以指骨转移为首发症状肺癌23例临床分析

目的探讨原发性肺癌单纯以指骨转移为首发症状的临床特点及其发病机理。方法综合分析各专业文献报道的、单纯以指骨转移为首发症状的原发性肺癌患者的资料。结果文献报道的单纯以指骨转移为首发症状的23例原发性肺癌患者中,转移病灶位于左手指骨者10例,右手指骨者12例,双手指骨者1例。3例患者转移病灶位于近节指骨,其余患者转移病灶位于末节指骨;有7例患者的患病手指既往曾有外伤史。结论传统的机械-解剖学说和种子—土壤学说的观点,均不能解释原发性肺癌发生指骨转移的机理。临床中如遇久治不愈的手指软组织炎症时,应考虑是否肺部肿瘤细胞转移的可能性。     

以单纯指骨转移为首发症状的肺癌2例并文献复习

目的探讨原发性肺癌以单纯指骨转移为首发症状的临床特点以及肺癌发生指骨转移的机理。方法对1991年至2007年间，见诸于有关文献报道的以单纯指骨转移为首发症状的原发性肺癌病人的文献资料进行综合性分析。结果在文献报道的以单纯指骨转移为首发症状的17例原发性肺癌的病人中，其转移病灶位于左手指骨者7例，右手指骨者9例，双手指骨者1例，指骨转移病灶的数量在两手之间的分布大致相等，除3例病人其转移病灶位于近节指骨外，其余病人的转移病灶均位于其末节指骨；有6例病人的患病手指既往曾有外伤史。结论传统的机械一解剖学说和种子一土壤学说的观点均不能解释原发性肺癌发生指骨转移的机理，故临床上如遇久治不愈的手指软组织炎症时，应想到是否有肿瘤细胞转移至此的可能性。     

以指骨转移为首发症状的原发性肺癌的临床特点

原发性肺癌骨转移是肺癌晚期常见的临床症状之一,发生率约为50.0%～70.0%,而单纯以手指末端骨转移为首发症状的原发性肺癌极为少见。我们就我院收治的2例以指骨转移为首发症状的原发性肺癌患者的临床资料,以及文献报道的14例以指骨转移为首发症状的原发性肺癌患者的文献资料进行了分析,以探讨这类患者的临床特点。     

以肺外转移症状为首发的原发性肺癌28例

以肺外转移症状为首发的原发性肺癌２８例江苏省启东市肝癌研究所施亚芳原发性肺癌的临床表现为多种多样，除常见的呼吸道症状和体征外，往往出现肿瘤转移所引起的一系列肺外转移症状和体征。本所收治９２例原发性肺癌中，２８例是以肺外转移症状为首发的肺癌，现报道如下...     

以神经症状为首发的23例肺癌误诊分析

肺癌典型的症状为咳嗽、咳痰、咯血、胸痛 ,而以神经症状为首发症状的往往在临床被误诊。我科 1996年 1月—1999年 1月收治 2 3例以脑转移灶引发的神经症状为首发症状 ,而无肺部症状就诊于神经科的患者 ,经进一步确诊为原发性肺癌脑转移而转入我科治疗 ,现将误诊原因分析如下。1　临床资料1.1　一般资料　全组 2 3例患者 ,男 16例 ,女 17例 ,年龄最大 6 9岁 ,最小 4 2岁 ,平均年龄 5 6 .7岁。首发症状以肢体活动障碍为主者 10例 ,以头痛、头晕 ,伴恶心呕吐为主者 5例 ,以头晕、头痛为主者 1例 ,以肢体运动障碍伴头痛、头晕、恶心、呕吐者 5…     

14例以脑转移症状为首发表现的肺癌诊治分析

１４例以脑转移症状为首发表现的肺癌诊治分析山东省德州市肿瘤医院（德州市２５３００４）赵路军，吴振瀛，雷少波，宋惠珍肺癌通常以肺部症状为首发表现，以脑转移症状为首发者较为少见。我院自１９８９年４月至１９９４年２月共收治肺癌病人９１０例，以脑转移症状为首...     

肺癌右小指末节指骨转移误诊为指头炎一例

骨转移肿瘤多见于脊柱骨盆等部位,四肢较为少见,转移至指骨者罕见,常因为不被认识而误诊,现报告肺癌小指末节指骨转移误诊为指头炎1例. 临床资料 患者男性,73 岁,2010 年1 月因胸背部疼痛就诊于我院胸外科,发现左肺肿块,诊断为原发性肺癌,曾行系统化疗( 方案不详),未做手术治疗及病理检查.治疗后胸痛症状略缓解.     

