段在40 ～59岁(占65.0％),以40～ 49岁(占35.8％)为最高发病年龄段.浸润性导管癌(占36.1％)、浸润性小叶癌(占39.3％)、黏液癌(占35.4％)均以40～ 49岁为发病高峰期;导管原位癌以40～49岁(占35.3％)和50～59岁(占35.3％)为发病高峰期;髓样癌以50～59岁(占37.0％)为发病高峰期.浸润性小叶癌、黏液癌发病年龄与浸润性导管癌发病年龄比较差异均无统计学意义,导管原位癌、髓样癌发病年龄与浸润性导管癌发病年龄比较差异均有统计学意义.结论:乳腺恶性肿瘤高发病年龄段在40 ～ 59岁,以40～ 49岁为最高发病年龄段.不同类型的乳腺癌在发病年龄高峰上存在差异.     

Basal-link乳腺癌12例治疗体会

目的 分析研究Basal-link乳腺癌的临床特点.方法 回顾性分析12例Basal-link乳腺癌病人的临床资料,对12例患者的年龄、病史、手术方法、术后治疗以及预后进行分析.结果 Basal-link乳腺癌中位年龄32岁,有3例1年半内死亡（占12例的25%）;9例出现转移或复发（占12例的75%）,在术后1～2年间.结论 Basal-link乳腺癌是复发转移快,死亡率高,治疗手段有限的恶性肿瘤.     

Conservative surgery and radiation therapy for intraductal carcinoma of the breast.

Nineteen women with intraductal carcinoma of the breast were treated with conservative surgery and radiotherapy from 1982 to 1990. All underwent excisional biopsy or wide local excision of the primary tumor. Definitive irradiation consisted of 4500 cGy in 180 cGy fractions given through tangential fields followed by a breast boost to the primary site to a total dose of 5900-6500 cGy. No patient received regional node irradiation. Median follow-up was 38 months. The five year actuarial rate of local failure was 9%. One patient failed with an infiltrating ductal carcinoma in the treated breast 31 months after initial treatment. Salvage mastectomy was performed. She remains without evidence of disease 43 months after initial treatment. Metastatic breast carcinoma has not developed in any of the patients. Cosmetic result was good to excellent in all patients. With short-term follow-up, conservative surgery and radiotherapy appear to be an acceptable alternative to mastectomy in carefully selected patients with ductal carcinoma in situ. As retrospective and randomized trials mature, the natural history of these lesions treated with conservative surgery and irradiation will be further defined.     

Invasive ductal carcinoma in a young male breast

Carcinoma arising in the male breast is a rare occurrence. The risk of male breast cancer increases with age, and the median age of diagnosis for men is 10 years later than that for females (67 to 71 years). Because of the absence of lobules in the normal male breast, lobular carcinoma cases are seen infrequently. All of the microscopic types identified in the female breast have been encountered in male but the most frequent is invasive ductal carcinoma and less frequent is invasive lobular carcinoma. We present the case of a 20 years old man presenting with a left breast lump. After left mastectomy with level 2 axillary clearance, histopathological examination revealed infiltrating ductal carcinoma. Our case represents ductal carcinoma in a proven genotypic young male patient showing no exogenous or endogenous estrogens exposure.     

3.0T磁共振成像对乳腺癌的诊断价值与病理学对照研究

目的结合病理结果探讨磁共振成像(MRI)对乳腺癌术前诊断的临床应用价值。方法回顾术前已行MRI检查并经外科手术治疗,术后经病理证实的乳腺癌患者63例及病理为良性病变的患者74例,分析对比其术前MRI检查资料。结果 MRI对乳腺癌的灵敏度为93.51%,特异度为90.32%,准确度为91.76%。其中对浸润性导管癌的敏感度较高(96.49%),对导管内原位癌的灵敏度较低(81.82%)。结论 MRI对乳腺癌的诊断有较高的敏感性及特异性,特别是针对浸润性导管癌,MRI可有效地提高乳腺癌的早期诊断率,降低漏诊和误诊率,对乳腺癌的筛查和临床诊治有重要意义。     

甲状腺转移癌临床诊治分析

目的探讨甲状腺转移癌的临床发病特点、诊断、治疗及预后分析。方法回顾性分析83例甲状腺转移癌病例。结果83例患者中,男性39例,女性39例,性别不明5例;年龄16-78岁,中位年龄52岁;原发癌依次为食管癌31例、肺癌12例、喉咽部癌8例、肾透明细胞癌7例、直肠癌6例、黑色素瘤6例、乳腺癌3例、肌肉瘤3例、胃癌2例、肝癌、宫颈癌、非嗜铬性副神经节瘤、卵巢癌、唇鳞癌各1例。64例经过治疗（手术或放疗或化疗）,原发癌转移至甲状腺时间间隔为1个月至26年,中位时间2．5年;79例以发现颈部肿物入院;80例行甲状腺转移癌切除术或放疗、化疗;83例中,生存期1个月至12年,中位生存期32个月。死亡原因为重要脏器的广泛癌转移。结论甲状腺转移癌临床不常见,对既往有恶性肿瘤史近期发现甲状腺包块的患者应考虑转移癌可能,治疗以手术切除为主,辅以放疗、化疗可延长生存期。     

男性乳腺癌6例临床分析

目的 探讨男性乳腺癌的临床特点、诊断、治疗及影响预后的因素.方法 回顾分析1996年至2009年收治的6例男性乳腺癌的临床资料.结果 1例行乳腺癌根治术,5例行改良根治术.I期患者2例,预后较好;Ⅱ期3例,Ⅲ期1例,预后差.6例患者中浸润性导管癌5例(83.3%),黏液腺癌1例.5例接受激素受体检测,4例(80%)ER...     

肾集合管癌的临床分析

目的：探讨肾集合管癌的临床特征、诊疗及预后.方法：回顾性分析18例肾集合管癌患者的临床资料.结果：18例中男性患者11例、女性为7例,发病年龄39～71岁,平均54.8岁.因血尿就诊11例,因腰痛就诊4例,因腰痛伴反复低热就诊1例,查体发现2例.18例均行手术治疗,术后给予辅助治疗.15例随访3个月～3年,其中1例术后3个月时发现肺转移,9个月死于肾癌转移,8例于术后1～2年之间死于肾癌肺或脑转移,3例术后2～3年之间死于肾癌转移,3例术后3～9个月仍无瘤生存,3例患者失访.结论：肾集合管癌恶性程度高,进展迅速,转移早,预后差.单纯手术治疗效果一般.免疫治疗及靶向治疗前景较好.