肠系膜纤维瘤病伴腹壁纤维瘤病1例

患者女性,43岁,发现腹部包块20余天,腹痛、腹胀伴呕吐1天,有剖腹产史.体检:腹壁陈旧性切口旁可触及一直径约5 cm的质硬肿物;腹部膨隆,右下腹可触及一直径约10 cm的质硬肿物,活动度差,有触痛、反跳痛,肌紧张不明显;肝脾未触及.影像学检查:B超示子宫右上方可见一直径约13 cm的实性包块,内部回声欠均匀,形态规则,周边可见游离液性暗区.     

侵袭性纤维瘤病中CTNNB1基因突变与复发的相关性

目的 分析CTNNB1基因在侵袭性纤维瘤病中的突变情况,探讨其与肿瘤复发的相关性.方法 回顾性分析2010年～2019年十堰市太和医院收治的32例CTNNB1突变阳性侵袭性纤维瘤病,采用免疫组化和PCR-Sanger测序法分别检测β-catenin蛋白表达和CTNNB1基因突变状态,分析侵袭性纤维瘤病局部复发的可能因素...     

影响胃癌患者术后复发死亡因素分析

目的 探讨影响胃癌患者术后复发死亡的因素。方法 总结分析了198例胃癌术后复发死亡的多种因素，生存率采用生命表法，影响预后的分析采用单因素及多因素Cox模型回归。结果 本组患者1年、3年、5年生存率分别为61．1％、41．9％、32．3％。胃癌术后复发死亡的因素：腹膜复发53．9％，血源性复发29．3％，区域局部复发14．4％，远处淋巴结转移复发2．4％。单因素分析显示胃癌术后的复发死亡与肿瘤大小、原发灶部位、Borrmann大体分型、癌细胞分化程度、癌细胞浸润程度、转移情况、手术方式、辅助化疗、术后病理pTNM分期有关，经过多因素回归分析后仅有肿瘤大小、辅助化疗、术后病理pTNl分期是胃癌术后复发死亡的独立影响因素。结论 胃癌患者术后复发死亡以腹膜复发和血源性复发为主；肿瘤大小、辅助化疗、术后病理pTNM分期是胃癌术后复发死亡的独立影响因素。     

影响胃癌患者术后复发死亡因素分析

目的探讨影响胃癌患者术后复发死亡的因素.方法总结分析了198例胃癌术后复发死亡的多种因素,生存率采用生命表法,影响预后的分析采用单因素及多因素Cox模型回归.结果本组患者1年、3年、5年生存率分别为61.1%、41.9%、32.3%.胃癌术后复发死亡的因素:腹膜复发53.9%,血源性复发29.3%,区域局部复发14.4%,远处淋巴结转移复发2.4%.单因素分析显示胃癌术后的复发死亡与肿瘤大小、原发灶部位、Borrmann大体分型、癌细胞分化程度、癌细胞浸润程度、转移情况、手术方式、辅助化疗、术后病理pTNM分期有关,经过多因素回归分析后仅有肿瘤大小、辅助化疗、术后病理pTNM分期是胃癌术后复发死亡的独立影响因素.结论胃癌患者术后复发死亡以腹膜复发和血源性复发为主;肿瘤大小、辅助化疗、术后病理pTNM分期是胃癌术后复发死亡的独立影响因素.     

韧带样型纤维瘤病的病理学和遗传学研究进展

韧带样型纤维瘤病是一类具有局部侵袭潜能的纤维母细胞／肌纤维母细胞性肿瘤,也称为韧带样瘤、侵袭性纤维瘤病、肌腱膜纤维瘤病等。2002年WHO新的软组织和骨肿瘤的病理学和遗传学分类中将其定义为发生于深部软组织的克隆性纤维母细胞增生,具有浸润性生长、局部复发倾向但不具有转移能力的特点。     

乳腺纤维瘤病

乳腺纤维瘤病（韧带样瘤）少见,1923年首先由Nichols报道。国外文献报道较多,国内仅见1例报道。在新版WHO乳腺肿瘤分类中,将其定义为病变来源于乳腺实质内的纤维母细胞和肌纤维母细胞,具有局部侵袭性,无转移潜能,须排除胸部筋膜来源的纤维瘤病累及乳腺。     

