成人原发性肾肉瘤的诊治及预后

目的探讨成人原发性肾肉瘤的诊断、治疗以及影响预后的因素。方法1996年至2005年收治成人原发性肾肉瘤15例，占同期收治794例肾肿瘤患者的1．9％。男6例，女9例。年龄36～68岁，平均50岁。临床表现为腹部肿块10例，腹部疼痛2例，健康体检发现后腹膜占位2例，肉眼血尿1例。肿瘤直径6．8～22．5cm，平均13．4cm，均为单发。临床分期Ⅱ期6例、Ⅲ期5例、Ⅳ期4例。15例影像学表现具有肾恶性肿瘤的特征，但与肾癌或错构瘤鉴别困难。结果11例行根治性肾切除术，4例因无法根治而行单纯肾切除术或肿瘤部分切除术。术后病理诊断为平滑肌肉瘤6例、脂肪肉瘤3例、低分化肉瘤3例、纤维肉瘤2例、滑膜肉瘤1例。13例随访3个月～8年，死亡10例，生存最长者为8年（脂肪肉瘤），最短者为3个月（术前已肝转移）。11例接受根治性肾切除术者平均生存期33个月，4例行单纯肾切除术或肿瘤部分切除术者平均生存期8个月；平滑肌肉瘤组平均生存期22个月，脂肪肉瘤组为46个月，低分化肉瘤组为15个月。结论腹部肿块是成人原发性肾肉瘤最常见的临床表现，是否可以进行根治性手术、病理类型是影响预后的重要因素。     

成人前列腺肉瘤7例临床分析

目的 :探讨前列腺肉瘤的诊断、治疗及预后因素。　方法 :回顾性分析我院诊治的 7例成人前列腺肉瘤临床表现、实验室检查、治疗方案、病理类型及预后。　结果 :平滑肌肉瘤 3例 ,横纹肌肉瘤 3例 ,恶性神经鞘瘤 1例。前列腺肉瘤有膀胱颈梗阻为主的复合表现 ,确诊依靠病理诊断 ,病理分型与疾病的进展相关联。 2例行根治性膀胱前列腺切除术者于术后 13个月和 2 1个月死亡 ;2例行全盆腔脏器切除术辅以放疗和 (或 )化疗者 ,随访 15个月仍存活 ;3例仅行放疗和 (或 )化疗 ,平均于初诊后 7个月死亡。　结论 :前列腺肉瘤预后较差 ,早期诊断和完整的外科切除有重要意义 ,密切随访可以早期发现复发。     

成人泌尿、男性生殖系统软组织肉瘤和肉瘤样癌的临床病理特征及预后分析

目的:比较成人泌尿、男性生殖系统软组织肉瘤(STS)与肉瘤样癌的临床病理特征和预后。方法:回顾性分析郑州大学第一附属医院收治的73例成人泌尿、男性生殖系统STS和15例肉瘤样癌患者的临床资料。STS组男59例,女14例;中位年龄41(18～78)岁;可测量病灶肿瘤最大径0.5～19.0 cm;肿瘤原发于睾丸及睾丸旁23...     

肾盂肉瘤样癌的临床病理特征及预后

目的:探讨肾盂肉瘤样癌的临床病理特征及预后。方法:对我院2000年1月~2010年12月收治的2例经病理检查证实为肾盂肉瘤样癌患者的临床资料进行回顾性分析。结果:2例术后病理检查均为肾盂肉瘤样癌,手术切缘阴性。1例(45岁,T3N0M0)术后未行放疗和化疗,随访12个月,患者死于全身多处脏器肿瘤转移;1例(80岁,T3N0M0)术后未行辅助治疗,随访10个月,患者死于恶病质。2例患者平均生存时间11个月(10~12个月)。结论:肾盂肉瘤样癌临床罕见,恶性程度高,浸润性强,预后不佳。术前不易确诊,确诊有赖于病理检查。     

胃肠平滑肌肉瘤的临床及病理探讨

作者报道经手术切除的胃肠道平滑肌肉瘤２６例，结果发现其区域淋巴结转移率为１１．５％，小肠平滑肌肉瘤较胃平滑肌肉瘤分化差，且易发生穿孔（４５．５％），结果提示本病部分病例需行局部淋巴结清扫是必要的。小肠平滑肌肉瘤预后较差的原因可能是：①病理分化不良者多；②易发生肿瘤穿孔致腹腔内播散。表阿霉素化疗可能对本病有一定疗效。     

