9例子宫内膜和卵巢同步癌的临床病理特征

目的 探讨子宫内膜和卵巢同步癌(SEOC)的临床病理特征。方法 回顾性分析2009年8月至2020年8月经手术切除并经病理组织学证实的9例SEOC患者的临床病理资料,分析其临床病理特征并复习相关文献。结果 患者年龄29~65岁,平均年龄47.44岁,首发症状以子宫异常出血为主。9例SEOC患者子宫内膜癌的病理类型均为子宫内膜样癌,以低级别、Ⅰ期肿瘤为主;8例伴子宫内膜非典型增生/子宫内膜上皮内瘤变(AH/EIN)。9例SEOC中,卵巢癌的病理类型为低级别子宫内膜样癌(G1、G2)8例,透明细胞癌1例;均为Ⅰ期肿瘤,多为单侧卵巢受累。6例存在卵巢子宫内膜异位症。均无淋巴脉管间隙浸润及输卵管受累。4例患者行腹水细胞学检查,仅1例发现癌性腹水。其中病例5既往有结肠腺癌病史,子宫内膜癌、卵巢癌及结肠腺癌免疫组化结果显示MLH1、PMS2表达缺失;病例8卵巢癌病理类型为透明细胞癌,子宫内膜癌及卵巢癌免疫组化结果显示MSH2、MSH6表达缺失。所有患者均接受手术治疗及术后辅助治疗。结论 SEOC通常发生于年轻女性。以低级别子宫内膜样癌、早期肿瘤为主。治疗以手术切除为主,患者预后良好。

女性子宫内膜与卵巢同步癌的研究进展

同时发生于女性生殖器官的原发性肿瘤相对罕见,而且在子宫内膜癌和卵巢癌中最为常见,大约10% 的卵巢癌患者和5% 的子宫内膜癌患者同时患有子宫内膜癌和卵巢癌。虽然一些研究人员假设胚胎学上相似的组织在同时暴露于致癌物或激素影响时可能发生同步肿瘤,但潜在的原因和发病机制仍不清楚。综述主要对患者同时发生子宫内膜癌和卵巢癌的发生机制进行归纳总结,探讨同时发生子宫内膜癌与卵巢癌患者的临床病理特征,诊断及生存预后。

子宫内膜癌卵巢受累的危险因素及MMR状态在卵巢受累中的预测价值

目的:探讨子宫内膜癌患者卵巢受累的危险因素及错配修复(MMR)蛋白表达状态在子宫内膜癌卵巢受累中的预测价值,为年轻子宫内膜癌患者保留卵巢提供依据。方法:回顾分析2019年1月至2022年1月于山东大学齐鲁医院济南院区及青岛院区接受全面分期手术的782例子宫内膜癌患者的临床病理资料,免疫组化法检测MMR状态。结果:单因素分析显示,非子宫内膜样腺癌、低分化(G3)、肿瘤直径大于4cm、肿瘤位于宫角/输卵管或子宫下段/宫颈、深肌层浸润、淋巴结转移、淋巴脉管浸润均与卵巢受累相关。多因素分析显示,肿瘤直径和肿瘤部位是子宫内膜样腺癌患者卵巢受累的独立危险因素。97例年龄≤45岁的患者中,9例卵巢受累,其病理类型均为子宫内膜样腺癌。8例在术前的影像学评估中即发现了一侧或双侧的卵巢肿物。MMR表达缺失仅与年龄大于45岁和淋巴脉管浸润相关,其卵巢受累发生率与MMR表达组患者基本一致。结论:年轻子宫内膜癌患者术前可通过影像学及宫腔镜检查来确定肿瘤的大小、位置及附件区情况,进一步评估保留卵巢的安全性。MMR蛋白表达状态与卵巢受累无关,提示制定卵巢保留的决策时可能不需考虑MMR状态。

