Philadelphia chromosome positive myelodysplastic syndrome and acute myeloid leukemia-retrospective study and review of literature

We conducted a retrospective study to define the significance of Philadelphia chromosome (Ph) in myelodysplastic syndrome and acute leukemia in the adults at this institution and the literature was reviewed. One hundred forty-eight cases of t(9;22)(q34;q11) were identified for the period September 1993 through August 2001. The presentation of 124 cases (84%) was that of typical CML in chronic phase. Nineteen cases (13%) presented as de novo ALL, two cases (1%) presented as de novo AML and three cases (2%) presented as myelodysplastic syndrome (MDS). The estimated incidences of t(9;22)(q34;q11) in ALL and AML are 21 and 0.6%, respectively. Ph+ AMLs are increasingly being reported with either M-BCR or m-BCR gene rearrangements, similar to those found with Ph+ ALL lending support to the notion that Ph+ AMLs are distinct entities and not merely blastic phases of undiagnosed CML. This is further supported by the existence of Ph+ MDS cases.     

直肠癌根治术中双吻合器的应用分析

:[目的]介绍和评价双吻合器在直肠癌低位前切除术中的应用。[方法]对90例直肠癌根治术中行双吻合器吻合的病例进行回顾性分析。[结果]行传统根治术75例 ,扩大根治术7例 ,直肠全系膜切除术(TME)者8例 ,吻合过程顺利。术后切口感染3例(3.33 %) ,吻合口狭窄5例(5.56 %) ,吻合口瘘3例(3.33%)。无手术死亡病例。术后吻合口复发2例 ,腹腔淋巴结转移3例 ,随访期间肝转移5例。全部病例中83例获得随访 ,5年生存率58.6%。[结论]双吻合器应用于直肠癌前切除术中的结直肠吻合具有操作简单 ,节约手术时间和安全等优点 ,并可适当提高低位直肠癌保肛率。     

乳腺癌3.0T MRI动态增强及扩散加权成像特点

目的 分析乳腺癌3.0 T MRI动态增强及扩散加权成像（DWI）的表现特征。方法 回顾性分析经病理检查证实的36例乳腺癌的3.0T MRI影像资料,分析其表现。结果 乳腺癌MRI表现：平扫T1WI病灶呈等或稍低信号;T2WI呈等或稍高信号;肿块形状不规则,部分呈深浅不同程度分叶状,边界模糊,并见毛刺征。DWI像：所有病灶均呈高信号,ADC图呈低信号ADC值为（0.97±0.22）×10^-3 mm²/s。动态增强示：不均匀强化,多呈斑点状、条片状或团状,部分病灶周围血管影增多;时间－信号强度曲线：流出型（Ⅲ型）曲线29例（80.6%）;平台型（Ⅱ型）型曲线5例（13.9%）; 流入型（Ⅰ型）曲线2例（5.5%）。36例中34例诊断为乳腺癌,2例误诊为纤维腺瘤,诊断符合率为94.4%。结论 乳腺癌具有一定MRI表现特征,结合3.0T MRI动态增强及DWI检查对乳腺癌的诊断具有较高的应用价值。     

肺癌术后支纤镜检查的价值

本文报道我院１９８２年２月－１９９２年１０月因肺癌术后支纤镜检查６３例，结果为：支气管痰液阻塞２９例（４６．０３％）；肺内复发癌１１例（１７．４６％），肺内第二原发癌６例，（９．５２％），残端炎症８例（１２．７０％）；残端线头残留４例（６．３５％），残端正常５例（７．９３％）。笔者认为：术后呼吸困难者应行紧急支纤镜吸痰，若病人有血丝痰，不论胸片是否有新病灶，均应立即行支纤镜检查。有助于早期发现肺内     

Palliative surgery of metastatic bone disease: A review of 83 cases

Of a total of 83 patients with metastatic bone disease, surgery was performed in 17 cases at the prefracture stage, in 54 cases after complete fracture and in 10 cases to decompress the spinal cord. Positive short-term results were obtained in 75% of cases. 7 patients presented mild complications. In 2 cases, the patients had to be reoperated. 55% of the patients were still alive after 6 months, 31% after 12 months and 10% after 2 years.     

Endobronchial metastasis: An epidemiologic and clinicopathologic study of 174 consecutive cases

Purpose

Endobronchial metastases from extrapulmonary solid tumors are a rare event and currently available epidemiological and clinico-pathological data mainly derive from anecdotal case reports.

