An unusual histologic type and low-grade malignancy of salivary gland (SG) carcinomas, namely solid carcinoma (SC), is reported. Histopathologic characteristics of 12 cases of the SC include (1) large solid nest struc...An unusual histologic type and low-grade malignancy of salivary gland (SG) carcinomas, namely solid carcinoma (SC), is reported. Histopathologic characteristics of 12 cases of the SC include (1) large solid nest structure, (2) isomorphic and blandness of the epithelial cells in cytoloogy, (3) squamous metaplasia and keratinization in different degrees. (4) infiltrative growth pattern. Immunohistochemical stainings reveal that the cells of the SCs are reacted positive with anti-cytokeratins 12 and 27, anti-S-100P, anti-EMA antibodies in different degrees, and negative with anti-desmin, anti-GFAP, anti-lysozyme antibodies. The positive reactions with anti-CEA, anti-actin, and anti-myoglobin are detected in a few individuals. Follow-up data show the recurrence rate and mortality of the SC are 73% and 18% respectively. The histogenesis of SC and differential diagnosis are also discussed in the paper.展开更多
BACKGROUND Eosinophilic solid and cystic(ESC)renal cell carcinoma(RCC),a unique and emerging subtype of RCC,has an indolent nature;in some rare instances,it may exhibit metastatic potential.Current cases are inadequat...BACKGROUND Eosinophilic solid and cystic(ESC)renal cell carcinoma(RCC),a unique and emerging subtype of RCC,has an indolent nature;in some rare instances,it may exhibit metastatic potential.Current cases are inadequate to precisely predict the clinical outcome of ESC RCC and determine treatment choices.CASE SUMMARY Herein,we report two patients with ESC RCC.Patient 1 was a young woman with classical pathological characteristics.Patient 2 was a 52-year-old man with multifocal metastases,involving the pulmonary hilar and mediastinal lymph nodes,liver,brain,mesosternum,vertebra,rib,femur,and symphysis pubis.Awareness of ESC RCC,along with its characteristic architecture and immunophenotype,would contribute to making a definitive diagnosis,even on core biopsy samples.CONCLUSION The discovery of ESC RCC molecular signatures may provide new therapeutic strategies in the future.展开更多
This study aimed to determine and quantitate the mammographic and sonographic characteristics in 13 cases of solid neuroendocrine breast carcinoma(NEBC) and to analyze the association of radiological findings with the...This study aimed to determine and quantitate the mammographic and sonographic characteristics in 13 cases of solid neuroendocrine breast carcinoma(NEBC) and to analyze the association of radiological findings with the clinical and histopathologic findings.The clinical data and imaging findings of 13 female patients with histologically confirmed solid NEBC were reviewed.Imaging data were evaluated by two radiologists for a consensual diagnosis.All patients presented with one palpable mass;only 1 experienced occasional breast pain,and 5 complained of fluid discharge.In 7 patients,the masses were firm and mobile.Regional lymph node metastasis was noted in only 1 patient.For the 10 patients who underwent mammography,6 had a mass,1 had clustered small nodules with clustered punctuate microcalcifications,2 had asymmetric focal density,and 1 had solitary punctuate calcification.Most of the masses had irregular shape with indistinct or microlobulated margins.For the 9 patients who underwent ultrasonography(US),9 masses were depicted,all of which were hypoechoic,mostly with irregular shape and without acoustic phenomena.Different types of acoustic phenomena were also identified.One patient had developed distant metastases during follow-up.NEBC has a variety of presentations,but it is mostly observed on mammograms as a dense,irregular mass with indistinct or microlobulated margins.Sonographically,it typically presents as an irregular,heterogeneously hypoechoic mass with normal sound transmission.Histories of nipple discharge and calcification observed using imaging are not rare.展开更多
