Surgical resection

手术切除
  • 文章类型: Case Reports
    先天性囊性腺瘤样畸形包括一系列囊性畸形病变,其特征是不同大小和分散的异常细支气管形成。这种疾病的大多数病例是在生命的最初几年发现的,通常影响婴儿。我们报告了一例15个月大的男孩出现急性呼吸窘迫时出现胸腔积液的CCAM病例。胸部CT显示右肺下叶囊性图像。病人做了手术切除,病理检查证实了1型CCAM的诊断,没有恶性物质。手术后,患者的一般情况有所改善,在8个月的随访期间没有观察到新的呼吸道症状。提高儿科医生和放射科医生对这种罕见疾病的认识对于促进早期诊断和适当治疗至关重要。
    Congenital cystic adenomatoid malformation encompasses a series of cystic malformative lesions characterized by aberrant bronchiolar formations of varying size and dispersion. Most cases of this illness are detected in the first few years of life, usually affecting infants. We report a case of CCAM presenting as pleural effusion in a 15-month-old boy who presented with acute respiratory distress. Chest CT revealed a cystic image in the right lower lobe of the lung. The patient had surgical excision, and a pathological examination validated the diagnosis of CCAM type 1 with no malignant material. Following surgery, the patient\'s general condition improved, and no new respiratory symptoms were observed during an 8-month follow-up period. Increased awareness of this rare condition among pediatricians and radiologists is crucial for facilitating early diagnosis and appropriate treatment.
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  • 文章类型: Journal Article
    胃癌(GC)是最广泛的癌症之一,脑转移(BM)是一个明显的罕见和不利的结果。本荟萃分析评估了非手术治疗与非手术治疗之间的关系使用电子数据库对患者的生活质量和潜在生存率进行额外的手术BM切除,包括PubMed(1980-2024年4月),Medline(1980-2024年4月),科克伦图书馆,和EMBASE(1980-2024年4月)。在文献检索之后,6篇文章被纳入最终研究库.接受BM和保守治疗的患者人数为289(80.05%),而接受额外手术切除的患者人数为72(19.95%)。平均年龄为59.2岁,从五项研究中可获得的264人中,男性为195人(73.8%)。本荟萃分析的结果表明,BM肿瘤切除术对接受立体定向放射外科额外治疗的GC患者的疗效。全脑放疗或化疗对他们的生存有利。
    Gastric cancer (GC) constitutes one of the most wide-ranging cancers, with brain metastasis (BM) being a markedly uncommon and unfavorable outcome. The present meta-analysis evaluated the relationship between no-surgical treatment vs. additional surgical BM resection on the patient\'s quality of life and potential survival using electronic databases, including PubMed (1980-April 2024), Medline (1980-April 2024), Cochrane Library, and EMBASE (1980-April 2024). After a literature search, six articles were included in the final study pool. The number of patients with BM and conservative treatment was 289 (80.05%) compared with those that underwent an additional surgical resection 72 (19.95%). The mean age was 59.2 years, and the males were 195 (73.8%) of 264 available from five studies. The findings of the present meta-analysis revealed that the curative effect of BM tumor resection on patients with GC undergoing additional treatment with stereotactic radiosurgery, whole-brain radiotherapy or chemotherapy was favorable for their survival.
