中国结直肠癌肝转移诊断和综合治疗指南（2018版）

正第一部分诊疗指南肝脏是结直肠癌血行转移最主要的靶器官,结直肠癌肝转移(colorectal cancer liver metastases)是结直肠癌治疗的重点和难点之一。15%～25%的结直肠癌病人在确诊时即合并肝转移,另有15%～25%的病人将在结直肠癌根治术后发生肝转移,其中绝大多数(80%～90%)的肝转移灶初始无法获得根治性切除。结直肠癌肝转移也是结直肠     

Aggressive Angiomyxoma: an Unusual Presentation

Aggressive angiomyxoma is an uncommon mesenchymal myxoid tumor that is characterized by slow growth and frequent local recurrence. It is currently regarded as a nonmetastasizing tumor. We describe a case of recurrent aggressive angiomyxoma with invasion into the veins including the inferior vena cava and the right atrium and with pulmonary metastases. Our case, together with those unusual cases documented in previous reports, may lead to a reappraisal of the nature of aggressive angiomyxoma.     

The Case of the Fever of Unknown Origin

This presentation is by William B. Seaman, professor and chairman of the department of radiology, Columbia-Presbyterian Medical Center, who edits “X-Ray Casebook.”     

Predictive factors associated with long-term survival in patients with neuroendocrine tumors of the pancreas

Background Neuroendocrine tumors of the pancreas are rare tumors. We identified predictive factors that are associated with long-term survival (≥5 years). Methods Fifty patients with a diagnosis of neuroendocrine tumors of the pancreas were retrospectively evaluated. The following factors were evaluated for disease-specific mortality: age, sex, primary tumor location, functional status, type of primary tumor treatment, presence or absence of liver metastases, timing of liver metastases occurrence, and type of liver metastases treatment. Aggressive treatment of the liver metastases included surgery, chemoembolization, or intrahepatic arterial infusion chemotherapy. Results Twenty-three patients (47%) had tumor located in the head of the pancreas, and 29 patients (58%) had nonfunctioning tumor. Thirty-nine patients (78%) had liver metastases. The median follow-up for the entire group was 35 months (range, 76–206 months). The median survival for the entire group was 40 months, and the overall 1-, 2-, and 5-year survival rates were 84%, 69%, and 36%, respectively. Factors that had a significant favorable effect on survival included curative resection of the primary tumor, metachronous liver metastases, absence of liver metastases, and aggressive treatment of the liver metastases. Conclusions Definitive surgical resection of the primary tumor, absence of liver metastases, metachronous liver metastases, and aggressive treatment of the liver metastases were predictors of long-term survival in patients with neuroendocrine tumors of the pancreas. Presented as a poster presentation at the Society of Surgical Oncology 55th Annual Cancer Symposium, Denver, Colorado, March 14–17, 2002.     

CT导引经皮穿刺注射无水乙醇治疗溶骨性骨转移瘤

目的探讨CT导引下经皮穿刺注射无水乙醇（CT～PEI）治疗溶骨性骨转移瘤的价值及安全性。方法对17例骨转移瘤患者（25个病灶）采用CT—PEI治疗，使用无水乙醇和超化碘油10：1的混合剂，用CT精确定位、准确穿刺瘤灶并密切监控无水乙醇弥散情况及用量，以减少并发症。对接近椎管及椎间孔的病灶，采用利多卡因实验性治疗以避免严重并发症。术前及术后定期CT检查，3例病人行同位素骨扫描检查，与治疗前检查进行对照研究。对患者随访3～30个月观察其临床疗效。结果所有患者经1次CT—PEI治疗后，疼痛即明显减轻，经2～3次CT-PEI治疗后疼痛完全缓解（CR）16例（24处病灶），疼痛部分缓解（PR）1例。术后随访3个月时，23处病灶内肿瘤组织均发生坏死，被高密度碘油混合液均匀浸润。其中，9处病灶体积缩小。随访3～30个月，除1例因周边出现新的肿瘤浸润灶而再次出现疼痛，其余病例转移瘤处止痛效果无反复。所有病例无严重并发症。结论CT—PEI是一种治疗骨转移瘤有效、微创、安全、简便的方法，使骨转移瘤内肿瘤组织坏死，最大限度的杀灭肿瘤细胞，从而达到满意的止痛效果，明显改善恶性肿瘤溶骨性转移病人的生活质量。     

