Radiological diagnosis of early esophageal carcinoma

1. Clinically, intramucosal carcinoma guarantees good prognosis. So, to detect them is very important. 2. Intramucosal carcinoma give rise to slight wall stiffness and/or very fine mucosal abnormality on double contrast view. 3. To detect intramucosal carcinoma, we must pay careful attention to the above abnormalities of the esophageal wall.     

早期食管癌诊断研究进展

早期食管癌的诊断对提高食管癌治疗效果和改善患者预后具有极其重要的意义.对食管癌高发区或高危人群进行筛检,对具有食管疾病症状但常规内镜检查不能确定其病变性质者,采用色素内镜、超声内镜、肿瘤标志物检测和联合检测等方法检查可明显提高早期食管癌的诊断率,为早期食管癌临床治疗评估提供充分且科学的依据.     

Histopathological classification of esophageal carcinomas

Esophageal carcinomas are steadily rising worldwide; they rank sixth among tumors. Adenocarcinoma is the most common histological type in Western countries while squamous carcinoma is more common in the developing countries. Both types are preceded by pre-neoplastic lesions rappresented by Barrett's esophagus for adenocarcinoma and low and high grade dysplasia for squamous carcinoma. Some continuity exists between dysplastic lesions and frankly invasive tumors. Moreover rare hystological types have been described. The surgical pathologist plays an important role in evaluating small endoscopic biopsies as well as in examining surgical specimens from esophagectomy. In the former case the role is exclusively diagnostic while in the latter surgical radicality, cancer stage and outcomes of neoadjuvant therapies are assessed. All these data are crucial not only for prognosis but also for therapy planning.     

93例可手术切除食管癌三维适形放疗长期生存分析

目的 分析临床可切除食管癌三维适形放疗的长期疗效和副反应及治疗失败原因,并与同期手术治疗患者结果进行比较.方法 回顾分析93例接受三维适形放疗的可切除食管癌患者,采用6 MV X线直线加速器放疗50～70 Gy.对影响患者预后因素进行单、多因素分析,并分析死亡原因.分析同期93例手术治疗患者治疗结果.结果 放疗组随访满1、3、5年者分别为79、42、13例,随访率为100%.1、3、5年总生存率分别为84%、50%、29%,局部控制率分别为83%、63%、55%,无瘤生存率分别为83%、49%、28%,无远处转移生存率分别为84%、51%、28%.单因素分析显示患者年龄、疗前进食状况、疗前有无胸背部疼痛、病变部位、X线病变长度、CT扫描显示病变最大侵袭深度、近期疗效及未行手术原因与预后相关,多因素分析显示患者年龄、疗前有无胸背部疼痛、病变部位、X线病变长度是独立预后因素.局部复发和远处转移仍为患者主要死亡原因.手术组随访满1、3、5年者分别为80、46、16例,随访率为100%.1、3、5年总生存率分别为86%、62%、41%,中位生存期47.8个月.结论 三维适形放疗可切除食管癌能取得较好疗效,可作为其治疗方法之一.

Abstract：

Objective To analyze the result of3-dimensional conformal radiotherapy(3DCRT)and operation of early stage esophageal carcinoma. Methods Ninety-three patients with early stage esophageal carcinoma were treated with 3DCRT from October 2000 to December 2006. The total dose was 50 -70 Gy/25 -35F/5 -7 w. Toxicities and survival rates were evaluated by Kaplan Meier method and the factors of death were analyzed. Results In the 3DCRT group, 79, 42 and 13 cases were followed up for at least 1-,3-,and 5-year, respectively. Follow-up rate was 100%. The 1-, 3-, and 5-year actuarial survival rates were 84% ,50% and 29%, respectively, with a median survival time of 37.0 months. The 1-, 3-, and 5-year local control rates were 83% ,63% and 55% ,respectively. The 1-, 3-, and 5-year disease free survival rates were 83% ,49% and 28%, respectively. The 1-, 3-, and 5-year metastasis free survival rates were 84%,51% and 28%, respectively. There were significant influence on the prognosis of age, the state of food taken before treatment, the pain of chest and back, the disease region, the tumor length in x-ray, the maximuminfiltration depth in CT scan, the preliminary curative effect and the no operation in univariate analysis. The Cox multivariate model showed that age, the pain of chest and back, the disease region and the tumor length in X-ray were independent prognostic factors. In the operation group, 80,46 and 16 cases were followed up for at least 1-,3-,and 5-year, respectively. Follow-up rate was 100%. The 1-, 3-, and 5-year actuarial survival rates were 86% ,62% and 41%, respectively, with a median survival time of 47.8 months. Conclusion Three-dimensional conformal radiotherapy is one of the best radiation treatment regimen for early esophageal carcinoma.     

