The majority of benign meningiomas exhibit a slow growth rate and are associated with a good prognosis. The recurrence and extracranial metastases of meningioma are rare. The present report describes the case of a patient with recurrence of transitional meningioma for which total resection had been performed 8 years prior. Furthermore, the transitional meningioma transformed into atypical meningioma, and metastasized to the ribs. The present report aimed to describe the clinical features and pathological findings of a case of malignant transformation and distant metastasis of benign meningioma. A review of the literature was also performed.
Objective:To explore the changes of complement C3a and its relationship with therapeutic efficacy in immunotherapy of advanced renal clear cell carcinoma.Methods:Tissue samples from 78 renal clear cell carcinoma patients were collected. Immunohistochemistry was used to detect the expression of complement C3a in tumor and adjacent tissues. Enzyme-linked immunosorbent assay method was used to measure the concentration of complement C3a in peripheral serum of advanced renal clear cell carcinoma patients before and after four cycles of programmed cell death protein 1 (PD-1) inhibitor therapy. The therapeutic effect was evaluated according to response evaluation criteria in solid tumors version 1.1.Results:Among the 78 renal clear cell carcinoma specimens, 52 patients showed positive expression of C3a (67%), with brownish-yellow staining in cytoplasm and membrane of tumor cells. There was no difference in the expression of complement C3a in tumor tissues among different genders, ages, locations and histological grades (all P>0.05). When the transverse diameter of the tumor was greater than 3.5 cm, the expression of complement C3a was significantly increased ( P=0.025), and it was also elevated in stage Ⅱ patients according to TNM staging ( P=0.015). Among the 60 advanced renal clear cell carcinoma patients who received immunotherapy, there were 24 cases of complete remission (CR) and partial remission (PR), 14 cases of stability of disease (SD), and 22 cases of progression of disease (PD). After PD-1 inhibitor therapy, the serum C3a concentration was decreased in the CR+PR+SD patients, while it was increased in the PD patients ( P<0.001). The patients with a decrease in complement C3a after PD-1 inhibitor therapy were significantly longer progression-free survival compared to those with an increase in C3a ( P<0.001). Conclusions:Complement C3a is highly expressed in renal clear cell carcinoma tissues, and its expression is closely related to tumor staging and tumor size. During the PD-1 inhibitor therapy of renal clear cell carcinoma, changes in complement C3a can partially reflect the efficacy and prognosis.
Immunoglobulin-like transcript 4 (ILT4) is an inhibitory receptor of the immunoglobulin superfamily, mainly expressed in myeloid cells, including monocytes, macrophages, dendritic cells, and granulocytes. ILT4 mainly inhibits immune function by transmitting inhibitory signals to cells after binding to its ligands. Increasing evidence suggests that ILT4 is abnormally expressed in many human tumors, which plays a regulatory role in malignant biological behaviors such as tumor proliferation, invasion, and metastasis, and is closely related to the T lymphocyte infiltration in tumor microenvironment. Further study on the expression and mechanisms of ILT4 in tumors will contribute to the development of targeted medicine for related tumors.
软脑膜转移是晚期非小细胞肺癌（non-small-cell-lung-cancer，NSCLC）患者的严重并发症之一。患者一旦发生脑膜转移，预后差，治疗策略存在巨大挑战。本研究旨在探讨合并脑膜转移的表皮生长因子受体（epidermal growth factor receptor，EGFR）突变NSCLC患者在靶向治疗时代的生存情况。肺癌脑膜转移预后差，未经治疗的脑膜转移癌生存期仅1~3个月，在靶向药物面世之前放化疗对其生存期的延长非常有限 ［1］。随着靶向治疗时代的来临，第1代EGFR-TKI改善了EGFR突变肺癌患者的预后 ［2］，而随着患者生存期延长，脑膜转移的发生也明显增加 ［3］。肺癌合并脑膜转移的患者是否也能从TKI中获益？第1代TKI哪种疗效更好？第1代TKI使用过程中发生的脑膜转移换用第3代TKI疗效如何？这篇来自复旦大学附属华山医院单中心真实世界的回顾性分析数据给到了这些问题的部分答案。脑膜转移后中位生存时间达16.0个月，3年总生存率达23%，远远超越了靶向治疗前时代，并且同既往的研究报道相符 ［4］；而第3代TKI疗效优于第1代TKI也与既往临床研究结论相符 ［5, 6］；第1代TKI耐药后发生的脑膜转移，如果耐药原因是T790M突变，换用第3代TKI可以有效改善脑膜转移症状 ［7］。
Lymph node metastasis of cervical cancer is an important factor affecting the survival rate of patients. Para-aortic lymph nodes, as one of the most common sites of cervical cancer metastasis, are regarded as a distant metastasis, which often indicates a poor prognosis for these patients. However, the optimal treatment strategy for para-aortic lymph node metastasis has not been determined. This article reviews the current status of diagnosis and treatment of cervical cancer patients with para-aortic lymph node metastasis, and provides references for clinicians and related researches.
