20例食管癌肉瘤的诊断与治疗分析

目的 食管癌肉瘤是一种罕见病 ,通过回顾分析本组较大样本食管癌肉瘤的病理及临床特点 ,探讨其诊断治疗。方法 对 2 0例食管癌肉瘤病人的临床资料进行回顾性分析。结果 食管癌肉瘤多为覃伞样、息肉样腔内生长 ,个别呈浸润生长。光镜下肉瘤与癌两种成份共存 ,瘤体以肉瘤成分为主 ,表面及蒂多分布癌组织 ,活检常显示为鳞癌 ,故术前多不能明确诊断。2 0例患者中 9例侵犯粘膜层 ,1例浅肌层 ,4例深肌层 ,6例侵犯外膜。 4例出现淋巴结转移 ,淋巴转移率 2 0 % ,转移成分 3例鳞癌 ,1例肉瘤。手术切除率 10 0 %。 1、3、5年生存期分别为 85 %、6 8%、6 8%。结论 食管癌肉瘤是一种低侵袭性 ,低淋巴转移率 ,预后尚佳的肿瘤。X线表现为食管腔内息肉样的充盈缺损 ,轮廓较为光滑整齐 ,粘膜显示“涂抹征”。食管镜活检多显示鳞癌或低分化癌 ,术前难以确诊。治疗以手术切除为主 。

肿瘤型假体机械性重建保肢手术治疗股骨远端骨肉瘤:单中心、回顾性早中期疗效分析

目的探讨肿瘤型假体在股骨远端骨肉瘤保肢手术中的临床疗效。方法对42例确诊为股骨远端骨肉瘤患者进行新辅助化疗及瘤段切除肿瘤型假体膝关节重建。结果 42例获15-55月(平均32月)随访。短期并发症发生率为11.9%,按Enneking功能评分系统,优19例,良21例,中等2例。2年无瘤生存32例;5年无瘤生存26例,4例带瘤生存,5年总生存率为71.4%。结论对股骨远端骨肉瘤配合新辅助化疗行肿瘤广泛性切除,应用肿瘤型假体重建膝关节,取得较好的治疗效果。

儿童胆道横纹肌肉瘤的诊断与治疗

目的分析儿童胆道横纹肌肉瘤(rhabdomyosarcoma of the biliary tree,RMS/BT)的临床特点、治疗策略及预后情况。方法回顾性研究2013年1月至2020年3月首都医科大学附属北京儿童医院诊治的6例RMS/BT患儿临床资料,并对患儿预后情况及相关并发症进行随访。结果6例RMS/BT患儿中男5例、女1例,中位发病年龄28.5个月(7~50个月),中位随访时间21个月(3~43个月)。原发于肝内胆道2例,原发于肝外胆道3例,原发于肝门部胆总管近端和左右肝管1例。肝内型主要以腹痛或局部包块为原发症状就诊,肝外型和肝门部肿瘤主要以胆道梗阻表现为首发症状就诊。根据横纹肌肉瘤治疗前TNM(tumor-node-metastasis)临床分期标准,T 2b N 0M 0期2例,T 2b N xM 0期3例,T 1b N 0M 0期1例;根据美国横纹肌肉瘤研究组术后-病理分期系统,5例为Ⅲ期,1例为Ⅰ期。RMS/BT患儿采取以手术、化疗及放疗为主的综合性治疗模式。2例行一期肿瘤切除术,4例行肿瘤活检化疗后再手术。术后6例均行化疗,3例进行了原发部位的放疗,未结束化疗的1例拟接受放射治疗。在治疗过程中1例发生肿瘤破裂、胆瘘、胆汁性腹膜炎。本组6例RMS/BT患儿中,5例存活,2例复发,1例死亡。存活的5例中,2例结束治疗无瘤生存,2例仍在治疗中,1例肿瘤复发继续治疗中。结论RMS/BT对化疗敏感,遵循肿瘤活检、化疗、延迟手术及放疗的诊疗流程,大多能达到肿瘤根治性切除、有效减少局部复发的目的。

