Clinical Analysis of 45 Patients with Thymic Carcinoma

OBJECTIVE To retrospectively evaluate the prognostic factors for advanced thymic carcinoma.METHODS The data from 45 patients with advanced thymic carcinoma were retrospectively analyzed according to Masaoka stage criteria. There were 29 Stage Ⅲ patients and 16 Stage Ⅳ patients (13 Stage IVA patients and 3 Stage IVB patients).According to the World Heath Organization Histological Criteria (2004), 25 cases were identified as low-grade and 20 cases were identified as high-grade. All diagnoses were confirmed by biopsy. Five patients underwent gross total resection, 21patients underwent subtotal resection and 19 patients underwent biopsy alone. Forty-two patients received radiotherapy with a median dose of 60 Gy, and 37 patients underwent conventional radiotherapy, including local irradiation and expanded irradiation.Local irradiation volume covered the primary tumor bed and approximately 1-2 cm2 surrounding the tumor (according to preoperative imaging). Expanded irradiation volume covered the full mediastinal and pericardium areas (with or without prophylactic irradiation in the supraclavicular area). Five cases received stereotactic radiotherapy. Thirty-one patients were also treated with chemotherapeutics, including Cisplatin, VP-16,Endoxan, 5-FU and taxol.RESULTS The median follow-up period was 59 months. The overall 3-year survival rate was 57.8%, and the median survival was 45 months. Univariate statistical analysis showed that the histological subtype and Masaoka stage were prognostic factors.The 3-year survival rate was 61.9% in patients treated with gross total resection and 55.0% in those who underwent biopsy only. The 3-year survival rate was 59.5% in patients treated with conventional radiotherapy and 80% in those treated with stereotactic radiotherapy. The 3-year survival rate was 64.5% in patients treated with simultaneous chemotherapy and 42.9%in patients treated without simultaneous chemotherapy (P >0.05). Chemotherapy in combination with radiation treatment and surgery achieved better outcomes for Stage Ⅳ patients than radiation treatment and surgery without chemotherapy (P < 0.05).CONCLUSION For patients with Stage Ⅲ and Ⅳ thymic carcinoma, complete resection and postoperative radiotherapy or fractionated stereotactic radiotherapy constitute the best treatment solution. Chemotherapy can also be used in combination to improve prognosis. For patients with Stage Ⅳ thymic carcinoma,chemotherapy is necessary.     

Huge Bilateral Pulmonary and Pleural Metastasis from Intracranial Meningioma: A Case Report and Review of the Literature

Summary A case of recurrent meningioma with atypical features and extracranial metastases is reported. A 34-year-old female was operated in 1996, 2000, and 2002, and frontal parasagital meningioma was extirpated. Histological diagnoses of all the resected tumors were meningotheliomatous meningioma, WHO Grade I. However, 2 years later, the tumor recurred in the frontal scalp and was removed again totally. Histological diagnosis was reported as an atypical meningioma; meningotheliomatous type; WHO Grade II. She received radiation therapy. But the tumor had metastasized to the lung and pleura. Transthoracic tru-cut biopsy was performed from large mass of the left lung. Cytopathology was consistent with malignant meningioma, metastasis from the patient’s known intracranial meningioma. Ki-67 staining index at the primary and metastatic sites of the present cases were 7 and 5%, respectively. We reviewed and discussed the histopathological features and mechanisms of metastasizing meningioma.     

Metastasis of renal cell carcinoma to a meningioma

A case of metastatic renal cell carcinoma within an intracranial meningioma is presented. The pathological and radiological findings are discussed.     

Solitary Metastasis from Papillary Thyroid Carcinoma in Cirrhotic Liver with Hepatocellular Carcinoma

We report a surgical case of hepatocellular carcinoma and solitaryliver metastasis from papillary thyroid carcinoma in differentlobes of the liver. The former, located in the right anteriorsuperior segment, and the latter, in the left caudate lobe,were resected simultaneously. The hepatocellular carcinoma wasa micro(thin)-trabecular, pseudoglandular type of Edmondson'sgrade. II. The liver metastasis was a papillary carcinoma offollicular variant from the thyroid. This is the first reportof hepatocellular carcinoma accompanying a solitary liver metastasisfrom papillary thyroid carcinoma without metastasis in otherorgans.     

