肺原发恶性纤维组织细胞瘤的影像表现

探讨肺原发恶性纤维组织细胞瘤（ＭＦＨ）的影像特点,提高术前确诊率。方法对本院７例及文献中４４例共５１例影像资料进行分析。包括胸片５１例,ＣＴ９例及ＭＲＩ１例。结果本院肺原发ＭＦＨ占同期肺癌０．０１％。全组发病中位年龄５５岁。主要症状为咳嗽、血痰及胸痛。随诊４０例中,死因不明５例,复发和（或）转移１５例,复发率为４２．８％（１５／３５）,发生在一年内占８０．０％。肿瘤位于右叶３４例,左叶１７例。周围型４９例,占９６．１％;中心型２例,占３．９％。影像表现：肿瘤呈软组织肿块,瘤体较大,≥５ｃｍ者３５例,占６８．６％。形态呈规则或不规则形。边缘光整或界限清者２９例,占５６．９％;伴有分叶者２２例,占４３．１％;密度均匀者３３例,占６４．７％。少数病灶边缘有毛刺、囊性变及空洞形成。ＣＴ显示病变密度低且有坏死区,周围组织器官受侵。结论肺原发ＭＦＨ的影像表现虽无特征,但瘤体大,边界清,少分叶,少毛刺,密度低,可有别于常见的肺癌和良性肿瘤。ＣＴ及ＭＲＩ检查有助于显示病变内部密度、侵犯范围和转移情况,可提高诊断率。本病变恶性度高,复发转移快,根治切除可有长期生存的可能     

原发周围型肺癌的早期X线诊断──附101例报告

总结了≤２ｃｍ的早期周围型肺癌１０１例的Ｘ线诊断，其中１５例加了ＣＴ检查。病理鳞癌１５例，腺癌４６例，小细胞癌２３例，其他７例。形态结节状９１例，浸润状１０例。Ｘ线其他征象的多寡依次为边缘毛利征，分叶征，空泡征，索条征和胸膜凹陷征。手术的９６例胸内淋巴结转移３３例（３４．３％），远处转移２例。     

宫颈腺鳞癌6例临床分析

宫颈腺鳞癌６例临床分析冯梅，林肖玉，刘瑞华，陈国英，孙树芳（福建省肿瘤医院３５００１４）从１９８５年１月至１９９０年１２月，我院共收治宫颈癌１０７８例。其中，鳞癌１０１２例，腺癌６６例。在腺癌中．有腺鳞癌６例（９％）。文献［１，２］报道腺鳞癌占腺癌的...     

肺腺鳞癌54例外科疗效分析

目的：总结探讨肺腺鳞癌切除术后的临床病理特点及预后。方法：采用ＳＰＳＳ软件建立肺癌病例数据库并进行统计学分析;对其中５４例肺腺鳞癌的统计资料作进一步的理论及预后分析。结果：５４例肺膛癌中,周围型４２例,占７７．７８％,有淋巴移者２６例,率为４８．１５％（２６／５４）,切除淋巴总数５７９枚,有转移淋巴结１１５枚,转移度为１９．８９％（１１５／５７９）。根治性切除者４２例,姑息性切除者１２例。５年生存     

局限型胸膜间皮瘤的影像诊断

作者分析了经手术及病理证实的局限型胸膜间皮瘤１９例，其中良性９例，恶性８例，未定型２例。影像表现肿物多呈椭圆形、梭形或分叶状，边缘清楚锐利，贴近胸膜表面，少数瘤内有钙化或囊变。９例良性局限性纤维型胸膜间皮瘤中，５例有蒂，蒂长１～８ｃｍ，无一例有侵犯胸壁征象；８例恶性中，２例为带蒂肿物，５例伴有胸壁软组织侵犯，４例有肋骨破坏。ＣＴ评价胸膜间皮瘤的部位和范围有明显优越性。但除了胸壁软组织和肋骨侵犯提示恶性外，影像检查结果不能区别局限型胸膜间皮瘤的良、恶性。恶性胸膜间皮瘤术后容易复发，应长期随诊。     

