卵巢性索间质肿瘤69例临床观察

目的探讨卵巢性索间质肿瘤临床表现及早期诊断要点。方法回顾分析我院近6年收治的卵巢性索间质肿瘤69例的临床资料，并查阅有关文献。结果随访3年～10年不等，少见因本病死亡者。结论对腹部包块伴雌激素刺激症状的妇女，应该注意此类肿瘤的可能。     

Vulvar granular cell tumor

Granular cell tumors are rare, usually benign, soft tissue neoplasms of neural origin. They occur more often in females than males, the peak age incidence is in the fourth through fifth decades. They can occur anywhere in the body with up to 15% situated in the vulva. The commonest presentation is as an asymptomatic mass. Microscopic findings are usually sufficient, but immunohistochemistry can also be helpful in confirming the diagnosis. The vulvar tumors are benign in 98% of cases with 2% reported as malignant. In this case report we describe a woman with a granular cell tumor confirmed by biopsy who underwent excision of the mass but with focal extension to the resection margin on microscopy. Our recommendation of re-excision was declined. Since it is not uncommon with these tumors to find groups of tumor cells extending beyond the macroscopic limits of growth, we conclude that it is advisable to have margins assessed intraoperatively by frozen section such that further excision can be performed for positive margins. Our patient has been followed for 18 mo without recurrence, should the tumor recur, re-excision, with frozen section control, is indicated. Recurrence rates are reported as 2%-8% with clear margins and 20% with positive margins.     

Collision lung tumor associating typical carcinoid tumor to sclerosing hemangioma

Collision tumors associating carcinoid tumor and sclerosing pneumocytoma have rarely been reported in the literature. The clinical presentation may be challenging especially in cases showing multiple and bilateral nodules. This case illustrates the association of both tumors diagnosed incidentally and illustrates a full spectrum of neuroendocrine lesions and sclerosing pneumocytoma. The authors present the case of a 52‐year‐old patient presenting an abdominal pain revealing a vesicular lithiasis and multiple pulmonary nodules. Radiologic follow‐up of the asymptomatic lung lesions revealed the stabilization of a left lobe lesion with a disappearance of the other lesions. A lobectomy with a mediastinal lymph node curettage was performed. The microscopic examination revealed both tumor components associating a typical carcinoid tumor to a sclerosing pneumocytoma in association to lesions of diffuse neuroendocrine hyperplasia present in the peri‐tumoral parenchyma. This case illustrates radiologic, gross, and microscopic features of a rare pulmonary tumor.     

Adult‐type granulosa cell tumor: An unusual testicular tumor

Adult type granulosa cell tumours are extremely rare. Albeit mostly benign, 10% have malignant potential associated with unfavorable pathological features. The present case with the longest history duration, shows that size alone may not necessarily be unfavorable prognosticator when not associated with other factors.     

恶性肿瘤特异性生长因子对小儿恶性肿瘤的诊断价值

目的　探讨恶性肿瘤特异性生长因子 (TSGF)在小儿恶性实体瘤诊断中的临床意义。方法　对正常组 (16 8例 )、良性肿瘤组 (32例 )、恶性肿瘤组 (5 1例 )及感染组 (31例 )血清中TSGF的浓度分别进行检测。结果　恶性肿瘤组病儿血清中TSGF浓度与正常组比较明显升高 (P <0 0 1) ,良性肿瘤组与正常组比较无差异性。感染组病儿在治疗前血清中TSGF浓度与正常组比较也有升高 (P <0 0 1) ,但治疗后 2周血清中TSGF浓度会下降至参考范围内。以6 0U/ml为参考值 ,则诊断灵敏度为 88%、特异性为 89%。结论　TSGF对小儿恶性实体瘤有诊断意义 ,具有很高的特异性、敏感性和广谱性。炎症对TSGF有很强的干扰性 ,当使用TSGF作恶性肿瘤诊断时 ,应排除炎症因素。     

