宫颈微小偏离性腺癌的诊治分析

目的 研究宫颈微小偏离性腺癌(MDA)的临床特点及诊治方法.方法 回顾性总结15例MDA的临床资料,分析临床表现、辅助检查、病理、治疗方法及随诊情况.结果 15例MDA中,有11例治疗前行宫颈脱落细胞学检测,其中3例(27.3%)提示腺癌或可疑腺癌;有8例(53.3%)宫颈活检病理结果为MDA;有2例行诊断性锥切.病理学检查显示,6例手术患者宫颈切面可见多个囊腔.镜下见宫颈腺体不规则增生,肿瘤细胞异型性小,免疫组化CEA、α-SMA阳性.全组患者中位随访时间为51.0个月,5年生存率为85.7%;复发4例,均在术后2年出现阴道、盆腔复发;死亡3例,平均生存时间为36.3个月.结论 MDA较少见,其肿瘤细胞异型性小,临床及病理诊断较困难,必要时应及时行宫颈深部组织切除或锥切,免疫组化可提高病理诊断的准确性.MDA治疗以手术为主,必要时可辅助放疗和(或)化疗.     

早期宫颈小细胞癌的临床分析

目的 探讨早期宫颈小细胞癌(SCCC)的临床特点、治疗及预后因素.方法 回顾性分析19例早期SCCC的临床特征、治疗及预后相关资料.结果 19例患者3、5年生存率分别为57.89%(11/19)、36.84%(7/19).FIGO分期:Ⅰ b 1期8例, b 2期4例,a期7例,期存活3、5年患者分别为6、2、3例及4、1、2例.盆腔淋巴结阳性9例中5年生存仅1例;脉管瘤栓7例中无一例生存5年.根治性放疗联合化疗1例及单一手术1例未生存5年以上;术前治疗11例中5年生存5例,前未治疗7例中5年生存2例;手术+放疗2例中无一例生存5年以上,术+化疗5例中5年生存3例,术+化疗+放疗10例中5年生存4例.结论 对于早期SCCC,巴侵犯及脉管瘤栓是主要高危因素,术+化疗为基础的综合治疗是一种较好的治疗方式,前化疗对控制远处转移有益,后辅助放疗可以防止局部复发.     

宫颈微小偏离性腺癌临床病理分析

目的 探讨宫颈微小偏离性腺癌(MDA)的临床、病理特征.方法 对2例宫颈微小偏离性腺癌临床资料进行分析,组织化学及免疫组化(S-P法)检测CEA、CK7、CK8、Ki-67、P53,并结合文献进行复习.结果 MDA多见于中老年人,病程6个月至3年不等,预后较差.临床表现主要为白带增多或阴道流水样液,可伴阴道不规则出血.妇检:宫颈肥大,表面糜烂或颗粒状,质硬;宫颈管扩张,可呈桶状.术前临床及病理易误诊为慢性宫颈炎.镜下:MDA分化程度高,瘤组织形态和正常颈管腺体差异微小,腺体结构呈奇异性分支和成角浸润,少见背靠背现象;瘤细胞异型性小,可见个别胞核轻中度增大或核上移,核分裂像无或极少见.浸润深度达宫颈壁的2/3(或7 mm以上),间质可见血管及神经侵犯.可向上侵犯宫腔及淋巴结转移.腺周间质可见不同程度的组织反应及炎细胞浸润.组织化学PAS阳性.免疫组化CEA、CK7、CK8、Ki-67瘤细胞阳性P53蛋白阴性.结论 MDA是一种较为少见的特殊类型的子宫颈腺癌.     

