原发胸内恶性纤维组织细胞瘤二例

原发胸内恶性纤维组织细胞瘤（ＭＦＨ）罕见,我院遇见２例。例１　患者男,４０岁。右胸痛伴乏力消瘦８个月,１９９５年３月２７日入院。查体：贫血,右下胸叩浊实音,右下肺呼吸音稍弱。Ｘ线胸片示右下胸有一１０ｃｍ×１５ｃｍ类圆形致密影,边缘光滑,侧位靠前,密度均匀。术前诊断为纵隔肿瘤。术中见右前下纵隔有一１０ｃｍ×１５ｃｍ×８ｃｍ包膜完整肿瘤,肺门及纵隔无增大淋巴结。行单纯肿瘤切除术。病理诊断：非典型纤维组织细胞瘤。５个月后右胸痛复发,伴咳嗽、发热,再入院。Ｘ线胸片示右下纵隔有一１０ｃｍ×１０ｃｍ类圆形致…     

胸腹壁恶性纤维组织细胞瘤的诊治

恶性纤维组织细胞瘤 (ｍａｌｉｇｎａｎｔｆｉｂｒｏｕｓｈｉｓｔｉｏｃｙ ｔｏｍａ ,ＭＦＨ)占全部软组织肉瘤的 18%[1] 。由于对此病认识不深刻 ,常造成临床的误诊和误治。 1978年至1997年 ,作者所在单位诊治发生于胸腹壁的ＭＦＨ共15例。现结合文献复习 ,对胸腹壁ＭＦＨ的诊断和治疗分析如下。材料与方法一、临床资料　本组男性 9例 ,女性 6例。年龄 19～ 71岁 ,中位年龄 5 4岁。原发于胸壁 5例 ,腹壁 10例。无意中发现皮下结节并渐行增大 11例 ,有局部针刺样轻微痛为主诉者 4例。否认局部外伤史 ;血糖均正常。体检见肿块处的皮肤无红热 …     

纵隔巨大恶性纤维组织细胞瘤二例

纵隔巨大恶性纤维组织细胞瘤二例王思愚黄植蕃关键词纵隔肿瘤恶性纤维组织细胞瘤中图号Ｒ７３４．５恶性纤维组织细胞瘤（ＭａｌｉｇｎａｎｔＦｉｂｒｏｕｓＨｉｓｔｏ－ｃｙｔｏｍａＭＦＨ）发生于纵隔者少见，我院于１９９１年及１９９３年收治２例，现报告如下。病例１...     

胃的肝样腺癌的临床病理分析

目的 研究胃的肝样腺癌（ｈｅｐａｔｏｉｄ ａｄｅｎｏｃａｒｃｉｎｏｍａ ｏｆ ｔｈｅ ｓｔｏｍａｃｈ，ＨＡＳ）和病理形态和临床特点。方法 采用常规ＨＥ染色和免疫组织化学方法对３例胃的肝样腺癌进行研究。结果 ３例ＨＡＳ细胞胞质内均有甲胎蛋白（ＡＦＰ），α－抗胰糜蛋白酶（ＡＣＴ）和α－抗胰蛋白酶（ＡＡＴ）表达。肿瘤的发病部位以胃窦部多见，３例均有局部胃壁脉管浸润和局部淋巴结转移，其中２例有肝转移，分别     

胸壁恶性纤维组织细胞瘤

恶性纤维组织细胞瘤ｍａｌｉｇｎａｎｔ ｆｉｂｒｏｕｓ ｈｉｓｔｉｏｃｙｔｏｍａ，ＭＦＨ是成人最常见的软组织肉瘤，但国内外文献对原发于胸壁的ＭＦＨ仅限于小样本的个案报告。１ 材料与方法 １．１ 临床资料 自１９６４年至１９９６年中国医学科学院肿瘤医院胸外科诊治原发性胸壁ＭＦＨ共１５例。男１０例，女５例。年龄１５～６７岁，平均３９．３岁中位年龄３９岁。偶然发现皮下结节增大１０例，以胸痛为主诉５例，合并结肠癌１例有肿瘤家族史。血糖均正常。 影像检查示肿瘤边界不清１３例，侵及肋骨４例、肺１例、包饶…     

