肺良性肿瘤53例的诊断和外科治疗

我院1979年9月～1987年12月,手术治疗肺良性肿瘤53例,诊断准确率仅10％。炎性假瘤22例,术前均误诊,错构瘤17例,术前仅3例诊断明确。炎性假瘤和错构瘤即占总数73.6％。本文依据临床资料与肺癌、肺结核瘤的鉴别诊断加以讨论。并对外科治疗中,不能确诊者应做冰冻切片检查,以便确定术式,区别对待,但应尽量保留肺组织。

胆囊良性肿瘤及瘤样病变40例分析

本文总结了胆囊良性肿瘤及瘤样病变40例,其中管状腺瘤2例,纤维瘤2例,平滑肌瘤1例,胆固醇息肉27例,炎性息肉8例。多数病例有典型的慢性胆囊炎临床表现,B超、CT提示胆囊内赘生物,经手术和病理学检查可以确诊,本组病例均行胆囊切除术而治愈。笔者体会凡B超、CT提示胆囊赘生物并有症状或赘生物直径>1.0cm,一般应行切除胆囊,对全身情况差、赘生物<1.0cm,或症状轻微者,可定期B超或CT随访观察。

妊娠合并乳腺纤维腺瘤20例临床治疗的体会

目的初步探讨妊娠合并乳腺纤维腺瘤的临床治疗体会。方法选取本院自2006年5月2008年5月收治妊娠合并乳腺纤维瘤患者20例。结果在20例患者中1例产后乳腺纤维腺瘤恶变,5例患者产后乳腺纤维腺瘤出现不同程度的增大,13例患者产后乳腺纤维腺瘤体积无变化。结论妊娠合并乳腺纤维腺瘤应在怀孕后3-6月内手术切除乳腺纤维腺。

彩色多普勒超声在乳腺癌筛查中的应用价值

目的探讨彩色多普勒超声在乳腺癌筛查中的应用价值,为早期疾病确诊提供依据。方法回顾性分析2019年7月至2020年12月宜春市人民医院收治的30例乳腺癌患者的临床资料,将其归为恶性组,另回顾性分析同期收治的30例乳腺良性肿块患者的临床资料,将其归为良性组。所有患者均采用彩色多普勒超声检查,并以病理学检查结果作为金标准。对比两组患者的彩色多普勒超声声像特征,彩色多普勒超声对乳腺良恶性肿块的诊断效能。结果恶性组中病灶边缘毛刺、肿块形状为不规则性、微钙化灶、边界模糊、血流Ⅱ~Ⅲ级的患者占比均显著高于良性组,肿块组织血流阻力指数显著高于良性组,收缩期峰值血流速度(PSV)显著快于良性组,血流0~Ⅰ级患者占比显著低于良性组(均P<0.05);彩色多普勒超声诊断真阳性29例,真阴性28例,假阳性2例,假阴性1例,灵敏度为96.67%,特异度为93.33%,准确度为95.00%,阳性预测值为93.55%,阴性预测值为96.55%。结论在乳腺癌筛查中,彩色多普勒超声诊断的应用价值高,具有较高的诊断灵敏度、特异度及准确度,能准确地诊断患者的疾病类型,清晰地观察出患者病灶组织的实际情况。

Telomerase Activity in Human Renal Cell Carcinoma with Reference to Clinicopathologic Features

Objective: To study the telomerase activity in human renal cell carcinoma and to evaluate the correlation with the clinicobiologic features of the neogrowth.Methods: The telomerase activity was studied by means of a modified telomeric repeat amplification protocol (TRAP) in 32 renal cell carcinoma tissues, 32 normal renal tissues and 32 paracancer tissues and its correlation with the clinicopathologic features of the tumor was evaluated.Results: Telomerase activity was strongly positive in 17, positive in 12 and negative in 3 cases of renal cell carcinoma tissues, the total positive rate being 91%. Telomerase activity was weakly positive (6%) in only 2 out of 32 samples of normal renal cortex tissues and positive in 6 paracancer tissues (19%), the difference was conspicuous (P<0.01).Conclusion: The positive rate of telomerase activity was significantly higher in renal cell carcinoma tissues and might serve as a prognostic marker for estimating the biologic characteristics of renal cell carcinoma.

