肺微小磨玻璃结节血管征及气管征对良恶性的鉴别意义

目的探讨肺微小磨玻璃结节（GGN）的血管征及气管征对良恶性评估的价值。方法收集2016年1月至2018年1月,在江苏省肿瘤医院经手术或穿刺病理证实为肺腺癌的单发局灶性GGN 127例的临床资料。将GGN分为3组,良性组36例、浸润前组51例、浸润腺癌组40例。比较不同病理类型GGN大小与血管征及气管征的关系。结果GGN良性组最大径（522±245）mm,浸润前组最大径（816±283）mm,浸润腺癌组最大径（1315±341）mm,3组两两相比,差异有统计学意义（均P＜005）。各型血管征在3组不同病理分型GGN所占比例均不同,差异有统计学意义（均P＜005）。Ⅰ型、Ⅱ型血管征多见于良性组,Ⅲ型、Ⅳ型血管征多见于浸润前组与浸润腺癌组。各类型支气管征在3组不同病理分型GGN所占比例不同,差异有统计学意义（均P＜005）。Ⅱ型、Ⅲ型气管征多见于浸润腺癌组,Ⅳ、Ⅴ型气管征多见于良性组、浸润前组。结论了解GGN与血管、支气管征的关系及其在微小GGN分类中的应用,对GGN良恶性的鉴别诊断具有重要意义。     

肺野边缘型肿瘤的CT引导下经皮肺活检术

目的探讨CT引导下的经皮肺活检法对肺野内结节性病变的诊断性能及合并症的发生率.方法采用CT下经皮肺活检法对肺野内的249个结节性病灶进行了穿刺活检.肿瘤直径6mm～100mm(平均23.5mm),胸膜到肿瘤的深度为2mm～80mm(平均56mm).结果确诊为恶性165例,灵敏性为89%,良性的确诊率为85%.术后发生气胸36例(14%),肺内出血26例(10%).结论CT引导下的经皮肺活检法安全、易行,尤其对确诊邻近胸膜的病灶具有意义.     

术前规划联合荧光胸腔镜精准肺段手术较传统胸腔镜肺段手术治疗早期肺腺癌近期结果比较

背景与目的 肺癌的死亡率居所有恶性肿瘤的第一位,但对于早期肺腺癌患者不同的肺段切除术之间手术效果及对肺功能的影响研究较少.本研究旨在评估术前规划联合荧光胸腔镜精准肺段切除术与传统肺段切除术两种手术方式对早期肺腺癌患者肺功能保留程度和近期结果比较.方法 前瞻性选取2020年1月1日-2020年10月31日于中国科学技术大...     

螺旋CT对转移性肺肿瘤的诊断价值

目的分析和探讨螺旋CT对肺野内转移性肿瘤的检出价值.方法采用25mm/秒、20mm/秒的床速对9例恶性肿瘤肺转移的病人进行扫描,对普通CT所拍出的病变图像及螺旋CT所拍出的录像相比较.结果普通CT检出转移性病灶120个,其中肺尖区12个,中央区91个及膈肌下区17个;螺旋CT检出肿瘤82个,平均直径为5.6mm、9mm和9.5mm,平均8.6mm.25mm/秒的速度,肺尖区的检出率较中央区及膈肌下区为低.而按20mm/秒的速度进行扫描时,肺尖区的检出率不及中央区,而优于膈肌下区.结论螺旋CT对肺中下肺野转移性肿瘤的检出具有价值.     

10 mm以下孤立性肺结节的影像学特征

目的探讨10 mm以下孤立性肺结节(SPN)的影像学特征,为临床诊断提供参考。方法对2013年至2016年,吉林省前卫医院直径10 mm、有病理结果的143例SPN进行分析。比较良恶性病变的差异,总结SPN的影像学特征。结果 10 mm以下的SPN中,原发性肺癌占单病种的第1位。影像学上,良恶性病变在边缘不齐、有毛刺征、气管和血管受累等方面,差异有统计学意义(P0.05)。强化值上,原发性肺癌、转移性肺癌和炎性假瘤易于被强化,而结核、肺内淋巴结和其他良性病变不易被强化,差异有统计学意义(P0.05)。结论增强对10 mm的SPN的CT影像特征的认识,有助于提高早期肺癌的诊断率。     

