电视胸腔镜手术治疗胸膜孤立性纤维瘤的临床分析

目的探讨电视胸腔镜手术（VATS）治疗胸膜孤立性纤维瘤（SFTP）的价值,总结微刨治疗经验。方法1999年2月至2010年10月VATS治疗SFFP患者19例,其中全胸腔镜手术14例,胸腔镜辅助小切口（6～8cm）手术3例,胸腔镜联合后外侧大切口（15cm）手术2例。结果全组均完整切除肿瘤,手术顺利,无并发症及围手术期死亡。术中证实13例肿瘤起源于脏层胸膜有蒂,5例起源于壁层胸膜无蒂宽基底,1例起源于纵隔胸膜有蒂。主要诊断依据免疫组化分析,19例患者的Vimentin和CD34均阳性表达;病理诊断良性17例,恶性2例。平均住院时间6d（4-11d）。术后平均随访51个月,无复发和转移。结论VATS创伤小,可作为治疗SFTP的首选方法,值得推荐。     

电视胸腔镜手术在肺恶性肿瘤合并气胸诊断和治疗中的应用

目的探讨电视胸腔镜手术（video-assisted thoracoscopic surgery,VATS）对肺恶性肿瘤合并气胸的诊断和治疗价值。方法 2002年4月～2008年5月,19例术前胸部CT提示单侧周围型肺肿瘤合并气胸,术前均无明确病理诊断,行VATS手术探查,术中取肺肿瘤组织快速冰冻切片,根据病理结果和病人情况决定手术方式,同时处理肺脏漏气部位。结果全胸腔镜肺肿瘤楔形切除10例,胸腔镜辅助小切口手术9例（其中原发肺癌根治4例,肺肿瘤射频消融5例）。14例肺转移瘤均行胸膜摩擦固定。均手术顺利,均明确病理诊断。手术时间45～90 min（平均51.4 min）,术中出血量50～280 ml（平均150 ml）,胸管引流时间3～8 d（平均4.5 d）。术后2例轻度漏气,无特殊处理自愈,无围手术期死亡。术后所有患者肺复张良好。19例术后随访2～49个月,平均23个月,仅1例气胸复发,行胸腔闭式引流治愈。结论 VATS对明确周围型肺肿瘤病理诊断有重要作用,同时及时有效治疗气胸和肺恶性肿瘤,值得推荐。     

胸腔镜下胸顶壁层胸膜切除术治疗自发性气胸

目的探讨胸腔镜下胸顶壁层胸膜切除治疗自发性气胸的可行性及其临床效果。方法21例自发性气胸患者均行胸腔镜手术治疗,术中肺尖部发现肺大疱15例,未发现肺大疱6例。肺尖部肺组织局部切除17例,结扎法处理肺大疱4例;20例行胸顶壁层胸膜切除,1例继发性气胸除胸顶胸膜切除外同时行滑石粉胸膜固定术。留置多侧孔胸顶引流管,引流量少于100ml／d后拔除。结果无中转开胸。手术时间平均87（60～192）min;术中出血量平均47（20～100）ml。手术后拔管时间平均4（3～7）d。无切口感染,无术后胸腔活动性出血。术后胸部X线发现胸顶胸膜增厚8例。术后平均随访12（6～30）月,无复发。结论胸顶壁层胸膜切除在胸腔镜手术治疗自发性气胸中可以作为有效的胸膜固定方法,对于术中未发现明显肺大疱者尤为重要。     

胰腺囊性肿瘤的诊断与手术治疗

目的 探讨胰腺囊性肿瘤的诊断与手术治疗方式,提高对该疾病的认识与诊治水平。方法回顾性分析绍兴市人民医院2016年9月至2020年8月经病理证实的37例胰腺囊性肿瘤患者的临床资料。结果 术前行肿瘤全套检查37例（CEA升高5例,CA199升高2例）;腹部B超检查21例（囊性16例,囊实性5例）;腹部增强CT检查27例（诊断与术后病理符合15例）;腹部MRI检查22例（诊断与术后病理符合12例）。37例患者经术前综合评估决定手术方式,包括Whipple手术8例,胰体尾切除术24例和肿瘤局部切除术5例。16例患者术后出现A级胰漏,经禁食与抑制胰酶治疗后痊愈出院。34例患者术后获得随访,随访时间2～37个月,中位时间15.2个月;其中1例导管内乳头状黏液性肿瘤（IPMN）癌变患者术后复发死亡,其余患者未见肿瘤复发转移征象。结论 腹部B超对于鉴别胰腺囊性肿瘤囊性或囊实性具有重要价值;腹部增强CT与MRI仍是术前诊断和评估胰腺囊性肿瘤最重要的无创检查手段。依据胰腺囊性肿瘤的部位、性质以及与周围组织的关系,选择相对微创的手术方式不仅利于肿瘤治疗,也能最大程度保留胰腺功能,造成最小的手术创伤。     

