Minimal deviation melanoma. Borderline and intermediate melanocytic neoplasia

In the concept of MDM, the term melanoma has been reserved for lesions showing a vertical growth component. Vertical growth, divorced from any prognostic implications, is simply a morphologic designation. Such a maneuver also serves to validate the category of MDM, although it might then be inappropriate to characterize such lesions as melanoma. From my view, the modifier "minimal deviation" takes the onus of prognosis out of the equation. For common melanomas, size of a vertical growth component has relativity to prognosis. It is unlikely that, in comparable size-ranges, the MDM have a more aggressive nature than the common melanoma. It seems appropriate to propose that MDM measuring less than 1.5 mm in vertical dimensions could be characterized as melanocytic neoplasia of indeterminant malignant potential. Those less than 1 mm in vertical dimensions would be borderline variants and those in the range of 1 to 1.5 mm would be intermediate examples. Those greater than 1.5 mm could be characterized as melanocytic neoplasias of indeterminant (uncertain) malignant potential without additional qualifications.     

宫颈微偏腺癌10例临床病理分析

目的通过10例宫颈微偏腺癌（MI）A）临床病理分析，进一步探讨MDA的临床症状、病理形态及免疫组化特征。方法对10例宫颈MI）A的病理活检和，或全子宫切除标本进行巨检、光镜观察，其中7例行免疫组化染色测定CEA、p16、p53、Ki-67、CA125、ER、PR、HPV16／18等免疫表型。结果10例患者平均年龄49．5岁，临床症状以宫颈水样溢液为主，伴，不伴接触性出血，体征多数为宫颈肥大和，或宫颈糜烂。术前病理活检确诊6例，术后随访2。60个月，其中2例分别于5个月和7个月时死亡；2例转移，2例健在，余4例失访。结论宫颈MDA的早期确诊率极低，应警惕宫颈水样溢液和，或宫颈肥大者，应争取宫颈深部（〉5mm）活检，必要时施行高频电刀宫颈锥形切除术。CEA、p53（＋）及CA125、ER（-）具有辅助诊断价值。     

Minimal deviation adenocarcinoma with elevated CA19-9: A case report

BACKGROUNDMinimal deviation adenocarcinoma is a rare malignancy with a high rate of misdiagnosis and high aggressiveness, and its diagnosis relies on histopathology. Surgical resection is the preferred and most effective treatment, but the outcomes are often unsatisfactory.CASE SUMMARYA 60-year-old perimenopausal woman was admitted to the hospital and found to have elevated CA19-9 on physical examination without abdominal pain or vaginal bleeding. Clinical examination and positron emission tomography/computed tomography examination were unremarkable, magnetic resonance imaging examination was suggestive of dominant cervical lesions, and methylation examination was suggestive of malignant lesions. Tissue samples were taken from the suspected cervical lesion, and the final pathologic diagnosis was minimal deviation adenocarcinoma. Based on the pathologic diagnosis of suspected minimal deviation adenocarcinoma, radical abdominal total hysterectomy, bilateral oophorectomy, and pelvic and para-aortic lymph node dissection were performed. The final histological report confirmed minimal deviation adenocarcinoma of the cervix, stage IB2, with lymph node metastasis. Minimal deviation adenocarcinoma is a tumor with aggressive clinical behavior.CONCLUSIONPatients with minimal deviation adenocarcinoma have a lower survival rate than patients with conventional human papillomavirus-related cervical adenocarcinoma. A precise preoperative pathologic diagnosis may reduce the mortality rate due to missed optimal treatment with multiple surgical interventions. To date, there is no therapeutic consensus; therefore, each case must be treated individually.     

