原发睾丸恶性淋巴瘤：（附13例报告）

自1977～1988年我院共收治13例原发睾丸恶性淋巴瘤,占同期睾丸恶性肿瘤的11.5％。本病少见,大部分发生在50岁以上。本文50岁以上者10例,约占80％。此病预后差,本文11侧2年内死亡,占85％。5年生存率仅为15％。本文5例术后辅以放、化疗,8例术后单纯化疗,两者生存期无明显差异,故我们认为手术 化疗为本病的首选治疗方案。     

恶性葡萄胎、绒癌化疗的护理

近年应用抗癌化疗药物治疗恶性葡萄胎、绒癌效果显著 ,但是化疗药物缺乏选择性 ,不仅对肿瘤细胞具有杀伤作用 ,同样对体内增殖旺盛的骨髓细胞、消化道粘膜细胞、生殖细胞、毛囊细胞、皮肤上皮细胞等具有一定的损伤作用。加上恶性葡萄胎和绒癌近年来多采用大剂量冲击治疗 ,两种或两种以上联合用药 ,多种途径用药 ,使用剂量要达到接近中毒剂量方才有效 ,致使副作用不可避免。因此对恶性葡萄胎和绒癌病人化疗的护理非常重要。1　临床资料我院 1990至 2 0 0 0年共收治恶性葡萄胎病人 2 33例 ,绒癌病人 2 0 3例。均为生育年龄妇女 ,最大年龄 4 6…     

表皮生长因子受体及nm23-H1在滋养细胞肿瘤中表达的相关性及临床意义

葡萄胎、侵蚀性葡萄胎和绒毛膜癌是发生在育龄期妇女中较常见的滋养细胞肿瘤。我们采用免疫组化方法 ,检测表皮生长因子受体 (ｅｐｉｄｅｒｍａｌｇｒｏｗｔｈｆａｃｔｏｒｒｅｃｅｐｔｏｒ,ＥＧＦＲ)及ｎｍ2 3 Ｈ1基因在正常早孕绒毛和滋养细胞肿瘤组织中的蛋白表达量 ,以探讨其与滋养细胞肿瘤的关系 ,特别是对葡萄胎恶性变的预测价值进行了分析。一、材料与方法1 标本来源 :恶性滋养细胞肿瘤 18例 (侵蚀性葡萄胎10例、绒毛膜癌 8例 )为北京协和医院 1986年 8月～ 1999年3月急症手术切除的子宫标本。葡萄胎为同期收治的部分患者 ,共 2 0例 …     

50岁以上滋养细胞肿瘤19例分析

50岁以上妇女滋养细胞肿瘤的发病率较低,但易误诊,恶变率高,恶性病例疗效较差。本文就我院近20年来收治的19例50岁以上滋养细胞肿瘤作一分析。     

卵巢癌与恶性葡萄胎的微循环和指纹观察

本文对卵巢癌和恶性葡萄胎患者的血液流变、微循环和指纹进行了观察。 材料和方法 观察对象为73例住院病人,恶性葡萄胎40例,卵巢癌33例。年龄18～55岁,平均31岁。卵巢癌行切除术,恶性葡萄胎施刮宫术,二者术后均进行化疗。73例病人进行指纹分析。51例治疗前作血液流变学观察,其中22例治疗后进行复查。28例治疗前后微循环对比观察。     

江西省绘制葡萄胎发病分布图

滋养细胞肿瘤(包括葡萄胎)是东南亚地区及我国妇女的一种发病较高的疾病。据1979年全国23个省、市、自治区的200多万妇女调查,江西省是我国葡萄胎发病较高的省。1981年12月江西省妇女保健院绒癌研究室等单位,在江西省卫生厅及各有关卫生部门的支持下,依靠本省的妇幼保健组织,以自然人群的户口为依据,回顾调查了该省81个县9个市18岁～60岁的妇女245,688人。按各县调查1,000～2,000人左右,市区调查5,000人以上统计,普查率近95％以上,发现葡萄胎1,055人,     