胸部局限性Castleman病的临床特征及外科治疗

目的 探讨胸部局限性Castleman病的临床特征及外科治疗方法.方法 回顾性分析1996年6月至2008年11月收治的32例胸部局限性Castleman病患者的临床资料,探讨该病的临床和病理特点,总结其外科治疗效果.32例患者中男性14例,女性18例,年龄16～48岁,平均34.2岁.其中8例患者表现为胸闷、气短;3例患者表现为刺激性干咳;2例患者表现为胸痛;14例患者无临床症状,为体检时偶尔发现.CT检查均发现纵隔或肺门单发肿瘤.结果 除1例因术中麻醉意外死亡外,其余患者全部行手术完整切除肿瘤,病理改变符合Castleman病,病理类型以透明血管型为主.5例患者伴有副肿瘤性天疱疮,其中3例出现闭塞性细支气管炎;常规激素治疗均尤效,肿瘤切除后药物治疗1～2个月皮损明显好转,但肺部病变持续加重.术后随访全部患者均未见肿瘤复发.结论 胸部局限性Castleman病是一种罕见的胸部疾病,副肿瘤性天疱疮和肺部异常为Castleman病的少见而严重的合并症,手术切除肿瘤为首选治疗.     

恶性胸膜间皮瘤18例临床分析

目的总结恶性胸膜间皮瘤的诊治经验。方法回顾性分析18例恶性胸膜间皮瘤患者的临床资料。结果18例患者发病年龄为（56．3±12．7）岁;12例有石棉接触史;临床主要表现为胸痛、咳嗽、气促和胸腔积液。CT表现胸膜弥漫性增厚14例,胸膜多发性结节或胸膜肿块8例;改良的Cope针胸膜多点活检确诊10例,CT引导下经皮胸膜或肿块、结节活检确诊3例,纤维支气管镜代胸腔镜胸膜活检确诊1例,胸腔镜检查确诊4例。全部病例均未手术。结论恶性胸膜问皮瘤在中老年患者中发病率较高;与长期吸入石棉粉尘有关;胸部CT检查是目前可靠的影像学检查;用改良的Cope针多点胸膜活检为基层医院推荐的方法。     

胸腔镜在治疗CT未发现肺大疱的复发性气胸中的应用

目的探讨电视胸腔镜手术(VATS)在治疗CT未发现肺大疱的复发性气胸中的应用。方法将泰山医学院附属聊城市第二人民医院胸外科自2011年7月至2015年11月期间收治的CT未发现肺大疱的复发性气胸,且行胸腔镜治疗的32例患者作为研究对象。32例患者行胸腔镜下部分肺叶切除术或胸膜摩擦固定术,术后进行随访,随访终点为复发。结果所有患者术后恢复顺利,均一期痊愈出院,随访3~48个月,均无复发。结论 VATS治疗CT未发现肺大疱的复发性气胸,可明显降低患者气胸的复发风险,值得在临床推广。     

单操作孔胸腔镜手术治疗肺隔离症的临床体会

目的 总结单操作孔胸腔镜手术治疗肺隔离症的临床经验,评价其安全性、有效性。方法 回顾性分析2015年1月至2019年5月共21例单操作孔胸腔镜手术治疗的肺隔离症患者临床资料,其中男性10例,女性11例,年龄21~57（39.5±9.2）岁,21名患者均为下肺病变,包括左下肺13例,右下肺8例;叶外型1例,叶内型20例,术前均行增强CT扫描和三维重建;双腔气管插管全麻下单操作孔胸腔镜行肺叶或肺段切除20例,中转开胸1例。结果 胸腔严重粘连者8例,行下肺叶切除术20例,下肺后基底段切除1例;手术均顺利完成,手术时间（167.3±61.5）min,术中出血量（157.3±30.2）mL,术后带管时间（5.3±1.6）天,术后住院时间（6.2±1.5）天,围手术期无死亡及严重并发症发生;随访21例无失访,随访时间7~59个月,21例患者复查胸片或CT无复发。结论 单操作孔胸腔镜手术治疗肺隔离症安全可行,术前合理的检查评估和术中对隔离肺异常血管的合理处理是手术成功的关键。     

