肺鳞癌皮肤转移3例并文献复习

肺癌皮肤转移临床少见,一旦出现多伴有其他部位转移,预后较差,诊断依靠病理学检查。本院自2008年1月至2010年12月发现肺鳞癌皮肤转移3例,报道如下。     

原发性肺黑色素瘤1例报道并文献复习

目的 分析原发性肺黑色素瘤(PMML)的流行病学及临床、病理特点,提高临床医师对PMML的诊断水平.方法 报道了济宁市第一人民医院呼吸科1例经病理确诊的PMML,并对其病理特点及32例PMML患者的治疗进行回顾分析.结果 患者,男,22岁,主因“反复咯血8个月,加重3d”于2011年3月31日在我院呼吸科住院治疗.肺CT是多发结节灶,后行胸腔镜肺活检病理示黑色素瘤.迄今为止,国外诊断PMML 32例,国内报道22例,主要症状为咯血,咳嗽.影像学为孤立性病灶多见.结论 本例肺内多发结节的PMML患者在国内外都是首例报道.手术是目前最好的方法,晚期可以给予放化疗.     

胃原发性恶性黑色素瘤1例并文献复习

胃原发性恶性黑色素瘤是一种罕见的高度恶性肿瘤,应该与转移性胃恶性黑色素瘤、胃低分化腺癌、胃其他原发性肿瘤及转移瘤等相鉴别。该肿瘤位于胃底部,呈浸润性生长。镜下可见肿瘤细胞弥漫性片状分布,细胞呈多形性,细胞核呈空泡状,核仁明显,核分裂象易见,肿瘤细胞内见少量黑色素颗粒。免疫组织学检查发现肿瘤细胞中HMB45、S-100蛋白呈强阳性表达,而不表达Cytokeratin、EMA、CEA。我们通过对1例胃原发性恶性黑色素瘤患者的报道并文献复习,提高对该病的认识。     

肺血管肉瘤的诊断与治疗——附1例报告并文献复习

目的复习肺血管肉瘤的临床表现、病理形态学特点、诊断、鉴别诊断和治疗。方法结合文献报道,回顾性分析5例肺血肉瘤患者临床资料。结果肺血管肉瘤临床症状为胸痛、咳嗽、咯血,肺内多发结节、斑片影,病理检查瘤体主要为血管内衬异型的瘤细胞（血管内皮细胞）,可见相互吻合大小不一形态不规则的血管网,免疫组化CD34、CD31和vimentin阳性。结论肺血管肉瘤是罕见的软组织高度恶性肿瘤,预后差。肺血管肉瘤需与肺腺癌、肺结核、真菌等疾病鉴别。     

肺血管肉瘤的诊断与治疗——附1例报告并文献复习

目的复习肺血管肉瘤的临床表现、病理形态学特点、诊断、鉴别诊断和治疗。方法结合文献报道,回顾性分析5例肺血肉瘤患者临床资料。结果肺血管肉瘤临床症状为胸痛、咳嗽、咯血,肺内多发结节、斑片影,病理检查瘤体主要为血管内衬异型的瘤细胞(血管内皮细胞),可见相互吻合大小不一形态不规则的血管网,免疫组化CD34、CD31和vimentin阳性。结论肺血管肉瘤是罕见的软组织高度恶性肿瘤,预后差。肺血管肉瘤需与肺腺癌、肺结核、真菌等疾病鉴别。     

肺鳞癌结肠黏膜转移一例报告和文献复习

肺癌患者发生结肠转移非常罕见，患者一般无典型症状，晚期可出现腹痛、消化道出血、梗阻、穿孔等症状，并发症和死亡率较高，短期预后差。本中心报道一位63岁男性患者，以"间断咳嗽和右下腹隐痛"就诊，诊断肺鳞状细胞癌并纵隔淋巴结转移和结肠寡转移，经过PD-1免疫治疗，症状改善明显，目前仍在治疗和随访中。     

肺脂肪瘤1例报道并文献复习

目的 分析肺脂肪瘤的流行病学特征及临床特点,提高临床医师对肺脂肪瘤的诊治水平.方法 报道宁波大学附属医院呼吸科1例经病理确诊支气管脂肪瘤病例并对国内54例肺脂肪瘤病例进行回顾性分析.结果 患者女性,57岁,因“咳嗽、咯痰2个月,发热3周”于2010年8月24日入院,当地医院考虑“肺炎”,给予抗菌药物治疗,疗效欠佳转入我院.入院后行纤维支气管镜检查发现左下叶开口处肿物,后转入胸外科手术治疗,确诊为支气管脂肪瘤.到目前为止,国内能检索到的确诊为肺脂肪瘤的病例共54例.54例患者包括男性44例,女性10例,平均年龄(51.7±11.6)岁,支气管内脂肪瘤44例,肺内脂肪瘤10例,48例患者存在症状,主要症状无特异性,包括咳嗽、咯痰、发热、气促、咯血.50例患者存在异常影像表现,肺不张26例,渗出或实变13例,肿块18例,CT扫描下肿块呈低密度灶,CT值范围在-83～-122 Hu之间.23例患者行纤维支气管镜检查,但仅有6例(26.1％)得到正确诊断.34例患者描述手术方式,其中3例进行内镜下切除,术后恢复良好.结论 肺脂肪瘤以中老年男性为主;胸部CT发现脂肪密度肿块,需考虑脂肪瘤;硬质支气管镜镜下切除为支气管腔内脂肪瘤首选的治疗方式,肺内脂肪瘤或支气管脂肪瘤已发生肺实质的不可逆损害应手术切除.     