食管粘膜下癌淋巴结转移12例

 探讨食管粘膜下癌发生淋巴结转移的有关因素及特点,制定治疗早期食管癌的最佳方案.方法:手术切除食管粘膜下癌52例,常规清扫区域淋巴结,分组病理检查,术后进行长期随诊.结果:本组食管粘膜下癌淋巴结转移率为23.1%(12/52),发生淋巴结转移主要与肿瘤的分化程度有关,分化越差,转移率越高,其次与肿瘤的大小、病理形态类型等因素有关.跳跃式转移发生率高,转移淋巴结大部分≤1cm,可能是食管粘膜下癌发生淋巴结转移的特点.结论:对早期食管癌应行食管次全切除术,并常规清扫区域淋巴结.     

脑转移为首发症状的原发性支气管肺癌

本文分析了脑转移瘤为首发症状的原发性支气管肺癌３８例资料，着重对“脑先行”肺癌的二者关系进行探讨。结果表明：①腺癌最易发脑转移２０／３８，未分化癌脑转移最早。②外围型较中心型转移多见。③临床以精神异常及外伤就诊，一般呼吸道症状不明显。④ＣＴ对“脑先行”可起到先果后因的作用。并讨论肺癌脑转移的机制及诊治应取积极的态度。     

Thymic Carcinoma With Glandular Differentiation Arising in a Congenital Thymic Cyst

A case of thymic carcinoma with glandular differentiation arising in congenital thymic cyst in a 50-year-old male is reported. Neoplasia in congenital thymic cyst is a rare phenomenon and is seldom associated with glandular differentiation. It is important to differentiate these neoplasms from carcinomas of die lower respiratory tract and from thymic carcinomas with secondary cystic degeneration, in view of their relatively good prognosis and die therapeutic implications. © 1994 Wiley-Liss, inc.     

鼻咽癌淋巴系统扩散的临床探讨

作者报告１９８８年１月～１９９１年１２月放射治疗鼻咽癌患者１４５６例，其中发生远处淋巴结转移者８２例。根据淋巴系统的解剖特点进行临床观察，结果可见：锁骨上区淋巴结（直径０．５～２。０ｃｍ）２２例，倾向于血源性转移为主；颈淋巴结（＞５．０ｃｍ）１９例，则倾向于淋巴系统转移为主；②鼻咽癌的远处淋巴结转移与颈内静脉淋巴结转移有关：③作者探讨了３例同侧颈淋巴结、纵隔、肺门淋巴结转移，发生同侧肺转移的病例。根据肺淋巴结引流的解剖特点，提示这类肺的转移可能为淋巴结逆行性转移所致。作者还对鼻咽癌淋巴结转移提出了一些治疗建议。     

Pulmonary Metastasis of Renal Cell Carcinoma Resected Sixteen Years after Nephrectomy

A 50-year-old man underwent a left nephrectomy for renal cellcarcinoma of the clear cell type in February, 1978. He was examinedusing computed tomography in September, 1993, and was foundto have a small coin lesion in his right lung. A fine needleaspiration biopsy failed to disclose any tumor cells. He underwenta video-assisted thoracoscopic biopsy of the right lung in February,1994, 16 years after his nephrectomy. The resected specimencontained a coin lesion measuring approximately 1 cm in diameter,and the lesion was microscopically diagnosed as a renal cellcarcinoma of the clear cell type metastatic to the lung. Thepatient is doing well with no signs of re-recurrence six monthsafter the resection of the metastatic lesion. To our knowledge,the time interval between his nephrectomy and resection of themetastatic lesion is the longest ever reported in Japan     

Brain Metastasis of Small Cell Lung Carcinoma: Comparison of Gd-DTPA Enhanced Magnetic Resonance Imaging and Enhanced Computerized Tomography

Small cell carcinoma of the lung (SCLC frequently metastasizesinto the brain, resulting in serious influences upon prognosis.Delayed brain damage caused by prophylactic cranial irradiation(PCI) is also problematic. Gadrinium diethylene triamine pentaaceticacid (Gd-DTPA) enhanced magnetic resonance imaging (MRI) wasperformed to detect early brain metastasis from SCLC, and itsusefulness was compared with contrast computerized tomography(CT). Among 25 SCLC patients, brain metastasis was detectedin 11 by MRI and in 10 by CT, although six of them were completelyasymptomatic. In the 11 patients, 6.3 and 2.4 lesions were respectivelydetected on average by MRI and CT. The ability of MRI to detectmetastatic lesions of 15 mm diameter did not differ from thatof CT, but became different as lesions became smaller (P<0.002),and MRI had a decided advantage over CT because as many as 30lesions of 5 mm diameter were detected by MRI, whereas suchlesions visualized on CT numbered only one (P< 0.0001). MRIwas incomparably superior to CT (P< 0.0004) for subtentoriallesions since 18 lesions were detected on MRI, but only three,measuring 25 mm in diameter, were demonstrated on CT. Gd-DTPAenhanced MRI was determined to be extremely useful in the earlydiagnosis of SCLC brain metastasis. MRI was thought to reducedelayed brain damage caused by PCI if performed according toan adequate schedule.     

