胃癌和胃淋巴瘤的CT表现对比分析

背景与目的:进展期胃癌与胃淋巴瘤的CT表现在鉴别诊断上较困难,均可表现为胃壁增厚、腔内肿块、胃腔狭窄、淋巴结肿大、远处脏器转移等。本研究通过对比胃癌与胃淋巴瘤的CT表现差异,以提高对胃肿瘤,特别是胃淋巴瘤的CT诊断水平。方法:回顾性分析27例进展期胃癌和25例胃淋巴瘤患者的CT表现,观察病变部位、病变大体形态、胃周径侵犯范围、病灶的最大厚度、粘膜是否光整、粘膜皱襞是否增厚、浆膜受侵情况、有无坏死、病变强化程度、强化是否均匀、其他器官受累情况、腹部淋巴结情况。结果:23例(85.2%)胃癌近胃腔表面见"白线"征,门静脉期"白线"区范围较动脉期大;所有胃淋巴瘤患者均未见"白线"征。13例(48.1%)胃癌非"白线"区门静脉期强化程度高于动脉期。所有胃癌患者胃壁侵犯范围均<50%,23例(85.2%)胃淋巴瘤患者胃壁侵犯范围>75%。所有27例(100%)胃癌患者均见胃粘膜溃疡,1例(4%)胃淋巴瘤见胃粘膜溃疡。11例(44.0%)胃淋巴瘤有2个区或以上的胃周淋巴结肿大,8例(32.0%)胃淋巴瘤患者有肾门下腹膜后淋巴结肿大;所有胃癌患者均未见2个区或以上胃周肿大淋巴结,亦未见肾门下腹膜后淋巴结肿大。结论:胃癌与胃淋巴瘤的CT表现各有其特点,包括有无胃粘膜"白线"征、粘膜溃疡、胃壁侵犯范围、胃周肿大淋巴结分布、有无肾门下腹膜后肿大淋巴结等,这些特点对于二者的鉴别诊断具有一定的参考价值。     

MSCT及其后处理技术对胃癌的诊断价值

目的 探讨多层螺旋CT（MSCT）在胃癌术前临床分期中应用价值.方法 对43例经胃镜及术后证实的胃癌患者行术前MSCT扫描,所得图像进行MPR、CTVE、SSD及Raysum重建,观察胃癌病灶大小、位置、侵犯胃壁深度及侵犯胃周器官的范围、胃周淋巴结大小及远处转移;按国际统一的TNM分期法进行术前CT分期,其结果 与术后病理TNM分期对照.结果 MSCT对胃癌T分期的总准确率为83.7%（36/43）;对N分期的总准确率为72.1%（31/43）;对M分期的总准确率为93.0%（40/43）.结论 通过MSCT的多种后处理方式的相互结合,能全方位显示胃腔内、外病灶,能提高胃癌TNM分期的准确率,是胃癌术前分期的可靠方法,对外科制定合理的治疗方法 有较高的价值.     

MSCT双对比剂充盈对胃癌TNM分期的诊断价值

目的:探讨MSCT双对比剂充盈、三期增强结合三维重建在胃癌术前分期及评估中的应用价值.方法:对34例经胃镜活检证实的胃癌患者术前行MSCT平扫、三期动态增强扫描及三维重建扫描,再运用多平面重建、容积重建及CT仿真内窥镜等后处理技术,进行胃癌MSCT-TNM分期,并与手术病理分期结果相比较.结果:1)MSCT表现病灶厚度与手术病理的浆膜侵犯,淋巴结转移均相关(P<0.05);MSCT的强化特点与手术病理的淋巴结转移相关(P<0.05),与浆膜侵犯不相关.2)MSCT-TNM分期:MSCT对胃癌T、N、M分期的判断准确率分别为79.4%、75.6%和100%,其中对淋巴结转移的敏感性和特异性分别为73.9%和88.9%.MSCT对胃癌TNM临床分期判断的准确率为81.8%.结论:MSCT可在很大程度上提高微小病变的检出率,可对癌肿侵犯胃壁的深度、区域淋巴结转移情况、周围脏器浸润以及远处转移情况做出较为准确的判断,较准确的作出TNM分期.MSCT作为一种新型、无创、在体的评价手段,能较准确的对胃癌进行术前分期及评估,对指导临床治疗具有较大的临床应用价值.     