Methods

A series of 174 consecutive cases of endobronchial metastases from extrathoracic solid tumors were collected over a period of 18 years. Immunohistochemistry was performed in 115 cases. Complete imaging features were available in 81 patients, and analysis of the latency period between primitive tumor diagnosis and occurrence of endobronchial metastasis was obtained.

Results

Among all bronchoscopic examinations performed in the same period for malignancy, a mean of 5.6 cases per year consisted of endobronchial metastases (range 2–17 cases), with a statistically significant increase when comparing the periods 1992–2000 (65 cases, 37%) and 2001–2009 (109 cases, 63%) (p = 0.05). Overall, 4% of endobronchial biopsies for suspected malignancy disclosed an endobronchial metastasis from extrapulmonary tumor. Breast (52 cases, 30%), colorectal (42 cases, 24%), renal (14%), gastric (6%) and prostate (4.5%) cancers and melanoma (4.5%) were the most common metastatic neoplasms presenting as endobronchial mass. One-hundred fifty-four cases were identified after the primitive tumor diagnosis (metachronous cases, 89%), 11 cases were simultaneously evidenced in extrapulmonary and endobronchial sites (synchronous cases, 6%), while 9 occult metastatic cases (5%) first presented as endobronchial mass (anachronous cases). Overall, mean latency from extrapulmonary tumor diagnosis and endobronchial metastasis was 136 months (range, 1–300 months). The most frequent symptoms were dyspnea (23%), cough (15%) and haemoptysis (12%), while 26% of patients were totally asymptomatic. At radiology, 53% presented as multiple pulmonary nodules, while other cases presented as hilar and mediastinal mass, single peripheral nodule, atelectasis or pleural effusion.

Conclusions

Endobronchial metastases from extrapulmonary tumors account for about 4% of all bronchoscopic biopsies performed for suspected malignancy and in 5% of the cases the metastasis is the first manifestation of the neoplasm.     

A study of prevalence of cholesteatoma in complications of suppurative otitis media

Complications of suppurative otitis media are common in developing world. Cholesteatoma has been implicated as the causative factor. We studied 76 cases of suppurative otitis media presented with complica tions and found that only 64% cases had cholesteatoma. Granulation were present in most of the cases of intracranial complications (16.68%).     

Kaposi's sarcoma in Rwanda: clinico-pathological and epidemiological aspects

The clinico-pathological and epidemiological features of 119 cases of Kaposi's sarcoma diagnosed during the years 1979-1986 in the main pathology department of Rwanda are presented. Skin involvement (89%) was predominant with almost 70% of cutaneous lesions localised on the lower limbs; 11% of cases presented with extracutaneous localisations, 77% (10 cases out of 13) in the lymph nodes. Incidence rises progressively with age, and males are more affected than females with a sex ratio (m:f) of 6.4:1. The highest frequencies were observed in the western prefectures which border the province of Kivu in eastern Zaire. Histologically, three types were encountered: a mixed type (84%), a spindle cell-predominant type (12.6%) and an anaplastic type (3.4%). The factor VIII-related antigen was present in all 40 cases tested by the PAP method. Antihuman immunodeficiency virus antibodies were looked for in 18 cases: 10 cases with localised Kaposi's sarcoma, all of whom were seronegative, and 8 cases with aggressive generalised Kaposi's sarcoma, all of whom were seropositive. The results are compared with those of other authors, and the histogenesis and pathogenesis, particularly the relationship with the acquired immunodeficiency syndrome, are discussed.     

男性乳腺癌30例诊治体会

目的：探讨男性乳腺癌的诊断和治疗方法。方法：回顾性分析自1990年3月-2007年4月期间收治的30例行手术治疗的男性乳腺癌患者的临床资料。结果：行改良根治术27例，行乳腺癌根治术1例，1例行扩大切除术，1例局部切除术；30例患者中浸润性导管癌27例，导管内癌1例，粘液腺癌1例，不典型髓样癌1例。17例进行了激素受体检测：ER阳性率为88．2％（15／17）；PR阳性率为88．2％（15／17）。C—erb—B2检测15例，阳性率为6．7％（1／15）。淋巴结转移14例（46．7％，14／30），淋巴结转移≥4个占50．0％（7／14）；获随访26例，4例失访，平均随访41．1个月。随访时间超过5年的生存者5例，死亡者4例，随访时间不足5年的无瘤存活者17例。结论：对于男性乳腺肿块应当重视并积极开展超声及穿刺病理学检查，首选改良根治术治疗，并根据患者肿瘤分期、淋巴结状况、激素受体情况等辅以放、化疗或内分泌治疗。     