An associated concomitant early multiple esophageal carcinoma and gastric carcinoma

Presented is the case of a 71-year-old female with an associated, concomitant early multiple esophageal carcinoma and a gastric carcinoma. An esophageal endoscopy revealed a reddish region in the upper and middle esophagus. This lesion, in part, remained unstained by lugol. Further, three lesions were observed at the upper and middle portions of the esophagus in a resected specimen, and the macroscopic diagnosis was 0-II c, These lesions were histologically diagnosed as being moderately differentiated squamous cell carcinomas, 5 x 15 mm, 2 x 5 mm, and, 3 x 5 mm in size. Furthermore, a lesion in the cardia was found superimposed on the esophageal cancer, and diagnosed as being an adenocarcinoma (II b), 10 x 15 mm in size. In the literature, reports of a concomitant association of an early esophageal carcinoma and a gastric carcinoma amount to 19 cases in Japan, our case being the twentieth case. In formatively, our case was found to display a multiple carcinoma in the esophagus.     

早期食管癌自然生存状态的长期观察

目的 观察拒绝治疗的早期食管癌患者的自然发展状态.方法 1985年至1990年间,在河南省林州市食管癌高发现场,完成内镜筛查4800例.按内镜下观察为浅表黏膜病变,经活检病理诊断为原位癌、黏膜内癌或鳞癌的标准,共检出132例早期食管癌患者,其中48例因不同原因拒绝治疗.对48例未经治疗的食管癌患者进行随访,观察其自然发展状态.随访期间,有40例患者曾做过1～4次内镜复查.结果 随访至2005年12月31日,48例患者中,5例仍生存,43例死亡,其中死于食管癌者38例,占79.2%;死于非癌疾病者5例,占10.4%.全组生存时间≥5年者37例,患者的5、10、15和20年生存率分别为77.1%、39.6%、25.0%和10.4%.结论 食管癌从早期发展到晚期是一个漫长的演变过程,这对于食管癌的早期诊断和选择治疗时机很有帮助.如果要评价早期食管癌的治疗效果,应充分考虑其自然发展史的领先时间偏倚.     

早期食管癌的内镜诊治

随着近年来消化内镜诊治技术的研究进展,越来越多的早期食管癌得到诊断和治疗,提高了食管癌患者的生存率.现综述早期食管癌的内镜下特点、分型、诊断标准及内镜治疗方法,包括内镜下食管粘膜切除术、NdYAG激光治疗、光动力学治疗、氩离子血凝法、局部注射抗癌药物等.     

Cytologic diagnosis of hepatocellular carcinoma by fine-needle aspiration biopsy

From 1976 to June 1982, 237 patients with clinical suspicion of hepatic malignant disease underwent guided percutaneous fine-needle aspiration biopsy of the liver. Of these, 12 were diagnosed cytologically as "hepatocellular carcinoma" and this diagnosis was confirmed in the follow-up of all cases. On the basis of the cytomorphologic features observed in the aspirates, the tumor was subclassified into three types; well differentiated, pleomorphic large cell; and poorly differentiated. The various cytologic appearances of different types of hepatocellular carcinoma are presented and illustrated. Cytomorphologically, these three types of hepatocellular carcinoma were distinctly different and their cytomorphologic features were also sufficiently distinctive from those of secondary hepatic cancer to be diagnostic. Guided percutaneous fine-needle aspiration biopsy of the liver appears to be a definitive minimally invasive means of establishing the diagnosis of hepatocellular carcinoma, and promises to be a valuable diagnostic procedure for potentially resectable localized hepatocellular carcinoma.     