肺内单纯磨玻璃结节的影像学特征及鉴别诊断价值

摘 要：［目的］ 探讨肺内良、恶性单纯磨玻璃密度结节（pGGN）的影像学特征及鉴别诊断价值。［方法］ 收集51例肺内pGGN患者的临床资料及影像学资料,所有患者均经病理及临床随访证实。回顾性分析患者的临床资料、病灶的影像学特点。应用t检验、卡方检验及受试者工作特征曲线计算截断点。［结果］ 51个pGGN中,良性19个,恶性32个。良、恶性pGGN患者在年龄、性别、吸烟史、病灶的位置间差异无统计学意义（P＞0.05）。形态学征象中分叶、空泡、胸膜凹陷征在良、恶性pGGN间差异有统计学意义（P＜0.05）,而三维比例、毛刺、支气管充气征、血管集束征在良、恶性pGGN间差异无统计学意义（P＞0.05）。病灶的大小、质量在良、恶性pGGN中差异有统计学意义（P＜0.05）。ROC曲线显示病灶大小、质量诊断恶性pGGN的最佳截断值分别是为10mm、0.16g。［结论］ 结合病灶的大小、质量以及HRCT特征综合评价pGGN,有利于恶性pGGN的检出。     

联合肺叶和肺段切除术治疗肺癌21例分析

1996年 5月 3 1日～ 2 0 0 4年 3月 3 1日 ,我们对累及叶间裂的Ⅲ期以上肺癌 2 1例实施了肺叶 肺段切除术 ,避免了全肺切除术 ,保留了有效的肺功能 ,结果总结报道如下。1　临床资料1.1　一般资料2 1例患者 ,男 18例 ,女 3例。年龄 5 4～ 68岁 ,中位年龄 5 9岁。右侧肺癌 13例 ,左侧肺癌 8例。所有病例胸部影像学 (包括CT)检查 ,均提示肿瘤直径≥ 5cm ,并累及叶间裂。纤支镜检查提示 ,肿瘤累及叶支气管开口处。只有 1例患者术前行 1个周期化疗。术前均有病理诊断。1.2　手术方式手术均在双腔气管插管全麻下经后外侧切口施行。术中根据肿瘤…     

肿瘤影像学诊断的回顾,现状和展望

传统放射学由于仅能提供有限的形态信息 ,在很长时间被认为是“辅助性”学科。近年来 ,由于各种成像方法的迅猛发展 ,特别是介入放射学的出现 ,使放射学发展为具有诊断、治疗职能的临床学科。作为医学领域发展最快的学科之一 ,传统放射学已扩展为现代影像学 ,并改变了其在肿瘤诊断中的地位 ,逐步由单一的辅助性检查转变为重要的诊疗手段之一。主要表现为 :①影像形态学信息大大丰富。除大体形态外 ,还可从分子水平乃至基因水平探讨病变组织的微观结构。②实现了从大体形态学向功能成像的转换。功能成像的完善 ,肿瘤生化、代谢、灌注的在体研…     

肺和胸膜肿瘤的病理组织学新分类

１９８１年世界卫生组织（ＷＨＯ）的“肺肿瘤的组织学分型”将肺肿瘤分为鳞状上皮细胞癌、腺癌小细胞癌、大细胞癌、腺鳞癌（混合型）、类癌、支气管腺癌等８种类型。随着肺癌免疫组化研究的发展以及临床研究的深入,上述组织学分类已不能适应。 肺癌的组织结构比较复杂,在同一例肺癌组织中,可因癌细胞的分化方向不统一而呈不同结构。即使在同一肿瘤的不同部位,其分化程度也显著不同,甚至其转移癌的组织学类型也可与原发癌不一样。按１９８１年分类法,病理诊断容易紊乱。为此,１９９４年国际肺癌学会（ＩＡＳＬＡ）提出重新修订肺肿…     

