眼眶原发性非何杰全淋巴瘤2例报告

本文报道了二例眼眶原发性非何杰金淋巴瘤，复习了国内外有关文献，分析了该瘤的发病率、临床特点、诊断和鉴别诊断、治疗和预后。     

肿瘤标志物的诊断试验评价

对肿瘤的早期诊断和治疗是提高生存率的关键。目前有很多新的手段可以帮助诊断和判断预后，仅肿瘤标记常用的就有１３０种之多，还不包括其它影像学检查如Ｘ线、放射性核素、超声诊断、ＣＴ和ＭＲＩ。要充分发挥其临床应用价值，必须要有一套判断指标。诊断试验评价正是应用了临床流行病学的方法对新的诊断试验进行评价研究，有助于临床医师正确选用各种诊断试验，科学地解释诊断试验的各种结果，从而提高诊断水平。如癌胚抗原（ＣＥＡ）开始应用于临床时认为对结肠癌有很高的诊断价值，但以后发现其它恶性肿瘤也有这种抗原，并且在非肿瘤的…     

^18F—FDG PET显像在鼻咽癌诊断治疗中的价值

目的：探讨^18F—FDG PET显像在鼻咽癌诊断治疗中的价值。方法：35例鼻咽癌PET与同期CT、MRI、骨ECT诊断结果比较分析，全部经病理组织学证实。结果：35例鼻咽癌PET与临床和CT、MRI、骨ECT诊断相符31例(88．6％)，诊断不符4例(11．4％)．其中真阴性2例和假阴性2例，1例ECT疑为多处骨转移，PET未发现核素浓聚改变，随访排除了骨转移；1例MRI疑为复发，PET未发现核素浓聚改变，病理及随访排除了复发：1例CT诊断肝转移，1例MRI诊断桥脑转移，PET均未发现核素浓聚改变。PET检测出CT、MRI和ECT未发现的转移灶6例(17．1％)。结论：^18F—FDG PET对鼻咽癌定性诊断具有较高的准确性和特异性，在诊断淋巴结和远处转移方面优于CT和MRI；诊断肝、脑转移有假阴性表现，提示PET应结合CT、MRI进行综合分析，才能作出正确的诊断。     

多学科协作理念下胰腺癌的诊疗方针

胰腺癌早期诊断困难，病死率高，是一种难治的消化系统肿瘤。该文探讨了多学科协作理念下胰腺癌的诊断治疗方针。在诊断方面，重点探讨了CA19 9与Lewis和Secretor联合分组提高CA19 9诊断敏感性和特异性的新发现，以及B超、薄层CT、增强MRI、PET检查协作诊断胰腺癌的优势。讨论了可切除胰腺癌、转移性胰腺癌、局部进展期胰腺癌、交界可切除胰腺癌等的标准治疗手段，包括开放手术、腹腔镜或机器人辅助技术，辅助放化疗、靶向治疗等。此外，作者进一步介绍了国内外正在开展的临床实验研究。胰腺癌全程治疗涉及多个科室的协同合作，多学科团队（MDT）能整合各个科室优势，为患者提供最优化的诊疗方案，有助于进一步提升我国胰腺癌诊疗水平。     

膀胱癌新诊断技术

膀胱镜和尿脱落细胞学检查的局限性限制了对膀胱癌诊断的应用，故寻求新的诊断方法十分必要。现对超声、计算机断层扫描、生存素、膀胱肿瘤抗原等新的膀胱癌诊断方法进行综述，希望为膀胱癌的诊断提供新的思路。     

采用骨髓细胞免疫分型诊断恶性淋巴瘤

山西省肿瘤医院血液科侯淑玲等推出采用骨髓细胞免疫分型法进行恶性淋巴瘤的诊断，提高了恶性淋巴瘤的分期水平，对该病的治疗和预后具有很重要的临床价值。恶性淋巴瘤多见于儿童和青少年，发病率呈上升趋势，而且恶性淋巴瘤的预后与其临床诊断能否及早、准确、细致分期、分型有直接关系。传统上采用光镜形态学诊断，但存在一定缺陷。该院候淑玲等利用骨髓细胞进行免疫分型，不仅免除了传统方法中患者行淋巴结活检之苦，而且弥补了光镜的漏点，阳性检测出光镜形态学诊断骨髓未浸润者，并可测得免疫分型和亚型，提高了骨髓浸润的阳性结果和分…     

