黑色素瘤的治疗新进展

黑色素瘤的遗传学特性颇具代表性,常作为肿瘤研究的首选。本文对黑色素瘤发病的分子机理研究与基因治疗新进展作综述。     

黄姑鱼的恶性黑色素瘤

从我国南海海域捕获的黄姑鱼(Nibea albiflora)中发现15例恶性黑色素瘤(malignant melanoma)。本文较详细地介绍了有关这种肿瘤的病理解剖学、病理组织学和超微结构的观察结果。在国内外首次报道黄姑鱼的这种恶性肿瘤对肿瘤学有一定的研究价值。     

16层螺旋CT血管成像诊断颅内动脉瘤的价值

目的:探讨16层螺旋CT血管成像(16SCTA)诊断颅内动脉瘤的价值.方法:对33例16SCTA诊断的颅内动脉瘤进行回顾性分析.其中4例经手术证实,13例经数字减影血管造影(DSA)证实.结果:16SCTA在33例患者中,共发现40个动脉瘤.其中3例为两个动脉瘤,2例为三个动脉瘤.40个动脉瘤中大脑中动脉瘤9个,大脑前动脉瘤8个,大脑后动脉瘤2个,后交通动脉瘤4个,颈内动脉瘤12个,基底动脉瘤3个,胼周动脉瘤1个,小脑上动脉瘤1个.16SCTA均清晰显示瘤体的大小、位置、形态及瘤颈宽度、瘤轴指向、载瘤动脉、动脉瘤与周围重要解剖结构的关系.有DSA资料对照的13例中,16SCTA发现16个动脉瘤中DSA只发现13个,另外DSA发现1个动脉瘤而16SCTA漏诊.16SCTA诊断颅内动脉瘤的敏感度、特异度、阳性预测值、阴性预测值分别为92.9%、97.1%、81.3%、99%.结论:16SCTA在颅内动脉瘤临床诊断和术后随访中有较高的应用价值.     

原发性肝癌磁共振成像诊断的动物实验研究

本文采用11只大鼠肝癌模型活体MR成像,分析了对肝癌具有诊断意义的MRI征象,并将病灶内各种信号变化与病理进行了较细致的对照。结果表明:①在SE长TR、多回波图像上,肝癌的信号变化具有较特征性的规律,绝大多数病灶表现为不均匀的高信号区,并随回波时间延长信号强度衰减,信号变得更为不匀;②通过对T_1和T_2加权图像病灶内各种信号强度变化的综合分析可大致反映它们不同的病理学基础。     

原发性子宫颈恶性黑色素瘤1例并文献复习

目的 探讨1例原发性子宫颈恶性黑色素瘤（primary malignant melanoma of the cervix, PMMC）的临床病理学特征、鉴别诊断、治疗及预后。方法 应用HE染色、免疫组织化学染色对武汉市中心医院收治的1例PMMC的临床病理特点及免疫表型进行分析,并进行相关的国内外文献复习。结果 大体标本呈乳头状,色暗红,局灶灰黑,大小4 cm×4 cm;镜下见不规则巢团样排列的肿瘤细胞弥漫浸润子宫颈壁,肿瘤细胞主呈上皮样,胞质较丰富,核多形较明显,少数细胞可见清晰核仁,未见明显色素颗粒;免疫组织化学表型：S-100、SOX-10、melan-A、MiTF弥漫强阳性,p16、vimentin阳性,CD34、D2-40示脉管,Ki-67增殖指数约50%,HMB-45、PCK、p40阴性。结论 PMMC是一种恶性程度极高、临床上罕见的肿瘤,术前诊断主要依赖临床表现、病理活检及免疫组织化学染色结果。手术治疗为主,术后结合辅助治疗,预后差。     

