Cognitive and adaptive outcome in low-grade pediatric cerebellar astrocytomas： evidence of diminished cognitive and adaptive functioning in National Collaborative Research Studies （CCG 9891/POG 9130）.

PURPOSE： Clinicians often assume that children with posterior fossa tumors are at minimal risk for cognitive or adaptive deficits ff they do not undergo cranial irradiation. However, small case series have called that assumption into question, and have also suggested that nonirradiated cerebellar tumors can cause location-specific cognitive and adaptive impairment. This study （1） assessed whether resected but not irradiated pediatric cerebellar tumors are associated with cognitive and adaptive functioning deficits, and （2） examined the effect of tumor location and medical complications on cognitive and adaptive functioning. PATIENTS AND METHODS： The sample was composed of 103 children aged 3 to 18 years with low-grade cerebellar astroeytomas, who underwent only surgical treatment as part of Children＇s Cancer Group protocol 9891 or Pediatric Oncology Group protocol 9130. The sample was divided into three groups based on primary tumor location： vermis, left hemisphere, or right hemisphere. Data were collected prospectively on intelligence, academic achievement, adaptive skills, behavioral functioning, and pre-, peri-, and postsurgical medical complications. RESULTS： The sample as a whole displayed an elevated risk for cognitive and adaptive impairment that was not associated consistently with medical complications. Within this group of children with cerebellar tumors, tumor location had little effect on cognitive, adaptive, or medical outcome. CONCLUSION： We did not replicate previous findings of location-specific effects on cognitive or adaptive outcome. However, the elevated risk of deficits in this population runs contrary to clinical lore, and suggests that clinicians should attend to the functional outcomes of children who undergo only surgical treatment for cerebellar tumors.     

Clinical Characteristics and Surgical Management of Patients with Temporal Lobe Gangliogliomas

OBJECTIVE To review the clinical features and surgical treatment for patients with temporal lobe gangliogliomas. METHODS Patients with temporal lobe gangliogliomas who underwent resection of temporal lobe tumors, confirmed by surgical pathology, seen between September 1998 and November 2004 at the West China hospital, were selected. Medical records were reviewed for age at diagnosis, age at onset of seizures, delay between seizure onset and tumor diagnosis, types and frequencies of seizures, EEG results, extent of surgery, and pathologic diagnosis. The follow-up periods varied from 12 to 60 months (mean 30 months). RESULTS Eighteen patients were identified, including 14 males and 4 females. Age at operation ranged from 4 years to 34 years (mean 17.6 years). All patients underwent at least one surgical procedure. Fifteen tumors were classified as WHO Grade I lesions, and 3 as WHO Grade II lesions. None of patients experienced a tumor recurrence. Among the patients, 85% had complete and sustained seizure relief. CONCLUSION Complex partial seizures and auras were the common presenting symptom of these patients. The follow-up suggested good relief from the seizures after surgery and a low risk for tumor recurrence and malignant progression.     

Mesenchymal Hamartoma of the Liver in Children： a Report of Four Cases

OBJECTIVE Mesenchymal hamartoma of the liver (MHL) is a rare disease that makes up about 5%-8% of primitive hepatic tumors in children. The etiology of MHL has been the subject of considerable discussion. The possibility of malignant transformation of MHL is inclusive. To enhance the recognition of MHL in children, we have review the procedures in diagnosis and treatment and present 4 of our own cases. METHODS The clinical characteristics of MHL in 4 children including history, physical examination, lab examination, imaging data and pathology were analyzed and discussed and related to reports from the literature. RESULTS All the cases were diagnosed with B-ultrasonography and CT preoperatively, and were confirmed intra-operatively and histologically. Satisfactory results were reached postoperatively. CONCLUSION MHL is an uncommon benign lesion in children. The main presentation is abdominal painless mass. Diagnosis is aided with B-ultrasonography and CT preoperatively. Complete tumor removal is the best choice for MHL treatment resulting in a good outcome.     

