巨大淋巴结增生合并POEMS综合征一例

患者女 ,36岁。颈部淋巴结肿大 2 0ｄ ,于 1997年 2月 16日入院。双颈部及锁骨上数个蚕豆大小淋巴结 ,质硬、无压痛 ,活检病理示淋巴滤泡增生 ,部分淋巴细胞增生活跃 ,未治疗而出院。 1年后出现双下肢腓肠肌痛 ,活动后加重。 2年后出现双足麻木、活动障碍。腰椎ＣＴ :左侧第 10肋后肋可见一圆形低密度影 ,边界清晰 ,右侧髂骨内亦可见一低密度圆形影 ,周围环形高密度硬化缘 ,腰椎可见多发大小不等类圆形高密度影 ,考虑转移瘤的可能性大。腰椎ＭＲＩ亦报告多发浸润性骨破坏伴骨硬化改变 ,全身骨骼发射计算机体层摄影术 (ＥＣＴ)未见异常放射性…     

妊娠合并肺癌二例并文献复习

目的 提高对妊娠合并肺癌临床表现的认识.方法 分析南方医科大学南方医院收治的2例妊娠合并肺癌患者的临床表现、诊断及治疗经过,并结合文献进行讨论.结果 第1例患者31岁,妊娠34周,X线胸片示右侧胸腔积液.于妊娠35周行剖宫术产出男婴1名,同时进行右锁骨上淋巴结活检,病理检查提示转移性肺大细胞未分化癌.产后第2天患者病情持续恶化,给予机械通气及抗生素、吉非替尼治疗无效,产后28 d死亡.第2例患者28岁,妊娠27周,正电子发射计算机断层扫描示右侧肺癌合并心包、右侧胸膜、肝脏及盆腔转移.气管镜活检病理结果提示肺小细胞未分化癌.人工终止妊娠后,给予足叶乙甙+顺铂(EP方案)化疗2个周期后病变缩小,患者转回当地医院.结论 妊娠合并肺癌少见,患者预后较差.为改善孕妇的预后及减少胎儿转移,需要在权衡利弊的情况下进行适当的全身抗肿瘤治疗.     

小叶间隔增厚伴胸腔积液

本例表现为咳嗽、咳痰和气短症状的青年女性患者, 胸部CT提示小叶间隔增厚伴胸腔积液, 胸腔积液肿瘤标志物明显升高, PET-CT未见确切原发病灶, 最后经右锁骨上淋巴结穿刺明确为转移性腺癌(胃印戒细胞癌来源可能)和临床诊断为肺淋巴管癌病伴恶性胸腔积液。这提示即使对于年轻患者, 也应将肺淋巴管癌病纳入小叶间隔增厚伴胸腔积液的鉴别诊断范畴, 同时要警惕隐匿的胃印戒细胞癌。     

能谱CT在不同分化胃癌转移性淋巴结定性诊断中的价值

［摘要］　目的　探讨能谱CT在不同分化胃癌转移性淋巴结定性诊断中的价值。方法　分析50例经胃镜病理证实的胃腺癌患者的能谱CT影像资料,测量胃周淋巴结动脉期及静脉期标化碘值,并与手术病理结果相比较。结果　50例胃腺癌患者中,胃癌手术及病理证实伴淋巴结转移38例,无淋巴结转移12例。经病理结果确认转移淋巴结83个,其中高中分化腺癌转移性淋巴结34个,低分化腺癌转移性淋巴结49个,非转移淋巴结31个。通过利用标化碘值及能谱曲线,能谱CT诊断胃癌淋巴结转移的灵敏度为90.4%(75/83),特异度为87.1%(27/31),诊断符合率为89.5%（102/114)。高中分化胃腺癌转移性淋巴结与非转移淋巴结动脉期及静脉期标化碘值比较,差异均有统计学意义（P<0.05）。结论　能谱CT对于不同分化胃癌淋巴结的定性诊断具有重要价值,能够为胃癌的临床诊断及治疗方案的选择提供帮助。     