原发性鼻腔、鼻窦恶性黑色素瘤(附15例报告)

讨论 恶性黑色素瘤多发生于头颈部皮肤。Moore报告1546例中头颈部占27.6％,耳鼻咽喉部位占1.7～2.7％。1869年Luck首次报告了鼻腔恶性黑色素瘤及手术治疗。Grace报告48例中18例有鼻息肉摘除史,本组15例中则有7例。Lerner等认为脑垂体中叶内有一种黑色素生成激素。因此,儿童由于内分泌系统发育不健全而很少发生本病,相反,妇女在怀孕期则易患此病。本组8例女性病人6例在40岁以上,     

E-cadherin及nm23-H1在滋养细胞疾病中的表达及意义

目的:探讨E-cadherin及nm23-H1基因在妊娠滋养细胞疾病发生发展中的作用.方法:采用免疫组化法检测24例葡萄胎(随访2年以上未发生恶变)、15例侵蚀性葡萄胎、15例绒毛膜上皮癌、18例正常绒毛组织的石蜡包埋标本E-cadherin和nm23-H1基因的表达状况.结果:E-cadherin的表达在正常早孕绒毛高于侵蚀性葡萄胎和绒毛膜癌(P＜0.01),葡萄胎高于侵蚀性葡萄胎和绒毛膜癌(P＜0.05).nm23-H1的表达正常早孕绒毛明显高于恶性滋养细胞疾病(P＜0.01),葡萄胎高于侵蚀性葡萄胎(P＜0.01)和绒毛膜癌(P＜0.05).在葡萄胎和恶性滋养细胞疾病中E-cadherin和nm23-H1基因的表达均为正相关.结论:滋养细胞疾病E-cadherin和nm23-H1表达与其侵袭性相关,二者可能成为葡萄胎预后的标志物.在侵袭转移过程中细胞滋养细胞较合体滋养细胞更为重要.     

更年期女性警惕子宫内膜癌

子宫内膜癌又称子宫体癌,80%发生于50岁以上的妇女.近20年来,本病的发生率有上升的趋势,究其原因,与人类寿命延长、营养过剩及滥用雌激素等有关.与妇科其它癌瘤相比,子宫内膜癌恶性程度较低,因长在子宫腔内,向其它脏器转移较慢,若能早期发现,治疗的效果也相对较好.那么子宫内膜癌究竟有哪些特征呢?     

葡萄胎子宫次全切除后十四年患宫颈绒毛膜癌一例报告

 绒毛膜癌是一种高度恶性的妇科肿瘤,绝大多数继发于足月产,流产或葡萄胎之后。通过血运形成全身转移,常见于肺、阴道、外阴、脑等,单独宫颈转移者比较少见,但患葡萄胎十四年后年已六十四岁的老年妇女患病者临床上实不多见。     

Salivary gland tumors of the tongue. Analysis of 55 new cases and review of the literature

Fifty-five cases of primary salivary gland tumors of the tongue from the files of the Armed Forces Institute of Pathology are reported and analyzed and the results compared with the information in the literature. Five tumors were benign and 50 were malignant. The average age at presentation was 47 years for the benign tumors and 54.3 years for the malignant ones. Although the overall benign/malignant ratio was 1:10, women were more likely to have a malignant tumor than were men. The site of 80% of the benign tumors was the middle to anterior portion of the tongue, whereas over 85% of malignant tumors involved the base. Clinical signs and/or symptoms related to the site aroused suspicion in some cases but often were of short duration and in over 60% of cases did not occur. The most common benign tumor type was the myoepithelial variant of the benign mixed tumor. The most common malignant tumor type was the low-grade mucoepidermoid carcinoma (38%) followed by adenocarcinoma (20%), high-grade mucoepidermoid carcinoma (14%), adenoid cystic carcinoma (10%), and clear cell carcinoma (8%), with occasional basaloid, papillary cystadenocarcinoma, acinic cell and mucus-producing adenocarcinoma. Treatment was similar to that of other accessory salivary gland neoplasms of similar histologic type and clinical stage. Prognosis worsened with high histologic grade, old age, and advanced clinical disease at presentation.     

