甲状腺非霍奇金氏淋巴瘤的诊治

目的：探讨外科手术在甲状腺非霍奇金氏淋巴瘤诊治中的作用。方法：L回顾分析1984至1999年22例甲状腺恶性淋巴瘤的临床特点及治疗结果，并进行预后因素分析。结果：22例病人的5年生存率为60％。年龄与肿瘤的病理类型可能与预后相关,而手术方式不影响治疗结果及预后，但与术后并发症的发生相关，结论：甲状腺非霍奇金氏淋巴瘤的治疗应采取化疗辅助甲状腺及颈部放疗相结合的综合治疗，治疗性的外科手术应避免，而仅作为病理诊断的一种辅助方法。     

ⅠE和ⅡE期原发性甲状腺非霍奇金淋巴瘤临床预后分析

目的 探讨原发性甲状腺非霍奇金淋巴瘤的预后因素.方法 回顾性分析1981年1月至2008年1月收治的47例甲状腺非霍奇金淋巴瘤Ⅰ E和ⅡE期患者,所有病例均经病理诊断为B细胞来源非霍奇金淋巴瘤,弥漫性大B细胞淋巴瘤(diffuse larse B-cell lymphoma,DLBCL)28例,黏膜相关淋巴样组织淋巴瘤(mucosa-associated lymphoid tissue,MALT)19例.生存率统计采用Kaplan-Meier法,组间生存率的比较应用Log-rank检验,多因素分析采用Cox回归模型,分析年龄、性别、症状、肿瘤分期、肿瘤浸润范围、病理类型、治疗方式和放疗照射剂量等多种因素对预后的影响.结果 全组5年癌症相关生存率为61.8%.单因素分析显示原发肿瘤局限于甲状腺组与超出甲状腺被膜组的5年生存率分别为86.7%与50.0%(P=0.012).放疗剂量不足40 Gy组与超过40 Gy组的5年生存率分别为30.8%与79.0%(P=0.002).27例ⅡE期患者中采用单一治疗方法和多种治疗方法的5年生存率分别为33.3%和61.1%(P=0.037).病理类型为DLBCL与MALT两组的5年生存率分别为50.0%与79.0%(P=0.038).Cox回归多因素分析显示浸润范围、放疗剂量、病理类型、ⅡE期患者治疗方式是影响预后的危险因素(OR值分别为11.108、5.466、4.071、3.058,P值均<0.05).结论 病变是否局限于甲状腺,放疗的剂量以及病理类型是影响原发甲状腺非霍奇金淋巴瘤(Ⅰ E和ⅡE期)预后的重要因素.ⅡE期患者综合治疗的疗效优于单一治疗方式.     

60例鼻部非霍奇金氏淋巴瘤临床分析

目的 探讨鼻部非霍奇金氏淋巴瘤(non-Hodgkin’slymphoma)临床治疗结果,就临床分期与预后的关系进行讨论。方法 就60例鼻部非霍奇金氏淋巴瘤患者的临床表现、实验室检查及影像学(CT)资料,采用Ann Arbor临床分期,结合放疗为主的治疗结果进行分析。结果 临床Ⅰ期、Ⅱ期、Ⅲ期的5年生存率分别为92.86％(13/14),41.67％(10/24)和11.11％(2/18);4例临床Ⅳ期病人均在1年内死亡;60例病人的1年、2年、3年和5年生存率分别为:81.67％(49/60),61.67％(37/60),51.67％(31/60)和41.70％(25/60)。结论 鼻部非霍奇金氏淋巴瘤临床分期与预后关系密切;早期诊断和治疗是治愈的关键。     

头颈部恶性淋巴瘤的临床分析

目的　提高对头颈部恶性淋巴瘤的认识及诊断水平。方法　对近 1 0年经青岛海慈医院和中南大学湘雅三医院确诊的 4 1例头颈部恶性淋巴瘤病人的临床资料进行回顾性分析。结果　 4 1例病人经 1次或多次组织病理检查 ,部分结合免疫组织化学检查 ,确诊为恶性淋巴瘤。 39例为非霍奇金淋巴瘤 ,2例为霍奇金病。结论头颈部恶性淋巴瘤的临床表现特征性不明显 ,与耳鼻咽喉科某些常见病的临床表现相似 ,易误诊或漏诊。提高对恶性淋巴瘤临床表现的认识、应尽早行相关辅助检查以及组织病理检查并结合免疫组织化学检测 ,以确诊恶性淋巴瘤 ,为早期治疗赢得时间 ,提高病人的生存率和生活质量。     

