右手背血管平滑肌瘤恶性变一例报告

手部血管平滑肌瘤术后复发恶变极为少见,现将我们收治一例报告如下: 吕××:女性,3岁,住院号183193,1985年9月无明显诱因其母发现右手背有一包块,因包块生长较快,在外院行包块切除,病理诊断为血管平滑肌瘤。1987-4-1因肿瘤复发在我院第二次手术,病理诊断同前。术后右手功能正常。1987-11-21右手背肿物再次复发,生长速度较快。右手背相当于第二、三掌骨处皮下可触及一个约2.0×1.5×1.0cm大小肿块,无压痛,表面光滑,边界不清楚。

手部恶性肿物(附15例报告)

总结 1 5例手部恶性肿瘤资料 ,有 5种不同类型的肿瘤 ,并对这些肿瘤的发生。

CT对胃平滑肌类肿瘤的鉴别及评价(附13例报告)

目的 总结胃平滑肌类肿瘤的CT表现,讨论其应用价值及鉴别诊断。方法 分析13例经手术病理证实的胃平滑肌瘤的CT征象,其诊断结果与胃镜、胃肠道钡餐造影检查比较。结果 13例中,平滑肌瘤8例,平滑肌肉瘤5例。除1例误诊为胰腺癌外,CT都确诊为胃平滑肌类肿瘤,CT定性诊断准确率为92.3％;优于另外两种方法(P<0.05)。良恶性平滑肌瘤的CT图像有一定的CT特征。位于腔外的肿瘤多为肉瘤。当肿瘤直径大于5.0cm,瘤体内有不规则低密度坏死区或溃疡深而不规则,邻近器官或组织有侵犯或转移时,要考虑恶性。结论 CT在显示胃平滑肌类肿瘤的部位、大小、生长方式及其内部密度情况有独特价值,尤其可以观察肿瘤对邻近器官和组织有无侵犯或转移。据此判断肿瘤的良恶性,并决定手术切除的可能性。

多模态影像融合在颅底肿瘤的诊断、治疗中的应用价值

目的探讨多模态影像融合在颅底肿瘤的诊断、治疗中的应用价值。方法 9例颅底肿瘤术前均行DynaCTA检查及MRI薄层(2 mm)增强扫描检查,将多组影像数据输入工作站,采用"双容积重建"技术进行脑血管及MRI的影像融合,通过静态及动态融合影像观察肿瘤与脑结构、血管及颅骨的毗邻关系,并对肿瘤的诊断、手术治疗及预防血管并发症进行分析。结果 9例均获得满意的影像融合、具有很好的空间一致性,在一张影像上可以清晰显示病变及其周围脑结构、血管及颅骨解剖关系,提高精准性诊断,并应用于指导治疗策略、设计手术划及预防并发症。9例均恢复满意出院。结论多模态影像融合对提高颅底肿瘤的诊断精准性、提高肿瘤全切除率、降低病死率和残疾率效果肯定,对血管损伤并发症治疗疗效肯定。

Clinical Experience of Primary Retroperitoneal Tumor: Report of 600 Cases

Objective： To summarize the experience of management for primary retroperitoneal tumor （PRPT） and to analyze the factors influencing the outcome after operation. Methods： The data of 600 cases of PRPT in General Hospital of PLA were reviewed retrospectively. Results： Of 600 cases of PRPT, 546 were surgically treated. Among theme 369 were malignant and 177 benign. 366 cases were followed up for 1 month to 15 years. The 1-years 3-year, and 5-year survival rate in the patients subject to complete resection was 90.5%, 73.2% and 53.6%, respectively, and that in incomplete resection patients was 70.6%, 32.0%, 5.7% respectively （P〈0.01）. The Cox multi-various regression analysis revealed showed completeness of tumor resection, sex and histologic type were associated closely with local recurrence. Conclusion： Sufficient preoperative preparation and complete tumor resection play important roles for reducing recurrence and improving survival.

