以脑转移为首发症状的肺癌临床误诊分析

目的 探讨以脑转移为首发症状的肺癌临床特点及误诊原因。方法 结合33例患者的临床表现、影像学表现进行分析。结果 以脑转移为首发症状的肺癌易被误诊为脑血管病变或原发脑肿瘤。结论 对突发神经系统症状的患者应考虑到脑转移的可能，应完善检查，以免误诊。     

以腹股沟肿大淋巴结为首发表现的阴茎癌6例报告

目的：探讨以腹股沟肿大淋巴结为首发表现的阴茎痛的I临床特点及诊治方法.方法：本组患者6例,均因为肿大的腹股沟淋巴结初诊于外院,在我院经细胞穿刺学证实为鳞癌转移.全部患者均有包茎或包皮过长病史,在成年后接受过包皮环切手术.4例患者在阴茎包皮环切瘢痕处有小灶肿块或溃疡,广切后病理显示为阴茎鳞癌,2例患者既往环切术标本经病理复片后诊断为阴茎鳞癌.结果：阴茎癌原发灶病理分析显示4例为T1期病变,2例为T2期病变,临床病灶均较小,直径为5～10 mm.腹股沟肿大淋巴结直径最小4 cm.最大达9 cm且伴破溃.6例患者中4例先接受了手术治疗,2例接受了新辅助化疗后再次手术.术后淋巴结病理送检证实腹股沟淋巴结鳞癌累及,且均有淋巴结外癌侵犯.6例患者中有5例复发,仅1例无病存活26个月.结论：以腹股沟肿大淋巴结为首发表现的阴茎癌并不多见,但是初诊时往往被误诊为其他疾病而延误了及时治疗.提高此类患者治疗效果的关键在于早期准确诊断,需要进行腹股沟淋巴结的穿刺病理检查,细致的寻找原发病灶.     

以腰腿痛为首发症状的肺癌腰椎转移1例

<正>肺癌的临床症状多以刺激性咳嗽及痰中带血为首发症状,有时伴有胸闷气喘、胸痛等,以腰腿痛为首发症状者较易被误诊。2014-08-05我科收治1例以腰腿痛为首发症状的肺癌患者,经相关检查确诊为左中央型肺癌伴腰椎转移,报道如下。1临床资料患者男,69岁,农民,有吸烟史30余年,因反复腰痛伴左下肢疼痛2月加重1周,于2014-08-05来     

阴茎转移癌18例临床分析

目的探讨阴茎转移癌的临床特点、诊治方法及预后。方法回顾性分析18例阴茎转移癌患者的临床及随访资料并复习相关文献。18例患者原发肿瘤包括膀胱癌8例,前列腺癌4例,直肠癌2例,结肠癌、肾癌、食管癌和肺癌各1例。其中9例患者接受了阴茎切除+静脉化疗,5例患者仅接受静脉化疗未行阴茎切除术,2例患者仅接受了阴茎局部放疗,1例肾癌患者仅接受了索拉菲尼靶向治疗。结果本组18例患者中,从确诊原发肿瘤至出现阴茎转移时间为1~100月,平均(18.7±1.9)月。从确诊阴茎转移至患者死亡时间为4~23月,平均(10.2±1.7)月。所有18例患者均死于出现阴茎转移2年内。结论阴茎转移癌是一种罕见且预后较差的疾病,即使进行治疗,多数患者仍死于确诊阴茎转移1年内。逆行性静脉途经是发生阴茎转移的主要机制。阴茎切除仅限于缓解局部症状而不应常规应用。     

直肠腺癌Miles术后阴茎海绵体转移1例报道并文献复习

目的探讨继发性阴茎癌的临床特点及诊治方法。方法回顾性分析成都军区总医院全军普外中心收治的1例直肠癌术后36个月发生阴茎转移患者的临床资料,并结合国内、外46例文献报道的资料(1988~2010年),对其发病情况、临床表现、转移途径、诊断、治疗和预后进行总结。结果 阴茎转移癌以泌尿系来源最多见(51.05%),其次为消化系统来源(36.17%);多发生在原发肿瘤术后5~18个月,部分表现为首发症状;转移灶多位于阴茎体部或根部(87.23%),多表现于单发结节(48.94%),部分为多发结节(29.97%);25.53%伴有异常阴茎勃起;常伴有其他部位转移(55.32%)。对单纯继发性阴茎癌不伴其他脏器转移者行部分或全部阴茎切除,术后辅以放疗、化疗和内分泌治疗能够提高治疗效果,延长生存期;非手术治疗的患者,多因其他部位转移不能手术,绝大多数生存期在1年内。结论 对阴茎出现单个或多个结节或伴有异常勃起的肿瘤患者,要考虑阴茎继发性转移的可能;活检可明确诊断;手术切除、辅以放化疗及内分泌治疗可延长患者的生存期。     

