Treatment of Pathological Fractures of the Proximal Femur Due to Advanced Metastasis of Highly Malignant Tumors: A Clinical Controlled Study of Enterostenosis Reconstruction and Conservative Treatment

Objective: To investigate whether different treatment methods have an impact on the quality of life and life span after fracture of patients with proximal femoral pathological fractures caused by advanced metastasis of highly malignant tumors. Methods: Karnofsky performance status (KPS) and visual analogue score (VAS) were counted at the time of admission and 2 months after the treatments. Survival analysis was implemented to compare the median survival time and 6-month survival rate of the 2 groups. Musculoskeletal score (MSTS) was used to evaluate limb function in the surgical group at 2 months after the treatment. Results: There was no significant difference in KPS score and VAS score between the two groups at the time of admission (p > 0.05). At 2 months after treatment, the KPS score of the surgical group was higher than that of the conservative group (P < 0.05), and the VAS score of the survivors of the surgical group was lower than that of the conservative group (P < 0.05). Survival analysis showed that the median survival time and 6-month survival rate after fracture in the surgical group were higher than those in the conservative group (P < 0.05). After 2 months of treatment, the average MTST score of survivors in the surgical group was 20.38 ± 0.9 (16 - 26 points). Conclusion: Surgical intervention can benefit patients with pathological fractures of the proximal femur due to metastasis of highly malignant tumors in terms of quality of life and survival. Local tumor resection and endoparasitic replacement, which can be tolerated by most patients, can effectively reconstruct the limb function of these patients and restore their self-care ability.

Surgically treated primary malignant tumor of small bowel:A clinical analysis

AIM:To evaluate the clinical presentation,treatment and survival of patients with primary malignant tumor of small bowel(PMTSB).METHODS:Clinicopathologic data about 141 surgically treated PMTSB patients(91 males and 50 females) at the median age of 53.5 years(range 23-79 years) were retrospectively analyzed.RESULTS:The most common initial clinical features of the patients were intermittent abdominal discomfort or vague abdominal pain(67.4%),abdominal mass(31.2%),bowel obstruction(24.1%),hemotochezia(21.3%),jaundice(16.3%),fever(14.2%),coexistence of bowel perforation and peritonitis(5.7%),coexistence of gastrointestinal bleeding and shock(5.0%),and intraabdominal bleeding(1.4%).Ileum was the most common site of tumor(44.7%),followed by jejunum(30.5%)and duodenum(24.8%).PMTSB had a nonspecific clinical presentation.Segmental bowel resection(n=81)was the most common surgical procedure,followed by right hemicolectomy(n=15),pancreaticoduodenectomy(n=10),and others(n=19).Twenty-seven adenocarcinoma patients and 13 malignant lymphoma patients received adjuvant chemotherapy with 5-fluorouracil and cyclophosphamide,adriamycin,vincristine and prednisone,respectively.Information about 120 patients was obtained during the follow-up.The median survival time of PMTSB patients was 20.3 mo.The 1-,3-and 5-year survival rate was 75.0%(90/120),40.0%(48/120)and 20.8%(25/120),respectively.Adenocarcinoma was found in 73.7%(42/57),21.1%(12/57)and 15.8%(9/57)of the patients,respec-tively.Gastrointestinal stromal tumor was observed in 80.0%(20/25),72.0%(18/25)and 36.0%(9/25)of the patients,respectively.Carcinoid was detected in 100.0%(15/15),80.0%(12/15)and 46.7%(7/15)of the patients,respectively.Malignant lymphoma was demonstrated in 69.2%(9/13),30.8%(4/13)and 0%(0/13)of the patients,respectively.CONCLUSION:En bloc resection is the principal therapy for most PMTSB and chemotherapy is the important treatment modality for malignant lymphoma and other malignant tumors of small bowel which cannot be radically removed.

