乳头血性浆液性分泌物患者X线乳腺导管造影的探讨

自1930年Ries(1)用碘油进行乳腺导管造影诊断乳腺脓肿取得良好效果，及1937年Hickenqa 氏（2）采用此法确诊了导管内的乳头状瘤之后，乳腺导管造影始被人们重视，尤其对某些乳头血性或浆液分泌物患者为了明确导管内的早期病变，常被使用，本法的优点是：诊断符合率高，无副作用，操作简便且安全易行，因此应用较多，今将我院的30例分析总结如下。

手术分期Ⅰ期的子宫乳头状浆液性腺癌患者辅助铂类化疗后存活率的提高

Uterine papillary serous carcinoma (UPSC) is an aggressive form of endometrial cancer characterized by a high recurrence rate and a poor prognosis. Prior studies evaluating treatment of UPSC have been limited by small numbers of patients and inclusion of partially staged patients. The purpose of this study was to evaluate the efficacy of adjuvant platinumbased chemotherapy and vaginal cuff radiation in a large cohort of surgical stage I UPSC patients. Methods. We retrospectively reviewed 74 stage I patients with UPSC who underwent complete surgical staging at our institution between 1987 and 2004. Results. Stage IA patients were divided into two groups: patients with no cancer in the hysterectomy specimen (defined as no residual uterine disease) and patients with cancer in the hysterectomy specimen (defined as residual uterine disease). Stage IA patients with no residual uterine disease had no recurrences, regardless of adjuvant therapy (n = 12). Stage IA patients with residual uterine disease who were treated with platinum-based chemotherapy had no recurrences (n = 7). However, 6 of 14 (43% ) stage IA patients with residual uterine disease who did not receive chemotherapy recurred. The 15 patients with stage IB UPSC who received platinum-based chemotherapy had no recurrences but 10 of the 13 (77% ) stage IB patients who did not receive chemotherapy recurred. One of the 7 patients with stage IC UPSC who received platinum-based chemotherapy recurred and 4 of the 5 (80% ) stage IC patients who did not receive chemotherapy recurred. Overall platinum-based chemotherapy was associated with improved disease-free survival (P < 0.01) and improved overall survival (P < 0.05) in patients with stage I UPSC. None of the 43 patients who received radiation to the vaginal cuff recurred locally, but 6 of the 31 (19% ) patients who were not treated with vaginal radiation recurred at the cuff. Conclusions. Platinum-based chemotherapy improves the disease-free and overall survival of patients with stage I UPSC and vaginal cuff radiation provides local control. Stage IA UPSC patients with no residual uterine disease can be observed but concomitant platinum-based chemotherapy and vaginal cuff radiation (referred to as chemoradiation) should be offered to all other stage I UPSC patients.

16例卵巢外腹膜浆液性乳头状癌临床分析

目的 探讨卵巢外腹膜浆液性乳头状癌 (EPSPC)的临床特点、诊断及鉴别诊断、组织学来源、治疗和预后。方法 对协和医院 1996年到 2 0 0 3年收治的 16例术后诊断为卵巢外腹膜浆液性乳头状癌患者的临床资料进行回顾性分析。结果 除 1例放弃治疗外 ,余 15例患者均施行了肿瘤细胞减灭术 ,术中腹腔放置卡铂 ,术后PAC方案化疗。 9例患者已死亡 ,生存期 6个月到 36个月不等。平均存活期为 19个月 ,4例仍在化疗中 ,2例失去随访。结论 EPSPC为来源于第二苗勒氏系统的恶性肿瘤 ,发病率低 ,误诊率高 。

绝经后巨大卵巢交界性浆液性乳头状囊腺瘤一例

1典型病例 女性．70岁．绝经20年。因下腹坠痛6d于2008年5月4日入院。患者绝经20年，绝经后无异常分泌物，6d前无诱因出现腰痛及下腹坠痛，无发热，二便无异常，体重无下降。入院检查：体温36．5℃．呼吸80次／分，脉博18次份，血压130～80mmHg。患者一般状态良好，轻度贫血外观，心肺未见异常，全腹膨胧，无压痛，无反跳痛，无移动性浊音。妇科检查示外阴老年型，阴道畅，无异常分泌物，子宫颈萎缩，宫体前位，右附件区可触及双拳大囊性肿物，压痛（＋），活动度欠佳，左附件区未触及异常。

