十例肛管直肠恶性黑色素瘤的临床病理分析

本文报告10例肛管直肠恶性黑色素瘤的临床病理及免疫组织化学特点。10例病人男女之比为2.3:1，平均年龄57.1岁，主要症状为便血、肛门肿物。4例发生于肛管部，4例发生于齿状线，2例于直肠下端。肉眼见呈结节状，息肉状或溃疡型。镜下形态多样，主要为上皮细胞，梭形细胞等，8例见黑色素颗粒。肿瘤细胞对S－100及HMB－45抗体呈阳性反应。对该病的组织发生、形态学及病理诊断进行了讨论。     

肛管直肠粘膜恶性黑色素瘤的临床与病理学分析

目的：探讨肛管直肠恶性黑色素瘤的临床发病特征和病理诊断特点。方法：采用免疫组织化学法和光镜法分析8例肛管直肠粘膜恶性黑色素瘤的临床表现、组织病理学变化特点及其与相关抗原表达的关系。结果：8例肛管直肠粘膜恶性黑色素瘤的发病均为老年患者,年龄最大79岁,最小59岁。临床均有便血,脓血便,或大便性状的改变。病理类型：息肉样型2例,肿瘤型2例,溃疡型4例;镜下肿瘤细胞表现为多样性,组织结构多样性,多数瘤细胞含有黑色素颗粒且色素含量分布不对称。免疫组化瘤细胞S-100、HMB-45、Malen-A呈不同程度的阳性表达。结论：肛管直肠粘膜恶性黑色素瘤肿瘤细胞和组织结构呈多样性,瘤细胞含有黑色素,S-100、HMB-45和Malen-A阳性有助于诊断和鉴别诊断。     

10例肛管直肠恶性黑色素瘤临床病理免疫组化研究

目的研究肛管直肠恶性黑色素瘤（简称恶黑）的临床病理特点及免疫组化染色在恶黑诊断中的作用。方法对肛管直肠恶黑的临床资料进行回顾性分析，用免疫组化s—P法作HMB45、S-100、Vimetin等染色。结果10例肛管直肠恶黑临床初步诊断恶黑1例，误诊其它疾病9例。病理形态：上皮样细胞为主7例，梭形细胞为主2例，小细胞似淋巴细胞样细胞为主1例。免疫组化染色：10例HMB-45、s-100均阳性，9例Vimetin阳性，其中1例CK阳性，LCA阴性。结论肛管直肠恶黑临床表现大便带鲜血，无明显黏液，肛门异物及息肉样突出肛门为特征，临床极易误诊。形态观察支持恶黑起源于表皮基底层黑色素细胞，免疫标记提示黑色素细胞起源于神经嵴。HMB45、S-100、Vimetin，三者联合应用能提高恶黑病理诊断的准确性。     

肛管直肠恶性黑色素瘤的临床病理特征分析

目的探讨肛管直肠恶性黑色素瘤（anorectal malignant melanoma,AMM）的临床病理学特征。方法收集南京中医药大学附属南京中医院2008年7月至2019年8月收治的15例AMM患者的临床病理资料,分析其临床及病理组织学特征、免疫表型及BRAF基因突变情况,并复习相关文献进行分析。结果15例AMM患者年龄45～88岁（中位年龄66岁）,男5例,女10例。临床主要表现为便血、肛管直肠肿物、肛门坠胀疼痛。15例中仅有2例临床诊断为恶性黑色素瘤。镜下肿瘤细胞形态多样,异型性明显,核大,核仁明显,胞浆内可见黑色素颗粒。免疫组化结果显示肿瘤细胞表达S 100、Vimentin、HMB 45及Melan A,不表达CK、EMA、LCA,Ki 67表达10%～60%阳性不等,1例可见BRAF基因突变。结论AMM是一种临床少见、预后较差的恶性肿瘤,临床表现无特异性,临床误诊率高,明确诊断需结合免疫组化标记物检查。治疗上以手术为主,辅以放疗、化疗及免疫治疗等。     

肛管直肠恶性黑色素瘤18例临床分析

肛管直肠恶性黑色素瘤１８例临床分析管祖庆１莫善兢１朱慰祺１杜祥２上海医科大学附属肿瘤医院腹外科１病理科２（上海２０００３２）原发性肛管直肠恶性黑色素瘤（ＭｅｌａｎｏｍａｏｆｔｈｅＡｎｏｒｅｃｔａｌＲｅｇｉｏｎ，简称ＡＲＭ）在临床上是一种比较少见但恶性...     