Brainstem gliomas--retrospective analysis of 86 patients

Brainstem gliomas constitute 10% of brain tumors in children and less than 2% in aduhs. Since therapeutic options are limited and brainstem gliomas are associated with a high morbidity and mortality, we sought to analyze the prognostic factors associated with a better outcome. We reviewed the records of 86 patients with brainstem gliomas treated between 1996 and 2006. We recorded demographic and clinical variables as well as radiological findings and survival. Patients were divided in two groups regarding overall survival： late progressors （survival ≥ 12 months） or early progressors （survival〈12 months）. Of 86 patients with brainstem gliomas, 55.8% were females. The mean age at diagnosis was 14.2 years （range 1 to 52 years）. Twenty-four （27.9%） patients were adults.     

A modified method for locating parapharyngeal space neoplasms on magnetic resonance images：implications for differential diagnosis

The parapharyngeal space （PPS） is an inverted pyramid-shaped deep space in the head and neck region, and a variety of tumors, such as salivary gland tumors, neurogenic tumors, nasopharyngeal carcinomas with parapharyngeal invasion, and lymphomas, can be found in this space. The differential diagnosis of PPS tumors remains challenging for radiologists. This study aimed to develop and test a modified method for locating PPS tumors on magnetic resonance （MR） images to improve preoperative differential diagnosis. The new protocol divided the PPS into three compartments： a prestyloid compartment, the carotid sheath, and the areas outside the carotid sheath. PPS tumors were located in these compartments according to the displacements of the tensor veli palatini muscle and the styloid process, with or without blood vessel separations and medial pterygoid invasion. This protocol, as well as a more conventional protocol that is based on displacements of the internal carotid artery （ICA）, was used to assess MR images captured from a series of 58 PPS tumors. The consequent distributions of PPS tumor locations determined by both methods were compared. Of all 58 tumors, our new method determined that 57 could be assigned to precise PPS compartments. Nearly all （13/14; 93%） tumors that were located in the pre-styloid compartment were salivary gland tumors. All 15 tumors within the carotid sheath were neurogenic tumors. The vast majority （18/20; 90%） of trans-spatial lesions were malignancies. However, according to the ICA-based method, 28 tumors were located in the pre-styloid compartment, and 24 were located in the post-styloid compartment, leaving 6 tumors that were difficult to locate. Lesions located in both the pre-styloid and the post-styloid compartments comprised various types of tumors. Compared with the conventional ICA-based method, our new method can help radiologists to narrow the differential diagnosis of PPS tumors to specific compartments.     

Surgical treatment of skull base chondrosarcomas

Skull base chondrosarcomas are rare tumors and individual experience with their management is limited. We present a series of such tumors treated at our institution. Particular attention was paid to their extension pattern, choice of surgical approach, and outcome. Twenty-five patients were operated consecutively over a period of 19 years. Their clinical presentation, radiological features,surgical treatment, early and late treatment outcome, as well as survival rate were analyzed. The most frequent initial symptom was abducent palsy. The typical bone destruction of the petrous apex was found in 83%. Chondrosarcomas extended in 92% to the posterior cranial fossa. Total number of surgeries was 39. The operative approach was tailored to each case. The retrosigmoid approach was used in 30.8%, the pterional in 23%, and the transethmoid in 15.4%. Total tumor removal was achieved in 19 of the surgeries. New neurological deficits immediately after surgery appeared in 33.3%.     

Endoscopic options in children： experience with 134 procedures

OBJECT： There are frequent applications for endoscopy in neurosurgery. However, endoscopic surgery in children has peculiar characteristics and is associated with different rates of success. In this study, the authors report on their experience with 134 consecutive endoscopy procedures performed in 126 patients〈18 years of age. METHODS： Between April 1993 and October 2007, 134 endoscopic procedures were performed in 126 children. Indications for surgery included brain tumors in 48 children, cystic lesions in 24, aqueductal stenosis in 23, various malformations in 20, hemorrhage and infarction in 6, and isolated ventricles in 5 children. In this long-term followup study, data were analyzed with respect to clinical and radiological success rates, as well as shunt dependence both in relation to lesion origin, and to the type of endoscopic procedure performed （endoscopic third ventrieulostomy [ETV], septostomy, aqueductoplasty, or cystocistemostomy）. Finally, the influence of patient age on the success rate was evaluated.     

