原发性肺肉瘤的诊断与外科治疗12例分析

目的总结原发性肺肉瘤的诊断与治疗经验。方法对我院2002年-2007年经手术确诊的12例原发性肺肉瘤进行回顾性分析。结果12例病人均经手术治疗,其中手术切除右肺上叶6例,右肺中叶1例,左肺上叶4例,左全肺1例,无手术死亡及术后并发症。术后对12例病人进行了放疗和化疗,8例平滑肌肉瘤患者术后生存期18、19、21、25、27、29、31、33个月,2例纤维肉瘤为21、24个月,2例横纹肌肉瘤为28、31个月。结论原发性肺肉瘤的临床表现与影像学征象无特异性,术前易误诊为支气管肺癌、肺囊肿,预后差,外科手术为首选治疗。     

宫腔镜宫颈锥切治疗宫颈糜烂40例临床观察

目的：探讨宫腔镜宫颈椎形电切术治疗严重宫颈糜烂的疗效。方法：用官腔镜锥形电切除宫颈糜烂面，切除宫颈组织全部送病理检查，治疗40例，随访30例。结果：术后2个月宫颈糜烂一次性治愈率达96．67％，宫颈肥大明显缩小，10例随访6个月以上，无糜烂及息肉复发，平均手术时间15分钟，术中出血5～10ml，术后无1例感染，5例患者脱痂出血似月经量，经局部云南白药压迫血止。结论：宫腔镜、宫颈锥形电切术治疗严重宫颈糜烂治愈率高，操作安全、简便、出血少，术中术后并发症极少，患者乐于接受。     

宫腔镜电切宫颈治疗慢性宫颈炎的临床研究

目的 探讨宫腔镜电切宫颈治疗严重宫颈炎的疗效。方法 用宫腔镜环状锥形切除宫颈增生炎性组织。治疗42例，随访36例。平均随访时间12个月（术后1－24个月）。结果 术后2个月宫颈糜烂一次性治愈率达97．22％，80．56％宫颈恢复正常大小。10例随访2年无息肉糜烂复发。术后3例（8．33％）患者脱痂出血超过月经量，经压迫3d血止。无一例感染。结论 宫腔镜电切宫颈治疗严重宫颈炎治愈率高，操作安全、简便、术后并发症较少，患者乐于接受。     

宫颈环形电切术在治疗维吾尔妇女宫颈病变中的应用

目的探讨宫颈环形电切术在诊治维吾尔妇女宫颈病变患者中临床意义。方法回顾分析98例行宫颈LEEP手术的宫颈上皮内瘤变患者,观察手术前后病理诊断变化及术后随访情况,评价LEEP手术对宫颈上皮内瘤变的治疗效果。结果98例患者阴道镜下宫颈活检结果与宫颈LEEP术后病理诊断完全复合者72例（73．4％）,不符合者18例（18．36％）,诊断不足12例（12．2％）漏诊浸润癌2例,漏诊率（2．04％）,92例随访6个月,12个月行细胞学检测及阴道镜活检,复发率2例。结论LEEP在切除病变时可有效消除HPV感染。有效降低了CIN患者向宫颈癌进展的危险性,由此可见LEEP是治疗CIN的理想手段。     

子宫癌肉瘤29例临床分析

目的探讨子宫癌肉瘤的临床特点、治疗及预后相关因素。方法回顾性分析我院1998年7月～2007年11月收治的29例子宫癌肉瘤的临床资料并对29例患者进行随访。结果29例子宫癌肉瘤患者中,宫颈癌肉瘤2例,宫体癌肉瘤27例。主要临床表现为不规则阴道流血和阴道异常排液。确诊需要依据病理组织检查。29例患者均接受手术,其中14例术后辅助化疗,2例术后辅助放疗,6例术后联合放化疗。2例宫颈癌肉瘤中1例于术后53个月复发死亡,1例随访至今30个月无瘤生存。27例宫体癌肉瘤1、3、5年生存率分别为71.4%、37.0%、26.0%。结论手术是子宫癌肉瘤的主要治疗方法,预后与手术病理分期、治疗方式有关,治疗上以手术治疗为主,术后辅以放化疗,以提高患者生存率。     

膀胱肉瘤样癌1例报道及分析

目的探讨膀胱肉瘤样癌的组织学特性,提高对膀胱肉瘤样癌的诊治水平。方法报道1例膀胱肉瘤样癌患者的临床资料,复习相关文献进行讨论。结果术后病理检查见上皮和肉瘤样间质2种恶性成分,之间可见移行过度,免疫组化CK、SMA(+),生存7个月后患者死于多脏器转移。结论膀胱肉瘤样癌具有浸润性生长的生物学特性,恶性程度高,预后不良,确诊依靠病理学及免疫组织化学检查,早期诊断和采用根治性膀胱切除是改善预后的关键。     

