基于国人皮肤镜黑素细胞肿瘤图像的智能化分类与识别研究

目的建立国人皮肤黑素细胞肿瘤(MT)图像智能化分类与识别方法。方法采用皮肤镜法获取MT图像信息,提出自生成神经网络的自适应聚类分割与特征提取算法,定量分析MT的形状不对称(AY)、形状偏心率(EY)、边界凹陷率(BDR)、过渡区辐射不均匀度(URTA)、颜色多样性(CD)、纹理相关性(TC)六个特征,结合组合神经网络分类器对MT的良、恶性进行分类与识别,经病理验证与统计学分析。结果 642幅MT图像,其中良性82.4%;恶性17.6%;URTA、TC、BDR、CD灵敏度86.73%～95.58%,特异度97.3%～100%;AY和EY灵敏度41.59%～47.78%,特异度69.91%～76.99%;对MT的良、恶性分类与识别,准确率达93.65%;分类符合率经χ2检验均有显著性差异(χ2=4.51,P<0.05)。结论皮肤镜MT图像分析法,可有效实现MT良、恶性分类与自动识别,为解决国人皮肤恶性黑素瘤的智能化识别瓶颈问题奠定了基础。     

Working classification of spinal tumors and their surgical treatment

A working classification of vertebral tumors is discussed. The classification is based on tumor process expansion, presence of soft-tissue component and the degree of vertebral and neurologic complications. The extent and type of surgical procedure are determined in accordance with the authors' approach to tumor process staging.     

Radiation therapy of conjunctival and orbital lymphoid tumors

Lymphoid tumors of the conjunctiva and orbit are rare and remain localized in the majority of cases. Sometimes it is not possible either clinically or histologically to differentiate between a non-Hodgkin's lymphoma (NHL) and benign lymphoid hyperplasia. A series of 24 patients is reported. Nineteen were classified as having malignant NHL and 5 benign hyperplasia; 1 of these 5 later developed metastases, however. All patients had systemic work-up: 18 had Stage I, 1 had Stage II, and 5 had Stage IV disease. All patients received local radiation therapy with doses of 2400 to 2750 rad in 2-3 weeks for lesions of the eyelid and conjunctiva, and between 3000 and 3750 rad in 3-4 weeks for retrobulbar lesions. The lens was shielded in all patients except in 2 who had NHL of the vitreous body. A method of shielding the lens with a lead block mounted on a "low vac lens" is described, and the dose distribution within the eye and orbit is presented. The dose to the ocular lens is reduced to about 10% of the tumor dose with this technique. Patients who were treated with doses higher than 3000 rad experienced conjunctivitis and skin erythema that resolved completely. No other effects of radiation on normal structures of the ocular adnexa were observed in the 20 patients who are alive and without signs of tumor 10-46 months with a median follow-up time of 22 months.     

肾癌的微创治疗现状与进展

肾癌的微创治疗近年来发展迅速,与开放性手术相比具有住院时间短、恢复快、美观性好等优势。肾癌腹腔镜治疗的安全性及疗效与开放性手术相当,是目前肾癌微创治疗的主要选择。初步研究显示射频和冷冻治疗有一定的短期疗效,但应进一步验证,可作为有外科手术禁忌证患者的治疗选择。其他微创治疗方法如高强度超声聚焦、放射外科、化学消融、激光热消融及微波热疗等仍处于实验阶段,疗效不确定、需更多探索。肾癌的微创治疗代表着肾癌外科治疗的趋向。     

Current status of the treatment of urothelial tumors

Cancer of the urinary bladder, renal pelvis and ureter is usually transitional cell carcinoma. One third of cases of urethral cancer are also transitional cell carcinoma. In planning the treatment for these urothelial cancers, the anatomic stage (Ta-T4), the histologic grade (1-3), tumor multiplicity and tumor size are generally taken into account. Superficial and low-grade tumors can usually be treated by transurethral resection. However, such patients run the risk of subsequent tumor recurrence in the bladder. This risk may be reduced by intravesical administration of anti-neoplastic agents and BCG. Diffuse carcinoma in situ (CIS) should be treated intravesically before deciding on surgical extirpation of the bladder. Patients with tumors showing deep muscle invasion are usually managed by surgery. The role of adjuvant chemotherapy and/or radiation therapy is currently under investigation. Patients with unresectable cancer and/or metastases are candidates for systemic chemotherapy. This form of therapy is now resulting in an increased number of complete and partial remissions. However, there is still no evidence that systemic chemotherapy prolongs the duration of survival, especially in patients showing partial remission.     

