Superior vena cava obstruction: is stenting necessary?

No therapy is currently available for patients with recurrent vascular obstruction of the superior vena cava (SVC) caused by tumor regrowth after chemotherapy or radiation therapy. Intravascular stenting is a new option for the treatment of vena cava syndrome. Forty cancer patients with SVC syndrome (SVCS) were evaluated by computed tomography (CT) and venography. The SVC or its tributaries were stenosed or thrombosed in all patients. The etiology was malignant in all but 2 cases: non-small-cell lung carcinoma (n = 28), mediastinal nodal metastasis (n = 5), lymphoma (n = 2), pleural mesothelioma (n = 2), small-cell lung carcinoma (n = 1), and postradiation fibrous mediastinitis (n = 2). Stenting was achieved in 39 of the 40 patients, and clinical symptoms subsided in 92%. Stents remained patent in 36 of these 39 patients throughout a mean follow-up of 24 weeks (range 3 days to 24 months). SVC stenting is safe, effective and allows rapid cure of SVCS and port catheter implantation in patients in poor health.     

Alleviation of severe compressive symptoms in a patient with advanced lung carcinoma using tracheal and superior vena cava stents

Lung cancer is now the leading cause of death from cancer worldwide. Although surgery remains the treatment of choice, the majority of patients will be unresectable at presentation with a poor survival outcome. In those patients who also have tracheobronchial involvement; the aim of intervention is to restore airway patency, thus improving quality of life in a minimally invasive way. Superior vena cava (SVC) infiltration by lung carcinoma is present in 3%-5% of patients with lung cancer. In patients with malignant SVC syndrome, the average life expectancy is 3 to 10 months. In these cases the disease progresses rapidly and obstruction develops before there is time for collaterals to develop. We present a case of a 75-year-old man who had alleviation of severe compressive symptoms secondary to advanced lung carcinoma using tracheal and SVC stents placed as a single procedure.     

Echocardiographic diagnosis of malignant lesions of the heart

Three cases (all verified) were considered in terms of the potentialities of echocardiographic diagnosis of secondary malignant cardiac lesions (in bronchogenic lung cancer, mediastinal lymphosarcoma and Kaposi's sarcoma). The following signs of malignant cardiac lesion (with the involvement of the left chambers) were noted: inadequacy of a degree of obstruction and an obstructive effect, change of the mitral valvular cusps, the presence of additional echo-signals (from a tumor) in both chambers, their distribution at the walls, the hypokinetic and akinetic character of movement.     

原发性肺癌合并Trousseau综合征19例

目的：提高对原发性肺癌合并Ｔｒｏｕｓｓｅａｕ综合征的认识。方法回顾性总结１９９０年１月经我院诊治的１７９２例原发性肺癌的临床资料。对合并Ｔｒｏｕｓｓｅａｕ综合征的病例进行分析。结果１７９２例肺癌有１９例合并Ｔｒｏｕｓｓｅａｕ综合征,发生率１．０６％（１９／１７９２）,其中小细胞肺癌的发生率为０．３８％（２／５１８）,非小细胞肺癌的发生率为１．３３％（１７／１２７４）。实验室检查结果,凝血酶原时间（     

肺癌心包积液与其影像及病理分型关系的临床分析

目的　探讨肺癌心包积液与影像学及肺癌病理组织学分类关系。方法　分析近一年来经胸部CT或心脏B超证实肺癌伴有心包积液患者的影像及病理特点。结果　在 2 0 5例肺癌患者中 ,①影像学方面 :中央型肺癌伴心包积液占 10 6 % ,周围型肺癌伴心包积液占 10 1% ,弥漫型肺癌伴心包积液占 3 5 7% ;②病理组织学方面 :肺腺癌伴心包积液占 12 12 % ,肺鳞癌伴心包积液占 3 17% ,肺小细胞癌伴心包积液占2 2 72 % ,肺腺鳞癌伴心包积液占 9 0 9% ,未分化大细胞癌伴心包积液占 10 %。经比较 ,提示肺癌影像学分型方面中央型肺癌与周围型肺癌的心包积液差异无显著意义 ,而病理组织学分型差异有显著意义 ,肺小细胞癌的心包积液较肺腺癌、肺鳞癌高。结论　肺癌发生心包积液与肺癌的病理组织学分型有密切关系 ,肺小细胞癌较肺腺癌、肺鳞癌更易发生心包积液 ;而与肺癌的影像学分型无明显关系。     

