原发性纵隔肿瘤的诊断和外科治疗

纵隔肿瘤是较为常见的胸部疾病,手术是其首选治疗方法.1982年4月～2009年2月,本科共收治原发性纵隔肿瘤80例,均经手术及病理确诊,现报告如下.     

原发性纵隔肿瘤的临床诊治分析

目的探讨原发性纵隔肿瘤的临床诊治措施。方法回顾分析65例患者的临床资料。结果本组死亡1例，为3个月患儿纵隔巨大淋巴囊肿术后死于呼吸衰竭。其余均恢复出院。结论纵隔肿瘤一旦确诊，只要没有明确的远处转移和呼吸、循环系统功能不全，以及没有重要脏器功能严重受损者均应尽早手术治疗，即使无法手术根治的患者，也应尽量行姑息性减状手术以减轻患者的痛苦，提高生存质量。     

原发性纵隔精原细胞瘤

原发性精原细胞瘤是纵隔障内十分罕见的肿瘤。本病临床症状少,术前确诊困难,肿瘤呈侵润性生长,切除率极低,但对放射治疗极为敏感且复发少,能较长时间生存。故主张积极行手术探查,不应因晚期恶性肿瘤而盲目放弃治疗。本文报告了2例治疗及随访结果。     

原发性纵隔肿瘤60例诊治分析

目的 :总结原发性纵隔肿瘤的临床诊断与外科治疗特点。方法 :对 1986年 10月～ 2 0 0 1年 3月收治、资料比较完整的 6 0例病例进行总结分析。结果 :术前明确诊断 5 1例 ,误诊 9例 ;手术切除 5 6例 ,单纯探查 4例 ,手术死亡 2例。结论 :( 1)对纵隔肿瘤的诊断要X线检查、CT和超声检查相结合 ,特别要注意胸部大血管的超声检查 ,以减少误诊。 ( 2 )切口选择以能充分暴露肿瘤和保障安全为宜 ,对巨大肿瘤 (特别是对良性实体肿瘤 )可以分块切除 ,巨大囊性肿瘤可以先行囊内切除减压 ,然后争取完全切除肿瘤。     

原发性纵隔肿瘤的临床分析(附246例报告)

原发性纵隔肿瘤的临床分析(附246例报告) 付军科　 梁景仁　 秦志端　 李兆志　 关键词：纵隔肿瘤;　病理学;　外科手术 分类号：R734.5　文献标识码：B 文章编号：1008-6315(2001)01-0050-02 作者单位：付军科（西安医科大学第一附属医院 710061）　 　　　　　梁景仁（西安医科大学第一附属医院 710061）　 　　　　　秦志端（西安医科大学第一附属医院 710061）　 　　　　　李兆志（西安医科大学第一附属医院 710061）　 参考文献： ［1］Gibbon S.Surgery of the chest.3rd Edition.Toron to:Saunders WB company, 1976.406-422 ［2］张大为,黄国俊,许佩璋,等.原发性纵隔肿瘤及囊肿327例的外科治疗.中华肿瘤杂志,1985,7(2)：123 ［3］赵富元,安若昆,王恩酮,等.原发性纵隔肿瘤的诊断和外科治疗.中华胸心血管外科杂志,1990,6(2)：159 ［4］罗　迪,丁嘉安,计威康,等.原发性纵隔肿瘤的外科治疗(附101例分析).中华肿瘤杂志,1981,3(3)：200 ［5］孙衍庆,吴兆荣,朱大雷,等.原发性纵隔肿瘤与囊肿的诊断与鉴别诊断.中华外杂志,1984,22(10)：581 收稿日期：2000年7月18日 修稿日期：2000年9月11日     

原发纵隔肿瘤的诊断和外科治疗

１９８０年１月￣１９９３年１２月手术治疗纵隔肿瘤４３例，其中畸胎类肿瘤１７例，胸腺肿瘤１４例，神经源性肿瘤７例，纵隔囊肿３例，其他少见肿瘤２例，全部治愈．本病一旦确诊皆应手术治疗。文中讨论了纵隔肿瘤胸部Ｘ线检查及超声检查的征象特点，诊断和鉴别诊断，并介绍了手术技术和经验。     

