X-ray features of primary non-squamous cell carcinoma and other malignant neoplasms in the trachea and main bronchi--analysis of 23 cases

X-ray features of 23 cases (25 foci) of non-squamous cell carcinoma and other malignant neoplasms in the trachea and main bronchi were reviewed. They were 15 (17 foci) adenoid cystic carcinomas, 3 carcinoids, 2 mucoepidermoid carcinomas, 1 well-differentiated adenocarcinoma, leiomyosarcoma and extramedullary plasmocytoma each. The symptoms were non-specific leading to a delayed diagnosis more than one year in 52% of cases. The X-ray findings were classified into 3 types: intraluminal polypoid (11 tumors), sessile mass without and with extraluminal invasion (3 and 11 tumors). These tumors were prone to extraluminal invasion and can be demonstrated by X-ray. The air lumen involved appeared as localized expansion in 3 adenoid cystic carcinomas, 1 of which was proved by operation. Routine chest films were of limited value with 30% false negative chest film, 26% mediastinum mass and 30% obstructive pneumonitis/atelectasis. Lesions of posterior tracheal wall and carina were better revealed by lateral tomography. Of the 10 cases with lateral tomography, images were superior to those of AP tomography in 5. Three cases had CT scan, by which intra-tracheal/bronchial lesions, invasions of mediastinum and regional lymph nodes were shown. CT scan is more accurate compared with the other imaging modalities in visualizing these lesions and more helpful in selecting treatment.     

原发性颈段气管肿瘤11例临床分析

目的: 总结11例原发性颈段气管肿瘤的临床资料及诊治经验,提高对该类疾病的认识。 方法: 回顾性分析从1984年1月至2006年11月我院诊治的11例原发性颈段气管肿瘤患者的临床资料。恶性者共有9例,其中腺样囊性癌3例,鳞状细胞癌3例,粘液表皮癌1例,透明细胞癌2例。良性者2例,平滑肌瘤和神经纤维瘤各1例。 结果: 中位年龄为47.5岁(1.5～63岁)。呼吸困难和咳嗽咳痰是最多见的症状,有7例患者早期被误诊(63.6%)。纤维喉镜、纤维支气管镜或气管镜检查为确诊的重要手段。行手术治疗者8例,其中行气管袖状切除者2例,部分气管壁切除者3例,全喉、部分气管及甲状腺腺叶切除者1例,内窥镜下YAG激光切除者1例,气管开窗肿瘤剔除术1例。恶性肿瘤患者3年和5年生存率分别为72.9%和43.8%,而良性肿瘤患者均术后无瘤生存。姑息性放疗或化疗者3例,2例均于3年内死亡。手术治疗的并发症发生率为37.5%(3/8),主要为气胸和声音嘶哑。 结论: 原发性颈段气管肿瘤较少见,早期易误诊,应重视早期诊断。恶性者居多,最多见的是腺样囊性癌和鳞状细胞癌。手术是主要的治疗手段,气管袖状切除端端吻合术是得到广泛认可的理想术式,而单纯放疗或化疗效果均不理想。     

原发性气管和主支气管恶性肿瘤的外科治疗

目的 探讨原发性气管和主支气管恶性肿瘤外科治疗的临床经验.方法 对18例原发性气管和主支气管恶性肿瘤患者进行外科手术治疗,其中12例在非体外循环下进行,6例在体外循环下进行.全组气管袖式切除、端端吻合8例,气管下段和隆突切除、隆突重建4例,单纯行肿瘤刮除术4例,右全肺加隆突切除1例,左全肺加隆突切除1例.结果 腺样囊性癌7例,鳞状细胞癌9例,淋巴上皮样癌1例,滤泡型非霍奇金淋巴瘤1例.术后10 d,1例患者因气管切开后气管内大出血而窒息死亡,其他患者术后呼吸困难均有明显改善,近期疗效较好.结论 原发性气管和主支气管恶性肿瘤首先应考虑手术切除,并根据患者的具体情况选择适当的手术方法;手术治疗要兼顾根治性和安全性.     

