小肠原发性肿瘤33例临床分析

目的 :探讨小肠肿瘤临床特点和早期诊断手段。方法 :回顾性分析 33例原发性小肠肿瘤患者的临床资料。结果 :小肠良性肿瘤 5例均为平滑肌瘤 ;恶性肿瘤 2 8例 ,其中平滑肌肉瘤 13例 (4 6 4 % ) ,淋巴肉瘤 11例 (39 2 % ) ,腺癌 3例 (10 7% ) ,类癌 1例 (3 5 % )。临床上无特异性症状及可靠的诊断方法 ,内窥镜和全消化道钡餐造影是主要诊断手段。 5 3 6 %的恶性病例在手术时已有远处转移 ,仅 13例(4 6 4 % )行根治性切除。根治切除术后 5年生存率为 4 6 1%。结论 :早期诊断、早期治疗是提高小肠恶性肿瘤患者生存率的关键 ,对无远处转移者应争取行根治术。     

原发性腹膜后神经源性肿瘤的治疗评价

目的探讨腹膜后原发性神经源性肿瘤的治疗.方法腹膜后原发性神经源性肿瘤较少见,本文共报道27例此类患者的治疗过程,并随访25例疗效.结果手术死亡率3.7%,良性肿瘤二年生存率89.4%,恶性肿瘤随访6例中,有5例于术后一年内死亡;共4例肿瘤复发,为神经纤维瘤、恶性神经鞘瘤和交感神经母细胞瘤.结论原发性神经源性肿瘤良性较恶性预后好,恶性肿瘤较易复发.     

Adenocarcinoma of the small intestine including the duodenum

Adenocarcinoma, malignant lymphoma and leiomyosarcoma are the main malignant tumors found most frequently in the small intestine and adenocarcinoma should be differentiated from these lesions as well as benign tumors. Ten cases with primary adenocarcinoma of the duodenum and 14 of the small intestine (the jejunum and ileum) were diagnosed and treated surgically in our clinic during recent 22 years. Analysing the clinical signs, symptoms and roentgenological features of these patients, the diagnosis, treatment and prognosis for these lesions were discussed and reviewed. To enhance the 5-year survival rate for these patients, the early diagnosis in the curative stage should be established.     

卵巢生殖细胞肿瘤181例临床分析

目的研究卵巢生殖细胞肿瘤的临床特点、合理的治疗方案及预后。方法回顾性分析1988年1月至2005年7月间收治的卵巢生殖细胞肿瘤181例的临床特点、治疗方式和预后之间的关系。结果良性卵巢生殖细胞肿瘤110例,手术后均治愈无复发,恶性卵巢生殖细胞肿瘤71例,其中2000年7月前病例数为41例,5年生存率为70%,2000年7月之后病例数为30例,死亡2例,余均健在。结论良性卵巢生殖细胞肿瘤应以保留具生育功能的肿瘤切除或附件切除为主,恶性卵巢生殖细胞肿瘤对化疗敏感,手术不宜过大,可行保留生育功能的手术切除 术后化疗,预后较好。     

Diagnosis and treatment of gastric stromal tumors: report of 70 cases

Objective To investigate the diagnosis and treatment of gastric stromal tumors (GSTs). Methods The clinical data from 70 cases with GSTs were analyzed retrospectively. Results Wedge resections were performed on 32 patients and major gastrectomies on 38 patients. The median tumor size was 5.4cm in diameter and 2 out of 70 cases (2.9% ) indicated positive lymph node metastasis. Immunohistochemical staining showed 66 out of 70 (94.3%) were positive for CD117, 53 (75.7%) positive for CD34, 24 positive for SMA and 8 positive for Desmin and S100. Ten out of 70 cases recurred or metastasized. The 5-year survival rate in this series was 71.3%. The 5-year survival rate of benign and malignant GSTs were 92.3% and 61.8% (P<0.05) respectively. The 5-year survival rate for tumors of size <5 cm and ≥5 cm were 95.0% and 48.4% (P< 0.05), respectively. Conclusion The primary treatment for gastric stromal tumors is surgery. Tumor size and mitotic counts were observed to be important prognostic indicators.     

