原发性支气管腺样囊性癌的诊断和治疗

 本文报道了我科1978～1992年收治原发性支气管腺作囊性癌3例,发生率为0.3%（3/1016）.术前病史都较长,临床表现和X线检查缺乏特异性,常延误诊断。手术切除是最有效的治疗方法,术后长期生存率较高。     

原发性气管癌的治疗分析

目的 探讨原发性气管癌临床与病理特点及不同治疗对生存率的影响。方法 1983年至2001年，本科收治经放疗的原发性气管癌14例，6例手术加术后放疗，单纯放疗8例。结果 全组病例伴发鼻咽重复癌1例。1、2、5a生存率分别为64．28％(9／14)、57．14(8／14)、25％(3／12)。2a生存率比较：手术加术后放疗组100％(6／6)，单纯放疗组25％(2／8)，P=0．01。腺样囊性癌100％(5／5)、非腺样囊性癌33％(3／9)，P=0．03。结论 本组原发性气管癌伴发重复癌比例为7．14％。2a生存率比较手术加术后放疗及腺样囊性癌病人预后较好。显示有统计学意义。     

支气管腺样囊性癌的诊断与治疗体会

探讨支气管腺样囊性癌的临床特点，病理特征和治疗原则，总结12例支气管腺样囊性癌的治疗经验，3年生存率100%（12/12），5年生存率75%（9/12），支气管腺样囊性癌是一种少见的低度恶性肿瘤，手术切除是最有效的治疗方法。     

原发性气管和主支气管恶性肿瘤的外科治疗

目的 探讨原发性气管和主支气管恶性肿瘤外科治疗的临床经验.方法 对18例原发性气管和主支气管恶性肿瘤患者进行外科手术治疗,其中12例在非体外循环下进行,6例在体外循环下进行.全组气管袖式切除、端端吻合8例,气管下段和隆突切除、隆突重建4例,单纯行肿瘤刮除术4例,右全肺加隆突切除1例,左全肺加隆突切除1例.结果 腺样囊性癌7例,鳞状细胞癌9例,淋巴上皮样癌1例,滤泡型非霍奇金淋巴瘤1例.术后10 d,1例患者因气管切开后气管内大出血而窒息死亡,其他患者术后呼吸困难均有明显改善,近期疗效较好.结论 原发性气管和主支气管恶性肿瘤首先应考虑手术切除,并根据患者的具体情况选择适当的手术方法;手术治疗要兼顾根治性和安全性.     

原发性支气管腺样囊性癌的诊断和治疗

目的 探讨原发性支气管腺样囊性癌的临床、病理特征和治疗原则。方法 1980年1月～1997年5月手术治疗8例原发性支气管腺样囊性癌,均经手术和病理证实。结果 原发性支气管腺样囊性癌占同期原发性肺部恶性肿瘤的0.48％(8/1676);男性5例,女性3例;中心型6例,周围型2例;除1例肿瘤固定不能切除外,余7例均行手术切除,且其中4例存在癌残留。3年生存率为83.3％(5/6),5年生存率为60％(3/5)。结论 原发性支气管腺样囊性癌是一种罕见的低度恶性肿瘤,好发于主、叶支气管,X线表现与肺癌不易区别,纤维支气管镜检查最重要。目前认为手术切除是腺样囊性癌最有效的治疗方法,即便是姑息性切除,术后也能生存多年。     

气管、支气管腺样囊性癌的诊断与治疗

背景与目的 腺样囊性癌是一种原发于支气管肺部的低度恶性肿瘤.本研究回顾性分析本院1958年1月-2007年12月共50年间收治的43例患者,探讨原发性气管、支气管腺样囊性癌的临床特点、病理特征和治疗方法.方法 总结我院50年间收治的43例原发性气管、支气管腺样囊性癌患者,其中40例采取手术治疗,3例患者在纤支镜下行介入治疗(均经手术或病理证实).全组43例患者术后均无并发症发生,无手术死亡,总随访率为97.6%(42/43),1例失访按死亡计.结果 本组43例患者中,3年生存率为100%(41/41),5年生存率为89.5%(34/38),10年生存率为87.1%(27/31).结论 原发性气管、支气管腺样囊性癌是一种少见的低度恶性肿瘤,临床症状不典型,早期发现并采取手术联合放疗是最好的治疗手段,未手术者在内镜下介入治疗也是一种较好的治疗方法.     

