多排螺旋CT增强扫描结直肠黏液腺癌患者肠壁及肠腔的特征

目的 探讨多排螺旋CT三期增强扫描在结直肠黏液腺癌患者的肠壁及肠腔特征性分析中的应用.方法 采用GE Discovery CT 750HD扫描仪行平扫、动脉期、门静脉期和延时期的扫描.观察5 1例结直肠黏液腺癌病例平扫及增强后病变肠壁、肠腔及近端正常肠腔的表现,进行必要的数值测量和CT值测量.结果 结直肠黏液腺癌患者肠壁呈环形不均匀增厚,半球形增厚.增厚肠壁见内缘有分叶,外缘有分叶或无分叶.增强后见三层结构和两层结构的分层征及类囊肿征.转移淋巴结体积较大时、肝转移、卵巢转移可表现为类囊肿征.肠腔狭窄根据形态分为自然流线型狭窄、不规则同定型狭窄、不规则缩窄型狭窄.病变近端正常肠管表现为闭合、轻度扩张或重度扩张.结论 结直肠黏液腺癌患者肠壁呈不均匀环形增厚或半球形增厚.肠壁内可有钙化.增强后表现为分层征和类囊肿征.病变肠壁僵硬程度下降近端肠管发生梗阻者减少.依靠这些特征,CT检查可以做出结直肠黏液腺癌的诊断.     

经直肠超声诊断前列腺癌的临床价值

[目的]探讨经直肠超声检查诊断前列腺癌的临床价值：[方法]32例血清前列腺特异性抗原升高或直肠指诊阳性的前列腺患者，经直肠超声检查引导穿刺活检。[结果]32例患者中，病理证实前列腺癌30例、移行细胞癌及黏液腺癌各1例。按声像图表现分为弥漫型、结节型及无结节型。经直肠超声检出异常结节23个，病理证实为癌性结节14个，增生结节9个。[结论]经直肠超声声像图有较高的敏感性。经直肠超声穿刺活检有助于提高前列腺癌的诊断。     

甲状腺乳头状腺癌的声像图表现

目的探讨二维超声对甲状腺乳头状腺癌的诊断价值.方法总结52例经手术和/或超声导向穿刺活检并经病理证实的甲状腺乳头状癌的声像图表现.结果甲状腺乳头状癌特征性声像图表现为边界不清,不规整,无包膜,实性肿块多呈低回声,其内及囊性肿物的实性突起内均见沙粒状微钙化.但甲状腺各种病灶在声像图上表现交叉现象严重,且有多源性,复杂性特点,导致单凭声像图难以鉴别,尤其对微小癌的诊断尚缺乏有力依据.本组10例依靠超声导向穿刺活检明确诊断.结论二维超声在甲状腺乳头状癌的诊断中有着重要应用价值,超声导向穿刺活检可协助诊断.     

宫颈微小偏离性腺癌临床病理分析

目的 :探讨宫颈微小偏离性腺癌的临床病理特征。方法 :对4例宫颈微小偏离性腺癌进行临床病理分析。结果 :宫颈微小偏离性腺癌临床表现为血性和水样黏液性白带增多 ,均见宫颈糜烂、肥大 ,呈桶状 ,表面可呈结节状。镜下表现为宫颈腺体增多且大小不一 ,腺体形态类似正常宫颈腺体 ,并向深层浸润 ,浸润生长的腺体呈分枝状 ,部分腺上皮有异形。结论 :宫颈微小偏离性腺癌是一种特殊类型的癌 ,应注意鉴别诊断     