63例原发性气管肿瘤的诊断与治疗

目的 总结原发性气管肿瘤的临床诊治经验,提高其诊断治疗水平.方法 63例原发性气管肿瘤患者中,61例行手术治疗,2例行激光治疗.61例手术治疗的患者中,行气管袖状切除端-端吻合22例,气管隆嵴切除重建术6例,半隆嵴切除重建6例,颈段气管肿瘤及垂直半喉切除+胸锁乳突肌瓣喉室气管缺损重建术2例,气管肿瘤局部切除17例,气管切除造口术4例,颈段气管切除+甲状腺部分切除+食管肌层切除术1例,颈段气管切除+全喉切除+单纯气管切除造口术1例,隆突搔刮术2例.结果 63例患者中,恶性肿瘤42例,良性肿瘤21例.61例手术治疗的患者中,术后出现并发症8例,其中发生气管纵隔胸膜瘘2例,因喉返神经损伤出现声音嘶哑1例,气管狭窄1例,胸膜腔感染1例.围手术期死亡3例.结论 原发性气管肿瘤临床表现不典型,易误诊,气管恶性肿瘤预后不佳.解除气道梗阻是治疗气管肿瘤的主要目的 .

Abstract：

Objective To summarize the experience in diagnosis and treatment of primary tracheal tumors, and to improve the life quality of patients. Methods Sixty-three patients with primary tracheal tumors treated in the First Affiliated Hospital of China Medical University during the past 40 years were included in this study, among them, there were 42 cases of malignant tumors and 21 cases of benign tumors. The 61 patients underwent surgery including tracheal sleeve resection (22), carinal resection and reconstruction (6), semi-carinal resection and reconstruction (6), tracheal resection for tracheal tumors (17) ;tracheostomy (4), tracheal resection, partial resection of the thyroid (goiter) and esophagomyotomy (1), tracheal tumor resection and vertical hemilaryngectomy with reconstruction of laryngeal ventricle and trachea by sternocleidomastoid flap (2), cervical trachea and laryngeal resection (1), and carinal scrape (2). Results Fifty-five patients had an uneventful recovery. Eight patients suffered from postoperative complications, among them 3 patients died postoperatively. Conclusions Primary tracheal tumors often present atypical symptoms, are easily misdiagnosed and with poor prognosis. The main aim of treatment remains to remove the airway obstruction.     

Clinicopathologic study of thyroid carcinoma infiltrating the trachea

Eighteen patients (10 women and 8 men), ranging in age from 37 to 80 years, with thyroid carcinoma infiltrating the trachea comprised this series. Eleven had primary and 7 had recurrent cases. Total laryngectomy was performed in 4 patients, and tracheal resection was carried out followed by end-to-end anastomosis in 13 patients. In one patient, reconstruction was done with Naville's artificial trachea after tracheal resection. Eleven patients were alive after 1 year and 8 months to 6 years and 7 months after the operation. This result was significantly better than that of a group of ten patients without resection of the infiltrated trachea (seven patients died within 6 months). Thus, combined resection of the upper airway improved the prognosis of advanced thyroid carcinoma with tracheal infiltration. Histologic examination of surgical specimens demonstrated well-differentiated carcinoma in seven patients, poorly differentiated carcinoma in seven patients, undifferentiated carcinoma in three patients, and squamous cell carcinoma in one patient. The result showed a higher frequency of poorly differentiated carcinoma than in the control group of 70 patients without tracheal infiltration.     

肾脏转移瘤与肾原发癌CT表现的对比研究

目的 探讨肾转移瘤的ＣＴ表现特点。方法 对比分析经手术病理证实的１１例肾转移瘤及１００例原发肾癌的ＣＴ资料。转移瘤来自肺癌者６例,食管癌２例,肾上腺皮质癌,睾丸精原细胞瘤和原发灶不明各１例。     

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。      

Thyroglobulin production by malignant thyroid tumors. An immunocytochemical and radioimmunoassay study

