恩度联合EP方案治疗小细胞肺癌的临床疗效

[目的]观察恩度联合EP方案治疗晚期小细胞肺癌的临床疗效.[方法]40例晚期小细胞肺癌患者随机分为两组,观察组20例行EP方案d1～14加15 mg/d恩度治疗,对照组的20例仅采用EP方案治疗,1个周期为21 d,治疗2周期后比较两组的治疗效果.[结果]观察组有效率为70%,对照组有效率为45%,两组相比较差异具有统...     

Primary small cell carcinoma of the esophagus: Case presentation and review of the literature

A case of primary small cell carcinoma of the esophagus is presented. The clinical, radiologic, and pathologic findings of our case and 72 other cases were reviewed. The most common presenting symptoms were weight loss and dysphagia. Eighty percent were larger than 4 cm at presentation and 97% were in the mid to distal esophagus. The esophageal tumors were identical histologically to small cell carcinoma of the lung. Esophageal luminal widening on esophagram has been found to be more common in nonsquamous cell carcinomas. While rare, small cell carcinoma should be considered in the differential diagnosis of primary esophageal tumors, particularly in the presence of these findings.     

小肠原发性鳞状细胞癌临床病理观察

目的探讨小肠原发性鳞状细胞癌的临床及病理学特征。方法通过组织病理学及免疫组化方法对1例小肠原发性鳞状细胞癌进行观察,探讨其发病机制并复习相关文献。结果 1例发生于近端回肠的鳞状细胞癌,其病理组织学特征与发生于其他部位(宫颈、食道、皮肤)的鳞状细胞癌相同,并可找到鳞状细胞癌与正常小肠黏膜腺上皮之间的移行过渡区。免疫组化:肿瘤细胞34βE12、AE1/AE3、CK5/6和p63(),CK20、NSE、Syn和CgA(-)。结论原发于小肠的鳞状细胞癌非常罕见,需与继发性鳞癌、腺鳞癌、类癌及其他神经内分泌癌等相鉴别,其发病机制尚不清楚,可能与腺上皮细胞鳞化进而继发性恶变有关。     

柴胡对人食管癌细胞株Eca-109的抑制作用

目的:探讨中药柴胡对人食管癌细胞株Eca-109的抑制作用。方法:体外培养人食管癌细胞株(Eca-109),分别给以不同浓度的柴胡溶液对体外培养的Eca-109细胞株进行干预。以MTT比色法测定柴胡溶液对Eca-109细胞株的抑制增殖的作用,计算其细胞增殖存活率。结果:MTT实验显示柴胡溶液可以明显抑制Eca-109细胞株的增殖。用药后Eca-109细胞增殖存活率下降幅度与剂量呈正相。结论:中药柴胡在体外具有抗肿瘤作用,其机制是抑制肿瘤细胞增殖,及抑制细胞的分化而达到抗肿瘤的目的。     

晚期非小细胞肺癌放化疗疗效观察

目的探讨同步放化疗与序贯化放疗治疗晚期非小细胞肺癌临床疗效及毒副反应。方法60例经病理或细胞学证实为非小细胞肺癌患者,鳞癌31例,腺癌23例,大细胞癌2例,未定型癌4例。经CT或MRI可测值病灶分期Ⅲa15例,Ⅲb30例,Ⅳ15例;年龄在21—86岁;Kamofsky评分／〉70;被随机分为A、B两组。A组30例为：序贯方法,即化疗＋放疗＋化疗;B组30例为：同步化放疗（周一-五放疗,周六化疗）＋化疗。结果近期疗效：PR＋CR：B组明显好于A组,差异有显著性。毒副作用：胃肠反应B组高于A组,骨髓抑制A组高于B组,差异有统计学意义。结论晚期非小细胞肺癌同步化放疗近期疗效明显优于序贯化放疗,而毒副作用没明显增加,更远期疗效尚待进一步观察。     

