肺癌癌性空洞48例临床分析

癌性空洞多见于较大肺内肿块,空洞的X线形态、大小常与其病理类型有关,我科1988年6月10日～1994年6月10日经纤维支气管镜( 纤支镜)活检、刷检和(或)支气管肺活检(TBLB)确诊为肺癌2 145例,其中X线显示有空洞形成者为48例,占同期确诊肺癌总例数的2.23%.为提高肺癌癌性空洞的诊断及鉴别诊断水平, 我们对其X线表现、纤支镜检查的诊断作用进行对比分析,总结报道如下.     

肺癌癌性空洞48例临床分析

癌性空洞多见于较大肺内肿块，空洞的X线形态、大小常与其病理类型有关，我科1988年6月10日～1994年6月10日经纤维支气管镜(纤支镜)活检、刷检和(或)支气管肺活检(TBLB)确诊为肺癌2145例，其中X线显示有空洞形成者为48例，占同期确诊肺癌总例数的2．23％。为提高肺癌癌性空洞的诊断及鉴别诊断水平，我们对其X线表现、纤支镜检查的诊断作用进行对比分析，总结报道如下。     

空洞性肺癌

空洞见于9％的原发性肺癌,4％的转移性肺肿瘤。虽然肺部空洞性恶性肿瘤较少见,但有鉴别诊断意义。经 CT 检查共207例肺癌。96例原发性肺癌中,36例鳞癌,36例腺癌,19例小细胞癌,5例大细胞癌,皆经病理证实;111例转移性肿瘤,来自消化道者20例,泌尿生殖系22例,头颈部26例。结果:96例原发性肺癌中8例(8.3％)有空洞,腺癌最多,占13.9％,其次是鳞癌为8.3％,以未发现小细胞癌和大细胞癌空洞;111例转移性肺肿瘤中,5例(4.5％)有空洞,其中3例经病理证实。原发性肺癌年龄为58～73岁,平均68     

支气管镜冷冻肺活检联合血清CCR3、LDH、IL-33在周围型肺癌检出率及病理分型判断中的应用

目的 探讨支气管镜冷冻肺活检联合血清CC趋化因子受体3(CCR3)、乳酸脱氢酶(LDH)、白介素33(IL-33)对周围型肺癌检出率及病理分型判断的价值。方法 选取78例确诊为周围型肺癌的患者,经病理检查出腺癌39例、鳞癌19例、小细胞癌12例、其他类型肺癌8例。对患者进行支气管镜冷冻肺活检,并检测其血清CCR3、LDH、IL-33水平;分析各检测方法单独及联合检测对不同病理分型与病灶大小的阳性检出率。结果 经支气管镜冷冻肺活检、血清CCR3、LDH、IL-33及其联合检测的阳性检出率分别为82.05%、62.82%、58.97%、51.28%、92.31%,经支气管镜冷冻肺活检联合血清CCR3、LDH、IL-33的检出率高于单独检查(P<0.05)。支气管镜冷冻肺活检联合血清CCR3、LDH、IL-33对腺癌、鳞癌、小细胞癌及其他类型肺癌的阳性检出率高于单独检测(P<0.05)。支气管镜冷冻肺活检联合血清CCR3、LDH、IL-33对病灶直径<2 cm、2～6 cm、>6 cm的阳性检出率高于单独检测(P<0.05)。结论 支气管镜冷冻肺活检联合血清CC...     

