An unusual presentation of primary malignant B-cell-type dural lymphoma

Primary malignant B-cell-type dural lymphoma is a rare subtype of primary central nervous system lymphoma (PCNSL). We herein report an unusual case of diffuse B-cell lymphoma that presents as a chronic subdural haematoma without extracranial involvement. The notable aspects of this case include the patient’s immunocompetence, a short clinical history of symptom onset, rapid neurological deterioration and a final diagnosis of high-grade PCNSL. This case highlights the challenges neurosurgeons face, especially in the emergency setting, when the disease manifests in varied presentations.     

Multiple malignancies in a female patient with common variable immunodeficiency syndrome

We herein present the case of a 55-year-old woman with a previous history of malignancies – uterine adenocarcinoma, basal cell carcinoma (which occurred twice consecutively), recurrent respiratory infections due to common variable immunodeficiency (CVID), and systemic granulomatous disease diagnosed at a later age. The patient suffered from diffuse large B cell lymphoma (DLBCL), which was successfully treated with R-CHOP chemotherapy, and continued with immunoglobulin supplementation. The patient was free of lymphoma and infectious complications for over 20 months despite her persistent immunodeficiency, but eventually developed colorectal adenocarcinoma. To the best of our knowledge, this is the first reported case of CVID associated with multiple solid tumours and DLBCL.     

Sinonasal natural killer/T-cell lymphoma presenting as pyrexia of unknown origin with nasal symptoms

A 68-year-old Chinese man presented with an eight-month history of pyrexia of unknown origin and chronic sinusitis despite multiple courses of antibiotics. He underwent extensive investigations, including workups for infections, chronic granulomatous diseases and malignancy. Nasal biopsies were performed twice under local anaesthesia, but did not show any evidence of malignancy. Eventually, the patient was diagnosed with natural killer (NK)/T-cell lymphoma, nasal variant, based on histopathological findings from harvested deep tissue obtained via functional endoscopic sinus surgery. This study highlights that, for patients presenting with pyrexia of unknown origin and nasal symptoms, NK/T-cell lymphoma must be considered as a differential diagnosis. Generous amounts of tissue should be harvested under general anaesthesia rather than limited tissue under local anaesthesia, in order to facilitate and ensure a definitive diagnosis.     

老年弥漫大B细胞淋巴瘤一线治疗进展

老年弥漫大B细胞淋巴瘤(DLBCL)患者较年轻患者预后差,这与该人群未能接受标准治疗,以及疾病本身的不良生物学特征相关。尽管R-CHOP方案(利妥昔单抗、环磷酰胺、多柔比星、长春新碱和泼尼松)是治疗老年DLBCL的一线标准,但还需结合患者的年龄、治疗耐受性、分子生物学特征、危险分层等因素综合考虑。目前老年DLBCL患者中的一线改良方案多以R-CHOP方案为基础,不断尝试添加新药单药或联合化疗,以提高该人群治疗的安全性和有效率。     

老年弥漫性大B细胞淋巴瘤静脉血栓形成的危险因素分析

目的 探讨老年弥漫性大B细胞淋巴瘤(DLBCL)患者发生静脉血栓栓塞(VTE)的影响因素.方法 选取我院2003年6月至2013年10月收治的142例老年DLBCL患者作为观察对象,分析性别、体质指数(BMI)、体能评分(ECOG-PS)、肿瘤分期、乳酸脱氢酶水平(LDH)、高血压、糖尿病、血红蛋白水平、白细胞、血小板计数等因素与VTE发生的关系,并分析目前血栓治疗措施的疗效.结果 单因素logistic回归分析结果显示:PS评分≥2(P=0.027)、国际淋巴瘤预后指数(IPI)积分=3～4分(P=0.051)、3～4个疗程化疗未达到完全缓解(non-CR,P=0.016)是影响老年DLBCL患者血栓形成的危险因素;多因素回归分析显示:PS评分≥2、3～4个疗程化疗non-CR是影响血栓形成的独立危险因素(P＜0.05).结论 PS评分≥2、3～4个疗程化疗non-CR是影响老年DLBCL患者血栓形成的独立危险因素.     

