European vs 2015-World Health Organization clinical molecular and pathological classification of myeloproliferative neoplasms

The BCR/ABL fusion gene or the Ph^1-chromosome in the t(9;22)(q34;q11)exerts a high tyrokinase acticity,which is the cause of chronic myeloid leukemia(CML).The1990 Hannover Bone Marrow Classification separated CML from the myeloproliferative disorders essential thrombocythemia(ET),polycythemia vera(PV)and chronic megakaryocytic granulocytic myeloproliferation(CMGM).The 2006-2008 European Clinical Molecular and Pathological(ECMP)criteria discovered 3variants of thrombocythemia:ET with features of PV(prodromal PV),"true"ET and ET associated with CMGM.The 2008 World Health Organization(WHO)-ECMP and 2014 WHO-CMP classifications defined three phenotypes of JAK2^(V617F)mutated ET:normocellular ET(WHO-ET),hypercelluar ET due to increased erythropoiesis(prodromal PV)and ET with hypercellular megakaryocytic-granulocytic myeloproliferation.The JAK2^(V617F)mutation load in heterozygous WHO-ET is low and associated with normal life expectance.The hetero/homozygous JAK2^(V617F)mutation load in PV and myelofibrosis is related to myeloproliferative neoplasm(MPN)disease burden in terms of symptomaticsplenomegaly,constitutional symptoms,bone marrow hypercellularity and myelofibrosis.JAK2 exon 12mutated MPN presents as idiopathic eryhrocythemia and early stage PV.According to 2014 WHO-CMP criteria JAK2 wild type MPL^(515)mutated ET is the second distinct thrombocythemia featured by clustered giant megakaryocytes with hyperlobulated stag-horn-like nuclei,in a normocellular bone marrow consistent with the diagnosis of"true"ET.JAK2/MPL wild type,calreticulin mutated hypercellular ET appears to be the third distinct thrombocythemia characterized by clustered larged immature dysmorphic megakaryocytes and bulky(bulbous)hyperchromatic nuclei consistent with CMGM or primary megakaryocytic granulocytic myeloproliferation.

PVSG and WHO vs European Clinical,Molecular and Pathological Criteria for prefibrotic myeloproliferative neoplasms

The Polycythemia Vera Study Group(PVSG),World Health Organization(WHO) and European Clinical,Molecular and Pathological(ECMP) classifications agree upon the diagnostic criteria for polycythemia vera(PV) and advanced primary myelofibrosis(MF). Essential thrombocythemia(ET) according to PVSG and 2007/2008 WHO criteria comprises three variants of JAK2V617 F mutated ET when the ECMP criteria are applied. These include normocellular ET,hypercellular ET with features of early PV(prodromal PV),and hypercellular ET due to megakaryocytic,granulocytic myeloprolifera-tion(ET.MGM). Evolution of prodromal PV into overt PV is common. Development of MF is rare in normocellular ET(WHO-ET) but rather common in hypercellular ET.MGM. The JAK2V617 F mutation burden in heterozygous mutated normocellular ET and in heterozygous/homozygous or homozygous mutated PV and ET.MGM is of major prognostic significance. JAK2/MPL wild type ET associated with prefibrotic primary megakaryocytic and granulocytic myeloproliferation(PMGM) is characterized by densely clustered immature dysmorphic megakaryocytes with bulky(bulbous) hyperchromatic nuclei,which are never seen in JAK2V617 F mutated ET,and PV and also not in MPL515 mutated normocellular ET(WHO-ET). JAK2V617 mutation burden,spleen size,LDH,circulating CD34+ cells,and pre-treatment bone marrow histopathology are mandatory to stage the myeloproliferative neoplasms ET,PV,PMGM for proper prognosis assessment and therapeutic implications. MF itself is not a disease because reticulin fibrosis and reticulin/collagen fibrosis are secondary responses of activated polyclonal fibroblasts to cytokines released from the clonal myeloproliferative granulocytic and megakaryocytic progenitor cells in ET.MGM,PV and PMGM.

