Primary tumors of the small intestine

In our department of surgery 28 patients with malignant and 10 with benign tumors of the small intestine were treated from 1940 to 1974. Fifteen patients with malignant and 7 with benign tumors underwent surgery with the intention to cure. Palliative operations or explorations were carried out on 13 patients with malignant tumors. Three patients with benign tumors were not operated on. The initial symptoms were vague: abdominal pain, nausea, anemia or bleeding in 75 and 80 percent of patients with malignant and benign tumors, respectively. The indication for operation in the malignant cases was, however, stenosis of the intestine or biliary tract or a palpable mass in 60 percent of the cases. At operation the tumors were thus in an advanced stage. Because the initial symptoms are vague, early diagnosis is difficult.The overall 5 year survival rate was 21 percent after surgery for malignant tumors. Among the patients considered by the surgeons to have had radical operations excluding cancer patients, 40 percent survived 5 years. The surgeon's opinion regarding “radical” operation as well as the presence or absence of metastases at microscopy were of limited prognostic value.     

Phyllodes tumors of the breast: A clinicopathological study of 118 cases

The clinical and pathological features of phyllodes tumors of the breast were evaluated through a study of 118 cases: 110 benign tumors, four borderline tumors, and four malignant tumors. Local excision was utilized in 105 patients (88%) and radical mastectomy was performed in 10 patients (8%) as the initial treatment. Estrogen receptor (ER) status was positive in seven (50%) of 14 cases and progesterone receptor (PgR) status was positive in nine (75%) of 12 cases. Local recurrence developed in eight patients, six of those having benign tumors, and two having malignant tumors, all of whom were treated by local excision. Of the four patients with malignant tumors, one died of lung and liver metastases 47 months after her first operation. We believe that excision with sufficient free margin may be the treatment of choice for most benign or borderline phyllodes tumors, whereas an Auchincloss modified radical mastectomy or a total glandectomy with lymph node dissection is recommended for patients with malignant tumors. However, a number of problems regarding the treatment of patients with distant metastasis remain yet to be addressed.     

Experience in the diagnosis and treatment of malignant and benign tumors of the chest]

The article analyses the follow-up of 155 patients among whom 63 had malignant tumors, 65 had benign tumors, while in 27 patients the tumor-like lesions were recognized as posttraumatic and post-inflammatory processes. Among 61 patients with sarcomatous lesions of the thoracic wall 21 had a resectable tumor. Operation was undertaken as a component of combined treatment in 21 patients. In a group of 19 patients 10 (16.4% of those admitted for treatment) have a survival period of 6 months to 18 years without signs of tumor growth. The other patients died in periods of 3 to 18 months. In a group of 65 patients with benign tumors 51 were treated by operation. Complications were not encountered. Among 27 patients with "false" tumors 5 underwent operation. The results of the study allow combined treatment of malignant tumors of the thoracic wall to be recommended for wider application.     

原发性纵隔肿瘤的诊断和外科治疗(附39例报告)

目的探讨原发性纵隔肿瘤的临床特征和诊疗方法。方法回顾性分析我院2002年1月至2007年10月39例原发性纵隔肿瘤外科诊治的临床资料。结果手术完整切除30例,姑息性切除9例。全组无手术死亡,术后32例获随访,随访3个月-5年。良性肿瘤患者术后均预后良好,恶性肿瘤出现远处转移2例,共3例在术后因肿瘤复发及其并发症而死亡。结论原发性纵隔肿瘤不论是良性还是恶性,只要无明确手术禁忌证均应及早手术,术后综合治疗是影响预后的重要因素。     

Thyroid surgery

In a 5-year period we treated 233 patients referred to us with a thyroid swelling. Among them, 39 patients (17%) had a malignant tumor. Seventy-eight percent of the patients were women. The preoperative examination procedure is discussed. Preoperatively, recurrent nerve palsy was found in 2.6% of patients with benign tumors and in 28% of patients with malignant tumors. The histologic features of the benign and the malignant tumors are described. The operative procedure in the benign group consisted of enucleation, resection, or lobectomy. In the patients with malignant tumors a radical operation was performed, consisting of lobectomy (unilateral or bilateral) when possible, eventually combined with radical neck dissection. The operative complications are discussed.     