前列腺肉瘤6例临床分析

原发性前列腺肉瘤少见 ,1990年 1月～ 2 0 0 2年1月我院收治前列腺恶性肿瘤 130例 ,其中前列腺肉瘤病人 6例 ,报告如下。1　临床资料1.1　一般资料　本组 6例 ,年龄 2 8～ 4 5岁 ,平均 36岁。 6例病人均有排尿困难 ,其中伴有发热、骨盆疼痛和排便困难各 1例。临床 Ⅲ 期 4例 ,Ⅳ 期 2例。1.2　实验室检查1 2 .1　血常规　 1例白细胞 11.3× 10 9/Ｌ ,中性粒细胞比例 0 .839,其余 5例血常规均正常。1.2 .2　血清前列腺特异抗原 (ＰＳＡ)测定　 1例未测 ,余 5例均正常。1.3　直肠指检 (ＤＲＥ)　 6例病人前列腺均明显增大 (横径 10～ 13ｃｍ ,…     

成人前列腺肉瘤6例临床分析

目的:探讨前列腺肉瘤的诊断、治疗及预后因素。方法:本组6例患者,年龄18~44岁,中位年龄31岁。病程3~12个月,中位病程7个月。Ⅱ期2例,Ⅲ期3例,Ⅳ期1例。6例中,5例行手术治疗+放疗和(或)化疗,1例行单纯膀胱造瘘术。结果:病理诊断:平滑肌肉瘤3例,横纹肌肉瘤2例,恶性神经鞘瘤1例。免疫组化结果显示6例vim entin均为阳性,PSA和PAP均为阴性。平滑肌肉瘤和横纹肌肉瘤肌动蛋白(HHF35)为阳性,恶性神经鞘瘤S-100和溶解酶为阳性。1例失访,5例于术后2~11个月死亡。结论:前列腺肉瘤首发症状为进行性排尿困难,直肠指检可以提示前列腺肉瘤,依靠前列腺穿刺病理学检查获得确诊,早期诊断和完整的外科切除有重要意义,预后较差。     

前列腺肉瘤7例临床分析

目的探讨前列腺肉瘤的诊断、治疗及预后因素。方法报道7例前列腺肉瘤患者的诊治方法和随访结果。结合文献讨论诊治方案。结果平滑肌肉瘤5例,横纹肌肉瘤2例。回肠膀胱术1例随访20个月后死于心脏疾病,巨大前列腺肉瘤摘除 双侧输尿管膀胱再植术1例现随访3个月存活,余5例均在16个月内死于远处转移。结论前列腺肉瘤预后差,长期存活依赖于早期诊断和以根治手术为主的综合治疗。     

原发性肾血管肉瘤的临床特点及预后影响因素分析

目的探讨原发性肾血管肉瘤的临床特点和预后影响因素。方法收集国内外关于原发性肾血管肉瘤的文献资料,总结其临床特点和治疗方法,分析预后影响因素。结果共收集国内外文献资料的80例患者及2例我院患者。发病年龄(60.1±14.1)岁。男性发病率明显高于女性。手术是目前主要的治疗方法,放化疗是重要的辅助治疗手段。单因素分析显示肿瘤大小(P=0.001)、合并转移(P0.001)是影响预后的主要因素。多因素分析显示肿瘤大小(RR=3.396,RR95%CI 1.125～10.254,P=0.030)、转移(RR=7.040,RR95%CI 1.76～27.900,P=0.005)是原发性肾血管肉瘤患者生存的独立危险因素。结论原发性肾血管肉瘤是一种极其罕见且恶性程度很高的肿瘤,预后极差。手术是主要治疗手段,尚缺乏有效的治疗方案。随着研究的不断深入,分子治疗和靶向治疗可能提供新的治疗方式,但仍需更多的研究进一步证实。     

原发性前列腺滑膜肉瘤1例

<正>患者男,27岁,3个月前无明显诱因出现肛周疼痛,伴大便变细、下坠,10余天前出现小便次数增多,未接受直肠指诊。入院后实验室检查血清总前列腺特异性抗原(prostate specific antigen,PSA)为0.32ng/ml,游离PSA为0.05ng/ml,PSA比值为0.16。CT示盆腔占位。MR检查示患者前列腺区有较大不规则团块状肿块,呈稍短T1稍长T2信号(图1A、1B),内部信     