云南省曲靖市631例肺癌患者临床特征分析

目的分析肺癌患者的临床特征,为肺癌的相关预防、诊治提供依据。方法选择云南省曲靖市第二人民医院2015年1月-2018年6月收治的631例肺癌患者作为研究对象,分析所有患者的性别、年龄、地域分布、吸烟史、肺部疾病史、病理类型等临床资料。结果 631例肺癌患者中,有腺癌378例(占59.91%),鳞癌197例(占31.22%),小细胞肺癌44例(占6.97%),其他12例(占1.90%)。肺癌患者男女比例为1.84:1。在鳞癌和小细胞肺癌中,男性所占比例均明显高于女性〔鳞癌:94.42%(186/197)比5.58%(11/197),小细胞肺癌:75.00%(33/44)比25.00%(11/44)〕,差异均有统计学意义(均P<0.01),在腺癌和其他病理分型中,男性和女性所占比例差异均无统计学意义(均P>0.05)。肺癌患者平均发病年龄为(61.95±10.98)岁,男性平均(62.56±10.97)岁,女性平均(60.57±11.66)岁,高发年龄为51~70岁。肺癌患者地域分布为麒麟区(216例)、宣威市(115例)、富源县(98例)、沾益区(81例)最为高发。肺癌患者的吸烟率为46.28%,其中鳞癌、小细胞肺癌患者的吸烟率较高,分别为69.04%、56.82%,腺癌患者吸烟率相对较低,为34.13%。既往有慢性肺部疾病史的肺癌患者共101例,占16.01%。结论云南省曲靖市是云南省肺癌高发地区,分析肺癌患者的临床特征对控制危险因素和促进高风险人群的早期发现具有重要意义。     

超声支气管镜引导下针吸活检术结合免疫组化及基因学检测在肺癌诊治中的应用*

目的评价超声支气管镜引导下针吸活检术(EBUS-TBNA)结合免疫组化技术和基因学检测在肺癌的诊断及治疗中的应用价值。方法回顾性分析从2013年5月-2015年10月共55例初诊的临床诊断纵隔占位或疑为肺癌伴纵膈或肺门淋巴结转移的患者,为明确诊断行EBUS-TBNA检查,必要时联合免疫组化检测进一步完善诊断及分型,并对部分肺癌患者行表皮生长因子受体(EGFR)或间变性淋巴瘤激酶(ALK)检测以明确分子分型从而为靶向治疗提供依据。结果 55例患者中,经EBUS-TBNA确诊为肺癌37例,肺转移癌3例,软组织肉瘤1例,转移性淋巴结腺癌1例,淋巴瘤1例,结核病4例,慢性炎症1例,7例经EBUS-TBNA未能明确诊断。EBUS-TBNA在该组肺癌诊断中的敏感性及准确性分别为92.5%(37/40)和94.5%(52/55)。29例EBUS-TBNA组织标本依赖免疫组化检测证实为肺癌且得到明确分型,其中17例肺腺癌,6例肺鳞癌,6例小细胞肺癌。6例EBUS-TBNA组织标本行EGFR基因检测,其中1例同时行ALK基因检测,基因检测结果示EGFR基因突变型4例,ALK基因无融合1例。所有病例无1例严重并发症发生。结论 EBUS-TBNA诊断肺癌具有良好价值,且安全性较好,结合免疫组织组化检测及基因突变检测对肺癌的诊断及指导治疗有突出的价值。     

Characterization and the clinical application of cultured human pulmonary carcinoma cells.

We had developed a new method for the selective cultivation of cancer cells in short-term. As a result of these improvement in the culture technique, long-term subcultures of cancer cells are possible in about 80% of cases of small cell carcinoma of the lung and nearly 40% of cases of non-small cell carcinoma of the lung. 23 small cell lung carcinoma (SCLC) cell lines, 48 non-SCLC cell lines and 4 metastatic lung tumor cell lines were established in our institute using the culture method. Fractional culture of cells exhibiting the same growth pattern in primary culture produce several subtype cell lines, which can be used in experimental studies of the heterogeneity of lung cancer and in treatment of patients with lung cancer. Using subcultured cancer cells of the second or third generation, we have developed and have clinically utilized a simple sensitivity test with a Terasaki's microplate for anticancer drugs. In 15 surgical patients with SCLC treated between April 1982 and March 1985, the sensitivity test was used to select optimal anticancer drugs for postoperative chemotherapy. The routine use of the sensitivity test in selecting postoperative chemotherapy definitely improved the 3-year survival rate from 38% to 52%.     

