消化道类癌的临床诊治进展

消化道类癌的临床诊治进展上海医科大学肿瘤医院（２０００３２）朱慰祺１概述消化道类癌发生于Ｌｉｅｂｅｒｋｕｈｎ腺泡的ｋｕｌｔｓ－ｃｈｉｔｚｓｋｙ细胞，应用Ｇｒｉｍｅｌｉｕｓ嗜银染色癌细胞内可见嗜银颗粒，故又名嗜银细胞癌，１８０８年Ｍｅｒｌｉｎｇ首先描述...     

消化道类癌的诊断与治疗及其预后分析

目的探讨消化道类癌的诊断和治疗方法及影响预后的因素。方法对我院1973年12月至2002年12月间收治的消化道类癌的临床资料进行回顾分析。结果35例患者男女比例2∶1,平均年龄52岁。主要临床表现为腹痛、腹部肿块、消化道出血和梗阻。肿瘤位于结肠13例,胃11例,直肠7例,阑尾2例,小肠和十二指肠各1例。肿瘤直径2cm以下者4例,超过2cm者31例,最大直径6cm。根治性切除30例,术后5年生存率为(57.3±11.0)%;姑息性切除5例,术后5年生存率为0。肿瘤大小及浸润深度与淋巴结转移相关。结论消化道类癌较为少见,无特异性表现,极少伴类癌综合征。手术治疗预后较好,切除的彻底性是影响预后的主要因素。     

消化道类癌的临床诊断

消化道类癌的临床诊断同济医科大学附属协和医院（武汉，４３００２２）陈道达张建平类癌（Ｃａｒｃｉｎｏｉｄ）一词由Ｏｂｅｒｎｄｏｒｆｅｔ于１９０７年命名，占消化道内分泌肿瘤的５０％以上。因其具有银染特性，故又名“嗜银细胞瘤”，传统定义类癌为一种源自散在内...     

临床医生应重视消化道类癌的诊治

临床医生应重视消化道类癌的诊治上海医科大学华山医院（２０００４０）张延龄消化道类癌不常见，在全部恶性肿瘤中占０．０５％～０．２％，在胃肠道恶性肿瘤中占０．４％～１．８％，约占尸检数的１．２％以下，但其分类众多，症状各异，术前确诊不易，预后良劣差别很大...     

消化道类癌的诊治问题

消化道类癌的诊治问题辽宁省人民医院（１１００１５）刘承训１历史概况消化道是人体最大的内分泌器官，而消化道内分泌肿瘤的发病率却远低于消化道腺癌。在消化道内分泌肿瘤中类癌占有很高的比率（５５％～８６％）［１］。但其总发病率仅占胃肠恶性肿瘤的０．４％～１．...     

15例消化道类癌临床病理分析

１５例消化道类癌临床病理分析湖北医科大学附属第二医院（４３００７１）消化内科林军，邓长生病理教研室陈德基，邹祖玉类癌（ｃａｒｃｉｎｏｉｄ）因其能产生多肽类激素，属内分泌肿瘤的产肽胺激素细胞瘤（ａｐｕｄｏｍａ）范畴，起源于粘膜腺体腺管的Ｋｕｌｓｃｈｉｔ...     

后肠类癌的诊治进展

类癌是神经内分泌系统肿瘤中组织分化较好、生长缓慢的低度恶性肿瘤。消化道类癌细胞起源于消化道粘膜腺体Ｌｉｅｂｅｒｋｉｉｈｎ腺泡的Ｋｕｌｔｓｃｈｉｔｚｓｋｙ细胞（肠嗜铬细胞）。而在胚胎发育过程中起源于后肠（包括横结肠的后１／３、降结肠、乙状结肠和直肠）的消化道类癌则称为后肠类癌，其与前肠和中肠起源的消化道类癌在病理学和临床生物学特性上有不少差别，在治疗上也不尽相同。本文综合国外相关文献，对后肠类癌的诊断和治疗作一综述。     

消化道类癌16例治疗分析

消化道类癌１６例治疗分析北京友谊医院普外科（１０００５０）尹燕平王宇类癌因结构似癌但其生物学特征与癌不同、症状不明显，易被忽视。我科于１９９０～１９９６年共收治消化道类癌１６例。现报告如下。１临床资料本组１６例，男７例，女９例。年龄最小３６岁，最大６...     

