以指骨转移为首发症状肺癌23例临床分析

目的探讨原发性肺癌单纯以指骨转移为首发症状的临床特点及其发病机理。方法综合分析各专业文献报道的、单纯以指骨转移为首发症状的原发性肺癌患者的资料。结果文献报道的单纯以指骨转移为首发症状的23例原发性肺癌患者中,转移病灶位于左手指骨者10例,右手指骨者12例,双手指骨者1例。3例患者转移病灶位于近节指骨,其余患者转移病灶位于末节指骨;有7例患者的患病手指既往曾有外伤史。结论传统的机械-解剖学说和种子—土壤学说的观点,均不能解释原发性肺癌发生指骨转移的机理。临床中如遇久治不愈的手指软组织炎症时,应考虑是否肺部肿瘤细胞转移的可能性。     

以指骨转移为首发症状肺癌23例临床分析

目的 探讨原发性肺癌单纯以指骨转移为首发症状的临床特点以及肺癌发生指骨转移的机制.方法 搜集自1991年至2010年见渚于各专业文献报道的单纯以指骨转移为首发症状的原发性肺癌患者的资料,并进行综合性分析.结果 在文献报道的单纯以指骨转移为首发症状的23例原发性肺癌中,其转移病灶位于左手指骨者10例,右手指骨者12例,双...     

以指骨转移为首发症状的原发性肺癌的临床特点

原发性肺癌骨转移是肺癌晚期常见的临床症状之一,发生率约为50.0%～70.0%,而单纯以手指末端骨转移为首发症状的原发性肺癌极为少见。我们就我院收治的2例以指骨转移为首发症状的原发性肺癌患者的临床资料,以及文献报道的14例以指骨转移为首发症状的原发性肺癌患者的文献资料进行了分析,以探讨这类患者的临床特点。     

以肺外转移症状为首发的原发性肺癌28例

以肺外转移症状为首发的原发性肺癌２８例江苏省启东市肝癌研究所施亚芳原发性肺癌的临床表现为多种多样，除常见的呼吸道症状和体征外，往往出现肿瘤转移所引起的一系列肺外转移症状和体征。本所收治９２例原发性肺癌中，２８例是以肺外转移症状为首发的肺癌，现报道如下...     

14例以脑转移症状为首发表现的肺癌诊治分析

１４例以脑转移症状为首发表现的肺癌诊治分析山东省德州市肿瘤医院（德州市２５３００４）赵路军，吴振瀛，雷少波，宋惠珍肺癌通常以肺部症状为首发表现，以脑转移症状为首发者较为少见。我院自１９８９年４月至１９９４年２月共收治肺癌病人９１０例，以脑转移症状为首...     

“脑型”肺癌的诊断问题(附10例临床分析)

 脑转移癌并不少见,其发生率约占脑瘤的13.5～37.5%,占恶性肿瘤尸检资料的5～10%。有时原发肿瘤病灶隐匿,以脑转移损害作为首发症状,常被误认为原发性脑瘤而手术,诊断每感困难。国内外资料证明脑转移癌以肺癌占首位,肺癌以神经精神症状而首先发病者并不少见,我们一年中就收集到10例病人,多误诊为其它神经精神疾病。     

73例以脑转移为首发症状肺癌放射加化疗的疗效分析

笔者所在医院自 1990年 1月至 2 0 0 3年 6月间共收治1389例肺癌 ,其中以脑转移为首发症状的 73例 ,现将其治疗结果报道如下。一、材料和方法1.临床资料 :该 73例占同期原发性肺癌的 5 .3% ( 73/1389) ,占同期原发性肺癌以肺外症状为首发的 2 5 .6 % ( 73/2 85 )。男 5 1例 ,女 2 2例。年龄 30～ 39岁 4例 ,4 0～ 4 9岁 16例 ,5 0～ 5 9岁 2 1例 ,6 0～ 6 9岁 2 4例 ,70岁以上 8例。全组病例均经胸部X线片和胸部及头颅CT证实同时有肺内原发病灶和颅内转移灶。 73例肺癌中中央型 5 0例 ,周围型 2 3例。头颅CT见颅内一侧单个病灶占 2 7.4 % …     

肝外病灶为首发现表现的原发性肝癌（附4例临床分析）

本报告4例肝原发病灶症状尚不明显而转移病灶的症状为其首发临床表现的原发性肝癌。4例病例的共同特点是就诊时仅发现有肝外转移病灶，而肝内未能发现占位性病变，AFP均＞400ng/ml。初诊均误诊为良性肿瘤。确诊依据为病理检查，病人虽属晚期，因其肝内病灶出现较晚，生存期相对较长。     

