纤维板层型肝癌二例报道及文献复习

 目的　分析纤维板层型肝癌（FL-HCC）的临床表现、影像学特点及病理情况,提高对FL-HCC的认识。方法　回顾性分析经手术治疗的2例FL-HCC患者的临床资料。结果　2例患者男女各1例,发病年龄均＜40岁,其中1例合并乙型肝炎感染,1例乙型肝炎病毒指标阴性,甲胎蛋白、癌胚抗原均正常,增强CT检查提示肿瘤动脉期明显强化,1例肿瘤内部见钙化。2例均成功行手术治疗, 1例术后8个月肝内单病灶复发,1例随访16个月无复发。结论　FL-HCC临床少见,多见于青年人,多不合并乙型肝炎感染,影像学检查动脉期强化,门脉期去强化,可有肿瘤钙化。手术治疗是首选的治疗方法,术后预后较好。     

纤维板层型肝癌二例报道及文献复习

Objective To investigate the clinical features,imaging and pathologic findings of fibrolamellar hepatocellular carcinoma (FL-HCC).Methods Clinical data from 2 patients with FL-HCC confirmed by operation were analyzed retrospectively.Results There were 1 man and 1 woman,both of them were younger than 40 years.The man had hepatitis B,the woman did not have underlying hepatitis.The 2 patients had a normal hepatic function and α-fetoprotein level.Under dynamic contrast material-enhanced computed tomography,hepatic arterial phase CT images demonstrated heterogeneous enhancement of the tumor.Calcification was depicted in the CT images of 1 patients.Both of them underwent a successful operation.After 8 months of follow-up,1 patient had recurrence.And the other patient had no evidence of recurrence during 16 months follow-up time.Conclusion FL-HCC is a rare liver tumor that has distinct clinicopathologic features comparing with hepatocellular carcinoma.Most of FL-HCC occurs in young patients with normal level of α-fetoprotein and no history of hepatitis.Tumors may have calcification and become predominantly on hepatic arterial phase CT images.The most effective treatment for FL-HCC is surgical resection and prognosis is good.     

纤维板层型肝癌二例报告

纤维板层型肝癌二例报告山东省寿光市人民医院（寿光市２６２７００）袁永胜王滨张献忠王洪波纤维板层型肝癌（Ｆｉｂｒｏｌａｍｅｌａｎｃａｒｃｉｎｏｍａｏｆｌｉｖｅｒ，ＦＣＬ）是ＨＣＣ的一个变种，非常罕见，１９５６年Ｅｄｍｏｎｄｓｏｎ对１例进行描述（１），...     

纤维板层型肝细胞癌1例报道及文献复习

目的:提高对纤维板层型肝细胞癌的认识,避免误诊、早期确诊、治疗,改善预后.方法:对纤维板层型肝细胞癌的诊断、治疗及预后做复习.结果:纤维板层型肝细胞癌与普通型肝细胞癌相比,恶性程度低、发展慢、很少转移,更具有手术切除的可能性,可切除率为58%;预后明显好于普通型肝癌.结论:纤维板层型肝细胞癌应尽可能行手术治疗,术后要定期随访,定期CT复查有助于及早发现复发和转移灶.     

纤维板层型肝癌的影像学表现

目的 观察纤维板层型肝癌（ＦＬ－ＨＣＣ）的影像学表现。方法 １１例ＦＬ－ＨＣ互病理证实。做超声波（ＤＳ）检查１０例,ＣＴ扫描１１例,ＭＲＩ８傲因管造影９例。结果 ＵＳ显示肿瘤呈高回声４例,混杂回声６例,４例有大小不一的囊性区,ＤｏｐｐｌｅｒＵＳ提示肿瘤实性部分血供丰富。ＣＴ显示肿瘤单发９例,多个结节融合２例,平扫均为低密度,７例肿块中心区见放射状更低密度区,病理检查为致密胶原瘢痕,４例见点状钙化,     

脑膜癌病二例报道及文献复习

 目的 探讨脑膜癌病（MC）的诊断方法，提高对MC的认识。方法 对2例MC患者的临床资料进行回顾性分析并结合相关文献进行讨论。结果 MC的临床表现具有多样性，但确诊需脑脊液（CSF）细胞学检查。结论 CSF细胞学检查以及全面细致的体格检查，仍为诊断的重要依据     