Epithelioid Angiosarcoma of Bone: A Neoplasm with Potential Pitfalls in Diagnosis

Angiosarcoma of bone is an exceedingly rare primary bone malignancy that can present as an aggressive osteolytic lesion. This subset can radiologically mimic non-vascular neoplasms and impose serious challenges in reaching the correct diagnosis. Meanwhile histological diagnosis can be extremely challenging too, as the pathological features often resemble that of aneurysmal bone cysts. We present an unusual case of a 22-year-old woman who presented with a rapidly growing humeral tumor of 8 months’ duration. The case of intraosseous angiosarcoma presented as a diagnostic dilemma and the relevant radiological and pathologic findings were discussed. We describe the clinical, radiological and pathological features of this unique case, and review the literature concerning Angiosarcoma of bone. Our case highlights the diagnostic difficulties for such very rare tumours and clinico-pathological correlation is of paramount importance to differential diagnosis.

乳腺癌细胞条件培养基对骨髓间充质干细胞生物学行为的影响

目的探讨MCF-7乳腺癌细胞条件培养基对骨髓间充质干细胞(BMSC)增殖、凋亡和迁移的影响及分子机制。方法正常环境下培养的BMSC为对照组,以MCF-7细胞条件培养基培养的BMSC为MCF-7条件培养基组,向MCF-7条件培养基组添加10 nmol/L GSK690693(Akt抑制剂)为Akt抑制剂组,向MCF-7条件培养基组添加10µmol/L Reparixin(CXCR1/2抑制剂)为CXCR1/2抑制剂组。MTT实验检测各组BMSC增殖情况,Annexin V-FITC/PI双标记流式细胞凋亡实验检测各组BMSC凋亡率,Transwell细胞迁移实验检测各组BMSC的迁移能力,酶联免疫吸附试验检测两种细胞培养上清液和MCF-7细胞条件培养基中白细胞介素(IL)-8蛋白含量,Western blot检测各组BMSC的蛋白激酶B(Akt)/磷酸化Akt(p-Akt)和哺乳动物雷帕霉素靶蛋白(mTOR)/磷酸化mTOR(p-mTOR)蛋白表达。结果与对照组相比,MCF-7条件培养基组BMSC的细胞增殖水平、迁移数目以及p-Akt和p-mTOR蛋白相对表达量均增高,细胞凋亡率降低(P<0.05);与MCF-7条件培养基组相比,CXCR1/2抑制剂组和Akt抑制剂组BMSC的细胞增殖水平、迁移数目以及p-Akt和p-mTOR蛋白相对表达量均降低,细胞凋亡率增加(P<0.05);MCF-7细胞条件培养基和MCF-7培养上清液中IL-8蛋白含量均较BMSC培养上清液中IL-8蛋白含量高(P<0.05)。结论MCF-7细胞条件培养基通过激活Akt-mTOR信号通路促进BMSC增殖和迁移,抑制BMSC凋亡,其中IL-8-CXCR1/2轴发挥关键作用。

帕米膦酸二钠对肺癌骨转移性疼痛及骨纤维结构的影响研究

目的观察帕米膦酸二钠对肺癌骨转移性疼痛的及骨纤维结构的影响。方法南阳医学高等专科学校附属中医院2021年1月至2022年12月收治的109例肺癌骨转移患者,所有患者均伴有不同程度的骨痛症状。采用随机数字表法对入组患者进行分组,即常规组(54例)和试验组(55例)。常规组予以内科综合止痛治疗,试验组在常规组的治疗基础上采用帕米膦酸二钠配合治疗,比较两组患者的骨纤维结构改善情况、疼痛介质变化情况、骨痛缓解情况及预后情况。结果治疗前,两组患者的骨纤维结构相关指标差异无统计学意义(P>0.05);治疗后,试验组的骨钙素、Ⅰ型胶原C端肽、Ⅰ型胶原氨基端前肽均低于常规组(P<0.05)。治疗前,两组患者的疼痛介质差异无统计学意义(P>0.05);治疗后,试验组的前列腺素、血清乳酸均低于常规组(P<0.05)。治疗前,两组患者的骨痛程度差异无统计学意义(P>0.05);在不同治疗方案下,试验组治疗1~3个周期后的视觉模拟疼痛量表评分均低于常规组(P<0.05)。在不同治疗方案下,两组不良反应发生率比较,差异无统计学意义(P>0.05);试验组的肺癌患者生存质量测定量表中,身体状况评分,社交/家庭状况评分,情感状况评分及功能状况评分均高于常规组(P<0.05)。结论帕米膦酸二钠能有效改善肺癌骨转移患者的骨纤维结构,可通过下调疼痛介质水平而缓解骨痛症状,用药安全性良好,对改善患者远期生活质量有积极意义。

