Diagnostic accuracy in malignant melanoma.

The diagnostic accuracy and index of suspicion concerning malignant melanoma were calculated based on review of 5,538 histologically examined lesions (of which 99 were melanomas) that were recorded in the Oncology Section of the Skin and Cancer Unit from 1955 to 1967. The diagnostic accuracy of the physicians in the Section was determined to be 64.4%. Thus, in almost one of every three melanomas an error in clinical diagnosis was made. This "batting average" is, however, better than those of previously published reports. The index of suspicion in relation to malignant melanoma in our series was 96%. Thus, the physicians in the Oncology Section demonstrated an appropriate awareness of this tumor. However, coupled with a diagnostic accuracy of 64%, a problem nevertheless exists in the diagnosis of this serious cutaneous cancer. Our study emphasizes the importance of having histologic verification prior to definitive radical surgery on patients with malignant melanoma.     

核磁共振成像对顽固性血精症的诊断价值

目的:探讨顽固性血精症患者盆腔的核磁共振成像(MRI)影像学特点及其临床意义.方法:回顾性分析顽固性血精患者9例,先行盆腔MRI检查之后,8例48h内再行椎管麻醉下经尿道应用超脉冲等离子切割镜对精阜进行去顶状切开,榆尿管镜下对精囊、前列腺内进行观察并与之相对应的影像学特点进行对比分析;1例行前列腺穿刺活检.结果:7例病灶位于精囊(双侧或单侧),大部分精囊腺体积增大,MRI表现为T1WI呈高信号或低信号,T2WI呈低信号或压脂序列呈高信号影;1例病灶位于前列腺中线区,MRI表现为在T1WI序列上见类圆形高信号影,边界清楚,直径约1.8cm,在T2WI及脂肪抑制序列上呈高低混杂信号影,可见分层;1例MRI表现为前列腺体积增高,大小约4.5cm×3.4cm×5.1cm,左后方外周带可见了类圆形灶,呈等T1短T2信号,直径约1.7cm,边界模糊,增强后病灶呈较均匀强化.8例患者进行输尿管镜下观察,发现7例患者在相应精囊(双侧或单侧)存在咖啡色或暗红色胶冻状液体,精囊有不同程度炎性改变.1例前列腺区见囊状肿块内见暗红色液体;1例血精患者盆腔MRI平扫提示前列腺癌,穿刺活检术后证实为前列腺癌.结论:MRI检查能清晰显示精囊、前列腺的病变,对于顽固性血精症患者的诊断及治疗具有重要参考价值.     

Infrared thermography in malignant melanoma. Diagnostic potential and limits

Using infrared thermography, 264 in patients who were clinically suspected of having primary malignant melanoma (mM) of the skin were examined with regard to the thermographic pattern of both tumor and peritumoral skin area. In 84% of the patients with histologically confirmed mM deviations from normothermic pattern (mainly hyperthermic) were found of the tumor itself and/or the peritumoral area. All nodular mM proved to be hyperthermic. Pigmented skin tumors other than mM (e.g., angioma, basalioma, nevus cells, mole, histiocytoma) predominantly exhibited local isothermia or only minor thermographic changes. The infrared radiation intensity of the mM depended on the individual surface attributes of the tumors. As a rule, the larger mM are warmer than small mM. When comparing histological staging of a mM with thermographic classification, the pT values were strongly correlated with the thermographic values, ranging from Q1 to Q4. The highest measurements of infrared radiation were obtained in the nodular and acrolentiginous mM, as compared to the other melanoma types. There is evidence that mM exhibiting marked local hyperthermia have a particularly to poor prognosis.     

磁共振对AIDS合并神经梅毒患者的诊断价值及其成像特点分析

目的探究磁共振对获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS)合并神经梅毒患者的诊断价值及其成像特点。方法选取杭州市西溪医院2016年1月至2018年12月诊治的128例AIDS疑似合并神经梅毒患者,所有患者均进行磁共振成像检测,分析磁共振对AIDS合并神经梅毒的诊断价值及其成像特点。结果本研究中,128例患者经实验室病理学检测确诊,AIDS合并神经梅毒76例,影像学诊断结果显示,阳性69例,阴性7例;单纯AIDS患者52例,影像学诊断结果显示,阳性4例,阴性48例,即,真阳性69例、假阳性4例、真阴性48例、假阴性7例。检测灵敏度90.79%,特异度92.31%,约登指数83.10%;本研究合计76例AIDS合并神经梅毒患者,共检出4种表现型,分别为脑膜血管型、脑实质型、树胶肿型及脊髓型。结论磁共振对AIDS合并神经梅毒具有一定的诊断价值,有助于本病的早期发现、诊断及临床分型。     

Cerebral magnetic resonance imaging (MRI) in the diagnosis of leptomeningeal carcinomatosis in melanoma patients

OBJECTIVE: Meningeal involvement is frequent in metastatic melanoma, approximately 30% in autopsy series. Functional signs may be misleading and the neurological examination may be normal. Certain diagnosis requires identification of tumor cells in the cerebrospinal fluid. CSF cytology is however sometimes negative and magnetic resonance imaging (MRI) with gadolinium injection may provide the diagnosis. The aim of this retrospective study was to assess the role of imaging in the diagnosis of leptomeningeal carcinomatosis. PATIENTS AND METHODS: The diagnosis of leptomeningeal carcinomatosis was made in 8 patients between 1992 and 1998. All had signs of neurological function impairment, but the neurology examination was abnormal in only 2. RESULTS: Cytology examination of the cerebrospinal fluid provided the diagnosis of leptomeningeal carcinomatosis in 5 patients. One out of 5 brain CT scans were positive, showing meningeal enhancement confirmed by brain MRI. The spinal tap was not contributive in 2 cases and was not done in 1. In these three cases, the brain CT did not provide any diagnostic element while the brain MRI with gadolinium injection confirmed the diagnosis of leptomeningeal carcinomatosis. DISCUSSION: Forty-one percent of patients with autopsy proven leptomeningeal carcinomatosis have a normal ante mortem spinal tap. Brain MRI with gadolinium injection has better sensitivity than brain CT scan. All patients with nonspecific neurological signs and a normal spinal tap should be explored with a brain MRI.     