Hepatic tuberculosis: a rare cause of fluorodeoxyglucose hepatic superscan with background suppression on positron emission tomography

Fluorodeoxyglucose (FDG) hepatic superscan refers to the diffuse intense uptake of 18F-FDG in the liver on positron emission tomography (PET), with reduced physiological activity in the brain and heart. The common causes include lymphoma and metastasis. In this case report, we describe the imaging features of tuberculosis as a rare cause of FDG hepatic superscan. PET imaging may be the only clue to a diagnosis of hepatic tuberculosis, as other imaging modalities may demonstrate only nonspecific hepatomegaly. It is important to consider this entity in the differential diagnosis of patients presenting with FDG hepatic superscan and proceed with liver biopsy for a definitive diagnosis.     

A rare case of multiple bronchial artery aneurysms associated with a double aortic arch

Bronchial artery aneurysm is uncommon, and the occurrence of multiple aneurysms arising from a bronchial artery is even rarer. To date, there has been only one published case report describing double bronchial artery aneurysms. We herein describe a case of three aneurysms arising from a left bronchial artery, accompanied by multiple bilateral hypertrophied bronchial and intercostobronchial arteries, as well as a double aortic arch. Bronchial artery aneurysm is potentially life-threatening, and immediate treatment is recommended to minimise the potential risk of rupture. The aneurysms in our case were successfully treated via transcatheter arterial embolisation using coils.     

弥漫大B细胞淋巴瘤中医体质分布及其与预后的相关性

目的：探讨弥漫大B细胞淋巴瘤（DiffuselargeB-celllymphoma,DLBCL）中医体质分布,分析中医体质与DLBCL预后的关系。方法：收集受试者病例资料,包括基本信息、初诊时间、病灶部位、血清LDH、骨髓累及情况、病理活检、免疫组化、化疗方案等,采用标准化的9种中医体质分类量表进行中医体质评价,对结果进行统计分析。结果：共收集76例患者,平和质24例（约占31．6％）,偏颇质52例（约占68．4％）;在偏颇质中,阳虚质27例（51．9％）〉气虚质10例（19．2％）〉气郁质6例（11．5％）〉特禀质5例（9．7％）〉阴虚质3例（5．8％）〉血瘀质1例（1．9％）;68例进行了6次化疗后的疗效评估,偏颇质cR率（68．9％）明显较和平质（39．1％）高（P〈0．05）;阳虚质、气郁质、阴虚质、气虚质、特禀质、血瘀质Ctk率分剐为80．0％、75．O％、50．（％、66．7％、25．0％、0,各偏颇质类型间及与平和质间比较,均无统计学意义（P〉0．05）。结论：（1）DLBCL患者体质或以偏颇质为多,且阳虚体质最多;（2）中医体质与DLBCL预后有相关性,偏颇体质预后较和平质佳。     

中期18F-FDG PET/CT在弥漫大B细胞淋巴瘤疗效评价中的价值分析

目的:探讨中期18F标记的脱氧葡萄糖正电子发射计算机断层显像(fluorie-18fluorodeoxyglucose positron emission tomography,18F-FDG PET/CT)在弥漫大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)疗效评价的临床价值?方法:32例初诊并经病理证实的DLBCL,化疗前后均行18F-FDG PET/CT检查?参照2007年制定的恶性淋巴瘤疗效评价标准分组?统计分析采用独立样本t检验及二分类Logistic回归分析?结果:疗效佳(完全缓解和部分缓解)组和疗效不佳(疾病稳定和疾病进展)组的SUV4max(4疗程后化疗中期SUVmax)及ΔSUVmax(化疗前与化疗中期SUVmax差值)差异有统计学意义(P=0.021,P=0.028),与SUV0max(化疗前SUVmax)比较差异无统计学意义(P=0.494)?二分类Logistic回归分析示临床疗效的影响因素是SUV4max(OR=0.646)?结论:DLBCL患者治疗中期行18F-FDG PET/CT检查有助于化疗疗效的评估及后续治疗的指导?     