Histone acylation is one in every of the posttranslational modification that incorporates a role within the regulation of sequence expression. This study was aimed to ameliorate neoplasm cell model Solid Ehrlich malig...Histone acylation is one in every of the posttranslational modification that incorporates a role within the regulation of sequence expression. This study was aimed to ameliorate neoplasm cell model Solid Ehrlich malignant neoplastic disease with sulforaphane extracted from cabbage alone and together with immune suppressant drug (MTX) by study the activity of simple protein deacetylase accelerator (HDAC). In this study, sulforaphane was extracted from cabbage leaves and evaluated victimization GC-MS and ultraviolet illumination spectrophotometry. 60 white male rats were divided into six equal groups. Group I: management ordinarily. The remaining mice were subjected to Ehrlich neoplasm cells. Group II: Tumor-bearing group. Group III: immune suppressant drug “MTX” treated group. Group IV, V treated with SFN before and when Paul Ehrlich cells implantation group VI (Methotrexate and sulforaphane-treated group). This result showed that sulforaphane was extracted from cabbage (Brassica oleracea) in concentration of 833 μg/g leave. HDAC was attenuated when treatment with sulforaphane after treatment with methotrexate or sulforaphane alone. The desoxyribonucleic acid injury was attenuated in neoplasm tissue of tumor-bearing mice when treatment with immune suppressant drug and hyperbolic considerably in tumor tissue of tumor-bearing mice treated with sulforaphane before and after carcinogenesis and together with methotrexate treatment after carcinogenesis.展开更多
Sorafenib is thus far the only systemic treatment for hepatocellular carcinoma(HCC) based on the results of two randomized controlled trials performed in Western and in Eastern countries, despite a poor response rate(...Sorafenib is thus far the only systemic treatment for hepatocellular carcinoma(HCC) based on the results of two randomized controlled trials performed in Western and in Eastern countries, despite a poor response rate(from 2% to 3.3%) following conventional evaluation criteria. It is now recognized that the criteria(European Association of the Study of the Liver criteria, modified response evaluation criteria in solid tumors) based on contrast enhanced techniques(computed tomography scan, magnetic resonance imaging) aimed to assess the evolution of the viable part of the tumor(hypervascularized on arterial phase) are of major interest to determine the efficacy of sorafenib and of most antiangiogenic drugs in patients with HCC. The role of alphafetoprotein serum levels remains unclear. In 2016, in accordance with the SHARP and the Asia-Pacific trials, sorafenib must be stopped when tolerance is poor despite dose adaptation or in cases of radiological and symptomatic progression. This approach will be different in cases of available second-line therapy trials. Some recent data(in renal cell carcinoma) revealed that despite progression in patients who received sorafenib, this drug can still decrease tumor progression compared to drug cessation. Then, before deciding to continue sorafenib post-progression or shift to another drug, knowing other parameters of post-progression survival(Child-Pugh class, Barcelona Clinic Liver Cancer, alphafetoprotein, post-progression patterns in particular, the development of extrahepatic metastases and of portal vein thrombosis) will be of major importance.展开更多
The term "intracystic papillary ductal carcinoma in situ " constitutes only 0.5% to 1% of all breast cancers.It is usually seen in postmenopausal age group.Herein,we are presenting a minireview about this un...The term "intracystic papillary ductal carcinoma in situ " constitutes only 0.5% to 1% of all breast cancers.It is usually seen in postmenopausal age group.Herein,we are presenting a minireview about this unusual breast malignancy usually difficult to diagnose on clinical grounds and highlighting modalities of diagnosis and management.展开更多
Hepatocellular carcinoma(HCC) is an aggressive malignancy,resulting as the third cause of death by cancer each year. The management of patients with HCC is complex,as both the tumour stage and any underlying liver dis...Hepatocellular carcinoma(HCC) is an aggressive malignancy,resulting as the third cause of death by cancer each year. The management of patients with HCC is complex,as both the tumour stage and any underlying liver disease must be considered conjointly. Although surveillance by imaging,clinical and biochemical parameters is routinely performed,a lot of patients suffering from cirrhosis have an advanced stage HCC at the first diagnosis. Advanced stage HCC includes heterogeneous groups of patients with different clinical condition and radiological features and sorafenib is the only approved treatment according to Barcelona Clinic Liver Cancer. Since the introduction of sorafenib in clinical practice,several phase Ⅲ clinical trials have failed to demonstrate any superiority over sorafenib in the frontline setting. Locoregional therapies have also been tested as first line treatment,but their role in advanced HCC is still matter of debate. No single agent or combination therapies have been shown to impact outcomes after sorafenib failure. Therefore this review will focus on the range of experimental therapeutics for patients with advanced HCC and highlights the successes and failures of these treatments as well as areas for future development. Specifics such as dose limiting toxicity and safety profile in patients with liver dysfunction related to the underlying chronic liver disease should be considered when developing therapies in HCC. Finally,robust validated and reproducible surrogate end-points as well as predictive biomarkers should be defined in future randomized trials.展开更多