卵巢交界性浆黏液性肿瘤临床病理研究

目的探讨卵巢交界性浆黏液性肿瘤(SMBT)的临床病理特点。方法回顾性分析9例卵巢SMBT的临床病理资料,选取同期卵巢交界性浆液性肿瘤(SBT) 39例及黏液性肿瘤(MBT) 32例进行对比分析。结果 9例SMBT患者年龄21~69岁(中位年龄30岁),肿瘤大体呈囊性,直径3~13 cm,囊内含褐色或淡黄色脓液样黏液,囊内壁可见乳头状赘生物,直径0. 3~3. 5 cm。9例中,7例单侧,2例双侧,3例囊壁或乳头间质出现钙化(33%),4例病变伴随同侧卵巢子宫内膜异位(44%)。镜下8例SMBT以复杂的、纤维化、水肿性的乳头结构为特征,其中1例局部出现微乳头状结构,1例以微腺体增生为特征,表面衬覆多种细胞类型,包括黏液、浆液、中性细胞(indifferent cell)、透明、鳞状、鞋钉样或嗜酸性细胞。所有肿瘤的间质及腺腔内均见多量中性粒细胞浸润。8例FIGO分期Ⅰ期,1例FIGO分期Ⅱ期(伴同侧输卵管种植),术后随访8~84个月,无复发或进展。SMBT与SBT、MBT比较,三者发病年龄、术前血CA125、血CA199、病变侧别无差异(P值均>0. 05)。三者是否伴有子宫内膜异位症及钙化差异性显著(P<0. 01)。结论卵巢SMBT以乳头状或微腺体增生样结构为特征,形态与SBT有一定重叠。而对于其组织起源、分子特征及预后尚需进一步研究明确。     

肿瘤标志物Cyclin D1与肿瘤预后相关性

Ｃｙｃｌｉｎ Ｄ１是一种重要的细胞增殖因子，是近几年才被确定的原癌基因，它通过促进Ｇ１－Ｓ期的转变而促进细胞周期。多种研究表明Ｃｙｃｌｉｎ Ｄ１基因扩增和（或）过表达与肿瘤发生、进展及预后有关。本文就Ｃｙｃｌｉｎ Ｄ１与肿瘤预后相关性作一文献回顾。     

血管球瘤1例

患者,女,24岁.左手中指疼痛3年近日加重入院.体检:左手中指甲床呈蓝紫色,局部温度正常,触痛,屈指、伸指运动自如,指端无麻木.X线见中指末节指骨远端圆形缺损,边缘整齐(图1).术中见左手中指远端瘤样组织,直径约3 mm.呈紫色,包膜完整.术后病理报告:血管球瘤.     

Delineation of brain tumor margins using intraoperative sononavigation: implications for tumor resection

PURPOSE: Sonography has been employed for real-time intraoperative delineation of tumor boundaries during resection of brain tumors. However, the variably hyperechoic appearance of brain edema or gliosis surrounding the brain may interfere with accurate depiction of tumor margins. The goal of the present study was to use sononavigation, which provides coregistration between real-time sonograms and MRI scans, to assess the accuracy of sonographic determination of tumor margins. METHODS: Sononavigation was performed on 12 brain tumors (7 metastatic brain tumors, 2 meningiomas, 1 anaplastic oligodendroglioma, 1 anaplastic pilocytic astrocytoma, and 1 anaplastic astrocytoma). Sonograms of tumor margins were categorized into 1 of 3 types: in type 1, the tumor margin was clearly visualized and corresponded to the margin of the enhanced lesion on MR scan in all areas; in type 2, the tumor margin was clearly seen in some areas but was obscure in others due to hyperechoic edema; and in type 3, the tumor margin was indistinguishable from surrounding tissues in all areas. RESULTS: Three metastatic brain tumors and 1 meningioma were categorized as type 1. Three metastatic brain tumors, 1 meningioma, and 1 anaplastic oligodendroglioma were categorized as type 2. The anaplastic pilocytic astrocytoma, 1 metastatic brain tumor (which consisted mainly of necrotic tissue), and the anaplastic astrocytoma were categorized as type 3. These data assist in determining whether the sonographic appearance of tumor margins is accurate and whether to rely on information from either sonography (type 1) or the sononavigation system when resecting tumor types 1, 2, and 3. CONCLUSIONS: Sononavigation can help categorize the sonographic tumor margins into 3 different patterns, and this categorization can assist in determining which imaging modalities are needed to better delineate the tumor margins for subsequent resection.     

胰腺实性假乳头状瘤与胰岛细胞瘤鉴别诊断的探讨

目的探讨胰腺实性假乳头状瘤(SPTP)与胰岛细胞瘤(ICT)的鉴别诊断要点。方法8例SPTP与11例ICT分别做HE、PAS、免疫组化(SP法)染色观察。结果8例SPTP患者平均年龄20.1岁,术后均无复发;肿块均有包膜,囊实性相间;组织学上,以瘤细胞围绕血管排列成假乳头状结构且伴有退行性改变为其特征。11例ICT患者平均年龄43.2岁,术后有2例复发;部分肿块有包膜,多为实性;组织学上,瘤细胞胞质少,细胞核内染色质呈细颗粒状,细胞排列成小梁状、腺泡状或实性。免疫组化显示,SPTP组瘤细胞AACT、ACT、Vim多为( ),CgA、CKI、ns多为(-)。结论瘤细胞的退行性变及假乳头状结构、免疫组化ACT、AACT、Vim( ),CK(-),有助于胰腺SPTP与ICT的鉴别。     

