肝周恶性腹膜间皮瘤磁共振影像及其鉴别诊断

恶性腹膜间皮瘤是一种非常罕见的浆膜恶性肿瘤,临床上常表现为腹膜和网膜多发的软组织肿块,多数伴有腹水。本研究展示1例经病理学检查证实为腹膜恶性间皮瘤的磁共振图像,该病例罕见局限于肝周腹膜并向肝内生长,在没有腹水衬托情况下,容易与肝内起源病变混淆。通过病例分析,一方面展示恶性腹膜间皮瘤的磁共振影像学表现,另一方面则是探讨肝外和肝内起源病变的鉴别要点,以提高对这种疾病的认识及鉴别诊断能力。     

手术和腹腔内高温灌注联合治疗晚期胃癌的肯定疗效

为评价腹腔内高温灌注(intraperitoneal hyperthermic perfusion IPHP)治疗晚期胃癌,尤其是伴腹膜种植的病人临床疗效。作者对59例在该院行手术治疗的晚期胃癌病例进行研究,认为IPHP对治疗晚期胃癌的腹膜转移和控制复发具有明显效果。根据是否采用术后IPHP治疗。本组病例共分两组,A组手术加术后IPHP治疗,B组单纯手术治疗为对照组。 A组(30例):平均年龄52岁,17例伴癌性腹水,3例术中腹水细胞学检查为阳性,余10例肿瘤侵犯浆膜层。手术方式包括全胃切除术,胃大部切除     

腹膜转移肿瘤治疗研究的最新进展

<正>消化道恶性肿瘤病人往往伴有腹膜转移的现象,常会导致肠梗阻、恶性腹水、疼痛等并发症。腹膜转移肿瘤病人的预后往往很差。近年来,随着人们对腹膜转移肿瘤认识的     

恶性腹水的治疗

颃固性恶性腹水的处理是癌瘤病人的治疗中一个重要问题。本文复习了恶性腹水的发病机制和治疗。恶性腹水的产生多是由于膈下淋巴梗阻和腹腔液产生增多所致。Coates 将~(99m)锝硫化胶体注入伴有腹水的继发性肿瘤病人腹腔内,纵隔淋巴闪烁照相在约85%病人的膈上区未能显示出放射活性。另一例卵巢和盆腔癌肿病人的闪烁照相检奄显示正常,其腹水纯然是液体产生增加的结果。Bronskill 在22例恶性腹水病人应用碘~(131)标记人体血清白蛋白进行检查,获得相同的结果。Allen 报道液体产生增加是腹水形成中一个重要原因,Hirabayaski 还证实恶性腹水病人的正常腹膜表面能增加腹膜液的产生,由肿瘤表面     

腹腔内恶性肿瘤腹膜转移的治疗进展

腹膜转移癌多由进展期胃肠道癌肿和卵巢癌等恶性肿瘤的腹腔内播散和转移所致,属于癌肿演进过程中的终末阶段。临床上这些患者往往伴有不同程度的恶性腹水和胃肠道并发症等,病情发展快,预后差,治疗相当困难。近年来对腹膜癌转移的外科治疗有了一些新的认识和发展,对于一些恶性程度低、肿瘤分化较好的患者仍可进行以减瘤性腹膜切除术为主的综合性治疗,并可取得较好的临床疗效,现就其主要有关的内容作一综合分析。     

胃癌同时伴腹膜扩散或肝转移及其相关的危险因素

腹膜扩散(PD)和肝转移(LM)是胃癌转移的主要途径,有此情况,预后明显恶化。因为无论是早期或晚期对原发胃癌与转移之间关系的研究均在复发病人中进行,因而在外科手术和转移的后果之间存在着时间差。本文则比较胃切除治疗同时伴有 PD 或 LM 的胃癌病人之间的临床病理特征,用逻辑回归分析法分析临床和病理对转移发生的影响。1965～1985年期间,计有1108例晚期胃癌作胃切除术,其中135例(12.2%)伴有 PD,62例(5.6%)伴有     

