Primary pulmonary lymphoepithelioma-like carcinoma misdiagnosed as lung squamous cell carcinoma:A case report

BACKGROUND Primary pulmonary lymphoepithelioma-like carcinoma(PPLELC)is an uncommon subtype of squamous cell carcinoma(SCC)of the lung,closely associated with Epstein-Barr virus(EBV)infection.The pathological features of PPLELC closely resemble those of SCC,which makes it prone to misdiagnosis.Surgical intervention constitutes the primary treatment approach for PPLELC.CASE SUMMARY This report describes a 44-year-old woman who was hospitalized for 1 mo due to left chest pain.Computed tomography revealed a mass shadow in the anterior basal segment of the left lower lobe,and a subsequent needle biopsy suggested SCC.The patient underwent radical tumor resection in the lower left lobe of the lung,and postoperative pathological examination indicated lymphoepithelial carcinoma,and the test for EBV encoded small RNA was positive.Following surgery,the patient was scheduled to receive four cycles of adjuvant chemotherapy,using the paclitaxel+carboplatin regimen,but the patient refused further treatment.CONCLUSION PPLELC is an exceptionally rare subtype of lung SCC and is prone to misdiagnosis.

Metastatic stomach lymphoepithelioma-like carcinoma and immune checkpoint inhibitor therapy:A case report

BACKGROUND Pulmonary lymphoepithelioma-like carcinoma(PLELC)is a rare type of nonsmall-cell lung cancer.Stomach lymphoepithelioma-like carcinoma(LELC)metastasis secondary to PLELC has not been reported recently.CASE SUMMARY A 64-year-old female was admitted to our hospital for a regular gastroscopy examination with a 6-year history of surgical resection for left PLELC.Positron emission tomography/computed tomography suggested high accumulation of 18F-fludeoxyglucose in the gastric cardia region.Upper gastrointestinal endoscopy confirmed a large mass at the stomach fundus.Immunohistochemistry(IHC)of the biopsy suggested metastatic stomach LELC.Proximal gastrectomy showed that this 6.5 cm×5.0 cm mass was located in the stomach fundus near the cardia.Histopathological examination showed a poorly differentiated carcinoma with prominent lymphoplasmacytic infiltration.IHC demonstrated that the tumor was positive for CK(AE1/AE3),p63,p40,p53,Ki-67(70%),and EGFR(3+)and negative for CK7,CK20,Her2,and CD10.In situ hybridization analysis showed positive staining Epstein-Barr virus-encoded RNA.Tumor programmed cell death ligand 1(PD-L1)expression score was 98%,and the combined positive score was 100,with no evidence of microsatellite instability.Thus,the patient was unequivocally diagnosed with metastatic stomach LELC secondary to pulmonary LELC.After discharge,this patient underwent PD-1 inhibitor treatment(toripalimab,240 mg)every 3 wk for ten cycles,and she has had no tumor recurrence.CONCLUSION For gastric LELC metastasis,PD-1 inhibitor therapy could become a new therapeutic approach,though there is still no evidence from large data sets to support this.

Development and validation of a postoperative pulmonary infection prediction model for patients with primary hepatic carcinoma

