Undifferentiated liver embryonal sarcoma in adults: A report of four cases and literature review

AIM: To evaluate the undifferentiated embryonal sarcoma of liver (UESL) in adults in order to improve its diagnosis and treatment. METHODS: Four primary and one recurrent cases of UESL were clinicopathologically evaluated and immunohistochemically investigated with a panel of antibodies using the EnVision+ system. Relevant literature about UESL in adults was reviewed. RESULTS: Three males and one female were enrolled in this study. Their chief complaints were abdominal pain, weight loss, or fever. Laboratory tests, imaging and pathological features of UESL in adults were similar to those in children. Immunohistochemistry showed evidence of widely divergent differentiation into mesenchymal and epithelial phenotypes. The survival time of patients who underwent complete tumor resection followed by adjuvant transcatheter arterial chemoembolization (TACE) was significantly longer than that of those who underwent surgical treatment alone.CONCLUSION: UESL in adults may undergo pluripotential differentiation and its diagnosis should be made based on its morphological and immunohistochemical features. Complete tumor resection after adjuvant TACE may improve the survival time of such patients.

Undifferentiated embryonal sarcoma of the liver:Clinical characteristics and outcomes

BACKGROUND Undifferentiated embryonal sarcoma of the liver(UESL)is a rare liver malignancy originating from primary mesenchymal tissue.The clinical manifestations,laboratory tests,and imaging examinations of the disease lack specificity and the preoperative misdiagnosis rate is high.The overall prognosis is poor and survival rate is low.AIM To investigate the diagnosis,treatment,and prognosis of UESL.METHODS We performed a retrospective,single-center cohort study in Shengjing Hospital of China Medical University,which is a central hospital in northeast China.From 2005 to 2017,we recruited 14 patients with pathologically confirmed UESL.We analyzed the clinical manifestations,laboratory tests,imaging examinations,pathological examinations,therapy,and prognosis of these patients.RESULTS There were nine males and five females aged 2-60 years old included in the study.The major initial symptoms were abdominal pain(71.43%)and fever(57.14%).Preoperative laboratory tests revealed that seven patients had increased leukocyte levels,four showed a decrease in hemoglobin levels,seven patients had increased glutamyl transpeptidase levels,nine had increased lactate dehydrogenase levels,and three showed an increase in carbohydrate antigen 199.There was no difference in the rate of misdiagnosis in preoperative imaging examinations of UESL between adults and children(6/6 vs 5/8,P=0.091).The survival rate after complete resection was 6/10,while that after incomplete resection was 0/4(P=0.040),suggesting that complete resection is important to improve survival rate.In total,five out of the eight children achieved survival.During the follow-up,the maximum survival time was shown to be 11 years and minimum survival time was 6 mo.Six adult patients relapsed late after surgery and all of them died.CONCLUSION Preoperative imaging examination for UESL has a high misdiagnosis rate.Multidisciplinary collaboration can improve the diagnostic accuracy of UESL.Complete surgical resection is the first choice for treatment of UESL.

Neoadjuvant transcatheter arterial chemoembolization and systemic chemotherapy for the treatment of undifferentiated embryonal sarcoma of the liver in children

