肺癌伴进行性贫血及长期高热一例并文献分析

肺癌是临床上常见的恶性肿瘤，其临床表现多样，轻至中度贫血及不规则发热并不少见，但表现为进行性贫血和长期高热者罕见报道。2005年7月我院收治了1例肺癌伴进行性贫血及长期高热的患者，现报告如下，并就相关文献进行分析。     

肺鳞癌结肠转移伴直肠原发腺癌1例及文献复习

原发性肺癌的消化道转移不常见,文献报道多为个案病例报道,临床发生率为0.30%~1.77%[1]。1996年日本肿瘤中心研究了1635例原发性肺癌患者,发现胃肠道转移30例,总发生率约为1.8%[2]。原发性肺癌的胃肠道转移为血行转移,其发生往往提示疾病晚期且预后不佳。一项回顾性研究显示,肺癌消化道转移患者的中位生存期约为66天[3]。本文结合相关文献对1例肺鳞癌结肠转移伴直肠原发腺癌患者的临床资料进行分析和探讨,现报道如下。     

肺癌脊髓内转移二例报道并文献复习

背景与目的 肺癌脊髓内转移病例少见,目前没有标准治疗方案,疗效差.本研究的目的是探讨肺癌脊髓内转移的临床特征、诊断及治疗方法.方法 对我院2005年收治的2例肺癌脊髓内转移患者诊断及治疗过程进行分析,并复习相关文献.结果 两例肺癌脊髓内转移患者进展迅速,疗效差.结论 肺癌脊髓内转移临床表现不典型,MRI为首选诊断方法,放疗为主要治疗手段.该病预后差.     

原发性肺癌胃肠道转移2例报道并文献复习

原发性肺癌最常见的远处转移部位包括肺、肝、脑、骨、肾上腺等,胃肠道转移鲜有报道。北京大学肿瘤学院胸部肿瘤内科近期先后收治了经病理证实为原发性肺癌发生胃肠道转移的2例患者,本文将就其诊治及随访情况进行报告,并回顾国内外相关文献,以加深对肺癌少见部位转移的认识,避免漏诊和误诊。     

以低钠血症为首发症状的肺癌三例临床分析

回顾分析3例以低钠血症为首发表现的肺癌患者临床资料,并进行文献复习.3例患者临床确诊为抗利尿激素分泌不适当综合征(syndrome of inappropriate secretion of antidiuretic hormone,sIADH),其中2例误诊为胃炎及药源性,病理确诊2例为小细胞肺癌,1例为鳞癌.回顾分析结果提示,对临床上低钠血症表现的患者应考虑到SIADH的可能,它是副癌综合征的表现之一,多为小细胞肺癌;治疗上以去除原发病为主,辅以限水和利尿等措施,可提高本病的疗效.     

垂体转移癌的临床诊治

目的:通过1例肺癌垂体转移病例报道,回顾分析本院另1例影像学诊断为垂体转移癌的病例,并复习相关文献,总结垂体转移癌的临床特点.方法:分析2例垂体转移癌的临床资料,整理复习近期国内外关于垂体转移癌的相关文献.结果:垂体转移癌患者临床表现多为尿崩、头痛、视物模糊等眼部症状,病情通常进展较快.影像学表现为鞍区骑跨鞍隔生长而呈“哑铃状”浸润性肿瘤.结论:患者出现垂体异常增大或伴有垂体病变的临床症状时,首先要考虑垂体转移,垂体转移癌病人预后极差.     

首发症状特殊的支气管肺癌13例

支气管肺癌(简称肺癌)多以咳嗽、咯血、胸痛等呼吸道症状为首发表现。但有少数患者的临床表现特殊,易于误诊。在我院收治的肺癌病例中,有13例是以特殊的临床表现为首发症状就诊,且初期多被误诊。现总结报道如下。13例中男性11例,女性2例。年龄38～65岁,平均54岁。其中以脑...     