高龄活体亲属供肾移植14例临床分析

 目的 比较高龄活体亲属供肾移植与标准活体亲属供肾移植的临床效果。 方法 回顾性分析高龄活体亲属供肾移植14例、标准活体亲属供肾移植84例的临床资料,并对供/受体进行回访,比较两组供肾移植术后供/受体的肾功能恢复情况及移植肾功能恢复延迟发生率、急性排斥反应发生率、存活率。 结果 高龄供体及标准供体间手术前后肾功能的变化量无显著差异（P>0.05）;移植肾功能恢复正常时间在高龄供肾组为（4.2 ± 2.1）d,在标准供肾组为（3.3 ± 1.6）d,两组间无显著差异（P>0.05）;高龄供肾组和标准供肾组移植肾急性排斥反应发生率分别为14.3%和9.8%,移植肾功能恢复延迟发生率分别为21.4%和11.0%,移植肾存活率在分别为92.9%和98.8%。 结论 术前对高龄供体进行严格筛选及全面综合评估,高龄活体亲属供肾移植同样也是安全有效的。     

PRDM1在弥漫大B细胞淋巴瘤中表达和预后意义的研究

目的:探讨阳性调控区Ⅰ蛋白(PRDM1)在弥漫大B细胞淋巴瘤中的表达和预后意义。方法:采用免疫组织化学方法根据CD10、BCL6和IRF4的表达将82例弥漫大B细胞淋巴瘤患者分为生发中心和非生发中心型,显微切割联合RT-PCR和W estern杂交方法检测患者PRDM1的表达情况并观察对CHOP和美罗华联合CHOP方案(R-CHOP)治疗后生存期的影响;利用半定量RT-PCR和W estern杂交观察PRDM1在B细胞淋巴瘤Namalwa细胞株中表达和美罗华、阿霉素以及美罗华联合阿霉素对其表达的影响,利用ELISA方法观察PRDM1表达与NF-κB活性的关系。统计分析软件SAS 8.2,P值小于0.05有统计学意义。结果:PRDM1存在α和β两种亚型,显著表达于弥漫大B细胞淋巴瘤非生发中心亚型的肿瘤细胞(73.5%比38.8%,39.4%比6.1%;P=0.0020和P=0.0009),而PRDM1β在CHOP方案治疗的非生发中心型患者中与短生存期相关,但在R-CHOP方案治疗组中未显示相关性;Namalwa细胞株中表达PRDM1β,美罗华和美罗华联合阿霉素均能够抑制PRDM1β表达,同时伴随NF-κB的失活...     

PRDM1在弥漫大B细胞淋巴瘤中表达和预后意义研究

目的:探讨阳性调控区Ⅰ蛋白(PRDM1)在弥漫大B细胞淋巴瘤中的表达和预后意义。方法:采用免疫组织化学方法根据CD10、BCL6和IRF4的表达将82例弥漫大B细胞淋巴瘤患者分为生发中心和非生发中心型,显微切割联合RT-PCR和W estern杂交方法检测患者PRDM1的表达情况并观察对CHOP和美罗华联合CHOP方案(R-CHOP)治疗后生存期的影响;利用半定量RT-PCR和W estern杂交观察PRDM1在B细胞淋巴瘤Namalwa细胞株中表达和美罗华、阿霉素以及美罗华联合阿霉素对其表达的影响,利用ELISA方法观察PRDM1表达与NF-κB活性的关系。统计分析软件SAS 8.2,P值小于0.05有统计学意义。结果:PRDM1存在α和β两种亚型,显著表达于弥漫大B细胞淋巴瘤非生发中心亚型的肿瘤细胞(73.5%比38.8%,39.4%比6.1%;P=0.0020和P=0.0009),而PRDM1β在CHOP方案治疗的非生发中心型患者中与短生存期相关,但在R-CHOP方案治疗组中未显示相关性;Namalwa细胞株中表达PRDM1β,美罗华和美罗华联合阿霉素均能够抑制PRDM1β表达,同时伴随NF-κB的失活。结论:PRDM1显著表达在弥漫大B细胞淋巴瘤非生发中心亚型中,PRDM1β可能与疾病的不良预后有关。     

Penile cancer: a local case series and literature review

INTRODUCTION

Penile cancer is an uncommon disease affecting only about one in 100,000 men worldwide in a year. The diagnosis of the condition is frequently delayed, and the disease and its treatment frequently result in significant morbidity in patients.

METHODS

We herein describe seven cases of penile tumours: six cases of squamous cell carcinomas and one case of B-cell lymphoma that presented to our hospital’s urology department between March 2011 and October 2012. We reviewed the literature to discuss the clinical presentation, natural history and current management of penile cancer.

RESULTS

The patients were followed up for 1–24 months. They were managed according to their disease stage and lymph node status. Four out of seven patients showed disease progression during the follow-up period.

