肺神经内分泌肿瘤的CT诊断与病理对照

目的分析肺神经内分泌肿瘤的CT表现,并与病理分型对照,提高对该病的认识。方法回顾性分析本院2003年8月至2012年9月间诊治的32例肺神经内分泌肿瘤病例,对照分析CT表现与病理分型。结果 32例肺神经内分泌肿瘤包括4例典型类癌、4例不典型类癌、10例大细胞神经内分泌癌、14例小细胞肺癌。其中男27例、女5例,平均年龄54.9岁;中央型14例、周围型18例;肿瘤平均直径(32.145±13.335)mm,分叶征12例(37.5%),密度均匀23例(71.9%),增强扫描CT值增高(41.594±18.641)HU;合并纵隔及肺门淋巴结转移20例。结论肺神经内分泌肿瘤的CT表现与其病理特性相对应,典型类癌及不典型类癌影像表现有一定特点,大细胞神经内分泌癌及小细胞肺癌缺乏特征性影像表现,确诊最终依赖病理。     

多层螺旋CT在周围型肺神经内分泌癌的诊断价值

目的 探讨不同类型周围型肺神经内分泌癌的MSCT征象及诊断价值.方法 对具有完整胸部MSCT资料并经病理学证实的42例周围型肺神经内分泌癌CT表现进行比较分析.结果小细胞癌与其他类型神经内分泌癌在淋巴结转移方面有显著性差异(P<0.05).不同病理类型的周围型肺神经内分泌癌病灶密度多较均匀(29例),多有分叶(30例);病灶毛刺征,血管集束征,胸膜凹陷征和周围阻塞性肺炎在本组少见(分别为8例,4例,7例,8例);病灶呈轻度强化,病灶密度值、强化程度相仿,以上征象均无统计学差异(P>0.05).结论 MSCT对不同周围型肺神经内分泌癌的诊断和鉴别诊断有一定价值.     

肺神经内分泌肿瘤的CT表现

目的探讨肺神经内分泌肿瘤的CT表现。方法对本院2013年~2015年收治的20例具有影像学资料和病理结果的肺神经内分泌肿瘤患者的资料进行回顾性分析,全部病例均行CT平扫及增强扫描。结果 20例中,典型类癌5例,不典型类癌2例,大细胞癌6例,小细胞癌7例。男性12例,女性8例。中央型13例,周围型7例。右肺11例,左肺9例。病灶中坏死15例;钙化3例。12例出现肺内转移、纵隔肺门淋巴结转移或远处转移。19例病灶实性部分呈轻度不均质强化,1例强化较明显。结论肺神经内分泌肿瘤CT表现有一定特征。最终确诊需要依赖病理结果。     

皮肤merkel细胞癌扁桃体转移1例并文献回顾

目的：探讨皮肤Merke!细胞癌的诊断及鉴别诊断、治疗及预后。方法：对1例皮肤Merkel细胞癌扁桃体转移患者的临床病史、肿瘤组织的病理免疫组化表达及治疗过程进行回顾性分析,并结合相关文献就其临床特征及转移方式进行讨论。结果：本例Merkel细胞癌患者表现为臀部merkel细胞癌,于术后5个月发生附近淋巴结转移,再次手术后出现远处转移。手术后2年,发现右颌下包块,咽部不适,扁桃体活检证实扁桃体小细胞神经内分泌癌;免疫组化EMA（＋）NSE（4-）CK、CgA、Vim、ICA均（-）。结论：Merkel细胞癌罕见且进展快,即使综合治疗后仍有局部复发和远处转移的倾向,预后差。诊断主要依靠病理,免疫组化染色有助于鉴别诊断。临床上需结合病史与扁桃体原发癌相鉴别。     

