多结节和复发性肝细胞癌来源的临床研究

通过对１６０例肝细胞癌（ＨＣＣ）根治性切除者的随访，讨论了多结节ＨＣＣ中单中心与多中心起源者的不同临床特征，不同复发来源的ＨＣＣ的鉴别，同时性和异时性多中心ＨＣＣ的确定。由此提出了：同时癌或异时癌的生物学行为类似于单中心的单结节ＨＣＣ，应尽一切可能予以切除。有卫星灶的单中心ＨＣＣ，如能切除，应以肝叶切除为主。术后ＨＣＣ复发如属肝内转移者，应以局部灌注化疗为主。     

秦氏隐血珠在上消化道癌初筛普查中实用价值的调查研究——附31972例初筛人群5、10年随访资料分析

目的：通过对隐血珠初筛人群及癌患5年、10年随访,进一步证实隐血珠对上消化道癌初筛普查的实用价值。方法：空腹时吞入隐血珠,3-5分钟拉出,观察珠内试纸的变化,黄色为阴性（-）,浅蓝色为（ ）,蓝色为（ ）,深蓝色为（ ）,5年、10年后对隐血珠初筛人群及癌患通过三级防癌网络进行全员随访。结果：初筛普查31927人,阳性组3347人做胃镜,经病理确诊为癌患125人,癌检出率3.74%,阴性组645人做胃镜,确诊癌患9人,癌检出率1.4%,两组中早期癌患共78人,占62.4%,性别、年龄、隐血珠反应均是影响癌检出率的因素。经5年及10年两次全员随访资料统计,隐血珠初筛阳性组癌发生率均明显高于阴性组,癌患5年生存率67.2%,10年生存率为55.2%,性别、年龄、隐血珠反应也是影响上消化道癌发病率因素。结论：秦氏隐血珠在上消化道癌初筛普查中有肯定的实用价值。值得推广。     

区域癌化及其临床意义

区域癌化是肿瘤发生机制中的重要理论，近年来，随着分子生物学的飞速发展，区域癌化理论不仅得到了大量研究的证实，其概念本身也得到了发展。区域癌化理论不仅可以深化我们对肿瘤多步骤、多阶段起源的生物学理解，同时在肿瘤风险评估、分子边界、预后评估、化学预防等方面具有重要临床意义。     

双侧甲状腺乳头状癌合并单侧滤泡癌1例

患者女性,58岁。因甲状腺肿物1年,憋气1个月于2019年4月收入天津中医药大学第二附属医院。体检:甲状腺左叶可触及多个肿物,最大约4.0 cm×3.0 cm×3.0 cm,质韧,边界清楚,轻度压痛,随吞咽移动;右叶可触及2个肿物,大小约1.0 cm×1.0 cm×1.0 cm,颈部淋巴结未肿大。彩超示:1)甲状腺左叶下极实性肿物3.7 cm×3.0 cm×2.7 cm,考虑不典型结节性甲状腺肿,恶性待除外(TI RADS 4a级);2)右叶2个实性结节,最大肿物1.0 cm×1.0 cm×0.8 cm,考虑恶性,不典型结节性甲状腺肿待除外(TI RADS 4b级);3)甲状腺左右叶多发结节,考虑结节性甲状腺肿(2级)。     

食管碰撞癌一例

患者男，60岁。进食梗阻感半个月，伴有胸骨后疼痛，无恶心、呕吐，无腹痛、腹泻及黑便。体检：浅表淋巴结未及肿大，皮肤及巩膜无黄染；全腹平软未及包块，无压痛、反跳痛，肝脾肋下未及，肠鸣音不亢，未闻及移动性浊音，直肠指检无异常。当地医院胃镜检查：距门齿27～30cm前壁左侧见黏膜隆起，表面高低不平，溃疡形成，质地脆、易出血，食管腔轻度狭窄；齿状线清晰，40cm过贲门，黏液混浊；胃底贲门无异常，胃体黏膜充血，胃角光滑，胃窦部充血水肿，蠕动正常；幽门口圆，无十二指肠球部溃疡和畸形，降部伸入未见异常。当地医院胃镜病理诊断：食管中段黏膜鳞癌。     

肝癌间质及癌旁病变的病理分析

目的　研究肝癌间质及癌旁病变的临床病理意义。方法　在 2 0例肝癌组织标本中取 45个癌结节 ,分别在癌结节中间、癌旁肝组织等部位取组织 4块 ,连续切片 ,显微镜下观察。结果　 19个结节有完整窦内皮细胞围绕癌巢 ,其中癌结节肉眼小于3cm者 13个 ,大于 3cm者 6个。 2 6个癌结节无完整窦内皮细胞围绕癌巢 ,其中癌结节直径大于 3cm者 2 4个 ,小于 3cm者 2个。2 0例中有 13例合并肝硬化 ,17例有乙型肝炎病毒感染和HBsAg阳性。 结论　病理连续切片 ,显微镜下观察肝癌间质及癌旁病变是预测肝癌患者预后的重要病理学指标     

