同侧肾脏的同时性重复癌1例报告

同一侧肾脏同时发生肾癌和肾盂癌在临床上非常少见。我院收治1例，报告如下。     

肝、胃同时性重复癌一例

患者因“反复发作上腹部隐痛不适10余年 ,加重 1周”入院。入院后经术前准备 ,在全麻下行胃癌根治性胃次全切除、不规则肝切除、胆囊切除、胆总管切开肝总管癌栓取出术。术中见胃窦部及胃体部角切迹上方后壁近小弯侧有 2枚肿块 ,呈溃疡型 ,大小分别为 3cm× 3cm× 1.5cm、2cm×     

乳腺及面部同时性重复癌1例

<正>多发原发恶性肿瘤(multiple primary malignat tumors,MPMT),亦称重复癌,是指同一器官、成对器官组织、同一系统不同部位及不同系统的器官组织中同时或先后发生2个(双重癌)或2个以上各自独立的原发癌种。重复癌临床较少见,对其认识不足易漏诊或误诊。就我科2014年3月收治的1例重复癌诊治情况报道如下。1病例介绍患者女,93岁,发现右侧乳房肿块3年及右面部肿块2个     

同期手术治疗同时性食管肺重复癌一例CSCD

临床资料 患者,男,62岁。因“进行性吞咽困难半年”入院。病程中无胸闷、气促、咳嗽、咯痰。既往吸烟300年支,戒烟10年。胸部增强CT示：食管胸中段管壁环状增厚,双肺及各级支气管未见异常（图1a,1b）。胃镜示：距门齿25~33 cm食管黏膜散在糜烂、结节样改变（图1c）,活检为鳞状细胞癌。     

同侧肾脏的同时性重复癌1例

患者,男,81岁.因B超检查发现右肾占位5d入院.无腰腹部疼痛及肉眼血尿,无发热.体检:一般状态可.彩超提示右肾占位性病变,左肾囊肿;CT平扫 增强提示右肾占位、右肾癌可能性大,左肾囊肿;IUP示右肾上盏消失、上部肾盂内可见充盈缺损.尿脱落细胞学检查阴性.血、尿常规及各项生化学检查未见异常.术前诊断为"右肾癌"于2002年5月22日在全麻下行经腰根治性右肾切除术.右中取出右肾纵行剖开后可见两个肿物.一个位于上极肾实质,直径约3.0 cm,切面黄黑相间;另一个位于上部肾盂内,直径约2.0 cm,呈菜花样.根据大体标本所见补充诊断为右肾癌并发右肾盂癌,另取Gibson切口行右侧输尿管部分膀胱切除术.术后病理诊断:透明细胞癌和移行细胞癌工～Ⅱ级.术后1年复查未见复发、转移.     

肝癌重复癌的外科治疗

报道我院1968～1997年收治的并经手术治疗的肝癌重复癌5例，均经病理检查证实。其中同时性2例，异时性3例。异时性3例中第一癌和第二癌确诊时间相隔最长18年，最短2年。文章重点讨论了肝癌重复癌的诊断、手术治疗及预后的问题。     

同时性重复癌(食管鳞癌、肺腺癌)1例

1.病例介绍 患者男,69岁,2004年12月因胃胀不适在外院行胃镜检查发现中段食管中分化鳞癌,确诊后行食管内放疗数次,未手术和化疗.2005年5月来我院复查胃镜见食管距门齿35 cm处见一0.3 cm×0.3 cm斑样隆起,病理活检示:可见异形细胞.     

胆管下段癌同时性合并胃癌一例

多原发癌(multiple primary cancers,MPCs)也称重复癌或多中心癌,指同时或先后发生于患者同一或不同器官的2种或2种以上经组织病理学证实的原发性恶性肿瘤[1].一般认为,两个肿瘤间隔时间<6个月为同时性多原发癌,>6个月为异时性多原发癌.患者同一次就诊时发现两种癌症的情况较为罕见,定义为即时性双...     