CONCLUSION

The accurate staging of inguinal nodes in cases of low-risk disease is important to prescribe appropriate surgery for the inguinal nodes. Aggressive management of inguinal and pelvic lymph nodes remains the cornerstone in the treatment of high-risk disease cases.     

弥漫大B细胞淋巴瘤的免疫学亚型与预后的关系

目的 根据不同的免疫组化分型方法将弥漫大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)分成预后不同的亚型,并探讨各分型方法对国内病例的适用性.方法 利用免疫组化检测121例DLBCL的CD10、BCL-6、MUM1和CD138的表达,构建了3种分型方法:方法1,CD10阳性者归入GCB亚型,若CD10阴性而BCL-6阳性且MUM1阴性者归入GCB亚型,其余归入non-GC型;方法2,CD10和/或BCL-6阳性,而MUM1和/或CD138阴性者归入A组,MUM1和/或CD138阳性者归入B组,CD10和BCL-6阴性,而MUM1和/或CD138阳性者归入C组,四者均阴性者归入D组;方法3,CD10阳性者归入GCB亚型,CD10阴性时若MUM1阴性者归入GCB亚型,MUM1阳性者则归入non-GCB亚型.评测各临床及生物学因素与预后的关系.结果 CD10、BCL-6、MUM1和CD138的阳性率分别为21.5%(26/121)、32.2%(39/121)、32.2%(38/118)和2.5%(3/118),其中CD10和BCL-6阳性者预后较好(OS, P=0.023 1和0.027 8),而MUM1阳性者预后较差(OS, P=0.013).在方法1中,non-GCB组(占67.8%)5年总生存率OS(27.6%)和无进展生存率PFS(24.69%)明显差于GCB组;根据方法3,non-GCB组患者比例减少(占27.5%),5年OS(18.96%)和PFS(15.08%)更差,并且独立于IPI和治疗起作用.结论 各分型方法均在预后分析中起作用,尤以方法3可以识别部分高危患者,在本组病人中更具有适用性.     

韦氏环原发弥漫性大B细胞淋巴瘤分子分型的研究

目的探讨韦氏环原发弥漫性大B细胞淋巴瘤（DLBCL）的分子分型及与临床病理的关系。方法采用EnVision免疫组化法标记16例韦氏环原发弥漫性大B细胞淋巴瘤中MUM1、bcl-6、CD10、bcl-2、Ki-67的表达。结果 16例韦氏环原发弥漫性大B细胞淋巴瘤中,10例发生于扁桃体（62.5%）。5例为生发中心细胞样型（GCB）,11例为非生发中心细胞样型（非GCB）。非GCB型的增殖活性与GCB型相似;GCB型和非GCB型中bcl-2表达的阳性率分别为20.0%（1/5）和54.5%（6/11）。结论韦氏环原发弥漫性大B细胞淋巴瘤以扁桃体好发,分子分型以非GCB型多见,预后较差。     

GDP方案治疗复发或难治性弥漫大B细胞淋巴瘤临床分析

目的评价由吉西他滨(GEM)、顺铂(DDP)、地塞米松(DXM)组成的GDP方案治疗复发或难治性弥漫大B细胞淋巴瘤(DLBCL)的近期疗效和毒副作用。方法 2007年7月至2011年9月收治的17例复发或难治性DL-BCL患者,应用GDP方案化学治疗(GEM 1 000 mg.m-2,静脉滴注,第1、8天;DDP 25 mg.m-2,静脉滴注,第1～3天;DXM 10～40 mg.d-1,静脉滴注,第1～4天),每21 d重复1次,2个疗程后随访疾病进展情况,评价其疗效及毒副作用。结果 17例患者中5例(29.4%)获完全缓解,6例(35.3%)获部分缓解,主要不良反应为轻至中度的消化道反应和骨髓抑制。结论 GEM联合DDP、DXM的GDP方案治疗复发或难治性DLBCL的近期疗效较好,易耐受,安全性较高。     