咽旁间隙肿瘤(附61例临床分析)

１９７０－１９８９年间，我院收治了６１例咽旁间隙肿瘤，大部份为良性。ＣＴ扫描对诊断和指导治疗有重要意义。良性肿瘤以手术治为主，本组手术切除４８例，其中良性肿瘤３９例，恶性肿瘤９例，均采取颈外侧进路，５例恶性肿瘤加术后放疗。良性肿瘤术后很少复发，恶性肿瘤的３、５年生存率分别为５３．３％和３６．４％。     

原发性小肠恶性间质瘤B超和CT诊断的影像表现分析

目的探讨原发性小肠恶性间质瘤患者行B超和CT诊断的影像表现及价值。方法选取2017年1月至2020年1月间陕西省咸阳市核工业215医院收治的102例原发小肠间质瘤患者,患者均行B超和CT检查,获得详细的影像资料,以手术病理结果为标准,良性45例,恶性57例,评价两种方法检出率及良恶性鉴别价值。结果CT诊断对<2.0 cm和2.0~3.0 cm原发小肠间质瘤检出率分别为95.2%和100.0%及总检出率98.0%,均高于B超诊断的相应检出率73.8%、85.7%和83.3%,差异均有统计学意义(均P<0.05)。B超诊断原发小肠恶性间质瘤敏感性88.0%、特异性82.0%、鉴别准确率81.2%和诊断准确率67.6%均低于CT诊断95.6%、94.5%、95.0%和93.1%,差异均有统计学意义(均P<0.05)。B超诊断32例呈现强回声的中低水平回声,外形不规则,5例内部回声不均、肿瘤内坏死液化。CT诊断100例观察到大小不等的、圆形、类圆形、分叶状或不规则软组织肿块影,增强扫描41例呈现肿块不均匀强化,囊性区域和低密度坏死范围大。结论在原发性小肠恶性间质瘤诊断中行B超和CT诊断均具有检出价值,其中CT影像表现更加详细,且对良恶性鉴别准确率高,实现对原发小肠恶性间质瘤准确检出,为治疗提供可靠依据,值得推广应用。     

Diagnosis and Treatment of Gastric Stromal Tumors： Report of 70 Cases

Objective  To investigate the diagnosis and treatment of gastric stromal tumors (GSTs). Methods  The clinical data from 70 cases with GSTs were analyzed retrospectively. Results  Wedge resections were performed on 32 patients and major gastrectomies on 38 patients. The median tumor size was 5.4cm in diameter and 2 out of 70 cases (2.9% ) indicated positive lymph node metastasis. Immunohistochemical staining showed 66 out of 70 (94.3%) were positive for CD117, 53 (75.7%) positive for CD34, 24 positive for SMA and 8 positive for Desmin and S100. Ten out of 70 cases recurred or metastasized. The 5-year survival rate in this series was 71.3%. The 5-year survival rate of benign and malignant GSTs were 92.3% and 61.8% (P<0.05) respectively. The 5-year survival rate for tumors of size <5 cm and ≥5 cm were 95.0% and 48.4% (P< 0.05), respectively. Conclusion  The primary treatment for gastric stromal tumors is surgery. Tumor size and mitotic counts were observed to be important prognostic indicators.     

儿童原发性睾丸肿瘤47例诊治分析

目的:探讨小儿原发性睾丸肿瘤的诊断及治疗经验.方法:回顾性分析2000年1月至2010年12月间手术治疗的47例原发性睾丸肿瘤患儿临床资料,包括患儿B超检查、血清AFP、病理类型、治疗、肿瘤分期和生存情况.结果:小儿睾丸恶性肿瘤血清AFP明显高于良性肿瘤(P＜0.05).小儿睾丸恶性肿瘤B超检查特征多表现为实质性占位,睾丸良性肿瘤多表现为囊实混合性占位,睾丸良恶性肿瘤间肿块性质差异有统计学意义(P＜0.05).31例卵黄囊瘤中,Ⅱ、Ⅲ期2年生存率为75％,5年生存率接近50％.结论:小儿睾丸肿瘤以卵黄囊瘤多见,血清AFP、超声检查在术前小儿睾丸肿瘤良恶性的鉴别、预后评估及术后随访中具有重要的参考价值.     

原发性腹膜后脂肪肉瘤20例报告

自１９６５年５月至１９９１年７月共收治原发性腹膜后脂肪肉瘤２０例，均经手术及病理证实。２０例中完全切除者１５例，部分切除者４例，活检１例。肿瘤切除合并肾，肠襻等邻近器官切除者达１２例。全组的５年，１０年生存率分别是５７．１％和２０．０％，完全切除组的５年１０年生存率分别是６３．６％和２８．６％。２０例病人共进行了４８次切除手术。首次手术死亡２例。着重讨论了本病的诊断、治疗和突出的临床特点。     

The clinical features and prognosis of phyllodes tumors: a single institution experience in Taiwan

Background and objectives

The aim of this study was to document the clinical and pathological features of a single institutional series of Asian patients with phyllodes tumors, and to determine the prognosis, the adequate management and the predictive histological features.

Methods

The clinical data were retrospectively studied from the medical records and the pathological data from the Department of Pathology were utilized to identify 33 patients diagnosed with phyllodes tumors between 2003 and 2010.