《食管外科电子杂志》征稿与征订通知

各位尊敬的读者:由国家卫生计生委主管、人民卫生出版社主办、河北医科大学第四医院承办的《食管外科电子杂志》经国家批准(ISSN 2095-5324;CN 11-9333/R),自2013年1月正式向国内外公开发行。本刊刊载内容涵盖胸外科、普外科、消化内科、内镜学、病理学、病理生理学、影像学等与食管疾病诊断治疗相关的内容,也包括相关的基础理论研究。可刊载论文内容具体有:(1)有关食管癌的各类文章,以及食管良性疾病如食管创伤、食管运动异常。

Neuroendocrine tumors of the gastro-entero-pancreatic system

Gastro-entero-pancreatic (GEP) neuroendocrine tumors (NETs) are rare neoplasms, although their prevalence has increased substantially over the past three decades. Moreover, there has been an increased clinical recognition and characterization of these neoplasms. They show extremely variable biological behavior and clinical course. Most NETs have endocrine function and secrete peptides and neuroamines that cause distinct clinical syndromes, including carcinoid syndrome; however, many are clinically silent until late presentation with mass effects. Investigation and management should be individualized for each patient, taking into account the likely natural history of the tumor and general health of the patient. Management strategies include surgery for cure or palliation, and a variety of other cytoreductive techniques, and medical treatment including chemotherapy, and biotherapy to control symptoms due to hormone release and tumor growth, with somatostatin analogues (SSAs) and alphainterferon. New biological agents and somatostatintagged radionuclides are under investigation. Advances in the therapy and development of centers of excellence which coordinate multicenter studies, are needed to improve diagnosis, treatment and therefore survival of patients with GEP NETs.

Unusual gastric tumors and tumor-like lesions: Radiological with pathological correlation and literature review

Although gastric tumors have overlapping radiologic appearances, some unusual tumors may present specific imaging features. Using multidetector computed tomography(MDCT), with water as a negative oral contrast agent and intravenous contrast medium, can provide critical information for the diagnosis of gastric diseases. In addition, MDCT can evaluate the involvement of the gastric wall and extragastric extent of the disease, as compared with gastroenteroscopy and double-contrast upper gastrointestinal study. Regarding lesion location and size, enhancing and growth patterns, presence of calcification or fat, and involvement of the gastric wall and adjacent structures, CT may provide useful information. In this review article, we review the relevant literature and discuss the CT features and the histopathologic findings of different types of gastric lesions. The lesions are divided into benign(glomus tumors, schwannomas, leiomyomas, and lipomas), malignant(gastrointestinal stromal tumors, mucinous carcinomas, lymphomas, and carcinoid tumors), and tumor-like lesions(ectopic pancreas and bezoar). Familiarity with imaging appearances and pathologic findings can help physicians make an accurate diagnosis.

Evolving role of the endoscopist in management of gastrointestinal neuroendocrine tumors

Neuroendocrine tumors(NETs) are uncommon gastrointestinal neoplasms but have been increasingly recognized over the past few decades. Luminal NETs originate from the submucosa of the gastrointestinal tract and careful endoscopic exam is a key for accurate diagnosis. Despite their reputation as indolent tumors with a good prognosis,some NETs may have aggressive features with associated poor long-term survival. Management of NETs requires full understanding of tumor size,depth of invasion,local lymphadenopathy status,and location within the gastrointestinal tract. Staging with endoscopic ultrasound or cross-sectional imaging is important for determining whether endoscopic treatment is feasible. In general,small superficial NETs can be managed by endoscopic mucosal resection and endoscopic submucosal dissection(ESD). In contrast,NETs larger than 2 cm are almost universally treated with surgical resection with lymphadenectomy. For those tumors between 11-20 mm in size,careful evaluation can identify which NETs may be managed with endoscopic resection. The increasing adoption of ESD may improve the results of endoscopic resection for luminal NETs. However,enthusiasm for endoscopic resection must be tempered with respect for the more definitive curative results afforded by surgical treatment with more advanced lesions.

