2021年美国甲状腺学会《甲状腺未分化癌病人管理指南》更新解读

甲状腺未分化癌（ATC）发病率低、预后差,为指导临床医生和研究人员对其进行规范化诊断和治疗管理,美国甲状腺学会于2012年制定了第1版《甲状腺未分化癌病人管理指南》。随着分子检测和靶向治疗结果的不断积累,2021年美国甲状腺学会对该指南进行了更新。新版指南强调了BRAFV600E分子检测在诊断及靶向治疗中的作用,增加了靶向治疗的内容,对晚期无法切除的 ATC病人更加推荐靶向治疗,而化疗则被更多的用于过渡性治疗和最终治疗。此外,新版指南也对病人的人文关怀进行了丰富和完善。     

Towards a new WHO classification of renal cell tumor: what the clinician needs to know—a narrative review

In 1952, renal cell carcinomas had been divided into 2 categories—clear cell or granular cell—depending upon their cytoplasmic staining characteristics. In the following years, the inventory of renal epithelial tumors has expanded by the addition of tumors named by their architectural pattern (i.e., papillary RCC, tubulocystic RCC), anatomic location (i.e., collecting duct carcinoma, renal medullary carcinoma), associated diseases (i.e., acquired cystic disease-associated RCCs). With the extensive application of molecular diagnostic techniques, it becomes possible to detect genetic distinctions between various types of renal neoplasm and discover new entities, otherwise misdiagnosed or diagnosed as unclassified RCC. Some tumors such as ALK rearrangement-associated RCC, MiT family translocation renal carcinomas, SDH-deficient renal cancer or FH-deficient RCC, are defined by their molecular characteristics. The most recent World Health Organization (WHO) classification of renal neoplasms account for more than 50 entities and provisional entities. New entities might be included in the upcoming WHO classification. The aim of this review is to summarise and discuss the newly acquired data and evidence on the clinical, pathological, molecular features and on the prognosis of new RCC entities, which will hopefully increase the awareness and the acceptance of these entities among clinicians and improve prognostication for individual patients.     

脑膜瘤术前颈外供血动脉超选择栓塞治疗

目的 回顾40例脑膜瘤施行术前血管内栓塞治疗,阐明栓塞的效果。方法 40例幕上脑膜瘤均行术前超选择颈外供血动脉明胶微粒栓塞,栓塞后1－7d行开颅脑膜瘤切除。结果 肿瘤单纯颈外供血19例,颈内、颈外均参与供血21例（其中颈内为主6例）。肿瘤全切除38例,大部分切除2例,无栓塞相关并发症。结论 单纯颈外供血或主要颈外供血者,栓塞后3－7d施肿瘤切除术,术中出血明显减少,手术时间显著缩短,并发症少。超选择栓塞治疗能减少栓塞治疗本身的并发症,是一种安全而有效的辅助治疗。     

矢状窦旁脑膜瘤的显微外科治疗

目的 提高矢状窦旁脑膜瘤的手术治疗效果。方法 回顾性总结分析１５２例太 窦旁脑膜瘤的临床表现、诊断方式、显微手术及其疗效。结果 肿瘤全手术切除１２３例（８１．０％）,次全切除２４例（１６．０％）,５例（３．０％）于术后３ｗｋ内死亡,长期随访（平均５．６ａ）１３１例,其中１１７例（８９．０％）恢复良好,９例（７．０％）肿瘤复发,需行再次手术。结论显微外科技术治疗矢状窦旁脑膜瘤,是一种安全、有效的方法     

Peripheral T-cell lymphomas. Clinico-pathologic study of 168 cases diagnosed according to the R.E.A.L. Classification