BACKGROUND Undifferentiated embryonal sarcoma of the liver(UESL)is a rare and aggressive mesenchymal tumor in children.Herein,we describe our experience in neoadjuvant therapy(NAT)and subsequent surgery for the treatment of UESL in children.AIM To evaluate the efficacy of NAT and explore a new choice for successful operation of UESL in children.METHODS We retrospectively analyzed six patients newly diagnosed with unresectable UESL who received NAT and then surgery at our center between January 2004 and December 2019.The tumor was considered unresectable if it involved a large part of both lobes of the liver or had invaded the main hepatic vessels or inferior vena cava.The NAT included preoperative transcatheter arterial chemoembol ization(TACE)and systemic chemotherapy.The patients were 4 boys and 2 girls with a mean age of 7 years.The longest tumor at presentation ranged from 8.6 to 14.8 cm(mean,12 cm).Extrahepatic metastases were present in 2 cases.Preoperative systemic chemotherapy was administered 3 wk after TACE.Tumor resection was performed 3 wk after one or two cycles of NAT.The patients received systemic chemotherapy after surgery.RESULTS All patients successfully underwent NAT and complete resection.The tumor volumes decreased by 18.2%–68.7%,with a mean decrease of 36%after 1 cycle of NAT(t=3.524,P=0.017).According to the Response Evaluation Criteria In Solid Tumors criteria,4 patients had a partial response and underwent surgery,while 2 had stable disease and received another cycle of NAT before surgery.Massive tumor necrosis was seen on pathological examination of the surgical specimen:>90%necrosis in two,>50%necrosis in three,and 25%necrosis in 1,with an average of 71.8%.Post-NAT complications included fever,nausea and vomiting,and mild bone marrow suppression.Elevated alanine transaminase levels occurred in all patients,which returned to normal within 7–10 d after treatment.No cardiac or renal toxicity,severe hepatic dysfunction,bleeding and nontarget embolization were observed in the patients.The median follow-up period was 8 years with an overall survival of 100%.CONCLUSION NAT effectively reduced tumor volume,cleared the tumor margin,and caused massive tumor necrosis.This may be a promising choice for successful surgery of UESL in children.

Recurrent undifferentiated embryonal sarcoma of the liver in adult patient treated by pembrolizumab: A case report

BACKGROUND Undifferentiated embryonal sarcoma of the liver(UESL)is a neoplasm that rarely develops in adults.The main treatments for UESL are upfront gross total surgical resection and adjuvant multiagent chemotherapy.Here,we report a case of recurrent UESL in an adult treated with pembrolizumab and discuss a method to identify proper candidates for antibody of programmed cell death protein 1(anti-PD-1)treatment.CASE SUMMARY A 69-year-old woman was admitted for abdominal pain that developed for 1 wk.Computed tomography showed a 16 cm mass in the right lobe of the liver.Right hemihepatectomy and lymphadenectomy were performed,and histological diagnosis was UESL.Six months later,the patient suffered from painless obstructive jaundice,and positron emission tomography-computed tomography revealed multiple metastases.Then,percutaneous transhepatic cholangial drainage was applied to reduce jaundice,and radiofrequency ablation was used to control the lesion near the hepatic hilum.However,the patient suffered from a serious fever caused by the tumor.The patient received treatment with pembrolizumab,and the prescribed dosage was 2 mg/kg every 3 wk.After the seventh dose,positron emission tomography-computed tomography revealed that the multiple metastases had nearly disappeared.Radiologic exam was used to evaluate the disease state,and no new lesions were found.Next-generation sequencing and immunohistology were applied to determine the reason why the patient had such a favorable response to pembrolizumab.Tumor mutation burden,microsatellite instability,and programmed death ligand 1 expression can be combined to predict the effect of PD-1 antibodies. When every one of thesebiomarkers are detected in a tumor patient, the patient may be a proper candidatefor PD-1 antibodies.CONCLUSION Anti-PD-1 treatment for tumors needs further research to identify indications andproper biomarkers.

Undifferentiated embryonal sarcoma of the liver presenting as a hemorrhagic cystic tumor in an adult

BACKGROUND:Undifferentiated embryonal sarcoma (UES) of the liver is a rare,highly malignant neoplasm with a poor prognosis occurring almost exclusively in late childhood (6-10 years of age).Only a few cases have been reported in adults accounting for less than 1% of all primary liver neoplasms.METHODS:A 47-year-old woman presented with a palpable mass in the left upper abdomen.Magnetic resonance imaging revealed a 12×10 cm cystic mass with hemorrhage in the left lateral segment of the liver.The initial impression was a hemorrhagic cystic tumor of the liver.The patient underwent a left lateral sectionectomy of the liver.Histopathology and immunohistochemistry helped make a diagnosis of UES.RESULTS:The patient recovered uneventfully and received systemic chemotherapy.Radiologic examination for follow-up revealed a metastatic lesion in the lumbar spine (L5).She was subjected to radiotherapy at the lumbar spine.She survived 48 months.CONCLUSION:Although hepatic cyst as UES of the liver is difficult to diagnose because of its rarity in adults and lack of specific findings,it should be considered in a differential diagnosis.