Adult primary prostate sarcoma: A multi-center cohort study and comparison between Chinese and American cases

Background/objectivesTo assess the effects of clinical factors and treatments on the overall survival (OS) of patients with prostate sarcomas.MethodsWe reported 41 cases diagnosed with prostate sarcomas from eight hospitals in China and retrospectively analyzed the prognostic factors by combining our data with cases from five previously published cohorts, including one extra Chinese cohort and four cohorts from US cohorts. Additionally, we investigated the differences in treatment regimens between China (n = 66) and the USA (n = 74).ResultsThe median survival time of the 41 cases was 18.6 months (95% confidence interval [CI]: 13.9–23.2). The status of negative distant metastasis (P = 0.004) and radical tumor resection with negative margin (P = 0.001) were significantly associated with better overall survival, whereas age, tumor size, duration of initial symptoms, and chemo/radiotherapy were not significantly related to OS. The survival time was longer in patients with rhabdomyosarcoma than in those with leiomyosarcoma (P = 0.049). Combined analysis of the current and 5 prior cohorts showed that more patients in the US cohorts underwent radical surgery (P = 0.005), and the overall survival was better among those with radical cystoprostatectomy compared to those with radical prostatectomy alone (P = 0.008).ConclusionRadical resection to achieve a negative margin contributes to better survival for patients with prostate sarcoma.     

滑膜肉瘤的大小初次治疗方法与其预后的关系(附41例报告)

目的 :探讨滑膜肉瘤大小、初次治疗方法对其预后的影响。方法 :分析 41例滑膜肉瘤病人肿瘤的大小、初次治疗方法和预后情况。随访 2 3～ 198个月 ,平均 73个月。结果 :肿瘤直径 <5cm者与肿瘤直径 >5cm者的5、 10年生存率、复发率、转移率均有显著差异。肿瘤直径 >5cm的滑膜肉瘤病人 ,单纯手术切除与手术加放化疗后5年生存率有显著差异 ;复发率、转移率均无显著差异。结论 :( 1)肿瘤大小是影响滑膜肉瘤预后的一个重要因素。直径小于 5cm的预后好 ,肿瘤愈大 ,预后愈差。 ( 2 )初次治疗方法与其预后密切相关。     

Clinical characteristics and prognosis of ANCA-associated vasculitis in patients with renal injury

Objective To investigate the characteristics and outcome of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) in patients with renal injury. Methods AAV patients with renal injury diagnosed in the Department of Nephrology, Renmin Hospital of Wuhan University, from January 2012 to January 2017 were included into this study. Patients were divided into MPO-ANCA positive and PR3-ANCA positive groups for further study. The clinical characteristics, pathological and laboratory indexes, treatment and prognosis were retrospectively analyzed. Results A total of 68 cases were enrolled, among which 52 cases (76.5%) were MPO-ANCA positive and 16 cases (23.5%) were PR3-ANCA positive, and 41 patients (60.3%) were over 65 years old. The incidences of interstitial lung disease, digestive and nervous system damage in PR3-ANCA positive group were significantly higher than those MPO-ANCA positive group (P＜0.05). There were significant differences of hemoglobin, complement C3, complement C1q, IgE, 24 h urinary protein, erythrocyte sedimentation rate, procalcitonin, BVAS score and eGFR in two groups (P＜0.05). 19 cases had done renal biopsy,among them 14 cases were MPO-ANCA positive and 5 cases were PR3-ANCA positive. Incidence of crescentic necrotizing glomerulonephritis in PR3-ANCA positive group was significantly higher than that in MPO-ANCA positive group, and incidence of diffuse global glomerulosclerosis in MPO-ANCA positive group was significantly higher than that in PR3-ANCA positive group (all P＜0.05). At the median follow-up time of 32 months, the relapse rate at 6 month of MPO-ANCA-positive and PR3-ANCA-positive patients were 46.2% and 75.0%, respectively (P＜0.05). Multivariate logistic regression analysis showed that PR3-ANCA positive, age≥65 years old, baseline eGFR＜30 ml?min-1?(1.73 m2)-1, and combined with pulmonary interstitial lesions were all independent risk factors for relapse. And the incidence of ESRD were 42.3% and 75.0% during the follow-up period and 10 patients (14.7%) died. COX regression analysis showed that patients older than 65 years old, BVAS score≥18 points, eGFR＜30 ml?min-1?(1.73 m2)-1 and complicated with pulmonary interstitial disorders at the onset were independent risk factors causing ESRD or death. Conclusion The PR3-ANCA-positive patients had more severe renal injury than those with MPO-ANCA-positive patients, and the injury of extrarenal organs was more serious, recurrence rate was higher, and the prognosis was worse.     

