食管癌胃癌多发家族1例报告

食管癌胃癌多发家族１例报告刘旺元，陆秀珍恶性肿瘤多发家族国内外均有报道。我们发现１例食管癌、胃癌多发家族、现报告如下。先证者（Ⅲ１８）男，３６岁，１９９３年１２月因进行性吞咽困难三月余，经上消化道造影诊断为食管中段癌，行根治性手术，病理报告为鳞癌，术...     

家族性白血病1例

1病例介绍 1.1例1,男,46岁,农民.因头昏、乏力2周于1998年10月8日入华西医大附院血液科二部.入院前2周出现头昏、乏力,面色苍白,无发热、无出血征.入院前1天当地查血异常来诊.家族史:其父亲、姐姐均死于白血病(具体类型不详).     

家族性乳腺癌与散发性乳腺癌的临床生物学特性分析

目的比较家族性乳腺癌与散发性乳腺癌的临床和分子生物学特性，探讨家族性乳腺癌的临床特点和预后。方法回顾性分析河北医科大学第四医院外科2005年6月至2006年5月收治的681例乳腺癌患者的临床资料，其中家族性乳腺癌18例，散发性乳腺癌663例，比较两组间临床生物学行为特点。结果家族性乳腺癌的组织学分级Ⅲ级比例（44．4％）明显高于散发性乳腺癌（17．2％），两组间差异有统计学意义（Х^2=9．943，P=0．007）；家族性乳腺癌的ER阴性率（50．0％）高于散发性乳腺癌（27．0％），两组间差异有统计学意义（Х^2=6．203，P=0．045）；家族性乳腺癌的VEGF表达阳性率（44．4％）高于散发性乳腺癌（21．9％），两组间差异有统计学意义（Х^2=6．783，P=0．034）。但家族性乳腺癌和散发性乳腺癌患者在年龄分布（Х^2=0．505，P=0．918），绝经状况（Х^2=0．915，P=0．633），肿瘤大小（Х^2=1．595，P=0．660），临床分期（Х^2=1．882，P：0．597），病理类型（Х^2=2．430，P=0．876），腋淋巴结转移率（Х^2=0．999，P=0．607），PR（Х^2=3．088，P=0．214）及C—erbB-2表达（Х^2=3．094，P=0．213）等方面的差异均无统计学意义。结论家族性乳腺癌的组织学分级、ER阴性率、VEGF表达阳性率均明显高于散发性乳腺癌，提示预后较差。     

479例乳腺DCIS的回顾性分析研究

目的：探讨乳腺导管原位癌（ｄｕｃｔａｌ ｃａｒｃｉｎｏｍａ ｉｎ ｓｉｔｕ，ＤＣＩＳ）的发病趋势及治疗模式的变化。方法：以１９８２￣１９９５年Ｈａｒｔｆｏｒｄ医院诊治的４７９例乳腺ＤＣＩＳ病人为研究对象，进行回顾性分析研究。结果：乳腺ＤＣＩＳ占人武部乳腺癌的比例由１９８２年的３．３０％上升到１９９５年的１７．３５％，这种趋势发生在４０岁以上的各年龄组中且上升最明显的年龄组是４０￣４９岁。乳腺ＤＣＩＳ病人的治疗模式中，乳腺切除术由１００．００降至２１．９５％，局部切除术辅以放射治疗或者单纯局部切除术由０．００上升至７８．０５％。结论：近２０年来，乳腺ＤＣＩＳ的发病较前明显增多，其发病年龄趋于年轻化。乳腺ＤＣＩＳ的常用治疗方法是保守手术辅以术后放射治疗。     

乳腺软组织骨化性纤维黏液样肿瘤1例

1临床资料 患者,女性,26岁,因发现左乳肿块两年余入院。B超检查示：双乳小叶增生,左乳偏低回声团（大的病灶内伴钙化斑,RI值偏高）。专科体检左乳腺上方12点钟距乳头约3cm处扪及一肿块,大小3.0cm×2.0cm×2.0cm,表面光滑,边界尚清,活动可,无压痛,左乳外下5点钟位置乳晕边缘扪及一肿块大小约1．0cm×1．0cm×0．8cm,质中,边界清,活动可,无压痛。     