PRAME、APPL1在原发性肺腺癌中的表达及临床意义

目的探讨黑色素瘤特异性抗原(PRAME)、适应性蛋白L1(Adaptor protein containing PH domain,APPL1)在原发性肺腺癌中的表达及临床意义。方法收集2014年2月至2015年12月期间被我院收治的52例原发性肺腺癌患者手术切除的肺腺癌组织和癌旁组织为实验标本。采用RT-PCR技术检测组织标本中的PRAME、APPL1 mRNA表达量。结果肺腺癌组织中PRAME表达水平低于癌旁组织,差异有统计学意义(P0.05)。肺腺癌组织中APPL1表达水平高于癌旁组织,差异有统计学意义(P0.05)。随着肺腺癌病例病理分期的升高、肿瘤大小的增加、分化程度的降低,肺腺癌组织中PRAME mRNA表达减弱,APPL1 mRNA表达增强,此外,肺腺癌组织中PRAME、APPL1 mRNA水平与病例是否伴淋巴结转移有关。伴淋巴结转移的肺腺癌组织,PRAME mRNA水平低于未出现淋巴结转移的肺腺癌组织(P0.05),APPL1 mRNA水平高于未出现淋巴结转移的肺腺癌组织(P0.05)。原发性肺腺癌组织中PRAME、APPL1 mRNA表达量呈负相关(r=-0.412,P=0.007)。结论 PRAME在原发性肺腺癌组织中的表达水平低于癌旁组织,APPL1在原发性肺腺癌组织中的表达水平高于癌旁组织。PRAME、APPL1的表达与原发性肺腺癌组织的病理分期、肿瘤体积、分化程度及是否伴淋巴结转移有关。     

隐匿性甲状腺癌一例

隐匿性甲状腺癌多经尸体解剖而发现 ,临床诊断者多因其他原因行甲状腺手术而意外发现 ,或原发灶很小而有局部淋巴结或远隔转移而诊断。临床报道相对较少 ,现将我院 1例因颈淋巴结转移而发现的患者予以报道。临床资料患者 ,女性 ,2 8岁 ,以颈部包块 9个月入院。患者于 9月前产后 1个月无意中发现左侧颈部有一绿豆大小包块 ,活动。无任何不适 ,曾服安西林 2周无效。 2个月前左侧颈部包块逐渐增大至花生米大小 ,故行颈部淋巴结切除术 ,术中见淋巴结大小 1.2cm× 1.0cm× 0 .5cm ,表面包膜完整。病理诊断 :左侧颈部淋巴结转移性乳头状腺癌Ⅰ级。…     

以心包积液为首发症状的肺癌（附10例报告）

本文对1987年～1998年11年间住院治疗的10例以心包积液为首发症状的肺癌的诊断与治疗进行分析。其中肺腺癌6例,小细胞癌3例,大细胞1例。行单纯心包抽液引流3例,经皮穿刺心包置管引流2例,行心包开窗引流术5例。心包积液解除后,行病变肺叶切除2例,全身化疗8例,配合放疗4例。作者认为:肺癌伴心包积液并非全为心包转移致,虽然肺癌伴恶性心包积液已属晚期,但采用合理的综合治疗,能减轻病人痛苦和延长病人生命。     