Mucin-producing tumors of the pancreas: clinicopathological features, surgical treatment, and outcome

Mucin-producing tumors (MPTs) of the pancreas are increasingly being recognized. To evaluate the appropriate surgical treatment and predict the prognosis of MPTs, we performed a retrospective clinicopathological study in 51 patients, 27 with benign tumors and 24 with borderline/malignant tumors. Three of the malignant tumors showed stromal invasion and lymph node metastasis on histological examination. Of the 24 patients with borderline/malignant tumors, 2 died of MPTs and 4 died of other diseases. At the last follow-up, 35 patients were alive and well. The 5-year postoperative survival rate was 90% for patients with benign tumors, and 78% of these with borderline/malignant tumors. Five of the patients with borderline/malignant tumors had multicentric tumors. Three of these patients underwent resection of the rest of the pancreas, 5, 6, and 8 years, respectively, after the first operation. Extended radical resection is required for malignant MPT with invasion of the pancreatic stroma. We prefer to perform pancreatogastrostomy or Imanaga's procedure to allow examination of the body and tail of the pancreas by endoscopic retrograde pancreatography after resection of the pancreatic head. Careful follow-up for a long period may be the most prudent approach for detecting multiple MPTs in the residual pancreas after surgical treatment. Received for publication on June 30, 1998; accepted on March 3, 1999     

Spectrum of catecholamine-secreting tumors of the organ of Zuckerkandl

In a series of 24 pheochromocytomas, four were tumors in the organ of Zuckerkandl. Their presenting symptoms of headache, palpitation, diaphoresis, and anxiety were similar to symptoms of adrenal pheochromocytomas. Two patients had paroxysmal and two patients sustained hypertension. All four had elevated urinary vanillylmandelic acid, metanephrine or catecholamine levels. Two of the tumors were localized with angiography before the availability of computerized tomography. Two patients underwent initial computerized tomography, which was nondiagnostic. Later scans looking specifically for organ of Zuckerkandl tumors were positive. Organ of Zuckerkandl tumors, like other ectopic pheochromocytomas, have a higher rate of malignancy. Two of the four were malignant tumors. One patient died 4 years after operation, but the other patient remains stable despite metastatic disease 8 years after operation. The two patients with benign tumors remain well 2 and 3 years after resection and treatment with alpha-blockade.     

Surgical management of the ectopic ACTH syndrome.

Most patients with extra-pituitary ACTH-secreting tumors die from carcinoma, but a few can benefit from operation. Of 96 patients with Cushing's syndrome, 11 probably had such tumors. There were three modes of presentation: (1) three had malignant tumors with visceral metastases initially. One (bronchial carcinoid) died without operation. Two with carcinoma (thyroid medullary and islet-cell) underwent adrenalectomy with remission, but died soon. (2) three had apparently benign tumors initially. One (appendicular carcinoid) underwent appendectomy and one (bronchial carcinoid with hilar node metastases) underwent lobectomy. Both had rapid remissions. The third (pheochromocytoma) died after resection of the tumor. (3) five patients had no obvious tumors and underwent adrenalectomy with remission. In one a benign bronchial carcinoid was removed later. Four others remain well, but without localizing signs of tumor. The main biochemical features in all were hypokalemic alkalosis and very high urinary excretion of free cortisol. Seven of the eight patients without visceral metastases are in remission from one to 15 years after operation.     

Smooth muscle tumors of the stomach.