鼻神经内分泌癌的临床病理学观察

目的 分析鼻神经内分泌癌的临床病理特点、诊断和鉴别诊断。方法 用形态学和免疫组化等方法观察12例鼻神经内分泌癌的病理学变化。结果 12例鼻神经内分泌癌多为中青年,男女之比为5：1,平均年龄39．6岁。神经内分泌癌的分型：小细胞型8例。大细胞型3例,不典型型1例。8例在透射电镜下见癌细胞胞浆内有大小不等的神经内分泌颗粒。肿瘤细胞对EMA、CK、CgA、NSE及Syn均呈阳性。结论 鼻神经内分泌癌的组织形态学分类有助于该病临床治疗方案的制定和预后的判断。     

胆囊神经内分泌癌的CT表现分析

目的探讨分析胆囊神经内分泌癌的CT影像学表现特点,提高对罕见病的认识。方法回顾性分析我院经病理证实的3例胆囊神经内分泌癌的CT检查结果、病理和临床资料,其中1例同时行MRI检查。观察肿块的分布范围、大小及强化方式,是否合并局部浸润、淋巴结转移,有无胆囊结石。结果 3例胆囊神经内分泌癌CT平扫时表现为胆囊壁的不规则弥漫性增厚或胆囊窝的团块,增强扫描为不均匀强化。2例合并有肝脏和淋巴结转移,1例合并有肝总管浸润。结论胆囊神经内分泌癌CT表现为胆囊部位的弥漫性肿块,易侵犯邻近的肝脏组织,伴有胆管侵犯、肝门部、腹膜后淋巴结转移。     

食管神经内分泌癌与鳞状细胞癌的CT鉴别诊断

目的分析食管神经内分泌癌的CT影像学表现,探讨食管神经内分泌癌(NECs)和鳞状细胞癌(SCCs)的CT鉴别特征。方法收集我院经病理及免疫组化证实的22例食管神经内分泌癌,作为对照组采用1:1匹配抽样纳入22例食管鳞癌;回顾性分析两种肿瘤的临床资料和CT影像学特征。采用单变量和多变量的统计分析方法评估CT表现的各种分类和连续性变量;连续性变量的CT特征采用ROC曲线分析,最终确定转移性淋巴结大小的最佳界限值。用Kappa检验分类变量两观察者一致性;用ICC检验连续性变量两观察者一致性。结果食管神经内分泌癌与鳞癌在临床症状(吞咽困难)、瘤周食管内壁界面形态、增强模式、淋巴结转移、转移淋巴结大小、肝转移瘤增强模式等方面,差异具有统计学意义(P0.05)。两种肿瘤的淋巴结大小的最佳界值为2.05cm。结论 CT对鉴别食管神经内分泌癌与鳞癌有一定的作用,为临床治疗方式的选择及预后分析提供了一定依据。     

肝脏原发性小细胞神经内分泌癌TACE治疗3例报道

目的探讨肝脏原发性小细胞神经内分泌癌的临床特点、诊断、治疗与预后。方法对本组3例肝脏原发性小细胞神经内分泌癌患者的临床病史、影像学表现、病理学免疫组化及介入治疗进行总结,并复习相关文献。结果 3例患者均有不同程度的腹痛,CT平扫表现为肝内稍低密度影,增强扫描表现为不均匀环状强化,穿刺组织病理学结果均确诊为肝脏神经内分泌癌。3例患者经介入治疗后,近期均有一定治疗效果,其中1例患者经多次介入治疗,随访1年半,疗效尚满意,另2例半年后失访。结论肝脏原发性小细胞神经内分泌癌属于临床少见恶性肿瘤,可通过CT引导穿刺行病理学免疫组化确诊,选择TACE治疗安全有效。     

