中心性浆液性脉络膜视网膜病变的中西医研究现状

作者综述了近年来中心性浆液性脉络膜视网膜病变在病因、病机、治疗方面的研究现状以及中医药治疗本病的最新进展。     

浆膜腔积液片检测肿瘤细胞中的应用价值

目的探讨浆膜腔积液在检测肿瘤细胞中的应用价值。方法取浆膜腔积液以3000转／min离心标本5min，取灰白膜层沉淀涂片，用苏木素-伊红染色镜检。结果136例浆膜腔积液标本共检出有肿瘤细胞的37例，其中乳腺癌7例，肺痛6例，胃癌5例，子宫癌7例，肠癌3例，肝癌9例，阳性率27．2％，经病理活检，全部为恶性肿瘤，其特异性和细胞学诊断预料值均达100％。结论血性或黄色、乳白色标本、李凡他试验阳性、细胞计数大于100小于500个／mm^3的标本，一定要离心取沉渣片检测肿瘤细胞，以便为临床诊断提供可靠的诊断依据，早发现、早诊断、早治疗。     

Selective retina therapy in patients with central serous chorioretinopathy

Background Central serous chorioretinopathy (CSC) is a disease with a localized breakdown of the outer blood–retinal barrier located within the retinal pigment epithelium (RPE) causing subretinal fluid accumulation. Selective retina therapy (SRT) is a new, minimally invasive laser technology that has been designed to selectively target the RPE. SRT spares retinal tissue.Methods Twenty-seven eyes of 27 patients with active CSC were treated with SRT using a pulsed double-Q-switched Nd-YLF prototype laser (λ=527 nm, t=1.7 μs). At baseline, best-corrected visual acuity was determined and fluorescein angiography and optical coherence tomography were performed. The patients were followed for up to 3 months.Results After 4 weeks 85.2% of patients showed complete resolution of subretinal fluid and in 96.3% there was no leakage visible on fluorescein angiography. After 3 months 100% of patients demonstrated no subretinal fluid and 100% of patients had no leakage activity on fluorescein angiography. Visual acuity, 20/40 at baseline, improved to 20/28 after 4 weeks and to 20/20 after 3 months.Conclusion SRT is a safe and effective treatment for active CSC. Especially if the RPE leak is located close to the fovea, SRT is the favoured therapeutic option. We recommend earlier treatment of patients with acute CSC in order to prevent development of chronic changes due to CSC with irreversible anatomical and functional damage. SRT might be considered as a first-line treatment for active CSC.     

15例子宫内膜浆液性乳头状癌临床资料分析

[目的]探讨子宫内膜浆液性乳头状癌（uterine papillary serous carcinoma,UPSC）的临床病理特征以及合理的治疗方法。[方法]对1995年1月-2007年12月收治的15例UPSC患者进行回顾性研究,对其发病趋势、危险因素、临床表现、病理特征、诊断方法和治疗方案进行分析。[结果]平均发病年龄63.8岁,80%患者雌孕激素受体阴性,53.3%患者术后手术病理分期高于术前临床分期,P53在60%患者中有表达,中晚期患者血清CA-125水平均有升高。所有患者均接受手术治疗,多数术后辅助化疗、放疗,生存率仍较低。[结论]UPSC不同于子宫内膜样腺癌,具有其特殊性,恶性程度较高,预后差。合理的个体化综合治疗可提高生存率。     

Mixed serous—endometrioid carcinoma of the uterus: pathologic and cytopathologic analysis of a high-risk endometrial carcinoma

A review of the pathology and cytopathology of 295 endometrial adenocarcinomas treated surgically at King Edward Memorial Hospital for Women, with full 5-year follow-up, revealed 16 cases of pure serous carcinoma (USC), 10 cases of mixed serous and endometrioid carcinoma with a predominant serous component (mixed USC-EAC) and six cases of mixed serous and endometrioid carcinoma with a predominant endometrioid component (mixed EAC-USC). The mixed carcinomas may be characterized microscopically by classical serous features side by side with classical endometrioid features, or additionally by features intermediate between the two. Many of these features are reproduced in preoperative cervicovaginal smears. USC and mixed USC-EAC were found to be indistinguishable clinically and prognostically, with an identical corrected 5-year survival of 40%, although numbers are small. Mixed EAC-USC (which contained 10–25% serous differentiation in this series), however, were similar in many respects to a control population of 95 EAC of Grade 2 and 3. The corrected 5-year survival in these two groups was 67% and 79%, respectively, which is not statistically significant in this small series. This study suggests that the behavior of a mixed tumor containing 50% or more serous differentiation is similar to that of pure serous carcinoma, and that the behavior of a mixed tumor containing less than 25% serous differentiation is similar to that of the other component. Given the poor correlation between pathologic findings in curettage and subsequent hysterectomy specimens, however, identification of any significant serous element in curettage material may prove vital in optimizing surgical and adjuvant therapy.     

Visual phenomena following light coagulation in central serous retinopathy (CSR)

A report on three patients with illustrations of their visual anomalies following light coagulation for their CSR disease is presented. The correspondence of the phenomena illustrated with the ophthalmoscopically visible fundus changes prove their objective origin.     

