腹膜神经胶质瘤病

腹膜神经胶质瘤病是卵巢实性畸胎瘤合并神经胶质组织的腹膜种植现象。报道的８例中，活检时平均年龄１７．４岁。卵巢畸胎瘤最大直径是３０ｃｍ，平均２１．４ｃｍ。５例的肿瘤包膜局部缺损邻近脏器粘连。１例卵巢畸胎瘤术后１０个月，二次手术时发现腹膜播散。我们认为肿瘤包膜的缺损是导致腹膜的主要原因，腹膜种植结节总是由胶质纤维酸性蛋白和Ｓ－１００蛋白阳性并成熟的神经胶质组织组成。本组的平均随访期３６．２个月。其中病     

子宫颈小细胞癌3例

临床资料１９９３年４月～１９９６年１１月,我院收治子宫颈小细胞癌３例,３例患者平均年龄４３岁（３８～５０岁）,平均孕次３次（２～４次）,平均产次１７次（１～２次）。本组患者临床症状均有阴道不规则流血或排液。术前宫颈活检诊断为“子宫颈低分化或未分化癌...     

阑尾类癌并粘液囊肿1例

阑尾类癌并粘液囊肿１例张德良曹荣至患者女，１７岁。右下腹疼痛反复发作１年，近来加重。拟诊为慢性阑尾炎急性发作收入院。剖腹探查见回盲部有一约６．５ｃｍ×３．５ｃｍ×２．５ｃｍ大的长条状肿物，表面灰黄色，与大网膜粘连，已看不到阑尾的完整形态，切除肿块，送...     

开胸电化学治疗晚期肺癌6例分析

１９９４年－１９９７年开胸下电化学治疗晚期肺癌６例，男性４例，女性２例，其中鳞癌３例，腺癌２例，大细胞肺癌１例，Ｔ２Ｎ２Ｍ０２例，Ｔ４Ｎ１１Ｍ０４例，２例术前行１－３次支气管动脉灌注治疗，２例术后加一个疗程放疗，６例患者中４例治愈，２例缓解，分别随访６月－３年均存活且无复发，电化学治疗是在肿瘤内插入铂金针，连续直流电治疗仪，在直流电的作用下肿瘤组织细胞产生电化学效应而达到治疗目的。     

踝跖部神经显微断层解剖及其临床意义

目的：为不同部位断足再植提供理论基础和有关数据。方法：用体视学方法对６６例成人踝跖部胫神经及其重要分支进行观测。结果：胫神经的平均横径和面积分别为：第１断层５．８ｍｍ，１４．１ｍｍ２，足底内侧神经的平均横径和面积分别为：第１断层４．０ｍｍ，７．２ｍｍ２，第２断层４．１ｍｍ，６．８ｍｍ２；第３断层４．３ｍｍ，６．５ｍｍ２；第４断层３．７ｍｍ，５．４ｍｍ２；第５断层３．１ｍｍ，４．４ｍｍ２；第６断层３．２ｍｍ，４．４ｍｍ２；第７断层２．９ｍｍ，４．７ｍｍ２。足底外侧神经的平均横径和面积分别为：第１断层３．０ｍｍ，４．８ｍｍ２；第２断层３．１ｍｍ，４．５ｍｍ２；第３断层３．５ｍｍ，４．７ｍｍ２；第４断层４．０ｍｍ，４．４ｍｍ２；第５断层４．５ｍｍ，４．６ｍｍ２。结论：提出了“三段”断足分型法。不同断层平面断足再植吻接神经时要首选吻接主干，但断层１１和１２应根据足部感觉功能需要首选吻接胫侧神经。     

腹腔镜手术治疗卵巢良性上皮性肿瘤53例分析

目的探讨电视腹腔镜手术治疗卵巢良性上皮性肿瘤患者的治疗效果。方法对2002年1月-2006年12月在我院接受腹腔镜手术治疗卵巢良性上皮性肿瘤共53例病例进行回顾性分析。结果41例行腹腔镜下肿瘤剔除术,12例行附件切除术。术后随访46例,时间半年到5年。1例在术后1年复发,为同侧卵巢浆液性囊腺瘤,其余患者术后均无复发,无腹膜粘液瘤发生。结论腹腔镜手术治疗卵巢良性上皮性肿瘤是一种安全、有效的方法。     