Primary Embryonal Lung Carcinoma and Testicular Seminoma in the Same Patient Ten-Years Later: Case-Report and Literature Review

Primary germ cell tumors of lung are extremely rare. The prognosis is usually poor, with various symptoms seriously affecting quality of life. In this paper we describe the unique case of a patient affected by an embryonal carcinoma of lung and a testicular seminoma after ten years. We also report literature about pulmonary extragonadal germ cell tumors.

Our Experience with Embryonal Rhabdomyosarcoma Presenting as Aural Polyp

Aural polyps are a common clinical entity encountered by otorhinolaryngologist in daily practice. Polyps are frequently seen in paediatric patients, usually inflammatory in nature. In children rhabdomyosarcomas (RMS) can mimic all the cinical features of chronic suppurative otitis media which usually present as external auditory canal mass or polyp. Here we present a case where a male child presented with recurrence of polyp in left ear which was finally diagnosed as embryonal rhabdomyosarcoma which is a rare and invariably fatal disease in children. Through this article we intend to highlight the failures and delay committed in attaining diagnosis in this patient in spite of multispecialty evaluation involving repeated imaging and histopathological correlation. Our experience with embryonal rhabdomyosarcoma throws light on the high vigilance required in handling the aural polyps in pediatric population as early diagnosis and treatment are the key elements for successful outcomes.

Undifferentiated embryonal sarcoma of liver in an old female:Case report and review of the literature

The clinical characteristics of undifferentiated(embryonal) sarcoma of the liver(UESL) were investigated and the best treatment modalities were recommended.Both histology and immuno-histochemistry demonstrated the cellular features of this peculiar tumor.The tumor size was 12 cm × 9 cm × 8 cm in the right liver lobe.The patient underwent surgical resection of the tumor.The postoperative recovery was uneventful and she died eight months after diagnosis.The tumor showed mixed spindle and polygonal cells within the myxoid matrix.Some tumor cells contained eosinophilic hyaline globules that were positive for resistant diastase.Immunohistochemistry showed positive vimentin.Stellate and spindle cells were positively stained with alpha-1-antichymotrypsin(AACT) and CD68.This case indicates that UESL is not obviously differentiated in old-aged adults.

胎儿的心脏的间充质的干细胞表示 embryonal 标记并且展出区别进所有三细菌层的房间

AIM:To study the expression of embryonal markers by fetal cardiac mesenchymal stem cells(fC-MSC)and their differentiation into cells of all the germ layers. METHODS:Ten independent cultures of rat fCMSC were set up from cells derived from individual or pooled fetal hearts and studies given below were carried out at passages 3,6,15 and 21.The phenotypic markers CD29,CD31,CD34,CD45,CD73,CD90, CD105,CD166 and HLA-DR were analyzed by flow cytometry.The expression of embryonal markers Oct-4, Nanog,Sox-2,SSEA-1,SSEA-3,SSEA-4,TRA-1-60 and TRA 1-81 were studied by immunocytochemistry.The fC-MSC treated with specific induction medium were evaluated for their differentiation into(1)adipocytes and osteocytes(mesodermal cells)by Oil Red O and Alizarin Red staining,respectively,as well as by expression of lipoprotein lipase,PPARγ2 genes in adipocytes and osteopontin and RUNX2 genes in osteocytes by reverse-transcription polymerase chain reaction(RT- PCR);(2)neuronal(ectodermal)cells by expression of neuronal Filament-160 and Glial Fibrillar Acidic Protein by RT-PCR and immunocytochemistry;and(3)hepa- tocytic(endodermal)cells by expression of albumin by RT-PCR and immunocytochemistry,glycogen deposits by Periodic Acid Schiff staining and excretion of urea into the culture supernatant. RESULTS:The fC-MSC expressed CD29,CD73,CD90, CD105,CD166 but lacked expression of CD31,CD34, CD45 and HLA-DR.They expressed embryonal markers,viz.Oct-4,Nanog,Sox-2,SSEA-1,SSEA-3,SSEA-4, TRA-1-81 but not TRA-1-60.On treatment with specific induction media,they differentiated into adipocytes and osteocytes,neuronal cells and hepatocytic cells. CONCLUSION:Our results together suggest that fCMSC are primitive stem cell types with a high degree of plasticity and,in addition to their suitability for cardiovascular regenerative therapy,they may have a wide spectrum of therapeutic applications in regenerative medicine.