空洞性肺癌的临床与外科病理学讨论

肺癌病变内有空洞形成者称为空洞性肺癌,发生率较高。作者报告1962年1月～1978年6月间岗山大学第2外科住院的26例原发性空洞性肺癌患者,研究其中24例切除病例的临床与病理学。1.发生率:16年间住院病人中临床诊断为原发性肺癌327例,空洞性肺癌占8%,经组织学确诊的266例中空洞型占10%,手术切除的192例中空洞型占13%。2.性别和年令分布:26例中男21,女5,男:女=4.2:1。年令为45～72岁,平均为58.6岁。与同期全部肺癌的男女比例和年令分布相似。3.组织类型:鳞癌15例,腺癌9例,大细胞型未分化癌2例。全部肺癌组织学类型鳞癌109例,腺     

233例小细胞肺癌纤维支气管镜检查分析

我院自1979年9月至1987年9月,在纤支镜检查病例中有1,165例经病理组织学和/或细胞学确诊为肺癌。其中,小细胞肺癌233例(20％),鳞癌549例(47.1％),腺癌291例(25％)和其它型癌92例。本文重点分析小细胞肺癌并以鳞癌和腺癌做对照组。一、纤支镜与病理诊断阳性率本组233例小细胞肺癌,226例纤支镜检查有所见,可做出肺癌之纤支镜检查诊断。该226例全部经纤支镜直接刷检和/或活检。其中142例病理确诊为肺癌。在84例刷、活检阴性病例中71例继续查痰找到癌细胞;13例依X线诊断手术切除肺标本做病理检查确诊为肺癌。7例周边型肺癌术前常规纤支镜检无所见,术后肺标本病理确诊为肺癌。本组之对照组一鳞癌和腺癌也用同样方法和途径获得病理诊断。本组纤支镜检查肺癌诊断阳性率97％(226/233)。对照组鳞癌91.4％(502/549);腺癌72.9％(212/291),差异显著(P<0.05)     

肺鳞癌患者CEA、SCC-Ag、Cyfra21-1和NSE水平

至今尚未发现对肺癌或肺组织有特异性的标志物。癌胚抗原 (CEA)作为肺腺癌的标志物、鳞癌相关抗原 (SCC Ag)作为肺鳞癌的标志物 ,其敏感性均不令人满意。Cyfra2 1 1对诊断NSCLC有重要进展。为评价CEA、SCC Ag、Cyfra2 1 1和NSE检测在肺鳞癌预后的敏感性和特异性进行此项研究。2 0 0例肺鳞癌 (Ⅰ期 2 5例 ,Ⅱ期 2 6例 ,ⅢA期 34例 ,ⅢB 98例 ,Ⅳ期 17例 )均经支气管镜活检和 (或 )外科证实。对照组包括健康组 12 4例和良性疾病 (BLD组 ) 96例 (结节病、结核、纤维化、哮喘、错构瘤、非癌性肿瘤、肺炎 )。两组年龄、性别、吸烟…     

肺癌患者血清磷酸已糖异构酶测定的临床意义

近年来 ,许多肿瘤标志物已广泛应用于临床 ,但有关血清酶诊断肺癌的研究文献报告甚少 ,本文通过观察血清磷酸已糖异构酶 (ＰＨＩ)活性检测对肺癌的临床诊断应用进行探讨。研究对象Ⅰ组 :均未经放疗及化疗。经Ｘ线、纤支镜活检及组织学证实的肺癌 4 0例。年龄 38～ 78岁。Ｘ线证实 :中央型肺癌 2 3例 ,周围型肺癌 17例。组织学证实 :鳞癌 2 4例 (Ⅰ期 5例 ,Ⅱ、Ⅲ期 19例 ) ,腺癌及腺鳞癌 10例 (Ⅰ期 6例 ,Ⅱ、Ⅲ期 4例 ) ,未分化癌 6例 ,(均Ⅱ、Ⅲ期 )。Ⅱ组 :转移性肺癌组 7例 ,分别为肾肿瘤肺转移 1例 ,乳腺癌肺转移 3例 ,胰腺癌肺转移 1…     

