同时性食管贲门重复癌34例报告

１９７６年１月至１９９４年１２月，我们收治同时性食管贲门重复癌３４例，占同期食管、贲门癌病人的０．７％（３４／５０４０）。全组食管病变全部为鳞癌，贲门病变中腺癌３２例、恶性纤维组织细胞瘤和平滑肌肉瘤各１例。术前诊断率７０．６％（２４／３４），手术切除率７９．４％（２７／３４），术后１、３、５年生存率分别为８７．５％（２１／２４）、４５．０％（９／２０）和１８．８％（３／１６）。作者认为：注意各项检查的相互配合及仔细的上消化道全面检查能提高诊断率，早期手术并扩大手术范围可提高手术疗效。     

Invasive neuroendocrine carcinoma of the breast

BACKGROUND:

Neuroendocrine carcinoma (NEC) of the breast, a pathologic entity newly defined in the 2003 World Health Organization classification of tumors, is a rare type of tumor that is not well recognized or studied. The purpose of this first case‐controlled study is to reveal the clinicopathologic features, therapeutic response, and outcomes of patients with NEC of the breast.

METHODS:

Seventy‐four patients with NEC of the breast who were treated at The University of Texas M. D. Anderson Cancer Center were analyzed; 68 of them had complete clinical follow‐up. Two cohorts of invasive mammary carcinoma cases were selected to pair with NEC to reveal demographic, pathologic, and clinical features at presentation, along with therapeutic response to treatment and patient outcomes.

RESULTS:

NEC was more likely to be estrogen receptor/progesterone receptor positive and human epidermal growth factor receptor 2 negative. Despite similar age and disease stages at presentation, NEC showed a more aggressive course than invasive ductal carcinoma, with a higher propensity for local and distant recurrence and poorer overall survival. High nuclear grade, large tumor size, and regional lymph node metastasis were significant negative prognostic factors for distant recurrence‐free survival; high nuclear grade and regional lymph node metastasis were also significant negative prognostic factors for overall survival. Although endocrine therapy and radiation therapy showed a trend toward improved survival, the small number of cases in this study limited the statistical power to reveal therapeutic benefits in NEC of the breast.

CONCLUSIONS:

NEC is a distinct type of aggressive mammary carcinoma. Novel therapeutic approaches should be explored for this uniquely different clinical entity. Cancer 2010. © 2010 American Cancer Society.     

Rare Breast Cancer Subtypes: Histological,Molecular, and Clinical Peculiarities

Breast cancer encompasses a collection of different diseases characterized by different biological and pathological features, clinical presentation, response to treatments, clinical behavior, and outcome. On the basis of cell morphology, growth, and architecture patterns, breast cancer can be classified in up to 21 distinct histological types. Breast cancer special types, including the classic lobular invasive carcinoma, represent 25% of all breast cancers. The histological diversity of breast carcinomas has relevant prognostic implications. Indeed, the rare breast cancer group includes subtypes with very different prognoses, ranging from the tubular carcinoma, associated with an indolent clinical course, to metaplastic cancer, whose outcome is generally unfavorable. New approaches based on gene expression profiling allow the identification of molecularly defined breast cancer classes, with distinct biological features and clinical behavior. In clinical practice, immunohistochemical classification based on the expression of human epidermal growth factor receptor 2 and Ki67 is applied as a surrogate of the intrinsic molecular subtypes. However, the identification of intrinsic molecular subtypes were almost completely limited to the study of ductal invasive breast cancer. Moreover, some good‐prognosis triple‐negative histotypes, on the basis of gene expression profiling, can be classified among the poor‐prognosis group. Therefore, histopathological classification remains a crucial component of breast cancer diagnosis. Special histologies can be very rare, and the majority of information on outcome and treatments derives from small series and case reports. As a consequence, clear recommendations about clinical management are still lacking. In this review, we summarize current knowledge about rare breast cancer histologies.     

CyclinD1表达与泌尿系统肿瘤关系的研究进展

D型细胞周期蛋白（Cyclin）是目前已知的细胞周期蛋白（Cyclins）中的亚型之一,与肿瘤的关系最为密切,D型Cyclin中的CyclinD1是细胞周期中起关键作用的正向调节因子,主要作用于细胞增殖及细胞分裂过程,CyclinD1特异性过表达于多种肿瘤细胞。研究发现,在泌尿系恶性肿瘤中也存在Cy-clinD1过表达现象,且与肿瘤细胞的侵袭、转移和复发有关。因此,以CyclinD1作为泌尿系肿瘤的研究靶点,有可能为泌尿系恶性肿瘤的预防及治疗等提供新的思路。     

Squamous cell carcinoma of the thyroid: a report of two cases.