Real case of primitive embryonal duodenal carcinoma in a young man

We report here the case of a young man suffering from a rare germ cell tumour. The patient was a 25-yearold man who was referred to our centre for asthenia, stinging epigastric pain, and an iron deficiency anaemia. Gastroscopy revealed a circumferential vegetating lesion on the second portion of the duodenum. The lesion was indurated at the third portion of the duodenum, responsible for a tight stenosis. A computerized tomography-scan of the chest, abdomen and pelvis, and a pancreatic MRI showed a circumferential lesion with a bi-ductal dilatation(i.e., of the common bile duct and Wirsung's duct) without metastatic localisation. The patient underwent a pancreaticoduodenectomy with lymph node dissection including all cellular adipose tissues of the hepatic pedicle from the hepatic common artery and of the retroportal lamina. Histological findings were suggestive of a duodenal embryonal carcinoma with pancreatic infiltration. This is the second published case highlighting the duodenal primitive localisation of an embryonal carcinoma with pancreatic infiltration.

A case of prostate embryonal rhabdomyosarcoma in an adult patient

Prostate embryonal rhabdomyosarcoma(ERMS) is characterized by a high degree of malignancy, both local rapid growth with formation of large pelvic masses, often leading to renal failure due to urethra obstruction, and systemic spread, commonly to the lungs, liver, and bone. ERMS of the prostate is a commonly occurring tumor in infants and children. It is rarely seen in adults. Here, we report on a case of the prostate ERMS in a 27-year-old man.

Overview of embryonal rhabdomyosarcoma of cervix in women over 40-year-old

The literature on cervical embryonal rhabdomyosarcoma(RMS) is reviewed here to identify management guidelines for middle-aged women diagnosed with this rare type of gynecologic cancer. Specifically, the Pub Med, Web of Science and Google Scholar databases, were searched to find published case series on cervical embryonal RMS reporting on four or more patients, of whom at least one was > 40-year-old. The χ2 test was used to assess heterogeneity. Five articles published between 1986 and 2013 were identified, reporting on a total of 47 patients, of whom 22(46.8%) were older and 25(53.2%) younger than 40-year-old. Although the two age groups did not differ significantly by stage of disease or radiotherapy treatment, the older age groupreceived less chemotherapy(55% vs 90%, P = 0.008)and had more hysterectomy(86% vs 43%, P = 0.009).Follow-up data was missing for 18/47(38.3%) patients.Among the 29 patients with follow-up data, survival was shorter in the older group, with 8/12(67%) alive and3 with disease at a median follow-up of 2.6 years, as compared with the younger group that had 15/17(88%)alive and none with disease at a median follow-up of 3.5years. The longest survivals among the older women were observed in those who received radiotherapy,including one case with a resected lung metastasis.A prospective multi-institutional collaboration and better follow-up are needed to determine the optimal management of cervical embryonal RMS. Long-term survival appears feasible if management is accompanied by chemotherapy and radiotherapy.