Acquired hemophilia A(AHA) is a rare, hemorrhagic autoimmune disease, whose pathogenesis involves reduced coagulation factor Ⅷ(FⅧ) activity related to the appearance of inhibitors against FⅧ. Common etiological fac...Acquired hemophilia A(AHA) is a rare, hemorrhagic autoimmune disease, whose pathogenesis involves reduced coagulation factor Ⅷ(FⅧ) activity related to the appearance of inhibitors against FⅧ. Common etiological factors include autoimmune diseases, malignancy, and pregnancy. We report two cases of AHA in solid cancer. The first case is a 63-year-old man who developed peritoneal and intestinal bleeding after gastrectomy for gastric cancer. He was diagnosed with AHA, and was treated with prednisone, followed by cyclophosphamide. In the second case, a 68-year-old man developed a subcutaneous hemorrhage. He was diagnosed with AHA in hepatocellular carcinoma on CT imaging, and treated with rituximab alone. Hemostasis was achieved for both patients without bypassing agents as the amount of inhibitors was reduced and eradicated. However, both patients died within 1 year due to cancer progression. Successful treatment for AHA in solid cancer can be difficult because treatment of the underlying malignancy is also required.展开更多
BACKGROUND Drug-eluting bead transarterial chemoembolization(DEB-TACE)is an endovascular treatment to release chemotherapeutic agents within a target lesion,minimizing systemic exposure and adverse effects to chemothe...BACKGROUND Drug-eluting bead transarterial chemoembolization(DEB-TACE)is an endovascular treatment to release chemotherapeutic agents within a target lesion,minimizing systemic exposure and adverse effects to chemotherapeutics.Therefore,identifying which patient characteristics may predict imaging response to DEB-TACE can improve treatment results while selecting the best candidates.Predictors of the response after DEB-TACE still have not been fully elucidated.This is the first prospective study performed with standardized DEBTACE technique that aim to identify predictors of radiological response,assessing patients clinical and laboratory characteristics,diagnostic imaging and intraprocedure data of the hepatocellular carcinoma treated in the neoadjuvant context for liver transplantation.AIM To identify pre-and intraoperative clinical and imaging predictors of the radiological response of drug-eluting bead transarterial chemoembolization(DEB-TACE)for the neoadjuvant treatment of hepatocellular carcinoma(HCC).METHODS This is prospective,cohort study,performed in a single transplant center,from 2011 to 2014.Consecutive patients with HCC considered for liver transplant who underwent DEB-TACE in the first session for downstaging or bridging purposes were recruited.Pre and post-chemoembolization imaging studies were performed by computed tomography or magnetic resonance.The radiological response of each individual HCC was evaluated by objective response using mRECIST and the percentage of necrosis.RESULTS Two hundred patients with 380 HCCs were examined.Analysis of the objective response(nodule-based analysis)demonstrated that HCC with pseudocapsules had a 2.01 times greater chance of being responders than those without pseudocapsules(P=0.01),and the addition of every 1mg of chemoembolic agent increased the chance of therapeutic response in 4%(P<0.001).Analysis of the percentage of necrosis through multiple linear regression revealed that the addition of each 1mg of the chemoembolic agent caused an average increase of 0.65%(P<0.001)in necrosis in the treated lesion,whereas the hepatocellular carcinoma with pseudocapsules presented 18.27%(P<0.001)increased necrosis compared to those without pseudocapsules.CONCLUSION The presence of a pseudocapsule and the addition of the amount of chemoembolic agent increases the chance of an objective response in hepatocellular carcinoma and increases the percentage of tumor necrosis following drug-eluting bead chemoembolization in the neoadjuvant treatment,prior to liver transplantation.展开更多
