子宫颈原位癌临床诊治分析

目的 针对子宫颈原位癌临床诊治中的问题进行探讨,提高子宫颈原位癌诊断的及时性、准确性以及子宫颈原位癌治疗的水平.方法 选择该院收治的60例住院治疗的子宫颈原位癌患者临床资料进行分析.结果 经宫颈锥切术诊断,子宫颈原位癌手术前后病理诊断符合率为100%,明显优于经阴道镜多点活检的符合率(P<0.01).结论 子宫颈原位癌的可靠诊断方式为阴道镜检加宫颈锥切术诊断.     

Rectal biopsies: inaccuracy of histological grading in carcinoma of the rectum.

In a consecutive series of 70 patients with carcinoma of the rectum, 42 had operable tumours and in these the histology of the initial biopsy was compared with that of the excised specimen. In 9 of the 42 patients the histological grading of the original biopsy was different from that of the final specimen; in 3 the carcinoma was missed despite repeated preoperative biopsies; and in 5, errors were made in the diagnosis of carcinoma in polyps. In 5 of 7 cases of poorly differentiated carcinoma the initial biopsies indicated moderate differentiation: there was therefore a 70% inaccuracy in the preoperative diagnosis of poorly differentiated carcinoma of the rectum. The implications of this inaccuracy for the surgery of rectal cancer are discussed.     

原发性胆囊癌36例治疗体会

目的：总结原发性胆囊癌的诊治经验,探讨早期诊断策略。方法：对36例经手术后病理证实为原发性胆囊癌的临床资料进行回顾性分析。结果：该病早期无特异的临床表现,75%与胆囊结石合并存在。结论：原发性胆囊癌的临床表现缺乏特异性,极易误诊;B超检查是早期诊断的首选方法;对高危人群及时进行B超和/或CT等影像学检查并实施手术及术中病检,可望早期诊断原发性胆囊癌。     

Carcinoma of the papilla of Vater. Diagnostic and therapeutic problems. An analysis of 32 Tunisian cases

The aim determine the clinical, morphological, endoscopical and progressive profile of patients with ampullary carcinoma. PATIENTS AND METHODS: Thirty-two patients with a carcinoma of the ampulla of Vater, hospitalised in the Gastro-enterology service of Habib Thameur Hospital (Tunis) (1992-2002) have been analysed retrospectively. RESULTS: Twelve men and 20 women of an average age of 66 years have been included. Twelve patients (37%) had had a cholecystectomy into the 3 years preceding the diagnosis of the ampullary carcinoma. A duodenal tumour had been found at 29 patients (91%). After endoscopical sphincterectomy, an intra-ampullar exophytic tumour had been found in I case and an infiltrated aspect of the ampulla of Vater in 2 cases. The jaundice was frequent. The use of lateral duodenoscopy allowed carrying the positive diagnosis in all cases. Five patients had metastasis at the moment of diagnosis. A DPC has been practiced at 15 patients. A palliative biliary diversion has been realized at 9 patients. Six patients had an endoscopical palliative drainage with installation of a plastic prosthesis. The rate of post- operative mortality was 20%. The rate of morbidity linked to the surgery was 21.8%. CONCLUSION: The ampullary carcinoma is a rare tumour diagnosed belated. The postoperative mortality is raised. The identification of factors forecast and the utilization of adjuvant processing will be able to allow the improvement of the prognosis.     

Delayed diagnosis of cancer with emphasis on oral cavity cancers.