Background: One hundred sixty-eight peripheral T-cell lymphomas (PTCLs)were reviewed according to the Revised European–American Lymphoma (R.E.A.L.)Classification.Patients and methods: The cases, originally diagnosed on the basis of theUpdated Kiel Classification (UKC), were all provided with histologicalpreparations, immunophenotype, clinical information, and follow-up data. Theslides were reclassified by five observers, who integrated the R.E.A.Lcriteria with cell size measurements. The prognostic value of clinical andpathologic findings was assessed by univariate and multivariate analysis.Results: The R.E.A.L. Classification was reproducibly applied by all of theobservers. Clinically, anaplastic large cell lymphomas (ALCLs) differed fromthe remaining PTCLs by mean age (29.5 vs. 52.9 years), bulky disease(52.3% vs. 11.3%; P = 0.000), mediastinal mass (52.7% vs.32%; P = 0.004), and disease-free survival (68.0% vs.38.2%; P = 0.0001). Although each histological type displayed specificclinical aspects, PTCLs other than ALCL were basically characterised by a poorclinical outcome which was not influenced by the UKC malignancy grade. Atmultivariate analysis, the risk of a lower complete remission rate was relatedto bulky disease (P = 0.001), histologic group (non-ALCL) (P = 0.01), andadvanced stage (III–IV) (P = 0.0002).Conclusions: The present study supports the classification of T-celllymphomas proposed by the R.E.A.L. scheme.     

Progestin receptors in meningiomas

Summary The results are reported of ligand binding and enzyme immunoassays in tumour cytosols, and of immunoperoxidase assays in cryostat and paraffin sections measuring oestrogen (ER) and progestin receptors (PR) in 22 meningiomas and three non-meningioma tumours (two neurinomas and one haemangiopericytoma).With regard to the meningioma tissues, cytochemical immunoperoxidase PR-staining was present in all cryostat sections and in all but one of the paraffin sections. There was a good degree of qualitative accordance between all assay methods; they revealed the picture of typical meningiorna: high PR and low ER.In this series, immunoperoxidase staining for the detection of PR-receptors, both in cryostat and paraffin sections, rendered encouraging results, thus offering a method for the detection of progestin receptors, which can compete with cytosolic methods.     

A New Approach to an Old Problem

A patient with progressive visual loss was found to have an optic nerve sheath meningioma. The patient was treated with stereotactic radiotherapy, a computer-guided stereotactic technique that minimizes the risk of radiation-induced optic neuropathy. Six months after treatment, the patient was doing well and showed no signs of radiation-induced optic neuropathy.     

Increase in ω3 (Peripheral-Type Benzodiazepine) binding site densities in different types of human brain tumours

Summary The density of ₃ (peripheral type benzodiazepine) binding sites, a marker of reactive and tumoural cells, has been measured in different types of human brain tumours; ₃ sites were quantified autoradiographically in sections from biopsy or autopsy specimens labelled with the specific radioligand³H-PK 11195. Compared to normal brain parenchyma, up to 12-fold increase in ₃ site densities were found in appparently viable areas of high grade astrocytoma and glioblastoma specimens, whereas more limited increases (2 to 3-fold) in this marker were observed in areas of necrosis. Low grade gliomas (astrocytomas) and meningiomas exhibited only moderate increases (2 to 3-fold) in this autoradiographic marker. Metastases of lung or kidney origin were characterized by greatly elevated (up to 20-fold) ₃ site densities as compared to normal brain parenchyma. In every case, there was a good spatial correspondence between the histopathological limits of the tumour and the anatomical location of the increase in ₃ site densities. These results suggest that ₃ site densities in human brain tumours reflect their proliferative activity and point to a possible future usefulness of positron or gamma-ray emitting ₃ site ligands for the clinical investigation and detection of human brain proliferative diseases.     

15例甲状腺间变癌临床病理及免疫组化分析

[目的]探讨甲状腺间变癌的临床病理特征和免疫组化结果的意义。[方法]光镜观察和免疫组织化学SP法检测15例甲状腺间变癌。[结果]甲状腺间变癌的病理分型为梭形细胞型、巨细胞型和混合细胞型。15例中免疫组化阳性表达率分别是：Vimentin86．6％(13／15)、CK73．3％(11/15)、CEA60．0％(9／15），CD68 6．6％(1/15)；TG和降钙素均为阴性。2例伴有乳头状癌其中Vimentin和CK均阳性；1例伴破骨样巨细胞CD68阳性。[结论]甲状腺间变癌是上皮源性、恶性度高的肿瘤。熟悉其形态特征．结合免疫组化对诊断甲状腺间变癌具有重要意义。