17例小肾癌的影像学诊断

目的:探讨及评价影像学检查在小肾癌诊断中的应用价值。方法:对17例经手术及病理证实为小肾癌(直径≤3.0cm)的B超、CT、静脉尿路造影(IVU)、选择性肾动脉造影(DSA)等影像学表现进行回顾性分析。结果:17例小肾癌中,B超诊断恶性肿瘤14例,诊断准确率82.4%。15例行IVU,6例有间接征象,诊断准确率40.0%。CT诊断恶性肿瘤16例,诊断准确率94.1%。1例行选择性肾动脉造影诊断恶性肿瘤。结论:在B超、IVU、CT、DSA等综合影像学检查中,CT及增强扫描对小肾癌的定性、定位诊断有重要价值。     

32例肾癌的彩色多普勒超声影像特点分析

目的：通过肾细胞癌的二维超声图像和彩色多普勒血流特点,探讨彩超诊断肾细胞癌的应用价值。方法：对32例患者的超声二维图像及彩色多普勒血流显像特点进行分析。结果：肾细胞癌二维超声波表现大多为实性,边界较清晰,形态规则,部分有包膜,以较均匀的低回声或等回声为主,彩色多普勒血流显像检查,多可在肿瘤内或及周边探及血流信号。部分病例可以在肿瘤周边探查到特征性的抱球状血流信号。结论：彩超可用于对肾细胞癌的诊断,对于不典型的以强回声表现或出现透声较差的不规则无回声时,应注意鉴别。     

乳头状肾细胞癌13例诊治体会

目的 探讨乳头状肾细胞癌的临床特点,提高对其诊断、治疗及预后的认识.方法 回顾性分析2001年1月至2009年1月收治的13例乳头状肾细胞癌患者的临床资料.所有患者均行超声、CT及静脉尿路造影(IVU)检查,4例行MRI检查.肿瘤直径2.6～11.0 cm,平均(6.8±2.7)cm.10例行根治性肾切除术,3例行保留肾单位手术,术后均辅以免疫治疗.结果 术后经病理证实均为乳头状肾细胞癌.13例患者均获得随访,随访时间4～42个月,平均26个月,1例于术后9个月死于脑血管意外,1例保留肾单位手术者于术后12个月局部复发,行根治性肾切除术,余均存活良好.结论 乳头状肾细胞癌是一种特殊类型的肾细胞癌,临床表现和其他类型肾癌类似,影像学和病理学方面与其他类型肾癌有所不同.早期根治性肾切除术是首选的治疗方法,预后较好.     

Papillary renal cell carcinoma

The authors present a case of a papillary type renal cell carcinoma. The tumor is mostly discovered accidentally; a histopathological evaluation is indispensable for an exact diagnosis. Because of a better prognosis, differentiation of this tumor type from the classic variant of renal cell carcinoma is necessary, however, the contralateral appearance of a second tumor is not to be excluded, which necessitates a strict patient follow-up. Prevalence of this tumor is higher in patients with chronic dialysis.     

Clinical evaluation of interventional radiology for renal cell carcinoma in 100 patients.

One hundred of 160 patients with renal cell carcinoma (RCC) were treated by interventional radiology (IVR) in the period from 1978 to 1989. The number and kind of interventions done each year were classified retrospectively. More than half of the patients underwent therapeutic arterial embolization or intraarterial infusion of anticancer drugs during the first half of the period. More recently, about half of the patients have had nephrectomies without IVR. One patient with advanced RCC by IVR 18 times lived 8 years and three months after diagnosis, but that was exceptionally long. IVR has been more effective against hepatocellular carcinoma than RCC, for several reasons.     

囊性肾癌的临床分析

目的提高囊性肾癌的诊治水平，提高对囊性肾瘴的认识。方法回顾性分析2001年6月～2006年1月收治的16例囊性肾癌患者的流行病学、病理学、临床表现、影像学特征及临床治疗资料，并与TNM分期构成与囊性肾癌组相同的11例非囊性肾癌比较预后。结果囊性肾癌无特征性的临床表现，术前影像学检查可以提供诊断线索，经病理确诊肾癌囊性变10例，多囊性肾癌4例，单纯性囊肿癌变2例。结论囊性肾癌是一类在影像学和大体病理上具有囊性改变的肾癌的统称，由3种病理学类型构成，术前正确鉴别各亚型是选择手术方式和判断预后的关键。     