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  • 文章类型: Journal Article
    肝癌是一个全球性的健康挑战,造成重大的社会经济负担。肝细胞癌(HCC)是原发性肝癌的主要类型,在分子和细胞特征方面是高度异质的。早期或小肿瘤通常用手术或消融治疗。目前,化疗和免疫疗法是不可切除肿瘤或晚期HCC的最佳治疗方法。然而,药物反应和获得性耐药是不可预测的与现有的系统指南有关的突变模式和分子生物标志物,导致许多非典型分子谱患者的治疗结局不佳。凭借先进的技术平台,有价值的信息,如肿瘤遗传改变,表观遗传数据,和肿瘤微环境可以从液体活检获得。说明了肝癌的肿瘤间和肿瘤内异质性,这些数据为治疗方案的决策过程提供了坚实的证据.本文回顾了目前对HCC检测方法的理解,旨在更新使用液体活检进行HCC监测的发展。最近在分子基础上的重要发现,表观遗传概况,循环肿瘤细胞,循环DNA,和组学研究详细阐述了肝癌的诊断。此外,讨论了与治疗选择相关的生物标志物。还强调了一些最近关于靶向治疗的值得注意的临床试验。提供见解,将知识转化为潜在的生物标志物,用于检测和诊断。预后,治疗反应,以及在临床实践中的耐药指标。
    Liver cancer is a global health challenge, causing a significant social-economic burden. Hepatocellular carcinoma (HCC) is the predominant type of primary liver cancer, which is highly heterogeneous in terms of molecular and cellular signatures. Early-stage or small tumors are typically treated with surgery or ablation. Currently, chemotherapies and immunotherapies are the best treatments for unresectable tumors or advanced HCC. However, drug response and acquired resistance are not predictable with the existing systematic guidelines regarding mutation patterns and molecular biomarkers, resulting in sub-optimal treatment outcomes for many patients with atypical molecular profiles. With advanced technological platforms, valuable information such as tumor genetic alterations, epigenetic data, and tumor microenvironments can be obtained from liquid biopsy. The inter- and intra-tumoral heterogeneity of HCC are illustrated, and these collective data provide solid evidence in the decision-making process of treatment regimens. This article reviews the current understanding of HCC detection methods and aims to update the development of HCC surveillance using liquid biopsy. Recent critical findings on the molecular basis, epigenetic profiles, circulating tumor cells, circulating DNAs, and omics studies are elaborated for HCC diagnosis. Besides, biomarkers related to the choice of therapeutic options are discussed. Some notable recent clinical trials working on targeted therapies are also highlighted. Insights are provided to translate the knowledge into potential biomarkers for detection and diagnosis, prognosis, treatment response, and drug resistance indicators in clinical practice.
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  • 文章类型: Case Reports
    阑尾黏液囊肿是一种罕见的疾病,有时可以模仿急性阑尾炎或在手术中意外发现。阑尾黏液囊肿的临床表现是由于黏液积累引起的管腔扩张。这种情况有良性和恶性的潜在病因,这可以通过组织病理学检查来证实。阑尾黏液囊肿的急性表现很少见,大多类似于急性阑尾炎的症状。由于粘液扩散引起的腹膜假性黏液瘤的风险,阑尾黏液囊肿的治疗至关重要,黏液囊肿穿孔,或粘液癌等恶性肿瘤的存在。手术切除,阑尾切除术,肺切除术,或者有时右半结肠切除术,是推荐的管理方法。这是一例74岁的男性,腹部疼痛是主要的主诉。他有一个明显的右髂窝肿块。阑尾黏液囊肿的诊断是通过对比增强计算机断层扫描,后来被组织病理学证实。患者接受了手术切除,在三个月的随访中表现良好。
    Appendiceal mucocele is a rare disease that can sometimes mimic acute appendicitis or be discovered accidentally during surgeries. The clinical presentation of appendiceal mucocele is observed as lumen distension due to mucin accumulation. This condition has both benign and malignant underlying etiologies, which can be confirmed by histopathological examination. Acute presentation of appendiceal mucocele is rare and mostly resembles the symptoms of acute appendicitis. The treatment of appendiceal mucocele is crucial due to the risk of pseudomyxoma peritonei caused by the spread of mucus, mucocele perforation, or the presence of malignancy such as mucinous carcinoma. Surgical resection, either appendicectomy, typhlectomy, or sometimes right hemicolectomy, is the recommended management approach. This is a case of a 74-year-old male with pain in the abdomen as the major presenting complaint. He had a palpable right iliac fossa mass. The diagnosis of appendiceal mucocele was made by contrast-enhanced computed tomography, which was later confirmed by histopathology. The patient underwent surgical resection and was doing well at the three-month follow-up.