胃肠道类癌49例临床分析

目的 探讨胃肠道类癌的诊断和治疗方法及影响预后的因素。方法 回顾分析我院1980年1月至2005年1月收治的胃肠道类癌49例的临床资料。结果 49例患者中，胃类癌13例，直肠类癌16例，阑尾类癌7例，结肠类癌12例，回肠类癌1例。术前误诊71.4％，其中胃类癌、阑尾类癌和回肠类癌全部误诊，直肠类癌25.0％、结肠类癌83.3％误诊。肿瘤直径在2cm以内、无肌层侵犯和淋巴结转移者1、3、5年累计生存率为100％、100％和96.9％；肿瘤直径超过2cm、侵犯肌层或有淋巴结转移者累积1、3、5年累计生存率为70.3％、62.3％和58.4％。结论 胃肠道类癌术前误诊率高，预后主要取决于肿瘤的大小、有无肌层侵犯或淋巴结转移。     

消化道类癌的诊治和预后

目的:探讨消化道类癌的诊断、治疗和预后。方法:回顾性分析122例消化道类癌的临床资料。结果:消化道类癌临床表现不典型。54.1％的病例类癌浸及肌层,18％的类癌有区域淋巴结转移。随访3年以上的89例类癌其3年、5年和10年生存率分别为81.7％、66.7％和44.4％。结论:肿瘤直径<2cm者应行局部广泛切除术,>2cm者行根治术。结肠及胃部类癌切除范围应相对较大,而阑尾及空回肠类癌手术范围应相对较小。消化道癌早期手术预后较好。     

Carcinoid Tumors of the Gastrointestinal Tract

The charts of 135 patients with gastrointestinal carcinoid tumors diagnosed over a 22-year period at 2 hospitals are reviewed and the clinical and pathological aspects discussed. Carcinoids occur most commonly in the appendix, jejunoileum, and rectum. Those smaller than 1 cm in diameter provide evidence of malignant potential only occasionally; lesions in the 1-1.9 cm range do this quite variably, and tumors 2 cm and larger are almost always invasive or metastatic or both. All gastrointestinal carcinoids except those of the appendix enlarge, invade, and metastasize predictably if given sufficient time. Most carcinoids except those of the rectum have already been adequately treated surgically when diagnosed by the pathologist. Local excision is effective treatment for noninvasive rectal carcinoids smaller than 2 cm in diameter, but those that have invaded or grown to 2 cm should undergo more radical resection. In general, gastrointestinal carcinoids carry better prognoses than do adenocarcinomata, and even in the presence of distant metastases long-term survival occurs in a significant number of patients. The frequent concomitance of associated malignant diseases accounts for as many or more deaths in these patients than the carcinoids themselves.     

Gastrointestinal Carcinoid Tumors: Factors that Predict Outcome

Gastrointestinal (GI) carcinoids are neuroendocrine tumors originating in multiple locations throughout the GI tract. The prognosis for patients with GI carcinoid tumors is diverse. To determine the factors that significantly affect prognosis, we reviewed our experience. Between 1992 and 2000 a total of 70 patients with GI carcinoid tumors underwent surgical resection at our institution. The patients were grouped into three categories based on the origin of the carcinoid tumor: foregut, midgut, hindgut. The mean age of the patients was 56 ± 2 years. All patients with foregut carcinoids had symptoms upon presentation, whereas 61% of those with midgut carcinoids and only 37% of those with hindgut carcinoids had symptoms (p < 0.001). The factors that most strongly affected survival on univariate analysis were a symptomatic presentation and the site of origin. Patients with foregut or midgut lesions had lower 5-year disease-free survivals than those with hindgut tumors. Moreover, the size of the primary tumor and the presence of liver metastases were not independent predictors of survival. Despite the larger tumor size and the higher incidence of liver metastases, patients with foregut carcinoids appear to have the same prognosis as those with midgut carcinoids. These data therefore suggest that the outcomes of patients with carcinoid tumors are highly dependent on the presence of symptoms and the site of origin.     

急性胰腺炎微循环障碍和银杏液的治疗作用

目的:探讨微循环障碍在急性胰腺炎发病中的作用以及杏丁注射液对改善微循环的效果。方法:选择Wistar大鼠为对象,经十二指肠胆胰管逆行加压注射5%牛磺胆酸钠,建立急性胰腺炎模型,静脉输入银杏注射液。测定TXB2,PGF1的浓度,同时观察大鼠胰腺组织的病理形态学变化。结果:TXB2,PGF1,T/P随病情加重,总趋势上升,银杏液可改善这种趋势。结论:银杏注射液可以改善微循环,减轻病情,阻止其进一步发展。     

Gastrointestinal Carcinoid Tumors: Long-term Prognosis for Surgically Treated Patients