顺铂、情来霉素、阿霉寨三药联用治疗转移性前列腺癌

前列腺癌主要以内分泌疗法为主,但是,一旦内分泌药物治疗有反应或初次治疗发生抗药性、且有50%的病人癌症转移灶有恶化趋势,这是临床治疗中一个重要问题,本文报告、应用顺铂、情来霉素及阿霉素三药联用来治疗转移性前列腺癌,取得良好的效果。对象与方法; 作者近2年来对12例转移性前列腺癌症用上述三种药物进行治疗,年龄均为50～80岁之间,其中有4例病人分别进行过TURP放射性治疗和双侧睾丸切除术,其余8例均属初期治疗,肿瘤分化程度、高分化型5例,中度分化型2例、低分化型5例,12例病人都有骨转移其中1例伴有后腹膜转移、另1例伴有胸膜转移、酸性磷酸酶值12例中有11例增高。     

前列腺癌伴淋巴结转移患者行前列腺癌根治术的生存利益研究

前列腺癌根治术通常被认为是治疗早期前列腺癌的首选治疗，而伴有淋巴结转移的一般则采取激素治疗和（或）放射治疗。目前有些研究表明对前列腺癌伴有淋巴结转移的患者行前列腺癌根治术可提高其特异性生存率。本研究将慕尼黑癌症数据库中1413名前列腺癌伴淋巴结转移的患者以是否行前列腺癌根治术分为两组，比较其总生存率和相对生存率。     

我国165例腹膜恶性间皮瘤临床特点

目的：总结我国腹膜恶性间皮瘤的临床表现及诊治方法。方法：以腹膜恶性间皮瘤为检索词,分别对中国期刊网全文数据库、维普资讯网中文科技期刊数据库在2000—2010年期间发表的中文临床报道进行检索。结果：共检出腹膜恶性间皮瘤165例,男性多于女性。临床症状以腹痛、腹胀为最常见,出现率约为77.8%及63.9%。腹水是最常见的体征,出现率约为96%。剖腹及腹腔镜下探查是确诊的最常见手段。腹膜恶性间皮瘤预后较差,综合治疗后中位生存期约1.5年。结论：腹膜恶性间皮瘤是临床罕见病,误诊率高,应充分认识其特点,提高早期诊治腹膜恶性间皮瘤的水平。积极的综合治疗可以延长病人的生存期。     

伽玛刀联合Ommaya囊留置治疗颅内囊性多发转移瘤

肺癌、乳腺癌等癌症晚期患者常常发生颅内转移，文献报道，不经治疗中位生存期为3个月。颅内转移瘤常规治疗以放、化疗及手术为主，近来伽玛刀治疗报道亦较多。颅内多发转移瘤尤其是含有囊性病灶者往往伴有一定的颅内高压，且病人体弱多病，给上述各种治疗增加难度。本中心自2000年1月至2009年1月，对37例颅内囊性多发转移瘤行Ommaya囊留置并联合伽玛刀治疗．现将有关资料分析总结如下。     

Clinical and diagnostic significance of preoperative computed tomography findings of ascites in patients with advanced gastric cancer

BACKGROUND: The relationship between ascites, as detected by preoperative computed tomography (CT), and peritoneal metastasis of gastric cancer requires clarification because of its likely significance for clinical outcome. METHODS: A retrospective analysis of 293 patients with advanced gastric cancer investigated the association between preoperative CT findings of ascites and surgical findings of peritoneal washing cytology and peritoneal metastasis. RESULTS: Forty-five of 293 patients (15%) presented with ascites on preoperative CT. Positive ascites on CT predicted the presence of free tumor cells with 40% sensitivity and 97% specificity, and peritoneal metastasis with 51% sensitivity and 97% specificity. Ascites on CT was an independent prognostic factor by univariate (P < .001) and multivariate (relative risk, 2.03; 95% confidence interval, 1.39-2.96; P < .001) analyses. The median survival time was 6.0 months in patients with positive ascites on CT. CONCLUSIONS: The presence of ascites on CT suggests the presence of peritoneal metastasis and indicates a poor prognosis. The presence of peritoneal metastasis should be confirmed by diagnostic laparoscopy in gastric cancer patients with ascites.     

