绒癌肺转移的诊断与外科治疗

1991—08／2003—10我们收治经临床和病理证实的绒癌肺转移8例，手术治疗5例，现分析报告如下。     

肺转移性透明细胞肾细胞癌的临床病理学观察

［摘要］　目的　探讨肺转移性透明细胞肾细胞癌临床病理学特点。方法　回顾性分析4例穿刺活检诊断肺转移性透明细胞肾细胞癌的临床病理特征,采用免疫组化染色检测CK、p40、p63、TTF-1、Napsin A、PAX8、CD10,观察其表达情况。结果　4例患者中,男3例,女1例,年龄44～71岁,平均58.75岁;均为双肺多发结节,其中各例最大的结节位于左下肺2例,右下肺2例。4例均表达CK、PAX8、CD10,而TTF-1、Napsin A、p40、p63阴性。结论　具有透明细胞形态特点的肺肿瘤需要考虑肺转移性透明细胞肾细胞癌的可能。     

胸腔镜肺部分切除术治疗肺转移癌的疗效(附45例分析)

目的1997年6月～2004年12月,本院共进行了各类胸腔镜手术732例,对45例肺转移癌施行了肺部分切除术,占同期手术量的6．15％,男性30例,女性15例,平均年龄53．27岁。26例原发部位为肺。所有病例均行肺部分切除术。其中32例行辅助小切口。每例切除结节1～3个。有37例行孤立肺结节切除术。均为原发灶切除后2年内定期随访中发现转移。术后给予对原发肿瘤敏感的化疗4～6个疗程。结果无手术死亡,1年内失访3例。术后生存率如下：1年为75％（24／32）,3年为50％（11／22）,5年为45％（9／20）。死亡病例中,肺腺癌转移2例,肺腺鳞混合癌转移2例,直肠癌转移3例,类癌转移1例。术后并发症有：漏气、出血、皮下气肿、肋间神经痛。所有病员在术后1周左右出院。结论对于有条件的病人,辅以合适的全身治疗,胸腔镜肺部分切除手术治疗肺转移癌不失为一种合理的选择,创伤小,且疗效肯定。     

雾化吸入治疗肺转移瘤的现状

肺是最常见的恶性肿瘤转移部位之一。在死亡的恶性黑色素瘤患者中,有2 9%是死于肿瘤肺转移。尸体解剖结果显示:死于肺转移的恶性黑色素瘤患者中,2 0 %只在肺发现转移瘤。骨和软组织肉瘤的转移往往只发生在肺[1] 。肺转移瘤的治疗一直受到临床的重视,但治疗效果不甚满意。对大多数肺转移瘤患者来说,手术是惟一真正有希望的治愈方法。可是只有1/ 3的患者具有手术治疗的适应证(能控制或完全切除原发病灶、没有肺外转移、能够切除全部肺内转移灶以及患者能够耐受手术等)。手术切除原发病灶后,化疗也许可控制全身微转移灶。但是,化疗对肺转移瘤的…     

全肺放射治疗双肺转移癌的心电图改变研究

目的 探讨全肺放射治疗肺转移癌的心电图改变.方法 选取1999-01～2007-12月收治48例进行全肺放射治疗的双肺多发肺转移癌患者的临床资料进行回顾分析.结果 全组的心电图异常率占31.3%(15/48),其中窦性心动过速(>100次/min)占12.5%(6/48),窦性心动过缓(<60次/min)占8.3%(4/48),ST段改变(下移超过0.05mv)占8.3%(4/48),1例为完全性右束支阻滞占2.1%(1/48).心电图异常出现时间分别在治疗第3周2例、第4周5例、结束时8例,随访至3个月后全部恢复正常.结论 恶性肿瘤肺多发转移采用全肺放射治疗可获得较好疗效.照射面积大而放射剂量小可发生急性放射性心脏损伤,其损伤程度较轻且为一过性.     