Clinical nutrition therapy is an important part of comprehensive diagnosis and treatment of modern medicine, so that students majoring in nutrition must master relevant theories and skills. However, compared with the rapid development of clinical medicine, the construction and development of clinical nutrition specialty in Chinese medical institutions are not ideal. which makes some effects on the construction and development of clinical nutrition discipline because the level of practice teaching lags behind. In order to improve the practical skills of nutrition students and promote the development of clinical nutrition science in China,we hope to explore a new innovative application of holistic thought in clinical nutrition practice teaching by analyzing the characteristics of teaching model in Clinical Nutrition.
Central nervous system metastasis of malignant tumors includes parenchymal metastasis and leptomeneneal metastasis. The optimal treatment of patients with central nervous system metastases involves a multidisciplinary approach, including supportive care, local treatments such as surgery, stereotactic radiation therapy and whole brain radiotherapy, and systemic therapy. In this paper, the choice of drugs, the selection of radiotherapy, the diagnosis of meningeal metastasis and Ventriculoperitoneal shunts were reviewed.
Thyroid cancer is the most common malignant tumor of the endocrine system. In the process of thyroid cancer diagnosis and treatment in China, there is a lack of systematic collection and collation of standardized clinical data, as well as a lack of high-level clinical studies related to diagnostic accuracy, treatment effectiveness and complication rate. Therefore, the establishment of a thyroid cancer specific disease database is a necessary way. The data structure, integrity, accuracy and timeliness of thyroid cancer single disease database should be guaranted. The construction of single-center thyroid cancer specific disease database is the foundation of multi-center database construction. Through the collaboration of multi-center clinical research based on blockchain technology alliance, the country′s first multi-center, integrated and standardized thyroid cancer characteristic disease database had been established. The difficulty of establishing multi-center thyroid cancer specific disease database mainly lies in the unification of data standards and data uploading format, which requires unified supervision, management organization and data sharing and cooperation mode.
Long non-coding RNA colon cancer-associated transcript 2 (lncRNA CCAT2) lncRNA CCAT2 is a type of RNA encoded by human 8q24 chromosomal region and plays diverse mechanisms in oncobiologic behaviors. lncRNA CCAT2, as a tumorigenic factor, participates in the upstream and downstream regulation of multiple signaling pathways. It involves in the process of neoplastic invasion and metastasis through regulating molecular sponge, chromosome modification, and post-transcriptional modification. It interacts with microRNAs to form the competing endogenous RNA and constitutes of complex lncRNA-microRNA interaction regulatory networks. The lncRNA CCAT2 also engages in the regulation of multiple classical signaling pathways such as Wnt/β-catenin pathway, and it interacts with a variety of RNA-binding proteins to promote the invasion and metastasis of tumors. It has been gradually acknowledged that the single nucleotide polymorphism of lncRNA CCAT2 influences the malignant progression of tumors, which may provide evidence for fully demonstrating the genetic structures and molecular functions of lncRNA CCAT2. The research on molecular biological functions of lncRNA CCAT2 may not only facilitate the drawing of a comprehensive regulatory map of lncRNA CCAT2 on invasion and metastasis of tumors but also provide scientific theoretical basis for development of targeted drugs and gene detection based on the regulatory map of lncRNA CCAT2.
Objective:Sinonasal mucosal melanoma (SNMM) is a rare disease with limited treatment and poor prognosis after brain metastases. The purpose of this study was to investigate the effective treatment of SNMM with brain metastases.Methods:A case of SNMM treated in Jilin Cancer Hospital was collected to analyze its clinical and pathological features as well as the treatment methods after brain metastases, and the related literature was reviewed.Results:This case was a middle-aged male patient who received surgical treatment at first diagnosis. After one year of adjuvant immunotherapy with Toripalimab, the disease recurred within a short time. The patient received Dacarbazine in combination with Endostatin as first-line therapy, and the disease again progressed rapidly with multiple brain metastases accompanied by significant clinical symptoms. The brain metastases were then treated with radiation, which was less effective, and the patient was in critical condition. The patient received Toripalimab combined with Lenvatinib and Temozolomide as second-line treatment. The clinical symptoms were significantly improved and the brain metastases were significantly reduced. Progression-free survival was 18 months and overall survival was 46 months.Conclusion:The combination of immunotherapy with antiangiogenic therapy and chemotherapy can improve the quality of life and significantly prolong the survival time of SNMM with brain metastases, providing a referable treatment strategy for these patients.
A 74-year-old man referred to the clinic with the chief complaint of pathological bone fracture and anterior cervical mass for four years. Color Doppler ultrasound demonstrated a solid nodule in the left lobe of the thyroid gland, suggesting possible follicular thyroid carcinoma. PET-CT suggested thyroid malignancies and multiple systemic bone metastases including left femur. Total thyroidectomy, left femoral osteotomy and right iliac tumor resection were performed. The routine surgical pathology demonstrated follicular thyroid carcinoma, encapsulated angioinvasive. The carcinoma composed of signet ring cells and clear ells in a solid trabecular pattern. Metastatic carcinoma in both the left femur and the right ilium was found to be the same with the primary thyroid carcinoma both histologically and immunohistochemically, showing positive immunoreaction with TG, TTF1, PAX8, CD56 and CyclinD1. Ki-67 labelling index was 5%-10%. TERT promoter(C228T) mutation was detected by quantitative real-time polymerase chain reaction, and BRAF V600E, RET, RAS, NTRK, PAX8-PPAR γ were proved to be wild type. Signet-ring cell thyroid variant follicular carcinoma is rare, and immunohistochemical staining is helpful in differentiating the diagnosis of other morphologically similar tumors.