术前低张力水充盈胃薄层CT扫描30例进展期胃癌诊断的临床价值分析

[目的]探讨术前低张力水充盈胃薄层CT扫描在进展期胃癌中的临床价值。[方法]30例进展期胃癌术前行低张力水充盈胃薄层CT扫描,并与术后病理对照分析。[结果]30例CT扫描示胃壁厚度5～25mm,术后病理为8～28mm。CT检查15例淋巴结转移,术后病理18例淋巴结转移。术后证实6例周围脏器侵犯,CT准确率为85.7%。[结论]低张力水充盈胃薄层CT扫描可了解病变的侵犯范围及转移情况,对确定肿瘤分期、提供治疗方案起重要的作用。     

胃癌腹主动脉周围淋巴结清扫的解剖学基础和临床疗效评价

我国进展期胃癌占所有胃癌的绝大多数，对相当部分进展期胃癌以原发病灶切除伴随D2清扫的手术，难以达到根治。应根据胃癌进展范围和淋巴结转移状况选择合理范围的淋巴结清扫。对胃的淋巴流向和淋巴结转移规律的研究表明，胃腹腔内淋巴最后引流到腹主动脉周围淋巴结。腹主动脉周围淋巴结是胃癌腹腔内淋巴结转移的最终淋巴结群，也是淋巴转移进入胸导管的最后屏障。这个部位即使发生淋巴结转移，进行广泛的淋巴结清扫可使部分病例获得长期生存；若未发生转移，进行预防性清扫对提高进展期胃癌五年生存率也起到一定作用。     

29例弥漫浸润型胃癌的X线与超声表现

报告２９例经手术病理确诊的弥漫浸润型胃癌的Ｘ线与超声征象。典型Ｘ线表现为胃腔缩小、壁僵硬、粘膜破坏中断；超声特点为胃壁增厚、层次结构消失、与相邻组织间的境界回声消失及区域淋巴结肿大等。一对显示病变部位、病变范围、胃腔狭窄程度、胃壁僵硬度、粘膜破坏、蠕动功能异常等精确，定性诊断符合率高；超声对观察肿瘤的浸润深度、周围侵犯及淋巴转移等情况下很可靠，利于制定治疗方案，弥补了Ｘ线检查的不足。     

64排螺旋CT多期增强扫描对进展期胃癌术前评估的价值

目的探讨64排螺旋CT三期增强扫描对进展期胃癌术前评估中的价值。方法选择CT检查前已确诊为胃癌的患者80例,术前行64排螺旋CT三期增强扫描,然后进行病理分期TNM分期,分析螺旋CT与病理分期的效果,并且探讨增强CT对于手术判断的效果。结果CT影像学主要表现为胃壁异常增厚、肿瘤向周围直接侵犯、局部和远处淋巴结转移,CT与病理诊断对比在T分期与N分期上有显著性差异（P〈0．05）,而对M分期对比上无明显差异（P〉0．05）。CT预测治疗方式与临床相符合的敏感度为78．6％,特异性为86．5％,准确率为83．8％。结论多层螺旋CT（MSCT）可较准确地显示胃癌侵犯胃壁的深度、淋巴结转移和远处脏器的转移情况,在胃癌M分期判断上有较高的准确率,能为手术治疗方案选择提供参考。     

胃癌治疗中的胃和淋巴结切除范围

进展期胃癌患者中,约有1/2～2/3已有淋巴结转移。有淋巴结转移治愈率明显下降。胃癌切除致死亡者尸检中,在胃周围发现有淋巴结转移高达22％。因而,如何彻底清除已转移淋巴结防止残留复发,是提高胃癌治愈率的一个重要环节。而癌瘤侵犯胃壁的深度同样也是衡量本病预后的重要因素。如Mine认为有淋巴结转移和浆膜受累患者清扫至第     

29例弥漫浸润型胃癌的X线与超声表现

报告２９例经手术病理确诊的弥漫浸润型胃癌的Ｘ线与超声征象。典型Ｘ线表现为胃腔缩小、壁僵硬、粘膜破坏中断；超声特点为胃壁增厚、层次结构消失、与相邻组织间的境界回声消失及区域淋巴结肿大等。认为Ｘ线对显示病变部位、病变范围、胃腔狭窄程度、胃壁僵硬度、粘膜破坏、蠕动功能异常等精确，定性诊断符合率高；超声对观察肿瘤的浸润深度、周围侵犯及淋巴转移等情况很可靠，利于制定治疗方案，弥补了Ｘ线检查的不足。     