脑肿瘤卒中的MR特点

目的 提高脑肿瘤卒中ＭＲ特征的认识。方法 对２６例３７个瘤卒中和２５例单纯脑内血肿作影像对照。重点观察血肿的结构及在ＭＲ重度Ｔ２ＷＩ和梯度回波图像上血肿周围含铁血黄素沉积圈的出现率和寒带性，对瘤卒中和单纯血肿进行比较。结果 ３７个瘤卒中，血肿周围含铁血黄素沉积圈完全缺失１２个（３２％），部分缺失１９个（５１％）。厚度不均匀６个（１６％），而２５例单纯脑内血肿的血肿周围均可以见到寒带均匀的含铁血黄素沉积圈。结论 亚急性、慢性血肿周围含铁血黄素沉积圈的不完整性和不规则性可以作为诊断瘤卒中的一个重要依据。     

内皮祖细胞在肿瘤疾病中作用研究进展

内皮祖细胞是一类具有游走特性的能定向增殖分化为成熟血管内皮细胞的前体细胞,可自骨髓迁移至外周血,并分化为血管内皮细胞的祖细胞,不仅参与胚胎发育过程的血管发生和血管新生,且在肿瘤发生、发展及转移中起一定作用.本文就内皮祖细胞在肿瘤疾病中作用的研究进展作一综述.     

肿瘤患者的营养疗法

Nutritionindietisthematerialbasetokeeplivingandhealthy．Diethasdecisiveeffectonthebodyfunctionconditiontosomedegree．１PurposeofalimentotherapyTocorrectorimprovenutritiveconditionofthepatients，toimproveimmunefunctionespeciallyantineoplasticfunction，i．e．eliminatingpathogeneticfactorandsupportinghealthyenergy；Toimprovethequalityoflifeinthepatients，avoidanxietythroughadjustnutritiveconditionresultinginapleasantmentalenviron－ment；Toimprovethetoleranceofsurgerytreatments，reducepost－opera…     

肿瘤血管生成及其在乳腺肿瘤影像学中的应用研究

乳腺癌是女性常见的恶性肿瘤之一,早期诊断对其治疗和预后尤为关键,而肿瘤血管在肿瘤的发生、发展的各阶段中起着重要的作用。随着医学影像技术的发展,肿瘤血管的生成在肿瘤诊疗过程中的应用已成为影像学领域的研究热门,影像学诊断方法采用“肿瘤血管的生成”这一信息来提高乳腺肿瘤检测和鉴别诊断的准确率。目前检测乳腺肿瘤的常用影像学方法有超声、增强核磁、近红外线及动态光学等,本文就新生血管生成和其影像检测方法的应用作简要综述。     

肿瘤微环境下HMSC分化为肿瘤相关成纤维细胞及其对肿瘤生长作用的观察

摘要：目的：鉴定人骨髓间充质干细胞（human bone marrow-derived mesenchymal stem cell,HMSC）在肿瘤微环境下分化为肿瘤相关成纤维细胞（tumor associated fibroblast,TAF）及对肿瘤生长作用的观察。 方法：用Transwell实验鉴定HMSC向人胃腺癌细胞株（SGC-7901）迁移的能力。对与人胃癌组织或SGC-7901培养上清液（TCM）长期共培养后的HMSC细胞,用免疫荧光染色检测肌动蛋白微丝(F-actin)的表达、免疫细胞化学染色检测α-平滑肌肌动蛋白（α-smooth muscle actin,α-SMA）及波形蛋白（vimentin）的表达。用实时定量PCR法检测与胃癌组织及TCM共培养后的HMSC细胞中α-SMA表达水平。分别以SGC-7901细胞、SGC-7901细胞＋HMSC细胞、胃癌组织与HMSC共培养细胞＋SGC-7901细胞、TCM与HMSC共培养细胞＋SGC-7901细胞接种裸鼠,构建裸鼠致瘤模型,测定4组模型致瘤时间及瘤体大小。 结果：Transwell实验结果表明HMSC在肿瘤微环境诱导下具有向肿瘤迁移的能力,诱导后的HMSC细胞高表达TAF细胞表面特征蛋白F-actin、α-SMA及vimentin,实时定量PCR结果表明与胃癌组织及TCM共培养后的HMSC细胞α-SMA mRNA表达水平分别为(0.58±0.05)和(0.52±0.06),与对照组(0.35±0.04)相比明显增高（F=4.72,F=5.31,P均<0.05）。 裸鼠致瘤模型显示经肿瘤微环境诱导后的TAF可促进体内肿瘤生长。 结论：肿瘤微环境诱导下HMSC活化并可分化为TAF,并对肿瘤生长起到促进作用。     