脑动静脉畸形的MRA诊断技术及诊断价值

目的：回顾性分析脑动静脉畸形（AVM）的MRA诊断方法厦诊断价值。方法：51例AVM病人,男30人,女21人,年龄为9—66岁。均进行MR平扫压3D—TOFMBA或3D—PCMBA扫描。结果：删能清晰显示瘤巢压AVM的继发改变,MBA可基本显示AVM的全貌。结论：船认是诊断AVM的有效方法,但常需结合DSA。     

脑动静脉畸形的MRA诊断技术及诊断价值

目的:回顾性分析脑动静脉畸形(AVM)的MRA诊断方法及诊断价值。方法:51例AVM病人,男30人,女21人,年龄为9-66岁。均进行MR平扫及3D-TOF MRA或3D-PC MRA扫描。结果:MRI能清晰显示瘤巢及AVM的继发改变,MRA可基本显示AVM的全貌。结论:MRA是诊断AVM的有效方法,但常需结合DSA。     

CT、常规MRI序列和SWI诊断弥漫性轴索脑损伤比较

目的：探讨弥漫性轴索损伤（DAI）的CT、常规MRI序列和磁敏感加权成像（SWI）表现与诊断价值。方法：回顾分析42例DAI患者的影像资料,分析、比较CT、MRI和SWI的信号特征及脑内病灶显示率。结果：SWI显示病灶最多、最敏感;脑CT扫描次之;常规MRI序列敏感性差,只有部分病灶显示。结论：CT、MRI和SWI对DAI早期诊断、治疗及评价预后具有重要参考价值,SWI是诊断DAI最有效的首选影像学检查方法。     

黑色素瘤的靶向治疗

黑色素瘤是常见的皮肤肿瘤,它放化疗的效果差,达卡巴嗪仍是目前晚期黑色素瘤化疗药物治疗中公认的金标准,但有效率仅8%~12%左右。现抗细胞毒T淋巴细胞相关抗原4(cytotoxic Tlymphocyte-associated antigen-4,CTLA-4)单抗和针对基因突变的分子靶向药物的出现,增加了治疗的手段并取得了好的疗效。这些药物在延长晚期黑色素瘤患者的生存期方面取得了令人瞩目的突破,有可能对晚期黑色素瘤患者的治疗进行彻底的革命,这为治疗晚期恶性黑色素瘤患者带来希望,在目前常用的药物中,虽然威罗菲尼和易普利姆玛被用来治疗转移性黑色素瘤,但他们都有局限性。威罗菲尼有效应答时间短,而易普利姆玛应答率低。本文就恶性黑色素瘤分子靶向治疗的研究进展进行综述,未来几年靶向药物的联合治疗及新的有效靶点的发现可能会成为黑色素瘤治疗的突破点。     

功能性核磁共振成像技术对原发性三叉神经痛患者脑功能的评估价值及血清IL-1β、TNF-α检测的临床意义

目的:研究功能性核磁共振成像(fMRI)技术对原发性三叉神经痛(ITN)患者静息状态下脑功能的评估价值及血清白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)检测的临床意义。方法:选取2017年2月～2019年2月安徽医科大学附属口腔医院接受诊治的ITN患者共50例进行研究,记为ITN组。另选取同期接受体检的健康人员50例记作健康对照组。两组均于静息状态下行fMRI扫描,比较两组脑区的平均低频振幅率(mfALFF)以及血清IL-1β、TNF-α水平。结果:ITN组左侧的枕中回、枕下回、梭状回、距状裂周围皮层、中央旁回、三角部额下回、右侧背外侧额上回以及左小脑脚1区的mfALFF值高于健康对照组(均P0.05)。ITN组右颞上回、右颞中回、右颞下回、右中央沟盖、右缘上回、右岛盖部颞下回、左前扣带回、扣带旁回、左颞极、颞上回脑区的mfALFF值显著低于健康对照组(均P0.05)。ITN组患者的血清IL-1β、TNF-α水平高于健康对照组(均P0.05)。结论:fMRI对ITN患者静息状态下脑功能的评估价值较高,血清IL-1β、TNF-α水平升高可能与ITN的发病密切相关,可发挥促进疾病发生、发展的作用。     