The clinical characteristics and treatment outcome of 57 children and adolescents with primary central nervous system germ cell tumors

Primary central nervous system germ cell tumors （CNS-GCTs） in children and adolescents have unique clinical features and methods of treatment compared with those in adults. There is little information about Chinese children and adolescents with CNS-GCTs. Therefore, in this study we retrospectively analyzed the clinical features and treatment outcome of Chinese children and adolescents with primary CNS-GCTs. Between January 2002 and December 2012, 57 untreated patients from a single institution were enrolled. They were diagnosed with CNS-GCTs after pathologic or clinical assessment. Of the 57 patients, 41 were males and 16 were females, with a median age of 12.8 years （range, 2.7 to 18.0 years） at diagnosis; 43 （75.4%） had non-germinomatous germ cell tumors （NGGCTs） and 14 （24.6%） had germinomas; 44 （77.2%） had localized disease and 13 （22.8%） had extensive lesions. Fifty-three patients completed the prescribed treatment, of which 18 underwent monotherapy of surgery, radiotherapy, or chemotherapy, and 35 underwent multimodality therapies that included radiotherapy combined with chemotherapy or surgery combined with chemotherapy and/or radiotherapy. PEB （cisplatin, etoposide, and bleomycin） protocol was the major chemotherapy regimen. The median follow-up time was 32.3 months （range, 1.2 to 139 months）. Fourteen patients died of relapse or disease progression. The 3-year event-free survival （EFS） and overall survival rates for all patients were 72.2% and 73.8%, respectively. The 3-year EFS was 92.9% for germinomas and 64.8% for NGGCTs （P = 0.064）. The 3-year EFS rates for patients with NGGCTs who underwent monotherapy and multimodality therapies were 50.6% and 73.5%, respectively （P = 0.042）. Our results indicate that multimodality therapies including chemotherapy plus radiotherapy were better treatment option for children and adolescents with CNS-GCTs.     

Correlation of VEGF and COX-2 Expression with VM in Malignant Melanomas

OBJECTIVE To investigate the relationship between vascular epithelial growth factor (VEGF) and cyclooxygenase-2 (COX-2) in melanomas and the expressive difference of VEGF and COX-2 between melanomas with and without vasculogenic mimicry(VM).METHODS Sixty cases of malignant melanomas emoeaaea In paraffin were studied. The tumors were divided into a high-grade malignant group and a low-grade malignant group based on their tumor type, atypia and survival time of the patient. Then tissue microarrays were produced from these paraffin-embedded tumor tissues which were stained for VEGF, COX-2 and PAS. The difference in expression between VEGF and COX-2 in the malignant melanomas was compared using a grid-count. In addition, the tumors were also divided into mimicry and non-mimicry groups based on their PAS staining. Then the differences between the PAS positive and negative areas of the 2 groups were compared.RESULTS In malignant melanomas with VM, VEGF and COX-2 expression was less in tumors in which VM was absent, but VEGF, COX-2 expression in high-grade malignant melanomas was higher than that in low-grade grade malignant melanomas. Expression of VEGF was correlated with COX-2 expression.CONCLUSION VM exists in some high-grade malignant melanomas. The differences and relations between VEGF and COX-2 showed that some high-grade malignant melanomas possess a unique molecular-mechanism of tumor metastasis and blood supply.     

Value of relative cerebral blood volume measurement using perfusion MRI in glioma management

INTRODUCTION： Neoangiogenesis is a critical feature that can differentiate high-grade from low-grade glioma. Conventional MR imaging does not assess this histological feature accurately. The goal of this study was to evaluate the gain in relative cerebral blood volume measurement using perfusion MRI in the management of cerebral gliomas. MATERIALS AND METHODS： Between 1998 and 2001, 32 histologically proven glial tumors were assessed by petfusion MRI using echoplanar imaging （EPI） and gradient-echo techniques. Relative cerebral blood volume （rCBV） was measured in all patients and compared to histological data.     