阑尾泡状棘球蚴病1例

阑尾泡状棘球蚴病１例屠道同１临床资料患者，男性，２５岁。腹痛６ｄ急诊入院。在草原上工作，有生食牛羊肉史。入院后行剖腹探查，术中见腹腔积脓，阑尾周围粘连，分离粘连后行阑尾切除。临床诊断：（１）阑尾炎；（２）肠梗阻；（３）弥漫性腹膜炎。２病理检查阑尾长７...     

腹膜外剖宫产的解剖学基础

目的：研究避免腹膜外剖宫产副损伤的方法；方法：作者对８９例晚期妊娠孕妇的反折腹膜缘和膀胱顶的位置及体表投影进行了测量。结果：孕妇年龄２６．９±４．１（２０～４０）岁；孕周３９．５±１．１（３７～４２）周。结果显示反折腹膜缘与脐和耻骨联合上缘间距分别为１５．８±４．０ｃｍ和５．７±１．９ｃｍ；膀胱顶与脐和耻骨联合上缘间距分别为１３．７±３．６ｃｍ和７．２±２．２ｃｍ。结论：在腹膜外剖宫产术时，应按反折腹膜缘及膀胱顶的位置与体表投影进行腹膜剥离。     

腹膜外剖宫产应用于前置胎盘33例分析

３３例前置胎盘患者应用腹膜外剖宫产术终止妊娠，与同期３３例前置胎盘患者应用腹膜内剖宫产术相比较。结果表明：手术时间：腹膜外组平均４６．９分钟，腹膜内组平均６９分钟（Ｐ＜０．０５）；出血量：腹膜外平均８６６ｍｌ，平均输血６８７ｍｌ，腹膜内组平均１１２０ｍｌ，平均输血９４３ｍｌ（Ｐ＜０．０１）．新生儿窒息率：腹膜外组２４．７％，腹膜内组３０．３％（Ｐ＞０．０５）。产后大出血率：腹膜外组９．１％，腹膜内组６．１％（ｐ＞０．０５）。肠功能恢复时间：腹膜外组平均３０．４小时，腹膜内组６８．６小时（Ｐ＜０．０１）。术后病率：腹膜外组１８．２％，腹膜内组５４．５％（Ｐ＜０．０１）。提示前置胎盘患者腹膜外剖宫产术终止妊娠优于腹膜内剖宫产术。     

小儿伤寒多器官损害的临床特征

本文分析了１９９４年８月～１９９８年８月１４例小儿伤寒多器官损害病例资料,报告如下： １临床资料１４例中男９例、女５例,年龄＜３岁１例,～７ 岁５例,～１４岁８例．高热者Ｉ３例,其中驰张热６例,稽留热３例,不规则发热４例;各系统临床表现为：肝大４例,脾大２例;心音低钝３例,级脉２例,早搏２例,皮疹４例．血ＷＢＣ＜３ ×１０／Ｌ者 ３例（２３．１％）,３～１０×１０／Ｌ者 ７例（５７．７％）,＞１０ ×１０／Ｌ者４例（１９．２％）,ＰＬＴ＜１０×１０／Ｌ者２例（７．６％）,嗜酸性粒细胞绝对计数 ≤０． ０…     

Ovarian mucinous borderline tumors of intestinal type without intraepithelial carcinoma: Are they still tumors of low malignant potential?