宫颈上皮内瘤变315例手术前后病理分析

背景与目的:宫颈上皮内瘤变(cervical intraepithelial neoplasia, CIN)是宫颈癌的癌前期病变.近年来,越来越多的年轻女性被诊断出CIN,如何正确而适度的处理CIN是临床处理的目标.本文通过对宫颈上皮内瘤变患者手术治疗前后病理情况分析,探讨治疗宫颈上皮内瘤变的合理方式.方法:对2004年4月至2006年11月间我院收治的315例行宫颈锥切术或子宫切除术的CIN 患者进行回顾性分析.比较不同手术治疗前后组织病理诊断,并随访治疗后复发情况.结果:315例患者中,232例(73.65%)行锥切治疗,26例(8.25%)行全子宫切除,57例(18.1%)行次广泛子宫切除.232例锥切治疗患者,术后病理转阴22例,级别升高36例,其中浸润癌20例.锥切术后继续手术治疗15例,其中5例证实有病灶残留.在子宫切除的83例患者中,病理阴性4例,微早浸润癌ⅠA1期3例,浸润癌1B1期4例,该4例接受再次手术或放射治疗.214例锥切为最终治疗,术后未再治疗的CIN患者中,随访中发现5例(2.4%)再次出现宫颈病变.结论:宫颈锥切是一种能准确诊断宫颈病变并能较好治疗CIN的方法.建议对于CIN患者应尽量先行宫颈锥切,根据锥切后病理情况及患者对保留生育功能的要求再决定进一步的处理方案.     

10例头颈部髓外浆细胞瘤的临床分析及文献复习

背景与目的:髓外浆细胞瘤(extramedullary plasmacytoma,EMP)为一种罕见肿瘤,主要发生在头颈部,约80%的EMP发生于上呼吸道及上消化道。在临床表现和病理学上,该肿瘤极易与头颈部常见的一些肿瘤相混淆。本研究通过回顾性分析,探讨头颈部髓外浆细胞瘤的临床特点及其诊断及治疗。方法:回顾分析我院1977年1月～2003年12月期间收治的10例头颈部髓外浆细胞瘤患者的资料,全组10例患者中,单纯手术治疗2例、手术加辅助放疗2例、根治性放疗5例(其中1例于放疗后行辅助化疗),1例未治疗。结果:临床表现主要表现为局部肿物及其引起的相应症状。本组患者所有病例均经病理学诊断为浆细胞瘤,3例行免疫组化检测IgG,1例为λ型,2例为κ型。6例检测过尿本周蛋白均为阴性;4例检测过M蛋白,均为阴性;4例骨髓穿刺均未见异常;4例全身骨X线检查均正常。末次随访2004年5月,随访率90%,6例无瘤生存的患者中有5例无瘤生存时间超过1年(其中3例超过15年);死亡3例;失访1例。结论:EMP的诊断主要依靠临床表现和病理;放疗和手术是治疗头颈部髓外浆细胞瘤的主要手段。     

子宫颈微偏腺癌8例临床病理分析

摘 要：［目的］ 探讨宫颈微偏腺癌（MDA）的临床特征、诊断、治疗及预后。［方法］ 回顾性分析8例子宫颈微偏腺癌的临床病理资料。［结果］ 子宫颈微偏腺癌占同期收治宫颈腺癌的4.0%,临床主要症状为阴道分泌物增多及不规则或接触性阴道出血。病理特征为黏液腺体增生浸润肌组织、细胞异型性小。本组病例均经病理确诊,其中4例行手术+放化疗,4例行手术+化疗。［结论］ MDA诊断应结合临床表现、影像学检查及细胞组织学,对高度怀疑MDA者应取深部组织活检或宫颈锥切以明确诊断,早期诊治预后较好。     

胃癌与结直肠癌宫颈转移22例临床分析

背景与目的:胃癌及结直肠癌宫颈转移十分罕见,治疗效果不理想.为此,本文对近年来我院收治的胃癌及结直肠癌宫颈转移患者的临床特点、治疗、预后等进行分析,为临床治疗提供依据.方法:回顾性分析我院1994年至2007年收治的22例胃及结直肠癌宫颈转移病例.对患者原发部位、病理类型、转移特点、总生存时间及预后等进行分析.结果:22例患者主要症状为阴道不规则出血(占54.5%).预后不佳,单纯手术6例,单纯放疗3例,单纯化疗1例,手术、放疗及化疗三种手段中两种或三种联合治疗9例,放弃治疗3例.术后病理分析显示,胃癌转移者的宫体均有内膜受侵,而结直肠转移者的宫体均有浆膜肌层受侵.22Y0患者除3例仍在治疗中,1例失访外,其余18例均死亡,平均总生存期14.6个月.胃癌及结直肠癌宫颈转移患者的平均总生存时间分别为11.2个月和17.9个月.印戒细胞癌、粘液腺癌和高/中/低分化腺癌患者的平均总生存时间分别为10、13和18.1个月.放疗、手术和综合治疗患者的平均总生存期分别为:10.7、13.2和17.7个月.4例行根治性手术和5例行减瘤术患者的平均总生存期分别为22.3个月和7.8个月.结论:本组原发瘤为胃癌者的平均总生存期较结直肠癌者短.不同病理类型中,印戒细胞癌平均总生存期最短,其次为粘液腺癌.在所有患者中胃癌转移至宫颈的印戒细胞癌总生存期最短.胃癌宫颈转移除逆行淋巴道转移外,癌细胞经过输卵管、宫体而达到宫颈也可能为其转移途径:而结直肠癌宫颈转移的主要模式则是经腹膜播散,直接浸润转移到宫颈.预后不佳,原发肿瘤类型、病理类型及治疗方式可能为影响患者预后的主要因素.对于能手术的患者应选择以手术为主的综合治疗方案,手术及放疗的同时必须联合全身化疗.     