以重症肌无力为首发症状的小细胞肺癌1例

病人 男，54岁。出现眼睑下垂症状5周，症状进行性加重，并出现四肢无力，无咳嗽、咳痰、痰中带血等症状，胸部CT检查发现右上纵隔3．0cm×3．0cm占位。以右上纵隔肿瘤伴重症肌无力人院，经皮立体定位纵隔肿瘤穿刺活检，病理学检查找到癌细胞，倾向小细胞肺癌。肌电图检查面神经、腋神经、腓总神经低高频刺激均见波幅异常衰减现象。予以口服吡啶斯的明0．06g每日3次后，眼睑下垂及四肢无力症状完全缓解。行EP、CAVE交替方案术前新辅助化疗两个疗程后，2002年11月手术治疗右上肺纵隔型小细胞肺癌，[第一段]     

先天性阴茎显露不良诊治特点分析

目的 探讨先天性阴茎显露不良的诊断与治疗特点.方法 阴茎显露不良患者89例,平均年龄10.6(5～45)岁.其中隐匿型32例(36%)、埋藏型42例(47%)、混合型15例(17%),轻度38例(43%),中度27例(30%)、重度24例(27%).36例中、重度者住院行手术矫正.53例轻、中度患者采取非手术治疗观察,其中38例获随访平均30(12～48)个月.结果 36例手术患者.手术前后阴茎长度分别为(1.37±0.58)、(4.05±0.52)cm,手术前后比较差异有统计学意义(t=17.68,P＜0.01),阴茎外观满意.38例轻、中度非手术患儿随访至青春期14～16岁,阴茎显露长度由(2.60±0.40)cm增至(4.90±0.50)cm.结论 根据阴茎显露不良的分型、分度采用相应的手术指征、适当的治疗方案治疗效果满意;轻中度患者随访观察显露不良症状多可自然改善.     

以低钠血症为首发表现的肺癌一例

肺癌的临床表现多种多样，其中以低钠血症为首发表现的抗利尿激素分泌失调综合征（syndrome of inappropriate secretion of antidiuretic hormone, SIADH）并不多见。我院于2008年10月17日收治了1例以顽固性低钠血症为首发表现的肺癌患者，现报道如下。     

以肢体及关节痛为首发症状的肺癌20例临床分析

目的 为了准确及时诊断肺癌,减少误诊和漏诊。方法 对２２９例肺癌住院患者的首发症状作一分析。结果 发现以肢体及关节疼为首发症状的肺癌２０例,以腺癌多见。结论 对肢体及关节疼痛患者,应检查双侧锁骨上淋巴结并将胸部Ｘ线摄片作为常规检查,就不会造成误诊和漏诊。     

Successful penile reconstruction after multimodal therapy in patients with primitive neuroectodermal tumor originating from the penis

We herein present an extremely rare case of primitive neuroectodermal tumor originating in the penis. A 16‐year‐old male adolescent presented with painful penile swelling. Pathological, immunohistochemical and cytogenetical examinations of the specimens obtained from total penectomy confirmed the diagnosis of primitive neuroectodermal tumor. After total penectomy, the patient received adjuvant chemotherapy with ifosfamide‐based regimen for 48 weeks. As a series of therapies, the patient underwent penile reconstruction surgery after completing adjuvant chemotherapy. The patient has not shown any evidence of recurrence for the 7 years after penile reconstruction surgery, and voiding function is completely normal. A favorable outcome was observed by multimodal therapy including aggressive resection for local control, intensive adjuvant chemotherapy, and penile reconstruction with cosmetic and functional success. Similar therapeutic approaches might be selected for children with primary malignant tumors of the penis.     

Glomus tumor of the penis

Glomus tumors of the penis are extremely rare. A patient with multiple regional glomus tumors involving the penis is reported. A 16-year-old boy presented with the complaint of painless penile masses and resection of the lesions was performed. The pathologic diagnosis was glomus tumor of the penis. This is the ninth case of glomus tumor of the penis to be reported in the literature.     

Reconfiguration of the severely fibrotic penis with a penile implant

PURPOSE: Using evidence based methods we prospectively evaluated the impact of a new surgical procedure on penile deformity caused by severe cavernous fibrosis. MATERIALS AND METHODS: In 10 patients with severe penile curvature, shortening and impaired penile rigidity due to fibrosis of the corpora cavernosa we made multiple relaxing incisions of the tunica albuginea and subsequently placed a 3-piece inflatable penile implant. Patients were evaluated before and after the procedure by the International Index of Erectile Function and several general assessment questions. Preoperatively and postoperatively we measured flaccid and erect penile length. RESULTS: At the 6-month followup all International Index of Erectile Function domains were significantly improved compared with preoperative values. Average penile length was increased 2.3 and 3 cm. while flaccid and erect, respectively, compared with before surgery. Complete penile straightening was achieved in 9 of 10 cases (90%). Surgical reoperation was performed in 1 patient (10%) in whom the implant was removed due to scrotal infection and in another (10%) in whom a further single relaxing incision of the fibrotic plaque was needed to attain complete penile straightening. CONCLUSIONS: Patients with severe penile curvature, shortening and impaired penile rigidity due to penile fibrosis may be offered this surgical alternative, which proved to be effective and safe in our preliminary series.     