Residual or recurrent cerebellar low-grade glioma in children after tumor resection： is re-treatment needed？ A single center experience from 1983 to 2003

PURPOSE： The aim of this study was to report on children with cerebellar low-grade glioma （LGG）, who were found to have progressive or nonprogresssive residual tumors or tumor recurrence after tumor resection. PATIENTS AND METHODS： Medical records and magnetic resonance imaging （MRI） studies of children （〈16years） with cerebellar LGG were retrospectively analyzed. RESULTS： Of 289 patients with CNS tumors referred between 1983 and 2003, 28 （9.7%） （15 male, 13 female; median age at diagnosis： 71 months） had cerebellar LGG （pilocytic astrocytoma grade Ⅰ： n=21; fibrillary astrocytoma grade Ⅱ： n=5; mixed hamartoma/pilocytic astrocytoma： n=1; radiographic diagnosis： n=1）. Total resection was initially performed in 16 patients （57.1%）, near total resection in 4 （14.3%）, and partial resection in 6 patients （21.4%）. One patient underwent biopsy. At a median follow-up of 112 months, 25 patients （89.3%） were alive, 18of them being in complete remission. Three patients died, 2 due to symptoms related to brain stem compression/infdtration and 1 patient due to postoperative cerebral edema. Presently 5 patients have nonprogressive residual tumors and 2 patients developed nonprogressive recurrences 10 years and 20 months after initial total resection, respectively. None of them required second surgery and none received additional nonsurgical therapies. Only 1 additional patient had to undergo second surgery due to disease progression. CONCLUSIONS： A ＂wait and see＂ strategy is justified in patients with nonprogressive recurrent or residual cerebellar LGG after primary tumor resection. However,     

Clinic Pathological Features of Angiomyofibroblastoma in Vulva

Objective： To analyze the clinicopathological features and differential diagnosis of angiomyofibroblastoma （AMFB） of the vulva. Methods： Two cases of AMFB were examined by light microscopy and immunohistochemical study and to discuss the clinicopathological features and differential diagnosis of AMFB with the reference to the literature. Results： Tumors were all circumscribed, and 〈5 cm in diameter. Microscopically, the tumors were composed of spindle or polygonal cells that were cellularly or hypocellularly arranged with perivascular accentuation in a mucoid or fibrocollagenous background. The tumors contained numerous small- to medium-sized blood vessels, which were characteristically thin walled. Immunohistochemically, two cases of tumor cells were positive for vimentin, SMA, CD34（＋） and FⅧ（＋）. Desmin and MSA were positive in one case; Cytokeratin, S-100, CD31 were negative in both. Conclusion： AMFB is a rare, benign soft tissue tumor that occurs in the genital tract of adult women. The origin remains unclear, but it is suggested that an origin from a perivascular pluripotent stem cell that is capable of myofibroblastoma differentiation. Angiomyofibroblastoma should be differentiated from other neoplasms of the vulva such as aggressive angiomyxoma, superficial angiomyxoma and cellular angiofibroma.     

Current diagnostic approach to patients with adnexal masses:which tools are relevant in routine praxis?

Objective: The aim of the study was to investigate which anamnestic, laboratory and ultrasound parameters used in routine practice could predict the nature of adnexal mass, thus enabling referral to relevant specialist. Methods: Study involved the women treated for adnexal tumors throughout a period of 2 years. On admission, detailed anamnestic and laboratory data were obtained, expert ultrasound scan was performed, and power Doppler index (PDI), risk of malignancy index (RMI) and body mass index (BMI) were calculated for all patients. Obtained data were related to histopathological findings, and statistically analyzed. Results: The study included 689 women (112 malignant, 544 benignant, and 33 borderline tumors). Malignant and borderline tumors were more frequent in postmenopausal women (P=0.000). Women who had benignant tumors had the lowest BMI (P=0.000). There were significant (P<0.05) differences among tumor types regarding erythrocyte sedimentation rate, CA125 and carcinoembryonic antigen (CEA) levels. Among ultrasound findings, larger tumor diameter and ascites were more frequent in malignant tumors (P=0.000). Women with malignant tumors had highest values of RMI and PDI (P=0.000). Conclusions: Anamnestic data, ultrasound parameters and laboratory analyses were all found to be good discriminating factors among malignant, benignant and borderline tumors.     