薄壁空洞周围型肺癌的CT影像学临床特征

目的探讨形成薄壁空洞的周围型肺癌的CT影像学临床特征。方法选取2012年4月至2016年6月间北京中医医院延庆医院收治的22例已被证实为周围型肺癌伴薄壁空腔的患者,采用CT扫描观察患者肺癌实性病灶、空洞病灶及空洞与肺癌主体病灶毗邻关系的CT影像学临床特征。结果 22例周围型肺癌伴薄壁空洞患者中,肺癌病灶CT影像学显示,主体病灶位于右肺者16例(72.7%),位于左肺者6例(27.3%);表现分叶征者19例(86.4%),毛刺征16例(72.7%),血管集束征10例(45.5%),小泡征5例(22.7%),细支气管充气征4例(18.2%),沙粒样钙化表现2例(9.1%)。空洞病灶CT影像学显示,大多呈圆形或类圆形,腔壁呈均匀表现,壁厚<2mm者18例(81.8%),壁厚2~3mm者4例(18.2%)。出现内壁结节者4例(18.2%),空洞病灶外壁相贴或推移血管影者8例(36.4%),空洞内见分隔或细小血管者19例(86.4%)。空洞位于肺癌实体病灶周边者18例(81.8%),位于肺癌实体病灶内者4例(18.2%)。结论 CT影像学检查对于周围型肺癌伴薄壁空洞具有一定的诊断和鉴别价值,可提高临床对该病的诊断准确率。     

p63和TTF-1在肺癌组织中的表达及鉴别诊断意义

目的:探讨p63和TTF-1蛋白在肺癌不同组织类型中的表达特点及鉴别诊断的价值。方法:应用免疫组织化学S-P法检测116例原发性肺癌组织中p63和TTF-1蛋白的表达情况。结果:p63在肺鳞癌中阳性表达率为100%(47/47),而在其他组织类型肺癌中基本不表达。TTF-1在肺小细胞癌和肺腺癌中阳性表达率分别为93.3%(14/15)和93.5%(43/46),而在鳞癌中未见表达。结论:p63可作为肺鳞状上皮源性肿瘤标记物,是判断鳞癌的可靠指标。TTF-1可作为肺小细胞癌、腺癌的特异性标记。联合检测p63和TTF-1对肺癌不同组织类型的诊断、鉴别诊断具有较高的实用价值,尤其可作为鉴别分化差的鳞癌、腺癌和小细胞癌的指标。     

20例食管癌肉瘤的诊断与治疗分析

目的食管癌肉瘤是一种罕见病,通过回顾分析本组较大样本食管癌肉瘤的病理及临床特点,探讨其诊断治疗.方法对20例食管癌肉瘤病人的临床资料进行回顾性分析.结果食管癌肉瘤多为覃伞样、息肉样腔内生长,个别呈浸润生长.光镜下肉瘤与癌两种成份共存,瘤体以肉瘤成分为主,表面及蒂多分布癌组织,活检常显示为鳞癌,故术前多不能明确诊断.20例患者中9例侵犯粘膜层,1例浅肌层,4例深肌层,6例侵犯外膜.4例出现淋巴结转移,淋巴转移率20%,转移成分3例鳞癌,1例肉瘤.手术切除率100%.1、3、5年生存期分别为85%、68%、68%.结论食管癌肉瘤是一种低侵袭性,低淋巴转移率,预后尚佳的肿瘤.X线表现为食管腔内息肉样的充盈缺损,轮廓较为光滑整齐,粘膜显示"涂抹征".食管镜活检多显示鳞癌或低分化癌,术前难以确诊.治疗以手术切除为主,必要时辅以放化疗.     

Significance of psammoma bodies in serous cavity fluid: a cytopathologic analysis

