恶性心包积液细胞块病理检查的意义（附30例分析）

目的：通过心包积液中肿瘤细胞制作的细胞块进行疾病诊断和肿瘤来源的鉴别诊断,评价心包积液对临床诊断的价值。方法：30例恶性肿瘤并发恶性心包积液患者,心包穿刺引流积液送病理制作细胞块进行肿瘤来源的诊断,验证临床疾病的诊断。结果：30例恶性心包积液细胞块鉴别诊断病因中,肺癌21例,其中腺癌17例,鳞癌3例,小细胞未分化癌1例;乳腺癌4例;食管癌1例;结肠癌2例;红细胞太多,无法制作细胞块2例。结论：恶性心包积液细胞块留取对疾病的诊断有重要临床意义,对晚期肿瘤转移性心包积液确定原发灶提供病理诊断和临床肿瘤的治疗有积极的作用。     

Napsin A、TTF-1及CK7在肺腺癌转移性心包积液的表达及其意义

目的 探讨Napsin A、TTF-1及CK7在肺腺癌转移性心包积液中的表达及其临床诊断的意义。方法 收集肺腺癌心包转移患者心包积液样本32例,其他肿瘤心包转移患者心包积液样本13例（其中乳腺癌10例,胰腺癌3例）,非肿瘤性心包积液样本31例。制作心包积液细胞块切片,进行常规HE染色,同时采用免疫组织化学检测Napsin A、TTF-1及CK7的表达。结果 HE常规染色仅能部分诊断恶性心包积液的组织学类型,无法判断组织学来源。肺腺癌转移性心包积液Napsin A的阳性率为87.5 %（28／32）,TTF-1的阳性率为75.0 %（24／32）,CK7的阳性率为93.8 %（30／32）。乳腺癌转移性心包积液CK7的阳性率为30.0 %（3／10）,Napsin A和TTF-1均为阴性;胰腺癌转移性及非肿瘤性心包积液样本中三者均未表达。结论 Napsin A、TTF-1和CK7联合检测对肺腺癌转移性心包积液有较高的特异性,对判断恶性心包积液的组织学来源具有较高的诊断价值。     

恶性浆膜腔积液细胞块在分子病理诊断中的应用

目的 探讨恶性浆膜腔积液细胞块技术在分子病理诊断上的应用价值。方法 85例恶性浆膜腔积液分层离心获取肿瘤细胞并制作成石蜡细胞块,应用常规病理染色、免疫组化染色、荧光原位杂交（FISH）、基因测序等方法对其进行检测。结果 细胞块切片中肿瘤细胞丰富、集中,细胞结构清晰,并保持部分组织学形态特征,免疫组化染色能够辅助肿瘤确诊及明确分型,荧光原位杂交和基因测序可提供基因扩增及突变情况。30例非小细胞肺癌样本中10例EGFR基因的FISH阳性,8例EGFR基因突变。结论 恶性浆膜腔积液细胞块技术对于疾病的诊断有重要临床意义,可以帮助肿瘤确诊并查找原发灶,有效指导肿瘤分子靶向治疗。     

30例恶性心包积液综合治疗疗效分析

自2001年3月至2005年6月,我科对伴有恶性心包积液的30例晚期癌症患者进行经皮心包腔置管引流术并每周注药的综合治疗,取得了较好疗效,无明显不良反应及并发症,现报告如下。一、资料与方法1.临床资料:选择2001年3月至2005年6月恶性心包积液患者30例,男18例,女12例。年龄28～70岁。均有影像学、病理或细胞学诊断。肺癌23例(腺癌15例,鳞癌8例),乳腺癌5例,胃癌2例。Karnofsky评分40分以上。心包积液脱落细胞学均查到恶性瘤细胞。血性积液24例,草黄色积液6例。2.临床症状:患者均有不同程度的心包填塞表现,如气短、呼吸困难,不能平卧,心音低,心浊…     

恶性心包积液细胞蜡块联合基因检测在明确肿瘤来源及肺腺癌个体化治疗中的应用

目的 探讨恶性心包积液细胞蜡块联合基因检测在明确肿瘤来源及肺腺癌患者个体化治疗中的应用价值.方法 选择50例恶性心包积液标本作为研究对象,制备细胞蜡块,进行苏木素-伊红(HE)染色,同时选择钙网膜蛋白(CR)、间皮细胞(MC)、肾母细胞瘤基因1(WT1)、癌胚抗原M2A单克隆抗体(D2-40)、尾型同源盒转录因子2(C...     

