原发性附睾肿瘤的诊断与治疗(附35例报告)

目的:探讨原发性附睾肿瘤的诊断及治疗方法。方法:回顾性分析本院35例原发性附睾肿瘤患者的临床资料。行肿瘤切除术10例,患侧附睾切除23例,患侧睾丸附睾切除加腹股沟淋巴结清扫1例,患侧根治性睾丸切除加二期腹膜后淋巴结清扫术1例。附睾恶性纤维组织细胞瘤1例术后辅以放疗及化疗。结果:术后病理诊断良性肿瘤33例,其中腺瘤样瘤21例,平滑肌瘤7例,纤维瘤4例,乳头状囊腺瘤1例;恶性肿瘤2例,附睾恶性纤维组织细胞瘤1例,附睾腺癌1例。35例术后随访10个月至6年,未见复发、转移及死亡病例。结论:原发性附睾肿瘤术前明确诊断困难,对于高度怀疑附睾肿瘤的患者应首选手术探查,良性者可行肿瘤或附睾切除,恶性者行根治性睾丸切除加腹膜后淋巴结清扫术。     

小儿原发性睾丸肿瘤的诊断和治疗

目的 提高小儿睾丸肿瘤的临床诊断和治疗水平.方法 回访近6年27例小儿原发性睾丸肿瘤患者,平均年龄41.3个月(1～150个月),平均病程14个月,其中25例源于生殖细胞,17例为良性畸胎瘤;恶性胎瘤10例,其中6例为卵黄囊瘤,2例为胚胎性癌,非生殖细胞恶性肿瘤2例.结果 所有患儿随访1～6年,良性畸胎瘤患儿均施行保睾手术,预后良好.10例恶性肿瘤行根治性睾丸切除,其中3例辅加单侧腹膜后淋巴结清扫术,4例术后复发,其中3例曾再次手术,术后2例患儿死亡.结论 小儿恶性睾丸肿瘤多为卵黄囊瘤,睾丸良性肿瘤多为畸胎瘤,睾丸肿瘤的发现以及诊断并不困难.对于恶性睾丸肿瘤应采取睾丸切除加高位精索结扎术和腹膜后淋巴清扫术,必要时附加化疗.     

睾丸网腺癌6例报告

目的:探讨睾丸网腺癌的发病和临床特点,以做到早诊断、早治疗.方法:报告6例睾丸网腺癌患者的临床资料.6例均为左侧发病,术前均诊断为左侧附睾和睾丸炎,并继发性睾丸鞘膜积液;拟行患侧附睾切除加鞘膜翻转术.术中发现左睾丸质硬有肿物并侵及附睾,遂行睾丸、附睾切除术.结果:术后病理检查诊断为睾丸网腺癌侵及睾丸和附睾;6例术后均获随访.结论:睾丸网腺癌在临床表现独特,根治性睾丸切除辅以根治性腹膜后淋巴结清扫术效果满意,放疗和化疗效果欠佳.     

原发性附睾肿瘤的诊断与治疗

目的：提高原发性附睾肿瘤的诊治水平，进一步认识附睾恶性肿瘤的生物学行为及可行的诊断和治疗方法。方法：回顾性分析我院1998～2003年12月收治的6例原发性附睾肿瘤患者的临床资料：5例为附睾良性肿瘤，其中2例行肿块切除，3例行附睾切除。1例为附睾小圆细胞高度恶性肿瘤，行患侧睾丸附睾切除术并精索高位切断，术后用DDP80～100mg／m^2加VP16300mg／m^2加IFO5．0mg／m^2方案化疗，三个疗程后行放疗三个疗程。结果：5例良性肿瘤患者随访至今无一例复发；1例小圆细胞高度恶性肿瘤已随访12个月未见明显转移。结论：附睾良性和恶性肿瘤无特异性，术前诊断仍应综合病史、体检、影像学检查确定。附睾恶性肿瘤的组织来源复杂，其病理学诊断往往需结合组织化学、电镜观察进行，必要时需作遗传学和基因学诊断。手术是治疗良性和恶性附睾肿瘤的首选方法。     

原发性附睾肿瘤

目的提高对原发性附睾肿瘤的诊治水平。方法报告原发性附睾肿瘤２３例,良性２２例（９５．７％）,其中附睾腺样瘤１４例,平滑肌瘤６例,附睾多发纤维假瘤１例,硬化性血管瘤１例。恶性１例,为附睾腺癌。良性肿瘤作单纯肿瘤或患侧附睾切除。结果预后良好,１９例获随访,术后无复发。恶性肿瘤预后差,处理方法与睾丸恶性肿瘤相同。附睾肿瘤极易误诊为附睾结核、慢性附睾炎、精液囊肿等。结论良性肿瘤除具有一定良性表现特征外,采用Ｂ超及针吸细胞学检查,有助于术前对该病的诊断。恶性肿瘤生长迅速,往往侵及睾丸精索。     

