胰腺腺鳞癌9例临床分析

目的探讨胰腺腺鳞癌临床病理学特点和诊断治疗方法.方法回顾性分析9例经手术和病理证实的胰腺腺鳞癌的临床、手术及病理资料.结果本组共9例,77.8%(7/9)为老年患者,肿瘤位于胰头6例,胰体尾3例.主要的临床表现是黄疸和腹痛,CT提示胰腺低密度占位.8例获手术切除,1例行胆囊空肠襻式吻合术.病理检查:瘤体平均直径为4.5 cm,镜下表现为腺癌和鳞癌混杂.肿瘤侵犯十二指肠3例,侵犯肠系膜上静脉1例,侵犯脾静脉1例,侵犯胃1例,侵犯神经2例,淋巴结转移2例,肝转移1例.随访7例,术后生存3～17月,平均生存时间5.5月,均死于肿瘤复发和肝转移.结论胰腺腺鳞癌呈侵袭性生长,易侵犯周围脏器和远处转移,恶性程度高,预后差;临床症状和影像学表现无特异性,术前确诊困难;手术切除是有效的治疗手段.     

胰腺腺鳞癌71例的临床病理学分析

目的 分析胰腺腺鳞癌的临床病理特征及术后患者的生存期.方法 回顾性分析2003年至2011年上海长海医院手术治疗并经病理证实的71例胰腺腺鳞癌患者资料.术后进行随访,截止时间为2012年12月31日.失访14例,失访病例按截尾数据处理.采用不同的检验方法对患者术后生存期进行单因素分析.结果 71例患者中男性56例,女性15例,年龄28 ～ 81岁,平均60岁.临床症状：腹痛52例次（73.2％）,腹胀13例次（18.3％）,腰背部放射痛14例次（19.7％）,黄疸17例次（23.9％）,恶性呕吐2例次（2.8％）,体重下降3例次（4.2％）.肿瘤位于胰头36例（50.7％）,胰颈1例（1.4％）,胰体29例（40.8％）,胰尾5例（7.0％）;肿瘤长径2～12 cm,平均4.9 cm;TNM分期：ⅠA期2例（2.8％）,ⅠB期1例（1.4％）,ⅡA期22例（31.0％）,ⅡB期36例（50.7％）,Ⅲ期6例（8.5％）,Ⅳ期4例（5.6％）;淋巴结转移37例（52.1％）.行胰十二指肠切除术31例（43.7％）,胰体尾切除或联合脾切除术37例（52.1％）,探查活检术3例（4.2％）.术后行全身化疗35例（49.3％）.71例患者术后生存时间为0.1 ～19个月,平均8.5个月,术后1年生存率为21.1％,随访结束无1例存活.肿瘤TNM分期（以ⅡA期为界）、淋巴结转移、术后全身化疗是影响患者术后生存期的独立因素.结论 胰腺腺鳞癌是一种以腺癌和鳞癌混合组成的恶性肿瘤,具有侵袭性较强的生物学行为,患者预后差.     

胰腺原发性腺鳞癌9例临床病理分析及文献回顾

目的分析胰腺原发性腺鳞癌的临床和病理学特点,以提高对该病的认识和诊治水平。方法对2012年11月至2013年3月本院收治的9例胰腺原发性腺鳞癌患者的临床病理学资料进行回顾性分析,同时对14篇有关腺鳞癌的文献报道进行复习。结果在9例胰腺原发性腺鳞癌中,肿瘤位于胰头部者3例,胰体尾部5例,胰颈体1例。肿瘤的平均直径为（4．17±1．52）cm;其中1例侵犯门静脉,1例侵犯胃窦黏膜,1例侵犯十二指肠,1例侵犯横结肠,1例侵犯左侧肾上腺包膜,4例伴有胰周淋巴结转移;获随访的8例中死亡1例,术后生存时间为1～5个月,平均3．0个月。结论胰腺原发性腺鳞癌是一种少见的胰腺恶性肿瘤,组织学上肿瘤由导管腺癌成分和鳞状细胞癌成分混合构成,其临床表现与胰腺导管腺癌相似。通过早期诊断与手术结合放射、化学治疗可提高疗效。     