Clinicopathologic Patterns of Adult Renal Tumors in Pakistan

Background: Renal cancer is a serious public health problem which may be under reported and registeredin our setup, since the Karachi cancer registry documented only 43 cases out of 4,268 incident cancer cases over3 year duration. Therefore we aimed to determine the clinicopathologic characteristics of adult renal tumors inour setup. Materials and Methods: The study was conducted in histopathology department, Liaquat NationalHospital and included total of 68 cases of adult renal tumors over 4 years. Detailed histopathologic characteristicsof tumors were analyzed. Results: Mean age of patients was 56.4 (18-84) years. Renal cell carcinoma (RCC) wasthe most common cell type (78%) cases; followed by transitional/urothelial carcinoma (12.5%), leiomyosarcoma(4.7%), oncocytoma (1.6%), squamous cell carcinoma (1.6%) and high grade pleomorphic undifferentiatedsarcoma (1.6%). Among 50 RCC cases; 62% were conventional/clear cell RCC (CCRCC) type followed bypapillary RCC(PRCC), 24%; chromophobe RCC(CRCC), 6% and sarcomatoid RCC(SRCC), 8%. Mean tumorsize for RCC was 7.2 cm. Most RCCs were intermediate to high grade (60% and 40% respectively). Capsularinvasion, renal sinus invasion, adrenal gland involvement and renal vein invasion was seen in 40%, 18%, 2% and10% of cases respectively. Conclusions: We found that RCC presents at an earlier age in our setup compared toWestern populations. Tumor size was significantly larger and most of the tumors were of intermediate to highgrade. This reflects late presentation of patients after disease progression which necessitates effective measuresto be taken in primary care setup to diagnose this disease at an early stage.     

Assessment of surgical treatment in elderly patients with breast cancer

AIMS AND BACKGROUND: The incidence of breast cancer increases with advancing age and in clinical practice approximately 50% of new cases occur in women over the age of 65 years. Although breast cancer in elderly patients presents more favorable biological characteristics than similar-stage cancer in younger women, disease control still remains uncertain and is becoming a major health problem. PATIENTS AND METHODS: Between 1984 and 2006, 133 patients aged over 65 with operable breast cancer underwent surgical treatment. Patients with ductal or lobular carcinoma in situ, bilateral breast cancer or a previous malignancy were excluded. The mean age was 72.8 years (range, 66-89). Breast-conserving surgery was performed in patients with early breast cancer (T1, T2 < 2.5 cm), while most patients with advanced tumors (T2 >2.5 cm, T3, T4) were treated by modified radical mastectomy. RESULTS: The pathological stage was I in 44, IIA in 54, IIB in 18, IIIA in 10 and IIIB in 7 patients. Postoperative complications occurred in 13 patients (9%); there were no postoperative deaths. Eighty-nine patients underwent adjuvant therapy (chemotherapy, hormonal therapy). After a median follow-up of 96 months (range, 5-266), disease progression was observed in 21 patients (15.8%). The overall mortality from breast cancer was 11%, whereas the cancer-unrelated mortality was 9%. CONCLUSION: There is no evidence that breast cancer has a more favorable prognosis in the elderly and surgical procedures should be carried out as has been established in younger women. At present, elderly patients are much less likely to be entered into randomized clinical trials and are often undertreated. However, in the absence of serious comorbid disease, they are able to withstand standard multimodal treatment options as well as do younger patients.     

Do women ?50 years of age need as much screening as women <50 years after they have had negative screening results?