囊性肾癌的临床分析

目的提高囊性肾癌的诊治水平,提高对囊性肾癌的认识。方法回顾性分析2001年6月～2006年1月收治的16例囊性肾癌患者的流行病学、病理学、临床表现、影像学特征及临床治疗资料,并与TNM分期构成与囊性肾癌组相同的11例非囊性肾癌比较预后。结果囊性肾癌无特征性的临床表现,术前影像学检查可以提供诊断线索,经病理确诊肾癌囊性变10例,多囊性肾癌4例,单纯性囊肿癌变2例。结论囊性肾癌是一类在影像学和大体病理上具有囊性改变的肾癌的统称,由3种病理学类型构成,术前正确鉴别各亚型是选择手术方式和判断预后的关键。     

Pathological profile of lung carcinoma in Tunisia. About 869 cases

To establish the pathologic profile of broncho-pulmonary carcinoma, 869 cases were retrospectively collected. Mean age was 60, 1 years (range 13 - 98 years), with men predominating (10, 3 male (M) / 1 female (F). This sex-ratio was less than one recorded in 1994 (11, 5 M / 1F), and then the question is: did the womanly broncho-pulmonary carcinoma on the increase, in Tunisia?. 16, 5 % of women and 3, 9% of men were aged less than 41 years, but sex ratio was 2,4M / 1F. They represented 5, 1% of all cases. Such result differs from reports in the literature (1 - 3, 4%). In histological data, we noted that adenocarcinoma is actually more frequent than epidermoid carcinoma. Its ratio increased from 15, 3 % in 1994 to 30, 3 % in 2003, whereas, epidermoid carcinoma's ratio decreased from 42, 8 % to 29, 5 %. The relationship tobacco- different histological type of broncho-pulmonary carcinoma was clearly observed, varying between 90, 6% (adenocarcinoma) and 100 % (large cell carcinoma).     

Gene-environment interactions in renal cell carcinoma

The majority of renal cell carcinomas (RCCs) are sporadic, and increasing incidence rates suggest that such environmental risk factors as smoking play a role in the etiology of the disease. Cases with RCC were selected from the population-based cancer registry of Orange County, California, between 1994 and 1997; controls were recruited by telephone using random digit dialing. A total of 115 case and 259 control subjects were genotyped for N-acetyltransferase 2 (NAT2), which codes for a polymorphic enzyme involved in tobacco-carcinogen metabolism. Subjects with slow acetylator genotypes were found to be at twofold increased risk (odds ratio (OR) = 1.8; 95 percent confidence interval (CI): 1.1, 2.9) of RCC. Although cancer risk doubled among smokers (OR = 2.2; 95 percent CI: 1.3, 3.7), stratified analysis revealed gene-environment interaction among slow acetylators that smoked (OR = 3.2; 95 percent CI: 1.7, 6.1) compared with rapid acetylators that smoked (OR = 1.4; 95 percent CI: 0.7, 2.9). A dose response was found for pack-years among slow acetylators (p < 0.01) but not among rapid acetylators (p = 0.06). Although smoking is a well-established risk factor of RCC, our data suggest that the risk is pronounced among slow rather than rapid acetylators.     

Smoking cessation and renal cell carcinoma

PURPOSE: The magnitude and timing of the reported decrease in risk of renal cell carcinoma (RCC) attributed to smoking cessation is not well characterized. Furthermore, conclusions from previous investigations have been hampered by unstable risk estimates, broad exposure categories and/or insufficient adjustment for the inverse correlation of cessation years with lifetime smoking exposure. METHODS: To address these issues, we report data from a population-based case-control study conducted in Iowa from 1986 to 1989. RCC cases (n = 387) were identified through the Iowa Cancer Registry, while controls (n = 2,333) were randomly selected from the general population, frequency-matched on age and sex. Subjects provided detailed information on a mailed questionnaire regarding their smoking history as well as other anthropometric, lifestyle, dietary and medical history risk factors. RESULTS: Smoothing spline regression analysis provided evidence of a consistent inverse linear trend between years of cessation and risk of RCC. In categorical analysis, compared with current smokers, those quitting > or =30 years ago experienced a 50% reduction in risk of RCC (OR = 0.5; 95% CI 0.3 to 0.8) after adjustment for age, sex, BMI, hypertension and pack-years of smoking. Risk among long-term quitters was similar to risk among never smokers (OR = 0.6; 95% CI 0.4 to 0.8). In contrast, cessation of <10 years, 10 to 19 years and 20 to 29 years all resulted in a less pronounced reduction in RCC risk ( approximately 20% to 30%). CONCLUSIONS: Our findings suggest that while cessation of smoking is indeed associated with a linear decrease in RCC risk even after adjustment for potential confounders, this benefit may not be sizeable until more than 20 years following cessation.     

