Six Cases of Carcinosarcoma of the Esophagus

Clinical aspects of six cases of esophageal carcinosarcoma werereported. They were all male in their sixties. Although almostall cases of carcinosarcoma of the esophagus reported in theliteratures had polypoid lesions, two of our cases showed ulcerativeappearance and were not considered to be carcinosarcoma by macroscopicobservations. Recently, preoperative irradiation has been adoptedfor the treatment of esophageal carcinoma in many hospitalsand it may be possible that some of sarcomatous component hasdisappeared at the time of operation. Therefore, more casesof esophageal carcinosarcoma could be present among those whohad been diagnosed as esophageal carcinoma.     

Carcinosarcoma of the Esophagus: a Twenty-case Study

The present report reviews results from 20 carcinosarcoma patients,and compares them with 773 cases of squamous cell carcinomaof the esophagus treated surgically at the National Cancer CenterHospital from 1971 to 1988. Although there were no significantdifferences in age, sex, symptoms or location between the twogroups, the carcinosarcoma group had morphological characteristicsas follows. (1) Seventy-five percent of the carcinosarcomaswere of the elevated type. (2) The tumor was large. (3) Thedepth of invasion was limited to the esophageal wall in 80%of the carcinosarcomas. The rate of lymph node metastasis wasalmost the same, at >65%, in both groups. Moreover, lymphnode metastasis occurred at various stages, of the depth ofinvasion in the carcinosarcoma group. The curative resectionrate was higher for carcinosarcoma (80%) than for squamous cellcarcinoma (46.5%). There was no significant difference in recurrencerate between them. Compared with the high frequency of lymphnode recurrence in the squamous cell carcinoma group, the recurrencedue to hematogenous metastasis was more frequent in the carcinosarcomagroup. Although the three-year survival rate was higher forcarcinosarcoma (62.8%) than for squamous cell carcinoma (28.1%),there was no significant difference in the five-year survivalrate between them (26.7 vs. 22.4%). In conclusion, radical esophagectomywith lymph node dissection is a necessary therapy for carcinosarcoma,and careful follow-up, paying special attention to hematogenousmetastasis, is required.     

Primary Adenocarcinoma of the Esophagus Report of Six Cases

Six primary adenocarcinomas were found among 1,346 cases ofesophageal carcinoma, an incidence of 0.45%. Three of the adenocarcinomaswere the "type ordinaire" of Lortat-Jacob, two were adenoidcystic carcinoma, and one was mucoepidermoid carcinoma. Theinitial symptom was dysphagia in all six cases. All six lesionswere located in the middle and/or lower third of the esophagus.Esophagograms showed tumorous-type lesions in four cases andspiral-type in two cases. Although endoscopical examinationwas performed in five cases, the biopsied specimen showed adenocarcinomasin only two. Four patients were operated and on two receivedradiation therapy. Four patients died within one year, and twoare still alive more than 21 months after surgery.     

食管癌肉瘤的诊断和治疗：附18例分析

总结两家医院自1969年12月～1995年4月手术治疗食管（贲门）恶性肿瘤7920例，共发现食管癌肉瘤18例，发生率为0．23％。资料表明，平均发病年龄54．7岁，男性多见，男女之比为2．6：1。临床症状主要为缓慢加重的吞咽困难，好发于食管中段，X线表现为食管腔内巨大充盈缺损。病变处食管梭形膨大，很少见到周围软组织块影。食管镜检查可见食管腔内息肉样肿物突出，活检报告多为鳞癌。病理特征为癌与肉瘤两种成分并存，无鳞状上皮癌与肉瘤之间的过渡形态。手术切除率高，极少转移，预后较好。     

食管癌肉瘤的临床及X线诊断

目的:分析食管癌肉瘤的临床X线特征,提高对本病的认识。方法:9例食管癌肉瘤行钡餐检查。结果:本病好发于食管中段,以腔内息肉样充盈缺损并伴有分叶、局部食管扩张为特征,它可以带蒂,一般不引起梗阻。结论:本病临床症状出现晚,病史较长,结合钡餐检查的腔内息肉样充盈缺损,应考虑食管癌肉瘤,本病均需组织学检查才能确诊。     

食管小细胞癌(附1例光镜、电镜及免疫组化观察)

对1例食管小细胞癌进行了光镜、电镜及免疫组化观察。肿瘤的组织学特点酷似燕麦细胞癌,但NSE 染色阴性,电镜下瘤细胞内亦未见神经分泌颗粒。作者认为若仅靠光镜观察而未做电镜检查时,将此类肿瘤命名为食管小细胞癌较为妥当。电镜下瘤细胞内有神经分泌颗粒的食管小细胞癌为燕麦细胞癌,无神经分泌颗粒者为储备细胞癌,二者可伴有或不伴有鳞或(和)腺样分化。本文观察结果支持食管小细胞癌起源于全能干细胞(totipotent primitive cell)的观点。     