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  • 文章类型: Case Reports
    颅咽管瘤是上皮起源的罕见良性肿瘤。通常位于鞍区和鞍上区域,它们通常表现出质量效应的症状,颅内张力升高,或内分泌异常。没有这些症状的非典型表现通常会延迟诊断并恶化患者的预后结果。而没有这些症状的及时诊断对患者的获益至关重要。下面,我们介绍了一例50岁女性的adamantinoma型颅咽管瘤,症状轻微且无特异性。影像学检查报告鞍区存在囊性病变,鞍上,和手术切除前的鞍旁区域。告知患者,并决定对肿块病变进行手术切除。术后组织病理学研究证实该肿瘤为金刚烷酸颅咽管瘤。
    Craniopharyngiomas are rare benign neoplasms of epithelial origin. Usually located in the sellar and suprasellar regions, they typically present with symptoms of mass effect, raised intracranial tension, or endocrinological aberrations. Atypical presentations without these symptoms often delay diagnosis and worsen patient prognostic outcome, while timely diagnosis without these symptoms is essential for patient beneficence. Below, we present a case of an adamantinomatous craniopharyngioma in a 50-year-old female with minimal and non-specific symptoms. Radiographic imagining reported the presence of a cystic lesion in the sellar, suprasellar, and parasellar regions before the surgical excision. The patient was informed and a decision was made to undergo surgical resection of the mass lesion. The postoperative histopathologic study confirmed the neoplasm to be an adamantinomatous craniopharyngioma.
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  • 文章类型: Journal Article
    背景:脑转移(BrM)在NSCLC患者中普遍存在,和手术切除的BrM构成了一个有希望的局部管理和组织病理学诊断的治疗策略,尽管它是为一组选定的患者提供的。关于BrM切除术后的表现状态(PS)改善或随后的全身治疗分层的结果的信息有限。
    方法:我们进行了一项回顾性单中心队列研究,包括手术切除BrM的NSCLC患者,重点关注PS的改善和BrM切除后的后续治疗。
    结果:纳入71例患者,中位总生存期为18.3个月(95%置信区间[95%CI]:8.7,未达到).接受手术切除BrM的NSCLC患者的PS显着改善(18%和39%的患者在BrM切除前后显示ECOGPS为0-1,分别为[p=0.006]),PS改善的患者比PS未改善的患者年轻(中位数,62岁对66岁;p=0.041)。关于BrM切除术后的全身治疗,21例(30%)患者接受细胞毒性化疗,14例患者(20%)接受酪氨酸激酶抑制剂(TKIs),3名患者(4%)接受了免疫检查点抑制剂(ICIs),21例患者(30%)未接受后续治疗.通过随后的系统治疗进行分层的患者的生存结局表明,接受TKI或ICI的患者显示出更好的生存结局。尽管少数患者阻碍了统计比较。
    结论:我们描述了接受BrM手术切除的NSCLC患者的预后,揭示年轻患者更有可能预期PS的改善,在BrM切除后接受TKI或ICI的患者往往表现出更好的预后。
    BACKGROUND: Brain metastasis (BrM) is prevalent among patients with NSCLC, and surgical resection of BrM constitutes a promising treatment strategy for local management and histopathological diagnosis, although it is offered for a select group of patients. Limited information exists concerning the improvement in performance status (PS) following BrM resection or the outcomes stratified by subsequent systemic therapy.
    METHODS: We conducted a retrospective single-center cohort study including NSCLC patients with surgically resected BrM and focused on the improvement in PS and subsequent therapy after BrM resection.