Malignant peritoneal mesothelioma of the prostate: a case report

A case of malignant peritoneal mesothelioma of prostate in a 52-year-old male is reported. He was admitted to the hospital with the complaint of perineal pain. The prostate was enlarged markedly, elastic soft and severely tender. CT scan and some examinations suggested the possibility of prostatic malignancy. The histological findings of the needle biopsy specimen revealed peritoneal mesothelioma. Complete pelvic exenteration was performed, because of direct invasions to the urinary bladder and the rectal anterior wall. The final pathological diagnosis revealed malignant fibrous peritoneal mesothelioma with solitary type of the rectovesical recess. At three months after the operation, the patient died of local resurrence and multiple metastasis to liver and lung. Only three cases of peritoneal mesothelioma, with solitary type, of rectovesical recess or retrovesical space have so far been reported in Japan.     

胃肠道癌腹膜转移的化疗策略

腹膜转移是严重影响胃肠道癌患者预后的独立不良因素,"种子-土壤"学说被认为是解释腹膜转移的主要理论。由于腹膜转移结节初发时体积小,早期诊断尤为困难,因此,腹膜转移的风险评估就显得尤为重要。目前诊断方法已由临床病理因素逐渐向细胞学、乃至分子层面纵深发展,而包括影像组学在内的多组学整合评估,也进一步丰富了腹膜转移的精准诊断...     

Prostate cancer presenting with malignant ascites: signet-ring cell variant of prostatic adenocarcinoma.

A case of prostate cancer presenting with malignant ascites as the sole clinical manifestation is reported. The clinical course simulated occult gastrointestinal malignancy. At the histologic level, the tumor had a signet-ring morphology. Detailed immunocytochemical and ultrastructural studies, however, confirmed the prostatic origin of this neoplasm. Signet-ring carcinoma of the prostate is a rare aggressive form of prostatic cancer which may present with a malignant effusion and may mimic gastrointestinal cancer.     

胃肠道癌术中腹腔内温热化疗临床适应证的探讨

目的:探讨胃肠道癌术中腹腔内温热化疗(IPHC)防治腹膜转移的临床适应证.方法:78例胃癌,5例结肠癌,剖腹后先收集腹水或腹腔冲洗液行细胞学或病理学检查,寻找游离癌细胞,并与肿瘤生物学特性进行单因素和多因素判别分析.结果:腹腔内游离癌细胞阳性率同腹膜转移、浆膜侵犯、TNM分期、浆膜侵犯面积、淋巴转移、腹水、Borrmann分型等因素有关(P<0.05),其中前两者为独立影响因素(P<0.0001).结论:IPHC的临床适应证为:①肉眼可见腹膜转移灶或癌性腹水;②术后腹膜转移;③腹腔冲洗液中发现游离癌细胞;④肿瘤侵及浆膜.     

Endobronchial metastasis from adenocarcinoma of gastric cardia 7 years after potentially curable resection

Endobronchial metastasis (EBM) is a rare form of metastasis from extrapulmonary malignant tumors, although there are few reports of EBM from gastric cancer specifically. We report the case of a 51-year-old woman who had undergone gastrectomy for advanced gastric cancer seven years previously but was diagnosed with a solitary lung tumor by follow-up computed tomography. On diagnosis of primary lung cancer, she underwent pulmonary lobectomy, but immunohistochemical examination confirmed the resected tumor to be an EBM from the gastric cancer. Six months later, she was diagnosed with peritoneal metastases and underwent chemotherapy with gastric cancer regimen. She is still alive at 33 mo after the lobectomy. Generally, the prognosis for EBM is poor although multidisciplinary treatment can lead to long-term survival. Precise diagnosis on the basis of detailed pathological and immunohistochemical evaluation can contribute to deciding the most effective treatment and improving prognosis.     