全胸腔镜纵隔肿瘤切除31例临床分析

目的 探讨全胸腔镜纵隔肿瘤切除的手术方法及临床疗效.方法 回顾性总结分析该院2006年4月～2010年2月施行全腔镜下纵隔肿瘤切除31例,对该术式的疗效、住院时间、并发症、适应证进行分析.结果 31例全部经胸腔镜成功完成手术.术后恢复良好,无围手术期并发症.结论 全胸腔镜手术创伤小,安全有效,适合于多数纵隔肿瘤治疗,尤其是纵隔良性肿疮的切除.     

125I粒子植入在治疗纵隔区恶性肿瘤中的应用

目的:评价125I放射性粒子植入治疗纵隔区恶性肿瘤的临床价值。方法:回顾分析我院2008年12月至2010年5月间收治的18例经病理确诊为恶性纵隔肿瘤患者,接受包括125I放射性粒子植入治疗在内的综合治疗。术后1个月复查胸部CT进行近期疗效评价。结果:18例患者中肿瘤完全缓解10例,部分缓解5例,无变化2例,进展1例,总有效率83.3%(15/18)。随访18例,随访时间12～30个月。1年局部控制率88.9%(16/18)。结论:125I粒子穿刺植入治疗纵隔恶性肿瘤安全、可行,配合手术和(或)药物化疗,近期治疗效果满意。     

原发性纵隔肿瘤586例外科治疗分析

目的：探讨原发性纵隔肿瘤的诊断及外科治疗的经验和体会。方法：回顾分析我院1960年6月至2003年11月收治并经病理证实的586例原发性纵隔肿瘤。结果：胸腺瘤277例，畸胎瘤111例，神经源性肿瘤99例，胸骨后甲状腺肿29例，其他肿瘤79例；纵隔肿瘤完全切除534例，开胸探查肿瘤活检52例；术后死亡15例。结论：原发性纵隔肿瘤的诊断主要依靠CT检查，治疗应以手术为主。     

纵隔原发性恶性纤维组织细胞瘤的诊断与治疗

目的:探讨纵隔恶性纤维组织细胞瘤临床特点、病理特征、诊断和治疗。方法:回顾分析1992—2005年6例纵隔原发性恶性纤维组织细胞瘤的临床和病理资料。结果:全组均行手术治疗,姑息切除1例,纵隔肿瘤切除4例,纵隔肿瘤加右肺下叶背段和后基底段切除1例。术后病理检查确诊。术后无并发症和死亡。术前诊断为气管囊肿1例;支气管肺囊肿1例,肺恶性纤维组织细胞瘤1例;纵隔肿瘤3例。肿瘤细胞呈多形性,以梭形纤维母细胞和组织细胞样细胞为主,并混有各种过渡型细胞、未分化及多核巨细胞等,3例免疫组化检查示肿瘤细胞Vimentin、CD68、AACT及AAT均表达阳性。结论:该病临床症状无特征性,术前确诊极为困难,应结合临床表现和形态学及免疫组化标记综合考虑。该病应手术治疗,彻底切除是手术的关键。该病恶性度高,易复发和转移,预后不佳。     

经胸超声心动图可用于无症状纵隔肿瘤的诊断

目的评价经胸超声心动图对纵隔肿瘤的诊断价值。方法回顾性分析2018年1月1日~2019年12月31日经胸超声心动图检查首次发现纵隔肿瘤的体检者临床资料,总结纵隔肿瘤在经胸超声心动图中的超声特点,并分别与放射影像（X线和CT扫描）及组织病理对比。结果共获得20例经胸超声心动图诊断纵隔肿瘤的无症状患者,检出纵隔肿瘤分为囊肿9例、胸腺肿瘤5例、淋巴结肿大3例、畸胎瘤2例、淋巴瘤1例。相较X线诊断而言,超声检查纵隔肿瘤有着较为明显的优势。此外,超声对纵隔肿瘤的检查价值也不亚于CT检查（Kappa=0.792,P＜0.001）。以病理检查结果为金标准,经胸超声心动图诊断纵隔肿瘤的误诊率为15%,对肿物良恶性质诊断的敏感性为75%,特异性为92%。结论经胸超声心动图检查可以用于纵隔肿瘤的诊断,不仅能对纵隔占位病变的内部结构进行观察,还可以对其良恶性质进行判定。      

