Benign Metastasizing Leiomyomatosis to the Skin and Lungs,Intravenous Leiomyomatosis,and Leiomyomatosis Peritonealis Disseminata: A Series of Five Cases

Benign metastasizing leiomyomatosis (BML) is a rare disease that typically occurs in women with a history of uterine leiomyomatosis. Benign metastasizing leiomyomatosis occurs more frequently in the lungs but may also develop in other organs and tissues. Other unusual variants of extra-uterine leiomyomatosis include intravenous leiomyomatosis (IVL) and leiomyomatosis peritonealis disseminata (LPD). In this article, three cases of BML are presented. One case, in a premenopausal woman, presented cutaneous metastases. We also present a case of IVL and a case of LPD, which occurred in postmenopausal women. Given the rarity of BML, IVL, and LPD, the authors reviewed the literature and herein discuss the implications for treatment in all five cases. Evidence for treating BML, IVL, and LPD is still scarce, and data available from our series and other small series seem to point to the patient’s hormonal status playing a fundamental part in the treatment plan. Furthermore, a collecting bag when performing excision of uterine leiomyomas may help avoid the potential spreading of leiomyomatosis. Hysterectomized patients with chronic cough, frequent respiratory infections, abdominal discomfort, right heart failure, or non-specific symptoms should be actively screened for BML, IVL, and LPD. Treatment should be individualized according to each patient’s hormonal status and desires.     

16例子宫静脉内平滑肌瘤临床分析

目的：分析子宫静脉平滑肌瘤的临床病理特征,探讨其诊断与治疗方法。方法：回顾性分析自2004年4 月至2009年10月我院确诊的子宫静脉平滑肌瘤患者的临床特征及病理资料。结果：子宫静脉平滑肌瘤的临床表现与子宫肌瘤或子宫肌腺症相似,术前超声诊断率很低,术中绝大部分子宫静脉平滑肌瘤可以诊断,子宫静脉平滑肌瘤可以发生在宫体、宫颈及阔韧带内。手术方式有子宫肌瘤剔除术、全子宫切除术、全子宫+双附件切除术。术后随访有1 例复发。结论：子宫静脉平滑肌瘤是一种具有生长转移特征的的良性肿瘤,术前诊断困难,术中应仔细探查,切除全部肿瘤,且术后要严密随访。     

静脉内平滑肌瘤病延伸至右侧心腔5 例报告

目的：探讨静脉内平滑肌瘤病延伸至右侧心腔的诊断与外科治疗。方法：2001年1 月至2009年1 月我院收治静脉内平滑肌瘤病延伸至右侧心腔患者5 例,年龄41～49岁,心功能（NYHA）Ⅲ级3 例,Ⅱ级2 例。均为女性,5 例患者均有不同程度的心慌、胸闷、晕厥症状,病程4 天～5 个月。体检示双下肢水肿、腹水及肝大2 例,盆腔占位3 例。影像学检查提示,5 例患者下腔静脉、右心占位。3 例有因子宫肌瘤行子宫切除术病史,1 例有左卵巢畸胎瘤剔除史;腹部手术与本次手术间隔15～36个月。肿瘤起源于左右生殖静脉各1 例,起源于左髂内静脉2 例,右髂内静脉1 例。术前行输尿管DJ管植入术2 例。结果：2 例患者接受分期手术。3 例患者一期行盆腔肿瘤及体外循环下行下腔静脉、右心肿瘤切除手术,2 例停循环时间分别为29,43min。无围手术期并发症,术后随访1～72个月,心功能明显改善,其中Ⅰ级4 例,Ⅱ级1 例,1 例术后3 个月B 超发现盆腔复发肿瘤,随访5 年无盆腔包块明显增大,患者无自觉症状。3 例经下腔静脉切开的患者,1 例行下腔静脉重建,其它2 例均直接修补,术后随诊无下腔静脉梗阻。结论：提高对有子宫肌瘤病史或右心房肿物患者的警惕性,外科直视下进行心脏内肿物子宫附件病变组织及盆腔残余瘤体切除术,可获满意的外科治疗效果。     

