Treatment Outcome of Women with Vulvar Cancer Treated in Bangladesh

Vulvar cancer has not been well studied in Bangladesh. This retrospective review reports on the experience often women with vulvar cancer who were treated at the National Institute of Cancer Research Hospital and Delta Private Hospital from October 2010 through March 2011. Survival was analyzed by age, stage and grade of the cancers. The ages often women with vulvar cancer ranged from 45 years to 70 years with a median of 59 years. The majority of patients （nine） presented with stage If! disease. One patient had a stage II cancer. Nine women had squamous cell cancers and one had an adenocarcinoma of the Bartholin＇s gland, All patients underwent surgery and nine underwent either preoperative or postoperative radiation therapy. At 24 months of follow-up, eight patients are currently alive and disease free.     

Tumours of the Scalp： A Review of Ten Cases

Background： The scalp is a common site for the development of tumours. Most of these tumours are benign; among the malignant ones, squamous cell carcinoma （SCC）） and basal cell carcinoma （BCC） predominate. In Ghana patients with scalp turnouts do not report to hospital unless they are symptomatic. Data on the condition is therefore scanty. Patients and Methods： The objective of the study was to document the hospital prevalence and the management outcome of patients with scalp tumours. Patients with turnouts of the scalp reporting at the Reconstructive Plastic Surgery and Burns Unit （RPSBU） at Komfo Anokye Teaching Hospital （KATH） who were managed by the author between June 2003 and June 2009 were entered into the study. The patients were examined clinically and the diagnosis confirmed by biopsy. The scalp tumours were excised and the defect closed directly, skin grafted, or repaired with a flap as appropriate. Results： Ten patients with eleven scalp tumours were managed during the study period from June 2003 to June 2009, made up of four males and six females. Their ages ranged from 16 to 70 years, with a mean age of 41.7 years. Two benign scalp turnouts, a sebaceous cyst and a sebeceoma were located in the frontal region; five cases of SCC and one case of basosquamous cell carcinoma （BSC） in the parietal region, two cases of SCC in the temporal region, and one case of SCC in the occipital region of the scalp. Eight of the tumours developed de novo from the scalp; one developed from a chronic burn scar （Marjolin＇s ulcer）; two tumours developed from the scalp of a patient with xeroderma pigmentosum. Two patients had excision and direct closure of the defect; six had excision and skin grafting; two had excision and flap repair. One patient had block dissection of the left cervical lymph nodes, and two patients had adjuvant radiotherapy. Conclusions： Most tumours of the scalp presenting at the RPSBU at KATH are SCC which developed de novo. Chronic burn scars and xeroderma pigmentosum were some of the aetiological factors identified. Early lesions can be cured by excision and skin grafting.     

恶性黑素瘤研究进展

恶性黑素瘤发病率存在明显的人种、性别、地域和种族差异,发病因素多样、复杂且不确定,根据临床表现和病理组织学,主要分为浅表扩散型、结节型、恶性雀斑痣样和肢端雀斑痣样四型;确诊主要是靠病理诊断;目前常用的治疗方法是综合治疗,但效果不是很理想,其预后较差、病死率高。现从流行趋势、病因、临床表现与分型、临床诊断和治疗五方面对其进行总结。     

CT 值鉴别鼻腔鼻窦软组织肿物的意义

目的：探讨CT值是否有助于鉴别鼻腔鼻窦软组织肿物的病变性质。方法：回顾性分析277例患者的术前非 增强CT资料,以术后病理结果作为确诊及分类依据。计算各类病变CT值范围并比较各类病变CT值之间的差异。将各类 样本重新分析作出诊断,比较将病变CT值范围纳入诊断依据前后的诊断准确率。结果：鼻息肉CT值为(25.3±3.5) Hu,浆 液囊肿CT值为(7.9±3.5) Hu,黏液囊肿CT值为(42.2±4.7) Hu,乳头状瘤CT值为(40.7±5.3) Hu,真菌球CT值为(112.3±10.9) Hu, 血管瘤CT值为(41.7±4.8) Hu,恶性黑色素瘤CT值为(51.2±9.9) Hu,鳞状细胞癌CT值为(47.1±9.9) Hu。鼻息肉CT值高 于浆液囊肿,低于黏液囊肿、乳头状瘤、真菌球、血管瘤、恶性黑色素瘤及鳞状细胞癌,差异均有统计学意义(均 P<0.05);浆液囊肿CT值低于其他类疾病,差异均有统计学意义(均P<0.05);真菌球CT值高于其他类疾病,差异均有 统计学意义(均P<0.05);黏液囊肿、乳头状瘤、血管瘤、恶性黑色素瘤、鳞状细胞癌平均CT值之间差异均无统计学 意义(均P>0.05)。将病变CT值范围纳入诊断依据后,诊断准确率由71.1%提高至92.4%,差异有统计学意义(χ2=42.150, P<0.01)。结论：浆液囊肿、鼻息肉、真菌球的CT值明显不同于其他病变,单从CT值就可以将这3种病变与其他病变 区分;黏液囊肿、乳头状瘤、血管瘤、鳞状细胞癌、恶性黑色素细胞瘤CT值范围相近,需要结合影像及临床其他特 征进行鉴别诊断。将CT值纳入诊断依据可提高诊断准确率。     