To assess the adequacy of a routine screening to identify cervical intraepithelial neoplasia 2 or worse (CIN2+) in women over 50 years of age, a retrospective cohort was set in six Italian organised population-based screening programmes. In all, 287 330 women (1 714 550 person-years of observation, 1110 cases) screened at age 25-64, with at least two cytological screening tests, the first negative, were followed from their first negative smear until a biopsy proven CIN2+ lesion or their last negative smear. For women aged 25-49 and 50-64 years, crude and age-standardised detection rate (DR), cumulative risk (CR), adjusted hazard risk for number of previous negative screens, probability of false-positive CIN2+ after two or more smear tests were calculated. Detection rate is significantly lower over 50 years of age. Multivariable analysis shows a significant protective effect from four screening episodes (DR=0.70, 95% CI: 0.51-0.97); the effect of age >or=50 is 0.29 (95% CI: 0.24-0.35). The CR of CIN2+ is at least eightfold higher in women <50 (CR=2.06, 95% CI: 1.88-2.23) after one previous negative test than in women >or=50 years with four screens (CR=0.23, 95% CI: 0.00-0.46). Over 50 years of age, after four tests at least three false-positive cases are diagnosed for every true positive. Benefits arising from cytological screening is uncertain in well-screened older women.     

Preoperative 18F-FDG-PET/CT imaging and sentinel node biopsy in the detection of regional lymph node metastases in malignant melanoma

The objective of this study was to evaluate the role of preoperative 18F-fluorodeoxyglucose-positron emission tomography/computed tomography scanning, preoperative lymphoscintigraphy (LS), and sentinel lymph node biopsy in patients with malignant melanoma. Fifty-two patients (36 men: 16 women; mean age 55.0+/-13.0 years; median age 61 years; range 17-76 years) with malignant melanoma were selected. According to the latest version of the American Joint Committee on Cancer staging system, the disease in the study patients was initially classified as either stage I or II. The other primary tumor characteristics were mean Breslow depth=2.87 mm and median=2 mm; range 1-12.0 mm and Clarks levels III-V. None of the study patients had clinical or radiological evidence of regional lymph node metastatic disease. At least one sentinel node was identified in all patients. Preoperative LS detected a total of 111 sentinel lymph nodes (average 2.13 sentinel lymph node per patient) and demonstrated a single nodal draining basin in 38 (73%) patients and multiple (2-3 draining basins) in the remaining 14 (27%) patients. Fourteen out of the 52 patients (27%) had at least one involved sentinel node. Positron emission tomography was true positive in two patients with a sentinel node greater than 1 cm and false positive in two other patients. In this study, the detection of sentinel lymph node by LS and gamma probe had a sensitivity of 100%. In contrast, 18F-FDG-PET imaging demonstrated very low sensitivity (14.3%; 95% CI, 2.5 to 44%) and positive predictive value (50%; 95% CI, 9 to 90%) for localizing the subclinical nodal metastases. The specificity, net present value, and diagnostic accuracy were 94.7, 75, and 73%, respectively. Preoperative fluorodeoxyglucose-positron emission tomography/computed tomography imaging is not able to substitute LS/sentinel lymph node biopsy in patients at stage I or II.     

CD44V6、基质金属蛋白酶-9、p57^kip2罐及人类绒毛膜促性腺激素在葡萄胎中的表达及意义

目的分析CD44V6、基质金属蛋白酶（MMP）-9、p57＾kip2及人类绒毛膜促性腺激素（hCG）的表达在葡萄胎诊断、鉴别诊断及生物学行为预测中的价值。方法采用免疫组织化学SP法检测55例葡萄胎组织、20例流产伴绒毛水肿、10例正常胎盘绒毛中CD44v6 MMP-9、p57^kip2的表达;采用化学发光法测定患者hCG水平。分析CD44v6、MMP-9、p57^kip2及hCG对鉴别诊断完全性、部分性葡萄胎及绒毛水肿的价值及对判断葡萄胎恶变的意义。结果55例葡萄胎中恶变9例,未恶变46例;葡萄胎恶变组与未恶变组CK44v6、MMP-9、p57^kip2的表达（77．8％比30．4％,77．8％比34．8％,11．1％比58．7％）差异有统计学意义（均P〈0．05）;完全性与部分性葡萄胎组中p57^kip2的表达（5．0％比100．0％）差异有统计学意义（P〈O．05）,而CD44v6、MMP-9的表达差异无统计学意义（P〉0．05）;葡萄胎组、流产伴绒毛水肿组、正常胎盘绒毛组组问比较,CD44v6、MMP-9、p57kip2的表达差异均无统计学意义（P〉0．05）;在葡萄胎恶变组血hCG4例持续阳性、5例降而复升;对部分性葡萄胎p57啦诊断的敏感度为100．0％,特异度95．0％,阴性预测值100．0％。单项检测CD44v6。对诊断葡萄胎恶变的敏感度为77．8％,特异度69．6％,阴性预测值94．1％;MMP-9的敏感度为77．8％,特异度为65．2％,阴性预测值为93．8％;而CD44v6和MMP-9两项联合检测敏感度达88．9％,阴性预测值96．3％,CD44v6、MMP-9和hCG三者结合,可使诊断敏感性、阴性预测值明显提高。结论 p57^kip2啦结合组织学对鉴别完全性与部分性葡萄胎有价值;CD44v6和MMP-9在葡萄胎恶变过程中起重要作用,联合检测DD44v6、p57^kip2、MMP-9及hCG有助于判断葡萄胎的生物学行为和预后。     