子宫静脉内平滑肌瘤病3例及文献复习

目的:探讨子宫静脉内平滑肌瘤病(IVL)的临床特征和诊治要点.方法:对接受手术治疗的3例IVL患者的临床和病理资料进行分析,并对相关文献进行复习.结果:3例患者因子宫肌瘤接受全子宫切除手术,术前均未明确诊断出IVL,其中1例在术中偶然发现子宫静脉内瘤栓并将其完整取出,另2例术后病理检查时才发现微小瘤栓,瘤栓组织形态符合良性平滑肌瘤.3例测定雌激素受体,其中2例阳性.3例术后均未经特殊治疗,随诊8～32个月,无异常情况.结论:IVL容易被临床忽视,应注重术前检查及术中探查,根治IVL依靠彻底性手术.     

静脉内平滑肌瘤病2例报告

静脉内或淋巴管内平滑肌瘤病是一种很少见的组织学形态良性的 ,但具明显侵入脉管内生长的平滑肌瘤。现将我们见到的２例报告如下 :例１ :女性 ,４０岁,因月经过多 ,经期延长半年就诊。妇检发现子宫增大如孕３个月大小 ,表面尚平滑 ,Ｂ超提示宫体平滑肌瘤。病理检查 :次全子宫１３ｃｍ×９ｃｍ×７ｃｍ ,表面平滑 ,切面宫壁厚４ｃｍ～５ｃｍ ,后壁见４ｃｍ×４ｃｍ圆形灰白色编织状肿块伴部分粘液变 ,境界清 ,其外周宫壁散见大小０ １ｃｍ～１ｃｍ的灰白色圆形结节 ,呈膨胀性生长外观 ,质较硬 ,部分结节可自宫壁分离或脱落 ,并残留一内壁光…     

累及下腔静脉及右心的静脉内平滑肌瘤病的外科治疗-附2例报道

目的:静脉内平滑肌瘤病是一种较罕见的特殊类型的子宫平滑肌瘤病,临床治疗特殊,本文结合2例患者临床资料及文献对其治疗方式进行探讨.方法:回顾性分析海军总医院于2014年6月至2016年1月期间共收治的2例静脉内平滑肌瘤病患者,其中1例累及下腔静脉,另1例累及下腔静脉及右心房,2例患者均行经腹一期手术,手术均切除子宫平滑肌瘤,同期切开肿瘤侵犯的静脉取出瘤栓.结果:手术均获得成功,顺利取出静脉内及右心房瘤栓,无围手术期死亡或并发症.随访6~24个月肿瘤无复发.结论:静脉内平滑肌瘤病累及下腔静脉及右心时选择单纯经腹一期手术取瘤栓创伤小,安全有效.     

子宫静脉内平滑肌瘤病4例并文献复习

目的:探讨子宫静脉内平滑肌瘤病（IVL）的临床特点和诊治要点。方法:回顾性分析2000年1月至2017年12月于北京大学第一医院经手术病理证实的4例IVL患者的临床资料,并对相关文献进行复习。结果:4例患者平均年龄42.8岁,均未绝经,均有子宫肌瘤病史。以右心功能受损表现就诊1例,阴道不规则出血就诊1例。术前影像学检查提示可疑IVL病灶者2例,术中偶然发现盆腔静脉内瘤栓并将其完整取出者1例,另1例术后病理检查时才诊断IVL,瘤栓组织形态符合良性平滑肌瘤。4例术后均未经特殊治疗。结论:IVL缺乏特异性临床表现,容易被临床忽视,超声、CT及MRI有助于检出IVL,临床上应提高对IVL的认识,注重术前检查及术中探查,根治IVL主要依靠彻底性手术,术后需要长期随访。     

