颅内血管外皮细胞瘤多器官转移临床分析

目的分析颅内血管外皮细胞瘤颅外多器官转移的临床特点,以提高诊治水平。方法回顾分析1例颅内血管外皮细胞瘤8a间的回访资料,根据临床表现、影像学表现、手术治疗及放射治疗效果及转移情况,结合文献探讨其临床特点。结果颅内血管外皮细胞瘤患者术前影像与脑膜瘤不易区别,导致误诊。术中见脑膜有明显侵犯,血供丰富。术后病理需免疫组化确诊。术后随访期内发生原位复发及颅内附近转移和颅外多发转移。结论颅内血管外皮细胞瘤发生颅外多发转移较为罕见,需与脑膜瘤、孤立性纤维瘤鉴别。治疗以手术切除为首选,术后应常规行放疗,复发时可再次放疗并需定期随访。     

Interbrain phase synchronization during turn‐taking verbal interaction—a hyperscanning study using simultaneous EEG/MEG

Recently, neurophysiological findings about social interaction have been investigated widely, and hardware has been developed that can measure multiple subjects' brain activities simultaneously. These hyperscanning studies have enabled us to discover new and important evidences of interbrain interactions. Yet, very little is known about verbal interaction without any visual input. Therefore, we conducted a new hyperscanning study based on verbal, interbrain turn‐taking interaction using simultaneous EEG/MEG, which measures rapidly changing brain activities. To establish turn‐taking verbal interactions between a pair of subjects, we set up two EEG/MEG systems (19 and 146 channels of EEG and MEG, respectively) located ～100 miles apart. Subjects engaged in verbal communication via condenser microphones and magnetic‐compatible earphones, and a network time protocol synchronized the two systems. Ten subjects participated in this experiment and performed verbal interaction and noninteraction tasks separately. We found significant oscillations in EEG alpha and MEG alpha/gamma bands in several brain regions for all subjects. Furthermore, we estimated phase synchronization between two brains using the weighted phase lag index and found statistically significant synchronization in EEG and MEG data. Our novel paradigm and neurophysiological findings may foster a basic understanding of the functional mechanisms involved in human social interactions. Hum Brain Mapp 39:171–188, 2018. © 2017 Wiley Periodicals, Inc.     

Application of Independent Component Analysis for the Data Mining of Simultaneous Eeg–fMRI: Preliminary Experience on Sleep Onset

The simultaneous acquisition of electroencephalogram (EEG) and functional MRI (fMRI) signals is potentially advantageous because of the superior resolution that is achieved in both the temporal and spatial domains, respectively. However, ballistocardiographic artifacts along with ocular artifacts are a major obstacle for the detection of the EEG signatures of interest. Since the sources corresponding to these artifacts are independent from those producing the EEG signatures, we applied the Infomax-based independent component analysis (ICA) technique to separate the EEG signatures from the artifacts. The isolated EEG signatures were further utilized to model the canonical hemodynamic response functions (HRFs). Subsequently, the brain areas from which these EEG signatures originated were identified as locales of activation patterns from the analysis of fMRI data. Upon the identification and subsequent evaluation of brain areas generating interictal epileptic discharge (IED) spikes from an epileptic subject, the presented method was successfully applied to detect the theta and alpha rhythms that are sleep onset-related EEG signatures along with the subsequent neural circuitries from a sleep-deprived volunteer. These results suggest that the ICA technique may be useful for the preprocessing of simultaneous EEG–fMRI acquisitions, especially when a reference paradigm is unavailable.     

Anterior expandable cylindrical cage reconstruction after cervical spinal metastasis resection

Surgical therapy of cervical spine metastases had evolved a in the last years from posterior decompressive approaches to a direct anterior reconstructive approaches. Indication for surgery included intractable neck pain, spinal cord compression and stabilization of impending pathological fractures. We report our experience with expandable cylindrical cages in order to reconstruct and to stabilize cervical spine with metastasis. Between June 2004 and January 2006, a consecutive series of six patients underwent to resection of metastatic tumor in the cervical spine followed by expandable cylindrical cage reconstruction of the anterior vertebral column. All patients achieved immediate stability with neurological preservation. There were no significant complications related to the expandable cages in a mean follow up period of 10.5 months.Expandable cylindrical cages are effective resources for functional reconstruction after tumor resection in patients with cervical metastasis with advantages in the quality of life.     

