Natural history of breast cancer

The natural history of breast cancer has been, and will be, extremely hard to study. Indirect evidence suggests that any cancer cell population may be phenotypically unique with multiple abnormal traits which decisively forge the clinical behavior. Histopathologic grouping will only give a very imperfect reflection of phenotypical individuality. It is proposed that essential determinants of the subsequent behavior have already been fixed during the induction period, i.e. long before the clinical debut. This may to some extent be reflected by the DNA content of the tumor cells. Metastases to axillary lymph nodes is strongly determined by size of primary tumor according to a function which suggests a smooth linear risk for lymphatic spread over a broad size interval. It is suggested that each cell of any given cancer may be endowed with a small chance of dissemination to axillary lymph nodes which may be essentially constant during the entire natural life history. Number of cancer cells of the primary tumor would then be the decisive determinant for risk of metastatic dissemination. It is not necessary to invoke qualitative progression from 'non-metastasibility' to 'metastasibility'. Small differences exist in the natural history of different histological types of breast cancer.     

Could fever and neuroinflammation play a role in the neurobiology of autism? A subject worthy of more research

Autism is neuropsychiatric disorder in which a hyperglutamate state may play a role. It is suggested here that fever or hyperthermia may be able to alter glutamate levels in the brain and may therefore be able to impact on the symptoms of autism. More study on this possibility is clearly warranted.     

Design and characterisation of miniaturised cavity-backed patch antenna for microwave hyperthermia

Autism is neuropsychiatric disorder in which a hyperglutamate state may play a role. It is suggested here that fever or hyperthermia may be able to alter glutamate levels in the brain and may therefore be able to impact on the symptoms of autism. More study on this possibility is clearly warranted.     

Lymphographic evaluation of cervico-uterine carcinoma (author's transl)

Bilateral pedial lymphography is a technique which has already been long employed and which had aroused great hopes in the detection of metastatic node involvement. The method has nevertheless failed to form an invariable part of the pretherapeutic assessment of cervico-uterine carcinomas. This attitude may be easily explained by the difficulties encountered in the interpretation of lymphographies as indicated in the first publications. New data nevertheless have made it possible to refine the method. Whilst false negatives remain inevitable in almost half the cases with histological evidence of involvement, false positives may be reduced to a minimum by very strict criteria of interpretation. Lymphography, a harmless technique, can then provide valuable information which enables the surgeon to confirm the success of his lymph node dissection and the radiotherapist to define areas requiring treatment. It is of major prognostic value. It may be used to guide transparietal lymph node biopsies and secondary detect lumbo-aortic nodes.     

Multidrug Resistance in Leukaemia

The treatment of many haematological malignancies is complicated by the development of resistance to cytotoxic agents. Cells which acquire the multidrug resistant (MDR) phenotype lose sensitivity to a spectrum of structurally unrelated chemotherapeutic drugs. Several distinct drug resistance mechanisms are now recognised which may be involved in clinically resistant leukaemia. It is possible that leukaemic cells may utilise one or more of these resistance processes as a survival mechanism and to maintain a proliferative advantage. If relevance of resistance mechanisms can be established, then the potential therapeutic benefit by circumvention of MDR is considerable with patients rendered chemosensitive and curable. There are many drugs which in vitro can reverse resistance processes, but their efficacy in vivo is yet to be fully demonstrated. It is likely that the final picture of the involvement of drug resistance in leukaemia will be complicated. Further investigation is warranted as the potential rewards are high.     

CYP2D6与他莫昔芬疗效相关性的研究进展

CYP2D6是一种重要的P450系氧化代谢酶,是他莫昔芬在体内代谢成更强抗雌激素作用代谢产物endoxifen的重要代谢酶,因此,强代谢乳腺癌患者服用他莫昔芬后引起明显的潮热症状,而潮热症状的发生与他莫昔芬疗效正相关。除了CYP2D6基因多态性可能影响他莫昔芬体内的代谢外,帕罗西汀（paroxetine）可竞争性抑制CYP2D6对他莫昔芬的代谢,使乳腺癌患者对他莫昔芬疗效明显降低。     

ING4基因的抗肿瘤作用研究进展

生长抑制因子4（ING4）是2003年发现并克隆出的抑癌基因ING家族新成员,是肿瘤抑制基因p53活动所必需的一个蛋白家族,能抑制肿瘤血管生成、增强p53基因的活性、抑制HIF的活性、抑制接触抑制的丢失、诱导细胞凋亡、增加肿瘤的放化疗敏感性、抑制肿瘤细胞侵袭转移。本文就ING4的基因结构、生物学功能及与恶性肿瘤的关系、作用机制及其临床意义作一综述。     