The purpose of this study was to clarify whether ovarian intestinal-type mucinous borderline tumors without intraepithelial carcinoma should still be considered tumors of low malignant potential. Fifty-five intestinal-type mucinous borderline tumors without intraepithelial carcinoma in which a section had been taken for each 2 cm or less of the tumor's greatest diameter were selected. The International Federation of Gynecology and Obstetrics' stage and follow-up data of each case were examined. All 55 patients had stage I disease (including one with pseudomyxoma peritonei of superficial organizing type, according to Lee and Scully's classification). No patient had metastases or died from the tumor, although in one patient who underwent cystectomy, the disease recurred in the remaining ovary 5 years after surgery. However, the patient was alive and well after undergoing salpingo-oophorectomy. The patient with pseudomyxoma peritonei had no recurrence and did not die from the tumor. These findings indicated that intestinal-type mucinous borderline tumors, in which intraepithelial carcinoma has been ruled out with adequate histological sampling, are benign tumors, not tumors of low malignant potential. It is proposed here that these tumors should be designated as high-grade mucinous adenoma. Unilateral salpingo-oophorectomy is the recommended treatment because cystectomy alone may allow local recurrence in the remaining ovary.     

Histopathologic analysis in 46 patients with pseudomyxoma peritonei syndrome: failure versus success with a second-look operation.

Pseudomyxoma peritonei syndrome is a disease characterized by mucinous ascites and mucinous tumor disseminated on peritoneal surfaces; the disease almost always originates from a perforated appendiceal epithelial tumor. Histopathologic assessment of aggressive versus noninvasive character of the mucinous tumor has been shown to have an impact on survival in patients treated with cytoreductive surgery and intraperitoneal chemotherapy. Out of a database of 312 patients having a complete cytoreduction for pseudomyxoma peritonei syndrome, 46 patients (24 male and 22 female) had at least one second-look surgery. Before this review, all 46 of these patients were clinically uniformly categorized with a diagnosis of pseudomyxoma peritonei. Using the criteria described by Ronnett and colleagues, all specimens from the multiple surgical procedures performed on these patients were reviewed and reclassified as disseminated peritoneal adenomucinosis (adenomucinosis), adenomucinosis/mucinous adenocarcinoma (hybrid), or mucinous adenocarcinoma. The review was performed in a blinded fashion by a single pathologist (HY). To facilitate a critical evaluation of these histopathologic assessments, the patients were separated into two groups: (1) 19 patients who had a second-look surgery that was unsuccessful in that they went on to die of their disease or in that they currently have disease progression and a limited survival and (2) 27 patients who had a successful second look and currently continue disease free with a minimum 3-year follow-up period. As a result of this review, 11 of 19 patients with an unsuccessful second look and originally designated pseudomyxoma peritonei were reclassified as hybrid-type malignancy (four patients) or mucinous adenocarcinoma (seven patients). Only two patients were reclassified in the successful second-look group (P =.0005). Transitions from a less aggressive to a more invasive histology from one cytoreduction to the next occurred on 13 occasions in patients whose second-look surgery failed and in one patient with a successful second-look surgery (P <.0001). Seven patients retained a histologic classification of disseminated peritoneal adenomucinosis but went on to die of an aggressive disease process. Clinical assessments suggested that failure of second-look surgery for pseudomyxoma peritonei was associated with a biologically more aggressive disease. Unsuccessful second-look surgery for patients with a clinical diagnosis of pseudomyxoma peritonei tumor was often related to an inaccurate initial histologic classification of appendiceal mucinous tumor. Also, a transition from less to more aggressive histology was frequently seen in patients dying of this disease. Assessment of tumor histology can predict the outcome if a uniform surgical treatment is used in patients with peritoneal dissemination of mucinous epithelial tumors of the appendix.     

Mucinous epithelial cysts of the spleen associated with pseudomyxoma peritonei

AIMS: We report two rare cases of neoplastic pseudomyxoma peritonei associated with splenic mucinous epithelial cysts and review previously reported cases of splenic mucinous lesions in order to investigate the extent and implications of such an association. METHODS AND RESULTS: The majority of mucinous lesions of the spleen appear to be associated with pseudomyxoma peritonei. The clinicopathological profile of these cases conforms to that of neoplastic pseudomyxoma peritonei, showing a similar age of onset, outcome and histological features. Most of the cases were associated with a confirmed or suspected appendiceal primary. The immunophenotype (cytokeratin 7 negative; cytokeratin 20 and CEA positive) of the lesions of both our cases, including those in the ovary, was suggestive of a gastrointestinal origin. CONCLUSIONS: Splenomegaly due to cystic intrasplenic mucinous epithelial lesions may occasionally be the presenting feature of pseudomyxoma peritonei or herald tumour recurrence. Mucinous epithelial cysts of the spleen may also precede the development of pseudomyxoma peritonei. All cases of pseudomyxoma peritonei should be investigated for splenic involvement and, conversely, a primary mucinous neoplasm sought elsewhere in the abdomen in all cases of splenic mucinous cysts.     