Malignant hepatic vascular tumors in adults: Characteristics,diagnostic difficulties and current management

Malignant vascular tumors of the liver include rare primary hepatic mesenchymal tumors developed in the background of a normal liver parenchyma. Most of them are detected incidentally by the increased use of performing imaging techniques. Their diagnosis is challenging, involving clinical and imaging criteria, with final confirmation by histology and immunohistochemistry. Surgery represents the mainstay of treatment. Liver transplantation(LT) has improved substantially the prognosis of hepatic epithelioid hemangioendothelioma(HEHE), with 5-year patient survival rates of up to 81%, based on the European Liver Intestine Transplantation AssociationEuropean Liver Transplant Registry study. Unfortunately, the results of surgery and LT are dismal in cases of hepatic angiosarcoma(HAS). Due to the disappointing results of very short survival periods of approximately 6-7 mo after LT, because of tumor recurrence and rapid progression of the disease, HAS is considered an absolute contraindication to LT. Recurrences after surgical resection are high in cases of HEHE and invariably present in cases of HAS. The discovery of reliable prognostic markers and the elaboration of prognostic scores following LT are needed to provide the best therapeutic choice for each patient.Studies on a few patients have demonstrated the stabilization of the disease in a proportion of patients with hepatic vascular tumors using novel targeted antiangiogenic agents, cytokines or immunotherapy. These new approaches,alone or in combination with other therapeutic modalities, such as surgery and classical chemotherapy, need further investigation to assess their role in prolonging patient survival. Personalized therapeutic algorithms according to the histopathological features, behavior, molecular biology and genetics of the tumors should be elaborated in the near future for the management of patients diagnosed with primary malignant vascular tumors of the liver.

Malignant giant cell tumors of the tendon sheath of the right hip:A case report

BACKGROUND Malignant giant cell tumor of the tendon sheath(MGCTTS)is an extremely rare malignant tumor originating from synovial and tendon sheath tissue with highly aggressive biological behavior and a high rate of local recurrence and distant metastasis which should be considered a highly malignant sarcoma and managed aggressively.How to systemically treat MGCTTS remains a challenge.In this case,a patient with MGCTTS suffered a recurrence after 2 surgical resections received adjuvant chemotherapy and radiation therapy,but the treatment outcome remained poor.More clinical trials and better understanding of the biology and molecular aspects of this subtype of sarcoma are needed while novel medicines should be developed to efficiently target particular pathways.CASE SUMMARY A 52-year-old man presented with persistent dull pain in the right groin accompanied by limited right hip motion starting 6 mo ago.Two months before his attending to hospital,the patient’s pain worsened,presenting as severe pain when standing or walking,limping,and inability to straighten or move the right lower extremity.Surgical excision was performed and MGCTTS was confirmed by pathology examination.Two recurrences occurred after surgical resection,moreover,the treatment outcome remained poor after adjuvant chemotherapy and radiation therapy.The patient died only 10 mo after the initial diagnosis.CONCLUSION MGCTTS is characterized by a joint mass with pain and limited motion.It typically grows along the tendons and infiltrated into the surrounding muscle and bone tissue,with a stubborn tendency to relapse,as well as pulmonary metastasis.Radically surgical resection provides a choice of treatment whereas post-operation care should be taken to preserve the function of the joint.Chemotherapy and radiotherapy can be used as alternative treatments when radical resection cannot be performed.

Rare neonatal malignant primary orbital tumors: Three case reports

BACKGROUND Aggressive malignant primary orbital tumors are extremely rare in newborns.The current cases further clarify the clinical features of malignant primary orbital tumors in neonates.CASE SUMMARY At the time of presentation at the Seventh Center of People’s Liberation Army General(PLAG)Hospital,the children were 1-,2-and 5-mo-old,respectively,and included 2 boys and 1 girl.All three cases had unilateral proptosis at birth,and underwent mass excision and histopathologic examination.A peripheral primary neuroectodermal tumor,an aggressive infantile fibromatosis and an embryonic rhabdomyosarcoma were diagnosed,respectively.The first case underwent routine chemotherapy following surgery but died within three months due to worsening condition as the tumor spread throughout the body.The other two children were treated by surgery,and at the follow-up visits 6 mo and 1 year after surgery,respectively,the wound was completed healed,and they had normal growth and development without radiotherapy or chemotherapy.A review of highly uncommon orbital tumors in newborns is also provided.CONCLUSION Malignant primary tumors should be considered in the presence of unilateral proptosis in newborns.

Malignant Peripheral Nerve Sheath Tumors of the Scalp: Case Report and Review of Literature

Malignant peripheral nerve sheath tumors of the scalp are rare lesions of the nervous system. ?Only 16 cases have been reported to date. In this report, we present a case of a malignant peripheral nerve sheath tumor (MPNST) of the scalp and retrospectively analyze the clinical features, imaging findings, pathological features, and prognoses of these tumors.