儿童睾丸卵黄囊瘤

卵黄囊瘤是婴儿和儿童最常见的睾丸恶性肿瘤,约占总数的72％,多在12—24月时确诊。经腹股沟途径作根治性睾丸切除已成定论,但对嗣后要否作腹膜后淋巴清扫、放疗及化疗仍有争论。作者回顾了宾州儿童医院1971—1983年间11例典型睾丸卵黄囊瘤的治疗经验。肿瘤均为单侧,全属一期(肿瘤限于睾丸内)。经腹股沟途径作根治性睾丸切除后,4例加作腹膜后淋巴清扫术(均未发现有淋巴转移),部分患者辅以各种方案的联合化疗。结果:单作睾丸切除的4例中3例无癌生存已4.5、2.7和1.5年,1例术后     

原发性附睾腺癌的诊断与治疗（附2例报告并文献复习）

目的：提高对原发性附睾腺癌的认识。方法：回顾性分析2例原发性附睾腺癌患者的临床资料：2例肿瘤均位于右侧，累及附睾体部、尾部及精索，其中1例发现有远处转移。1例行右侧精索、附睾、睾丸高位切除术，另1例行’右睾丸、附睾、精索根治性切除术并腹膜后淋巴结清扫术。结果11例病理检查报告为右侧附睾乳头状腺癌伴慢性炎症，随访至今未见转移及其他异常；另1例报告为右附睾腺癌，部分累及睾丸，术后5个月死于多器官功能衰竭。结论：原发性附睾腺癌早期确诊困难，病程进展快，预后差。手术是首选治疗手段，放疗和化疗尚缺乏临床经验。     

睾丸网腺癌1例报告并文献复习

目的：认识睾丸网腺癌的发病和临床特点，提高早期诊断和治疗水平。方法：分析1例睾丸网腺癌患者的临床资料，并结合文献复习就睾丸网腺癌的早期诊断和治疗进行讨论。结果：术前诊断为左侧附睾丸睾丸炎，并继发性睾丸鞘膜积液，拟行左附睾切除加鞘膜翻转术，术中发现左睾丸质硬并有肿物，遂行睾丸、附睾切除术，术后病理检查诊断为睾丸网腺癌侵及睾丸和附睾。结论：睾丸网腺癌临床表现独特，其基本治疗是根治性睾丸切除术辅以根治性腹膜后淋巴结清扫术，放疗和化疗效果欠佳。     

恶性睾丸间质细胞瘤(2例报告并文献复习)

目的探讨恶性睾丸间质细胞瘤的诊断、治疗及预后.方法报告2例恶性睾丸间质细胞瘤患者的临床资料并文献复习.结果根据患者临床表现及相关检查结果,术前诊断睾丸间质细胞瘤.1例伴有肺部转移,1例患者出现腹膜后淋巴结肿大.2例均行病侧睾丸切除术,术后病理结果证实均为恶性睾丸间质细胞瘤.术后1例行放射治疗.术后随访8~21个月,1例术后9个月可见腹膜后淋巴结肿大.1例拒绝进一步治疗,随访8个月后失访.结论恶性睾丸间质细胞瘤比较罕见.通过患者术前睾酮、雌二醇等性激素水平的检查对恶性睾丸间质细胞瘤的诊断有重要意义.早期发现并行根治性患侧睾丸切除术是治疗恶性睾丸间质细胞瘤的有效方法;晚期肿瘤预后较差,放射治疗可以在一定程度上提高患者的生活质量.     

原发性附睾肉瘤的诊断与治疗（附1例报告并文献复习）

目的：报告罕见原发性附睾肉瘤1例,并讨论其临床特点及诊疗原则。方法：首次报告附睾肌源性间叶源性肉瘤1例,并检索复习文献。结果：患者22岁,自觉左侧睾丸增大1月余,B超提示左侧附睾尾5．5cm×4．2cm混合回声占位,择期行左侧附睾肿物切除术,术后病理报告示附睾低分化肌源性间叶源性肉瘤。随即行患侧睾丸高位切除术。术后2个月发现腹膜后多发淋巴结转移,术后6个月发现双肺转移。附睾肉瘤国内外文献共报道37例。结论：附睾肉瘤极为罕见,中老年常见,恶性程度较高,治疗以睾丸高位切除为主,预后较差。     

原发性附睾肿瘤22例

目的：提高对原发性附睾肿瘤的认识和诊疗水平。方法：结合文献回顾性分析22例附睾肿瘤的临床资料,其中20例良性肿瘤中9例行附睾肿瘤单纯切除术,11例行附睾切除术,2例恶性肿瘤行根治性睾丸切除术。结果：术后随访6个月－10年,良性肿瘤无术后复发,2例恶性肿瘤分别于术后6个月和9个月因肿瘤复发,淋巴结转移而死亡。结论：诊断主要依靠病史、体检和B超检查,手术是首选治疗方法。     