Omental metastasis with malignant ascites: an unusual manifestation of prostatic adenocarcinoma

Omental metastasis with malignant ascites from prostatic adenocarcinoma is rare. This case report is about a patient who presented with a 24-hour history of a swollen right leg. Clinical examination revealed a hard prostate and blood biochemistry demonstrated an elevated prostate specific antigen level. A Doppler ultrasound scan excluded deep venous thrombosis, but a CT scan of the abdomen revealed marked para-aortic lymphadenopathy and prostate gland biopsy confirmed prostatic adenocarcinoma. The patient was treated with goserelin. Three years later, he presented with ascites and an omental mass. Histology of the omental mass showed metastasis from the prostatic adenocarcinoma. He was treated with second-line hormonal therapy but died after 4 months. We discuss the clinical progression, with a review of the literature.     

Parasternal Lymph Node Metastasis of Malignant Peritoneal Mesothelioma: Report of a Case

We report a case of malignant peritoneal mesothelioma with parasternal lymph node metastasis. The patient was a 34-year-old man who presented with a history of several years of abdominal pain and ascites of unknown origin. Exploratory laparoscopic biopsies yielded histological findings of malignancy, but a final diagnosis was not able to be made. A chest computed tomographic scan done the following year showed a parasternal nodule, and thoracoscopically obtained biopsied material was positive for calretinin. These findings led to a pathological diagnosis of metastasis to the parasternal lymph node from peritoneal mesothelioma.     

Acute acalculous cholecystitis caused by gallbladder metastasis due to the peritoneal dissemination of gastric cancer: A case report

Introduction and importanceAcute acalculous cholecystitis (AAC) is associated with a high mortality rate. AAC caused by metastasis to the gallbladder is rare. We report a case of AAC caused by gallbladder metastasis due to the peritoneal dissemination of gastric cancer.Case presentationAn 84-year-old male visited our hospital because of epigastric pain. Ultrasonography and computed tomography revealed swelling and thickening of the gallbladder wall, but stones were not observed in the gallbladder. We performed emergency surgery with a diagnosis of acute cholecystitis. Laparoscopy revealed the presence of many nodules around the abdominal cavity including the hepatoduodenal ligament. Inflammation of Calot’s triangle was severe, so we performed subtotal cholecystectomy. We also resected one of the peritoneal nodules. Macroscopically, there were no stones in the gallbladder and histopathological examination revealed acute cholecystitis and existence of adenocarcinoma involving the subserosa of the gallbladder wall and the resected peritoneal nodule. After surgery, esophagogastroduodenoscopy revealed Borrmann type II lesions at the antrum and gastric biopsy showed adenocarcinoma. He was diagnosed with advanced gastric cancer with peritoneal dissemination. His postoperative course was good.Clinical discussionThe cases of AAC caused by gallbladder metastasis have been little reported in the literature. This case is advanced gastric cancer with peritoneal dissemination and AAC was thought to be caused by peritoneal dissemination from operative and histopathological findings. We successfully treated this rare case of AAC with laparoscopic surgery.ConclusionAlthough metastasis to the gallbladder is rare, it is necessary to be aware of this possibility when treating AAC.     

端粒酶与前列腺癌及其生物学行为的关系

目的 探讨端粒酶（ＴＥ）与前列腺癌（ＰＣａ）及其生物学行为的关系。方法 应用端粒重复片段扩增法（ＴＲＡＰ）法,检测３９例ＰＣａ组织,１５例前列腺增生（ＢＰＨ）组织及１０例正常前列腺（ＮＰ）组织中的ＴＥ活性,并比较ＴＥ活性水平与ＰＣａ病理分化程度,临床分期及转移情况的关系。