14例食管肉瘤样癌的临床病理分析

目的:探讨食管肉瘤样癌病理诊断及临床的特点。方法:对14例食管肉瘤样癌患者的临床资料进行回顾性分析。结果:食管肉瘤样癌多为息肉样腔内生长,有细短蒂和食管壁相连,个别呈浸润生长,光镜下肉瘤样成分与癌成分共存,瘤体多以肉瘤样成分为主,肉瘤样组织中未见明确的骨、软骨、横纹肌肉瘤等异源性成分。14例患者5年生存率为50%。结论:食管肉瘤样癌本质上是一种特殊类型的癌,以息肉状生长为主,是一种侵袭性差、淋巴结转移率低、预后较佳的肿瘤,手术切除是其首选和主要的治疗手段。     

食管肉瘤样癌

目的　探讨食管肉瘤样癌的病理诊断及临床特点。方法　分析了 12例食管肉瘤样癌的临床资料、病理变化并复习有关文献。结果　 12例中 ,男性 10例 ,女性 2例。平均年龄 60岁。临床症状为逐渐加重的吞咽困难。病程从 10余天到 5个月。发生在食管中段者 5例 ,下段者 7例。大体形态 :8例呈典型的息肉样生长 ,2例呈蕈伞型 ,另 2例髓质型 ;病理均为鳞癌与肉瘤样成分 ,6例浸润深度位于粘膜固有膜或粘膜下层。 5例术后时间超过 5年者尚有 3例存活 ,5年生存率为 5 0 %。结论　食管肉瘤样癌本质上是一种特殊类型的癌 ,以息肉样生长为主 ,因病程短 ,浸润深度常较浅 ,手术切除预后好     

同时性食管贲门重复癌34例报告

１９７６年１月至１９９４年１２月，我们收治同时性食管贲门重复癌３４例，占同期食管、贲门癌病人的０．７％（３４／５０４０）。全组食管病变全部为鳞癌，贲门病变中腺癌３２例、恶性纤维组织细胞瘤和平滑肌肉瘤各１例。术前诊断率７０．６％（２４／３４），手术切除率７９．４％（２７／３４），术后１、３、５年生存率分别为８７．５％（２１／２４）、４５．０％（９／２０）和１８．８％（３／１６）。作者认为：注意各项检查的相互配合及仔细的上消化道全面检查能提高诊断率，早期手术并扩大手术范围可提高手术疗效。     

Invasive neuroendocrine carcinoma of the breast

BACKGROUND:

Neuroendocrine carcinoma (NEC) of the breast, a pathologic entity newly defined in the 2003 World Health Organization classification of tumors, is a rare type of tumor that is not well recognized or studied. The purpose of this first case‐controlled study is to reveal the clinicopathologic features, therapeutic response, and outcomes of patients with NEC of the breast.

METHODS:

Seventy‐four patients with NEC of the breast who were treated at The University of Texas M. D. Anderson Cancer Center were analyzed; 68 of them had complete clinical follow‐up. Two cohorts of invasive mammary carcinoma cases were selected to pair with NEC to reveal demographic, pathologic, and clinical features at presentation, along with therapeutic response to treatment and patient outcomes.

RESULTS:

NEC was more likely to be estrogen receptor/progesterone receptor positive and human epidermal growth factor receptor 2 negative. Despite similar age and disease stages at presentation, NEC showed a more aggressive course than invasive ductal carcinoma, with a higher propensity for local and distant recurrence and poorer overall survival. High nuclear grade, large tumor size, and regional lymph node metastasis were significant negative prognostic factors for distant recurrence‐free survival; high nuclear grade and regional lymph node metastasis were also significant negative prognostic factors for overall survival. Although endocrine therapy and radiation therapy showed a trend toward improved survival, the small number of cases in this study limited the statistical power to reveal therapeutic benefits in NEC of the breast.

CONCLUSIONS:

NEC is a distinct type of aggressive mammary carcinoma. Novel therapeutic approaches should be explored for this uniquely different clinical entity. Cancer 2010. © 2010 American Cancer Society.     