重组人干细胞因子对人类急性髓系白血病干／祖细胞自我更新作用的实验研究

应用无血清液体一半固体二次培养法，观察了重组人干细胞因子（ｒｅｃｏｍｂｉｎａｎｔｈｕｍａｎｓｔｅｍｃｅｌｌｆａｃｔｏｒ，ｒｈＳＣＦ）对人类急性髓系白血病干／祖细胞（ＡＭＬ－ＣＦＵ）自我更新的影响。认为ｒｈＳＣＦ是一作用阶段早于白介素３（ＩＬ－３）和粒／巨噬细胞集落刺激因子（ＧＭ－ＣＳＦ）的造血生长因子（ＨＧＦ）。无论单一，还是与其它ＨＧＦ联合，ｒｈＳＣＦ对绝大部分ＡＭＬ患者，均有强大的维持其ＡＭＬ－ＣＦＵ自我更新的作用。但不同ＦＡＢ亚型及ＦＡＢ亚型相同的患者之间，这种维持作用差异较为显著。提示ＳＣＦ在ＡＭＬ病理过程中起重要作用。     

骨肉瘤的大剂量化疗

本文报告ＨＤＭＴＸＣＦＲ治疗原发性骨肉瘤１８例的临床疗效，所有病例除一例经Ｘ线诊断外，余经病理学确诊。ＭＴＸ每疗程剂量０．５～３．０／Ｍ￣２，静滴ＭＴＸ开始至ＣＦ解救时间为１６～１８小时，其毒副反应轻，无一例发生意外。骨肉瘤术后辅助化疗后２年生存率５５．６％，生存５年以上者３例。本文提示，骨肉瘤的辅助化疗有肯定疗效，ＨＤＭＴＸ为有效的辅助化疗方案之一，但剂量不宜过低，只要注意水化，尿碱化及ＣＦ解救，此疗法是安全的。     

原发肺纵隔恶性纤维组织细胞瘤2例

恶性纤维组织细胞瘤 (ＭＦＨ)是一种来自间叶组织的恶性肿瘤 ,胸内ＭＦＨ罕见 ,今将我们收治 2例胸内ＭＦＨ报告如下 :例 1　患者　男 ,2 5岁。咳嗽咳痰伴胸痛 2月 ,15天前咳鲜血一次于 1993年 12月 31日入院。体查 :右下胸叩诊浊音 ,呼吸音消失。ＣＴ片 :右肺门处有 10× 12ｃｍ类园状软组织密度肿块影 ,内见斑片状低密度影 ,边缘光滑。支气管纤维镜 :右中间支气管距上叶开口约 2ｃｍ处见一肿物 ,占据整个管腔 ,表面光滑 ,易出血。术前诊断右中肺中央型肺癌。术中见右肺与胸壁广泛粘连 ,右中下肺肿块约 18× 15× 10ｃｍ ,有完整包膜 ,切开…     

恶性纤维组织细胞瘤颈内静脉转移一例

恶性纤维组织细胞瘤 (ＭＦＨ)是较常见的软组织恶性肿瘤 ,侵袭性强 ,易发生远处转移 ,但转移至颈内静脉者尚未见报道。我院收治 1例 ,现报告如下。患者男 ,78岁。于 2 0 0 2年 3月 15日入院。 15年前发现右腮腺区黄豆大小肿物 ,呈渐增性 ,无明显不适 ,未行治疗。3年前肿物增长迅速 ,局部疼痛。入院前 3个月在外院活检诊断为 :ＭＦＨ。行放射治疗 ,无明显疗效。体检 :颜面双侧不对称 ,右腮腺区及颈上部肿块约 8ｃｍ× 8ｃｍ× 6ｃｍ ,质地中硬 ,无明显压痛 ,活动度差。表面皮肤充血、发红。无面瘫症状。口内咽侧未见明显肿物突出。ＣＴ检查 :…     

肺原发恶性纤维组织细胞瘤的影像表现

探讨肺原发恶性纤维组织细胞瘤（ＭＦＨ）的影像特点,提高术前确诊率。方法对本院７例及文献中４４例共５１例影像资料进行分析。包括胸片５１例,ＣＴ９例及ＭＲＩ１例。结果本院肺原发ＭＦＨ占同期肺癌０．０１％。全组发病中位年龄５５岁。主要症状为咳嗽、血痰及胸痛。随诊４０例中,死因不明５例,复发和（或）转移１５例,复发率为４２．８％（１５／３５）,发生在一年内占８０．０％。肿瘤位于右叶３４例,左叶１７例。周围型４９例,占９６．１％;中心型２例,占３．９％。影像表现：肿瘤呈软组织肿块,瘤体较大,≥５ｃｍ者３５例,占６８．６％。形态呈规则或不规则形。边缘光整或界限清者２９例,占５６．９％;伴有分叶者２２例,占４３．１％;密度均匀者３３例,占６４．７％。少数病灶边缘有毛刺、囊性变及空洞形成。ＣＴ显示病变密度低且有坏死区,周围组织器官受侵。结论肺原发ＭＦＨ的影像表现虽无特征,但瘤体大,边界清,少分叶,少毛刺,密度低,可有别于常见的肺癌和良性肿瘤。ＣＴ及ＭＲＩ检查有助于显示病变内部密度、侵犯范围和转移情况,可提高诊断率。本病变恶性度高,复发转移快,根治切除可有长期生存的可能     