肛管直肠恶性黑色素瘤6例临床病理学分析

摘 要：［目的］ 探讨肛管直肠恶性黑色素瘤的临床病理特点。［方法］ 收集6例肛管直肠恶性黑色素瘤的临床病理资料并随访,分析其临床和病理组织学特征和免疫表型。［结果］ 6例患者中,肿瘤位于直肠下端2例,齿状线附近1例,肛管肛缘3例,临床主要表现为肛门赘生物及进行性排便困难伴出血。镜下肠黏膜下见肿瘤呈多形性片状,大部分由类圆形细胞构成,核异型,可见核分裂,其中4例患者肿瘤细胞见黑色素沉着。免疫组化示肿瘤细胞HMB45、S-100、Vimentin和MelanA强阳性,LCA、CK和EMA均阴性。［结论］ 肛管直肠恶性黑色素瘤是少见的恶性肿瘤,且临床表现无特征性,预后较差。诊断需根据形态学及免疫组化综合判断。     

肛管直肠恶性黑色素瘤的临床病理特点并文献复习

目的:探讨肛管直肠恶性黑色素瘤的临床病理特征、免疫表型、诊断及鉴别诊断。方法:对5例肛管直肠恶性黑色素瘤病例的组织形态、免疫组化等进行观察,并复习相关文献。结果:5例患者男性2例,女性3例,年龄60~84岁,平均70.2岁,临床主要为直肠出血、直肠肿块和疼痛等表现,镜下以上皮样和梭形细胞为主要成分,瘤细胞呈巢团或片状分布伴有多形性,细胞核大而深染,胞浆丰富,细胞有丝分裂指数高,并可见不典型性核分裂象,部分肿瘤细胞内见有黑色素沉着。免疫组化显示肿瘤细胞可表达S-100、HMB-45和Melan A,不表达AE1/AE3。结论:肛管直肠恶性黑色素瘤是一种少见、具有侵袭性的肿瘤,因其解剖学部位和非特异性临床表现,诊断较困难,确诊有赖于常规病理和免疫组化,临床医师应当高度重视该病,避免延误治疗。     

肛管直肠恶性黑色素瘤免疫检查点抑制剂治疗一例

恶性黑色素瘤(malignant melanoma,MM)是一种常见的恶性肿瘤,死亡率高,预后差.我国恶性黑色素瘤发病率的年增长率约为3％～5％,每年约有2万例新发病例 [1].恶性黑色素瘤根据发病部位和发病原因分为慢性阳光损伤型(chronic sun-damaged,CSD)、非慢性阳光损伤型(non-chroni...     

肛管直肠恶性黑色素瘤二例

肛管直肠恶性黑色素瘤少见。临床及病理均易误诊为癌。现把我院收治的 2例报告如下。1　临床及病理资料1 1　例 1　患者女性 ,40岁 ,因便血、肛门口有新生物突出 2个月入院。查体 :一般状况好。全身浅表淋巴结无肿大。心、肺、腹无异常。肛门指诊 :距肛门口约 2ｃｍ处触及一肿物 ,约 2ｃｍ× 1 5ｃｍ大小 ,表面凹凸不平 ,宽蒂 ,指套血染。病理活检考虑为上皮性恶性肿瘤 (当时未做免疫组化染色 )。行手术治疗。巨检 :Ｍｉｌｅ′ｓ手术标本 :直肠长 15ｃｍ ,距肛门口 2 3ｃｍ处肛管内有以菜花状肿物 ,2 0ｃｍ× 1 8ｃｍ× 1 0ｃｍ ,表面凹凸…     