胰腺腺鳞癌1例报告

患者男性 ,5 8岁 ,因纳差 8月 ,左上腹隐痛 5月 ,腰背部疼痛 10d入住本院。入院查体 :生命体征稳定 ,慢性消瘦病容 ,浅表淋巴结未及肿大 ,腹平软 ,肝脾肋下未及 ,左上腹有一 5cm左右包块 ,质硬 ,稍有压痛 ,边界不清 ,腹部移动性浊音阴性。腹部CT示胰尾部占位 7× 5cm ,肝左叶 2 .5× 1.6cm的局限性低密度影。CA 199>10 0 0u/ml,CA 5 0 117.6u/ml ,CA 2 42 76.1u/ml,CEA 7.4ng/ml。诊断胰腺癌伴肝转移。入院后行手术治疗 ,术中发现胰尾部巨大占位 ,与胃后壁、脾、横结肠、左肾包膜、门静脉、肠系膜上静脉、腹腔动脉、肝动脉及后腹膜广泛…     

胰腺腺鳞癌—附3例报告及文献复习

胰腺腺鳞癌(pancreatic adenosquamous carcinoma)属于外分泌胰腺的原发性上皮性肿瘤。文献散见于个例报道。临床经过凶险,预后差。本报告3例并结合文献复习,以提高对其认识。 例1:住院号:392310。男性,60岁。因上腹部饱胀疼痛1月,于2000年3月18日入院。1月前无明显诱因感上腹部饱胀疼痛,向腰背部放射。外院查CT提示胰头癌。病程中无发     

胰腺腺鳞癌的影像与病理诊断分析

目的 探讨胰腺腺鳞癌的影像及病理学特征,提高对该疾病的认识和诊断水平.方法 回顾性分析7例经手术切除及病理证实的胰腺腺鳞癌患者的临床资料,分析其影像和病理学特点.结果 7例胰腺腺鳞癌发病年龄平均为57岁,肿瘤位于胰头及钩突部5例,胰体尾2例,瘤体直径平均(3.5±1.5)cm,临床主要表现为腹痛和黄疸.腺鳞癌的病理特征表现为实体部分由导管腺癌成分和鳞癌成分以不同比例混合而成,本组鳞癌成分占10%～60%.鳞癌占优势的胰腺腺鳞癌影像学表现为囊实性占位,本组有5例,且肿瘤体积越大,其中央囊性区直径与瘤体直径的比值就越大.囊性部分在增强前后均呈低密度,囊性区内无分隔,囊周多伴有不规则小囊.实性结构在平扫呈低或等密度,增强后动脉期轻度强化,门静脉期明显强化,本组有2例.伴有胰胆管扩张5例,伴胰腺萎缩4例.结论 鳞癌占优势的胰腺腺鳞癌有相对特征性的影像学和病理学表现,对于早期诊断有重要意义.     

胰腺腺鳞癌一例

患者男,31岁,7个月前无明显诱因感上腹部隐痛不适, 与饮食无关,不向腰背部放射,未予重视。6个月前上述症状加重,夜间尤甚。体检:皮肤巩膜无黄染,心肺听诊无异常。腹平软,上腹部扪及一约4 cm×5 cm大小包块,质硬,压痛, 无搏动。肝脾未触及。实验室检查:血常规、肾功能、血甲胎蛋白与癌胚抗原     

胰腺腺鳞癌研究进展

胰腺腺鳞癌（adenosquamouscarcinoma,ASC）又称胰腺黏液表皮样癌（mucoepidermoidcarcinoma）、胰腺棘皮癌（adenoacanthoma）,是一种临床罕见的胰腺外分泌肿瘤,约占胰腺恶性肿瘤的2．1％,恶性程度高,预后很差。病理学上肿瘤由导管腺癌成分和鳞状细胞癌成分混合构成,临床表现与胰腺导管腺癌类似,术前确诊较困难,     

胰腺腺泡细胞癌10例临床分析

目的 探讨胰腺腺泡细胞癌的组织学特点、生物学特征、治疗方法及预后.方法 回顾性分析1999至2008年间收治的10例胰腺腺泡细胞癌患者的临床特点、影像学改变、病理学特征、治疗经过及随访资料.结果 10例胰腺腺泡细胞癌患者中男9例,女1例,平均年龄(62±8)岁.CT检查示肿瘤位于胰腺钩突部1例,胰头7例,胰体尾2例;肿瘤大小平均为4.5 cm ×4.7 cm;7例胆总管和肝内胆管明显扩张、胰管扩张;2例侵犯肠系膜上静脉.行胰头十二指肠切除术8例,其中3例合并扩大淋巴结清扫术,2例合并门静脉切除置换;2例行胰体尾+脾切除.病理检查示瘤体平均4.0 cm×3.3cm×3.4 cm;镜下见5例胰头肿瘤侵犯十二指肠,2例侵犯肠系膜上静脉;7例肿瘤侵犯神经;6例淋巴结转移.随访9例,1例失访.术后存活3～51个月,平均存活18个月,均死于肿瘤复发和转移.结论 胰腺腺泡细胞癌是胰腺一个独立的高度恶性的类型,对放化疗可能都不敏感,其生物学特征有待进一步研究.     