Results

Eight patients had benign tumors, 13 borderline and 12 malignant. Nine patients (27 %) had recurrence. No patients classified as benign phyllodes tumors had recurrence, but those with malignant phyllodes tumors had a high recurrence rate (41 %). The 5-year disease-free survival was 59 %. The 5-year overall survival was 81 %. The width of surgical margin was not related to disease recurrence and stromal overgrowth was the only prognostic factor in terms of disease-free survival and overall survival.

Conclusions

The phyllodes tumors of borderline and malignant classification in Asian patients had a high recurrence rate. Clinical and pathological factors, except for stromal overgrowth, cannot predict disease recurrence. Further molecular research is warranted.     

Radiotherapy as an alternative to surgery in elderly patients with resectable lung cancer

From 1978 to 1983, 50 patients with a peripherally located non-small cell tumor of the lung were irradiated with curative intent. These patients were not operated upon because of poor cardiac or pulmonary condition, old age or refusal to operate. Mean age was 74 years, 40 patients being over 70 years of age. All patients had T1-2 N0M0 tumors according to the AJC classification and received 60 Gy to the primary tumor only. The overall response rate was 90%, with 50% complete responses in tumors smaller than 4 cm. The crude overall survival rates were 56% at 2 years and 16% at 5 years, with a median survival of 27 months. Age did not influence survival. There was a strong correlation of survival to tumor size, with 5-year survival rates of 38, 22, 5 and 0% in tumors with diameters of less than or equal to 2, 2-3, 3-4 and greater than 4 cm respectively. Only 5 out of 20 complete responders had a local recurrence, the 5-year survival in this group was 42%. These results compared favorably to a group of 86 patients over 70 years of age who were selected for operation in the same hospital. The 2- and 5-year survival rates in these patients were 48 and 26% respectively, median survival being 23 months. We conclude that in patients over 70 years of age with resectable lung cancer, radiotherapy with curative intent should be offered as an alternative to operation, especially if the tumor is not larger than 4 cm.(ABSTRACT TRUNCATED AT 250 WORDS)     

Smooth muscle tumors of the alimentary tract--a review of 397 cases

397 cases of smooth muscle tumor of the alimentary tract were analysed. 385 were collected from the domestic literature in the recent 10 years and 12 are added by the authors. The tumor occurred more frequently in patients 40-60 years old. Diameter of the tumor ranged from 0.5-35 cm. The diameter of leiomyosarcoma was larger than that of leiomyoma on an average. The ratio of benign to malignant incidence was 3.2:1. Exclusive of 204 (51.4%) cases which occurred in the esophagus, the ratio was 1.1:1 in the other 193. In the 12 cases reported by the authors, it was 1:3. In the 193 cases of the GI tract, the lesion occurred in the stomach in 50.8%, in the small intestine in 29.0%, in the colon 1.0% and in the rectum 19.2%. The three most common clinical symptoms of those in the stomach and small intestine were abdominal mass (54.3%), bleeding (49.1%) and abdominal pain (45.7%). These 12 cases reported comprised 0.019% of 62, 088 patients admitted into our hospital, 0.09% of 12,678 tumor inpatients during the same period and 0.61% of 1,983 of malignant tumors in the alimentary tract. The preoperative diagnostic accuracy of this tumor was low, only 7.7% of all the GI neoplasms. On basis of the present data, improving the preoperative diagnostic accuracy is stressed.     

肺部罕见肿瘤疾病谱变化及预后

目的 通过对原发性肺部罕见恶性肿瘤疾病谱及各病理亚型患者的预后进行分析，为该类患者的治疗提供参考。方法 回顾性分析SEER数据库2004—2015年经病理确诊的原发性肺部罕见恶性肿瘤患者临床资料、各亚型构成及发病趋势，Kaplan-Meier法计算1、3、5年生存率及绘制生存曲线。结果 共纳入13 428例患者，包括大细胞癌、腺鳞癌、肉瘤样癌、唾液腺型恶性肿瘤、淋巴上皮瘤样癌、间质性肿瘤和异位来源性肿瘤，在同期所有肺部恶性肿瘤中的构成比分别为1.72%、1.13%、0.36%、0.09%、0.01%、0.19%和0.01%。大细胞癌的新发病比例逐年下降，腺鳞癌的比例缓慢上升。所有肺部罕见恶性肿瘤患者的5年总体生存率为16.86%，中位生存时间为8月。结论 肺腺鳞癌成为发病顺位第一的原发性肺部罕见恶性肿瘤，原发性肺部罕见恶性肿瘤由于驱动基因突变率低、突变基因中较易出现少见突变类型等原因导致总体预后差。     

原发性小肠肿瘤20例临床分析

作者报告原发性小肠肿瘤２０例，其中男性１２例，女性８例，年龄４５岁￣７９岁，平均６２．１岁。２０例中良性５例，恶性１５例。肿瘤分布在十二指肠、空肠各６例，回肠８例。恶性肿瘤以腺癌最多，其次为平滑肌肉瘤和淋巴系统恶性肿瘤。腹痛、上消化道出血和肠梗阻是本组小肠肿瘤的主要症状，不同程度的贫血和腹块是常见体征。本组临床诊断与手术及病理对照，误诊率为５５．０％。除１例未手术外，余１９例均作了手术治疗。作者就     

A clinicopathologic and immunohistochemical study of gastrointestinal stromal tumors.