Clinicopathological study of malignant peripheral nerve sheath tumors in the head and neck:Case reports and review of literature

BACKGROUND Malignant peripheral nerve sheath tumor(MPNST)is a rare and aggressive soft tissue sarcoma that poses a major diagnostic and therapeutic challenge.CASE SUMMARY We retrospectively reviewed patients with head and neck MPNSTs treated in our hospital from 2000 to 2021.The clinical features,pathological manifestations,treatments,and prognoses were summarized.We also reviewed the literature,focusing on MPNST in the mandible and maxilla.The study population consisted of five women and five men aged 22–75 years(mean age,49 years).Of the 10 patients,7 were initial cases and 3 were recurrent cases.All lesions were sporadic.The most common site was the mandible.The most frequently encountered symptoms were a progressive mass and local swelling.Complete or partial loss of trimethylation at lysine 27 of histone H3(H3K27me3)was evident on staining in four of nine cases(one case was excluded due to lack of tissue for evaluation of loss of H3K27me3).The 2-and 5-year disease-specific survival rates were 86%a nd 43%,respectively.The average survival time was 64 mo.CONCLUSION MPNST is a highly malignant tumor with a poor prognosis,prone to a high risk of recurrence and distant metastasis.Complete surgical resection is the main treatment.

Efficacy and safety of endoscopic resection in treatment of small gastric stromal tumors: A state-of-the-art review

Gastrointestinal stromal tumors can occur in any part of the gastrointestinal tract,but gastric stromal tumors(GSTs)are the most common.All GSTs have the potential to become malignant,and these can be divided into four different grades by risk from low to high:Very low risk,low risk,medium risk,and high risk.Current guidelines all recommend early complete excision of GSTs larger than 2 cm in diameter.However,it is not clear whether small GSTs(sGSTs,i.e.,those smaller than 2 cm in diameter)should be treated as early as possible.The National Comprehensive Cancer Network recommends that endoscopic ultrasonographyguided(EUS-guided)fine-needle aspiration biopsy and imaging(computed tomography or magnetic-resonance imaging)be used to assess cancer risk for sGSTs detected by gastroscopy to determine treatment.When EUS indicates a higher risk of tumor,surgical resection is recommended.There are some questions on whether sGSTs also require early treatment.Many studies have shown that endoscopic treatment of GSTs with diameters of 2-5 cm is very effective.We here address whether endoscopic therapy is also suitable for sGSTs.In this paper,we try to explain three questions:(1)Does sGST require treatment?(2)Is digestive endoscopy a safe and effective means of treating sGST?and(3)When sGSTs are at different sites and depths,which endoscopic treatment method is more suitable?

Professor Jia Li-qun’s experience in external treatment of tumor complications based on the theory of“use communication as a complement”

The external treatment of Traditional Chinese Medicine has a long history of external treatment,with the characteristics of simplicity,convenience,cheapness,and effectiveness.It also plays an important role in the treatment of malignant tumor complications.The academic idea of“Use communication as a complement”has existed since ancient times,and it still has great significance in guiding clinical treatment.Based on the theory of“Use communication as a complement”,Professor JIA Liqun used Tongluo powder to treat chemotherapy-induced peripheral neuropathy,Wentong acupoint sticking for external treatment of cancer pain,and digestive tract reaction after chemotherapy,and achieved good clinical effects.An inspection case is attached to prove it.

Advances in the diagnosis and treatment of patients with cancer cachexia

Cachexia is a common complication with an incidence rate of 50%–80% in cancer patients. It is also responsible for 20% of mortality among these patients. Cachexia can significantly reduce the efficacy of antitumor therapies and increase treatment-related toxicity and adverse effects in cancer patients. This increases the symptom burden in patients, affects their quality of life, and ultimately shortens their survival time. The mechanism underlying the development of cachexia is complex and diverse and involves various factors and pathways, each playing an important role. Treatment approaches for cachexia are multimodal, including nutrition support therapy, appetite stimulants, and therapeutic drugs that specifically target the mechanism behind the disease. In recent years, we have gradually gained a better understanding of cachexia, and significant progress has been made in delineating molecular mechanisms, staging and diagnosis, and therapeutic drug treatment of cancer cachexia. This article reviews the research progress of cancer cachexia based on these contexts.