纤维结构不良恶性变一例报告并文献复习

目的：探讨纤维结构不良恶变的临床病理特征及其诊断和鉴别诊断。方法：分析了1例纤维结构不良骨肉瘤变患的临床表现，放射学及病理形态学的特征，并就病因及鉴别诊断等问题进行了讨论。结果：纤维结构不良发生恶变是一种罕见病变，其诊断必须依赖于临床、放射、病理三的结合。     

细湿针穿刺细胞学检查诊断直肠癌

[目的]为了进一步探讨直肠癌诊断的新途径，运用穿刺针吸细胞学在其它疾病的检查诊断方法，应用于直肠癌的诊断。[方法]总结分析了经细湿针45例针吸细胞学检查诊断直肠癌的病例。[结果]其结果与术后病理诊断完全符合，提示其对直肠癌诊断正确率100％。[结论]细湿针穿刺细胞学诊断直肠癌，不需特殊医疗器械、操作方法简单易行、无大出血感染之危、损伤小、安全可靠、不会引起肿瘤种植。因此认为细湿针穿刺细胞学诊断直肠癌比临床上常用的细干针穿刺细胞学诊断方法具有更高的成功率和正确率。     

流式细胞仪三色荧光标记技术在白血病免疫分型中的应用

目的：建立一种准确、可靠的白血病免疫分型检测方法。方法：采用流式细胞仪单染色和三色荧光标记技术。结果：单染色标记法检测48例白血病患者，诊断不明确9例(18.7％)，初始诊断与最后诊断不符2例(4％)，三染色标记法检测36例白血病患者，未发现诊断不明确者或初始诊断与最后诊断不符者；且通过二维表型图谱，可发现相关抗原共同表达，利于混合型白血病诊断。结论：流式细胞仪三色荧光标记法进行白血病免疫分型，克服了单染色标记法细胞分群不清的问题，对白血病诊断、发生发展和预后判断有重要的指导意义。     

前列腺癌的诊断(附65例分析)

报告６５例经病理确诊的前列腺癌，讨论了其早期诊断的方法及其临床价值。方法经直肠指诊，经直肠超声，经腹会阴超声，前列腺特异性抗原，酸性磷酸酶诊断前列腺癌。结果以上几种诊断阳性率分别为８５％、７５％、６２％、８０％和３５％。结论ＤＲＥ，ＴＲＵＳ，ＰＳＡ及经直肠穿刺检是目前筛选及早期诊断ＰＣ的重要方法。     

Book Reviews

Book reviewed in this article: An Atlas of Lower Limb Ischaemia, by T. S. Weston and S. E. Brooks. Pp. 40, The Princess Margaret Hospital, Christchurch, New Zealand, 1976. Computerised Axial Tomography: J. Gambarelli, G. Guerinel, L. Cheverot, M. Mattei, (Springer-Verlag, New York, 1977). Cross-Sectional Anatomy: Computed Tomography & Ultrasound Correlation, Barbara L. Carter, James Moorehead, Samuel M. Wolpert, Steven B. Hammerschlag, Harry J. Griffiths and Paul C. Kahn. (Appleton Century Crofts, New York, 1977). Dynamic Radiology of the Abdomen: Normal and Pathological Anatomy, Meyers, A.M. (Springer-Verlag, New York, 1976). Radiology of the Abdomen: Anatomic basis: Joseph P. Whelan, (Lea & Febiger, 1976. Philadelphia).     

Prognostic factors for high-grade malignant glioma: Development of a prognostic index