R-CHOP方案治疗老年弥漫大B细胞性淋巴瘤的长期研究结果分析——GELA的一项临床试验

1 文献类型 治疗。 2 证据水平 1b。     

“微移植”治疗难治性淋巴瘤的临床观察

目的 探讨“微移植”治疗难治性淋巴瘤的临床疗效和安全性.方法 研究对象为2009年10月至2012年2月第二炮兵总医院血液科收治的10例经一线正规治疗失败或复发的难治性淋巴瘤患者.所有患者均接受了“微移植”治疗,首先给予患者Hyper-CVAD/MA方案(环磷酰胺+长春新碱+吡喃阿霉素+地塞米松/甲氨蝶呤+阿糖胞苷)化疗,在MA方案化疗结束后48 h给予重组人粒细胞集落刺激因子动员的HLA单倍型相合的亲缘供者外周血干细胞(G-PBSC)输注,不做移植物抗宿主病(GVHD)预防.在治疗2个疗程后评价疗效,并对治疗安全性进行分析.结果 10例患者共完成31个疗程“微移植”治疗.获得完全缓解(CR)6例,部分缓解(PR)2例,总有效(CR+PR)8例.化疗后全部患者发生Ⅳ度骨髓抑制,但在G-PBSC输注后中性粒细胞、血小板恢复的中位时间分别为9、14 d;其他不良反应均在2级以内.18例次患者出现G-PBSC输注相关性发热.全部患者在“微移植”治疗期间未观察到GVHD相关临床表现.2013年3月随访截止时,无病存活6例,死亡4例,其中3例为病情进展,1例为感染.10例患者1年和3年的总生存、无病生存率均为60％.结论 “微移植”治疗难治性淋巴瘤的疗效较好,安全性较高.     

miR-31、miR-21和miR-155在弥漫大B细胞淋巴瘤中的表达及意义

目的分析mi R-31、mi R-21和mi R-155在弥漫大B细胞淋巴瘤(diffuse large B cell lymphoma,DLBCL)中的表达水平,并探讨其与DLBCL临床病理特征的关系。方法采用实时荧光定量聚合酶链反应(real-time quantitativepolymerase chain reaction,RT-PCR)检测92例DLBCL患者和84例对照mi R-31、mi R-21和mi R-155的表达水平,间期荧光原位杂交技术分析患者MYC和p53基因的异常情况,根据Hans的分类方法分为生发中心B细胞型(germinal center Bcell type,GCB型)和非生发中心B细胞型(non-GCB型)。结果 DLBCL组mi R-31、mi R-21及mi R-155表达水平高于对照组(P0.05),mi R-31、mi R-21及mi R-155在non-GCB型的表达高于GCB型(P0.05)。与MYC基因没有发生重排的患者相比,mi R-31、mi R-21及mi R-155在MYC重排的患者中表达下调(P0.05)。mi R-31、mi R-21及mi R-155在p53基因丢失组的表达较基因正常组下调(P0.05)。BCL-2蛋白阳性组mi R-31、mi R-21及mi R-155的表达较BCL-2蛋白阴性组下调(P0.05)。Kaplan-Meier生存分析显示,mi R-31、mi R-21及mi R-155高表达的DLBCL患者生存率低于低表达的患者(P0.05)。应用单因素和多因素Cox模型分析,发现mi R-31、mi R-21及mi R-155表达水平、免疫分型、p53基因与预后差异有统计学意义(P0.05)。结论 mi R-31、mi R-21和mi R-155对DLBCL的诊断分型及预后判断有一定的参考价值,有望成为DLBCL治疗的新靶点。     

Treatment of severe,disabling spasticity with continuous intrathecal baclofen therapy following acquired brain injury: the experience of a tertiary institution in Singapore

INTRODUCTION

Intrathecal baclofen (ITB) therapy is a proven, effective treatment for disabling cortical spasticity. We describe the first local series of five patients with acquired brain injury (ABI) who received ITB and were followed up for 63.8 months.

METHODS

A retrospective review of medical and rehabilitation records of patients who received ITB therapy was carried out. Data studied included baseline demographic and injury variables, implantation data, spasticity and function, ITB dosage over time and complications.

RESULTS

From 2006 to 2010, a total of five patients received ITB therapy via implanted pumps about 39.4 months after ABI. Four out of five patients experienced significant reductions in their lower limb spasticity scores and improvements in global function and dependency. One patient had minor adverse events associated with baclofen-related sedation. The mean ITB dose at one year was 182.7 ± 65.6 mcg/day.

CONCLUSION

Our preliminary study showed encouraging long-term outcomes and safety for ITB therapy after ABI-related intractable spasticity. Individual ITB responses over time were variable, with gender differences. The outcomes experienced by our centre were comparable to those in the general ABI population, supporting the efficacy of ITB therapy for chronic disabling spasticity.