腹膜后肿瘤

目的　对腹膜后肿瘤的诊断、治疗和并发症的防治进行探讨。方法　对 1984年 1月～2 0 0 0年 6月收治的 32例原发性腹膜后肿瘤的临床资料进行回顾性分析。结果　本组收治的 32例患者均经病理诊断证实为腹膜后肿瘤 ,其中良性肿瘤 17例 ,恶性肿瘤 15例。结论　影像学检查对腹膜后肿瘤的确诊有重要意义 ,治疗上主张尽量作肿瘤全切除和整块切除 ,特别是恶性肿瘤 ;不能彻底切除的应争取作肿瘤包膜内切除。良性肿瘤如手术风险很大 ,不必勉强作肿瘤全切除 ,可行肿瘤部分切除术。对于复发的腹膜后肿瘤 ,争取早期再次手术治疗。     

Paracolic recurrence: the importance of wide excision of the spermatic cord at retroperitoneal lymph node dissection.

PURPOSE: Four patients who underwent retroperitoneal lymph node dissection elsewhere and subsequently had radiographic evidence of expanding ipsilateral paracolic recurrence were referred to our institution for treatment. We evaluated ipsilateral spermatic cord metastatic involvement at retroperitoneal lymph node dissection and identified the possible etiology of these unusual recurrences. MATERIALS AND METHODS: Between January 1988 and February 1998, 34 of 685 patients who underwent a total of 702 retroperitoneal lymph node dissections had metastatic disease in the spermatic cord specimen. Variables examined in this group of patients included other disease sites, lymphovascular invasion in the primary tumor, histopathological findings of the primary tumor and retroperitoneal disease, clinical and pathological stage, disease side and the specific site of anatomical involvement of metastatic disease within the spermatic cord specimen, that is spermatic vessels and/or surrounding lymphatic tissue. RESULTS: Of these 34 positive spermatic cord specimens 18 were in primary retroperitoneal lymph node dissections and 16 were in post-chemotherapy specimens. Histopathological evaluation in 25 (74%) and 9 (26%) of the 34 primary tumors showed a mixed germ cell pattern and pure embryonal carcinoma, respectively. Similarly 9 of the 34 retroperitoneal lymph node specimens (26%) showed pure embryonal cell carcinoma and the remainder showed mixed histopathological findings. Disease was clinical stage I in 13 cases (38%) and lymphovascular invasion was absent in the primary tumor in 11 (32%). Despite disease in the spermatic cord specimen there was none at the primary landing zone in 2 patients (6%), including 1 in whom the spermatic cord was the only disease site. In 12 positive spermatic cord specimens (35%) disease was identified in the surrounding perivascular and lymphatic tissue without gonadal vessel involvement. CONCLUSIONS: Metastatic disease in the spermatic vessels and/or surrounding lymphatic tissue represents a possible site of recurrence when incompletely excised. The lack of lymphovascular invasion in the primary tumor does not preclude metastatic disease in the spermatic cord specimen. Complete and wide excision of the spermatic cord and surrounding lymphatic tissues at retroperitoneal lymph node dissection is necessary and may prevent paracolic recurrence.     

手部恶性肿瘤的诊治分析

目的探讨手部恶性肿瘤的临床特点和治疗效果。方法1985-2006年，对101例手部恶性肿瘤的患者，采用超关节截肢（指）69例，超关节截肢（指）同时行区域性淋巴结清扫11例，局部扩大切除同时行皮瓣转移术21例。结果术后69例获得随访，随访时间为6个月～16年，32例失访。手部恶性肿瘤以黑色素瘤多见，其次为鳞癌和滑膜肉瘤，骨性恶性肿瘤少见。5年存活率超关节截肢（指）组为58．7％，超关节截肢（指）同时行区域性淋巴结清扫组为66．7％，局部扩大切除同时行皮瓣转移术组为58．8％。结论手部恶性肿瘤是以软组织肿瘤为主，早期诊断并选择合适的手术方案是提高疗效的关键。     

A huge metastatic liver tumor from leiomyosarcoma of the inferior vena cava: report of a case

Leiomyosarcoma of the inferior vena cava (IVC) is a rare malignant tumor, and only a few cases of the resection of IVC leiomyosarcomas with synchronous liver metastases have been reported. This report describes a female patient who initially presented with a solitary, huge liver tumor and a retroperitoneal tumor. Following our preoperative diagnosis of primary liver cancer with a retroperitoneal lymph node metastasis, the patient underwent combined resection of both tumors. The surgical findings revealed that the retroperitoneal tumor originated from the IVC wall. The pathological and immunohistochemical findings revealed that both tumors were leiomyosarcomas. Although the liver tumor was much larger than the IVC tumor, we considered that the metastatic liver tumor arose from the IVC leiomyosarcoma. This was an instructive case because the metastatic liver tumor from the IVC leiomyosarcoma was so large as to be mistaken for a primary liver tumor.     