CIK治疗恶性肿瘤的疗效及相关肿瘤标志物的变化

目的探讨CIK治疗恶性实体肿瘤的疗效及相关肿瘤标志物的改变。方法选择32例恶性实体肿瘤患者进行CIK治疗,观察治疗前后生活质量、客观疗效、肿瘤标志物及免疫指标的变化。结果 CIK治疗后患者卡氏评分(KPS)提高率59.4%,RR为46.9%,DCR为84.4%。治疗后,相关肿瘤标志物CEA、NSE、AFP、CA153、CA199、Fer检测值总体有所下降。CD_3~+较治疗前显著升高(P0.05)。CD_4~+、CD_8~+、CD_4~+/CD_8~+与治疗前相比无显著变化(P0.05)。结论 CIK细胞治疗可提高恶性实体肿瘤患者的生存质量,但相关肿瘤标志物无明显变化。     

卵巢性索间质肿瘤的超声表现与病理对照分析

目的探讨卵巢性索间质肿瘤（OSCST）的超声表现,对照病理诊断结果分析其声像图特点,提高对该病的诊断水平。方法回顾性分析经手术病理证实的23例OSCST的超声表现,并与病理资料对照分析。结果23例OSCST中实性肿块12例,囊实性肿块11例。12例实性肿块均为卵巢卵泡膜细胞纤维瘤,表现为形态规则、边界清、内部回声欠均匀的实性低回声。其中4例后方回声衰减。11例囊实性肿块中7例为卵巢颗粒细胞瘤、2例为支持一间质细胞瘤、2例为卵巢卵泡膜细胞瘤（OT）,表现为囊实性低回声肿块。边界清。内可见大小不等的囊性回声区。本组OSCST术前超声诊断18例与病理诊断相符（18／23）,误诊5例（5／23）,其中3例误诊为浆膜下肌瘤、2例误诊为卵巢癌。结论OSCST的二维超声表现有一定特征性,超声结合临床对其具有诊断价值。     

腹膜后巨大恶性孤立性纤维性肿瘤1例

1病例资料患者,男,27岁。主因腹痛40d伴呼吸困难1d就诊于我院急诊科。腹部增强CT提示：①左后纵隔跨膈肌延伸至腹腔巨大软组织肿物,考虑恶性可能;②左侧’肾上腺病灶,转移瘤可能;③脾脏低密度影;④脾周及腹腔内少量积液;⑤腹膜及肠系膜多发结节影,腹膜后多发增大淋巴结;⑥左侧少量,     

Uterine tumor resembling an ovarian sex cord tumor: A case report and review of literature

BACKGROUNDEndometrial stromal tumors originate from the endometrial stroma and account for < 2% of all uterine tumors. Uterine tumor resembling an ovarian sex cord tumor (UTROSCT) is a rare histological class of endometrial stromal and related tumors according to the latest World Health Organization classification of female genital tumors. Here, we report a case of UTROSCT in a 51-year-old woman.CASE SUMMARYA 51-year-old woman had irregular menses for 6 mo. The patient visited a local hospital for vaginal bleeding. Pelvic computed tomography (CT) showed a mass in the pelvic cavity. Five days later, she came to our hospital for further diagnosis. The results of contrast-enhanced CT and pelvic ultrasound at our hospital suggested a malignant pelvic tumor. She then underwent total removal of the uterus with bilateral salpingectomy. Postoperative histological examination showed that the tumor cells had abundant cytoplasm, ovoid and spindle-shaped nuclei, fine chromatin, a high nucleoplasm ratio, and a lamellar distribution. The findings were consistent with UTROSCT, and the results of immunohistochemical analysis supported that diagnosis. The tumor was International Federation of Gynecology and Obstetrics stage IB. No adjuvant therapy was administered after radical surgery. The patient was followed up for 58 mo, and no recurrence was found.CONCLUSIONWe report a case of UTROSCT with abnormal menstruation as a symptom, which is one of the most common symptoms. In patients with vaginal bleeding, ultrasonography can be used as a screening test because of its convenience, speed, and lack of radiation exposure. For patients with long-term tamoxifen use, routine monitoring of the endometrium is recommended. As UTROSCT may have low malignant potential, surgery remains the primary management strategy. Additionally, fertility preservation in patients of childbearing age is a vital consideration.     

天幕脑膜瘤的术后护理

目的探讨天幕脑膜瘤患者的术后护理。方法加强患者术后病情观察,监护生命体征的变化,防治并发症,维持良好的营养状态。结果15例患者术后未发生手术相关的感染或死亡。患者出院后经6个月~5年的随访,12例治愈;2例分别于手术后1年、4年复发,行再次手术治愈;1例肿瘤生长活跃,有恶性倾向。结论做好天幕脑膜瘤患者术后的护理,积极防治并发症,是促进患者早日康复的重要环节。