Differential study of DCE-MRI parameters in spinal metastatic tumors, brucellar spondylitis and spinal tuberculosis

Objective： In the present study, spinal metastatic tumors, brucellar spondylitis and spinal tuberculosis werequantitatively analyzed using dynamic contrast-enhanced magnetic resonance imaging （DCE-MRI） to assess thevalue of DCE-MRI in the differential diagnosis of these diseases.Methods： Patients with brucellar spondylitis, spinal tuberculosis or a spinal metastatic tumor （30 cases of each）received conventional MRI and DCE-MRI examination. The volume transfer constant （Ktrans）, rate constant （Kep）,extravascular extracellular volume fraction （Ve） and plasma volume fraction （Vp） of the diseased vertebral bodieswere measured on the perfusion parameter map, and the differences in these parameters between the patients werecompared.Results： For pathological vertebrae in cases of spinal metastatic tumor, brucellar spondylitis and spinaltuberculosis, respectively, the Ktrans values （median ＋ quartile pitch） were 0.989±0.014, 0.720±0.011 and0.317±0.005 min-1; the Kep values were 2.898±0.055, 1.327±0.017 and 0.748±0.006 min-1; the Ve values were0.339±0.008, 0.542±0.013 and 0.428±0.018; the Vp values were 0.048±0.008, 0.035±0.004 and 0.028±0.009; thecorresponding H values were 50.25 （for Ktrans）, 52.47 （for Kep）, 48.33 （for Ve） and 46.56 （for Vp）, and all differenceswere statistically significant （two-sided P〈0.05）.Conclusions： The quantitative analysis of DCE-MRI has a certain value in the differential diagnosis of spinalmetastatic tumor, brucellar spondylitis and spinal tuberculosis.

Strategies of surgical treatment of the spinal metastatic tumors

Objective To study the clinical features, surgical treatments and the prognosis of the 103 patients with the metastatic tumors in the spine. Methods From Jan. 1996 to Dec. 2001,103 cases were treated by operation in our department, there were 62 males and 41 females, aging from 33 to 79 years old (average,59 years). The lesions were located at cervical spines in 34 cases, thoracic spines in 39,lumbar spines in 25 and sacrum in 5. The patients underwnet anterior, prosterior,combined or staged antero-posterior operations based on the location of lesions in the spine. Most of the patients were adopted vertebral reconstruction and internal fixation depending on the conditions. Preoperative clinical evaluation included of general conditions,X-ray films,CT scan.MRI and ECT in odrer to decide the endurance of the patient to the surgical treatment. The operation was only considered when the patient could have the expected survival time more than 6 months. Operative indications, surgical methods and prognosis

Metastatic tumor to the iris and ciliary body as an initial sign of lung cancer: a case report

The most common sites of lung cancer metastases are pleura, bone, brain,pericardium and liver. Tumor metastasis to the eye is a rare complication of lung cancer. Metastaticcancer to the ocular region most often involves the uveal tract, however, most uveal metastasesoccur in the posterior uvea, and iris metastases are relatively rare. We describe a patient withadenocarcinoma of the lung metastatic to the iris as the first clinical sign without symptoms oflung cancer.

MRI APPEARANCE OF SPINAL LESIONS: METASTATIC TUMORS OR INFECTIONS?

Three patients with pathologically verified spinal osteomyelitis and another three with metastatic tumors of the spine were investigated. MRI of the spine of four patients show-ed several unusual findings. The preservation of intervertehral discs and endplates did not predict accurately the diagnosis of either infections or tumors. The pepper and salt appearing feature may also occur in a metastatic tumor. Plain radiographs. CT. and radioisotope bone scans were less sensitive than MRI to disclose the lesions. In cases of osteomyelitis, the systemic sources of infections were frequently not found. and the responsible microorganisms could not be identified even from the surgical specimens of two patients. However, mycobacterium tuberculosis was found in the surgical specimen of a patient with cervical spinal lesion whose MRI was indistinguishable from a metastatic tumor. Surgicopathological diagnosis was therefore crucial and mandatory in these in stances.

Analysis of therapeutic efficacy of Aredia in treating pain caused by advanced malignant metastatic bone tumors

Objective To study therapeutic efficacy of Aredia in treating malignant metastatic bone tumors. Method 60～90 mg Aredia was administrated iv in 31 cases with malignant metastatic tumors,once each week. Results Pain in 12 cases was significantly relieved.14 cases acquired relif.Total effective rate was 83.9%.Activity ability was improved by 80.6%.No apparent toxicological and adverse effects as well as fever and cold symptoms were observed.Conclusion Aredia is a kind of ideal drugs for treatment of pain caused by malignant metastatic bone tumors.It is convenient in use and could be endured by patients.