PICC导管在卵巢癌同步放化疗患者中的应用研究

目的阐述PICC导管在卵巢癌同步放化疗患者中的应用及护理方法,观察干预效果。方法采用抽签法随机分组,所有患者均采用相同方法进行同步放化疗,PICC置管方法相同,对照组实施常规护理,观察组于PICC置管期间,实施预见性护理。结果观察组一次置管成功率100%、置管长度(51.0±1.5)cm,与对照组无显著差异(P>0.05)。观察组留管时间(154.2±3.6)d、穿刺侧肿胀发生率2.6%、过敏率2.6%、局部渗血率2.6%,与对照组相比,差异显著(P<0.05)。结论于卵巢癌同步放化疗期间应用PICC导管,可有效减轻反复穿刺对患者所带来的痛苦。携带PICC导管期间,实施预见性护理,可有效预防脱管、堵管、感染等风险,提高治疗的安全性,使留管时间得以延长。

多原发癌7例报导

1976年1月至1995年6月共收治多原发癌7例。其中男3例女4例,年龄在50岁以上,平均年龄66岁,同时癌1例,异时第二原发癌5例,异时第三原发癌1例。多原发癌部位以结直肠癌占多数,共6例次,其余分别为乳腺癌3例次,胃癌2例次,胆囊癌1例次,回肠癌1例次,子宫癌1例次。多原发癌发病率有逐年增加趋势。根据1932年Warren提出的诊断标准,对多原发癌的认识有重要临床意义:1．勿轻易将第二原发癌误诊为转移癌而放弃治疗。2．对第二原发癌如能及时诊断治疗,预后同原发癌同样良好。3．对不同器管的同时原发癌应尽可能一期切除,以免丧失时机。4．结直肠癌的同时多原发癌较多见,手术时应探查全结肠,以免遗漏病变。

宫颈腺癌同步放化疗疗效及残余病灶挽救性治疗分析

目的评估宫颈腺癌根治性同步放化疗后疗效,分析同步放化疗后仍有残留病灶患者的治疗及预后。方法回顾性分析2005-2016年间收治的109例局部进展期宫颈腺癌患者的临床资料。外照射临床靶体积处方剂量50.4 Gy分28次,内照射A点剂量30~36 Gy分5~7次。同步顺铂或紫杉醇周疗。放化疗后进行临床疗效评价。对部分缓解(PR)者进行挽救性治疗(手术和/或紫杉醇联合卡铂或顺铂化疗和/或放疗)。Kaplan-Meier法生存分析。结果中位随访时间48个月,3、5年总生存率分别为74.1%、58.5%。放化疗后72例(66.1%)患者达完全缓解,31例(28.4%)患者达PR。PR患者挽救性治疗后3年总生存、无进展生存率分别为53%、41%。放化疗后仅4例(3.7%)和2例(1.8%)患者出现>3级泌尿系和胃肠道不良反应。结论对于同步放化疗后仍有临床残余病灶的宫颈腺癌患者应积极采取挽救性治疗,以期更多的生存获益。

Simultaneous laparoscopy-assisted low anterior resection and distal gastrectomy for synchronous carcinoma of rectum and stomach

Laparoscopic resection of rectal cancer or gastric cancer has been advocated for the benefits of a reduced morbidity,a shorter treatment time,and similar outcomes.However,simultaneous laparoscopy-assisted low anterior resection and distal gastrectomy for synchronous carcinoma of rectum and stomach are rarely documented in literature.Endoscopic examination revealed a synchronous carcinoma of rectum and stomach in a 55-year-old male patient with rectal bleeding and epigastric discomfort.He underwent a simultaneous laparoscopy-assisted low anterior resection and distal gastrectomy with regional lymph nodes dissected.The operation time was 270 min and the estimated blood loss was 120 mL.The patient required parenteral analgesia for less than 24 h.Flatus was passed on postoperative day 3,and a solid diet was resumed on postoperative day 7.He was discharged on postoperative day 13.With the advances in laparoscopic technology and experience,simultaneous resection is an attractive alternative to a synchronous gastrointestinal cancer.

