胆囊鳞癌和腺鳞癌9例临床分析

[目的]探讨原发性胆囊鳞癌和腺鳞癌的临床病理特征及手术治疗疗效。[方法]回顾性分析9例胆囊鳞癌（5例）和腺鳞癌（4例），采用Kaplan-Meier法计算生存率。[结果]T1和T4病变8例（88．9％），B病变1例（11．1％）。7例（77．8％）累及肝脏，淋巴结转移5例（55．6％）。凡切除5例，R1切除1例，R2切除3例。全组1年、3年及5年生存率分别为55．6％、29．6％和29．6％。R0切除的1年生存率为100％，R1／R2切除的1年生存率为0。[结论]胆囊鳞癌和腺鳞癌恶性程度高，易侵犯肝脏。即使局部晚期患者，R0切除可延长生存期。     

输尿管鳞癌4例诊断与治疗

原发性输尿管移行上皮肿瘤较少见,其中鳞癌尤为罕见。1997年11月至2008年1月,我院收治输尿管鳞癌患者4例,占总输尿管肿瘤的4.5%（4/89）,均由术后病理诊断证实,     

针吸细胞学诊断乳腺肿块476例临床分析

476例乳腺肿块针吸细胞学诊断乳腺肿块的组织病理学诊断符合率为91.5%.其中乳腺癌肿块小于2cm和大于2cm的符合率分别为97.2%和96.8%,假阴性率为8.6%,假阳性率为5.7%.     

Clinical Application of Ultrasound-Guided Thyroid Fine Needle Aspiration Biopsy and Thinprep Cytology Test in Diagnosis of Thyroid Disease

Purpose: To study the clinical application value of ultrasound guided thyroid fine needle aspiration biopsy and thinprep cytology testing in diagnosis of thyroid disease. Methods: A total of 78 patients with thyroid nodules were enrolled, 34 males and 44 females, aged 33-64 years old with mean age of 47.6 years. All underwent thyroid module fine needle puncture after surgery to assess cell pathology and histopathological features. Results: Sufficient specimens were obtained from all of 78 patients, the cytological results of 73 cases (93.6 %) being consistent with pathological results. While 20 cases (25.6 %) were malignant tumors, 44 (56.4 %) were benign and 9 (11.5 %) were non-tumor lesions. The sensitivity of benign and malignant thyroid nodule by thyroid fine needle puncture was 90.9 %, specificity was 98.1 % and the positive predictive value was 96.3 %. Conclusions: It is demonstrated that ultrasound-guided thyroid fine needle aspiration biopsy and thinprep cytology testing have diagnostic value in clinical application for thyroid disease,showing good diagnostic coincidence rates with histopathological examination. They can thus be regarded as safe and effective for preoperative diagnosis and providing an appropriate basis for selection of surgery.     

外阴癌复发(附55例临床分析)

目的:分析外阴癌外阴局部复发和区域淋巴结转移复发的临床特点及其预后,并探讨外阴癌的治疗。方法:回顾性分析我院1958～2000年收治的435例外阴原发性鳞癌中55例复发患者的临床特点和治疗。结果:复发率为12.6%(55/435)。55例复发患者中,32例单纯外阴局部复发,12例单纯腹股沟淋巴结转移,11例外阴局部复发合并腹股沟淋巴结转移。2年内复发、5年以上至10年内、10年以上复发分别占复发者的49.1%、25.5%、3.6%。外阴单纯复发和腹股沟淋巴结转移复发患者再次治疗后5年生存率分别为49.2%和6.4%,两者差异显著(P<0.01)。结论:单纯外阴复发预后较好,腹股沟淋巴结转移复发预后差。原发外阴癌患者腹股沟淋巴结的处理,仍应以手术治疗为主。为预防外阴局部复发,外阴白斑及其周围皮肤应一并切除,切缘离肿瘤尽可能大于2cm。如果肿瘤接近或侵犯尿道口、肛门而行保留尿道或保肛手术均应于术前或术后辅以放射治疗。     

Horrifying Basal Cell Carcinoma: Cytological,Immunohistochemical, and Ultrastructural Findings

