巨块型乳腺原发性鳞状细胞癌一例

乳腺鳞状细胞癌 (ｓｑｕａｍｏｕｓｃｅｌｌｃａｒｃｉｎｏｍａ ,ＳＣＣ)临床上罕见 ,我院近期收治 1例 ,现报告如下。患者女 ,38岁。半年前发现左乳鸡蛋大小肿块 ,进行性增大 3个月后肿块破溃出血。近半个月出现阵发性刺激性干咳。查体 :Ｔ 38℃ ,ＢＰ 80 / 5 0ｍｍＨｇ,严重贫血貌 ,面部浮肿。左乳外上象限见一巨形肿块 ,直径 18ｃｍ× 18ｃｍ ,质地硬、活动 ,与胸大肌无粘连。皮肤红 ,中央有二处破溃 :一处 5ｃｍ×5ｃｍ ,创面有脓性分泌物伴恶臭 ,另一处 2ｃｍ× 2ｃｍ ,创面深约 4ｃｍ ,呈干性坏疽样表现。左腋窝可触及多枚肿大淋巴结 …     

腹腔镜前入路右半肝切除治疗全内脏反位伴巨块型肝细胞癌1例报告并文献复习

目的 报道1例全内脏反位伴巨块型肝细胞癌患者的诊疗经过及疗效,并复习文献总结其临床特点和诊治手段,重点探讨手术方法的要点。方法 患者男性,76岁,因“上腹部疼痛1月余”于入院,入院诊断为右肝巨块型肝癌合并全内脏反位。患者吲哚氰绿15分钟储留率(indocyanine green retention rate at 15 minute, ICG R15)为9.6%。CT提示肝右叶肿块,最大径12.8 cm,伴门静脉右支癌栓。肝脏虚拟成像测算肝脏总体积(total liver volume, TLV)约1 727 cm³,肝肿瘤体积(tumor volume, TV)约380 cm³,剩余肝体积为(remnant liver volume, RLV)489 cm³;标准化肝体积(standard liver volume, SLV)1 344 cm³,有效肝体积约36.4%。结果 完善术前准备后在全麻下行腹腔镜前入路右半肝切除术。Trocar共5个,位置偏左,主刀站位于患者两腿之间。手术顺利,出血约30...     

巨滤泡型甲状腺乳头状癌（附3例报告）

目的 探讨巨滤泡型甲状腺乳头状癌（macrofollicular variant of papillary thyroid carcinoma,MFPTC）的临床病理特点。方法 回顾分析3例MFPTC病人临床资料、病理形态学及免疫组织化学检测结果。结果 MFPTC超声检查主要表现为不规则强回声,血流丰富。显微镜下可见巨大滤泡,腔内富含胶质。滤泡上皮细胞核被挤压呈立方至扁平状。免疫组织化学显示与其他类型PTC相同。MFPTC的肿瘤上皮细胞CK19、galectin-3、HBME-1呈弥漫或部分阳性。结论 MFPTC在临床病理诊断中容易漏诊。结合临床资料,独特的组织学形态以及免疫组织化学检查有助于明确诊断。     

混合型肝癌与肝细胞癌共存1例报告并文献复习

背景与目的 混合型肝癌（cHCC-CC）是临床原发肝癌中比较少见的类型,因其临床表现不典型导致术前诊断困难,主要依靠术后病理确诊。在同一肝癌组织标本中,肝细胞癌（HCC）和cHCC-CC同时存在的病例更是少见。本文回顾1例cHCC-CC和HCC共存的临床资料,结合既往文献对本病特点进行复习,以期为临床工作提供经验借鉴。方法 回顾性分析海南省肿瘤医院肝胆胰外科收治的1例肝癌患者的临床资料,该患者术后病理提示肝VII段2个病灶分别为HCC、cHCC-CC,结合前期文献资料进行复习总结。结果 患者,男性,60岁;因肝占位病变就诊海南省肿瘤医院肝胆胰外科行手术治疗。术前上腹部增强MRI可见肝VII段肿物2个,其中一肿物动脉期强化明显,静脉及延迟期造影剂快速排出;另一肿物动脉期肿瘤部分强化,静脉期肿瘤不均匀强化。初步诊断：肝癌伴肝内转移。全麻下行肝VII段切除术。术后病理：肝VII段肿瘤2个,肿瘤1大小2.0 cm×1.5 cm×1.0 cm,免疫组化hepatocyte（+）,GPC-3（部分+）,CD34（血管内皮+）,Ki（2%+）,考虑HCC;肿瘤2大小1.2 cm×1.5 cm×0.5 cm,免疫组化Hepatocyte（+）,GPC-3（-）,CD34（血管内皮+）,Ki（<1%+）,CK19（胆管+）,CK7（胆管+）。病理诊断：cHCC-CC;周围肝组织呈肝硬化改变,有片状坏死及脉管瘤栓,切缘阴性。术后10 d恢复顺利出院;未见高危复发因素,无预防性靶向治疗。常规随访未见肿瘤复发征象,患者肝功能,甲胎蛋白（AFP）,CA19-9,CEA均正常,一般状况良好。结论 当发现影像学和肿瘤标志物不能完全匹配HCC和胆管细胞癌,且存在AFP、CEA、CA19-9同时增高时,应考虑cHCC-CC的可能性,必要时可行穿刺活检证实,在充分考虑肿瘤分期和肿瘤生物学活性的基础上,根治性手术治疗是此类型肝癌的最佳治疗方案。     

