Kimura‘s病2例报告

1病例报告 例1.男性,45岁.因左耳前肿块2年,于1994年11月9日入院.患者2年前发现左耳前肿块,近2个月来明显增大,除耳前皮肤偶有瘙痒外,无其他不适感.曾有嗜酸性细胞增多症病史.10余年前曾因右耳后肿块而行手术切除.病理检查示:嗜酸性细胞聚集.体检:左耳屏前肿块4 cm×3 cm,其表面皮肤色泽正常,质稍软,边界不清,可移动,无压痛.右耳后肿块2cm×2 cm,质地中等.右上颈部亦可触及大小为1 cm×1 cm的淋巴结.无其他阳性体征.因诊断不明,在局麻下行肿块切除术,术中见肿块与腮腺及周围组织无明显界限,即行左腮腺浅叶及肿块切除术.术后病理诊断:左腮腺良性淋巴上皮病变.免疫组化检查结果:淋巴样细胞显示LCA、UCHL1、DPD4阳性,淋巴滤泡套区L26阳性,结合HE切片诊断为Kimura's病.     

Kaposi’s肉瘤的放射治疗

目的：探讨Ｋａｐｏｓｉ肉瘤的发展现律，临床特点及疗效。材料与方法：１９８５－１９９２年间新疆医学院肿瘤医院收治７例。维吾尔族６例，哈萨克族１例。除１例病变起始左股部有腹股沟淋巴结受累外，余６例无淋巴结及内脏受侵。用ｘ线或６０Ｃｏ治疗，射野超过病灶边缘２ｃｍ－３ｃｍ，每日１．８－２．０Ｇｙ，每周５次，总剂量２３－５７ＧＹ。结果：首发于上肢４例，２～６年后向对侧上肢及双下肢远端扩散，进展相对较快。首发于下肢３例，内有２例经８－１１年时沿同侧肢体远端扩散，１例侵及上肢，病程较慢。尽管起病部位不同，是终仍为向心性发展，生存２年以上７／７例，４年以上５／５例，５年以上４／４例。结论：本病病程较长，疗效判断也相应长；对放射线治疗有效，减症剂量１０－２９Ｇｙ，病变消失量２８－５７Ｇｙ。     

Kimura病8例报告

[目的]了解Kimura病的临床病理特征.[方法]回顾分析8例Kimura病患者的临床资料.[结果]1例患者以腹胀、腹泻、双下肢浮肿起病,伴下腹部散在红色丘疹及双侧耳后淋巴结、肠系膜淋巴结肿大.7例患者以颈部肿块就诊.8例均行肿块切除、皮质激素或细胞毒药物治疗.[结论]外周血嗜酸性粒细胞和血清IgE升高对该病的诊断具有重要意义.皮质激素应作为Kimura病的首选治疗方法.     

26例新疆Kaposi’S肉瘤放射治疗的疗效分析

目的：探讨Kaposi’s肉瘤（KS）放射治疗剂量与疗效的关系。方法：26例Kaposi’s肉瘤患者共有66个照射野,按总剂量不同分为三组,〈40Gy组,40Gy-45Gy组,46Gy-52Gy组。采用加速器x线,电子线或混合射线常规分割照射,每周5次,每次2Gy。结果：本组66个照射野总的客观缓解率（CR＋PR）66．7％,其中〈40Gy组为41．7％,40DGy-45Gy组为81．8％,46Gy-52Gy组为80．6％。40Gy～45Gy组与46Gy-52Gy组疗效优于〈40Gy组,差异具有统计学意义（P〈0．05）。放射性皮炎随着剂量的增加而加重,〈40Gy组Ⅲ°～Ⅳ°放射性皮炎发生率8．3％,40Gy～45Gy组为27．3％,46Gy-52Gy组为77．4％,46Gy～52Gy组Ⅲ°～Ⅳ°放射性皮炎发生率明显高于40Gy～45Gy和〈40Gy组（P〈0．001）,但皮损局部消炎处理后基本可痊愈。26例患者5例KS患者死于其他疾病,1例患者死于皮肤及肺部感染,其余20例患者带瘤存活。结论：Kaposi’s肉瘤是一种放射治疗敏感的恶性肿瘤,常规分割照射剂量40Gy-52Gy为宜。     