手部类肿瘤显微外科技术治疗效果分析

分析在手部类肿瘤患者临床治疗中采用显微外科技术的临床效果。方法 随机选取本院收治的72例手部类肿瘤患者为 调查对象,采用双盲法将其分为对照组和实验组,各36例,对照组患者采用传统手术治疗,实验组患者采用显微外科手术技术,对比两 组患者治疗效果和复发情况。结果 调查结果显示,实验组患者术后切口恢复情况和治疗效果均明显优于常规组,有统计学意义(p< 0.05)。结论 在手部类肿瘤患者临床治疗中采用显微外科技术取得显著临床效果,此治疗技术值得在临床上被广泛应用。

Modern management of rectal cancer: A 2006 update

The goal of this review is to outline some of the important surgical issues surrounding the management of patients with early (T1/T2 and NO), as well as locally advanced (T3/T4 and/or N1) rectal cancer. Surgery for rectal cancer continues to develop towards the ultimate goals of improved local control and overall survival, maintaining quality of life, and preserving sphincter, genitourinary, and sexual function. Information concerning the depth of tumor penetration through the rectal wall, lymph node involvement, and presence of distant metastatic disease is of crucial importance when planning a curative rectal cancer resection. Preoperative staging is used to determine the indication for neoadjuvant therapy as well as the indication for local excision versus radical cancer resection. Local excision is likely to be curative in most patients with a primary tumor which is limited to the submucosa (T1N0M0), without high-risk features and in the absence of metastatic disease. In appropriate patients, minimally invasive procedures, such as local excision, TEM, and laparoscopic resection allow for improved patient comfort, shorter hospital stays, and earlier return to preoperative activity level. Once the tumor invades the muscularis propria (T2), radical rectal resection in acceptable operative candidates is recommended. In patients with transmural and/or node positive disease (T3/T4 and/or N1) with no distant metastases, preoperative chemoradiation followed by radical resection according to the principles of TME has become widely accepted. During the planning and conduct of a radical operation for a locally advanced rectal cancer, a number of surgical management issues are considered, including: (1) total mesorectal excision (TME); (2) autonomic nerve preservation (ANP); (3) circumferential resection margin (CRM); (4) distal resection margin; (5) sphincter preservation and options for restoration of bowel continuity; (6) laparoscopic approaches; and (7) postoperative quality of life.

Surgical outcome of adenosquamous carcinoma of the pancreas

Adenosquamous carcinoma is rare,accounting for 3%-4% of all pancreatic carcinoma cases. These tumors are characterized by the presence of variable proportions of mucin-producing glandular elements and squamous components,the latter of which should account for at least 30% of the tumor tissue. Recently,several reports have described cases of adenosquamous carcinoma of the pancreas. However,as the number of patients who undergo resection at a single institute is limited,large studies describing the clinicopathological features,therapeutic management,and surgical outcome for adenosquamous carcinoma of the pancreas are lacking. We performed a literature review of English articles retrieved from Medline using the keywords 'pancreas' and 'adenosquamous carcinoma'. Additional articles were obtained from references within the papers identif ied by the Medline search. Our subsequent review of the literature revealed that optimal adjuvant chemotherapy and/or radiotherapy regimens for adenosquamous carcinoma of the pancreas have not been established,and that curative surgical resection offers the only chance for long-term survival. Unfortunately,the prognosis of the 39 patients who underwent pancreatic resection for adenosquamous carcinoma was very poor,with a 3-year overall survival rate of 14.0% and a median survival time of 6.8 mo. Since the postoperative prognosis of adenosquamous carcinoma of the pancreas is currently worse than that of pancreatic adenocarcinoma,new adjuvant chemotherapies and/or radiation techniques should be investigated as they may prove indispensible to the improvement of surgical outcomes.