60例小细胞肺癌的CT表现

目的：分析小细胞肺癌（small cell lung cancer,SCLC）的CT表现特点,以提高对该病的认识。方法：收集有CT和临床资料并经病理证实的SCLC 60例,回顾性总结分析CT影像特征。结果：中央型肺癌47例,CT表现为肺门分叶状结节或肿块,伴阻塞性肺炎11例（23.4%）,阻塞性肺不张5例（10.6%）,42例（89.4%）伴有纵隔淋巴结肿大,36例行CT增强,其中32例肿块和淋巴结均匀强化。13周围型SCLC中,9例肿大的肺门、纵隔淋巴结较肺内肿瘤大。结论：SCLC CT主要征象以肺门区实性肿块为主,多伴有肺门、纵隔淋巴结转移,支气管阻塞征象出现较晚。     

不同种EP方案治疗老年人非小细胞肺癌的临床观察

目的 :探讨不同剂量及途径用药的EP方案治疗非小细胞肺癌的疗效和不良反应。方法 :1999年 1月～ 2 0 0 2年 1月将 14 3例非小细胞肺癌患者随机分为A(35例 )、B(36例 )、C(37例 )、D(35例 ) 4组 ,分别使用静脉小剂量滴注顺铂加口服足叶乙甙或静脉滴注足叶乙甙 ,以及静脉大剂量滴注顺铂加口服足叶乙甙或静脉滴注足叶乙甙四种EP方案治疗。结果 :4例EP方案的有效率分别为 4 0 .0 % (14 / 35 )、38.9% (14 / 36 )、4 0 .5 % (15 / 37)、4 2 .9% (15 /35 ) ;中位缓解期分别为 3.8月、4月、3.7月、3.4月。A组有白细胞下降、恶心、呕吐及脱发等不良反应最少 ,D组最多。结论 :静脉小剂量滴注顺铂口服足叶乙甙组成的EP方案简便、不良反应少 ,而且经济 ,适合老年人的非小细胞肺癌患者的姑息性治疗     

肺癌经支气管动脉灌注118例疗效观察

目的：观察化疗药物经支气管动脉灌注肺癌的疗效。材料与方法：收集化疗药物经支气管动脉灌注原发性肺癌118例，其中中央型78例，周围型40例；鳞癌52例，腺癌33例，大细胞未分化癌19例，小细胞未分化癌14例。观察其组织学类型、血供情况及发生部位与疗效的关系。结果：小细胞未分化癌总缓解率为78．6％，鳞癌75．0％，腺癌63．6％，大细胞未分化癌57．0％，中央型与周围型总缓解率分别为71．4％和52．3％；多血供型与中等血供型总缓解率为74．2％。而少血供型仅为23．5％。结论：化疗药物经支气管动脉灌注是治疗肺癌的有效方法；疗效主要取决于癌瘤血供癌细胞对抗癌药物的敏感及／与癌瘤细胞学类型。     

Differential diagnosis of intracavitary tumors obstructing the right ventricular outflow tract.

Three cases of right ventricular outflow tract obstruction caused by 3 distinct tumors-myxoma, sarcoma, and presumed metastatic tumor-diagnosed by transthoracic and transesophageal echocardiography are presented. The differences among these 3 types of tumors with similar clinical and echocardiographic findings are highlighted, and a review of the pertinent literature is discussed. By applying the approximate frequencies of cardiac tumors categorized by type and site, statistically, an intracavitary right ventricular outflow tract tumor is 70 to 140 times more likely to be malignant than benign; furthermore, if it is a primary cardiac tumor, it is approximately 2 times more likely to be a sarcoma than a myxoma.     

Classification of the Four Main Types of Lung Cancer Using a MicroRNA-Based Diagnostic Assay

For patients with primary lung cancer, accurate determination of the tumor type significantly influences treatment decisions. However, techniques and methods for lung cancer typing lack standardization. In particular, owing to limited tumor sample amounts and the poor quality of some samples, the classification of primary lung cancers using small preoperative biopsy specimens presents a diagnostic challenge using current tools. We previously described a microRNA-based assay (miRview squamous; Rosetta Genomics Ltd., Rehovot, Israel) that accurately differentiates between squamous and nonsquamous non-small cell lung cancer. Herein, we describe the development and validation of an assay that differentiates between the four main types of lung cancer: squamous cell carcinoma, nonsquamous non-small cell lung cancer, carcinoid, and small cell carcinoma. The assay, miRview lung (Rosetta Genomics Ltd.), is based on the expression levels of eight microRNAs, measured using a sensitive quantitative RT-PCR platform. It was validated on an independent set of 451 samples, more than half of which were preoperative cytologic samples (fine-needle aspiration and bronchial brushing and washing). The assay returned a result for more than 90% of the samples with overall accuracy of 94% (95% CI, 91% to 96%), with similar performance observed in pathologic and cytologic samples. Thus, miRview lung is a simple and reliable diagnostic assay that offers an accurate and standardized classification tool for primary lung cancer using pathologic and cytologic samples.     

