Utilidad de la tiroglobulina en lavado de aguja del aspirado de 16 lesiones cervicales en pacientes con cáncer de tiroides

Background and objectiveThyroglobulin in the needle washout (Tg-FNA) and cytology of fine needle aspiration (cyto-FNA) are recommended for diagnosis of metastatic lymphadenopathies and recurrence of differentiated thyroid cancer. The objective of this study was to assess the value of these procedures in 16 cervical masses from patients with thyroid cancer of the follicular epithelium (TC).Patients and methodsThe study included six patients with TC and cervical lymphadenopathies evaluated before initial thyroid surgery and 10 patients followed up after TC surgery with cervical lumps discovered. FNA was performed in all 16 masses. Results of cyto-FNA, Tg-FNA and of the combined tests were compared to the final diagnosis of each lesion.ResultsAmong 10 lesions proven to be malignant at surgery, cyto-FNA, Tg-FNA and the combination of both allowed for adequate diagnosis in 7, 9, and 10 cases respectively. Among 6 lesions considered to be benign, cyto-FNA was able to confirm diagnosis in 4, was non-diagnostic in one, and was falsely negative in the remaining case, while Tg-FNA was below the established cut-off value (to consider malignancy) in all cases.ConclusionsIn patients with TC and suspect cervical masses, Tg-FNA improved the diagnostic yield of cyto-FNA alone, thus warranting its routine recommendation when FNA is performed. However, universal standardization of the technique and definition of valid cut-off thyroglobulin values (depending on the immunoassay used) above which the lesion should be considered to be malignant are still pending.     

MRI 在宫颈癌分期中的应用价值

目的:探讨宫颈癌的MRI表现与分期,评价其诊断价值及临床意义。方法:由2名经验丰富的妇科肿瘤医师前瞻性地对80例宫颈活组织病理检查证实为宫颈癌或可疑早期浸润癌的患者进行妇科盆腔检查,共同决定分期和手术可行性。对可直接手术或经先期治疗后有手术可能的患者,于开始治疗前2周内(平均6.5d)行盆腔和腹膜后MRI扫描。在MRI图像上观察原发肿瘤的位置、信号特征及侵犯范围。将MRI分期与临床分期进行对比,手术病理分期为金标准,采用诊断检验方法,以敏感度、特异度、准确度3项指标分析MRI判断宫颈癌分期、宫旁侵犯和盆腔淋巴结转移的价值。结果:MRI对宫颈癌术前分期的总准确度为88.7%,对浸润性癌(Ⅱa及Ⅱa以上)诊断准确度为86.7%。MRI对宫旁侵犯的判断敏感度为85.2%,特异度为85%,准确性为85.1%,MRI预测淋巴结转移的敏感度为58%,特异度为96%,准确性为90%。结论:MRI能多方位清晰显示宫颈癌瘤灶及侵犯范围与途径,明显优于其他影像学检查方法,MRI对术前宫颈癌分期明显优于临床,可做为宫颈癌术前常规的影像检查方法。     

人乳头状瘤病毒分型及病毒载量与宫颈病变的研究进展

宫颈癌作为目前妇女最常见的恶性肿瘤,新发病例在全球范围内仍处于上升趋势。已有实验证明,HPV感染是宫颈癌发生发展的必要条件。然而不同分型及其病毒载量高低仍会影响诊断率,从而影响病情,使之发展为持续性感染,最终演变为癌前病变或宫颈癌。目前,研究者对于高危型HPV病毒载量与宫颈病变之间是否存在依存关系尚存争议。研究表明,高病毒载量可能成为预测宫颈癌前病变进展的指标,然而对于病理诊断明确的宫颈癌患者而言,病毒载量并不能代表病理分期。本文综述了人乳头状瘤病毒,不同基因分型,病毒载量等因素对于宫颈病变及宫颈癌的相关性的近年研究进展,希望有助于指导临床工作。     