Effects of 7.5% hypertonic saline on fluid balance after radical surgery for gastrointestinal carcinoma

AIM: To investigate the effects of 7.5% hypertonic saline on positive fluid balance and negative fluid balance, after radical surgery for gastrointestinal carcinoma. METHODS: Fifty-two patients with gastrointestinal carcinoma undergoing radical surgery were studied. The patients were assigned to receive either Ringer lactate solution following 4 mL/kg of 7.5% hypertonic saline (the experimental group, n = 26) or Ringer lactate solution (the control group, n = 26) during the early postoperative period in SICU. Fluid infusion volumes, urine outputs, fluid balance, body weight change, PaO2/FiO2 ratio, anal exhaust time as well as the incidence of complication and mortality were compared between the two groups. RESULTS: Urine outputs on the operative day and the first postoperative day in experimental group were significantly more than in control group (P<0.000001, P=0.000114). Fluid infusion volumes on the operative day and the first postoperative day were significantly less in experimental group than in control group (P= 0.000042, P= 0.000415). The volumes of the positive fluid balance on the operative day and during the first 48 h after surgery, in experimental group, were significantly less than in control group (P<0.000001). Body weight gain post-surgery was significantly lower in experimental group than in control group (P<0.000001). The body weight fall in experimental group occurred earlier than in control group (P<0.000001). PaO2/FiO2 ratio after surgery was higher in experimental group than in control group (P= 0.000111). The postoperative anal exhaust time in experimental group was earlier than in control group (P= 0.000006). The overall incidence of complications and the incidence of pulmonary infection were lower in experimental group than in control group (P= 0.0175, P= 0.0374). CONCLUSION: 7.5% hypertonic saline has an intense diuretic effect and causes mobilization of the retained fluid, which could reduce fluid infusion volumes and positive fluid balance after radical surgery for gastrointestinal carcinoma, as well as, accelerate the early appearance of negative fluid balance after the surgery, improve the oxygen diffusing capacity of the patients' alveoli, and lower the overall incidence of complications and pulmonary infection after the surgery.

Clinical Value of Whole-body Magnetic Resonance Diffusion Weighted Imaging on Detection of Malignant Metastases

Objective To evaluate the value of whole-body diffusion weighted imaging （WB-DWI） on detection of malignant metastasis. Methods Forty-six patients with malignant tumors underwent WB-DWI examinations between April 2007 and August 2007 in our hospital. Before WB-DWI examination, the primary cancers of all the patients were confirmed by pathology, and the TNM-stage was assessed with conventional magnetic resonance imaging （MRI） or computed tomography （CT）. WB-DWI was performed using short TI inversion recovery echo-planar imaging （STIR-EPI） sequence. Abnormal high signal intensities on WB-DWI were considered as metastases. The results of WB-DWI were compared with other imaging modalities. For the assessment of the diagnostic capability of WB-DWI, WB-DWI were compared with CT for demonstrating mediastinal lymph node metastases and lung metastases, and with conventional MRI for demonstrating metastases in other locations. Results WB-DWI demonstrated 143 focuses, 14 routine imaging. The number of bone metastases depicted of which were diagnosed to be benign lesions in on WB-DWI and routine imaging was 85 and 86; lymph node metastases was 17 and 18; liver metastases was 14 and 14; lung metastases was 4 and 8; and brain metastases was 6 and 8, respectively. WB-DWI failed to detect 12 metastatic lesions including 3 osteoplastic bone metastases, 4 lung metastases, 3 mediastinal lymph node metastases, and 2 brain metastases Four metastatic lesions including 2 deltopectoral lymph nodes and 2 rib metastases were detected with WB-DWI alone, all of which evolved greatly during clinical follow-up for more than 6 months. WB-DWI had higher detection rates for metastatic lesions in liver, bone, and lymph nodes than those in lung and brain （ X^2=30, P〈0.001）. Conclusions WB-DWI could detect most of metastatic lesions that were diagnosed with conventional MRI and CT. The limitations of WB-DWI might be had high false-positive rate and low efficiency in detecting mecliastinal lymph node, brain, and lung metastases.