放射治疗脑转移瘤患者的流行病学及其与临床特征的相关性（附205例）

目的:探讨放射治疗脑转移瘤患者的流行病学及其与临床特征的关联,为其诊治提供依据。方法:收集2007年1月至2017年12月间行放射治疗的205例脑转移瘤（brain metastases,BM）患者的临床资料,并对其进行统计学分析。结果:205例脑转移瘤患者男女比为1.47∶1,中位年龄60岁,肺癌占82.0%;男性吸烟及饮酒率明显高于女性(P＜0.05);性别在年龄、城乡分布、转移灶数量及原发肿瘤上无统计学差异。接受IMRT的患者比例整体呈上升趋势。BM首发有症状者68.3%,其中头晕头痛恶心占47.8%、肢体障碍占32.2%。BM病灶位于额叶及顶叶最多。病灶位于额叶及枕叶与意识下降及反应迟钝相关（P=0.015、P=0.034）;位于小脑与头晕头痛恶心相关（P=0.04）。BM与原发肿瘤间隔的中位时间为7.0（0～166）个月,与性别、是否有颅外转移、病种及病理类型相关（P＜0.05）。结论:BM多继发于肺癌,男性多于女性,男性吸烟及饮酒者明显高于女性。首发有症状者较多,以头晕头疼恶心、肢体障碍为主。占位以额叶及顶叶常见,病灶位于额叶及枕叶者容易出现意识下降及反应迟钝,位于小脑容易有头晕头痛恶心症状。男性、无颅外转移及肺癌患者更易发生脑转移。     

以头颅骨转移为首发表现的原发性肝癌治疗浅析

原发性肝癌转移以肝内播散转移为常见，肝外转移可至肺、肾上腺及全身其它部位。骨转移在肝癌病人中并不少见，其常见于体轴骨骼发下肢骨，而首发症状颅骨转移的文献报道极少。我们遇1例以头颅肿块为首发表现的的原发性肝癌，治疗效果较佳，现报道如下：     

Metastasis of bronchogenic carcinoma to the thumb

Bone metastasis in the hand is rare. The etiology is quite different from that of metastasis to other bones; bronchogenic carcinoma is by far the most frequent case. Distal phalanges are mainly involved with irregular osteolysis and cortical destruction. Differential diagnosis of phalangeal metastasis includes osteomyelitis, rheumatoid arthritis and gout. The prognosis is always that of metastatic bronchial cancer with an average survival of three months. Treatment may involve distal digital amputation or antalgic radiotherapy. A case of bronchogenic carcinoma with metastasis to the thumb is presented. The metastasis was located in the distal phalanx of the left thumb. The primary tumor was located in the lung. Treatment consisted of amputation. The overall survival was five months.     

Two cases of acrometastasis to the hands and review of the literature

This paper reports two cases of acrometastasis to the hands. The first case involved a 78-year-old woman with a permeative osteolytic lesion in her proximal second metacarpal. A biopsy of this lesion suggested a diagnosis of non-small-cell lung carcinoma with secondary osseous metastasis. This was the first presentation of the woman’s primary diagnosis. A single 8-Gy fraction of palliative radiotherapy was delivered to the patient’s left hand. The treatment proved successful: the woman soon experienced pain relief and regained the use of her hand. The second case involved a 69-year-old woman with extensive lytic destruction involving the proximal two thirds of her third metacarpal. This patient had been diagnosed with carcinoma of the breast in 1990. She also received a single 8-Gy fraction of radiation, which improved both her pain and her hand mobility.An extensive review of the literature uncovered 257 previously reported cases of acrometastasis. Articles were analyzed based on age and sex of the patient, site of the primary carcinoma, metastatic locations within the hand and affected appendage or appendages, the treatment given, and the patient’s length of survival. Men were almost twice as likely to experience acrometastasis as women, and the median age of the patients overall was 58 years (range: 18 months–91 years). Lung, kidney, and breast carcinoma were the three most prevalent primary diagnoses reported in the literature. Cancers of the colon, stomach, liver, prostate, and rectum affected the remainder of the population.Overall, the right hand was more often host to the metastatic lesions. In addition, almost 10% of the patients experienced lesions in both hands. The third finger was the digit most affected by osseous metastases reported in the literature. Lesions of the thumb, fourth finger, second finger, and fifth finger were less commonly reported. The region of the digit most often affected within the patient population was the distal phalanx. The metacarpal bones, proximal phalanges, and middle phalanges comprised the remainder of the four most frequent acrometastatic sites. In the literature, single lesions were more prevalent than multiple bony lesions.Based on the reported cases, amputation appeared to be the preferred method of treatment. Radiation, excision, and systemic therapy were the next most frequently used treatments. Patient survival was not well documented within the literature. However, the median survival of patients in the reported cases was 6 months. Thus, our review suggested that a diagnosis of hand metastasis is an indication of poor prognosis.This report serves to emphasize the importance of properly diagnosing acrometastases. Identifying and effectively treating these metastases in a timely manner can lead to a dramatic improvement in a patient’s quality of life.     