原发性卵巢小细胞癌（高钙血症型）一例临床病理分析并文献复习

【目的】探讨原发性卵巢小细胞癌（高钙血症型）（OSCCHT）的临床病理特征,并对其诊断和鉴别诊断进行讨论。【方法】报告1例卵巢OSCCHT并结合文献对其临床病理特征进行分析。【结果】原发性卵巢小细胞癌是卵巢的一种起源不明确的少见的高度恶性小细胞肿瘤,其病理组织学分型包括高钙血症型和肺型,0SCCHT2／3患者伴血钙升高,肿瘤摘除后血钙恢复正常,组织学特点主要由大小较一致的小细胞组成,可见散在分布的滤泡样结构,40％肿瘤内出现大细胞。【结论】本病预后差,联合治疗（特别是放疗）可能延长生存时间。     

环氧合酶-2对非小细胞肺癌血管生成及预后的影响

目的研究环氧合酶-2（COX-2）在非小细胞肺癌（NSCLC）中的表达及其对血管生成和预后的影响。方法随访手术切除且临床资料完整的48例非小细胞肺癌患者,采用免疫组织化学技术检测活检标本中COX-2、血管内皮生长因子（VEGF）表达和微血管密度（MVD）。通过生存曲线法比较阳性组和阴性组患者的预后情况。结果COX-2在非小细胞肺癌组织中阳性表达率为66.7%（32/48）,与VEGF表达68.8%（33/48）呈显著正相关（r=0.687,P〈0.01）,COX-2与淋巴结转移、组织分型、肺癌分期及较短生存期具有相关性。MVD随COX-2、VEGF表达增强而增高。结论COX-2的高表达可使VEGF表达上调,促进肿瘤血管形成,增加微血管密度。COX-2在非小细胞肺癌组织中高表达与肿瘤血管生成密切相关,可作为预测非小细胞肺癌预后的一种有用指标。     

原发性肝癌淋巴结转移的临床分析 ——附57例报告

目的：探讨原发性肝癌（肝癌）淋巴结转移的临床表现、病理特点与预后。方法：将肝癌伴淋巴结转移的57例患者设为转移组,同期不伴淋巴结转移的50例肝癌患者为非转移组,比较2组的临床、病理特点和预后等情况。结果与结论：与非转移组比较,转移组的临床表现缺乏特异性;肝癌病灶最大直径等于或超过5cm、肿瘤包膜不完整、病理Ⅲ-Ⅳ级者多见;术后1年生存率低。提示伴淋巴结转移是影响肝癌预后的重要因素。     

食管鳞状细胞癌并发食管胃肠间质瘤临床病理观察

目的 探讨食管鳞状细胞癌并发食管胃肠间质瘤的临床病理学特征及鉴别诊断要点.方法 观察1例食管癌并发食管间质瘤的病理形态和免疫组化特点,并进行文献复习和讨论.结果 患者女性,77岁.进食哽噎20余天.巨检见食管黏膜局部有一息肉状肿物突入管腔,紧邻该肿物另见一溃疡型肿物;镜检见食管鳞状细胞癌细胞多为基底细胞型,呈巢状、弥漫排列,侵及肌层;食管间质瘤由梭形细胞和上皮样细胞组成,呈束状、编织状排列,病理核分裂象＞ 10个/50HPF.免疫组化标记CD117呈强(+).结论 食管鳞状细胞癌并发食管间质瘤属少见的消化道恶性肿瘤,掌握临床病理及免疫组化特征对该病的诊断与鉴别诊断具有重要意义.     