Basal cell carcinoma (BCC) is a slow-growing and frequently occurring tumor of the eyelids. Among BCC cases, there is a subtype of aggressive cases called horrifying BCC (HBCC). There are also rare BCC cases that show neuroendocrine differentiation. Here, we describe a case of HBCC with neuroendocrine differentiation. The patient, a 41-year-old woman, presented with abnormal left eye tearing and left cheek pain. On computed tomography imaging, a tumor that extended to the left orbit was detected in the left cheek. On cytological examination of fine-needle aspiration (FNA) samples, the tumor cells were observed as sheet-like clusters and single bare nuclei with a clear background; peripheral palisading was not clearly seen. On examination of the biopsy specimen taken after FNA, the tumor was found to be composed of cancer cell nests with scattered peripheral palisading in the dermis. Immunohistochemically, the tumor cells were positive for cytokeratin (CK) 7 and CD56 and were negative for CK20, synaptophysin, and chromogranin A. Membrane-bound dense-core granules were detected on ultrastructural study. A HBCC case with neuroendocrine differentiation has not been previously reported. The correlation between the presence of neuroendocrine differentiation in HBCC and patient prognosis should be further studied.Key words: Horrifying basal cell carcinoma, Cytology, Immunocytochemistry, Electron microscopy     

Clinicopathologic Importance of Women with Squamous Cell Carcinoma Cytology on Siriraj Liquid-Based Cervical Cytology

Objectives: The purposes of this study were to determine the prevalence and predictive value to detectsignificant neoplasia and invasive lesions, and to evaluate the correlation between clinical and histopathology ofwomen with squamous cell carcinoma (SCCA) on Siriraj liquid-based cervical cytology (Siriraj-LBC). Methods:The computerized database of women who underwent Siriraj-LBC at Siriraj Hospital, Mahidol Universityfrom January 2007 to December 2010 were retrieved. The hospital records of women with SCCA cytology werereviewed. Results: The prevalence of SCCA cytology was 0.07%. A total of 86 women, mean age was 58.1 years.Sixty-one women (70.9%) were post-menopausal. Overall significant pathology and invasive gynecologic cancerwere detected in 84 women (97.7%) and 71 women (82.5%), respectively. The positive predictive values fordetection of significant neoplasia and invasive lesion were 97.7% and 82.6%, respectively. The cervical cancerwas diagnosed in 69 women and among these 58 women were SCCA. Thirteen women (15.1%) had cervicalintraepithelial neoplasia (CIN) 3 and two women (2.3%) had cervicitis. The sensitivity and specificity of colposcopyfor cervical cancer detection in SCCA cytology were 83.3% and 75%, respectively. Median follow up period was17.6 months and 64 patients were alive without cytologic abnormality. Conclusions: The final histopathology ofSCCA cytology in our populations demonstrated a wide variety, from cervicitis to invasive cancer and the mostcommon diagnosis was invasive cervical cancer. Colposcopy with biopsy and/or endocervical curettage and loopelectrosurgical excision procedure should be undertaken to achieve histologic diagnosis.     

血清鳞状细胞癌抗原在宫颈鳞状细胞癌临床管理中的进展

血清鳞状细胞癌抗原(SCC-Ag)是宫颈鳞状细胞癌(CSCC)最常用的肿瘤标志物,是CSCC的预后预测指标;SCC-Ag与早期CSCC的术后临床病理高危因素相关,与术后辅助治疗风险相关,SCC-Ag的补充有助于建立更完善的危险因素预测模型,指导术后辅助治疗;SCC-Ag水平在宫颈癌治疗过程中下降,逐渐正常化,可以籍以判断疗效、预测复发;在随访过程中,SCC-Ag的升高先于临床复发,结合PET-CT检查可有效地评估病情、判断复发。SCCAg在CSCC的全程管理中发挥重要作用,可以作为个体化和精细化风险预评估的指标。     

Histopathological Outcomes of Women with Squamous Cell Carcinoma on Cervical Cytology