Sorafenib is an effective anti-angiogenic treatment forhepatocellular carcinoma(HCC). The assessment of tumor progression in patients treated with sorafenib is crucial to help identify potentially-resistant patients,a...Sorafenib is an effective anti-angiogenic treatment forhepatocellular carcinoma(HCC). The assessment of tumor progression in patients treated with sorafenib is crucial to help identify potentially-resistant patients,avoiding unnecessary toxicities. Traditional methods to assess tumor progression are based on variations in tumor size and provide unreliable results in patients treated with sorafenib. New methods to assess tumor progression such as the modified Response Evaluation Criteria in Solid Tumors or European Association for the Study of Liver criteria are based on imaging to measure the vascularization and tumor volume(viable or necrotic). These however fail especially when the tumor response results in irregular development of necrotic tissue. Newer assessment techniques focus on the evaluation of tumor volume,density or perfusion. Perfusion computed tomography and Dynamic ContrastEnhanced-UltraS ound can measure the vascularization of HCC lesions and help predict tumor response to antiangiogenic therapies. Mean Transit Time is a possible predictive biomarker to measure tumor response. Volumetric techniques are reliable,reproducible and time-efficient and can help measure minimal changes in viable tumor or necrotic tissue,allowing the prompt identification of non-responders. Volume ratio may be a reproducible biomarker for tumor response. Larger trials are needed to confirm the use of these techniques in the prediction of response to sorafenib.展开更多
Advanced stage hepatocellular carcinoma(HCC) is a category of disease defined by radiological, clinical and hepatic function parameters, comprehending a wide range of patients with different general conditions. The ma...Advanced stage hepatocellular carcinoma(HCC) is a category of disease defined by radiological, clinical and hepatic function parameters, comprehending a wide range of patients with different general conditions. The main therapeutic option is represented by sorafenibtreatment, a multi-kinase inhibitor with anti-proliferative and anti-angiogenic effect. Trans-arterial Radio Embolization also represents a promising new approach to intermediate/advanced HCC. Post-marketing clinical studies showed that only a portion of patients actually benefits from sorafenib treatment, and an even smaller percentage of patients treated shows partial/complete response on follow-up examinations, up against relevant costs and an incidence of drug related adverse effects. Although the treatment with sorafenib has shown a significant increase in mean overall survival in different studies, only a part of patients actually shows real benefits, while the incidence of drug related significant adverse effects and the economic costs are relatively high. Moreover, only a small percentage of patients also shows a response in terms of lesion dimensions reduction. Being able to properly differentiate patients who are responding to the therapy from non-responders as early as possible is then still difficult and could be a pivotal challenge for the future; in fact it could spare several patients a therapy often difficult to bear, directing them to other second line treatments(many of which are at the moment still under investigation). For this reason, some supplemental criteria to be added to the standard modified Response Evaluation Criteria in Solid Tumors evaluation are being searched for. In particular, finding some parameters(cellular density, perfusion grade and enhancement rate) able to predict the sensitivity of the lesions to anti-angiogenic agents could help in stratifying patients in terms of treatment responsiveness before the beginning of the therapy itself, or in the first weeks of sorafenib treatment. This would bring a strongly desirable help in clinical managements of these patients.展开更多
目的:探讨乳腺实性乳头状癌(solid papillary carcinoma of the breast,SPC)的灰阶超声、彩色多普勒超声及超声弹性成像表现,并探讨SPC的超声表现与其病理学检查结果的相关性。方法:分析71例经术后病理学检查证实的SPC患者的临床资料,...目的:探讨乳腺实性乳头状癌(solid papillary carcinoma of the breast,SPC)的灰阶超声、彩色多普勒超声及超声弹性成像表现,并探讨SPC的超声表现与其病理学检查结果的相关性。方法:分析71例经术后病理学检查证实的SPC患者的临床资料,共包括75个SPC病灶的灰阶超声、彩色多普勒超声表现和35个SPC病灶的超声弹性成像表现。比较不同病理学亚型SPC的超声表现及与病理学检查结果的相关性。结果:SPC的超声表现大多为单发的低回声实性肿块,呈水平生长,形态不规则,边缘不光整,后方回声增强或不变,可伴有导管扩张及钙化,Adler血流分级Ⅱ~Ⅲ级,阻力指数(resistance index,RI)为0.62~0.84。几乎不伴有腋窝淋巴结转移。75个SPC病灶病理学分子分型均为Luminal A型。Ki-67增殖指数在42个原位SPC病灶中均<20%,在15个浸润性SPC中为20%~60%,两者差异有统计学意义(P=0.000)。结论:SPC超声表现具有一定特征性,结合灰阶、彩色多普勒超声及超声弹性成像可提高其诊断准确度,但超声无法鉴别原位SPC及浸润性SPC,Ki-67增殖指数与SPC是否浸润有关。展开更多