以头颅骨转移为首发表现的原发性肝癌治疗浅析

原发性肝癌转移以肝内播散转移为常见，肝外转移可至肺、肾上腺及全身其它部位。骨转移在肝癌病人中并不少见，其常见于体轴骨骼发下肢骨，而首发症状颅骨转移的文献报道极少。我们遇1例以头颅肿块为首发表现的的原发性肝癌，治疗效果较佳，现报道如下：     

以肺外表现为首发症状的肺癌30例临床分析

目的:探讨以肺外表现为首发症状肺癌的临床特点.方法:分析30例以肺外表现为首发症状肺癌的临床特点及组织学类型、大体分型等关系.结果:以转移症状为首发者,腺癌、小细胞未分化癌多于鳞癌,周围型肺癌多于中央型肺癌.结论:加强对肺外表现为首发症状肺癌的识别,提高早期诊断率,减少误诊率.     

以肺外症状为首发的原发性肺癌83例临床分析

随着肿瘤诊治水平的提高,原发性肺癌患者的五年生存率有所提高,但因部分原发性肺癌患者不以肺癌的典型症状,如咳嗽、咳痰、胸痛、咯血等症为首发,而以其肺外症状如肿瘤的转移灶症状为首发,多被忽略或错误导向,而未进行常规胸部X线检查,从而延误诊断,延误治疗。现将我院近二年来诊治的1000例原发性肺癌患者中,以肺外症状为首发的83例患者报导如下,并从病理分类,发生率以及延误治疗的原因进行讨论。     

胰腺癌伴肝、左眼眶转移1例

眼眶转移癌发生比例较小,及早发现原发病灶非常关键。原发性胰腺癌眼眶转移更为罕见,机理尚不清楚。本文报告1例原发胰腺癌伴肝、左眼眼眶转移病例,为临床诊断提供了一定参考。患者经过颅骨和上腹部断层扫描、左眼眶占位摘除活检术,再结合术后病理及实验室检查结果拟诊。行单药健择化疗3周期,患者病症有所减轻。     

Early diagnosis of metastatic brain tumor

For the early diagnosis of metastatic brain tumor, careful and long-term follow-up is important when the primary tumor has already been found. Metastatic brain tumor should be suspected whenever neurological symptoms develop in such a patient. In the cases of lung cancer or lung metastases, CT scan of brain should be taken even if the patients have no neurological symptoms, because lung cancer frequently metastasizes to the brain and other cancers metastasize to the brain via the lung. When the primary sites are unknown, primary brain tumors should be distinguished. Relatively rapid progression of symptoms including mental disturbance, multiple lesions on CT scan, lesions on chest X ray film, careful cerebral angiogram and MRI are helpful for the differential diagnosis.     

宫颈癌肺转移患者手术治疗效果及预后因素分析

目的:通过对宫颈癌治疗后肺转移患者临床资料进行分析,评价外科手术治疗宫颈癌肺转移的疗效,研究影响患者生存的预后因素.方法:回顾性分析44例宫颈癌治疗后肺转移患者临床资料(手术组23例,对照组21例),采用Kaplan-Meier法进行生存分析,Log-rank检验进行单因素分析,COX风险回归模型进行多因素分析.结果:手术组1、2年生存率分别为78.2%、34.7%.手术组患者的生存曲线高于非手术组患者的生存曲线,差异有统计学意义(P<0.05),单因素分析显示,肿瘤分化程度、肺转移瘤数目、肺转移性肿瘤最大直径与患者生存率有关(P<0.05);COX比例风险回归模型分析显示,肺转移瘤数目及肺转移肿瘤最大直径是宫颈癌肺转移患者预后的独立影响因素(P<0.05).结论:对于肺转移灶数目较少,直径较小的患者,可从肺转移灶切除中获益,积极行肺转移瘤外科治疗有助于改善宫颈癌肺转移患者的长期预后.     

Expression of variant CD44, exon 6 in patients with metastatic pulmonary tumor

High expression ratios of CD44 variant 6 (CD44 V6) in patients with metastatic pulmonary tumor were found in those with primary lesions of cancer of the colon, uterus, larynx, liver and osteosarcoma. It was clarified that patients showing expression of CD44 variant 6 likely revealed pulmonary metastasis at earlier time following operations of primary cancer (p<0.05). CD44 V6, an adhesion molecule, was a factor to participate in pulmonary metastases from various organ cancers. No significant correlation was observed in survival between patients with CD44 V6 positive versus negative tumors, except laryngeal tumor after resection of primary or metastatic lung tumor. CD44 V6 related to its invasive and further metastatic functions in metastatic lung tumor. We suggest that cancer cells expressing the CD44 molecule especially V6 may adhere to vascular endothelium and hyaluronic acid in the lung. And cancer cells without this molecule liberated from the primary focuses hardly adhere to the pulmonary tissues supposedly resulting in delayed metastases and proliferations in the pulmonary tissues.     