Gastric cancer patients at high-risk of having synchronous cancer

AIM： To identify patients with a high-risk of having a synchronous cancer among gastric cancer patients. METHODS： We retrospectively analyzed the prospective gastric cancer database at the National Cancer Center, Korea from December 2000 to December 2004. The clinicopathological characteristics of patients with synchronous cancers and those of patients without synchronous cancers were compared. Multivariate analysis was performed to identify the risk factors for the presence of a synchronous cancer in gastric cancer patients. RESULTS： 111 of 3291 gastric cancer patients （3.4%） registered in the database had a synchronous cancer. Among these 111 patients, 109 had a single synchronous cancer and 2 patients had two synchronous cancers. The most common form of synchronous cancer was colorectal cancer （42 patients, 37.2%） followed by lung cancer （21 patients, 18.6%）. Multivariate analyses revealed that elderly patients with differentiated early gastric cancer have a higher probability of a synchronous cancer. CONCLUSION： Synchronous cancers in gastric cancer patients are not infrequent. The physicians should try to find synchronous cancers in gastric cancer patients, especially in the elderly with a differentiated early gastric

X-ray diagnosis of synchronous multiple primary carcinoma in the upper gastrointestinal tract

AIM:To analyze the radiological features of multiple primary carcinoma (MPC) in the upper gastrointestinal (GI) tract,study its biological characteristics and evaluate X-ray examination in its diagnosis. METHODS:Hypotonic double-contrast GI radiography was performed in 59 multiple primary carcinoma cases,pathologically proved by surgery or endoscopy biopsy. Radiological findings were analyzed. RESULTS:Of the 59 cases,esophageal MPC (EMPC) was seen in 24,esophageal and gastric MPC (EGMPC) in 27 and gastric MPC (GMPC) in 8. Of the 49 lesions found in 24 EMPC,hyperplastic type was seen in 23,medullary type in 9. The lesions were located at the upper (n = 17),middle (n = 19) or lower (n = 13) segment of the esophagus. In 27 EGMPC,the esophageal lesions were located at the middle (n = 16) or lower (n = 11) segment of the esophagus,while the gastric le-sions were located at the gastric cardia (n = 16),fundus (n = 1),body (n = 3) and antrum (n = 7). The esophageal lesions were mainly of the hyperplastic type (n = 12) or medullary type (n = 7),while the gastric lesions were mainly of the hyperplastic type (n = 18). A total of 119 lesions in the 59 patients with synchronous multiple carcinoma were proved by surgery or endoscopy biopsy,and preoperative upper radiographic examination detected 100 of them (84.03% sensitivity). Eighteen (52.94%) of the T1 lesions were found during preoperative diagnosis by radiographic examination. Moreover,only 3 (3.53%) of the T2-4 lesions were misdiagnosed. CONCLUSION:Hypotonic double-contrast upper gastrointestinal examination,providing accurate information about lesion morphology,location and size,can serve as a sensitive technique for the preoperative diagnosis of MPC.

Synchronous quintuple primary gastrointestinal tract malignancies: Case report

Multiple primary malignancy is defined as two or more malignancies detected in an individual person. In particular, synchronous quintuple primary malignancy is extremely rare. A 52-year-old male with anal pain and intermittent blood-tinged stool was diagnosed with malignancies in the stomach, jejunum, ascending colon, transverse colon and rectum. He underwent a subtotal gastrectomy, segmental resection of the jejunum and total protocolectomy with end ileostomy. The postoperative pathologic findings were moderate differentiated gastric adenocarcinoma (pT1bN0M0, pStageIA), combined adenocarcinoma and neuroendocrine carcinoma of the jejunum (pT3N0M0, pStageIIA), three mucinous adenocarcinoma of the ascending colon (pT3N0M0, pStageIIA), transverse colon (pT1N0M0, pStageI) and rectum (pT3N1aM0, pStageIIIB). The tumors did not lack MLH-1 and MSH-2 expression, as the markers (bat26, D5S346, bat25, D2S123) suggest MSI-H presence. Adjuvant chemoradiotherapy was started according to regimen, FOLFOX 4 for advanced rectal cancer. Six years post-operation, the patient is currently attending regular follow-ups without recurrence or metastasis.