子宫肌瘤剔除术后复发的影响因素分析

目的:研究子宫肌瘤剔除术后复发的影响因素.方法:回顾性分析2017年8月至2018年8月我院经子宫肌瘤剔除术治疗的105例患者的临床资料,设计一般资料调查表,通过患者病历资料,记录患者的年龄、体质量、肌瘤数量、肌瘤最大径、肌瘤生长部位(浆膜下、肌壁间以及黏膜下)、术前合并症状、术后肌瘤残留、残留患者后续是否进行药物治疗...     

经手术治疗子宫肌瘤患者术后复发情况及影响因素分析

目的分析经手术治疗子宫肌瘤患者术后复发情况及影响因素。方法选择本院2015年4月至2018年8月收治的102例子宫肌瘤患者作为研究对象,收集患者各项临床资料回顾性分析导致患者术后复发的相关因素。结果 102例子宫肌瘤患者经手术治疗后,在随访期间有39例患者复发,复发率为38.24%;经Logistic回归分析结果显示,患者年龄、肿瘤直径、数目及术后肌瘤残留是患者术后子宫肌瘤复发的独立因素(P0.05)。结论子宫肌瘤患者术后复发率为38.24%,年龄40岁、肿瘤直径大、数目多及术后有肌瘤残留是患者术后子宫肌瘤复发的独立危险因素,为了降低复发率,需要针对危险因素采用相关预防对策。     

乳腺纤维瘤病临床病理分析

目的探讨乳腺纤维瘤病的临床病理学特征、诊断及鉴别诊断。方法回顾性分析14例乳腺纤维瘤病的临床表现、影像学特点、组织学特征及免疫表型,并复习相关文献。结果14例乳腺纤维瘤病患者均为女性,年龄21～75岁。镜下见形态温和的梭形细胞和胶原纤维呈束状排列,肿瘤在乳腺组织内浸润性生长,呈指突状侵犯乳腺导管及小叶。11例肿瘤细胞vimentin、β-catenin、SMA、CD34部分病例中呈阳性,CKpan、ER、desmin、S-100均呈阴性。2例行乳房完整切除,其余均肿块单纯切除或扩大切除。结论乳腺纤维瘤病临床少见,易误诊为乳腺癌,需与良恶性梭形细胞病变鉴别,首选治疗方案是手术,放疗和抗雌激素受体治疗疗效尚不明确。     

脂肪纤维瘤病1例

患儿男婴,16个月,发现右手小鱼际肿物半年,术中发现肿物实性,界限不清,与皮肤及皮下组织、肌肉粘连。病理检查眼观:破碎软组织两堆,直径为1.4~3 cm,切面为灰黄、灰白色。镜检:大量成熟的脂肪组织被条索状的纤维组织分隔呈小叶状(图1),纤维组织呈条索样或宽带状增生,并侵犯周围的骨骼肌(图2)。     

Microbiologic factors affecting Clostridium difficile recurrence

BackgroundRecurrent Clostridium difficile infection (rCDI) places a huge economic and practical burden on healthcare facilities. Furthermore, rCDI may affect quality of life, leaving patients in an rCDI cycle and dependant on antibiotic therapy.AimsTo discuss the importance of microbiologic factors in the development of rCDI.SourcesLiterature was drawn from a search of PubMed from 2000 onwards with the search term ‘recurrent Clostridium difficile infection’ and further references cited within these articles.ContentMeta-analyses and systematic reviews have shown that CDI and rCDI risk factors are similar. Development of rCDI is attendant on many factors, including immune status or function, comorbidities and concomitant treatments. Studies suggest that poor bacterial diversity is correlated with clinical rCDI. Narrow-spectrum gut microflora-sparing antimicrobials (e.g. surotomycin, cadazolid, ridinilazole) are in development for CDI treatment, while microbiota therapeutics (faecal microbiota transplantation, nontoxigenic C. difficile, stool substitutes) are increasingly being explored. rCDI can only occur when viable C. difficile spores are present, either within the gut lumen after infection or when reacquired from the environment. C. difficile spore germination can be influenced by gut environmental factors resulting from dysbiosis, and spore outgrowth may be affected stage by some antimicrobials (e.g. fidaxomicin, ramoplanin, oritavancin).ImplicationsrCDI is a significant challenge for healthcare professionals, requiring a multifaceted approach; optimized infection control to minimize reinfection; C. difficile–targeted antibiotics to minimize dysbiosis; and gut microflora restoration to promote colonization resistance. These elements should be informed by our understanding of the microbiologic factors involved in both C. difficile itself and the gut microbiome.     