The aim of this study was to determine the final histopathological outcome for women with a squamous cellcarcinoma (SCCA) diagnosed by cervical cytology. The medical records and computerized colposcopic database ofpatients with SCCA on cytology who underwent colposcopy at Chiang Mai University Hospital between February2003 and December 2005 were reviewed and 48 women with SCCA cytology were identified (mean age 50 years,range 31-73). Nineteen (39.6%) women were postmenopausal. Unsatisfactory colposcopy was noted in 42 (87.5%).Thirty one (64.6%) of the patients had a final pathological diagnosis of high-grade squamous intraepithelial lesions(HGSIL), whereas only 16 (33.3%) had invasive cancer. The remaining one patient had a low-grade squamousintraepithelial lesion. Sensitivity and specificity of colposcopic examination for predicting invasive cancer was 50%and 78%, respectively. In conclusion, most women with a SCCA on cervical cytology have high-grade cervical lesionson final pathology, with only one third demonstrating invasive cancer. The loop electrosurgical excision procedure(LEEP) remains an important measure for combined treatment and diagnosis.     

宫颈鳞癌患者血清鳞状上皮细胞癌抗原检测及其临床意义

目的：探讨宫颈鳞癌患者血清鳞状上皮细胞癌抗原（ＳＣＣＡｇ）的检测及其临床意义。方法采用微粒子酶免疫分析法检测１２４例宫颈癌患者治疗前血清ＳＣＣＡｇ值,早期患者（Ⅰ－Ⅱａ期）术后１周重复检测,部分手术患者随诊中监测。结果宫颈癌血清ＳＣＣＡｇ检测的敏感性为７３．４％,特异性为９６．１％。ＳＣＣＡｇ阳性率随临床分期进展而增高,有非常性差异（Ｐ〈０．０１）,早期患者术前ＳＣＣＡｇ异常者术后均下降至正常水平     

子宫颈低分化鳞状细胞癌80例临床与预后分析

目的：分析影响宫颈低分化鳞癌预后的相关因素以及治疗方式对预后的影响。方法：回顾分析2000年～2005年我院收治的80例Ⅰ期-Ⅱ期的宫颈低分化鳞癌患者的临床资料，并对其病理特点及预后因素应用Log-rank进行单因素分析，COX模型进行多因素分析。结果：单因素分析显示肿瘤的临床分期、盆腔淋巴结转移、脉管转移、深肌层浸润对宫颈低分化鳞癌的预后有统计学意义（P〈0．05）。多因素分析发现脉管转移是影响宫颈低分化鳞癌的独立的预后因素（P〈0．05）。结论：由于宫颈低分化鳞癌恶性程度高，转移早，因此应根据病情对其采取手术、放疗及化疗的综合治疗措施。对于年轻的患者，在病情允许的情况下可考虑保留卵巢。如术后拟行放疗，应将保留的卵巢移位，以避免损伤卵巢功能，从而在提高宫颈低分化鳞癌患者的生存率的同时，改善患者的生存质量。     

子宫颈低分化鳞状细胞癌80例临床与预后分析

目的:分析影响宫颈低分化鳞癌预后的相关因素以及治疗方式对预后的影响。方法:回顾分析2000年～2005年我院收治的80例Ⅰ期～Ⅱ期的宫颈低分化鳞癌患者的临床资料,并对其病理特点及预后因素应用Log-rank进行单因素分析,COX模型进行多因素分析。结果:单因素分析显示肿瘤的临床分期、盆腔淋巴结转移、脉管转移、深肌层浸润对宫颈低分化鳞癌的预后有统计学意义(P<0.05)。多因素分析发现脉管转移是影响宫颈低分化鳞癌的独立的预后因素(P<0.05)。结论:由于宫颈低分化鳞癌恶性程度高,转移早,因此应根据病情对其采取手术、放疗及化疗的综合治疗措施。对于年轻的患者,在病情允许的情况下可考虑保留卵巢。如术后拟行放疗,应将保留的卵巢移位,以避免损伤卵巢功能,从而在提高宫颈低分化鳞癌患者的生存率的同时,改善患者的生存质量。     

颞骨鳞状细胞癌临床诊疗的研究现状

颞骨鳞状细胞癌发病率很低,导致对颞骨鳞状细胞癌的临床认识不够,也未有规范化的诊断治疗指南,本文对颞骨鳞状细胞癌的流行病学特点、临床表现、临床诊断、治疗手段、预后康复等方面进行总结,以期提高临床医护人员对颞骨鳞状细胞癌的认识,促进颞骨鳞状细胞癌诊疗水平的发展。     