原发性阴道恶性肿瘤（附26例报告）

目的探讨原发性阴道恶性肿瘤的治疗及预后因素。方法回顾分析26例原发性阴道恶性肿瘤的诊殆情况及预后因素。结果鳞癌21例、腺癌3例、恶性黑色素瘤1例、内胚窦瘤1例。经综合治疗后，总体5年生存率为50．0％，Ⅰ、Ⅱ、Ⅲ及Ⅳ期分别为：64．3％、42．9％、25．0％及0，P〈0．05；Ⅰ、Ⅱ及Ⅲ级分别为66．7％、40．0％及33．3％，P〈0．05；鳞癌、腺癌、恶性黑色素瘤及内胚窦瘤分别为52．4％、66．7％、0及0，P〈0．01；按阴道受侵长度〈1／3、1／3-2／3、〉2／3分为3个组，3组分别为63．2％、20．0％及0，P〈0．01；按肿瘤直径大小〈2cm、2cm-5cm、〉5cm分为3个组，3组分别为69．2％、37．5％及20．0％，P〈0．05。结论原发性阴道恶性肿瘤多采用综合治疗，其预后与肿瘤临床分期、病理分级、病理类型、阴道受侵长度及肿瘤直径大小有关。     

Clinical Diagnostic Accuracy in the Management of Primary Stage 1 Cutaneous Malignant Melanoma in a Plastic Surgery Unit

In a retrospective review of 614 primary Stage I cutaneous malignant melanomata and 40 nonmelanoma lesions, the diagnostic accuracy(DA) for malignant melanoma was 86.2%. A positive preoperative clinical diagnosis of malignant melanoma was confirmed histologically in 564/604 (93.3%) of lesions. For 614 histologically proven malignant melanomata a correct pre-operative clinical diagnosis had been made in 564/614 (91.9%).An additional 172 patients were referred for wider excisional surgery within 3 months of a biopsy elsewhere. For the total 786 (614+172) patients, the incidence of biopsy of a clinicially unsuspected (but subsequently histologically proven) malignant melanoma prior to referral to the Plastic Surgery Unit was lowest for lesions of the head and neck (18.3%) and lower limb (19.0%), and highest (almost half of the patients) for lesions of the hands and fingers.Previous reports of the poor level of clinical diagnostic accuracy in cutaneous malignant melanoma have not been confirmed in the present study.

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不同靶向药物治疗恶性黑色素瘤皮肤并发症发生率差异的网状Meta分析

目的 采用网状Meta分析方法比较5种靶向药物方案治疗恶性黑色素瘤的皮肤鳞癌和皮疹发生率差异.方法 计算机检索PubMed和Cochrane Library数据库,检索范围从建库起至2015年11月.网状Meta分析将直接和间接比较的证据合并,评估5种靶向药物方案治疗恶性黑色素瘤的皮肤并发症发生率差异的合并比值比(OR)和累积排序概率.结果 6项随机对照试验符合纳入标准被纳入.结果表明:与达拉非尼+曲美替尼相比,维罗非尼在患者中皮肤鳞癌发生率相对较高(OR=9.20,95%CI=1.26～52.53),维罗非尼+罗氏替尼的皮疹发生率相对较高(OR=6.81,95%CI=1.01～41.87).累积排名曲线下面积(SUCRA)值结果表明,采用曲美替尼的患者的皮肤鳞癌发生率最低,达拉非尼+曲美替尼的皮疹发生率最低.结论 达拉非尼+曲美替尼对恶性黑色素瘤患者所产生的并发症发生率最低.     

