癌症病人切除淋巴结内隐匿性微小癌转移灶的免疫组化研究

经常规病理检查切除淋巴结内无癌转移的350例早期癌症病人(肺癌94例、乳腺癌112例、食管癌115例及外阴癌29例)3 715枚淋巴结,用连续切片、免疫组化染色重新检查、单克隆抗细胞膜(EMA)、抗细胞角蛋白(AEI/AE3)、多克隆抗角蛋白抗体免疫染色,查出部分淋巴结内存在微小癌灶或/及单个癌细胞.肺癌病人阴性率为56.4%(53/94 ),淋巴结为16.6%(123/739);乳腺癌病人阳性率为27.7%(31/112),淋巴结为2.72%(50/1840);食管癌病人阳性率为22,6%(26/115),淋巴结为7.0%;处阴癌病人阳性率为10.3%,淋巴结为1.4%.所有癌症病人总阴性率为32.3%,淋巴结为5.5%.肺鳞癌病人阳性率(58.0%)大大高于食管鳞癌(22.5%)与外阴鳞癌(10.3%)(P<0.05);肺腺癌病例阳性率(53%)也明显高于乳腺腺癌(P<0.05).随访材料显示局部淋巴结内存在隐匿性很小癌灶的病例预后较差(P<0.05).研究结果表明:应用连续切片及免疫组化染色可大大提高淋巴结内微小癌灶的检出率.淋巴结内隐匿性微小癌灶可能是恶性肿瘤广泛扩散的第一步.若能在外科手术时尽可能清除这类淋巴结,或许可以防止癌广泛转移、播放.从而能更有效地控制恶性肿瘤以提高治愈率.

彩色多普勒血流动力学测定在检测肝转移癌方面的研究

目的 探讨肝脏彩色多普勒血流动力学测定,在诊断及预测恶性肿瘤转移性肝癌、隐匿性肝转移癌中的价值。 方法 应用彩色多普勒超声诊断仪,对254例恶性肿瘤患者及60例正常对照组的肝脏彩色多普勒血流动力学变化的测定进行分析研究。结果 恶性肿瘤发生肝转移者,其肝脏血流动力学指标均明显异常于正常对照组(P<0.05)。结论 彩色多普勒超声的肝脏血流动力学定量指标不但可以检测肝转移癌,而且能够诊断隐匿性肝转移癌。

Presentation of Axillary Metastases from Occult Breast Carcinoma

Axillary presentation from occult breast cancer is uncommon and continues to be a diagnostic and therapeutic challenge to physicians. Once the diagnosis of adenocarcinoma metastatic to an axillary lymph node has been confi rmed, a preoperative workup should be done. The current experience is based on several relatively small retrospective reviews and case reports. It is diffi cult to determine the best management of occult breast cancer. However, treatment of axillary lymph node dissection is recommended for local control and complete staging information. Treatment of breast should be a choice between breast conservation with whole-breast radiotherapy and mastectomy. Adjuvant systemic treatment should be offered.