糖类抗原125、糖类抗原15-3、糖类抗原19-9和人附睾蛋白4单独及联合检测对卵巢癌的诊断价值

目的研究糖类抗原125(CA125)、CA15-3、CA19-9和人附睾蛋白4(HE4)单独及联合检测对卵巢癌的诊断价值,探讨最优的联合诊断方案。方法选取90例卵巢癌患者、90例良性卵巢疾病患者及90同期健康体检者,分别作为肿瘤组、良性组和健康组。比较3组受试者血清CA125、CA15-3、CA19-9和HE4水平及阳性率,比较上述四种肿瘤标志物单独及联合检测对卵巢癌的诊断灵敏度、特异度及准确度。结果肿瘤组患者CA125、CA15-3、CA19-9和HE4水平及阳性率均高于良性组患者和健康组受试者,良性组患者血清CA125、CA15-3和CA19-9水平均高于健康组受试者,良性组患者血清CA125、CA15-3、CA19-9和HE4阳性率均高于健康组受试者,差异均有统计学意义(P﹤0.05)。CA125+CA15-3+HE4、CA125+CA15-3+CA19-9+HE4诊断卵巢癌灵敏度最高,均为91.11%。HE4单独诊断卵巢癌的特异度最高,为94.44%。CA125+CA15-3+HE4诊断卵巢癌的准确度最高,为85.93%。结论CA125+CA15-3+HE4三项联合检测可提高卵巢癌诊断效率,对临床诊断卵巢癌有参考价值。     

Is T9-11 the true thoracolumbar transition zone?

ObjectiveDegenerative thoracic stenosis has been shown to most frequently involve the lower thoracic segments (T9-T12) where there is greater mobility and vulnerability due to flexion, extension and rotation of the spine. The thoracolumbar junction is considered anatomically to be T12-L1; the anatomical transition between the relatively immobile thoracic spine and relatively mobile lumbar spine. From anecdotal experience at our institution, we hypothesise that the true thoracolumbar junction is higher, at T10-11; the point of transition from floating to false ribs resulting in increased mobility at T10-11.Methods and materialsA retrospective review was performed of MRI lumbar and whole spine performed on patients aged 10–40 years in our institution over a 5-year period. Patients with previous surgery, chronic spinal disorders and congenital abnormalities were excluded from the study. Intervertebral discs from T8-9 to L1-2 were assessed for evidence of degeneration using the Pfirrmann grading system. Data obtained from a study using computer-based models to assess mean resultant loads in flexion, sitting and standing from T8-9 to L1-2 on patients aged 18–35 years was also analysed. The mean load gradients between two consecutive discs from T8 to L2 were analysed. Statistical analysis was performed with SPSS (p < 0.05 was considered statistically significant).ResultsThree-hundred and twenty-two MRI studies were reviewed. Mean Pfirrmann grade was highest at T8-9 and T9-10 (1.35 ± 0.99 and 1.32 ± 0.93 respectively).Pfirrmann grade differed significantly at each level (χ² = 45.137 p = 0.001). Difference in mean load gradient from T9 to T11 was significantly higher than mean load gradient across T11 to L1 in both sitting and standing (0.095 ± 0.062 vs 0.050 ± 0.044 kN; p = 0.007, and 0.101 ± 0.061 kN vs 0.040 ± 0.054 kN; p = 0.007).ConclusionThe changes in segmental loads and more severe disc degeneration at T9-11 compared to T11-L1 support our hypothesis that the true thoracolumbar transition is higher than expected, at T10-11; where the rib cage transitions from floating to false ribs.     

Breast Cancer Risk Related to Combined Oral Contraceptive Use

Conflicting literature exists regarding the relationship of combined oral contraceptives (COCs) and breast cancer risk. Although earlier studies demonstrated an association between the use of COCs and overall breast cancer risk in previous and current users, more recent research exhibits a small increased risk in current users only, with risk declining within 5 years after discontinuation. Furthermore, recent research demonstrates that COCs may protect against ovarian, endometrial, and colorectal cancer. This report reviews literature from 2010 to current on breast cancer incidence among average- and high-risk women who ever used COCs as well as protective benefits they may provide.     

Cutaneous neoplasms composed of melanoma and carcinoma: A rare but important diagnostic pitfall and review of the literature

We report two cases of combined cutaneous tumors composed of melanoma and carcinoma. The first tumor presented as a 5-mm pink-blue macule over the right zygomatic arch in an 85-year-old man. Shave biopsy and immunohistochemical studies revealed that the tumor was composed of melanoma (highlighted by SOX10 and MART-1, with high Ki-67 proliferative index) intermixed with nodular basal cell carcinoma (highlighted by pan-cytokeratin and Ber-EP4). The neoplastic melanocytes were confined to the basal cell carcinoma nodules, and a diagnosis of combined melanoma in situ and basal cell carcinoma was rendered. After therapeutic excision, the patient was disease-free at 9 months after the initial diagnosis. The second tumor presented as a 6-mm pink-brown crusted papule on the right forehead in an 89-year-old man. Shave biopsy and immunohistochemical studies revealed that the tumor was composed of malignant melanoma (MM) (highlighted by S100 and MART-1) intermixed with squamous cell carcinoma (SCC) (highlighted by cytokeratin and p63), and a diagnosis of combined MM-SCC was rendered. These two cases highlight the importance of recognizing these rare types of melanocytic-epithelial cutaneous neoplasms to arrive at an accurate diagnosis that may inform appropriate disease stage and therapy.