Summary Although the prognosis of high grade malignant glioma patients is generally poor, it is possible to identify groups of patients with varying prognoses. Basing our results on the first MRC glioma study, multivariate methods were used to identify prognostic factors independently associated with the length of survival. Young age, the presence of fits, especially of long duration, extensive surgical removal of tumour and good clinical performance status were found to be the most important predictors of longer survival. The effect of tumour grade (3 or 4) was not significant, being considerably diluted by an association with extent of neurosurgery. A prognostic index was derived which split the patients into 6 groups of varying prognoses, with 2-year survival rates of between 1 and 32%. The results were verified in patients entered into a subsequent MRC trial. The successful identification of different prognostic groups suggests the use of this index as an aid in making treatment decisions for individual patients, and in interpreting the results of uncontrolled phase II studies.This report was prepared on behalf of the participating members by S.P. Stenning, L.S. Freedman (statisticians) and N.M. Bleehen (Chairman). The following clinicians and their colleagues participated in the Misonidazole or BR2 studies and/or are members of the Brain Tumour Working Party: G.E. Adams, A.M.A. Ayoub Bey, R.O. Barnard, J. Bozzino, J.D. Bradshaw, T.B. Brewin, J. Bullimore, D.P. Dearnaley, P. Gortvai, N.F.C. Gowing, A. Gregor, J.M. Henk, H.F. Hope-Stone, A. Hovenden, N. Howard, H. Hughes, A. Jones, R.M. Kalbag, I. Kerby, V. Levin, A.R. Lyons, D.S. Murrell, M.J. Ostrowski, C.E. Polkey, R. Rampling, R.I. Rothwell, P.F. Salaman, C. Scholtz, J.S. Scott, R. Sealy, L.F.N. Senanayake, B. Southcott, J. Stone, H.M. Sultana, B.E. Tomlinson, C.S. Treip, S. Vaidya, P. Wale, P.J. Winter, P. Xavier. Data management was carried out by Mrs. Bethan Smith.     

微无创消融技术治疗早期乳腺癌

随着外科治疗理念的革新和医疗技术的发展，乳腺癌的治疗手段日益多样；其中，微无创消融技术治疗早期乳腺癌符合治疗微创化、精准化的趋势，受到越来越广泛的关注。与传统外科手术相比，微无创治疗不仅可以达到与手术相当的疗效，还在保留乳房外观美容上独具优势。目前临床常见的微无创消融技术包括射频消融、冷冻消融、激光消融、微波消融和高强度聚焦超声消融等，每种技术都有其自身的优缺点。作者主要通过介绍国内外治疗乳腺癌的多种微无创消融技术最新的研究与进展，论述其临床应用前景。     

Book Reviews

Hepatitis Viruses IARS Scientific Publication No. 59 International Agency for Research on Cancer, Lyon France, 1994, 286 pp. ISBN: 92-832-1259-6 sFr. 65.-

Cancer Prevention and Control P. Greenwald, B. S. Kramer & D. L. Weed, eds. Marcel Dekker Inc., New York, USA, 1995, 803 pp., 106 figures, 167 tables. ISBN: 0-8247-9258-0

Manual of Oncologic Therapeutics, 3rd Edition J. MacDonald, D. Haller & R. Mayer, eds. J.B. Lippincott Company, Philadelphia, USA, 1995, 553 pp. ISBN: 0-397-51 394- 1 GBP 35.-

The Dictionary of Cell Biology, 2nd Edition J. Lackie & J. Dow, eds. Academic Press, Orlando, USA, 1995, 380 pp. ISBN: 0- 12-432562-9 USD 45.-

Radiation Therapy in Pediatric Oncology J.R. Cassady, ed. Springer-Verlag, Berlin-Heidelberg-New York-London-Paris-Tokyo-Hong Kong-Barcelona- Budapest, 1994, 388 pp., 77 figures. ISBN: 3-540-54105-5 DEM 428.- Hardbound

Clinical Oncology M.D. Abeloff, J.O. Armitage, AS. Lichter & J.E. Niederhuber, eds. Churchill Livingstone, Naperville, Illinois, USA, 1995, 2 200 pp., 1 021 illustrations (including 140 two-colour and 133 full-colour) ISBN: 0-443-08941 -8 GBP 156.-     

Inhibitory effects of bovine lactoferrin on intestinal polyposis in the Apc(Min) mouse