结直肠腺癌EMMPRIN蛋白的表达及其临床病理学意义

目的:研究结直肠腺癌细胞外基质金属蛋白酶诱导因子(extracellularmatrixmetalloproteinaseinducer,EMMPRIN)蛋白表达的临床病理意义。方法:免疫组织化学(SP)法检测89例结直肠腺癌组织中EMMPRIN的表达,分析EMMPRIN与组织学类型、分化程度、肿瘤神经组织浸润、浸润肠壁深度、淋巴结转移和Dukes分期等生物学行为的关系。结果:全组结直肠腺癌EMMPRIN的阳性率为43%(38/89)。53例癌旁腺上皮的阳性率为17%(9/53),明显低于同组腺癌组织的58%(31/53)(P=0.016)。EMMPRIN表达与组织学类型、分化程度、肿瘤神经组织浸润、浸润肠壁深度、淋巴结转移和Dukes分期均无关(P>0.05)。结论:EMMPRIN在结直肠腺癌中的表达明显较癌旁腺上皮增多,但与癌的生物学行为关系不大。     

宫颈微小偏离性腺癌临床病理分析

目的：探讨宫颈微小偏离性腺癌的，临床病理特征。方法：对4例宫颈微小偏离性腺癌进行临床病理分析。结果：宫颈微小偏离性腺癌临床表现为血性和水样黏液性白带增多．均见宫颈糜烂、肥大。呈桶状，表面可呈结节状。镜下表现为宫颈腺体增多且大小不一，腺体形态类似正常宫颈腺体。并向深层浸润，浸润生长的腺体呈分枝状．部分腺上皮有异形。结论：宫颈微小偏离性腺癌是一种特殊类型的癌，应注意鉴别诊断。     

单纯型和混合型乳腺黏液腺癌的超声特征分析

目的 分析单纯型乳腺黏液腺癌（pure mucinous breast carcinoma,PMBC）和混合型乳腺黏液腺癌（mixed mucinous breast carcinoma,MMBC）的二维超声和彩色多普勒血流显像特征。方法 回顾性分析2013年1月至2020年12月于我院就诊且经手术病理证实的49例乳腺黏液腺癌（mucinous breast carcinoma,MBC）患者的二维超声、彩色多普勒血流显像表现,比较PMBC和MMBC患者在形态、边缘、内部回声、后方回声、钙化、血流分级和BI-RADS分类等方面的差异。 结果 49例MBC病灶中,BI-RADS 3类1例,BI-RADS 4a类4例,BI-RADS 4b类15例,BI-RADS 4c类11例,BI-RADS 5类18例。PMBC组肿块呈混合回声的显示率高于MMBC组（P=0.025）;MMBC组肿块后方回声衰减及边缘毛刺、模糊的显示率高于PMBC组（P=0.008,0.023）;MMBC组血流3级肿块和BI-RADS 5类肿块占比均高于PMBC组;BI-RADS 4b类肿块占比低于PMBC组。结论 PMBC较MMBC更易表现出良性超声特征,综合分析肿块的边缘、内部回声、后方回声及彩色多普勒血流显像等超声表现有助于鉴别PMBC和MMBC,从而提高MBC的超声诊断符合率。     

支气管黏液表皮样癌的CT诊断及鉴别

目的 分析支气管黏液表皮样癌的CT表现.方法 回顾性分析5例经病理学确诊的支气管黏液表皮样癌的CT资料.结果 5例均为单发肿瘤,中央型4例,周围型1例.中央型中1例呈支气管腔内型,表现为右主支气管内边界清楚的等密度类圆形结节,相应基底支气管壁稍增厚;其余3例呈支气管腔内-外型,表现为支气管腔内、外生长的等及稍低密度不规则结节或肿块,1例边界较清晰,2例边界不清,2例伴有点状钙化.2例肿瘤远端条片肺不张,内见支气管黏液栓,近侧支气管腔内见黏液围绕肿瘤呈液性新月征.1例周围型呈左肺舌叶边界较清晰的等密度类圆形结节,边缘见浅分叶.CT增强后肿瘤强化均不均匀,4例中央型较明显强化,1例周围型中度强化.4例中央型均继发不同程度的支气管阻塞性改变,2例伴肺门及纵隔淋巴结肿大,1例伴中等量胸腔积液.结论 CT对支气管黏液表皮样癌的诊断具有较大价值.     