宫腔镜电切宫颈治疗慢性宫颈炎的临床研究

目的　探讨宫腔镜电切宫颈治疗严重宫颈炎的疗效。方法　用宫腔镜环状锥形切除宫颈增生炎性组织。治疗 4 2例 ,随访 36例。平均随访时间 12个月 (术后 1～ 2 4个月 )。结果　术后 2个月宫颈糜烂一次性治愈率达 97 2 2 % ,80 5 6 %宫颈恢复正常大小。 10例随访 2年无息肉糜烂复发。术后 3例 (8 33% )患者脱痂出血超过月经量 ,经压迫 3d血止。无一例感染。结论　宫腔镜电切宫颈治疗严重宫颈炎治愈率高 ,操作安全、简便 ,术后并发症少 ,患者乐于接受     

体表及软组织低度恶性肿瘤19例治疗分析

现就我院收治体表及软组织低度恶性肿瘤１９例 ,经首次一次性扩大切除加整形修复术治疗 ,报道如下 :１临床资料１ １一般资料 :１９例中男１４例 ,女５例 ;年龄１３岁～４５岁。脂肪肉瘤７例 ,横纹肌肉瘤３例 ,慢性溃疡恶变 (鳞癌 )４例 ,黑色素瘤３例 ,纤维肉瘤２例。其中四肢１５例 ,躯干４例。就诊时曾做单纯切除６例 ,半年至１年后均复发 ,最多曾作３次手术 ,复发时间依次缩短 ,分别为１６月、７月、３月。肿瘤已侵犯至股动脉鞘。１ ２治疗方法 :初次就诊无手术史者采取以肿块为中心 ,边缘最少达５ｍｍ范围做广泛切除 ,深达深浆膜层 ,肿…     

复发性腹膜后肉瘤的治疗及其预后探讨

目的对复发性腹膜后肉瘤的治疗方法及其预后进行探讨。方法分析18例复发性腹膜后肉瘤的临床资料。结果对18例患者进行6个月~12年的随访,其中10例(55.6%)死亡;3例生存5年以上;2例生存10年以上;2例已分别随访2~4年,现仍存活;1例术后并发低位小肠瘘,经治疗6个月后痊愈。1、3、5年生存率分别为85.7%,54.9%和42.3%。结论提高复发性肉瘤生存率及生存质量,及时的手术切除肿瘤是主要的治疗手段。结合患者的身体状态及具体情况,给予包括肿瘤在内的周围联合脏器切除,能提高肿瘤完整切除率。根据肿瘤的病理类型,适当的放化疗对肉瘤复发可起一定程度的控制作用,高分化脂肪肉瘤者,其治疗效果好于其他病理类型肉瘤者。     

13例乳腺叶状囊肉瘤临床病理分析

目的结合乳腺叶状囊肉瘤的临床病理学特征,探讨鉴别诊断的方法及应注意的问题。方法对13例乳腺叶状囊肉瘤病例临床资料和病理特征进行回顾性分析。结果13例叶状囊肉瘤病例中10例行全乳房切除加腋窝淋巴结清扫,另有3例因肿瘤瘤体小,且属低度恶性,行大区段切除手术,未做淋巴清扫。2例因分化程度较好,原发肿瘤误诊为纤维瘤,术后复发,纠正诊断后再行全乳切除;以上病例随访至今,1例为重度恶性,术后26个月死亡;2例术后复发,再次手术切除,效果满意;其余患者无复发或转移,并无瘤生存。结论乳腺叶状囊肉瘤是一种易误诊的肿瘤,而又具有潜在复发倾向,正确的诊断与治疗是减少复发的关键。     

Ifosfamide: new idications-new dose strength. Limited evidence of effectiveness

In three new approved indications (non Hodgkin's lymphoma, Hodgkin's lymphoma and acute lymphoblastic leukaemia) and in three previously existing indications (ovarian cancer, soft tissue sarcomas and osteogenic sarcomas), non comparative trials show that ifosfamide can induce tumour regression in patients who relapse after a first course of chemotherapy (sometimes containing cyclophosphamide). But clinical assessment has not yet formally demonstrated that this leads to a significant increase in survival time and/or quality of life, mainly because of toxicity. In cervical cancer, a new indication, a comparative trial shows higher tumour response rates with the ifosfamide + cisplatin combination than with cisplatin alone. However, the greater toxicity of the combination and the lack of any increase in survival must both be taken into account. In breast cancer and lung cancer comparative trials show no difference in efficacy between cyclophosphamide and ifosfamide, while toxicity may be worse with ifosfamide. Ifosfamide has no specific value in these approved indications. The same applied to ENT cancer, against which ifosfamide seems to have little activity.     