EFFECTIVENESS OF ELECTROCHEMICAL TREATMENT OF PRIMARY PULMONARY MALIGNANT TUMORS

Electrochemical therapy is a new therapy for the treatment of cancer.From January 1989 to November 1991

基于治未病理论灸药同治对实体恶性肿瘤化疗患者骨髓抑制的预防作用

目的:基于治未病理论探讨灸药同治对实体恶性肿瘤化疗患者骨髓抑制的预防作用。方法:选取2019年1月至2022年1月于武汉科技大学附属武汉亚心总医院接受治疗的实体恶性肿瘤化疗患者120例作为研究对象,采用随机数字表法分为对照组和观察组,每组60例。对照组常规接受化疗,观察组化疗前连续3 d给予灸药同治(艾灸+加味八珍汤)。比较治疗前、化疗后7 d 2组患者中医证候积分、血常规[血红蛋白(Hb)、白细胞计数(WBC)、血小板计数(PLT)、中性粒细胞计数(NEUT)]、生命质量[卡诺夫斯凯计分(KPS)、中国癌症患者生命质量(QOL_(2))调查问卷],比较化疗后7 d 2组患者骨髓抑制情况[发生率、严重程度、重组人粒细胞集落刺激因子(rhG-CSF)使用情况]。结果:化疗后7 d,2组患者中医证候积分升高,但观察组低于对照组(P<0.05);Hb、WBC、PLT、NEUT、KPS评分及QOL_(2)评分降低,但观察组高于对照组(均P<0.05);观察组骨髓抑制发生率、rhG-CSF使用率低于对照组,0、Ⅰ度比例高于对照组(均P<0.05)。结论:基于治未病理论,灸药同治能够改善实体恶性肿瘤化疗患者临床症状及血常规,提高患者生命质量,减少骨髓抑制的发生。

腹膜恶性肿瘤从三焦癌毒辨治的理论依据与临床应用

腹膜恶性肿瘤包括原发性腹膜癌和继发性腹膜恶性肿瘤,既往对其认识较少,随着外科肿瘤减灭术和腹腔热灌注化疗的兴起,腹膜恶性肿瘤的理念逐渐被接受,相关研究日益增多。结合历代古籍和临床经验,针对腹膜恶性肿瘤的特点,本文提出三焦为其病位,正虚癌毒为其病因,癌毒内结、三焦运化不畅为其病机;从三焦癌毒立法进行辨证论治,其治则为以攻毒为第一要素,以三焦为本,调达整体,并列举临床验案以资参考。

洛莫司汀治疗恶性肿瘤的临床应用及其研究进展

洛莫司汀(CCNU)是一种经典的亚硝脲类烷化剂,口服给药,具有良好的脂溶性和血脑屏障穿透性,可用于治疗多种恶性肿瘤。CCNU联合放疗、联合其他抗肿瘤药物(替莫唑胺、贝伐珠单抗等)治疗脑胶质瘤,疗效确切,安全性好。CCNU还可用于治疗恶性淋巴瘤、老年急性髓系白血病和黑色素瘤等多种肿瘤,在临床实践和多项研究中充分体现其有效性和耐受性。本综述重点介绍了CCNU治疗恶性肿瘤的现状以及近年来有关研究进展,以供临床医师用药时参考。

妇科恶性肿瘤术后下肢淋巴水肿患者CDT治疗依从性的质性研究

目的探究妇科恶性肿瘤术后下肢淋巴水肿患者行淋巴水肿综合消肿治疗(CDT)的依从性。方法采用质性研究中Colaizzi七步法对2023年3月至2024年3月于福建省妇幼保健院确诊为妇科恶性肿瘤者且术后出现下肢淋巴水肿的15例患者进行深入观察与访谈,归类整理其访谈内容,找出其回答中各要素的共性,对反映出的现象做出讨论。结果由访谈得知患者在认知方面存在信息缺乏和认知误区;心理存在一定变化,常有不确定感和复发恐惧、对疾病和疼痛常保持忍耐心态;在治疗过程中渴望家庭与社会的支持,社交层面变狭窄。结论CDT可提高患者对疾病、治疗方面的认知;让患者处于积极、乐观心态;通过加强家庭、社区和专业机构之间的合作来提高患者治疗依从性。