肺硬化性血管瘤的影像学表现分析

目的：分析肺硬化血管瘤的影像学特征。方法回顾性分析20例经手术和病理检查确诊的肺硬化血管瘤患者的影像学表现。结果20例患者均为单发病灶,且病灶直径为10～75 mm（平均直径为45 mm）,其中病灶为圆形的有12例,椭圆形的有8例,所有患者病灶密度均匀,且未见坏死灶或者是钙化影,同时均未见毛刺。7例行增强CT扫描均可见血管特征;8例行PET／CT扫描,诊断准确率为41．1％,肺硬化血管瘤对FDC的摄取无特异性。结论对肺硬化血管瘤患者行CT平扫之后再行CT增强扫描,能有效提高诊断率。     

Primary pulmonary adenocarcinoma with enteric differentiation

A pulmonary neoplasm with cytologic characteristics typical of differentiated small intestinal epithelium is reported. Individual cells showed features suggesting columnar absorptive, goblet, Paneth, and neuroendocrine cell differentiation. Thorough investigation and follow-up for 4 years did not identify a primary tumor other than in the lung. The occurrence of such a neoplasm at this site is evidence for the existence of a common stem cell in the lower respiratory and gastrointestinal tract mucosa.     

Correlation between mast cells and survival rates in patients with pulmonary adenocarcinoma

BACKGROUND: A retrospective study on the correlation between mast cells and survival rates of 90 pulmonary adenocarcinoma patients is reported. METHODS: Surgical specimens were stained with alcian blue and safranin O, and parenchymal mast cells were counted. Based on the counts, the patients were divided into two groups: Group A had mast cell counts of > 20/microscopic field; Group B, < 20. TNM staging and histological findings were recorded for both groups. Phenotypes of mast cells were determined using enzymehistochemistry. Total count numbers, the histological differentiation of adenocarcinomas, and phenotypes were evaluated with regard to patient survival rates. RESULTS: Group A had a 5-year survival rate of 45.85%, as compared with Group B's rate of 16.32% (P < 0.01). Group A also represented a higher percentage of well-differentiated adenocarcinomas. In both cancerous tissue and normal lung tissue, the predominant mast cell phenotype was MC(T). CONCLUSIONS: There appears to be a direct relationship between the number of mast cells and clinical outcome in patients with pulmonary adenocarcinoma, even though the mast cells exhibited no significant phenotypic changes.     

肺腺癌患者中EGFR突变与肺结核的相关性研究

  目的  研究肺腺癌患者中表皮生长因子受体（epidermal growth factor receptor,EGFR）基因突变与肺结核在肺腺癌中的相关性。  方法  采用PCR扩增及基因测序方法检测506例肺腺癌患者EGFR基因突变情况,分析其与肺结核之间的关系,进一步使用Kaplan-Meier法进行生存分析并行Log-rank检验。  结果  506例肺腺癌患者中有218例患者存在EGFR突变,其中25例患者有感染肺结核病史。在肺腺癌患者中,有肺结核病史的患者EGFR基因突变率,尤其是外显子21缺失显著高于单纯肺腺癌者（P= 0.047,P=0.002）。肺腺癌与结核灶在同一肺叶或同侧肺的患者EGFR基因突变率明显高于二者在不同侧肺,尤其是外显子21突变（P=0.020,P=0.030）。有肺结核病史患者的2年生存率明显高于单纯肺腺癌患者（P=0.039）,且在未经EGFR-TKIs治疗的具有肺结核史的患者中,EGFR突变组与野生型组相比,2年生存率无统计学差异（P=0.948）,经过EGFR-TKIs治疗的患者2年生存率亦差异无统计学意义（P=0.425）。  结论  肺腺癌患者中,有肺结核病史的患者EGFR基因突变发生率明显增高,且EGFR基因突变与其预后无关。      