Amputation of the penis due to electrical burn--role of prefabricated urethra in penile reconstruction

Amputation of the penis due to electrical burns is not rare in India. There are many methods of penile reconstruction and same is true for urethral reconstruction. We describe the use of prefabricated radial fascial urethra with good results in such patients.     

Metastases to the penis from carcinoma of the prostate

A 58-year-old man presented with dysuria at the Osaka Medical College Hospital in November 1996. Laboratory examination revealed elevated serum prostate-specific antigen (PSA) to > 100 ng/mL. Adenocarcinoma of the prostate with metastasis to the bone was diagnosed after a biopsy of the prostate and bone scintigraphy; hormonal therapy was administered. Although bone metastasis was well controlled and the serum PSA level declined to within normal levels (2.0 ng/mL), several painless nodules were found on the penile glans. Biopsy of the nodules showed that the penile tumor was a metastasis from the prostate cancer. The patient underwent partial penectomy for relief from penile pain. The serum PSA level showed no elevation 3 months after the partial penectomy, suggesting that careful observation of prostate cancer patients is necessary, even when oseous metastasis is well controlled and serum PSA levels are kept within normal ranges by hormonal therapy. The case also indicates that urologists should consider the possibility of metastasis to the penis from prostate cancer.     

Spermatic cord metastasis as an initial manifestation of non-small cell carcinoma of the lung

Lung cancer is among the most common cancers which continue to be a major cause of death in the world and many present with distant metastasis in advanced stages precluding curative treatment. Herein, we report a 62-year-old male patient admitted to our hospital with complaint of a painful mass in his left inguinal region. Surprisingly, a chest radiograph revealed a mass in his left lung with ipsilateral pleural effusion. Thorough radiological and pathologic examinations he was confirmed to have a non-small cell lung cancer with only spermatic cord metastasis and unfortunately the patient died two weeks after admission.     

肺鳞癌、腺癌纵隔淋巴结转移的特点

目的 研究原发肺鳞癌及腺癌纵隔淋巴结转移特点,探讨临床意义.方法 对353例原发肺癌施行同侧纵隔淋巴结廓清术,病理检测淋巴结转移频度.结果 清除淋巴结2380组,平均每例6.74组.N2 淋巴结转移率16.2%.T1、T2、T3间淋巴结转移率差异有统计学意义(P<0.01).N2转移率在鳞癌、腺癌分别为30.1%、44.1%.64.2% 鳞癌N2转移为某一组淋巴结,腺癌3组以上转移者46.2%.上叶肺癌跨区域N2转移占15.1%,下叶(包括中叶)肺癌跨区域转移占53.1%.跳跃式转移占N2转移的53.7%.结论 肺鳞癌及腺癌纵隔淋巴结转移具有多发性、跳跃性及跨区域性特点.     

Primary mediastinal lymph node malignancy with features suggestive of dendritic cell sarcoma

A 56-year-old man underwent preoperative chest computed tomography to further evaluate a well denned mass in the middle lobe with subcarinal lymph node swelling. There was no pathological diagnosis established by either bronchoscopic biopsy specimens or computed tomography-guided percutaneous needle biopsy. The middle lobe and mediastinal lymph nodes were excised, then postoperative radiotherapy (60 Gy) was administered to the mediastinum. Results of histological and immunohistochemical study showed that the lung mass consisted of completely necrotic tissue and that the subcarinal lymph node was involved by malignant cells suggestive of dendritic cell sarcoma. Primary dendritic cell sarcoma of the mediastinal lymph node is extremely rare. Dendritic cell sarcoma is a neoplasm of reticular dendritic origin and includes both follicular dendritic cell sarcoma and interdigitating reticulum (or dendritic) cell sarcoma. These rare neoplasms may pose difficulty in pathologic diagnosis and treatment. Although our patient died of hepatic rupture due to dendritic cell sarcoma or gastric cancer metastases one year after surgery, complete surgical resection with or without postoperative radiotherapy may be an acceptable therapeutic option for localized dendritic cell sarcoma.     

成人隐匿阴茎的外科治疗临床分析

目的提高对成人隐匿阴茎的认识,探讨适宜的手术方法。方法对28例成人隐匿阴茎,基本术式为阴茎延长术,并根据其不同的临床表现结合松解切除纤维索带、包皮口成形、切除耻骨前过多的脂肪组织、二期行阴茎腹侧延长或阴茎阴囊转位矫治术。结果术后随访6～36个月,24例(85．71%)有一过性阴茎皮肤水肿；2例(7．14%)顽固性淋巴肿；2例(7．14%)切口处脂肪液化；术后阴茎勃起时长度较术前平均增加(4．19±0．15)cm,24例(85．71%)患者的阴茎外观满意,显露良好。结论阴茎延长术结合其他方法对成人隐匿阴茎进行个性化处理是一种合适的手术方法。