Origin of adenocarcinoma cells observed on cervical cytology

OBJECTIVE: To clarify the ratio of diseases suspected when malignant glandular cells are observed on cervical cytology. STUDY DESIGN: Seventy cases of cervical adenocarcinoma/adenosquamous carcinoma, 207 cases of endometrial adenocarcinoma, 7 cases of tubal adenocarcinoma and 83 cases of ovarian adenocarcinoma were reviewed. The positive rate in cervical cytology performed 3 months before surgery was calculated. Based on the positive rate for each entity and the number of cases treated in the previous 10 years, we estimated the incidence of disease responsible for malignant glandular cells on cytology. RESULTS: The positive rate was 93% in cervical adenocarcinoma/adenosquamous carcinoma, 45% in endometrial adenocarcinoma, 14% in tubal adenocarcinoma and 6% in ovarian adenocarcinoma. These positive rates and case numbers at our institute indicated the percentage of suspicious diseases to be 38% for cervical aaenocarcinoma/adenosquamous carcinoma, 53% for endometrial adenocarcinoma, 1% for tubal adenocarcinoma and 8% for ovarian adenocarcinoma. CONCLUSION: When a cytologic specimen suggested the existence of adenocarcinoma, the most probable disease was endometrial adenocarcinoma, and the second was cervical adenocarcinoma/adenosquamous carcinoma. Adnexal malignancies were responsible in 9% of cases. In the case of positive cervical cytology suggesting adenocarcinoma, the ratio of suspicious diseases is as valuable as the cytologic findings for the differential diagnosis.     

Oncological principles of surgery in the periorbital region

The aim of this study is to describe the most common malignant periorbital tumours and principles of their surgical treatment. The most common malignant tumours of the eyelids are: basocellular carcinoma, squamocellular carcinoma, sebaceous carcinoma and malignant melanoma. The primary treatment of periorbital tumours is surgery, other methods are cryotherapy or radiotherapy. Malignant tumours of the eyelids are fairly rare. Diagnosis in some of the cases is difficult, since the first signs of the tumours are small changes on the eyelid margin or eyelid skin. Focal loss of the eyelashes could be the first sign of a malignant tumour. General oncological principles are valid also in the surgery of periorbital region. Eyelids have special anatomical structure and their main role is protection of the eyeball. Therefore, early diagnosis and total tumour removal--regardless of the anatomical borders--as well as immediate reconstruction are important in the treatment of eyelid tumours.     

Malignant teratoma of the thyroid with predominantly neuroepithelial differentiation. Fine needle aspiration cytologic, histologic and immunocytochemical features of a case

BACKGROUND: Teratoma of the thyroid in adults is extremely rare, and most are malignant. Only nine cases have been adequately documented in the English-language literature, and there are no reports detailing the fine needle aspiration (FNA) cytologic characteristics. CASE: A 32-year-old female presented with a left-sided nodular thyroid mass with left cervical lymphadenopathy. FNA cytology of the thyroid and lymph nodes was done. The cytologic and immunocytochemical features were that of a small round cell tumor with neuroepithelial (NE) differentiation, metastasizing to the cervical nodes. Microscopic study of the thyroidectomy specimen showed a tumor showing an NE pattern with occasional islands of squamous and cuboidal epithelium, leading to a diagnosis of malignant teratoma. CONCLUSION: Knowledge of FNA cytologic features of rare but highly malignant lesions like thyroid teratomas allow early recognition so that suitable and possibly aggressive treatment protocols can be adopted in the hope of prolonging survival.     

Juvenile active ossifying fibroma with massive involvement of the mandible

Fibro-osseous lesions of the maxillofacial complex are often difficult to diagnose from both a clinical and a histopathologic point of view. The parameters for the diagnosis of juvenile active ossifying fibroma are as follows: a patient under 15 years of age, localization of the tumor, the radiologic aspect, and the tendency to recur. Although many authors favor conservative surgery rather than radical en bloc resection, immediate recurrence characterized by a high aggressive growth rate and the absence of a distinct separation between the tumor and the adjacent bone requires ex- tensive surgery, with wide demolition of the involved bone.     

High serum alkaline phosphatase cooperating with MMP-9 predicts metastasis and poor prognosis in patients with primary osteosarcoma in Southern China

Background

A malignant fibrous histiocytoma is a soft tissue tumor that most commonly occurs in the extremities, but rarely involves the liver. The clinical characteristics and therapeutic experiences of primary hepatic malignant fibrous histiocytoma are still limited.

Methods

Two cases of primary hepatic malignant fibrous histiocytoma were analyzed retrospectively, and all the literature concerning primary hepatic malignant fibrous histiocytoma was analyzed.

Results

In China, a total of 76 cases had been reported, among which 50 were men, with a male to female ratio of 1.9:1. Mean age of the patients was 51.0 years old, and more than 85 percent were older than 40 years. 82.9 percent (63/76) of hepatic MFH were solitary lesions, with tumor size ranging from 2.5 to 23.5 cm (average 10.3 cm). Major clinical presentation (78.4%) was abdominal pain or discomfort, accompanied with some other non-specific symptoms such as malaise, anorexia, weight loss, jaundice and fever, and small cases (14.9%) were asymptomatic. Computed tomography and ultrasound usually revealed the location of lesions. The rate of pre-operative misdiagnosis was extremely high, and 14.9 percent of patients were even misdiagnosed as a benign liver cyst, liver abscess or hematoma. Integrated resection was performed among the most cases (49/68), among which only a few ones (12 cases) were introduced to have no recurrence or metastasis or be still alive with no detail information provided, while among the cases with palliative operation or only a biopsy, the cases that were followed-up all died.