CTGF, intestinal stellate cells and carcinoid fi brogenesis

AIM： To investigate the role of small intestinal carcinoid tumor-derived fibrotic mediators, TGFβ1 and CTGF, in the mediation of fibrosis via activation of an ＂intestinal＂ stellate cell. METHODS： GI carcinoid tumors were collected for Q RT-PCR analysis of CTGF and TGFβ1. Markers of stellate cell desmoplasia were identified in peritoneal fibrosis by immunohistochemistry and stellate cells cultured from fresh resected fibrotic tissue. CTGF and TGFβ1 were evaluated using quantitative tissue array profiling （AQUA analysis） in a GI carcinoid tissue microarray （TMA） with immunostaining and correlated with clinical and histologically documented fibrosis. Serum CTGF was analyzed using a sandwich ELISA assay. RESULTS： Message levels of both CTGF and TGFβ1 in SI carcinoid tumors were significantly increased （〉 2-fold, P 〈 0.05） versus normal mucosa and gastric （non-fibrotic） carcinoids. Activated stellate cells and markers of stellate cell-mediated fibrosis （vimentin, desmin） were identified in histological fibrosis. An intestinal stellate cell was immunocytochemically and biochemically characterized and its TGFβ1 （10-7M） initiated CTGF transcription response （〉 3-fold, P 〈 0.05） demonstrated. In SI carcinoid tumor patients with documented fibrosis, TMA analysis demonstrated higher CTGF immunostaining （AQUA Score： 92 ± 8, P 〈0.05）, as well as elevated TGFβ1 （90.6 ± 4.4, P 〈 0.05）. Plasma CTGF （normal 12.5 ± 2.6 ng/mL） was increased in SI carcinoid tumor patients （31 ± 10 ng/mL, P 〈 0.05） compared to non-fibrotic GI carcinoids （〈 15 ng/mL） CONCLUSION： SI carcinoid tumor fibrosis is a CTGF/ TGFβl-mediated stellate cell-driven fibrotic response. The delineation of the biology of fibrosis will facilitate diagnosis and enable development of agents to obviate its local and systemic complications.

Three cases of retroperitoneal schwannoma diagnosed by EUS-FNA

Schwannomas are peripheral nerve tumors that are typically solitary and benign.Their diagnosis is largely based on surgically resected specimens.Recently,a number of case reports have indicated that retroperitoneal schwannomas could be diagnosed with endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA).We report the diagnosis of three cases of schwannoma using EUS-FNA.Subjects were two males and one female,ages 22,40,and 46 years,respectively,all of whom were symptom-free.Imaging findings showed well-circumscribed round tumors.However,as the tumors could not be diagnosed using these findings alone,EUS-FNA was performed.Hematoxylin-eosin staining of the resulting tissue fragments revealed bland spindle cells with nuclear palisading.There was no disparity in nuclear sizes.Immunostaining revealed S-100 protein positivity and all cases were diagnosed as schwannomas.Ki-67 indexes were 3%-15%,2%-3%,and 3%,respectively.No case showed any signs of malignancy.As most schwannomas are benign tumors and seldom become malignant,we observed these patients without therapy.All tumors demonstrated no enlargement and no change in characteristics.Schwannomas are almost always benign and can be observed following diagnosis by EUS-FNA.