A huge adenosquamous carcinoma of the pancreas with sarcomatoid change: An unusual case report

Adenosquamous carcinoma rarely occurs in the pancreas,and is characterized by the presence of cellular components from both duct adenocarcinoma and squamous carcinoma.Here,we describe a rare case of pancreatic adenosquamous carcinoma with sarcomatous change.Immunohistochemistry showed that the sarcomatous lesion lost the epithelial marker and aberrantly expressed of acquired mesenchymal markers,which indicated that this special histological phenotype may be attributed to epithelial-mesenchymal transition.This case also indicated that a routine radical surgery without aggressive treatment strategies was still appropriate for adenosquamous carcinoma of the pancreas with sarcomatoid change.     

Primary adenosquamous carcinoma of the esophagus

AIM:To investigate the clinical characteristics,diagnosis,treatment,and prognosis of primary adenosquamous carcinoma(ASC)of the esophagus.METHODS:A total of 4015 patients with esophageal carcinoma underwent surgical resection between January 1995 and June 2012 at the Cancer Hospital of Shantou University Medical College.In 37 cases,the histological diagnosis was primary ASC.Clinical data were retrospectively analyzed from these 37 patients,who underwent transthoracic esophagectomy with lymphadenectomy.Theχ2or Fisher’s exact test was used to compare the clinicopathological features between patients with ASC and those with squamous cell carcinoma(SCC).The Kaplan-Meier and Log-Rank methods were used to estimate and compare survival rates.A Cox proportional hazard regression model was used to identify independent prognostic factors.RESULTS:Primary esophageal ASC accounted for0.92%of all primary esophageal carcinoma cases(37/4015).The clinical manifestations were identical to those of other types of esophageal cancer.All of the 24patients who underwent preoperative endoscopic biopsy were misdiagnosed with SCC.The median survival time(MST)was 21.0 mo(95%CI:12.6-29.4),and the1-,3-,and 5-year overall survival rates were 67.5%,29.4%,and 22.9%,respectively.In multivariate analysis,only adjuvant radiotherapy(HR=0.317,95%CI:0.114-0.885,P=0.028)was found to be an independent prognostic factor.The MST for ASC patients was significantly lower than that for SCC patients[21.0 mo(95%CI:12.6-29.4)vs 46.0 mo(95%CI:40.8-51.2),P=0.001].In subgroup analyses,the MST for ASC patients was similar to that for poorly differentiated SCC patients.CONCLUSION:Primary esophageal ASC is a rare disease that is prone to be misdiagnosed by endoscopic biopsy.The prognosis is poorer than esophageal SCC but similar to that for poorly differentiated SCC patients.     

Efficacy of chemotherapy for patients with metastatic or recurrent pancreatic adenosquamous carcinoma: A multicenter retrospective analysis

Background/objectivesPancreatic adenosquamous carcinoma (PASC) is a rare variant of pancreatic ductal adenocarcinoma (PDAC). The usual treatment for metastatic or recurrent PASC is systemic chemotherapy in accordance with the PDAC treatment strategy. This study aimed to investigate the efficacy of chemotherapy, especially the benefit of recent combination therapies, in patients with metastatic or recurrent PASC.MethodsWe conducted a multicenter retrospective analysis of 116 patients with metastatic or recurrent PASC treated with first-line chemotherapy between April 2001 and December 2017 at 24 Japanese institutions.ResultsCombination chemotherapies included gemcitabine + nab-paclitaxel (GnP, n = 28), fluorouracil/leucovorin + irinotecan + oxaliplatin (FFX, n = 10), gemcitabine + S-1 (GS, n = 10), and others (n = 9). Monotherapies included gemcitabine (n = 51) and S-1 (n = 8). The median overall survival (OS) was 6.5, 7.3, and 4.3 months for the whole cohort, the combination therapy group, and the monotherapy group, respectively. Multivariate analysis indicated that combination therapy showed a better trend in OS than monotherapy (hazard ratio = 0.68; 95% confidence interval, 0.38–1.20). GnP or FFX were selected in 58.7% of patients after FFX was approved in Japan, and revealed a median OS, median progression-free survival, and objective response rate of 7.3 months, 2.8 months, and 26.9% in GnP and 7.2 months, 2.3 months, and 20.0% in FFX respectively.ConclusionsThis study suggests that combination therapy may be more effective than monotherapy. GnP and FFX showed similar and clinically meaningful efficacy for patients with metastatic or recurrent PASC.     