双荧光标记的人高骨转移肺腺癌细胞株的建立及其转录组学特征分析

背景与目的骨是肺腺癌常见的转移部位,但肺腺癌骨转移的机制尚不明确。目前肺腺癌骨转移机制研究缺乏易于示踪且稳定高骨转移的肺腺癌细胞模型,因此,本研究旨在建立绿色荧光蛋白(green f luorescent protein,GFP)和萤火虫荧光素酶(firefly luciferase,LUC)双标记的人高骨转移肺腺癌细胞株,为肺腺癌骨转移的研究提供新的实验工具。方法人肺腺癌细胞系A549-GFP-LUC经左心室注射至裸鼠体内构建骨转移模型,经连续3次体内驯化,获取人高骨转移肺腺癌细胞株A549-GFP-LUC-BM3;CCK-8(cell counting kit-8)、克隆形成实验比较A549-GFP-LUC-BM3细胞株和亲本细胞的体外增殖能力,划痕实验、Transwell实验以及Western blot比较迁移和侵袭能力;并进一步将A549-GFP-LUC-BM3细胞和亲本细胞行测序转录组学分析。结果成功建立人高骨转移肺腺癌细胞A549-GFP-LUC-BM3,相较于亲本细胞,该细胞骨转移发生率显著提高,且体外增殖、迁移和侵袭能力显著增强。转录组学测序结果显示,相较于亲本细胞,A549-GFP-LUC-BM3细胞中共筛选到差异基因2954个,其中1021个基因上调,1933个基因下调;基因本体(Gene Ontology,GO)功能富集显示差异基因主要定位于细胞外周、质膜以及细胞外基质等细胞组分,分子功能主要富集在信号受体结合、钙离子结合和细胞外基质结构成分等,生物过程富集在细胞黏附和生物黏附等;京都基因与基因组百科全书(Kyoto Encyclopedia of Genes and Genomes,KEGG)富集分析显示差异基因在细胞色素P450(cytochrome P450,CYP)对外源性物质的代谢、视黄醇代谢、细胞黏附分子、CYP对药物代谢、类固醇激素的生物合成以及核因子κB(nuclear factor kappa B,NF-κB)信号通路上显著富集。结论成功建立GFP和LUC双标记的人高骨转移肺腺癌细胞株,该细胞株在生物学行为水平和转录组测序水平均提示具有高骨转移潜能。

免疫细胞在肿瘤骨转移骨微环境调控中的作用研究进展

肿瘤的发生发展与其所在的微环境密切相关,在肿瘤发生骨转移的过程中,骨髓微环境中大量的免疫细胞对于肿瘤细胞的定植以及转移灶的形成,发挥了重要的作用,其中较为显著的就是协助肿瘤细胞发挥免疫逃逸作用。因此如何针对肿瘤的免疫逃逸进行有效干预显得尤为重要。本文就巨噬细胞、骨髓来源的抑制细胞以及淋巴细胞在肿瘤骨转移中的作用进行综述,为肿瘤免疫治疗的基础研究和临床治疗提供参考。