14例腭扁桃体非霍奇金氏淋巴瘤的临床分析

目的 :探讨原发于腭扁桃体非霍奇金氏淋巴瘤 (non- Hondgkin′s lymphoma,NHL)的临床表现、诊断和治疗。方法 :回顾性分析 1992年～ 2 0 0 0年收治的 14例原发于腭扁桃体非霍奇金氏淋巴瘤。全部肿瘤病灶活检 ,病理确诊。结果 :其临床有特征性表现 ,主要为咽肿痛、颈部肿块、吞咽困难 ,病变扁桃体早期多以结节型增生 ,呈外生性生长。治疗主要采用综合治疗 :化疗 +放疗 ,手术 +放疗。随访 3年存活率 5 0 .0 %。结论 :腭扁桃体非霍奇金氏淋巴瘤临床有其特征性 ,早期确诊为局部活检 ,免疫组化有助鉴别诊断 ,治疗上采用综合治疗。早期诊断和尽早化疗是本病患者提高生存期的重要条件     

蝶窦B细胞性非霍奇金淋巴瘤的诊治(附1例报告及文献复习)

目的提高临床医生对蝶窦B细胞性非霍奇金淋巴瘤的认识,概括其诊断要点,避免误诊。方法分析我科收治的1例蝶窦B细胞性非霍奇金淋巴瘤的临床特征、病理特点、诊断要点与治疗,并复习相关文献。结果在全麻下行鼻内镜下蝶窦开放术,并辅以放疗、化疗,随访1年无复发。结论原发于蝶窦的淋巴瘤较罕见,其早期诊断困难。病检取材与CT阅片在其诊断中需要重视。外科手术联合放疗、化疗可以延长早期鼻腔淋巴瘤患者的生存时间、延缓肿瘤的复发。     

60例鼻部非霍奇金氏淋巴瘤临床分析

目的 探讨鼻部非霍奇金氏淋巴瘤(non—Hodgkin’slymphoma)临床治疗结果，就临床分期与预后的关系进行讨论。方法 就60例鼻部非霍奇金氏淋巴瘤患者的临床表现、实验室检查及影像学(CT)资料，采用Ann Arbor临床分期，结合放疗为主的治疗结果进行分析。结果 临床Ⅰ期、Ⅱ期、Ⅲ期的5年生存率分别为92．86％(13／14)，41．67％(10／24)和11．11％(2／18)；4例临床Ⅳ期病人均在1年内死亡；60例病人的1年、2年、3年和5年生存率分别为：81．67％(49／60)，61．67％(37／60)，51．67％(31／60)和41．70％(25／60)。结论 鼻部非霍奇金氏淋巴瘤临床分期与预后关系密切；早期诊断和治疗是治愈的关键。     

鼻腔、咽部非霍奇金氏淋巴瘤

目的 :探讨鼻腔、咽部非霍奇金氏淋巴瘤 ( NHL)的临床特征、诊断要点及误诊原因。方法 :对1 986年～ 1 996年住院的 2 4例鼻腔、咽部非霍奇金氏淋巴瘤的患者作一回顾性分析。结果 :2 4例临床表现差异较大 ,缺乏特征性的表现。首次诊断 NHL6例 ,其余 1 8例初诊时诊断 :慢性鼻炎 8例 ,恶性肉芽肿3例 ,鼻息肉 2例 ,鼻中隔粘膜肥厚 2例 ,扁桃体炎 2例 ,慢性咽炎 1例。 2 4例均经病理切片及免疫组化确诊。结论 :鼻腔、咽部非霍奇金氏淋巴瘤临床表现复杂 ,缺乏特征性 ,早期易误诊。提高临床医师对本病的认识 ,反复活检及免疫组化等方法有利于本病的确诊。     