Thoracoscopic resection of a cystic seminoma of the mediastinum

Mediastinal seminoma is an uncommon tumor that accounts for 25% of primary mediastinal germ cell tumors, which in turn comprise fewer than 5% of all germ cell tumors. Although CT normally shows a solid, lobulated tumor, mediastinal cystic seminoma has rarely been described. Here, we report a 24‐year‐old man who presented with a mediastinal cystic tumor that was resected after an 18‐month delay via video‐assisted thoracoscopic surgery while in the supine position; the procedure involved lifting the chest wall with a subcutaneous Kirschner wire. Pathological examination revealed a mediastinal cystic seminoma. No evidence of recurrence has been noted during 25 months of follow‐up. Mediastinal cystic seminoma should be considered in the differential diagnosis of cystic lesions of the mediastinum. Moreover, video‐assisted thoracoscopic resection may be an appropriate option for the diagnosis and treatment of such lesions.     

纵隔肿瘤的CT诊断

目的探讨cT对纵隔肿瘤的诊断价值,以提高对纵隔肿瘤的准确诊断。方法收集16例经手术或病理证实的纵隔肿瘤的相关资料,结合文献,进行回顾分析。结果胸腺瘤6例,胸内甲状腺3例,支气管囊肿2例,恶性淋巴瘤2例,神经源性肿瘤2例,畸胎瘤1例。CT定位准确率100％,定性准确率93．75％。结论CT检查是诊断纵隔肿瘤最有效的方法之一,根据纵隔肿瘤的发生部位、影像学特征及得当的检查方法,并密切结合临床资料及实验室检查,一般均能对纵隔肿瘤做出准确的诊断。     

Ganglioneuroma masquerading as spinal pain

OBJECTIVE: To discuss the clinical features of ganglioneuroma and to propose it as a differential diagnosis for a young patient suffering from chronic back pain. CLINICAL FEATURES: A 25-year-old patient suffered from chronic mid-thoracic pain and a history of scoliosis. The physical examination result was unremarkable; thus radiographs were obtained. A posteroanterior and lateral chest radiograph demonstrated a well-defined opacity extending from the region of the left hilum to below the diaphragm. A differential diagnosis of a posterior mediastinal mass was advanced. Computed tomography revealed a homogenous, nonenhancing left posterior mediastinal mass with adjacent posterior rib deformity. Computed tomography (CT)-guided biopsy subsequently defined the mass as a ganglioneuroma. INTERVENTION AND OUTCOME: The mass was surgically resected. Although the patient experienced some postsurgical discomfort, she has fared well. CONCLUSION: Twenty percent of mediastinal tumors are neurogenic, and 10% of neurogenic tumors are ganglioneuromas. In spite of the rarity of this tumor, ganglioneuroma should be considered in the differential diagnosis of young patients suffering from back pain. The diagnosis is important to ascertain because surgical resection is curative and can relieve the symptoms.     

Endoscopic ultrasonography in the diagnosis and staging of neoplasms of the head and neck