伽玛刀治疗肺癌脑转移瘤疗效及影响疗效的相关因素分析

目的探讨伽玛刀治疗肺癌脑转移瘤疗效及影响疗效的相关因素。方法回顾性分析2007年1月至2010年1月期间在我院采用伽玛刀治疗的116例有病理学证实的肺癌脑转移瘤患者的临床资料,其中男性76例,女性40例。根据肿瘤的大小、位置及肿瘤周边正常组织的耐受情况,小病灶(直径﹤3.0cm)直接选择伽玛刀一次性治疗,周边剂量12～18Gy,45%～70%等剂量曲线为处方剂量。对于较大肿瘤病灶(直径≥3cm但≤4cm)选择伽玛刀二次剂量分割治疗,两次治疗间隔6～8小时,周边剂量7～9Gy,40%～50%等剂量曲线为处方剂量。结果随访116例患者,随访期6～45个月,肿瘤控制率95%,中位生存期14.8个月,1年生存率63%,2年生存率25%。KPS评分在1个月内达到90分以上者占92%。结论伽玛刀是治疗肺癌脑转移瘤安全有效的方法,其疗效与肿瘤大小、位置、治疗剂量及肺癌的病理类型有关。     

颅内转移性恶性黑色素瘤：一例报告并文献复习

目的探讨颅内转移性恶性黑色素瘤临床组织病理学及免疫组织化学特征。方法应用组织病理学及免疫组织化学检测方法对1例颅内多发转移性恶性黑色素瘤患者的两次手术标本进行观察,通过复习文献分析其组织病理学和免疫组织化学特征,提出诊断与鉴别诊断要点。结果男性患者,48岁。因颅内多发占位性病变、肿瘤卒中而行右侧额颞叶肿瘤切除术。两次手术标本组织病理学表现不一：首次右侧额叶病灶表现为异型性上皮样肿瘤细胞围绕毛细血管和纤维组织呈乳头状排列;再次手术标本为右侧颞叶,病灶表现为梭形细胞呈片巢状或束状排列,胞质丰富、淡染或透亮,胞核异型性明显、核仁呈明显嗜酸性。左侧腹股沟淋巴结活检提示肿瘤转移,且肿瘤组织局部可见大量黑色素颗粒。免疫组织化学染色肿瘤细胞弥漫表达S一100蛋白、人黑色素细胞瘤抗原45、Melan—A和波形蛋白,部分表达上皮膜抗原,而细胞角蛋白、高分子角蛋白、低分子角蛋白、胶质纤维酸性蛋白、突触素、神经微丝蛋白等表达阴性。结论颅内转移性恶性黑色素瘤的组织学表现复杂多样,临床病史和影像学资料对诊断具有重要参考价值,但明确诊断仍需依靠免疫组织化学检测结果。需注意与转移癌、脑膜肿瘤、淋巴瘤及其他含黑色素的颅内肿瘤相鉴别。     

非小细胞肺癌脑转移放射治疗新进展

随着CT、MRI和PET-CT技术的临床应用,以及非小细胞肺癌(non-small cell lungcancer,NSCLC)发病率上升和治疗后患者长期生存率的延长,NSCLC脑转移的检出率有上升趋势.放射治疗是最有效的治疗方法之一,对改善患者生存质量,延长生存期具有重要意义.     