Roles of the Nanog protein in murine F9 embryonal carcinoma cells and their endoderm-differentiated counterparts

Nanog 是支撑胚胎的茎(ES ) 的 pluripotency 的一个最近发现的 homeodomain 抄写因素房间和块他们的区别进内胚叶。鼠科的 F9 embryonal 癌房间线是为内胚叶房间系区别的一个记录得好的模型系统。这里，我们在 F9 房间内胚叶区别检验了 Nanog 的功能。Nanog 的在表示上把 F9 房间还给 ES 房间的早地位并且镇压在 F9 房间的原始内胚叶和顶骨内胚叶的区别，而它没在内脏的内胚叶的区别上有效果。相反， C 终端截断域的 Nanog 的表示自发地在 F9 房间支持内胚叶区别。这些数据建议 Nanog 被要求支撑 F9 房间，和 Nanog transduces 的 C 终端域的合适的无差别的地位在镇压的大多数效果在 F9 房间的原始内胚叶和顶骨内胚叶区别。

脂滴功能及其与卵母细胞成熟和胚胎发育的关系研究进展

脂滴不仅是真核细胞内贮存甘油三酯和胆固醇酯等中性脂质的重要细胞器,也是细胞代谢和细胞器质量控制的中心调控者,参与细胞能量代谢、类固醇激素合成、内质网应激、线粒体功能以及生物膜结构形成等过程的调控。目前认为脂滴合成于内质网,并以出芽的方式进入细胞质。脂滴是呈动态分布的细胞器,其数量、大小以及分布受细胞获得营养物质和代谢状态影响。众所周知,哺乳动物卵母细胞含有脂滴,且卵母细胞中含有足够数量的脂滴与卵母细胞成熟和早期胚胎发育密切相关。更重要的是,最近的研究表明,脂滴在胚胎附植着床过程中发挥了至关重要的作用,即使卵母细胞中脂滴含量较低的哺乳动物,维持适量的脂滴对早期胚胎发育也很重要。因此,本文综述了脂滴的合成与分布,分析了脂滴的主要功能,重点阐述脂滴在动物卵母细胞成熟和早期胚胎发育期间的关键作用,并讨论脂滴卵母细胞和胚胎内脂滴含量与胚胎滞育持续时间的关系,以期为通过调控脂滴代谢而增强卵母细胞质量和胚胎发育能力,进而提高动物繁殖性能提供理论基础。

异丙隆原药对大鼠的致畸作用

目的:研究异丙隆原药对大鼠的致畸作用。方法:将受孕的雌性Wistar大鼠随机分为对照组(花生油)和低(36.9 mg/kg)、中(73.8 mg/kg)、高(369.0 mg/kg)3个异丙隆原药染毒剂量组,每组15只孕鼠。对照组和各染毒组于大鼠妊娠第6~15天灌胃给予受试物,每天1次,连续10 d。于妊娠第20天处死各组孕鼠,观察母鼠和胎鼠的生长、发育情况。结果:与对照组比较,低、中剂量组孕鼠各项观察指标差异均无统计学意义(P>0.05)。高剂量组孕鼠于受孕第9天出现萎靡不振、背毛蓬松、体质量下降(P<0.01);着床数、活胎数减少,死胎数增多,窝均体质量降低(P<0.5);部分胎鼠出现囟门大、枕骨及胸骨骨化不全、肋骨弯曲,骨骼畸形率为27.78%,与对照组相比,差异均具有统计学意义(P<0.05)。结论:在本实验条件下,369.0 mg/kg组异丙隆原药可引起Wistar大鼠的母体毒性和胚胎发育毒性。