术前血清碱性磷酸酶及乳酸脱氢酶检测水平对结直肠癌患者病情评估的临床价值

[目的]探讨术前血清碱性磷酸酶(ALP)及乳酸脱氢酶(LDH)水平对结直肠癌患者病情评估的临床价值。[方法]选取2012年8月～2018年12月在本院确诊为结直肠癌并住院接受手术治疗的228例患者和81例健康对照组作为研究对象,收集健康对照组及结直肠癌患者术前血清ALP和LDH水平及结直肠癌组术后病理学资料。比较正常对照组与结直肠癌组患者术前血清ALP及LDH水平,并分析术前血清ALP水平LDH水平与临床病理特征之间的相关性。[结果]结直肠癌组术前血清ALP及LDH水平明显高于对照组(均P0.05);有淋巴结转移、有远处转移的结直肠癌患者术前血清ALP水平均比无淋巴结转移、无远处转移的患者更高(均P0.05)。肿瘤浸润较深的T3～T4期、有淋巴结转移、远处转移,CEA≥5μg/L的结直肠癌患者术前血清LDH水平均比肿瘤浸润深度较浅的T1～T2期、无淋巴结转移、远处转移、CEA5μg/L的患者更高(均P0.05)。不同TNM分期,不同分化程度的结直肠癌患者术前血清ALP和LDH水平不同,分期越高,分化程度越低,ALP及LDH水平越高,差异具有统计学意义(均P0.05)。[结论]术前结直肠癌患者血清ALP及LDH水平越高,提示肿瘤浸润程度越深,分期越高,越易出现淋巴结及远处转移。术前ALP及LDH水平可作为评价结直肠癌患者临床预后的辅助指标。     

直肠癌术后首发颈部淋巴结转移1例报告

患者男 ,5 8岁 ,因大便带血 1个月 ,于 1997年 2月入院。直肠指诊 :距齿状线约 7cm的直肠前壁处扪及一约 4 cm× 3cm包块 ,质硬 ,活动度好。肠镜检查及病理诊断直肠黏液管状腺癌。B超、胸片等检查未发现远处转移灶 ,癌胚抗原 (CEA)阴性。行经腹、会阴联合直肠癌切除、乙状结肠造瘘术 ,术中未发现肝脏、腹主动脉周围等有转移。术后病理 :1直肠溃疡型黏液管状腺癌 ,癌细胞灶性浸及浆膜层 ;2癌旁淋巴结转移性腺癌 ;3肠系膜淋巴结转移性腺癌 ;4直肠动脉旁淋巴结反应性增生。术后患者恢复良好而出院。此后曾多次入院化疗、综合治疗及对症处理 ,…     

99m TcN-NOET 显像 SPECT／CT 检查在分化型甲状腺癌术后颈部淋巴结转移判断中的应用

目的探讨99mTc N-NOET显像SPECT/CT检查对分化型甲状腺癌(DTC)术后颈部淋巴结转移的判断价值。方法接受甲状腺切除术和131I治疗的DTC患者28例,所有患者诊断性131I全身显像(Dx-WBS)阴性、血清甲状腺球蛋白(Tg)阳性,且B超检查发现疑似颈部淋巴结转移。对28例进行99mTc N-NOET SPECT/CT早期、延迟显像。利用ROI技术在病变部位勾画感兴趣区ROI1,取对侧相同面积部位标记为ROI2,以ROI1/ROI2计算病变部位与正常组织摄取比值(T/N)。将SPECT/CT检查结果与颈部淋巴结病理检查结果进行对照。结果 28例(52个病灶)经病理检查证实颈部淋巴结转移21例(39个病灶),良性病变7例(13个病灶)。99mTc N-NOET显像提示转移灶17例(30个病灶)、良性病变4例(9个病灶)。99mTc N-NOET显像SPECT/CT检查判断DTC颈部淋巴结转移的灵敏性76.92%,特异性61.54%,准确性73.08%,假阳性率38.46%,假阴性率23.08%,阳性似然比2.00,阴性似然比0.38。7例病理诊断为颈部淋巴结良性病变者T/N,低于21例病理诊断为颈部淋巴结转移者(P<0.01)。结论99mTc N-NOET显像SPECT/CT检查判断DTC患者术后颈部淋巴结转移效能较好,尤其适合Dx-WBS阴性、Tg阳性、B超检查疑似颈部淋巴结转移的患者。     