前列腺肉瘤19例报告并文献复习

目的 探讨前列腺肉瘤的临床特点和诊治方法. 方法 1995年10月至2010年9月我院19例前列腺肉瘤患者,年龄16 ～48岁,平均36岁.均因排尿困难入院,其中6例伴膀胱刺激征,3例伴肉眼血尿,3例伴尿中排出血块,3例伴排便困难,2例伴尿路感染,1例伴腰痛.直肠指检16例前列腺体积明显增大,其中6例向直肠内突出明显;余3例触及质硬结节且有触痛.B超检查均提示有前列腺肿物,内部组织回声不均匀.12例盆腔MRI检查提示前列腺不规则软组织密度影,边缘不清,前列腺内部呈高低混杂信号,肿物向外突出.其中7例前列腺明显增大与膀胱分界不清,6例与直肠分界不清,1例提示为囊实性改变.10例盆腔CT检查提示前列腺不规则肿物,其中5例肿物侵犯双侧精囊,2例肿物侵犯单侧精囊,3例伴淋巴结肿大.2例胸部X线片提示肺内有广泛转移. 结果 6例行全膀胱前列腺切除术,8例行前列腺根治性切除术,1例行双输尿管皮肤造瘘和直肠造瘘术,1例行膀胱造瘘术,1例行前列腺穿刺活检后化疗,2例仅行前列腺穿刺活检.病理诊断:平滑肌肉瘤6例,横纹肌肉瘤6例,恶性间叶瘤2例,叶状囊肉瘤1例,粒细胞肉瘤1例,分叶状肉瘤1例,恶性纤维组织肉瘤1例,低分化肌源性肉瘤1例.免疫组化检查19例波形蛋白均阳性表达,平滑肌肌动蛋白和肌红蛋白分别在平滑肌肉瘤和横纹肌肉瘤中阳性表达,而结蛋白在上述两种肉瘤中有不同程度的表达.CD117和S-100仅分别在1例含未分化成分和1例含脂肪肉瘤的恶性间叶瘤中弱阳性表达,粒细胞肉瘤中抗过氧化物酶阳性表达,分叶状肉瘤中p63阳性表达,恶性纤维组织细胞瘤中CD34阳性表达.14例术后给予化疗,其中6例联合放疗.19例均获随访,随访时间4～30个月,平均13个月.4例患者未复发,术后存活24～30个月,余15例均在确诊后18个月内死亡.结论 前列腺肉瘤是临床罕见的恶性肿瘤,恶性程度较高,临床表现缺乏特异性,确诊依靠病理活检和免疫组化,早期诊断和根治性手术切除对提高生存率有一定的积极意义.     

膀胱前列腺切除术中前列腺偶发癌临床特点及其预后影响因素分析

【摘要】 目的 探讨膀胱前列腺切除术中前列腺偶发癌（Incidental prostate cancer ,IPCa）临床特点及其预后影响因素。方法 选取2008年9月至2013年9月于本院接受治疗的165例膀胱前列腺切除术中前列腺偶发癌患者为研究对象。前列腺偶发癌临床特点并采用单因素分析和多因素分析法的分析影响膀胱前列腺切除术中前列腺偶发癌预后的因素。结果 IPCa局限于前列腺内pT1有65.45%(108/165),pT2有31.52%(52/165),pT3有3.03%(5/165)。Gleason评分小于6分的有36.97%(61/165),6分有33.33%(55/165),7分有25.45%(42/165),大于7分有4.24%(7/165)。4例前列腺切缘阳性,所有患者淋巴结转移阴性。单因素分析和多因素分析法显示影响患者预后的因素为年龄、焦虑、疾病分期。结论 膀胱前列腺切除术中前列腺偶发癌临床特点为淋巴结转移阴性IPCa局限于前列腺内pT1较多,Gleason评分主要集中在小于7分,有前列腺切缘阳性的可能。年龄、疾病分期、焦虑是影响膀胱前列腺切除术中前列腺偶发癌预后的危险因子。     

前列腺肉瘤的诊治(附四例报告)