心包腔置管引流治疗恶性心包积液临床观察(附5例报告)

我科自 2 0 0 0年 8月至 2 0 0 1年 7月 ,对 5例恶性心包积液患者行B超引导下心包腔穿刺置管闭式引流术 +腔内化疗 ,取得较好疗效。现报告如下 :1　材料与方法1 1　临床资料　全组恶性心包积液患者 5例中 ,男2例 ,女 3例。年龄 35岁～ 6 0岁。全组患者均经病理诊断 :非小细胞肺癌 3例 ,乳腺癌 2例。恶性心包积液均经胸部X线、B超和心包积液脱落细胞学查实。全部患者均有中到大量心包积液 ,有明显心包填实症状。1 2　治疗方法　所有患者穿刺前均行B超检查 :通过胸骨旁、心尖部、肋缘下等多部位探查 ,了解积液量及积聚部位 ,选择最佳穿刺…     

经皮置管对恶性心包积液的诊断和治疗(附34例报告)

目的　对于恶性心包积液者 ,经皮一次心包穿刺置管达到急救、诊断和对因治疗。方法34例拟诊为恶性心包积液者 ,穿刺心包成功后 ,经针尾部置入外径 1.8mm引流管 ,以医用三通将引流管与引流袋连通。收集引流袋内积液中类似组织状的凝集块 ,按组织活检标本处理后光镜检查 ;同时送检积液细胞学。病因明确者 ,心包内注入抗癌药 4h后再开放引流 ,引流量连续 2天≤ 30ml/ 2 4h时拔管。结果　 34例均一次置管成功 ,心包填塞症状于 15～ 6 0min解除。凝集块阳性率 91.2 % ,细胞病理分型确定率 10 0 % ;细胞学阳性率 6 1.8% ,细胞病理分型确定率 81.0 %。两种方法比较 ,差异均有显著性 (P <0 .0 0 5 ,P <0 .0 2 5 )。凝集块和细胞学两种方法相加阳性率 94.1%。 2 9例心包内注入抗癌药行局部化疗。 33例置管引流时间平均 6d。结论　此法是一种集急救、诊断、对因治疗为一体的心包置管引流方法 ;以积液凝集块细胞病理学作为病因诊断的手段 ,是一种无创、阳性检出率高的病理标本获取和检查方法。     

氨甲喋呤加地塞米松治疗17例恶性心包积液临床观察

氨甲喋呤加地塞米松治疗恶性心包积液临床少见报道。1986年1月至1999年12月,我院共收治恶性肿瘤转移性心包积液31例,其中17例在B超引导下,行心包穿剌注入氨甲喋呤和地塞米松,取得较好疗效,现报告如下。1 材料与方法 诊断依据：本组17例均为恶性肿瘤转移性心包积液。原发性肿瘤均经病理和各种影像学证实;心包积液均经B型超声切面显像证实;2例心包积液中找到恶性肿瘤细胞。性别与年龄：男12例,女5例,男女之比为2．41。年龄28～65岁,平均年龄42．1岁。病因分析：肺癌11例（64．7％）,其中腺癌8例,鳞癌2例,小细胞未分化癌1例。…     

细胞蜡块结合免疫组化技术在胸腔积液中的诊断价值

目的探讨细胞蜡块结合免疫组化技术在胸腔积液中的诊断价值。方法选取郑州大学第二附属医院2018年7月至2020年5月送往病理科的79例临床高度怀疑恶性的胸腔积液标本,同时进行常规细胞学制片及细胞蜡块的制作,制作后均进行常规HE染色,其中细胞蜡块同时进行免疫组化染色。比较2种检测方法的明确诊断率。结果细胞蜡块结合免疫组化技术明确诊断79例(100.00%),而常规细胞学制片明确诊断39例(49.37%),细胞蜡块结合免疫组化技术明确诊断率明显高于常规细胞学制片,差异有统计学意义(χ^(2)=53.559,P<0.001)。结论细胞蜡块结合免疫组化技术可以极大提高胸腔积液的明确诊断率,并可以依靠免疫组化特异指标明确肿瘤组织来源,特别是对留取组织学标本困难的患者意义很大,是一种值得推广的微创诊断方法。     

心包置管术治疗心包积液(附20例分析)