TRAIL联合顺铂对横纹肌肉瘤细胞Fas表达和caspase3活性的影响

目的:探讨肿瘤坏死因子相关凋亡诱导配体(TRAIL)和顺铂(DDP)协同抑制横纹肌肉瘤(rhabdomyosarcoma,RMS)细胞生长和诱导凋亡的作用。方法:将不同浓度的TRAIL和DDP作用于人RD细胞,通过噻嗟蓝(MTT)比色法、丫啶橙染色及流式细胞仪分析细胞的增殖、形态学、细胞凋亡、Fas蛋白表达和caspase3活性改变。结果:浓度分别为1.0、10.0和100.0μg/L的TRAIL作用于RD细胞后,细胞生长抑制率(CI)分别为18.9%、20.8%和43.5%;浓度分别为1.0、5.0和10.0mg/L的DDP作用于RD细胞后,CI分别为9.8%、23.4%和43.8%。而浓度为100μg/L的TRAIL与浓度为5mg/L的DDP联合作用时,CI明显增加(66.4%),Fas蛋白的表达及caspase3的活性也明显提高。荧光显微镜下可见明显的凋亡细胞形态特征。结论:TRAIL和DDP联合应用对诱导RMS细胞凋亡具有明显的协同效果,这一作用与增加Fas和caspase3活性有关。

子宫肉瘤的诊治进展和争议问题

子宫肉瘤在临床上是较为少见的一种疾病,在女性的生殖道恶性肿瘤中仅占1%,约占所有子宫恶性肿瘤的3%[1],但因为其恶性程度高、预后差,5年生存率仅30%左右[2],严重威胁女性健康。子宫肉瘤的临床表现往往没有特异性。

前列腺肉瘤的诊治（附4例报告）

【目的】探讨前列腺肉瘤的诊断、治疗及预后。【方法】回顾分析2005年12月至2009年9月本院收治的4例前列腺肉瘤患者的临床资料。【结果】4例患者均经直肠B超引导下行前列腺穿刺活检病理确诊。其中肌源性肉瘤者3例，包括平滑肌肉瘤2例，横纹肌肉瘤1例；纤维源性肉瘤1例。患者均接受手术切除、放疗、化疗、中医药及免疫治疗等综合治疗。随访4例，3例在确诊后第6个月，1例在确诊后第13个月因肿瘤转移死亡。【结论】前列腺肉瘤进展迅速，预后较差，明确诊断有赖于病理检查，应制订适宜的个体化治疗方案。

头颈部横纹肌肉瘤12例回顾分析

目的 探讨头颈部横纹肌肉瘤的临床表现、诊断、病理类型、治疗及预后。方法 回顾性分析 12例横纹肌肉瘤的资料。结果 12例中 9例行手术切除加化疗、放疗 ,1例单纯手术 ,2例化疗 +放疗 ,5年生存率为 5 0 %。结论 采用手术与放疗和化疗综合治疗方案能明显提高生存率。

颞面部巨大复发性隆突性皮肤纤维肉瘤一例并文献复习

【目的】探讨隆突性皮肤纤维肉瘤（DFSP）的临床特点、治疗及预后。【方法】对1例罕见的颞面部巨大复发性DFSP的临床资料进行回顾分析并结合文献进行讨论。【结果】患者第2次手术采用肿瘤广泛切除＋局部组织瓣转移修复＋游离皮片移植术，术后2周接受颞面部病灶放疗，随访1年肿瘤未复发。【结论】DFSP局部手术切除后容易复发，广泛切除手术是降低复发率的关键。临床医师应该提高对该病的认识，做到早期正确诊断和首次治疗的正规彻底，同时合理采用综合治疗方法。

原发性粒细胞肉瘤2例报告并文献复习

目的:探讨原发性粒细胞肉瘤的诊断、鉴别诊断及治疗策略。方法:报告2例近期我院收治的原发性粒细胞肉瘤,并复习相关文献。结果:2例均以局部孤立性肿物为首发症状,病理标本的免疫组化MPO、CD68(KP-1)、溶菌酶均阳性,手术切除肿物后按急性粒细胞白血病的方案化疗,均效果良好。结论:原发性粒细胞肉瘤易误诊为淋巴瘤,诊断主要依靠免疫组化,MPO、溶菌酶和CD68(KP-1)阳性对诊断粒细胞肉瘤最有意义。治疗方法有局部手术切除、化疗、放疗和干细胞移植。