Clinicopathological analysis of paraganglioma with literature review

AIM： To investigate the 152 cases of paragangliomas resected over the past 32 years in West China Hospital dinicopathologically.METHODS： All cases of paragangliomas diagnosed at the Department of Gastrointestinal Surgery and Department of Pathology, West China Hospital, China were reviewed. The pathological documents were supplied by the Department of Pathology, West China Hospital, and other necessary data were extracted from the hospital records. The statistical analyses were performed by survival analysis （Kaplan-Meier method）, descriptive statistical analyses and Х^2 analysis.RESULTS： The neuroendocrine marker vimentin was found to be selectively expressed in the benign tumors, and there were significant differences in the expression of those markers in both benign and malignant tumors. The survival analysis revealed that survival correlated significantly with the malignancy, metastasis and nodal status.CONCLUSION： Vimentin may be useful in the differential diagnosis between malignant and benign tumors. The difference in the expression of this marker in the tumors could be a clue to the future clinical diagnosis. The malignancy, metastasis and the nodal status may predict the prognosis of this disease.

Endoscopic resection of carcinoid of the minor duodenalpapilla

We encountered a 65-year-old man with a carcinoid tumor of the minor duodenal papilla. Since he had liver cirrhosis and completely refused surgery, we performed an endoscopic snare papillectomy. The papillectomy was performed successfully without procedure-related complication. The specimens revealed a carcinoid tumor showing that the margin of the tumor was positive. One week later, upper GI endoscopy was performed and the biopsy specimens obtained from base of ulcer showed no neoplastic cells. We performed a duodenoscopy and CT 3, 6 and 18 mo later, and there was no macroscopic or microscopic evidence of tumor recurrence after more than 4 years.

Regression of liver metastases of occult carcinoid tumor with slow release Lanreotide therapy

Few clinical studies have demonstrated an anti-proliferative activity of somatostatin (SST) analogs in carcinoids. We report the case of a woman with liver metastases of neuroendocrine tumor and no evidence of the primary tumor. The liver metastases were characterized by high proliferation index, immunoreactiviy for somatostatin receptor (SSTR)-l, 2, 3 and 5 and positive octreoscan. Urinary 5-hydroxyindolacetic acid, serum serotonin and chromogranin A were elevated. Slow release lanreotide (SR-LAN) therapy for 3 mo controlled clinical and biochemical signs of carcinoid tumor and caused a clear-cut reduction in the diameter of two liver metastases and disappearance of another lesion, with further reduction after 6 and 18 mo. We demonstrated a clear-cut long-lasting anti-proliferative effect of SR-LAN on liver metastases of occult carcinoid with high proliferation index and immunoreactivity for SSTR-1, 2, 3, and 5. Immunohistochemistry for SSTRs could be a suitable method for the selection of patients with metastatic carcinoid that may benefit from SST analog therapy.

Science Letters:Serum protein fingerprinting coupled with artificial neural network distinguishes glioma from healthy population or brain benign tumor

To screen and evaluate protein biomarkers for the detection of gliomas (Astrocytoma grade Ⅰ-Ⅳ) from healthy individuals and gliomas from brain benign tumors by using surface enhanced laser desorption/ionization time of flight mass spectrometry (SELDI-TOF-MS) coupled with an artificial neural network (ANN) algorithm. SELDI-TOF-MS protein fingerprinting of serum from 105 brain tumor patients and healthy individuals, included 28 patients with glioma (Astrocytoma Ⅰ-Ⅳ), 37 patients with brain benign tumor, and 40 age-matched healthy individuals. Two thirds of the total samples of every compared pair as training set were used to set up discriminating patterns, and one third of total samples of every compared pair as test set were used to cross-validate; simultaneously, discriminate-cluster analysis derived SPSS 10.0 software was used to compare Astrocytoma grade Ⅰ-Ⅱ with grade Ⅲ-Ⅳ ones. An accuracy of 95.7%, sensitivity of 88.9%, specificity of 100%, positive predictive value of 90% and negative predictive value of 100% were obtained in a blinded test set comparing gliomas patients with healthy individuals; an accuracy of 86.4%, sensitivity of 88.9%, specificity of 84.6%, positive predictive value of 90% and negative predictive value of 85.7% were obtained when patient's gliomas was compared with benign brain tumor. Total accuracy of 85.7%, accuracy of grade Ⅰ-Ⅱ Astrocytoma was 86.7%, accuracy ofⅢ-Ⅳ Astrocytoma was 84.6% were obtained when grade Ⅰ-Ⅱ Astrocytoma was compared with grade Ⅲ-Ⅳ ones (discriminant analysis). SELDI-TOF-MS combined with bioinformatics tools, could greatly facilitate the discovery of better biomarkers. The high sensitivity and specificity achieved by the use of selected biomarkers showed great potential application for the discrimination of gliomas patients from healthy individuals and glioma from brain benign tumors.