中国单中心肺腺癌患者基因突变特征及与欧美肺腺癌人群比较分析

目的 探讨肺腺癌的基因突变特征及其意义,为靶向用药提供依据。方法 利用高通量测序平台靶向捕获测序技术,检测昆山市第一人民医院2017年5月至2018年8月确诊的104例肺腺癌患者的56个癌相关基因突变情况。分析肺腺癌基因突变特征并与欧美肺腺癌人群基因突变特征进行比较,分析基因突变与临床特征相关性并筛查靶向用药位点。结果 104例肺腺癌患者中,84例(81%)检测到34种基因突变,前4位高频突变基因包括表皮生长因子受体(EGFR)(49%,51/104)、TP53(21%,22/104)、KRAS(13%,14/104)、BRAF(6%,6/104)。检测到的187个突变中,76%(142个)为错义点突变,13%(24个)为小片段缺失,6%(12个)为拷贝数扩增,3%(5个)为小片段插入,2%(4个)为无义突变。104例肺腺癌患者中,68例(65%)检测到涉及13个基因的34种靶向用药相关基因的突变,其中19例(18%)检测到≥2种靶向用药相关基因突变。女性患者比男性患者更容易发生EGFR基因突变[62%(34/55)比35%(17/49),χ2=7.629,P=0.006],男性患者比女性患者更容易发生KRAS基因突变[22%(11/49)比5%(3/55),χ2=6.424,P=0.011]。EGFR、TP53、KRAS、CDKN2A基因在昆山市第一人民医院与欧美肺腺癌人群中的突变率差异均有统计学意义(均P<0.05)。结论 肺腺癌的基因突变特征较为复杂,且在不同人群中的差异较大。基于高通量测序技术的多基因联合检测可相对全面地揭示患者肿瘤相关基因突变特征,对个体化的靶向用药指导、耐药监测及预后评估有一定的意义。     

Correlation between computed tomography findings and epidermal growth factor receptor and KRAS gene mutations in patients with pulmonary adenocarcinoma

We examined the correlation between computed tomography (CT) findings and the incidence of epidermal growth factor receptor (EGFR) and KRAS mutations in lung adenocarcinoma. We analyzed the tumors of 136 patients with surgically resected primary lung adenocarcinoma. CT scans were evaluated for the presence of ground grass opacity (GGO), spiculation and the maximum diameter of the tumor was measured. SMart Amplification Process (ver. 2) was used to detect the presence of EGFR and KRAS mutations. EGFR and KRAS mutations were found in 56 (41.1%) and 25 (18.4%) of the 136 cases, respectively. Although no significant association was found between GGO and EGFR mutations (p=0.07), the EGFR mutation occurred more frequently in male patients with GGO than in those without GGO (p=0.04). The KRAS mutation occurred more frequently in patients whose tumor diameter was ≥ 31 mm than in those whose tumor diameter was <30 mm (p=0.003). Evaluation of CT findings may be helpful for determining the presence of EGFR and KRAS mutations, particularly when it is not possible to obtain a tumor specimen.     

Thymidylate synthase expression is closely associated with outcome in patients with pulmonary adenocarcinoma

The aim of this study is to elucidate the prognostic significance of thymidylate synthase (TS), orotate phosphoribosyltransferase (OPRT) and dihydropyrimidine dehydrogenase (DPD) in completely resected non-small cell lung cancer (NSCLC). One hundred and sixty patients with NSCLC were included in this study. Tumor sections were stained by immunohistochemistry for TS, OPRT, DPD, glucose transporter 1 (Glut1), hypoxia inducible factor-1α (HIF-1α), vascular endothelial growth factor (VEGF), microvessel density (MVD) determinated by CD34, epidermal growth factor receptor (EGFR), phosph-Akt, phosph-mammalian target of rapamycin (mTOR) and p53. TS, OPRT and DPD were positively expressed in 46, 71 and 54%, respectively. The expression of TS and OPRT was significantly higher in patients with non-adenocarcinoma (non-AC) (n = 53) than adenocarcinoma (AC) (n = 107), and DPD expression was higher in adenocarcinoma as compared with non-adenocarcinoma. A positive TS expression was an independent prognostic factor for predicting a poor outcome in patients with AC, but not in those with non-AC. In AC patients, TS expression was significantly associated with advanced stage, lymph node metastases, vascular invasion, Glut1, HIF-1α, angiogenesis, EGFR signaling pathway and p53. In patients with non-AC, TS expression was not closely correlated with outcome and these biomarkers. A positive TS expression was a powerful prognostic factor to predict a poor outcome in completely resected AC patients.     