胆囊癌肉瘤1例报告并文献复习

目的:探讨胆囊癌肉瘤的临床病理特征、诊断及鉴别诊断、治疗、误诊的原因和预防。方法:分析1例胆囊癌肉瘤的临床表现,对标本进行组织病理学和免疫组织化学染色观察,并复习文献,了解该肿瘤的特征。结果:胆囊癌肉瘤罕见,女性多于男性,恶性度高,预后差。组织学检查显示有癌和肉瘤成分,免疫组织化学对鉴别诊断有帮助。手术及放、化疗均疗效不好。结论:原发于胆囊的癌肉瘤较罕见,预后与肿瘤分期有关。临床实践中要特别重视本病与胆囊的一些相似疾病鉴别。避免误诊。

VEGF和PCNA反义寡核苷酸联合治疗裸鼠骨肉瘤的实验研究

目的探讨血管内皮生长因子（VEGF）反义寡核苷酸和增殖细胞核抗原（PCNA）反义寡核苷酸单用或联用对裸鼠骨肉瘤生长的抑制作用。方法制备Balb／c裸鼠皮下骨肉瘤模型24只，随机分为4组：VEGF反义寡核苷酸（ASODN）治疗组、PCNA反义寡核苷酸治疗，组、联合治疗组和对照组，6只／组。接种MG-63人成骨肉瘤细胞后24h内分别用VEGF反义寡核苷酸或（和）PCNA反义寡核苷酸皮下注射进行治疗，对照组只注射生理盐水，2次／周，连续4周；观察各组裸鼠肿瘤的生长情况、裸鼠的一般情况与生存期。断颈处死裸鼠，游标卡尺测量肿瘤体积大小，天平称量肿瘤的重量。结果VEGF-ASODN治疗组、PCNA—ASODN治疗组和联合治疗组裸鼠骨肉瘤的生长均受到不同程度的抑制，抑瘤率分别为44．56％、46．53％和72．71％。结论VEGF和PCNA两种反义寡核苷酸均对骨肉瘤的生长具有抑制作用，两种反义寡核苷酸联合应用比单用的疗效更为显著。

Inactivated Bone Replantation with Preservation of the Epiphysis in Children with Osteosarcoma:Clinical Report of Two Cases

Objective: To evaluate the value of inactivated bone replantation with preservation of the epiphysis following the effective chemotherapy in avoiding postoperative discrepancy of the affected limb in children with osteosarcoma. Methods: Two children (aged 5 and 10 years, 1 male and 1 female) with osteosarcoma underwent inactivated bone replantation with preserving epiphysis following chemotherapy (MMIA protocol, including high-dose methotrexate, adriamycin and ifosfamide). After two cycles of preop-erative chemotherapy, pain vanished, the local mass shrank and there was no pain on pressing the affected parts. Sera AKP and LDH were reduced to normal levels; marked shrinkage and sclerotic changes and good margin of lesions were seen on plain radiographs and MR images. Two courses of the same protocol as preoperative chemotherapy were administered postoperatively. Results: Postoperative histological examination of the specimens demonstrated absence of vital tumor cells. Incisions healed well and no complications occurred. The replanted inactivated bone healed with host at 6 months after operation. In the two patients, no evidence was seen of metastasis and recurrence and discrepancy of the affected limbs in postoperative 36 and 48 months. Functions of the affected limbs were satisfactory. Conclusion: Inactivated bone replantation with preserving epiphysis was a viable option for osteosarcoma in children. The long-term outcomes remain to be further proven.