Delayed diagnosis of cancer and, of oral cavity cancers in particular, is of crucial importance for the clinical management, costs of care and unfavourable outcome. Many scientists have studied the causes of delayed diagnosis to find solution of the problem. However, only few studies of this kind have been performed in Bulgaria, especially for oral cavity cancers. The aim of this overview was to summarize and analyze publications on problems and causes of delayed diagnosis of cancer in general and, of oral cavity cancers in particular. The literature search was made in different databases such as MEDLINE, BIOSIS, INTERNET, etc. More than 100 relevant items of information were extracted but only 22 of them were found suitable and further analyzed. The analysis of the literature has revealed the importance of recognizing the warning signals and causes of delayed diagnosis in cancer in general and in oral cavity cancers in particular. For instance, survival of patients with squamous cell carcinoma of the tongue (Dx:141) was related to delayed diagnosis (20% of patients survive more than 5 years and 71%--only 2 years after diagnosis). The problems of delayed diagnosis in patients with multiple neoplasm of the oral cavity (Dx:143-145) and with nasopharyngeal carcinoma (Dx:146-149) were also discussed (96.6% of patients were in stage III at diagnosis). This overview has summarized problems in and stressed the main aspects of delayed diagnosis of cancer in general. It has also denoted hints in delayed diagnosis of cancer of the oral cavity and their relevance to the clinical management, outcome and costs of care for such patients. The latter has been considered of primary importance for general practitioners, dentists and specialists in public health medicine.     

Interobserver agreement in the histologic diagnosis of colorectal polyps. the experience of the multicenter adenoma colorectal study (SMAC)

Current clinical practice guidelines for patients with colorectal polyps are mainly based on the histologic characteristics of their lesions. However, interobserver variability in the assessment of specific polyp characteristics was evaluated in very few studies. The purpose of this study was to evaluate the interobserver agreement of four pathologists in the diagnosis of histologic type of colorectal polyps and in the degree of dysplasia and of infiltrating carcinoma in adenomas. A stratified random sample of 100 polyps was obtained from the 4,889 polyps resected within the Multicentre Adenoma Colorectal Study (SMAC), and the slides were blindly reviewed by the four pathologists. Agreement was analyzed using kappa statistics. A median kappa of 0.89 (range 0.79-1.0) was estimated for the interobserver agreement for the diagnosis of hyperplastic polyp vs. adenoma. The agreement in the diagnosis of tubular, tubulovillous, and villous type, was given by median kappa values of 0.50, 0.15, and 0.36, respectively. The median kappa for the diagnosis of infiltrating carcinoma was 0.78 (range 0.73-0.84). Agreement on diagnosis of adenoma histologic subtypes, degrees of dysplasia, or infiltrating carcinoma in adenoma was moderate. A simpler classifications might help to better identify patients at different risk of colorectal cancer.     

Dysphagia due to 'mediastinal carcinomatosis', a late sequela of breast carcinoma

Five patients suffered from dysphagia due to breast carcinoma. Several aspects of diagnosis and therapy are discussed. It is recommended to start the therapy based on the clinical diagnosis and not to wait until the diagnosis is histologically confirmed.     

螺旋CT对肾癌的诊断价值

目的:评价螺旋CT多期扫描在肾癌诊断中的价值.方法:回顾性分析23例肾癌的螺旋CT表现.结果:根据Robson分期标准,诊断肾癌Ⅰ期4例,Ⅱ期6例,Ⅲ期8例,Ⅳ期5例,与术后病理诊断的总体符合率是93%.结论:螺旋CT多期扫描在肾癌的诊断中有明显优越性,确诊率高,是肾癌检查的首选辅助手段.     

子宫内膜癌术前诊断性刮宫与术后病理诊断差异的研究

目的 探讨子宫内膜癌术前诊断性刮宫与术后病理诊断的差异,为提高术前子宫内膜癌诊断的准确率提供指导.方法 回顾性分析124例经病理检查确诊为子宫内膜癌患者的病历资料,包括临床分期、病理分期、病理类型、组织学分级等.结果 124例子宫内膜癌患者中,术前诊断性刮宫结果为子宫内膜癌102例,诊断符合率为82.3％（102/124）;误诊22例,误诊率为17.7％（22/124）.102例术前和术后诊断相符患者的术前临床分期与术后病理分期总符合率为81.4％（83/102）,其中Ⅰ期符合率为86.1％（62/72）,Ⅱ期符合率为72.0％（18/25）,Ⅲ期符合率为3/5;术前诊断性刮宫组织学分级与术后病理组织学分级总符合率为65.7％ （67/102）,G1级符合率为55.6％（25/45）,G2级符合率为69.2％（27/39）,G3级符合率为15/18.结论 子宫内膜癌术前诊断性刮宫和术后病理诊断的病理类型、病理分期以及组织学分级均存在不一致的情况,因此临床中需要结合多种检查手段,全面评估,以减少手术前后的诊断差异,提高术前诊断的准确率.     