Chemopreventive effects of bovine lactoferrin (bLF), previously shown to strongly inhibit intestinal carcinogenesis in rats (K. Sekine, E. Watanabe, J. Nakamura, N. Takasuka, D.J. Kim, M. Asamoto, V. Krutovskikh, T.H. Baba, T. Ota, M.A. Moore, M. Masuda, H. Sugimoto, H. Nishino, T. Kakizoe, H. Tsuda, Inhibition of azoxymethane-initiated colon tumor by bovine lactoferrin administration in F344 rats, Jpn. J. Cancer Res. 88 (1997) 523-526; K. Sekine, Y. Ushida, T. Kuhara, M. Iigo, H. Baba-Toriyama, M.A. Moore, M. Murakoshi, Y. Satomi, H. Nishino, T. Kakizoe, H. Tsuda, Inhibition of initiation and early stage development of aberrant crypt foci and enhanced natural killer activity in male rats administered bovine lactoferrin concomitantly with azoxymethane, Cancer Lett. 121 (1997) 211-216), on spontaneous intestinal polyp development were assessed in the ApcMin mouse, a model for both familial adenomatous polyposis and sporadic colon cancers. In the experiment, 54 mice at 6 weeks of age were given 2% bLF (15 mice), 0.2% bLF (15 mice) and AIN-93G (24 mice) as basal diet ad libitum for 8 weeks. An overall tendency for a reduction in the total number of polyps in the small intestine was evident in the bLF-treated animals, along with significant suppression in the jejunum at the 2% dose (P < 0.05, 68% of the control). In addition, body growth suppression, presumed to be due to anemia and/or intussusception as a consequence of numerous polyps in the intestine, was alleviated. No toxic effects were observed in the intestinal epithelium. Although not as obvious as observed for the rat case, the data suggest that bLF may be a chemopreventor of intestinal polyposis.     

Postoperative chemotherapy without radiation in young children with malignant non-astrocytic brain tumours

Young children with malignant brain tumours have particularly poor survival and manifest severe sequelae of radiation therapy. A multi-institutional pilot study of post-operative primary chemotherapy for children under 3 years with primitive neuroectodermal tumours (PNET) or ependymoma was initiated in 1987. The chemotherapy protocol comprised earboplatin, vincristine and the eight drugs in 1 day regimen. Radiation was recommended only if tumour progression or recurrence was documented. A total of 14 patients between 5 and 36 months of age were enrolled. Seven had supratentorial tumours (PNET, pinealoblastoma, intracranial retinoblastoma) with multiple predictors of adverse outcome. Four of these responded to initial chemotherapy but subsequently progressed and all had died by 16 months from diagnosis. The seven patients with infratentorial tumours (three medulloblastomas, four ependymomas) had more favourable predictors of outcome: no meningeal dissemination and gross macroscopic resection in six of the seven cases. One patient progressed rapidly and died within 5 months. The other six are alive at 37–57 months from diagnosis. Four are in continuous complete remission at 57, 51, 41 and 37 months, respectively from the time of their tumour resection. One is described as having stable disease with a persistent radiographic lesion at 41 months from diagnosis. One has relapsed on two occasions and is the only surviving patient to have been irradiated. Intelligence scores for the six long-term survivors have thus for remained within the normal range. It is suggested that some infants with standard-risk ependymoma and, possibly, medulloblastoma may be cured without radiation therapy.Investigators of the ANZCCSG: M. Vowels, I. Toogood, M. Stevens, L. Dalla Pozza, H. Ekert, P. Smith, K. Waters, K. Tiedemann, D. O Gorman Hughes, A. Clarke, W. McWhirter, S. Kellie, P. O'Regan, M. Rice, R. Seshadri, H. Mameghan, V. Tobias, L. White, J. Skeen, S. McFarlane, D. Mauger, J. Gillies, C. Yang, P. Downie, E. Smibert, M. Bergin, G. Stevens, R. Matthews, M. Burgess, P. Duval, G. Marshall, G. Kennourakis, P. Shaw, M. Berry, L. Lockwood     

Cancer induction in mice by feeding the raw false morel mushroom Gyromitra esculenta.

One of the false morel mushrooms, Gyromitra esculenta, was administered p.o. to Swiss mice that were 6 weeks old at the beginning of the experiment. The mushrooms were fed to the mice for 3 days and were followed by a semisynthetic diet for 4 days each week for life. The treatment induced tumors in the lungs, nasal cavity, blood vessels, forestomach, glandular stomach, cecum, and liver in the following incidences: 80, 10, 50, 16, 4, 28, and 6% in females, and 70, 12, 32, 18, 20, 22, and 12% in males. In the untreated controls, the corresponding tumor incidences were 28, 0, 14, 0, 0, 8, and 0% in females and 38, 0, 6, 0, 0, 8, and 2% in males. The light microscopic examination revealed the typical appearance of adenomas and adenocarcinomas of lungs, adenomas and adenocarcinomas of nasal cavities, hemangiomas and hemangiosarcomas of blood vessels, squamous cell papillomas and carcinomas of the forestomach, adenomas and adenocarcinomas of the glandular stomach, polypoid adenomas and adenocarcinomas of the cecum, and hepatomas. The work demonstrates the carcinogenic action of the raw G. esculenta mushroom.     