纵隔淋巴结肿大作为非小细胞肺癌N病变标记的意义

报告５６例非小细胞肺癌（ＮＳＣＬＣ）手术摘除的纵隔淋巴结标本的直接观察结果。发生淋巴结肿大（直径≥１．０ｃｍ）假定为Ｎ病变５２例（９２．９％）。其中假定Ｎ１１１例，Ｎ２４１例。经病理学检查确定为Ｎ病变１９例，包括Ｎ１３例，Ｎ２１６例。假定为Ｎ０病变４例，其中１例为真正Ｎ１病变。鳞癌患者普遍为假定的Ｎ２病变，但真正Ｎ病变发生率低（２／１６例，１１．１％），和非鳞癌患者（１４／２５例，５６％）对比，差异有非常显著性（Ｐ＜０．０１）。因此，仅根据纵隔淋巴结大小不能可靠地评估Ｎ病变和术前分期，特别是鳞癌。在发生纵隔淋巴结肿大，但未取得转移病变的组织学依据时，应争取开胸探查手术治疗。     

Thyroiditis: a Clinico-cytomorphological Study with a Reference to the Ethnic Groups of Northeast Regions of India

Definite clinico-cytological criterion is outlined for thyroid lesions. Fine needle aspiration cytology (FNAC) makes it easier to segregate cases of thyroiditis (Chronic lymphocytic thyroiditis/Hashimoto’s thyroiditis—CLT/HT, and subacute thyroiditis—SAT) from other benign and malignant lesions of thyroid. The study was done for a period of 5½ years at a diagnostic centre in Guwahati. Patients underwent FNAC and smears were studied for cytomorphology. A correlation with clinical features and thyroid function, including antithyroid antibody estimation, was done, wherever possible. 792 thyroid lesions were encountered during the study, of which 213 (26.89 %) were cases of thyroiditis (70.43 % CLT/HT, 24.9 % SAT and 3.76 % having overlapping features of CLT/HT and SAT); 2 cases (0.9 %) of CLT showed suspicion of Non-Hodgkin’s Lymphoma (NHL), which was confirmed on histopathology. 24 cases (11.26 %) belonged to different ethnic tribal groups of Northeast India. CLT/HT presented predominantly with diffuse thyroid enlargement, but 12 cases (8 % of CLT/HT cases) had nodular enlargement. Patients presented with predominantly hypothyroidism; however occasional hyperthyroid cases were also seen. SAT showed signs of inflammation and presented with hyperthyroidism. Overlap cases of CLT/HT and SAT showed combined clinico-cytomorphological features of both lesions. 37.5 % cases with overlapping features belonged to tribal communities. A rise in incidence of thyroiditis, particularly CLT/HT, was seen. Overlap features of CLT/HT and SAT was noticed in significant percentage. No bias was noticed amongst any specific tribal community. FNAC, coupled with clinico-serological study, helps to diagnose thyroiditis at early stage.     

Hodgkin's Lymphoma in Pakistan : A Clinico-epidemiological Study of 658 cases at a Cancer Center in Lahore

Objectives: To study the clinico-epidemiological profile of Hodgkin’s lymphoma (HL) in Pakistan. Patients andMethods: We retrospectively studied all histopathologically proven cases of HL, who presented between Dec 1995 toJune 2003 at Shaukat Khanum Memorial Cancer Hospital and Research Hospital (SKMCH & RC). All the relevantinformation was obtained through the hospital based cancer registry and medical records of the selected patients.Results: Six hundred and fifty eight histopathologically confirmed cases of HL were identified. There were 505 malesand 153 females, with a male to female ratio of 3.3: 1. Patients ranged in age from 1 year - 84 years. The mean age atpresentation was 23.8 years. Three hundred and twenty cases (48.6%) belonged to age group ≤ 18 years and 338cases (51.4%) were > 18 years of age. Histopathologically, mixed cellularity (MC) constituted 63.8% of cases, followedby nodular sclerosis (NS) 19.9%, lymphocyte predominant (LP) 7.3% and lymphocyte depleted (LD) 1.2%. Earlystage (stage I and II) disease was present in 43.9% of patients at presentation, while 56.1% patients presented withadvanced stage (stage III and IV). The majority of patients (81.2%) presented with cervical lymphadenopathy.Conclusion: The clinico–epidemiological pattern of Hodgkin’s lymphoma in Pakistan manifested is similar to thatobserved in other developing countries, with male predominance, mixed cellularity as the commonest histologicaltype, advanced stage at presentation and absence of bimodal age distribution.     