乳腺黏液腺癌的超声表现及其与病理特征的关系

目的探讨乳腺黏液腺癌超声表现与病理特征的关系。方法于彩超下观察乳腺黏液腺癌患者的超声表现,根据其病理特征分为单纯型、混合型2组,分析超声表现与病理特征的关系。结果混合型乳腺黏液腺癌患者中检测到动脉血流频谱占88.6%,高于单纯型乳腺黏液腺癌患者,差异有统计学意义(P<0.05);2组患者的峰值血流速度、阻力指数无明显差异(P>0.05);混合型乳腺黏液腺癌患者血流信号达2级、3级者分别为37.1%、20.0%,明显高于单纯型乳腺黏液腺癌患者,差异有统计学意义(P<0.05)。2组患者的肿瘤边界、肿瘤边缘、肿瘤后方回声分型、瘤内钙化有显著差异(P<0.05);在回声类型、肿瘤形态无明显差异(P>0.05)。结论与单纯型乳腺黏液腺癌相比,混合型黏液腺癌在超声下具有动脉血流频谱、血流信号分级升高,肿瘤边界不清、边缘模糊、肿瘤后方回声增强、瘤内出现钙化的特点。     

WHO新旧分类在结直肠腺癌活检病理诊断中的差异探讨

目的:结合 WHO(2000) 对结直肠癌的诊断标准,对结直肠内窥镜活检癌的临床病理诊断进行探讨.方法:对52例结直肠活检诊断癌的标本进行回顾性阅片,确定癌侵及黏膜下层的标准,并与相应的手术切除标本的病理诊断进行对照,进行手术前后的病理诊断分析.结果:25例明确黏膜下层浸润,诊断为结直肠腺癌,符合率为48.1%,其余27例均未见黏膜肌或未见明显黏膜下层浸润,诊断为高级别上皮内瘤变.病理组织学新分类与活检粒数及单粒最大径之间无差异.结论:采用不同的诊断标准可能产生不同的结果,实际工作中不宜过份强调是否存在"明确的黏膜下浸润"病理组织学特点,以免造成过低诊断导致贻误治疗.     

免疫组化标记物在子宫内膜样腺癌与宫颈腺癌鉴别诊断中的表达及意义

目的探讨免疫组化标记物波形蛋白(Vimentin)、癌胚抗原(CEA)、雌激素受体(ER)、孕激素受体(PR)和p16蛋白在子宫内膜样腺癌与宫颈腺癌鉴别诊断中的表达和意义。方法采用免疫组织化学染色法检测48例子宫内膜样腺癌和21例宫颈腺癌患者肿瘤组织中Vimentin、CEA、ER、PR和p16的表达,并分析其临床意义。结果子宫内膜样腺癌患者肿瘤组织中Vimentin、CEA、ER、PR和p16阳性表达率分别为79.2%、31.3%、87.5%、81.3%和20.8%。宫颈腺癌患者肿瘤组织中Vimentin、CEA、ER、PR和p16阳性表达率分别为14.3%、90.5%、23.8%、42.9%和81.0%。经2检验,Vimentin(2=25.50)、CEA(2=20.50)、ER(2=27.29)、PR(2=10.17)和p16(2=22.17)在子宫内膜样腺癌和宫颈腺癌患者肿瘤组织中阳性表达率的差异均有统计学意义(P<0.05)。结论免疫组化法检测Vimentin、CEA、ER、PR和p16的表达有助于临床鉴别诊断宫颈腺癌和子宫内膜样腺癌。     

人胃腺癌组织的自体荧光光谱特性

目的：探讨人胃腺癌组织的自体荧光光谱特性。方法：测定26例胃腺癌标本肿瘤及非肿瘤区域的组织自体荧光光谱。结果：人胃腺癌组织自体荧光光谱与非肿瘤胃壁组织自体荧光光谱明显不同，人胃腺癌组织自体荧光光谱的峰值明显低于非肿瘤胃壁组织；用波长为360nm、390nm激光激发的人胃腺癌组织自体荧光光谱出现双峰。结论：用激光激发的自体荧光光谱可有效识别人胃腺癌组织与非肿瘤胃壁组织。     