Lentigo Maligna and Malignant Melanoma

Lentigo maligna, a precancerous lesion, is a brown-black irregularly pigmented freckle, usually occurring on the face of the elderly subject. In a series of 99 patients with malignant melanomas, lentigo maligna was the pre-existing lesion in 21. The clinical and histological findings, and previous publications on the subject are reviewed. Lentigo maligna itself is not a superficial malignant melanoma. After the development of malignant melanoma from lentigo maligna, eight of 21 patients developed metastatic disease. This seems to indicate that once malignant melanoma has developed (whether de novo from the junctional portion of a pre-existing nevus, or from a lentigo maligna), the outlook is the same. During the development of malignant melanoma from lentigo maligna there is an indefinite period when it is virtually impossible to determine histologically whether malignant melanoma is present. Naturally, the inclusion of these indefinite cases will greatly influence reported results of treatment.     

Prognostic significance of γ-H2AX in laryngeal squamous cell carcinoma after surgery

Background The clinical significance of Y-H2AX in laryngeal squamous cell carcinoma （LSCC） has not yet been established. This study was performed to assess the expression of nuclear y-H2AX in benign and malignant laryngeal lesions and to assess its clinicopathological significance. Methods A total of 70 LSCC tumor-normal tissue paired samples were evaluated for y-H2AX expression using immunohistochemical staining. Their expression was correlated with different clinicopathological parameters. Results Nuclear Y-H2AX expression was frequently detected in LSCC tissues （P 〈0.001）. High nuclear Y-H2AX levels were not associated with any clinicopathological characteristics of LSCC （P 〉0.05）. Univariate Kaplan-Meier analysis showed that positive nuclear Y-H2AX expression was associated with a decreased overall survival （P=0.017）. Multivariate Cox regression analysis showed that nuclear Y-H2AX expression was an independent risk factor for overall survival. Conclusion The expression of nuclear Y-H2AX might be closely related to the prognosis of LSCC. Chin Med J 2014;127 （14）： 2664-2667     

恶性浆膜腔积液200例细胞学检验的临床分析

目的对200例恶性浆膜腔积液进行回顾性研究,分析临床资料及细胞形态,以总结经验,提高恶性浆膜腔积液检出率及细胞学诊断水平。方法对200例恶性浆膜腔积液进行8个年龄组的划分归类以及镜下阅片,观察分析各型恶性肿瘤的特征。结果 200例恶性浆膜腔积液中包括76例恶性腹水,111例恶性胸水,13例恶性心包积液。76例恶性腹水,高发年龄组在50～59岁(27例)及60～69岁(22例),恶性肿瘤的类型以腺癌所占比例最高有71例(占93.4%),3例恶性淋巴瘤(占3.9%),1例肝癌(占1.3%),1例恶性黑色素瘤(占1.3%);111例恶性胸水,高发年龄组在50～59岁(23例)及60～69岁(31例),恶性肿瘤的类型以腺癌所占比例最高有105例(占94.5%),鳞癌2例(占1.8%),恶性淋巴瘤2例(占1.8%),恶性黑色素瘤1例(占0.9%),恶性胸膜间皮瘤1例(占0.9%);13例恶性心包积液,高发年龄组集中在40～49岁(3例)及50～59岁(5例),恶性肿瘤的分型以腺癌为主占12例(92.3%),另外1例为恶性淋巴瘤。结论浆膜腔积液细胞学检查,对于肿瘤的诊断、分型、预后评价具有重要意义。     

Expression and Significance of Cox-2 and Livin in Oral Squamous Cell Carcinoma with Tissue Microarray

Objective To detect the expression of Cox-2 and livin in oral squamous cell carcinoma and precancerous lesion with tissue microarray, and discuss their significance and relationship in the occurrence and development of oral squamous cell carcinoma. Methods Immunohistochemical （IHC） staining and tissue microarray technique were used to detect the expression of Cox-2 and livin in noma! oral mucous membrane, precancerous lesion and oral squamous cell carcinomas. Results The expression of Cox-2 was negative in normal oral mucous membrane, and positive in precancerous lesion （81.6%） and squamous carcinoma （85.2%）; while the expression of livin was negative or weakly positive in normal oral mucous membrane, and positive in precancerous lesion （89.8%） and squamous carcinoma （100%）. The positive expression of Cox-2 and livin were both closely related to pathological classifications of oral squamous cell carcinomas. But there was no correlation between them. Conclusion Cox-2 and livin have close relationship with the occurrence and development of oral squamous cell carcinoma, but no correlation with the expression.     