肿瘤高发家族一宗报告

1临床资料先证者(Ⅲ-10)女,46岁,汉族。河北邯郸人。17岁时发现颈部肿大,疲乏无力,气促,身体消瘦。在当地医院就诊,被诊断为结节性甲状腺肿。此后定期检查,服药。2002年8月(43岁),体检发现右侧甲状腺有一肿物,大小约3cm×3cm,无触压痛,经放射性核素甲状腺血管造影及临床检查诊断为:“甲状腺肿物”。患者身高164cm,体重48kg,智力和身体发育正常,营养中等。血压、心肺未见异常。锁骨上未触及肿大的淋巴结。于2002年9月2日在我院外科局麻下行甲状腺部分切除术。术中见肿物位于甲状腺右叶,约3cm×3cm×2cm大小,质硬。甲状腺左叶有一约1cm×1cm结…     

巨大乳腺交界性叶状肿瘤诊治一例

<正>乳腺叶状肿瘤（phyllodes tumor of the breast,PTB）是由乳腺上皮组织和纤维结缔组织组成的纤维上皮性肿瘤,其主要表现为乳房无痛性肿块,临床易误诊,需与乳腺纤维腺瘤（breast fibroadenoma,BF）相鉴别。本文从首都医科大学附属北京中医医院乳腺科收治的1例巨大PTB患者入手进行分析,旨在提高对PTB的认识。     

碰撞性肿瘤：附3例报告

碰撞性肿瘤（附３例报告）王明树主治医师王天昌，郭伯璋齐齐哈尔医学院二附院外科（１６１００６）１９９０年以来，收治碰撞性肿瘤３例报告如下。例１：女３４岁，左乳头溃疡流黄水６个月，左乳肿物２个月住院。查体：左乳头有０．６ｃｍ×０．５ｃｍ溃疡，表面有薄黄色...     

家族性白血病6例报告

 目的 探讨家族性白血病的发病因素、临床类型及预后.方法 分析我院收治的6例父子家族性白血病临床表现、诊治经过及转归.结果 以父子或父女发病,白血病类型1组相同,2组为非同系,生存时间比同期、同类型白血病短.结论 家族性白血病与遗传和/或环境因素有关.发病类型相差大,呈随机发病,临床表现极为相似.生存时间明显缩短,预后差.     

乳腺导管内原位癌术后左锁骨上淋巴结转移一例报道

乳腺导管内原位癌（ductal carcinoma insitu,DCIS）占乳腺癌的10％,占所有乳腺X线照相诊断为乳腺肿瘤的20％～30％[1]“。DCIS术后预后好。综合文献资料只有1％～2％的腋窝淋巴结转移率[2]。本院1例DCIS术后5年后发生左锁骨上淋巴结转移。     

Growth pattern of ductal carcinoma in situ (DCIS): a retrospective analysis based on mammographic findings.

The aim of this study was to obtain information concerning the direction and rates of growth of ductal carcinoma in situ (DCIS). The previous mammograms of 124 women diagnosed with DCIS were examined. If in retrospect calcifications were present on the previous examination, the exact size and position were recorded on both diagnostic and previous imaging. The rates of change and direction of change in extent of calcifications were calculated. 39 women with a diagnosis of DCIS in retrospect had calcifications visible on both their current and prior examinations; these formed the study group. For individual clusters of calcification, change occurred along an axis to the nipple at a mean of 5.5 mm y(-1)and along an axis at 90 degrees to the nipple at 2.6 mm y(-1). Increase in calcifications along the axis to the nipple occurred at 2.6 mm y(-1)toward and 2.8 mm y(-1)away from the nipple. Increase in the axis to the nipple occurred at 1.8 mm y(-1)for low grade, 4.2 mm y(-1)for intermediate grade and 7.1 mm y(-1)for high grade. DCIS growth along an axis to the nipple occurs at over twice the rate of growth in the other direction(s) and growth toward and away from the nipple occurred equally. Growth rates increased with increasing nuclear grade of DCIS. These results validate nuclear grading of DCIS. Additionally, the results suggest that increased importance should be placed on identifying the 'nipple' and 'anti-nipple' margins of DCIS represented by calcifications for both surgical excision and pathological scrutiny.     

Ductal carcinoma in situ (DCIS) of the breast: perspectives on biology and controversies in current management

The incidence of ductal carcinoma in situ (DCIS) has increased because of increasing use of sensitive imaging modalities. MRI is commonly used for the detection of breast cancer but has not yet been validated in randomized trials. There have not been randomized trials addressing optimal margins of excision or axillary sampling. Whole breast radiation after lumpectomy decreases the risk of recurrence but may be omitted in selected patients. Adjuvant Tamoxifen reduces the risk of recurrence but has no impact on overall survival rates.     

