天津城市居民甲状腺乳头状癌发病率和构成比的长期时间趋势分析

目的 对1981－2006年期间天津城市居民的甲状腺乳头状癌(PTC)的发病情况进行分析。方法 采用描述流行病学方法计算PTC的平均发病率,性别、年龄别发病率以及PTC占全部甲状腺癌新发病例的构成比情况。依据时期发病率,采用Joinpoint回归模型计算26年来PTC发病率的年度百分比变化(APC%)。结果 1981-2006年天津市居民PTC平均发病率为 1.30/10万,其中女性为2.14/10万。近26年PTC的发病率年均增长6.7%,超过总体甲状腺癌的年均增长幅度。女性PTC的发病率明显高于男性,从1981的0.87/10万增加到2006年4.70/10万,增加了4.4倍,年均增长6.2%。26年来PTC发病在甲状腺癌中所占的构成比从1981年的11.1%上升到2006年的69.5%,增加了5.3倍。女性与男性PTC的发病比呈现20～49岁年龄组高峰。结论 近年来女性PTC的发病率和构成比均呈逐年快速升高的趋势,特别是男女性别比存在特殊的年龄高峰期,提示仍需进一步研究寻找相关的危险因素和针对性的预防措施。     

分化型甲状腺癌行全（近全）甲状腺切除术以及应用实时监测的适应证

一、分化型甲状腺癌行全（近全）甲状腺切除术的适应证 （一）绝对适应证1．童年期有头颈部放射线照射史或放射性尘埃接触史;2．原发灶最大直径〉4cm;3．多癌灶,尤其是双侧癌灶;4．不良的病理亚型,如高细胞型、柱状细胞型、弥漫硬化型、实体亚型甲状腺乳头状癌,广泛浸润型甲状腺滤泡状癌,低分化型甲状腺癌;     

Let-7a在甲状腺乳头状癌的表达及其功能的初步探讨北大核心CSCD

甲状腺乳头状癌（papillary thyroid carcinoma,PTC）是最常见的内分泌恶性肿瘤。越来越多的证据表明,miRNA在PTC的发生发展中发挥着重要的作用。许多研究表明let-7a在多种肿瘤中特异性低表达悼。但其在PTC组织中的表达情况及其与临床病理特征相关性目前研究较少。本研究探讨miRNAlet-7a在PTC组织中的表达情况及其临床意义,为PTC的早期诊断和治疗提供实验依据。     

计算机辅助设计在乳腺癌根治术后一期再造的临床应用

随着生活水平的提高及饮食习惯的西方化,我国妇女乳腺癌发病率呈快速上升趋势,乳腺癌发病率已居女性恶性肿瘤的首位,且发病高峰提前至40～50岁,甚至早于西方国家发病年龄.同时,乳腺癌也是死亡率增长最快的癌症之一[1].     

肝转移癌的外科治疗

肝脏转移癌临床多见,在近10年里其治疗取得很大进步,包括局部治疗、化疗、生物治疗和导向治疗,而手术切除肝脏转移癌是惟一可获长期生存、治愈肝转移癌的有效方法,而且围术期并发症率和死亡率明显降低,无病生存期延长.而非手术治疗仅可有限延长病人生存期或无效[1,2].肝脏转移癌以大肠癌肝转移占多数,21%大肠癌患者初诊时已有肝转移,大部分大肠癌患者发生肝转移在原发肿瘤切除后3年之内[3,4],其他部位或病理类型的恶性肿瘤出现肝转移相对较少.本文结合文献复习,分析了我院2000年至2005年恶性肿瘤肝转移手术切除患者36例的临床资料,现报告如下.     

甲状腺扫描对甲状腺结节的诊断价值

通过对425例甲状腺结节患者的甲状腺扫描与术后病理结果的分析，发现热、温、凉、冷结节中发生甲状腺癌的机会分别为4．8％、11．1％、8．1％和5．9％；而扫描所显示的结节位置与手术所见的符合率为88．9％。认为，甲状腺扫描对甲状腺结节的定位有帮助，但无鉴别肿瘤良、恶性的临床价值。     

胚胎胸腺移植治疗恶性肿瘤的临床观察

为了增强恶性肿瘤患者的免疫功能，研究胚胎胸腺移植疗效最佳的移植部位，把２１例晚期胸部恶性肿瘤患者分为Ａ、Ｂ、Ｃ三组，将胚胎胸腺剪成１．０ｃｍ×１．０ｃｍ×０．１５ｃｍ的薄片，分别移植到股前肌群、背膏肓穴肌肉及肾被膜下，移植后半个月、２个月、６个月末梢血淋巴细胞亚群（ＣＤ３、ＣＤ４、ＣＤ８、ＣＤ４／ＣＤ８）及淋巴细胞转换率（ＬＢＴ）与移植前相比，移植后２个月差异显著（Ｐ＜０．０１），患者症状明显改善，生存质量有所提高。移植６个月后，Ｃ组以上诸值与术前相比仍保持较高水平（Ｐ＜０．０１），且症状的改善，生活质量的提高皆优于Ａ、Ｂ两组。结果表明，治疗恶性肿瘤，胚胎胸腺肾被膜下移植较其它部位为优     