Low intensity ultrasound-induced apoptosis in human gastric carcinoma cells

AIM： To investigate the low intensity ultrasound （US）- induced apoptosis in human gastric carcinoma cells and its potential mechanism and to suggest a new therapeutic approach to gastric carcinoma. METHODS： Human SGC-7901 gastric carcinoma cells were cultured in vitro and irradiated by low intensity US for 10 min at different intensities with different incubation times after irradiation. Morphologic changes were examined under microscope with trypan blue staining and then the percentage of early apoptotic cells was detected by flow cytometry （FCM） with double staining of fiuorescein isothiocyanate （FITC）- Annexin V/propidium iodide （PI）. Two-dimensional electrophoresis （2DE） was used to get the protein profile and some proteins differently expressed after US irradiation were identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry （MALDI-TOF-MS）. Functional analysis was performed to investigate the mechanism of US-induced cell apoptosis. RESULTS： The percentage of apoptotic cells increased about 10% after US irradiation （12.0 W/cm^2, 12 h culture）, The percentage of early apoptosis and secondary necrosis in the US-irradiated cells increased with the increased US intensity. Moreover, apoptotic cells increased with the increased culture time after US irradiation and reached its maximum at about 12 h.Several new proteins appeared after US irradiation and were up or down regulated more than 2 times. Some heat shock proteins （HSPs） were found to be associated with the signal process simulating the apoptosis of cells. CONCLUSION： Low intensity US could induce apoptosis in human gastric carcinoma cells. US-induced apoptosis is related to US intensity/culture time. US-induced apoptosis may be caspases-dependent and endoplasmic reticulum （ER） stress-triggered apoptosis may also contribute to it. Proteomic experimental system is useful in finding the protein alteration in carcinoma cells after US irradiation, helping to develop a new cancer therapy.

Surgical management of esophagogastric junction tumors

Surgical resection with lymphadenectomy is the mainstay of treatment for all resectable esophagogastric junction tumors, prior to systemic generalization of the disease. This makes accurate pre-treatment staging and classification of the tumors most demanding. A well-established and internationally accepted classification for adenocarcinomas of the esophagogastric junction （AEG） helps to choose the appropriate surgical approach and to make results from different institutions comparable. Distal esophageal adenocarcinomas （AEGⅠ） are distinguished from true cardia carcinomas （AEGⅡ） and subcardiac gastric cancers （AEGⅢ）. Substantial advancements in this surgical field during the preceding decades have clearly revealed that individualization of the surgical strategy is the key to successfully approaching these entities. In this review we discuss the surgical management of esophagogastric junction tumors with a tailored surgical strategy.

Current preventive treatment for recurrence after curative hepatectomy for liver metastases of colorectal carcinoma: A literature review of randomized control trials

To review the preventive approaches for recurrence after curative resection of hepatic metastases from colorectal carcinoma, we have summarized all available publications reporting randomized control trials (RCTs) covered in PubMed. The treatment approaches presented above include adjuvant intrahepatic arterial infusion chemotherapy, systemic chemotherapy, neoadjuvant chemotherapy, and immunotherapy. Although no standard treatment has been established, several approaches present promising results, which are both effective and tolerable in post-hepatectomy patients. Intrahepatic arterial infusion chemotherapy should be regarded as effective and tolerable and it increases overall survival (OS) and disease free survival (DFS) of patients, while 5-fluorouracil-based systemic chemotherapy has not shown any significant survival benefit. Fortunately chemotherapy combined with hepatic arterial infusion and intravenous infusion has shown OS and DFS benefit in many researches. Few neoadjuvant RCT studies have been conducted to evaluate its effect on prolonging survivals although many retrospective studies and case reports are published in which unresectable colorectal liver metastases are downstaged and made resectable with neoadjuvant chemotherapy. Liver resection supplemented with immunotherapy is associated with optimal results; however, it is also questioned by others. In conclusion, several adjuvant approaches have been studied for their efficacy on recurrence after hepatectomy for liver metastases from colorectal cancer (CRC), but multi-centric RCT is still needed for further evaluation on their efficacy and systemic or local toxicities. In addition, new adjuvant treatment should be investigated to provide more effective and tolerable methods for the patients with resectable hepatic metastases from CRC.