定量测量前列腺周围脂肪组织对预测前列腺癌骨转移的临床价值

目的:建立新发前列腺癌患者骨转移风险列线图预测模型,探讨前列腺周围脂肪组织(PPAT)与前列腺癌骨转移的关系。方法:纳入160例患者(骨转移组、非骨转移组各80例),在MRI图像上定量测量耻骨联合层面腹部皮下脂肪厚度(NFSP)、耻骨联合至椎体前缘的最短直线距离(FNPF)、耻骨联合层面后背部皮下脂肪厚度(BSF)、耻骨联合至前皮下最大距离(PSSF)、耻骨联合至前列腺的最大垂直距离(MDSP)、耻骨联合上缘切线至椎体前缘的距离(PSPF)、前列腺面积(PA)、前列腺周围脂肪面积(PPFA),分析其与前列腺癌骨转移的相关性,筛选特征属性。采用分层随机抽样的方法将160例患者按照7∶3的比例分为训练集和测试集,建立脂肪定量测量回归预测模型,并测试集进行验证。结果:MDSP、PSPF、FNPF、PPFA/PA是前列腺癌骨转移的独立危险因素(均P<0.05)。测试MDSP、PSPF、FNPF、PPFA/PA及包含上述4种特征的联合模型的诊断效能,在训练集AUC分别为0.90、0.78、0.72、0.80、0.92,在测试集AUC为0.87、0.86、0.68、0.79、0.98。结论:基于脂肪定量测量的列线图可很好地预测前列腺癌患者的骨转移风险。

纤维结构不良的致病机制和治疗研究进展

纤维结构不良(FD)是一种由基因突变导致的罕见良性骨肿瘤,主要由鸟嘌呤核苷酸结合蛋白α刺激活性多肽基因突变导致骨骼矿化缺陷、局部破骨细胞增多,从而引起正常骨骼被纤维组织侵蚀。FD可累及各部位骨骼,尚缺乏针对性的分类系统,且难以制订标准术式,目前一般采用髓内钉、椎体切除内固定等手术方式治疗。FD的药物治疗常使用双膦酸盐以缓解骨痛,降低骨折风险。核因子κB受体活化因子配体(RANKL)抑制剂地诺单抗通过抑制FD患者体内RANKL的过量表达阻止病变进展,而生长激素受体拮抗剂培维索孟可降低生长激素水平,故用于伴有内分泌疾病FD患者的治疗。

Long-term survival after gastrectomy and metastasectomy for gastric cancer with synchronous bone metastasis

Bone metastasis is a rare event in patients with gastric cancer, but pathologic fracture, paralysis, pain and hematological disorders associated with the bone metastasis may influence the quality of life. We report herein the case of a 53-year-old man who presented with primary remnant gastric cancer with bone metastasis. The patient requested further investigations after detection of a metastatic lesion in the 2 nd lumbar vertebra during evaluation for back pain that had persisted for 3 mo. No other metastatic lesions were detected. He underwent total gastrectomy and palliative metastasectomy to aid in reduction of symptoms, and he received combination chemotherapy with tegafur(S-1) and cisplatin. The patient survived for about 60 mo after surgery. Currently, there is no treatment guideline for gastric cancer with bone metastasis, and we believe that gastrectomy plus metastasectomy may be an effective therapeutic option for improving qualityof life and survival in patients with resectable primary gastric cancer and bone metastasis.

The evaluation of Tracp5b as a marker for monitoring treatment results of bone metastasis in breast cancer patients

Objective ：To evaluate the sensitivity of serum tartrate-resistant acid phosphatase 5b（Tracp5b） activity in monitoring bisphosphonate treatment results of bone metastasis in breast cancer（BC） patients. Methods：The serum activities of Tracp5b, CEA, CA153 were measured in 58 BC patients, including 26 without bone metastasis, 32 with bone metastasis. The serum activities of TracpSb, CEA, CA153 were also measured in 19 patients with bone metastasis after 3 months of bisphosphonate treatment. Eighteen healthy women with age from 34 to 70 served as control. Results：Serum TracpSb was significantly elevated in patients with bone metastasis compared with that in all any other groups（P〈 0.05）. The sensitivity of TracpSb was 78.13% and the specificity was 86.36%. The sensitivity of CA153 was 37.50% and the specificity was 77.27%. The sensitivity of CEA was 21.88% and the specificity was 84.09%. The serum activity of TracpSb decreased significantly（P 〈 0.05） after 3 months of bisphosphonate treatment, while the levels of CA153 and CEA were unchanged. Conclusion：Serum Tracp5b activity is a useful diagnostic marker for bone metastasis in BC patients and can be used to evaluate the treatment results of bisphosphonate.