Expression of beta-catenin and p53 are prognostic factors in deep aggressive fibromatosis

AIMS: To determine the prognostic significance of beta-catenin in aggressive fibromatosis and to identify potential molecular markers for new targeted therapies. METHODS AND RESULTS: A tissue microarray of 37 cases of deep aggressive fibromatosis was constructed and subjected to immunohistochemical analysis for beta-catenin, p53, smooth muscle actin (SMA), desmin, Ki67, c-erbB2, epidermal growth factor receptor (EGFR), c-kit, CD34 and S100. Complete clinical follow-up was available for 23 patients. Nuclear beta-catenin expression was associated with an increased rate of local tumour recurrence (60.0% 1-year and 0% 5-year event-free survival; P < 0.05). Furthermore, p53 expression was associated with an increased risk of tumour recurrence (50% 1-year event-free survival rate and 0% 5-years event-free survival rate, P < 0.05). The coexpression of p53 and beta-catenin was significantly correlated (P < 0.05). No statistically significant association was seen between MIB1 and p53 or beta-catenin expression, respectively. No expression of EGFR, c-erbB2 or c-kit was seen. CONCLUSIONS: The overexpression of beta-catenin and p53 is associated with a decreased event-free survival in deep aggressive fibromatosis. Further studies are required to establish whether these findings can lead to an improvement in the treatment of this rare neoplasm.     

Congenital bowing of the ulna and aggressive fibromatosis.

The association of skeletal anomalies and aggressive fibromatosis has been documented. Isolated bowing of the ulna is rare, yet its occurrence, particularly in conjunction with congenital dislocation of the radial head, has been documented. This article presents two cases of ulnar bowing in which the patients subsequently developed aggressive fibromatosis. We feel that aggressive fibromatosis may be a latent manifestation of congenital bowing of the ulna. The course of the disease appears to be of an aggressive nature, and patients who present with bowing of the ulna should be followed for the potential development of this disease.     

The role of radiotherapy in the treatment of aggressive fibromatosis

Aggressive fibromatosis is a rare benign soft tissue tumor that is difficult to cure because of its infiltrative nature and high tendency to recur locally. The authors retrospectively analyzed 20 patients with histologically-confirmed fibromatosis. All patients underwent surgery with a wide or marginal margin. Five (25%) cases with histologically-negative margins had recurred. External beam radiotherapy was administered to patients whose margins were positive or who had local recurrence. However, out of concern for safety, radiotherapy was not given to two babies and a reproductive-aged woman. The average dose was 5,020 cGy. During the follow-up (mean 32.6 months), all the patients undergoing radiotherapy showed no evidence of local recurrence. A wide local excision has traditionally been the treatment of choice. However, postoperative radiotherapy could be an effective measure for preventing local recurrence in patients with a histologically-positive surgical margin and recurrence independent of any signs of relapse.     