螺旋CT增强扫描对进展期胃癌胃周淋巴结转移的研究

目的探讨螺旋CT增强扫描在判定进展期胃癌胃周淋巴结性质上的应用价值.方法应用螺旋CT增强扫描方法对56例进展期胃癌的胃周淋巴结的直径、形态类型等影像特征进行观察,并与术后病理诊断对照,明确与进展期胃癌胃周淋巴结转移相关的生物学行为因素.结果支持以直径9mm作为螺旋CT增强扫描诊断胃周淋巴结转移的直径标准(P＜0.05).多种胃癌生物学行为CT影像特征与癌肿对应淋巴结转移率密切相关(P＜0.05).结论应用螺旋CT增强扫描检查对进展期胃癌的胃周淋巴结性质进行判断,手术方式的确定和综合治疗具有重要意义.     

胃癌MSCT表现与HER-2表达的关系

目的:探讨胃癌多排螺旋计算机断层扫描（MSCT）表现与HER-2(epidermal growth factor receptor 2)表达的关系。方法:回顾性分析117例哈尔滨医科大学附属肿瘤医院胃癌患者的MSCT扫描资料,分别测量或判断肿瘤的大小、厚度、部位、强化方式及程度、浸润深度、Borrmann分型以及是否有淋巴结转移,全部患者标本均通过免疫组织化学常规检测HER-2表达,用统计学方法分析MSCT影像学表现和HER-2表达之间的关系。结果:117例患者中有23例（19.7%）HER-2过表达,HER-2过表达与肿瘤大小、强化程度及淋巴结是否转移之间差异具有统计学意义（P＜0.05）。HER-2过表达与肿瘤的厚度、部位、强化方式、浸润深度、Borrmann分型之间差异无统计学意义（P＞0.05）。结论:胃癌MSCT中表现的肿瘤大小、强化程度及淋巴结是否转移在一定程度上能够反映HER-2的表达情况,具有潜在的临床应用价值。     

A case of gastric adenosquamous carcinoma with abdominal paraaortic lymph node metastases successfully treated by TS-1 plus CDDP neoadjuvant chemotherapy

A 62-year-old woman was admitted for anemia. An endoscopic examination revealed type 2 cancer from the upper body of the stomach to the antrum, and abdominal CT scan demonstrated enlarged abdominal paraaortic lymph nodes. The preoperative diagnosis was cStage IV gastric cancer (cT 3, cN 3, cH 0, cP 0, cM 0). Since a curative operation was deemed impossible, we conducted neoadjuvant chemotherapy using TS-1 plus cisplatin (CDDP) for downstaging. TS-1( 100 mg/day) was orally administered for 3 weeks,and CDDP (60 mg/m2) was given intravenously on day 8. Appetite loss of grade 3 and erythropenia of grade 1 were observed. After two courses of chemotherapy the primary lesion and the paraaortic lymph nodes were significantly reduced in size. She was judged as clinical PR, followed by distal gastrectomy and lymph node dissection, resulting in curability A. Histopathologically, the tumor was diagnosed as adenosquamous carcinoma of the stomach with lymph node metastasis at only No.3. This case suggests that neoadjuvant chemotherapy using TS-1 plus CDDP is effective for advanced gastric adenosquamous carcinoma with massive lymph node metastases.     

胃癌组织中NEDD9、CD44和Ki67的表达及与临床病理特征的关系

目的:探究胃癌组织中NEDD9、CD44和Ki67的表达及与胃癌临床病理特征的关系。方法:选取2017年05月-2019年05月于我院住院治疗的胃癌患者120例作为观察组,同时选取正常胃黏膜50例作为参照组,检测NEDD9、CD44和Ki67在早期胃癌、进展期胃癌与正常胃黏膜组织中阳性率的表达,分析3种指标与临床病理特征的关系。结果:早期胃癌患者与进展期胃癌患者的NEDD9阳性表达率均显著高于正常胃黏膜患者,且进展期胃癌患者高于早期胃癌。NEDD9高表达随浸润程度、分化程度的增加而增强,与年龄、性别、肿瘤大小、淋巴结转移无关。CD44与患者年龄、性别无关,但与TNM分期、肿瘤大小、浸润程度、分化程度、淋巴结转移有关。Ki67在进展期胃癌中的阳性表达率高于早期胃癌,与性别、TNM分期、肿瘤大小、浸润程度有关,与年龄、分化程度及有无淋巴结转移无关。NEDD9、CD44、Ki67在早期胃癌患者中已有较高表达率。结论:检测NEDD9、CD44、Ki67指标对早期胃癌的诊断、评估胃癌的恶性程度有重要意义,或为胃癌的诊断、治疗、预后提供帮助,为胃癌临床治疗提供新的潜在靶点。     

