285 (3) (4) cm 67kg4214* squamous cell carcinoma stageiv 78 7/20 (- ) ( )(-) (-)(-) B C(-) (-)(+) lung left

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笞灏元
7 years ago
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1 (4) 中醫藥配合放射線及化學治療胸腺癌的病例報告陳明和梁文哲吳蓉茹邱瑞發嘉義基督教醫院中醫部 42 : 3 0.2~1.5% 10~20% Levine Rosai 1978 (invasive thymic tumor) (thymomas) (thymic carcinomas) (1) (2) (05) c158@cych.org.tw

2 285 (3) (4) ** cm 67kg4214*** squamous cell carcinoma stageiv 78 7/20 (- ) ( )(-) (-)(-) B C(-) (-)(+) lung left lower lobe frozen sectionsquamous cell carcinoma. mediastinum frozen section biopsyfibroadipose tissue with carcinoma (see micro); pericardium frozen section biopsy- fibrosis. microscopic finding:lll nodule show alveolar parenchyma with sequamous

3 (4) cell carcinoma. Moderately differentiated. BP: 130/76 mmhg. TPR: C/86/20. Conscious: clear. E4V5M6. HEENT: supple neck and normal eyes, ears, nose, and throat. No jugular vein engorgement, No lymphadenopathy. Thyroid enlargement (-). Eyes: sclera: icteric (-); conjuctiva: pale(-); pupil size: isocoria (+). Chest: symmetric expansion, wheezing (-), B.S: rale; LLL decreased. Heart: RHB with mark murmur. Echo: MVP. Abdomen: soft /ovoid with normoactive B.S.; without tenderness,distension. Extremities: freely movable without pitting edema. 91/9/9 Thymic squamous carcinoma with lung metastasis s/p op. 91/9~91/11 post-op R/T and concurrent C/T 91/12~92/3 PAC x 4; 92/3~92/9 oral UFUR 92/9~92/12 disease progression with bone metastasis s/p R/T+ Navelbine + gemcitiabine x 6 93/12~94/5 disease progression s/p weekly CPT-11+ Lipo-DOX x 15 95/2~95/6 disease progression with multiple bone metastasis s/p Taxol + Tarceva x /1~96/3 bone pain, start biweekly FL 48hr x 4. 96/4 Taxotere + Cisplantin x 2. 96/6 Left rib cage metastasis s/p R/T + Taxotere x g 1g 1g 1g 1g 0.8g TID*7

4 287 ; /04/28 WBC 2.9K Thymic CA & Lung metastasis,s/p left lung lobectomy + CCRT R/T(72th) for left pleural & pelvic bony metastasis TIDx7 95/05/12 Thymic CA & Lung metastasis,s/p left lung lobectomy + CCRT,R/T(72th) for left pleural & pelvic bony metastasis TIDx (CCRT) 95/05/29 WBC 2.9K 4.3K Ditto

5 (4) TIDx /09/25 WBC 4.3K 5.6K H.S. murmur, Ditto TIDx7 96/05/24 Ditto TIDx7 96/06/23 96/1 CT LT pleural metastasis BP: 81/54mmHg H.S. murmur, TIDx7 96/07/20 Hb TIDx7

6 p< ~1.5 % (anterior mediastinum), (1) Masaoka Stage I: Completely encapsulated tumor without microscopic capsular invasion. Stage II: (1) Microscopic capsular invasion into the surrounding fatty tissue or mediastinal pleura. (2) Microscopic invasion into the capsule. Stage III: Macroscopic invasion into the neighboring organ (pericardium, great vessels,or lung). Stage IV: (a) Pleural or pericardial dissemination. (b) Lymphatic or hematogenous metastasis. (epithelial cells) (lymphocytes)( T ) WHO 1999 (thymic epithelial tumors) A B C (a) type A spindle cell type medullary type thymoma (b) type AB mixed type(a B ) (c) type B B1 B2 B3 (B1) lymphocyte-rich type, lymphocytic

7 (4) type, predominantly cortical type, or organoid type (B2) cortical type (B3) epithelial type, squamoid type,or atypical thymoma, welldifferentiated thymic carcinoma. (d) type C thymic carcinoma. a)+b) CDDP ADOC(ADR CDDP VCR CYC) PVB(CDDP VP-16 BLM) (5) (6 ) (6)

8 291 (1) (2) (3) (4) (5) (7) p=0.017 p= % 15.3% (8) (9) (10) 74 (11) stage(iv) 78 95/ /9 96/6

9 (4) BP:81/ Tierney LM, Mcphee SJ, Papadakis MA: Current Medical Diagnosis & Treatment 1998, McGraw-Hill Companies, USA, 1998: 97; (2) Eng TY, Fuller CD, Jagiradar J, Bains Y,Thomas CR: Thymic carcinoma: state of the art review, Int J Radiat Oncol Biol Phys,2004; 59: Acta Cardiologic Sinica (2) (3)

10 293 Treatment of Thymic Carcinoma with the Combination of Chinese Medicine, Radiotherapy and Chemotherapy: A Case Report Min-Ho Chen, Wen-Che Liang, Jung-Ju Wu, Jui-Fa Chiu Chiayi Christian Hospital Chinese Medicine Department Abstract This 42 year-old male patient suffered from thymic carcinoma with multiple metastasis. He had received surgical operation and many courses of chemotherapy with radiation therapy. He visited our Chinese medicine department due to dull pain over left thoracic region. Thymic carcinoma has been recognized in Chinese medical theories as phlegm node, aggregation-accumulation, scrofula. This diagnosis was heat toxin blocking the lung and affecting spleen, stomach, liver and kidney. The therapeutic principles were soothing the liver, counteracting heat toxin, resolving phlegm and drying dampness. The medicinals for fortifying the spleen, harmonizing the stomach, directing qi downward to relieve hiccup, tonifying the kidney, nourishing blood, relaxing sinews and activating collaterals were also used. In this successful case, we found that the combination of Chinese medicine, chemotherapy and radiotherapy was a good treatment for thymic carcinoma. This combined treatment would successful control the thymic carcinoma and significantly reduce the side effect of chemotherapy and radiotherapy. Key words: thymic carcinoma, radiotherapy, chemotherapy, Chinese medicine.

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<4D6963726F736F667420576F7264202D20A4A4C2E5C3C4B074A658A9F1AE67BD75AA76C0F8A8C5C0F9AABAAF66A8D2B3F8A7695FB3AFA9FAA94D5F2E646F63> 中醫藥配合放射線治療乳癌的病例報告 197 中醫藥配合放射線治療乳癌的病例報告陳明和吳劭彥吳蓉茹嘉義基督教醫院中醫部摘要前言一 45 歲女性患者之乳癌病理報告為 invasive ductal carcinoma,t2n0m0 (Stage II), 經部分乳