Kimura病7例报道并文献复习

 目的 探讨Kimura病的临床病理特征和诊断。 方法 对7例Kimura病进行临床资料分析、光镜观察和免疫组织化学检测,并结合文献对其鉴别诊断进行讨论。 结果 该病好发于男性,临床上表现为头颈部或肘部无痛性软组织肿块,形态学上以淋巴滤泡增生伴生发中心扩大、嗜酸性粒细胞浸润、小血管增生和间质纤维化为基本病变,免疫组化染色κ和λ的共同表达提示KD是一多克隆增生性疾病。 结论 Kimura病是一种病因不明的特异性炎症病变,应与上皮样血管瘤相鉴别。     

Kimura病和ALHE的临床和病理学特点

Kimum病（Kimurm disease,KD）和血管淋巴样增生伴嗜酸性粒细胞增多症（angiolymphoidhy—perplasi with eosinophilia,ALHE）都是临床上少见病,二者均好发于头颈部,有局部切除后易复发的倾向;均有淋巴细胞、单核细胞及大量嗜酸性粒细胞浸润、血管增生的病理学改变。     

乳腺与乳腺外Paget''''s病临床病理分析

目的探讨比较乳腺与乳腺外Paget’s病临床病理特征。方法回顾性总结1980年~2004年黑龙江省医院及哈尔滨市第五医院外科收治的47例乳腺Paget’s病与37例乳腺外Paget’s病临床、病理资料,就其病理与临床特征等进行比较研究。结果乳腺和乳腺外Paget’s病组织学形态相同。乳腺Paget’s病患者均为女性,平均年龄50.1岁;而乳腺外Paget’s病男性32例,女性5例,平均年龄66.1岁。乳腺Paget’s病中45例合并乳腺癌(11例导管内癌;34例浸润性导管癌,其中21例有腋窝淋巴结转移性浸润性导管癌);乳腺外Paget’s病中,女性外阴5例(3例上皮内Paget’s病;2例伴低分化腺癌,其中1例淋巴结传移);其余患者均为男性,阴囊和(或)阴茎30例(17例上皮内Papet’s病,6例为浸润性Paget’s病,7例伴低分化腺癌,其中1例淋巴结转移);阴囊合并腋窝1例,伴阴囊处低分化腺癌,可见瘤栓,并腹壁皮下转移;上眼睑1例,伴低分化腺癌。结论乳腺和乳腺外Paget’s病之间临床病理特征有许多相同和不同之处,有待进一步研究。     

何杰金病的放射治疗

1940年Craft报告了52例未经治疗的何杰金病,其5年生存率为5.8％,另一组179例经X线治疗其5年生存率为23.4％,说明X线对何杰金病具有治疗价值。1950年Peter报告113例何杰金病经放射治疗其5年生存率为51％,直到这时放射治疗对何杰金病的价值才得到重视。近20年来何杰金病的治疗效果有显著的提高。在国际上总的5年生存率为70～80％,Ⅰ、Ⅱ期的5年生存率为80～90％。本院Ⅰ、Ⅱ     

Radiation Therapy in Kimura's Disease

Kimura's disease is a rare disorder which predominantly involves the head and neck region and causes eosinophilia in peripheral blood. It often responds well to corticosteroid therapy but some patients can be resistant; in these patients symptomatic radiation therapy can be of value. We reviewed 10 patients with Kimura's disease who received radiation therapy from 1975 through 1981 in the Department of Radiology, Chiba University Hospital. Nineteen tumors were irradiated and 15 of them locally controlled. in 5 patients, steroid therapy could be withdrawn. for local control, 25 to 30 Gy seemed to be adequate.     