14例腭扁桃体非霍奇金氏淋巴瘤的临床分析

目的：探讨原发于腭扁桃体非霍奇金氏淋巴瘤（non-Hondgkin's lymphoma,NHL)的临床表现、诊断和治疗。方法：回顾性分析1992年－2000年收治的14例原发于腭扁桃体非霍奇金氏淋巴瘤。全部肿瘤病灶活检，病理确诊。结果；其临床有特征性表现，主要为咽肿痛、颈部肿块、吞咽困难，病变扁桃体早期多以结节型增生，呈外生性生长。治疗主要采用综合治疗，化疗＋放疗，手术＋放疗。随访3年存活率50．0％。结论：腭扁桃体非霍奇金氏淋巴瘤临床有其特征性，早期确诊为局部活检，免疫组化有助鉴别诊断，治疗上采用综合治疗。早期诊断和尽早化疗是本病患者提高生存期的重要条件。     

鼻黏膜相关淋巴组织淋巴瘤临床特征及治疗(11例报告及文献复习)

目的:探讨鼻黏膜相关淋巴组织淋巴瘤(MALTL)的临床特征及治疗,提高对鼻MALTL的认识.方法:回顾性分析9年来我科收治的11例鼻MALTL的临床表现和治疗方法.结果:11例随访6个月～3年.4例死亡,7例完全缓解.结论:鼻MALTL无特异性临床表现;早期易误诊或误治.鼻内镜检查发现可疑者应尽早完整切除送病理检查.鼻MALTL是非霍奇金淋巴瘤的一种亚型,起病隐匿,病程长,进展慢,晚期患者治愈率低.     

The treatment and outcome analysis of primary squamous cell carcinoma of the thyroid

Objectives

Primary squamous cell carcinoma (SCC) of the thyroid is a rare disease. It usually presents with locally advanced disease and has an overall poor prognosis. In this study, we investigated the characteristics and outcomes of patients with SCC of the thyroid, and reported our experience with chemotherapy with lenvatinib in the treatment of SCC of the thyroid.

分化型甲状腺癌侵犯喉气管临床分析

目的　探讨甲状腺癌累及喉、气管时的外科处理方法。方法　2000年1月～2010年12月在我院手术治疗晚期分化型甲状腺癌24例,根据肿瘤侵犯喉、颈段气管的范围及程度分别行肿瘤削除术和气管袖状切除端端吻合术;喉部分切除胸锁乳突肌或颈阔肌皮瓣修复术。结果　24例患者均接受根治性手术切除,喉、气管缺损修复重建。术式：肿瘤削除术8例,气管袖状切除8例,喉部分切除术8例。吻合方式：气管端端吻合8例,胸锁乳突肌皮瓣修复4例,颈阔肌皮瓣修复4例。本组患者肿瘤复发率为8.3%,5年累积生存率为91.6%。结论　对侵犯喉、气管的分化型甲状腺癌患者应采取更为积极的外科治疗,以减少术后复发,提高生存率。     

Aerodigestive tract invasion by well-differentiated thyroid carcinoma: diagnosis, management, prognosis, and biology