Pseudo-chondrosarcoma: solitary osseous metastases from atypical bronchogenic carcinoma.

A patient with bronchogenic carcinoma with a solitary metastases to the femur in whom the clinical, radiologic, and pathologic setting suggested that the primary tumor was the bone lesion (chondrosarcoma) and the pulmonary lesion was a solitary metastasis is presented. This case is added to the limited literature indicating that mucin-secreting tumors metastatic to bone may simulate primary bone tumors radiographically.     

P53 mutations in primary tumors and subsequent liver metastases are related to survival in patients with colorectal carcinoma who undergo liver resection

BACKGROUND: The appearance of p53 mutations in colorectal carcinoma was determined, independent of differentiation and tumor stage of the primary tumors, in relation to the survival of patients who were scheduled to undergo liver resection. METHODS: Tumor material was analyzed for p53 mutations in primary colorectal tumors and subsequent liver metastases from 41 consecutive patients who were scheduled to undergo surgical liver resection. DNA sequencing and immunohistochemical staining of p53 protein within tumor nuclei were performed. RESULTS: Primary tumors displayed p53 mutations within exons 5-9 in 41% of patients. No mutations were found in exons 4, 10, or 11. Forty-one percent of metastatic lesions had the same single mutation that was found in the primary tumor, whereas 11% of metastatic lesions had one additional mutation within exons 5-9; 22% had mutations only in their liver metastases, whereas corresponding primary tumors displayed wild-type p53. None of the patients had mutated p53 in their primary tumor and wild type in their metastases. Survival after undergoing liver resection was correlated negatively (P < 0.05-0.01) with Duke Stages A-D classification of the primary tumors, tumor differentiation, and radicality (> 0.7-0.8 mm) of resected liver metastases. CONCLUSIONS: The presence of p53 mutations in patients with metastatic lesions was related significantly (P < 0.003) to better survival after the patients underwent liver resection compared with patients with wild type p53 in their metastatic lesions. This finding was not related to covariates, such as Duke classification, tumor differentiation, type of liver metastasis, or metastatic radicality during resections. Explanations for this unexpected finding remain unclear, although the authors speculate that occult tumor cells with p53 mutations may be less responsive to growth factor(s) exposure during hepatic regeneration after resection.     

Comparison of HER-2 status determined by fluorescence in situ hybridization in primary and metastatic breast carcinoma

BACKGROUND: Accurate assessment of HER-2 status is necessary prior to anti-HER-2 antibody (trastuzumab) therapy for metastatic breast carcinoma. However, controversy exists regarding whether to assess HER-2 status in the primary tumor or in metastatic lesions. It is also unclear whether HER-2 status can change during disease progression or after chemotherapy. METHODS: Breast carcinoma samples from 60 women with known HER-2 status in both primary tumors and paired metastases (locoregional disease, n = 43 patients; distant disease, n = 17 patients) were reviewed retrospectively. Thirty-two patients underwent chemotherapy before their metastatic lesions were sampled, including 18 patients who received neoadjuvant chemotherapy and 14 patients who received adjuvant chemotherapy. The HER-2 gene was examined by fluorescence in situ hybridization either in paraffin-embedded tissue samples (48 primary tumors and 9 metastatic tumors) or in fine-needle aspirates (12 primary tumors and 51 metastatic tumors). HER-2 gene amplification was defined as a HER-2:chromosome 17 signal ratio >/= 2.0. RESULTS: The HER-2 status of primary and metastatic tumors agreed in 58 of 60 patients (97%), including 18 (30%) amplified tumors and 40 (67%) nonamplified tumors. A discrepancy in HER-2 status was observed in specimens from two patients in which HER-2 amplification was detected in the primary tumor but not the metastatic tumors. In one patient, three foci of tumor nodules were found in the same breast; the HER-2 status was assessed in only one of them, which showed amplification; however, HER-2 amplification was not detected in the axillary lymph node metastasis. In another patient, the HER-2 gene was amplified in the primary tumor but not in the liver metastasis. No metastases showed HER-2 amplification without amplification in the primary tumor. Locoregional and distant metastases demonstrated similar concordance rates with their corresponding primary tumors (98% and 94%, respectively). Complete concordance of HER-2 status was found between primary tumors prior to chemotherapy and metastases that were sampled after chemotherapy. CONCLUSIONS: The HER-2 status in breast carcinoma generally was stable during metastasis, whether to locoregional or distant sites. Chemotherapy did not modify the HER-2 status in metastatic lesions. Therefore, HER-2 amplification can be evaluated reliably in material from either primary or metastatic tumors in most patients. Further study with larger series is warranted to elucidate the significance of discordant results.     