原发性气管支气管腺样囊性癌的研究进展

原发性气管支气管腺样囊性癌(primary tracheobronchial adenoid cystic carcinoma, TACC)是一种罕见的非小细胞肺癌,仅占所有肺恶性肿瘤的0.1%～0.2%。按照2021版世界卫生组织(world health organization, WHO)肺肿瘤组织学分类,该肿瘤属于唾液腺型肿瘤。该疾病临床表现及影像学无特异性,易被延误诊治,确诊需病理,分期尚无公认标准,治疗首选手术,术后或不能手术者可行放疗,单纯全身治疗(化疗、靶向、免疫)效果差。该文对TACC从命名和组织学分类、临床特征、影像学、病理、分期、治疗和预后共七个方面进行了综述。     

陈旧性气管支气管断裂的外科治疗

目的：总结陈旧性气管支气管断裂的外科治疗效果。方法：X片和CT以及支气管镜是诊断气管支气管断裂的可靠方法。肺的鉴定根据麻醉机气气囊加压冲气是否膨胀来断定肺功能术后恢复的可能性。结果：8例采用瘢痕切除端端吻合，术后肺膨胀良好，肺功能基本恢复。结论：陈旧性气管支气管断裂的病人无论外伤时间多长均可手术治疗，疗效满意。     

原发性肝癌的外科治疗

原发性肝癌(简称肝癌)是全球第5位常见恶性肿瘤,每年约100万人死于肝癌。欧美的肝癌发病率正逐年增加。上世纪80年代以来,美国肝癌发病率增加了75％。其主要原因是病毒性肝炎感染人群的增加以及诊断技术的提高。对高危人群的随访以及诊断技     

肺部少见的原发恶性肿瘤——附19例报告

目的:探讨肺部少见原发性恶性肿瘤的临床特点、诊断和治疗方法。方法:总结我院1987年~2006年的肺少见原发性恶性肿瘤共19例临床资料结合文献进行分析。结果:19例病人中肺平滑肌肉瘤3例,肺纤维肉瘤3例,肺软骨肉瘤1例,肺母细胞瘤2例,肺癌肉瘤1例,肺恶性淋巴瘤3例,支气管乳头状瘤恶变2例,肺恶性神经鞘瘤1例,肺恶性血管外皮瘤2例,肺恶性黑色素瘤1例。全组病人均经手术切除病变肺组织,其中肺叶切除17例,肺段切除1例,全肺切除1例。无手术及术后住院期死亡,无术后严重并发症。结论:手术是肺部少见原发性恶性肿瘤主要的诊断和治疗手段。     

肺部少见的原发恶性肿瘤——附19例报告

目的：探讨肺部少见原发性恶性肿瘤的临床特点、诊断和治疗方法。方法：总结我院1987年-2006年的肺少见原发性恶性肿瘤共19例临床资料结合文献进行分析。结果：19例病人中肺平滑肌肉瘤3例,肺纤维肉瘤3例,肺软骨肉瘤1例,肺母细胞瘤2例,肺癌肉瘤1例,肺恶性淋巴瘤3例,支气管乳头状瘤恶变2例,肺恶性神经鞘瘤1例,肺恶性血管外皮瘤2例,肺恶性黑色素瘤1例。全组病人均经手术切除病变肺组织,其中肺叶切除17例,肺段切除1例,全肺切除1例。无手术及术后住院期死亡,无术后严重并发症。结论：手术是肺部少见原发性恶性肿瘤主要的诊断和治疗手段。     

原发性气管肿瘤的外科治疗

 自1991年6月至1996年11月, 我们对原发性气管肿瘤23例进行手术治疗, 其中良性肿瘤2例, 恶性肿瘤21例, 施行气管节段切除11例, 侧壁切除6例, 气管腔内肿瘤刮除加电灼术6例。 术后无发生气管瘘、无手术死亡。 术后1、3、5年生存率分别是86％、53％和21％。 作者认为应根据气管肿瘤的病理性质, 病变范围和外侵程度, 酌情使用气管节段切除、侧壁切除和肿瘤刮除加电灼术。     

国产镍钛支架治疗气道狭窄

目的　评价国产镍钛合金气管支架治疗气管支气管良恶性狭窄的疗效。方法　气管、支气管良恶性狭窄13例 ,狭窄部位 :气管 5例、气管主支气管 6例 ,主支气管 2例 ,经纤支镜和X线合用共放置 15枚支架。结果　全部支架均放置成功 ,呼吸困难改善 ,死亡病例平均存活时间 11.4个月 ,1例仍存活。结论　经纤支镜和X线合用 ,植入国产镍钛合金支架是治疗气管、支气管良恶性狭窄的有效方法。     

Epiphysis preserving operations for the treatment of lower limb malignant bone tumors

Purpose

To assess two epiphyseal sparing procedures for the treatment of lower limb malignant bone tumors.