Multiple metastases to the small bowel from large cell bronchial carcinomas

AIM: Metastases from lung cancer to gastrointestinal tract are not rare at postmortem studies but the development of clinically significant symptoms from the gastrointestinal metastases is very unusual. METHODS: Formalin-fixed, paraffin-embedded tissues were cut into 5 urn thick sections and routinely stained with hematoxylin and eosin. Some slides were also stained with Alcian-PAS. Antibodies used were primary antibodies to pancytokeratin, cytokeratin 7, cytokeratin 20, epithelial membrane antigen, vimentin, smooth muscle actin and CD-117. RESULTS: We observed three patients who presented with multiple metastases from large cell bronchial carcinoma to small intestine. Two of them had abdominal symptoms (sudden onset of abdominal pain, constipation and vomiting) and in one case the tumor was incidentally found during autopsy. Microscopically, all tumors showed a same histological pattern and consisted almost exclusively of strands and sheets of poorly cohesive, polymorphic giant cells with scanty, delicate stromas. Few smaller polygonal anaplastic cells dispersed between polymorphic giant cells, were also observed. Immunohistochemistry showed positive staining of the tumor cells with cytokeratin and vimentin. Microscopically and immunohistochemically all metastases had a similar pattern to primary anaplastic carcinoma of the small intestine. CONCLUSION: In patients with small intestine tumors showing anaplastic features, especially with multiple tumors, metastases from large cell bronchial carcinoma should be first excluded, because it seems that they are more common than expected.

Endoscopic ultrasonography does not differentiate neoplastic from non-neoplastic small gallbladder polyps

AIM： To assess the ability of endoscopic ultrasonography （EUS） to differentiate neoplastic from non- neoplastic polypoid lesions of the gallbladder （PLGs）.METHODS： The uses of EUS and transabdominal ultrasonography （US） were retrospectively analyzed in 94 surgical cases of gallbladder polyps less than 20 mm in diameter.RESULTS： The prevalence of neoplastic lesions with a diameter of 5-20 mm was 27.2% （10/58）; 22-15 mm, 25.4% （4/26）, and 16-20 mm, 50% （5/20）. The overall diagnostic accuracies of EUS and US for small PLGs were 80.9% and 63.9% （P 〈 0.05）, respectively. EUS correctly distinguished 12 （63.2%） of 19 neoplastic PLGs but was less accurate for polyps less than 1.0 cm （4/10, 40%） than for polyps greater than 1.0 cm （8/9, 88.9%） （P = 0.02）.CONCLUSION： Although EUS was more accurate than US, its accuracy for differentiating neoplastic from non-neoplastic PLGs less than 1.0 cm was low. Thus, EUS alone is not sufficient for determining a treatment strategy for PLGs of less than 1.0 cm.

Colonic J-pouch anal anastomosis after ultralow anterior resection with upper sphincter excision for low-lying rectal cancer