肺粘膜相关型淋巴瘤1例报道并文献复习

肺粘膜相关型淋巴瘤 (mucosaassociatedlymphoidtissuelymphoma ,简称MALT型淋巴瘤 ) ,因其临床表现 ,影像学改变缺乏特异性而易致误诊。近年来由于病理学和免疫组化技术的发展 ,MALT型淋巴瘤的报道已不罕见[1] 。我科于2 0 0 2年 5月诊治 1例。临床资料患者男 ,73岁 ,玻璃仪器厂退休工人。因发热、咳嗽、气急、盗汗半月 ,胸片示双侧少量胸腔积液于 2 0 0 2年 1月 2日入住当地医院 ,予青霉素抗炎及对症治疗 10天后体温恢复正常 ,但咳嗽、气急、盗汗症状无明显改善。胸片示双侧胸腔积液较前增多 ,左侧明显 ,胸CT示右中叶片状影及双侧胸腔…     

肺癌脊髓内转移二例报道并文献复习

背景与目的 肺癌脊髓内转移病例少见,目前没有标准治疗方案,疗效差.本研究的目的是探讨肺癌脊髓内转移的临床特征、诊断及治疗方法.方法 对我院2005年收治的2例肺癌脊髓内转移患者诊断及治疗过程进行分析,并复习相关文献.结果 两例肺癌脊髓内转移患者进展迅速,疗效差.结论 肺癌脊髓内转移临床表现不典型,MRI为首选诊断方法,放疗为主要治疗手段.该病预后差.     

肾集合管癌1例报道及文献复习

目的:分析起源于肾髓质集合管的集合管癌的临床病理特征及鉴别诊断。方法:对1例肾集合管癌进行大体、光镜及免疫组化观察并结合文献复习。结果:镜下肿瘤呈弥漫性腺管状排列,肿瘤间质纤维性反应性增生。免疫表型肿瘤细胞CK7( ),CK34βE12(-),CEA(-)。结论:肾集合管癌是一种罕见的肾脏恶性上皮性肿瘤,诊断时需与乳头状肾细胞癌、尿路上皮癌及肾髓质癌等鉴别。     

纤维板层型肝癌2例

纤维板层型肝癌(Fibrolamella carcoinoma of live,FLC)是肝细胞癌HCC的一个变种,很罕见,迄今国外报告不足百例,国内尚未见报道,现报道2例如下。     

A light microscopic and ultrastructural study of two cases of fibrolamellar hepatocellular carcinoma

We describe two cases of fibrolamellar hepatocellular carcinoma of the liver in two young women. Both patients presented with diffuse intra-abdominal metastases; nevertheless they had a survival of 28 and 32 months, respectively, which sustains the better prognosis of this neoplasm. Electron microscopy of one case confirmed the oncocytic features of the neoplastic cells and showed intra- and intercellular duct-like vacuoles with numerous microvilli containing a microfilament core that terminated in a terminal web, which represents an unusual aspect in the spectrum of differentiation of fibrolamellar hepatocellular carcinoma.     

Metastatic carcinoma to the tongue: a report of two cases and a review of the literature.

Metastatic tumors of the oral cavity are uncommon. Most of them are located in the mandible while only a small percentage are found within the soft tissues. Two cases of metastatic bronchogenic carcinomas to the tongue are described. Review of the literature showed that cancer of the lung was the most common primary lesion that metastasized to the soft tissues of the oral cavity. The base of the tongue was the most prevalent site of metastases to soft tissue within the oral cavity.     

Refractory Hyperammonemic encephalopathy in Fibrolamellar hepatocellular carcinoma,a case report and literature review

Fibrolamellar hepatocellular carcinoma is a rare type of hepatocellular carcinoma with unclear etiology. Its prevalence ranges from 0.6%-5%. One of the rare manifestations of FHCC includes hyperammonemic hepatic encephalopathy (HAE). Data regarding HAE in FHCC is limited to case reports, and much is unknown, including its precipitating factors, clinical course, and management. We have reported one such case of FHCC associated HAE and presented an extensive literature review on the topic. We report the case of a 26-year-old Pakistani male who was diagnosed with fibrolamellar hepatocellular carcinoma. On day five after the first chemotherapy, he presented with nausea, vomiting, and confusion. His serum ammonia level was raised, and he was treated with lactulose and rifaximin. The patient continued chemotherapy and had recurrent admissions with HAE. A detailed workup revealed acquired ornithine transcarbamylase deficiency. Ammonia level peaked at 694 umol/L during the clinical course of his disease. He received treatment with multiple ammonia scavengers, including sodium benzoate + phenylacetate, with relief of symptoms and reduction in ammonia level. The patient was eventually lost to follow-up. HAE presents as a paraneoplastic manifestation of FHCC. Patients have laboratory features suggestive of acquired ornithine transcarbamylase deficiency. There is a variable frequency of episodes reported in the literature. Most patients respond well to ammonia scavenger therapies rather than conventional HE management with lactulose or rifaxmin.     