BACKGROUND There are factors that significantly increase the risk of postoperative pulmonary infections in patients with primary hepatic carcinoma(PHC).Previous reports have shown that over 10%of patients with PHC experience postoperative pulmonary infections.Thus,it is crucial to prioritize the prevention and treatment of postoperative pulmonary infections in patients with PHC.AIM To identify the risk factors for postoperative pulmonary infection in patients with PHC and develop a prediction model to aid in postoperative management.METHODS We retrospectively collected data from 505 patients who underwent hepatobiliary surgery between January 2015 and February 2023 in the Department of Hepatobiliary and Pancreaticospleen Surgery.Radiomics data were selected for statistical analysis,and clinical pathological parameters and imaging data were included in the screening database as candidate predictive variables.We then developed a pulmonary infection prediction model using three different models:An artificial neural network model;a random forest model;and a generalized linear regression model.Finally,we evaluated the accuracy and robustness of the prediction model using the receiver operating characteristic curve and decision curve analyses.RESULTS Among the 505 patients,86 developed a postoperative pulmonary infection,resulting in an incidence rate of 17.03%.Based on the gray-level co-occurrence matrix,we identified 14 categories of radiomic data for variable screening of pulmonary infection prediction models.Among these,energy,contrast,the sum of squares(SOS),the inverse difference(IND),mean sum(MES),sum variance(SUV),sum entropy(SUE),and entropy were independent risk factors for pulmonary infection after hepatectomy and were listed as candidate variables of machine learning prediction models.The random forest model algorithm,in combination with IND,SOS,MES,SUE,SUV,and entropy,demonstrated the highest prediction efficiency in both the training and internal verification sets,with areas under the curve of 0.823 and 0.801 and a 95%confidence interval of 0.766-0.880 and 0.744-0.858,respectively.The other two types of prediction models had prediction efficiencies between areas under the curve of 0.734 and 0.815 and 95%confidence intervals of 0.677-0.791 and 0.766-0.864,respectively.CONCLUSION Postoperative pulmonary infection in patients undergoing hepatectomy may be related to risk factors such as IND,SOS,MES,SUE,SUV,energy,and entropy.The prediction model in this study based on diffusion-weighted images,especially the random forest model algorithm,can better predict and estimate the risk of pulmonary infection in patients undergoing hepatectomy,providing valuable guidance for postoperative management.

Primary Ovarian Small Cell Carcinoma of Pulmonary Type: Analysis of 6 Cases and Review of 31 Cases in the Literatures

Objective Primary ovarian small cell carcinoma of pulmonary type(SCCOPT)is a rare ovarian tumor with a poor prognosis.The platinum-based chemotherapy is the standard treatment.However,there is little research on the clinical characteristics of SCCOPT and the potential benefits of other treatments due to its low incidence.The study aims to investigate clinicopathological characteristics and treatment of SCCOPT.Methods We summarized the clinical,imaging,laboratorical and pathological characteristics of 37 SCCOPT cases,in which 6 cases were admitted to the Gansu Provincial Hospital from the year of 2008 to 2022 and 31 cases reported in 17 English and 3 Chinese literatures.Results The median age of the studied SCCOPT cases(n=37)was 56.00(range,22-80)years.Almost 80%of them had a stageⅢorⅣtumor.All patients underwent an operation and postoperative chemotherapy.Nevertheless,all cases had a poor prognosis,with a median overall survival time of 12 months.Immunohistochemical y,the SCCOPT of all patients showed positive expressions of epithelial markers,such as CD56 and sex-determining region of Y chromosome-related high-mobility-group box 2(SOX-2),and negative expressions of estrogen receptor,progesterone receptor,vimentin,Leu-7,and somatostatin receptor 2.The tumor of above 80%cases expressed synaptophysin.Only a few cases expressed neuron-specific enolase,chromogranin A,and thyroid transcription factor-1.Conclusions SCCOPT had a poor prognosis.SOX-2 could be a biomarker to be used to diagnose SCCOPT.

Primary Embryonal Lung Carcinoma and Testicular Seminoma in the Same Patient Ten-Years Later: Case-Report and Literature Review

Primary germ cell tumors of lung are extremely rare. The prognosis is usually poor, with various symptoms seriously affecting quality of life. In this paper we describe the unique case of a patient affected by an embryonal carcinoma of lung and a testicular seminoma after ten years. We also report literature about pulmonary extragonadal germ cell tumors.

11例原发性肺淋巴上皮瘤样癌的临床病理分析

目的探讨原发性肺淋巴上皮瘤样癌(PPLELC)的影像学及临床病理表现,以提高对该疾病的认识和诊断水平。方法回顾性分析2017年1月至2022年12月经手术病理证实的11例PPLELC患者的临床表现、影像学和组织病理学特征以及治疗和预后情况。结果11例患者中,男性6例,女性5例;年龄32~79岁。8例无症状。CT显示,病灶均呈单发、实性,边界多较清,最大径为1.2~6.2 cm,CT值为31~78 HU,部分肿瘤周边可见长、短毛刺或浅分叶或胸膜牵拉;增强扫描显示,大部分病灶呈不均匀明显强化。免疫组化染色显示,CK5/6、p63均为阳性,6例PD-L1阳性表达。Epstein-Barr病毒编码小RNA(EBER)检查均为阳性。11例患者均接受了手术治疗,其中7例接受辅助化疗。截至2023年3月,11例患者均存活,10例患者无瘤生存,1例患者腹膜后淋巴结转移。结论PPLELC多为单发肿块,周围型为主,手术切除或手术联合化疗是首选治疗方案,患者预后较好。