皮肌炎伴发卵巢浆液性乳头状腺癌1例

患者,女,54岁,无明显诱因出现腹胀,大便次数减少,于2013年1月10日入院。曾因“四肢酸软乏力2月伴皮疹1周”于2012年8月1日入住我院内科。患者2个月前无诱因出现四肢酸软乏力,近端肌肉对称受累,以上肢带肌受累为甚,上肢活动轻度受限;下肢乏力,步行约10 min需停下休息,下蹲后起身困难。1周前出现皮疹。

12例腹膜原发性浆液性乳头状癌临床诊治分析

目的 探讨腹膜原发性浆液性乳头状癌的临床特点、诊断标准、治疗方法和预后。方法 对1997年 1月～ 2 0 0 4年 12月在我院经病理确诊为腹膜原发性浆液性乳头状癌的 12例患者的临床资料进行回顾性分析。结果 所有患者均行肿瘤细胞减灭术 ,术后施以铂类为主的化疗方案。生存期大约 2 0个月的患者均接受 6次以上化疗 ,术前接受化疗的患者的平均生存期大于 2 8 3个月 ,较术前未行化疗者生存期长。结论 腹膜原发性浆液性乳头状癌是一种起病隐袭 ,发病率较低的恶性肿瘤 ,易被误诊。明确的诊断、术前化疗、手术的彻底性及术后足量的化疗可以延长患者的生存期。CA1 2

Ⅱ型表皮生长因子受体(HER2/neu)过度表达的种族差异:子宫浆液性乳头状癌的主要预后指标

Objective: A difference in survival rates between black and white patients with cancer of the corpus uteri is well established. This study was conducted to determine whether the overexpression of HER2/neu oncogene is associated with poor outcome in uterine serous papillary endometrial cancer, which is a highly aggressive variant of endometrial cancer, and whether a racial difference in the frequency of HER2/neu overexpression may contribute to the disparity in endometrial cancer survival. Study design: Immunohistochemical evaluation was used to examine HER2/neu expression in paraffin blocks from 27 women with stage IA to IV uterine serous papillary endometrial cancer. Univariable analysis was performed and followed by multivariable analysis with Cox’ s proportional hazard model to evaluate whether HER2/neu expression was associated with poor outcome in uterine serous papillary endometrial cancer. Results: Black patients tended to be younger (P =. 02) and have higher HER2/neu expression than white patients (trend P =. 02). Seven of 10 black patients (70% ) showed heavy (3+ ) expression, compared with 4 of 17 white patients (24% ; P =. 04). The association of heavy HER2/neu expression with race persisted after age was controlled through stratification (P =. 05). Earlier deaths from uterine serous papillary endometrial cancer were seen among heavy HER2/neu expressers (P =. 002), black patients (P =. 04), and patients ≤ 65 years old (P =. 04). However, multivariate Cox regression showed that short survival was associated significantly with heavy HER2/neu expression (P =. 02) but not with age (P =. 07) or race (P =. 35), which indicates that HER2/neu expression accounted for much of the race disparity in survival in this patient population. Conclusion: Overexpression of HER2/neu in uterine serous papillary endometrial cancer is an independent variable that is associated with poor outcome, occurs more frequently in black women, and may contribute to racial disparity in survival. HER2/neu expression may guide clinical treatment of patients with uterine serous papillary endometrial cancer and may have implications for the implementation of novel treatment strategies.

914例乳头溢液患者回顾分析报告

目的:探讨乳头溢液的临床诊治方法。方法:对914例乳头溢液患者的诊治进行回顾性分析,并结合文献总结探讨。结果:914例患者中,血性98例,浆液性707例,浆液血性42例,水样65例,乳汁样2例;行乳管内视镜检查:乳腺导管炎及导管扩张736例,乳头状瘤139例,乳头状瘤病28例,导管癌11例;对提示为隆起性或占位性病变的患者125例行手术及病理检查:乳头状瘤符合率83.7%,乳头状瘤病符合率88.2%,导管癌符合率100%。结论:以乳头溢液为主诉的患者良性疾病最常见,导管内视镜检查对相关乳腺疾病的诊断有重要作用,但最后诊断必须依赖手术病理检查。