形态动力学联合减数分裂纺锤体观测在卵裂期胚胎筛选中的应用

目的利用胚胎形态动力学联合卵母细胞减数分裂纺锤体(MS)观测,探索预测胚胎发育潜能的卵裂期胚胎筛选方法。方法回顾性分析2020年8月至2022年6月在苏州市立医院生殖与遗传中心行卵胞浆内单精子注射(ICSI),同时行卵母细胞MS观测和胚胎实时观测培养的46个周期患者的临床资料。根据卵母细胞MS形态、胚胎是否存在异常分裂方式,以及胚胎形态学差异对卵母细胞及卵裂期胚胎进行分类研究,分析胚胎形态动力学参数及MS形态预测胚胎发育潜能的价值,建立预测囊胚形成的早期胚胎分层筛选模型,并利用受试者工作特征(ROC)曲线探讨该模型的预测价值。结果MS正常组的囊胚形成率显著高于MS异常组(63.6%vs.46.9%,P<0.05);直接分裂(DC)1组的囊胚形成率显著低于DC2组和无DC组(5.0%vs.46.7%、63.9%,P<0.05);D3形态学优质胚胎的囊胚形成率显著高于D3形态学非优质胚胎(79.4%vs.24.6%,P<0.05)。采用多元Logistic回归分析发现,在D3形态学优质胚胎中,3细胞到5细胞的发育时间(cc3)、5细胞到8细胞的发育时间(s3)和MS形态对囊胚形成有预测价值(P<0.05);在D3形态学非优质胚胎中,卵裂球数目对囊胚形成有预测价值(P<0.05)。以此建立了D3胚胎分层筛选模型,共11级(A~K级),A级最优,K级最劣。该筛选模型对囊胚形成的ROC曲线显示,曲线下面积为0.857[95%CI(0.816,0.899),P=0.000]。结论采用胚胎形态动力学参数联合MS形态分析建立的D3胚胎分层筛选模型,对胚胎发育潜能具有较好的预测能力。

儿童肝脏未分化胚胎性肉瘤的影像表现及病理分析

目的:分析儿童肝脏未分化胚胎性肉瘤(undifferentiated embryonal sarcoma of the liver,UESL)的超声、CT及MRI影像学表现,以提高对该病的认识水平。方法:回顾性收集2009年12月至2021年12月首都儿科研究所附属儿童医院经手术及病理证实的11例儿童UESL,分析所有患儿的超声、CT及MRI影像表现,总结其影像学特点。结果:病灶均为单发,肿块最大径11.5~19.8 cm。CT平扫显示所有病灶边缘较清楚、其内呈不均匀低密度,内可见厚薄不均的分隔;囊性密度区边缘或分隔周围可见少许片絮样软组织密度影。6例超声图像均提示实性占位,表现为混合回声的实性包块内可见大小不等的无回声区。3例MRI表现为边界清楚肿块影,T1WI呈不均匀混杂低信号,病灶内可见高信号区;T2WI呈混合高信号区和条状低信号区。9例病灶增强扫描动脉期均以边缘强化为主,8例可见迂曲增粗血管影;延迟期病灶呈持续不均匀强化,边缘持续强化,且从外围向中心充盈,强化范围增大,8例延迟期可见假包膜。结论:儿童UESL影像学表现有一定特征性,了解其影像特点并结合临床特征,有助于早期诊断。

红鲫胚胎发育过程中Sox8基因对壬基酚胁迫的响应

【目的】明确红鲫SRY相关高迁移率族盒蛋白8基因(Sox8)表达模式及壬基酚(NP)暴露对红鲫胚胎发育过程中Sox8基因表达的影响,为揭示NP胁迫下红鲫胚胎发育畸形的分子机制提供科学依据。【方法】运用RACE克隆红鲫Sox8基因cDNA全长序列,通过ProtParam、ProtScale、InterPro、PredictProtein、DeepTMHMM等在线软件进行生物信息学分析,利用实时荧光定量PCR检测红鲫Sox8基因在各成体组织及不同胚胎发育阶段的表达情况,以及不同浓度NP暴露对红鲫胚胎期Sox8基因表达的影响。【结果】红鲫Sox8基因c DNA序列全长2163 bp,其开放阅读框(ORF)1176bp,共编码391个氨基酸残基;红鲫SOX8蛋白相对分子量为43798.30Da,理论等电点(pI)为6.90,脂溶指数为49.92,不稳定指数为66.04,总平均亲水性指数(GRAVY)为-1.026,其N端含有Sox_N二聚化结构域和HMG-box结构域;基于SOX8氨基酸序列相似性构建的系统发育进化树显示红鲫与鲫的亲缘关系最近。红鲫Sox8基因在各成体组织中广泛表达,以脑组织中的Sox8基因相对表达量最高,显著高于其他组织(P<0.05,下同);在红鲫胚胎发育过程中,Sox8基因的表达从受精后到14体节期呈逐渐下降趋势,但从21体节期开始Sox8基因相对表达量显著增高,直到孵化期始终维持在较高水平。在大多数情况下,NP暴露能显著影响红鲫胚胎发育过程中Sox8基因的表达,特别是14体节期后的发育阶段,NP暴露主要是不同程度地激活Sox8基因表达。【结论】Sox8基因表达在红鲫成体中具有组织特异性,且在胚胎发育过程中呈先降低后升高的变化趋势。NP暴露能显著影响红鲫胚胎发育过程中Sox8基因的表达,14体节期后Sox8基因表达水平升高可能是NP致畸红鲫胚胎的重要原因之一。