Two patients with squamous cell carcinoma, which accounts for 1.1% of all primary thyroid carcinomas, are described. Squamous metaplasia is the most likely etiology, but an occasional carcinoma may be derived from remnants of embryonic origin. Although squamous metaplasia has been documented in several conditions involving the thyroid, no evidence exists that this predisposes to squamous cell carcinoma. Metastases and direct extension of squamous cell carcinoma in the thyroid gland are much more frequent than primary involvement and are always part of a generalized carcinomatosis. A primary lesion must always be sought; however, diagnosis may not be possible until an initially occult tumor becomes evident or even until autopsy. Because this lesion typically runs a fulminant course, radical surgical resection at the earliest opportunity offers the best hope for cure. The lesions are usually radioresistant, and chemotherapy has not been shown to alter the course of this disease.     

Two Cases of Lipid-Secreting Carcinoma of the Breast: Case Reports with an Electron Microscopic Study

Two very rare cases of lipid-secreting carcinoma of the breastare reported, together with a review of the literature. Bothpatients were Japanese women aged 70 and 81 years, respectively.In each, a mass had been found in the breast, and radical mastectomieswere performed based on a diagnosis of breast cancer at an earlyclinical stage. Both resected tumors were found to be solidand localized. In them, both estrogen and progesterone receptorswere negative. Microscopically, hematoxylin-eosin staining showedthe tumor cells to have foamy and vacuolated eosinophilic cytoplasm.Lipid staining showed the vesicles in the cytoplasm of the tumorcells to be colored a flaming red and consequently recognizedas lipid droplets. An electron-microscopic study showed thatthe tumor cells contained various sizes of lipid droplets inthe cytoplasm with no degenerative changes, and suggested thatthese lipid droplets were produced and stored in the tumor cells.It would appear, from the literature that lipid-secreting carcinomashave aggressive clinical courses, but neither vascular invasionnor lymph node metastasis was seen in either of our two cases.     

Clinical and laboratory findings of carcinoma of the pancreas and periampullary structures

Primary carcinoma of Stensen's duct is a rare neoplasm with only 15 cases reported in the English literature since 1927. The authors present a recent additional patient and discuss their criteria for the determination of true primary ductal lesions based upon clinical presentation, operative findings, and tumor histology. This method of selection, most particularly involving electron microscopy in the reported case, is necessary to define whether the lesion originates from the ductal epithelium. All previously reported cases were reviewed, together with the actual pathologic slides in four available cases. Only ten were retained as primary ductal lesions. Most important, this analysis clarifies the natural history of these neoplasms and reinforces a recent theory of histogenesis of salivary gland tumors. In light of these findings, a rational treatment plan can be suggested.     

Verrucous carcinoma of the frontal sinus: A case report and review of the literature

Carcinoma of the frontal sinus is rare. Treatment is controversial, and prognosis is poor, The etiology is unknown, although some risk factors for other paranasal sinus carcinomas have been identified. A 70-year-old male presented with proptosis and x-ray findings consistent with a mucocele of the frontal sinus. At operation the patient was felt to have a cholesteatoma. Pathologic diagnosis was verrucous carcinoma of the frontal sinus. The case is discussed and the literature is reviewed.     

食管碰撞癌一例

患者男，60岁。进食梗阻感半个月，伴有胸骨后疼痛，无恶心、呕吐，无腹痛、腹泻及黑便。体检：浅表淋巴结未及肿大，皮肤及巩膜无黄染；全腹平软未及包块，无压痛、反跳痛，肝脾肋下未及，肠鸣音不亢，未闻及移动性浊音，直肠指检无异常。当地医院胃镜检查：距门齿27～30cm前壁左侧见黏膜隆起，表面高低不平，溃疡形成，质地脆、易出血，食管腔轻度狭窄；齿状线清晰，40cm过贲门，黏液混浊；胃底贲门无异常，胃体黏膜充血，胃角光滑，胃窦部充血水肿，蠕动正常；幽门口圆，无十二指肠球部溃疡和畸形，降部伸入未见异常。当地医院胃镜病理诊断：食管中段黏膜鳞癌。     

吻合器在食管癌和贲门癌切除术的应用

报告我院自1982年2月至1987年底应用吻合器治疗食管癌和贲门癌207例的临床经验.其中食管癌171例,贲门癌34例,食管双原位癌2例;弓下吻合58例,弓上吻合122例,胸膜顶吻合27例.并发症发生率为16.4%,吻合口瘘发生率为2.4%,吻合口狭窄发生率为5.8%,手术死亡率为2.4%.本文还讨论了吻合口瘘和狭窄的发生原因和提高吻合技术的重要性.     