子宫内膜癌的预后影响因素分析

背景与目的:子宫内膜癌的预后影响因素较多,但其中仅有少数因素对预后构成独立影响。本研究的目的在于探讨子宫内膜癌的独立预后影响因素。方法:对我院1990年1月至2000年12月间初治时行手术治疗的265例子宫内膜癌患者的临床资料进行回顾性研究,预后相关因素采用单因素分析及多因素相关回归分析,并进行逐步筛查。结果:本组病例的5年无瘤生存率及总生存率分别为83.3%和84.3%。单因素分析显示:临床分期、手术-病理分期、病理分级、组织学类型、肌层浸润深度、宫颈受累、淋巴结转移、腹腔液性质、脉管瘤栓及附件转移与5年无瘤生存率及总生存率有显著性相关(P<0.05),年龄、合并症因素与预后无显著性相关(P>0.05)。经多因素分析后得出,手术-病理分期、病理分级、肌层浸润深度及宫颈受累4个因素对子宫内膜癌患者的5年无瘤生存率及总生存率均产生显著性影响(P<0.05),临床分期仅对5年无瘤生存率有显著性影响(P<0.001),而对总生存率无显著性影响(P=0.074)。肌层浸润>50%者远处转移率(12.9%)明显高于≤50%者(0.6%)(P<0.001)。宫颈受累者的淋巴结转移率(21.1%)明显高于宫颈未受累者(3.6%)(P<0.001)。结论:FIGO分期、病理分级、肌层浸润深度及宫颈受累是子宫内膜癌独立的预后影响因素。在估计预后方面,手术-病理分期     

13例Askin 瘤诊断与治疗

目的:分析Askin瘤的临床病理特征,探讨该肿瘤的诊断及治疗。方法:回顾性分析天津医科大学附属肿瘤医院1997年1 月～2008年1 月13例Askin瘤患者的临床、病理及随访资料。13例患者均见胸壁肿物,其中6 例发生肺部浸润。13例患者均接受了化疗及病灶局部的放疗,6 例行姑息性肿瘤切除术,3 例接受了肿瘤根治术。结果:13例患者的中位总生存期（OS）为16个月,临床表现主要为胸闷、咳嗽、憋气及胸壁进行性生长的疼痛性肿块;组织学上以稀少的纤维血管间质将小圆、卵圆瘤细胞围绕成巢状或小叶状结构,网染细胞间网状纤维少或无,PAS 染色部分病例（+）,CD99、VIM 部分病例（+）,此外,还可表达NSE 、S-100。结论:Askin瘤预后差,手术切除是治疗的主要方法,主张以手术为主的综合治疗。尽可能的切除肿瘤,并进行规范的放化疗,能够延长患者的生存期。      

宫颈微偏腺癌21例临床分析

目的探讨宫颈微偏腺癌（MDA）的临床特征、诊断、治疗及预后。方法对我院1985年1月至2008年1月收治的21例MDA患者的临床和病理资料进行回顾性分析。结果本组病例占同期宫颈腺癌治疗患者的4．O％。临床主要特征为水样或黏液样白带（61．9％）和不规则阴道出血（42．9％）。治疗前仅5例（23．8％）初次宫颈活检诊断出MDA。14例患者经过2～5次宫颈活检或锥切才最终确诊,确诊时间1—25个月（中位时间2个月）。临床分期：ⅠB期4例;ⅡA期2例,ⅡB。期5例;ⅢB期8例;外院治疔后无法分期者2例。11例ⅡB期以上者行根治性放化疗,全部肿瘤未控于7～26个月死亡;8例Ⅱ。期以下者行广泛性子宫切除术,有5例术后辅助放化疗,术后随访12～97个月,无一例死于本病;2例外院全宫双附件切除术后患者,1例阴道残端复发后行放疗肿瘤未控死亡,1例经补充手术及术后放疗无瘤生存。结论MDA常规活检诊断率低。早期患者应尽量采用根治性手术,对晚期患者实施放化疗效果差。及时确诊是治疗的关键。     