A case of inoperable gastric small cell carcinoma effectively treated by chemotherapy and radiotherapy

We herein report a case of advanced gastric small cell carcinoma treated by chemotherapy and radiotherapy. A 69-year-old man was admitted to our hospital presenting with appetite loss and body weight loss. He was diagnosed to have an inoperable gastric small cell carcinoma with severe lymph node metastases and left adrenal gland metastasis. Chemotherapy with TS-1/paclitaxel, cisplatin/irinotecan and cisplatin/etoposide was sequentially performed. Primary and metastatic foci had obviously diminished. Eighteen months after the initial therapy, he had dysarthrosis and multiple brain metastases were found. Metastatic foci were decreased and his symptom was improved by successful radiotherapy. We conclude that chemotherapy and radiotherapy are effective for primary and metastatic lesions of gastric small cell carcinoma.     

Expression of Fas ligand in gastric carcinoma relates to lymph node metastasis

Tumors may escape a host's immune response by means of various mechanisms. The Fas (CD95/APO-1)/Fas ligand (FasL) system is one of the major apoptotic pathways. Recently, it has been reported that tumor cells can express FasL, induce apoptosis in tumor infiltrating lymphocytes, and thus can escape host immune surveillance. In gastric carcinoma, tumor progression by way of the lymphatics is often seen, and lymph node metastasis is a critical factor influencing the recurrence of cancer and its prognosis. We, therefore, investigated the relationship between the expression of FasL and the lymphatic spread of gastric carcinoma. FasL-expression was examined by an immunohistochemical method using 100 surgically resected gastric carcinomas and 55 metastatic lymph nodes. Apoptotic cells among tumor infiltrating T lymphocytes were detected by T lymphocyte staining and the terminal deoxynucleotidyl transferase (TdT) mediated dUTP nick end labeling (TUNEL) method in a series of sections of metastatic lymph nodes. FasL-expression was detected in 86% of primary lesions and 71% of metastatic lymph nodes. In cases with high levels of FasL-expression, the observed expression of lymph node metastases was significant (p=0.047). Moreover, FasL-positive cases with both primary lesions and metastatic lymph nodes showed also distant lymph node metastasis beyond the regional lymph nodes (p=0.030). Apoptosis among tumor infiltrating T lymphocytes was more frequently seen in FasL-positive lesions (p=0.057). Furthermore, patients with FasL-negative primary lesions tended to exhibit longer survival times than patients with FasL-positive primary lesions. The results suggest tumor escape through the lymphatic pathway via FasL-expression in gastric carcinomas.     

Solitary metastases from renal cell carcinoma: a review.

Nineteen patients with solitary metastatic lesions from renal cell carcinoma, 5 synchronous and 14 metachronous, were seen at the Tata Memorial Hospital over a 7 year period between 1981 and 1987. The mean metastatic interval for the metachronous lesions was 31.2 months. The commonest sites of metastases were bone, lung, and liver. The solitary nature of the metastasis was confirmed by appropriate investigations. All patients underwent nephrectomy for the primary kidney lesion. The metastatic lesions were treated with intent of cure. Only 1 patient with synchronous metastasis survived for 2 years and none survived 5 years while in the metachronous metastasis group, the estimated overall survival was 50% at 2 years and 25% at 5 years. The patients with a long metastasis-free interval were found to have a better survival. The patients with liver metastasis did poorly as compared to those with metastases at other sites. The stage of the disease also had a bearing on the survival.