70例肢体软组织肉瘤临床分析

目的 探讨肢体软组织肉瘤(LSTS)的临床特点,并分析影响LSTS患者预后的影响因素.方法 回顾性分析70例LSTS患者的临床资料,包括年龄、性别、肿瘤直径、肿瘤位置、病理分期以及手术外科切缘等临床资料,并对患者进行随访,分析LSTS患者局部复发和发生全身转移的影响因素.结果 术后随访期间,70例LSTS患者中,局部复发患者为15例,局部复发率为21.43%;发生全身转移的患者为22例,全身转移率为31.43%;初治、广泛切除肿瘤以及外科切缘阴性LSTS患者的术后局部复发率和全身转移率低;LSTS患者的术后局部复发率和全身转移率随着FNCLCC分级和MSTS分期的升高而升高,而与LSTS患者的年龄、性别、肿瘤直径、肿瘤位置以及肿瘤深度无关(P﹥0.05).结论 LSTS患者应优先考虑广泛切除治疗,高分期、外科切缘阳性和二次治疗的LSTS患者术后应注意局部复发和全身转移情况的发生.     

腹部恶性纤维组织细胞瘤47例临床和预后分析

目的探讨腹部恶性纤维组织细胞瘤(MHF)的临床病理特点、治疗策略及预后相关因素。方法回顾性分析1970年1月至2000年1月间天津医科大学附属肿瘤医院47例腹部恶性纤维组织细胞瘤患者手术切除治疗情况。所有患者均经手术病理证实,病变单一。结果术后随访中共有32例患者出现复发、转移,术后单纯局部复发13例(29.5%),出现肺及胸膜转移7例(15.9%),肝转移4例(9.0%),骨转移6例(13.6%),肾脏转移2例(4.5%),复发 转移5例(11.4%)。术后1,3,5年无瘤生存率分别为65.9%、40.9%和29.5%,累计生存率分别为70.5%、52.3%和31.8%,中位生存期为18个月。影响预后的主要因素为肿瘤发生的部位、治疗方式、病理类型、肿瘤的局部复发等。以手术为主的综合治疗较单纯手术及放化疗预后好,术后辅以放疗可降低局部复发率,尤其对那些切端阳性患者。结论腹部MHF侵袭性强,复发率高,病理分级差,以手术切除为主辅以放疗有助于提高患者的远期生存率。     

Malignant fibrous histiocytoma of the lung

Twenty-two cases of primary malignant fibrous histiocytoma (MFH) of the lung are described, and a review of the literature is presented. As in the soft tissue, this sarcoma is found primarily in older individuals, usually as a solitary peripheral mass. Chest wall invasion at diagnosis was seen in four cases. The most common histologic subtype was the storiform-pleomorphic type of MFH. Vascular invasion was seen in 50% of cases. Histologic features did not correlate with prognosis, and subsequent aggressive behavior was related primarily to symptomatic presentation, advanced stage at diagnosis, incomplete excision, invasion of the chest wall or mediastinum, and subsequent recurrence or metastasis. Primary MFH of the lung should be distinguished from spindle cell carcinoma and inflammatory pseudotumors, and this histologic differential diagnosis is discussed.     

