29例乳腺肉瘤临床治疗分析

为探讨乳腺肉瘤临床最佳治疗方案,作者对１９６４年３月至１９９４年５月收治的２９例乳腺肉瘤的临床资料进行了回顾性分析。随诊４个月至２５年。７例死亡,９例复发;１５例存活１０年以上,５例存活２０年以上。作者认为,本病多需病理证实,以手术治疗为主,无论低度或高度恶性,均应采取包括肿瘤周围正常组织的广泛切除;对复发病例不应放弃再次手术机会;对临床未能触及肿大淋巴节者可不予清扫腋下淋巴节。     

乳腺叶状囊肉瘤治疗分析（附6例报告）

目的 讨论乳腺叶状囊肉瘤的诊断和治疗。方法 对经手术治疗的6例乳腺囊肉瘤患者的临床资料进行回顾性分析。结果 行乳腺肿物切除1例,乳腺单纯切除2例,乳癌改良根治术2例,乳癌根治术1例。6例患者中随访5例,随访5－10年,局部复发1例,经给予化疗后,于术后3年死于肺转移;另4例现均健在,已分别存活5,7,8,10年。结论 乳腺叶状囊肉瘤诊断主要依据病理学检查,对可疑患者应行术中冰冻切片检查。手术治疗为本病的主要治疗方法。     

乳腺叶状囊肉瘤24例临床分析

目的探讨乳腺叶状囊肉瘤的临床特点、外科治疗方法及影响预后的因素。方法对24例乳腺叶状囊肉瘤患者采用局部切除11例,单侧乳房切除术10例,乳房切除并腋窝淋巴结清除3例,其中5例(20%)曾诊断为乳腺腺纤维瘤或巨纤维瘤因术后肿瘤复发而经历2~3次局部切除术。结果术后病检证实:低度恶性11例,中度恶性9例,高度恶性4例。随访1~10年(平均5.2年),局部复发率29.1%,5年生存率97%。结论乳腺叶状囊肉瘤发病率低,易误诊;手术切除是其首选的治疗方法,局部切除术后复发应行乳房切除;多数乳腺叶状囊肉瘤恶性程度较低,进展缓慢,预后较好;乳腺叶状囊肉瘤预后与肿瘤的病理类型、肿瘤大小和手术切除是否彻底有关。     

透明细胞肉瘤的治疗及疗效分析

目的探讨透明细胞肉瘤的临床特点及治疗方法,分析治疗效果及影响因素。方法对1990年6月至2004年7月收治的17例透明细胞肉瘤进行回顾性分析。男8例,女9例;年龄12￣73岁,平均36.8岁。14例曾于外院行局部切除术,10例复发,2例有区域淋巴结转移。发病部位:足5例,上肢6例,下肢1例,躯干5例。肿瘤大小在5cm以上者6例,小于5cm者11例。17例中15例行手术治疗,2例放疗;联合使用化疗13例。手术方式包括间室切除2例,广泛切除12例,截趾1例。联合淋巴结清扫术4例,清扫后截肢1例。结果所有患者随访5￣89个月,平均31.5个月。15例行手术治疗者中1例局部复发。17例中9例出现区域淋巴结转移,转移率为52.9%;7例远隔转移,其中肿瘤大小在5cm以上者6例。死亡6例,存活11例,其中1例为带瘤存活。2年生存率为84%,5年生存率为36%。结论透明细胞肉瘤比较罕见,恶性度高,预后差。首次规范的手术治疗是治疗成败的关键,肿瘤大小是影响预后的重要因素。肿瘤大小、是否复发与是否发生转移关系密切,淋巴结转移与血行转移者预后差。放、化疗的疗效尚需进一步研究。     