The expression of TGF-β1, ADAM12 and HB-EGF in primary hepatic carcinoma

Objective: To detect the expression and location of TGF-β1, ADAM12 and HB-EGF in primary hepatic carcinoma and study their effect on the growth and metastasis of hepatoma carcinoma cell. Methods: TGF-β1, ADAM12 and HB-EGF were detected by RT-PCR and immunohistochemistry in 30 cases of hepatic carcinoma tissues, 30 cases of adjacent carci-noma tissues and 5 cases of normal hepatic tissues. Results: RT-PCR analyses showed that the mRNA expression of TGF-β1, ADAM12 and HB-EGF were markedly increased in each hepatic carcinoma tissue compared with its adjacent tissue (P < 0.01), but no signal was detected in normal hepatic tissue, tmmunohistochemistry showed the same outcome on the expression of above three factors in hepatic tissues as RT-PCR. Proteins location analyses showed the proteins of TGF-β1, ADAM12 and HB-EGF all distributed in the stroma of hepatic carcinoma tissues. The positive correlation was found between TGF-β1 and ADAM12 (r=0.6137, P < 0.05), as well as ADAM12 and HB-EGF (r=0.5763, P < 0.05). The protein expression of TGF-β1, ADAM12 and HB-EGF were correlated with the size of tumors, degree of differentiation of hepatoma carcinoma cells, portal vein thrombus and the metastasis of absorbent glands, especially with hepatic cirrhosis caused by hepatitis B virus. Conclu-sion: TGF-β1, ADAM12 and HB-EGF possibly play an important role in the process of growth, invasion and metastasis of hepatoma carcinoma cell, meanwhile, the above three factors may collectively participate in the transition from hepatic cirrhosis caused by hepatitis B virus to hepatocellular carcinoma.     

Anti-tumor effect and its mechanisms of ursolic acid on human esophageal carcinoma cell Eca-109 <Emphasis Type="Italic">in vivo</Emphasis>

Objective： To investigate the anti-tumor effect and possible mechanisms of ursolic acid on human esophageal carcinoma in vivo. Methods： Atransplanted tumor model by injecting Eca-109 cells into subcutaneous tissue of BALB/c nude mice was established. 40 nude mice bearing tumors were randomly divided into 4 groups and 0.2 ml saline or 0.2 ml ursolic acid （25-100 mg·kg^-1·d^-1） was injected into abdominal cavity respectively once everyday and lasted for fourteen days. The changes of tumor volume were measured continuously and tumor inhibition rate was calculated. The morphological changes of apoptosis were observed by electron microscope. The expressions of COX-2, bcl-2 and Bax protein in transplanted tumors were detected by immunohistochemistry. At last the PGE2 level of transplanted tumors was detected byradioimmunoassay. Results： Treatment of nude mice with 25, 50, or 100 mg·kg^-1·d^-1 of ursolic acid significantly inhibited the growth of the human esophageal carcinoma tumor in nude mice and induced Eca-109 cells apoptosis as demonstrated by electron microscopy analyses. The expressions of COX-2 and bcl-2 in the transplanted tumors were decreased in ursolic acid groups, while the Bax increased. The PGE2 level of transplanted tumors was decreased in ursolic acid groups with adose-relatedmanner. Conclusion： Ursolic acid has anti-tumor effects against human esophageal carcinoma cells in vivo, which are likely mediated via induction of tumor cell apoptosis and inhibition of COX-2 and PGE2.     