Hodgkin's disease presenting with progressive liver failure

We report an unusual case of a 70-year-old man with a diagnosis of Hodgkin's disease, who presented with fever and liver dysfunction. A few cervical lymph nodes, less than 1 cm in diameter were palpable, but other lymph nodes were not detected even by CT scan. Blood cell counts showed thrombocytopenia (platelet counts 6.8 x 10(4)/microliter), and some values for liver enzymes were out of the normal range (AST 56 U/l, ALT 87 U/l, LDH 347 U/l, ALP 1,529 U/l, and gamma-GTP 190 U/l). Abdominal CT scan showed diffuse enlargement of the liver and spleen. Endoscopic retrograde biliary cholangiopancreatography was performed because of progressive jaundice, but no abnormality was found in the biliary tract. A few granulomas were observed in bone marrow clot specimens, but tumor cells were not detected. A diagnosis of Hodgkin's disease was established by a cervical lymph node biopsy. Chemotherapy was immediately instituted, and both the jaundice and fever improved dramatically. Because cervical lymph nodes were not detected at one month after the onset and liver dysfunction appeared before cytopenia, it is suggested that the site of the primary lesion in this case was the liver.     

A case of lung cancer with hyperthyroidism]

We here report a case of metastasis from lung cancer to the thyroid. On presentation, this patient showed painful anterior cervical swelling and right supraclavicular lymph node swelling. Laboratory data showed primary hyperthyroidism. Although subacute thyroiditis was suspected, echo-guided needle aspiration biopsy and lymph node biopsy revealed poorly differentiated squamous cell carcinoma. As a result, primary lung cancer with thyroid metastasis was diagnosed based on mediastinal enlargement on chest X ray films and normal findings in organs other than the lung and thyroid. Chemotherapy for lung cancer induced a decrease in the size of tumor and the normalization of thyroid function. However, 2 months after the normalization, cervical swelling enlarged and a lung mass in right upper lobe and skin tumor appeared. Despite treatment with chemotherapy, she died. Postmortem revealed that the right upper lung carcinoma was the primary lesion and immunohistochemical staining for surfactant protein was positive in the thyroid, skin tumor and lymph node, which revealed these carcinomas had metastasized from lung cancer. To the best of our knowledge, thyrotoxicosis induced by thyroid metastasis of lung cancer is an uncommon case.     

A case of group G Streptococcus sepsis, chest wall abscess, and vertebral osteomyelitis mimicking a primary lung cancer with bone metastasis]

A 73-year-old woman who had been followed in our department of gynecology because of ovarian cancer since 2002, was admitted with liver dysfunction and complaining of back pain and light precordial chest pain. The chest radiograph on admission revealed a tumor in her left upper lung field, and chest CT revealed a tumor adjacent to the chest wall and mediastinum. FDG-positron emission tomography (PET) showed abnormal uptake in the tumor and Th6/7, and the subaortic lymph nodes. On the basis of these findings, primary lung cancer with bone metastasis was suspected. She had a high grade fever on admission, and blood cultures were positive for group G streptococcus. The treatment with intravenous penicillin was started. Percutaneous biopsy of the tumor in her left chest showed an abscess wall in the chest wall, but no evidence of malignancy. Transbronchial lung biopsy and CT-guided biopsy also showed no malignant cells. Since the tumor decreased in size and back pain improved gradually by only antibiotic treatment, a diagnosis of sepsis of group G streptococcus, chest wall abscess, and vertebral osteomyelitis was made. She was treated with intravenous penicillin for 4 weeks and oral amoxicillin for another 4 weeks. After 60 days of antibiotic treatment, the tumor vanished.     

A case of primary lung cancer with initial symptoms due to orbital metastases]

We encountered a case of lung cancer in which symptoms due to orbital metastasis were recognized. A 55-year-old man presented with a chief complaint of double vision. Orbital MR image demonstrated a right intraorbital mass with bone destruction, which resulted in oculomotor nerve palsy and optic nerve disturbance. Chest CT scan showed a 4 cm mass in the right S6, which was diagnosed on biopsy as a poorly differentiated adenocarcinoma. A whole-body scintigram revealed multiple bone metastases: the right orbital wall, the lower cervical spine, the left knee joint, and so on. Based on the clinical findings, we believed that the orbital tumor was a metastasis from the lung. Systemic chemotherapy and irradiation of the right orbital tumor and the left knee joint were performed. Though a favorable response was achieved in ocular movement, the patient died 3 months after initial treatment because of progression of the primary lesion. Including this case, seventeen reported cases in which lung cancer metastasized to the orbit in Japan were also reviewed.     