原发性腹膜后脂肪肉瘤27例

探讨腹膜后原发性脂肪肉瘤(PRPLS)的临床特点、诊断方法和治疗措施。对2006年8月—2017年6月27例PRPLS患者临床特点、诊断及治疗方法等进行回顾性分析。结果显示,患者中男16例,女11例,年龄43~68岁,中位年龄52岁。PRPLS最大直径6~38 cm,平均12.5 cm。彩色多普勒检查动脉及静脉血流信号不明显,CT检查提示不均质实性肿物,增强CT检查提示肿瘤未见明显强化。27例PRPLS患者手术治疗前均诊断明确,其中19例经腹腔入路采取开放性手术治疗,8例采用腹腔镜经腹膜后入路手术治疗。18例有临床症状患者术后症状消失。术后23例患者获得随访,随访时间3个月~10年,14例复发,均接受再次手术,CT及彩色多普勒检查未见再次复发。结果表明,PRPLS临床少见,容易误诊、漏诊,发现腹膜后肿瘤时应加以鉴别诊断。完整手术切除PRPLS是治疗本病的重要手段,可改善预后、降低复发率,对复发患者应争取早期再手术治疗。     

肝血管周上皮样细胞瘤的诊断与外科治疗

目的 总结肝血管周上皮样细胞瘤（PEComa）的临床特征,探讨该病的诊断与治疗方法.方法 回顾性分析2008年1月至2012年1月南京医科大学第一附属医院收治的16例肝PEComa患者的临床资料,总结该病的发病情况、临床特点、影像学特征、手术及病理检查情况.患者行部分肝切除术后定期复查腹部B超、肝功能和肿瘤标志物,必要时复查腹上区CT,了解肿瘤有无复发、转移.随访时间截至2012年12月.结果 16例患者中发病以中年女性患者居多,8例无自觉症状,其他患者表现为右季肋区不适、肝区隐痛或胀痛.肿瘤均为单发,位于肝右叶11例、肝左叶4例、肝尾状叶1例.术前B超检查无明显特异性征象,CT检查示肿瘤呈不均匀低密度表现.16例患者均行部分肝切除术,术后病理检查示均为R0切除,无手术并发症发生及患者死亡.免疫组织化学检测示16例患者上皮样肿瘤细胞中恶性黑色素瘤HMB-45、Melan-A和血管平滑肌肌动蛋白均呈阳性.16例患者均获随访,平均随访时间为27.9个月（9.0 ～46.0个月）,随访期内无肿瘤复发和死亡.结论 肝PEComa好发于中年女性患者,无特异性临床表现,术前CT检查有利于肝PEComa的鉴别诊断,行部分肝切除术治疗近期疗效良好.     

Metastatic solitary fibrous tumor of the meninges. Case report

Solitary fibrous tumor (SFT) is a unique tumor composed of interstitial dendritic cells that was first described in the thorax and subsequently reported in diverse organs. Extrathoracic SFTs are predominantly benign but rare malignant cases have been documented. In the nervous system, SFT has been described as a meningeal lesion although all 14 previously reported cases were benign. The authors report the first case of a meningeal SFT occurring in a 55-year-old woman. The tumor first presented as a meningeal lesion that after three recurrences over a 10-year period metastasized to the soft tissues and lungs. The potentially malignant nature of cranial SFTs, especially those with atypical histological features and high mitotic counts, should be recognized.     

Multiple recurrent malignant solitary fibrous tumors: long-term follow-up of 24 years

Solitary fibrous tumor (SFT) of the pleura is a rare, generally benign, neoplasm that accounts for less than 5% of all pleural tumors. However, 10% to 30% of SFTs display aggressive behavior with local recurrence, malignant transformation, and distant metastasis. We report a case of multiple recurrent SFTs of the thorax in a 77-year-old Korean woman. During a 24-year period, she underwent six surgical resections for six recurrent SFTs. The tumor eventually underwent morphologically malignant transformation. This unique case highlights the necessity of long-term follow-up in cases of SFT because of the potentially malignant biological behavior of this type of tumor.     