^(68)Ga-PSMA PET/CT versus CT and bone scan for investigation of PSA failure post radical prostatectomy

Objective:To evaluate the use of Gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography(^(68)Ga-PSMA PET/CT),compared with conventional CT abdomen/pelvis(CTAP)and whole body single photon emission CT bone scan(BS),for detection of local or distant metastasis following biochemical failure/recurrence in post-prostatectomy patients.Methods:We conducted a review of our prospectively maintained,institutional database to identify 384 patients with post-prostatectomy biochemical failure/recurrence who underwent PSMA PET/CT,CTAP and BS from February 2015 to August 2017 in Nepean Hospital,tertiary referral centre.The results of the three imaging modalities were analysed for their ability to detect local recurrence and distant metastases.PSMA PET/CT and CTAP imaging were separately performed on the same day and the BS was performed within several days(mostly in 24 h).Difference in detection rates was determined between the modalities and the Chi square test was used to determine significance.Results:A total of 384 patients were identified with a median prostate-specific antigen(PSA)of 0.465 ng/mL(interquartile range =0.19-2.00 ng/mL).Overall,PSMA PET/CT was positive for 245(63.8%)patients whereas CTAP and BS were positive in 174 patients(45.3%).A total of 98 patients(25.5%)had local or distant metastasis detected on PSMA only,while 20 patients(5.2%)had recurrences detected on CTAP but not on PSMA PET/CT.Conclusion:The use of PSMA PET/CT has a higher detection rate of predicted local or distant metastasis compared to CTAP and BS in the staging of patients with biochemical recurrences after radical prostatectomy.

Imaging of bone metastasis: An update

Early detection of skeletal metastasis is critical for accurate staging and optimal treatment. This paper briefly reviews our current understanding of the biological mechanisms through which tumours metastasise to bone and describes the available imaging methods to diagnose bone metastasis and monitor response to treatment. Among the various imaging modalities currently available for imaging skeletal metastasis, hybrid techniques whichfuse morphological and functional data are the most sensitive and specific, and positron emission tomography(PET)/computed tomography and PET/magnetic resonance imaging will almost certainly continue to evolve and become increasingly important in this regard.

FEASIBILITY OF WHOLE BODY DIFFUSION WEIGHTED IMAGING IN DETECTING BONE METASTASIS ON 3.0T MR SCANNER

Objective To evaluate the feasibility of whole body diffusion weighted imaging (DWI) in bone metastasis detection using bone scintigraphy as comparison. Methods Forty-five patients with malignancy history were enrolled in our study. All the patients received the whole body DWI and bone scintigraphy scan within 1 week. The magnetic resonance (MR) examination was performed on 3.0T MR scanner using embedded body coil. The images were reviewed separately by two radiologists and two nuclear medicine physicians, who were blinded to the results of the other imaging modality. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the two techniques for detecting bone metastasis were analyzed. Results A total of 181 metastatic lesions in 77 regions of 34 patients were detected by whole body DWI, and 167 metastatic lesions in 76 regions of 31 patients were identified by bone scintigraphy. The patient-based sensitivity and PPV of whole body DWI and bone scintigraphy were similar (89.5% vs. 81.6%, 97.1% vs. 91.2%), whereas, the patient-based specificity and NPV of whole body DWI were obviously higher than those of bone scintigraphy (85.7% vs. 57.1%, 60.0% vs. 36.4%). Ten regions negative in scintigraphy but positive in whole body DWI, mainly located in spine, pelvis, and femur; nine regions only detected by scintigraphy, mainly located in skull, sternum, clavicle, and scapula. The region-based sensitivity and specificity of whole body DWI were slightly higher than those of bone scintigraphy (89.5% vs. 88.4%, 95.6% vs. 87.6%). Conclusion Whole body DWI reveals excellent concordance with bone scintigraphy regarding detection of bone metastasis, and the two techniques are complementary for each other.

The value of bone scintigraphy on the determination of the full extent of tumor involvement in jaw bones