异位甲状旁腺癌肺转移一例报告

原发性甲状旁腺功能亢进症（primary perparathyroidism，PHPT）在我国尚无明确的发病率统计，不过，近年来随着诊断技术水平的提高，发病例数有逐步增多的趋势。本例甲状旁腺病变较为特殊，现结合有关文献资料，报告如下。     

晚期肺腺癌并心包转移个体化治疗一例

<正>肺癌是全球范围内发病率及病死率最高的肿瘤疾病~([1-2])。心包积液是肺癌常见的并发症之一,其临床后果严重,处理棘手。尽早对肺癌患者进行准确诊治,并对其并发症积极有效地干预,是提高肺癌患者生存期的关键。现对我科收治的一例肺癌并心包积液病例报道如下。病历资料患者男性,57岁,因咳嗽、咳痰7月余,加重伴气促2个月于2015年12月21日收入我科。患者于7月前受凉后开始出现阵发性咳嗽,咳大量白色粘稠痰液。多次行胸部CT,     

肺大细胞癌小肠黏膜转移致多处肠套叠一例

患者男 ,5 1岁。因阵发性腹部绞痛伴恶心、呕吐 1周入院。既往慢性咳嗽、咳痰病史 30余年。体检 :双锁骨上扪及肿大淋巴结 ,左侧 2枚 ,右侧 1枚 ,均约 0 .5ｃｍ× 0 .5ｃｍ ,质硬 ,活动可 ;桶状胸 ,右侧第三、四肋间叩诊浊音 ,呼吸音低。心界不大 ,心率 10 8次 /ｍｉｎ ,律齐 ,无杂音。腹膨隆 ,未见肠形及蠕动波 ,全腹弥漫性压痛 ,未扪及包块 ,叩诊呈鼓音 ,移动性浊音阴性 ,肠鸣音活跃 ,肛门指诊正常。Ｘ线胸片示右上肺球形阴影 (图 1)。腹部平片示多个液平面及扩大肠腔(图 2 )。Ｂ超示腹部发现强回声团。考虑机械性肠梗阻 ,予胃肠减压、补…     

56例肺转移瘤临床分析

为探讨肺转移瘤的诊断，治疗及其预后，回顾分析我院５６例肺转移瘤的临床资料。５４％的患者无自觉症状，无病间隔期最短１个月，最长７年８个月，ＤＦＩ中位数２５个月。肝氏分化癌及肺内外多发性转移瘤患者生存离最低，手术综合治疗组１，３，５年生存率分别为９２．３１％，７６．９２％及４６．１５％，较非手术综合治疗组为高。     

Pancreatic metastasis of renal cell carcinoma

BACKGROUND: Renal cell carcinoma (RCC) is a common cancer, but pancreatic metastasis of RCC is unusual. Because of the rarity and peculiarity, pancreatic lesions from RCC me-tastasis were described mostly in case reports which highlight the importance of a systematic analysis of this clinical condi-tion.
DATA SOURCES: Data of 7 patients with pancreatic metasta-sis of RCC treated in the Peking Union Medical College Hospi-tal were extracted and 193 similar patients reported in the past 10 years from the literature were analyzed. Epidemiological, pathological and follow-up information were investigated. Po-tential prognostic factors were compared with corresponding data reported 10 years ago.
RESULTS: Multivariate Cox regression showed that asymp-tomatic metastasis and surgical procedure were independent factors associated with better survival. Compared with the data reported 10 years ago, follow-up of RCC patients has been emphasized in recent years, and atypical surgery is fre-quently used since it has similar effect as typical surgery on tumor resection while it is able to preserve more pancreatic function.
CONCLUSION: Surgical treatment should be an option as long as the pancreatic metastasis of RCC is resectable.     

Tonsillar metastasis of small cell lung carcinoma

Metastasis to palatine tonsils are rare, accounting from only 0.8% of all tonsillar tumors, so far only 100 cases reported in the English literature. Only a few cases have been reported for small cell and non‐small cell lung cancer as a primary site. With a diagnosis of small cell lung cancer, a 68‐year‐old male patient relapsed after six cycles of chemotherapy in tonsilla palatina and cervical lymph nodes. Patients died 26 months after being diagnosed with lung cancer and 2 months after detection of tonsil metastasis. We present the current case report because of the rarity of metastasis to tonsil in lung cancer.     