直肠内超声在直肠癌分期中的价值

本文舛36例直肠癌病人使用术前腔内超声检查肿瘤病变的深度及肛诊检查估计病变深度与术后病理报告相对照。发现直肠内超声检查直肠癌浸润深度的正确诊断率为88.8％,对早期直肠癌的正确诊断率为80％,肛诊检查的正确诊断率仅为52.8％。直肠内超声对正常直肠壁显示5层结构。直肠癌超声图像为边界不规则的低回声或相对低回声区。直肠内超声的使用为临床医生合理选择手术方式提供了客观依据。     

Local excision and postoperative radiation therapy for rectal adenocarcinoma

Sixty‐seven patients with early‐stage adenocarcinoma of the rectum who had lesions thought to be unsuitable for either local excision alone or endocavitary irradiation were treated with local excision followed by postoperative radiation therapy. The purpose of this study was to evaluate the effectiveness of local excision followed by radiation therapy for treatment of rectal adenocarcinoma. The patients were treated between 1974 and 1999; follow‐up time was 6 to 273 months (median, 65 months). All living patients had follow‐up for at least 2 years. The indications for postoperative irradiation included equivocal or positive margins, invasion of the muscularis propria, endothelial‐lined space invasion, poorly differentiated histology, and perineural invasion. Cox proportional hazards regression analysis was performed using six explanatory variables including tumor size, configuration (exophytic vs. ulcerative), histologic differentiation, pathologic T stage, endothelial‐lined space invasion, and margin status. The time interval between treatment and development of recurrent disease was in the range of 11 to 48 months. The 5‐year results were as follows: local‐regional control, 86%; ultimate local‐regional control, 93%; distant metastasis‐free survival, 93%; absolute survival, 80%; and cause‐specific survival, 90%. When the Cox proportional hazards regression analysis was performed for these endpoints, margin status influenced absolute survival (P = 0.0074), cause‐specific survival (P = 0.0405), and ultimate local‐regional control (P = 0.0439). Tumor configuration marginally influenced cause‐specific survival (P = 0.0577). None of the variables had an influence on the endpoints' local‐regional control, ultimate local‐regional control with sphincter preservation, or distant metastasis. Five patients (7%) had severe complications; no complication was fatal. Local excision and postoperative radiation therapy results in a high probability of local‐regional control and survival for selected patients with relatively early‐stage rectal adenocarcinoma. Patients with ulcerative tumors may have a lower likelihood of cause‐specific survival. © 2002 Wiley‐Liss, Inc.     

直肠类癌的临床病理特征及预后分析

目的分析直肠类癌的临床病理特征、外科治疗方法及其长期疗效。方法对1966年1月至2004年12月手术治疗的74例直肠类癌患者的临床资料进行回顾性分析,按照不同危险因素分组进行统计学分析,比较各组手术治疗效果和生存率。结果 1,3,5年累计生存率分别为98.9%、94.3%和89.2%,直肠类癌最大径≤2.0 cm组与最大径〉2.0 cm组的生存比较差异有显著性（P〈0.05）;未侵犯肌层组与浸润肌层组的生存比较差异有显著性（P〈0.05）。结论肿瘤大小和肌层浸润是决定直肠类癌手术方式的关键,也是影响预后的两个重要相关因素,肿瘤最大径〉2 cm、肌层浸润的直肠类癌预后不良,应综合考虑采用个体化治疗方案。早期发现、早期诊断和根治性治疗是进一步提高患者生存率的关键。     

Unique role of proximal rectal dose in late rectal complications for patients with cervical cancer undergoing high-dose-rate intracavitary brachytherapy

