脐尿管癌12例诊治与预后分析

目的探讨脐尿管癌的诊断、治疗和影响预后因素。方法回顾性分析1995年1月～2011年12月我院收治的12例脐尿管癌患者,对其临床和病理资料进行分析,重点探讨脐尿管癌的临床特点、诊断、治疗方式及预后因素。结果 12例患者均行手术治疗,其中4例根治性切除,8例行广泛性扩大膀胱部分切除术。术后有4例出现远处转移,行化疗。本组12例患者均进行随访,其中1年生存率为83.3%(10/12),3年生存率为58.3%(7/12)。5年生存率为25.0%(3/12)。结论脐尿管癌是不多见的恶性肿瘤,临床预后差,手术为主要治疗手段,早期诊断及治疗及行扩大性膀胱部分切除术可以达到长期无病生存的效果。     

空肠多发肉瘤样癌术后肺、脑转移:1例报告并文献复习

目的 探讨空肠肉瘤样癌患者的临床表现、治疗及预后等特点,为临床诊治提供参考.方法 本文报道1例我院收治的空肠多发肉瘤样癌术后肺、脑转移患者,并分析14篇个案报道、共18例病例.结果 患者因肠套叠并消化道出血,行空肠部分切除术,术后4月出现脑、肺等多发转移,术后8月因多器官功能衰竭而死亡.空肠肉瘤样癌国内外命名不统一,诊断困难,尤其难以早期明确诊断,主要诊断依据为病理检查和免疫组化.目前无明确的治疗指南,包括肿瘤在内的广泛手术切除是主要有效治疗手段,但预后极差,中位生存期仅为5.5月(0.36~36月),多死于复发和转移.结论 空肠肉瘤样癌较罕见,本例空肠多发性发病并发脑等部位转移更加罕见.规范命名、尽早诊断、通过全身多部位扫描明确其他部位是否存在癌灶、充分评估病程以及尽早治疗均十分重要.手术是治疗的基础,可尝试运用各种肿瘤局部治疗手段.Ki-67作为预后判断和PD-L1靶向免疫治疗的潜在价值需进一步探究.     

儿童甲状腺髓样癌1例

髓样癌是临床上比较少见的一种甲状腺恶性肿瘤,仅占国内甲状腺癌的5%～10%,而儿童甲状腺髓样癌更是罕见。甲状腺髓样癌（MTC）分为散发型和遗传型,遗传型为常染色体显性遗传,约占MTC总数的10%～20%,发病与RET原癌基因突变密切相关。髓样癌影像学无特异性,主要表现为占位性实性结节,不易与分化型甲状腺癌鉴别,但恶性程度相对较高,较早出现淋巴结转移,侵犯神经及脉管概率更高,远处转移的风险更大。故尽早采用足够手术范围切除或同时清除颈部淋巴结,与患者预后密切相关。我院收治1例儿童甲状腺髓样癌,女性,12岁,腺叶次全切除术后1年,对侧叶再次发现髓样癌结节,从而行二次手术。现将该患者完整诊疗经过报道如下,以期对该类疾病的临床诊治提供帮助。     

Bilateral femur metastasis in endometrial adenocarcinoma

Bone metastasis of endometrial carcinoma is uncommon, and bilateral femur metastasis is extremely rare. A 48-year-old woman with Federation International of Gynecology and Obstetrics stage IIB grade 2-3 endometrial adenocarcinoma underwent curative radical hysterectomy, bilateral salpingo-oophorectomy, and pelvic and para-aortic lymphadenectomy followed by radiotherapy and chemotherapy. Twenty-two months after surgery, she suffered from progressive pain and then presented bilateral femur metastasis. She was administered the surgical excision of bony metastasis and adjuvant therapies including chemotherapy, palliative radiation, and hormone therapy. Three and a half years after treatment of bony metastasis, she remains clinically well. Bone metastasis of endometrial carcinoma may occur at some unusual sites, and bilateral femur metastasis should be considered in patients. Multimodal therapies are usually advocated for bone metastasis of endometrial carcinoma.     