Protective Role of Selenium and High Dose Vitamin E against Cisplatin - Induced Nephrotoxicty in Rats

Background: Cisplatin (CDDP) is one of the most active cytotoxic agents in the treatment of cancer. Weinvestigated the effect of selenium (Se) with high dose vitamin E (VE) administration to prevent CDDP-inducednephrotoxicity in rats. Materials and Methods: In this study, 40 female Wistar rats were randomly dividedinto five equal groups. The first group, which served as the control, was administered physiological saline (2.5cc/day, 5 days) intraperitoneally (IP), while group A was administered cisplatin (6 mg/kg BW/ single dose)plus physiological saline IP. Groups B, C, D received IP five doses of Se (1.5 mg/kg BW), and a high dose ofVE (1000 mg/kg BW) (Se-VE) in combination before, simultaneously, and after CDDP, respectively. The ratswere sacrificed five days after CDDP administration. Plasma malondialdehide (MDA), glutathione peroxidase(GSH-Px), reduced glutathione (GSH), catalase, urea, creatinine levels, renal histopathological changes weremeasured. Results: The histopathological injury score, plasma levels of MDA, urea, creatinine were found toincrease in group A compared to the control (p<0.05), while plasma levels of GSH-Px, GSH and catalase decreased(p<0.05). In contrast, plasma levels of MDA decreased (p<0.05) in groups B, C, D, which were treated with Se-VE, whereas levels of GSH-Px, GSH were found to increase only for group D (p<0.05). Plasma urea, creatininelevels improved in the treatment groups compared to group A (p<0.001). Histopathological changes caused byCDDP were also significantly improved after Se-VE treatment (p<0.05). Conclusions: Oxidative stress increaseswith CDDP-induced nephrotoxicity in rats. Se-VE supplementation might thus play a role in the prevention ofCDDP-induced nephrotoxicity in patients.     

经皮穿刺碘油-EADM注射治疗肾上腺转移瘤

目的:探讨经皮穿刺碘油-表阿霉素EADM注射治疗肾上腺转移瘤的效果。方法:对12例肾上腺转移瘤患者在B超、CT引导下定位穿刺,注射碘油-EADM的混悬液,EADM20mg~40mg,共4次。结果:12例患者完全缓解(CR)41.66%(5/12),部分缓解(PR)41.66%(5/12),稳定(SD)8.33%(1/12),进展(PD)8.33%(1/12),总有效率(CR PR)83.33%。结论:经皮穿刺碘油-EADM注射治疗肾上腺转移瘤不失为临床可选用的治疗手段。     

Phase II study of oral administration of etoposide for patients with well- and moderately-differentiated adenocarcinomas of unknown primary site

BACKGROUND:: The prognosis of patients with well- and moderately-differentiatedadenocarcinomas of unknown primary is poor, as a consequenceof chemotherapy resistance. PATIENTS AND METHODS:: We performed a phase II study with prolonged oral administrationof etoposide in 25 chemotherapy-naive patients with well- andmoderately-differentiated adenocarcinomas of unknown primarysite. The treatment regimen was 50 mg/m² for 21 days, everyfour weeks. RESULTS:: Of 24 evaluable patients, two achieved partial responses (8%)lasting 15+ and 17 months, 11 patients had stable disease, and11 progressed during treatment. The major toxicity was myelosuppression.WHO grades 3 or 4 leukocytopenia was seen in six patients butconfined to the first treatment cycle in five of them. Fourof these latter five patients already had disease progressionafter one treatment cycle. A primary tumor site was later identifiedin four patients, three colon carcinomas and one carcinoma ofthe pancreas. CONCLUSION:: Etoposide given in this dose and schedule has only limited activityin patients with well- or moderately-differentiated adenocarcinomasof unknown primary site. carcinomas of unknown primary, chemotherapy, etoposide     