A series of fifty-one smooth muscle tumors of the stomach seen at the Massachusetts General Hospital over a twenty year period is reviewed. Virtually all benign tumors were asymptomatic and were discovered in the course of autopsy or an unrelated operation. Malignant tumors frequently caused symptoms. Contrast studies and endoscopy, although they confirmed the presence of the lesions, were of limited value in differentiating between benign and small malignant tumors preoperatively. Eighty-two per cent of the malignant lesions were well circumscribed, and 57 per cent of patients with gastric leiomyosarcomas survived at least five years after resection. Benign tumors may be treated by local resection, but malignant tumors should be resected widely, with involved adjacent organs if technically feasible.     

Neurogenic tumors of the mediastinum in children]

The age peak of neurogenic tumors of the mediastinum in children is from 2 to 7 years, malignant tumors being more frequently observed at the age before 2 years, benign tumors after 2 years of age. The method of choice in treatment of benign neurogenic tumors is operation. The selection of the method for treatment of malignant tumors depends on the stage of the disease: operative treatment is necessary for the I-II stages, the III-IV stages are better treated by radiation therapy and polychemotherapy. The survival of patients with mediastinum neuroblastomas made up 61.1%.     

原发性腹膜后神经源性肿瘤93例分析

目的　探讨原发性腹膜后神经源性肿瘤的临床病理特征及外科治疗原则 ,以提高手术切除率及安全性。方法　回顾性分析 13年间经手术和病理证实的原发性腹膜后神经源性肿瘤患者的临床资料。结果　神经源性肿瘤占同期腹膜后肿瘤的 2 0 .6% (93 /4 5 2 ) ,其中神经鞘瘤 2 4例(2 5 .8% )、恶性神经鞘瘤 19例 (2 0 .4% )、副节瘤 14例 (15 .1% )、神经纤维瘤 16例 (17.2 % )、其他少见肿瘤 2 0例 (2 1.5 % )。术前CT和MRI检查的诊断率分别为 65 .6%和 73 .9%。手术切除率为97.9% (91/93 ) ,2例行探查活检。良、恶性肿瘤术后的 3 ,5年生存率分别为 95 .9% ,80 .1%和42 .4% ,10 .5 %。良性肿瘤术后复发 8例 ,复发率为 13 .1% ;恶性肿瘤复发 14例 ,复发率为 43 .8%。结论　CT和MRI对本病诊断有辅助意义 ;治疗首选手术切除。良性肿瘤预后良好 ,恶性肿瘤术后易复发     

Treatment of patients with retroperitoneal non-organ tumors

The authors had 170 patients with retroperitoneal nonorganic tumors under observation. Operations were conducted on 143 patients. Patients with malignant tumors received intensive radiotherapy in a dose of 5Gr every other day to a total dose of 20-30 Gr. A course of telegammatherapy was applied in 17 patients in the preoperative period; in 22 patients the seat of the removed tumor was treated by telegammatherapy after radical operation. In 25 patients telegammatherapy was conducted as an independent method of treatment in inoperable cases and after exploratory laparotomy. Operative treatment of patients with benign tumors produced the best late-term results. Among patients treated for malignant new growths the late-term results were best when the seat of the removed tumor was exposed to intensive radiotherapy.     

医学美学原则在口腔颌面部肿瘤手术中的应用

目的:探讨医学美学原则在口腔颌面部肿瘤手术中的具体应用方案,评价医学美学原则在口腔颌面部恶性和良性肿瘤手术治疗中的临床疗效。方法:随机选择100例口腔颌面部肿瘤患者,分为两组,其中50例作为实验组,应用医学美学原则进行手术,另一组进行普通外科手术,作为对照组,其中65例为良性肿瘤,35例为恶性肿瘤。术后进行定期随访,调查患者对本次手术的满意度以及患者是否进行了二次手术修复。结果:实验组相对于对照组术后总体效果恢复较好并且患者对本次手术的满意度也较高,而对照组进行二次修复手术的例数较多。结论:将医学美学原则应用于口腔颌面部肿瘤手术,能够减少对口腔颌面部外形、功能的破坏,降低患者心理障碍,提高患者术后的生存质量。     