Rare Breast Cancer Subtypes: Histological,Molecular, and Clinical Peculiarities

Breast cancer encompasses a collection of different diseases characterized by different biological and pathological features, clinical presentation, response to treatments, clinical behavior, and outcome. On the basis of cell morphology, growth, and architecture patterns, breast cancer can be classified in up to 21 distinct histological types. Breast cancer special types, including the classic lobular invasive carcinoma, represent 25% of all breast cancers. The histological diversity of breast carcinomas has relevant prognostic implications. Indeed, the rare breast cancer group includes subtypes with very different prognoses, ranging from the tubular carcinoma, associated with an indolent clinical course, to metaplastic cancer, whose outcome is generally unfavorable. New approaches based on gene expression profiling allow the identification of molecularly defined breast cancer classes, with distinct biological features and clinical behavior. In clinical practice, immunohistochemical classification based on the expression of human epidermal growth factor receptor 2 and Ki67 is applied as a surrogate of the intrinsic molecular subtypes. However, the identification of intrinsic molecular subtypes were almost completely limited to the study of ductal invasive breast cancer. Moreover, some good‐prognosis triple‐negative histotypes, on the basis of gene expression profiling, can be classified among the poor‐prognosis group. Therefore, histopathological classification remains a crucial component of breast cancer diagnosis. Special histologies can be very rare, and the majority of information on outcome and treatments derives from small series and case reports. As a consequence, clear recommendations about clinical management are still lacking. In this review, we summarize current knowledge about rare breast cancer histologies.     

CyclinD1表达与泌尿系统肿瘤关系的研究进展

D型细胞周期蛋白（Cyclin）是目前已知的细胞周期蛋白（Cyclins）中的亚型之一,与肿瘤的关系最为密切,D型Cyclin中的CyclinD1是细胞周期中起关键作用的正向调节因子,主要作用于细胞增殖及细胞分裂过程,CyclinD1特异性过表达于多种肿瘤细胞。研究发现,在泌尿系恶性肿瘤中也存在Cy-clinD1过表达现象,且与肿瘤细胞的侵袭、转移和复发有关。因此,以CyclinD1作为泌尿系肿瘤的研究靶点,有可能为泌尿系恶性肿瘤的预防及治疗等提供新的思路。     

Squamous cell carcinoma of the thyroid: a report of two cases.

Two patients with squamous cell carcinoma, which accounts for 1.1% of all primary thyroid carcinomas, are described. Squamous metaplasia is the most likely etiology, but an occasional carcinoma may be derived from remnants of embryonic origin. Although squamous metaplasia has been documented in several conditions involving the thyroid, no evidence exists that this predisposes to squamous cell carcinoma. Metastases and direct extension of squamous cell carcinoma in the thyroid gland are much more frequent than primary involvement and are always part of a generalized carcinomatosis. A primary lesion must always be sought; however, diagnosis may not be possible until an initially occult tumor becomes evident or even until autopsy. Because this lesion typically runs a fulminant course, radical surgical resection at the earliest opportunity offers the best hope for cure. The lesions are usually radioresistant, and chemotherapy has not been shown to alter the course of this disease.     

Two Cases of Lipid-Secreting Carcinoma of the Breast: Case Reports with an Electron Microscopic Study

Two very rare cases of lipid-secreting carcinoma of the breastare reported, together with a review of the literature. Bothpatients were Japanese women aged 70 and 81 years, respectively.In each, a mass had been found in the breast, and radical mastectomieswere performed based on a diagnosis of breast cancer at an earlyclinical stage. Both resected tumors were found to be solidand localized. In them, both estrogen and progesterone receptorswere negative. Microscopically, hematoxylin-eosin staining showedthe tumor cells to have foamy and vacuolated eosinophilic cytoplasm.Lipid staining showed the vesicles in the cytoplasm of the tumorcells to be colored a flaming red and consequently recognizedas lipid droplets. An electron-microscopic study showed thatthe tumor cells contained various sizes of lipid droplets inthe cytoplasm with no degenerative changes, and suggested thatthese lipid droplets were produced and stored in the tumor cells.It would appear, from the literature that lipid-secreting carcinomashave aggressive clinical courses, but neither vascular invasionnor lymph node metastasis was seen in either of our two cases.     

Clinical and laboratory findings of carcinoma of the pancreas and periampullary structures

Primary carcinoma of Stensen's duct is a rare neoplasm with only 15 cases reported in the English literature since 1927. The authors present a recent additional patient and discuss their criteria for the determination of true primary ductal lesions based upon clinical presentation, operative findings, and tumor histology. This method of selection, most particularly involving electron microscopy in the reported case, is necessary to define whether the lesion originates from the ductal epithelium. All previously reported cases were reviewed, together with the actual pathologic slides in four available cases. Only ten were retained as primary ductal lesions. Most important, this analysis clarifies the natural history of these neoplasms and reinforces a recent theory of histogenesis of salivary gland tumors. In light of these findings, a rational treatment plan can be suggested.