乳腺叶状囊肉瘤24例临床分析

目的探讨乳腺叶状囊肉瘤的临床特点、外科治疗方法及影响预后的因素。方法对我院收治的24例乳腺叶状囊肉瘤患者根据患者年龄、原发肿瘤大小、有无腋淋巴结转移等因素选择局部包块切除术或单乳切除术进行治疗,并对术后治疗结果进行随访。结果本组24例中行局部切除11例,单侧乳房切除术9例,乳房切除并腋窝淋巴结清除4例,其中5例(20％)曾诊断为腺纤维瘤或巨纤维瘤因术后肿瘤复发而经历2-3次局部切除术。术后病理学检查证实:良性11例,交界性9例,恶性4例。随访1-10年(中位5．2年),5年生存率97％,局部复发率31．3％。结论乳腺叶状囊肉瘤发病率低,多数病例病理分化较好,病程进展缓慢,手术切除是其首选的治疗措施,局部切除后反复复发者应行乳房切除;叶状囊肉瘤预后与肿瘤的病理类型、肿瘤大小和手术切除是否彻底有关。     

乳腺叶状囊肉瘤和巨纤维腺瘤诊治体会(附17例报告)

目的探讨乳腺叶状囊肉瘤和巨纤维腺瘤的诊断和治疗。方法回顾分析我院1985~2002年期间外科收治的9例乳腺叶状囊肉瘤和8例乳腺巨纤维腺瘤的临床资料。结果9例乳腺叶状囊肉瘤中行单纯乳房切除术4例,保留乳头皮下乳房切除术1例,保留乳头和部分压缩腺体 肿块切除术1例,改良根治术3例;术后恢复良好,仅1例复发。8例乳腺巨纤维腺瘤中行单纯乳房切除术2例,保留乳头皮下乳房切除术1例,保留乳头和部分压缩腺体 肿块切除术2例,单纯乳腺肿块切除术3例;术后恢复良好,术后2例复发。结论乳腺叶状囊肉瘤和巨纤维腺瘤临床上均表现为无痛性包块,除乳腺叶状囊肉瘤发病年龄较大、肿块范围大及易恶变外,二者主要依据病理检查结果相鉴别;均以手术治疗为主,根据患者年龄、肿块大小以及病理检查结果选择不同的手术方式。     

乳腺叶状囊肉瘤临床病理分析

目的　探讨乳腺叶状囊肉瘤的诊断、病理学特点和处理。方法　对经手术和病理诊断的１６ 例乳腺叶状囊肉瘤的临床资料进行回顾性分析。结果　行局部肿块切除３ 例;行包括相当健康组织的乳腺楔形切除术８ 例;全乳房切除术４ 例;根治性切除术１ 例。其中１４ 例获随访１ ～１０ 年,随访期间死亡１ 例,此例首次曾行局部肿块切除,尔后复发３ 次,最后于首次手术后６ 年死于肺转移;其余患者均仍存活,其中３ 例因肿瘤复发而再作全乳房切除术,术后情况良好,再次术后已分别生存４ ,５ ,７ 年。结论　本病确诊主要依靠病理学诊断,对可疑病变应行术中快速病理检查,送检标本需作多处切片。手术切除为其首选治疗方法,扩大的局部切除或全乳房切除为广泛采用的术式。     

儿童甲状腺癌的临床特征及外科治疗

目的　探讨儿童甲状腺癌的临床特征、外科治疗和预后。方法　回顾性分析我院 1980～2 0 0 1年收治的 2 5例儿童甲状腺癌的临床资料。结果　全组均行手术治疗。 2 5例儿童甲状腺癌中 ,乳头状癌 17例 ,乳头状癌合并滤泡状分化者 3例 ,滤泡状癌 3例 ,髓样癌 1例 ,甲状腺纤维肉瘤 1例。术后随访时间 4个月至 18年 ,中位随访时间 6年。死亡 2例中 ,1例术中颈静脉角处有癌灶残留 ,术后 2年出现颈部淋巴结及肺部广泛转移而死亡 ,1例死于甲状腺纤维肉瘤复发。其余患儿均存活良好。结论　儿童甲状腺癌多为分化型肿瘤 ,且以乳头状癌多见 ,预后良好 ,手术是其主要治疗手段。即使对有局部复发或颈部淋巴结转移的病例 ,再次手术仍可获得良好效果。     