With the increasing clinical use of cytostatic and novel biologic targeted agents,conventional morphologic tumor burden assessments,including World Health Organization criteria and Response Evaluation Criteria in Soli...With the increasing clinical use of cytostatic and novel biologic targeted agents,conventional morphologic tumor burden assessments,including World Health Organization criteria and Response Evaluation Criteria in Solid Tumors,are confronting limitations because of their difficulties in distinguishing viable tumor from necrotic or fibrotic tissue.Therefore,the investigation for reliable quantitative biomarkers of therapeutic response such as metabolic imaging or functional imaging has been desired.In this review,we will discuss the conventional and new approaches to assess tumor burden.Since targeted therapy or locoregional therapies can induce biological changes much earlier than morphological changes,these functional tumor burden analyses are very promising.However,some of them have not gone thorough all steps for standardization and validation.Nevertheless,these new techniques and criteria will play an important role in the cancer management,and provide each patient more tailored therapy.展开更多
文摘An unusual histologic type and low-grade malignancy of salivary gland (SG) carcinomas, namely solid carcinoma (SC), is reported. Histopathologic characteristics of 12 cases of the SC include (1) large solid nest structure, (2) isomorphic and blandness of the epithelial cells in cytoloogy, (3) squamous metaplasia and keratinization in different degrees. (4) infiltrative growth pattern. Immunohistochemical stainings reveal that the cells of the SCs are reacted positive with anti-cytokeratins 12 and 27, anti-S-100P, anti-EMA antibodies in different degrees, and negative with anti-desmin, anti-GFAP, anti-lysozyme antibodies. The positive reactions with anti-CEA, anti-actin, and anti-myoglobin are detected in a few individuals. Follow-up data show the recurrence rate and mortality of the SC are 73% and 18% respectively. The histogenesis of SC and differential diagnosis are also discussed in the paper.
文摘BACKGROUND Eosinophilic solid and cystic(ESC)renal cell carcinoma(RCC),a unique and emerging subtype of RCC,has an indolent nature;in some rare instances,it may exhibit metastatic potential.Current cases are inadequate to precisely predict the clinical outcome of ESC RCC and determine treatment choices.CASE SUMMARY Herein,we report two patients with ESC RCC.Patient 1 was a young woman with classical pathological characteristics.Patient 2 was a 52-year-old man with multifocal metastases,involving the pulmonary hilar and mediastinal lymph nodes,liver,brain,mesosternum,vertebra,rib,femur,and symphysis pubis.Awareness of ESC RCC,along with its characteristic architecture and immunophenotype,would contribute to making a definitive diagnosis,even on core biopsy samples.CONCLUSION The discovery of ESC RCC molecular signatures may provide new therapeutic strategies in the future.
文摘This study aimed to determine and quantitate the mammographic and sonographic characteristics in 13 cases of solid neuroendocrine breast carcinoma(NEBC) and to analyze the association of radiological findings with the clinical and histopathologic findings.The clinical data and imaging findings of 13 female patients with histologically confirmed solid NEBC were reviewed.Imaging data were evaluated by two radiologists for a consensual diagnosis.All patients presented with one palpable mass;only 1 experienced occasional breast pain,and 5 complained of fluid discharge.In 7 patients,the masses were firm and mobile.Regional lymph node metastasis was noted in only 1 patient.For the 10 patients who underwent mammography,6 had a mass,1 had clustered small nodules with clustered punctuate microcalcifications,2 had asymmetric focal density,and 1 had solitary punctuate calcification.Most of the masses had irregular shape with indistinct or microlobulated margins.For the 9 patients who underwent ultrasonography(US),9 masses were depicted,all of which were hypoechoic,mostly with irregular shape and without acoustic phenomena.Different types of acoustic phenomena were also identified.One patient had developed distant metastases during follow-up.NEBC has a variety of presentations,but it is mostly observed on mammograms as a dense,irregular mass with indistinct or microlobulated margins.Sonographically,it typically presents as an irregular,heterogeneously hypoechoic mass with normal sound transmission.Histories of nipple discharge and calcification observed using imaging are not rare.