BACKGROUND AND STUDY AIMS: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a minimally invasive and highly accurate method of detecting mediastinal lymph-node metastases in gastrointestinal and lung cancer. Little information is available regarding the use of EUS-FNA to stage tumors in the head and neck region. This study reports experience with EUS in the diagnosis and staging of these tumors and their mediastinal spread. PATIENTS AND METHODS: The records of patients who underwent EUS for diagnosis and/or staging of head and neck tumors were reviewed. Referral criteria were suspected invasion of the esophagus by a lower-neck mass on cervical computed tomography (CT) or magnetic resonance imaging (MRI), or mediastinal lymphadenopathy > 10 mm on a chest CT. RESULTS: Thirty-two patients (23 men, nine women; mean age 65 years, range 44 - 80) were referred and underwent 35 EUS examinations. In one patient, EUS was not possible due to a benign esophageal stricture. In 17 patients with suspected esophageal invasion on CT scans, EUS demonstrated invasion of the esophagus in four cases and of the pleura in one; 12 tumors showed no visible invasion of adjacent structures. The other 17 examinations were carried out for suspected mediastinal metastatic disease. In eight cases, EUS-FNA confirmed metastatic disease, whereas only benign changes were shown in the other nine cases. EUS-FNA also provided the first tissue diagnosis in two primary tumors and identified malignancy in one patient with no CT suspicion of positive mediastinal lymph nodes. EUS avoided the need for more invasive investigations in all patients with mediastinal lymphadenopathy, and it changed the management in 12 of the 17 patients (71 %) with suspected esophageal invasion and in eight of the 17 patients (47 %) with suspected mediastinal disease. CONCLUSIONS: EUS with FNA provides a viable approach to the diagnosis and staging of tumors in the head and neck region when there is a suggestion of esophageal invasion on CT or MRI, or enlarged mediastinal lymph nodes. EUS with FNA may avoid the need for mediastinoscopy or other more invasive techniques for staging of these neoplasms.     

Distant lymph node metastases in esophageal cancer: impact of endoscopic ultrasound-guided biopsy.

BACKGROUND AND STUDY AIMS: The aim of this retrospective study was to evaluate the impact of endoscopic ultrasound (EUS)-guided biopsy in patients with esophageal carcinoma where distant lymph nodes which were possibly metastatic were visualized using EUS. PATIENTS AND METHODS: Out of 198 patients (150 men, mean age 66 years) examined over a 4-year period by EUS for local staging of esophageal cancer (121 squamous cell carcinomas and 77 adenocarcinomas), there was EUS visualization of distant lymph nodes in 40 (20%). EUS-guided biopsy was carried out in the latter patients, of cervical nodes with mediastinal tumors (n = 19), of celiac nodes with cervical tumors (n = 2) or superior mediastinal tumors (n = 9), and upper mediastinal lymph nodes in the case of distal adenocarcinomas (n = 10). RESULTS: On EUS-guided biopsy, results were positive in 31 patients, eight were correctly negative (as confirmed by surgery), and in one patient there was a technical failure, with positive findings on subsequent surgery. The sensitivity and specificity of the diagnosis of malignant lymph nodes were therefore 97% and 100% respectively. The positive results of EUS-guided biopsy modified the tumor staging in 31 of these cases (77.5%), proving distant lymph node metastasis which is classified as stage M1. With regard to actual clinical management, surgery was withheld from 24 patients (60% of 40 cases) who were then treated with concomitant radiotherapy and chemotherapy. CONCLUSION: EUS-guided biopsy of distant lymph nodes was indicated in 20% of patients with esophageal cancers, and the biopsy results led to upgrading of the tumor stage in about 80% of cases and influenced the treatment decision in about 60%.     

超声对纵隔肿瘤的诊断价值

目的评价常规超声及介入超声对纵隔肿瘤的诊断价值。方法对临床诊断前纵隔肿瘤的56例患者进行超声：检查，并对其中46例进行超声引导下穿刺活检。结果56例前纵隔肿块超声均能显示，显示率100％；纵隔肿瘤穿刺活检者获确切病理诊断的占73．0％(32／44)，可疑诊断及不能帮助诊断者各占13．5％(6／44)。无并发症发生。结论常规灰阶超声能对大多数前纵隔肿瘤作出定位诊断；实时超声观察能清楚地显示肿块与心脏大血管的关系，从而准确地引导穿刺活检，使超声引导下纵隔肿瘤的穿刺活检成为一项安全可靠、简便、价廉的技术。     