Molecular pathogenesis of bone metastases in breast cancer: Proven and emerging therapeutic targets

Metastatic occurrence is the principal cause of death in breast cancer patients. The high osteotropism makes breast cancer the most common primary tumor type associated with metastatic bone disease. The peculiar clinical aspects associated with metastases limited to the skeletal system suggest considering these cases as a distinctive subset of metastatic patients with a better prognosis. Because bone is frequently the first metastatic site in disease relapse, it is feasible that the next improvement in therapeutic options for bone metastatic disease could be associated with an improvement of survival expectation and quality of life in breast cancer patients. Study of the molecular basis of bone remodeling and breast cancer osteotropism has allowed identification of several therapeutic candidates involved in formation and progression of bone metastases. These targets are frequently the determinants of positive feedback between the tumor and bone cells whose clinical outcome is osteolytic lesions. In this review, we discuss the physiopathologic features underlying targeted therapeutic strategies aimed at interfering with the aberrant bone remodeling associated with breast cancer metastases.     

6例原发肺腺癌乳腺转移的临床特征分析

目的：探讨原发肺腺癌乳腺转移的临床特点。方法回顾性分析6例经病理证实的原发肺腺癌乳腺转移患者的临床资料。结果6例均为女性,5例患者的乳腺转移病灶表现为无痛性、生长迅速的乳腺单发结节,1例表现为弥漫性乳房红肿。乳腺转移可以是原发肺腺癌的首发症状,也可在病程中出现。6例患者乳腺转移灶的病理均为腺癌,免疫组化结果显示：5例患者的雌激素受体为阴性,1例为弱阳性;孕激素受体均为阴性;5例患者甲状腺转化因子1表达强阳性,1例阳性。结论有原发肺腺癌病史和快速增长的乳腺结节患者需考虑乳腺转移。免疫组化是鉴别原发或继发乳腺恶性肿瘤的关键。     

Prognostic factors for soft tissue sarcoma patients with lung metastases only who are receiving first‐line chemotherapy: An exploratory,retrospective analysis of the European Organization for Research and Treatment of Cancer‐Soft Tissue and Bone Sarcoma Group (EORTC‐STBSG)

The prognosis of adult soft tissue sarcoma (STS) patients with metastases is generally poor. As little is known about the impact of the involvement of different metastatic sites and the extent of pulmonary lesions on the outcome for patients receiving first‐line chemotherapy, we aimed to establish prognostic factors for STS patients with lung metastases only. A retrospective, exploratory analysis was performed on 2,913 metastatic STS patients who received first‐line chemotherapy. Detailed information from 580 patients who had lung metastases only, was used for prognostic factor analysis. Patients with lung metastases only were more often asymptomatic and had undergone complete primary tumor resection more frequently compared to patients with additional metastases outside the lung or without lung metastases. For extremity STS, the incidence of lung metastases only was much higher compared to non‐extremity STS. Lung involvement only was an independent favorable prognostic factor for overall survival (OS) with regard to metastatic site. Within this subgroup, in a multivariate model, other factors associated with improved OS included: good performance status (PS), no progression at primary site, low histological grade, younger age, long interval between initial diagnosis and trial registration, and smaller diameter of the largest lung lesion. This unique analysis on prognostic factors in STS patients with lung metastases confirms well‐known patient factors (such as age and PS), and tumor characteristics (including tumor grade, interval between primary diagnosis, and metastases), but also identifies diameter of the largest lung lesion as a new prognostic factor. Knowledge about these factors may support decision‐making within multidisciplinary tumor boards.     

55例肺癌骨转移患者的回顾性分析

目的 探讨晚期肺癌骨转移的临床特征及诊断、治疗方法.方法 回顾性分析55例晚期肺癌骨转移患者的临床资料.结果55例晚期肺癌骨转移患者中,腺癌占70.91%,主要转移部位依次是椎体、肋骨、骨盆、肩胛骨、股骨和颅骨.多发骨转移占76.36%(42/55),孤立性骨转移占23.64%(13/55).诊断方法包括发射单光子计算机断层扫描(ECT)、磁共振成像(MRI)、电子计算机断层扫描(CT)及正电子发射计算机断层扫描(PET-CT)等.治疗主要以唑来膦酸联合止痛药物为主,有19例患者伴随疼痛,其中,15例患者经治疗后缓解.结论晚期肺癌骨转移中腺癌的发生率最高,转移部位以椎体为主.唑来膦酸联合止痛药物可以缓解患者的骨痛,改善患者的生活质量.晚期肺癌患者应常规进行全身骨扫描检查.