以肺栓塞为表现的绒毛膜上皮癌肺转移一例报道并文献复习

绒毛膜上皮癌（CCA）是一种恶性滋养细胞肿瘤,多由胚胎时期原始生殖细胞异常分化导致,常发生于性腺部位,常出现肺转移,进而增加肺动脉高压和肺栓塞发生风险。本文报道1例罕见的以肺栓塞为表现的CCA肺转移患者,其为中年女性,肿瘤病灶位于右肺动脉干,经皮肺动脉腔内组织活检病理检查证实为CCA肺转移。同时笔者对相关文献进行总结,以提高临床医生对该病的诊治水平。     

肺鳞癌胰腺转移病理分析并文献复习

肺鳞癌发生胰腺转移病例在临床上较少见。我科在2008年09月的送检1例。现结合文献报告如下。一、患者,男性,64岁。因右下肺鳞癌术后一年余,咳嗽咳痰发热伴乏力3天于2008年09月12日入院,发病过程中无咯血,无胸闷胸痛。发病感身体酸软,食欲减退。体格检     

肺嗜酸细胞类癌三例并文献复习

目的 探讨肺嗜酸细胞类癌的临床和病理特征及鉴别诊断要点.方法 观察2003年1月至2005年12月收治的3例肺嗜酸细胞类癌患者组织病理学及免疫组织化学改变,同时结合临床资料及相关文献进行复习.结果 3例患者均为男性,年龄32～73岁,临床症状以咳嗽、咳痰及咯血为主.组织细胞学特征为实性片状或巢团状排列的肿瘤细胞内可见大量嗜酸性颗粒.免疫组织化学染色可见肿瘤细胞中神经分泌标记物神经特异性烯醇化酶、突触素及嗜铬素A表达.结论 肺嗜酸细胞类癌是罕见的恶性肿瘤,组织学、免疫组织化学及电镜观察对于该病的诊断和鉴别诊断具有重要作用.     

Colonic metastasis after resection of primary squamous cell carcinoma of the lung:A case report and literature review

Lung cancer is a common malignancy in the world;however symptomatic colonic metastasis from primary lung cancer is rare.A 64-year-old man was originally found poorly differentiated squamous cell carcinoma of right lung and received right lower lobectomy and lymph node dissection.Three years later,the patient presented to our emergency room with the symptom of upper abdominal pain and weight loss.Abdominal palpation and computed tomography scan of the abdomen revealed a large mass measuring 7.6 cm×8.5 cm in the ascending colon.Colonoscopy and biopsy revealed poorly differentiated squamous cell carcinoma with similar morphological pattern to that of the previous lung cancer.Chemotherapy was given and the patient died 5mo later.Lung cancer metastatic to the colon confers a poor prognosis:overall survival ranged from 5 wk to 1year,with a median survival of 3 mo after the diagnosis of the colonic metastasis.     

Solitary pancreatic metastasis from squamous cell lung carcinoma: A case report and review of literature

BACKGROUNDPancreatic metastases from squamous cell lung carcinoma (SCLC) are unusual. These lesions are often asymptomatic and detected incidentally or during follow-up investigations, occasionally several years after removal of the primary tumor.CASE SUMMARYA 56-year-old male with SCLC developed jaundice 1 mo after the cancer diagnosis. An abdominal computed tomography (CT) scan showed a mass in the pancreatic head with distention of both intra- and extrahepatic biliary ducts. Endoscopic retrograde cholangiopancreatography and sphincterotomy were performed first, culminating with plastic biliary stent placement. Cytological examination of the pancreatic mass sample collected by fine-needle aspiration (FNA) under endoscopic ultrasound (EUS) guidance revealed the presence of malignant cells compatible with well-differentiated squamous cell carcinoma. After liver function normalized, chemotherapy was initiated with carboplatin and paclitaxel; however, 4 d later, the patient presented dysphagia. Cervico-thoraco-abdominal CT showed tracheoesophageal fistula and stent migration. After replacement with a 10 cm/10 mm uncovered metallic biliary stent and treatment of the tracheoesophageal fistula with a fully covered esophageal stent, the patient was able to start oral feeding progressively. He died 9 mo after the initial diagnosis.CONCLUSIONThe diagnosis of pancreatic metastasis from SCLC is challenging for clinicians. EUS-FNA is the primary exam for confirmatory diagnosis.     