Removal of esophageal benign tumors with gastroscope-assisted thoracoscopic surgery

The purpose of the study was to report our experience in the treatment of benign esophageal tu- mors with fiberoptic gastroscope-assisted thoracoscopic surgery. Methods： We retrospectively analyzed the clinical data of 24 consecutive patients （22 with esophageal leiomyoma and 2 with esophageal mesenchymoma） who underwent gas-troscope-assisted thoracoscopic surgery. There were 17 male and 7 female with a mean age of 36 years. The tumors were located in the upper and middle part of the esophagus in 17 cases and lower part in 7 cases. Results： All 24 procedures were successfully performed. The median operative time was 84 minutes and the median hospital stay was 7.5 days. One esophageal perforation due to dissection of a large lesion occurred intraoperatively, which was repaired by suturing. No deaths or other severe postoperative complications were encountered during the median follow-up period of 20.5 months. Conclusion： Gastroscope-assisted thoracoscopic surgery provides a safe and effective alternative to open thoracotomy in the treatment of benign esophageal tumors.     

A CLINICAL ANALYSIS OF 7878 PATIENTS WITH TUMORS IN THE HEAD AND NECK

7878 patients with tumors in the head and neck were analyzed in a period of twenty years. All the diagnosis were confirmed by pathologic examination. There were 5485 cases (69.62%) of malignant tumors. Nearly an half of malignant tumors were in the nasopharynx (49.32%). Among the malignant tumors of the nasopharynx, 2698 were carcinoma (99.34%) and only 18 (0.66%) sarcoma. Nine of them were under 10 years of age, the youngest patient was 3 years old, and this is rare in our county. The incidence of head and neck tumors was 37.66% and that of the head and neck malignancies was 26.22% of tumors in the whole body. This study indicates that incidence of malignant tumor in head and neck was rather higher, it is worth to improve ths procedure of treatment and prevention.     

COMBINED IMAGING DIAGNOSIS OF PAROTID MASSES

Computed tomography (CT), ultrasonography, sialography, and 99mTc scintigraphy were applied before operation to 108 patients with parotid masses. The results of each technique and the combined study of them were compared with the pathological diagnosis. Ultrasonography was found to be a very effective diagnostic aid in determining the presence of space-occupying lesion in the parotid. CT was the best technique to provide adequately reliable informations regarding the location of the tumor and the relationship between tumor and surrounding tissues. For diagnosing the nature of tumors, ultrasonography combined with sialography was reliable. 99mTc scintigraphy was better than other techniques in diagnosis of adenolymphoma. The diagnostic accuracy of combined diagnosis (90.7%) was higher than those of ultrasonography (83%), CT (80.5%), sialography (79%), and 99mTc scintigraphy (13.9%) alone. The advantage of combined diagnosis was particularly obvious for the diagnosis of low-grade malignant tumors.     

腋窝淋巴结l～3个转移的早期乳腺癌根治术后放疗的临床价值(英文)

Background and Objective:The role of postmastectomy radiotherapy(PMRT) in breast cancer patients with T1-T2 tumors and 1-3 positive axillary nodes is still uncertain.This study investigated the value of PMRT for these patients.Met hods:In the retrospective data of 488 eligible patients,survival analysis was performed using the KaplanMeier method.Univariate and multivariate analyses were performed using a log-rank test and the Cox proportional hazards model,respectively.Result s:The median observation time w...     

ANEUPLOIDY INDUCTION BY THE WATER EXTRACT OF TRIPTERYGIUM HYPOGLAUCUM(LEVEL) HUTCH IN MOUSE BONE MARROW CELLS

The aneuploldy inducing activity of a Chinese medicinal herb, Tripterygium hypoglaucum (level) Hutch (THH) were investigated by means of thhree cytogenetic end points, namely C-mitotic (CM) effects, micronucleus (MN) and parallel chromosome structural aberration (CA) analyses in vivo. The experiments were performed on mouse bone marrow cells. THH showed similar gentoxic effects to colchicine (COL) in CM, MN and CA analyses; positive CM effects were observed accompanied with increases of mitotic index and frequencies of C-mltotic cells as well as decreased frequencies of anaphase in all of the THH-treated groups. The compound showed a positive MN response in bone marrow polychromatic erythrocytes but was negative in CA analyses. The preliminary results suggested that THH is an aneuploldy inducer in mouse bone marrow cells under present experiment conditions.