Altered expression of cell cycle regulatory proteins in benign and malignant bone and soft tissue neoplasms

BACKGROUND: The binding of cyclins to cyclin-dependent kinases regulates cell proliferation. Overexpression of cyclins is believed to deregulate the cell cycle in human tumors. Here the expression of G1 cyclins D1 and D3, and of Ki-67 in a variety of bone and soft tissue sarcomas was assessed as compared to adjacent normal tissue and to a subset of leiomyomas. MATERIALS AND METHODS: Twenty-nine human bone and soft tissue sarcomas were evaluated. Tissue sections from each case were subjected to immunostaining for cyclin D1, cyclin D3 and Ki-67 using the avidin-biotin complex method. RESULTS: Cyclin D1 nuclear positivity was detected in 28% of sarcomas and in none of the leiomyomas. Cyclin D3 nuclear positivity was present in 62% of sarcomas and in none of the leiomyomas. Ki-67 nuclear staining was positive in 86% of sarcomas but in only 16% of leiomyomas. In addition, upregulation of cyclin D1 was observed in leiomyosarcomas, pleomorphic sarcomas and gastrointestinal stromal tumors, but not in liposarcomas or osteosarcomas. Cyclin D3, however, was expressed in all of the sarcoma types including 2 out of 5 liposarcomas and 1 out of 4 osteosarcomas. The normal soft tissue adjacent to the tumors when present (10 cases) was negative for cyclin D1 and D3, and expressed Ki-67 in 5% of the cell nuclei. The expression of cyclin D3 was also noted in human sarcoma cell lines (SKLMS, MG63, SaOS-2 and HT1080) by Western blot. CONCLUSION: The higher expression of cyclin D1 and D3 and of Ki-67 in bone and soft tissue sarcomas, as compared to leiomyomas and peritumoral normal soft tissue, suggests that high cyclin expression may contribute to deregulation of the cell cycle in bone and soft tissue tumors. These data suggest a role of cyclins in the process of human sarcomagenesis.     

KIT在子宫肉瘤的表达及临床意义

目的：研究用甲磺酸伊马替尼治疗子宫肉瘤的可能性。方法：使用免疫组化的方法分析30例甲醛固定石蜡包埋的子宫肉瘤KIT的表达。结果：使用半定量免疫组化计分发现在所有检验的子宫肉瘤中只有1例KIT表达,而且较微弱,而被检验的子宫肉瘤中没有表现出很强的表达。结论：目前的资料表明甲磺酸伊马替尼不可能作为单一有效的药物对子宫肉瘤使用。     

Molecularly targeted therapies in adult soft tissue sarcomas: present approach and future directions

BACKGROUND: Sarcomas are rare neoplasms. Given the overwhelming chemotherapy resistance of the disease, patients with progressive and metastatic soft tissue sarcomas are ideal candidates for trials of investigational new drugs. OBJECTIVE: The authors review the molecular mechanisms underlying soft tissue sarcomas and discuss molecularly targeted therapies developed to improve the poor outcome of these uncommon tumors. METHODS: A Medline and American Society of Clinical Oncology abstract search was conducted using the keyword 'soft tissue sarcoma'. Articles and abstracts were reviewed and eligible for inclusion if they used targeted therapies for the treatment of patients with soft tissue sarcomas. Results/conclusion: Phase II clinical trials for patients with soft tissue sarcomas using novel targets and present recognized targets are ongoing and planned.     

Transmission studies of sarcoma in the soft-shell clam, Mya arenaria.

Transmission experiments with adult soft-shell clams (Mya arenaria) demonstrated that clam sarcomas are transmissible with hemolymph from neoplastic animals but not with cell-free ultrafiltrates. Non-neoplastic clams were injected with either hemolymph from neoplastic clams or a cell-free ultrafiltrate prepared from a subsample of the same hemolymph. Injected clams were held in separate flow-through aquaria and examined for sarcomas by histocytology and histology. Data at 17 weeks showed a 44% prevalence of sarcomas in clams injected with neoplastic inoculum. No sarcomas were observed either in clams injected with a cell-free ultrafiltrate or in the control animals. The lack of sarcomas in clams injected with the ultrafiltrate argues against a viral etiology for the disease.     