Conclusions

Hepatic malignant fibrous histiocytoma is a rare malignant mesenchymal tumor. The variable features of clinical presentations and images make the diagnosis difficult. Though the prognosis of primary hepatic malignant fibrous histiocytoma was rather poor, integrated resection might provide a few cases a good opportunity for surviving, suggesting that surgery might be an effective treatment.     

Primary cervical lymphoma: the role of cervical cytology

Two cases of primary malignant lymphoma of the uterine cervix are reported. Both were confirmed by histology as high grade B cell lymphomas. In one case, the diagnosis was made on a second colposcopic biopsy after an initial cervical smear and colposcopic biopsy were negative. In the second case, dyskaryotic cells of uncertain type were identified in a cervical smear taken at colposcopy performed as part of follow up for previous cervical intraepithelial neoplasia (CIN)I. The cytologic features and differential diagnosis of this rare cervical neoplasm are discussed, with emphasis on the role of the Papanicolaou smear in the initial diagnosis of this tumour.     

P-cadherin expression in glandular lesions of the uterine cervix detected by liquid-based cytology

OBJECTIVE: To study P-cadherin aberrant expression as a possible marker for cervical adenocarcinomas in cytological samples. METHODS: We studied P-cadherin immunoexpression in liquid-based cervical cytology samples of biopsy-proven cervical lesions. RESULTS: We found a statistically significant correlation between P-cadherin expression and a cytological diagnosis of malignancy, either glandular or squamous (P < 0.0001). Twenty-two of 33 malignant cases showed P-cadherin membrane staining. None of the 30 benign cases tested showed membrane staining, but three of them displayed an aberrant nuclear P-cadherin expression. CONCLUSIONS: We concluded that P-cadherin can be used to discriminate between malignant and benign cervical cytological specimens, but not to discriminate glandular from squamous lesions.     

宫颈癌根治术泌尿系损伤的临床分析

目的：手术是治疗早期宫颈癌的主要手段,本文回顾性分析宫颈癌根治术泌尿系损伤的发生率、探讨防治措施,以减少泌尿系损伤的并发症,提高患者生活质量。方法：对新疆肿瘤医院2003年1月-2008年1月收治的482例早中期子宫颈癌行根治术的患者进行回顾性分析。其中Ia期6例,Ib期131例,IIa期142例,IIb期;鳞癌：440例,腺癌：31例,其他类型：11例。结果：发生泌尿系损伤9例,发生率为1．9％。其中输尿管损伤7例,膀胱损伤2例,其发生率分别为1．5％,0．4％。结论：宫颈癌根治手术致泌尿系损伤是少见但较严重的并发症,对输尿管损伤及时发现及时修补可以避免术后尿瘘的发生,严格操作步骤仍然是子宫颈癌根治术泌尿系损伤防治的关键问题。     

宫颈环形电切及锥切术治疗子宫颈病变临床分析

目的探讨宫颈环形电切及锥切术（LEEP）在宫颈上皮内瘤变（CIN）等宫颈病变诊疗中的应用价值。方法对我院以LEEP治疗CIN等宫颈病变69例,对比手术前后病理检查结果、并进行随访,统计其HPV感染情况。结果术前宫颈活检与术后病理检查结果符合率为76．8％（53／69）。LEEP可以一次性治疗CINⅠ和反复宫颈炎病例,在41例CINⅡ和Ⅲ病例中有2例复发。HPV感染率在CIN中70．0％（42／60）,反复宫颈炎患者中44．4％（4／9）。结论LEEP治疗CIN等宫颈病变手术操作简便,术后恢复好、复发率低,是可以推广的较为理想的诊断及治疗措施。     