Basosquamous Basal Cell Carcinoma with Bone Marrow Metastasis

Basal cell carcinoma (BCC) is the most common cancer in Caucasians. It is slow growing and rarely metastasizes. If left untreated over time, invasive growth can occur. We present a patient case with a primary BCC located in the right sub-mammary area, with extensive metastases to the skeleton and bone marrow. Histopathological examination of the tumour showed BCC with a diverse growth pattern. There were no signs of local metastases. Surgery was successfully performed. Three months post-surgery the patient developed normocytic anaemia and elevated inflammation markers. [¹⁸F]FDG PET/CT showed extensive FDG uptake in the entire skeleton and bone marrow. Biopsy confirmed the infiltration of BCC with similar histopathological features as the primary tumour. Prognosis of metastasized BCC is poor and, therefore, long-term follow-up of patients with risk factors is of importance.     

肝素酶在大肠癌转移中的作用

目的探讨乙酰肝素酶在大肠癌中的表达搜意义。方法应用原位杂交方法检测乙酰肝素酶mRNA在60例大肠癌组织中的定位及表达。结果60例大肠癌组织中,乙酰肝素酶mRNA阳性表达31例（51．66％）。34例大肠癌伴淋巴结转移者,其原发灶内乙酰肝素酶mRNA表达明显高于无转移组,差异有统计学意义（P〈0．01）。乙酰肝素酶mRNA表达与大肠癌组织浸润深度、淋巴结转移有关。结论乙酰肝素酶可能在大肠癌的生长、浸润和转移中起一定作用。     

原发性肝癌复发转移防治的临床与基础研究

简述近年复旦大学肝癌研究所获“九五”国家科技攻关等基金的资助对防治原发性肝癌复发转移的临床与基础研究课题的一些进展。在临床研究方面,亚临床复发作再切除手术是进一步提高疗效的主要途径,但预防复发则甚为困难。术后栓塞化疗（TACE）、生物治疗、术中肝动脉插管、冷冻肝切除等,可能有助于降低术后复发率。在实验研究方面,建立了人肝癌转移动物模型和细胞株。在分子水平对肝癌侵袭性作了研究,初步发现CerbB2、p12、p21、p53、mdm-2、VEGF、TGFα、EGF受体、MMP－2、uPA、uPA－R、ICAM－1与肝癌侵袭性呈正相关;nm23-H1、TIMP－2、Integrinα、E－cadherin、Kai-1则呈负相关。在实验性干预治疗方面,反义H－ras、Suramin、Heparin、抗肿瘤血管生成TNP－470、抗CD3／抗HBx的双特异抗体合并LAK治疗、基质金属蛋白酶抑制剂BBP－94及我所自行设计的β肽等对肝癌转移模型均有抑制转移的作用。预期生物治疗、转移复发的预测指标、多模式的干预治疗对防治肝癌转移甚为重要,其中抗肿瘤血管途径尤为突出。     

2 年内远处转移鼻咽癌28 例分析

 目的 探讨鼻咽癌放射治疗后2年内发生远处转移的影响因素及干预措施。方法 统计2000年及2001年两年首程放射治疗（Ⅲ期、Ⅳa期加辅助化疗）的鼻咽癌303例，治疗后2年内发生远处转移28例，分析其影响因素及辅助化疗的作用。结果 远处转移发生与N分期有关（P〈0．05），加用辅助化疗的Ⅲ、Ⅲ。期病例远处转移发生率与单纯放疗的Ⅰ、Ⅱ期病例相似（P〉0．05）。结论 辅助化疗能减少晚期鼻咽瘤患者远处转移发生率，晚期鼻咽癌病例应综合治疗。     