    RESULTS: 71 patients were included, and the median overall survival was 18.3 months (95% confidence interval [95% CI]: 8.7, not reached). Patients with NSCLC who underwent surgical resection of BrM showed significant improvement in PS (18% and 39% showed ECOG PS of 0-1, before and after BrM resection, respectively [p = 0.006]), and patients with PS improvement were younger than those with PS unimprovement (median, 62 years versus 66 years; p = 0.041). Regarding subsequent systemic therapy after BrM resection, 21 patients (30%) received cytotoxic chemotherapy, 14 patients (20%) received tyrosine kinase inhibitors (TKIs), 3 patients (4%) received immune checkpoint inhibitors (ICIs), and 21 patients (30%) received no subsequent therapy. The survival outcomes of patients stratified by subsequent systemic treatments suggested the tendency that those who received TKI or ICI showed better survival outcomes, although a small number of patients hindered statistical comparisons.
    CONCLUSIONS: We describe the outcomes of patients with NSCLC who underwent surgical resection of BrM, revealing that younger patients were more likely to anticipate improvement in PS, and patients who received TKI or ICI after BrM resection tended to exhibit a more preferable prognosis.
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  • 文章类型: Case Reports
    特发性腹膜后纤维化(IRF)是一种罕见的疾病,其特征是腹膜后间隙的纤维组织增生,通常影响输尿管和其他腹部结构。本病例报告描述了一名52岁女性以前没有记录的IRF,在六个月内出现反复消化道出血和严重贫血的患者。诊断检查包括内窥镜检查,结肠镜检查,腹部计算机断层扫描(CT),还有活检,显示肠系膜血管的纤维包裹,导致缺血性损伤和胃肠道出血。治疗包括大剂量皮质类固醇和手术切除纤维化组织,导致症状完全缓解。本病例报告的目的是强调IRF的这种独特表现,讨论诊断挑战,并探索有效的治疗策略来管理这种罕见但重要的并发症。
    Idiopathic retroperitoneal fibrosis (IRF) is a rare condition characterized by fibrous tissue proliferation in the retroperitoneal space, commonly affecting the ureters and other abdominal structures. This case report describes a previously undocumented presentation of IRF in a 52-year-old female, who presented with recurrent gastrointestinal bleeding and severe anemia over six months. Diagnostic workup included endoscopy, colonoscopy, abdominal computed tomography (CT), and biopsy, revealing fibrous encasement of the mesenteric vessels leading to ischemic damage and gastrointestinal bleeding. Treatment involved high-dose corticosteroids and surgical resection of the fibrotic tissue, which resulted in complete resolution of symptoms. The aim of this case report is to highlight this unique presentation of IRF, discuss the diagnostic challenges, and explore effective treatment strategies for managing this rare but significant complication.
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  • 文章类型: Editorial
    暂无摘要。
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  • 文章类型: Journal Article
    引言胃肠道间质瘤(GIST)是源自Cajal间质细胞的肿瘤,负责肠道运动的起搏器细胞。局部晚期GIST患者和由于重要解剖结构接近而进行边界切除的患者,这可能导致不可接受的术后发病率,需要特殊的治疗考虑。伊马替尼,酪氨酸激酶抑制剂,在转移性GIST的非手术治疗中取得了显著成功,其在辅助治疗中对总生存率的有利影响使得推测其作为新辅助药物在局部晚期疾病患者中可能提供的益处是合乎逻辑的。方法将2012年1月至2016年12月在墨西哥城国家西格洛XXI中心肿瘤医院接受治疗的18-90岁经免疫组织化学(CD117阳性)证实为GIST的患者纳入研究。这是一项为期四年的回顾性研究。从医疗记录中收集临床数据,其中包括性,年龄,肿瘤位置,初始可切除性,不可切除的原因,初始肿瘤大小,和有丝分裂率。在无法切除的疾病的情况下,我们对接受肿瘤学评估并接受每日400mg伊马替尼治疗的患者进行了评估.结果对312例确诊为GIST的患者进行分析。男性有131人(42%),平均年龄为57岁,181名女性(58%),平均年龄为59岁。最常见的解剖位置是胃(n=185,59.2%)。在诊断的时候,210例患者(67.3%)出现可切除疾病,而n=102例患者(32.7%)患有不可切除的疾病。共有102例不可切除的疾病患者接受了每天400mg伊马替尼的治疗。16例患者(15.7%)的肿瘤尺寸减小并接受了手术。结论该研究强调了完全手术切除的重要性以及新辅助伊马替尼治疗在将不可切除的疾病转化为可切除的疾病中的潜在益处。结果表明,伊马替尼可以有效地将不可切除的GIST转化为可切除的GIST,允许进行完全切除,并在这些病例的93.7%中获得R0切除。