超氧化物歧化酶、丙二醛和细胞因子在肺肿瘤患者中的表达

目的：探讨肺癌患者超氧化物歧化化酶（SOD）活性、丙二醛（MDA）含量、肿瘤坏死因子（TNF—α）和白细胞介素（IL-6））的变化及临床意义。方法：使用黄嘌呤氧化酶法、硫代巴比妥酸法和ELISA酶联免疫法测定了55例肺癌、33例肺部疾病及40例对照组血清中的SOD活性、MDA含量、TNF-α和IL-6水平。结果：肺癌患者SOD活性显著地低于对照组（P〈0．05）;MDA、TNF-α和IL-6则显著的高于对照组（P〈0．05）;随治疗后,患者血清中的SOD活性逐渐增强;MDA、TNF-α和IL-6则迅速下降,临床症状得以缓解,其变化与肺癌的治疗效果与病情相关。结论：血清中SOD活性、MDA含量、TNF—α和IL-6水平可能与肺癌的发生、发展有关,测定这些指标可作为临床病情观察和监测疗效的辅助手段。     

The role of radiotherapy in treating squamous cell carcinoma of the external auditory canal, especially in early stages of disease.

PURPOSE: Our intent was to investigate the role of radiotherapy in treating external auditory canal squamous cell carcinoma, especially in early stages of disease. MATERIALS AND METHODS: The treatment results for 20 patients treated between 1980 and 1998 were retrospectively analyzed. Radiotherapy was used as an initial treatment without surgery in eight patients and with surgery in 12 patients. The patients treated by radiotherapy alone received 65 Gy in 26 fractions over 6.5 weeks. The patients treated with radiotherapy perioperatively received 30-75 Gy in 12-30 fractions. The follow-up period for survivors including patients died of intercurrent disease ranged from 7 to 205 months (mean: 71 months). RESULTS: The 5-year survival rate calculated by the Kaplan-Meier method for all patients was 59%. According to Stell classification (Laryncol. Otol. 99 (1985) 847), the 5-year survival rates for eight patients with T1 disease and eight with T2 disease were 100 and 38%, respectively. In the eight patients with T1 disease, disease control was 100%. Local control with hearing preservation was achieved in five patients with T1 disease by radiotherapy alone. No late complications related to radiotherapy were observed. CONCLUSIONS: A precise diagnosis of the disease in terms of whether or not it has invaded the bone is important in order to predict the treatment outcome. Radiotherapy with or without surgery is the treatment of choice for patients with T1-stage disease. Surgery with radiotherapy is recommended as standard care for tumors with bony invasion.     

Squamous cell carcinoma of the maxillary sinus: a Tata Memorial Hospital experience

BACKGROUND: The optimal treatment of maxillary sinus carcinoma remains to be defined and there is a paucity of Indian studies on the subject. AIMS: To present experience of management of squamous cell carcinoma of the maxillary sinus treated with curative intent at a single institution. SETTINGS AND DESIGN: Retrospective study of patients with squamous cell carcinoma of the maxillary sinus who presented between 1994 to 1999. MATERIALS AND METHODS: The records of 73 patients with squamous cell carcinoma of the maxillary sinus were analyzed. Sixty-two patients were evaluable. Forty patients (65%) were treated with surgery followed by postoperative radiotherapy, five patients (8%) were treated with radiotherapy alone, five patients (8%) were treated with surgery alone; 12 patients (19%) received chemotherapy. Statistical analysis used: Statistical analysis was done using Kaplan-Meier method. RESULTS: The majority of patients presented with locally advanced disease (52, 84%); nodal involvement was observed in five patients (8%). The most common site of recurrence was at the primary site, which was observed in 28 patients (45%) and regional failures occurred in 10 (16%). The 3 and 5-year overall survival was 38% and 35% and the disease free survival was 29% and 26% respectively. The 5-year overall survival after surgery and postoperative radiotherapy was 42%. CONCLUSIONS: The majority of patients present with advanced disease resulting in poor outcomes to conventional treatment modalities. Locoregional tumor progression remains a significant pattern of failure. New approaches such as neoadjuvant or concomitant chemoradiotherapy with aggressive surgery need to be considered and evaluated in prospective studies.     