从原位癌到微小浸润：乳腺肿瘤的临床病理分析及对外科治疗的影响

背景对乳腺原位癌（CIS）是否应进行前哨淋巴结活检（SLNB）目前仍处于争议中。临床诊疗中常遇到：一些在术前穿刺或术中活检被诊断为原位癌且未进行SLNB的患者,术后却经病理确诊为乳腺微小浸润性癌（MIBC）。此时,是否二次手术进行腋窝淋巴结状态评估对外科医师来说是一个困难的选择。一方面,MIBC淋巴结转移风险尚不明确;另一方面,再次手术时SLNB的准确性及可操作性往往受到质疑,多数情况下腋窝淋巴结清扫成为唯一的选择。目的识别原位癌伴发微小浸润的危险因素;比较CIS和MIBC腋窝淋巴结的转移风险;探索选择合适的病例直接进行术中前哨淋巴结活检以避免二次手术的合理性。方法对接受手术且经病理确诊的乳腺原位癌（493例）及微小浸润癌（199例）患者的临床病历资料进行回顾性的统计分析;采用Pearson卡方检验和Fisher确切概率法进行组间比对;通过单因素分析和多因素Logistic回归识别原位癌伴发微小浸润的危险因素。结果原位癌组中出现4例小叶原位癌（LCIS）,其余均为导管原位癌（DCIS）,而MIBC所伴发的原位癌均以DCIS为主。单因素分析显示,X线片BI-RADS≥4级的钙化,肿瘤﹥2.5 cm,高级别DCIS,ER（－）,PR （－）,HER-2（+++）是原位癌伴微小浸润的危险因素（P均﹤0.05）;Ki-67≥20%也可能与发生微小浸润有关（P=0.057）。使用Logistic回归将重要协变量（年龄）与上述危险因素一起进行多因素分析显示,年龄﹥50岁（P=0.034）,肿瘤﹥2.5 cm（P=0.033）,高级别DCIS（P=0.011）等是原位癌伴微小浸润的独立危险因素。此外,相对于2.0%的原位癌淋巴结转移概率,MIBC的淋巴结转移概率为5.5%,二者比较差异具有统计学意义（P=0.029）。结论 MIBC淋巴结转移风险为5.5%,多伴发于患者年龄超过50岁的较大范围的高级别DCIS中。目前来说,对合并这些高风险因素的原位癌患者直接进行SLNB是一种合理和稳妥的诊治手段,可以有效避免二次手术的发生并为下一步治疗提供依据。     

乳腺周围型乳头状瘤与导管原位癌的临床、病理诊断、鉴别诊断

目的:探讨乳腺周围型乳头状瘤与导管原位癌的临床特点,病理诊断与鉴别诊断。方法:HE及免疫组化SP法检测轻度乳腺周围型乳头状瘤14例、重度乳腺周围型乳头状病4例和导管原位癌8例中SMA、34βE12、Ki-67、p53的蛋白表达情况。结果:SMA在轻度周围型乳头状瘤肌上皮呈阳性表达,表达完整,在重度周围型乳头状瘤呈阳性表达,表达完整,与正常乳腺导管相比轻度变薄,在导管原位癌呈阴性或个别细胞阳性表达,34βE12在轻度周围型乳头状瘤、重度周围型乳头状瘤和导管原位癌中小型导管上皮细胞膜和细胞质阳性表达率分别为85.7%、75.0%、25.0%,Ki-67蛋白表达分别为21.4%、50.0%、75.0%,p53蛋白表达分别为12.8%、25.0%、87.5%。轻度与重度周围型乳头状瘤及导管原位癌组比较均有差异。结论:重度周围型乳头状瘤是重要的癌前病变,有时仅凭组织形态学难与导管原位癌鉴别,需结合SMA、34βE12、Ki-67、p53表达的差异进一步进行鉴别,才能得出正确的诊断。     

甲状旁腺腺瘤并多器官功能不全一例报告并文献复习

甲状旁腺是重要的内分泌腺体,主要调节人体钙磷代谢[1],甲状旁腺腺瘤是一种少见的原发于甲状旁腺的良性肿瘤,由甲状旁腺腺瘤引发的甲状旁腺功能亢进症约占90%左右,是原发性甲状旁腺功能亢进的最主要原因[2]。近年来随着甲状腺体检普及而发病率略有提高,手术切除是甲状旁腺腺瘤最主要的治疗方法[3]。本研究对收治的1例甲状旁腺腺瘤并多器官功能不全患者的资料进行分析,结果报道如下。     