免疫检查点抑制剂相关性肺炎的CT特征分析及文献复习

目的:初步探讨免疫检查点抑制剂相关性肺炎(checkpoint inhibitor-related pneumonitis, CIP)患者的胸部CT特征及变化,并复习相关文献。方法:回顾性分析对比5例确诊为CIP患者的CT图像,初步总结CIP影像特征。5例患者均为男性,确诊为肺癌后予免疫检查点抑制剂治疗后,不同时期出现气短、心悸、咳嗽、胸闷、腹泻、Velcro啰音、骨髓抑制等临床表现。肺部CT征象主要包括磨玻璃影、斑片实变影、网格影、蜂窝状影、纤维条索影、牵拉性支气管扩张及结节影等,对称或不对称分布。结果:CIP影像主要表现为肺内以间质改变为主的多样性、多态性病变,分布以双侧或单侧肺野中外带为主,经皮质类固醇激素治疗后,临床症状及体征均有所好转,影像表现均有所吸收。结论:CIP的影像学征象表现各异,但CT可以客观清晰显示间质性肺疾病的变化,对CIP患者的诊断及疗效评价具有重要意义。     

恶性血液病相关性噬血细胞综合征二例并文献复习

 目的　提高对血液肿瘤相关性噬血细胞综合征（HPS）的临床表现、诊断及治疗的认识。方法　报道2例恶性血液肿瘤相关性HPS并进行文献复习。结果　髓外浆细胞瘤1例，T／NK细胞非霍奇金淋巴瘤1例，均在疾病进展期发生HPS表现。结论　血液肿瘤相关性HPS多发生在疾病的进展期，与感染、免疫缺陷、淋巴瘤浸润有关，病情进展迅速，多在短期内死亡。治疗主要是抗感染和抗肿瘤。     

纳武利尤单抗联合伊匹木单抗治疗胸膜间皮瘤导致免疫相关性脑炎一例报道及文献复习

免疫相关性脑炎是一类由机体自身免疫机制介导的脑炎,肿瘤和感染是较明确的诱发因素。免疫检查点抑制剂(ICI)引起的免疫相关性脑炎鲜有报道。本文报道本院收治的1例免疫相关性脑炎病例,患者为60岁男性,因胸膜间皮瘤应用纳武利尤单抗联合伊匹木单抗治疗,用药后第5周出现精神行为异常、意识障碍,但脑脊液自身免疫性脑炎相关抗体、副肿瘤综合征相关抗体及寡克隆区带均为阴性,经停止免疫治疗、糖皮质激素大剂量冲击及足量的丙种球蛋白等综合治疗后,患者精神行为及意识恢复正常,症状好转出院。此外,本文还就免疫相关性脑炎的发病机制、临床表现和诊断治疗等方面进行了相关文献分析讨论,以期能提高临床医师对免疫相关性脑炎的认识和治疗水平。     

Raw versus cooked vegetables and cancer risk.

This review of the medical literature from 1994 to 2003 summarizes the relationship between raw and cooked vegetables and cancer risk and examines whether they may affect cancer risk differently. Twenty-eight studies examined the relationship between raw and cooked vegetables and risk for various cancers. Twenty-one studies assessed raw, but not cooked, vegetables and cancer risk. The majority of these assessed risk of oral, pharyngeal, laryngeal, esophageal, lung, gastric, and colorectal cancers. Most showed that vegetables, raw or cooked, were inversely related to these cancers. However, more consistent results were found for oral, pharyngeal, laryngeal, esophageal, and gastric cancers. Nine of the 11 studies of raw and cooked vegetables showed statistically significant inverse relationships of these cancers with raw vegetables, but only 4 with cooked vegetables. The few studies of breast, lung, and colorectal cancers also suggested an inverse relationship with both raw and cooked vegetables, but these results were less consistent. In the two studies of prostate cancer, there was no association with either raw or cooked vegetables. One of two bladder cancer studies found an inverse relationship with cooked, but not raw, vegetables. Possible mechanisms by which cooking affects the relationship between vegetables and cancer risk include changes in availability of some nutrients, destruction of digestive enzymes, and alteration of the structure and digestibility of food. Both raw and cooked vegetable consumption are inversely related to epithelial cancers, particularly those of the upper gastrointestinal tract, and possibly breast cancer; however, these relationships may be stronger for raw vegetables than cooked vegetables.     