Methods

Between January 2007 and January 2011, 15 patients, seven males and eight females with a mean age of 11.75 years (range, 7–24), underwent epiphysis preservation operations. There were ten osteosarcomas, three Ewing's sarcomas and two fibrosarcomas. Ten tumors were in the distal femur and five in the proximal tibia. Chemotherapy was administered pre- and post-surgery. A transepiphyseal resection was performed in nine patients and an epiphysis section after physeal distraction in six. The affected bones were substituted with massive allograft bone and fixed with intramedullary nails or plates and screws. Follow-up assessment included plain X-rays and MRI.

Results

One patient died from lung metastases 32 months post-surgery. Surgical complications included length discrepancy between both legs of 1–3 cm in four patients, >3 cm in one patient, delayed union at the proximal allograft-host junction in two patients and at the distal junction in 13 patients. Graft bone rejection occurred in two patients, superficial infection was seen in one patient, and broken fixation and partial graft bone resorption occurred in one patient. No relapse was observed during the follow-up period. Normal knee joint flexion-extension was achieved in 14 patients. All patients were able to walk unaided 24 months after surgery.

Conclusions

Limb saving surgery with epiphyseal sparing is useful for the management of malignant bone tumors in children and adolescents, and maintains normal joint function with few complications.     

Surgical treatment of phyllodes tumors of the breast: retrospective review of 172 cases

BACKGROUND AND OBJECTIVES: Phyllodes tumors (PTs) are uncommon biphasic breast tumors that usually occur in adult females. They are composed of a benign epithelial component and a cellular, spindle cell stroma forming a leaf-like structure. No one morphologic finding is reliable in predicting the clinical behavior of the tumor. The purpose of this study was to explore the clinicopathologic factors associated with outcome and metastasis. METHODS: We retrospectively reviewed the records of 172 patients seen at Mackay Memorial Hospital from January 1985 to December 2003. Clinical data analyzed included age, presenting symptoms and signs, tumor size, location, type of surgery, time to recurrence, and metastasis. The clinicopathologic factors associated with outcome and metastasis were analyzed statistically using the chi-square test with Yate correction. RESULTS: The mean follow-up was 71 months (range 7-237). The mean age was 37 years (range 11-73). The majority of tumors were found in the upper outer quadrant (46.0%), with an equal propensity to occur in either breast (48.8% vs. 50.0%). The pathologic diagnoses included 131 benign, 12 borderline, and 29 malignant lesions. Nineteen patients (11%) had a recurrence and three (1.7%) had metastases. The initial diagnosis of all 19 recurrent tumors were benign. Age, surgical approach, mitotic activity, and surgical margin were significantly correlated with recurrence (P = 0.029, 0.020, 0.048, and 0.00018, respectively). Stromal cellularity, stromal overgrowth, stromal atypia, mitotic activity, tumor margin, and heterologous stromal elements were significantly correlated with metastases (P = 0.032, 0.00008, 0.000002, 0.004, 0.005, and 0.046, respectively). Mammography and breast echo were not reliable for differentiating PTs from fibroadenomas (6.9% vs. 37.9% and 3.3% vs. 45%, respectively). Frozen section was of limited value (41.6%). The role of adjuvant radiotherapy and chemotherapy remains to be defined. Local excision, wide excision, or mastectomy with negative surgical margins yielded high local control rates (88.7%, 88.2%, and 100%, respectively), but local excision was associated with a relatively high percentage of positive surgical margins (18.3%). A total of 42 modified radical mastectomies were performed. The reasons for these procedures included a diagnosis of malignancy on frozen section or because the tumors were so large, they were assumed to be carcinomas. No axillary lymph node metastases were found. Fifteen patients in our series had tumors with infiltrating tumor margin, severe stromal overgrowth, atypia, and cellularity. All three patients with metastases (3/15) were in this group. Presence of metastases was significantly correlated with this group (P = 0.0000038). CONCLUSIONS: Wide excision with a clear margin may be the preferable initial therapy, even for malignant PTs. Routine axillary lymph node dissection is not recommended. Patients have tumors with infiltrating tumor margin, severe stromal overgrowth, atypia, and cellularity are at high risk for metastases.     