舒芬尼在腹部肿瘤患者术后自控静脉镇痛中的应用

目的:以芬太尼为对照,比较不同剂量舒芬尼用于腹部肿瘤手术患者PCIA的优劣。方法:ASAⅠ～Ⅱ级腹部肿瘤手术80例随机分为4组,每组20例。术后PCIA:Ⅰ、Ⅱ、Ⅲ组分别为舒芬尼0.02、0.03、0.04μg/kg·ml,Ⅳ组为芬太尼0.3μg/kg·ml,镇痛不全者加用哌替啶50mg肌注/次。记录各组使用镇痛泵4、24、48、72小时的VAS值、Ramsay评分,呼吸、血氧变化和恶心、呕吐情况及术后3天每天的镇痛液和哌替啶用量。结果:1)VAS评分:Ⅰ组各时点评分均明显高于其他组(P<0.01);2)Ramsay评分:Ⅰ组术后4、24小时评分低于其他各组(P<0.05),Ⅲ组术后48、72小时评分高于其他各组(P<0.05);3)Ⅳ组恶心呕吐发生率高于Ⅰ、Ⅱ组(P<0.05),呼吸抑制发生情况高于其他各组(P<0.05);4)Ⅰ组术后1、2天镇痛液用量和术后第1天哌替啶消耗量明显高于其他各组(P<0.01)。结论:舒芬尼用于腹部肿瘤手术患者术后PCIA,0.3μg/kg·ml效果良好,少数患者可增加药量,但一般不超过0.4μg/kg·ml。     

累及右侧心腔的静脉内平滑肌瘤病三例报告并文献复习

为了探讨心脏受累的静脉内平滑肌瘤病(ICL)的临床特征和诊治要点,回顾分析3例ICL患者的临床和病理资料,并对相关文献进行复习。3例患者中2例有心慌、胸闷、晕厥或静脉栓塞症状,1例有子宫肌瘤手术史。3例均一期行盆腔肿瘤加静脉瘤栓取出术。随访10～37个月,无复发病例。初步研究结果提示,ICL治疗以手术为主,提高术中确诊率与正确选择手术方式能改善其预后。肿瘤可复发,长期随访十分必要。     

A Case of Uterine Leiomyoma with Intravenous Leiomyomatosis—Histological Investigation of the Pathological Condition—

Intravenous leiomyomatosis (IVL) is generally defined as a histologically benign leiomyoma derived from a uterine myoma or intrauterine venous wall that has grown and extended intravenously. We here report on a single case of IVL, and investigate its pathological genesis. Regarding the part of the myoma extending to the vessel lumen, observations found the myoma to be pushing into the vessel. Immunostaining with CD34 antibody gave an image of the area where the myoma pushed into the vessel, showing CD34-positive vessel endothelium cells folded back into a layer covering the myoma, and continuing to line of the surface of the myoma within the vessel. Early pathological genesis of IVL was clarified for the first time that the tumor did not invade the vessel by breaking the venous wall, but rather advanced by stretching the vascular wall and progressing into the vein like a polyp, covered in endothelium cells.     

开胸肿瘤切除术后舒芬太尼自控静脉镇痛临床研究

目的：通过疼痛评估及呼吸监测等方法评价舒芬太尼用于开胸肿瘤切除术后自控静脉镇痛（patient-controlled intravenous analgesia，PCIA）的有效性及安全性。方法：开胸肿瘤切除手术病人53例，随机分为两组：舒芬太尼组（S组，n=25）背景剂量为舒芬太尼0．03μg（kg·h）^-1，自控剂量为舒芬太尼0．03μg·kg^-1；芬太尼组（F组．n=28）背景剂量为芬太尼0．3μg（kg·h）^-1，自控剂量为芬太尼0.3μg·kg^-1，锁定时间均为15min.术后监测心率、血压、呼吸及脉搏氧饱和度，采用视觉模拟评分法（visual analogue scale，VAS）和6点Ramsay镇静评分法评估镇痛镇静效果．并记录每天的镇痛用药容量及不良反应。结果：S、F组的镇痛满意率分别为88．0％、89.3％．组间无统计学差异（P〉0．05）：S组术后第1天用药容量明显高于F组（P〈0．01），术后第2天、第3天用药容量亦高于F组（P〈0．05）；两组的VAS评分、Ramsay评分无统计学差异（P〉0．05），呼吸抑制、血流动力学稳定性、术后恶心呕吐发生率等方面均无统计学差异（P〉0．05）结论：舒芬太尼用于开胸肿瘤切除术后PCIA操作简单，镇痛效果确切，呼吸抑制作用轻微，血流动力学稳定，在监测疼痛程度、呼吸幅度及意识状态的情况下使用安全性较高.     