Radiation therapy in craniopharyngiomas

Eighteen patients with cranipharyngiomas, who were studied and treated between 1970–1980, are presented. Each patient was treated with surgery and radiotherapy (50–60 Gy). Six patients were treated with radiotherapy because the tumor recurred after surgery. An extensive representation of the clinical symptomatology typical of this tumor was seen. In 3 patients an improvement in visual symptoms was demonstrated; in 11 the headaches and vomiting were controlled after treatment. The 18 treated patients are still alive without evidence of progression of the tumor, after a period of 2 to 12 years. Our experience supports the contention that conservative surgery coupled with radical radiotherapy remains the treatment of choice for the craniopharyngioma.     

Radiation therapy for inflammatory breast cancer

Inflammatory Breast Cancer (IBC) is a rare and very aggressive breast cancer, still associated with poor prognosis. Therefore, management of IBC requires carefully integrated care, and ideally, patients should be evaluated in a multidisciplinary team from the beginning, to identify the best treatment strategy.IBC is usually unresectable at presentation, and neo-adjuvant systemic therapy is considered the standard of care.Response to the primary treatment, especially pathological complete response (pCR), is important to move forward to definitive local therapy with the goal to improve survival. In any case, regardless the response to neo-adjuvant therapy, surgery and radiotherapy should administered to ensure a better loco-regional tumor control. Mastectomy with axillary lymph node dissection followed by chest wall and regional nodal radiotherapy is the most frequent approach, and whether breast-conserving surgery could be preferable in some selected groups of patients with clinical complete response is still a debated question. Radiotherapy alone has recommended only in cases of persistent unresectability.To date, the approach remains as established in the current recommendations, with the best option for trimodality treatment, and further studies clearly warranted.     

Radiation therapy for postoperative local-regionally recurrent lung cancer

Twenty-four patients with post-resection local-regionally recurrent non-small-cell-undifferentiated lung carcinoma received external beam radiation therapy over an 18-year period at the Department of Radiation Medicine, Massachusetts General Hospital. No patient had demonstrable distant metastases; the median time interval from initial surgery to recurrence was 15 months. Fully $\text{17}\text{24}$ patients (71 %) had histopathologic/cytologic proof of recurrence, and none had either prior, concurrent, nor adjuvant chemotherapy. The 5-year actuarial survival rate for the 24 patients was 10%; our 2 long term survivors each had early-stage initial lesions: (one T₂N₀ patient with later hilar/supraclavicular recurrence who received a dose Time-Dose-Fractionation (TDF) 67 and lived 7.3 years with normal chest x-ray (CXR) at death; the other patient, T₁N₀ with first stump/hilar recurrence removed surgically but had later stump re-recurrence, received a dose TDF 67 and lived 9.5 years with normal CXR at death). In 11 patients local tumor control was achieved, documented by autopsy and/or CXR at death or last follow-up. complete and permanent disapperance was achieved post-irradiation for 15/31 thoracic symptoms (48%). Of 8 patients with isolated bronchial stump ± adjacent hilum recurrence, local control was achieved in 5.     

Radiation therapy alone in the treatment of tumours of the trachea

A retrospective analysis of 23 patients with tracheal malignancy treated with a radiation therapy alone is reported. All patients were irradiated at Bydgoszcz Cancer Center during the period 1990–1996. To overcome serious damage to normal tissues, a dose escalation combination of external beam irradiation and brachytherapy was used in most cases. Squamous cell carcinoma was the most common type and was seen in 13 cases. Adenoid cystic carcinoma occurred in seven, adenocarcinoma in two and carcinoid in one patient. Eight patients were treated with definitive and 15 with palliative intent. Local control was attained in 8 of 23 patients and was more frequent for patients from curative group treated with doses greater than 60 Gy. The mean survival for all patients was 9.5 months, and 26 and 7.2 months for definitive and palliative group, respectively. Survival was strongly correlated to histologic type and response to radiotherapy.     