胃肠道平滑肌肿瘤nm23表达与细胞增殖活性关系的研究

目的探讨ｎｍ２３表达与胃肠道平滑肌肿瘤（ＧＩＳＭＴ）良恶性、恶性程度、转移、预后及细胞增殖活性的关系。方法采用免疫组化法检测８６例ＧＩＳＭＴ患者ｎｍ２３的表达情况,采用胶银染色法及免疫组化法检测核仁组成区嗜银蛋白（ＡｇＮＯＲｓ）、增殖细胞核抗原（ＰＣＮＡ）来反映细胞的增殖活性。结果ｎｍ２３的表达按平滑肌瘤、低度恶性平滑肌肉瘤、高度恶性平滑肌肉瘤的顺序依次明显下降（Ｐ＜０．０１）。ｎｍ２３表达与肿瘤的良恶性生长方式、大小、中心有无坏死亦有明显的关系（Ｐ＜０．０１或Ｐ＜０．０５）。ｎｍ２３阳性表达组的５年生存率明显高于阴性表达组（Ｐ＜０．０５）。ｎｍ２３阴性组的ＡｇＮＯＲｓ和ＰＣＮＡ表达明显高于ｎｍ２３阳性表达组（Ｐ＜０．０１）。结论ｎｍ２３是反映ＧＩＳＭＴ生物学特性的良好标志物,与ＡｇＮＯＲｓ、ＰＣＮＡ可互补作为判断ＧＩＳＭＴ良恶性、恶性程度、转移及预后的客观指标。     

T-lymphocyte subsets in peripheral blood of patients with bone tumors

Peripheral blood T-cell subsets of 54 patients with malignant or benign bone and soft tissue tumors and 20 age-and sex-matched normal controls were studied by using monoclonal antibodies. T-cell subsets were also studied before and after operation in ten patients with osteosarcoma. The number of T cells (OKT 11) and OKT 4 cells significantly decreased in malignant bone and soft tissue tumors. The number of OKT 8 cells increased. Statistically significant decrease in the T4/T8 ratio and the number of macrophage were also found in malignant bone and soft tissue tumors. In giant cell tumor of bone, the number of T cells and OKT 4 cells were also statistically decreased. But, the number of OKT 8 cells and macrophage remained unchanged. The ratio of T 4/T 8 was nearly normal. There was no difference in T cell subsets between benign bone tumors and normal controls. In malignant bone tumors, the number of T cells and T 4/T 8 ratio in some degree may be as a predictor for prognosis.     

儿童及青少年脊柱肿瘤

目的 探讨儿童及青少年脊柱肿瘤的临床特点、治疗方法及预后。方法 对1987年1月～2002年6月间收治的43例儿童及青少年脊柱肿瘤患者进行回顾性分析，男31例，女12例；年龄3～16岁，平均11．8岁。瘤样病变11例(占25．6％)，良性肿瘤13例(占30．2％)，恶性肿瘤19例(占44．2％)。根据发病部位可分为颈椎15例，胸椎16例，腰椎6例，骶椎6例。除1例胸椎恶性淋巴瘤患者采取化疗外，其他患者均行手术治疗，根据病情的不同予以植骨融合或植骨融合内固定，所有恶性肿瘤患者术后均接受放疗或化疗。结果 随访时间为1～10年，平均4.3年。良性肿瘤及瘤样病变患者术后疗效较满意，所有患者的局部疼痛和神经症状均有所好转，未出现病变复发、恶变；恶性肿瘤患者中有6例(原始神经外胚层瘤2例、Ewing瘤1例、神经母细胞瘤1例、浆细胞瘤1例、软骨肉瘤1例)因肿瘤转移、全身衰竭死亡，占总数的14．0％、恶性肿瘤的31．6％。1例骨巨细胞瘤、1例恶性神经鞘瘤分别于术后2．5年及10个月局部复发。1例Frankel A级和1例B级患者术后无明显改变，其余均有不同程度改善；3例由C级恢复至D级；8例由D级恢复至E级。结论 儿童及青少年脊柱肿瘤中，良性肿瘤如果切除彻底。预后良好；恶性肿瘤治疗效果相对欠佳，有较高的复发及死亡率，其预后与肿瘤的性质、手术治疗的方式及术后的后续治疗直接相关。     