Toll样受体7激动剂对荷瘤小鼠肾癌的抑制作用及免疫机制

目的　研究Toll样受体7激动剂Imiquimod对荷瘤小鼠肾癌的抑制作用及免疫机制。方法　用Renca肾癌细胞构建BABL/c小鼠肾癌模型,实验分为control组、imiquimod组和sorafenib组。观察3组小鼠肿瘤体积及重量、抑瘤率,qPCR法检测肿瘤组织中炎性相关因子肿瘤坏死因子α（Tumor necrosis factor-α,TNF-α）、白细胞介素1β（Interleukin-1β,IL-1β）、白细胞介素6（Interleukin-6,IL-6）、干扰素α（Interferon-α,IFN-α）、干扰素β（Interferon-β,IFN-β）、干扰素γ（Interferon-γ,IFN-γ）及Toll样受体通路相关因子Toll样受体7（Toll-like receptor 7,TLR7）、髓样分化因子88（Myeloid differentiation primary response gene 88,MyD88）、核因子κB （Nuclear factor κB,NF-κB）mRNA表达,Western blot法检测瘤组织中TLR7、MyD88、NF-κB蛋白表达。流式细胞术检测脾脏中CD4+T、CD8+T、CD4+IFN-γ和CD8+IFN-γ细胞比例。结果　与control组比较,imiquimod组和sorafenib组小鼠的肿瘤体积及瘤体重量降低（P＜0.05）;与control组相比,imiquimod组TNF-α、IL-6、IL-1β、IFN-α、IFN-β、IFN-γ及TLR7、MyD88、NF-κB mRNA水平升高（P＜0.05）,而sorafenib组各因子略有上升（P＞0.05）;与control组和sorafenib组比较,imiquimod组CD4+T、CD8+T细胞比例有不同程度的升高（P＞0.05）,CD4+IFN-γ和CD8+IFN-γ细胞比例增加（P＜0.05）。结论　Toll样受体7激动剂通过活化TLR7-MyD88-NF-κB信号刺激多种炎性细胞因子分泌,并上调CD4+T、CD8+T比例及功能,对荷瘤小鼠肾癌发挥抑制作用。     

多囊性肾细胞癌18例诊疗分析

目的 探讨多囊性肾细胞癌的诊断、鉴别诊断、治疗与预后.方法 1999年1月至2010年10月,共收治398例肾癌患者,其中多囊性肾细胞癌18例,回顾并总结其临床诊治资料.结果 多囊性肾细胞癌占同期肾癌病例的4.52％( 18/398)；肿瘤TNM分期:pT1N0M0期肿瘤5例,pT2N0M0期肿瘤13例；G1级肿瘤8例,G2级肿瘤10例.结论 多囊性肾细胞癌术前鉴别诊断难度大,诊断主要依据CT,尤其是螺旋CT检查,治疗上应以根治性肾切除术为主,部分病例可行保留肾单位手术.     

糖尿病导致肾损伤的病理变化

糖尿病(diabetesmellitus)是由多种病因引起以慢性高血糖为特征的代谢紊乱。高血糖是由于胰岛素分泌或作用的缺陷,或两者同时存在而引起的。常见的是胰岛素依赖型(IDDM )或糖尿病1型和胰岛素非依赖型(NIDDM)或糖尿病2型。除碳水化合物代谢紊乱外,尚可出现蛋白质和脂肪的代谢异常。随着病程延长,可导致多系统损伤,如眼、肾、神经、心脏、血管等。肾脏损伤是糖尿病患者的重要合并症,1 992年美国的终末肾患者共2 0 5 798例,其中2 7.2 %为糖尿病患者,1 996年的终末肾患者5 45 86人,糖尿病患者占36 .3% ,1 998年的终末肾患者中,糖尿病患者占4…     

Seven cases of radiation-induced cutaneous squamous cell carcinoma

We report 7 cases of radiation-induced skin cancer. The diagnosis was based on the history of radiotherapy for benign skin diseases (5 cases) and of occupational exposures to medical doctors (2 cases). All cases were squamous cell carcinomas which arose from chronic radiodermatitis. The estimated latent period of these tumors ranged from 6 to 64 years, with an average of 29.9 years. After surgical treatments of the lesions, no local recurrences were observed in all cases. Benign skin diseases had sometimes been treated with low-energy radiation before the 1960s. Considering the estimated latent period, the peak time point of developing risk of radiation-induced skin cancer by such treatment has been already passed, however, the danger of it should not be ignored in future. In association with multiplicity of radiation usage, occupational exposure of radiation may develop the risk of occurrence of skin cancer in future. Therefore, we should recognize that radiation-induced skin cancer is not in the past. In the cases of chronic skin diseases showing warty keratotic growth, erosion and ulcer, we should include chronic radio-dermatitis in the differential diagnosis. It is necessary to recall all patients about the history of radiotherapy or radiation exposure. Rapid histopathological examination is mandatory because of the suspicion of radiation-induced skin cancer.