影像诊断在颅内动脉瘤中的研究进展

颅内动脉瘤(intracranial aneurysms,ICA)是由于脑血管局部异常改变而产生的血管瘤样突起,世界2%的人口患有颅内动脉瘤。颅内动脉瘤是引起脑卒中的第三大病因,仅次于脑血栓形成和高血压脑出血,脑卒中病死率、致残率极高,总病死率约为40~50%,早期诊断ICA对预防脑卒中意义重大。颅内动脉瘤的早期诊断主要依赖于影像学检查,近年多层螺旋CT、MRI及DSA技术的迅猛发展对颅内动脉瘤的早期诊断有很大帮助,本文就CT以及MRI功能成像在颅内动脉瘤的应用研究进展进行综述。     

Cytomorphology of Metastatic Melanoma—Use of S-100 Protein In the Diagnosis of Amelanotic Melanoma

The cytomorphological features of cells from 52 cases of metastatic melanoma obtained by fine needle aspiration cytodiagnosis were studied. Morphologically, 11, 19 and 22 cases were classified as spindle, epithelial, and mixed cell types of metastatic melanoma respectively. There were 34 melanotic and 18 amelanotic melanomas. Besides melanin, the presence of intranuclear cytoplasmic inclusions, eosinophilic macronucleoli and giant cells were helpful in the diagnosis of a melanoma. Where attempted, staining for S-100 protein was positive in all the 19 cases (eight amelanotic and 11 sparsely pigmented melanomas). In addition eight cases of metastatic tumour where a differential diagnosis of poorly differentiated carcinoma or large cell lymphoma was entertained, were also studied for localization of S-100 protein and all were found to be negative. Electron microscopy was performed in five cases and showed the presence of melanosomes and/or premelanosomes.     

Comparative Histopathology of Grey‐Horse‐Melanoma and Human Malignant Melanoma

Equine melanoma shows striking features particularly with regard to clinical development in grey horses: in contrast to malignant melanoma in humans and in solid coloured horses that are characterized by early onset of metastasis, pigment cell tumours display almost benign clinical features in ageing grey horses. Through evolution, grey horses appear to be in a favourable position in regard to the biological behaviour of melanomas. Yet unknown factors inhibiting or retarding early melanoma metastasis may be responsible for this phenomenon. In this study, immunostaining profiles and histopathologic patterns of equine vs. human melanotic tumours were compared. In addition, the expression of melanoma markers currently used in human melanoma detection and characterization were evaluated for their applicability in equine melanoma diagnosis. Immunohistopathologic investigations revealed that benign grey horse melanomas share common features with human blue nevi and with human malignant desmoplastic melanomas, whereas their resemblance to other types of human cutaneous malignant melanomas is less pronounced. Our data equally underline that S‐100, proliferating cell nuclear antigen (PCNA), HMB‐45, Ki‐67, T‐311 and CD44 can serve as reliable markers for horse melanomas. Further investigations aiming at identifying factors retarding metastasis in affected grey horses are needed, as they may contribute to the development of novel treatment strategies for human malignant melanoma.     

Imaging atoms in medicine

The innovations in science and technology have allowed researchers to look inside the human body. In some cases, like MRI, the protons present in the body generate enough signal for an image. However, the employ of certain atoms, metallic or non-metallic, enable detection through different imaging techniques (computed tomography, nuclear imaging, ultrasound or optical imaging), and improve the quality of the images. Here we discuss the different imaging atoms used depending on the imaging technique and the new possible imaging atoms for medical applications.     