斑蝥酸钠维生素B_(6)联合化疗药物胸腔内热灌注治疗肺癌合并恶性胸腔积液的疗效和安全性

目的观察斑蝥酸钠维生素B_(6)联合化疗药物胸腔内热灌注治疗肺癌合并恶性胸腔积液的疗效和安全性。方法选取2018—2022年扬中市人民医院收治的肺癌合并恶性胸腔积液患者130例,按照随机抽签法分为A组与B组,各65例。所有患者将胸腔积液完全排出后,A组经导管注入注射用顺铂、地塞米松磷酸钠注射液、注射用人白介素-2胸腔内热灌注,B组在A组基础上加用斑蝥酸钠维生素B_(6)注射液胸腔内热灌注。比较2组临床疗效,KPS评分改善分级,治疗前后肿瘤标志物[癌胚抗原(CEA)、细胞角蛋白19片段抗原21-1(CYFRA21-1)和神经元特异性烯醇化酶(NSE)],不良反应。结果B组客观缓解率高于A组(82.67%vs.50.67%,χ^(2)=17.280,P<0.001)。B组KPS评分改善分级优于A组(u=2.053,P=0.040)。治疗后,2组血清CEA、CYFRA21-1、NSE水平低于治疗前,且B组低于A组(P<0.01)。B组与A组不良反应总发生率比较,差异无统计学意义(34.67%vs.29.33%,χ^(2)=0.490,P=0.484)。结论斑蝥酸钠维生素B_(6)联合化疗药物胸腔内热灌注治疗肺癌合并恶性胸腔积液可提高疗效、改善患者功能状态,抑制肿瘤标志物表达,延缓病情进展,且未提高不良反应发生率。

恶性肿瘤中西医结合治疗模式探索

恶性肿瘤是严重威胁人类健康的重大疾病,虽然目前中西医结合已成为我国恶性肿瘤治疗的专家共识,但尚未形成成熟的中西医结合治疗模式。通过探索构建恶性肿瘤中西医结合治疗模式,即中西医协同治疗、中医姑息治疗和中医防变治疗,覆盖恶性肿瘤不同阶段,以期在恶性肿瘤治疗过程中充分发挥中西医结合治疗的优势与特色。

卵巢颗粒细胞瘤8例临床病理观察并文献复习

目的:探讨卵巢颗粒细胞瘤的临床病理特征、诊断、鉴别诊断及预后。方法:收集本院2013-2023年诊断为卵巢颗粒细胞瘤的病例8例。分析其临床病理学特征及免疫组化表型,并复习相关文献。结果:8例平均年龄54岁,均手术治疗,除1例8年后复发死亡外,其余均存活。肿瘤平均大小10.38cm,呈囊性、多房囊性或实性。镜下肿瘤呈弥漫、实性排列,也可见假乳头状、岛状、巢团状、被富于细胞的纤维间质分隔。免疫组化显示肿瘤细胞α-Inhibin、Vimentin、CD99阳性,EMA、CK7阴性。结论:卵巢颗粒细胞瘤是低度恶性肿瘤,镜下表现方式多样,免疫组化染色及基因检测可协助诊断。手术治疗是主要方式,存在远期复发可能,需要定期随诊。

名中医沈伟生基于“治未病”理念防治恶性肿瘤经验

江苏省名中医沈伟生从事中西医结合肿瘤防治领域,秉持中医“治未病”思想,提出应将中医药融入恶性肿瘤全程管理的治疗理念,并将这一理念运用于临床实践及科学研究中,形成了其在肿瘤防治领域的“治未病”学术思想。癌前阶段,未癌先防:用中西医协同的治疗方法,阻断幽门螺杆菌、乙肝病毒等致癌因素,预防肿瘤的形成,协同增效;肿瘤治疗阶段,既癌防变:将中药尽早参与至化疗、放疗、手术等现代医学治疗手段中,预防肿瘤治疗相关不良反应的发生,减毒增效;肿瘤康复阶段,瘥后防复:在治疗结束后的肿瘤康复阶段,运用中药预防肿瘤复发转移及肿瘤并发症的发生,提高患者生活质量,延长生存期。

肿瘤患者互联网诊疗应用前景与展望

目的/意义探究与展望互联网在建立和完善肿瘤诊疗体系中的应用前景。方法/过程通过文献调研法和实地调研法,从肿瘤早期筛查、肿瘤慢病管理、肿瘤循证多学科诊疗、肿瘤康复及肿瘤辅助诊疗平台的搭建5个维度深入探析。结果/结论互联网诊疗模式在肿瘤早预防、早诊断、早治疗方面使患者获益;“全方位、全周期”的健康管理及院外随访与宣教,可有效延长肿瘤患者的生存时间,改善生活质量。