AIM:There is some evidence of functional superiority of colonic J-pouch over straight coloanal anastomosis (CM) in ultralow anterior resection (ULAR) or intersphincteric resection. On the assumption that colonic J-pouch anal anastomosis is superior to straight CM in ULAR with upper sphincter excision (USE: excision of the upper part of the internal sphincter) for low-lying rectal cancer, we compare functional outcome of colonic J-pouch vsthe straight CM. METHODS: Fifty patients of one hundred and thirty-three rectal cancer patients in whom lower margin of the tumors were located between 3 and 5 cm from the anal verge received ULAR including USE from September 1998 to January 2002. Patients were randomized for reconstruction using either a straight (n = 26) or a colonic J-pouch anastomosis (n = 24) with a temporary diverting-loop ileostomy. All patients were followed-up prospectively by a standardized questionnaire [Fecal Inco-ntinence Severity Index (FISI) scores and Fecal Incontinence Quality of Life (FIQL) scales]. RESULTS: We found that, compared to straight anastomosis patients, the frequency of defecation was significantly lower in J-pouch anastomosis patients for 10 mo after ileostomy takedown. The FISI scores and FIQL scales were significantly better in J-pouch patients than in straight patients at both 3 and 12 mo after ileostomy takedown. Furthermore, we found that FISI scores highly correlated with FIQL scales. CONCLUSION: This study indicates that colonic J-pouch anal anastomosis decreases the severity of fecal incontinence and improves the quality of life for 10 mo after ileostomy takedown in patients undergoing ULAR with USE for low-lying rectal cancer.

Predictive factors of endoscopic submucosal dissection procedure time for gastric superficial neoplasia

AIM:To identify the determinants of endoscopic submucosal dissection(ESD) operation time.METHODS:This investigation was conducted as a single-center,prospective study in which ESD was performed by the same endoscopist at the Chinese PLA General Hospital.A total of 173 patients underwent ESD operations performed by Dr.Lu from July 2007 to December 2011,and 183 lesions were enrolled.Patient gender,age,tumor location,gross type,tumor size,pathological type and adhesions were recorded prospectively.The order of treatment represented the experience of the operator.Univariate analysis and multivariate analysis were performed to evaluate the relationships between these factors and ESD procedure time.RESULTS:Univariate analysis showed the ESD time was closely related to the gender(P = 0.0210),tumor size(P < 0.0001),location(P < 0.0001),gross type(P < 0.0001) and adhesion(P = 0.0010).The surgical proficiency level was associated with ESD time in unit area(P < 0.0001).Multivariate analysis revealed that the ESD time was positively correlated with tumor size(P < 0.0001),adhesion(P < 0.0001) and location(P < 0.0001),but negatively correlated with surgical proficiency level(P = 0.0046).CONCLUSION:Large tumor size,adjacency to the cardia,and adhesion are predictors of a long ESD time,whereas high surgical proficiency level predicts a short ESD time.

Role of blood AFP mRNA and tumor grade in the preoperative prognostic evaluation of patients with hepatoceiluiar carcinoma

AIM： To explore the potential prognostic role of preoperative tumor grade and blood AFP mRNA in a cohort of patients with hepatocellular carcinoma （HCC） eligible for radical therapies according to a well-defined treatment algorithm not including nodule size and number as absolute selection criteria. METHODS： Fifty patients with a diagnosis of HCC were prospectively enrolled in the study. Inclusion criteria were： （1） histological assessment of tumor grade by means of percutaneous biopsies; （2） determination of AFP mRNA status in the blood; （3） patient＇s eligibility for radical therapies. RESULTS： At preoperative evaluation, 54% of the study group had a well-differentiated HCC, 42% had AFP mRNA in the blood, 40% had a tumor larger than 5 cm and 56% had more than one nodule. Surgery （resection or liver transplantation） was performed in 29 patients, while 21 had percutaneous ablation procedures. After a median follow-up of 28 too, 12-, 24-, and 36-mo survival rates were 78%, 58%, and 51%, respectively. Surgical therapy, performance status and three tumor-related variables （AFP mRNA, HCC grade and gross vascular invasion） resulted as significant survival predictors at univariate analysis. Nodule size and number did not perform as significant prognosticators. Multivariate study selected only surgical therapy and a biologically early HCC profile （AFP mRNA negative and well-differentiated tumor without gross vascular invasion） as independent survival variables. CONCLUSION： The preoperative determination of tumor grade and blood AFP mRNA status may potentially refine the prognostic evaluation of HCC patients and improve the selection process for radical therapies.