Expression of the Tumor Metastatic Suppressor Gene in Mouse Melanoma Model: Inverse Association to Metastatic Potential

Data obtained in experimental cutaneous melanomas have suggested that the nm23 gene may function as a metastasis suppressor gene. The nm23 level in 8 human cutaneous melanoma cell lines and 2 murine melanoma cell lines were examined. Each melanoma cell line was transplanted subcutaneously into the flank of nude mice, and the metastatic behavior was evaluated by counting lung tumor fool and by determining host survival time. It was found that expression of 'm23 mRNA in human melanomas is correlated closely with reduced metastatic behavior in experimental animals and may serve as a sensitive prognostic indicator of malignancy and survival in patients with melanomas.

The application of ultra-wide-field fundus autofluorescence in early metastatic choroidal tumor screening

I am Dr.Ke Yao,from Eye Center,the Second Affiliated Hospital,School of Medicine,Zhejiang University,Hangzhou,China.I write to present three cases with metastatic choroidal tumor using an ultra-wide-field scanning laser ophthalmoscope.

Prognostic factors and its predictive value in patients with metastatic spinal cancer

BACKGROUND The spine is the most common location of metastatic diseases.Treating a metastatic spinal tumor depends on many factors,including patients’overall health and life expectancy.The present study was conducted to investigate prognostic factors and clinical outcomes in patients with vertebral metastases.AIM To investigate prognostic factors and their predictive value in patients with metastatic spinal cancer.METHODS A retrospective analysis of 109 patients with metastatic spinal cancer was conducted between January 2015 and September 2017.The prognoses and survival were analyzed,and the effects of factors such as clinical features,treatment methods,primary lesions and affected spinal segments on the prognosis of patients with metastatic spinal cancer were discussed.The prognostic value of Frankel spinal cord injury functional classification scale,metastatic spinal cord compression(MSCC),spinal instability neoplastic score(SINS)and the revised Tokuhashi score for prediction of prognosis was explored in patients with metastatic spinal tumors.RESULTS Age,comorbidity of metastasis from elsewhere,treatment methods,the number of spinal tumors,patient’s attitude toward tumors and Karnofsky performance scale score have an effect on the prognosis of patients(all P<0.05).With respect to classification of spinal cord injury,before operation,the proportion of grade B and grade C was higher in the group of patients who died than in the group of patients who survived,and that of grade D and grade E was lower in the group of patients who died than in the group of patients who survived(all P<0.05).At 1 mo after operation,the proportion of grade A,B and C was higher in the group of patients who died than in the group of patients who survived,and that of grade E was lower in patients in the group of patients who died than in the group of patients who survived(all P<0.05).MSCC occurred in four(14.3%)patients in the survival group and 17(21.0%)patients in the death group(P<0.05).All patients suffered from intractable pain,dysfunction in spinal cord and even paralysis.The proportion of SINS score of 1 to 6 points was lower in the death group than in the survival group,and the proportion of SINS score of 7 to 12 points was higher in the death group than in the survival group(all P<0.05).The proportion of revised Tokuhashi score of 0 to 8 points and 9 to 11 points were higher in the death group than in the survival group,and the proportion of revised Tokuhashi score of 12 to 15 points was lower in the death group than in the survival group(all P<0.05).Frankel spinal cord injury functional classification scale,MSCC,SINS and revised Tokuhashi score were important factors influencing the surgical treatment of patients with metastatic spinal cancer(all P<0.05).CONCLUSION Frankel spinal cord injury functional classification scale,MSCC,SINS and revised Tokuhashi score were helpful in predicting the prognosis of patients with metastatic spinal cancer.

Do liver metastases from gastric cancer contraindicate aggressive surgical resection?A 14-year single-center experience

BACKGROUND Advanced gastric cancer(GC)with liver metastasis is often characterized by multiple and bilobular metastases and may also be associated with extrahepatic metastatic lesions.Hence,many physicians consider that radical surgeries are contraindicated for liver metastases from GC(LMGC).According to the 2017 Japanese treatment guideline for GC,a smaller number of liver metastases without unresectable factors may be an indication for liver resection(LR)with curability.The actual 5-year overall survival(OS)rate ranges from 0 to 0.37.AIM To present the institutional indications for LR for LMGC and identify important factors for prognostic outcomes.METHODS In total,30 patients underwent LR for LMGC during a 14-year period,and we evaluated the clinical,surgical,and oncological findings.In all patients,radical surgery with intentional lymphadenectomy was performed for the primary GC.The median follow-up duration after the initial LR was 33.7 mo,and three patients with no recurrence died of causes unrelated to the LMGC.The OS and recurrence-free survival rates after the initial LR were assessed.RESULTS Seventeen patients had metachronous LMGC.The initial LR achieved curability in 29 patients.Perioperative chemotherapy was introduced in 23 patients.The median greatest LMGC dimension was 30 mm,and the median number of LMGC was two.Twenty-two patients had unilobular LMGC.The 5-year OS and recurrence-free survival rates were 0.48 and 0.28,respectively.The median survival duration and recurrence-free duration after the initial LR were 16.8 and 8.6 mo,respectively.Twenty-one patients developed recurrence after the initial LR.Additional surgeries for recurrence were performed in nine patients,and these surgeries clearly prolonged the patients’survival.Pathological serosal invasion was an independent predictor of a poor prognostic outcome after the initial LR.Aggressive LR may be indicated for carefully selected patients with LMGC.CONCLUSION Our results of LR for LMGC seem acceptable.Additional surgeries for recurrence after the initial LR might prolong OS.Pathological serosal invasion is important for poor prognostic outcomes.