超声与钼靶X线对浸润性导管癌临床诊断价值的比较

目的:对比超声与钼靶X线检查在乳腺浸润性导管癌中的诊断价值。方法:对420例乳腺肿块患者按绝经前后分两组比较超声及钼靶X线检查对乳腺浸润性导管癌的诊断准确性,并对病理证实122例乳腺浸润性导管癌的超声及钼靶X线征象进行对比分析。结果:绝经前组超声符合率89.7%,钼靶X线诊断符合率74.8%;绝经后组超声的诊断符合率为89.7%,钼靶X线诊断符合率为89.1%。绝经前超声诊断乳腺浸润性导管癌比钼靶X线的诊断符合率高(P<0.05),绝经后两者诊断符合率差异无统计学意义(P>0.05)。绝经前乳腺浸润性导管癌患者中的超声检查对乳腺肿块影、钙化灶检出率均高于钼靶X线(P<0.05)。结论:超声与钼靶X线对绝经前、后浸润性导管癌均有较高诊断价值,乳腺超声成像对绝经前浸润性导管癌患者的诊断价值更大。     

宫颈电圈环切术联合阴道镜在宫颈病变诊治中的临床分析

目的:探讨宫颈电圈环切术(Loop electrosugiral excision Prcedure,LEEP)联合阴道镜在宫颈病变诊治中的临床应用价值。方法:回顾性分析经宫颈薄层液基细胞学(TCT)检测异常和电子阴道镜下宫颈多点组织病理检查异常的174例患者,均经LEEP治疗,切除组织行病理检查。结果:电子阴道镜下宫颈活检诊断结果与LEEP术后诊断符合率为72.41%,LEEP术后3个月随访慢性宫颈炎100%治愈,ClNⅠ100%治愈,CINⅡ96.7%治愈,CINⅢ93.3%治愈。原位癌术后6月、1年随访正常。结论:LEEP对包括炎症、损伤、癌前病变等宫颈疾病是一种非常理想的诊断、治疗手段。宫颈细胞学检查,阴道镜下活检,LEEP术后病理诊断构成了宫颈病变系统的一个新的诊断模式,尤其是对微小浸润癌和原位癌的早期诊断价值高。     

影响子宫内膜不典型增生诊断的临床因素

目的:探讨子宫内膜不典型增生(AEH)的临床特点和影响诊断的相关因素。方法:回顾性分析广西医科大学第一附属医院77例术前诊断为AEH患者的临床病理资料,根据术后病理诊断分为子宫内膜癌组(A组,50例)和AEH组(B组,27例)进行比较分析。结果:A组全部为子宫内膜样腺癌,占64.9%,B组占35.1%;两组年龄比较,t=2.708,P=0.008<0.05,差异有统计学意义;术后病理诊断与术前诊刮AEH的分度有关,轻、中、重度AEH合并子宫内膜癌率分别为28.6%、42.1%、78.4%;两组肿瘤标记物CA125比较,P=0.140>0.05,差异无统计学意义。结论:①年龄是AEH合并子宫内膜癌的高危因素;②随着诊刮AEH分度增加,合并子宫内膜癌有增加趋势;合并子宫内膜癌多数分化较好、浸润少、期别以Ⅰ期为主。③血清CA125不是预测AEH合并子宫内膜癌的敏感指标。     

Surveillance for hepatocellular carcinoma: does it work?

BACKGROUND: The surveillance of cirrhotic patients for early detection of hepatocellular carcinoma is recommended but its efficacy is now discussed. The aim of our study was to present the results of a screening program in 110 patients. METHODS: it is a retrospective study that included 110 patients with cirrhosis in a screening program of hepatocellular carcinoma, based on the realization of abdominal ultrasound exam and the determination of alpha-fetoprotein amount every 6 months in 95 patients and every 3 months in 15 patients. RESULTS: the mean duration of the surveillance was 36 months. A hepatocellular carcinoma was diagnosed in 13 patients. Curative treatment was done in only 3 cases and consisted in a hepatic resection in 1 patient and an alcoolisation in 2 cases. Ten patients had new treatment : for 8 patients the discussed was very agressive and 2 patients had a server hepotic failure. The cost of this study was 37.500 Tunisian dinars. CONCLUSIONS: systematic screening for hepatocellular carcinoma offer a limited cost effectiveness ratio.     