Endoscopic and clinicopathologic characteristics of early gastric cancer with high microsatellite instability

AIM： To investigate endoscopic and clinicopathologic characteristics of early gastric cancer （EGC） according to microsatellite instability phenotype. METHODS： Data were retrospectively collected from a single tertiary referral center. Of 981 EGC patients surgically treated between December 2003 and October 2007, 73 consecutive EGC patients with two or more microsatellite instability （MSI） mutation [high MSI （MSI-H）] and 146 consecutive EGC patients with one or no MSI mutation （non-MSI-H） were selected. The endoscopic and clinicopathologic features were compared between the MSI-H and non-MSI-H EGC groups.RESULTS： In terms of endoscopic characteristics, MSI-H EGCs more frequently presented with elevated pattern （OR 4.38, 95% Cl： 2.40-8.01, P 〈 0.001）, moderate- to-severe atrophy in the surrounding mucosa （OR 1.91, 95% CI： 1.05-3.47, P = 0.033）, antral location （OR 3.99, 95% CI： 2.12-7.52, P 〈 0.001） and synchronous le- sions, compared to non-MSI-H EGCs （OR 2.65, 95% CI： 1.16-6.07, P = 0.021）. Other significant clinicopatholog- ic characteristics of MSI-H EGC included predominance of female sex （OR 2.77, 95% CI： 1.53-4.99, P 〈 0.001）, older age （〉 70 years） （OR 3.30, 95% CI： 1.57-6.92, P = 0.002）, better histologic differentiation （OR 2.35, 95% Cl： 1.27-4.34, P = 0.007）, intestinal type by Lau- ren classification （OR 2.34, 95% CI： 1.15-4.76, P = 0.019）, absence of a signet ring cell component （OR 2.44, 95% CI： 1.02-5.86, P = 0.046）, presence of mu- cinous component （OR 5.06, 95% Cl： 1.27-20.17, P = 0.022）, moderate-to-severe lymphoid stromal reaction （OR 3.95, 95% CI： 1.59-9.80, P = 0.003）, and co-exist- ing underlying adenoma （OR 2.66, 95% CI： 1.43-4.95, P = 0.002）. CONCLUSION： MSI-H EGC is associated with unique endoscopic and clinicopathologic characteristics includ- ing frequent presentation in protruded type, co-exist- ing underlying adenoma, and synchronous lesions.

Synchronous triple occurrence of MALT lymphoma, schwannoma, and adenocarcinoma of the stomach

We present a case of a 56-year-old man with 3 synchronous gastric tumors. The patient presented with melena, and 3 gastric abnormalities were detected on gastroduodenoscopic examination, including a small ulcerative lesion in the gastric antrum, a submucosal mass in the gastric body, and severe erosion in the fundus. Histological examination of biopsy samples yielded respective diagnoses of gastric adenocarcinoma, gastritis, and mucosa-associated lymphoid tissue(MALT) lymphoma. The patient first received medication to eradicate any underlying Helicobacter pylori infection, which might have been a cause of the MALT lymphoma. Four weeks later, after examination of repeat biopsy samples revealed that the MALT lymphoma had resolved, the patient underwent subtotal gastrectomy. Further histological examination of resected tissue confirmed the antrum lesion as adenocarcinoma and the body lesion as schwannoma. To our knowledge, this is the first reported case of synchronous triple primary gastric adenocarcinoma, MALT lymphoma, and schwannoma.

Synchronous Multiple Primary Gastric Carcinomas： A Case Report

IntroductionCarcinomas of the stomach are the most common malignant tumors in China. Due to the recent developments in diagnostic techniques and instrumentation, the early detection of gastric carcinoma （GC） has increased. Yet synchronous multiple primary gastric carcinomas, de- fined as 2 or more primary gastric carcinomas occurring in 1 patient simultaneously, are not frequently seen. The etiology of synchronous tumors is still unclear, and their coexistence can be problematic for surgeons, oncologists and pathologists in regards to diagnosis, treat- ment, and follow-up. Research has focused mainly on such issues as the frequency of occurrence of primary multiple carcinomas, identi- fication of high-risk groups, early diagnosis, treatment methods, and prognostic factors. The purpose of this article is to present a rare case of synchronous tumors and to review the literature addressing the surgical treatment for patients with multiple cancers.