Expression of Survivin Gene and Its Relationship with Clinical Multidrug Resistance in Osteosarcoma

Objective: To study the expression of survivin and its relationship with clinical multidrug resistance in osteosarcoma. Methods: By using immunohistochemistry (S-P) method, the expression of Survivin in osteosarcoma, osteochondroma and normal osseous tissue, and the expression of P-glycoprotein in osteosarcoma was detected. Results: Survivin positive expression rate was 65.71% in osteosarcoma, but no expression of Survivin was detectable in osteochondroma and normal osseous tissue. The positive expression rate of Survivin was significantly associated with Enneking clinical stages and histological typing (WHO), but no relationship was found among Survivin expression and age, sex and tumor location. The positive expression rate of P-glycoprotein was 45.71%. There was a significant correlation between Survivin and p-glycoprotein. Conclusion: Survivin overexpression was significantly associated with clinical multidrug resistance in osteosarcoma. It could be a potential target for treatment of osteosarcoma.

宫颈上皮内瘤样病变的诊治探讨

【目的】探讨宫颈上皮内瘤变的最佳诊断和治疗方法,以达到减少漏诊,减少术后病变残留、复发的目的。【方法】对2003年12月至2005年1月采用宫颈液基细胞学、高危HPV检测、阴道镜检查筛查出宫颈上皮内瘤变302例。根据病变不同程度和生育要求,行宫颈电灼术、电环切除、全子宫切除,对其疗效作回顾性分析。【结果】细胞学检查存在着假阴性率15.2%。高度上皮内瘤变约97.6%高危HPV阳性,低度上皮内瘤变中88.2%高危HPV阳性。行电环切除术196例,术后病理为阴性的49例,病变仍有CIN,但期别减轻者64例,升级者18例,相同者65例。LEEP术后排除浸润癌,再行子宫切除,子宫标本未发现浸润癌。电灼和电环切除术后并发症少,随访最长18个月没有复发。【结论】细胞学结合HPV检查可减少宫颈上皮内瘤变的漏诊率,根据期别和生育要求对宫颈上皮内瘤变行宫颈电灼和电环切除术可获得满意疗效。

强磁场对小鼠S180肿瘤影响的实验研究

目的 观察磁疗对小鼠 S180肿瘤的治疗效果。 方法 30只 S180荷瘤小鼠随机分两组 ,15只用强磁场处理 ,15只作对照。 10 d后称瘤块湿重及作病理检查。 结果 磁疗组肿瘤湿重显著低于对照组 (P<0 .0 0 1) ;病理检查提示磁疗组肿瘤坏死明显。

Updates on abdominal desmoid tumors

Desmoid tumor is a monoclonal, f ibroblastic proliferation arising in musculoaponeurotic structures. This connective tissue hyperplasia inf iltrates locally, recurs frequently after resection but does not metastasize. Abdominal desmoid occurs sporadically, in association with some familial syndromes and often represents a clinical dilemma for surgeons. The enigmatic biology and anatomical location of abdominal desmoids make treatment recommendations diff icult. This distinct pathological entity is reviewed with a specif ic focus on aetiology and management.

Huge primitive neuroectodermal tumor of the pancreas:Report of a case and review of the literature

Primitive neuroectodermal tumor (PNET) of the pancreas is an extremely rare tumor that usually occurs in children or young adults. We report a case of a 33-year-old male patient with an 18 cm × 18 cm × 16 cm mass arising from the pancreatic body and tail with a one- day history of abdominal pain. Initial CT scan showed no signs of metastatic tumor spread. The tumor caused intrabdominal bleeding and the patient underwent primary tumor resection including partial gastrectomy, left pancreatic resection and splenectomy. Diagnosis of PNET was confi rmed by histology, immunohistochemistry and FISH analysis. All neoplastic cells were stained positive for MIC2-protein (CD99). Approximately one month after surgery, several liver metastases were observed and the patient underwent chemotherapy according to the Euro- Ewing protocol. Subsequent relaparotomy excluded any residual hepatic or extrahepatic abdominal metastases. Although PNET in the pancreas is an extremely rare entity, it should be considered in the diffential diagnosis of pancreatic masses, especially in young patients. This alarming case particularly illustrates that PNET in the pancreas although in an advanced stage can present with only a short history of mild symptoms.