SATB2在原发性肺肠腺癌和结直肠癌肺转移中的鉴别诊断价值

目的 原发性肺肠型腺癌(pulmonary enteric adenocarcinoma,PEA)主要由高柱状癌细胞组成,癌细胞呈不规则腺泡状或筛状排列,中央广泛坏死,与显微镜下结直肠癌的外观非常相似,因此,很难区分PEA和结直肠癌肺转移(pulmonary metastases of colorectal carcinoma, PM-CRC),需要探索新的免疫标志物。方法 由4名病理学专家,根据WHO诊断标准,结合临床病史、影像学检查和结肠镜检查,对肺肿瘤病例进行初步筛查,以纳入PEA和PM-CRC病例。对这些病例的组织标本进行多种免疫组织化学指标染色。结果 纳入28例PEA标本和42例PM-CRC标本。PEA和PM-CRC中特殊富含AT序列的结合蛋白2 (special AT-rich binding protein-2,SATB2)阳性率分别为0.00%和92.86%。SATB2区分PEA和PM-CRC的敏感性、特异性和诊断准确性分别为92.86%、100%和95.71%,角蛋白7(cytokeratin 7,CK7)分别为83.33%、96.43%和88.57%。结论 SATB2对于PEA和PM-CRC的鉴别诊断价值较高,而CK7略逊色于SATB2。因此,SATB2可被视为区分PEA与PM-CRC的最佳免疫标志物,CK7可作为参考。

慢性阻塞性肺疾病合并原发性支气管肺癌118例临床特征分析

背景与目的探讨慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并原发性支气管肺癌的临床特征,以便临床早期诊断COPD合并原发性支气管肺癌患者。方法回顾性分析我院2013年1月-2016年12月118例COPD合并原发性支气管肺癌患者的临床资料,包括年龄、性别、吸烟史、吸烟指数、临床症状及体征、病理类型、分期、转移部位及肺功能指标,选择同时期的120例单纯性COPD患者作为对照。结果 COPD合并肺癌组患者吸烟率(55.1%)及吸烟指数≥400支/年患者比例(90.8%)均高于单纯COPD组患者(20.8%,48.0%),组间差异有统计学意义(P<0.01);COPD合并肺癌组患者常见症状如咳嗽、咳痰、发热、乏力、呼吸困难发生率与单纯COPD组患者相比无统计学差异(P>0.05),而咯血、消瘦、胸痛、声音嘶哑、胸腔积液、肺不张发生率均显著高于单纯COPD组患者,差异有统计学意义(P<0.01);COPD合并肺癌组患者首次诊断时63.6%为晚期或局部晚期,远处转移以胸膜转移和骨转移多见;两组患者之间第一秒用力呼气容积(forced expiratory volume in one second,FEV_1)与用力肺活量(forced vital capacity,FVC)比值(FEV_1/FVC)、FEV_1占预计值的百分比(FEV_1%pre)、肺总量(total lung capacity,TLC)、残气容积(residual volume,RV)与TLC的比值(RV/TLC)无明显差异(P>0.05),但COPD合并肺癌组患者的一氧化碳弥散量(diffusing capacity of carbon monoxide,DLCO)较单纯COPD组患者降低,差异有统计学意义(P<0.05);COPD合并肺癌组患者病理类型以鳞癌最多见(51.7%),其中男性患者以鳞癌(60.7%)为主,而女性患者以腺癌(69.0%)为主。结论 COPD合并原发性支气管肺癌好发于男性吸烟患者,鳞癌发生率高,早期临床表现缺乏特异性,首次诊断时多为晚期或局部晚期,定期对COPD患者行胸部CT检查可以尽早发现肺癌。

