纵隔淋巴结肿大作为非小细胞肺癌N病变标记的意义

报告５６例非小细胞肺癌（ＮＳＣＬＣ）手术摘除的纵隔淋巴结标本的直接观察结果。发生淋巴结肿大（直径≥１．０ｃｍ）假定为Ｎ病变５２例（９２．９％）。其中假定Ｎ１１１例，Ｎ２４１例。经病理学检查确定为Ｎ病变１９例，包括Ｎ１３例，Ｎ２１６例。假定为Ｎ０病变４例，其中１例为真正Ｎ１病变。鳞癌患者普遍为假定的Ｎ２病变，但真正Ｎ病变发生率低（２／１６例，１１．１％），和非鳞癌患者（１４／２５例，５６％）对比，差异有非常显著性（Ｐ＜０．０１）。因此，仅根据纵隔淋巴结大小不能可靠地评估Ｎ病变和术前分期，特别是鳞癌。在发生纵隔淋巴结肿大，但未取得转移病变的组织学依据时，应争取开胸探查手术治疗。     

肿瘤专科医院院际会诊特点分析

目的 分析肿瘤专科医院院际会诊的特点,探讨院际会诊对肿瘤专科医院患者诊疗方案的影响。方法 回顾性分析北京大学肿瘤医院2013年1月1日至2017年12月31日期间肿瘤患者进行院际会诊的1 323例病历资料,明确会诊原因、会诊目的及会诊结果,分析院际会诊对抗肿瘤方案制定产生的影响。结果 1 323例患者中急会诊：117例（8.8%）,普通会诊：1 206例（91.2%）。受邀请会诊较多的专业科室是：心内科、神经内科和呼吸科。会诊的疾病包括：心血管疾病317例（24.0%）、呼吸系统疾病182例（13.8%）、血液系统疾病139例（10.5%）、神经系统病变132例（10.0%）、消化系统疾病131例（10.0%）、泌尿系统疾病82例（6.2%）、皮肤病及性病65例（4.9%）、内分泌与代谢性疾病53例（4.0%）、自身免疫性疾病23例（1.7%）,其他疾病199例（15%）。通过院际会诊,894例患者（67.5%）获得最佳抗肿瘤治疗,350例患者（26.5%）获得最佳对症支持治疗,79例（6.0%）患者未能明显获益。住院期间的疾病转归：1 286例（97.2%）患者病情稳定或者好转,37例（2.8%）患者病情恶化死亡。结论 心血管疾病是导致肿瘤专科医院院际会诊的主要原因。院际会诊有助于抗肿瘤治疗方案的制定。     

An evaluation of intraabdominal involvement in hodgkin disease

An analysis of the staging procedure in 80 patients with histologically confirmed Hodgkin disease was performed at Tata Memorial Hospital, Bombay. There was a marked male preponderance. The mixed cellularity type of Hodgkin disease is the commonest histological variety (47.5%) and has the highest incidence of subsequently proven generalized disease (76%). The lymphocytic predominant variety was the next most common (27.5%) and was present as unsuspected disease in 45% of cases. Systemic symptoms were associated with advanced disease in 57% of clinical IB and 73% of clinical IIB cases. Splenic involvement was histologically confirmed in 41% of cases with stage I disease and 52% of cases with stage II disease and was associated with liver involvement in two cases. A lymphogram was performed, in addition, prior to the laparotomy in 40 cases and the lymphogram-laparotomy concordance was approximately 72% in our series. This stresses the importance of a staging laparotomy.     