Study of c-kit immunoexpression in canine cutaneous melanocytic tumors

Melanocytic tumors occur as much in humans as in dogs and are frequently associated with receptor tyrosine kinase dysregulation. The transmembrane c-kit protein is a receptor tyrosine kinase that is crucial in melanocytic homeostasis and, when mutated, is associated with tumor development in those cells. In human studies, its expression is generally detected in melanocytomas and primary malignant melanomas, being lost with tumor progression and metastasis. In this study, we aimed to analyze c-kit expression in canine cutaneous melanocytic tumors and its association with tumor behavior, in order to investigate the dog's potential in comparative pathology and c-kit's potential in the diagnosis of these tumors. The expression of c-kit was evaluated immunohistochemically in 39 canine cutaneous melanocytic tumors and scored in terms of the labeling location, extension, and intensity. The labeling location was essentially cytoplasmic, and the labeling extension and intensity were generally higher in melanocytomas (83.3% diffuse-labeled cells) than those in malignant melanomas (22.2% negative-labeled cells). The differences found in the labeling extension were statistically significant (P < 0.001). There was no association between c-kit immunoexpression in malignant melanomas and the clinicopathological criteria, except between the labeling intensity and the degree of intralesional pigmentation (P = 0.048). Our results for labeling extension are in agreement with similar human studies, reinforcing the dog's potential as a model organism for investigation in this type of cancer. In addition, the loss of c-kit expression in malignant melanomas might be a criterion of tumor aggressiveness, indicating that this receptor may be useful in the diagnosis of these tumors.     

脊柱转移瘤治疗的现状

本文主要围绕脊柱转移瘤介绍脊柱转移瘤外科治疗、介入治疗、放射治疗等治疗的现状。     

Histologic classification of thymic epithelial tumors: comparison of established classification schemes

The object of our multicenter retrospective study was to compare the new histologic World Health Organization (WHO) classification and the classical histologic Bernatz classification in terms of interobserver agreement and prognostic importance. The influence of coexisting diseases was also analyzed using the Charlson score. We evaluated 218 patients from 5 different hospitals who were treated between 1967 and 1998. The statistical methods of analysis included Kaplan-Meier estimates of survival curves and the application of Cox proportional hazards models to identify sets of prognostic factors for survival. Interobserver agreement was assessed by kappa coefficients. For both WHO and Bernatz classifications, interobserver agreement was good (weighted kappa > 0.87). However, the subdiversification of the "bioactive" WHO subgroup (B1, B2, B3) resulted in an interobserver agreement of only 0.49 within this group. In multivariable models, both the WHO classification and the Bernatz classification including carcinomas showed similar prognostic capabilities. The B3 type in the WHO classification and the predominantly epithelial type in the Bernatz classification had an intermediate prognostic ranking in comparison with the carcinomas and with the other subgroups. For both classifications, further simplification and subclassification into 3 subgroups led to classes with good discriminative power in respect to survival. In addition, very good interobserver agreement was observed in the simplified classifications. Comorbidity, sex, age of the patient and lymphofollicular hyperplasia had no major influence on overall survival. Both classifications showed similar prognostic power. Interobserver agreement of the type B subgroups was only moderate. By simplification of the classifications, subgroups with distinct survival could be identified.     

Hepatocellular tumors: Immunohistochemical analyses for classification and prognostication

Following the classification of hepatocellular nodules by the International Working Party in 1995 and further elaboration by the International Consensus Group for Hepatocellular Neoplasia in 2009,entities under the spectrum of hepatocellular nodules have been better characterized.Research work hence has been done to answer questions such as distinguishing high-grade dysplastic nodules from early hepatocellular carcinoma (HCC),delineating the tumor cell origin of HCC,identifying its prognostic markers,and su...     

Orbital and conjunctival lymphoma treatment and prognosis

115 patients with lymphoid tumours presenting in the orbit were seen between 1970 and 1984. The histological types were high-grade malignant lymphoma--18, low-grade malignant lymphoma--43, and indeterminate lymphocytic lesions--54. Eighteen patients were found to have disseminated lymphoma at presentation. The majority of the patients received radiotherapy to the orbit; local control was achieved in all cases and the ocular morbidity from radiotherapy was low with 11 patients developing lens opacities and 5 a dry eye. Survival of patients with stage I low-grade lymphoma and indeterminate lymphocytic lesions was similar to that of a normal population of the same age distribution. The clinic features and dissemination pattern of the low-grade malignant lymphomata and the indeterminate lymphocytic lesions were identical, suggesting that most, if not all, lymphoid masses presenting in the orbit are neoplastic rather than reactive in nature.     

