肺癌肉瘤的诊断和外科治疗

目的探讨肺肉瘤的临床病理特征,诊断、鉴别诊断和合理外科治疗方法。方法回顾我院1980～2008年间收治的21例肺肉瘤患者的临床资料,并结合文献分析。结果21例患者中,男17例,女4例;年龄19～71岁,平均49．1岁;主要临床症状包括咳嗽、咳痰、痰中带血和胸痛,周围型15例,中央型6例;全组19例手术治疗,术前均误诊,手术切除率为100％,术中和术后住院期间无死亡,并发症发生率为26．3％（5／19）。术后病理检查证实肺癌肉瘤,5年生存率为23．8％（5／21）。结论肺癌肉瘤术前易被误诊,早期诊断和外科治疗是关键,手术指证及术式选择应根据患者具体情况而定。     

肺癌肉瘤与肺母细胞瘤的临床分析及文献复习

目的 探讨肺癌肉瘤与肺母细胞瘤的临床特点、诊断、治疗方法、以提高其诊断率。方法 回顾性地总结自１９７９年１月￣１９９８年１１月收住的肺癌肉瘤１５例，肺母细胞瘤２例，并结合献对其组织发生、临床表现、诊断及治疗方法进行分析。结果 肺癌肉瘤及肺母细胞瘤均为肺内罕见的恶性肿瘤，镜下均可见上皮及间质两种成分，但又有其不同之处，手术前很难确诊。肺癌肉瘤主要症状为咳嗽、咳痰，血丝痰等。Ｘ线示以周围型居多，病灶     

放射治疗诱发肉瘤的诊断及治疗（附3例报告）

目的探讨放射治疗（放疗）诱发的肉瘤的诊断及治疗方法。方法对3例因放疗而诱发的肉瘤患者的临床及病理资料作回顾性分析。结果3例均经病理学检查证实,予手术切除或联合化疗。随访8～18个月,1例未见肿瘤转移及复发,1例死于肿瘤转移,1例死于肿瘤复发。结论放疗诱发的肉瘤的诊断需依靠病史及病理检查,治疗以手术切除为主,可联合化疗。     

肺肉瘤样癌2例并文献复习

目的提高对肺肉瘤样癌（lung sarcomatoid carcinoma,LSC）的诊断、治疗及预后方面的认识。方法通过对2例LSC患者的诊治进行分析,结合相关文献复习。结果患者表现为咳嗽、咯血、胸痛,其症状与其它类型肺癌相似,增强CT示环形强化为其特征。肺组织活检确诊肺肉瘤样癌（病理及免疫组化）。手术联合化/放疗可延长患者生存时间。结论肺肉瘤样癌罕见,较一般肺癌更具侵袭性,预后差。本病缺乏特异性临床表征,增强CT扫描示环形强化为其特征,但诊断主要依靠手术病理。手术是LSC的首选治疗方法。     

原发性胸膜脂肪肉瘤的临床特点

目的原发性胸膜脂肪肉瘤是一种非常罕见的肿瘤，本文报道国内首例病例，并探讨其临床特点、诊断及治疗。方法分析我院近期发现的1例原发性胸膜脂肪肉瘤的临床资料并复习相关文献。结果原发性胸膜脂肪肉瘤全世界仅报道17例（包括此例）。本病好发于男性，中老年人多见，病理类型以黏液型多见；临床症状以胸痛和气促最常见；诊断主要依靠影像学和开胸探查。目前治疗推荐手术切除加辅助放疗。结论原发性胸膜脂肪肉瘤的治疗和预后的评估有待进一步积累资料。     

肺转移性横纹肌肉瘤1例

患者女性,６１岁。１９８８年１月曾行“左腰骶棘肌肿瘤”手术,术后病理诊断左腰骶棘肌多形性横纹肌肉瘤。１９９０年２月因左肩背肿物再次入院手术,术后病理诊断左肩背横纹肌肉瘤转移。两次均用环磷酰胺、长春新碱化疗１个疗程,６０钴放疗２个疗程。此次因右侧胸痛伴低热、咳嗽、气促１５天,Ｘ线片示“右胸腔积液”,ＣＴ检查提示为“右肺中央型肺癌伴右肺门淋巴结转移并右胸腔积液”。于１９９７年８月１７日入内科治疗。查体：慢性病容,气管偏左,右肺语颤减弱,呼吸音减弱。左肺未见明显异常。肝脾肋下未触及。临床诊断：“右肺中…     

