恶性胸膜间皮瘤：3例尸解病例的组织化学和免疫组织化学研究

本文报告8例恶性胸膜间皮瘤尸解病例,上皮型2例,1例纤维型大体改变为巨大结节,并推挤膈肌至脐平面。对此3例进行了PAS、D-PAS,CM、AB、H-AB、CI、H-CI和CEA、Keratin、Vimentin等组化和免疫组化研究,并结合文献复习对人体胸膜间皮的组化和免疫组化特征进行了讨论,提出了人体胸膜间皮瘤的临床病理诊断与鉴别诊断意见。本组3例均合并DIC,推测本病有产生DIC的倾向性,临床对此病应警惕DIC发生的危险。     

One-stage versus two-stage lymph node dissection after investigation of sentinel lymph node in cutaneous melanoma: a comparison of complications, costs, hospitalization times, and operation times

The aim of the study was to evaluate whether complication rate, costs, operation times, and hospitalization times differed in two different patient groups: in group 1, frozen section analysis of the sentinel lymph node and lymph node dissection were carried out in the same operation. In group 2, normal investigation of the sentinel lymph node and lymph node dissection were done in a second operation. One hundred thirty-five patients with cutaneous melanoma were included. Hospitalization times, costs, complication rates, and operation times of two-stage and one-stage lymph node dissection of the draining area after detection of metastases in the sentinel lymph node were retrospectively compared. Lymph node metastasis in the sentinel lymph node was found in 23 patients. In 11 patients, removal of the sentinel lymph node and dissection of the lymph node basin was performed in the same operation. In 12 patients, a two-stage procedure was the treatment of choice. Operation times were not different in the two groups (p=0.87) while two-stage operation patients were hospitalized significantly longer (14.2 ± 9.7 vs 23.9 ± 24 days; p=0.01) and costs were significantly higher (7,836.90 ± 2,397.95 Swiss francs vs 5,279.40 ± 1,994.90 Swiss francs). In addition, more complications were found in the two-stage group.     

恶性淋巴瘤自体造血干细胞移植后复发的研究进展

自体造血干细胞移植 (ASCT)是治疗复发性、难治性和侵袭性恶性淋巴瘤的有效方法 ,但因存在体内肿瘤细胞负荷过多和移植物被肿瘤细胞污染 ,使移植后的复发率增高。为了提高ASCT的疗效 ,可采取 :①移植前美罗华体内净化 ,除去外周血B细胞 ,清除移植物的肿瘤细胞污染 ;②移植后用美罗华和非交叉耐药药物交替联合化疗 ,以杀伤体内肿瘤细胞 ;③移植前或后累及野放射治疗 (IFRT)辅助 ,降低原发灶的复发率     

颌面颈部恶性淋巴瘤临床分析

目的：总结口腔颌面颈部恶性淋巴瘤(ML)的诊断方法及治疗措施。方法：回顾性分析收治的ML患者38例的临床资料。结果：霍奇金病(HD)5例，非霍奇金淋巴瘤(NHL)33例，31例采用综合治疗，7例采用单纯化疗，38例1，3，5a生存者分别为5，14，12例，存活患者中以临床Ⅰ，Ⅱ期者占绝大多数，死亡患者中以Ⅳ期为多。结论：早期明确ML的诊断并早期治疗效果较好，综合治疗是最有效的治疗手段，临床分期对预后有重要参考价值。     

髂骨恶性骨肿瘤切除后骨盆环稳定性重建

目的 评价髂骨原发性恶性骨肿瘤及转移瘤切除后椎弓根钉棒固定系统联合异体骨移植或联合骨水泥（polymethylmethacrylate，PMMA）重建骨盆环稳定的方法及效果。方法 1999年7月～2004年7月，采用完全切除重建的方法治疗16例髂骨恶性骨肿瘤，男9例，女7例。年龄16～80岁。原发性骨肿瘤10例，其中软骨肉瘤4例，骨肉瘤3例，尤文氏瘤2例，恶性骨巨细胞瘤1例；根据Enneking肿瘤分期系统进行分期，ⅠA期2例，ⅡB期8例，髂骨完全切除后，均采用异体骨联合椎弓根钉棒固定系统重建骨盆环稳定。转移瘤6例，其中乳腺癌2例，肺癌1例，肾癌1例，甲状腺癌1例，前列腺癌1例，均为孤市性转移病灶；采用椎弓根钉棒固定系统或结合PMMA固定重建。术后观察重建并发症，局部肿瘤复发及植骨愈合情况，采用Enneking保肢功能评价标准进行功能评定。结果 10例髂骨原发性恶性骨肿瘤获随访5～65个月，平均35．6个月。可疑深部感染2例，内固定松动2例，异体植骨不愈合1例；植骨愈合时间4．2～8．4个月，平均5．8个月，无排异反应；肿瘤局部复发2例，肺转移3例，死亡2例；8例生存者平均功能评分24．8（82．7％），其中优4例、良3例、可1例。转移瘤患者中位生存期11．8个月（4．6～48．5个月），4例患者生存超过1年；术后无深部感染，2例内固定松动均未使用PMMA，局部出现新病灶3例，术后患者疼痛均有明显缓解，并能负重行走；1年时随访，平均功能评分21．7（72．3％），其中优2例、良2例。结论 椎弓根钉一棒固定系统联合异体骨或PMMA对髂骨原发性及转移性恶性骨肿瘤全髂骨切除后骨盆环重建可以达到稳定的目的，其并发症低，功能效果满意。     