To evaluate long-term survival of patients with gastrointestinal carcinoid tumors and to assess factors that may influence prognosis, 154 patients (49% females, 51% males), median age 62 years (range 12–84 years) treated at our institution during 1972–1982 have been followed long term. Tumor location included the foregut (7%), midgut (62%), and hindgut (30%). Ninety-five percent of the patients underwent surgical or endoscopic excision of the primary tumor, with overall operative mortality and postoperative morbidity rates of 2.6% and 11%, respectively. At follow-up, 60 patients (39%) were alive (median follow-up 18 years; range 1–26 years). The main causes of death included carcinoid tumor burden (32%), unrelated causes (45%), other malignancy (19%), and unknown causes (4%). Observed overall 5- and 10-year survivals were 69% and 53%, respectively. Survival was not related to gender or symptoms at presentation. However, age, embryologic origin, tumor size, depth of invasion, nodal status, and stage of disease proved to be of statistical significance (log-rank). In a multivariate Cox' model, only older age (> 62 years) [P =0.001, odds ratio (OR) = 3.4) and embryologic origin (midgut versus foregut) (P = 0.045, OR = 0.45) provided independent prognostic power when death from any cause was taken as the end-point. This study confirms that patient's age and the site of the primary tumor have prognostic significance. Carcinoid tumors are neuroendocrine tumors with a relatively good prognosis, and long-term survival is possible despite advanced stages of disease.     

An Analysis of Rare Carcinoid Tumors: Clarifying These Clinical Conundrums

Carcinoid tumors are distinct neuroendocrine neoplasms with characteristic histological, clinical, and biological properties. Though commonly associated with the gastrointestinal tract and bronchopulmonary system, a substantial number of these tumors originate in less common anatomical sites and can range from indolent, unrecognized entities to highly active, metastatic secretory tumors. Their presentation within unfamiliar locations often results in clinical confusion, and they persist as unrecognized lesions, subjecting patients to delayed, inappropriate, or ineffective treatment. The authors reviewed 13,715 carcinoid tumors identified by three consecutive registries of the National Cancer Institute (NCI) from 1950 to 1999, focusing on the anatomic sites accounting for less than one percent of all carcinoids. In addition, data from the worlds literature published on carcinoid tumors within these particular anatomic locations were then analyzed with respect to incidence, clinical presentation, symptoms, diagnostic evaluation, microscopic and immunohistochemical findings, treatment strategies, and prognosis. The primary organs in which carcinoids are most commonly mistaken for some of the more conspicuous endemic tumors include the esophagus, pancreas, liver, biliary tract, gallbladder, and Meckels diverticulum, as well as within the pelvic and otolaryngeal organs and the breast. In general, the highest proportion of rare carcinoids was identified in the gastrointestinal (GI) tract, with the ovary as the single most affected extra-GI site. Tumors with the worst prognosis were those that involved the pancreas (37.5%: 5-year survival) and those in the cervix (12-33%: 3-year survival). While gastrointestinal carcinoids have become a more recognized entity and thus more amenable to identification, similar lesions are often not considered in other sites and have often either been overlooked or misdiagnosed. Widespread reports of their occurrence in rare locations warrants attention. The diminution of the likelihood of inadvertently neglecting these often benign, indolent neoplasms that are well known to metastasize if unaddressed would represent an important advance. Familiarity with such unusual sites of origin will facilitate appropriate recognition and characterization of such tumors, allowing for timely intervention.     

HER2 Expression in Gastrointestinal Carcinoid Tumors: High in Intestinal but not in Gastric Tumors

We investigated HER2 expression immunohistochemically in 12 patients with a gastrointestinal (GI) carcinoid tumor. The tumors were located in the stomach in three patients, the duodenum in four, the vermiform appendix in one, and the rectum in four. HER2 was highly expressed in the nine intestinal, but not in the three gastric carcinoid tumors. These findings suggest that HER2 might be highly expressed in intestinal, but not in gastric, carcinoid tumors.     

胃肠道间质细胞肿瘤43例临床及病理分析

目的:探讨胃肠道间质瘤临床表现和良性、潜在恶性、恶性的病理诊断标准,及其对临床评估预后的价值.方法:选用43例临床资料完整的病例,经免疫组化S-P方法测定CD117、CD34、SMA、S-100、NSE及组织化学Masson染色.结果:43例免疫组化阳性率CD117 40/43例(93.0%);CD34 34/43例(79.1%);CD117及CD34皆阳性30/43(69.8%),SMA 16/43例(37.2%)向平滑肌分化;S-100阳性或兼有NSE阳性14/43例(32.6%)向神经鞘分化;6/43例(14.0%)双向分化.良性5例,潜在恶性10例,恶性28例,预后与肿瘤病理判定密切相关.结论:胃肠道间质瘤的病理诊断除结合临床各项检查外,仍需依靠免疫组化测定(CD117及/或CD34),其中必须一项呈阳性者方能确定诊断.