原发性肾脏滑膜肉瘤1例并文献复习

目的 探讨原发性肾脏滑膜肉瘤的临床病理特征、诊断、治疗和预后.方法 报告1例原发性肾脏滑膜肉瘤诊治过程及临床病理资料,并结合文献分析其临床病理特征.结果 患者临床和影像学表现无特异性,行根治性肾切除术;术中冰冻病理诊断为尿路上皮细胞癌,行患侧输尿管全长切除术;术后常规病理诊断为后肾始基分化欠成熟的双向分化的癌肉瘤,经联合病理会诊及免疫组化检查确诊为肾脏原发性滑膜肉瘤（梭形细胞为主型）.术后生物治疗,随访1 a无复发.结论 原发性肾脏滑膜肉瘤是一种罕见的恶性程度高、进展迅速、侵袭性强的肿瘤,易发生于年轻成人,预后较差;确诊主要依据病理学检查、免疫组化、细胞遗传学,治疗需采取早期手术联合术后化疗、放疗或生物治疗的综合疗法.     

肺癌非外科手术多学科治疗进展

肺癌是一种肺内肿瘤，又是一种全身性疾病，按肿瘤的发展规律，可向周围组织、器官侵犯，又可在血道、淋巴道形成微转移灶，出现远处转移，治疗时必须针对胸部，又兼顾全身。手术、放射治疗（放疗）、化学药物治疗（化疗）3种手段各有特点，互为补充，三者有机结合，缺一不可，形成了现代肺癌多学科综合治疗的格局。多学科综合治疗的原则是区域和全身治疗的有机结合，即根据肺癌病理类型和临床分期制定不同的治疗策略。随着肺癌治疗方法的不断改进，肺癌疗效有了一定提高，其中化疗对小细胞肺癌（SCLC）的缓解率自20世纪80年代初的40％左右提高到70％～80％，而非小细胞肺癌（NSCLC）自15％提高到35％～45％。手术治疗为肺癌治疗方案中的最佳手段，但适合手术治疗者仅占20％-30％，     

小儿横纹肌肉瘤的影像学诊断

目的探讨小儿横纹肌肉瘤（RMS）的cT和磁共振成像（MRI）表现,提高对该病的认识。方法收集经该院手术及病理证实的19例4,JL横纹肌肉瘤,结合相关文献分析其CT和MRI表现。结果位于头面部者2例,腹腔内2例,盆腔内11例,四肢2例,脊柱旁2例。胚胎型17例,腺泡型2例。RMS影像表现为软组织密度或信号肿块,增强后明显强化,可引起邻近骨质溶骨性破坏。结论RMS具有软组织恶性肿瘤的一般影像特征,但缺乏特异性,应结合患儿年龄及临床特征作出综合诊断。     

老年多发非小细胞肺癌的鉴别诊断与外科治疗

目的探讨老年患者肺内多发非小细胞肺癌（MFLC）的诊断策略及有效的治疗方法。方法对I〉65岁的老年MFLC患者的临床资料进行回顾性分析,采用前期研究得出的鉴别诊断策略,对这类病人进行多原发肺癌或肺癌肺内转移的诊断。生存分析采用Kaplan—Meier法,以无病生存期作为研究终点,采用Log—rank检验作生存期比较。结果 2008年1月至2013年6月,共52例老年MFLC患者（每位患者2个肿块,共52对肿瘤）纳入研究,占同期MFLC患者的20．4％。52例患者中,接受单肺叶切除11例,肺叶＋楔形切除19例,双肺叶切除11例,肺段＋楔形切除2例,楔形＋楔形切除9例。无手术并发症或手术死亡病例。术后病理发现50对腺癌,2对腺癌．鳞癌组合。最终诊断为多原发肺癌32例,肺癌肺内转移20例,两类病人的2年无病生存率分别为72．7％和49．2％,差异有统计学意义（P=0．012）。结论老年MFLC患者逐年增加,应加强术前检查和鉴别诊断。对于最终诊断为多原发肺癌或者肺内转移的病人,治疗上应该区别对待,后者可能不能从手术治疗中获益。     