巨块型肝癌合并门静脉癌栓的治疗：附15例报告

目的　探讨外科手术、肝动脉化疗栓塞及联合或不联合门静脉灌注化疗治疗巨块型肝癌伴门静脉癌栓的效果。方法　 15例伴有门静脉癌栓的巨块型肝癌 ,均采用切除原发癌灶并取尽癌栓治疗 ,其中 5例患者留置门静脉化疗泵 ,术后 2周行肝动脉化疗栓塞或联合门静脉化疗。结果　全组术后无严重并发症发生。 6,12 ,18个月生存期分别为 10 0 % (15 /15 ) ,80 .0 % (12 /15 ) ,60 .0 %(9/15 )。结论　手术仍是治疗巨块型肝癌合并门静脉癌栓的有效方法 ,手术后辅以介入为主的综合治疗能有效提高生存率。     

11年手术治疗巨块型肝内胆管细胞癌的单中心经验

肝内胆管细胞癌（ICC）是仅次于肝细胞癌的肝脏恶性肿瘤,目前的主要治疗方法包括化疗、介入和手术。巨块型ICC因早期诊断困难、手术风险大,故目前的手术切除率较低。作者对1995．1～2005．12的107例巨块型ICC病例进行了分析,重点对67例手术治疗病例展开研究并分析各危险因素对患者术后生存率及肿瘤复发的影响。67例剖腹探查病例中45例进行了根治性切除,其余22例因发生远处转移或肿瘤体积过大无法切除。术后平均随访时间为32个月,术前最显著的临床症状分别为体重下降、右上腹痛及黄疸。45例根治性切除病例中36例达到R0切除,     

TACE联合射频消融及索拉非尼治疗巨块型肝细胞癌的回顾性研究

目的:评估经导管肝动脉栓塞化疗(TACE)联合射频消融及索拉非尼在巨块型肝细胞癌治疗中的安全性及疗效。方法:回顾分析2012年1月至2017年12月于中山大学附属第三医院诊治的36例肝细胞癌(直径5～7 cm)患者资料,其中男性33例,女性3例,年龄范围32.0～76.0岁,平均51.8岁。所有患者均接受TACE联合射...     

尾状叶巨块型肝癌联合下腔静脉切除1例报道

病例资料患者,男,44岁,因＂上腹部胀痛不适1月余＂入院。病程中伴纳差、乏力、小便色黄、腹胀;无伴发热,呕血、无便血、黑便、无身目黄染。当地医院CT检查提示：肝尾状叶巨大肿物,侵犯第二肝门。患者有乙肝病史数年,未行正规抗肝炎病毒治疗。入院体检：皮肤巩膜无黄染;剑突下2指可及肿物,质硬,表面光滑,固定,向上边界不清,无明显压痛。肝区叩痛（＋）性,余无特殊。     

多房囊性肾细胞癌1例报告

<正>多房囊性肾细胞癌(multilocular cystic renal cell carcinoma,MCRCC)是肾癌的一种特殊类型,恶性程度低,易与复杂性肾囊肿、囊性肾瘤、肾结核、肾脓肿、坏死性囊性肾癌等疾病相混淆,临床上较难鉴别。我科收治1例,报告如下。     

转化治疗联合蔡氏ALPPS治疗晚期肝细胞癌1例报告

肝细胞癌(HCC)是我国最常见的恶性肿瘤之一,目前手术治疗仍然是肝癌的首要治疗手段.但我国70％～80％的HCC病人初诊时已为中晚期,失去了手术机会.近年来,随着HCC系统治疗ORR的显著提升,越来越多的初始不可手术病人获得了手术机会,实现了成功的转化治疗,病人近期肿瘤学疗效得以明显改善.该病例通过采取肝动脉持续灌注化...     