Results of hypotonic cisplatin treatment on seven patients with carcinomatous pleuritis

Carcinomatous pleuritis frequently undermines the quality of life in advanced malignant disease patients. The traditional treatment for pleural effusion is intrapleural administration of a chemical agent, but its efficacy was not at all satisfactory. Ichinose et al.developed hypotonic cisplatin treatment for patients with carcinomatous pleuritis in 1993, and its therapeutic efficacy was assessed by the Japan Clinical Oncology Group. This treatment was performed on seven patients in our hospital since 2002: five patients with non-small-cell lung cancer, one with transverse colon cancer who had myocardial infarction (grade 4) after treatment, and another with gastric cancer who had grade 4 hemosputa. These patients, aged 52 to 88, complained of dyspnea before treatment, but all of them were able to be discharged with control of pleural effusion including the above-mentioned two patients. Although six patients had already died of disease, survival time after treatment of all patients ranged from 96 to 610 days, with an average of 346.7+/-228.2 days. The average time in five patients with non-small-cell lung cancer was longer than that in two with gastrointestinal malignant disease (not significant statistically). Hypotonic cisplatin treatment seemed to enhance the quality of life in lung cancer patients with carcinomatous pleuritis.     

Investigation of the Antioxidant Status in Multiple Myeloma Patients: Effects of Therapy

Background: Multiple myeloma is a malignant silent incurable plasma cell disorder. The present study aimedto assessed the activation of the oxidative stress pathway in afected patients Materials and Methods: Advancedoxidation protein products (AOPPs), malondialdehyde (MDA), adenosine deaminase (ADA), total antioxidantcapacity (TAC) levels, glutathione, ascorbic acid (vitamin C), α-tocopherol (vitamin E) in addition to relatedenzymes glutathione peroxidase (GSH-Px), glutathione reductase (GSH-R) and superoxide dismutase (SOD)were analyzed in sixty patients with multiple myeloma before and after one month treatment with inductiontherapy. Results: The results of the study showed a significant elevation in AOPPs, MDA, ADA levels in patientswith multiple myeloma before and after treatment in comparison to healthy control samples In contrast TACglutathione, vitamin C and E, and the antioxidant enzymes levels were decreased significantly. On comparingsamples of MM patients after treatment, there was significant increase of TAC glutathione, vitamin C and E, andthe antioxidant enzymes in parallel with decreasing AOPPs, MDA and ADA levels in comparison with samples ofpatients before treatment. Conclusions: The results indicate oxidative stress and DNA damage activity increasein MM and are alleviated in response to therapy.     

Is adjuvant tamoxifen used optimally in the treatment of breast cancer? Results of an Italian survey

Background: Institutional and physician-related factors can influence the way in which physicians interpret research results. The aim of this study was to determine what physicians know about, and their opinions of, hormone treatment in breast cancer patients, and the factors comprising their medical decision-making.Materials and methods: A questionnaire was mailed to a random sample of physicians inquiring as to their preferences with respect to adjuvant tamoxifen, and the usual duration of the treatment applied in various clinical scenarios (according to a woman's menopausal status, the oestrogen receptor status and the stage of disease).Results: Of 500 physicians identified, 38% returned the questionnaire. Of the non-responders, a random sample of 60 physicians was interviewed by phone. The total number of available questionnaires was 250 (50%).About 3/4 of the doctors would prescribe tamoxifen in older ER+ women and 30%–40% in post-menopausal ERõ- patients, but only 2/5 would do so in younger ER+ women.The vast majority of physicians considered five years as standard for ER+ patients. Nevertheless, about 1/4 of the doctors chose a shorter treatment duration for node-negative, pre-menopausal patients. A minority of physicians used tamoxifen for longer than five years. Older clinicians were less likely to prescribe tamoxifen, particularly for low-risk patients.Conclusions: According to the data of the recent EBCTG overview, an additional 20,000 lives could be saved worldwide each year if tamoxifen were given to all early breast cancer patients with hormone-sensitive disease, irrespective of age and disease stage, and for a minimum of five years.Our study, involving a representative sample of physicians practicing in Italy, shows that tamoxifen is not used optimally, with a substantial under-use in younger women and women with node-negative disease.