    Introduction Gastrointestinal stromal tumors (GISTs) are neoplasms originating from the interstitial cells of Cajal, pacemaker cells responsible for intestinal motility. Patients with locally advanced GISTs and those with borderline resections due to the proximity of vital anatomical structures, which could result in unacceptable post-surgical morbidity, require special therapeutic consideration. Imatinib, a tyrosine kinase inhibitor, has demonstrated significant success in the non-surgical management of metastatic GIST, and its favorable impact on overall survival in the adjuvant setting makes it logical to speculate on the benefit it could provide as a neoadjuvant medication in patients with locally advanced disease. Methods Patients aged 18-90 years with a diagnosis of GIST confirmed by immunohistochemistry (CD117 positivity) who were treated at the Oncology Hospital of Centro Médico Nacional Siglo XXI in Mexico City from January 2012 to December 2016 were included in the study. It is a retrospective study with a duration of four years. Clinical data were collected from the medical records, which included sex, age, tumor location, initial resectability, reason for unresectability, initial tumor size, and mitotic rate. In the case of unresectable disease, patients who were evaluated by medical oncology and who had received treatment with 400 mg of imatinib daily were evaluated. Results A total of 312 patients diagnosed with GIST were analyzed. One hundred thirty-one were men (42%) with a mean age of 57 years, and 181 were women (58%) with a mean age of 59 years. The most frequent anatomical location was the stomach (n=185, 59.2%). At the time of diagnosis, 210 patients (67.3%) presented with resectable disease, while n=102 patients (32.7%) had unresectable disease. A total of 102 patients with unresectable disease received therapy with 400 mg of imatinib per day. Sixteen patients (15.7%) presented a reduction in tumor dimensions and underwent surgery. Conclusion The study highlights the importance of complete surgical resection and the potential benefit of neoadjuvant imatinib therapy in converting unresectable to resectable disease. The results suggest that imatinib can be effective in converting unresectable GISTs to resectable ones, allowing for a complete resection to be performed and obtaining an R0 resection in 93.7% of these cases.
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  • 文章类型: Case Reports
    脑室内心脏血管瘤是非常罕见的肿瘤,占所有心脏肿瘤的5-10%。我们报告了一例无症状的21岁年轻男性,该男性在超声心动图和磁共振成像中偶然发现了心室质量。进行手术切除以确认并避免潜在的并发症。组织病理学和免疫组织化学研究证实了脑室血管瘤的诊断。随后的定期随访显示没有并发症或复发,强调良好的长期预后。此病例报告强调了即使在无症状个体中诊断评估的重要性,允许早期识别和有效管理这种罕见的心脏实体。
    Intraventricular cardiac hemangiomas are very rare tumors that account for 5-10% of all cardiac tumors. We report a case of an asymptomatic 21-year-old young male who was incidentally detected with ventricular mass on echocardiography followed by magnetic resonance imaging. Surgical resection was done for confirmation and to avoid potential complications. Histopathology and immunohistochemical studies confirmed the diagnosis of a hemangioma of the ventricle. Subsequent regular follow-up has revealed no complications or recurrence, underscoring the favorable long-term prognosis. This case report highlights the importance of diagnostic evaluation even in asymptomatic individuals, allowing for early recognition and effective management of this rare cardiac entity.
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