目的将有希望地在在颌骨决定肿瘤参与的最大程度上调查骨头 scintigraphy 的价值并且估计转移的存在。这研究有本地道德的委员会赞同的方法，和所有病人给了写的知情同意。有在颌骨的主要恶性瘤的三十七个连续病人为学习被招募。骨头 scintigraphy 在外科前在所有病人被执行测量多骨的参与的最大程度，它与 histologic 调查结果相比。结果全部身体扫描与多重多骨的转移揭示了一个案例。36 个骨头瘤的切除术标本病理地被分析识别每个肿瘤的类型和尺寸。在骨头 scintigraphy 和病理定义的颌骨的肿瘤参与的长度是 5.62 ± 1.58 厘米， 4.48 ± 1.57 厘米，分别地(P 【 0.05 ) 。从移开的标本的肿瘤 negative 边缘病理地根据骨头 scintigraphy 被证实。与是的 histologic 调查结果参考的标准，骨头 scintigraphy 的精确性在在颌骨决定肿瘤参与的最大程度是 100%(36 个病人中的 36 个) 。当完全清除肿瘤房间并且每当可能时，保存功能时，结论骨头 scintigraphy 趋于在决定骨头切除术的适当程度提供特定的指南并且在建立多骨的转移。

Massive allograft replacement in management of bone tumors

Objective:To evaluate the functional outcome and complications of allograft replacement in management of bone tumors. Methods:Between March 1992 and September 2002,164 patients underwent bone tumor resection and massive allograft reconstruction of bone defects. The length of the resected part ranged from 5-35 cm. The resections were classified as marginal or wide resections of the tumor on the basis of the Musculoskeletal Tumor Society staging system. Fresh-frozen allografts were employed as osteoarticular grafts(n = 95),hemi-condylar(n = 15),massive(n = 23),allograft-prosthesis composite(n = 12),intercalary grafts(n = 15) or hemi-pelvic grafts(n = 4). Most of the lesions were osteosarcoma and giant cell tumor of bone and located in proximal and distal femur,proximal tibia and humerus. Results:At a median follow-up of 47 months(range,12 to 168 months) after the operation,154 of the patients in the study were free of disease and 10 died of disease. Twenty-one(12.8%) patients had local recurrence and 38(23.2%) nonunion. Late complications included 11(6.7%) fractures of the allograft and 18(11.0%) infections of the graft. Instability of the joint in the form of subluxation was noted in 13(7.9%) patients. Ten extremities were amputated due to local recurrence or severe infection. Conclusion:Allografts can be used for reconstruction of bony defects after tumor resection. Allograft has nearly similar shape,strength,osteo-inductivity and osteo-conductivity with host bone. Allograft implantation is a high complication reconstruction method,and the risk of recurrence increases when less surgical margin achieves.

MULTIVARIATE ANALYSIS OF BONE METASTASES IN BREAST CARCINOMA

Objective： To investigate the risk factors of bone metastases in breast carcinoma. Methods： By cross sectional study, the data of 225 breast cancer patients who were inpatients in four hospitals in Hangzhou were analyzed. All patients underwent total body bone scan with single photon emission computed tomography （SPECT） at least once during 1995 to 2000. Results： All patients were followed-up to 294 months after operation, bone metastases were found in 113 cases, suspected bone metastases 3 cases, with a bone metastases rate of 50.9% （113/222）. Multivariate analysis by Cox＇s proportional hazards regression model showed that there were four risk factors of bone metastases in breast cancer： （1） clinical stage, Ⅰ～Ⅳ stages with a hazard ratio of bone metastases of 1.945, 95% confidence interval 1.396～2.710; （2） number of invaded axillary lymph nodes, with a hazard ratio of 1.039, 95% confidence interval 1.0142～1.068; （3） skeletal complications （yes vs. no）, with a hazard ratio of bone metastases of 1.722, 95% confidence interval 1.060～2.796; （4） age at the time of surgery or diagnosis, with a hazard ratio of 2.048, 95% confidence interval 1.123～3.876 for patients of age 40～50 y versus patients bellow 40 y of age and 2.837, 95% confidence interval 1.473～5.465 for patients of age above 50 y versus patients of ages between 40 and 50. Kaplan-Meier curves showed that for patients with more than 5 invasive axillary lymph nodes, compared with those with 1～5, the bone metastasis rates increased significantly （x^2 =6.3319, P=0.012）. Conclusion： The clinical stage, number of metastatic axillary lymph nodes, age at the time of operation and skeletal complications are essential risk factors of bone metastases.

