舌下腺皮脂腺腺癌一例

患者女,69岁,因发现左侧舌下肿物1月余于2018年8月20日入院。患者主诉1个月前无意中发现左侧舌下有一约大拇指大肿物,质软,无疼痛,无破溃,左侧颌下少许疼痛,无畏寒发热,无咽干咽痛。当时未予重视,现因肿物逐渐增大遂至东阳市人民医院就诊。专科查体:左舌下可见一约3.0 cm×3.0 cm大小肿物,质软,界欠清,活动度可,压痛阴性。口咽部MRI显示下颌骨内侧舌下腺走行区见斑片状、结节状异常信号影,边界尚清,较大者约2.3 cm×1.7 cm,T1WI呈低信号,T2WI呈稍高信号,增强后较明显强化,所见骨质未见明显破坏;诊断下颌骨内侧舌下腺走行区占位,考虑肿瘤,性质待定。患者于2018年8月26日在全身麻醉下行口底肿瘤局部扩大切除术+舌下腺摘除术+口腔颌面部软组织缺损局部黏膜瓣修复术:自左舌皱壁外侧做与牙龈缘平行的弧形切口,切开黏膜层,避开下颌下腺导管,顺舌下腺外侧潜行分离,远中钝分离舌神经及舌深动静脉,自后向前将舌下腺完整游离后摘除,舌下肉阜近导管开口处的溃疡瘢痕样组织予以切除。     

MSCT对肾脏嗜酸细胞腺瘤和透明细胞癌的鉴别诊断价值

目的:探讨多层螺旋CT(Multi-slice spiral computed tomography,MSCT)四期扫描对肾脏嗜酸细胞腺瘤(Renal oncocytoma,RO)和透明细胞癌(Clear-cell renal cell carcinomas,ccRCC)的鉴别诊断价值。方法:搜集因肾脏占位行肾脏CT平扫和三期增强扫描患者79例共80枚瘤灶,经术后病理证实RO 29例,ccRCC 50例,并回顾性分析两组病例的影像表现,采用SPSS 19.0软件对肿瘤CT值、校正CT值、皮质期与实质期CT差值及增强廓清率进行独立样本t检验分析。采用Fisher确切概率法对肿瘤部位、形态、平扫特点、强化程度、强化方式、皮质期与实质期强化CT值差异、节段增强反转等征象进行统计分析。结果:RO和ccRCC皮质期CT值、皮质期校正CT值、皮质期与实质期CT差值和增强廓清率差异有统计学意义(P<0.05),平扫、实质期、排泄期CT值校正CT值差异均无统计学意义(P>0.05)。中央星状低密度影、强化程度、强化均匀度、轮辐状强化、皮质期与实质期强化CT值差异及节段增强反转等征象差异有统计学意义(P<0.05),部位、形态、钙化,病灶周边絮状和条索状影等征象差异无统计学意义(P>0.05)。结论:在MSCT多期扫描表现中,皮质期CT值、皮质期校正CT值、皮质期与实质期CT差值和增强廓清率、中央星状低密度影、强化程度、强化均匀度、轮辐状强化、皮质期与实质期强化CT值差异及节段增强反转等征象对于RO、ccRCC二者的鉴别具有重要价值。     

Molecular analysis of the TP53 gene in Barrett's adenocarcinoma

The TP53 gene is the most frequently mutated gene in human cancers. Barrett's esophagus provides an excellent model by which to understand the genetic events that lead from dysplasia to cancer. We screened for mutations in the TP53 gene by a combination of denaturing gradient gel electrophoresis and DNA sequencing in ten cases of adenocarcinoma arising in Barrett's mucosa. We have identified missense mutations in five of the ten samples, three transitions (R282W, G245S, R248W) and two transversions (E286Q and C176F). In one case we have analyzed biopsy specimens taken from the same site, one year before the patient developed an intra mucosal carcinoma. The mutation that was identified in this high grade dysplastic area was identical to that detected in the cancer. This would suggest TP53 mutations occur as an early genetic event in the development of Barrett's adenocarcinoma. © 1996 Wiley-Liss, Inc.     

Barrett食管和食管腺癌的基因表达谱研究

目的:研究Barrett食管(BE)和食管腺癌的基因表达谱,筛查与食管腺癌相关的基因.方法:使用Dchip软件对已经在GEO数据库中公开的BE和食管腺癌Affymetrix芯片表达谱数据进行分析.还原扫描图像进行独立核验,并对基因和组织进行双向聚类,最后用配对t检验筛查出在BE和食管腺癌中表达水平都发生变化的基因,并进一步分析其功能.结果:24张Affymetrix芯片的杂交质量稳定,被污染和发生交叉杂交的探针簇都少于5%.对基因和样本的双向聚类表明,大部分组织分类正确.只有N8和A5位于错误的组织类型中.对其余22张芯片再次分别进行配对t检验,得到24个基因.其中表达水平呈进行性上升的5个,呈进行性下降的19个.新检出的PITX1已在稍前不久的另一项研究中得到证实.结论:用新的分析方法研究已公开的表达谱芯片资料为研究肿瘤的发病机制提供了新的手段.     