导管内乳头状瘤75例的临床及病理分析

乳腺导管内乳头状瘤（intraductal papilloma,IP）是发生于乳腺导管上皮细胞的一种良性乳头状瘤,多见于40-50岁女性,主要症状表现为间歇性乳头溢出血性或棕色浆液性液体,此病的癌变率可高达14.5%-14.8%。

乳头溢液异常疾病多

乳头溢液,是指妇女在乳头处有异常分泌物而言。一般来说,溢液是从乳腺管内流出来的。引起乳头溢液的疾病可以有以下几种:1、浆液性、浆液血性溢液。此种最常见。其颜色为黄色、粉红色、棕色或红色,多因乳腺管内乳头瘤所致。此病患者尚无其他感觉。

鹅的几种常见传染性疾病及其防治

1小鹅瘟 小鹅瘟是由小鹅瘟病毒引起，通过消化道传染的雏鹅急性、败血性传染病，多发生于出壳后4～20日龄左右的雏鹅。病鹅的表现是精神萎顿，缩头松毛，步行艰难，离群独处，打瞌睡，继而食欲废绝，喜饮水，严重下痢，排灰白或淡黄绿色并混有气泡的稀粪。鼻孔流浆液性分泌物，摇头，口角有液体甩出，呼吸用力，喙端色泽变暗，嗉囊中有多量气体或液体。

腹膜浆液性乳头状腺癌的临床分析

目的探讨腹膜浆液性乳头状腺癌(腹膜浆乳癌)的临床特点及治疗。方法对1984年至2002年收治的14例腹膜浆乳癌和50例卵巢浆液性乳头状腺癌(卵巢浆乳癌)患者的临床表现、治疗效果及生存率进行回顾性对比分析。结果腹膜浆乳癌患者的平均年龄为62 7岁,卵巢浆乳癌患者的平均年龄为53 6岁,两者比较,差异有统计学意义(P<0 01)。腹膜浆乳癌患者有腹水12例(86%, 12 /14),有盆腹腔包块10例(71%, 10 /14);血清CA125平均水平为2289kU/L。卵巢浆乳癌患者有腹水40例(80%, 40 /50),有盆腹腔包块45例( 90%, 45 /50 );术前血清CA125平均水平为1741kU/L。两者分别比较,差异均无统计学意义(P>0 05 )。腹膜浆乳癌患者中12例行肿瘤细胞减灭术,术后均行化疗,对化疗耐药者10例(83%, 10 /12);另2例于手术前死亡。卵巢浆乳癌50例患者均行肿瘤细胞减灭术,术后均行化疗,对化疗耐药者19例(38%, 19 /50)。两者各项比较,差异均有统计学意义(P<0 05)。腹膜浆乳癌患者1、2、3年的生存率分别为72%、10%、0;卵巢浆乳癌患者分别为95%、79%、62%。两者分别比较,差异均有统计学意义(P<0 05)。结论腹膜浆乳癌患者较卵巢浆乳癌患者的发病年龄高,化疗效果及预后差。

常见鹅传染性疾病的治疗

小鹅瘟是由小鹅瘟病毒引起，通过消化道传染的雏鹅急性、败血性传染病，多发生于出壳后4-20日龄左右的雏鹅。病鹅的表现是精神萎顿，缩头松毛，步行艰难，离群独处，打瞌睡，继而食欲废绝，喜饮水，严重下痢，排灰白或淡黄绿色并混有气泡的稀粪。鼻孔流浆液性分泌物，摇头，口角有液体甩出，呼吸用力，喙端色泽变暗，嗉囊中有多量气体或液体。

腹膜原发性乳头状浆液性癌误诊及分析

患者女,59岁,因间断腹痛4个月余,加重伴恶心、呕吐于2007年9月入院,患者于2007年5月无明显诱因出现间断腹痛,以脐周为主,无放射痛,进食后加重,伴纳差,大便稀,无反酸、烧心,在中医院诊治,服用中药后腹痛无减轻.患者人院前10 d腹痛加重,伴恶心、呕吐胃内容物,无咖啡样物,每次量不详,伴不排气,无发热.