PURPOSE: To investigate the correlation of the radiation dose to the upper rectum, proximal to the International Commission of Radiation Units and Measurements (ICRU) rectal point, with late rectal complications in patients treated with external beam radiotherapy (EBRT) and high-dose-rate (HDR) intracavitary brachytherapy (ICRT) for carcinoma of the uterine cervix. METHODS AND MATERIALS: Between June 1997 and February 2001, 75 patients with cervical carcinoma completed definitive or preoperative RT and were retrospectively reviewed. Of the 75 patients, 62 with complete dosimetric data and a minimal follow-up of at least 1 year were included in this analysis. Of the 62 patients, 36 (58%) also received concurrent chemotherapy, mainly with cisplatin during EBRT. EBRT consisted of a mean of 50.1 +/- 1.3 Gy of 18-MV photons to the pelvis. A parametrial boost was given to 55 patients. Central shielding was used after 40-45 Gy of pelvic RT. HDR ICRT followed EBRT, with a median dose of 5 Gy/fraction given twice weekly for a median of four fractions. The mean dose to point A from HDR ICRT was 23.9 +/- 3.0 Gy. In addition to the placement of a rectal tube with a lead wire during ICRT, 30-40 mL of contrast medium was instilled into the rectum to demonstrate the anterior rectal wall up to the rectosigmoid junction. Late rectal complications were recorded according to the Radiation Therapy Oncology Group grading system. The maximal rectal dose taken along the rectum from the anal verge to the rectosigmoid junction and the ICRU rectal dose were calculated. Statistical tests were used for the correlation of Grade 2 or greater rectal complications with patient-related variables and dosimetric factors. Correlations among the point A dose, ICRU rectal dose, and maximal proximal rectal dose were analyzed. RESULTS: Fourteen patients (23%) developed Grade 2 or greater rectal complications. Patient-related factors, definitive or preoperative RT, and the use of concurrent chemotherapy were not associated with the occurrence of rectal complications. The maximal rectal dose during ICRT was at the proximal rectum rather than at the ICRU rectal point in 55 (89%) of 62 patients. Patients with Grade 2 or greater rectal complications had received a significantly greater total maximal proximal rectal dose from ICRT (25.6 Gy vs. 19.2 Gy, p = 0.019) and had a greater maximal proximal rectal dose/point A dose ratio (1.025 vs. 0.813, p = 0.024). In contrast, patients with and without rectal complications had a similar dose at point A (25.0 Gy vs.23.6 Gy, p = 0.107). The differences in the ICRU rectal dose (17.8 Gy vs.15.4 Gy, p = 0.065) and the ICRU rectal dose/point A dose ratio (0.71 vs. 0.66, p = 0.210) did not reach statistical significance. Patients with >62 Gy of a direct dose sum from EBRT and ICRT to the proximal rectum (12 of 29 vs. 2 of 33, p = 0.001) and >110 Gy of a total maximal proximal rectal biologic effective dose (13 of 40 vs. 1 of 22, p = 0.012) presented with a significantly increased frequency of Grade 2 or greater rectal complications. The correlations between the maximal proximal rectal dose and the ICRU rectal dose were less satisfactory (Pearson coefficient 0.375). Moreover, 11 of the 14 patients with rectal complications had colonoscopic findings of radiation colitis at the proximal rectum, the area with the maximal rectal dose. CONCLUSION: Eighty-nine percent of our patients had a maximal rectal dose from ICRT at the proximal rectum instead of the ICRU rectal point. The difference between patients with and without late rectal complications was more prominent for the proximal rectal dose than for the ICRU rectal dose. It is important and useful to contrast the whole rectal wall up to the rectosigmoid junction and to calculate the dose at the proximal rectum for patients undergoing HDR ICRT.     