BACKGROUND: Psammoma bodies (PBs) are encountered only rarely in body cavity fluids (BCF). Although to the authors' knowledge their presence in certain neoplasms (e.g., those of the thyroid, ovary, lung, brain, etc.) is established, their significance in BCF has not been well defined. METHODS: Diagnoses concerning 3335 BCF samples were reviewed from the cytopathology files for the presence of PBs over an 8-year period. Cytologic preparations included cytospin preparations and Millipore filters stained with the Papanicolaou stain. Clinicopathologic correlation was performed on any subsequent surgical studies. RESULTS: Of the 3335 BCF samples studies (2444 pleural samples, 688 peritoneal samples, and 203 pericardial samples), PBs were noted in 123 cases (3.7%). Of these 123 cases, 112 were the peritoneal fluid (91%), 10 were the pleural fluid (8.1%), and 1 was in the pericardial fluid (0.81%). All 11 cases of pleural and pericardial effusions with PBs were malignant (carcinomas of the thyroid, lung, and ovary) compared with 62 of 112 peritoneal fluid samples (55.4%) (carcinoma of the ovary and uterus and mesothelioma). Nine of the remaining 50 cases of cytologically benign peritoneal fluids with PBs detected on follow-up tissue biopsy demonstrated peritoneal metastases from ovarian or endometrial carcinoma. Therefore, 41 of 112 cases of peritoneal fluid with PBs remained benign even after clinical follow-up and/or tissue biopsy (36.6%) and demonstrated ovarian cystadenoma/cystadenofibroma, papillary mesothelial hyperplasia, endosalpingiosis, endometriosis, and other miscellaneous benign diagnoses. CONCLUSIONS: PBs in BCF is a rare finding. Although in the authors' experience their presence in pleural and pericardial effusions signifies carcinomatous involvement, in the current study, peritoneal fluids with PBs were found to be benign in a significant number of cases (36.6%). In the latter scenario and in the absence of an obvious malignancy, attempts should be made to rule out the above-mentioned benign lesions.     

纤支镜刷检常见肺癌各型癌细胞形态特征的探讨

 本文选择病理、刷检和痰脱落细胞检查皆为阳性的肺癌患者142例（鳞癌62例，腺癌18例未分化小细胞癌59例）。以病理分型为标准，对刷检、痰检中同类型癌细胞，在排列方式、细胞浆嗜色、细胞大小、细胞核畸形程度和染色质结构等方面进行对比，探讨刷检癌细胞的形态特征。     

Ad-hTERTp-HSV-TK/GCV系统对肝癌腹水抑制效应的实验研究

目的:探讨由人端粒酶逆转录酶启动子驱动单纯疱疹病毒胸腺激酶基因的重组腺病毒,联合更昔洛韦(GCV)对肝细胞癌腹水生成的影响.方法:将H22细胞注入小鼠腹腔建立肝癌腹水瘤模型,并通过观察各组小鼠体质量、腹围、腹水量、生存时间、脏器及细胞凋亡率等指标的差异.揭示Ad-hTERTp-HSV-TK/GCV系统对肝癌腹水的治疗作用.结果:经过Ad-hTERTp-HSV-TK/GCV治疗的小鼠,显示出明显的腹水抑制作用,其腹水量显著低于各对照组(P<0.01),生存时问延长(P<0.01),细胞凋亡率提高(P<0.01).并且无明显毒副反应.而单独使用Ad-hTERTp-HSV-TK和GCV对腹水生成无明显作用.结论:Ad-hTERTp-HSV-TK/GCV系统对肝癌细胞有较强的靶向杀伤作用,治疗肝癌腹水效果显著,对其临床应用具有理论意义.     

电子鼻咽镜下不同活检方法对早期诊断鼻咽癌的临床价值

目的探讨电子鼻咽镜下不同活检方法对早期诊断鼻咽癌的临床价值。方法将166例疑是鼻咽癌患者随机分为2组。对照组83例,电子鼻咽镜下采用配套活检钳经活检道行鼻咽部活检;手术组83例,电子鼻咽镜下采用常规活检钳经口腔行鼻咽部活检术。结果活检准确率以1次钳取组织即取得阳性结果为标准计算,对照组活检准确率79．5％,手术组活检准确率98．8％,2组比较,手术组活检准确率明显过于对照组（P〈0．05）。结论电子鼻咽镜下采用常规活检钳经口腔行鼻咽部活栓术,能检查鼻咽部各个部位并钳取各个部位的组织,对深层病变组织钳取更有优势,有利于早期诊断鼻咽癌。     

Successful re-treatment with gefitinib for carcinomatous meningitis as disease recurrence of non-small-cell lung cancer