周围型非小细胞肺癌CT征象与临床病理分型的关系

目的:探讨周围型非小细胞肺癌CT征象与临床病理类型的关系。方法:选择2015年1月至2017年9月在我院就诊的周围型非小细胞肺癌患者154例作为研究对象,观察患者CT征象与临床病理分型的关系。结果:不同病灶位置病理类型分布差异无统计学意义（P>0.05）。腺癌、鳞癌、腺鳞癌实性高密度结节发生率高于肺泡癌,鳞癌磨玻璃样密度结节发生率低于腺癌、肺泡癌和腺鳞癌,肺泡癌磨玻璃密度结节发生率高于腺癌、鳞癌和腺鳞癌,差异均有统计学意义（P<0.05）。腺癌的CT征象主要表现为血管穿过征、分叶征、毛刺征,较少表现为空泡征、血管集束征和胸膜凹陷征;鳞癌的CT征象主要表现为分叶征,较少表现为毛刺征、空泡征、血管穿过征、血管集束征;肺泡癌CT征象主要表现为血管穿过征、空泡征、胸膜凹陷征,较少表现为血管集束征、分叶征、毛刺征;腺鳞癌CT征象主要表现为分叶征、血管穿过征和毛刺征,较少表现为空泡征、血管集束征、胸膜凹陷征。结论:周围型非小细胞肺癌病理分型与CT征象具有一定关联,临床可通过不同CT征象对病理类型进行预判断,以对进一步诊治进行指导。     

子宫内膜腺鳞癌51例临床预后分析

目的通过对子宫内膜腺鳞癌临床特征的分析,探讨影响预后的因素。方法回顾性研究1997年7月至2007年5月湖南省肿瘤医院共收治51例子宫内膜腺鳞癌病人。结果①腺鳞癌占同期全部宫内膜癌的4．78％,腹膜后淋巴结转移率14．0％。②肌层浸润〈1／2与〉1／2的宫外转移率分别为26％和62．5％,差异具有显著性（P〈0．05）。③单因素线性回归分析显示：腺癌分化程度与浸润肌层深度有关（P=0．035）。④Ⅰ期5a生存率85．7％,Ⅲ期5a生存率66．7％,而Ⅳ期2a生存率分别为33．3％。结论子宫内膜腺鳞癌临床特征与普通子宫内膜样腺癌无明显区别。分化程度和肌层浸润深度是影响其预后的重大因素。     

胸膜间皮瘤19例临床分析

目的总结１９例胸膜间皮瘤的诊断经验。方法分析１９例胸膜间皮瘤的临床资料,包括年龄、石棉接触史、临床表现、影像学检查、实验室检查和转移情况。结果１９例患者均无明确石棉接触史;８例（４２．１％）无明显胸痛;９例（４７．４％）单纯右侧胸腔积液;２例（１０．５％）臂丛神经受影响;１例（５．２６％）胸水中查到恶性间皮细胞;９例（４７．４％）Ｂ超检查发现胸膜肥厚或结节;１３例（６８．４％）ＣＴ检查发现胸膜结节状病灶。结论石棉接触史并非胸膜间皮瘤的唯一病因;胸痛并非胸膜间皮瘤诊断的必要条件;Ｂ超和ＣＴ检查对临床发现胸膜间皮瘤有提示作用。     

无症状肺癌手术疗效分析

本院胸外科１９８９年５月至１９９９年５月收治无症状肺癌２５例,均为体检或偶然胸片检查发现,并经病理确诊。术前无自觉症状,全部进行了手术治疗,现报告如下。１临床资料本组２５例中男性１９例,女性６例,年龄４３～７６岁,平均年龄６０．３岁。其中１１例为体检中发现,１４例为偶然Ｘ线摄胸片时发现。２３例行肺叶切除术,右肺叶切除术１２例,左肺叶切除术１１例。鳞癌７例,腺鳞癌２例,腺癌１４例。肿瘤最小为２ｃｍＸＺ。ｍＸ２ｃｍ,最大６ｃｍＸ８ｃｍＸ５ｃｍ。另外有２例Ｘ线胸片检查发现时已有胸腔积液,胸腔液检查发现…     

肺腺鳞癌手术病例临床分析

背景与目的 肺腺鳞癌是一种少见的病理类型。本研究旨在探讨肺腺鳞癌的临床特点。方法 回顾性总结经手术切除、病理确诊的115例肺腺鳞癌的临床资料。结果 无症状病例占全组12．17％（14／115）。女性肺腺鳞癌患者中49岁以下者占19．44％（7／36）。支气管残端阳性者占14．04％。淋巴结转移度为37．51％。Ⅲ期病例占全组54．78%（63／115）。结论 年轻女性（49岁以下，尤其是30～39岁）肺腺鳞癌发病率较高。常规手术支气管残端阳性多见。淋巴结转移度高。     

The Value of Multislice Spiral Computed Tomography in Demonstrating the Relationship between Bronchial and Peripheral Lung Cancer