外鼻恶性肿瘤58例临床分析

目的研究外鼻恶性肿瘤的治疗方法,以及在手术彻底切除肿瘤的基础上同期修复的疗效。方法分析近10年58例外鼻恶性肿瘤,其中基底细胞癌37例,鳞状细胞癌19例,恶性黑色素瘤1例,恶性纤维组织细胞瘤1例;术中彻底切除肿瘤,以切缘冰冻切片决定安全界;同时56例选择了不同的修复方法(直接缝合7例,邻近皮瓣36例,耳后复合瓣2例和植皮11例)。术后7例接受放射治疗。结果49例患者目前无复发征象,失访5例,死亡4例(死于老龄和心血管疾病);56例同期修复的患者中2例对外鼻形态不满意。结论在彻底切除恶性肿瘤时应重视安全界的概念,并尽可能应用各种方法进行I期修复。     

正常宫颈粘膜及宫颈粘膜良、恶性病变的核仁组织形成区嗜银蛋白研究

本文通过核仁组织形成区嗜银蛋白(AgNORs)染色技术对10例正常宫颈粘膜上皮及50例宫颈粘膜良、恶性病变进行研究,发现10例正常宫颈粘膜上皮的AgN。Rs计数为1.98±0.24/细胞。20例宫颈粘膜良性病变和30例鳞癌的AgNORs计数分别为2.01±0.32/细胞和4.20±0.32/细胞。结果表明正常宫颈粘膜上皮与宫颈粘膜良性病变的AgNORs计数无显著性差异(t=0.288,P>0.05),而正常宫颈粘膜上皮及宫颈粘膜良性病变与宫颈鳞癌的AgNORs计数有非常显著性差异(t=13.22P<0.001)。     

头皮恶性肿瘤切除后创面的皮瓣修复

目的探讨利用皮瓣转移修复头皮恶性肿瘤切除后创面的疗效。方法对38例头皮恶性肿瘤患者（鳞状细胞癌25例、基底细胞癌9例、黑色素瘤2例、疣状癌2例）实施肿瘤扩大切除术（切口距肿瘤边缘3～5cm,其中17例切除局部颅骨,10例切除局部硬脑膜,5例行同侧颈部淋巴清扫）。肿瘤切除后创面采用皮瓣转移修复（24例采用一个单蒂头皮瓣,6例采用多个单蒂头皮瓣,3例采用双蒂头皮瓣,3例采用下斜方肌皮瓣,2例采用背阔肌皮瓣）。硬脑膜缺损采用阔筋膜修补,颅骨缺损暂不修补。供瓣区直接缝合或中厚植皮修复结果其中31例患者皮瓣血运完全正常,另7例患者共8个皮瓣出现皮瓣远端静脉回流障碍,经高压氧治疗后皮瓣最终存活。所有患者供瓣区愈合好或植皮全部存活。患者对疗效均感满意。术后随访6个月～3年,未见肿瘤复发。结论利用皮瓣转移修复头皮恶性肿瘤切除后创面的疗效基本满意。     

反射式共聚焦显微镜所示黑素瘤和痣中Paget样黑素细胞增生的体内特征

黑素细胞在表皮内的Paget样浸润是组织学上诊断黑素瘤的相关指标，尽管这种现象也可偶见于良性皮损。因为反射式共聚焦显微镜在体内能观测到浅表层细胞水平上的溶解，因此作者通过使用该仪器，对84例良性和恶性黑素细胞性皮损的表皮改变及Paget样细胞浸润进行观测对比，并与组织病理学比较，以探讨其在良性与恶性皮损间的不同及诊断意义。恶性皮损的特征为浅表层细胞排列紊乱。在体内，明确存在于大部分黑素瘤和一些良性皮损的Paget样细胞可能有助于黑素瘤的诊断。共聚焦显微镜与组织病理学有很好的一致性。而且，共聚焦显微镜确认的一些特征，如大且数量多的紧密排列细胞延伸至角质层，与恶性皮损呈现强相关。总之，共聚焦显微镜能很好确定黑素细胞在黑素细胞性皮损处以Paget样的方式向上扩散。因此，当用共聚焦显微镜观察到Paget样黑素细胞增生时，应考虑黑素瘤的诊断，但无Paget样细胞时也不能排除此诊断，因为在恶性皮损中至少有10％缺乏此表现。     