Current and future cancer staging after neoadjuvant treatment for solid tumors

Until recently, cancer registries have only collected cancer clinical stage at diagnosis, before any therapy, and pathological stage after surgical resection, provided no treatment has been given before the surgery, but they have not collected stage data after neoadjuvant therapy (NAT). Because NAT is increasingly being used to treat a variety of tumors, it has become important to make the distinction between both the clinical and the pathological assessment without NAT and the assessment after NAT to avoid any misunderstanding of the significance of the clinical and pathological findings. It also is important that cancer registries collect data after NAT to assess response and effectiveness of this treatment approach on a population basis. The prefix y is used to denote stage after NAT. Currently, cancer registries of the American College of Surgeons' Commission on Cancer only partially collect y stage data, and data on the clinical response to NAT (yc or posttherapy clinical information) are not collected or recorded in a standardized fashion. In addition to NAT, nonoperative management after radiation and chemotherapy is being used with increasing frequency in rectal cancer and may be expanded to other treatment sites. Using examples from breast, rectal, and esophageal cancers, the pathological and imaging changes seen after NAT are reviewed to demonstrate appropriate staging.     

Gastrointestinal stromal tumors: Current management

Herein, we review the current management of localized and advanced gastrointestinal stromal tumors (GISTs). Although surgery remains the standard of care for patients with localized GIST, adjuvant imatinib can delay recurrence in some of these patients. In patients with advanced or metastatic disease, the standard of care is imatinib and surgery of residual masses is an option. Preoperative imatinib is an emerging treatment option for patients who require cytoreductive therapy. Sunitinib is a standard second‐line therapy. J. Surg. Oncol. 2010;102:530–538. © 2010 Wiley‐Liss, Inc.     

Lymphoma 2006: classification and treatment

The past 20 years have brought significant advances in our ability to manage patients with non-Hodgkin's lymphoma. More precise classification systems, improvements in diagnosis and staging, and effective new treatments have improved outcomes and made cure a reasonable goal for many patients with these disorders. In this overview of the progress seen in the field over the past 2 decades, we describe a variety of advances for specific lymphomas, including diagnostic methods such as gene array studies and immunophenotyping and new treatment approaches.     

三阴性乳腺癌基因学分子分型和个体化治疗新进展

目的 三阴性乳腺癌(triple negative breast cancer,TNBC)作为乳腺癌的一种特殊类型,具有高侵袭性,极易出现局部复发和远处转移.近年来关于TNBC进一步亚分类,并且针对各亚型进行相应靶向治疗的基础研究和临床研究均较多.本研究对国内外TNBC的分子分型和个体化治疗新进展进行综述分析.对国内外三阴性乳腺癌(triple negarive breast cancer,TNBC)的分子分型以及个体化治疗新进展进行综述分析.方法 应用PubMed及CNKI期刊全文数据库检索系统,以“三阴性乳腺癌、TNBC、分子分型、治疗”等为关键词,检索2011-01-2016-05相关文献,共检索到英文文献240条,中文文献449条.纳入标准:(1)TNBC的生物学功能;(2)TNBC的分子分型;(3)TNBC的个体化治疗.剔除标准:(1)乳腺癌的分子分型;(2)乳腺癌的个体化治疗.根据剔除标准剔除中文文献130条,英文文献141条,最后纳入分析63篇文献.结果 TNBC从基因学角度分为6个亚型,针对每个亚型均有不同的个体化治疗靶向药物,包括表皮生长因子受体(epidermal growth factor receptor,EGFR)抑制剂、铂类、聚腺苷酸二磷酸核糖转移酶(poly-AD-ribose polymerase,PARP)抑制剂、蒽环/紫衫、免疫治疗、血管内皮生长因子受体(vascular endothelial growth factor receptor,VEGFR)抑制剂、雄激素受体(androgen receptor,AR)拮抗剂以及各靶向治疗手段的联合使用.结论 TNBC是异质性疾病,其分子分型的确定对于理解肿瘤的生物学特征和临床行为,以及发展TNBC个体化治疗都是必需的.由于TNBC肿瘤信号通路之间的交联,发展不同靶向药物的联合应用才有望真正的提高该疾病的总生存.