67例早期胃癌临床病理特征及预后分析

目的：研究早期胃癌患者的临床病理特征及预后因素.方法：回顾性分析我院67例早期胃癌根治术标本的肿瘤直径、浸润深度、肉眼分型、组织学分型、淋巴结数目、淋巴结转移等资料.并对患者进行随访及预后分析.结果：早期胃癌发病高峰为40-59岁,以男性多见.大体分型以凹陷型、浅表型为主,组织学分型以管状腺癌为主,12例伴胃周淋巴结转移,5年生存率为95%,粘膜内癌不伴有胃周淋巴结转移者5年生存率为100%.结论：提高早期胃癌的检出率,降低胃癌死亡率.     

A case of advanced gastric cancer with liver and intra-abdominal lymph node metastasis treated by hypertensive selective chemotherapy with pharmacokinetic modulating chemotherapy

There have been few effective chemotherapeutic regimens for advanced gastric cancer with liver and intra-abdominal lymph node metastasis. A 78-year-old male patient was admitted to our hospital because of anorexia and abdominal discomfort. Gastroendoscopy showed a type 4 advanced gastric cancer in the antrum of the stomach. Histological study of biopsy specimens from the tumor revealed poorly differentiated adenocarcinoma. Examination by computed tomography and ultrasonography showed swollen paraaortic lymph nodes and liver metastasis. He was diagnosed as having advanced gastric cancer with liver and lymph node metastasis. This patient was treated weekly with an intraarterial 5-FU (500 mg) and MTX (100 mg) including AT-II by subcutaneously implanted port system placed into the celiac artery. Furthermore, he was administered tegafur/uracil (400 mg/day) 5 days weekly as pharmacokinetic modulating chemotherapy (PMC). After ten courses of treatment with PMC, the liver and lymph node metastases were reduced in size. This therapy was considered to be an effective treatment for advanced gastric cancer with liver and lymph node metastasis. The theoretical purpose of hypertensive chemotherapy used together with injection of angiotensin-II is to increase the delivery of anticancer drug to the target tumor tissue by increasing the blood flow in the tumor. We conclude that this chemotherapy is effective in cases of advanced gastric cancer with liver and lymph node metastasis from the viewpoints of toxicities, antitumor effect and QOL of the patient.     

T淋巴瘤侵袭转移诱导因子1在胃癌组织中的表达及其临床意义

目的观察胃癌和正常胃粘膜组织中T淋巴瘤侵袭转移诱导因子1(Tlymphomainvasionandmetas tasisinducingfactor1,Tiam1)蛋白的表达情况并探讨其临床意义。方法应用链酶亲和素-生物素过氧化物酶复合物免疫组化法检测60例经福尔马林固定、石蜡包埋之胃癌及正常胃粘膜组织标本中Tiam1蛋白的表达情况并分析其与胃癌临床病理参数间的关系。结果Tiam1蛋白在正常胃粘膜组织中呈阴性染色(0/60,0.00%),但在胃癌组织中则呈阳性染色(47/60,78.33%),两者间统计学差异非常显著(P<0.01);且随胃癌组织分化程度的降低、浸润深度的增加、TNM分期的升高及伴有淋巴结转移的发生,Tiam1蛋白染色阳性率逐渐升高,统计学意义显著(P<0.05)。但Tiam1蛋白表达水平与胃癌患者的性别、年龄、癌变原发部位及癌肿大小无关,统计学意义不显著(P>0.05)。结论Tiam1蛋白的表达与胃癌浸润、转移密切相关并有可能作为反映其生物学行为的一种新型标志物。     

Colliding gastric and intestinal phenotype well-differentiated adenocarcinoma of the stomach developing in an area of MALT-type lymphoma