Molecularly targeted therapies in adult soft tissue sarcomas: present approach and future directions

Background: Sarcomas are rare neoplasms. Given the overwhelming chemotherapy resistance of the disease, patients with progressive and metastatic soft tissue sarcomas are ideal candidates for trials of investigational new drugs. Objective: The authors review the molecular mechanisms underlying soft tissue sarcomas and discuss molecularly targeted therapies developed to improve the poor outcome of these uncommon tumors. Methods: A Medline and American Society of Clinical Oncology abstract search was conducted using the keyword ‘soft tissue sarcoma’. Articles and abstracts were reviewed and eligible for inclusion if they used targeted therapies for the treatment of patients with soft tissue sarcomas. Results/conclusion: Phase II clinical trials for patients with soft tissue sarcomas using novel targets and present recognized targets are ongoing and planned.     

Classification of sarcomas using bioinformatics and molecular profiling

Recent advances in genomic and proteomic technologies have revolutionized our way of classifying cancers. These high-throughput technologies allow the use of powerful and multivariate bioinformatic approaches to develop molecular classifiers. These classifiers can then be used to distinguish different types of tumors based on their molecular profiles. This is particularly important for heterogeneous groups of tumors such as sarcomas. Although sarcomas have a variety of histological appearances, the distinction among some of the diagnostic groups is vague. Therefore, molecular classification provides a new way to distinguish histologically similar but molecularly different types of sarcomas, and hence improves tumor diagnosis and stratification. In addition, identification of discriminatory genes that carry information to differentiate clinical subtypes of sarcomas will further elucidate the underlying molecular pathways and pathological mechanisms of these tumors. In this article, we review some current methods used in genomic and proteomic profiling, outline the approach of using bioinformatic techniques to develop a molecular classifier, and discuss some recent examples to illustrate the use of molecular classification to distinguish different types of sarcomas and understand the biology of these tumors.     

Pharmacotherapy of sarcoma

Background: Comprising < 1% of adult malignancies and approximately 12% of pediatric malignancies, sarcomas are derived from a variety of connective tissues and exhibit highly variable responsiveness to therapy. The clinical and biologic heterogeneity of the > 50 histologic subtypes of sarcomas often require different therapeutic approaches. Objective: This review describes the use of therapeutic agents in the management of bone and soft-tissue sarcomas. Methods: Relevant literature is identified and presented from major conference proceedings, as well as using the PubMed search engine. Results/conclusions: Chemotherapy has improved outcomes over the past few decade, particularly in patients with certain bone sarcomas and gastrointestinal stromal tumors; while in the majority of patients, additional strategies are necessary.     

Pharmacotherapy for pediatric soft-tissue sarcomas

INTRODUCTION: Soft-tissue sarcomas are rare, but they represent about 8% of all malignancies in pediatric age. Developing a multidisciplinary approach to treatment based on risk stratification has led to a dramatic improvement in survival, but a plateau has been reached with current treatment options in the last 20 years. Chemotherapy is usually effective for rhabdomyosarcoma and should be seen as the keystone of its treatment, while non-rhabdomyosarcoma soft-tissue sarcomas are still generally considered scarcely chemosensitive. AREAS COVERED: An overview of current, emerging and possible future medical therapies for pediatric soft-tissue sarcomas is provided. Insight into different chemotherapeutic strategies based on risk stratification for rhabdomyosarcoma and non-rhabdomyosarcoma soft tissue sarcomas in pediatric age is given. EXPERT OPINION: Integrating systemic therapy with local treatments (surgery and/or radiotherapy) is complex and requires adequate experience, which can only be assured by referral institutions. Future challenges include identifying novel targeted therapies and optimizing treatment protocols for customized patient care.     

Targeted therapies in bone sarcomas: current approach and future directions

INTRODUCTION: Bone sarcomas are rare malignancies and once advanced, there is limited response to current chemotherapeutic regimens. Targeted therapies could have substantial impact on these diseases. AREAS COVERED: Specific molecular targets of bone sarcomas are reviewed along with the various targeted therapies that have potential to change the outcome of these chemotherapy resistant diseases. EXPERT OPINION: There are promising pathways identified that targeted inhibitors could provide better treatment options for metastatic bone sarcomas. There is a strong need for continued Phase II and III clinical trials investigating these molecularly targeted therapies.