Synchronous double cancers of the common bile duct

We report an extremely rare case of synchronous double cancers of the common bile duct without pancreaticobiliary maljunction.Only two similar cases have been reported in the English literature.Endoscopic retrograde cholangiopancreatography showed a tuberous filling defect in the middle and superior parts of the common bile duct,and mild stenosis in the inferior duct.Computed tomography(CT) showed a well enhanced mass in the middle and superior parts of the common bile duct.A single cancer of the middle and superior bile duct was suspected and extra-hepatic bile duct resection was performed.CT eleven months after surgery revealed enhanced inferior bile duct wall and a slightly enhanced tumor within it.Retrospective review of the CT images taken before first surgery showed enhanced inferior bile duct wall without intrabiliary tumor only on the delayed phase.The inferior bile duct tumor was suspected to have originally co-existed with the middle and superior bile duct tumor.Pancreaticoduodenectomy was performed subsequently.Histopathological examination revealed that the middle and superior bile duct tumor was a moderately differentiated tubular adenocarcinoma while the inferior bile duct tumor was a papillary adenocarcinoma.The two tumors were separated and had different histological findings and growth patterns,further suggesting that they were two primary cancers.

Synchronous incidental gastrointestinal stromal and epithelial malignant tumors

AIM:To investigate the incidence of incidental gastrointestinal stromal tumor (GIST) and its etiopathogenesis.METHODS: From January 1, 2000 to December 31, 2007, 13 804 cases of gastrointestinal epithelial malignant tumor (EMT) and 521 cases of pancreatic adenocarcinoma (PAC) were successfully treated with surgery at the Department of General Surgery and the Department of Thoracic Surgery, West China Hospital, Sichuan University, China. The clinical and pathologic data of 311 cases of primary GIST, including 257 cases with clinical GIST and 54 cases of incidental GIST were analyzed.RESULTS: Of the 311 patients, 54 had incidental GIST, accounting for 17.4%. Of these tumors, 27 were found in 1.13% patients with esophageal squamous cell carcinoma (ESCC), 22 in 0.53% patients with gastric adenocarcinoma (GAC), 2 in 0.38% patients with PAC, 2 in 0.03% patients with colorectal adenocarcinoma, and 1 in one patient with GAC accompanying ESCC, respectively. Patients with incidental GIST presented symptoms indistinguishable from those with EMT. All incidental GIST lesions were small in size, and the majority had a low mitotic activity while only 1.9% (5/257) of clinical GIST lesions had a high risk.CONCLUSION: Incidental GIST may occur synchronously with other tumors and has a high prevalence in males. Surgery is its best treatment modality.

A randomized controlled trial of two chemotherapy regimens-paclitaxel liposome combined with platinum and paclitaxel combined with platinum in concurrent chemoradiotherapy for cervical carcinoma

Objective:The aim of the study was to compare the efficacy,side effect and influence on the survival rate of two chemotherapy regimens,paclitaxel liposome combined with platinum and paclitaxel combined with platinum,in concurrent chemoradiotherapy for cervical carcinoma.Methods:The 162 cases with primary cervical carcinoma diagnosed between January 2008 and November 2009 in Jiangxi Maternal and Child Health Hospital(China) were enrolled in this randomized controlled trial.Seventy-one cases were included in paclitaxel group and 91 in paclitaxel liposome group.And the chemotherapy doses were as follows:paclitaxel liposome and paclitaxel 135 mg/m2;cisplatin 80 mg/m2 or carboplatin AUC 4-6;then repeated every 21 days for two or three times.Radical radiotherapy was given to both groups at the same time.Efficacy was evaluated according to the tumor regression six months later and follow-up was done consistently.Results:The overall response rates of paclitaxel group and paclitaxel liposome group were 90.1% and 89 % respectively(P > 0.05).The one year cumulative survival was 91.4% for paclitaxel group and 89.2% for paclitaxel liposome group(P > 0.05).The incidence rates of adverse effects such as rash,gastrointestinal toxicity,bone marrow suppression and muscle/joint pain in paclitaxel liposome group were much lower than those in paclitaxel group(P < 0.05),while there was no difference regarding hair loss,hepatic function damage,peripheral neuritis and other aspects(P > 0.05).Conclusion:Paclitaxel liposome plus platinum is a safe and effective method for staging IIa-IV cervical carcinomas.While the long-term efficacy should be further observed.