鼻咽癌远处转移临床相关因素分析

目的 探讨鼻咽癌远处转移的临床相关因素。方法 对135例远处转移和95例6年以上无瘤生存的鼻咽癌患者的性别、年龄、症状、临床分期和局部复发等因素进行对比分析。结果 远处转移组中男性居多，以颈淋巴结转移为首发症状；就诊时转移的颈淋巴结为N3期、T3和T4期、双侧、多个、分布至颈下区、固定且直径≥4cm；局部有颅神经受损；放疗后局部复发者的比率，均明显高于未转移组，2组有显著性差异（P＜0．05）或非常显著性差异（P＜0．01）。结论 男性、首发症状为颈淋巴结转移、N3、T3和T4期以及放疗后局部复发等鼻咽癌患者，是发生远处转移的高危人群，应对此人群采取积极的综合治疗措施。     

Surgical Treatment of Adrenal Metastasis Following hepatectomy for Hepatocellular Carcinoma

In three patients who underwent hepatectomy for solitary hepatocellularcarcinoma (HCC), adrenal metastases, on the right sides of twopatients and the left side of the third were subsequently detectedby ultrasonography (US) and/or computed tomography (CT), andsuccessfully resected after an average interval of 16 monthsfrom hepatectomy. There were no metastatic lesions in the lung,lymph node or bone. Two patients, however, who were found tohave metastasis in the right adrenal also had multiple smallrecurrent foci in the residual liver. The latter were controlledby arterial embolization therapy and the patients are aliveat 12 and three months post-adrenalectomy. In the other patient,with left adrenal metastasis, the serum alpha fetoprotein levelof 3,000 ng/ml returned to normal and he is doing well threeand a half years after adrenalectomy. Since there is no effectivetherapy for metastatic adrenal HCC after hepatectomy, surgerywould appear to be indicated, should no other distant metastasisbe recognized clinically.     

208例食管癌淋巴结转移的临床病理分析

目的探讨食管癌淋巴结转移的规律,相关因素及临床意义。方法对208例食管癌根治术后的临床病理资料进行分析。结果208例中124例发现淋巴结转移,转移率为59．62％（131／208）清扫淋巴结2651个,其中430个淋巴结转移,淋巴结的转移率为16．22％（430／2651）,并讨论了影响淋巴结转移的相关因素。结论对中上段食管癌应行全胸段食管切除,食管胃颈部吻合,彻底清扫各组淋巴结,才能达到根治目的。     

大肠癌淋巴结转移的相关病理因素368例分析

目的　探讨大肠癌淋巴结转移相关的病理学因素。方法　对 3 68例大肠癌切除标本按统一标准 ,进行组织学分类、浸润深度、癌周淋巴细胞反应等项检查 ,探讨其与淋巴结内癌转移的关系。结果　淋巴结内癌转移率为 3 3 4% ,其中肠旁组淋巴结转移率占 77 2 % ,肠系膜淋巴结及系膜动脉结扎处淋巴结转移率占 17 9%和 4 9%。癌肿长径 >6cm及浸润深度达浆膜外 ,癌周淋巴细胞反应强度 > 时癌转移率最高 (P <0 0 0 5 ) ,组织学分级级别越高 ,癌转移率越高。组织类型与癌转移率有明显相关性 (P <0 0 5 ) ;结论　大肠癌淋巴结内癌转移以肠旁组为主 ,常为逐站转移 ,转移率与肿瘤大小、浸润深度呈正相关 ,与分化程度及淋巴细胞反应强度呈负相关 ,与组织学类型有明显相关性。     

Meningeal Chloroma (granulocytic Sarcoma) in Acute Lymphoblastic Leukemia Mimicking a Falx Meningioma

Isolated chloromas (granulocytic sarcomas) are rare tumors. Chloromas are masses composed of immature granulocytic cells. Granulocytic sarcoma occurs primarily in patients with acute myelogenous leukemia and may also arise in patients with other myeloproliferative disorders, but rarely in patients with acute lymphoblastic leukemia (ALL). When dural-based, granulocytic sarcoma may be indistinguishable from meningioma radiologically. We now describe one patient affected by ALL with isolated granulocytic sarcoma mimicking a falx meningioma as initial CNS relapses. These unusual clinical manifestation and radiological finding in ALL should be considered as recurrence of leukemia. Early detection and antileukemic treatment of granulocytic sarcoma are necessarily important for favorable prognosis.