Metastatic high-grade neuroendocrine tumor of mandible

Neuroendocrine tumors of the oral cavity and jaws are exceedingly rare.They include paragangliomas,a melanotic neuroectodermal tumor of infants,small cell carcinomas,and Merckel cell carcinomas.Most have been non-functional in nature.Breast,lung,liver,colon,and prostate are the most common reported primary malignancies which can metastasize to the oral cavity.In most cases,oral metastases involve maxilla and mandible rather than soft tissues.The premolar-molar region is the most common localization.The purpose of this article is to describe a rare case of a high grade neuroendocrine tumor of the mandible which metastasized from the cervix.

Differential thymosin β10 expression levels and actin filament organization in tumor cell lines with different metastatic potential

Background To investigate the differential expression levels of thymosin β10 (Tβ10) and the corresponding changes of actin filament organization in human tumor cell lines with different metastatic potential.Methods Four groups of nine human tumor cell lines with different metastatic potential were analyzed for the amount of Tβ10 mRNAs by Northern blot and for their peptide expression levels by immunohistochemistry. The filamentous actin (F-actin) was observed by staining of TRITC-phalloidin to detect changes in actin organization.Results In comparison with non-/weakly metastatic counterparts, Tβ10 was upregulated in highly metastatic human lung cancer, malignant melanoma and breast cancer cell lines. Staining of TRITC-phalloidin revealed less actin bundles, a fuzzy network of shorter filaments and some F-actin aggregates in the highly metastatic tumor cells. Meanwhile, the actin filaments were robust and orderly arranged in the non-/weakly metastatic cancer cell lines.Conclusion Tβ10 levels correlate positively with the metastatic capacity in human tumors currently examined. The increasing metastatic potential of tumor cells is accompanied by a loss of F-actin, poorly arranged actin skeleton organizations and presence of F-actin aggregates. There is a consistent correlation between the elevated Tβ10 expression and the disrupted actin skeleton.

EXPRESSION OF NM23-H1 GENE PRODUCT IN NASOPHARYNGEAL CARCINOMA AND ITS CLINICAL SIGNIFICANCE

Objective: The nm23 gene is one of the tumor metastatic suppressor genes. The expression of nm23H1 has been reported to be inversely associated with metastatic potentiality in a number of human carcinomas, including breast, colorectal, gastric, hepatocellular and gallbladder carcinomas. In this study, the immunohistochemical staining of nm23H1 protein in human nasopharyngeal carcinoma (NPC) was examined, and the relationship between nm23H1 and both metastasis and prognosis of patients with NPC was also investigated. Methods: Routine LSAB immunohistochemistry with the nm23H1 monoclonal murine antibody was employed to study the expression of nm23H1 protein in 95 paraffinembedded specimens of NPC treated at our hospital. The clinical pathologic data and results of followup were also retrieved. Comparisons between patients with and without expression of nm23H1 protein with respect to metastasis, locoregional recurrence and survival were performed using Log rank test. Multivariate prognostic analyses were performed by using Cox's regression model. Results: Nm23H1 negative expressive tumors were associated with a higher incidence of lymphnode metastasis (86.7%) than those of nm23H1 positive (48.6%, P<0.01). Nm23H1 negative expressive tumors were associated with a high incidence of recurrence and distant metastasis after radiotherapy (P<0.05). A significant association was found between expression of nm23H1 and prognosis (P<0.01). The expression of nm23H1 indicated favorable prognosis. Conclusion: It was suggested that nm23 H1 negative expression was significantly associated with lymphnode metastasis, recurrence and distant metastasis. Nm23H1 may have value for predicting the prognosis of NPC.

COMBINED EFFECTS OF METRONOMIC ZOLEDRONATE WITH CORIOLUS VERSICOLOR IN A METASTATIC BREAST TUMOR MOUSE MODEL

Incidence of breast cancer is high in women worldwide and mortality usually results from tumor metastasis.Adjuvant chemotherapeutic,such as zoledronate(ZOL),has been used in metastatic breast cancer mainly for skeletal protection.Our previous studies demonstrated that Coriolus versicolor(CV)aqueous extract exhibited anti-tumor

Left ventricular metastasis from a primary lung carcinoma

The most common tumors associated with cardiac metastases are lung carcinoma and melanoma.Although the cardiac involvement of lung cancer is common （lung cancer usually directly invades into the pericardium and/or left/right atrium）, the primary lung cancer accompanied with metastasis to the left ventricle is extremely rare. In this report, we describe a patient with primary lung carcinoma of the right ventricle accompanied by metastasis to the left ventricle, who simultaneously underwent a right lower lobectomy and a left ventriculotomy.