Carcinosarcoma in the cecum

Carcinosarcoma of the colon is rare. Seventeen cases have been reported in the English literature. Most cases occurred in the left side of the colon. Indeed, there is only one reported case of cecal carcinosarcoma. Carcinosarcoma has a tendency to distantly metastasize and shows dismal prognosis. We report a case of carcinosarcoma in the cecum and review the literature describing colonic carcinosarcoma.     

肺原发性癌肉瘤21例临床病理分析

原发性肺癌肉瘤21例。本病好发于中老年男性,肺上叶较易累及。中央型略多于周围型,周围型一般肿瘤较大。临床症状出现较晚,明确诊断时往往已有转移。最早出现的转移部位为肺门淋巴结,胸膜及纵隔亦可累及。手术切除后预后较差。 恶性上皮成分通常为鳞癌,其次为腺癌,小细胞未分化癌。间质成分以纤维肉瘤最多风。     

Pulmonary carcinosarcoma with skin metastasis

We describe a case of lung carcinosarcoma in a 70-years-old patient with chronic obstructive pulmonary disease. Pulmonary carcinosarcoma is an unfrequent lung tumor, and usually histologic diagnosis is carried out by microscopic examination of the resected tumor. We observed these situation in our patient that was diagnosed of squamous cell carcinoma before the surgical resection by transthoracic needle aspiration. One month after surgery he developed a lesion in the infranasal area that was identified as a skin metastasis of lung carcinosarcoma. There is no previously reported case of skin metastasis of this rare tumor of the lung, that contain an admixture of malignant epithelial and mesenchymal elements. Clinical symptoms of pulmonary carcinosarcomas are not different from other lung tumors. The treatment when it is possible is the surgical resection of the tumor. We review histologic, diagnostic and therapeutic features of lung carcinosarcomas.     

Carcinosarcoma of the lung: a report of 3 cases and a review of the literature

Three cases of lung carcinosarcoma are reported. This kind of tumour accounts for 0.1 percent in lung tumours. 53 cases in the literatures were reviewed. Authors analysed the histology, morphology, diagnosis, treatment and diagnosis. The carcinosarcoma is single or multiple symptoms of the carcinoma in the bronchi appear early, but it is difficult to diagnose it early. Final diagnosis depends on the biopsies.     

Carcinosarcoma of the ampulla of vater: a case report with immunohistochemical and ultrastructural studies

Carcinosarcoma of the duodenum has not been reported previously, although this type of tumor has been detected in other organs. We present here a case of carcinosarcoma of the duodenum, including immunohistochemical and electron microscopical findings. An ulcerating tumor, located in the duodenal ampullary region, contained two divergent components: ordinary differentiated tubular adenocarcinoma, and sarcomatoid tissue composed of spindle tumor cells. Immunohistochemically, the adenocarcinoma cells were stained with antibodies against epithelial markers including keratin and CA19-9. In contrast, the sarcomatoid tissue was strongly positive for vimentin and was focally positive for myoglobin, keratin, and CA19-9. We speculate that the sarcomatoid element of the carcinosarcoma arose from part of the ordinary adenocarcinoma tissue.     