B型超声对纵隔肿瘤诊断价值的探讨

目的 探讨B超诊断纵隔肿瘤的特征和鉴别诊断的价值。方法 对22例纵隔肿瘤患者通过观察肿块的形态、内部结构和物理性质，同时对照手术、病理结果确定B超诊断。结果 超声提示的诊断与手术、病理结果相符。结论 B超对纵隔肿瘤性质的诊断有一定的帮助，对确定手术方式和选择纵隔穿刺点有一定的价值。     

Endoscopic ultrasound-guided fine-needle aspiration biopsy of liver lesions: histological and cytological assessment

BACKGROUND AND STUDY AIMS: EUS-guided fine-needle aspiration biopsy (EUS-FNA) is used increasingly for the diagnosis of mediastinal, biliopancreatic, and gastric tumors. However, little is known about EUS-FNA in hepatic lesions and the best method for tissue analysis. We assessed EUS-FNA combined with histological and cytological evaluation in selected patients. PATIENTS AND METHODS: 41 patients (66 +/- 7 years) were prospectively studied, 33 of whom had clinical findings suggestive of liver malignancies. Selection for EUS-FNA was based on an increased risk of bleeding from percutaneous biopsy (coagulopathy, cirrhosis, ascites, aspirin intake; n = 15), presence of small liver tumors < 2 cm (n = 12), or liver lesions found incidentally (n = 14). Transgastric EUS-FNA of lesions located in accessible liver segments was performed using the Hitachi FG-34UX longitudinal echo endoscope and a 22-G aspiration needle. Specimens were submitted separately for standard cytological and histological evaluation. In the case of malignancies, findings at surgery with histological examination, endoscopy, or computed tomography (CT)-guided biopsy of the primary cancer served as reference results (n = 33), while in benign disorders, a combination of imaging studies (Magnetic Resonance Tomography , scintigraphy) and the clinical follow-up, as summarized in the physician's report, was used as reference. RESULTS: EUS-FNA provided appropriate biopsy specimens in 40/41 patients. It was not possible to aspirate sufficient material in one patient. On average, 1.4 needle passes were necessary to obtain sufficient amounts of tissue. With regard to malignancy, the combination of histological and cytological examination had a sensitivity of 94%, specificity of 100%, negative predictive value (NPV) of 78%, and positive predictive value (PPV) of 100%. Tissue diagnoses were in agreement in 27/41 patients (65%). In the remaining patients, only the cytological examination identified six lesions correctly, while the histological assessment was correct in another seven patients. Malignant lesions were correctly identified by cytology in 24/33 (73%) patients, while histology alone was diagnostic for malignancy in 27/33 (82%) patients. When both modalities were combined, 31 out of 33-malignancies (94%) were correctly diagnosed. Minor complications occurred in two patients and consisted of self-limiting local bleeding. CONCLUSIONS: EUS-FNA of liver tumors is a powerful, reliable, and safe procedure for the diagnosis of malignant liver lesions. Optimal diagnostic results are achieved by combining cytological with histological assessment. Hence, EUS-FNA is an alternative to percutaneous biopsy, particularly in patients at risk of bleeding or with small lesions of the liver.     

Primary small bowel tumors: a radiologic-pathologic correlation

Background: Primary small bowel tumors are rare and their preoperative diagnosis is unsatisfactory. The cornerstone of diagnosis remains contrast radiography. The present study was done to evaluate the radiologic findings of primary small bowel tumors as shown on enteroclysis and to correlate these observations with surgical and histopathologic findings. Methods: Seventy two patients with primary small bowel tumors identified by enteroclysis were evaluated. All the patients were subjected to jejunal biopsy or surgery. The diagnosis was established by histopathologic examination in all cases. Results: Radiologic findings were suggestive of benign tumors in 19 patients and malignant tumors in 31 patients. Nonspecific findings in the form of diffuse involvement of the small bowel were noted in 22 patients. There was 100% radiologic–surgical correlation. Leiomyomas and lymphomas were the most common benign and malignant tumors, respectively. Tumor specificities were 89.5% for benign tumors and 41.5% for malignant tumors. Conclusion: Distinctive morphologic patterns as shown on enteroclysis are highly suggestive of specific tumor types in the majority of cases. Received: 25 April 2000/Revision accepted: 20 September 2000