Four hundred thirty surgical and biopsy specimens of malignant thyroid tumors of 323 patients were analyzed by histologic and immunocytochemical examination for their thyroglobulin (TG) content. Almost 95% of the differentiated thyroid carcinomas of follicular origin contained immunoreactive TG. The authors could not demonstrate TG in anaplastic carcinomas. Postoperative follow-up and serum TG determinations were available for 111 athyroid patients. Serum TG was elevated in five patients with metastatic or recurrent moderately differentiated follicular carcinoma, in two patients with metastasizing papillary, and in one patient with anaplastic carcinoma. Four patients had detectable serum TG levels without clinical and radiologic evidence of recurrence or metastases. In addition to conventional histologic examination, immunocytochemical demonstration of TG is a reliable and valuable aid in the diagnosis, classification, and determination of the grade of differentiation of malignant thyroid tumors. From this the pathologist can provide a pathologic basis for postoperative patient management.     

Adenoid Cystic Carcinoma of Trachea: A Diagnostic and Therapeutic Challenge

Primary tumors of the trachea, which may be benign or malignant, account for fewer than 0.1 % of tumors. Adenoid cystic carcinoma is the second most common tracheal tumor. It poses a diagnostic and therapeutic challenge because of its slow growth and tendency for local recurrence and late metastasis. We present a case of adenoid cystic carcinoma of trachea which was misdiagnosed and mistreated as asthma initially because of its inherent indolent progression. It is important to be acquainted with this condition to prevent delay in diagnosis and provide timely treatment.     

肺腺鳞癌的影像学表现和病理对照研究

目的探讨肺腺鳞癌影像学表现是否具有特殊性;瘤内的腺癌、鳞癌成分与Ｘ线表现及预后的关系。方法复习经手术切除、病理确诊为腺鳞癌者５１例,５２个病灶。全部病例均有正侧位胸片,ＣＴ２３例,ＭＲＩ６例。按照镜下腺癌成分含量分为＜４０％、４０％～６０％、＞６０％三组。结果（１）腺鳞癌的影像学表现：中央型３例;周围型４８例,占９４．１％。肿瘤直径２～１５ｃｍ,平均５．７ｃｍ。均呈分叶状、边缘光整１９例,占３９．６％;边缘不光整但无明显毛刺１８例（１９个病灶）,占３７．５％;有毛刺１４例,占２９．２％;偏心空洞８例,占１５．７％;胸膜皱缩１２例,占２５．０％。（２）瘤内成分含量与Ｘ线表现的关系：部位、边缘、密度、胸膜皱缩在三组之间差异无显著性。结论本组结果表明,肺腺鳞癌以周围型多见,肿瘤无特异性Ｘ线表现;腺癌成分含量与Ｘ线表现和预后无明显关系。     

原发性气管主支气管恶性肿瘤的外科治疗(英文)

Objective:The aim of our study was to explore the clinical experience of surgical treatment for primary tracheobronchial malignant tumors.Methods:The clinicopathological data of 18 patients with primary tracheobronchial malignant tumors surgically treated from February 1994 to August 2007 were reviewed retrospectively.The surgical management included sleeve tracheal resection in 8 cases,lower trachea and carina resection with carina reconstruction in 4 cases,local enucleation of the tumor in 4 cases,left or...     

Clinicopathologic analysis of 487 thyroid tumors

In this paper, 487 cases of thyroid tumor, 387 (79.5%) benign and 100 (20.5%) malignant, were analysed clinicopathologically. Benign thyroid tumor was divided into three types: papillary, follicular and atypical adenomas; malignant thyroid tumor into five types: papillary, follicular, undifferentiated, medullary and squamous cancers. In the benign variety, follicular adenoma had the highest incidence (98.2%) and in the malignant tumors, papillary cancer ranked first (62%). In this series, there were two cases of carcino-sarcoma. The sex ratio of male and female was 1:1.62 for the whole series, 1:1.70 for benign and 1:1.38 for malignant tumors. The peak age was 21 to 40 years with a median of 35 for benign and 31 to 50 years with a median of 43 for malignant tumors. For papillary carcinoma, the patients over 40 years of age comprised 50%. The typing of benign and malignant tumors is discussed. It is proposed that the occult cancer be classified according to histomorphology. Calcitonin by immunohistochemical technic or neural secretory granules by electron microscopy gives the most reliable evidence to diagnosis of the medullary carcinoma.     

