脊柱转移性肿瘤的手术切除与脊柱稳定性重建

目的观察脊柱转移性肿瘤的手术切除和脊柱稳定性重建的外科疗效。方法对29例脊柱转移眭肿瘤患者进行脊椎肿瘤切除减压，单纯植骨或钛网、人工椎体植骨加椎弓根钉棒或钢板螺钉内固定，一期重建脊柱稳定性，术后根据病理结果均给予化疗、放疗和激素等综合治疗。观察术后局部疼痛缓解，脊髓神经功能恢复及脊柱椎节的稳定性情况。结果随访6个月～62个月，平均26个月。所有病人术后局部疼痛缓解，脊髓神经功能无加重损伤，其中12例患者脊髓神经功能得到不同程度恢复。术后影像学检查提示：脊柱内固定物在位，椎体序列恢复良好，椎问高度恢复。结论脊柱转移性肿瘤的手术切除和脊柱稳定性重建的外科疗效肯定，适应征具备者应积极手术治疗。     

Radiofrequency ablation for metastatic lung tumor

BACKGROUND: Radiofrequency ablation (RFA) is a thermal ablation technique which results in coagulative necrosis. Several preliminary studies have evaluated the efficacy of RFA for liver tumor and benign prostate disease, but few studies for lung tumor. We experienced RFA for a metastatic lung tumor and it was effective. CASE: A 61-year-old woman was admitted to our hospital with chest pain. Extended thymothymomectomy with lymph node dissection was performed after diagnosis of thymic carcinoid. After 14 months, multiple small lung nodules, which had been 5-10 mm in diameter, were appeared and resected. However, 23 months after the first operation and 14 months after the second operation, multiple small lung nodules were appeared again and RFA was performed for 1 tumor without any complications. We used RITA 500 PA (RITA Medical Systems, INC.) and quadruple-hook radiofrequency probe with electrodes. Under local anaesthesia and ultrasound guidance, the probe was inserted into the target tumor and the hooks were deployed. The tumor became smaller (35 mm to 25 mm in diameter) in 2 months. CONCLUSION: RFA is an effective and minimally invasive technique to destruct local tumors.     

肝脏转移性恶性黑色素瘤手术切除一例

病人，男，42岁。突发性上腹痛24h入院，呈持续性钝痛，局限在上腹部，6年前曾有左侧眼睑黑色素瘤，已手术切除。体检：一般情况可，生命体征稳定，心肺正常，腹肌紧张，以右上腹为著。彩超显示：肝左外叶前缘和右叶内各见一占位性病变。MRI显示：肝左叶见一类圆形混杂信号软组织块影，肝右前叶见短T1和长T2亮信号。胰腺及脾脏形态、大小正常，腹膜后无肿大淋巴结。诊断意见：肝左叶占位，继发性肝癌可能伴瘤体破裂出血。治疗：在全麻下行剖腹探查术，术中见肝脏左外叶一带蒂外生型肿瘤，约7cm×6cm×4cm大小，表面已破溃，肝右叶Ⅴ、Ⅵ段内可触及一约5cm×6cm×4cm大小肿块，行左外叶肿瘤切除、肝脏Ⅴ、Ⅵ段切除。术后恢复良好，随访23个月时彩超、CT发现肝左外叶占位性病变约5cm×6cm×4cm大小。拟恶性黑色素瘤复发。再次手术切除肝脏第Ⅲ段。术后康复顺利，随访3个月，一般状况良好，无肿瘤复发。两次手术的病理报告基本相同：肿块切面成黑色，镜下呈巢片状排列的细胞内见大量黑色素颗粒，诊断：肝转移性恶性黑色素瘤，梭形细胞型。[第一段]     

Testis tumor metastatic to lung: twenty-two-year survivor.

A case is presented of a twenty-two-year survivor following pulmonary resection of a solitary embryonal cell carcinoma metastasis from a primary teratocarcinoma of the testis. The literature is reviewed with regard to this problem, and the criteria for pulmonary resection of metastic lesions are presented.     

Surgical treatment and indication for metastatic lung tumor

Prognostic factors of patients with metastatic lung tumors were evaluated on 72 patients who were treated with pulmonary resection (49 via lateral thoracotomy and 23 via median sternotomy). The 5-year survival rate of these patients was 41.3%. Two factors, i.e., tumor free interval (TFI) and tumor size, significantly affected the survival after surgery. Patients with a longer TFI and smaller tumor(s) were associated with a favorable prognosis. The prognosis, however, was neither affected by the number of metastatic lung tumors nor whether they were unilateral or bilateral. The prognosis of lung metastases from colorectal cancer was the most favorable (61.4% at 5-year). On the other hand, patients with lung metastases from renal cell carcinoma and breast carcinoma showed poor prognosis respectively. As for testicular tumors and bone or soft tissue sarcomas, chemo-sensitivity is the most important prognostic factor. Good responders to prior chemotherapy showed a better prognosis than poor responders. These results urge the reappraisal of the role of surgery in the treatment of metastatic lung tumors and demonstrate that aggressive surgery can be indicated even for multiple or bilateral lung metastases. Nature of metastatic tumors, i.e., their origin and chemo-sensitivity, must be taken into consideration when the indication for surgery is decided.     