Aggressive malignant phyllodes tumor

IntroductionOriginally described in 1838 by Muller, phyllodes tumor is a rare fibroepithelial neoplasm which represents roughly 0.3–0.9% of all breast cancers. Phyllodes tumor are divided into benign, borderline and malignant histologic categories. Malignant phyllodes tumor represent anywhere from 10–30% of all phyllodes tumors. This group has both the potential to recur locally and metastasize, however not all malignant phyllodes behave this way. The challenge lays in predicting which tumor will recur locally or metastasize. Distinguishing this subset of malignant phyllodes tumor is paramount.Presentation of caseWe present a case of malignant phyllodes which presented with metastatic disease. What is fascinating about this case is not only the initial presentation but also the aggressiveness of this variation of phyllodes tumor. The patient initially presented with a large mass which encompassed her whole right breast. On surgical pathology the mass measured roughly 31 cm in diameter and weighed over 10 kg. Within 5 weeks from surgery the patient had suffered brain metastases and also 6 local recurrent tumors. The patient passed roughly 11 weeks after her first visit to our office.ConclusionDespite biopsy proven malignant phyllodes tumor, it was near impossible to predict such a rapid course of disease progression in our patient. Our case illustrates the unpredictable nature of this disease in general and it possibly sheds light on a variant of the disease which had undergone an aggressive transformation.     

原发性十二指肠恶性肿瘤17例报告

探讨原发性十二指肠恶性肿瘤诊断和外科治疗的方法。方法总结1991～1996年间经手术和病理证实的原发性十二指肠恶性肿瘤17例资料。结果从出现症状到获得诊治平均8个月．8例行根治性手术或肿瘤切除术，存活6个月～6年；7例行短路手术，5例术后2～8个月死亡，2例失访；2例末手术，均于6个月内死亡。结论原发性十二指肠恶性肿瘤发病率低，易误诊，应力争早期诊断，争取手术切除。     

41��ԭ���Ը�Ĥ�������������Ϻ�����

目的 总结原发性腹膜后恶性肿瘤的诊治经验。方法 回顾性分析41例原发性腹膜后恶性肿瘤病人的临床表现，影像学检查特点及手术处理。结果 初始临床表现为多腹部肿物，辅助检查CT诊断率为94.7%，肿瘤完全切除率为48.8%，完全切除组术后复发11例，再手术10例，6例完全切除肿瘤。结论 发现腹部无症状性肿物要考虑本病，CT是最重要的诊断性辅助检查，手术全切除及整块切除是治疗本病的重要手段，对复发性肿瘤应争取再手术治疗。     

A malignant proliferating trichilemmal tumor simulating a squamous cell carcinoma

An 84-year-old man with a 3x3 cm tumor of the nasal dorsum is described. The tumor was surgically removed, reconstruction was with a forehead flap. Histologically the tumor was a malignant proliferating trichilemmal tumor (MPTT). There has been no recurrence or distant spread two years after surgery. MPTT is a rare tumor occurring mainly on the scalp and face in elderly men. It can be difficult to differentiate from a squamous cell carcinoma (SCC), both clinically and histologically. It has a tendency to metastasize and recur more frequently than SCC. When a malignant tumor occurs on the scalp or face, the diagnosis of MPTT should be considered by both surgeon and pathologist.     

坏死性凋亡在恶性肿瘤中的研究进展

【摘要】〓经典理论认为,细胞死亡一般有凋亡和坏死两种途径。近年来大量研究发现坏死性凋亡在肿瘤疾病发生、进展与耐药过程中发挥重要作用。坏死性凋亡是一种可调控性的非依赖Caspase的程序性坏死。本文综述了近年来关于坏死性凋亡的机制探索,及其在恶性肿瘤的发生进展与抗肿瘤药物中的研究,从而进一步认识坏死性凋亡于恶性肿瘤的研究价值。     

Explosive malignant transformation of a primarily benign phyllodes tumor

Summary The case of a patient with a phyllodes tumor of the breast who over a period of 12 years underwent 15 operations for local recurrences, finally succumbing to the disease, is presented. Occurring at the age of 42 as a benign lesion, the tumor underwent malignant sarcomatous transformation after prolonged surgical management. An attempted ultraradical resection failed, because the explosively growing tumor had passed the borders of resectability and also metastasized. Surgical management of the phyllodes tumor of the breast, a rare pathologic entity of variable behavior, is discussed with regard to the literature.     

A minute nonfunctioning islet cell tumor demonstrating malignant features

We report a patient with a minute nonfunctioning islet cell tumor, 8mm in diameter, which demonstrated malignant features by histology. The patient was a 43-year-old Japanese woman, who had an elevated carbohydrate antigen (CA) 19-9 level, of 59U/ml (normal range, <37U/ml) identified on a health check to rule out malignancies. Ultrasonography and computed tomography demonstrated a well-defined pancreatic tumor, 8mm in diameter, in the body of the pancreas. Serum levels of pancreatic hormones were within normal limits, and thus a tentative diagnosis was nonfunctioning islet cell tumor. The size of the tumor remained unchanged for 1¹/₂ years, but, at this time, the serum level of CA19-9 was elevated to 253U/ml. Segmental pancreatectomy was performed because malignancy could not be ruled out. The resected specimen showed an endocrine tumor invading both the pancreatic parenchyma and the perineural spaces outside the tumor. In general, minute nonfunctioning islet cell tumors have been considered to be completely benign, but the present tumor showed clear malignant features. We might have to take surgical resection into consideration even if the size of such an endocrine tumor is minute.