腹腔静脉双途径化疗治疗晚期卵巢癌

采用卡铂腹腔内化疗及阿霉素和环磷酰胺的静脉内化疗方法，治疗１４例晚期卵巢癌，结果完全缓解５例，部分缓解７例，因疾病进展死亡２例，有效率达８５．７％。表明腹腔内及静脉内双途径化疗治疗晚期卵巢癌为一理想的治疗措施。     

子宫肿瘤的超声诊断与病理分析

目的 :探讨子宫肿瘤的超声影像特征、诊断与鉴别诊断的特点。方法 :全部病例术前采用超声诊断仪经腹部检查 ,并经手术与病理结果对照分析。结果 :12 1例子宫肿瘤的超声诊断总符合率为92 .56% ,误诊率 7.4 5% ;良性肿瘤的超声诊断符合率为 93.0 6% ;恶性为 91.84 %。结论 :根据子宫肿瘤的大小、形态、病灶周边及内部声像图特点、临床表现等综合分析 ,超声检查可明确诊断子宫肿瘤。     

下腔静脉内平滑肌瘤累及心脏伴盆腔平滑肌瘤1例

患者女性,42岁。劳动时气促2年余,加重1周,于2003年11月15日入院。5年前患子宫平滑肌瘤行子宫切除术。查体:体温36.5℃,脉搏82次/min,呼吸23次/min,血压13/8kPa。全身黏膜无黄染,浅表淋巴结未查见肿大。双肺呼吸音清,胸骨左缘闻及Ⅲ级收缩期杂音,胸壁广泛传导。肝脾未及,双下肢无明显浮肿。心电图示不全右束传导阻滞。心脏彩色超声检查示:右心房黏液瘤4.2cm×3.4cm,右心房增大,三尖瓣轻度返流;B超示下腔静脉至右髂总静脉内广泛附壁性血栓,右侧盆腔低回声灶;CT示下腔静脉明显增粗约4.3cm￣5.7cm,其内有不规则高密度阴影,右髂内静脉亦增粗,…     

大剂量甲氨蝶呤化疗的脑脊液药代动力学研究

Objective: To study the cerebrospinal fluid pharmacokinetics of intravenously administered high dose-methotrexate (HD-MTX) and provide a solid fundament for clinical practice. Methods: MTX at a high dose ranging from 1.0 to 3.0 g per course was intravenously administered to 30 patients with malignant tumors. Blood and CSF samples were consecutively collected up to 36 h after the initiation of infusion (6 h). MTX concentrations were measured by using a reversed phase high-performance liquid chromatography (RP-HPLC) assay. Results: CSF MTX concentrations were (1.65±1.52)×10^-6, (4.3±3.34)×10^-7, (1.46±1.10)×10^-7 and (3.19±4.38)×10^-8 mol/L, respectively, at 0, 6, 12 and 24 h post infusion, and became undetectable at 36 h post infusion. The concentration-time curve of CSF MTX closely resembled that of the plasma MTX and fitted with the following linear regression equation: Ŷ=0.057 97+0.010 82X (Ŷ: CSF MTX concentration, X: Plasma MTX concentration, r=0.8357). Conclusion: CSF MTX was metabolized in a linear two-compartment model. Additionally, pharmacokinetic analysis of MTX levels indicated a positive correlation between CSF MTX and plasma MTX levels.     

术后持续静脉镇痛对肺癌患者细胞免疫功能的影响

目的探讨在肺癌患者术后持续静脉镇痛中采用右美托咪定预处理对细胞免疫功能的影响。方法选择行肺癌开胸根治术的80例患者作为研究对象。将所有患者随机分为对照组与观察组各40例。观察组在麻醉前给予右美托咪定预处理,其他同对照组。对比两组的镇痛镇静评分、手术前后的NK细胞、T淋巴细胞亚群水平及不良反应发生率。结果观察组术后24 h、48 h时间点的VAS评分均低于对照组(P<0.05);两组24 h、48 h时间点的Ramsay评分比较观察组则明显高于对照组(P<0.05)。两组在术前各T细胞亚群及NK细胞水平对比无显著性差异(P>0.05);术后1天观察组CD3+细胞、CD4+细胞、CD8+细胞、CD4+/CD8+比值及NK细胞水平显著高于对照组(P<0.05)。对照组患者共出现不良反应15例(32.5%),观察组发生不良反应4例(10.0%),观察组发生率显著低于对照(P<0.05)。此外两组均未见心动过缓、呼吸抑制等严重不良反应发生。结论在肺癌患者术后持续静脉镇痛中采用右美托咪定进行预处理,可提高镇痛效果,且对患者的细胞免疫功能抑制程度相对较轻,不良反应发生率低,有益于患者术后康复。     