We report the case of a woman with gefitinib-sensitive lung adenocarcinoma, who was successfully re-treated with gefitinib for carcinomatous meningitis as the disease recurrence. The good response to gefitinib treatment was supported in part by the existence of epidermal growth factor receptor mutation in carcinoma cells in the specimen obtained from transbronchial lung biopsy, in which E709G in exon 18 and L858R in exon 21 were shown. Although carcinomatous meningitis had been well controlled by the treatment with gefitinib, serum carcinoembryonic antigen (CEA) level increased with re-growth of primary tumor and development of lymphangitic carcinomatosis. Immunohistochemical findings revealed de novo emergence of CEA-producing carcinoma cells in the biopsy specimen taken after recurrence of pulmonary lesion during re-treatment of gefitinib, but revealed little or no CEA expression in the specimen obtained at first presentation. These facts may suggest the possibility of oligo clonality of carcinoma cells in this case.     

Roentgenodiagnosis of primary lung carcinoma with cavity--analysis of 100 cases

This paper reports the roentgenopathologic findings of 100 primary lung carcinomas with cavitation. It was found that formation of carcinomatous cavity was related to the histopathologic classification. The cavity could be formed in four ways: 1. Cancer tissue necrosis. 2. Abscess formation after obstructive infection. 3. Cancer infiltration around the bronchial wall leading to bronchial cancer embolus and necrosis. 4. The air-cyst-like lesion formation by check valve obstruction of cancer within the bronchial. A variety of cavity formation could result in different patterns such as: the thick walled cavity (42%), central cavity (28%), consolidation cavity (5%), thin walled cavity (7%), abscess cavity (6%) and spotted cavity (12%). The lobule, spicules or notched margins are usually observed on the outer wall of the thick walled cavity which are considered as the typical manifestation of cancer cavity. The consolidation cavity, thin walled cavity, abscess cavity or spotted cavity should be differentiated from infections, tuberculosis etc. The diagnosis can be proved by sputum examination and/or fiberbronchoscopy.     

肺炎性假瘤和癌的关系

报告12例肺炎性假瘤和癌共存于同一瘤块。经详细病理观察认为,3例属碰撞性或癌伴假瘤,9例为假瘤癌变。后者占本单位同期切除肺炎性假瘤的9.8％.切除肺癌的2.7％。建仪诊断肺炎性假瘤癌变的组织学标准为,假瘤和癌共存于一个瘤块内,并见假瘤上皮细胞增生到癌的过渡改变。     

Prognostic significance of residual cancer tissue after diagnostic biopsy in breast carcinoma. Three-year short-term results

Among 3264 cases of breast carcinoma undergoing diagnostic biopsy and frozen section followed by one-stage mastectomy, the occurrence of residual cancer tissue (RCT) was evaluated as part of a prospective, nationwide trial in Denmark. RCT was defined by the presence of cancer left in relation to the biopsy cavity in the mastectomy specimen. A significantly higher cumulative recurrence rate within 3 yr was found in cases with residual cancer compared to cases without this finding. The difference was most pronounced in the premenopausal high-risk group. Therefore, RCT in the wall of the biopsy cavity is considered a prognostic hazard by itself.     

Tumor markers in the diagnosis of ascitic and pleural puncture fluids

The identification of carcinoma cells in ascitic and pleural effusions by the detection of tumor markers was studied using an indirect immunoperoxidase method. Punctates from 56 patients with carcinomas, 18 with other malignant diseases and 10 with benign diseases were examined. In 35% of carcinomatous punctates tumor cells were stained by a CEA antiserum. No positive cells were found, however, in non-carcinomatous benign or malignant effusions. The immunocytochemical staining of CEA could detect tumor cells in 36% of carcinoma cases classified suspicious or negative using conventional cytology only. A TPA antiserum as well as the monoclonal antibody OC 125 stained cells in carcinomatous as well as in non-carcinomatous malignant and in benign punctates.