影响恶性肿瘤诊治的非肿瘤性疾病分析

  目的  了解恶性肿瘤患者合并的非肿瘤性疾病情况,探讨非肿瘤性疾病对肿瘤患者诊疗方案的影响。  方法  收集2013年1月1日至2017年12月31日北京大学肿瘤医院住院患者经院际会诊的1 323例病历资料,筛选其中合并非肿瘤性疾病的病例。回顾性分析该组患者的临床病历资料,探讨非肿瘤性疾病在肿瘤诊治过程中的影响。  结果  本研究1 323例院际会诊病例中,筛选出非肿瘤性疾病1 153例（87.2%）,其中男性773例（67.0%）,女性380例（33.0%）。年龄为14~90岁,中位年龄62岁。原发肿瘤类型包括:肺癌、胃癌、淋巴瘤、结直肠癌、食管癌、乳腺癌、恶性黑色素瘤、肝癌、胆管癌/胆囊癌、胰腺癌和其他肿瘤。非肿瘤性疾病情况为心血管疾病356例（30.9%）,呼吸系统疾病196例（17.0%）,消化系统疾病107例（9.3%）,皮肤病及性病81例（7.0%）,神经系统病变74例（6.4%）,泌尿系统疾病72例（6.2%）,血液系统疾病70例（6.1%）,内分泌与代谢性疾病47例（4.1%）,自身免疫性疾病23例（2.0%）,其他疾病127例（11.0%）。直接影响肿瘤诊疗方案的制定为771例（66.9%）;不影响方案的制定为313例（27.1%）;不确定/无法判断的为69例（6.0%）。  结论  心血管疾病是恶性肿瘤患者合并的主要非肿瘤性疾病。非肿瘤性疾病是影响恶性肿瘤诊疗方案制定的重要因素。      

Leucocyte common antigen in the differential diagnosis of Hodgkin's disease

The utility of immunohistochemical staining for leukocyte common antigen (LCA) in the differential diagnosis of Hodgkin's disease was studied in a series of 42 cases of Hodgkin's and non-Hodgkin's lymphoma and compared with Leu M-1, a proposed marker for Reed-Sternberg cells. LCA staining of neoplastic cells was absent in 23 of 24 cases of Hodgkin's disease but present in 16 of 18 cases of non-Hodgkin's lymphoma including eight of 10 cases with pleomorphic Reed-Sternberg-like cells. Leu M-1, in contrast was present in 14 of 24 cases of Hodgkin's disease, but also in five of 18 cases of non-Hodgkin's lymphoma including five of 10 cases with pleomorphic Reed-Sternberg-like cells. Immunohistochemical staining for LCA appears useful in the differential diagnosis of Hodgkin's disease and appears to be a better discriminant than Leu M-1.     

附睾结节性疾病111例临床分析

目的 :探讨附睾结节性疾病的临床表现及诊断。方法 :回顾性分析 111例附睾结节性疾病的临床表现、病理类型及诊断等。结果 :111例病人中附睾肿瘤 11例、精子肉芽肿 2 8例、囊肿 2 4例、结核 2 1例、慢性炎症 2 7例。结论 :对附睾结节性疾病的诊断应全面考虑可能出现的病理类型、病史、体征 ,同时应与辅助检查相结合     

Metastatic inguinal nodes from an unknown primary neoplasm. A review of 56 cases

Fifty-six cases of this uncommon neoplastic manifestation are presented. These cases represent 0.065% of 86,589 new cases of malignant disease seen at The Princess Margaret Hospital from 1968 to 1982. There were 29 men and 27 women. The median age at presentation was 58 years. Three major groups were identified: inguinal disease, 24 cases; unilateral inguinal plus iliac disease, 16 cases; local plus systemic disease, 16 cases. Pathologic subtypes were anaplastic, 24; squamous, 11; adenocarcinoma, nine; melanoma, nine; and others, three. Survival at 5 years for all patients was 27%. Among 40 patients who presented with inguinal and inguinal plus iliac disease, survival was 37.5% at 5 years. Initial treatment following biopsy was radiation in 35, lymph node dissection in eight, and chemotherapy in four. Excisional biopsy only was performed in nine cases. There were no treatment-related deaths. The findings observed in this study, in which radiation therapy was employed as initial management in the majority of cases, suggests that radiation therapy is a valid alternative to surgery in the management of this disease.     

Serum Lactate Dehydrogenase Level in Patients with Nasopharyngeal Carcinoma

Serum lactic dehydrogenase (LDH) levels of 465 patients with nasopharyngeal carcinoma (NPC) were assayed retrospectively. Four cohorts were selected in order to investigate the enzymes: 1) stage IV disease (118 cases) with pretreatment measurement, 2) relapse cases (159 cases) with pretreatment measurements, 3) no evidence of disease (217 cases) with spotting or serial measurements, and 4) monitoring of response to cytotoxic chemotherapy (34 cases). Higher serum LDH levels and more cases with elevated values were found in metastatic disease, especially relapse cases with liver and/or multiple organ site metastases. Serum LDH levels in locoregional disease were rarely found to be greater than two times the normal level. The value of serial serum LDH measurement for detecting disease relapse in the follow-up of patients with NPC is limited. Twelve percent of cases with no evidence of disease demonstrated elevation in serum levels. Serum LDH levels were found to correlate with the clinical responsiveness to systemic chemotherapy. Cases with normal serum LDH before treatment had a better chance of survival than those with elevated levels (median: 53 vs. 10 months, p = 0.008).     