OBJECITVE To investigate the value of multislice spiral computed tomography (MSCT) in demonstrating the relationship between bronchial and peripheral lung cancer.METHODS MSCT was used to conduct volumetric targeted scans of 0.5 mm collimation for 53 cases of peripheral lung cancer and to demonstrate the relationship between bronchial and peripheral lung cancer by multiplanar reconstrUctions(MPR) images, curved multiplanar reformations(CMPR) and surface shaded display(SSD). The results were compared with macroscopic and microscopic specimens.RESULTS 1) All the bronchi at the 3rd to 7th order were displayed clearly and completely with this CT protocol. The tumors that were related to the bronchus included 29 (96.7%) adenocarcinomas and 13 (76.5%) squamous-cell carcinomas. Statistical analysis showed that there was no significant difference between the two groups (x2 =2.8, P ＞0.05). 2) The tumorbronchus relationship was divided into four subtypes, i.e. type Ⅰ: the bronchus was obstructed by a tumor, type Ⅱ: the bronchus was obstructed when penetrated by a tumor with tapered narrowing; type Ⅲ: the bronchial lumen shown within the tumor was unobstructed and intact, type Ⅳ: the bronchus ran at the periphery of a tumor, with an intact or narrowed lumen.3) Type Ⅰ occurred in 58.5% (31 cases), in which squamous-cell carcinoma was slightly more common than adenocarcinoma. Both type Ⅱ and type Ⅲ were seen in 15.1%(eight cases of each), of which all were adenocarcinomas. The incidence rate of type Ⅳ was 28.3% (15 cases), of which adenocarcinoma was slightly more frequent than squamous-cell carcinoma. 4)Squamous-cell carcinoma was more common than adenocarcinoma in the tumors in the fourth-order bronchus, whereas adenocarcinoma was more common than squamous-cell carcinoma in tumors with a relationship to the sixth-order bronchus.CONCLUSION MSCT with volumetric targeted scans of ultra-thin sections were conducted followed by MPR,CMPR and SSD reconstruction. This procedure can accurately demonstrate the relationship between the nature of tumors and bronchus and thereby to some extent reflect pathological changes.     

Adenosquamous carcinoma of the stomach. A clinicopathologic analysis of 28 cases

Twenty-eight cases of primary adenosquamous carcinoma (ASC) of the stomach were studied clinicopathologically. These cases were classified into two types, 16 with differentiated type adenocarcinomatous component (DAC) and 12 with undifferentiated type adenocarcinomatous component (UAC), according to the degree of glandular formation of the adenocarcinomatous elements. A large number with adenocarcinomas, including 131 with differentiated type and 133 with undifferentiated type, were studied as controls. As a consequence, with respect to biologic behavior, ASC with DAC was similar to the differentiated type adenocarcinoma, and ASC with UAC to the undifferentiated type adenocarcinoma. Accordingly, the behavioristic feature of ASC seemed to be governed by the adenocarcinomatous component. Histologically, a close relationship between neoplastic adenomatous and squamous components was evident in the intermingling areas, thereby suggesting a transition of both elements. In addition, a mucoepidermoid pattern was occasionally detected in the squamous component. Judging from the biologic behavior and histologic findings, the majority of ASC probably derives from the squamous metaplasia in an adenocarcinoma. The prognosis of ASC was less favorable than that of adenocarcinoma because of the more extensive tumor depth and higher frequencies of lymphatic and vascular permeations of the carcinoma cells.     

胃癌双期动态CT扫描的影像表现及其对肿瘤检出、大体分型的价值

目的分析胃癌双期增强动态ＣＴ扫描的影像表现,进一步评价动态ＣＴ扫描对肿瘤检出及大体分型的价值。方法对６３例经胃镜活检证实为胃癌的患者行双期动态ＣＴ扫描,将胃癌ＣＴ扫描表现、肿瘤检出及大体分型与手术、病理进行对照。结果ＣＴ扫描对早期胃癌和进展期癌的检出率分别为１００．０％和９８．２％。大体分型总的准确率为６５．４％,对早期癌分型准确率为０,对ＢｏｒｒｍａｎｎⅡ、Ⅲ、Ⅳ型的准确率分别为８５．７％、１００．０％和５５．６％。早期胃癌共８例,在增强早期显示为局限性胃壁增厚,其中中等或显著不均匀强化４例,一般不均匀强化４例。进展期胃癌显示为局限性或广泛性胃壁增厚,有溃疡或无溃疡,增强早期为中等或显著不均匀强化,第二时相呈均匀强化。粘液腺癌４例,其中３例见靶征或分层征,２例见钙化。结论（１）增强动态ＣＴ扫描对胃癌诊断有意义,但以在增强早期扫描效果为好。（２）细致的检查方法是提高胃癌诊断准确性的保证。     