Pseudomyxoma peritonei (mucinous carcinoma peritonei) preceded by intraductal papillary neoplasm of the bile duct

Pseudomyxoma peritonei (mucinous carcinoma peritonei) is a rare clinical disease. Although most cases derive from appendiceal mucinous tumors, a few are associated with pancreatic intraductal papillary mucinous neoplasms. Intraductal papillary neoplasms of the bile duct share many similarities with pancreatic intraductal papillary mucinous neoplasms and are thought to be their biliary counterparts. We report a case of low-grade intraductal papillary neoplasm of the bile duct who developed pseudomyxoma peritonei 6 years after surgical treatment of the primary biliary tumor. To the best of our knowledge, this is the first case of pseudomyxoma peritonei associated with intraductal papillary neoplasm of the bile duct. The tumor recurrence in our case may be due to tumor spillage at the time of the first surgery, since there is no recurrent biliary tumor in the preserved liver lobe. Prevention of spillage of epithelial cell-containing mucin during surgical operations is important in treating intraductal papillary neoplasms of the bile duct.     

Low-grade mucinous epithelial neoplasm (intestinal type) arising in a mature sacrococcygeal teratoma with late recurrence as pseudomyxoma peritonei

Mucinous epithelial neoplasms associated with mature teratomas are well described in the gonads, and some examples have presented with clinical pseudomyxoma peritonei. The association between pseudomyxoma peritonei and an extragonadal teratoma is limited to a single case report. We describe a mature teratoma in the sacrococcygeal region associated with an intestinal-type mucinous epithelial neoplasm that recurred with a disseminated intraperitoneal low-grade mucinous epithelial neoplasm and mucinous ascites. To our knowledge, this is the first reported case of a mature teratoma-associated mucinous epithelial neoplasm from any anatomical site with documented late recurrence as pseudomyxoma peritonei.     

Pseudomyxoma peritonei: A cytohistopathologic study of nine cases

Cytologic examination of seven peritoneal fluids from nine patients with pseudomyxoma peritonei revealed papillary clusters and isolated neoplastic cells. In all patients, one or both ovaries were replaced by proliferating (borderline) mucinous epithelial tumors of grade I–II intestinal type while three patients had synchronous appendiceal tumors of similar morphologic appearance. Four of the nine patients demonstrated positive correlation between the presence of neoplastic cells in the ovarian interstitial mucin (pseudomyxoma ovarii), the extraovarian peritoneum, and the free peritoneal fluid. Two patients demonstrated a negative correlation. The submission of an inadequate amount of ovarian or appendiceal tissue for histologic examination may account for the discordance in three patients. It is concluded that pseudomyxoma peritonei is a distinct clinicopathologic entity which can be subdivided into two types, acellular and cellular. This distinction, unlike the specific cytomorphologic features, may have prognostic significance. Diagn Cytopathol 1996;15:144–150. © 1996 Wiley-Liss, Inc.     

The coexistence of low-grade mucinous neoplasms of the appendix and appendiceal diverticula: a possible role in the pathogenesis of pseudomyxoma peritonei.