Occurrence and clinical features of brain metastasis after chemoradiotherapy for esophageal carcinoma

Brain metastasis from esophageal carcinoma has been considered rare and survival following esophageal carcinoma with distant metastasis is poor. The purpose of this report was to clarify cumulative incidence and risk factors for brain metastasis after chemoradiotherapy for esophageal carcinoma, and to consider recommended treatments for brain metastasis from esophageal carcinoma. We reviewed 391 patients treated with chemoradiotherapy. Median age was 65 years. Clinical stages were I, II, III, and IV in 32, 47, 150, and 162 patients, respectively. Brain imaging was performed usually when patients revealed neurological symptoms. The 3-year cumulative incidence of brain metastasis after chemoradiotherapy was 6.6%. There were 4 patients with single metastasis and 8 with multiple metastases. Initial clinical stages were II, III, and IV in 1, 2, and 9 patients, respectively. Histology included squamous cell carcinoma in 10 patients and others in 2 patients. Univariate analysis demonstrated M factor, distant lymph node relapse, and recurrent lung and liver metastasis as significant risk factors of brain metastasis (P < 0.05). Median survival time after diagnosis of brain metastasis was 2.1 months. Brain metastasis was not directly related to cause of mortality. The causes were extracranial tumor deterioration in 8 patients and infection in 4 patients. Brain metastasis may increase in the future with improving survival from esophageal carcinoma. However, considering the poor survival after diagnosis of brain metastasis, short-term palliative therapy for brain metastasis appears preferable to vigorous long-term therapy.     

子宫内膜癌患者TSGF表达与细胞增殖的关系

目的:探讨血清TSGF检测对子宫内膜癌的应用价值及其与细胞增殖的关系。方法:对30例子宫内膜癌患者术前外周血TSGF进行检测,同时对肿瘤组织DNA含量进行分析。结果:①子宫内膜癌患者血清TSGF含量及阳性率明显升高,敏感性为64.9%,特异性为62.5%,阳性预测值61.5%,阴性预测值65.8%,正确诊断率63.6%;②TSGF阳性者肿瘤细胞SPF明显升高,显著高于TSGF阴性者(P<0.05),PI指数略有上升,但无显著性差异(P>0.05),三者呈平行关系。结论:血清TSGF检测对子宫内膜癌具有一定的诊断价值,并与肿瘤细胞的增殖有关。     

甲胎蛋白异质体检测在肝癌与良性肝脏病变鉴别诊断中的临床价值

目的采用亲和离心柱法检测甲胎蛋白异质体AFP-L3,分析甲胎蛋白异质体AFP-L3在诊断肝癌的临床应用价值。方法选择100例临床检测甲胎蛋白AFP阳性(≥20ng/ml)的住院患者。使用亲和离心管方法检测甲胎蛋白异质体AFP-L3,并且对研究对象进行跟踪,分析甲胎蛋白异质体用于鉴别肝癌的临床作用。结果①以甲胎蛋白异质体AFP-L3≥10%作为诊断指标,肝癌患者血清中甲胎蛋白异质体AFP-L3异常升高者明显高于其他肝病患者(P0.01);②对69例临床确诊为肝癌的患者甲胎蛋白异质体AFP-L3的诊断灵敏度是81.16%;在82例临床诊断为其他肝脏疾病的患者甲胎蛋白异质体AFP-L3的诊断特异性达到91.46%,甲胎蛋白异质体AFP-L3的符合率为86.75%。结论应用新型亲和离心柱法检测甲胎蛋白异质体AFP-L3在肝癌与良性肝脏病变鉴别诊断中具有重要临床价值。     