Solitary fibrous tumor of the pancreas: Case report and review of the literature

Solitary fibrous tumor (SFT) is a mesenchymal tumor typically located in the pleura, but can also be found as an asymptomatic mass in other areas, including the liver, peritoneum, kidney and salivary glands. However, SFT rarely locates in the pancreas. We present such a case of pancreatic SFT, along with a review of all reported cases. A 55-year-old man was treated surgically for an asymptomatic pancreatic mass after a rigorous preoperative control. Histologic examination of the resected specimen showed characteristics of an SFT. As only 15 cases of pancreatic SFT have been reported so far, an attempt to compare the cases was considered intriguing. We found that patients with pancreatic SFT were mainly women (81.25%), with a median age of 54 years at the time of diagnosis and a median tumor size of 5.83 cm. Pancreatic SFTs were revealed incidentally in 50% of cases, and all of them showed an enhancement through arterial computed tomography. All tumors were positive for CD34, ten were positive for Bcl-2, and twelve were negative for S100. The diagnosis of this pancreatic tumor is established by a combination of clinical suspicion, imaging procedures and histological findings, and is confirmed by immunohistochemical staining. Although the behavior of SFTs is rather benign, close clinical follow-up is recommended due to a potentially malignant nature.     

Solitary fibrous tumors of the pleura: clinicopathological and immunohistochemical examination

The purpose of this work was to study clinical and biological characteristics of solitary fibrous tumor (SFT) of the pleura. We reviewed the clinicopathological and immunohistochemical features of 12 patients who underwent surgical resection for SFT. Ten cases were histologically defined as benign; two were found to be malignant. CD34 negativity and strong expression of p53 could be observed in a patient with fatal outcome. Ki-67 expression was increased in malignant cases, as compared with benign. We also found that Bcl-2 expression inversely correlated with a tumor diameter. As the development of malignant SFT might be associated with these molecular statuses, immunohistochemical staining should be performed in all cases to identify the biological characteristics of the tumor.     

Solitary fibrous tumor of the upper respiratory tract. A report of six cases.

We report six cases of a neoplasm that arose in the upper respiratory tract and had a histological appearance indistinguishable from that of solitary fibrous tumor of the pleura (SFT, so-called fibrous mesothelioma). The patients were adults who presented with nasal obstruction. The lesions lacked the characteristic features of other recognized neoplasms that occur in this region. The tumor cells were immunoreactive for vimentin but not for keratin. The occurrence of SFT in this location further supports the argument that SFT is a tumor of mesenchymal and not mesothelial origin. None of the tumors in this series had the histologic features of malignancy described for SFT in other locations, and there was no aggressive behavior in limited follow-up. Until more cases of SFT in unusual locations have been studied, we recommend that the same criteria used for assessing aggressiveness in SFT of the pleura be applied to them.     

Solitary fibrous tumor of the pleura presenting as an aneurysm-like lesion with the strongly contrasted tumor stain by angiography

We treated a patient with solitary fibrous tumor of the pleura (SFT) whose angiograms demonstrated its feeders and strongly contrasted tumor stain. Although no one has clearly identified the specific features of SFT on angiograms, SFT can be suspected in the clinical setting if a localized chest wall tumor presents with the feeders and strongly contrasted tumor stain shown by angiography.     

四肢孤立性纤维瘤的诊断及外科治疗

目的探讨四肢孤立性纤维瘤(SFT)的临床表现、影像学特点及病理学特征、手术治疗方式。 方法回顾性分析中山大学孙逸仙纪念医院关节外科9例经病理确诊的四肢孤立性纤维瘤患者的临床表现、影像学特点及病理学特征。9例患者中3例男性,6例女性,中位数年龄44岁(15～55岁);均进行MRI检查,手术切除后送病检行免疫组化,比较其临床表现、影像学特征及病理学特征。 结果9例患者中,肿瘤分布于上肢者6例,下肢3例。患者首要临床症状均为无痛性肿块,其中3例出现患肢远端麻木等压迫症状。影像学方面,9例患者术前行MR检查,了解其边界及邻近关系,7例患者MR表现为T1加权像为等信号,2例为低信号;T2加权像4例为混杂高信号,1例为高信号;9例患者增强像为不均匀明显强化;边界清楚者6例,模糊者3例。免疫组化结果显示9例患者中波形蛋白(vimentin)均为阳性(9/9),跨膜糖蛋白分子CD34阳性者8例(8/9); B淋巴细胞瘤－2因子(bcl-2)阳性者6例(6/9),信号转导与转录激活因子-6(STAT-6)阳性者3例(3/9);增殖细胞相关核抗原Ki67分布于5%～65%。 结论影像学中MRI通过不同加权像可以对SFT的瘤体边界进行定位,确定肿瘤的邻近关系,为SFT的诊断提供依据,为手术方案的选择提供依据。进行病理学免疫组化是诊断孤立性纤维瘤的主要手段,并可指导术后辅助放化疗方案的制定。     