细针吸取细胞学对甲状腺肿瘤的诊断与鉴别诊断

本文通过甲状腺肿瘤细针吸取细胞学涂片观察和结合文献，对甲状腺癌细胞中出现的某些特征：核内包涵体、核沟细胞、毛玻璃样核、乳头状结核作了详细的描述。研究显示：核内包涵体在乳头状癌中多见，可作为诊断乳头状癌的重要指标；核沟细胞在滤泡癌和乳头状癌中均可见到，但数量少，对诊断癌有一定价值；甲状腺癌细胞中罕见上述癌之特征。研究还发现，甲状腺癌细胞核普遍增大至１０～１２μｍ以上，并具备其它恶性指征。文章对甲状腺良恶性肿瘤细胞诊断和鉴别亦作了概括。     

原发性胆囊癌41例诊治体会

作者报告１９８６年至１９９６年间手术治疗并经病理诊断的４１例原发性胆囊癌，着重分析了影响早期发现胆囊癌的各种有关因素。作者认为，对本病应有足够的认识，联合应用多种检查方法是提高早期诊断率的有效手段，术中应重视对胆囊标本的检查。     

Clinical Outcomes of Basaloid Squamous Cell Carcinoma ofthe Esophagus: A Retrospective Analysis of 142 Cases

Background: Basaloid squamous cell carcinoma of the esophagus (BSCCE) is a rare and distinctive tumorwith no standard treatment. This study aimed to explore treatment in relation to prognosis of the disease.Methods: A total of 142 patients with BSCCE that underwent treatment in our hospital from March 1999 toJuly 2010 were retrospectively analyzed. All patients received surgery, 42 postoperative radiotherapy and 28patients chemotherapy. Results: There were 26 patients included in stage I, 60 in stage II, 53 in stage III and 3in stage IV. The clinical symptoms and macroscopic performances of BSCCE did not differ from those of typicalesophageal squamous cell carcinoma. Among 118 patients receiving endoscopic biopsy, only 12 were diagnosedwith BSCCE. The median survival time (MST) of the entire group was 32 months, with 1-, 3- and 5-year overallsurvival (OS) of 81.4%, 46.8% and 31.0%, respectively. The 5-year OS of stage I and II patients was significantlylonger than that of stages III/IV, at 60.3%, 36.1% and 10.9%, respectively (p<0.001, p=0.001). The MST and5-year OS were 59.0 months and 47.4% in patients with tumors located in the lower thoracic esophagus, and27.0 months and 18.1% in those with lesions in the upper/middle esophagus (p=0.002). However, the survivalwas not significantly improved in patients undegoing adjunctive therapy. Multivariate analysis showed TNMstage and tumor location to be independent prognostic factors. Furthermore, distant metastasis was the mostfrequent failure pattern, with a median recurrence time of 10 months. Conclusion: BSCCE is an aggressive diseasewith rapid progression and a propensity for distant metastasis. It is difficult to make a definitive diagnosis viapreoperative biopsy. Multidisciplinary therapy including radical esophagectomy with extended lymphadenectomyshould be recommended, while the effectiveness of radiochemotherapy requires further validation for BSCCE.     

HST1 and INT2 Gene Coamplification in a Squamous Cell Carcinoma of the Gallbladder

The HST1 gene has previously been found to be amplified in over40% of squamous cell carcinomas of the esophagus. We performedSouthern blot analyses on squamous cell carcinomas of the lung,nasal cavity, uterine cervix and gallbladder, using HST1, INT2and five other on cogenes as probes. The HST1 and INT2 genes,both of which were mapped to chromosome 11 at band q13, werecoamplified in a squamous cell carcinoma of the gallbladder.The degree of amplification exceeded eight fold.     

乳腺原发性鳞状细胞癌6例报告

目的:研究乳腺鳞状细胞癌临床病理特点。方法:观察6例乳腺鳞状细胞癌的临床病理特点。结果:光镜下对6例乳腺鳞状细胞癌作了描述,在组织病理学特征方面,有3例见到囊肿变化和末端导管鳞状细胞癌改变,并非由肿瘤中心坏死所致。结论:该肿瘤可能由导管上皮化生转化而来。