骨来源恶性肿瘤临床疗效的评估

目的:通过现有实体瘤临床评估体系,对骨来源恶性肿瘤术前化疗前后的影像学资料进行总结,对比病理学评估结果,进一步提出并完善适合骨来源恶性肿瘤疗效的临床评估体系。方法:回顾性分析自2014年6月至2017年3月就诊于北京大学人民医院的190例连续病例,最后纳入研究157例,通过病理学Huvos分级将病例进行分组,对术前化疗前后的临床资料(肿瘤最大径变化、代谢参数的变化,以及一些公认的描述性参数)进行差异性检验及通过受试者工作曲线(receiver operating characteristic curve,ROC)计算肿瘤各项参数的变化率对术前化疗病理反应的ROC曲线下面积,并判断病理学分级的截点。结果:对原发肢体骨包含软组织包块的病例,判断坏死率为100%、90%及50%的最大径变化率截点分别为86%、50.7%和0.02%,骨扫描的T/B值变化率对坏死率预测效果不好,而PET/CT的SUVmax变化率对应坏死率为90%和50%的截点分别为60.7%和31.4%;而骨性边界变清晰及骨性密度增高为90%以上的病理学特异性表现形式。对不含软组织包块的原发纯骨内病变的病例,尚未发现有意义的临床评估指标。对中轴骨(包括颌面骨、脊柱及骨盆等)的病灶,由于病例数少,临床评估的截点目前区分度不大。结论:本研究对骨来源肿瘤的疗效临床评估提出了更具体的定义和不同病理学分级的界值,该临床评估体系的完善需通过前瞻、多中心、大宗数据进一步验证和讨论。

BMPR2 and HIF1-α overexpression in resected osteosarcoma correlates with distant metastasis and patient survival

Objective： Bone morphogenetic protein receptor 2（BMPR2） and hypoxia-inducible factor 1-α（HIF1-α） existed abnormal expression in several types of cancer. However, their expressions and related roles in osteosarcoma are largely unknown.Methods：To investigate the clinical significance of BMPR2 and HIF1-αin osteosarcoma,we analyzed their expression levels in 103 osteosarcoma specimens by immunochemistry.Meanwhile,we conducted a follow-up to examine the metastatic behavior and overall survival（OS）of osteosarcoma patients.Results：Among 103 tissues,61 cases had BMPR2-positive expression and 57 cases had HIF1-αpositive expression.A significant correlation was noticed between BMPR2 and HIF1-αexpression in osteosarcoma specimens（P=0.035）.Receiver-operating characteristic（ROC）curves were calculated to investigate the predictive value of the two markers in tumor metastasis.By means of univariate and multivariate analysis,BMPR2 and HIF1-αexpression,as well as higher tumor grade,were identified as significant risk factors for OS in patients with osteosarcoma.Kaplan-Meier survival analysis revealed that the patients with BMPR2 and HIF1-αpositive expression had worse OS compared with patients with BMPR2-negative or HIF1-α-negative staining.Conclusions：It can be concluded that BMPR2 and HIF1-αexpression is highly correlated with metastatic behavior in patients with osteosarcoma and can serve as predictive markers for metastasis and OS of these patients.

Clinical implications and prognostic value of five biomarkers in endometrial carcinoma

Objective： The aim was to identify the relationship between ER, PR, P53, Ki-67, PTEN, the association with clinicopathological parameters and the correlation with survival. Methods： We studied 190 cases of primary endornetrial carcinoma in which ER, PR, Ki-67, P53, PTEN antigens were investigated with the use of immunohistochemical methods. To evaluate the correlations among immunohistochemical staining and the age, menopause status, histological type, FIGO stage, grading, depth of invasion, lymph nodes involvement and serum tumor marker. Survival analysis was assessed within single and combined biomarkers types. Results： The percentage of Ki-67 and P53 positive endometrial tumors was signifi- cantly higher in ER negative vs ER positive tumors （both P = 0.000）. The same trend was evident in PR positive and nega- tive group. The percentage of PTEN positive tumors was significantly higher in PR positive versus PR negative tumors （P = 0.021） but was no difference in different ER status. ER and PR status were significant predictors with FIGO staging, grading and recurrence. There was no clear association between PTEN positivity and clinicopathological parameters except more relevance with endometrioid histotype （P = 0.013）. Positive Ki-67 or P53 was found to be strictly related to more aggressive features. There was statistically significant difference in different status of P53 and Ki-67 in survival time. Conclusion： ER and PR positive tumors showed a statistically significant association with better clinical outcome, PR has more significant influ- ence on prognosis. The percentage of positive Ki-67 or P53 was significantly higher in hormone-independent group versus in hormone-dependent group and combined Ki-67 and P53 may have more effect on prognosis in former group.