原发性支气管肺癌合并慢性阻塞性肺疾病患者的临床研究

目的探讨原发性支气管肺癌合并慢性阻塞性肺疾病(COPD)的临床特征、肺功能特点和治疗方法,以提高两种疾病并存的诊疗效果。方法根据影像学表现和肺功能结果将365例原发性支气管肺癌患者分为COPD组和无COPD组,回顾性分析两组患者的临床特征、肺功能指标、病理分型、疾病无进展时间等,分析COPD组是否规律吸入表面糖皮质激素。结果 COPD组有227例(62.2%),平均年龄[(66.1±9.3)岁比(54.8±5.6)岁]、男性患者(77.5%比55.8%)、吸烟者(82.4%比62.3%)、既往有呼吸系统疾病史(46.3%比30.4%)均高于无COPD组患者(P<0.05)。两组患者的疾病分期及家族肿瘤病史均无显著差异。COPD组存在明显气道阻塞,FEV1%pred[(68.6±9.7)%比(75.3±7.5)%]和FEV1/FVC[(65.9±8.5)%比(75.6±9.1)%]均较无COPD组明显下降(P<0.05)。COPD组以鳞癌为主要病理分型(43.2%),明显高于无COPD组(31.2%);小细胞肺癌分型也高于无COPD组(20.7%比15.2%,P<0.05)。COPD组PS评分[(3.3±0.5)分比(2.8±0.4)分]、疾病无进展时间[(5.9±1.6)d比(7.5±2.1)d]均比无COPD组差(P<0.05)。COPD组肺癌患者中仅71例在抗肿瘤治疗的同时规范按时吸入表面糖皮质激素,该部分患者的PS评分与疾病无进展时间明显优于未吸入表面糖皮质激素的患者。结论肺癌合并COPD临床上较为常见,应提高其诊治水平。建议在抗肿瘤治疗的同时规范按时吸入表面糖皮质激素,以改善患者的生活质量及预后。

肝癌TACE术后破裂并发肝脓肿及肺动脉碘化油栓塞1例

临床资料 患者男，67岁。因体检发现肝脏占位1周就诊，既往有乙肝病史20年，不规律服用抗病毒药。入院后完善相关检查，Child—PugeA级，AFP〉1200u／ml，CT显示肝内巨大占位，达18cm×17cm，诊断为原发性肝癌。外科会诊后已无手术指征，遂行TACE。

原发性肺部低度恶性肿瘤的临床特点与治疗

目的 探讨原发性肺部低度恶性肿瘤的临床特点和外科手术治疗的术式选择。方法 总结并分析了我院胸外科自 195 6年 2 0 0 0年间手术治疗 89例原发性肺部低度恶性肿瘤的临床资料。结果 本组 89例中 ,支气管类癌 5 4例 ,粘液表皮样癌 18例 ,腺样囊性癌 17例。行气管内肿物单纯切除 3例 ,肺叶切除 49例 ,支气管袖式肺叶切除 14例 ,全肺切除 14例 ,肺楔形切除 6例。全组无手术死亡。随访资料统计显示支气管类癌的 5年生存率为 91.3 % ,腺样囊性癌的 5年生存率为 70 .6% ,粘液表皮样癌的 5年生存率为 10 0 % ,未出现复发及转移。结论 支气管类癌、粘液表皮样癌、腺样囊性癌是一组低度恶性的肺部肿瘤 ,主要好发于主支气管和叶支气管 ,临床症状多表现为肺部反复感染和间断血痰。胸部影像学和纤维支气管镜检查多能获得明确诊断。其治疗手段主要是外科手术 ,切除范围取决肿瘤的部位和受阻塞的肺组织的情况 ,常规肺叶切除和支气管袖式肺叶切除是主要的外科手术式。

原发性肝癌患者TACE术后并发肺部炎症原因及临床特征的研究

目的分析原发性肝癌TACE术后肺部炎症的发生原因及临床特征。方法对我院1136例原发性肝癌TACE治疗患者进行分析。结果术后发生肺炎25例(2.20%);肺癌中出现咳嗽、咳痰22例,占88%;发热占84%。白细胞计数升高7例,占28%;CRP升高17例,占68%。CD4+T细胞下降19例,占76%。CD4+/CD8+比例下降15例,占60%。15例白蛋白下降,占60%;影像学表现以右肺下叶肺段不张为主,多伴有胸腔积液;3例死亡。结论 TACE术后部分患者会发生的肺部炎症,多见于右肝癌及巨块型肝癌患者;临床表现不典型。