肺癌肉瘤3 例报告并文献复习

 目的 探讨肺癌肉瘤的临床特点、诊断、病理特点、治疗及预后. 方法 对3例肺癌肉瘤进行临床资料回顾性分析,并结合文献对其临床表现、诊断、治疗及预后进行分析. 结果 肺癌肉瘤主要症状为咳嗽、胸痛、血丝痰等,X 线示以周围型居多,还可见肺门、纵隔淋巴结肿大及远处转移.镜下见癌与肉瘤成分共存,光镜及免疫组化分析可确诊.1年生存率64.4%,5年生存率26.7%. 结论 肺癌肉瘤临床特征与肺癌不易区别,预后较肺癌好,外科手术是其主要的诊断和治疗手段.     

乳腺癌肉瘤（附7例病理及临床分析）

本文收集我院1954年1月至1992年1月间收治的7例乳腺癌肉瘤的病理临床资料,结合文献加以讨论。乳腺癌肉瘤十分少见,国内仅见个案报告。本组7例占我院38年间收治乳腺恶性肿瘤的0.09％。确定癌肉瘤的诊断,必须与假肉瘤样化生及碰撞瘤相鉴别。患者年龄,肿瘤大小,镜下边界及腋淋巴结转移情况是影响预后的重要因素。     

Macroglobulinemia and Chronic B-Cell Type Lymphocytic Leukemia in Japan -- Study of Autopsy Cases --

Autopsy cases of Waldenstroöm's macroglobulinemia (WM)and chronic lymphocytic leukemia of B-cell type (B-CLL) wereexamined to determine the geographical distribution and histologicalcharacteristics of these diseases in Japan. Both diseases occurred primarily at 50 to 60 years of age witha predominance of males and were distributed throughout Japanwith a population slightly lower than that of T-CLL in southwesternJapan. Histologically WM (31 cases) consisted mainly of smallcell type malignant lymphoma with plasmacytic differentiation(27 cases) according to the Japanese Classification (LSG) andcytoplasmic immunoglobulins with a monoclonal pattern of immunoglobulinM (IgM) (lambda 12; kappa seven). The bone marrow involvement(27 cases) was follicular, mixed (follicular and diffuse) ordiffuse. B-CLL (58 cases) also showed principally a small celltype histology (48 cases) and 16 of the cases showed plasmacyticdifferentiation as in WM. Cytoplasmic immunoglobulins with amonoclonal pattern were found in 10 (six of IgG, two of IgM,one of IgG and M, and one of IgA). Bone marrow involvement (56cases) revealed the same histological pattern as WM. According to the growth pattern of the tumor cells in the bonemarrow and lymph nodes, both diseases may be categorized asbone marrow-based lymphoma.     

头颈部癌肉瘤12例临床分析

[目的]探讨头颈部癌肉瘤的诊断与治疗。[方法]回顾性分析1964～2001年收治的12例头颈部癌肉瘤病人的临床资料,其中甲状腺4例,上颌窦3例,喉、口底、口颊、颌下腺、耳廓各1例。12例患者均行根治性手术,3例行术后放疗,2例行术后化疗。[结果]1年、3年、5年累积生存率分别为66.67%、16.67%、8.33%。[结论]头颈部癌肉瘤恶性度高,治疗后容易复发,宜采用以手术为主的综合治疗。     

早期胃癌的病理形态观察及组织发生学探讨

目的 探讨早期胃癌的组织发生学。方法 对１６例早期胃癌及癌周病变进行了病理形态观察。结果 其中２例为多灶性癌，占７５％（１２／１６）。同一病例的各个癌灶互不相连，且各个癌灶的分化程度及组织学类型不同。癌扣伴有没程度的萎缩性胃炎、肠上皮化生、胃腺囊及异型增生。结论 早期胃癌具有多灶性生长的特点。提示临床医生胃镜检查应注意多点取材，以防漏诊；以及正确定手术范围，防止手术残留。『     

食管胃两定点吻合法和食管血供的研究

作者报告了一种食管、贲门癌外科手术治疗中防止食管胃吻合口瘘的新的手术方法——“食管胃两定点吻合法”。食管胃两定点吻合法的技术要领是：利用定点吻合线的牵引作用，使食管胃吻合口的创缘自然合拢于一个平面上，使全层缝合状况改善，为创缘组织生长创造了良好环境。结果表明，本组连续４００例无一例吻合口瘘发生。作者同时进行３２例成人尸体食管血供的系统观测研究，发现下胸段食管动脉分支共有１５８支（平均４．９６±１．７３支），上胸段食管动脉分支共有１１２支（平均３．５３±１．８３支），腹段食管动脉分支共７５支（平均２．３０±１．２３支），作者认为食管全程血供丰富，手术治疗中，只要遵循外科手术的基本要求。吻合口血供能够得到满足。     