从我院卵巢癌收治情况看卵巢癌诊治现状

目的探讨近10年来本地区卵巢癌诊断和治疗现况。方法收集1998年1月-2008年1月我院所有拟诊为卵巢癌患者的基本信息和治疗情况,并作统计分析。结果我院收治的471例卵巢癌患者中,433例接受了手术治疗并获得明确病理组织学分型,71.62%就诊时已是Ⅲ～Ⅳ期,324例行初次手术。436例接受了化疗,出现明确化疗副反应的有314人次。146例患者复发,在随访到的患者中,3年生存率和5年生存率只有29.14%和9.27%。结论近10年来卵巢癌就诊人数明显增加,但有限的治疗手段使得晚期癌生存状况仍不容乐观。     

鼻咽癌患者的影像学诊断分析比较

目的：探讨鼻咽癌患者的DR和CT影像学表现,提高其诊断的准确性。方法：回顾性分析本院2011年1月-2014年1月经病理学证实的72例鼻咽癌患者的DR和CT的影像学资料,比较其影像诊断价值。结果：通过DR对病变能够提供鼻咽癌诊断的病例共54例（75.00%）,通过CT能够提供鼻咽癌诊断的病例共70例（97.22%）,差异有统计学意义（χ2=14.86,P〈0.05）,CT与DR相比,更有优势,且两种方法合并诊断率达100%。在不同鼻咽癌位置中,CT对于颅底骨质的检出率明显高于普通放射的DR诊断,差异有统计学意义（χ2=7.29,P〈0.05）。经过临床观察,CT诊断的临床分期在Ⅳ期患者中的临床符合率均明显高于DR诊断方法,差异均有统计学意义（χ2=9.44,P〈0.05）。结论：DR可以初步诊断鼻咽骨质破坏,CT能更清楚地显示鼻咽部位的侵犯范围,两者结合可为该病诊断和临床治疗提供更全面的影像信息。     

Treatment of small cell carcinoma of the bronchus by combined chemotherapy--clinicopathological correlation with response

Thirty-seven consecutive patients, referred to a respiratory unit with a histological diagnosis of small cell carcinoma of the bronchus, were treated with a combined chemotherapy regime of adriamycin, vincristine and cyclophosphamide. Palliative radiotherapy was given for the control of symptoms. Thirty of 37 patients responded to treatment, 11/37 having a complete and 19/37 a partial response. The median survival of those patients with a complete response was 55 weeks, significantly higher (P less than 0.01) than either those with partial or no response to treatment. Those patients with limited disease survived longer. A high proportion of patients relapsed at the primary site of the tumour in the lungs. The relationship between the therapeutic response and the histological subtype of small cell carcinoma suffered from the limitations of the available pathological material. However, more of the patients with a complete response were of the lymphocytic-like pattern of small cell carcinoma. Useful survival in these patients with inoperable small cell carcinoma was achieved using this regime of chemotherapy, even in those patients with extensive disease, five of whom had survived for over one year.     

前列腺癌影像学误诊分析

目的 研究前列腺癌影像学误诊的情况,探讨不同影像学检查在前列腺癌的确诊中的意义.方法 从天津市前列腺癌数据库中检索出1984-2006年有影像学检查结果的病例共1201例患者,对影像学诊断结果与最后所确诊的前列腺癌不符的病例进行回顾性分析.结果 585例经腹部超声检查结果中,误诊264例,误诊率45.1%;经直肠超声检查178例,误诊18例,误诊率10.1%;CT检查264例,误诊91例,误诊率34.5%;MRI检查174例,误诊13例,误诊率7.5%.经统计学分析,MRI误诊率最低,其次是经直肠超声,然后是CT,误诊率最高者为经腹部超声检查,MRI与经直肠超声检查的误诊率差异无统计学意义.结论 经腹部超声检查作为重要筛查手段应进一步提高确诊率,经直肠超声检查主要用于前列腺活检,与盆腔MRI相比没有优势.CT检查可用于前列腺癌转移病灶的发现,对早期前列腺癌误诊率较高.MRI检查由于具有无创、方便而且误诊率低的优点,应是确诊前列腺癌的首选影像学检查方法.