SOLITARY PLASMACYTOMA OF BONE AND EXTRAMEDULLARY PLASMACYTOMA

Among plasma cell disorders, solitary plasmacytoma (solitany-plasmacytoma of bone, SPB and extramedullary plasmacytoma, EMP) is rare as compared with mulitiple myeloma (MM). Furthermore.the relationship between solitary plasmacytoma and MM remains unclear.Between 1960 and 1994, 24 patients with SPB and 20 with EMP were treated. The criteria for diagonosis were: (1) No evidence of other lesions based on clinical and radiologic examinations;(2) Biopsy evidence of a plasma cell neoplasm; (3) Bone marrow biopsy specimen with negative findings (less than 10% plasma cell); (4) No anemia, hypercalcemia or renal involvement. The average follow-up period was 112 months (from 6 to 360 months). Fifty-four percent of patients with SPB and 40% of patients with EMP developed MM, however, there was no significant statistical difference between SPB and EMP (P <0.05).We suggested that solitary plasmacytomas be classified as two types, latent and aggressive. The former was histologically well-differentiated plasmacytomas. The latter was poorly differentiated tumors which easily progress to MM. The treatment of choice is wide excision or thorough curettage, by cryogenic necrosis with liquid nitrogen or cautery of the bony wall with phenol and the cavity filled with bone grafts or cement. All patients with apparently isolated plasmacytoma should he given if the tumor turns out to be poorly differentiated, in order to delay their progression to MM.

Bone marrow metastatic neuroendocrine carcinoma with unknown primary site:A case report and review of the literature

BACKGROUND Metastatic neuroendocrine carcinoma(NEC) of bone marrow is uncommon.Here,we report a case of bone marrow metastatic NEC with an unknown primary site.CASE SUMMARY A 73-year-old Chinese woman was admitted to our hospital because marked chest distress and asthma lasting 1 d on March 18,2018.She was initially diagnosed with pulmonary infection,cardiac insufficiency,thrombocytopenia and severe anemia.Following treatment with antibiotic therapy,diuresis and blood transfusion,the patient’s symptoms greatly improved.After bone marrow examinations,the patient was diagnosed with bone marrow metastatic NEC,bone marrow necrosis(BMN) and secondary myelofibrosis(MF).Further imaging workup did not show the primary tumor,we presumed that the primary site might regress spontaneously or merely be unexplored due to lack of positron emission tomography with gallium peptide.Everolimus(10 mg/d) was added to the treatment and the best supportive and symptomatic therapies were also administered.Unfortunately,the patient’s condition continued to deteriorate and she died on May 15,2018.CONCLUSION Bone marrow invasion of NEC is rare and our patient who suffered from bone marrow metastatic NEC as well as secondary BMN and MF had an extremely poor prognosis.Bone marrow biopsy plays an important role in the diagnosis of solid tumors invading bone marrow.

Practice patterns and outcomes of equivocal bone scans for patients with castration-resistant prostate cancer: Results from SEARCH

Objective:To review follow-up imaging after equivocal bone scans in men with castration resistant prostate cancer(CRPC)and examine the characteristics of equivocal bone scans that are associated with positive follow-up imaging.Methods:We identified 639 men from five Veterans Affairs Hospitals with a technetium-99m bone scan after CRPC diagnosis,of whom 99(15%)had equivocal scans.Men with equivocal scans were segregated into“high-risk”and“low-risk”subcategories based upon wording in the bone scan report.All follow-up imaging(bone scans,computed tomography[CT],magnetic resonance imaging[MRI],and X-rays)in the 3 months after the equivocal scan were reviewed.Variables were compared between patients with a positive vs.negative follow-up imaging after an equivocal bone scan.Results:Of 99 men with an equivocal bone scan,43(43%)received at least one follow-up imaging test,including 32/82(39%)with low-risk scans and 11/17(65%)with high-risk scans(p=0.052).Of follow-up tests,67%were negative,14%were equivocal,and 19%were positive.Among those who underwent follow-up imaging,3/32(9%)low-risk men had metastases vs.5/11(45%)high-risk men(p=0.015).Conclusion:While 19%of all men who received follow-up imaging had positive follow-up imaging,only 9%of those with a low-risk equivocal bone scan had metastases versus 45%of those with high-risk.These preliminary findings,if confirmed in larger studies,suggest follow-up imaging tests for low-risk equivocal scans can be delayed while high-risk equivocal scans should receive follow-up imaging.