Diagnosing endometrial carcinoma with cervical involvement by cervical cytology

OBJECTIVE: To assess the relationship of a cervical cytologic diagnosis based on number, size and degeneration of malignant clusters and necrotic background to cervical involvement of endometrial carcinoma. STUDY DESIGN: Cervical smears of 53 women with endometrial carcinoma were evaluated for cervical involvement. The cytologic diagnosis was compared with actual involvement, and accuracy was calculated. Retrospectively, cytologic features, including number, size and degeneration of malignant clusters and necrotic background, were analyzed in involved and noninvolved cases. RESULTS: Cervical involvement was confirmed in 15 patients (28.3%). The number and size of malignant clusters in the involved cases were significantly larger than those in the noninvolved cases (P < .001 and < .01, respectively). The proportion of degenerated malignant cells and necrotic background in involved cases were significantly higher than those in noninvolved cases (P < .05). Cytologic diagnosis had a sensitivity and specificity of 62.5% and 86.8%, respectively. CONCLUSION: Cervical smears of involved cases revealed a large number and large size of malignant clusters. These findings support cytologic diagnosis based on number, size and degeneration of malignant cells and necrotic background. Cervical cytology is useful to exclude cervical involvement because of its high specificity and can help detect cervical involvement because of its moderately high sensitivity.     

Immunocytochemical methods in the study of lymphoma and related conditions.

The diagnosis and classification of malignant lymphomas is based upon traditional histological criteria evolved over the years by successive generations of pathologists. Immunoperoxidase methods applied to formalin paraffin sections have permitted a direct correlation of these established morphologic criteria with newer immunological concepts of the form and function of the B lymphocyte and its derivatives. Study of material from 500 cases of Hodgkin's disease, non-Hodgkin lymphomas, and myeloma has revealed that many of these conditions may find a common origin in the lymphocyte, and that some malignant cells, previously identified as malignant histiocytes or reticulum cells are rather related to or derived from the transformed lymphocyte or immunoblast. The corresponding tumors are thus more logically designated immunoblastic sarcoma. The study also reveals a claser developmental relationship between multiple myeloma and immunoblastic sarcoma than previously suspected, and suggests that all of the B cell lymphomas occur as part of a continuous spectrum of disease, rather than as separate entities as implied by current histological classifications. The study of immunoglobulin in formalin paraffin sections is illustrative of the great potential of this method in the diagnosis and study of neoplasia in general.     

Peritoneal washing cytology in cervical carcinoma. Analysis of 109 patients

The peritoneal washing cytologies of 109 patients (112 procedures) undergoing laparotomy for cervical carcinoma were evaluated retrospectively and compared with the clinical and pathologic findings. Nine patients (8.3%) had malignant peritoneal washings (including three of four with washings initially termed "inconclusive"). Four (4.9%) of the 82 patients with squamous carcinoma and 3 (16.7%) of 18 with adenocarcinoma had positive washings. Five (5.6%) of 90 washings obtained at initial explorations were positive, as compared with 4 (18.2%) of 22 washings obtained as follow-up operations in recurrent cases. The 111 peritoneal washing cytologies with a corresponding histologic evaluation of the peritoneal cavity showed a good correlation; peritoneal washing cytology had an efficiency of 91.0%, a sensitivity of 52.9% and a specificity of 100%. Two cases in which the cytologies were considered positive only after review had negative peritoneal histologies; both patients died of progressive disease within 11 months. Peritoneal washing cytology was positive in 5 (5.9%) of 84 cases with FIGO stage 1 cancers, 2 (18.2%) of 11 cases with stage 2 cancers, 1 (33.3%) of 3 cases with stage 3 cancers, and 1 (10%) of 10 cases with recurrent tumors. Eight (88.9%) of nine patients with malignant peritoneal washings died of disease from 3 to 15 months following surgery; one showed no evidence of disease at 9 months. These results suggest that: (1) cervical carcinomas are infrequently associated with a positive peritoneal washing; (2) peritoneal washing cytology is more likely to be positive in cases of adenocarcinoma than in cases of squamous carcinoma; (3) peritoneal washings obtained at the time of surgery for recurrence are more likely to contain malignant cells than are washings obtained during initial exploration; (4) nonkeratinizing malignant squamous cells may be confused with reactive mesothelial cells; and (5) peritoneal washing cytology is a relatively insensitive technique for detecting advanced cervical disease, but correlates with a poor prognosis when positive.     