肺腺鳞癌外科治疗44例分析

目的 探讨肺腺鳞癌外科治疗的临床特点。方法 分析经手术切除,病理确诊的44例肺腺鳞癌资料,进行数据统计分析。结果 与同期肺鳞癌、腺癌比较直接侵犯率分别为79．4％、25．5％和36．1％;淋巴结阳性率分别为63．6％、40．6％ 和33．3％;术中所见的跨叶侵犯和淋巴结表现与术前x线及CT表现分别为40．9％、11．3％和63．6％、40．9％,均有显性差异。结论 本组结果表明：肺腺鳞癌在直接侵犯、淋巴结转移程度上明显高于鳞癌和腺癌,术前影像学检查很难表现出其实际病变范围,肺腺鳞癌的预后明显差于肺鳞癌和腺癌。     

胰腺结核误诊为胰腺癌1例

结核累及胰腺非常罕见，临床症状有时不典型，术前诊断困难，现将中山医院收治的1例术前误诊为胰腺癌的胰腺结核报道如下。     

Coexistence of pancreatic carcinoma and pancreatic tuberculosis: case report

Pancreatic tuberculosis (TB) is extremely rare and mimics pancreatic carcinoma both clinically and radiologically. This paper discusses the occurrence of 2 heterogeneous masses located in the head and tail of the pancreas in an adult male. In this patient, laparotomy was performed because of the high suspicion of pancreatic carcinoma. Intraoperative fine needle aspiration biopsy revealed the coexistence of pancreatic carcinoma with pancreatic TB, and a combined resection of the distal pancreas and spleen was successfully performed. Following surgery, the patient received standard chemotherapy for TB. At 7-month follow-up, computed tomography showed resolution of the mass in the pancreatic head. Clinicians must maintain a high index of suspicion for pancreatic TB in patients with pancreatic masses. The coexistence of malignancy and TB should be considered when patients present with multiple pancreatic masses.     

249例外分泌源性胰腺癌临床病理和免疫组化研究

目的 探讨外分泌源性胰腺癌病理形态学特征及相关基因产物表达和意义。方法 对249例胰腺癌按wH0标准进行病理组织学分类，同时对发病年龄、性别、肿瘤部位和侵袭转移等进行分析。应用EnVision免疫组化技术，对167例胰腺癌和101例癌旁胰腺组织p53、p14^ARF、p21^WAP1、ATM、MDM2、p33^INGT基因表达蛋白进行了检测。结果 249例胰腺癌中，男：女：2．04：1，40岁以上占94％，肿块3cm以上占65．9％，胰头部位占71．1％，导管腺癌占81．1％，发现6例黏液性非囊性癌。伴有十二指肠浸润、局部淋巴结和(或)远处转移者占32．5％，伴有周围神经浸润者占44．97％。免疫组化显示癌组织p53阳性率为57．5％，p14^ARF阳性率35．3％，p21^WAF1阳性率39．5％，ATM阳性率67．7％，MDM2阳性率64．1％，p33^ING1阳性率77．2％。61例有随访资料，患者平均存活16个月。结论 胰腺癌侵袭转移发生率高，特别是周围神经浸润可能为预后差的重要原因之一。6种肿瘤基因产物免疫组化检测结果显示，胰腺癌的发生发展过程涉及多种基因的异常，是一个复杂的分子事件。     

胰腺巨细胞癌临床病理特征分析

目的 探讨胰腺巨细胞癌的临床病理特征。方法 以96例普通胰腺腺癌为对照组，回顾性研究分析经病理确诊的19例胰腺巨细胞癌的临床病理特征。结果 19例胰腺巨细胞癌8例(42．1％)位于胰头，11例(57．9％)位于胰体层。首发症状以腹痛最多(57．9％)，确诊时主要症状为腹痛(73．7％)、消化不良(63．2％)、体重下降(36．8％)等，黄疸较为少见。常规化验检查异常率较普通胰腺癌低，肿瘤标志物检测与普通胰腺癌接近。超声、螺旋CT、MRI诊断敏感率、准确率较高。肿瘤生长大，处于Ⅳ期者近半数(9例，47．4％)，较普通胰腺癌稍高。病理镜检部分有骨样结构形成，肿瘤以低分化为主。1年存活率为17．6％，较普通胰腺癌稍低。结论 胰腺巨细胞癌临床病理特征与普通胰腺腺癌确有不同之处，应联合应用影像学检查及肿瘤标志物检测手段早期诊断巨细胞癌，努力改善预后。