原发性肺癌患者诊断延迟的影响因素分析

目的：分析原发性肺癌诊断延迟的相关因素，提出对策，降低肺癌患者的诊断延迟率。方法：回顾性分析2002年1月1日～2006年12月31日经住院诊断为原发性肺癌353例患者的病情资料。结果：353例中一半出现症状后及时就诊而在4周内（中位数）被推荐专科诊治。85．1％的患者在收到转诊信的1周内于专科诊治（BTS建议为100％）。100％的患者自收到转诊信后在2周内明确诊断并被告知（BTS建议为100％）。96．5％的患者在首次专科就诊3周内开始接受治疗（SLCG建议为80％）。结论：本研究的结果和国外学者的研究有较好的比较，但是患者诊断延迟的中位数和均数分别接近4周和6周，仍需缩短延迟时间。有效措施包括：加强对患者健康宣教，完善高危人群筛查，及时转入专科诊治，并从制度上落实。

应用腔静脉Z型支架治疗上腔静脉阻塞综合征

目的：评价国产腔静脉Z型支架治疗肺癌所致上腔静脉阻塞综合征的临床价值。方法：本组19例肺癌患者中，右肺上叶病变直接导致上腔静脉阻塞12例，纵隔淋巴结转移导致上腔静脉阻塞7例。右股静脉入路，将导管送入狭窄段远端并行DSA检查，测量狭窄段的长度和正常上腔静脉的直径。理想的支架直径应大于正常上腔静脉直径10％，支架长度应越过狭窄段两端1～2cm。术后应用透视或胸片观察支架位置，Doppler随访支架开通情况。结果：放置支架成功后，造影显示对比剂顺利通过开通的支架内，侧枝循环消失，平均上腔静脉压力由术前的27．3±8．4cmH2O降为14．2±3．7cmH2O，支架放置前后对比差异有显著性意义。结论：应用国产腔静脉Z型支架治疗肺癌伴上腔静脉阻塞综合征是微创、有效的治疗方法。

慢性阻塞性肺疾病合并支气管肺癌的临床研究

目的探讨慢性阻塞性肺病（COPD）合并原发性支气管肺癌的发病机制、临床特征、早期诊断及治疗方法。方法对48例COPD合并肺癌患者发病年龄、性别、临床表现及选择的治疗方法进行回顾性分析。结果48例患者中,男39例（81.3%）,女9例（18.7%）,大量吸烟史37例（77.1%）。病理类型：鳞癌26例（54.2%）,腺癌11例（22.9%）,小细胞癌5例（10.4%）,未定型癌6例（12.5%）。TNM分期：I期2例（4.2%）,Ⅱ期3例（6.2%）,ⅢA＋B期32例（66.7%）,Ⅳ期11例（22.9%）。出现可疑症状到确诊时间：1个月内1例（2.1%）,2～6个月29例（60.4%）,7～12个月12例（25.0%）,1年以上6例（12.5%）。治疗方法：手术切除2例（4.2%）,姑息性放和/或化疗13例（27.1%）,射频消融治疗5例（10.4%）,中医治疗15例（31.3%）,仅做对症、支持治疗9例（18.7%）,放弃治疗4例（8.3%）。结论COPD患者合并肺癌的症状无特异性,早期确诊率低。COPD患者伴胸痛、血痰、咳嗽性质的改变、胸腔积液、进行性消瘦应警惕合并肺癌的可能;定期X线和痰脱落细胞筛查对COPD合并肺癌的早期发现有一定的临床意义;胸部CT和纤支镜检查对COPD合并肺癌的临床诊断价值大。COPD合并肺癌的治疗以改善生活质量为主。

原发性肝癌肺转移的治疗进展

随着治疗技术的不断进步,原发性肝癌的局部控制率逐渐提高,患者也有了较好的生存获益,但是部分患者仍然发生肝内及肝外转移,直接影响了肝癌患者的预后。肺是最常见的肝外转移器官,临床上处理十分棘手,因此,有效控制肺部转移病灶对改善原发性肝癌肺转移患者的预后极为重要。原发性肝癌的治疗目前尚无明确的治疗措施和标准方案,临床上现有的方法主要包括肺部外科手术治疗、血管介入治疗、局部消融治疗、放射治疗、药物化疗、分子靶向治疗等。