Prostatic metastasis of large cell neuroendocrine carcinoma of the lung

Large cell neuroendocrine carcinoma (LCNEC) of the lung is a rare and aggressive tumour with a poor prognosis. Lung cancer metastases to the prostate are also uncommon, and are usually found incidentally during autopsy. Most reported primary lung cancers with prostatic metastases are small cell carcinomas, and prostatic metastases from LCNEC of the lung have not been reported previously. This case report describes a 70-year-old man with LCNEC of the lung and metastases in the prostate, brain, bone, liver and lymph nodes.     

Renal cell carcinoma with unusual metastasis to the gallbladder

Gallbladder involvement in patients with renal cell carcinoma (RCC) is extremely rare. We present a report of a 61-year-old man with a synchronous RCC metastasis to the gallbladder presenting as an intraluminal polypoid mass simulating primary gallbladder carcinoma. Enhanced abdominal computed tomography demonstrated a well-enhanced polypoid lesion in the gallbladder. Intraoperative rapid pathological examination of the gallbladder tumor showed clear cell-type cancerous cells. Microscopically, tumor cells of both the resected kidney and gallbladder had round uniform nuclei, clear cytoplasm, and well-defined cytoplasmic borders, forming alveolar patterns. Immunohistochemically, the tumor cells were negative for cytokeratin 7 (CK7) and carcinoembryonic antigen (CEA), which is usually positive in primary clear cell carcinoma of the gallbladder. Therefore, the final diagnosis was RCC with a synchronous gallbladder metastasis.     

Cardiac metastasis from a renal cell carcinoma

A 59-year-old man developed an episode of syncope while he was driving. This resulted in a motor vehicle accident, and the patient sustained an open fracture of the left femur. Biopsy of the left femur fracture showed a metastastic renal cell carcinoma, and echocardiography revealed a right ventricular mass without contiguous vena caval or right atrial involvement. This is one of the few reported cases of renal cell carcinoma associated with syncope as an initial symptom.     

Pulmonary metastasectomy in renal cell carcinoma: a mainstay of multidisciplinary treatment

Renal cell carcinoma (RCC) remains a public health issue and seems to be increasing. A significant proportion of RCC patients will develop pulmonary metastasis at some point in their evolution. In this review, we aimed to update the surgical management of pulmonary metastases as well as systemic therapy, including targeted therapies, according to recent data in the literature. We retrospectively reviewed studies evaluating the benefit of pulmonary metastasectomy in RCC patients and evaluating the place of different chemotherapies, targeted therapies and immunotherapies through November 1, 2019. Several retrospective studies have shown the benefit of pulmonary metastasectomy in metastatic RCC (mRCC), most in a situation with only pulmonary metastases. According to the prognostic criteria of the IMDC risk model, the patient is classified into a prognostic group to identify the best systemic treatment. With the development of targeted therapies, the modalities are multiple and may involve tyrosine kinase inhibitors/checkpoint inhibitors and soon vaccine therapy or CAR-T cells. At the local level, in patients who cannot benefit from surgery, stereotactic radiotherapy or radiofrequency has a place to be considered. Although there is a lack of a randomized study, pulmonary metastasectomy appears to be feasible and effective. The place and modalities of systemic therapies in the era of targeted therapies remain to be more clearly defined.     