OBJECTIVES/HYPOTHESIS: 1) To describe the clinical entity invasive well-differentiated thyroid carcinoma (IWDTC), 2) to determine prognostic factors for survival in patients with IWDTC, 3) to describe and compare types of surgical resection to determine treatment efficacy, 4) to offer a staging system and surgical algorithm for management of patients with IWDTC, 5) to examine alterations in expression of E-cadherin and beta-catenin adhesion molecules in three groups of thyroid tissue and propose a cellular mechanism for invasion of the aerodigestive tract. STUDY DESIGN: Basic science: quantification of expression of E-cadherin and beta-catenin in three groups of thyroid tissue. Clinical: retrospective review of patients with IWDTC surgically treated and followed over a 45-year time period. METHODS: Basic science: immunohistochemical staining was used with antibodies against E-cadherin and beta-catenin in three groups of tissue: group 1, normal control thyroid tissue (n = 10); group 2, conventional papillary thyroid carcinoma (n = 20); group 3, IWDTC (n = 12). Intensity scores were given on the basis of protocol. One-way analysis of variance (ANOVA) was used to evaluate differences between groups. Post hoc ANOVA testing was completed. P < .05 was significant. Clinical: patients were divided into three surgical groups within the laryngotracheal subset: group 1, complete resection of gross disease (n = 34); group 2, shave excision (n = 75); group 3, incomplete excision (n = 15). Cox regression analysis was used to determine significance of prognostic factors. Kaplan-Meier plots were used to evaluate survival. P < .05 was significant. RESULTS: Basic science: a significant difference between the three thyroid tissue groups for E-cadherin expression was demonstrated on one-way ANOVA testing. When controls were compared with either experimental group in post hoc ANOVA testing, differences between all groups were demonstrated (P < .001). For beta-catenin, the intensities of the three groups were not different by one-way ANOVA testing. Similar nonsignificant results were found on post hoc ANOVA testing. Clinical: there was a statistically significant difference in survival for patients with and without involvement of any portion of the endolarynx or trachea (P < .01). There was a significant difference among all three surgical groups when compared (P < .001). When complete and shave groups were compared with gross residual group there was a significant decrease in survival in incomplete resection group (P < .01). Cox regression analysis demonstrated invasion of larynx and trachea were significant prognostic factors for poor outcome. The type of initial resection was significant on multivariate analysis. Removal of all gross disease is a major factor for survival. CONCLUSIONS: Basic science: there is a decrease in membrane expression of E-cadherin in IWDTC, and loss of this tumor suppressor adhesion molecule may contribute to the invasive nature of well-differentiated thyroid carcinomas. Clinical: laryngotracheal invasion is a significant independent prognostic factor for survival. Patients undergoing shave excision had similar survival when compared with those undergoing radical tumor resection if gross tumor did not remain. Gross intraluminal tumor should be resected completely. Shave excision is adequate for minimal invasion not involving the intraluminal surfaces of the aerodigestive tract.     

Primary non-Hodgkin's lymphoma of the nasal cavity. Clinical case report and discussion

Primary non-Hodgkin's lymphoma of the nasal cavity is a disease more likely to affect men than women; it is characterized by a T cell immunophenotype and is often associated with involvement of the paranasal structures and with high recurrence rates. Many authors report that its extremely poor prognosis depends on tumour stage and extension into the paranasal sinuses. Patients with Ann Arbor stage IE limited to only one nasal cavity have better survival rates than those with the same stage but with tumour extension beyond the nasal cavity. Patients with stages IIE, IIIE and IV have a very poor prognosis that does not seem to be affected by the use of conventional chemotherapy. Optimal treatment for the disease is not yet known. The use of radiotherapy alone has been reported in initial stages of the disease; however, given that its prognosis is burdened by frequent local or systemic recurrence or both, combined modality therapy has been applied in all stages. In this case report we describe a case of primary non-Hodgkin's lymphoma of the nasal cavity localized at the middle turbinate, in combination with an updated literature review.     

Management considerations for differentiated thyroid carcinoma presenting as a metastasis to the skull base

OBJECTIVES/HYPOTHESIS: To characterize the salient features of skull base metastasis from differentiated thyroid carcinoma, discuss the diagnostic and treatment strategies, and propose rational management guidelines for such tumors. STUDY DESIGN: Case report. METHODS: Review of English literature from MEDLINE with the addition of our case. RESULTS: Skull base metastasis from differentiated thyroid carcinoma is rare, with only 20 cases reported to date, including our case report. On the basis of a review of all reported cases, both follicular and papillary thyroid cancers can metastasize to the skull base. Our case is unique because the lesion extends locally into the cavernous sinus and beyond. Histopathologic diagnosis is limited by the remote location of lesions. Most tumors are highly vascular, and there is potential for significant morbidity and mortality associated with surgical resection. The overall survival ranges from less than one year to 10+ years from the discovery of the metastasis and is similar in both tumor subtypes. There is no clear consensus on the management strategy for skull base metastasis from differentiated thyroid carcinoma. Interestingly, surgical resection of both the primary and metastatic lesions yields similar survival when compared with resection of the primary tumor alone. CONCLUSIONS: Distant metastasis from differentiated thyroid carcinoma needs to be considered in the differential diagnosis of destructive skull base lesions, regardless of the patient's age. Histopathologic tissue diagnosis should always be attempted, followed by total thyroidectomy, radioiodine, or external beam radiation, and chronic thyroid-stimulating hormone suppression. Surgical resection of the metastatic lesion should only be performed in carefully selected cases because it is associated with significant morbidity.     