鼻腔鼻窦恶性肿瘤的CT诊断

为了探讨鼻腔鼻窦肿瘤的特征性ＣＴ表现，对经手术病理证实的鼻腔恶性肿瘤２０例进行了回顾性分析．其中恶性黑色素瘤３例，恶性淋巴瘤６例，鳞癌６例，腺癌５例．鼻腔恶性肿瘤ＣＴ上均示软组织肿块，但恶性淋巴瘤病变范围广泛，且几乎均累及同侧面颊部软组织，而无确切骨质破坏；鳞癌病变范围广泛，向窦腔外组织结构侵犯，且邻近骨质结构明显、广泛破坏；腺癌和恶性黑色素瘤病变范围局限，邻近骨质破坏不明显．结果表明：鼻腔不同类型的恶性肿瘤均具有一定的ＣＴ影像特征     

9例食管恶性黑色素瘤的临床分析

目的探讨食管恶性黑色素瘤的临床特征、诊断、治疗以及预后。方法回顾我院9例外科手术切除的食管黑色素瘤的相关临床资料,并对所有患者进行回访。结果患者9例,男8例,女1例,平均年龄（59.7±7.42）岁;肿瘤位于食管中段2例,食管下段7例;术前胃镜病理误报为其他类型食管癌5例;1例行食管切除,食管、胃吻合术联合皮肤黑色素瘤切除术,其余行食管切除,食管、胃食管吻合术;术后行辅助放化疗5例;患者术后平均生存期为（7±2.34）月,从明确肿瘤转移到死亡的平均时间为2.42个月。结论原发性食管恶性黑色素瘤临床罕见,预后较食管鳞癌差;食管黑色素瘤无特异性临床症状及影像学征象;术前胃镜下病理误报率高;手术治疗能有效缓解患者症状,但没有足够证据证明其在延长生存期方面较内科保守治疗有效。     

PD-L1、BRAFV600E、CD68蛋白表达及肿瘤浸润淋巴细胞在恶性黑色素瘤诊断中的意义

  目的   分析PD-L1、BRAFV600E、CD68蛋白和肿瘤浸润淋巴细胞（TIL）在恶性黑色素瘤诊断中的意义。  方法   应用高通量组织芯片技术及免疫组化方法,检测60例原发性恶性黑色素瘤组织中PD-L1、BRAFV600E、CD68蛋白表达;分析PD-L1、BRAFV600E、CD68蛋白以及TIL与患者的临床病理特征及预后关系。  结果   （1）恶性黑色素瘤组织中CD68蛋白表达与肿瘤T分期之间,差异有统计学意义（P = 0.018）,而与肿瘤大小、肿瘤浸润深度、淋巴结转移和溃疡形成之间,差异均无统计学意义（P > 0.05）;（2）PD-L1、BRAFV600E和TIL与肿瘤T分期、肿瘤大小、肿瘤浸润深度、淋巴结转移和溃疡形成之间,差异均无统计学意义（P > 0.05）;（3）皮肤黑色素瘤BRAFV600E突变率约36.67%（22/60）,其中,肢端型黑色素瘤BRAFV600E突变率约68.18%（15/22）;黏膜黑色素瘤BRAFV600E突变率约23.33%（14/60）;（4）Cox回归生存分析结果显示肿瘤淋巴结转移是影响恶性黑色素瘤患者预后的因素。   结论   （1）CD68蛋白表达在判定患者预后方面可能有一定作用;（2）皮肤部位的黑色素瘤建议行BRAFV600E免疫组化检测;（3）患者存在淋巴结转移可作为恶性黑色素瘤预后判断的参考指标。     

子宫颈癌筛查异常妇女处理的共识指南(2006版)

2001年,美国阴道镜与宫颈病理学会（American Society for Colposcopyand Cervical Pathology,ASCCP）联合其他专业学会以及联邦与国际组织．制订了2001版的宫颈癌细胞学筛查结果异常妇女处理的共识指南。这是全面的、以循证医学为依据的指南,其目的是帮助所有亚专业的临床医生,处理每年约480万诊断为细胞学异常的美国妇女。     

烧伤后疤痕组织上皮细胞恶性变

本文报道了4例烧伤后疤痕组织上皮细胞恶性变,对其病理、临床特点及治疗效果进行了讨论。其中3例为鳞状上皮癌,1例恶性黑色素瘤。作者认为烧伤后疤痕导致恶性黑色素瘤在临床上是罕见的。并强调对烧伤患者尽早地消灭创面是非常重要的。