Cytologic diagnosis of bronchioloalveolar carcinoma by fine-needle aspiration biopsy

From 1970 to June 1984, 275 patients with bronchioloalveolar carcinoma were admitted to the Toronto General Hospital. Of these, 181 (190 aspiration biopsies, including nine repeat samples) had this diagnosis made following the use of transthoracic fine-needle aspiration biopsy. Based on the cytomorphologic features observed in the aspiration preparations, the tumor was subclassified into three types: nonsecretory, secretory, and poorly differentiated. The cytologic features of these three types of bronchioloalveolar carcinoma are presented and illustrated. Cytomorphologically, the three types of this tumor are distinctly different and their features are sufficiently distinctive from those of bronchogenic adenocarcinoma and metastatic adenocarcinomas to be of diagnostic value. Transthoracic fine-needle aspiration biopsy appears to be a definitive minimally invasive means of establishing the diagnosis of bronchioloalveolar carcinoma preoperatively and especially to be of value for those small peripheral cancers which are relatively inaccessible to direct method of study and are potentially surgically curable.     

前程加速放射治疗食管癌临床观察

目的　评价前程加速放射治疗食管癌的疗效。方法　自 1994年 1月至 1996年 2月 ,选择 10 6例食管癌患者 ,随机分为两组 :(1)前程加速放射治疗组 5 3例 ,放射治疗第 1,2周 ,每天 3Gy ,5次 /周 ,第 3 ,4周 ,每天 2Gy ,5次 /周 ,总剂量 5 0Gy/ 4周 ;(2 )常规放射治疗组 5 3例 ,每天 2Gy ,5次 /周 ,总剂量 60Gy/ 6周。 结果　前程加速组 5年局部控制率和 5年生存率明显高于常规放疗组 ,分别为 41.5 %比 18.9%和 18.7%比 9.7% ,放疗副作用两组无明显差别。结论　结果显示前程加速放射治疗能提高食管癌局部控制率和生存率。     

食管脱落细胞DNA分析对食管癌诊断价值的探讨

目的:探讨通过流式细胞术进行食管脱落细胞DNA分析,在食管癌诊断中的价值.方法:用食管拉网法获得61例食管癌和31例非食管癌患者食管脱落细胞,记录和计算DNA指数(DI)、G2/G1、S期比率(SPF)和细胞增殖活性指数(PI)等,同时结合肿瘤的临床病理学特征,并与脱落细胞常规细胞学检查进行对比.结果:食管癌组DI为1.31±0.23,对照组为1.00±0.03;异倍体(An)出现率为70.7%,高于对照组4.8%;食管癌组G2/G1为2.071±0.153,对照组为1.996±0.099;并且SPF和PI两组指标的差异均有统计学意义,P<0.05.结论:食管脱落细胞DNA增殖活性指标对食管癌普查及提高早期诊断率具有一定的应用价值.     

Automatic needle biopsy in the diagnosis of early breast cancer

An automatic needle biopsy system, Bioptycut, has been evaluated for use in the outpatient biopsy of 107 patients with suspected operable breast cancer. Of the 107 patients, 96 proved to have malignancy. The sensitivity of the test was 65%, and the specificity 100%. Using a fine gauge needle the sensitivity was originally less than that of Trucut biopsy, but improved results were obtained with more experience.     

Brain metastasis from esophageal carcinoma

Metastatic esophageal carcinoma to the brain is a rare occurrence that may account for abnormal neurological findings.