甲状腺乳头状癌淋巴结转移规律的研究

目的探讨甲状腺乳头状癌淋巴结转移的规律,为临床行选择性颈淋巴结清扫术提供依据。方法回顾性分析华中科技大学附属协和医院乳腺、甲状腺外科中心2003年6月至2006年6月间行甲状腺癌根治＋颈淋巴结清扫术,且颈清扫的淋巴结数目大于8枚的83例甲状腺乳头状癌临床资料。结果甲状腺乳头状癌最容易转移至Ⅵ区（单侧甲癌72.3%,双侧甲癌88.9%）,其次是Ⅲ、Ⅳ区（单侧甲癌57.9%,双侧甲癌50%～66.7%）,Ⅴ区和Ⅰ区较少发生淋巴结转移（单侧甲癌0%～20.1%,双侧甲癌25%～33.3%）。侵犯甲状腺包膜（88%）和滤泡亚型（85.7%）的甲状腺癌容易发生颈淋巴结转移。良性病变局部恶变（27.3%）和包膜型（25%）甲状腺癌,较少发生颈淋巴结转移。甲状腺上极的肿瘤可以先出现颈外侧区淋巴结转移。结论甲状腺乳头状癌的淋巴结转移的研究有助于确定选择性颈淋巴结清扫术范围,建议甲状腺乳头状癌常规清扫Ⅵ区淋巴结,肿瘤位于甲状腺下极者需清扫对侧下极淋巴结;对于肿瘤位于甲状腺上极的患者,应增加清扫Ⅱ、Ⅲ区的淋巴结。对风险较高的滤泡亚型及侵犯包膜的甲状腺乳头状癌清扫范围要更大,应清扫Ⅱ～Ⅵ区淋巴结。     

The effect of pre-vertebroplasty tumor ablation using laser-induced thermotherapy on biomechanical stability and cement fill in the metastatic spine

A biomechanical study comparing simulated lytic vertebral metastases treated with laser-induced thermotherapy (LITT) and vertebroplasty versus vertebroplasty alone. To investigate the effect of tumor ablation using LITT prior to vertebroplasty on biomechanical stability and cement fill patterns in a standardized model of spinal metastatic disease. Vertebroplasty in the metastatic spine is aimed at reducing pain, but is associated with risk of cement extravasation in up to 10%. Six pairs of fresh-frozen cadaveric thoracolumbar spinal motion segments were tested in axial compression intact, with simulated metastases and following percutaneous vertebroplasty with or without LITT. Canal narrowing under load, pattern of cement fill, load to failure, and LITT temperature and pressure generation were collected. In all LITT specimens, cement filled the defect without extravasation. The canal extravasation rate was 33% in specimens treated without LITT. LITT and vertebroplasty yielded a trend toward improved posterior wall stability (P = 0.095) as compared to vertebroplasty alone. Moderate rises in temperature and minimal pressure generation was seen during LITT. In this model, elimination of tumor by LITT, facilitates cement fill, enhances biomechanical stability and reduces the risk of cement extravasation.     

Repeat Transarterial Chemoembolization (TACE) for Progressive Hepatic Carcinoid Metastases Provides Results Similar to First TACE

Background Transarterial chemoemobolization (TACE) is commonly used to treat metastatic carcinoid tumors; however, the management of progressive disease is less clear. We sought to determine if patients with disease progression after TACE would benefit from repeat TACE. Methods The records of 27 patients undergoing repeat TACE for radiologic or symptomatic progression after TACE for metastatic carcinoid were reviewed and compared to 122 undergoing first TACE. Overall and progression-free survivals were estimated by the Kaplan–Meier method. Results Mean disease-free interval after first TACE was 11.8 months. Radiologic response was observed in 61% compared to 82% after first TACE (p = 0.058); hormone response in 64% compared to 80% (p = 0.159); and symptomatic response in 77% compared to 92% (p = 0.053). The complication rate after repeat TACE was lower than after first TACE (p = 0.03). Median overall survival was similar after repeat (28.1 months) and first TACE (33.3 months) (p = 0.53). Progression-free survival was shorter after repeat TACE but not significantly so. No factor examined could predict survival after repeat TACE. Conclusion Repeat TACE for patients with hepatic carcinoid metastases failing first TACE or having evidence of disease progression is safe and offers a viable treatment option. Presented at the 48th Annual Meeting of The Society for Surgery of the Alimentary Tract, Washington, DC, May, 2007.     

Sentinel Node Biopsy and Concomitant Probe-Guided Tumor Excision of Nonpalpable Breast Cancer

Background Preliminary data have shown encouraging results of a single intratumoral radiopharmaceutical injection that enables both sentinel node biopsy and probe-guided excision of the primary tumor in patients with nonpalpable breast cancer. The aim of the study was to evaluate this approach in a large group of patients. Methods Lymphoscintigraphy was performed in 368 patients with nonpalpable breast cancer after intratumoral injection of ^99mTc-nanocolloid (.2 mL, 123 MBq, 3.3 mCi) guided by ultrasound or stereotaxis. The sentinel node was pursued with the aid of vital blue dye (1.0 mL, intratumoral) and a gamma ray detection probe. In case of breast-conserving surgery, the probe was used to guide the excision. Results At least one sentinel node could be identified intraoperatively in 357 patients (97%), of whom 69 had involved nodes (19%). Age over 60 years was associated with less frequent nonaxillary lymphatic drainage and absence of internal mammary chain dissemination. Tumor-free margins were obtained in 262 (89%) of the 293 patients who underwent segmental excision. Re-excision of the primary tumor bed was performed in six patients (2%). During a median follow-up of 22 months, one breast recurrence and one axillary recurrence were observed. Conclusions Lymphatic mapping and probe-guided tumor excision of nonpalpable breast cancer by intralesional administration of a single dose of ^99mTc-nanocolloid and blue dye resulted in 97% identification of the sentinel node and in tumor-free margins in 89% of the patients who underwent breast-conserving surgery. Longer follow-up is needed to substantiate the accuracy and safety of this technique.