F-18-fluorodeoxyglucose positron emission tomography in differentiating malignant from benign pancreatic cysts: A prospective study

The differential diagnosis between benign and malignant pancreatic cystic lesions may be very difficult. We recently found that F-18-.uorodeoxyglucose positron emission tomography (18-FDG PET) was useful for the preoperative work-up of pancreatic cystic lesions. This study was undertaken to confirm these results. From February 2000 to July 2003, 50 patients with a pancreatic cystic lesion were prospectively investigated with 18-FDG PET in addition to helical computed tomography (CT) and, in some instances, magnetic resonance imaging (MRI). The validation of diagnosis was based on pathologic findings after surgery (n = 31), percutaneous biopsy (n = 4), and according to follow-up in 15 patients. The 18-FDG PET was analyzed visually and semiquantitatively using the standard uptake value (SUV). The accuracy of FDG PET and CT was determined for preoperative diagnosis of malignant cystic lesions. Seventeen patients had malignant cystic lesions. Sixteen (94%) showed increased 18-FDG uptake (SUV >2.5), including two patients with carcinoma in situ. Eleven patients (65%) were correctly identified as having malignancy by CT. Thirty-three patients had benign tumors: two patients showed increased 18-FDG uptake, and four patients showed CT findings of malignancy. Sensitivity, specificity, positive and negative predictive value, and accuracy of 18-FDG PET and CT in detecting malignant tumors were 94%, 94%, 89%, 97%, and 94% and 65%, 88%, 73%, 83%, and 80%, respectively. 18-FDG PET is accurate in identifying malignant pancreatic cystic lesions and should be used in combination with CT in the preoperative evaluation of patients with pancreatic cystic lesions. A negative result with 18-FDG PET may avoid unnecessary operation in asymptomatic or high-risk patients. Presented at the Forty-Fifth Annual Meeting of The Society for Surgery of the Alimentary Tract, New Orleans, Louisiana, May 15–19, 2004 (oral presentation). This study was supported by the Ministero Università e Ricerca Scientifica (Cofin 2001068593-001), Rome, Italy.     

Serous cystadenocarcinoma of the pancreas

A case of serous cystadenocarcinoma of the pancreas in an 85-year-old woman is reported. The tumor extensively involved the body and tail of the pancreas and contiguously invaded the spleen. The histopathology of the tumor was similar to that of serous cystadenoma, but mild nuclear hyperchromatism and atypism were noted, and the neoplastic invasion of nerve fibers in the stroma was observed. In the spleen neoplastic cells forming microcysts were diffusely insinuated in the red pulp without the fibrous stroma. The patient is in good health without recurrence and metastasis after the operation. The present case is the second example of this kind of neoplasm that showed direct splenic invasion. Because serous cystadenocarcinoma of the pancreas exhibits bland cytological features, diligent search for the invasion of the surrounding tissue or peripheral nerves is needed for the differentiation from its benign counterpart.     

Discrimination between uterine serous papillary carcinomas and ovarian serous papillary tumours by gene expression profiling

High-grade ovarian serous papillary cancer (OSPC) and uterine serous papillary carcinoma (USPC) represent two histologically similar malignancies characterised by markedly different biological behavior and response to chemotherapy. Understanding the molecular basis of these differences may significantly refine differential diagnosis and management, and may lead to the development of novel, more specific and more effective treatment modalities for OSPC and USPC. We used an oligonucleotide microarray with probe sets complementary to >10 000 human genes to determine whether patterns of gene expression may differentiate OSPC from USPC. Hierarchical cluster analysis of gene expression in OSPC and USPC identified 116 genes that exhibited >two-fold differences (P<0.05) and that readily distinguished OSPC from USPC. Plasminogen activator inhibitor (PAI-2) was the most highly overexpressed gene in OSPC when compared to USPC, while c-erbB2 was the most strikingly overexpressed gene in USPC when compared to OSPC. Overexpression of the c-erbB2 gene and its expression product (i.e., HER-2/neu receptor) was validated by quantitative RT-PCR as well as by flow cytometry on primary USPC and OSPC, respectively. Immunohistochemical staining of serous tumour samples from which primary OSPC and USPC cultures were derived as well as from an independent set of 20 clinical tissue samples (i.e., 10 OSPC and 10 USPC) further confirmed HER-2/neu as a novel molecular diagnostic and therapeutic marker for USPC. Gene expression fingerprints have the potential to predict the anatomical site of tumour origin and readily identify the biologically more aggressive USPC from OSPC. A therapeutic strategy targeting HER-2/neu may be beneficial in patients harbouring chemotherapy-resistant USPC.     

Genetic alterations and protein expression of KIT and PDGFRA in serous ovarian carcinoma

KIT and PDGFRA are receptor tyrosine kinases that can be specifically inactivated by small-molecule tyrosine kinase inhibitors, notably imatinib mesylate. In ovarian carcinoma, expression of KIT and PDGFRA protein has been documented, but the frequency and the molecular background of expression are poorly known. We analysed the expression of KIT and PDGFRA by immunohistochemistry in 522 serous ovarian carcinomas, and mutations of KIT and PDGFRA by denaturing high-performance liquid chromatographyin 125 and 187 serous ovarian carcinomas, respectively. No mutations of KIT or PDGFRA were detected. KIT expression was detected in 12% of carcinomas: low expression in 10% and high expression in 2% of cases. Using normal serous epithelium as a reference, decreased PDGFRA expression was detected in 12% and increased expression in 13% of carcinomas. Both KIT and PDGFRA expression were associated with high tumour grade, high proliferation index and poor patient outcome. By fluorescence in situ hybridisation, no KIT amplification was found in carcinomas with high KIT expression, but two cases showed a relative gain of chromosome 4. In conclusion, no mutations of KIT or PDGFRA were found, but a subset of serous ovarian carcinoma showed overexpression of the proteins, which was associated with aggressive tumour characteristics.