Cancer of the nasal cavity.

The experience with 40 consecutive cases of cancer of the nasal cavity seen over a period of 15 years is presented. Males outnumbered females in a ratio or 5 to 3. Age ranged from 35 to 88 years, and the median age was 67 years. Epidermoid carcinoma accounted for 78% of the cases. Smoking from early age was a noticeable habit among these patients. The median length of smoking history was 51 years. Most lesions were diagnosed in an advanced stage of the disease, 58% of the cases being T3 lesions. Regional lymph nodes metastases were infrequent; only 12% of the patients presented nodes on admission; another 5% developed metastatic nodes during the follow-up period. An overall 5-year survival of 56% was obtained. The survival of cases with T1N0 lesions was 91%. Radiation therapy was the treatment of choice employed in 85% of the cases. A 5-year survival of 50% was obtained in these patients. Irradiation offers an additional means of salvaging recurrences after surgery. The special characteristics of tumors of the nasal cavity merit the evaluation of such lesions separately from tumors of the paranasal sinuses.     

乳腺非肿块型强化病变性质的MRI分析

目的探讨乳腺非肿块型强化病变的MRI影像学特点。方法回顾性分析54例有病理结果的非肿块病灶的MRI主要影像特征。结果病理结果19例为恶性,35例为良性。平扫病灶的形态和信号特征不明确。增强扫描：恶性组,病灶分布呈节段性和区域性不均匀强化的占47．3％（9／19）;良性组,病灶呈网状或点簇状均匀性强化的占28．6％（10／35）。MRI诊断乳腺非肿块样病变的敏感度、特异度分别为90．7％、61．4％。结论MRI对乳腺非肿块型强化病变具有较高的诊断价值,结合其形态学特征及DWI有助于非肿块样强化病变的鉴别诊断。     

Metastatic inguinal nodes from an unknown primary neoplasm. A review of 56 cases

Fifty-six cases of this uncommon neoplastic manifestation are presented. These cases represent 0.065% of 86,589 new cases of malignant disease seen at The Princess Margaret Hospital from 1968 to 1982. There were 29 men and 27 women. The median age at presentation was 58 years. Three major groups were identified: inguinal disease, 24 cases; unilateral inguinal plus iliac disease, 16 cases; local plus systemic disease, 16 cases. Pathologic subtypes were anaplastic, 24; squamous, 11; adenocarcinoma, nine; melanoma, nine; and others, three. Survival at 5 years for all patients was 27%. Among 40 patients who presented with inguinal and inguinal plus iliac disease, survival was 37.5% at 5 years. Initial treatment following biopsy was radiation in 35, lymph node dissection in eight, and chemotherapy in four. Excisional biopsy only was performed in nine cases. There were no treatment-related deaths. The findings observed in this study, in which radiation therapy was employed as initial management in the majority of cases, suggests that radiation therapy is a valid alternative to surgery in the management of this disease.     

Intermediate lymphocytic lymphoma: its frequency and characteristics in Japan.

The nature of intermediate lymphocytic lymphoma (ILL) in Japan was investigated. For this purpose, we have reviewed 1,766 cases of malignant lymphoma and related diseases, and 38 cases were selected as ILL. In two cases, small lymphoid cells proliferated as a wide mantle of atrophic secondary follicles. The frequency of ILL in nodal and extranodal non-Hodgkin's lymphoma was 3.4% and 3.9%, respectively. The frequency was high in orbit and salivary gland lymphomas; two out of three cases and one out of six cases, respectively. Age range (median) and sex ratio (M:F) in nodal and extranodal cases were 34-65 (52) years and 2.1:1 and 22-82 (61) years and 1.1:1, respectively. The majority of nodal ILL presented as systemic disease, but extranodal ILL usually presented as localized disease. ILL when treated with chemotherapy and/or radiotherapy had a favorable prognosis, the 5-year survival rate was 82%.     