文摘Histone acylation is one in every of the posttranslational modification that incorporates a role within the regulation of sequence expression. This study was aimed to ameliorate neoplasm cell model Solid Ehrlich malignant neoplastic disease with sulforaphane extracted from cabbage alone and together with immune suppressant drug (MTX) by study the activity of simple protein deacetylase accelerator (HDAC). In this study, sulforaphane was extracted from cabbage leaves and evaluated victimization GC-MS and ultraviolet illumination spectrophotometry. 60 white male rats were divided into six equal groups. Group I: management ordinarily. The remaining mice were subjected to Ehrlich neoplasm cells. Group II: Tumor-bearing group. Group III: immune suppressant drug “MTX” treated group. Group IV, V treated with SFN before and when Paul Ehrlich cells implantation group VI (Methotrexate and sulforaphane-treated group). This result showed that sulforaphane was extracted from cabbage (Brassica oleracea) in concentration of 833 μg/g leave. HDAC was attenuated when treatment with sulforaphane after treatment with methotrexate or sulforaphane alone. The desoxyribonucleic acid injury was attenuated in neoplasm tissue of tumor-bearing mice when treatment with immune suppressant drug and hyperbolic considerably in tumor tissue of tumor-bearing mice treated with sulforaphane before and after carcinogenesis and together with methotrexate treatment after carcinogenesis.
文摘Sorafenib is thus far the only systemic treatment for hepatocellular carcinoma(HCC) based on the results of two randomized controlled trials performed in Western and in Eastern countries, despite a poor response rate(from 2% to 3.3%) following conventional evaluation criteria. It is now recognized that the criteria(European Association of the Study of the Liver criteria, modified response evaluation criteria in solid tumors) based on contrast enhanced techniques(computed tomography scan, magnetic resonance imaging) aimed to assess the evolution of the viable part of the tumor(hypervascularized on arterial phase) are of major interest to determine the efficacy of sorafenib and of most antiangiogenic drugs in patients with HCC. The role of alphafetoprotein serum levels remains unclear. In 2016, in accordance with the SHARP and the Asia-Pacific trials, sorafenib must be stopped when tolerance is poor despite dose adaptation or in cases of radiological and symptomatic progression. This approach will be different in cases of available second-line therapy trials. Some recent data(in renal cell carcinoma) revealed that despite progression in patients who received sorafenib, this drug can still decrease tumor progression compared to drug cessation. Then, before deciding to continue sorafenib post-progression or shift to another drug, knowing other parameters of post-progression survival(Child-Pugh class, Barcelona Clinic Liver Cancer, alphafetoprotein, post-progression patterns in particular, the development of extrahepatic metastases and of portal vein thrombosis) will be of major importance.
文摘The term "intracystic papillary ductal carcinoma in situ " constitutes only 0.5% to 1% of all breast cancers.It is usually seen in postmenopausal age group.Herein,we are presenting a minireview about this unusual breast malignancy usually difficult to diagnose on clinical grounds and highlighting modalities of diagnosis and management.
文摘Hepatocellular carcinoma(HCC) is an aggressive malignancy,resulting as the third cause of death by cancer each year. The management of patients with HCC is complex,as both the tumour stage and any underlying liver disease must be considered conjointly. Although surveillance by imaging,clinical and biochemical parameters is routinely performed,a lot of patients suffering from cirrhosis have an advanced stage HCC at the first diagnosis. Advanced stage HCC includes heterogeneous groups of patients with different clinical condition and radiological features and sorafenib is the only approved treatment according to Barcelona Clinic Liver Cancer. Since the introduction of sorafenib in clinical practice,several phase Ⅲ clinical trials have failed to demonstrate any superiority over sorafenib in the frontline setting. Locoregional therapies have also been tested as first line treatment,but their role in advanced HCC is still matter of debate. No single agent or combination therapies have been shown to impact outcomes after sorafenib failure. Therefore this review will focus on the range of experimental therapeutics for patients with advanced HCC and highlights the successes and failures of these treatments as well as areas for future development. Specifics such as dose limiting toxicity and safety profile in patients with liver dysfunction related to the underlying chronic liver disease should be considered when developing therapies in HCC. Finally,robust validated and reproducible surrogate end-points as well as predictive biomarkers should be defined in future randomized trials.