直肠神经内分泌肿瘤的CT诊断

目的：探讨直肠神经内分泌肿瘤（RNET）的CT影像学表现特征及诊断要点。方法回顾性分析21例经内镜活检或手术后病理证实的RNET患者的临床及CT影像学资料,总结其诊断及鉴别要点。结果在21例RNET患者中,典型类癌为8例、不典型类癌为3例、低分化神经内分泌癌/小细胞癌为10例。CT平扫显示病灶呈结节状软组织密度影突向直肠肠腔内,边界清晰,密度均匀,增强后动脉期明显强化,门脉期强化程度略减低。其中,18例患者的病灶突破直肠浆膜侵犯周围脂肪组织;16例患者出现直肠周围淋巴结转移;2例患者出现肝脏转移。结论 RNET的CT影像学表现具有一定的特异度,但最终诊断仍需根据临床病理及免疫组化的结果来确定。     

左胸壁小细胞性神经内分泌癌一例

左胸壁小细胞性神经内分泌癌一例全冠民①吴国忠②小细胞性神经内分泌癌来源于皮肤组织，非常罕见，笔者遇到１例，发生于左胸壁且侵犯肋骨，经ＣＴ检查及手术、病理证实，现报告如下。患者男，４７岁。左胸壁肿块伴持续性疼痛２个月。体检：肿块长约２．５ｃｍ，表面光滑...     

The monitoring of gynecological radiotherapy using serial tumor marker determinations

In 149 collum and 45 corpus carcinomas tumor marker concentrations in serum have been measured before, during and sex to eight weeks after termination of radiotherapy. For the collum carcinomas (average of FIGO I to IV) the sensitivity of CEA was found to be 51%, SCC 67%, CEA +SCC 80%. In corpus carcinomas CEA had low sensitivity and could not readily be used for therapy monitoring. However, in a number of cases CA125 was a good substitute. Six to eight weeks after termination of radiotherapy the average tumor marker levels have been declined by comparison with the pretherapeutic values (100%): For the collum carcinoma CEA dropped to 39%, SCC to 57%; for the corpus carcinoma CEA to 72%, CA 125 to 81%. The highest diagnostic information was gained by comparison of post-therapeutical tumor-marker levels with cut off values obtained from healthy women of the same age group. After treatment in 29 of 106 collum carcinomas CEA and or SCC levels did still exceed these cut off values. In eleven cases this marker elevation was due to paraaortic lymph node metastases, in seven cases a local tumor residue was discovered and in six cases general metastases. In corpus carcinomas the main reason for post-therapeutic elevated CA125 values also were paraaortic lymph node metastases. Thus, the use of serial tumor marker determination for control of gynecological radiotherapy is a helpful tool in early detecting local tumor residues and metastases. The decision making for further radiotherapeutical measures will be much easier, if accompanying tumor marker determinations have been done during primary radiotherapy.     

Renal metastases from a squamous cell carcinoma of the larynx

Laryngeal squamous cell carcinoma (SCC) tends to exhibit local spread with a low incidence of distal metastases. The majority of distal metastases are to the lungs and renal involvement is extremely rare. We present a case of laryngeal SCC with metastatic spread to the left kidney presenting as a large, mainly cystic mass. The radiological differentiation of renal metastases from primary renal tumours is discussed.     

Contribution of dynamic contrast MR imaging to the differentiation between dural metastasis and meningioma

Purpose To determine the perfusion-sensitive characteristics of cerebral dural metastases and compare them with the data on meningiomas.Methods Twenty-two patients presenting with dural tumor underwent conventional and dynamic susceptibility-contrast MR imaging: breast carcinoma metastases, two patients; colorectal carcinoma metastasis, one patient; lung carcinoma metastasis, one patient; Merkel carcinoma metastasis, one patient; lymphoma, one patient; meningiomas, 16 patients. The imaging characteristics were analyzed using conventional MR imaging. The cerebral blood volume (CBV) maps were obtained for each patient and the relative CBV (rCBV) in different areas was calculated using the ratio between the CBV in the pathological area (CBVp) and in the contralateral white matter (CBVn).Results The differentiation between a meningioma and a dural metastasis can be difficult using conventional MR imaging. The rCBVs of lung carcinoma metastasis (1 case: 1.26), lymphoma (1 case: 1.29), breast carcinoma metastasis (2 cases: 1.50,1.56) and rectal carcinoma metastasis (1 case: 3.34) were significantly lower than that of meningiomas (16 cases: mean rCBV = 8.97±4.34, range 4–18). Merkel carcinoma metastasis (1 case: 7.56) showed an elevated rCBV, not different from that of meningiomas.Conclusion Dural metastases are sometimes indistinguishable from meningiomas using conventional MR imaging. rCBV mapping can provide additional information by demonstrating a low rCBV which may suggest the diagnosis of metastasis.     