Lujan-Fryns syndrome (mental retardation, X-linked, marfanoid habitus)

Kikuchi-Fujimoto disease (KFD) is a benign and self-limited disorder, characterized by regional cervical lymphadenopathy with tenderness, usually accompanied with mild fever and night sweats. Less frequent symptoms include weight loss, nausea, vomiting, sore throat. Kikuchi-Fujimoto disease is an extremely rare disease known to have a worldwide distribution with higher prevalence among Japanese and other Asiatic individuals. The clinical, histopathological and immunohistochemical features appear to point to a viral etiology, a hypothesis that still has not been proven. KFD is generally diagnosed on the basis of an excisional biopsy of affected lymph nodes. Its recognition is crucial especially because this disease can be mistaken for systemic lupus erythematosus, malignant lymphoma or even, though rarely, for adenocarcinoma. Clinicians' and pathologists' awareness of this disorder may help prevent misdiagnsois and inappropriate treatment. The diagnosis of KFD merits active consideration in any nodal biopsy showing fragmentation, necrosis and karyorrhexis, especially in young individuals presenting with posterior cervical lymphadenopathy. Treatment is symptomatic (analgesics-antipyretics, non-steroidal anti-inflammatory drugs and, rarely, corticosteroids). Spontaneous recovery occurs in 1 to 4 months. Patients with Kikuchi-Fujimoto disease should be followed-up for several years to survey the possibility of the development of systemic lupus erythematosus.     

颅内海绵窦脑膜瘤的临床研究进展

海绵窦脑膜瘤虽多为良性肿瘤,但由于其解剖位置的特殊性,往往可累及颈内动脉、Ⅲ~Ⅵ对颅神经甚至垂体等重要结构,表现出类似恶性肿瘤的生物学行为。由于其毗邻颅内重要结构,手术全切难度高。近年来,随着CT、MR等现代影像技术的发展及广泛应用,以及对海绵窦解剖的认识、显微外科和颅底外科技术的发展,海绵窦脑膜瘤在术前诊断、评估及手术治疗等方面已取得了长足进步。然而,由于此区解剖复杂,手术难度大,在治疗方法上还存在一定的争议。我们对海绵窦脑膜瘤目前诊断及治疗策略的进展进行简要概述。     

Cervical disease in women referred to colposcopy following inadequate smears

The aim of this audit was to determine if inadequate cervical smears are associated with significant cervical pathology. Case records for 52 women with three consecutive inadequate smears referred for colposcopy to the Leicester Royal Infirmary (LRI) were retrieved. Sixteen women underwent large loop excision of the transformation zone (LLETZ) and cervical intraepithelial neoplasia (CIN) was identified in six cases. There were no cases of inadequate smears initiating the diagnosis in 100 consecutive women with invasive cervical cancer. Inadequate smears are associated with high rates of treatment for a low yield of CIN. To reduce morbidity associated with colposcopy it may be acceptable to repeat an inadequate smear after 6 months rather than arranging immediate recall.     

Cell block as an adjunct to conventional Papanicolaou smear for diagnosis of cervical cancer in resource-limited settings

OBJECTIVE: To assess the utility of indigenously prepared cell blocks (CBs) as an adjunct to a conventional smear test in providing a reliable diagnosis of clinically suspicious cervical cancer in resource-limited settings. METHODS: Eighty-six clinically suspicious cervical cancer cases underwent a conventional smear test, CB preparation from residual cellular samples and biopsies at the same sitting. Correlations were performed between these modalities in order to derive the sensitivity and specificity of the CB technique to diagnose cervical cancer. OBSERVATION & RESULTS: Out of 86 clinically suspicious cervical cancers, 72 (83.7%), 70 (81.4%) and 67 (77.9%) cases were diagnosed as malignant on tissue biopsies, CBs and smears respectively. CB-biopsy agreement in the diagnosis of malignancy was feasible in 87.5% of the cases while CB-Pap smear agreement was feasible in 92.5% of the cases. Sensitivity and specificity of CB preparation to diagnose malignancy was 92.5% and 100%, respectively, when the smear was taken as the reference test (excluding the unsatisfactory smears). When biopsy was taken as the gold standard, the sensitivity and specificity of CBs were 87.5% and 100% respectively (excluding the unsatisfactory biopsies). In 8/19 cases where the smear diagnoses were either unsatisfactory or atypical squamous cells/atypical glandular cells, CBs picked up malignant lesions. CONCLUSION: CBs prepared from the residual cellular sample of conventional cervical scrapes augment the sensitivity of the smear test. When used as an adjunct to the smear, CBs aid in providing a reliable diagnosis of cervical cancer in the majority of the clinically suspected cases and thus the biopsy load can be reduced significantly in resource-poor settings.     

Carcinoma of Large Bowel in the Young

The incidence of large-bowel carcinoma in young people seems to be increasing. Twenty-one cases occurring between the ages of 13 and 25 are reviewed. Most cases were found to be in an advanced state of the disease. High grade malignant growths were found to be twice as common in the young as in adults. The mode of presentation is no different from that in adults and a plea is made for improving results of treatment by earlier diagnosis, which can be established by an increased awareness of the disease in children and young adults.