文摘Acquired hemophilia A(AHA) is a rare, hemorrhagic autoimmune disease, whose pathogenesis involves reduced coagulation factor Ⅷ(FⅧ) activity related to the appearance of inhibitors against FⅧ. Common etiological factors include autoimmune diseases, malignancy, and pregnancy. We report two cases of AHA in solid cancer. The first case is a 63-year-old man who developed peritoneal and intestinal bleeding after gastrectomy for gastric cancer. He was diagnosed with AHA, and was treated with prednisone, followed by cyclophosphamide. In the second case, a 68-year-old man developed a subcutaneous hemorrhage. He was diagnosed with AHA in hepatocellular carcinoma on CT imaging, and treated with rituximab alone. Hemostasis was achieved for both patients without bypassing agents as the amount of inhibitors was reduced and eradicated. However, both patients died within 1 year due to cancer progression. Successful treatment for AHA in solid cancer can be difficult because treatment of the underlying malignancy is also required.
文摘BACKGROUND Drug-eluting bead transarterial chemoembolization(DEB-TACE)is an endovascular treatment to release chemotherapeutic agents within a target lesion,minimizing systemic exposure and adverse effects to chemotherapeutics.Therefore,identifying which patient characteristics may predict imaging response to DEB-TACE can improve treatment results while selecting the best candidates.Predictors of the response after DEB-TACE still have not been fully elucidated.This is the first prospective study performed with standardized DEBTACE technique that aim to identify predictors of radiological response,assessing patients clinical and laboratory characteristics,diagnostic imaging and intraprocedure data of the hepatocellular carcinoma treated in the neoadjuvant context for liver transplantation.AIM To identify pre-and intraoperative clinical and imaging predictors of the radiological response of drug-eluting bead transarterial chemoembolization(DEB-TACE)for the neoadjuvant treatment of hepatocellular carcinoma(HCC).METHODS This is prospective,cohort study,performed in a single transplant center,from 2011 to 2014.Consecutive patients with HCC considered for liver transplant who underwent DEB-TACE in the first session for downstaging or bridging purposes were recruited.Pre and post-chemoembolization imaging studies were performed by computed tomography or magnetic resonance.The radiological response of each individual HCC was evaluated by objective response using mRECIST and the percentage of necrosis.RESULTS Two hundred patients with 380 HCCs were examined.Analysis of the objective response(nodule-based analysis)demonstrated that HCC with pseudocapsules had a 2.01 times greater chance of being responders than those without pseudocapsules(P=0.01),and the addition of every 1mg of chemoembolic agent increased the chance of therapeutic response in 4%(P<0.001).Analysis of the percentage of necrosis through multiple linear regression revealed that the addition of each 1mg of the chemoembolic agent caused an average increase of 0.65%(P<0.001)in necrosis in the treated lesion,whereas the hepatocellular carcinoma with pseudocapsules presented 18.27%(P<0.001)increased necrosis compared to those without pseudocapsules.CONCLUSION The presence of a pseudocapsule and the addition of the amount of chemoembolic agent increases the chance of an objective response in hepatocellular carcinoma and increases the percentage of tumor necrosis following drug-eluting bead chemoembolization in the neoadjuvant treatment,prior to liver transplantation.
文摘Sorafenib is an effective anti-angiogenic treatment forhepatocellular carcinoma(HCC). The assessment of tumor progression in patients treated with sorafenib is crucial to help identify potentially-resistant patients,avoiding unnecessary toxicities. Traditional methods to assess tumor progression are based on variations in tumor size and provide unreliable results in patients treated with sorafenib. New methods to assess tumor progression such as the modified Response Evaluation Criteria in Solid Tumors or European Association for the Study of Liver criteria are based on imaging to measure the vascularization and tumor volume(viable or necrotic). These however fail especially when the tumor response results in irregular development of necrotic tissue. Newer assessment techniques focus on the evaluation of tumor volume,density or perfusion. Perfusion computed tomography and Dynamic ContrastEnhanced-UltraS ound can measure the vascularization of HCC lesions and help predict tumor response to antiangiogenic therapies. Mean Transit Time is a possible predictive biomarker to measure tumor response. Volumetric techniques are reliable,reproducible and time-efficient and can help measure minimal changes in viable tumor or necrotic tissue,allowing the prompt identification of non-responders. Volume ratio may be a reproducible biomarker for tumor response. Larger trials are needed to confirm the use of these techniques in the prediction of response to sorafenib.