A case of noninvasive ductal carcinoma arising in malignant phyllodes tumor

We report on an exceedingly rare case of noninvasive ductal carcinoma arising in malignant phyllodes tumor of the breast. The patient was a 75-year-old woman who presented with a chief complaint of an indolent tumor mass of the left breast. Papillotubular carcinoma was diagnosed by aspiration cytology, and mastectomy with preservation of the pectoral muscle was subsequently performed (Bt+Ax+Ic, R2). Histopathological examination showed proliferation of monotonous, uniform tumor cells in a cribriform pattern amid atypical and spindle-shaped cells. Neither stromal invasion of the epithelial tumor cells nor clear transition between epithelial tumor cells and non-epithelial tumor cells was seen. Immunohistochemical staining revealed that the epithelial component was positive for antibodies such as CEA, EMA and keratin, while the non-epithelial component was negative for the same antibodies. Malignant phyllodes tumor with a noninvasive ductal carcinoma was diagnosed rather than true carcinosarcoma of the breast. No metastasis was detected in the axillary lymph nodes, and the patient was classified as stage II A (T2N0M0). Although neither chemoendocrine therapy nor irradiation was employed postoperatively, no recurrence was observed two years and two months after the surgery. There is little consensus on the treatment or prognosis of the disease. Careful observation of the present case is therefore important.     

Radiation therapy for ductal carcinoma in situ: a decision analysis

BACKGROUND:

The benefit of adding radiation therapy after excision of ductal carcinoma in situ (DCIS) is widely debated. Randomized clinical trials are underpowered to delineate long‐term outcomes after radiation.

METHODS:

The authors of this report constructed a Markov decision model to simulate the clinical course of DCIS in a woman aged 60 years who received treatment with either of 2 breast‐conserving strategies: excision alone or excision plus radiation therapy. Sensitivity analyses were used to study the influence of risk of local recurrence, likelihood of invasive disease at recurrence, surgical choice at recurrence, and patient age at diagnosis on treatment outcomes.

RESULTS:

The addition of radiation therapy was associated with slight improvements in invasive disease‐free and overall survival. However, radiation therapy decreased the chance of having both breasts intact over a patient's lifetime. Radiation therapy improved survival by 2.1 months for women who were diagnosed with DCIS at age 60 years but decreased the chance of having both breasts by 8.6% relative to excision alone. The differences in outcomes between the treatment strategies became smaller with increasing age at diagnosis. Sensitivity analyses revealed a greater benefit for radiation with an increased likelihood of invasive recurrence. The decrement in breast preservation with radiation therapy was mitigated by an increased likelihood of mastectomy at the time of recurrence or new breast cancer diagnosis.

CONCLUSIONS:

The current analysis quantified the benefits of radiation after excision of DCIS but also revealed that radiation therapy may increase the likelihood of eventual mastectomy. Therefore, the authors concluded that patient age and preferences should be considered when making the decision to add or forgo radiation for DCIS. Cancer 2012;. © 2011 American Cancer Society.     

乳腺导管原位癌的间质微浸润危险因素分析

目的：分析乳腺导管原位癌（ductal carcinoma in situ,DCIS）间质微浸润的危险因素,探讨导管原位癌伴微浸润（ductal carcinoma in situ with microinvasion,DCIS-MI）患者的腋窝淋巴结术式。方法：回顾性分析2013年2 月至2016年2 月南京大学医学院附属金陵医院经手术后病理证实为DCIS、DCIS-MI 共45例患者临床资料,依据是否伴微浸润分为DCIS与DCIS-MI 组,对患者年龄、就诊时是否绝经、肿瘤大小等因素行统计学分析。结果：就诊时未绝经（P = 0.006）、肿物直径≥ 3.15cm（P = 0.006）、有恶性肿瘤家族史（P = 0.002）的患者更易发生肿瘤间质微浸润。结论：具有可触及腋窝肿物、未绝经、乳腺巨大肿物、有恶性肿瘤家族史危险因素,同时术前行穿刺或术中冰冻提示DCIS、DCIS伴可疑微浸润的患者存在微浸润可能性大,应予前哨淋巴结活检。触及腋窝肿物为首要症状患者,腋窝淋巴结清扫术应作为首选方式。