目的　提高前列腺肉瘤的诊治水平。　方法　报道 4例前列腺肉瘤患者的诊治方法和随访结果。结合文献讨论诊治方案。　结果　 4例患者中梭形细胞肉瘤 2例 ,平滑肌肉瘤 1例 ,横纹肌肉瘤 1例。均接受包括手术切除、放疗、化疗、中医中药及免疫治疗等综合治疗。 1例失访 ,2例于术后 7和 19个月死于肿瘤 ,1例无瘤生存至今 2 2个月。　结论　前列腺肉瘤进展迅速 ,预后较差 ,除争取尽早明确诊断外 ,应制订适宜的个体化治疗方案     

原发性结直肠上皮样肉瘤的临床特征分析

目的了解原发性结直肠上皮样肉瘤的临床特点。方法回顾性分析我院收治及文献个案报道的共32例原发性结直肠上皮样肉瘤的临床资料。结果男女发病比例均等,平均发病年龄64岁;首发症状以下腹疼痛为最常见,其次为便血和大便性状改变,偶见便秘、体重下降等。肿瘤好发于结肠;肿瘤直径2~24cm;同时性和异时性转移,均以肝转移最常见,腹腔淋巴结转移其次;手术治疗以根治术为主;中位生存时间11.4个月。结论原发性结直肠上皮样肉瘤无特征性表现,恶性程度较高,首选手术治疗,预后效果不佳。     

Validation of copy number variants associated with prostate cancer risk and prognosis

ObjectiveTwo recent studies have reported novel heritable copy number variants on chromosomes 2p, 15q, and 12q to be associated with prostate cancer (PCa) risk in non-Hispanic Caucasians. The goal of this study was to determine whether these findings could be independently confirmed in the Caucasian population from the South Texas area.Methods and materialsThe study subjects consisted of participants of the San Antonio Biomarkers of Risk for PCa cohort and additional cases ascertained in the same metropolitan area. We genotyped all 7 of the reported copy number variants using real-time quantitative polymerase chain reaction in 1,536 (317 cases and 1,219 controls) non-Hispanic Caucasian men, and additionally, we genotyped 632 (191 cases and 441 controls) Hispanic Caucasian men for one of these variants, a deletion on 2p24.3.ResultsAssociation of the deletion on 2p24.3 with overall PCa risk did not meet our significance criteria but was consistent with previous reports (odds ratio, 1.40; 95% confidence interval 0.99–2.00; P = 0.06). Among Hispanic Caucasians, this deletion is much less prevalent (minor allele frequencies of 0.059 and 0.024 in non-Hispanic and Hispanic Caucasians, respectively) and did not show evidence of association with risk for PCa. Interestingly, among non-Hispanic Caucasians, carrying a homozygous deletion of 2p24.3 was significantly associated with high-grade PCa as defined by Gleason score sum ≥8 (odds ratio, 27.99; 95% confidence interval 1.99–392.6; P = 0.007 [the Fisher exact test]). The remaining 6 copy number variable regions either were not polymorphic in our cohort of non-Hispanic Caucasians or showed no evidence of association.ConclusionsOur findings are consistent with the reported observation that a heritable deletion on 2p24.3 is associated with PCa risk in non-Hispanic Caucasians. Additionally, our observations indicate that the 2p24.3 variant is associated with risk for high-grade PCa in a recessive manner. We were unable to replicate any association with PCa for the variants on chromosomes 15q and 12q, which may be explained by regional population differences in low frequency variants and disease heterogeneity.     

Prostate tumor progression and prognosis. interplay of tumor and host factors

The prognosis for prostate cancer is largely dependent on the probability of metastatic dissemination. Prognostic markers currently in use are very poor predictors of metastatic potential, and as of yet none of the battery of new molecular markers has proven greatly superior. This may be due in part to their inability to assess the degree of interaction of subpopulations of prostate cancer cells with each other and with their microenvironment. A growing body of evidence indicates that these types of interactions are a major factor in the eventual genesis of cancer cells capable of metastasis. Recent research has demonstrated that specialized components of prostate tumors may play a critical supporting role for the overall growth of the larger tumor. The multifocal nature and apparent polyclonal origins of prostate tumors suggest that carcinogenesis and tumor progression are promoted by global influences or “field effects.” It appears that these effects extend beyond the proliferating epithelial component to the tissue stroma. Prostate cancer cells and stromal cells seem to act in concert to modify the microenvironment, leading to metastasis. An understanding of this synergy may provide a new class of prognostic markers which more accurately measure the complex set of interactions that determine tumor behavior.