肝癌术后孤立性肺转移灶切除术的临床应用

目的探讨原发性肝癌根治术后肺转移灶的治疗方案选择。方法回顾性分析2006年9月1日～2010年8月31日原发性肝癌根治术后肺转移癌患者的治疗方案。43例患者分为胸腔镜下行肺部肿块楔形切除术(实验组,18例)、胸腔镜下行肺叶切除+纵隔淋巴结清扫术(A对照组,16例)、系统化疗为主而未做手术(B对照组,9例)。结果实验组与A对照组在第1次肺部手术后第1、2、5年总体生存率无显著性差异(P>0.05);实验组、A对照组分别与B对照组在肺部肿块确诊后第1、2、5年总体生存率有显著性差异(P<0.05);实验组与A对照组在第1次行肺部手术时的手术时长、术中出血量、日均胸管引流量比较有非常显著性差异(P<0.01),与胸管放置天数和平均住院日比较有显著性差异(P<0.05)。结论胸腔镜下肺楔形切除术治疗原发性肝癌根治术后孤立性肺转移癌既可减少并发症,又能提高远期生存率。

介入治疗对原发性支气管肺癌患者凝血及纤溶功能的影响

目的 研究原发性支气管肺癌介入治疗前(A1 组)、治疗后(A2 组)凝血及纤溶功能的变化。方法 比较 A1 组(40 例)、A2 组(40 例)及对照组(B组,30 例)指标。PT、APTT、TT、Fg、FⅦ、FⅧ、FⅩ采用光散射比浊法、P 选择素(Ps)、血管性血友病因子(vWF)、尿激酶型纤溶酶原激活物(uPA)采用ELISA法,uPA抑制物(PAI)采用发色底物法测定。结果 与 B组比较,A1 组 APTT、TT、Fg、FⅧ、Ps、vWF、uPA和PAI均升高(P<0.05);与A1组比较,A2组Fg、FⅧ、Ps、uPA和PAI降低(P<0.05)。结论 原发性支气管肺癌患者凝血及纤溶过度激活,血小板活化,介入治疗后减轻。

用三维适形放疗治疗肝癌切除术后肺转移病灶的指征和疗效

目的 归纳总结采用三维适形放疗治疗原发性肝癌切除术后单纯肺转移病灶的指征和疗效。方法 回顾性分析近 3年 2 1例采用三维适形放疗技术治疗原发性肝癌切除术后单纯肺转移病灶的适应证、方法及疗效 ,并与同期1 2例采用放射介入治疗病人进行比较分析。结果 本组病例中采用三维适形放疗 2 1例 ,随访 1 8个月 ,肺转移癌有效控制率、缩小率、消失率分别是 1 0 0 %、62 .0 %和 38.1 %。血清甲胎蛋白经历了术后的正常 -升高 -降低 -再升高 -再正常的过程。而同期介入治疗组 1 2例 ,随访 1 8个月 ,肺转移癌有效控制率、缩小率、消失率分别是 58.3 %、41 .7%和 1 6 .7% ,P <0 .0 1。结论 三维适形放疗能够明显地控制和杀灭原发性肝癌切除术后出现的肺转移病灶 ,延长病人的存活时间 ,其疗效优于介入治疗组。仅存在肺部转移病灶而无肝内复发和转移 。

原发性肝癌行TACE术后肺栓塞护理

目的分析10例原发性肝癌行TACE术后并发肺栓塞的原因及护理体会。方法回顾性分析我院2008年1月～2012年12月行TACE治疗的原发性肝癌患者,共72 276人次。其中术后出现肺栓塞患者10例,总结、分析该10例患者的临床特点、治疗方式和护理。结果TACE术后并发肺栓塞例数占同期我院TACE例数的0.01%;出现肺栓塞时间为术后30min～5d。患者表现为呼吸困难、紫绀、心悸、胸痛、黄疸、血尿及血PO2、SatO2下降等肺栓塞症状;本组死亡6例,死亡率60%。结论肺栓塞是原发性肝癌患者TACE术后的严重并发症,起病急骤,死亡率高。严密、细致地观察患者病情变化,并加以综合分析,能及早发现症状,并及时处理,从而帮助临床正确施治,对提高肺栓塞治愈率有重要意义。