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。     

周围型肺癌CT征象与p53蛋白及增殖细胞核抗原表达间关系的研究

目的研究周围型肺癌ＣＴ征象与ｐ５３蛋白及增殖细胞核抗原（ＰＣＮＡ）表达间的关系。方法运用ＳＰ免疫组化法,检测３２例经病理证实的周围型肺癌组织中ｐ５３蛋白及ＰＣＮＡ的表达,并回顾性分析其与术前ＣＴ征象间的关系。结果ｐ５３蛋白、ＰＣＮＡ表达与瘤体大小、深分叶征、空洞、胸膜凹陷征、纵隔淋巴结转移有关,与毛刺征无关。结论周围型肺癌ＣＴ征象中,瘤体直径＞３ｃｍ,或出现深分叶征、空洞、胸膜凹陷征、纵隔淋巴结转移者,具有相对更高的恶性程度,肿瘤细胞的增殖更为活跃。     

多排螺旋CT显示支气管与外周肺癌关系的价值

目的 研究多排螺旋CT(MSCT)显示支气管与外周肺癌关系中的价值。方法 采用MSCT对53例外周肺癌行层厚为0．5mm的容积靶扫描,通过多层面或曲面重建(MPR or CMPR)以及表面遮盖显示(SSD)的方法,显示支气管与外周肺癌的关系。将结果与手术标本、病理切片对照。结果 (1)全部第3—7级支气管均全程清晰、完整的显示,肿瘤与支气管有关系者：30例腺癌中29例(96．7％),17例鳞癌中13例(76．5％)。(2)肿瘤-支气管关系分为4型：Ⅰ型：支气管被肿瘤截断;Ⅱ型：支气管进入肿瘤锥状中断;Ⅲ型：支气管在肿瘤内保持通畅;VI型：支气管紧贴肿瘤边缘走行,形态正常或受压移位。(3)Ⅰ型发生率为58．5％(31／53),其中鳞癌略多于腺癌;Ⅱ型和Ⅲ型均为15．1％(8／53),仅见于腺癌;Ⅳ型为28．3％(15／53),腺癌略多于鳞癌。(4)与第4级支气管相关的肿瘤,鳞癌多于腺癌;与第6级支气管相关的肿瘤,腺癌多于鳞癌。结论 采用MSCT,超薄层靶扫描后行MPR、CMPR和SSD重建能准确地显示肿瘤-支气管关系,反映一定的病理改变。     

肺肉瘤样癌的临床病理分析

目的探讨肺肉瘤样癌（pulmonary sarcomatoid carcinoma,PSC）的临床病理学特征,以提高对肺肉瘤样癌的早期诊断。方法回顾性分析6例肺肉瘤样癌的临床特征、影像学表现及病理学特征。结果6例患者最常见的呼吸系统临床表现为咳嗽、咳痰（100．O％）,其次5例为痰中带血（83．3％）和4例胸痛（66．7％）;影像学表现为增强CT扫描可见肿块实体部分轻度强化,转移淋巴结环形强化1例,肺内转移3例,纵隔转移2例,腋窝淋巴结转移2例,胸膜及胸壁侵犯3例,胸腔积液3例,肋骨转移1例,肝转移1例,脑转移2例;病理诊断3例为多形性癌,2例梭形细胞癌,1例为巨细胞癌。结论肺肉瘤样癌临床少见,其临床表现无特异性,肺部增强cT检查具有一定的特异性,诊断仍需依靠病理学检查,免疫组织化学有助于确诊。     

Primary malignant tumors of the trachea. A radiologic and clinical study

Fifty-four cases (55 foci) of primary tracheal malignancies were reviewed retrospectively. Radiologic material was available in 32 cases (33 tracheal foci). The most frequent primary malignant tumor of the trachea was squamous cell carcinoma (54.5%), followed by adenoid cystic carcinoma (18%) and adenocarcinoma (9%). The radiologic appearance of the tumors could be divided into intraluminal, wall-thickening, and exophytic forms. Wall-thickening and exophytic forms in this study accounted for 62% of the tumors. This indicates that malignant tumors of the trachea tend to extraluminal invasion. Tomography and computed tomography are the most helpful methods of radiologic examination for tracheal tumors. Bronchoscopy and radiologic examination are complementary procedures. The chief advantage of imaging is the demonstration of tracheal wall thickening and extraluminal changes. Hemoptysis, dyspnea, and cough were the most common symptoms. Four cases (7%) in our series presented as thyroid tumors due to direct extension into the thyroid gland. Fifteen of the 54 cases (28%) were associated with other carcinomas of the head and neck and the lung.