Short-term prognosis for hepatocellular carcinoma patients with lung metastasis: A retrospective cohort study based on the SEER database

Our study aimed to develop a prediction model to predict the short-term mortality of hepatocellular carcinoma (HCC) patients with lung metastasis. The retrospective data of HCC patients with lung metastasis was from the Surveillance, Epidemiology, and End Results registration database between 2010 and 2015. 1905 patients were randomly divided into training set (n = 1333) and validation set (n = 572). There were 1092 patients extracted from the Surveillance, Epidemiology, and End Results database 2015 to 2019 as the validation set. The variable importance was calculated to screen predictors. The constructed prediction models of logistic regression, random forest, broad learning system, deep neural network, support vector machine, and naïve Bayes were compared through the predictive performance. The mortality of HCC patients with lung metastasis was 51.65% within 1 month. The screened prognostic factors (age, N stage, T stage, tumor size, surgery, grade, radiation, and chemotherapy) and gender were used to construct prediction models. The area under curve (0.853 vs. 0.771) of random forest model was more optimized than that of logistic regression model in the training set. But, there were no significant differences in testing and validation sets between random forest and logistic regression models. The value of area under curve in the logistic regression model was significantly higher than that of the broad learning system model (0.763 vs. 0.745), support vector machine model (0.763 vs. 0.689) in the validation set, and higher than that of the naïve Bayes model (0.775 vs. 0.744) in the testing model. We further chose the logistic regression prediction model and built the prognostic nomogram. We have developed a prediction model for predicting short-term mortality with 9 easily acquired predictors of HCC patients with lung metastasis, which performed well in the internal and external validation. It could assist clinicians to adjust treatment strategies in time to improve the prognosis.     

Results of duodenopancreatectomy for solitary pancreatic metastasis from renal cell carcinoma

The pancreas is an uncommon site of metastasis from renal cell carcinoma. We present five patients with solitary pancreatic metastasis from renal cell carcinoma located in the head of the pancreas, treated by duodenopancreatectomy. There were no perioperative deaths. Mean survival was 48 months; three patients were alive at the end of the study (at 27, 46, and 88 months, respectively) and two patients died, at 13 and 70 months. The 3- and 5-year survival rates of our patients together with 22 previously reported patients were 86% and 68%, respectively. We advocate aggressive surgical treatment when the metastatic disease is limited to the pancreas.     

A rupture of lung metastasis of hepatocellular carcinoma causing haemothorax

A 67 year old male with non-resectable hepatocellular carcinoma (HCC) in both lobes and liver cirrhosis was treated with transcatheter arterial embolization and regional chemotherapy. He was doing well for 18 months. He was readmitted for fever, chest pain and multiple pulmonary metastases. During interleukin-2 therapy, he suddenly developed dyspnoea and palpitation, and was in shock. Left-sided haemothorax was confirmed by draining 3 L of fresh blood. In spite of intensive care, he died within 36 h. Autopsy showed that the haemothorax was caused by rupture of one of the metastases in the upper lobe of the left lung, and that the primary HCC was totally necrotic. Survey of the literature failed to find a report of fatal bleeding from a lung metastasis of HCC.     

Adenoid cystic carcinoma of the sublingual gland developing lung metastasis 20 years after primary treatment: A case report and literature review

Rationale:Adenoid cystic carcinoma (ACC) is a rare malignant tumor that primarily occurs in the salivary glands. Distant metastases can develop despite favorable local control. Moreover, distant metastasis of ACC can occur after a long time interval without local recurrence. We report the first case of ACC of the sublingual gland that developed lung metastasis 20 years after primary treatment.Patient concerns:A 52-year-old man was referred to our department with a 1-year history of painful swelling on the right oral floor.Diagnosis:An incisional biopsy was performed, and histopathological examination revealed malignancy.Interventions:Surgical excision of the right oral floor and right supra-omohyoid neck dissection with postoperative chemoradiation therapy were performed, and ACC of the sublingual gland was diagnosed. Left pulmonary metastasis was detected 20 years after the primary treatment. Metastasectomy was performed; however, subsequently, skin and bone metastases developed.Outcomes:After receiving palliative care, the patient died of multiple organ failure.Lessons:As late distant metastasis of salivary ACC can develop, patients who undergo primary treatment need a long-term, strict follow-up plan even if locoregional control is favorable.