67例肺癌ECT全身骨显像及血清Cyfra21-1、NSE、CEA、CA125联合测定分析

目的探讨肿瘤标志物Cyfra21-1、NSE、CEA、CA125与肺癌骨转移及转移程度之间的相关性。方法 ECT骨显像采用西门子e.cam SPECT,~(99m)TC-MDP为显像剂,67例确诊为肺癌的患者全部行ECT骨显像;采用罗氏电化学发光分析仪(Cabas6000.e 601)对30例健康者、33例肺结核患者及67例肺癌患者进行了血清肿瘤标志物Cyfra21-1、NSE、CEA、CA125联合测定。分析了肺癌骨转移与肿瘤标志物间的关系。结果肺癌血清肿瘤标志物Cyfra21-1、NSE、CEA、CA125明显高于肺结核及健康对照组;P0.01。胸水中的Cyfra21-1、NSE测定值明显高于血清值;肺癌肿瘤标志物与肺癌病理类型之间有一定相关性,鳞癌Cyfra21-1为(71.45±22.81)ng/mL明显高于其他肺癌组P0.01。小细胞肺癌NSE测定值为(98.67±36.54)ng/mL,明显高于其他肺癌组,P0.01;67例肺癌未发生明显骨转移征象者33例,占49.3%;发生不同程度骨转移者34例,占50.7%;其中发生1～2处骨转移者14例,占20.9%;广泛骨转移者20例,占29.9%。腺癌骨转移发生率最高,达64%,其次是小细胞肺癌和鳞癌;肺癌骨转移程度与肿瘤标志物浓度有一定关系,广泛骨转移者Cyfra21-1和NSE测定值局限转移未转移者。结论肺癌骨转移及骨转移的程度与肿瘤标志物的表达程度有一定的相关性,多发骨转移常伴有明显的肿瘤标志物异常。肿瘤标志物Cyfra21-1有利于非小细胞性肺癌的检出,尤其是鳞癌的检出;NSE则有利于小细胞性肺癌的检出。联合测定Cyfra21 1、NSE、CEA、CA125大大提高了肿瘤检查的阳性率、灵敏度和准确度。全身骨显像及肺癌肿瘤标志物的联合检查对于肺癌的诊断和鉴别诊断有重要的临床价值。     

256排螺旋CT联合血清CEA、CYFRA21-1、ProGRP在诊断原发性肺癌中的应用

目的 探究256排螺旋CT联合血清癌胚抗原（CEA）、细胞角蛋白19片段（CYFRA21-1）、胃泌素释放肽前体（ProGRP）在诊断原发性肺癌中的应用价值。方法 回顾性分析2020年1月～2022年4月收治的181例原发性肺癌患者临床资料,患者均已接受256排MSCT检查及血清肿瘤标志物CEA、CYFRA21-1、ProGRP检查,分析影像学表现及血清学检查结果,并以病理学诊断结果为金标准,判定各项指标对原发性肺癌的诊断正确率。结果 病理组织学检查：181例原发性肺癌患者中腺癌91例,鳞癌61例,小细胞癌29例。CT影像学特征：腺癌以周围型为主,多见磨玻璃影、血管集束征、分叶状、毛刺样改变、强化不均匀、胸膜凹陷;鳞癌、小细胞癌均以中央型为主,鳞癌多见支气管充气征、空泡征、分叶状、强化均匀,小细胞癌多见支气管充气征、空泡征、强化均匀,鳞癌分叶状征象占比多于小细胞癌（P<0.05）,小细胞癌强化均匀占比多于鳞癌（P<0.05）;各类型肺癌均伴有少量钙化;腺癌者、鳞癌者CEA、CYFRA21-1水平均高于小细胞癌者,ProGRP水平均显著低于小细胞癌者,腺癌者CEA水平高于鳞癌...     