12例原发性甲状腺鳞状细胞癌的临床及生存分析

目的 探讨原发性甲状腺鳞状细胞癌(PSCCT)的临床特征、生存分析及预后影响因素。方法 回顾性分析12例PSCCT患者的临床表现、甲状腺超声特点、治疗方式、组织病理学特点及预后情况。采用Kaplan-Meier法及Log-rank检验、Cox比例风险回归模型进行生存分析。结果 单因素分析显示,是否合并乳头状癌与甲状腺鳞癌总生存期(OS)相关;多因素分析显示,未合并乳头状癌是OS的危险因素。结论 PSCCT是罕见的甲状腺恶性肿瘤,恶性程度高,病情发展迅速,预后差。临床在诊断PSCCT的同时确定其是否合并乳头状癌,选择恰当的治疗方式是提高患者生存率的关键。     

Statistical analysis of localized non-Hodgkin's lymphomas of the head and neck--multivariate analysis of prognostic factors and evaluation of therapeutic modalities]

Prognostic factors and treatment outcome of 48 patients with Stage I (29) or II (19) non-Hodgkin's lymphoma of the head and neck were analyzed retrospectively. There were 26 males and 22 females, aged from 15 to 89 years old, with an average age of 57. The primary lesion was located in Waldeyer's ring in 25 patients, the nasal cavity and paranasal sinuses in 13, cervical lymph nodes in 8, and others in 2. Histologically, 2 had low grade lymphoma, 42 had intermediate grade disease, and 1 had high grade disease. The patients were treated with radiation alone (5 patients), chemotherapy according to a cyclophosphamide, doxorubicin, vincristine, prednisone- (CHOP) regimen (8 patients), or a combination of both treatments (35 patients). In univariate analyses, an unfavorable prognosis was associated with age > or = 60, Stage I disease, and extralymphatic lesion. Multivariate analysis showed that an extralymphatic lesion was a significant independent risk factor for death (p = 0.0093). The overall five-year survival rate was 73.5%. Differences in the treatment was not reflected in the outcome. Our results suggest that a combination of chemotherapy (CHOP) and radiation is an appropriate treatment for lymphatic stage I and II non-Hodgkin's lymphoma of the head and neck. However, more intensive therapy is necessary for patients with extralymphatic head and neck NHL.     

原发性甲状腺B细胞淋巴瘤的临床分析

目的:探讨原发性甲状腺B细胞淋巴瘤的临床表现、诊断及治疗。方法:回顾性分析8例原发性甲状腺B细胞淋巴瘤患者的临床资料,采用多种手段综合诊断及多种方法综合治疗。结果:随访2～7年,失访3例,死亡1例,存活4例,2年生存率为85.1%,5年生存率为76.3%。结论:多种手段综合诊断及多种方法综合治疗原发性甲状腺B细胞淋巴瘤,可提高诊断率,减少误诊,提高疗效。     

甲状腺鳞状细胞癌的治疗和预后

目的:探讨甲状腺鳞状细胞癌的治疗及预后。方法:对1994-12-2008-12间本院收治的全部甲状腺鳞状细胞癌患者的资料进行回顾性分析。结果:总的1年、3年生存率分别为36.4%和9.1%,中位生存期8个月;生存分析显示接受手术加术后放疗模式者预后较好。结论:甲状腺鳞状细胞癌预后极差;对甲状腺鳞状细胞癌患者给予手术加术后放疗可能有利于改善其预后。