颅内转移性恶性黑色素瘤:一例报告并文献复习

目的探讨颅内转移性恶性黑色素瘤临床组织病理学及免疫组织化学特征。方法应用组织病理学及免疫组织化学检测方法对1例颅内多发转移性恶性黑色素瘤患者的两次手术标本进行观察,通过复习文献分析其组织病理学和免疫组织化学特征,提出诊断与鉴别诊断要点。结果男性患者,48岁。因颅内多发占位性病变、肿瘤卒中而行右侧额颞叶肿瘤切除术。两次手术标本组织病理学表现不一:首次右侧额叶病灶表现为异型性上皮样肿瘤细胞围绕毛细血管和纤维组织呈乳头状排列;再次手术标本为右侧颞叶,病灶表现为梭形细胞呈片巢状或束状排列,胞质丰富、淡染或透亮,胞核异型性明显、核仁呈明显嗜酸性。左侧腹股沟淋巴结活检提示肿瘤转移,且肿瘤组织局部可见大量黑色素颗粒。免疫组织化学染色肿瘤细胞弥漫表达S-100蛋白、人黑色素细胞瘤抗原45、Melan-A和波形蛋白,部分表达上皮膜抗原,而细胞角蛋白、高分子角蛋白、低分子角蛋白、胶质纤维酸性蛋白、突触素、神经微丝蛋白等表达阴性。结论颅内转移性恶性黑色素瘤的组织学表现复杂多样,临床病史和影像学资料对诊断具有重要参考价值,但明确诊断仍需依靠免疫组织化学检测结果。需注意与转移癌、脑膜肿瘤、淋巴瘤及其他含黑色素的颅内肿瘤相鉴别。     

上皮样恶性外周神经鞘膜瘤淋巴结转移临床病理学特征:病例报告及文献复习

研究背景间叶性恶性肿瘤的转移途径以血行转移为主,而上皮性恶性肿瘤大多循淋巴管道转移,但间叶性肉瘤有时也会经淋巴管道进行转移。目的探讨上皮样恶性外周神经鞘膜瘤的临床病理学特征。方法复习1例淋巴管道转移性上皮样恶性外周神经鞘膜瘤患者临床资料,通过组织学观察、组织化学染色和免疫组织化学染色研究分析肿瘤细胞特点,并进行文献回顾。结果患者女性,42岁。临床表现为右侧腋窝4cm×4cm×3cm大小肿块伴右上臂及肩部麻木。术前影像学检查显示右侧腋窝软组织肿块影及周围多发肿大淋巴结影,考虑恶性病变。术中可见右侧腋窝多个结节状肿块,最大者约5cm×3cm×3cm大小,剖面呈灰红、灰黄色,质地坚硬,局部坏死。显微镜下观察淋巴结结构破坏,肿瘤细胞呈片状或巢状排列,可见纤细的血管纤维组织分隔,大多数肿瘤细胞呈上皮样,可见多核瘤巨细胞,核分裂象易见,部分区域间质呈黏液样变性。肿瘤细胞S-100蛋白、Sox-10蛋白、波形蛋白、Col-Ⅳ表达阳性;40%的肿瘤细胞胞核P53表达阳性;细胞角蛋白、癌胚抗原、上皮膜抗原表达阴性;Ki-67抗原标记指数>90%;网状纤维染色显示网状纤维包绕上皮细胞巢。既往曾因"右腕部肿物"行两次"肿物切除术",术后病理报告为上皮样恶性外周神经鞘膜瘤伴出血及灶性坏死,结合病史,最终诊断为右侧腋窝淋巴结转移性上皮样恶性外周神经鞘膜瘤。结论上皮样恶性外周神经鞘膜瘤主要通过血行转移,较少发生淋巴管道转移,应注意与具有相似组织学形态的肿瘤相鉴别,以免误诊或漏诊。     

Clinical Analysis of Novalis Stereotactic Radiosurgery for Brain Metastases

Objective

The authors analyzed the effectiveness and therapeutic response of Novalis shaped beam radiosurgery for metastatic brain tumors, and the prognostic factors which influenced the outcome.

Methods

We performed a retrospective analysis of 106 patients who underwent 159 treatments for 640 metastatic brain lesions between January 2000 and April 2008. The pathologies of the primary tumor were mainly lung (45.3%), breast (18.2%) and GI tract (13.2%). We classified the patients using Radiation Therapy Oncology Group Recursive Partitioning Analysis (RPA) and then analyzed the survival and prognostic factors according to the Kaplan Meier method and univariate analysis.

Results

The overall median actuarial survival rate was 7.3 months from the time of first radiosurgery treatment while 1 and 2 year actuarial survival estimates were 31% and 14.4%, respectively. Median actuarial survival rates for RPA classes I, II, and III were 31.3 months, 7.5 months and 1.7 months, respectively. Patients'' life spans, higher Karnofsky performance scores and age correlated closely with RPA classes. However, sex and the number of lesions were not found to be significantly associated with length of survival.

Conclusion

This result suggests that Novalis radiosurgery can be a good treatment option for treatment of the patients with brain metastases.