乳腺分叶状囊肉瘤32例诊疗分析

目的总结乳腺分叶状囊肉瘤的病理分类命名及正确的诊疗方法。方法回顾性分析32例乳腺分叶状囊肉瘤的临床资料。结果13例施行局部切除术,7例原位复发;17例施行足宽边界切除术,2例复发;2例施行单纯乳腺切除术,无复发。结论本病为既不同于纤维腺瘤也不同于乳癌的独立病种。局切速冻病理是最佳的诊断方法。施行足宽边界切除或乳腺单纯切除是最佳的手术方式。     

甲状旁腺癌11例诊治分析

目的探讨甲状旁腺癌的诊断和治疗方法,总结甲状旁腺癌的手术治疗经验。方法回顾分析11例甲状旁腺癌患者的临床资料,包括临床症状、体征、实验室检查和影像学结果。结果11例均完整切除肿瘤或复发转移灶,10例术后出现短期低钙血症,均经补钙后症状缓解。随访1~10年,手术后5年存活率81.82%。存活6例,其中2例分别于术后1、3年复发,再次术后无复发;4例患者健康存活,存活1年以上1例,存活3年以上1例,存活7年1例,存活10年1例。结论手术切除肿瘤以及同侧甲状腺是一种良好的根治方法,复发肿瘤或转移灶的切除仍然是一种十分有益的治疗方法。     

Dendritic cell and effector cell infiltration in soft tissue sarcomas with reactive lymphoid hyperplasia

The lymph node is the site of antigen presentation, and dendritic cells are sentinels for anti-tumor immunity. However, little is known about the histological features of lymph nodes and dendritic cells in soft tissue sarcomas. The reactive lymph node and infiltration of dendritic cells or effector cells were studied histologically in 10 soft tissue sarcomas with reactive lymphoid hyperplasia. The cases included four malignant fibrous histiocytomas, two malignant peripheral nerve sheath tumors, one synovial sarcoma, one epithelioid sarcoma, one malignant granular cell tumor, and one liposarcoma. The proportions of the T zone, lymphoid follicle, and lymphoid sinus (which was occupied by cells immunopositive for antibodies against CD3, CD20, or CD68) were 33.4% ± 11.0%, 6.1% ± 4.9%, and 13.5% ± 6.5%, respectively. T zone hyperplasia was observed in all cases, and sinus histiocytosis was found in four. The proportion of the T zone in regional lymph nodes of soft tissue sarcoma patients was significantly higher than that in adult autopsy cases without a cancer history. CD8-, TIA-1-, or granzyme B-positive effector cells were found in each sarcoma tissue. Whereas CD1a-positive dendritic cells were not detected, S-100 protein-positive or CD83-positive dendritic cells were observed in five sarcoma tissues. The coefficient correlation between the numbers of effector cells and dendritic cells positive for CD83 or S-100 protein were demonstrated. Although this is a preliminary report, the present study demonstrated that some soft tissue sarcoma patients showed reactive lymphoid hyperplasia. Furthermore, the association between the infiltration of dendritic cells and that of effector cells was observed in patients with soft tissue sarcomas.     

Malignant fibrous histiocytoma in the right portion of the mandible with metastasis in pancreas

BackgroundMalignant fibrous histiocytoma is a sarcoma of uncertain origin that can be found both in soft tissues and in bones. It is currently called undifferentiated pleomorphic sarcoma not otherwise specified and it represents a final common pathway in several tumors that are subject to the progress of dedifferentiation.Local recurrence of the tumor in the same location where it was originated occurs in 20–30% of the total number of soft tissue sarcomas. It is less frequent in limbs and more likely to recur in retroperitoneal sarcomas and in head and neck.Most tumors grow during the first two years after treatment.Most sarcoma metastases, especially those in the head and neck (including malignant fibrous histiocytoma) present as a lung disease (90%). Extrapulmonary diseases are not frequent and can occur in lymph nodes (10%), bones (8%) and in the liver (1%).Case report61 years old woman with history of malignant fibrous histiocytoma in the right portion of the mandible, resected four years ago. Subsequent checkups did not show any disease. The patient reports a constant abdominal pain not diagnosed, related to a pancreatic nodule.ConclusionMalignant fibrous histiocytoma is a potentially curable disease. The most important part of the treatment is complete surgical removal, usually followed by adjuvant radiation therapy. Chemotherapy is a treatment usually used only on those patients with higher recurrence risk or on those showingrecurrence or who have already showed recurrence.     