85例甲状腺病变多层螺旋CT影像分析

目的：分析甲状腺病变多层螺旋cT影像表现，提高CT诊断准确性。方法：回顾性分析85例经临床、病理证实的甲状腺病变资料。结果：甲状腺癌25例；甲状腺腺瘤22例；结节性甲状腺肿28例；甲状腺囊肿3例；桥本氏甲状腺炎4例；Graves病3例。CT诊断符合率为89．4％（78／85），CT报告病变检出率100％。结论：多层螺旋CT（MSCT）检查对甲状腺病变的显示、定性、以及病灶同周围重要器官的关系方面有重要价值。     

Investigation of UFT and radiation combination therapy of head and neck cancer--mainly in laryngeal cancer

We studied the effects of simultaneous combination therapy with UFT and radiation for 69 head and neck cases with the same protocol in 6 universities in Kanagawa. Completed cases (cases in which therapeutic effects could be evaluated) totaled 67 patients who could receive more than 40 Gy as a given radiation dose and more than 8.4 g as a total UFT dose. Responder rate at 90th day after completion of radiation in 67 completed cases (CR 57 cases + PR 6 cases/67 cases) was as favorable as 94%. A comparison between 52 cases of the most frequent laryngeal cancer and historical control 113 cases received single radiation therapy by means of Kaplan-Meier method resulted significantly (P less than 0.05) favorable in UFT combination group as for disease free rate in all cases, disease free rate in Stage IV cases, disease free rate in glottic cancer, and survival rate and disease free rate in supraglottic cancer. No severe adverse reactions were observed in all cases. This combination therapy with radiation and UFT was judged effective for head and neck cancer, especially laryngeal cancer.     

How does negative clinical evaluation of ovarian carcinoma after full course of chemotherapy correlate with second-look laparotomy findings?

Surgical reexploration was performed in 46 patients with epithelial nonmucinous ovarian adenocarcinoma requiring adjuvant chemotherapy whose initial therapy consisted of optimum debulking and surgical staging. All patients were placed on CAP (cisplatinum, Adriamycin, cyclophosphamide) chemotherapy for at least six courses until proved to be clinically disease free (mainly CA-125 below 35 U/ml and normal ultrasonography or computerized tomography). All women underwent second-look laparotomy (SLL) after completion of adjuvant therapy. We classified SLL findings in five categories, namely, no evidence of disease, cytological evidence of disease, histological evidence of disease, macroscopic evidence of disease (<2 cm), and bulky tumor (>2 cm). SLL demonstrated 14 (30%) patients with disease. Of these, five cases had histological evidence of disease and nine had macroscopic disease; however, we found no patient with persistent disease larger than 1.5 cm. No patient in stage I demonstrated disease at SLL. All cases with macroscopic disease and three cases with histological disease were initially in stage III. We found that about one third of cases who were clinically free of disease had persistent disease at the completion of chemotherapy. Hence, we conclude that routine SLL is still of importance in the management of patients with epithelial ovarian adenocarcinoma except those with stage I disease. © Wiley-Liss, Inc.     

骨髓坏死6例临床分析

目的:探讨骨髓坏死(BMN)的原发病、发病机理、临床特点及预后。方法:对6例骨髓坏死的临床资料进行分析。结果:6例BMN均以骨髓坏死为首要表现,以骨痛和发热为主要表现。1例原发病不明,其余5例均为恶性疾病,其中急性粒单核细胞白血病1例,急性淋巴细胞白血病2例,骨髓转移瘤2例。2例经积极治疗原发病取得一定疗效。结论:骨髓坏死是一种罕见的临床综合征,诊断难度大,预后差,应积极治疗原发病。     