Malignancy and concomitant primary hyperparathyroidism

Hypercalcemia is associated with a few primary malignant neoplasms and with a variety of tumors that have spread by metastases. Hyperparathyroidism is a diagnosis that is usually not considered in these patients. At our institution, 18 patients with malignant tumors presented over a 6-year period with hypercalcemia caused by hyperparathyroidism. There were five men and 13 women with a mean age of 48 years (range 24-87 years). Primary tumors in these patients included colon carcinoma (four cases), breast carcinoma (four cases), lymphoma (four cases), thyroid carcinoma (four cases), Paget's disease (one case), and lung carcinoma (one case). Metastases of the primary tumor occurred in seven patients, and in 11 patients the tumor was not metastatic or recurrent. Serum levels of calcium, phosphate, and chloride averaged 11.8 mg/dl, and 100 mEq/liter, respectively. C-terminal parathyroid hormone (PTH) levels ranged from 300 to 1,900 pg/ml with an average of 1,150 pg/ml (normal 50-340 pg/ml). At operation, a single parathyroid adenoma was discovered in 15 patients, and four-gland hyperplasia was noted in three patients. In all cases, serum levels of calcium returned to normal after operation. We conclude that patients with malignant tumors and concomitant hypercalcemia should be evaluated for the possibility of hyperparathyroidism. In cases of primary hyperparathyroidism, elevated C-terminal PTH level should be diagnostic. If hyperparathyroidism is determined to be the cause of hypercalcemia, neck exploration and parathyroidectomy are indicated.     

Predictive value of BI-RADS classification for breast imaging in women under age 50

In this study, we assessed the positive-predictive value (PPV) of mammography and/or ultrasonography in women age 50 based on recommendations for biopsies and final pathology results. We performed a retrospective analysis of all mammography and ultrasonography reports issued from 9/2005 to 1/2007 resulting in biopsy among women aged 18–50 at a large county hospital. Data included demographics, imaging modality, breast density, type of finding, BI-RADS, and final pathology. Results were compared to women aged >50 at the same institution. Four hundred and seventy-five biopsies in 395 patients were reviewed. The PPV of BI-RADS 3 (n = 11) was 9.1%, BI-RADS 4 (n = 440) 5.9%, and BI-RADS 5 (n = 24) 66.7%. Forty three (9%) were malignant, of which 31 (6.5%) were invasive carcinomas and 12 (2.5%) were noninvasive. None of the biopsies on patients aged <30 were malignant. Recommended biopsies based on mammography alone were malignant in 20.2% (20/99) compared to 3.4% (7/205) for ultrasonography alone, and 8.9% (15/168) for both mammography and ultrasonography. Suspicious calcifications were malignant in 25% compared to 6.8% for masses/nodules and 3.6% for cysts. Lesions larger than 2 cm are more likely to be malignant (11.8%) than lesions between 1 and 2 cm (3.6%) or below 1 cm (4.3%). The PPV of the current screening modalities diminishes markedly in women under the age of 50 and even more below the age of 40. Calcifications and masses larger than 2 cm should be biopsied, but the current BI-RADS criteria may benefit from revision for other findings in young patients.     