子宫内膜异位症与卵巢癌相关性临床分析

目的:探讨子宫内膜异位症(内异症)与卵巢癌的相关性。方法:收集199例卵巢癌患者,分内异症组(n=32),非内异症组（n=167）,回顾性分析两组患者一般情况、临床表现、病理特征、实验室检查及预后。结果:内异症组平均年龄明显小于非内异症组(P＜0.05),年龄<50岁、未生育患者构成比明显高于非内异症组;内异症组患者临床症状以月经改变和下腹痛、腹胀为主（P＜0.05）;内异症组肿瘤直径通常小于20cm,且主要在10-20cm之间,非内异症组肿瘤直径大部分为10-20cm;内异症组患者血CA125主要在200-1000kU/L之间,非内异症组大部分在200kU/L以下;内异症组患者以透明细胞癌、宫内膜样癌为主,非内异症组以浆液性囊腺癌为主(P＜0.05);内异症组患者分期较早,I期 、Ⅱ期占合并卵巢癌患者68.8%,非内异症组分期多处于Ⅱ期、Ⅲ期,占原发卵巢癌患者70.1%（P＜0.05）;内异症组患者病灶部位多位于左侧卵巢,非内异症组病灶部位在左侧、右侧、双侧分布较接近 (P＜0.05);内异症组5年生存率为59.4%,非内异症组5年生存率为34.7%,两组差异具有统计学意义(P＜0.05)。结论:应充分了解内异症恶变的临床症状及病理特征,提高早期诊断率。     

卵巢外腹膜浆液性乳头状癌诊疗进展

卵巢外腹膜浆液性乳头状癌是一种原发于腹膜的恶性肿瘤,来源于第二苗勒系统,其临床表现及组织学特征与卵巢浆液性乳头状癌相似,术前误诊率高,确诊主要依靠组织病理学检查及免疫组化指标。治疗原则以手术为主,术后辅以铂类为基础的联合化疗。分化程度低、侵袭性强、预后较差、病死率高。近几年对该病的认识有所提高,相关报道不断增多,现对其临床研究进展进行分析。     

The important role of radiotherapy in patients with non-melanoma skin cancer and other cutaneous entities

Non-melanoma skin cancer is the commonest malignancy worldwide and a significant public health issue. Although most non-melanoma skin cancers are small and easily excised or ablated, a recommendation of definitive radiotherapy is often made in patients where the outcome (cosmetic and/or functional) will probably be better with radiotherapy compared to surgery. The aim of adjuvant radiotherapy is to reduce the risk of loco-regional recurrence and the role of palliative radiotherapy is important in improving the quality of life in patients with advanced and/or incurable disease. The aim of this review article is to broadly discuss the various clinical settings in which a recommendation of radiotherapy may be made and also includes a discussion on less frequently encountered cutaneous entities (e.g. in situ squamous cell carcinoma, keratocanthoma, lentigo maligna, cutaneous lymphomas and malignant fibrous tumours).     

预防食管、贲门癌切除术后切缘残留癌的体会（附52例报告）

我院于１９７５年９月至１９９４年７月行食管、贲门癌切除８０８例，经病理检查切缘有残留癌者５２例，发生率为６．４３％，１９９０年以前残留癌的发生率为１０．８％（４３／３９８），１９９０年以后采取了一系列预防措施，使切缘残留癌的发生率降至２．２％（９／４１０），两者比较经统计学处理Ｐ＜０．００１，有权显著差异，说明这些措施是预防切缘残留癌的较好方法。     

Evaluation of leukocyte adherence inhibition (LAI) test in primary and secondary hepatic malignancies

Leukocyte adherence inhibition (LAI) has been demonstrated to be a simple, rapid, and reliable technique in the diagnosis of various malignancies including hepatocellular carcinoma. The LAI test was carried out employing modified tube LAI technique in patients with primary hepatocellular carcinoma (HCC) and secondary carcinomas of liver. Positive LAI response to HCC antigen was obtained in all six (100%) cases of hepatocellular carcinoma tested. None of the control cases, which included 8 healthy subjects and 16 cases of benign liver diseases, gave positive LAI response. Two out of 19 cases of secondary carcinoma gave a positive LAI reaction to HCC antigen. In secondary carcinomas, 19 out of 21 cases (90.48%) gave positive LAI reaction to secondary adenocarcinoma antigen. There were two false positives in controls (1 each of cirrhosis and amebic liver abscess), and 1 out of 8 cases of HCC also gave positive response to secondary carcinoma antigen. Thus, LAI test was found to be useful in the diagnosis of hepatic malignancies.     

原发性食管小细胞未分化癌——八例报告及文献复习

本文报告我科近7年来收治的原发性食管小细胞未分化癌8例,采用手术治疗加术后化疗的综合治疗方法,使患者平均生存9个月(1～20月)。另外本文还结合文献复习,讨论了本病的临床特点、治疗方法以及预后。