MOC-31 aids in the differentiation between adenocarcinoma and reactive mesothelial cells

BACKGROUND: Evaluation of effusion specimens for the presence of adenocarcinoma often is complicated by the presence of reactive mesothelial cells that can mimic adenocarcinoma. Ancillary studies, in particular immunohistochemistry, can be helpful in making this distinction. MOC-31 is an antibody that recently was reported to be useful in distinguishing adenocarcinoma from mesothelioma in tissue specimens. In this study we examined the utility of this antibody in pleural effusions. METHODS: Eighty-nine archival, formalin fixed, paraffin embedded cell blocks representing 59 adenocarcinomas, 12 other neoplasms (including 6 mesotheliomas), and 18 reactive effusions were retrieved. After protease digestion, recut slides were immunostained with the MOC-31 antibody utilizing a modified avidin-biotin complex technique. Only membrane-based reactivity was considered as positive. RESULTS: In two adenocarcinomas there was insufficient material remaining in the cell block. Among the 57 remaining cases, reactivity was observed in 54 cases. Reactivity also was observed in one of six mesotheliomas and one small cell carcinoma. The remaining cases, including all 18 reactive effusions, were nonreactive. In distinguishing adenocarcinoma from reactive mesothelial cells, the presence of MOC-31 reactivity was found to be 95% sensitive and 100% specific with a positive predictive value of 100% and a negative predictive value of 95%. CONCLUSIONS: MOC-31 is useful in differentiating between adenocarcinoma and reactive mesothelial cells in pleural effusion specimens. Cancer (Cancer Cytopathol) Copyright 1999 American Cancer Society.     

Relationship between the loss of heterozygosity and tobacco smoking in pulmonary adenocarcinoma

A loss of heterozygosity (LOH) is a major cause of lung carcinogenesis, and it is considered to be related to tobacco smoking in central type lung cancer. We investigated the relationship between LOH in lung adenocarcinoma and tobacco smoking. In a consecutive series of 50 patients with lung adenocarcinoma who underwent a surgical resection, cancer tissue specimens and corresponding normal peripheral lung and central bronchial tissue specimens were analyzed for LOH at the regions of D3S1234 (FHIT), D3S1300 (FHIT), D9S171 (CDKN2), and D17S796 (p53) by polymerase chain reaction using four fluorescence-labeled dinucleotide markers. To examine how cells are influenced by smoking, the A549 cell line was exposed to benzo[a]pyrene (B[a]P) for 24 weeks and then was subjected to the above analysis. The LOH in cancer tissue was thus detected in four (17%) patients at D3S1234, six (14%) at D3S1300, and seven (18%) at D17S796, but no LOH was detected in any normal tissue specimens. The incidence of LOHs in cancer tissue specimens from active smokers was 21% at D3S1234, 11% at D3S1300, and 19% at D17S796, whereas that of LOHs from nonactive smokers was 0% at D3S1234, 19% at D3S1300, and 14% at D17S796. Analyzing the relationship between the pack-year index and the presence of LOH, a significant difference was found among the active smokers. Besides, in the A549 cell line exposed to B[a]P, LOH was de novo detected in one (D2S123) of the nine regions examined. The incidence of LOH could be influenced by tobacco smoking in lung adenocarcinoma, thus suggesting the presence of an important event in the carcinogenesis of this disease.     

Immunomorphologic responses of regional lymph nodes and prognosis in patients with stage Ia pulmonary adenocarcinoma

The relationship between postoperative prognosis and the immunomorphologic response of regional lymph nodes was examined in 50 patients with stage Ia peripheral bronchial adenocarcinoma and compared with 22 patients in stage Ib and II. Regarding paracortical lymphocyte hyperplasia, the prognosis of the responsive group in patients with stage Ia was significantly better than that of the non-responsive group; however, no definite relationship was found between follicular hyperplasia and prognosis. Follicular hyperplasia correlated with the size of the primary lesion or the distance from the site of the primary lesion. In stage Ib and II cases with metastasis to the pulmonary hilar lymph nodes, paracortical lymphocyte hyperplasia or follicular hyperplasia had no relation to the postoperative prognosis.