基金Supported by Protocollo TESORM by Regione Toscana,Universitàdegli Studi di Firenze and Bayer Health Care s.p.a
文摘Advanced stage hepatocellular carcinoma(HCC) is a category of disease defined by radiological, clinical and hepatic function parameters, comprehending a wide range of patients with different general conditions. The main therapeutic option is represented by sorafenibtreatment, a multi-kinase inhibitor with anti-proliferative and anti-angiogenic effect. Trans-arterial Radio Embolization also represents a promising new approach to intermediate/advanced HCC. Post-marketing clinical studies showed that only a portion of patients actually benefits from sorafenib treatment, and an even smaller percentage of patients treated shows partial/complete response on follow-up examinations, up against relevant costs and an incidence of drug related adverse effects. Although the treatment with sorafenib has shown a significant increase in mean overall survival in different studies, only a part of patients actually shows real benefits, while the incidence of drug related significant adverse effects and the economic costs are relatively high. Moreover, only a small percentage of patients also shows a response in terms of lesion dimensions reduction. Being able to properly differentiate patients who are responding to the therapy from non-responders as early as possible is then still difficult and could be a pivotal challenge for the future; in fact it could spare several patients a therapy often difficult to bear, directing them to other second line treatments(many of which are at the moment still under investigation). For this reason, some supplemental criteria to be added to the standard modified Response Evaluation Criteria in Solid Tumors evaluation are being searched for. In particular, finding some parameters(cellular density, perfusion grade and enhancement rate) able to predict the sensitivity of the lesions to anti-angiogenic agents could help in stratifying patients in terms of treatment responsiveness before the beginning of the therapy itself, or in the first weeks of sorafenib treatment. This would bring a strongly desirable help in clinical managements of these patients.
文摘目的:探讨乳腺实性乳头状癌(solid papillary carcinoma of the breast,SPC)的灰阶超声、彩色多普勒超声及超声弹性成像表现,并探讨SPC的超声表现与其病理学检查结果的相关性。方法:分析71例经术后病理学检查证实的SPC患者的临床资料,共包括75个SPC病灶的灰阶超声、彩色多普勒超声表现和35个SPC病灶的超声弹性成像表现。比较不同病理学亚型SPC的超声表现及与病理学检查结果的相关性。结果:SPC的超声表现大多为单发的低回声实性肿块,呈水平生长,形态不规则,边缘不光整,后方回声增强或不变,可伴有导管扩张及钙化,Adler血流分级Ⅱ~Ⅲ级,阻力指数(resistance index,RI)为0.62~0.84。几乎不伴有腋窝淋巴结转移。75个SPC病灶病理学分子分型均为Luminal A型。Ki-67增殖指数在42个原位SPC病灶中均<20%,在15个浸润性SPC中为20%~60%,两者差异有统计学意义(P=0.000)。结论:SPC超声表现具有一定特征性,结合灰阶、彩色多普勒超声及超声弹性成像可提高其诊断准确度,但超声无法鉴别原位SPC及浸润性SPC,Ki-67增殖指数与SPC是否浸润有关。
文摘With the increasing clinical use of cytostatic and novel biologic targeted agents,conventional morphologic tumor burden assessments,including World Health Organization criteria and Response Evaluation Criteria in Solid Tumors,are confronting limitations because of their difficulties in distinguishing viable tumor from necrotic or fibrotic tissue.Therefore,the investigation for reliable quantitative biomarkers of therapeutic response such as metabolic imaging or functional imaging has been desired.In this review,we will discuss the conventional and new approaches to assess tumor burden.Since targeted therapy or locoregional therapies can induce biological changes much earlier than morphological changes,these functional tumor burden analyses are very promising.However,some of them have not gone thorough all steps for standardization and validation.Nevertheless,these new techniques and criteria will play an important role in the cancer management,and provide each patient more tailored therapy.