Glutathionedopa in malignant melanoma.

A human melanoma metastasis was found to contain a substance identical with synthetic glutathionedopa when examined by means of an automatic amino acid analyser, chromatography on a Dowex-50 column, thin-layer electrophoresis, and by fluorimetry. The presence of glutathionedopa in melanoma tissue and of enzymes capable of hydrolysing the glutathione moiety of the molecule, together with the absence of glutathionedopa in the urine, suggest that glutathionedopa is an intermediate substance in the formation of 5-S-cysteinyldopa.     

Pedunculated malignant melanoma.

A woman had a primary pedunculated malignant melanoma. This is a rare form of presentation and may result in clinical confusion with seborrheic keratosis, fibroepithelial papilloma, or granuloma pyogenicum. The aggressive nature of the lesion was indicated by the presence of erosion and bleeding. Though the tumor cells were present only in the pedunculated mass, it had metastasized to regional lymph nodes at the time of surgery.     

Desmoplastic malignant melanoma.

A 68-year-old man sought dermatologic attention for a tumor of the arm. Biopsy specimen showed abnormal, essentially amelanotic, spindle-shaped cells in the cutis, greatly fibrotic stroma, and focal epidermal invasion. Desmoplastic malignant melanoma was diagnosed. The lesion was widely excised and axillary lymphadenectomy performed; one node showed metastasis. Nine months later, he died with widespread metastatic disease. To our knowledge, this is the first report of this entity since its delineation in 1971 and the only case in which diagnosis was established on initial biopsy and followed by definitive therapy. Desmoplastic melanoma has been confused with benign fibrosis, invasive fibromatosis, and fibrosarcoma, and is another example, with morpheaform basal cell carcinoma and sclerodermoid metastatic lesions from breast carcinoma, in which desmoplastic stroma may obscure the epithelial nature of cutaneous neoplasm.     

Familial malignant melanoma.

Two sisters simultaneously developed a superficial spreading malignant melanoma on their legs. Concurrently, a brother was affected with fatal metastatic melanoma. Several explanations for familial malignant melanoma are reviewed, including: 1. Genetically determined predisposition; ,2 Phenotypic and environmental factors; and 3. Infectious etiology (virus?). Relatives of patients who develop malignant melanoma spould be aware that they have a higher risk than the general population of developing this serious type of cancer.     

Subungual malignant melanoma.

A sixty year old white woman with a history of Peutz-Jeghers syndrome with nail involvement, presented with a marked hyperpigmentation of the terminal phalanx and nail of the right index finger. Two preceding biopsy specimens from the fingertip were interpreted as junction nevus. After amputation of the fingertip and terminal phalanx, the final diagnosis was subungual malignant melanoma. Further amputation of the entire finger and portion of the corresponding metacarpal bone was done as a successful follow-up procedure.     

Epidermotropically metastatic malignant melanoma. Differentiating malignant melanoma metastatic to the epidermis from malignant melanoma primary in the epidermis

In four instances, metastases to epidermis from primary cutaneous malignant melanomas at different sites showed histological features similar to those of cutaneous malignant melanoma primary in the epidermis. In these metastases, atypical melanocytes were present within the epidermis and in the upper part of the dermis much as in primary cutaneous malignant melanoma. Therefore, the presence of atypical melanocytes within the epidermis is not in itself an absolute criterion of malignant melanoma primary in skin. Nor does that finding absolutely deny malignant melanoma metastastic to the skin. Features that may enable histologic differentiation of epidermotropically metastatic malignant melanoma from primary cutaneous malignant melanoma are emphasized.     

Immunotherapy of malignant melanoma.

The growth of melanoma in humans depends not only on the malignant potential of the tumor but also on the patient's immune response to the melanoma. As a result, a variety of strategies have evolved to treat melanoma by stimulating antitumor immune responses to melanoma. This article reviews the different approaches being taken and the results obtained to date.     

磁共振成像技术联合磁共振子宫输卵管造影技术在女性不孕症诊断中的应用

目的探讨磁共振成像技术(magnetic resonance imaging,MRI)与磁共振子宫输卵管造影技术(MR hysterosalpingography,MR-HSG)相结合在诊断女性不孕症中的应用价值。方法比较分析25例不孕症患者传统X线子宫输卵管造影(HSG)检查结果和磁共振子宫输卵管造影检查结果。结果全部患者均能够顺利完成2项检查,常规MRI比传统X平片更清晰地显示盆腔内各器官及粘膜结构,仅有1例患者2项检查不符,X线提示双侧输卵管堵塞,而MR-HSG提示右侧输卵管通畅而左侧堵塞。结论与传统X线子宫输卵管造影相比,在常规MRI基础上,MR-HSG具有可以清晰显示盆腔脏器结构、减少生殖腺辐射和提示可能病因的优势。     

Trichochromes in human malignant melanoma.

Decarboxytrichochromes B and C were isolated from a melanoma metastasis in a red-haired man, indicating the presence of trichochromes B and C in the tissue. Trichochromes E and F were not detected.