多中心型Castleman病临床病理分析并文献复习

目的:探讨多中心型Castleman病（multiple Castleman disease,MCD）的临床表现、病理学特征、鉴别诊断、病因及治疗,并分析其预后。方法:对9例多中心型Castleman病的临床资料、病理形态学特征进行分析,并行免疫组化检测及相关文献复习。结果:9例多中心型Castleman病例中,透明血管型5例,浆细胞型2例,透明血管浆细胞混合型2例。免疫组化无特征性表现,但可辅助诊断及鉴别诊断。9例多中心型患者均有完整随访资料,经治疗后其中有1例复发,1例死于心脏疾病,其余患者症状均有所缓解。结论:多中心型Castleman病是一种少见的淋巴组织增生性疾病,临床易与其他疾病相混淆,确诊需依靠病理学检查,准确的临床分型和病理类型对患者的治疗和预后具有重要意义。     

阴囊Ｐａｇｅｔ病１５例临床分析

目的：探讨有关阴囊Ｐａｇｅｔ病的临床特点、治疗方法和预后。方法：对１５例阴囊Ｐａｇｅｔ病患者的临床资料进行回顾性研究,全部患者先行患处活检,后手术治疗。结果：所有患者术后病理检查均发现Ｐａｇｅｔ细胞。根据Ｒａｙ分期：Ａ１期１０例,Ａ２期３例,Ｂ期２例（９例肿瘤局限于表皮,６例侵及真皮）。７例淋巴结肿大者经病理活检证实２例为淋巴结转移。１２例获得随访,随访时间３个月～５年,均未复发。结论：阴囊Ｐａｇｅｔ病应尽早活检确诊,病变局部广泛切除是本病首选治疗方法,愈后较好。     

Mondor's disease and breast cancer.

Mondor's disease or thrombophlebitis of the subcutaneous veins of the chest region is an uncommon condition and is rarely associated with breast cancer. From January 1980 to June 1990, 63 cases of Mondor's disease were diagnosed (57 women and 6 men). In 31 patients, no apparent cause was determined (primary disease), whereas in 32 cases, the disease was secondary because the etiopathogenesis could be discerned. The identified potential causes were three cases of myentasis (all in men), eight cases of accidental local trauma (seven in women), seven cases of iatrogenic origin (three surgical breast biopsies, one skin biopsy, one needle biopsy, one mastectomy, and one reconstruction operation), six cases of inflammatory process, and eight cases associated with breast cancer (all females). Three of the tumors were less than 1 cm in diameter. The authors performed conservative surgery in four patients and demolitive in the other four. In this series, the incidence of breast cancer in association with Mondor's disease was the highest yet reported (12.7%). It was concluded that Mondor's disease may at times be caused by breast carcinoma. This association is by no means exceptional and implies that mammography should always be performed for Mondor's disease, even when the results of a physical examination are negative.     

Utility of combining antigranulocyte with antileukocyte antibodies in differentiating Hodgkin's disease from non-Hodgkin's lymphoma

The authors have reviewed their experience using the antigranulocyte marker, anti-Leu-M1, in combination with the antileukocyte marker, PD7/26, applied to paraffin sections of malignant lymphomas difficult to subclassify using morphologic criteria. The study group consisted of 73 lymphomas; 53 cases of Hodgkin's disease and 20 cases of non-Hodgkin's lymphoma. Leu-M1 was expressed by the Reed-Sternberg and Hodgkin's cells in 33 (62%) of the cases of Hodgkin's disease. The Reed-Sternberg and lymphocytic and histiocytic (L&H) cells in four cases of lymphocyte-predominant Hodgkin's disease were Leu-M1 negative. The Reed-Sternberg cells and L&H cells expressed leukocyte common antigen, utilizing the monoclonal antibody PD7/26, in seven (13%) of the 53 cases including the four cases of lymphocyte-predominant subtype (three nodular, one diffuse). The Reed-Sternberg-like cells in four (20%) of the cases of non-Hodgkin's lymphoma were stained by anti-Leu-M1 whereas, in 12 cases (60%) these cells were stained by PD7/26. The combination of anti-Leu-M1 and PD7/26 provided more useful information than that provided by anti-Leu-M1 alone by providing immunologic support for the diagnosis of lymphocyte-predominant Hodgkin's disease and by identifying cases which stained with neither antibody. The authors interpret the immunologic findings in the latter cases as equivocal. These studies were most helpful in cases with many atypical cells and provided unequivocal support for the diagnosis of Hodgkin's disease in six of 11 cases of the "syncytial variant," a form of the nodular sclerosing type characterized by cohesive aggregates of Reed-Sternberg cells and lacunar variants, not uncommonly misdiagnosed using only morphologic criteria.     