肛管直肠恶性黑色素瘤38例临床分析

目的 通过对肛管直肠恶性黑色素瘤患者的临床病理特征、诊断治疗及生存预后进行分析,规范手术方式,探讨综合治疗模式.方法 回顾性分析38例经手术治疗的肛管直肠恶性黑色素瘤患者的临床病理资料,分析其与预后的相关性.结果 本组38例患者中,男10例,女28例,平均年龄58.7岁（28～75岁）,行腹会阴联合切除术28例,局部扩大切除术10例.1、3、5年无病生存率分别为64.9％、18.5％、5.7％,1、3、5年总生存率分别85.8％、24.1％、6.4％.肿瘤厚度≥1.51 mm、肿瘤直径≥3 cm与淋巴结转移相关（x2值分别为13.093、4.449;P值分别为0.011、0.020）,且肿瘤厚度亦与远处转移相关（χ^2=11.965,P=0.018）.单因素分析显示,术后辅助治疗与无病生存相关（χ^2=7.441,P=0.006）;肿瘤厚度、淋巴结转移、临床分期与总生存相关（χ^2值分别为16.741、16.474、16.775;P值分别为0.002、0.000、0.000）.多因素分析显示,术后辅助治疗为无病生存的独立危险因素（95％CI 1.420～17.621,P=0.012）;肿瘤厚度、淋巴结转移为总生存的独立危险因素（95％ CI 0.250～0.949,P=0.035;95％ CI 1.033～2.573,P=0.036）.结论 早期诊断、合理选择手术方式、重视免疫治疗的多学科协作诊疗是提高肛管直肠恶性黑色素瘤患者生存质量、延长生存期的关键.     

Toxic dermatitis induced by 10-ethyl-10-deaza-aminopterin (10-EdAM), a novel antifolate

A new methotrexate analog, 10-ethyl-10-deaza-aminopterin (10-EdAM), was found to induce a particular form of skin toxicity different than the skin rash reported to result from methotrexate. At histologic examination, it was found to be a toxic dermatitis that clinically most often first appears on the lower legs but can occur anywhere in the body, especially if treatment is continued. Nine cases are reported. A specific risk factor could not yet be identified. Discontinuation of 10-EdAM administration leads to complete healing; concomitant corticosteroid treatment also induces healing.     

10 Jahre ESMO-Designated-Center-Programm

Context

The integration of palliative care and oncology conceptualized as early integration as well as a prerequisite for the continuity of care and non-abandonment of patients is considered to be a core requirement in oncology. National and international societies and initiatives defined minimal standards for the provision of palliative care addressing issues of staff education, structure and organization. Nevertheless, serious deficits can be detected in day to day practice in the provision of palliative care for patients receiving cancer therapy, for post-therapy patients and in end-of-life care.

The designated center program

The designated center program was initiated 10 years ago by the European Society for Medical Oncology (ESMO) as an incentive for oncology departments and cancer centers to increase efforts to implement palliative care at least on a qualified level into routine work. This program turned out to be effective in promoting the idea of integration. The precisely formulated and relevant accreditation criteria act as a road map for the centers in the process of integration. In 2012 a total of 127 designated centers were accredited.

Conclusions

The designated center program can be considered as a key enabler for modern oncology and a working group of the 26 German-speaking designated centers has been established in order to analyze the efficacy and to promote the concept of integration.     

10 Jahre Sentinellymphknotenbiopsie

best practice onkologie -     

Gefitinib Combined with Cetuximab for the Treatment of Lung Adenocarcinoma Harboring the EGFR –Intergenic Region ( SEC61G ) Fusion and EGFR Amplification

EGFR fusions are rare genomic events in non‐small cell lung cancer (NSCLC), and a total of nine types have been previously reported in lung adenocarcinoma: EGFR‐RAD51, EGFR‐PURB, EGFR‐ANXA2, EGFR‐ZNF713, EGFR‐YAP1, USP42‐EGFR, EGFR‐SEPTIN14, EGFR‐TNS3, and EGFR‐ZCCHC6. EGFR fusion mutations combined with EGFR amplification are even rarer in NSCLC. The EGFR–intergenic region (IGR) fusion mutation is unreported, and thus, there are no studies targeting this fusion together with EGFR amplification in lung adenocarcinoma. Our brief study provides clinical evidence that combined targeted therapy with gefitinib and cetuximab could result in a significant antitumor response in patients with the EGFR‐IGR fusion and EGFR amplification.Key Points

• EGFR fusion mutations are rare, and EGFR fusion mutations combined with EGFR amplification are even rarer in non‐small cell lung cancer (NSCLC). To the authors’ knowledge, there is no previous report on the coexistence of the EGFR–intergenic region (IGR) fusion and EGFR amplification.
• This is the first report of a patient with NSCLC with the EGFR‐IGR fusion and EGFR amplification who achieved a significant antitumor response from treatment with gefitinib combined with cetuximab.