肾细胞癌甲状腺转移一例及文献复习

目的探讨肾细胞癌甲状腺转移的临床表现及影像学特点。方法回顾性分析一例肾细胞癌甲状腺转移患者的相关临床资料及影像学检查,并复习有关文献。结果肾细胞癌甲状腺转移为临床罕见病,发病隐匿,发病机制不明,临床诊断极其困难,明确诊断主要依靠病史、病理组织学及免疫组化检查等。超声声像图主要表现为甲状腺内的局灶性病变,形态不规则,分界清楚,呈实性低回声,无囊状结构,无包膜结构及强回声钙化斑,肿块内血流信号丰富。可出现颈部淋巴结转移及颈内静脉癌栓。结论肾细胞癌甲状腺转移影像学具有一定的特点,但无明显特异性征象,确诊主要依靠病理组织学及免疫组化,如果甲状腺是唯一的转移部位,必须进行甲状腺切除术。     

Metastatic renal cell carcinoma presenting as foot metastasis: case report and review of the literature

Malignant tumors frequently metastasize to bone centrally in the skeleton. Metastatic disease distal to the knee is unusual. Metastasis to the foot (acrometastasis) is rare (0.01%) and is usually a late manifestation of disseminated disease. The purpose of this article is to present a rare case of metastatic renal cell carcinoma with foot metastasis as the primary manifestation along with another rare localization of metastatic disease distal to the knee, in the contralateral tibial diaphysis. To highlight the delay in diagnosis of such a rare condition to consider it in the diagnosis of a painful foot, we also present a review of the literature.     

卵巢癌脑转移的诊治

目的探讨卵巢癌脑转移的诊断及治疗方法。方法回顾性分析我院2008年1月-2011年8月收治的6例卵巢癌脑转移患者的临床资料,并对相关文献进行复习。结果 6例诊断时中位年龄58.5岁,均已绝经,入院时血CA125均升高,治疗后均下降;4例病情复发时伴CA125升高。依据为影像学检查发现脑转移灶。患者均接受手术及术后以铂类为基础的联合化疗,其中3例进行了放射治疗,1例行开颅手术。4例仍接受化疗,2例死亡。结论卵巢癌脑转移预后差,手术辅以铂类为基础的联合化疗及放疗是主要治疗方法 ;预后与临床期别、肿瘤分化程度及对铂类化疗药物敏感程度有关,血清CA125可用于治疗后的监测随访。     

前列腺混合型恶性肿瘤5例报告附文献复习

目的：提高对少见的前列腺混合型肿瘤的认识。方法：分析5例前列腺混合型恶性肿瘤患者的临床资料,并结合文献讨论前列腺混合型恶性肿瘤的诊疗方法。结果：前列腺混合型小细胞癌和腺癌1例,予以经尿道前列腺汽化电切术(TUVP)术及氟他胺治疗,7个月后死于肺转移。前列腺混合型小细胞癌和腺癌1例,予以TUVP术及睾丸切除术,10个月后死于肺转移。前列腺腺鳞癌1例,予以TUVP术、放疗及氟他胺治疗,8个月后肺、肝、骨多处转移,死于多脏器衰竭。前列腺腺鳞癌1例,予以膀胱、前列腺切除并尿路改道,已生存1年,仍处于随访中。前列腺癌肉瘤1例,患者行膀胱、前列腺切除并尿路改道及盆腔淋巴结清扫术,术后予以放疗,13个月后出现广泛肺转移, 死于肺部并发症。结论：前列腺混合型恶性肿瘤预后差,确诊需经详细病检及免疫组织化学技术。应及时随访经过内分泌或放疗的前列腺腺癌患者,根治性手术是目前治疗前列腺混合型肿瘤最有效的措施。     

鼻腔原发性恶性黑色素瘤25例临床分析

目的　观察研究鼻腔原发性恶性黑色素瘤的临床特点 ,以帮助临床诊断和治疗。方法　对 1970～ 2 0 0 1年 6月间诊治的鼻腔原发性恶性黑色素瘤 2 5例临床资料进行回顾性分析。结果　 2 5例中 ,肿瘤多位于鼻腔外侧壁和鼻中隔 ,其中中鼻道 8例 ,鼻中隔 7例 ,中鼻甲 4例 ,下鼻甲 2例 ,鼻底 2例 ,另 2例病变范围广无法判断其来源 ;肿瘤呈黑色或紫褐色 2 1例 ,呈结节状或菜花状 ,淡红色表面光滑如息肉状 4例 ;肿瘤触之易出血。结论　本病临床少见 ,易误诊 ,应与鼻腔癌、血管瘤、鼻息肉相鉴别 :对鼻腔发现的黑色或紫褐色肿物 ,触之易出血者可作该病的临床诊断 ,而不必取活检 ,以免促进肿瘤转移。     