影响胃癌根治术后患者预后的多因素分析

目的探讨影响胃癌根治术患者远期复发及生存的相关因素,为临床判断患者预后、采用针对性治疗提供参考。方法对524例行胃癌根治术患者的临床资料进行回顾性分析,采用Kaplan-Meier法对患者的生存情况进行评价,采用Log-rank检验进行单因素分析,采用Cox比例风险模型进行多因素分析。结果单因素分析表明:性别、年龄对患者的生存率并无显著影响(P>0.05),病理分型、Borrmann分型、肿瘤生长部位、浸润情况、淋巴结转移程度、TNM分期、是否接受辅助放化疗为影响胃癌根治术患者预后的相关因素(P<0.05)。多因素分析表明:病理学分型、浸润情况、淋巴结转移程度为影响胃癌根治术患者预后的独立危险因素(P<0.05)。结论病理分型、浸润情况、淋巴结转移程度为影响胃癌根治术患者预后的独立危险因素,临床应根据上述因素判断患者预后,并给予合适的辅助治疗。     

结直肠癌临床及病理免疫组织化学多因素分析

目的探讨结直肠癌的生长方式,间质淋巴细胞浸润,Ｄｕｋｅｓ分期,ｐ５３和ｃ－ｅｒｂＢ－２蛋白,增殖细胞核抗原（ＰＣＮＡ）增殖指数,Ｐ２１蛋白,上皮生长因子受体（ＥＧＦＲ）、间质纤维组织增生及组织学类型１０种因素对患者预后的影响。方法运用Ｃｏｘ模型对６８例结直肠癌上述十种因素与预后的关系进行分析。结果单因素分析显示上述前六种因素对患者的预后有影响;经多因素分析显示Ｐ２１和ｃ－ｅｒｂＢ－２蛋白表达情况,Ｄｕｋｅｓ分期以及ＰＣＮＡ指数与病人预后有关,两种癌基因蛋白共同表达时病人的死亡相对危险度更高,ＤｕｋｅｓＡ期Ｐ２１或ｃ－ｅｒｂＢ－２蛋白阳性病人的死亡相对危险度比ＤｕｋｅｓＢ期相应蛋白阴性的病人高。结论Ｐ２１、ｃ－ｅｒｂＢ－２蛋白、ＰＣＮＡ增殖指数及Ｄｕｋｅｓ分期可作为估计结直肠癌患者预后的独立指标,Ｐ２１及ｃ－ｅｒｂＢ－２蛋白同时表达是预后更差的指征。     

1,25-Dihydroxy vitamin D3: can it be an effective therapeutic option for aggressive fibromatosis

Aggressive fibromatosis (AF), also known as desmoid tumor is a monoclonal fibroblastic proliferation in a collagen matrix that arises in musculoaponeurotic structures. Though considered as benign, they are locally invasive and their propensity for recurrence after conservative surgery is well documented. Addition of postoperative adjuvant radiotherapy produces higher local control rates, although recurrence rates are still high in patients with positive margins. The antineoplastic activity of vitamin D has been demonstrated both in vitro and in vivo models of several cancers. The proposed mechanisms for antineoplastic activity include inhibition of proliferation associated with cell cycle arrest, induction of apoptosis and reduction in invasiveness and angiogenesis. It has also been shown that vitamin D has a negative impact on collagen homeostasis by inhibiting the formation and increasing its degradation. Since vitamin D has an antineoplastic activity and negative effect on collagen synthesis and deposition, it is proposed that 1,25-dihydroxy vitamin D3 can be a right therapeutic option for the management of desmoid tumors.     

影响继发性不孕的相关因素分析

目的探讨影响继发性不孕的相关危险因素。方法通过对368例女性继发性不孕症患者和同期产检的370例孕妇的回顾性调查研究,利用Logistic回归方法统计,了解继发性不孕的相关影响因素。结果经分析发现,继发性不孕的主要危险因素有人流（OR：22.12,b′：0.701）,盆腔炎（OR：7.21,b′：0.532）,输卵管病变（OR：7.02,b′：0.514）,月经不调（OR：3.59,b′：0.418）,子宫内膜异位症（简称EM7）（OR：4.55,b′：0.425）,早年性交（OR：2.54,b′：0.412）,支原体感染（宫颈分泌物UU＋）（OR：2.23,b′：0.413）。结论人流,盆腔炎,输卵管病变是继发性不孕的高度危险因素,减少人流率,防治感染是降低继发性不孕的重要措施。