化疗及放化疗联合治疗局部晚期非小细胞肺癌的临床研究

【目的】比较单纯化疗与放化疗联合治疗局部晚期非小细胞肺癌（NSCLC）的疗效及毒性反应。【方法]56例不能手术的局部晚期NSCLC患者按治疗方法不同分为单纯化疗组31例（A组）,放化疗联合组25例（B组）,对比两组疗效及安全性。【结果】治疗有效率、中位生存期及1、3年生存率A组分别为38．7％、8．8个月、29％和0,B组分别为68％、13．5个月、56％和8％,B组较A组明显提高,差异有显著性（P〈0．05）。白细胞减少、血小板减少及消化道反应A组发生率分别为48．4％、16．1％和71％,B组分别为72％、20％和80％,两组相比差异均无显著性（P〉0．05）。【结论】对不能手术的局部晚期NSCLC采用放化疗联合治疗优于单纯化疗,且毒副反应能耐受。     

Radiation therapy of esophageal carcinoma: Correlation of clinical and radiographic findings

Seventeen patients with esophageal carcinoma treated by radiation therapy (RT) at our hospital between 1981 and 1984 had initial diagnostic esophagrams and 1 or more repeat esophagrams after completing RT. Total regression of the tumor was observed radiographically in 10 patients (59%) with a normal esophagus (24%) or benign-appearing residual stricture (35%) at the site of the previous lesion. Partial regression was observed in 4 patients, and progression of the tumor in 3. No correlation was found between the size, stage, or morphology of the lesion and its response to therapy. Although local recurrences were relatively uncommon, patient survival was often limited by the development of distant metastases. Fourteen of 15 patients with clinical followup initially had significant relief from dysphagia as the tumor regressed. However, 9 of those patients had recurrent or increased dysphagia over a subsequent 3–9-month period. Exacerbation of symptoms did not necessarily indicate recurrent carcinoma; it also resulted from benign radiation strictures, opportunistic esophagitis, or other complications of RT detected on esophagography.     

Metastatic thyroid carcinoma presenting as an expansile intraluminal esophageal mass

We report a patient with metastatic thyroid carcinoma invading the esophagus in whom barium and MR examinations revealed an expansile intraluminal mass indistinguishable from that of a primary esophageal malignancy. Metastatic thyroid carcinoma should therefore be included in the differential diagnosis of an expansile esophageal mass. As in our patient, MR imaging may be useful for showing that the mass originates in the thyroid gland.     

The value of PIVKA-Ⅱ versus AFP for the diagnosis and detection of postoperative changes in hepatocellular carcinoma

ObjectiveTo explore the diagnostic value of abnormal prothrombin Ⅱ (PIVKA-Ⅱ) and alpha-fetoprotein (AFP) in primary hepatocellular carcinoma (HCC).MethodsFrom 2018 0.01 to 2020.01, there were 158 patients with primary liver cancer caused by chronic hepatitis B (male 116, women 42) and 62 patients with chronic hepatitis B (male 34, female 28). The levels of serum PIVKA-Ⅱ and AFP were measured, and the results were statistically analyzed.ResultsThe value of PIVKA-Ⅱin liver cancer group was distinctly higher than that in chronic viral hepatitis B group, the difference is statistically significant (P ​< ​0.05). So does the value of AFP. Draw the subject working characteristic curve (ROC curve), the area under the curve of AFP and PIVKA-Ⅱ is 0.799 and 0.836, and that of the combination of AFP and PIVKA-Ⅱ is 0.854, the sensitivity is 57.6%,68.4%,72.2%,respectively, the specificity is 93.5%, 98.4%, 96.8%, respectively. After operation or interventional therapy, the value of PIVKA-Ⅱ in liver cancer group was clearly lower than that before treatment, and the difference was statistically significant.ConclusionIn the diagnostic value of primary liver cancer, PIVKA-II combined with AFP is higher than PIVKA-II, while AFP has the lowest benefit. We also find that PIVKA-II has higher disease monitoring value than AFP.     