睾丸肿瘤的CT诊断

目的:探讨睾丸肿瘤的CT表现及诊断价值。方法:回顾性分析12例睾丸肿瘤的CT资料,与手术病理对照。结果:CT图像上12例13个病变睾丸均不同程度增大,边界多数较清。其中9例精原细胞瘤呈实质性改变为主,可见不同程度低密度影,轻度强化,3例腹内型尚可见丰富供血血管,1例2个淋巴瘤,1例胚胎性癌伴内胚窦癌,1例胚胎性癌为表现为囊实性肿块混杂密度,呈环形强化或强化较明显。结论:CT对睾丸肿瘤的检出、分型诊断和分期等有一定价值,对腹内型睾丸肿瘤的鉴别诊断有重要意义。     

Proton beam therapy for malignancy in Bloom syndrome

Background and purpose

Bloom syndrome is a DNA repair disorder that is hypersensitive to radiotherapy. We describe the first case in which proton beam therapy (PBT) was used in a patient with Bloom syndrome to treat oropharyngeal cancer.

Patients and methods

The patient was a 32-year-old woman with Bloom syndrome who was diagnosed with oropharyngeal cancer staged as T2N2bM0 poorly differentiated squamous cell carcinoma. The primary tumor was located on the right tongue base and extended to the right lateral pharyngeal wall. Several right upper region lymph nodes were positive for metastases.

Results

We selected PBT in anticipation of dose reduction to normal tissue. The clinical target volume was defined as the area of the primary tumor and lymph node metastases plus an 8-mm margin. After treatment with 36 GyE (Gray equivalent) in 20 fractions (4–5 fractions per week), dietary intake was decreased by mucositis and intravenous hyperalimentation was started. Termination of treatment for 2.5 weeks was required to relieve mucositis. Administration of 59.4 GyE in 33 fractions markedly reduced the size of the primary tumor, but also caused moderate mucositis that required termination of PBT. One month later, lung metastases and breast cancer developed and the patient died 9 months after PBT. At this time the reduction in size of the primary tumor was maintained without severe late toxicity.

Conclusion

We obtained almost complete response for a radiosensitive patient with a deficiency of DNA repair, indicating the excellent dose concentration of proton beam therapy.     

直肠癌合并肝转移癌术前介入治疗的临床观察

目的:评价直肠癌合并肝脏转移癌术前介入治疗在肿瘤综合治疗中的价值。方法:采用Seldinger技术对16例直肠癌合并肝脏转移癌的患者进行术前肝脏及直肠局部介入化疗,其中6例对肝脏转移灶进行栓塞。术后3周进行手术治疗。结果:进行局部化疗后临床症状明显缓解,手术安全进行,有5例进行了根治性治疗,切除直肠及肝脏转移灶,14例原发灶完整切除。手术中出血减少,肿瘤易于剥离。结论:术前进行介入治疗不影响手术的安全性,可减少术中出血,提高手术切除率,减少术中扩散。在综合治疗中起相当重要的作用。     

Primary synovial sarcoma of the kidney: use of PET/CT in diagnosis and follow-up

Primary renal synovial sarcoma is a rarely seen renal neoplasm. An experienced uropathologist is needed to make the pathological diagnosis. A patient, operated on with a prediagnosis of renal cell carcinoma, the pathology of which was reported as synovial sarcoma, is presented in this article. 18F-fluoro-deoxyglucose positron emission tomography and computed tomography were performed preoperatively and in the postoperative follow-up to detect the primary tumor and lymph node metastases.     