乳腺癌骨转移相关的临床病理因素的研究

目的：研究与乳腺癌骨转移有关的临床、病理因素，探讨有助于预测乳腺癌骨转移的危险因素。方法：对本院1981年1月～2000年12月手术的3796例乳腺癌患者的随访资料进行回顾分析，根据首发转移部位分组，研究116例骨转移的临床、病理资料，并与内脏转移、淋巴结或软组织转移患者的情况作比较。结果：本组病例首次复发为骨转移者116例，占3．1％；骨转移与患者年龄轻、肿块直径大、临床体检腋淋巴结肿大、腋淋巴结转移数多、病期为Ⅱ／Ⅲ期、组织学类型为非特殊型浸润性癌相关；多因素逐步回归分析术前资料显示，肿块大小、体检腋淋巴结状况与骨转移相关；术后资料中，肿块大小、腋淋巴结转移数、病理类型与骨转移相关。本组骨转移患者均曾接受正规的局部治疗和辅助化疗；首次复发在局部、淋巴结、软组织或局部复发伴远处转移组中，特殊型浸润性癌所占比例明显高于骨转移的患者；骨转移和内脏转移的时间分布无差别，而局部复发和／或淋巴结、软组织转移组，复发时间较骨转移组早。结论：年轻的、肿块分级为T2／T3，临床体检腋淋巴结肿大者，术前有必要进行同位素骨扫描检查；非特殊型浸润性乳腺癌，肿块分级为T2／T3，腋淋巴结转移数≥4枚，为骨转移的高危因素，可在此类病例中开展双磷酸盐的辅助治疗研究。     

Case report: recurrence of soft tissue MFH in bone due to minute intravenous tumor emboli detected by MRI

We recently encountered a case with local recurrence of malignant fibrous histiocytoma (MFH) in the bone after wide resection, caused by minute intravenous tumor emboli which were retrospectively detected in MR imaging. The patient was a 69-year-old woman who initially noticed a mass in her left thigh. The tumor was diagnosed to be MFH, therefore a wide resection was performed; although the tumor was closely attached to the periosteum, it was not difficult to dissect the tumor subperiosteally from the cortex of the femur. The patient received postoperative brachytherapy, but no chemotherapy. Two years later, the tumor recurred with bony destruction of the femur. We reviewed the pre-operative films obtained by various imaging modalities, as well as the histology of the primary tumor, and found minute intravenous tumor emboli in the MR imaging obtained before surgery. Tumor emboli were also observed histologically in the small vessels of the surgically resected tumor. Such intravenous tumor emboli have recently been implicated in the development of regional bone metastasis near the site of the primary lesion in cases of malignant soft tissue tumors. Therefore, we concluded that the tumor recurrence in our case was caused by small tumor emboli invading the perforating veins of the femur. It is therefore emphasized that MR images should be carefully reviewed for the presence of such intravenous tumor emboli before surgery in cases of high-grade malignant sarcomas. As at the time of writing, our patient remains alive and disease-free, with no evidence of any local recurrence or distant metastasis after wide tumor resection for the recurrent tumor.     

^18F-FDG PET/CT诊断骨与软组织肉瘤术后复发及转移

目的 探讨18F-FDG PET/CT在诊断原发性骨与软组织肉瘤术后局部复发和（或）远处转移中的临床价值.方法 回顾性分析28例于2008年5月至2010年6月间,在我中心行手术切除的原发性骨与软组织肉瘤患者的病例资料,并随访其后续的诊治情况.以病理结果 或临床随访作为复发和转移灶的确认标准.随访至少3个月.结果 PET/CT提示局部复发16例,与临床、病理相符15例,假阳性1例.PET/CT监测肿瘤局部复发的敏感性、特异性、准确率、阳性预测值、阴性预测值分别为100﹪、92﹪、96﹪、94﹪和100﹪.PET/CT提示远处转移17例,正确诊断14例,假阳性3例.PET/CT监测远处转移的敏感性、特异性、准确率、阳性预测值、阴性预测值分别为100﹪、79﹪、89﹪、82﹪和100﹪.结论 PET/CT对于诊断原发性骨与软组织肉瘤术后复发及转移,表现为高度敏感性、中度特异性;可以更准确、更全面的发现肿瘤术后局部复发和（或）远处转移,为临床决策提供依据.     

Bone primary sarcomas undergone unplanned intralesional procedures - the possibility of limb salvage and their oncologic results

BACKGROUND: It is quite rare but some primary sarcomas of the bone can be misdiagnosed as benign and be treated using intralesional procedures. An unplanned surgical excision occurs when tumors are removed without the appropriate preoperative evaluation and consideration for the need to obtain tumor-free margins. Residual tumor tissue as a result of unplanned excision of soft tissue sarcoma is a risk factor for local recurrence. METHODS: Twenty-five patients, undergone unplanned intralesional procedures of lower extremities, were enrolled in this study. There were 22 (88%) cases of osteosarcomas, 2 (8%) MFH of bone and 1 (4%) adamantinoma. Twenty-two (88%) cases had a limb salvage and among them, 4 (18%) cases had local recurrences. Three cases (12%) had amputation without any local event. RESULTS: Lung metastasis developed in 6 (24%) cases. The CDF 5 year survival for 22 osteosarcoma cases was 65%(confidence interval: 52-82%). DISCUSSION: Despite the high recurrence rate, the CDF survival of osteosarcoma cases was comparable to the primary one. Limb salvage procedures are worthwhile in cases whose initial radiographic findings simulate benign lesions, showing favorable response to neoadjuvant chemotherapy. The relative contraindication to the limb salvage is cases with a history of a pathologic fracture and extensive operative fixation.     