32例气管肿瘤的外科治疗

目的：总结32例气管肿瘤患者外科治疗经验。方法：回顾性分析我科1980～2005年收治的32例气管肿瘤患者外科治疗临床资料。结果：32例气管肿瘤患者中，23例行气管袖状切除端-端吻合术；8例行气管隆凸切除重建术；1例行气管开窗、肿瘤刮除术。术后2例死亡，另有8例发生术后并发症。结论：手术切除是治疗气管肿瘤最有效的方法。气管袖状切除端-端吻合术是治疗气管恶性肿瘤最主要的术式，良性肿瘤可以考虑保守的术式。手术治疗应该兼顾手术的根治性和安全性。     

Ectopic thyroid: A rare cause of tracheal obstruction

The endoluminal presence of thyroid tissue in the trachea is a rare cause of airway obstruction. Only 14 well documented cases of intratracheal ectopic thyroid tissue have been reported in English Literature since 1966. These lesions are mostly benign and nearly all patients present with symptoms of respiratory obstruction. We present a case of ectopic thyroid in cervical trachea presenting with symptoms of airway obstruction. Thorough clinical examination and investigations were carried out. A right hemithyroidectomy and excision of a part of the tracheal wall through a tracheotomy was performed for removal of the ectopic thyroid tissue from trachea. The clinicians & radiologists must be aware of this entity to avoid mistaking it for evidence of invasion by a malignant neoplas, and hence this report.     

代谢综合征与分化型甲状腺癌的发生及严重程度的相关性

目的:分析代谢综合征及其组分与分化型甲状腺癌的发生及严重程度的相关性。方法:收集自2020年06月至2022年06月在我院因甲状腺结节行手术治疗，术后病理确诊为分化型甲状腺癌的285例患者以及病理确诊为良性甲状腺结节的138例患者的临床资料，根据病理结果，分为良性组138例和恶性组285例；根据是否合并代谢综合征，将恶性组患者分为甲癌组156例和甲癌合并代谢综合征组129例。结果:恶性组患者BMI平均数及代谢综合征占比明显高于良性组，恶性组年龄平均数低于良性组，且存在显著性差异（P＜0.05）；甲癌合并代谢综合征组患者较甲癌组体质量指数、血压、空腹血糖、甘油三酯、肿瘤直径≥1、肿瘤位于双侧甲状腺、肿瘤多灶均高（P＜0.05），高密度脂蛋白胆固醇水平低（P＜0.05）。结论:合并代谢综合征的甲状腺结节患者恶性可能性更高，且在肿瘤直径、肿瘤位置、癌灶数量方面较未合并代谢综合征者表现出更严重的倾向，提示代谢综合征可能是影响甲状腺恶性肿瘤严重程度的危险因素。     

甲状腺癌侵犯气管的手术治疗

目的　探讨甲状腺癌侵犯气管的术式选择。方法　回顾性分析 2 3例侵犯气管的甲状腺癌患者的临床资料 ,根据术式不同分为 :根治性切除 18例 ,肿瘤剔除 3例 ,气管切开或气管造瘘 2例。结果　根治性切除的 14例长期生存 ,肿瘤剔除的 2例 3年内均复发 ,气管切开的 1例死于术后并发症 ,1例九个月后死于广泛转移。结论　甲状腺癌侵及气管宜采取根治性手术 ,重建气管 ,可提高患者治愈机会 ,改善生活质量     

Radiation treatment of primary tracheal cancers

Two cases of primary squamous cell carcinoma of trachea are presented here, One case of low tracheal tumour with supraclavicular lymphnode metastasis presented with air way obstruction and required emergency treatment, is discussed. Second patient with high tracheal tumor which also presented with air way obstruction was managed with radiation therapy after tracheostomy. The management of both cases is described along with review of literature regarding primary tracheal tumors and its management.     