生殖系统重复癌1例

患者男性，84岁，因左阴囊部肿物6个月入院。自诉于4年前患阴茎癌已行阴茎部分切除，当时病理已证实。此次入院前6个月发现左阴囊不适，检查发现有小肿物，未引起重视，肿物增大迅速，无痛。因肿物影响日常生活及排尿而入院治疗。入院查体：阴茎部分缺如，残端由于     

Isolated acute cellular rejection of the liver after simultaneous liver and kidney transplantation: a case report

Simultaneous liver and kidney transplantation (SLKT) is now considered the treatment of choice for patients with concurrent end-stage liver and kidney diseases. Even though the early postoperative mortality rate following SLKT is reported to be high compared to that of liver transplantation alone, the liver graft from the same donor has been argued to induce better kidney graft acceptance as evidenced by a low rate of acute renal rejection episodes. There have been many reports of a low incidence of acute renal rejection following SLKT; however, only a few cases were proven by simultaneous biopsies. The authors experienced a case of biopsy-proven isolated acute cellular rejection of the liver graft following SLKT.     

胰、肾一期联合移植术一例报告

目的 评价胰、肾一期联合移植的远期疗效。方法 对1例接受胰1肾联合移植术的患者定期随访2年。结果 患者生活质量明显改善,移植胰1肾有功能存活2年。结论 胰、肾一期联合移植是治疗胰岛素依赖型糖尿病合并终末期肾病的有效方法。     

A case of simultaneous contralateral renal cell carcinoma and ureteral transitional cell carcinoma

A case of simultaneous contralateral renal cell carcinoma and ureteral transitional cell carcinoma is presented. This patient underwent right radical nephrectomy, partial resection of left ureter and bladder, and end-to-end transureteroureterostomy. He is alive with no finding of recurrence after 1 year. Methods of treatment for bilateral urinary tract tumors are reviewed.     

肝肾胰联合移植的围手术期处理

目的总结肝胰肾联合移植围手术期处理的经验。方法报告肝、胰、肾一期联合移植治疗1例乙型肝炎后肝硬化、肝功能不全合并慢性肾功能不全伴慢性胰腺炎导致胰岛素依赖型糖尿病患者的临床特点及治疗体会。对患者围手术期处理及相关资料进行回顾性分析。结果采用胰液空肠内引流及原位背驮式同期尸体肝、胰、肾联合移植。手术顺利，移植肝脏及胰腺功能1周内逐渐恢复，肾功能延迟恢复。术后第16天因移植肾血流下降，切除移植肾脏，于原移植部位行第2次肾移植，肾功能逐渐恢复正常。至2005年11月随访10个月，患者未发生排斥反应及明显感染，移植肝、胰、肾功能均正常，一般情况良好。结论肝胰肾联合移植技术安全，术后因各脏器对功能恢复所需内环境各不相同，矛盾较多，围手术期处理对患者的长期存活至关重要。     

Horseshoes kidney isthmus carcinoma. A case report

Horseshoe kidney is the most frequent fusion abnormality of the kidney. The incidence of renal carcinoma in patients with horseshoe kidney is similar to those with normal anatomy. Its special anatomical features must be borne in mind for both surgical approach and conservative surgery. We present a horseshoe kidney isthmus carcinoma case report in which we performed conservative surgery of both renal units.     

A case of renal cell carcinoma in a horseshoe kidney

A-50-year-old patient visited our hospital to have further examination for left renal mass. Drip infusion pyelography revealed a cluster of calculi in the upper pole of the left kidney. Computed tomography and magnetic resonance imaging revealed a heterogeneous mass on the left side of a horseshoe kidney. Left nephrectomy was performed through an abdominal transperitoneal approach. An operation for dividing isthmus was simultaneously done using a microwave tissue coagulator. Histopathological findings showed grade 1 > 2, pT1aN0M0, clear cell subtype, renal cell carcinoma. Convalescence was uneventful and the patient was free of tumor at one year postoperatively.     