Distribution of retroperitoneal metastases after chemotherapy in patients with nonseminomatous germ cell tumors.

For patients with advanced nonseminomatous germ cell tumors a retroperitoneal lymph node dissection is routinely performed following chemotherapy if the serum tumor markers have returned to normal. Bilateral retroperitoneal lymph node dissection has been recommended because metastatic deposits may be widespread. The aim of this study was to describe the distribution of retroperitoneal metastases following chemotherapy in patients with nonseminomatous germ cell tumor and determine if the extent of the retroperitoneal lymph node dissection can be modified. We studied 113 patients who had initially bulky retroperitoneal disease and underwent retroperitoneal lymph node dissection following chemotherapy. For the purposes of this study teratoma and malignant germ cell tumor are referred to as tumor. The most common location of tumor was the para-aortic area (91%) in patients with a left primary tumor and the interaortocaval area (78%) in those with a right tumor. Tumor was located outside the boundaries of a modified retroperitoneal lymph node dissection in 14 of the 60 patients with residual disease but the tumor was present within a palpable mass in 6 of these 14 patients. If the residual mass was removed and a modified retroperitoneal lymph node dissection was performed only 9 of the 113 patients (8%) would have tumor left in the retroperitoneum. For a select group of patients with advanced nonseminomatous germ cell tumor treated with chemotherapy, resection of the residual mass combined with modified retroperitoneal lymph node dissection is appropriate.     

Prognostic value of deoxyribonucleic acid aneuploidy in primary non-small-cell lung carcinomas and their metastases.

The ploidy status of the deoxyribonucleic acid of a malignant lung tumor provides additional information besides histologic grading and tumor staging according to lymph node infiltration and tumor metastasis. Ninety-nine surgical specimens from patients with non-small-cell lung carcinoma were investigated by flow cytometry. Deoxyribonucleic acid aneuploidy was found in 48% of the primary tumors. Patients with deoxyribonucleic acid-euploid tumors showed better survival (p < 0.01) than those with deoxyribonucleic acid-aneuploid carcinomas independent of tumor stage. Deoxyribonucleic acid ploidy status of the primary tumor was compared with that of N2 lymph node metastases in 29 cases. Seven samples showed a change from deoxyribonucleic acid aneuploidy in the primary tumor to deoxyribonucleic acid euploidy in the lymph node metastases. Survival was significantly better for patients with euploid primary tumors and lymph node metastases, followed by patients with deoxyribonucleic acid-aneuploid primary tumors and euploid lymph node metastases. Survival was poorest in patients with deoxyribonucleic acid-aneuploid primary tumors and lymph node metastases. It was observed that only the simultaneous determination of deoxyribonucleic acid ploidy of primary tumors and lymph node metastases permits accurate prognostic evaluation in case of lymph node infiltration.     

Inguinal node metastases from testicular tumors in patients with prior orchiopexy

Testicular tumors in patients who have had the lymphatics disrupted by prior scrotal or inguinal surgery can metastasize primarily to the ipsilateral inguinal nodes in addition to the usual retroperitoneal pattern. Whether routine inguinal node dissection along with retroperitoneal node dissection is warranted in patients with testicular tumors and prior scrotal surgery is controversial due to the small numbers of such cases reported in the literature. We report on 2 patients who had undergone previous orchiopexy and who presented with inguinal and testicular masses. Both patients underwent retroperitoneal lymph node dissection and inguinal node dissection with hemiscrotectomy and metastatic tumor was in each lymphatic area. Ipsilateral inguinal along with bilateral retroperitoneal node dissection should be considered in the primary therapy of any patient with a nonseminomatous testicular tumor who has had prior scrotal and certain inguinal procedures.     

附睾肿块155例临床分析

目的 :提高附睾肿块的诊断和治疗水平。　方法 :采用手术治疗附睾肿块 15 5例 ,其中 79例行附睾切除 ,76例行单纯性肿块切除。所有病例均行病理学检查。　结果 :囊肿占 4 6.4 5 % ,非特异性炎性肿块占 2 5 .16% ,结核占 9.0 3 % ,肉芽肿占 9.68% ,良性肿瘤占 9.68%。　结论 :附睾肿块大部分为良性病变 ,只有保守治疗无效和怀疑为肿瘤时方须手术治疗。B超可鉴别附睾囊肿与实质性肿块。附睾炎性肿块、肉芽肿 ,有时与附睾肿瘤难以鉴别 ,应适当放宽手术指征 ,必要时术中进行快速病理切片检查。