心包积液是临床上常见并严重危胁病人生命的并发症。由于心包壁扩张度有限 ,故短时间内心包积液增多常引起急性心包填塞导致心功能衰竭。我科近年来采用经皮穿刺心包置管术对各种原因引起的心包积液进行诊断及治疗 ,取得了较为满意的疗效 ,现报告如下。临床资料 :自 1996年 6月～ 1999年 12月我科共收治心包积液患者 2 0例 ,男 12例 ,女 8例 ,年龄 2 1～ 85岁 ,平均 5 3 .5岁 ,其中心包穿刺前恶性肿瘤诊断明确者 18例 :乳腺癌 5例、肺鳞癌 3例、肺腺癌 4例、肺未分化小细胞癌 1例、恶性淋巴瘤3例、恶性胸膜间皮瘤 2例 ,以心包积液首诊者 2例…     

肺癌心包转移：附13例报告

162 patients with lung cancer treated in our hospital from 1974 to 1986 are reported. Of these patients, thirteen had pericardial metastasis. There were 9 males and 4 females. The ages ranged from 32 to 73 years with an average of 54. The pericardial metastasis was diagnosed when the patients had pericardial friction sound, hydropericardium with or without malignant cells. Five of them had the above manifestations after lung cancers were confirmed. Four had large amount of hydropericardium, two had pericardial friction sound, and two had hydropericardium accompanied with thorax dropsy as initial presentation. Pathologically, the primary lung cancers were adenocarcinoma (7 cases), squamous cell carcinoma (4 cases) and small cell anaplastic carcinoma (2 cases). Cancer cells were found in 8 of 9 patients with hydropericardium (4 adenocarcinomas, 2 squamous cell carcinomas and 2 untyped carcinomas). It was believed that heart metastasis was rare, but 43.9-58.4% of the patients were found to have heart metastasis by autopsy and pericardium involvement was common. The incidence of pericardial metastasis was 8% in this series. This results accorded with the literatures reported. The data showed that pericardial metastasis is often misdiagnosed if hydropericardium with thorax dropsy appeared initially. It should be emphasized that repeated examination for malignant cells in "single" hydropericardium, especially for those being rapidly accumulated, is crucial for correct diagnosis.     

奥铂治疗恶性心包积液的临床疗效观察

目的观察奥铂治疗恶性心包积液的临床疗效。方法本组29例,支气管肺癌21例(NSCLC19例,SCLC2例),乳腺癌4例,食管-胃癌4例。随机分组:奥铂治疗组15例,对照组(顺铂)14例。超声引导下心包置管引流,心包腔注入奥铂(治疗组)50~100mg/次或顺铂(对照组)30~50mg/次,5%GS或NS稀释至20~40ml,间歇性给药2~3次。结果奥铂治疗组和对照组的完全缓解率及有效率分别为26.7%、21.4%和73.3%、64.3%(P>0.05)。奥铂治疗组与对照组的疗效差异无显著性,毒副作用轻微,无心脏骤停,心肌、冠状血管损伤等严重并发症。结论奥铂治疗恶性心包积液疗效显著,毒副作用轻。     

铜绿假单胞菌注射液治疗恶性胸腔积液和心包积液的临床分析

目的观察铜绿假单胞菌注射液治疗恶性胸腔积液和心包积液的疗效。方法共治疗恶性胸腔积液、心包积液26例。所有患者先行中心静脉导管置管进行积液引流,引流后注入铜绿假单胞菌注射液2～5ml和地塞米松5mg,2%利多卡因10ml,夹闭引流管48h,再开放引流管,根据引流情况连续注药2～3次。结果治疗恶性胸腔积液20例,有效18例（90.0%）;恶性心包积液10例均有效,不良反应为胸痛、气短、发热。结论铜绿假单胞菌注射液应用于恶性胸腔积液、心包积液的治疗,疗效较满意。     

铜绿假单胞菌注射液腔内注入治疗23例恶性心包积液的临床观察

目的：观察铜绿假单胞菌注射液（PA-MSHA）腔内注入治疗恶性心包积液的疗效及安全性。方法：对23例恶性心包积液患者,先心包腔内置入中心静脉导管行持续引流,待积液基本排尽后注入PA-MSHA 2-3ml和地塞米松5mg。夹闭引流管5-7天后复查B超,如效果不佳则再次引流后重复注射上述药物,反之则拔管。结果：共治疗23例,完全缓解14例（60.9%）,部分缓解7例（30.4%）,总有效率91.3%。心包腔内注药后有5例发热,2例胸痛。结论：PA-MSHA腔内注入治疗恶性心包积液疗效满意,不良反应不大。     

Capillary endothelial cell migration: stimulating activity of aqueous humor from patients with ocular cancers