正常大鼠脑CT灌注成像的可重复性研究

目的:评价多层螺旋CT灌注成像对正常大鼠脑血流动力学观测结果的可重复性.方法:分别对10只健康Wistar大鼠间隔2d进行CT灌注扫描,两组原始灌注数据由2名放射科医师分别进行5次后处理得出CBF、CBV和MTT值.分析观察者内和观察者间观测结果的可重复性,以及对同一组研究对象间隔2d两次检查结果的一致性.结果:多层螺旋CT对Wistar大鼠脑所采集的灌注原始数据在观察者内和观察者间观测结果均无统计学差别(P＞0.05),并具有很好的线性(CBF和CBV值)或等级(MTT值)正相关(P＜0.01).对同一组研究对象间隔2d的两次CT灌注成像结果也存在同样好的重复性.结论:多层螺旋CT灌注成像对于Wistar大鼠脑部血流动力学观测具有很高的精密度和准确性,完全适于小型动物模型脑部血流动力学的研究.     

正常大鼠脑血流动力学的CT灌注成像研究

目的:采用多层螺旋CT灌注成像探讨正常大鼠脑血流动力学特征.方法:对15只健康Wistar大鼠进行CT灌注扫描,定量测定全脑不同区域的血流动力学参数,分析正常Wistar大鼠脑血流动力学特征.结果:正常Wistar大鼠脑部不同区域的血流动力学参数存在较大差异(P＜0.05或0.01),Wistar大鼠的CBF和CBV值以小脑最高,其次是基底节区和延髓,大脑皮质的CBF和CBV值较低:而MTT值在Wistar大鼠脑部各区域比较接近,均值比较无统计学意义(P＞0.05).结论:多层螺旋CT可用于定量评价Wistar大鼠脑组织的血液动力学特征,完全适用于小型动物模型脑部血流动力学的研究.     

Proceedings from the Melanoma Research Foundation Mucosal Melanoma Meeting (December 16, 2022, New York,USA)

Mucosal melanoma remains a rare cancer with high mortality and a paucity of therapeutic options. This is due in significant part to its low incidence leading to limited patient access to expert care and downstream clinical/basic science data for research interrogation. Clinical challenges such as delayed and at times inaccurate diagnoses, and lack of consensus tumor staging have added to the suboptimal outcomes for these patients. Clinical trials, while promising, have been difficult to activate and accrue. While individual institutions and investigators have attempted to seek solutions to such problems, international, national, and local partnership may provide the keys to more efficient and innovative paths forward. Furthermore, a mucosal melanoma coalition would provide a potential network for patients and caregivers to seek expert opinion and advice. The Melanoma Research Foundation Mucosal Melanoma Meeting (December 16, 2022, New York, USA) highlighted the current clinical challenges faced by patients, providers, and scientists, identified current and future clinical trial investigations in this rare disease space, and aimed to increase national and international collaboration among the mucosal melanoma community in an effort to improve patient outcomes. The included proceedings highlight the clinical challenges of mucosal melanoma, global clinical trial experience, basic science advances in mucosal melanoma, and future directions, including the creation of shared rare tumor registries and enhanced collaborations.     

Experimental Boron Neutron Capture Therapy for Melanoma: Systemic Delivery of Boron to Melanotic and Amelanotic Melanoma

The boron-containing melanin precursor analogue p-boronophenylalanine (BPA) has previously been shown to selectively deliver boron to pigmented murine melanomas when administered in a single intragastric dose. If boron neutron capture therapy is to become a clinically useful method of radiation therapy for human malignant melanoma, the boron carrier must be capable of delivering useful amounts of boron to remote tumor sites (metastases) and to poorly pigmented melanomas. We have now determined the ability of BPA to accumulate in several nonpigmented melanoma models including human melanoma xenografts in nude mice. The absolute amount of boron in the nonpigmented melanomas was about 50% of that observed in the pigmented counterparts but was still selectively concentrated in the tumor relative to normal tissues in amounts sufficient for effective neutron capture therapy. Single intragastric doses of BPA resulted in selective localization of boron in the amelanotic Greene melanoma carried in the anterior chamber of the rabbit eye and in a pigmented murine melanoma growing in the lungs. The ratio of the boron concentration in these tumors to the boron concentration in the immediately adjacent normal tissue was in the range of 3:1 to 4:1. These distribution studies support the proposal that boron neutron capture therapy may be useful as a regional therapy for malignant melanoma.