Characteristics of molecular classification in 52 endometrial cancer and atypical hyperplasia patients receiving fertility-sparing treatment

Objective To investigate the molecular classification of endometrial cancer(EC)and atypical endometrial hyperplasia(AEH)patients treated with fertility-sparing treatment(FST),and its relationship with clinicopathological factors and treatment efficacy.Methods:A total of 52​EC and AEH patients who received FST and molecular classification tested by next generation sequencing in Peking University People's Hospital from June 2020 to December 2022,were retrospectively collected.We analyzed the relationship between molecular classification and clinicopathological factors and treatment outcomes.Results(1)Of the 52 patients,including 46​EC and 6 AEH patients,42(80.8%)achieved complete remission(CR)after FST,with a median time to achieve CR of 9 months.Ten cases(23.8%)had recurrence.(2)Patients were distributed into 4 molecular subgroups as 39 cases(75%)of copy number low(CNL),7 cases(13.5%)of microsatellite instability-high(MSI-H),4 cases(7.7%)of POLE mutations(POLEmut),and 2 cases(3.8%)of copy number high(CNH).Patients with MSI-H subgroup had more family history of tumor(6/7),more with loss of expression of mismatch repair(MMR)protein(7/7),and higher expression level of Ki-67(3/3).(3)Patients with MSI-H subgroup had the lowest CR rate at 6 months(0/7,P​=​0.014),and survival analysis showed that such patients were less likely to achieve CR than those with CNL(P​=​0.022).For CNL patients,median 6-month CR rate was 40.6%.In addition,CR was obtained in 3(3/4)POLEmut patients and 2(2/2)CNH patients,respectively.Conclusions Molecular classification relates with the treatment response in patients with EC and AEH receiving FST.Patients with MSI-H subgroup have poor treatment efficacy,and patients with CNL need to be further divided to predict treatment benefit.There are also a few successful cases in POLEmut and CNH subtgroups,which needs further research.

Neuroendocrine carcinoma of the cervix:A comprehensive clinicopathologic study and literature review

Aims Neuroendocrine carcinoma of the cervix(NECC)is a rare variant of cervical cancer.This study aims to investigate the clinicopathological features and prognosis of NECC.Methods A retrospective analysis was conducted on twenty-one patients diagnosed with NECC between May 2008 and September 2021at Peking University People's Hospital.The study involved histopathological examination,immunohistochemistry,ThinPrep cytology test(TCT),and high-risk HPV hybrid capture 2(HC2)assay.Follow-up was conducted through telephone interviews and medical records for a range of 3–160 months,with an average follow-up period of 49.8 months.Results The average age of the patients was 48.6 years(range:33–69 years).Seventeen patients were diagnosed with neuroendocrine carcinoma through biopsy.Nine cases underwent TCT and HC2 tests before biopsy,and TCT results of four cases showed high-grade squamous intraepithelial lesion(HSIL).High-risk HPV(HR-HPV)positive was detected in seven cases.The cancer cells exhibited consistent morphological features,including sparse cytoplasm,intensely stained nuclei,and extensive neoplastic necrosis.Thirteen cases were classified as pure NECC(61.9%),while eight cases were mixed types(38.1%).Three cases were associated with squamous cell carcinoma(SCC),and five cases were associated with adenocarcinoma.Prognosis varied significantly among these subtypes(p<0.05).The overall survival rate in the follow-up period was 66.7%(12/18).Conclusions NECC is an extremely rare and highly aggressive tumor with a poor prognosis,particularly in cases of mixed histology.It is strongly associated with HPV infection.TCT and HPV testing significantly enhance the detection rate before the biopsy.The diagnosis of NECC relies on histological and immunohistochemical examinations.This study provides valuable clinical observations on NECC and emphasizes the importance of early detection and accurate diagnosis for improved patient outcomes.

中国子宫内膜增生管理指南

子宫内膜增生多见于育龄期妇女,常见症状为异常子宫出血。本文汇总、整理子宫内膜增生相关研究,总结子宫内膜增生的高危因素、临床表现、评估和诊断、病理分型、治疗、随访以及患者长期管理、宣教等方面的循证医学证据,建立本指南,旨在为临床医师提供规范方案,促进女性健康和生育功能保护。

子宫内膜息肉临床诊疗路径

子宫内膜息肉是常见的子宫内膜良性病变之一,可发生于青春期后的任何年龄,患病率随年龄增加而增高,其常见症状为异常子宫出血、不孕,或无明显症状。本临床诊疗路径以循证医学证据为基础,以临床规范诊疗为目的,建立从子宫内膜息肉高危因素的识别、临床诊断、病理分型到治疗再到患者的长期管理、宣教的诊疗流程路径,给予临床医师共识性的指导建议,旨在为广大妇产科医师提供子宫内膜息肉临床诊疗的可行性和规范性流程。

Biliary candidiasis mimicking IgG4-related disease in a patient with normal immunity

Purpose:To report a rare case of biliary candidiasis in a host with normal immunity.Methods:Laboratory tests indicated an elevated G level of 1000 pg/ml.Microscopic examination of pathological sections demonstrated multiple,narrow base,budding yeast cells following Grocott's methenamine silver staining and periodic acid-Schiff staining.Subsequent sequence analysis supported the diagnosis of biliary candidiasis.Results:A 31-year-old previously healthy man developed obstructive jaundice under no obvious inducement.He experienced cholecystectomy and biliary drainage.Surgical specimens revealed granulomatous chronic inflammation in the gallbladder,liver,bile ducts and mesenteric lymph nodes.He was misdiagnosed with tuberculosis and received antituberculosis treatment.However,his condition did not improve.He was finally diagnosed with biliary candidiasis and administered the antifungal treatment with fluconazole.His symptoms improved after such treatment.Conclusions:We reported a case of biliary candidiasis that mimicked IgG4-RD in a host with normal immunity.Our findings highlighted the need for pathological diagnosis in patients with symptoms resembling IgG4-RD.