腺泡状软组织肉瘤临床病理及其组织发生的研究

报告３１例腺泡状软组织肉瘤。此瘤最常发生于年轻人下肢，５年生存率为５４．５％。２８例作免疫组化，２３例肌红蛋白阳性（８２．１％），１８例结蛋白阳性（６４．３％），３例Ｓ－１００蛋白阳性（１０．７％）；而神经原特异性烯醇化酶、神经微丝、溶菌酶、α１－抗胰蛋白酶、第Ⅷ因子相关抗原、角蛋白、上皮膜抗原、波形蛋白均为阴性．２例作电镜观察，瘤细胞浆内可见特殊的菱形结晶。作者认为腺泡状软组织肉瘤与肌细胞性肿瘤的常见类型之间可能存在着内在联系。     

气管支气管树腺样囊性癌MSCT表现

  目的  观察分析气管支气管树腺样囊性癌（adenoid cystic carcinoma,ACC）的MSCT表现,以期提高对该病的认识。  方法  回顾性分析和总结天津医科大学肿瘤医院2004年4月至2013年4月经组织病理证实的19例原发气管支气管树腺样囊性癌的MSCT表现。  结果  19例中气管病变7例,段及以上支气管病变10例,周围型病变2例;腔内外生长型15例（79%）,腔内生长型2例（11%）。气管ACC有明显的沿气管黏膜下浸润延伸趋势,表现为气管壁弥漫环周增厚2例,移行状增厚3例;10例段及以上支气管ACC均表现为腔内外型肿物,8例病变相邻支气管腔内可见息肉样影隆起或突入,7例腔外部分大于腔内。13例增强检查中3例无强化,5例轻度强化,4例中度强化,1例明显强化。  结论  气管支气管树腺样囊性癌MSCT表现具有一定特点,CT可定性诊断,但明确诊断需依靠病理。      

Present status of treatment for invasive cervical carcinoma

The results are presented of a retrospective clinical study carried out on 341 patients affected with cancer of the uterine cervix, with lymphography in the pretreatment diagnostic work-up, treated in our Institute from January 1961 to December 1976. The clinical classification of the patients studied was: 157 cases in Stage I (46.0%), 95 cases in Stage II (27.9%), and 89 cases in Stages III and IV (26.1%). During the period considered, the therapeutic approach for carcinoma of the cervix was practically constant and in line with the therapeutic policy most frequently followed for these neoplasms. For the early stages (9/341 patients or 27.6%) preference was given to a radical surgery and postoperative radiotherapy combination; for borderline cases and "bulky" and "barrel-shaped" lesions, radiotherapy usually preceded surgical treatment to enlarge its indications and improve its results (36/341 patients or 10.5%). The cases that were more developed locally or that presented contraindications to surgery received radiological treatment alone (211/341 patients or 61.9%). Radiotherapy treatment consisted of radium therapy performed with a single application of 226Ra conventional sources, followed by percutaneous irradiation with 60Co-teletherapy in the more developed cases and/or in the presence of lymph node metastases. All the patients were submitted to diagnostic lymphography at the onset of the treatment and 92 (26.9%) had lymph node metastases. In the framework of this clinical review, the 5-year disease-free survival from onset of the treatment varied from 88.2% for the cases at Stage Ib occult, 72.5% for the cases at Stage Ib, 63.8% for the Stage II cases, to 40.5% for the cases at Stage III and IV. The presence of a pathologic report at lymphography makes a considerable difference in terms of disease-free, long-term survival after treatment     

Pattern of ear, nose, pharynx, larynx and oesophagus(enplo) cancers in a rural based hospital

A total of 1527 cases of total body cancer (TBC) presented at M G I M S between 1^st Jan. 1992 to 30^th April 1999. ENPLO cancers comprised 656 (42.9%)casees. Ca cervix was the commonest cancer amongst TBC comprising 15.3% cases. Ca oral cavity was the commoncest among ENPLO cancers comprising 24.3% cases followed by Ca oesophagus comprising 19.1% Ca oropharynx comprising 16.9%, Ca hypopharynx comprising 13.4%, Ca larynx comprising 11.3% and Ca Nose and PNS comprising 5.7% cases. ENPLI cancers constiuted the major burden of TBC in our hospital.