Enhanced cytotoxicity with a novel system combining the paclitaxel-2′-ethylcarbonate prodrug and an HSV amplicon with an attenuated replication-competent virus,HF10 as a helper virus

We previously demonstrated that HF10, which is a natural, non-engineered HSV-1, has potent oncolytic activity in the treatment of solid malignant tumors in vitro and in vivo [H. Takakuwa, F. Goshima, N. Nozawa, T. Yoshikawa, H. Kimata, A. Nakao, et al., Oncolytic viral therapy using a spontaneously generated herpes simplex virus type 1 variant for disseminated peritoneal tumor in immunocompetent mice, Arch. Virol. 148 (2003) 813–825; S. Kohno, C. Lou, F. Goshima, Y. Nishiyama, T. Sata, Y. Ono, Herpes simplex virus type 1 mutant HF10 oncolytic viral therapy for bladder cancer, Urology 66 (2005) 1116–1121; D. Watanabe, F. Goshima, I. Mori, Y. Tamada, Y. Matsumoto, Y. Nishiyama, Oncolytic virotherapy for malignant melanoma with herpes simplex virus type 1 mutant HF10, J. Dermatol. Sci. 50 (2008) 185–196; A. Nawa, C. Luo, L. Zhang, Y. Ushijima, D. Ishida, M. Kamakura, et al., Non-engineered, naturally oncolytic herpes simplex virus HSV1 HF10: applications for cancer gene therapy, Curr. Gene. Ther. 8 (2008) 208–221]. Previous reports have also shown that a combination of HF10 and paclitaxel (TAX) was more efficacious than either regimen alone for some types of malignant tumors [S. Shimoyama, F. Goshima, O. Teshigahara, H. Kasuya, Y. Kodera, A. Nakao, et al., Enhanced efficacy of herpes simplex virus mutant HF10 combined with paclitaxel in peritoneal cancer dissemination models, Hepatogastroenterology 54 (2007) 1038–1042]. In this study, we investigated the efficacy of gene-directed enzyme prodrug therapy (GDEPT) using a novel system that combines the paclitaxel-2′-ethylcarbonate prodrug (TAX-2′-Et) and an HSV amplicon expressing rabbit-carboxylesterase (CES) with HF10 as a helper virus. This GDEPT system aims to produce high level of CES at the tumor site, resulting in efficient local conversion of the TAX-2′-Et prodrug into the active drug TAX [A. Nawa, T. Tanino, C. Lou, M. Iwaki, H. Kajiyama, K. Shibata, et al., Gene directed enzyme prodrug therapy for ovarian cancer: could GDEPT become a promising treatment against ovarian cancer?, Anti-Cancer Agents Med Chem 8 (2008) 232–239].     

原发性肝癌复发转移防治的临床与基础研究

简述近年复旦大学肝癌研究所获“九五”国家科技攻关等基金的资助对防治原发性肝癌复发转移的临床与基础研究课题的一些进展。在临床研究方面,亚临床复发作再切除手术是进一步提高疗效的主要途径,但预防复发则甚为困难。术后栓塞化疗（TACE）、生物治疗、术中肝动脉插管、冷冻肝切除等,可能有助于降低术后复发率。在实验研究方面,建立了人肝癌转移动物模型和细胞株。在分子水平对肝癌侵袭性作了研究,初步发现CerbB2、p12、p21、p53、mdm-2、VEGF、TGFα、EGF受体、MMP－2、uPA、uPA－R、ICAM－1与肝癌侵袭性呈正相关;nm23-H1、TIMP－2、Integrinα、E－cadherin、Kai-1则呈负相关。在实验性干预治疗方面,反义H－ras、Suramin、Heparin、抗肿瘤血管生成TNP－470、抗CD3／抗HBx的双特异抗体合并LAK治疗、基质金属蛋白酶抑制剂BBP－94及我所自行设计的β肽等对肝癌转移模型均有抑制转移的作用。预期生物治疗、转移复发的预测指标、多模式的干预治疗对防治肝癌转移甚为重要,其中抗肿瘤血管途径尤为突出。