A case of small cell carcinoma of the kidney

A 47-year-old man had a retroperitoneal tumor measuring 18 cm in maximum diameter of the left kidney that was diagnosed with computed tomography (CT)-guided needle biopsy as small cell carcinoma. Microscopically, the tumor cells showed immunohistochemical reaction for neural cell adhesion molecule antibodies. This patient with advanced renal small cell carcinoma and multiple metastatic lesions was treated with the first-line combination chemotherapy of cisplatin, etoposide and ifosphamide, which showed a partial response of primary renal tumor and a complete response of liver metastasis, and with the second-line chemotherapy of cisplatin and irinotecan, which showed a complete response of Virchow's nodal metastasis. Thereafter, in spite of salvage chemotherapy of amurubicin hydrochloride for persistent and refractory renal small cell carcinoma, he died 32 months after the first presentation due to local progression. However, combination chemotherapy of these anticancer agents made his prognosis more favorable than we expected before treatment. The extrapulmonary small cell carcinomas are generally known to be more aggressive and malignant than the lung small cell carcinomas, and small cell carcinoma arising from the kidney is an extremely rare malignant neoplasm, with only 34 cases reported in the English or Japanese literature. The prognosis of renal small cell carcinomas is currently limited as compared with the lung small cell carcinomas, and therefore a cumulative investigation of a larger number of cases treated with multidisciplinary modalities including combination chemotherapy is necessary.     

Results of simultaneous and sequential pediatric liver and kidney transplantation.

BACKGROUND: The indications for simultaneous and sequential pediatric liver (LTx) and kidney (KTx) transplantation have not been well defined. We herein report the results of our experience with these procedures in children with end-stage liver disease and/or subsequent end-stage renal disease. PATIENTS AND METHODS: Between 1984 and 1995, 12 LTx recipients received 15 kidney allografts. Eight simultaneous and seven sequential LTx/KTx were performed. There were six males and six females, with a mean age of 10.9 years (1.5-23.7). One of the eight simultaneous LTx/KTx was part of a multivisceral allograft. Five KTx were performed at varied intervals after successful LTx, one KTx was performed after a previous simultaneous LTx/KTx, and one KTx was performed after previous sequential LTx/KTx. Immunosuppression was with tacrolimus or cyclosporine and steroids. Indications for LTx were oxalosis (four), congenital hepatic fibrosis (two), cystinosis (one), polycystic liver disease (one), A-1-A deficiency (one), Total Parenteral Nutrition (TPN)-related (one), cryptogenic cirrhosis (one), and hepatoblastoma (one). Indications for KTx were oxalosis (four), drug-induced (four), polycystic kidney disease (three), cystinosis (one), and glomerulonephritis (1). RESULTS: With a mean follow-up of 58 months (0.9-130), the overall patient survival rate was 58% (7/12). One-year and 5-year actuarial patient survival rates were 66% and 58%, respectively. Patient survival rates at 1 year after KTx according to United Network of Organ Sharing (liver) status were 100% for status 3, 50% for status 2, and 0% for status 1. The overall renal allograft survival rate was 47%. Actuarial renal allograft survival rates were 53% at 1 and 5 years. The overall hepatic allograft survival rate was equivalent to the overall patient survival rate (58%). Six of seven surviving patients have normal renal allograft function, and one patient has moderate chronic allograft nephropathy. All surviving patients have normal hepatic allograft function. Six (86%) of seven sequentially transplanted kidneys developed acute cellular rejection compared with only two (25%) of eight simultaneously transplanted kidneys (P<0.04). CONCLUSIONS: Simultaneously transplanted kidneys were less likely to develop rejection than sequentially transplanted kidneys in this series. This did not have any bearing on patient or graft survival rates. Mortality correlated directly with the severity of United Network of Organ Sharing status at the time of kidney transplantation. Candidates for simultaneous or sequential LTx/KTx should be prioritized based on medical stability to optimize distribution of scarce renal allografts.