Sonographic patterns in extranold abdominal lymphomas

Between 1980 and 1993, 680 patients with non-Hodgkin's lymphomas (NHL) and Hodgkin's disese (HD) were studied by ultrasonography. In 210 patients a total of 254 extranodular abdominal lymphoma inflitrates were diagnosed. Infiltrates were confirmed histologically in 118 patients and through the clinical course and follow-up studies in 92 patients. Lymphoma infiltrates were seen most frequently in the spleen (N = 101), the gastrointestinal tract (n=70), the liver (n = 47), the kidneys (n = 17) and other organs (n = 19). The sonographic features of lymphomatous infiltrates in different extranodal sites are described, and possible correlations between lymphoma subtypes and sonographic texture characteristics are investigated. Different infiltration patterns of lymphoma subtypes could be indentical in liver and spleen. High-grade NHLs most frequently showed large-nodular lesions, whereas low-grade NHLs and HD showed a tendency towards small-nodular or diffuse lesions. The role of ultrasonography in the clinical management of lymphoma pateins is discussed.Correspondece to: C. Görg     

Neuron-specific enolase and malignant lymphomas (23 cases)

Summary The immunoreactivity of polyclonal antiserum to neuron-specific enolase (NSE) has been investigated. Twenty-three cases of malignant lymphoma (ML) were studied and compared with previously published reports. In our study 11 out of 23 cases showed strong or weak NSE positivity; any type of ML could be positive or negative even among B or T cell ML. This study indicated that polyclonal NSE is not a specific marker; it might be an inconstant marker of ML with no apparent correlation between reactivity and morphology or phenotype.     

Fulminant malignant hyperthermia associated with ketoacidotic diabetic coma

Malignant hyperthermia (MH) in humans is usually triggered by volatile anaesthetics and depolarizing muscle relaxants. However, other factors or drugs (e.g. cresol) are thought to induce MH. We report a case of fulminant MH associated with a ketoacidotic diabetic coma. After therapy for diabetic coma with insulin (containing the preservative cresol) and electrolyte solutions was started, the patient complained of increasing myalgia, developed a high fever and respiratory and metabolic acidosis and lost consciousness. MH was treated immediately with dantrolene; the patient recovered within 14 days. Five months later the patient was diagnosed as MH-susceptible by the in vitro caffeine and halothane contracture test. This case supports the assessment that MH and diabetes are associated diseases and that cresol could possibly trigger MH. Furthermore, therapy with dantrolene has been demonstrated to the beneficial in the treatment of MH associated with diabetic coma.     

Growth effects of epidermal growth factor (EGF) and a monoclonal antibody against the EGF receptor on four glioma cell lines

Summary Epidermal growth factor (EGF) has been shown to stimulate DNA synthesis and cell division in normal glia. At least half of malignant human gliomas (MHG) express high levels of the EGF receptor (EGFR), which are above those detected in normal brain. The demonstration that antibodies against the EGFR inhibit the growth of squamous cell carcinoma line A-431, with large numbers of EGFR, in vitro and in vivo raises the possibility that these agents could be used therapeutically against malignant human gliomas either alone or conjugated to other agents. We have measured the growth effects of EGF and an anti-EGFR monoclonal antibody, 528 (Ab-528), on four well-characterized human malignant glioma cell lines, D-263 MG, D-247 MG, U-343 MGa Cl 26, and D-37 MG, with 2.9×10⁴, 1.5×10⁵, 8.6×10⁵ and 1.59×10⁶ EGFRs per cell, respectively. EGF significantly increased cell number in D-263 MG and D-37 MG by 65% and 74%, respectively, had no effect on D-247 MG, and significantly decreased cell number in U-343 MGa Cl 26 by 39%. U-343 MGa Cl 26 growth was inhibited 19% by Ab-528, but Ab-528 had no effect on growth of the other MHG lines. Ab-528 significantly inhibited all EGF-mediated growth effects. These studies demonstrate that, although Ab-528 alone has little antiproliferative activity on MGH, it successfully competes with EGF to reduce the biological effects of EGF-EGFR binding. Therefore, this antibody could potentially be used to target radioisotopes to MHG via the EGFR for diagnosis and therapy.Supported by Grants CA-11898, NS-20023, CA-43722, and the Association for Brain Tumor Research (MHW, PAH)     

Malignant ovarian mixed germ cell tumour: a rare combination

Ovarian germ cell tumours are very rare and affect mainly young girls and women. Due to this, the conservation of reproductive potential is of great concern. One of the most remarkable advances in oncology is in the treatment of malignant ovarian germ cell tumours. Two histological groups are distinguished: dygerminomas, equivalent to testicular seminomas, and non-dysgerminomatous tumours. We report a case of a 30-year-old nulliparous woman who presented with persistent per vaginal bleeding and was found to have a malignant mixed germ cell tumour comprising of both embryonal carcinoma and choriocarcinoma.