肿瘤科

肿瘤学是一种研究肿瘤（尤其是恶性肿瘤，又称为癌症）的预防、诊断和治疗的综合性、独立性医学二级学科。 Enago在肿瘤学领域具有深厚的专业知识储备，拥有肿瘤学和相关学科，如细胞生理学、生物和生物医学等相关学科的学科专业翻译师、双语校对以及英语母语学科专家编辑，且已翻译了大量此领域相关的科研论文，并协助诸多学术作者成功在国际知名SCI/EI/SSCI期刊上发表高水平论文。

平滑肌肉瘤（LMS）是一种罕见的小肠肿瘤，起源于黏膜肌层或固有肌层。小肠LMS最常见的发生部位是空肠，其次是回肠和十二指肠。其常见表现包括腹部肿块、腹痛和明显的消化道出血。LMS主要发生于60岁左右人群，略多发生于男性。小肠肿瘤的术前诊断非常困难，尤其是良恶性肿瘤的鉴别诊断。近期文献综述显示，计算机断层扫描（CT）和磁共振（MR）小肠造影是评估小肠LMS的良好方法。浅表病变会在CT和MR中漏诊，但可通过水囊内镜检出，检出率约为80%。在组织学上，LMS与胃肠道间质瘤相似，但其CD117和CD34呈阴性，平滑肌肌动蛋白和结蛋白免疫组化染色呈阳性。当LMS的大小超过5cm时，它通常通过血液传播到肝脏（65%）、其他胃肠器官（15%）和肺部（4%）。它也可通过淋巴系统（13%）或腹膜途径（18%）传播。治疗小肠LMS唯一有效的方法是手术。应根治性切除原发肿瘤，并广泛切除肠系膜。LMS对化疗的反应尚不清楚，放疗对治疗不起作用。因此，应在可能的情况下考虑行转移瘤切除术。涉及多西紫杉醇和吉西他滨联合疗法的大型II期和III期试验报告了极高的LMS（主要源自子宫）应答率。然而，一些研究还不能证实这种联合疗法的有效性。近期研究显示曲贝替定对LMS的应答率高达56%，对蒽环类药物和异环磷酰胺联合治疗失败后的晚期和转移性LMS尤其有用。

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Leiomyosarcoma are rare tumors of small intestine which arise from the muscularis mucosa or muscularis propria. The most common site of LMS in the small intestine is jejunum followed by ileum and then duodenum. The common presentations include abdominal mass, abdominal pain or overt gastrointestinal bleeding. They are mainly seen in 6th decade of life with slight male preponderance. Preoperative diagnosis of small intestinal tumors is difficult, especially differentiating between benign and malignant tumors. For LMS in small intestine, recent review of literature revealed that CT and MRI-enterography and enteroclysis are good options.Cases of superficial lesion which can be missed by both CT and MRI, can however be detected by water capsule endoscopy with a detection rate of around 80%. Histologically LMS resembles like GIST, however they are CD117 and CD34 negative by immunohistochemistry and positive for smooth muscle antigen (SMA) and desmin. When these tumors are more than 5 cm they commonly spread hematogenously to liver (65%), other GI organs (15%), lung(4%). It also has the capability to spread via lymphatics (13%) or via peritoneal route (18%). The only effective treatment for small intestine LMS is surgery. The primary tumor should be excised radically, including a wide resection of the mesentry. Response to chemotherapy is doubtful, and there is no role for radiotherapy. Therefore, metastasectomy, if possible, should be considered. Large phase II and III studies combining docetaxel and gemcitabine yielded impressive response rates in LMSs (mostly of uterine origin). However, others were not able to confirm the efficacy of this combination. Recently, trabectedin showed response rates up to 56% in LMSs, and it appeared to be especially useful in far-advanced and metastatic LMSs after failure of the combination of anthracyclines and ifosfamide.

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Leiomyosarcoma (LMS) is a rare small intestinal tumor, which arises from the muscularis mucosa or muscularis propria . The most common site of occurrence of LMS in the small intestine is the jejunum, followed by the ileum and duodenum. Its common manifestations include abdominal mass, abdominal pain, and overt gastrointestinal bleeding.. They are mainly observed in the 6th decade of life, with slight male preponderance. In general, the preoperative diagnosis of small intestinal tumors such as LMSs is difficult, especially in terms of differentiating between benign and malignant tumors. According to a recent literature review computed tomography (CT) and magnetic resonance (MR) enterography and enteroclysis are good modalities for the assessment of LMS. Superficial lesions, which can be missed by both CT and MR imaging, can be detected by water capsule endoscopy, with a detection rate of approximately 80%. Histologically, LMS resembles gastrointestinal stromal tumor; however, on immunohistochemical analysis, it has been found to be negative for CD117 and CD34 and positive for smooth muscle actin and desmin. When the size of LMS is more than 5 cm, it can hematogenously spread to the liver (65%), other gastrointestinal organs (15%), and the lungs (4%). It can also spread via the lymphatic system (13%) or peritoneal route (18%). The response of LMS to chemotherapy is unknown, and radiotherapy does not play a role in the treatment. Therefore, surgery is the only effective treatment for LMS in the small intestine. The primary tumor should be excised radically with wide resection of the mesentery. If possible, metastasectomy should be considered. Large phase II and III trials involving the combination of docetaxel and gemcitabine have reported impressive response rates for LMSs (mostly of uterine origin). However, some studies have not been able to confirm the efficacy of this combination. Trabectedin has recently showed response rates of up to 56% for LMSs, and it appeared to be particularly useful against far-advanced and metastatic LMSs after failure of anthracyclines and ifosfamide combination therapy.