直肠癌合并肝转移癌术前介入治疗的临床观察

目的　评价直肠癌合并肝脏转移癌术前介入治疗在肿瘤综合治疗中的价值。方法　采用Seldinger技术对 16例直肠癌合并肝脏转移癌的患者进行术前肝脏及直肠局部介入化疗 ,其中 6例对肝脏转移灶进行栓塞。术后 3周进行手术治疗。结果　进行局部化疗后临床症状明显缓解 ,手术安全进行 ,有 5例进行了根治性治疗 ,切除直肠及肝脏转移灶 ,14例原发灶完整切除。手术中出血减少 ,肿瘤易于剥离。结论　术前进行介入治疗不影响手术的安全性 ,可减少术中出血 ,提高手术切除率 ,减少术中扩散。在综合治疗中起相当重要的作用     

非小细胞肺癌FDG摄取与转移的关系

目的 观察治疗前非小细胞肺癌患者的原发灶18F-脱氧葡萄糖(FDG)摄取与淋巴结和(或)远处转移的关系.方法 回顾性分析山东省肿瘤医院2004年6月至2007年4月治疗前行FDGPET/CT检查的拟诊肺癌患者资料,共收集到病理或细胞学检查明确诊断(除外糖尿病者)的肺腺癌患者94例和鳞癌65例资料.先分析原发灶大小(以CT肺窗的最大径表示)与FDG摄取[以最大标准摄取值(SUVmax)表示]关系,然后分析腺癌、鳞癌不同转移状态组间[分为无转移组和有淋巴结和(或)远处转移组]原发灶FDG摄取值的差异,并进一步采用Logistic回归法分析影响转移的因素.结果 原发灶的大小与FDG摄取呈正相关(腺癌:r=0.610,P<0.01;鳞癌:r=0.587,P<0.01),整体分析表明非小细胞肺癌原发灶FDG摄取值是影响淋巴结和(或)远处转移的因素[优势比(0R)=1.172,P=0.010],而原发灶大小不是影响因素(OR=0.906,P=0.513);分层分析发现肺鳞癌不同转移状态组间的FDG摄取差异无统计学意义(有、无转移组SUVmax分别为11.45±6.04和10.94±4.20,χ2=0.013,P=0.911),而肺腺癌有转移组的FDG;摄取值显著高于无转移组(SUVmax分别为10.28±3.92和6.33±2.89,χ2=15.125,P<0.01),Logistic分析表明肺腺癌原发灶的FDG;摄取值是影响转移的有意义因素(OR=1.403,P=0.002).结论 肺腺癌原发灶FDG摄取与转移有关,高FDG摄取提示可能已经发生转移;而肺鳞癌FDG摄取与转移无关.     

A case of spontaneous regression of hepatocellular carcinoma with multiple lung metastases

Spontaneous regression of hepatocellular carcinoma (HCC) is a rare phenomenon. We present herein the case of a patient with hepatocellular carcinoma with multiple lung metastases in whom malignancy spontaneously regressed after takingPhellinus linteus Mycelium. A 79-year-old man consulted our hospital complaining of epigastric discomfort. Abdominal MRI and CT revealed a 3 cm diameter tumor in the liver, and chest CT showed numerous nodular lesions. The levels of alpha-fetoprotein (AFP) and protein induced by vitamin K deficiency or antagonist-II (PIVKA-II) were very high. We diagnosed HCC with multiple lung metastases, and no therapy was performed. Independently he took exact fromPhellinus linteus Mycelium for one month, and 6 months later the tumors appeared to be in complete regression. The mechanism underlying this intriguing phenomenon remains unknown.