子宫颈微偏腺癌9例临床病理分析

目的探讨子宫颈微偏腺癌(MDAC)的临床病理特征、诊断和鉴别诊断。方法收集9例子宫颈MDAC的临床病理资料,采用HE染色和免疫组化进行观察。结果患者年龄31~56岁(平均47岁),临床上大多表现为多功能性子宫出血、阴道分泌物增多、绝经后阴道流血、腹胀。子宫颈较正常增大、质硬、脆。组织学特点为腺体扭曲、外形不规则,浸润宫颈壁全层,以及纤维组织增生性的间质反应,腺上皮呈CEA阳性。术后随访至2006年10月,5例死于肿瘤复发和广泛转移;3例分别在术后15个月、46个月和8年复发,放疗后至随访期末尚存活;仅1例术后2年未见复发。结论子宫颈MDAC少见,呈侵袭性生物学行为,预后较差,临床和病理上均易误诊为宫颈其他多种良好肿瘤及瘤样病变。     

Minimal craniocerebral trauma

The patient with mild head injury is the most frequently hospitalised trauma patient. The costs for this treatment are enormous. Guidelines for managing the patients are changing for the last 20 years. Haematoma rates of 10% have been shown with CT scans in prospective studies for patients with GCS 14/15 and normal neurological examination. One out of ten of these patients had to undergo craniotomy. CT scans have shown to reduce costs if done on all patients with mild head injury and discharged with normal findings. Patients with skull fractures and age over 65 years are at higher risk, but not patients with loss of consciousness and post traumatic amnesia. We suggest CT scans on all patients. If a CT scan is not available we recommend to observe the patient for 24 hours in the hospital. If a patient with GCS 15 is to be discharged, an information leaflet with instructions for surveillance at home should be given to the patients and to the care taker.     

Minimal fetal renal pyelectasis

To assess the possible relationship between the degree of maternal hydration and the sonographic identification of minimal fetal renal pyelectasis, a prospective study was performed in which fetuses demonstrating mild dilation of the renal pelvis (maximum diameter ranging from 3 to 11 mm) were reexamined after the mothers refrained from oral intake for 12 hours. Complete or almost complete resolution of the pyelectasis occurred in only four of 17 kidneys (23.5 per cent) while the remaining fetal kidneys demonstrated little or no change in the degree of pyelectasis following maternal dehydration. This observation, as well as previous experimental research, suggests that the state of maternal oral hydration is not a major cause of minimal fetal pyelectasis. Additionally, the observation of fetal pyelectasis measuring at least 3 mm in greatest dimension is common, occurring in approximately 18 per cent of fetuses older than 24 menstrual weeks.     

Determination of electrical axis deviation

While the determination of an abnormal electrical axis is not considered to be diagnostic, it will lend support to suspicions of abnormalities such as hypertrophy or intraventricular conduction defects. In some instances the recognition of axis deviation may be the first indication of underlying heart disease in an otherwise asymptomatic patient. Axis deviation can be determined easily in the critical care setting and should become as routine to the critical care nurse as the interpretation of a rhythm strip.     

Minimal change nephrotic syndrome

In minimal change nephrotic syndrome (MCNS), selective proteinuria is associated with structural alterations of the glomerular epithelial cells, such as effacement of the foot process. Although the pathogenesis of MCNS has not been completely clarified, clinical and experimental observations suggest that it results from T cell dysfunction in the pathogenesis. Recently, it has been proposed that the occurrence of MCNS has been associated with type 2 Th (Th2) lymphocyte-dependent conditions and some vascular permeability factors, which are induced by T cell disorder. In general, MCNS has the good long-term outcome with sustained remission and preserved renal function, because almost cases are responsible for the treatment. However, some patients show frequent relapses or resistance to this treatment and need large doses of immunosuppressive agents for a long time. Therefore, we should be care for the complications associated with prolonged these therapies.     

Intraperitoneal seeding from hepatoma

We report three cases of intraperitoneal seeding from hepatoma. Manifestation of intraperitoneal seeding from hepatoma were intraperitoneal masses (N = 2) and peritoneal thickening (N = 1). Main vascular feeder to intraperitoneal masses was omental branches of the gastroduodenal artery and/or the superior mesenteric artery.