术前血清CEA、CA153、CA724及CA199水平与直肠癌临床分期及预后的关系

目的探讨术前血清癌胚抗原(CEA)、糖类抗原153(CA153)、糖类抗原724(CA724)及糖类抗原199(CA199)水平与直肠癌临床分期及预后的关系。方法随机选取196例直肠癌患者为研究对象,比较不同分期及不同预后患者术前血清CEA、CA153、CA724和CA199水平。采用多因素Logistic回归分析直肠癌患者预后不良的影响因素;采用受试者工作特征(ROC)曲线分析术前血清CEA、CA153、CA724及CA199水平对直肠癌患者预后的预测价值。结果Ⅰ~Ⅳ期直肠癌患者术前血清CEA、CA153、CA724及CA199水平差异具有统计学意义(P<0.05),且随着分期的增加呈现上升趋势。预后不良组和预后良好组在淋巴结转移、分化程度、浸润深度及肿瘤直径方面比较差异具有统计学意义(P<0.05);与预后良好组比较,预后不良组术前血清CEA、CA153、CA724及CA199水平均明显较高(P<0.05);多因素Logistic回归分析结果显示,直肠癌患者血清CEA、CA153、CA724、CA199、淋巴结转移、低分化程度、浸润深度(T3~T4)为预后不良的独立危险因素(P<0.05)。ROC结果显示,血清CEA、CA153、CA724及CA199水平单独预测直肠癌患者预后的AUC分别为0.825、0.803、0.793、0.766,灵敏度分别为73.08%、67.31%、69.23%、71.15%,特异度分别为85.61%、84.89%、86.33%、87.05%;血清CEA、CA153、CA724及CA199水平联合预测直肠癌患者预后的AUC为0.883(95%CI:0.828~0.925),显著大于血清CEA单独预测的AUC(Z=2.134,P=0.033)、CA153单独预测的AUC(Z=2.167,P=0.030)、CA724单独预测的AUC(Z=2.288,P=0.022)和CA199单独预测的AUC(Z=2.801,P=0.005)。结论直肠癌患者术前血清CEA、CA153、CA724和CA199水平与临床分期和预后有关,且四者联合检测对患者预后具有较高的预测价值。

中枢神经系统多层菊花团的胚胎性肿瘤诊疗研究进展

近年随着脑肿瘤分子生物学的发展,具有不同组织形态的富含神经毡和真菊形团的胚胎性肿瘤、髓上皮瘤及室管膜母细胞瘤归属于同一分子实体,统称为多层菊花团的胚胎性肿瘤(embryonal tumor with multilayered rosettes,ETMR)。这些肿瘤的罕见性和更新给诊断和治疗带来了挑战。文章主要对ETMR的临床表现、影像特点、诊断及临床研究情况进行回顾分析,以期为临床管理提供指导帮助。对ETMR的临床特点及诊断治疗的研究情况进行文献综述。典型的组织学特点联合分子生物学改变,可以更好地诊断ETMR。目前ETMR的治疗建议主要基于小型、主要是回顾性患者队列的数据。普遍推荐最大安全切除,适应年龄和风险的放疗、化疗为ETMR主要治疗手段,早期放疗可能改善预后。