Sarcoma of the breast]

Sarcoma of the breast represents only 0.2-1% of all mammary malignancies. This study reports 5 such cases, including 2 osteosarcomas, 1 fibro-, 1 lipo-, and 1 malignant fibrous sarcoma. The treatment used was mastectomy in 3 cases with excision of axillary lymph nodes. The remaining 2 patients were treated by simple mastectomy whereby 1 of these received a immediate reconstruction with a prosthesis. 1 patient demonstrated local recurrence and died. The remaining 4 patients did not develop neither metastases nor local recurrence and are still alive after an observing period between 12 months up to 17 years. Today, first-line treatment is wide local excision or simple mastectomy. Excision of the axillary lymphatics, adjuvant radiotherapy, and chemotherapy have been disappointing in the treatment of breast sarcoma.     

Early lymphatic spread of osteogenic and soft-tissue sarcomas.

Records of 374 patients referred to the National Cancer Institute with a diagnosis of sarcoma over a 24-year period were reviewed to study the incidence of lymph node involvement in this disease. One hundred and thirteen patients had operations involving the draining nodal area and evaluation of these nodes for tumor. Only three patients (2.6%) had evidence of sarcoma metastatic to draining lymph nodes. Prophylactic removal or radiotherapy of draining lymph node areas in most adults with sarcomas does not appear to be worthwhile. A comprehensive analysis of the literature is presented.     

Lymph node metastasis from soft tissue sarcoma in adults. Analysis of data from a prospective database of 1772 sarcoma patients.

To examine the natural history of lymph node metastasis from sarcomas and the utility of therapeutic lymphadenectomy, clinical histories of all adult patients identified by a prospective sarcoma database for the 10-year period July 1982 to July 1991 were examined. Of the 1772 sarcoma patients, 46 (2.6%) were identified with lymph node metastasis. Median follow-up of all patients from diagnosis of lymph node metastasis was 12.9 months (range, 0 to 100 months). Median survival for nonsurvivors was 12.7 months (range, 0 to 40.7). The tumor types with the highest incidence of lymph node metastasis are angiosarcoma (5/37 total cases; 13.5%), embryonal rhabdomyosarcoma (ERMS) (12/88 total cases; 13.6%), and epithelioid sarcoma (2/12 total cases; 16.7%). Lymph node metastasis from visceral primary (p = 0.004) and malignant fibrous histiocytomas (p = 0.006) were associated with particularly poor prognosis. Thirty-one patients underwent radical, therapeutic lymphadenectomy with curative intent, whereas 15 patients had less than curative procedures, in most cases biopsy only. Patients not treated with radical lymphadenectomy had a median survival of 4.3 months (range, 1 to 32) whereas radical lymphadenectomy was associated with a 16.3 month median survival and the only long-term survivors (46% 5-year survival by Kaplan-Meier). The authors conclude that lymph node metastases from sarcoma are rare in adults, but vigilance is warranted, especially in angiosarcoma, ERMS, and epithelioid subtypes. Radical lymphadenectomy is appropriate treatment for isolated metastasis to regional lymph nodes and may provide long-term survival.     