泌尿生殖系癌肉瘤6例

目的:探讨泌尿生殖系癌肉瘤的诊断和治疗.方法:6例均行手术切除.结果:术后病理和免疫组化证实为癌肉瘤,1例于术后2个月死于肺转移,1例术后5个月死于肝、肺、骨转移,1例术后10个月死于肝、肺转移,1例术后30个月死于远隔转移,1例失访,1例现已生存28个月.结论:泌尿生殖系癌肉瘤临床罕见,术前诊断困难,免疫组化有助于诊断.恶性程度高,预后差,尽早行根治性切除是最佳治疗方法.     

食管平滑肌瘤124例分析

本文收集了国内近30年来文献报告的食管平滑肌瘤114例,连同本院10例共124例,进行了临床分析。男多于女,男女之比为2.9:1。约80％小于40岁。间歇性吞咽困难占56％,胸骨后疼痛占38％,上腹疼、胃灼热占21.8％。肿瘤以中段居多(60.7％)。单发117例,多发7例。本文分析了肿瘤的生长方式,描述了X线钡餐和内镜检查时的诊断要点和注意事项。粘膜外肿瘤摘除加肌层修补术是目前简便、安全、创伤小的理想术式。     

原发性食管腺癌：附47例报告

我院于１９７９年４月至１９８９年１０月间，经手术切除和病理证实的１７７６例食管癌中，原发性食管腺癌４７例（２．６５％），男３２例，女１５例，年龄为３９－６８岁（中位５５．７岁）。术前２４例细胞学检查，２１例诊断为食管鳞癌，误诊率８７．５％。４７例均行食管癌切除，其中３４例行食管胃弓上吻合术，１３例行颈部吻术，术后病理检查区域淋巴结有转移者２４例，切端残存癌３例。切除后５年生存率２８．６％。作者认为     

食管神经内分泌癌90例临床预后分析

[目的]探讨食管神经内分泌癌的临床特点、治疗方法及预后。[方法]回顾性分析1995年1月至2011年1月间收治的90例食管神经内分泌癌的临床和随访资料。[结果]全组患者中位生存时间为10.0个月;1、3、5年生存率分别为44.6%、21.6%和14.4%。局限期患者中位生存时间为11.5个月,广泛期患者中位生存时间为6.0个月,差异有统计学意义（P〈0.05）。局限期患者接受单一治疗、综合治疗的中位生存时间分别为9.8个月和16.7个月,差异有统计学意义（P〈0.05）。[结论]食管神经内分泌癌恶性程度高、预后差,综合治疗较单一治疗方案可提高患者生存率。     

阑尾黏液性肿瘤6例临床病理分析

目的探讨阑尾黏液性肿瘤的病理学特点、诊断及鉴别诊断方法。方法回顾性分析6例阑尾黏液性肿瘤的临床资料、组织病理学和免疫组化特点及随访结果。结果 6例患者中男女各3例,年龄41～71岁。无典型临床表现,术前一般不能做出准确诊断。阑尾增粗、腹盆腔黏液及卵巢黏液性肿瘤,为阑尾黏液性肿瘤的重要诊断依据。肿瘤性上皮和（或）黏液累及范围与阑尾黏液性肿瘤病理诊断及预后有关;卵巢及腹盆腔病灶继发于阑尾黏液性肿瘤,有赖于免疫组化CK20＋、CK7-、MUC-1-、MUC-2＋、CEA＋、CDX-2＋、ER-支持。结论阑尾明显增粗,且有黏液、黏液性腹腔积液及双侧卵巢黏液性肿瘤时,应高度怀疑阑尾黏液性肿瘤。肿瘤性上皮侵犯深度、范围,对判断肿瘤良恶性最为重要。免疫组化结果对确定卵巢、腹膜病灶的来源具有决定性作用。     

原发于肺的淋巴瘤6例并文献复习

目的:探讨原发于肺的淋巴瘤临床特点、诊断及治疗方法.方法:对6例原发于肺的淋巴瘤患者进行分析,结合文献对其临床特点、影像学改变、支气管镜表现、确诊手段及治疗方法进行分析.结果:原发于肺的淋巴瘤无特异性临床表现,易误诊为其它肺疾患.肺部影像学主要为单发团块或多发结节影,不易与肺癌鉴别.支气管镜下通常无异常表现或仅表现为慢性炎症,确诊主要依靠开胸手术组织病理学检查.手术切除或联合化疗是主要治疗手段.结论:原发于肺的淋巴瘤无典型临床特点,误诊率极高,支气管镜活检阳性率低,病理学检查是确定诊断的主要手段.