手术入路对食管胃结合部腺癌生存预后的影响

目的:评价经胸入路与经腹入路手术治疗SiewertⅡ/Ⅲ型食管胃结合部腺癌的临床疗效.方法:回顾分析2004年1月至2014年11月手术治疗的168例SiewertⅡ/Ⅲ型胃食管结合部腺癌患者的临床资料,对其人群特征、手术并发症、总生存率及生存预后的影响因素进行分析.结果:两组临床资料具有可比性,经胸入路组较经腹入路组...     

Development and validation of a CT-based radiomics nomogram for preoperative prediction of tumor histologic grade in gastric adenocarcinoma

Objectives:To develop and validate a radiomics nomogram for preoperative prediction of tumor histologic grade in gastric adenocarcinoma(GA).Methods:This retrospective study enrolled 592 patients with clinicopathologically confirmed GA(low-grade:n=154;high-grade:n=438)from January 2008 to March 2018 who were divided into training(n=450)and validation(n=142)sets according to the time of computed tomography(CT)examination.Radiomic features were extracted from the portal venous phase CT images.The Mann-Whitney U test and the least absolute shrinkage and selection operator(LASSO)regression model were used for feature selection,data dimension reduction and radiomics signature construction.Multivariable logistic regression analysis was applied to develop the prediction model.The radiomics signature and independent clinicopathologic risk factors were incorporated and presented as a radiomics nomogram.The performance of the nomogram was assessed with respect to its calibration and discrimination.Results:A radiomics signature containing 12 selected features was significantly associated with the histologic grade of GA(P<0.001 for both training and validation sets).A nomogram including the radiomics signature and tumor location as predictors was developed.The model showed both good calibration and good discrimination,in which C-index in the training set,0.752[95%confidence interval(95%CI):0.701-0.803];C-index in the validation set,0.793(95%CI:0.711-0.874).Conclusions:This study developed a radiomics nomogram that incorporates tumor location and radiomics signatures,which can be useful in facilitating preoperative individualized prediction of histologic grade of GA.     

Radiological and clinical features of screening-detected pulmonary invasive mucinous adenocarcinoma

 Open in a separate windowOBJECTIVESThe current understanding of pulmonary invasive mucinous adenocarcinoma is largely based on studies of advanced stage patients and data about early-stage invasive mucinous adenocarcinoma are sparse. We evaluated the radiological and clinical features of screening-detected early-stage invasive mucinous adenocarcinoma (SD-IMA).METHODSData from 91 patients who underwent surgical treatment for SD-IMA (≤3 cm) from 2013 to 2019 were reviewed retrospectively. Data on radiological characteristics, clinicopathological findings, recurrence and survival were obtained. Disease-free survival rate was analysed.RESULTSRadiologically, SD-IMAs presented as a pure ground-glass nodule (6.6%), part-solid nodule (38.5%) or solid (54.9%). Dominant locations were both lower lobes (74.7%) and peripheral area (93.4%). The sensitivity of percutaneous needle biopsy was 78.1% (25/32). Lobectomy was performed in 70 (76.9%) patients, and sublobar resection in 21 (23.1%) patients. Seventy-three (80.2%), 15 (16.5%) and 3 (3.3%) patients had pathological stage IA, IB and IIB or above, respectively. Seven patients developed recurrence, and 3 died due to disease progression. Pleural seeding developed exclusively in 2 patients who underwent needle biopsy. The 5-year disease-free survival rate was 89.4%. The disease-free survival rates at 5 years were 86.3% in the lobectomy group and 100% in the sublobar resection group.CONCLUSIONSSD-IMAs were mostly radiologically invasive nodules. SD-IMAs showed favourable prognosis after surgical treatment.     

超声内镜诊断Barrett食管的研究进展

Barrett食管(BE)是食管腺癌发病的最危险因素.超声内镜(EUS)能清晰地显示食管壁各层的结构.大量研究表明,EUS可显示BE食管壁黏膜层和黏膜下层增厚,但目前不推荐用EUS诊断BE,和鉴别BE是否存在异型增生.EUS在评估有重度异型增生或有食管黏膜下层癌的BE患者及其食管壁肿瘤侵犯程度和局部淋巴结转移方面有重要意义,虽然其准确性现在还存在争议,但其可为BE患者选择进一步治疗的方案提供重要依据.     

Surgical management of esophagogastric junction tumors

INTRODUCTION Different tumor entities arise in the vicinity of the esophagogastric junction. The appropriate classification of these entities is essential for choosing the appropriatesurgical approach and making results from different instutions comparabl…