Radiotherapy as an adjunct in the management of Merkel cell carcinoma

Four patients with a diagnosis of Merkel cell carcinoma initially underwent surgery followed by radiotherapy. Recurrent disease prompted use of radiation in three cases. The three cases of recurrent disease illustrate the aggressiveness of Merkel cell carcinoma and also provide further documentation of the radiosensitivity of this tumor. Additionally, these cases suggest that surgery alone frequently is inadequate to achieve local control of disease.     

SOX方案二线治疗晚期胃癌的疗效观察

目的:观察SOX方案（奥沙利铂联合替吉奥）二线治疗晚期胃癌的临床疗效和安全性。方法:经含蒽环类药物的ECF方案(表阿霉素联合顺铂、氟尿嘧啶)治疗失败后的晚期胃癌患者40例,应用奥沙利铂（OXA）联合替吉奥(S-1)方案:OXA 130mg/m2,第1天静脉滴注;S-1根据体表面积(BSA)按80、100或120mg/d给药,第1-14天每天分2次口服;持续至疾病进展或出现不可耐受的不良反应。每2个周期按照RECIST标准(1.1版)进行疗效评价及分析患者生活质量改善情况,按NCI-CTC(4.0版)评价不良反应并随访疾病进展时间。结果:40例可评价的患者中获得完全缓解2例,部分缓解11例,疾病稳定13例,疾病进展14例,有效率32.5%,总的疾病控制率为65%,大部分患者生活质量得到明显改善,中位疾病进展时间为3.7个月,主要不良反应为血象降低、轻度末梢神经病变、肝功能异常和消化道反应。结论:奥沙利铂联合替吉奥化疗方案二线治疗晚期胃癌效果明显,应用方便且不良反应少,患者耐受性良好,值得临床深入观察。     

血浆EBV DNA水平测定在监测鼻咽癌放疗后复发、转移中的临床意义

目的 探讨定量分析血浆EBV DNA水平在监测鼻咽癌复发、转移中的临床意义。方法 应用荧光定量PCR技术（real-time PCR）,检测360例根治放疗后鼻咽癌患者血浆EBV DNA水平,并与临床及影像学检查结果 比较。结果 360例患者中87例血浆EBV DNA检测阳性,273例阴性。在87例检出阳性者中,25例证实为临床复发,45例证实为远处转移,故其预测肿瘤进展阳性预测值为80%（70/87）。在273例血浆EBV DNA检测阴性患者中,共有17例复发和4例转移,故其阴性预测值为92%（252/273）。总计91例肿瘤进展患者中70例血浆EBV DNA阳性,其中复发42例,25例血浆EBV DNA阳性;转移49例,45例血浆EBVDNA阳性。269例临床缓解患者中17例血浆EBV DNA阳性,故其敏感性、特异性、假阳性率和假阴性率分别为77%（70/91）、94%（252/269）、6%（17/269）、23%（21/91）、90%（322/360）。复发患者、转移患者、肿瘤进展患者和临床缓解患者EBVDNA阳性率和中位拷贝数分别为：60%,4700 copies/ml;92%,425000 copies/ml;77%,38000 copies/ml;6%,〈500copies/ml。复发患者与转移患者比较、肿瘤进展患者与临床进展患者比较,血浆EBV DNA阳性率和中位拷贝数均有显著性差异。结论 血浆EBV DNA水平的检测是监测放疗后鼻咽癌患者转移、复发的有效指标。     

霍奇金淋巴瘤治疗后发生非霍奇金淋巴瘤的临床分析

目的：探讨霍奇金淋巴瘤治疗后发生非霍奇金淋瘤的病理类型、生物学行为及临床治疗与病理的关系。方法：结合文献回顾性分析肿瘤医院1983－1992年收治的4例霍奇金淋巴瘤治疗后发生非霍奇金淋巴瘤的临床及病理资料。结果：4例患者治疗前均为霍奇金淋巴瘤，但在放射治疗和化疗过程中或治疗结束后，病变演变为非霍奇金淋巴瘤，其临床表现也与相应的 病理类型相符。结论：霍奇金淋巴瘤治疗或化疗后可以与非霍奇金淋巴瘤可以同时发生。