Acute leukemia secondary to lung cancer. Case report and review of the literature

A case of acute myelomonocytic leukemia following cytotoxic therapy for an oat cell carcinoma of the lung in a 48-year-old man is reported. This case is characterized by a long phase of increasing macrocytosis during cyclophosphamide maintenance therapy. 15 other cases of secondary leukemia to lung cancer from the literature are reviewed. All patients received alkylating agents. Most patients showed peripheral blood changes more than 3 months before the onset of acute leukemia. All leukemia cases, except one, were nonlymphocytic with a high frequency of erythroleukemia. The development of acute leukemia seems to be linked with an unexpected good response to chemotherapy in advanced or poor histologic prognosis cancers. With therapeutic improvement in lung cancer, secondary leukemia could become a major hazard as in other cancers successfully treated with cytotoxic agents.     

A case of synchronous double primary lung cancer with neuroendocrine features.

We report a case of unique double primary lung cancers with neuroendocrine features in a 63-year-old male smoker. The mass in the left lower lobe (LLL) was a small cell/large cell carcinoma with spindle cell sarcomatous areas and organoid structure. The mass in the left upper lobe (LUL) was a tubular adenocarcinoma with neuroendocrine features including organoid nests showing occasional rosette formation, nuclear palisading in the periphery of the nests and positive immunoreaction for CD56, chromogranin A and synaptophysin. The difference in histological structures between the two masses led us to diagnose double primary lung cancer. The combination of small cell lung carcinoma and spindle cell carcinoma is very uncommon. The relationship between LLL and LUL tumors remains unclear. Multiple lung cancers with neuroendocrine features have only rarely been reported in the literature. The patient in our case died of widespread cancer 2 years and 4 months after the surgery without adjuvant chemotherapy, a longer postoperative survival time than in cases of ordinary extensive small cell lung cancer. Multiple lung cancers with neuroendocrine features are extremely rare and similar cases have not been reported in the literature. Neuroendocrine differentiation has attracted widespread attention and, therefore, examining neuroendocrine features in lung cancers is important.     

Temporal relationship between cancers of the lung and upper aerodigestive tract

We retrospectively reviewed the chart records at the Veterans General Hospital-Taipei for the period between January 1985 and December 1994 to examine the temporal relationship between cancers of the lung and upper aerodigestive tract. A total of 56 patients (54 males, 2 females) with histocytologically proven double primary cancers, with either lung cancer or upper aerodigestive tract cancers appearing first, were found. Squamous cell carcinoma was the most frequent histologic type of lung cancer (squamous 57%, adenocarcinoma 27%, poorly differentiated carcinoma 9%, small cell lung cancer 7%). The incidence of lung cancer patients with upper aerodigestive tract cancer was 0.9% (56/6412). There was no significant difference in the occurrence of upper aerodigestive tract cancer between non-small cell and small cell lung cancer (P > 0.05). However, the incidence of squamous cell lung cancer with upper aerodigestive tract cancer was higher than that of non-squamous cell lung cancer (P < 0.05). With regard to the location of lung cancer, the right lung was more commonly affected than the left (P < 0.001). The locations of upper aerodigestive tract cancers in these lung cancer patients were as follows: larynx 24, nasopharynx 11, esophagus 10, hypopharynx 4, pharyngeal tonsils 2, oral cavity 5. Most upper aerodigestive tract cancers were diagnosed before lung cancer (36/56, 64%), and lung cancer was diagnosed within 3 years in more than half of cases after the diagnosis of upper aerodigestive tract cancer (58.3%). Most lung cancers that preceded upper aerodigestive tract cancer were at an early stage at diagnosis (stage I 4, stage Illa 1), whereas the others, appearing either synchronously or after the diagnosis of upper aerodigestive tract cancer, were mostly at the late stage. There was no difference in survival between lung cancer patients with upper aerodigestive tract cancer and those without (P > 0.05).      

The impact of personalized medicine on survival: Comparisons of results in metastatic breast,colorectal and non-small-cell lung cancers

Breast, colorectal and lung cancers represent the three most incident forms of cancer worldwide. Among these three “big killers”, lung cancer is considered the one with the worst prognosis due to its high mortality even in early stages. Due to their more favorable prognosis, breast and colorectal cancers might appear to have benefited from major advances. Most oncologists who are faced with metastatic non-small cell lung cancer (NSCLC) find the reported results very frustrating when compared with those for metastatic breast (MBC) and colorectal cancers (MCRC).     