Hemangiopericytoma of the uterus: Report of a case with a comprehensive review of the literature

A case of locally recurrent and metastatic uterine hemangiopericytoma successfully treated with surgery, radiotherapy and chemotherapy is presented. The patient is alive without evidence of detectable tumor, 13 years after the initial diagnosis. Review of the literature revealed 64 reported cases of uterine hemangiopericytoma. The clinical features are not sufficiently characteristic to enable the diagnosis to be made preoperatively. However, with the help of histological and ultrastructural studies a definite diagnosis of hemangiopericy toma can be made. The primary treatment is radical surgery which usually involves total hysterectomy and bilateral salpingo-oophorectomy. The prognosis of uterine hemangiopericy toma is better than that of other sites. However, long follow-up of these patients is necessary because of the tendency to local and distant recurrence many years after the initial treatment. The recurrent tumor should be treated aggressively with surgery, radiotherapy, and chemotherapy as long-term survival is not unusual.     

Plasma Pharmacokinetics of Idarubicin and its 13-Hydroxymetabolite after Intravenous and Oral Administration under Fasting and Non-Fasting Conditions

The plasma pharmacokinetics of Idarubicin and its 13-hydroxymetabolite have been studied in 10 patients with solid tumours after intravenous and oral administration under fasting and non-fasting conditions in a randomized cross-over design. The plasma concentration time curves of Idarubicin after intravenous administration could be described by the open two or three compartment models. No pharmacokinetic modelling of Idarubicin was possible after oral administration. After oral administration of Idarubicin, the amount of intact drug was higher under non-fasting conditions. The extensive and long-lasting appearance of Idarubicinol suggests that this cytotoxic metabolite is of major clinical importance in i.v. and oral therapy with Idarubicin. The pharmacokinetics of Idarubicinol was not affected by food intake.     

血浆同型半胱氨酸和血清叶酸水平与妇科肿瘤关系

目的：探讨血浆同型半浆胱氨酸和血清叶酸水平与妇科肿瘤病人的关系。方法：采用高效液相色谱荧光检测仪测定７７名妇科肿瘤患者血浆中同型半胱氨酸水平,同时应用９６孔板微生物法测定肿瘤患者血清叶酸水平,其中子宫恶性肿瘤１８,卵巢恶性肿瘤１１例,子宫良性肿瘤２６例,卵巢良性肿瘤１４例,子宫内膜及宫颈癌前病变８例。并同时测定２０名正常人的血浆同型半胱氨酸和血清叶酸水平作为对照。结果：卵巢和子宫的恶性与良性肿瘤者     

Intravenous hyperalimentation as nutritional support for the cancer patient--an update

Debilitating cancer cachexia is multifactorial, but many of the etiologies and most of the resulting effects are similar to those seen in malnourished patients without cancer. From the work in human beings and experimental animals, nutritional support of the tumor-bearing host can replenish lean body mass, visceral protein components, and immunocompetence. This induction of anabolism, however, depends on time, content, the method of administration of hyperalimentation solutions; the initial and continuing catabolic response of the patient, as well as the degree of initial malnutrition; the energy expenditure of the patient required during oncologic therapy; and the expertise of the physician administering nutritional support. Increased tumor stimulation resulting from intravenous hyperalimentation (IVH) has never been observed in humans; the stimulatory effects of IVH on animal tumor systems have been identified only in previously depleted animals, and then growth rates have not been out of proportion to that of the host or to that of otherwise healthy animals. Animal data suggest that tumor growth characteristics can be affected by nutritional state and the exact substrates administered, ie, amino acids, carbohydrates, or fat. Further evidence suggests that the apparent enhanced tumor growth can be used to increase responsiveness to cell cycle-specific chemotherapeutic agents during nutritional repletion. Current evidence supports the use of intravenous hyperalimentation in malnourished cancer patients who have effective oncologic therapeutic options; such patients should not be denied these options simply on the basis of severe nutritional cachexia.