壶腹周围恶性肿瘤的临床外科病理分析

目的研究壶腹周围肿瘤的临床外科病理特点.方法回顾性分析1980年1月～2000年1月在中国医学科学院肿瘤医院腹部外科收治的454例壶腹周围恶性肿瘤的临床资料,用SSPS10.0统计软件包比较不同部位恶性肿瘤临床外科病理特点之间的差异.结果全组292例(64.3%)患者不能手术切除,其中胰头恶性肿瘤的症状持续时间显著长于胆总管、壶腹肿瘤(P＜0.05),血清总胆红素水平显著低于壶腹、胆总管肿瘤患者(P＜0.001);十二指肠恶性肿瘤患者的血清总胆红素水平、转氨酶水平显著低于其他3种恶性肿瘤(P＜0.05).与非胰腺来源的壶腹周围恶性肿瘤相比,胰头恶性肿瘤更易侵犯血管(P＜0.001);与胰头、壶腹恶性肿瘤相比,胆总管恶性肿瘤、十二指肠恶性肿瘤更易侵犯周围组织(P＜0.05).全组有162例(35.7%)手术切除,其中十二指肠、胰头恶性肿瘤患者的症状持续时间显著长于胆总管、壶腹肿瘤(P均＜0.05);十二指肠恶性肿瘤转氨酶水平显著低于胰头(P＜0.001)、胆总管(P=0.025)和壶腹肿瘤(P=0.001).十二指肠恶性肿瘤出现总胆红素升高的比例显著低于壶腹(P=0.004)、胰头(P=0.003);壶腹恶性肿瘤比胰头恶性肿瘤更易侵犯十二指肠(P=0.008).结论胰头恶性肿瘤患者的症状持续时间长,容易出现血管侵犯.胆总管、壶腹恶性肿瘤症状持续时间短,总胆红素水平高;十二指肠恶性肿瘤则相反.壶腹恶性肿瘤容易侵犯十二指肠,胆总管和十二指肠恶性肿瘤则容易侵犯周围组织.     

Surgical treatment of malignant liver tumors

One hundred and nineteen patients were operated upon, 89--for primary cancer of the liver, 30--for cancer metastases. Radical operations for primary cancer of the liver were performed in 5 of 89 patients, and in 8 of 30 patients with metastatic involvement of the liver. In radical operations for malignant hepatic neoplasms frequently there would arise the necessity of a temporary exclusion of the organ from the portal and caval circulation.     

Diagnostic and treatment strategy for small gastrointestinal stromal tumors

Gastrointestinal stromal tumors (GISTs) are considered to be potentially malignant mesenchymal tumors of the gastrointestinal tract. Clinically relevant GISTs are rare; however, subclinical GISTs (mini‐GISTs) (1‐2 cm) and pathologic GISTs (micro‐GISTs) (<1 cm) are frequently reported. Most mini‐GISTs and almost all micro‐GISTs of the stomach may exhibit benign clinical behavior, and only mini‐GISTs with high‐risk features may progress. For this review, a provisional algorithm was used to propose diagnostic and treatment strategies for patients with small GISTs. Because surgery is the only potentially curative treatment, in its application for small GISTs, the principles of sarcoma surgery should be maintained, and cost effectiveness should be considered. Indications for surgery include GISTs measuring ≥2 cm, symptomatic GISTs, and mini‐GISTs with high‐risk features (irregular borders, cystic spaces, ulceration, echogenic foci, internal heterogeneity, and tumor progression during follow‐up); however, a preoperative pathologic diagnosis is infrequently obtained. For small intestinal and colorectal GISTs, surgery is indicated irrespective of size because of their greater malignant potential. Otherwise, mini‐GISTs without high‐risk features, micro‐GISTs, and small submucosal tumors measuring <5 cm without high‐risk features may be followed by periodical endoscopic ultrasonography. Although surgical approaches and operative methods are selected according to tumor size, location, growth pattern, and surgical teams, laparoscopic surgery has produced similar oncologic outcomes and is less invasiveness compared with open surgery. After resection, pathologic examination for diagnosis and risk assessment is mandatory, and genotyping is also recommended for high‐risk GISTs. Endoscopic resection techniques, although feasible, are not routinely indicated for most mini‐GISTs or micro‐GISTs. Cancer 2016;122:3110–8 . © 2016 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.