免疫组化在肺小细胞癌支气管镜活检标本鉴别诊断中的应用

目的探讨免疫组化在肺小细胞癌和鳞状细胞癌鉴别诊断中的作用。方法应用免疫组化SP法,选择支气管镜活检标本病理形态疑似SCLC与低分化SCC共29例,检测CD56、PAX-5、TTF1、CgA、Syn、CK5/6及P63蛋白表达,分析SCLC的病理形态特征和免疫表型特点及其与SCC的鉴别。结果 29例支气管镜活检标本形态学观察SCLC与低分化SCC常有形态学重叠。免疫组化蛋白表达,CD56阳性21例,PAX-5阳性15例,TTF1阳性21例,CgA和（或）Syn阳性19例,CK5/6阳性8例,P63阳性9例。标记后诊断SCLC共21例,诊断低分化SCC共8例。分析SCLC与SCC的蛋白表达,各项指标均存在显著差异（P〈0.001）。结论 SCLC与SCC的蛋白表达存在显著差异,联合检测多种免疫组化指标,能够准确鉴别这两种类型的肺癌。     

原发性输卵管癌25例临床分析

目的：探讨原发性输卵管癌的临床特征及预后。方法：对25例经病理确诊的原发性输卵管癌患者临床资料进行分析。结果：25例原发性输卵管癌患者占同期住院妇辞垩性肿瘤患者的0．92％,其中有阴道排液、盆腔疼痛、盆腔包块中的2项者占60％。术前行糖链抗原125（CA125）检查18例,超过正常值11例（61％）。均为Ⅱ期及以上患者。术前行B超检查22例,均发现盆腔包块。Ⅰ期7例患者行全子宫加双侧附件切除;Ⅱ期及以上18例患者行肿瘤分期手术或肿瘤细胞减灭术,术后予以紫杉醇联合卡铂（TP）方案或环磷酰胺、阿霉素联合卡铂（CAP）方案化学治疗6—8个疗程。化学治疗3个疗程内CA125降至正常10例,另1例在将化学治疗方案从CAP更改为TP方案后逐渐降至正常。随访9—118个月,失访4例;本组3年存活率48％。术后残留癌灶与原发性输卵管癌的预后有关。结论：原发性输卵管癌症状不典型,临床诊断盆腔包块时要注意原发性输卵管癌的可能,确诊后要行规范化治疗,以改善患者预后。     

编码谐波超声血流成像诊断原发性小肝癌的应用价值

目的运用编码谐波血管造影技术观察原发性小肝癌造影成像特点,探讨该方法对原发性小肝癌定性诊断的临床应用价值.方法经左前臂浅静脉注射氟碳造影剂,对22例患者共24个病灶进行编码谐波血管造影检查,观察肿块区域血管显影时间、血管分布,并比较肿块与肝实质造影增强情况.所有病例造影前后表现均同步录像.结果注射造影剂后15～20秒肿块开始显影,60～90秒达到高峰,持续时间约200～260秒,肿块周围血管显影较正常肝组织早,形成环状浓染,大部分肿块增强程度高于正常肝组织;少部分为不增强团块(17%).结论编码谐波血管造影能实时观察原发性小肝癌的造影成像特点,对小肝癌的定性诊断有较高的临床应用价值.     

Radiographic microstructures of early esophageal carcinoma: Correlation of specimen radiography with pathologic findings and clinical radiography

To clarify the exact radiologic features of mucosal carcinoma of the esophagus with a favorable prognosis, contact radiography was performed on 8 surgical specimens diagnosed preoperatively as showing early or superficial carcinoma. Mucosal carcinoma appeared as a well-defined smooth or nodular protrusion or as a feathered flat mucosa with tiny nodulations and barium poolings. Submucosal carcinoma showed a mound-like defect. The size of tumor was not a good index for estimating the depth of invasion. Protruded lesions were easily demonstrated on clinical radiographs and their profile was useful in determining the depth of invasion. Flat lesions were not easy to recognize; attention must therefore be paid not only to mucosal patterns but also to the contour of the esophageal wall.     

消化管小细胞癌的临床病理研究

报道１０例消化管小细胞癌。组织学形态分为三型：小细胞型６例，中间细胞型２例，混合细胞型２例，其中３例出现灶性鳞状分化，２例腺样分化。免疫组化结果显示Ｋｅｒａｔｉｎ阳性５例，ＥＭＡ阳性５例，４例ＮＳＥ和ｃｈｒｏｍｏｇｒａｎｉｎ－Ａ阳性。支持此瘤的组织发生可能是全能干细胞来源学说。