A review of noninvasive staging of the mediastinum for non-small cell lung carcinoma

Lung cancer and bronchogenic carcinoma are malignancies originating from the airways and pulmonary parenchyma. Most (approximately 90%) lung cancers are classified as non-small cell lung cancer. This distinction carries important differences for staging, treatment, and prognosis. This article presents a review of mediastinal staging for patients with non-small cell lung cancer.     

Adrenal hemorrhage secondary to metastasis from lung cancer

The adrenals are common metastatic sites for lung cancers as well as a number of other primary cancers. Usually these metastases are asymptomatic. Hemorrhagic adrenal metastases from lung cancer are extremely rare. Only 5 prior reports of hemorrhagic adrenal metastases from lung cancer have appeared in the English literature. We report a case of spontaneous, massive, adrenal hemorrhage secondary to metastatic lung cancer in a 62-year-old patient. In lung cancer, patients with sudden onset of pain in the flank or back in association with anemia and hypotension, adrenal hemorrhage secondary to metastatic disease should be considered in the differential diagnosis. Computed tomography scans and magnetic resonance imaging aid in confirming the diagnosis.     

Thyroid cancer and multiple primary malignancies in Israel

The exact risk of multiple primary neoplasms in patients with thyroid cancer is difficult to ascertain from the data available in the literature. Three thousand seventy-two patients with thyroid cancer, listed in the Israel Cancer Registry during a 16-year time span, were studied to determine the true incidence of another primary cancer. Ninety-two cases were reported as having an additional primary cancer. The prevalence of multiple primary malignancies was 3%. The frequency was higher among patients of European rather than of Asian or African origin. The second primary cancers in order of decreasing frequency were of the breast, lung, colorectum, head and neck, and lymphoma/myeloma. Most of the deaths were due to the additional cancer. The 5-year survival rate was highest for head and neck and lowest for lung cancer patients. These results emphasize the need for greater awareness of the possibility of developing additional cancers, and indicate the need to incorporate strategies for the prevention, early detection, and treatment of multiple primary neoplasms.     

The reduced expression and aberrant methylation of p16(INK4a) in chromate workers with lung cancer

STUDY OBJECTIVES: It is known that chromium is one of the important inhaled carcinogens that cause lung cancer. Our previous studies revealed a variety of genetic changes in lung cancers from chromate-exposed workers (chromate lung cancer). However, the epigenetic effects of chromium are not understood. MATERIALS AND METHODS: We investigated the methylation of the p16 gene using a methylation-specific PCR method in 30 chromate lung cancers and 38 non-chromate lung cancers, and the expression of the p16 protein using immunohistochemistry in 25 chromate lung cancers. RESULTS: Ten (33%) chromate lung cancers showed methylation of the p16 promoter region. On the other hand, 10 (26%) of the non-chromate lung cancers also showed it. The frequency of p16 methylation in non-chromate lung cancer was 0%, 33% and 30% for low (< or =600), moderate (<600, >1000) and high (> or =1000) Brinkman indexes, respectively. However, the frequency of p16 methylation in chromate lung cancer was constant, irrespective of the Brinkman index. In chromate lung cancer, patients with chromate exposure of less than 15 years never had p16 methylation, while 40% (> or =25 years) or 43% (> or =15, <25 years) of patients with chromate exposure of more than 15 years did. In chromate lung cancer, chromate exposure, not smoking, mainly influenced the p16 methylation. Most of the chromate lung cancers with p16 methylation (85.7%) showed repression of the p16 protein. CONCLUSIONS: We speculate that not only genetic but also epigenetic alterations are involved in the carcinogenesis due to chromium.     

Two cases of amylase-producing lung cancer

In 1951, Weiss et al. first reported a case of an amylase-producing lung cancer. Since then, reports on immunohistochemical, ultrastructural, and biochemical studies have been published. We recently have experienced two autopsy cases of lung cancer that manifested high amylase activity in the serum, urine, and pleural effusions. Histologically, both lung cancers were classified as being well differentiated adenocarcinomas, and immunohistochemically, the tumor cells showed positive immunoreactivity for amylase. This paper discusses the histogenesis of amylase-producing lung cancers and cases found in the literature.