以咯大量胆汁为首发症状的肝棘球蚴囊肿一例

病人,女,28岁.因咳嗽、咳痰(痰液呈草绿色,每日200～300 ml)3 d收入院.查体:体温39.2℃,脉搏108次/min,呼吸26次/分,血压118/67 mm Hg.皮肤巩膜无黄染,表浅淋巴结无肿大.右肺呼吸音消失,叩诊呈浊音.心脏、左肺及腹部正常.血常规:白细胞18×109/L,中性粒细胞92%,红细胞3.56×1012/L,血红蛋白115 g/L.肝肾功能:谷丙转氨酶86 IU/L,谷草转氨酶56 IU/L,胆红素为18μmol/L,余检查均基本正常.X线:右侧胸腔大量积液.心电图:窦性心动过速.B超:肝胆脾双肾正常.胸穿抽出黄绿色液体.诊断:结核性胸膜炎并胸腔积液.     

Squamous cell carcinoma arising in a giant epidermal cyst: a case report

Epidermal cysts are commonly encountered in surgical practice. Malignant degeneration of epidermal sebaceous cyst is uncommon. The authors report the case of a 38-year Filipino woman presenting with a voluminous sebaceous cyst of the left buttock. Ultrasonography and computer tomography were made preoperatively without any hint of eventual malignant degeneration. Marginal excision was performed with direct closure of the skin. The histological examination revealed epidermal sebaceous cyst with squamous cell carcinoma in situ, which is a quite rare, but well known complication occurring in sebaceous cysts.     

原发性前列腺鳞癌1例报告并文献复习

目的:提高对原发性前列腺鳞癌的病因及诊治的认识。方法:回顾性分析1例64岁男性原发性前列腺鳞癌患者临床资料:经病理检查诊断为原发性前列腺鳞癌,行手术治疗后辅以放疗,并复习相关文献,探讨本病的病因、诊治及预后。结果:患者术后随访11个月,仍存活。结论:原发性前列腺鳞癌临床罕见,恶性程度高,肿瘤进展快,预后差;对内分泌治疗无效,早期手术治疗并辅以放化疗效果明显。     

巨大胆囊积液一例

病人,女性,55岁,以腹胀5年,加重半年而入院。病程中病人无畏寒、发热,无腹痛腹泻、恶心呕吐、黄疸等症状,感觉胃纳下降,大小便正常。体检:神志清楚,皮肤黏膜、巩膜无黄染,右上腹膨隆,剑突下及右肋缘下扪及一巨大肿块,23 cm×22 cm×18 cm大小,境界不清,呈囊性,无压痛。B超检查:肝区一巨大球形囊肿,胆囊未显示。入院诊断:腹腔     

肝血管瘤介入治疗术后右肝内胆管广泛坏死一例

病人,女,51岁,于2007年6月冈肝区胀痛,体检发现肝右叶占位,直径约8 cm,后确诊为肝血管瘤,入院后使用碘油、平阳霉素等行介入栓塞(HAE)治疗.     

A case of giant transitional cell carcinoma of the prostate

A 69-year-old man presented with a complaint of pollakisuria, dysuria and anal pain. Digital rectal examination, transrectal ultrasonography and tumor marker of the prostate indicated a giant benign prostate hypertrophy (BPH), but urethrocystogram and magnetic resonance imaging (MRI) of the prostate was not typical of BPH. A diagnosis of giant BPH was made by transrectal needle biopsy of the prostate. However, symptoms of dysuria and anal pain became severe and then a catheter was indwelt into his bladder. A biopsy performed, 3 months later revealed transitional cell carcinoma in the specimens, but he suddenly died of pulmonary infarction.     

A case of giant small cell carcinoma of the prostate

A 64-year-old man having backbone pain was referred to our institute, and laboratory examinations revealed that he was suffering from severe renal failure. Abdomino-pelvic CT revealed bilateral hydronephrosis, a giant prostate over 500 g in weight, and multiple para-aortic lymph node metastasis. Histological diagnosis of the prostate was small cell neuroendocrine carcinoma. Serum neuron-specific enolase (NSE) level was slightly high reflecting the positive immunohistochemical staining, but serum PSA remained within normal limits. The patient was treated with hormone-chemotherapy after successful treatment of the renal failure, but he died on the 74th hospital day. Small cell carcinoma is known to have a high rate of malignancy and metastasis from an early stage. Several giant prostatic tumors have been reported previously, but this case is considered to be the second gigantic small cell carcinoma in the Japanese literature.     

A case report of a massive pulmonary tumor embolism occurring during surgery for renal cell carcinoma]

A 59-year-old man, who suffered a massive pulmonary tumor embolism during surgery for renal cell carcinoma with vena caval invasion, was treated by emergency pulmonary embolectomy using cardiopulmonary bypass. Renal cell carcinoma occasionally extends into the inferior vena cava (IVC) as a tumor thrombus. In such patients, removal of the tumor thrombus from the IVC has to be performed in addition to radical nephrectomy. However, the massive pulmonary tumor embolism is a major potential hazard during radical surgical resection. To prevent intraoperative pulmonary embolisms from occurring, scheduled use of cardiopulmonary bypass with the cooperation of cardiovascular surgeons is recommended.