Basis for selection of anticoagulant drugs for therapeutic trials in human malignancy

Evidence indicates that progression of the Lewis lung carcinoma in mice and small cell carcinoma of the lung in humans is retarded by warfarin administration. This suggests that vitamin K-dependent pathways are of importance in the pathogenesis of these tumors. Available data were reviewed for these tumor types in an attempt to explore mechanisms and to gain insights that might guide the selection of other coagulation-reactive drugs for testing in future controlled clinical trials in small cell carcinoma of the lung. While many differences exist between the Lewis lung tumor and small cell carcinoma of the lung, both are rapidly growing malignancies of pulmonary origin that metastasize early to kill the host after a short time. Both are favorably influenced by combination chemotherapy and radiation therapy as well as anticoagulant treatment. Peripheral blood changes indicative of disseminated intravascular coagulation occur in each of these tumor types, and tumor cells from both are capable of interacting with the coagulation mechanism. While many details concerning the host-tumor interaction remain to be elucidated, the considerable and diverse information available for these tumor types provides a secure base for future investigation. It is postulated that certain drugs in addition to warfarin might reasonably be studied in controlled clinical trials of small cell carcinoma of the lung and that drugs other than warfarin might be effective for tumor types that are not responsive to this agent.     

系统性血管炎肺受累

系统性血管炎是风湿性疾病乃至内科领域最具有挑战性、最复杂,也是最常见的一类疑难性疾病,可累及全身 多系统。肺脏作为人体最重要的器官之一,有丰富的血管床,是系统性血管炎最常累及的部位,可表现为间质性肺疾 病、弥漫性肺泡出血、肺部结节、肺动脉高压、肺动脉瘤、肺动静脉血栓形成等,易与感染、肿瘤等疾病相混淆。由于其 发生率高,临床表现复杂,诊断鉴别困难,预后差,因此正确认识系统性血管炎肺受累的表现,早期诊断,积极治疗,将 有助于显著改善患者的预后。     

肺结节与肺癌全程智能管理云平台的构建及临床应用

目的 我国肺癌患病率、病死率稳居恶性肿瘤第一位。创建肺结节与肺癌全程管理模式,将肺结节纳入规范诊疗体系,以期实现肺癌早诊早治,提高患者复诊依从性。方法 构建肺结节与肺癌全程智能管理云平台,建立恶性肺结节队列、良性肺结节队列和未确诊肺结节规律随访队列。收集人口统计学、影像、病理、疗效等信息,通过全程管理后分析人群特征、诊治精准性与复诊率。结果 创建了基于重庆市肺结节管理工作室的肺结节与肺癌全程智能管理云平台。2019年1月至2021年12月期间,纳入全程管理的肺结节与肺癌患者共5 144例,确诊肺结节1 546例(30.05%),其中恶性1 194例,良性352例;Ia期肺癌占确诊肺癌的(80.80%);随访中肺结节3 598例(69.95%)。2019年进入平台登记管理后未确诊的肺结节,有≥1次复诊记录的患者652例(74.86%);2020年667例(65.67%);2021年245例(13.94%)。结论 建立肺结节与肺癌全程智能管理云平台有利于提高恶性肺结节早诊早治率与患者依从性,促进患者自我健康管理模式养成,改善肺癌预后,值得尝试。     

A case of preoperatively diagnosed primary pulmonary leiomyosarcoma]

A 29-year-old woman had been suffering from right back pain for 3 months. Chronic pulmonary thromboembolism was suspected and she was referred to our hospital. She presented with no risk factors for thromboembolism, and during the previous 6 months had lost 4 kg in body weight. Chest radiography showed nodular shadows in the lower field of the right lung. Contrast-enhanced computed tomography demonstrated a filling defect in the right pulmonary artery and nodular lesions in the lower field of the right lung, which were considered to be signs of pulmonary infarction. Absence of perfusion into the right lung was demonstrated by a perfusion scan. Right heart catheterization showed normal pressure in the pulmonary arteries, and pulmonary angiography showed an abrupt cutoff of the right pulmonary artery, which was similar to the finding of pulmonary thromboembolism. A transvenous catheter suction biopsy was performed in the right pulmonary artery and the histopathologic findings yielded a diagnosis of leiomyosarcoma. The patient underwent surgical resection under total cardiopulmonary bypass. A large tumor completely filled the right main pulmonary artery and invaded the posterior wall of the pulmonary trunk close to the left main pulmonary artery. Primary pulmonary leiomyosarcoma is a rare tumor and its prognosis is very poor. Radical surgical resection is the only effective treatment, but early diagnosis is very difficult. Transvenous catheter suction biopsy is a useful procedure for the early diagnosis of pulmonary artery sarcoma.