SEVEN CASES OF EPITHELIAL OVARIAN CARCINOMA WITH BRAIN METASTASIS

Objective To summarize the clinical characteristics, treatment, and prognosis of brain metastasis in patients with epithelial ovarian carcinoma. Metbods Retrospective analysis was conducted in 7 cases of brain metastases of epithelial ovarian carcinoma from January 1986 to March 2007 in Peking Union Medical College Hospital for summarizing therapy results and prognosisaffecting factors. Results Incidence of brain metastases of epithelial ovarian carcinoma was about 0. 66% （7/1 055 ）. Serous adenocarcinoma was the predominant pathological type in 4 cases and the subsequent was adenocarcinoma in 3 cases. All the patients were diagnosed at late stage, 6 cases with the International Federation of Gynecology and Obstetrics （HGO） stage Ⅲc and 1 with FIGO stage IV. The mean duration from diagnosis of ovarian carcinoma to brain metastasis was 32.7 ± 20. 0 months （range, 23-73 months）. Single metastasis focus occurred in 43% of cases and multiple metastases in 57% of cases. Fifty-seven percent of patients presented extracranial metastasis. Serum CA125 played a role in monitoring reoccur- rence and brain metastases. The average survival time was about 12 months. Better treatment with prolonged survival could be achieved by combination of operation and chemotherapy or combination of radiotherapy with chemotherapy. Concltusions As a rare condition, brain metastasis of epithelial ovarian carcinoma is rising in incidence with improved treatment of ovarian carcinoma and prolonged survival. However, brain metastasis indicates bad prognosis which can be improved by combined therapy.     

Dural metastasis of nasopharyngeal carcinoma: rare,but worth considering

Metastasis of nasopharyngeal carcinoma (NPC) to the dura, an extremely rare condition, can be symptomatically silent and mistaken for a benign entity radiographically. Missed diagnosis can lead to serious consequences or prove immediately fatal. We report a woman with dural metastasis of NPC that mimicked a meningioma on radiography. Craniectomy with tumour resection was performed due to rapid progression from the onset of symptoms to disability. The patient was still alive two years after surgery. This case emphasises the need to keep in mind the possibility of dural metastasis of NPC in patients with abnormal imaging features. This would not only avoid wrong and optimistic diagnosis, but also allow for appropriate treatment in a timely manner. To our knowledge, this is the first report of metastasis of NPC to the dura. We provide detailed information on the neoplastic lesion, which masqueraded as a benign entity and caused potentially fatal consequences.     

口腔及鼻腔粘膜恶性黑色素瘤的治疗

头颈部粘膜里色素瘤是一种少见的恶性程度极高的肿瘤．它生长迅速、很易复发和扩散，因而对其早期诊断、治疗和如何防止复发，仍然是一个困难的问题．作者对收治的８例头颈部粘膜恶性黑色素瘤进行了手术治疗．其中男５例．女３例．分别发生于口腔与鼻腔．８例病人均随访２年以上，除１例局部复发，１例怀疑肝、肺转移外．其余６例正常．文章结合８例患者的临床表现，讨论了口、鼻腔粘膜恶性黑色素瘤的早期诊断、好发部位和组织学特点，并阐述了常用治疗方法的优点、治疗中应注意的事项及预后．     

结直肠癌累及膀胱18例诊治体会

目的 探讨结直肠癌累及膀胱的临床特点并提高其诊治水平.方法 回顾分析1996年1月～2005年12月收治的18例结直肠癌累及膀胱的临床资料.结果 本组结直肠癌累及膀胱18例,伴肉眼血尿3例,均行膀胱部分切除术,术后经病理证实肿瘤侵犯膀胱5例,炎性增生13例.术后随访5个月～9年,9例死于肿瘤复发或转移,7例无瘤生存或死于非肿瘤疾病,2例失访.结论 结直肠癌累及膀胱少见,手术应一并整块切除受累膀胱组织,可以延长生存期.     

胃癌的皮肤转移：附4例报告

作者报告了经组织病理学检查证实的４例胃癌皮肤转移病例，并结合有关文献讨论了此种较罕见转移的发生率，可能途径及典型的临床表现。其确诊要根据组织病理学检查，治疗主要按原发肿瘤治疗。皮肤转移提示了患者机体处于较低的免疫功能状态，预后极差     

颈部肿块和瘢痕病变致颈动脉窦过敏综合征(附2例报告)

报告１例鼻咽癌颈淋巴结转移致颈动脉窦过敏综合征和１例全喉切除加颈淋巴结清扫术术后瘢痕形成出现颈动脉窦过敏综合征。对耳鼻咽喉科相关疾病引起的颈部肿块和瘢痕病变压迫颈动脉窦所致颈动脉窦过敏综合征的致病原因、临床表现及诊断、治疗原则进行了讨论。此类患者在临床上少见,易误诊,应引起重视。     

The patella as an unusual site of renal cell carcinoma metastasis

We report a rare case of renal cell carcinoma with metastasis to the patella in a 49-year-old man, who presented with seven months of left knee pain after a fall. Only two similar cases have been reported. Patellar metastasis is rare because it has a relatively poor blood supply and microemboli would have been sieved out by the pulmonary circulation. Patellectomy is the usual treatment for such cases. We suspect that the preferential metastasis in our patient is a result of tropism. Our treatment for this patient is unique. We opted for a patella-preserving operation involving the use of cryotherapy, as this treatment modality preserved the quality of life. An opportunistic biopsy one year later confirmed the absence of active disease within the patella. This case uniquely provides human in vivo histological confirmation that an intralesional procedure with local and systemic adjuvant therapy effectively controls local disease.     