大分割三维适形放射治疗肺癌单发脑转移

目的探讨大分割三维适形(3D-CRT)方法治疗肺癌单发脑转移的疗效。方法 87例患者接受大分割3D-CRT治疗。方法 3～4Gy/次,1次/d,5次/周,共8～12次。整个治疗期间配合脱水治疗以降低颅压。结果有效率71.2%,87例患者中位生存期为11个月,生活质量提高。结论大分割3D-CRT治疗肺癌单发脑转移是一种行之有效的治疗方法。     

Resection and reconstruction of the great vessels for lung cancer and mediastinal tumor

Between January 1994 and December 1997, 17 patients with lung cancer and 5 patients with mediastinal tumor underwent extensive resection and reconstruction of the great vessels. In patients with lung cancer, the aorta was resected under cardiopulmonary bypass in 4 patients, the superior vena cava in 12, and the left main pulmonary artery with combined resection of the left atrium in 1 and the aorta in 1. In five patients who underwent resection of the superior vena cava, subcarinal resection and reconstruction were also performed. Three patients died within 30 days after surgery. Six patients died of cancer between 3 months and 2 years after surgery. Two patients who underwent aortic resection for node negative lung cancer have survived more than 3 years after surgery. Six patients have survived between 6 months and 2 years after surgery. The histologic type of mediastinal tumor was thymic cancer in 3 patients, invasive thymoma in 1 and malignant lymphoma in 1. In patients who underwent resection of the superior vena cava for mediastinal tumor, bilateral brachiocephalic vein reconstruction was performed in 4 patients and the left brachiocephalic vein reconstruction in 1. One patient underwent resection of the right atrium. The patient with invasive thymoma has survived for more than 3 years. Two of 3 patients with thymic cancer died within 2 years. When complete resection is achieved with combined resection of the great vessels, survival may be anticipated in patients with N0 lung cancer or in those with invasive thymoma.     

True pulmonary carcinosarcoma suspected as a metastatic lung tumor

This patient, a 53-year-old man, has underwent operation on the diagnosis of esophageal cancer 2 years ago. An abnormal shadow was detected in the left lung field and he was admitted to our hospital for further examination. On the suspicion of metastatic lung tumor by transbronchial brushing cytology, partial resection of the left lower lobe was performed. Histologically the tumor was of carcinomatous (squamous cell carcinoma and adenocarcinoma) and sarcomatous (fibrosarcoma and chondrosarcoma) elements, so the patient was diagnosed as "true" pulmonary carcinosarcoma. True pulmonary carcinosarcoma is one of the very rarest neoplasms of the lung.     

Evaluation of recurrent metastatic brain tumor of lung cancer origin

The authors examined numerous clinical features in 15 patients in whom brain metastases from lung cancer recurred after total or subtotal removal. The incidence of recurrence after initial removal of brain nodules was 46.9% (15 of 32 cases). There was no significant correlation between the incidence of recurrence and the histology of the lung cancer, the site of brain nodules, or age. Recurrent brain nodules were the cause of or contributed to death in 60% of recurrent cases. Recurrence was within 3 months of initial removal of brain nodules in 10 of the 15 patients. Brain metastasis recurred only at the initial site in 11 cases (73.3%). Three patients developed carcinomatous meningitis and one had multiple metastases in addition to recurrence or regrowth at the original site. The primary lung cancer was relatively stable at the time of recurrence of brain nodules in 60% of the patients. Tumor removal and radiotherapy are highly recommended for prevention of early recurrence following initial removal of brain metastases. Removal of metastatic tumor is advised in the event of recurrence after 1 year from initial surgery, since the outcome after second surgery tends to be fair. However, tumor removal and radiotherapy are sometimes capable of inducing recurrence of brain nodules. Therefore, it is hoped that more effective cancer chemotherapy will be developed in the near future.     

Osteoclast-like giant cell tumor of the renal pelvis associated with urothelial carcinoma: computed tomography, gross, and histologic appearance

Osteoclastoma-like giant cell tumor of the renal pelvis, similar to the entity more commonly occurring in bone, is very rare, having been reported in twelve previous cases to our knowledge. This is the first report of this entity, to our knowledge, to include its cross-sectional imaging appearance. A hyperdense area within the lesion on non-contrast CT may correspond with extensive hemorrhagic content of the lesion identified histologically. As in most prior cases, an adjacent smaller urothelial carcinoma of the renal pelvis was also identified. In the limited reported cases, this entity has exhibited highly aggressive behavior with poor prognosis.     

Resection of a right atrial metastatic melanoma with unknown origin of primary tumor.

Cardiac involvement of malignant melanoma is generally part of a widespread tumor dissemination, which is mostly multifocal. Hence the disease is usually not amenable to surgical intervention. We report successful resection of a large intracavitary melanoma to the right atrium, the primary origin of which was unknown. The right atrium was reconstructed with an autologous pericardial patch. At 12-month follow-up the patient remains asymptomatic.     

Bilateral simultaneous inflammatory myofibroblastic tumor of the lung with distant metastatic spread

Inflammatory myofibroblastic tumors (IMT) of the lung are considered rare and benign; however, involvement of adjacent thoracic organs, local recurrence and distant metastases have been described. The potential presence of distant metastases supports the hypothesis that those tumors should not be considered 'clinically' benign, although histological features suggest this attitude; thus, complete resection and careful follow-up are mandatory. We present a case of a bilateral pulmonary IMT with left adrenal gland metastasis in a patient with dyspnea and cough.