人类Runt相关转录因子3及其在肿瘤细胞质中的异位表达

人类Runt相关转录因子3(RUNX3)属于Runt转录因子家族成员,在某些肿瘤中RUNX3蛋白在肿瘤细胞质中异位表达,被认为是导致肿瘤发生发展的另一重要机制.目前认为RUNX3蛋自发挥何种作用取决于其在细胞中的表达部位,当在细胞核中表达时发挥抑癌作用,而在细胞质中表达时则发挥致癌作用.     

Myeloid Sarcoma: Presentation,Diagnosis, and Treatment

Myeloid sarcoma is an extramedullary tumor of immature granulocytic cells. It is a rare condition, most often associated with acute myeloid leukemia (AML), although in some rare cases it may present in nonleukemic patients. It should therefore be considered as a differential diagnosis of any atypical cellular infiltrate. It may occur at any site, leading to very varied clinical presentations. Diagnosis is challenging and relies on a high index of suspicion as well as radiology, histology, immunophenotyping, and molecular analyses, which also are essential for risk stratification and treatment planning. Systemic chemotherapy using AML-like regimens should be commenced early, even in nonleukemic disease. Surgery and/or radiotherapy may be indicated for symptomatic lesions or tumors causing local organ dysfunction or obstruction. Allogeneic hematopoietic stem cell transplantation has demonstrated promising results, particularly in patients who achieved complete remission with AML-induction protocols, and recent advances in genetic profiling may enable the development of novel targeted therapies. Prospective multicenter controlled trials are required to further refine management decisions and investigate the role of novel targeted therapies.     

Antisense imaging: where are we now?

The field of antisense targeting is changing rapidly as additional results from in vitro studies and animal and patient trials become available. While these developments apply primarily to antisense chemotherapy, many have implications for antisense imaging and radiotherapy. It may now be profitable to reconsider antisense imaging in the light of these recent developments. With the benefit of further insight, it may be possible to predict which antisense mechanisms will be preferable for antisense imaging. It is also possible to consider the influences of carriers (vectors) on the targeting of antisense DNA and whether this might improve imaging. Furthermore, estimates showing only low mRNA steady-state copy numbers per cell may be reconsidered in refining predictions of tissue counting rates. Finally, recent results suggest that radiolabeling antisense DNAs may not adversely influence the targeting properties of antisense DNAs.     

The role of cancer stem cells in neoplasia of the lung: past,present and future

Through the identification and subsequent targeting of an exquisitely unique and phenotypically defined cancer stem-cell population exhibiting discrete therapeutic vulnerabilities (a potential source of tumor recurrence) better survival rates for these patients may be achieved. It is this impetus that is making the field of pulmonary stem cell biology a growing field in biomedicine. These efforts are leading to the steady identification of multi-potent, self-renewing and proliferative progenitor cell populations throughout the bronchopulmonary tree. These cells give rise to both transiently amplifying (TA) and terminally differentiated (TD) cells, which (like in many other organs) are crucial for tissue homeostasis. In leukemia, it has been shown that partially committed cells, which are normally responsible for tissue maintenance after trauma, may undergo transformation via mutations resulting in the selective expression of genes that accentuate and perpetuate these cells’ self-renewal capabilities. It is therefore perhaps legitimate to consider stem cells as protumorigenic. It is when these cells undergo genetic mutations which make them acquire the ability to metastasize, that cancer occurs, rendering the concept of ‘cancer stem cells’ a rather attractive one indeed.     

Computerised Arthrotomography of the Glenohumeral Joint

Computerised arthrotomography of the glenohumeral joint is an extension of double contrast arthrography. It is of particular value in the assessment of patients with shoulder in stability, including patients in whom the diagnosis of recurrent subluxation requires substantiation, and shoulders which may be the site of multidirectional instability. It also appears to be of value in assessment of the articular surfaces following severe trauma. It should also be helpful in the detection of bicipital lesions and loose bodies.     

Percutaneous needle biopsy for diagnosis of pancreatic cancer

Percutaneous fine needle aspiration biopsy of the pancreas is a safe procedure, which may be done inexpensively and rapidly accomplished with high diagnostic accuracy. The major drawback of this technique is the need for a competent cytopathologist for specimen interpretation. It is quite possible, as more trained personnel become available, that percutaneous fine needle aspiration biopsy may become the technique of choice for establishing the diagnosis of pancreatic malignancy.     