The clinicopathologic and immunohistochemical features in 120 cases of gastrointestinal stromal tumor (GIST) were reviewed. Excluding 24 cases of gastric schwannoma, 96 cases of GIST consisting of 62 benign tumors and 34 sarcoma (low grade, 17; high grade, 17), with 9 cases arising in the esophagus, 57 in the stomach, 28 in the small intestine, and 2 in the colon, were studied. All esophagus and colon tumors were benign and resembled a conventional leiomyoma histologically. However, the gastric and small intestine benign tumors mostly showed histologic features of cellular or epithelioid leiomyoma. Immunohistochemically, desmin caused a positive reaction in all esophagus and colon tumors, but only 26% of gastric and small intestine tumors. However, muscle-specific actin (HHF35) caused a positive reaction in most GIST (92%). The 10-year survival rates of the patients with gastric sarcoma and those with intestinal sarcoma were 74% and 17%, respectively. These results showed that histologic and immunohistochemical features were distinctly different, depending on the location in the gastrointestinal tract; that most GIST, excluding schwannoma, had smooth muscle differentiation; and that sarcomas had a more favorable prognosis when they occurred in the stomach rather than the intestine.     

A Systematic Review on Overall Survival and Disease-Free Survival Following Total Pelvic Exenteration

Backgrounds: Total Pelvic Exenteration (TPE) is a radical operation for malignancies in which all of the organs inside the pelvic cavity, including the female reproductive organs, the lower urinary tract, and a part of the rectosigmoid are removed. In this study, we aimed to conduct a systematic review to assess the overall survival (OS) and disease-free survival (DFS) following TPE. Methods: This systematic review is composed of a comprehensive review of PubMed and Scopus databases with various related keywords to synthesis the overall survival and disease-free survival following TPE. The Synthesis Without Meta-analysis guideline was used to summarize the results. Results: We included the results of 39 primary studies and the results revealed that one-year OS of gynecological cancer in patients who have undergone TPE ranged from 50.0% to 72.0% and the 5-years OS ranged from 6.0% to 64.6%. The one-year survival rate of colorectal cancer patients was reported to be over 80% in almost all studies. The 3-year survival rate of patients varied from 25% to 75% and the lowest 5-year survival rate was 8% and the highest survival rate was 92%. To synthesis the disease-free survival rate in colorectal cancer, ten studies were included and one-year recurrence rate was 9.1% and the one-year DFS was reported as 61.0%. Three-year recurrence rate study was 20.4% and 3 and 5-year DFS ranged from 22.0% to 78.0%. Conclusions: The results suggested that DFS in primary advanced cancers is higher than locally recurrence tumors. This review showed that patient overall survival and disease-free survival rates have increased over time, especially at high volume centers that are more experienced and possibly better equipped. Therefore, it can be suggested that the attitude towards PE as a palliative surgery can be turned into curative surgery.     

Neoplastic meningitis in patients with adenocarcinoma of the gastrointestinal tract

BACKGROUND: Neoplastic meningitis (NM) occurs in 5-10% of patients with malignant disease. Little is known about the outcomes of patients with gastrointestinal (GI) malignancies who develop NM. For this report, the authors characterized the clinical course and attempted to identify prognostic factors in patients with NM due to primary malignancies of the GI tract. METHODS: In this retrospective study, 21 patients with GI primary tumors and NM were identified: Their medical records and imaging studies were reviewed. RESULTS: The patient population was composed of patients with gastric adenocarcinoma (n = 8 patients), esophageal adenocarcinoma (n = 7 patients), colon and/or rectal adenocarcinoma (n = 5 patients), and pancreatic adenocarcinoma (n = 1 patient). The median overall survival after the initial diagnosis of adenocarcinoma was 55 weeks (range, 8-884 wks), and the median survival after the diagnosis of NM was 7 weeks (range, 0-64 wks). Four patients died during palliative radiotherapy. No factors identified had an impact on outcome, including symptoms, physical findings at diagnosis, imaging characteristics, or cerebrospinal fluid findings. Univariate analysis showed a trend toward better outcomes for patients who received any kind of treatment directed toward the NM. CONCLUSIONS: Patients with NM from GI tract adenocarcinomas universally had poor outcomes. Until NM can be diagnosed earlier and/or until more effective therapies are identified, comfort care alone may be a reasonable alternative for some of these unfortunate patients.