The modified Collis-Nissen operation for control of gastroesophageal reflux

In a series of 82 patients with tumors of the thymus and thymic region there were 11 with teratomas and germinal tumors. Four of these patients had benign cystic teratomas, 4 had malignant teratomas, 1 had an embryonal carcinoma, and 2 had seminomas. The benign teratomas were removed by simple extirpation without complications. The malignant teratomas were highly invasive, and despite extensive operations and postoperative radiotherapy, 3 of the 4 patients died within 9 months. One patient with predominantly seminomatous differentation of the teratoma was alive and well more than 3 years after the operation. The patient with an embryonal carcinoma died after 4 months. One of the 2 patients with seminoma remained alive 20 years after radical excision and postoperative radiotherapy. The other, who had a huge seminoma, died during operation. The prognosis in patients with seminomas or with predominantly seminomatous structures in teratomas seems to be good after combined radical excision and radiotherapy, although nonradical resection followed by raditherapy may be justified in high-risk patients.     

Clinical analysis of malignant meningiomas

It seems generally accepted that meningiomas are benign tumors, and that malignant meningiomas are not common. The pathological criteria for judging whether meningiomas are malignant or not are controversial. Hemangiopericytic type, high cellularity, brain invasion, high mitotic rate, necrotic foci, and papillary type are regarded as histological characteristics of malignant meningiomas. Of a series of 105 patients with surgically treated meningioma, 25 patients demonstrated malignant characteristics (24%). The overall recurrence rate in our patients was 14%. The incidence of recurrence in 25 patients with pathologically malignant characteristics, and recurrence in 80 patients with pathologically benign characteristics were 32% and 9%, respectively. In comparison with benign meningiomas, recurrent factors in malignant ones included Simpson grade II operation, attachment of skull base, and no radiation-therapy. In conclusion, our criteria for malignant meningiomas have proved to be acceptable, and these cases should be treated with radiation therapy after surgery.     

原发性脾脏肿瘤52例诊治体会

目的探讨原发性脾脏肿瘤的临床诊治经验。方法回顾性分析本院1977年8月～2010年11月收治的52例原发性脾脏肿瘤患者的临床资料,其中良性肿瘤29例,恶性肿瘤23例。良性肿瘤患者中25例行脾切除术,1例动脉瘤行脾脏栓塞术,3例拒绝手术。恶性肿瘤中8例行单纯脾切除术,8例行脾脏切除加胰腺体尾部切除,3例原发性恶性淋巴瘤,1例平滑肌肉瘤及1例淋巴肉瘤的患者剖腹探查因腹腔广泛转移仅行病理活检,2例拒绝手术。所有病例无手术并发症。结果脾脏良性肿瘤预后良好,随访的18例恶性肿瘤中术后生存2年以上7例,均为早期治疗的患者,存活1～2年的6例,不到1年的4例,1例患者术后第7天死亡。结论脾脏肿瘤的诊断主要依靠临床表现及影像学检查,B超为首选检查。脾脏良性肿瘤行手术切除是有效的治疗方法。早期诊断、根治手术和术后综合治疗是改善脾脏恶性肿瘤预后的重要手段。     

原发性心脏心包肿瘤及瘤样病变的外科治疗

为探讨原发性心脏心包肿瘤的发病率及其特征，并评估其治疗方法。病例均经胸部Ｘ线、超声心动图、ＣＴ、ＭＲＩ和心导管检查，并经病理学检查证实诊断。２４例行手术治疗病人中，良性肿瘤２０例术后存活至今，其中１５例术后随访５～１５年无复发；４例恶性肿瘤中３例行部分切除，１例仅做病理学检查，均于术后４个月内复发或转移死亡。作者认为，原发性心脏心包良性肿瘤采用手术治疗常可获得良好结果，恶性肿瘤早期手术结合放疗可延长病人生命。