Noninvasive precursor lesions of adenocarcinoma and mixed adenosquamous carcinoma of the cervix uteri.

It is postulated that squamous cell carcinoma, adenocarcinoma, and mixed adenosquamous cell carcinoma of the uterine cervix all have a common cell or origin, the subcolumnar reserve cell. The relative frequency with which the various types of carcinoma in situ are seen is in part explained by the ubiquitous nature of squamous metaplasia in the region of the transformation zone in women of reproductive age. It is suggested that squamous metaplasia is the soil on which most squamous carcinomas of the cervix evolve. The relatively low frequency with which adenocarcinoma and adenosquamous carcinoma in situ are encountered may also be dependent on their less accessible location in the endocervix.     

Congenital Cholesteatoma of Temporal Bone with Bezold’s Abscess: Case Report

Congenital cholesteatoma is a rare entity. It may originate at various sites in the temporal bone, for example, in the petrous apex, the cerebellopontine angle, the middle ear cavity, the mastoid process or in the external auditory canal. The least common site being the mastoid process. Most common presentation is a retrotympanic pearly white mass with no previous history of ear discharge, perforation or any ear surgery. It can lead to various complications, both intracranial and extracranial, some of which may be life threatening. Bezold’s abscess is an extracranial complication which is usually seen in children following acute otitis media with mastoiditis. Here we present a rare case of a 60 year old patient with congenital cholesteatoma complicating to Bezold’s abscess. After necessary investigations patient underwent surgery for complete removal of cholesteatoma and the abscess drainage.     

Fibroxanthosarcoma of the head and neck.

Fibroxanthosarcoma is a variant of malignant fibrous histiocytoma probably derived from the primitive tissue histiocyte. It occurs rarely in the head and neck. This lesion may be confused with the benign atypical fibroxanthoma. However, newer histologic criteria may allow definitive differential diagnosis which is important because of the agressive biologic behavior of fibroxanthosarcoma. Aggressive initial surgery with a consideration of regional lymphadenopathy offers the best chance for cure.     

Adenoid Cystic Carcinoma of Trachea: A Diagnostic and Therapeutic Challenge

Primary tumors of the trachea, which may be benign or malignant, account for fewer than 0.1 % of tumors. Adenoid cystic carcinoma is the second most common tracheal tumor. It poses a diagnostic and therapeutic challenge because of its slow growth and tendency for local recurrence and late metastasis. We present a case of adenoid cystic carcinoma of trachea which was misdiagnosed and mistreated as asthma initially because of its inherent indolent progression. It is important to be acquainted with this condition to prevent delay in diagnosis and provide timely treatment.     

Aneurysmal bone cyst of paranasal sinuses

Aneurysmal hone cyst is rare in paranasal sinuses. It may be uni or multilocutar It occurs alone or with other benign bone lesions. The exact pathogenesis of it is still unknown. The aggressiveness of the disease needs early diagnosis and proper management to prevent recurrence. This report describes a case of aneurysmal bone cyst involving the ethmoid and maxillary sinuses which was successfully managed.     

Etiopathogenesis of Gastric Cancer

Gastric cancer is a multifactorial and complex malignant disease seen commonly worldwide. It is one of the few malignant conditions in which the etiology involves infectious agents (Helicobacter pylori), but there are many other risk factors incuding high salt intake. Its pathogenesis generally involves interactions between environmental factors and genetic disposition. It is currently onsidered that stem cells may play a central role in gastric cancer development.     

Uterine Leiomyosarcoma Manifesting as a Tricuspid Valve Mass

Uterine leiomyosarcoma is a rare malignancy and carries a poorer prognosis when compared to endometrial carcinoma. It has been observed to metastasize to all the major organs. It presents with symptoms of abdominal distension, vaginal bleeding and may pass unnoticed until an advanced stage in patients with leiomyomas. Surgery is a viable option in patients with disease limited to the uterus, but metastasis to the heart may require surgery to prevent acute and catastrophic complications. The case described here involves metastasis to the tricuspid valve, which caused severe tricuspid regurgitation in the setting of acute pulmonary embolism. Surgical resection restored cardiac function and stabilized the patient. This case illustrates a rare site of metastasis of leiomyosarcoma which required immediate intervention and resulted in a favorable outcome.Key words: Leiomyosarcoma, Tricuspid valve, Metastasis, Pulmonary embolism