肝脏局灶性结节性增生38例临床分析并文献复习

背景与目的:肝脏局灶性结节性增生(focalnodularhyperplasia,FNH)临床上较少见,其诊断标准和治疗方法争论较大。本研究拟探讨FNH的诊断原则和治疗方法。方法:回顾分析中山大学肿瘤防治中心1997年7月～2004年7月收治的38例FNH患者的临床资料并复习文献,对该病的发病特点、临床表现、诊断及治疗方法进行总结。所有患者随访至2004年7月。结果:38例FNH患者中,30例(78.9%)为40岁以下青壮年;26例(68.4%)无临床症状;32例(84.2%)肝功能正常,所有患者AFP均为阴性。B型超声诊断正确率5.3%(2/38),彩色超声诊断正确率45.5%(5/11),超声造影诊断正确率100%(2/2),螺旋CT增强双期扫描诊断正确率36.8%(14/38)。34例(89.5%)行手术切除病灶,1例行穿刺活检加经皮肝动脉栓塞术(transcatheterarterialembolisation,TAE),2例行穿刺活检加瘤内无水酒精注射术(percutaneousethanolinjection,PEI),1例仅行穿刺活检术。患者行切除术后均恢复良好,且无并发症。有2例FNH患者分别于切除术后69个月和32个月复查发现切除处新生病灶,经再次手术切除后病理证实为肝细胞癌。患者行TAE及PEI术后病灶均无明显改变。随访37例患者均生存,另1例患者行PEI术后1年因其他疾病死亡。结论:FNH患者发病隐匿,无明显临床症状,多种影像学联合检查对FNH的诊断及鉴别诊断具有较大价值。明确诊断的无症状FNH患者可密切随访暂不手术。未能确诊、有症状、病灶增大明显或伴有肝炎肝硬化者应考虑手术切除。FNH患者预后较好。     

原发性甲状腺鳞状细胞癌2例病例报道并文献复习

原发性甲状腺鳞状细胞癌是一种临床罕见的甲状腺恶性肿瘤,其恶性程度高,侵袭力强,临床上早期诊断困难,根治手术难度较大,预后极差,中位生存期约6个月。治疗上以手术为主。对于不能行手术治疗的患者,可行放射治疗,放射治疗在一定程度上可提高局控率,化疗方面没有显示明显的优势。     

Metaplastic breast carcinoma with extensive osseous differentiation: a report of two cases and review of the literature

Invasive breast cancer with osseous metaplasia is rare. Here we report two cases of metaplastic breast carcinoma with extensive osseous differentiation. Case 1: The patient was a 60-year-old woman with a right breast tumor, about 4 cm in diameter. Mammogram and ultrasound presented an irregular-shaped mass suspected for malignancy. Core needle biopsy confirmed invasive carcinoma and the patient underwent a modified radical mastectomy. Case 2: The patient was a 48-year-old woman with a left breast tumor, about 3 cm in diameter. Mammogram demonstrated a well-circumscribed mass with extensive dense calcifications. Frozen section biopsy confirmed invasive carcinoma and a modified radical mastectomy was performed. The two patients had no metastatic carcinoma in the axillary lymph nodes and remained free of recurrence and systemic metastases in a 13- and 4-month follow-up period, respectively. Histopathologically, patient 1 had an adenocarcinoma with prominent sarcomatous (osteosarcomatous) differentiation with intervening spindle cells. The sarcomatous areas showed high nuclear atypia, pleomorphism and a high Ki-67 index. In Case 2, the neoplasm consisted of invasive ductal carcinoma of no special type with an osseous metaplasia component and showed a direct transition from the carcinoma to the osseous elements. The distinction between the different types of metaplastic carcinomas, specifically the distinction between benign and malignant metaplastic (osteoid) elements, should be taken into consideration.     

肾黏液性小管状和梭形细胞癌2例报道并文献复习

We reported the clinical and pathologic features of two different types of renal mucinous tubular and spindle cell carcinoma (MTSCC). The first patient was incidentally discovered by health examination, with lower nuclear grade, no part and distant metastasis. The second patient presented with persistence hyperpyrexia, part and distant metastasis, and high nuclear grade. Surgery were both performed successfully. The first patient had no recurrences and no distant metastases. The second patient died of multiple organ failure 3 months postoperatively. Although MTSCC is usually a low potential malignancy carcinoma, high malignancy may occur and lead to a fatal course. So it needs a proper management and prognostication.