Clinical Study on Simultaneous Modulated Accelerated Radiotherapy and Concurrent Chemotherapy for Locally Advanced Nasopharyngeal Carcinoma

OBJECTIVE To evaluate the clinical efficacy and toxicities of simultaneous modulated accelerated radiotherapy （SMART） and concurrent chemotherapy for locally advanced nasopharyngeal carcinoma. METHODS Eightyseven patients with nasopharyngeal carcinoma received SMART from April 2002 to September 2006. According to the UICC staging system, 30 patients were diagnosed as stage IIb, 42 patients stage III, 13 patients stage IVa and 2 patients stage IVb. The intensitymodulated radiotherapy was delivered with the ＂step and shoot＂ SMART technique with the prescribed dose of 66-76 Gy （2.2-2.4 Gy/day） to the gross tumor volume （GTV） and positive neck lymph nodes （GTVLN）, with 60 Gy （2.0 Gy/day） to the highrisk clinical target volume （CTV1）, encompassing the area around the nasopharynx and the upper neck, and with 54 Gy （1.8 Gy/day） to the lowrisk clinical target volume （CTV2）, including the lower neck and supraclavicular area. Among all the patients, 31 received 2 cycles of SMART concurrently with 5 fluorouracil （5-Fu） and cisplatin （the FP group） and 56 received 2 cycles of concurrent cisplatin. All the patients received 3 to 4 cycles of adjuvant combination chemotherapy of cisplatin and 5fluorouracil starting from the 1st month after completion of SMART. RESULTS With a median follow up of 59 months （ranging from 19 to 85 months）, the 1, 2 and 3year overall survival rates were 100%, 94.6% and 91.3% respectively. Acute mucositis and pharyngitis were more frequently observed in the FP group than in the cisplatin group. CONCLUSION SMART technique provides an excellent opportunity to spare normal tissue and is probably more biologically effective. Combination of single cisplatin was more tolerable.

Clinical study of docetaxel combined with concurrent radiotherapy in patients with advanced nasopharyngeal carcinoma

Objective： The aim of this study was to study the short-term curative effects and adverse reactions of docetaxel （DOC） in concurrent chemoradiotherapy compared to DDP plus 5-Fu （DF） combined with concurrent radiotherapy in patients with advanced nasopharyngeal carcinoma. Methods： Thirty-three patients in the experimental group （DOC group） were given DOC 25 mg/m2 ivgtt, dl, 7 times, concurrent radiotherapy was performed from dl. Thirty-three patients in the control group （DF group） were given cisplatin 25 mg/@ivgtt dl-3 and 5-Fu 550 mg/m2iv, dl-5, 3 weeks a cycle, 2 cycles, and concurrent radiotherapy was performed from dl. Six MV X-ray and 9 MeV electronic line for external irradiation were adopted in concur- rent radiotherapy. Results： The response rates of DOC group and DF group were 90.9% and 93.9%, the rates of neutropenia were 45.45% and 67.74%, and the rates of oral mucositis were 60.61% and 90.32%. Conclusion： The difference of short- term curative effects between DOC group and DF group was not statistically significant in patients with advanced nasopha- ryngeal carcinoma. The rates of adverse reactions were lower in DOC group. DOC combined with concurrent radiotherapy could be a new choice for patients with advanced nasopharyngeal carcinoma.

Synchronous primary cancer of the rectum and lung:a case report

Multiple primary cancers refer to the condition where more than two cancers occur independently in an individual. The incidence of lung cancer in cases of colorectal cancer is rare and synchronous rectal cancer and lung cancer is even rare. A 61-year-old man was referred to our hospital with a 2-month history of blood in his stool, tenesmus, and mucous discharge in July 2010. Colonoscopy showed an irregular ulcerated rectal mass and histological examination of biopsy material showed a poorly differentiated adenocarcinoma. Computed tomography （CT） scan of the chest and abdomen showed a mass in the posterior segment of the right upper lobe of the lung and a mass in the right rectal wall of upper rectum. The rectal tumor was diagnosed as primary cancer based on the findings of immunohistochemical stain. An anterior resection （AR） and video assisted thoracoscopic （VAT） wedge resection were performed and histological findings of resected rectal and lung tumor specimen showed synchronous primary rectal cancer and lung cancer. A combination chemotherapy regimen with docetaxel and Iobaplatin was used and the patient was successfully discharged from hospital in August 2010. Although the incidence of synchronous multiple primary cancers is very low, we need to remain suspicious, when faced with two or even multiple organ lesions, and employ the necessary examination methods to confirm the diagnosis. For synchronous multiple primary cancers, if conditions allow, surgical resection for all the cancers can be performed in a single operation.