Trousseau's Syndrome Presenting as Multiple Cerebral Infarctions Caused by Mucin-producing Bladder Micropapillary Urothelial Cancer

We herein report a 70-year-old man with recurrent multiple cerebral infarctions under warfarin therapy who was finally diagnosed with Trousseau''s syndrome resulting from advanced bladder cancer. A histological examination of the mesenteric lymph nodes revealed metastasis of micropapillary urothelial cancer with positive mucin markers CA125 and MUC1. Blood examinations also indicated elevated tumor markers, such as CA19-9 and CA125. To our knowledge, this is the first report of Trousseau''s syndrome in a patient with bladder micropapillary urothelial cancer in which mucin involvement was clearly proven by histological and serological examinations.     

Pancreatic metastasis of papillary thyroid carcinoma preoperatively diagnosed by endoscopic ultrasound-guided fine-needle aspiration biopsy: a case report with review of literatures

Pancreatic metastatic tumors from thyroid carcinoma are extremely rare. We report a case of an 80-year-old female with a pancreatic metastatic tumor derived from papillary thyroid carcinoma which was initially resected 158 months prior to detection of the metastatic pancreatic tumor. The patient has encountered cervical lymph-node metastasis on three occasions following the initial operation. Metastatic pancreatic lesions and cervical lymph nodes were first detected using 18-fluorodeoxyglucose positron-emission tomography/computed tomography, and she was preoperatively diagnosed using endoscopic ultrasound-guided fine-needle aspiration biopsy. A coin lesion, 10 mm in size, was detected in the left lung by chest computed tomography with no abnormal uptake in 18-fluorodeoxyglucose positron-emission tomography/computed tomography. Distal pancreatectomy and cervical lymph-node dissection were performed. Adjuvant chemotherapy with weekly paclitaxel was administered because anaplastic transformation had been detected in one of the cervical lymph nodes. The patient eventually died from multiple lung metastases 11 months after removing the metastatic pancreatic lesion. We reported a rare case of a pancreatic metastatic tumor from thyroid carcinoma, and found that 18-fluorodeoxyglucose positron-emission tomography/computed tomography and endoscopic ultrasound-guided fine-needle aspiration biopsy are useful for preoperatively diagnosing tumors.     

Portal hepatic lymphadenopathy involved by Rosai-Dorfman disease-like changes in a patient with hepatocellular carcinoma

We report a case of a 68-year-old woman with chronic hepatitis C who presented with a small hepatocellular carcinoma in segment 8 (S8) of liver and a portal hepatic tumor. Transhepatic arterial infusion therapy was performed, followed by partial hepatic resection of S8 and excision of the portal hepatic tumor with lymph node metastasis. Histologically, the lymph nodes showed marked infiltration of large histiocytes with clear cytoplasm and emperipolesis in the specimen stained with hematoxylin-eosin. These findings were generally compatible with the histological features of Rosai-Dorfman disease (RDD). However, immunohistochemical analysis revealed the proliferating histiocytes were negative for CD1a, CD68 and S-100 protein, but positive for only lysozyme. Therefore, we finally diagnosed it as a disease similar to RDD. This was a difficult case diagnostically distinguish between metastasis and benign disease.     