Breast cancer incidence and mortality in the breast cancer detection demonstration project [published errtum appears in J Natl Cancer Inst 1989 Oct 4;81(19):1513

The Breast Cancer Detection Demonstration Project (BCDDP) was a program of five annual screening examinations for breast cancer that was conducted at 29 centers in the United States. This report presents data on breast cancer incidence and mortality among the participants. A total of 283,222 women were enrolled. Our analysis is based on 55,053 white women who were 35-74 years of age at entry and who were selected for follow-up. For the first 9 years after entry, the cumulative incidence of breast cancer was estimated as 243.6 per 10,000, which is 1.34 times the expected incidence derived by use of data from the Surveillance, Epidemiology, and End Results (SEER) program. In contrast, 9-year cumulative mortality from breast cancer was only 79.6% of that expected in women with the age distribution of BCDDP participants who did not have diagnosed breast cancer at the start of observation. The ratio of observed to expected breast cancer mortality was 0.89 for women 35-49 years of age at entry, 0.76 for women 50-59 years of age at entry, and 0.74 for women 60-74 years of age at entry. Breast cancer incidence and mortality were lower for women who entered the BCDDP for routine screening than they were for women who entered for a reason such as concern about breast disease, family history of breast cancer, or a physician's recommendation. Among cases diagnosed within 5 years of entry, the 5-year case fatality attributed to breast cancer was 8.5%. Case fatality for all stages combined was greater than 50% lower for cases that were screen-detected than it was for cases that were not screen-detected. Case fatality was lower for cases diagnosed within the first 5 years of entry (which encompassed the period of screening) than it was for cases diagnosed in the sixth or seventh years.     

Older age predicts a decline in adjuvant chemotherapy recommendations for patients with breast carcinoma: evidence from a tertiary care cohort of chemotherapy-eligible patients

BACKGROUND: The appropriate use of adjuvant chemotherapy for elderly women with breast carcinoma remains controversial. Efficacy data in women age >/= 70 years are scarce, resulting in a lack of clear guidelines for patients in this age group. Although several studies have demonstrated decreasing use of chemotherapy with age, none specifically examined its use in an elderly cohort of patients who were deemed eligible for such therapy based on consensus guidelines, simultaneously examining the impact of comorbidity and previous history of malignant disease on these recommendations. METHODS: The authors examined adjuvant chemotherapy use among chemotherapy-eligible patients age > or = 50 years who were evaluated in a tertiary care cancer center. Associations between patient age and 1) physician recommendation for adjuvant chemotherapy, 2) recommended treatment regimen, and 3) patient acceptance of the treatment plan recommended were examined, adjusting for the impact of aggressive tumor characteristics, medical comorbidity, previous history of malignant disease, and features of the treatment setting. RESULTS: Of the 208 chemotherapy-eligible patients who were studied, 74% overall were recommended chemotherapy. Chemotherapy was recommended to 92% of women age 50-59 years compared with 77% of women age 60-69 years and 23% of women age > or = 70 years. Increasing age was associated strongly with a decreasing likelihood of receiving a recommendation in favor of chemotherapy. After adjusting for estrogen receptor status, previous history of malignant disease, comorbidity score, and prognostic group, the odds of receiving a recommendation in favor of chemotherapy fell by 22% per year or 91% per 10-year interval, and the rate of decline did not change significantly at age > or = 70 years. We found no age-related differences in either the drug regimens recommended or patient acceptance rates for adjuvant therapy. CONCLUSIONS: Age was associated strongly and independently with physician recommendation for adjuvant chemotherapy among a group of older women who were eligible specifically for such therapy. Medical comorbidity and a history of previous malignant disease did not alter this correlation significantly, although the latter was a significant predictor of chemotherapy use. Further studies clearly are needed to determine the underlying reasons for this strong age effect and to explore strategies that will optimize the utilization of this potentially curative therapy in the elderly.