木村病的临床研究进展

木村病又称为嗜酸性粒细胞增生性淋巴肉芽肿,是一种罕见的淋巴组织增生性炎症性疾病,主要发生于头颈部,尤其是腮腺及颌下区域,通常表现为单发或多发的皮下肿物。本文针对该病的临床报道进行系统性回顾,以提高广大医生对该病的认识,降低误诊率。     

Radiation therapy in the treatment of malignant fibrous histiocytoma

Between September 1%9, and September 1978, 17 patients with localized malignant fibrous histiocytomas received radiotherapy at The Medical College of Wisconsin Affiliated Hospitals. Of 5 patients who were treated by radiotherapy alone, 2 were locally controlled: a literature survey revealed that local control was obtained in only 2 of 16 patients treated by radiotherapy alone. Of the 12 patients treated postoperatively, 9 were controlled locally, whereas 12 of 14 patients collected from the literature were controlled with postoperative radiotherapy. Local recurrence following resection is reduced from approximately 50% to 20% by post-operative irradiation. Seven of 17 patients (41 %) developed distant metastases: six patients have died, and the remaining 11 have been followed for 12 to 35 months (median, 25 months). Radiotherapy can eradicate small tumor masses, and given postoperatively, appears to lower risk of recurrence.     

Radiation therapy in the treatment of giant cell tumor of bone

Purpose: To assess the local control rate and potential complications of radiotherapy, and the factors influencing response to radiotherapy for primary and locally recurrent giant cell tumor of bone.Methods and Materials: Twenty patients were irradiated for giant cell tumor of bone between 1983 and 1993. Fourteen patients received radiotherapy at the time of primary diagnosis (10 had biopsy and 4 partial surgery) and 6 patients at the time of local recurrence (following additional surgery in 2). Fourteen patients had tumors of the extremity and six of the vertebral column. The radiotherapy dose ranged from 40–60 Gy in 15–30 fractions over 3–6 weeks. The response to radiotherapy was assessed by clinical and radiological criteria and the probable factors influencing response were analyzed.Results: The median follow-up period was 48 months (range, 4 months to 13 years). Local control was obtained in 18/20 patients. The two local failures were salvaged, one by reirradiation and the other by surgery. Only one patient died of giant cell tumor, following extensive bone marrow infiltration. There was no serious late toxicity or malignant transformation. The response to radiotherapy was not influenced by disease status at presentation, tumor site, radiotherapy schedule, or presence of soft tissue extension.Conclusions: Radiotherapy is effective in producing local control in primary as well as recurrent giant cell tumor of bone. There are no major complications and no significant risk of malignant transformation. Radiotherapy could be considered as the primary treatment modality in patients where surgery would produce functional deficits.     

Radiation therapy for control of soft-tissue sarcomas resected with positive margins

PURPOSE: Positive margins (PM) remain after surgery in some soft-tissue sarcoma (STS) patients. We investigated the efficacy of radiation therapy (RT) in STS patients with PM. METHODS AND MATERIALS: A retrospective chart review was performed on 154 patients with STS at various anatomic sites with PM, defined as tumor on ink, who underwent RT with curative intent between 1970 and 2001. Local control (LC), disease-free survival (DFS), and overall survival (OS) rates were evaluated by univariate (log-rank) and multivariate analysis of prognostic and treatment factors. RESULTS: At 5 years, actuarial LC, DFS, and OS rates were: 76%, 46.7%, and 65.2%, respectively. LC was highest with extremity lesions (p < 0.01), radiation dose >64 Gy (p < 0.05), microscopically (vs. grossly visible) positive margin (p = 0.03), and superficial lesions (p = 0.05). Patients receiving >64 Gy had higher 5-year LC, DFS, and OS rates of 85%, 52.1%, and 67.8% vs. 66.1%, 41.8%, and 62.9% if < or =64 Gy, p < 0.04. OS was worse in patients with G2/G3 tumors with local failure (LF), p < 0.001. Other known prognostic factors, including grade, stage, size, and age (>50), also significantly influenced OS. By multivariate analysis, the best predictors of LC were site (extremity vs. other), p < 0.01 and dose (>64 vs. < or =64 Gy), p < 0.05; the best predictors for OS were size, p < 0.001, gross vs. microscopic PM, p < 0.05, and LF, p < 0.01. CONCLUSION: Local control is achieved in most PM STS patients undergoing RT. Doses >64 Gy, superficial location, and extremity site are associated with improved LC. OS is worse in patients with tumors with lesions >5 cm, grossly positive margins, and after local failure.