An Aggressive Solitary Fibrous Tumor with Evidence of Malignancy: A Rare Case Report

Solitary fibrous tumor (SFT) is rare mesenchymal neoplasm that has been originally and most often documented in the pleura. Recently, the ubiquitous nature of the SFT has been recognized with reports of involvement of numerous sites all over the body, i.e, upper respiratory tract, breast, somatic tissue, mediastinum, head, and neck, etc. The diagnosis of SFT still remains an enigma in our field. Furthermore, malignant SFT is extremely rare and only two cases have been reported in the oral cavity till date. Here, we present a rare case report of an aggressive solitary fibrous tumor which presented as a palatal mass and extended throughout the middle cranial fossa and exhibited features of malignancy.     

Malignant fat-forming solitary fibrous tumor (so-called "lipomatous hemangiopericytoma"): clinicopathologic analysis of 14 cases

Fat-forming solitary fibrous tumor is a rare variant of solitary fibrous tumor (SFT). Generally regarded as benign, very few fat-forming SFTs with malignant histologic features have been reported. Here, we report 14 histologically malignant fat-forming SFTs to better characterize this subset. Seven patients were female and 7 were male, with ages ranging 20 to 93 years (median, 57 y). Five tumors were located in the lower limb, 3 in the trunk, 3 in abdominopelvic locations, 2 in the head and neck region, and 1 in the upper limb. The tumor size ranged from 3.4 to 20 cm (median, 8.6 cm). Histologically, all exhibited at least focal hypercellularity; 12 tumors had mitoses >4/10 high-power fields (range, 2 to 37; median, 8), 12 showed at least moderate atypia, and 8 showed necrosis. It should be noted that 7 tumors contained only mature adipose tissue, whereas 5 contained multivacuolated lipoblasts and 2 had areas resembling atypical lipomatous tumor (ALT). Immunohistochemically, CD34 and CD99 were positive in most cases (11 of 14 and 8 of 10, respectively); MDM2 and CDK4 were both negative in all 4 cases tested (including both tumors with ALT-like areas). Follow-up data from 10 cases (median duration, 47.5 mo; range, 5 to 76) showed 2 patients with multiple metastases (both to lung and bones, and 1 each to breast and to soft tissue), both of whom died of disease. In conclusion, fat-forming SFTs exhibiting malignant histologic features have potential for aggressive behavior. The presence of lipoblasts and/or ALT-like areas, although described in some "benign" examples of fat-forming SFT, seems much more common in the malignant subset and may prompt a careful search for morphologic evidence of malignancy in any case of fat-forming SFT.     

肾脏孤立性纤维瘤2例报告并文献复习

目的:探讨肾脏孤立性纤维瘤的临床表现、诊断方法、误诊原因、治疗方法,以减少其误诊率,提高治愈率。方法:回顾性分析2例肾脏孤立性纤维瘤患者的临床资料,行腹腔镜下左肾根治性切除术。并结合文献分析该病病因、临床表现、影像学检查资料、病理学特征、鉴别诊断及治疗情况。结果:男女各1例,年龄45、59岁,临床及影像学检查诊断为肾癌。病理检查考虑为(左肾)孤立性纤维性肿瘤和梭形细胞肿瘤。免疫组织化学染色结合HE切片,倾向于孤立性纤维性肿瘤(其中例1倾向为恶性)。1例术后随访3个月,未见肿瘤复发。1例刚出院,未行随访。结论:肾孤立性纤维瘤是一种罕见肿瘤。肾脏孤立性纤维瘤缺乏特异性临床症状及影像学表现,术前很难确诊,需依赖病理学及免疫组织化学检查确诊。主要治疗方式为肾脏根治术,良性病变预后好。