Gastric carcinoid tumor in a patient with a past history of gastrointestinal stromal tumor of the stomach

Gastrointestinal stromal tumor is the most common mesenchymal tumor in the gastrointestinal tract. It may coexist with other type of cancers,and if so,the tumors usually involve the stomach. The most common associated cancers are gastrointestinal carcinomas. We report a 65-year-old woman with a history of gastric gastrointestinal stromal tumor who had undergone subtotal segmental gastrectomy. New polypoid lesions were detected on a follow-up gastroscopy one year later. The lesions were biopsied and found to be carcinoid tumors. There was serum hypergastrinemia,and type 1 gastric carcinoid tumor was diagnosed. A total gastrectomy was performed. Pathologic examination revealed both carcinoid tumors and a recurrent gastrointestinal stromal tumor.

Spontaneous resolution of multiple lymphangiomas of the colon:A case report

Lymphangioma of the colon is a relatively rare nonepithelial tumor and usually presents as a submucosal polypoid lesion.Many cases incidentally discovered are usually asymptomatic.However,they may present as abdominal pain or bleeding,and their resection is normally required.Lymphangioma itself is generally recognized as a benign tumor and no cases of malignant transformation have yet been reported,although its natural history is currently unknown.To the best of our knowledge,this study is the first to describe a case of spontaneous resolution in multiple colonic lymphangiomas without any specific treatment.

Midgut neuroendocrine tumor presenting with acute intestinal ischemia

Neuroendocrine tumors represent a heterogeneous group of neoplasms that arise from neuroendocrine cells and secrete various peptides and bioamines. While gastrointestinal neuroendocrine tumors,commonly called carcinoids,account for about 2/3 of all neuroendocrine tumors,they are relatively rare. Small intestine neuroendocrine tumors originate from intestinal enterochromaffin cells and represent about 1/4 of small intestine neoplasms. They can be asymptomatic or cause nonspecific symptoms,which usually leads to a delayed diagnosis. Imaging modalities can aid diagnosis and surgery remains the mainstay of treatment. We present a case of a jejunal neuroendocrine tumor that caused nonspecific symptoms for about 1 year before manifesting with acute mesenteric ischemia. Abdominal X-rays revealed pneumatosis intestinalis and an abdominal ultrasound and computed tomography confirmed the diagnosis. The patient was submitted to segmental enterectomy. Histopathological study demonstrated a neuroendocrine tumor with perineural and arterial infiltration and lymph node metastasis. The postoperative course was uneventful and the patient denied any adjuvant treatment.

Conservative resection for benign tumors of the proximal pancreas

AIM:To evaluate the safety and long-term prognosis of conservative resection (CR) for benign or borderline tumor of the proximal pancreas.METHODS: We retrospectively analyzed 20 patients who underwent CR at the Second Affi liated Hospital of Zhejiang University School of Medicine between April 2000 and October 2008. For pancreaticojejunostomy, a modified invagination method, continuous circular invaginated pancreaticojejunostomy (CCI-PJ) was used. Modified continuous closed lavage (MCCL) was performed for patients with pancreatic fistula.RESULTS: The indications were: serous cystadenomas in eight patients, insulinomas in six, non-functional islet cell tumors in three and solid pseudopapillary tumors in three. Perioperative mortality was zero and morbidity was 25%. Overall, pancreatic fistula was present in 25% of patients. At a mean follow up of 42.7 mo, all patients were alive with no recurrence and no new-onset diabetes mellitus or exocrine dysfunction.CONCLUSION: CR is a safe and effective procedure for patients with benign tumors in the proximal pancreas, with careful CCI-PJ and postoperative MCCL.