原发性肺黏液表皮样癌1例报告并文献复习

目的 提高对原发性肺黏液表皮样癌的认识.方法 结合1例原发性黏液表皮样癌患者的临床资料,搜集13篇国内文献的199例患者的临床资料以及复习国内外相关文献,分析、归纳该病的临床表现、影像学特点、病理学特征、诊断及鉴别诊断、治疗及预后.结果 原发性肺黏液表皮样癌的临床症状为咳嗽、咳痰、胸闷、胸痛,但症状缺乏特异性.胸片常显示出肺不张或肺炎,CT主要表现为光滑分叶状或息肉状肿块伴远端支气管黏液嵌塞和肺不张.病理学检查主要特征是可见不同比例的黏液分泌细胞、鳞状表皮样细胞以及中间型细胞组成,未见角化.治疗首选手术,放、化疗治疗效果目前没有得到肯定.预后相较于传统的非小细胞肺癌更好.结论 原发性肺黏液表皮样癌罕见,容易误诊,应充分认识该病的有关特点,提高疗效,改善预后.     

屎肠球菌所致肺脓肿一例并文献复习

目的 提高对屎肠球菌所致肺脓肿的认识,提高其诊断及治疗水平.方法 回顾性分析解放军总医院呼吸科1例经病理及肺组织细菌学培养确诊的屎肠球菌性肺脓肿病例并进行相关文献复习.结果 患者男,60岁,因"反复咳嗽、咳痰6个月余,加重伴痰中带血3个月余"于2008年1月30日入院,入院前曾怀疑"肺栓寒"、"肺癌"等,在外院2次CT引导下经皮肺穿刺组织活检考虑为"肺炎",但经多种抗菌药物治疗效果差,肺部病变进展伴空洞形成.入院后在CT引导下经皮肺穿刺组织活检及细菌学培养,确诊为屎肠球菌肺脓肿,根据药敏试验结果给予万古霉素、替考拉宁及利奈唑胺治疗后好转.到目前为止,国内外能检索到确诊为肠球菌性肺炎或肺脓肿的个案报道共13例,其中屎肠球菌性肺脓肿3例.结论 屎肠球菌性肺脓肿极少见,确诊需要病理及肺组织细菌学培养;根据药敏试验结果应用抗菌药物可取得较好疗效.     

Gastric metastasis from small cell lung cancer:A case report

Small cell lung cancer(SCLC) represents a group of highly malignant tumors that give rise to early and widespread metastases at the time of diagnosis.The preferential metastatic sites are the brain,liver,adrenal glands,bone,and bone marrow.However,metastases of the gastrointestinal system,especially the stomach,are rare; most cases of stomach metastasis are asymptomatic and,as a result,are usually only discovered at autopsy.We report a case of gastric metastasis originating from SCLC.The patient was a 66-year-old man admitted to our hospital due to abdominal pain.He underwent gastroscopy,with the pathological report of the tissue biopsy proving it to be a small cell cancer.Immunohistochemistry was positive for CD56,synaptophysin,and pan-cytokeratin.These results confirmed the diagnosis of gastric metastasis of a neuroendocrine small cell carcinoma from the lung.     

Colonic metastasis from primary carcinoma of the lung: report of a case and review of Japanese literature

We report a rare case of colonic metastasis from primary carcinoma of the lung. A 59-year-old man who underwent pulmonary surgery for lung cancer was referred to our hospital in June 2007. The patient complained of abdominal pain, and barium enema examination at another hospital had demonstrated a descending colon tumor. Postoperative histopathological and immunohistochemical findings indicated that the tumor was a colonic metastasis of lung cancer. Three months postoperatively, the cancer had metastasized to the brain, and the patient underwent radiotherapy. He survived for more than 1 year after colonic surgery. Clinically apparent metastases from lung cancer to the colon are rare, and in the 50 Japanese cases retrospectively investigated here, the prognosis was poor.     

Primary splenic angiosarcoma with liver metastasis: A case report and literature review

Primary splenic angiosarcoma(PSA) is an unusual and highly malignant vascular tumour with a high rate of metastatic. Moreover, the research on prognosis of the disease is poor. The epidemiology, etiology, clinical diagnosis and treatment of the disease remain challenging, because case reports of the disease are few in number. In accordance with other malignant tumors, PSA is very aggressive, and the majority of patients in which this disease is found are at an advanced stage. Almost all patients die within 12 mo of diagnosis irrespective of treatment. We report here a woman who had complained of upper bellyache and anorexia for 10 d. Magnetic resonance imaging showed enlargement of the spleen with multiple heterogeneous masses in the lower pole of the spleen. A hand-assisted laparoscopic splenectomy was performed which allowed histopathologic diagnosis. The patient was diagnosed with PSA and liver metastasis, and succumbed to the disease 35 d after surgery. The literature was finished combined with the clinical features, diagnosis and management of PSA.