胆总管浸润对Vater壶腹腺癌胰十二指肠切除预后的影响

目的 研究胆总管浸润对Vater壶腹腺癌胰十二指肠切除的预后影响.方法 回顾性分析胰十二指肠切除后存活的102例Vater壶腹腺癌患者的临床病理和生存资料,比较胆总管浸润和无浸润之间的差异.结果 T1期9例(8.8%),T2期40例(39.2%),T13期25例(24.5%),T4期28例(27.5%);NO 76例(74.5%),N1 26例(25.5%).TNM分期Ⅰ期42例(41.2%),Ⅱ期32例(31.3%),Ⅲ期27例(26.5%),Ⅳ期1例(1.0%).胆总管浸润26例(25.5%),无胆总管浸润76例(74.5%).胆总管浸润组出现胰腺浸润22例(84.6%),无胆总管浸润组为26例(34.2%),差异有统计学意义(X<'2>=19.78,P<0.001).全组有25例(24.5%)出现复发转移,中位复发转移时间为20(2～93)个月.无胆总管浸润组患者的术后中位无复发生存期和总体生存期显著优于胆总管浸润组.结论 胆总管浸润的Vater壶腹癌患者易出现胰腺浸润,无复发生存期和总体生存期显著下降,患者术后应该接受综合治疗.     

宫颈癌调强放疗中直肠体积与位置变化及对吸收剂量影响

目的 探讨宫颈癌患者调强放疗(IMRT)中直肠体积与位置变化及对吸收剂量的影响。方法 对随机选取 10例宫颈癌根治性IMRT患者采集分次治疗前锥形束CT (CBCT)图像,与原始计划CT图像基于骨性解剖结构进行刚体配准,勾画出CBCT图像直肠轮廓并映射回原始计划CT图像,分析直肠体积与位置变化并评价直肠接受≥45 Gy体积占总体积百分比(V₄₅)改变。直肠体积与 V₄₅相关性分析采用Spearman法。结果 10例患者共采集227次CBCT图像进行分析,其中直肠体积变化为(35.0±7.3)~(97.7±14.7) cm³,直肠中心位移左右方向为(0.14±0.06) cm、前后方向为(0.24±0.10) cm、头脚方向为(0.55±0.28) cm,直肠 V₄₅为(9.19±2.46)%~(60.54±11.67)%。直肠体积与 V₄₅相关性分析显示 7例患者呈正相关(r=0.582~0.743,P值均<0.01);治疗中 V₄₅≤50%次数共68次,占30.0%。结论 宫颈癌IMRT中直肠体积与位置及其实际吸收剂量在分次放疗间变化较大,大部分患者体积与 V₄₅之间呈正相关。     

Impact of changes in bladder and rectal filling volume on organ motion and dose distribution of the bladder in radiotherapy for urinary bladder cancer

PURPOSE: To determine the impact of filling volume changes of the urinary bladder and rectum on organ motion and dose distribution of the bladder and rectum during radical radiotherapy for bladder cancer and to calculate the internal margins to secure target coverage. METHODS AND MATERIALS: In 15 patients with muscle-invasive bladder cancer, a planning CT scan was performed with a bladder and rectal catheter, followed by three immediate CT scans with various filling of the urinary bladder and rectum. After 20 fractions, a fifth CT scan, without catherization, was performed. In each CT study, the bladder and rectum volumes were delineated and matched to the planning CT scan to measure the organ motion and calculate internal margins. These margins were compared with an isotropic standard margin of 2 cm. Dose-volume histograms were analyzed to describe the dose distribution in the bladder and rectum corresponding to various filling volumes. RESULTS: Bladder movement was most pronounced in the anterior and cranial directions. The internal margins required to cover the bladder movements due to filling of the bladder and rectum in 87% of the patients were 2.4 cm in the anterior, 1.1 cm in the posterior, 3.5 cm in the cranial, 0.5 cm in the caudal, and 1.3 cm in the lateral direction. CONCLUSION: The filling volumes of the bladder and rectum have a large impact on bladder movements, especially in the anterior and cranial directions. This should be included in the internal target volume with the introduction of anisotropic margins in conformal radiotherapy for bladder cancer.