PET/CT在肺癌诊断中的应用

目的探讨PEC/CT多种示踪剂及诊断性CT的应用对肺癌的诊断价值。方法对62例资料完整的肺癌患者PET/CT检查结果进行分析。结果62例肺癌患者中,中央型肺癌7例,周围型肺癌55例,明确诊断59例,诊断率95.16%。18F-FDG PET/CT检查见病灶有不同程度放射性异常浓聚,最大SUV1.0～22.3;11C-MET PET/CT检查的病灶均见不同程度放射性摄取,SUV0.5～4.9;CT增强扫描病灶边界清晰,明显强化,可见血管"集束征",HRCT检查见病灶有分叶、毛刺征、胸膜凹陷征及支气管阻断。结论18F-FDG PET/CT能较准确地对肺癌做出明确诊断,多种示踪剂及诊断性CT的联合应用能极大地提高肺癌尤其是小肺癌的诊断准确率。     

周围型肺癌的纤支镜检查分析

目的　分析纤支镜对周围型肺癌的诊断价值。方法　采用纤维支气管镜及病理学方法对 2 2 6例患者进行观察。结果　经纤支镜检查明确诊断 10 6例 ,占总数的 4 6 9%。其中有 9例根据影像定位在盲检及刷检情况下也获得了阳性结果。 2 9例影像检查病灶在外周 ,而纤支镜可见主气管和 (或 )左、右支气管已经受累 ,本组周围型肺癌以腺癌及鳞癌为多见 ,占总数的 6 6 4 % ,其次为小细胞癌 (19% ) ,未定性癌 (9 3% ) ,腺鳞癌 (3 5 % )和大细胞癌 (1 8% ) ,周围型肺癌纤支镜下特征以间接征象为多见 ,主要表现为粘膜的浸润、充血水肿、糜烂、管腔狭窄。有 10 3例 (45 6 % )镜下未见异常。结论　纤支镜对周围型肺癌具有很高的诊断价值 ,周围型肺癌以腺癌和鳞癌多见 ,其镜下特征主要以间接征象为主     

Shock due to superior vena cava obstruction detected with point of care ultrasound

Superior Vena Cava (SVC) syndrome is caused by SVC obstruction by external compression or intraluminal thrombus. Patients with the condition can present with upper body swelling, shortness of breath and shock. This case report highlights the use of point-of-care ultrasound (POCUS) to evaluate a patient with SVC syndrome in the emergency department. The test offers many advantages over computed tomography (CT), venography, and magnetic resonance imaging which are limited in hemodynamically unstable patients. A 60-year-old male presented with acute respiratory distress and shock. The POCUS showed the presence of a right lung consolidation and SVC thrombus. CT revealed the presence of a large mediastinal mass causing compression of the SVC with clot seen inside the vessel. The patient was thrombolysed with intravenous streptokinase and his hemodynamics improved. Further investigation confirmed the diagnosis of lymphoma. The SVC can be visualized with transthoracic echocardiography using either the suprasternal, right supraclavicular or right parasternal approach. In this case, the presence of consolidation of the right lung mass provided an acoustic window for the visualization of the SVC using the right parasternal view, thereby allowing for more rapid diagnosis and management.     

Annular malignancies of the small bowel

True annular malignancies of the small bowel with mucosal destruction and shelflike margins are generally thought to be caused by primary adenocarcinoma. At our institution, 18 annular malignancies were diagnosed radiographically in the small bowel by enteroclysis (16 cases) and conventional small bowel follow-through studies (2 cases) between 1977 and 1984. However, pathologic data revealed only 4 primary adenocarcinomas with 10 metastatic lesions (6 colon cancers, 2 malignant melanomas, 1 lung cancer, and 1 cervical cancer), 2 leiomyosarcomas, 1 non-Hodgkin's lymphoma, and 1 malignant carcinoid tumor. While these lesions may be indistinguishable radiographically, annular carcinomas tended to be short, relatively nonobstructing lesions; annular metastases (except those from malignant melanoma) tended to be highly obstructing lesions with significant narrowing and/or angulation of the bowel. Leiomyosarcomas, lymphoma, and metastases from malignant melanoma tended to be longer lesions with extensive ulceration, wider channels, and little or no evidence of obstruction. Nevertheless, surgical resection or biopsy of the lesion is ultimately required for a definitive diagnosis.     

立体定向放射治疗非小细胞肺癌的临床观察

目的　观察立体定向放射治疗 (体部伽玛刀 )非小细胞肺癌近期疗效和不良反应。方法　采用国产OUR QGD型体部伽玛刀治疗Ⅰ～Ⅲa期非小细胞肺癌 5 3例 ,比较治疗前后临床症状、有效率和不良反应。结果　 5 3例患者临床症状明显改善 ,治疗总有效率 88 6 % ,完全缓解 (CR) 10例 (2 2 6 % ) ,部分缓解(PR) 35例 (6 6 % ) ;治疗效果与肿瘤大小呈显著相关 (χ2 =2 4 5 6 ,P <0 0 1) ;治疗前后血常规、肺功能无明显变化 (P >0 0 5 ) ;19例患者于治疗后出现轻度乏力、食欲减退。结论　体部伽玛刀治疗非小细胞肺癌有较好近期疗效 ,不良反应少且轻。