乳腺癌肉瘤的临床特点与病理生物学特性

目的探讨乳腺癌肉瘤的临床特点与病理生物学特性，为以手术为主的综合性治疗提供重要依据。方法回顾性分析经手术和病理学证实26例乳腺癌肉瘤的临床资料，并将30例乳腺癌作为免疫表型的对照组，研究该肿瘤的临床特点和病理生物学特性。结果乳腺癌肉瘤中癌成分〉50％者占61．54％，同侧腋淋巴结癌转移率达30．77％；肉瘤成分〉50％者占38．46％，同侧腋淋巴结内未见癌转移。免疫组化癌成分中EMA和CK阳性率均96．15％，P53、ER和PR阳性率分别为53．85％、61．54％和30．77％，Vimentin和S100阳性率分别为19．23％和15．38％。肉瘤成分中Vimentin和S100阳性率分别为96．15％和88．46％，EMA、CK、ER、PR和P53阳性率分别为19．23％、11．54％、7．69％、3．85％和3．85％。P53、ER、PR、Vimentin和S100与对照组差异有统计学意义（P〈0．05）；EMA和CK与对照组差异无统计学意义。结论乳腺癌肉瘤是由上皮和间叶成分混合而成的恶性肿瘤，因其成分不同，免疫表型差异较大。它具有双重侵袭性和极易复发的生物学特性，手术和放化疗是最佳的综合性治疗方法。     

Surgical treatment of metastatic lung tumors

Surgical treatments were performed in 88 cases of metastatic lung tumors, where 5 years survival rate in all resected cases was 37.5%. We report our principles on the surgical treatment for metastatic lung tumors. First of all, the biological characteristics of the primary lesion is among the most important factors in considering the indication for the surgical treatment in metastatic lung tumors. For example, chemotherapy must be the first choice in treating lung metastasis of choriocarcinoma, and hormone therapy in lung metastasis of mammary carcinoma. On the other hand, such tumors as osteogenic sarcoma, soft tissue sarcoma, colorectal carcinoma and Grawitz's tumor, should be treated by surgery. Another point in the surgery of the metastatic lung tumor is the choice of the mode of operation for the solitary metastatic tumor according to tumor type. As a principle, partial or segmental resection is preferably chosen for metastatic lung tumor. However, the location of the lung tumor, tumor size, hilar lymph node metastasis and the pattern of invasion to the surrounding lung tissue must be considered to decide the surgical procedure. From these considerations, the segmental or partial resection for metastatic sarcomas and the lobectomy for the metastatic carcinomas are appropriate in general.     

Dedifferentiated liposarcoma of spermatic cord: degeneration of lipoma previously resected

Spermatic cord sarcomas are rare tumours. Dedifferentiated liposarcoma accounts for only 10% of all spermatic cord sarcomas. These are usually large-sized tumours histologically characterised for being well-differentiated liposarcomas with some high grade sarcoma areas. Volume, location, mass homogeneity as well as presence of pelvic and retroperitoneal adenopathies are reported by CT and ultrasound techniques. These are useful for post-treatment follow-up. This paper presents one spermatic cord, dedifferentiated liposarcoma from which lipomas from the same spermatic cord had been previously removed in three occasions. We believe this is a degeneration of the earlier resected lipoma. Management is by extended inguinal radical orchiectomy. Value of adjuvant radio- and chemotherapy is uncertain. Post-surgery local relapses are common, and haematogenous and pelvic nodes metastasis likely. Survival at 5 and 10 years is 75% and 63% respectively.     

Interdigitating dendritic cell sarcoma of urinary bladder mimicking large intravesical calculus

Interdigitating dendritic cell sarcomas are extremely rare neoplasms with an unpredictable clinical course that usually occur in lymph nodes. We report the first adult patient with interdigitating dendritic cell sarcoma involving the bladder. A 71-year-old man presented with lower urinary tract symptoms and gross hematuria. Cystoscopy and transabdominal ultrasonography showed a large hyperechoic intravesical mass. The histologic analysis revealed a spindled cell neoplasm with an immunophenotype consistent with interdigitating dendritic cell sarcoma. Complete resection was achieved, and the patient was well without evidence of tumor 6 years after surgery. Urologists should be aware of this entity, which should be included in the differential diagnosis of bladder tumors.