In double-masked studies, various concentrations of aqueous humor (AH) from 157 patients (208 samples) with ocular cancers, nonmalignant ocular lesions, and normal eyes were added to bovine capillary endothelial (BCE) cells plated onto gold-coated cover slips. The phagokinetic tracks made by 100 cells at each concentration were traced, and the mean area of migration plus or minus the standard error of the mean was determined. Data are expressed as the percentages of increase in mean track area made by 100 cells incubated in medium that contained AH samples beyond the mean area of 100 cells incubated in medium alone. The percentage increases in migration-stimulating activity were as follows: a) malignant ocular disease--retinoblastoma (30 samples), 34 +/- 2; malignant melanoma (55 samples), 37 +/- 3; b) nonmalignant ocular disease--cataracts, glaucoma, pseudoglioma, and diabetic retinopathy (36 samples), 14 +/- 2; c) control AH--no ocular disease (51 samples), 9 +/- 1; normal eyes and systemic cancer (36 samples), 38 +/- 6. The percentage increase in endothelial cell migration was as great in cases of systemic cancer as it was in cases of ocular cancer. The endothelial cell migration-stimulating activity in AH from patients with intraocular cancers was significantly higher than the levels in the other groups of patients having no systemic cancer (P much less than .001). In addition, when the results were compared in the control group and the group with benign ocular disease, no significant differences were detected (P greater than .01).     

铜绿假单胞菌注射液腔内注入治疗23例恶性心包积液的临床观察

目的:观察铜绿假单胞菌注射液(PA-MSHA)腔内注入治疗恶性心包积液的疗效及安全性。方法:对23例恶性心包积液患者,先心包腔内置入中心静脉导管行持续引流,待积液基本排尽后注入PA-MSHA 2-3ml和地塞米松5mg。夹闭引流管5-7天后复查B超,如效果不佳则再次引流后重复注射上述药物,反之则拔管。结果:共治疗23例,完全缓解14例(60.9%),部分缓解7例(30.4%),总有效率91.3%。心包腔内注药后有5例发热,2例胸痛。结论:PA-MSHA腔内注入治疗恶性心包积液疗效满意,不良反应不大。     

Diagnosis of Oral Cancers by Targeting VPAC Receptors: Preliminary Report

Introduction: Oral cancer is a major health problem. The study of exfoliative cytology material helps in the differentiation of premalignant and malignant alterations of oral lesions. The objective of this study was to assess the feasibility of detecting oral cancer by targeting genomic VPAC (combined vasoactive intestinal peptide (VIP) and pituitary adenylate cyclase-activating peptide) receptors expressed on malignant oral cancer cells. Patients & Methods: All patients with suspected oral cavity cancers/lesions formed the study group. The samples from the oral cavity lesion or suspicious area were collected with a cytology brush. The harvested material was examined for malignant cells by 1. the standard PAP stain and 2. targeting the VPAC receptors on the cell surface using a fluorescent microscope. Similarly, malignant cells were identified from cells shed in oral gargles. Results: A total of 60 patients with oral lesions were included in the study. The histopathological diagnosis was squamous cell carcinoma in 30 of these. The VPAC receptor positivity both on the brush cytology staining as well oral gargle staining was more sensitive than the brush cytology PAP staining. The accuracy of the various techniques was as follows, brush cytology PAP staining at 86.67%, brush cytology VPAC staining at 91.67% and oral gargle VPAC staining at 95%. Conclusions: This preliminary study validates our belief that malignant cells in the saliva can be identified by targeting the VPAC receptors. The test is simple, easy, non-invasive and reliable in the detection of oral cancers.     

Double primary malignant tumors involving a lung cancer

Patients with multiple primary malignant tumors involving a primary lung cancer have been analyzed at our department in the Gunma University hospital. With reference to the lung cancer, three quarters of these patients were clinically in stages III or IV. The lung cancers were histologically classified into 26 epidermoid cancers, 14 adenocarcinomas, one large cell carcinoma, and one small cell carcinoma. Other primary cancers were 13 gastric cancers, 7 laryngeal cancers, 6 cervical cancers, 3 colon cancers, and other such cancers. Cases manifesting simultaneous cancers showing less than a one-year interval were 15 whereas 27 cases had double primary cancers with intervals of over one-year. Eleven patients had been given radiation therapy for their initial malignant tumor, but only two cases were considered to have incurred a radiation-induced lung cancer with a latent period of 5 and 12 years respectively.