A 73-year-old man presented with an abnormal gastric shadow during a check-up of atomic bomb survivors. Radiological examination and endoscopy of the upper gastrointestinal tract revealed a protruding tumor, type 0-I+IIa, on the lesser curvature of the midstomach. An initial diagnosis of early gastric cancer was made and a segmental gastrectomy was planned. However, distal gastrectomy with D3 lymph node dissection was necessary, because intraoperative frozen section showed that the paraaortic lymph nodes (N3) were positive for cancer. The tumor in the resected specimen was, microscopically, a well-differentiated tubular adenocarcinoma (tub1) with pT2 (MP), pN3, ly2, and v1, in final (f) stage IV. The tumor cells of the type 0-I segment appeared as gastric phenotype and those of the type 0-IIa segment as intestinal phenotype. The border between the two was distinct. The tumor had focally invaded the muscularis propria where only the gastric phenotype was shown and the histological type became less differentiated. Thus, special attention should be paid to possible unexpected deep-wall invasion and lymph node metastasis in well-differentiated adenocarcinomas of the gastric phenotype. Further, in this patient, diffusely proliferating low-grade lymphoma was also observed incidentally in the gastric mucosa within and around the carcinoma. This was diagnosed as mucosa-associated lymphoid tissue (MALT)-type lymphoma with aberrant expression of BCL10. Finally, this case was considered to be a colliding gastric and intestinal phenotype well-differentiated adenocarcinoma of the stomach developed in an area involved by MALT-type lymphoma. Because no Helicobacter pylori was detected throughout the mucosae and the patient had no history of its infection, the three tumors may have developed under the same conditions as those seen in Helicobacter pylori infection, but without this infection.     

An oral anticancer drug, TS-1, enabled a patient with advanced gastric cancer with Virchow's metastasis to receive curative resection

We encountered a patient with advanced gastric cancer, with Virchow's lymph node metastasis, who subsequently underwent curative resection after neoadjuvant chemotherapy with the newly developed oral anticancer drug, TS-1. The patient was a 67-year-old woman who had a type 2 tumor in the middle third of the stomach, and Virchow's lymph node metastasis, which was diagnosed by fine-needle aspiration cytology; she also had swollen paraaortic lymph nodes. Curative resection was considered impossible, and TS-1 (100 mg/day) was administered for 28 days in one course, mainly in the outpatient clinic. Although grade 2 stomatitis interrupted the therapy on day 21 of the second course and on day 7 of the third course, the type 2 tumor showed marked remission (partial response; PR) and the metastasis in the Virchow's and paraaortic lymph nodes had completely disappeared after the third course (complete response; CR). Eleven weeks after the completion of the TS-1 treatment, total gastric resection with D3 lymph node dissection was performed. Histopathological examination revealed tumor involvement only in the mucosal and submucosal layers of the stomach and the no. 4d lymph node. Most of the tumor was replaced with fibrosis with granulomatous change in the muscularis propria of the stomach and in the no. 3, no. 6, and no. 7 lymph nodes. This may be the first report of a patient with advanced gastric cancer with Virchow's lymph node metastasis who successfully received curative resection following neoadjuvant chemotherapy with a single oral anticancer drug. Received: August 7, 2001 / Accepted: January 28, 2002     

Two cases of stage IV gastric cancer undergoing adjuvant surgery after down staging by chemotherapy

CASE 1: A 72-year-old man with epigastralgia was diagnosed with gastric cancer and referred to our hospital. An abdominal CT scan revealed liver metastasis and para-aortic lymph node metastasis. He was treated with S-1+CDDP. After 4 courses of this treatment, the liver metastasis and para-aortic lymph node metastasis disappeared, and adjuvant surgery was performed. There has been no recurrence for 16 months postoperatively. CASE 2: A 66-year-old man with anorexia was diagnosed with gastric cancer and referred to our hospital. An abdominal CT scan revealed para-aortic lymph node metastasis. He was treated with S-1+CDDP. After 9 courses of this treatment, para-aortic lymph node metastasis disappeared, and adjuvant surgery was performed. Eight months after the operation, lymph node metastases were confirmed by abdominal CT scan, and he was treated with chemotherapy as an outpatient as of 13 months after the operation. We experienced two cases of Stage IV gastric cancer undergoing adjuvant surgery after down staging by chemotherapy. It was suggested that adjuvant surgery to highly advanced gastric cancer could improve the prognosis of patients.