Long-term survival and improved quality of life after chemoradiotherapy to treat esophageal small cell carcinoma: a report of two cases

In case 1, endoscopy revealed a submucosal tumor with central ulceration in the esophagus of a 54- year-old man. A biopsy specimen revealed small cell carcinoma without metastasis and the stage of the cancer was stage I (T2N0M0). Two cycles of concurrent cisplatin, etoposide and radiotherapy resulted in an incomplete response/stable disease. The tumor recurred and had metastasized to the brain, lung, liver, lymph nodes of the mediastinum, abdomen and bones after six cycles. Two cycles of irinotecan and cisplatin then elicited a complete response in the primary esophageal lesion. However, progressive disease was identified in the metastatic bone tumors. Despite two further cycles of therapy, he died 447 days after the initial course. In case 2, a biopsy specimen of a tumor with central ulceration in the esophagus of a 77-year old man with swallowing difficulty indicated small cell carcinoma. The stage of the cancer was diagnosed as stage II (T3N0M0). Two cycles of irinotecan, cisplatin and concurrent radiotherapy elicited a complete response. However, the tumor metastasized to the brain and the liver 644 days after starting treatment. Two cycles of carboplastin plus irinotecan elicited a partial response in the metastatic tumors, but he died 988 days after starting chemotherapy.     

Evaluation of the usefulness of tumor budding on the prediction of metastasis to the lung and liver after curative excision of colorectal cancer

BACKGROUND/AIMS: We evaluated the usefulness of tumor budding, defined as the morphology of infiltration by small clusters of undifferentiated adenocarcinoma into the invasive front of the lesion, for the prediction of metastasis to the lung and liver after curative excision of colorectal cancer. METHODOLOGY: The subjects were 491 patients with a single colorectal cancer lesion, in whom follow-up observation was performed for more than 5 years, consisting of 278 patients without recurrence, 155 patients with the first metastasis to the liver alone, and 58 patients with the first metastasis to the lung alone. The invasive front was histologically re-examined using sections with the largest diameter of the primary colorectal cancer lesion, and the tumor budding was classified into 3 grades based on the morphology of infiltration. The usefulness of this factor for the prediction of metastasis to the lung and liver was examined by multivariate analysis together with conventional clinicopathological factors such as age, sex, tumor location, tumor size, histological type, tumor depth, invasion of lymph ducts, venous invasion, and metastasis to lymph nodes. RESULTS: Comparisons of the no-recurrence and lung metastasis groups by multivariate analysis indicated that moderate to severe tumor budding (odds ratio=0.1291, P<0.0001) and positive metastasis to lymph nodes (odds ratio=0.1142, P<0.0001) were extracted as the independent prediction factors of metastasis to the lung. Comparisons of the no-recurrence and liver metastasis groups indicated that infiltration over the proper muscular tunics (odds ratio=0.0284, P<0.0001) and positive metastasis to lymph nodes (odds ratio=0.3289, P=0.0002) were extracted as the independent prediction factors of metastasis to the liver. CONCLUSIONS: Tumor budding in the invasive front of the lesion was considered to be a simple and useful pathohistological factor for the prediction of metastasis to the lung in patients with colorectal cancer after curative excision. It was suggested that this factor is important for the prediction of metastasis to the lung after surgery and for the planning of treatment methods.     

A case of subacute necrotizing lymphadenitis with localized interstitial pneumonia

A 16-year-old male was admitted with a history of cervical lymph node swelling, high fever, cough and hemosputum. On admission, bilateral cervical lymph nodes swelling and fine crackles in the right lower lung field were noted. A chest X-ray film showed an infiltrative shadow in the right lower lung field and right hilar enlargement. Cervical lymph node biopsy specimens revealed wide areas of necrosis with nuclear debris. Transbronchial lung biopsy showed infiltration of lymphocytes in the interstitium and bronchoalveolar lavage fluid showed increased T-lymphocytes and a decreased T4/T8 ratio. The patient was diagnosed to have subacute necrotizing lymphadenitis with T-lymphocyte alveolitis. Additionally, antinuclear antibodies were positive, and anti HTLV-I antibody was false positive. These findings suggested an immunological abnormality in this case. His cervical lymph node swelling and infiltrative shadow on chest X-ray film improved with steroid therapy. Our case may be the first case of subacute necrotizing lymphadenitis with T-lymphocyte alveolitis.