胰腺腺泡细胞癌的CT表现

背景与目的：胰腺腺泡细胞癌(acinar cell carcinoma of the pancreas,ACCP)是一种罕见的胰腺恶性肿瘤,相关的影像学报道较少。该研究旨在探讨ACCP的CT表现。方法：收集自2011年1月-2014年1月经手术病理证实为ACCP的9例患者资料,回顾性分析其CT征象。结果：在9例ACCP患者中,肿块最大径均值为52 mm,肿瘤边缘不清的6例(66.7%),外生型生长者有6例(66.7%),强化程度低于正常胰腺组织者8例(88.9%),强化不均者6例(66.7%),累及血管者7例(77.8%),淋巴结转移者5例(55.6%),无出现肝转移病例,仅1例出现胰管扩张。结论：较大体积的乏血供胰腺肿块,内部异质性明显,呈外生型生长而无显著胰管扩张时,提示ACCP的可能。     

Intraoperative pathologic diagnosis of thyroid neoplasms. Report on experience with 504 specimens

Intraoperative pathologic examination with frozen section (FS) was performed on 504 specimens of thyroid tissue obtained from 457 patients over a period of 9 years. After examination of permanent sections (PS) a malignant neoplasm was diagnosed in 57 specimens (11.3%); 50 (87%) of these were primary thyroid carcinoma, four (8%) metastatic carcinoma, and three (5%) malignant lymphoma. The FS diagnosis was "benign" in 448 (88.9%), "malignant" in (30) 5.9%, and "deferred" in 26 (5.2%). The sensitivity of FS diagnosis of malignancy was 53% and the specificity and positive predictive value 100%. The negative predictive value was 97.8% and overall accuracy 97.9%. The PS disclosed a malignant neoplasm in 62% of specimens in which FS diagnosis was "deferred." Sixty-eight percent of papillary carcinomas, 87% of undifferentiated carcinomas, and a single case of medullary carcinoma were diagnosed with FS examination. A FS diagnosis of malignancy was not made in any of the ten specimens containing follicular carcinoma; in all ten the neoplasms were well-differentiated and eight were encapsulated and minimally invasive. The inability to diagnose follicular carcinoma intraoperatively with FS is the most significant factor accounting for the relatively low sensitivity of FS diagnosis of malignant thyroid neoplasms.     

Histopathological Patterns of Thyroid Disease in Al-Madinah Region of Saudi Arabia

Objectives: This study aimed to characterize the histopathological pattern of thyroid lesions among Saudipatients and to highlight the age and gender variations of these lesions as base line data. Materials and Methods:We retrospectively analyzed the data from thyroid specimens received at the Department of Pathology, KingFahad Hospital, Madinah, Saudi Arabia from January 2006 to December 2013. Results: The 292 thyroidectomyspecimens received during the study period came from 230 (78.8%) females and 62 (21.2%) males giving afemale: male ratio of 3.7:1. Age of the patients ranged from 14 to 95 years with a mean age 39.7 years. Twohundred and eleven (72.3%) cases were found to be non-neoplastic and 81 (27.7%) cases were neoplastic. Thenon-neoplastic group included: colloid goiter, including both diffuse and nodular goiter (170 cases; 58.2%),nodular hyperplasia (28 cases; 9.6%), Hashimoto/chronic lymphocytic thyroiditis (12 cases; 4.1%), and Grave’sdisease (1 case; 0.3%). In neoplastic lesions, there were 7 benign tumors and 74 malignant tumors. Among thebenign tumors, 5 were follicular adenomas and 2 were Hurthle cell adenomas. Papillary carcinoma was thecommonest malignant tumor accounting for 87.8% of all thyroid malignancies, followed by lymphoma, follicularcarcinoma and medullary carcinoma. The size of papillary carcinoma was more than 2 cm in 40 cases (76.9%).Conclusions: Non-neoplastic thyroid lesions were more common than neoplastic ones. Colloid goiter was themost common lesion. Follicular adenoma was the commonest benign tumor and papillary carcinoma was thecommonest malignant lesion. There appears to be a slightly increased trend of papillary carcinoma diagnosis,most being diagnosed at an advanced stage.