回顾性分析15例脐尿管癌的诊断、治疗和预后

脐尿管癌是来源于脐尿管上皮罕见的恶性肿瘤,由于发生部位特殊,早期诊治比较困难。本研究探讨脐尿管癌的临床特点、诊断、治疗方式及预后因素。结论 ：脐尿管癌发病位隐匿,术前诊断较为困难,治疗采取扩大性膀胱部分切除术或根治性全膀胱切除,辅以全身化疗、放疗为主的综合治疗可能有助于延长患者生存期。本病的预后很差,临床分期与预后密切相关。     

Intracranial metastases from carcinoma of the cervix

Uterine cervix carcinoma usually spread by local extension and through the lymphatics to the retroperitoneal lymph nodes. Brain metastases are extremely rare in the course, are usually seen late and have poor prognosis. We report a 49-year-old woman with squamous cell carcinoma of the cervix who developed right parieto-occipital lobe metastasis after three years of treatment of the primary disease. The presenting symptoms of the metastatic disease were hemiparesis, headache, and vomiting. Her hemiparesis improved after surgical excision of the metastasis. Treatment in these cases is mainly palliative but may offer symptomatic relief and improvement in the quality of life.     

肾盂癌的诊断与治疗(附12例报告)

目的:探讨肾盂癌的诊疗方法,提高诊治水平。方法:回顾分析12例肾盂癌临床资料。结果:12例均行手术治疗,病理检查报告移行细胞癌8例,鳞癌2例,腺癌2例。肿瘤侵犯肾实质9例,侵犯肾包膜6例,肾门淋巴结有转移5例,输尿管浸润3例,并膀胱肿瘤2例,侵犯肾血管、腹主动脉1例,侵犯肾上腺1例,侵犯十二指肠、胰腺1例。随防6月-10年,1年生存率72.7%,5年生存率3.82%,平均生存3.6年。结论:肾孟癌诊断主要靠临床表现及放射学检查,早期诊断、及时行根治性肾、输尿管全切除术是主要的治疗方法。     

喉部神经内分泌癌的诊断和治疗

目的 总结喉部神经内分泌癌的临床特征.方法 回顾性分析1988年6月至2010年12月在我院耳鼻喉科诊治的喉部神经内分泌癌患者的临床资料.结果 12例经病理确诊为喉部神经内分泌癌患者中,典型类癌1例,非典型类癌4例(2例伴有颈部淋巴结转移,1例伴有类癌综合征),小细胞神经内分泌癌7例(1例合并腺癌).典型类癌和非典型类癌患者均接受手术治疗,其中局部晚期或伴有颈淋巴结转移的患者接受术后放疗,随诊1～12年均未见局部复发.7例小细胞神经内分泌癌患者接受化疗和放疗,随访0.5～6.0年,其中1例半年内死于肺转移,另1例3年内死于肝转移.结论 喉部神经内分泌癌的病理分型和临床分期对于治疗和预后非常重要.典型类癌和非典型类癌采取喉部分或全部切除术,必要时行颈淋巴清扫术;小细胞神经内分泌癌预后差,治疗以化疗和放疗为主.

Abstract：

Objective To summarize the clinical features of laryngeal neuroendocrine carcinoma (LNEC).Methods The clinical data of all LNEC patients hospitalized during the period of June 1988-December 2010 were analyzed retrospectively.Results Among all LNEC 12 patients as confirmed by pathological examination,there were typical earcinoid(n=1),atypical earcinoid(n=4)(2 with cervical metastasis.1 with paraneoplastic syndrome),small cell neuroendocfine carcinoma(n=7)(1 with adenocarcinoma).All patients with typical and atypical carcinoid underwent surgery.And postoperative radiotherapy was offered for those diagnosed with advanced stage or cervical metastasis.They were followed up for 1-12 years without local recurrence.All patients with laryngeal small cell neumendocrine carcinoma received chemotherapy and radiotherapy.And the follow-up period was 0.5-6 years.One died of pulmonary metastasis within half a year while another died of liver metastasis within 3 years.Conclusions It is important to classify the LNEC patients correctly since their clinical course.treatment and prognosis varies greatly with the diagnosis.For typical and atypical carcinoid of larynx,partial or total laryngectomy and neck dissection may be performed depending on the site and extent of primary tumor.However,for laryngeal small cell neuroendocrine carcinoma,the mainstay of treatment is made up of chemotherapy and radiotherapy.And the prognosis of this type remains very poor.