软组织恶性纤维组织细胞瘤的放射治疗：附12例报告

本文报告12例软组织纤维组织细胞瘤的放疗结果,除1例单纯放疗外,首次术后辅助性放疗4例,其余7例为复发病例,其中2例单行放疗,2例再次手术,2例3次手术及1例5次手术后放疗。放疗剂量除1例因3次手术复发行术前照射2200cGy后而行截肢者外,其余病例为3354～7000cGy/24～40天。全组12例中6例生存1～3年,1例口咽部患者单纯放疗后健在4年余,其余4例无瘤生存5年以上,1例放疗后9个月死于肺转移。本文认为术后放疗可降低局部复发率,有些病例单纯放疗也可治愈,值得进一步探讨。     

胸段食管鳞癌左开胸二野清扫术后复发规律的探讨

目的:分析胸段食管鳞癌根治性左侧开胸二野清扫术后复发的规律,为术后辅助性治疗提供依据。方法:收集1998年6月-2012年12月收治的111例胸段食管鳞癌术后复发的患者,分析其复发情况。结果:111例患者中位复发时间为16.0个月,82.9%患者在术后3年内复发,复发时临床表现以声音嘶哑为最常见（36.0%）。复发类型:单纯局部区域复发76.6%,单纯远处转移6.3%,区域复发合并远处转移17.1%（P=0.000）。局部复发中纵隔淋巴结转移60.4%,下颈锁骨区淋巴结转移48.6%,腹腔淋巴结转移10.8%,吻合口复发15.3%,瘤床区复发1.8%。远处转移26例中,肺转移占50.0%。不同原发部位食管癌之间复发区域的差异无统计学意义（P>0.05）。纵隔淋巴结转移中,上纵隔复发率55.9%,中纵隔19.8%,下纵隔淋巴结转移1.8%（P=0.000）,在纵隔淋巴结复发中,1、2区淋巴结复发率分别为42.3%和34.2%,4区22.5%,7区18.0%。采用logistic分析复发部位与临床资料相关性,结果显示纵隔淋巴结转移与T分期有关。结论:胸段食管鳞癌根治性左开胸二野清扫术后复发多在术后3年内发生,以声音嘶哑常见,淋巴结复发为主要复发类型,其中下颈锁骨区及上纵隔1、2区淋巴结复发多见,不同原发部位食管癌之间复发区域无差异。     

Clinical report on transarterial neoadjuvant chemotherapy of malignant fibrous histiocytoma in soft tissue

Purpose

To review the experience in transarterial neoadjuvant chemotherapy of malignant fibrous histiocytoma (MFH) in soft tissue and to analyze the factors related to prognosis of MFH in soft tissue.

Methods

Between September 1999 and December 2011, 101 cases of MFH in soft tissue patients treated by transarterial administration of Cisplatin, Adriamycin and Norcantharidin were divided into primary group and recurrent group, and the clinical documents were reviewed. Nine factors that might affect prognosis such as age, sex, tumor size, tumor site, tumor infiltration depth, recurrence if any, pathological type, histologic grade and histologic response of chemotherapy were analyzed statistically.

Results

The 5-year relapse-free survival rate and the overall survival rate were 70.5 and 75.0 %, respectively, in the primary group; 56.1 and 57.9 %, respectively, in the recurrent group. Univariate analysis (log-rank test) showed that the factors affecting the prognosis were age (P = 0.03), tumor size (P = 0.01), pelvic tumor (P = 0.02), recurrence if any (P = 0.004), histologic grade (P = 0.01), and histologic response to chemotherapy (P = 0.007). Multivariate analysis showed that the major factors affecting prognosis were pelvic tumor (P = 0.01), tumor size (P = 0.002), histologic grade (P = 0.002), recurrence if any (P = 0.0004), and histologic response to chemotherapy (P = 0.008).

Conclusion

Transarterial neoadjuvant chemotherapy can significantly increase the curative efficacy of chemotherapy and survival rate in MFH treatment.