We examined 38 appendectomies with diagnoses of mucocele, diverticulum, or adenoma to study the coincidence of appendiceal diverticula and appendiceal low-grade mucinous neoplasms and to examine the possible role of diverticula in the pathogenesis of pseudomyxoma peritonei. Invasive adenocarcinomas and retention cysts were excluded (six cases). Cases were classified as adenomas or mucinous tumors of unknown malignant potential, with or without diverticula. Medical records were reviewed for multiple parameters, including presenting symptoms, presence of pseudomyxoma peritonei, and presence of associated malignancies. Binomial statistics were used to calculate the probability that the observed prevalence of low-grade mucinous neoplasms and diverticula together was significantly different from the expected prevalence of diverticula or low-grade mucinous neoplasms alone, using historical controls from the literature. Twenty-five percent of the total cases (8 of 32) contained both a low-grade mucinous neoplasm (7 cystadenomas and 1 mucinous tumor of unknown malignant potential) and a diverticulum. Thus, 8 of 19 low-grade mucinous neoplasms (42%) were associated with diverticula. Of the appendices with both low-grade mucinous neoplasms and diverticula, three contained dissecting acellular mucin within the appendiceal wall, four showed diverticular perforation, and one had pseudomyxoma peritonei associated with the ruptured diverticulum. A significant percentage (P < .001) of cases contained low-grade mucinous neoplasms and diverticula together. The case of coexistent low-grade mucinous neoplasm, diverticulum, and pseudomyxoma peritonei suggests that diverticula could play a role in the pathogenesis of pseudomyxoma peritonei. This could occur either by involvement of preexisting diverticula by the neoplasm or by distention of the appendiceal lumen by mucin, leading to increased intraluminal pressure and subsequent diverticulum formation at a weak area in the wall. Either mechanism might allow low-grade mucinous neoplasms to penetrate the appendiceal wall more easily.     

Appendiceal mucinous tumors and pseudomyxoma peritonei: histologic features, diagnostic problems, and proposed classification

Pseudomyxoma peritonei is an overused and underspecified condition that has garnered much attention in the historic literature. In recent years, this condition has been convincingly linked to appendiceal mucinous neoplasms, yet there has been insufficient attention to the histologic characteristics, classification, and differential diagnostic considerations of these neoplasms when encountered by the surgical pathologist. This review provides a coherent approach to the diagnosis and classification of appendiceal mucinous tumors and the peritoneal implants associated with the pseudomyxoma peritonei syndrome with emphasis on differential diagnostic considerations and recommendations for the final pathology report.     

MUC2 is a molecular marker for pseudomyxoma peritonei.

Pseudomyxoma peritonei, a syndrome first described by Rokitansky in 1842, is an enigmatic, often fatal intra-abdominal disease characterized by dissecting gelatinous ascites and multifocal peritoneal epithelial implants secreting copious globules of extracellular mucin. Although much past interest in the syndrome has focused on the question of whether the disease arises from primary appendiceal or ovarian mucinous tumors of varying malignant potential, the accumulation of extracellular mucin with its resulting obstruction of abdominal viscera and adhesion formation is one major cause of this disease's morbidity and mortality irrespective of the origin or transformed status of the epithelium secreting it. Because of this and because of the recent discovery and cloning of a series of specific mucin genes responsible for mucin secretion and extracellular deposition, we decided to analyze cases of pseudomyxoma peritonei with specific mucin cDNAs and corresponding antibodies to identify a characteristic marker for this disease which ultimately might be targeted therapeutically. Our study specifically investigated MUC2 and MUC5AC because these two mucins possessed the physicochemical property of being gel-forming, a property exhibited by pseudomyxoma peritonei grossly. Expression of MUC2 and MUC5AC in pseudomyxoma peritonei and in accompanying and non-accompanying appendiceal and ovarian mucinous neoplasms were analyzed by in situ hybridization, immunocytochemistry and digital image analysis. A striking overexpression of both MUC2 and MUC5AC was observed in nearly all cases of pseudomyxoma peritonei of unknown and appendiceal origin. In these cases, however, MUC2 gene expression was more prominent. The mucin:cell ratio averaged 10 to 1 in these cases. The primary ovarian mucinous tumors, some of which exhibited pseudomyxoma ovarii and/or peritoneal implants but not classic pseudomyxoma peritonei, in contrast, expressed only MUC5AC and gave rise to implants where the mucin:cell ratio averaged only 1 to 1. MUC2 overexpression then supported an intestinal rather than ovarian origin for true pseudomyxoma peritonei, irrespective of whether an appendiceal primary was documented. In all cases studied, the fidelity of MUC2 and MUC5AC expression held irrespective of the degree of malignant transformation which was present. MUC2 is therefore a reliable molecular marker for pseudomyxoma peritonei.