Metastatic pancreatic metastases are very rare, and pancreatic metastases to the pancreatic head tend to produce jaundice at an early stage. Combined with literature review, the clinical manifestations, diagnostic points, treatment options and histopathological features of 4 cases of metastatic pancreatic malignancies, including a case of kidney cancer, a case of breast cancer, a case of uterine leiomyosarcoma and a case of gastric cancer, were analyzed. Among the 4 metastatic pancreatic malignancies, 2 cases were diagnosed as metastatic before surgery, and 2 cases could not be identified. Two patients underwent pancreaticoduodenectomy, while the others underwent palliative bilioenterostomy. None of the patients developed jaundice after surgery, and all were still alive. Patients with metastatic pancreatic malignancies characterized by jaundice should be treated as soon as possible. Both pancreaticoduodenectomy and palliative bilioenterostomy can effectively prolong the survival period and quality of life of patients.
Melanoma of vaginal mucosa is very rare, and metastasis of the stomach is also very rare.The prognosis is poor. The immune checkpoint inhibitor represented by PD-1 antibody combined with small-molecule targeted drugs based on anti-angiogenesis has achieved good efficacy in many advanced solid tumors. This article introduces a case of metastatic melanoma of vaginal mucosa to the stomach. The progression-free survival time of toripalimab combined with axitinib has exceeded 2 years.
Objective:To analyze the predictive value of tumor budding grade on the risk of lymph node metastasis and its correlation with prognosis in patients with colorectal cancer(CRC).Methods:A total of 212 CRC patients who underwent laparotomy or laparoscopic surgery in our hospital from April 2012 to December 2019 were enrolled. The predictive efficacy of tumor budding grade (TBG) for the risk of lymph node metastasis was analyzed with receiver operating characteristic, and the cutoff value was determined. The correlation between TBG and prognosis was analyzed with Kaplan-Meier survival curve. The risk factors of lymph node metastasis and affecting factors of overall survival (OS) were analyzed with Cox model. Results:Tumor budding was present in 140 of 212 CRC patients, accounting for 66.04%, and tumor budding had a high power to predict the risk of lymph node metastasis, with an area under the cure of 0.757. The number of budding 4 was selected as the cutoff value, when tumor budding predicted lymph node metastasis with a sensitivity of 0.640 and a specificity of 0.780. In patients with high tumor budding≥4, the lymph node metastasis rate was significantly higher than that in patients with low budding group( P<0.05), and the survival time was shorter than that in the low budding group( P<0.05), and tumor budding≥4 was an independent risk factor for the development of lymph node metastasis and affecting factors of OS( P<0.05). Conclusion:TBG is a useful indicator for predicting the risk of lymph node metastasis in CRC patients and is closely related to prognosis, which can provide a reference for treatment selection and prognosis of CRC.
Objective:To explore the effects of magnetic nanoparticles on the proliferation, activation, cytotoxicity, and differentiation of immune cells in tumor therapy, and to provide new therapeutic strategies for further improving the therapeutic effect of cellular immunity.Methods:Iron oxide magnetic nanoparticles (SPIONCitrate) were prepared and directly mixed with CD8(+) T cells and CAR-T cells to observe the effects of immune cell phenotype, proliferation, and killing effect on Raji-luc cells in both in vitro and in vivo experiments.Results:After passing through magnetic nanoparticles, the proportion of Tem (CD45RO(+)CD62L(-)) and Tcm (CD45RO(+)CD62L(+)) in CD8(+)T cells increased, and the proportion of Tcm (CD45RO(+)CD62L(+)) decreased, which improved the proliferation ability of CD8(+)T cells both in vivo and in vitro, and also enhanced the killing effect of CD19-CAR-T cells.Conclusion:Magnetic nanoparticles can directly alter the phenotype of immune cells, enhance their ability to proliferate and kill tumor cells.
Objective:To explore the early adverse reactions of 131I in the treatment of differentiated thyroid carcinoma (DTC) and the correlation of its influencing factors. Methods:The dose range of 131I was 2.96 to 7.4 GBq (80-200 mCi), which was used to ablate residual thyroid or treat DTC metastasis. A total of 127 DTC patients who received 131I treatment were interviewed and data-collected with questionnaires one month after orally taking 131I. The adverse reactions were recorded and the relevant clinical factors were analyzed. Results:Among 127 patients, 34 had neck pain or swelling, 21 had digestive symptoms, 25 had dry mouth, 29 had abnormal taste, 7 had oral ulcers, 11 had dry eyes, and 2 had dyspnea. These side effects were related to gender, COVID-19 infection before iodine treatment, stage, TgAb and iodine absorption rate before 131I treatment. Conclusion:The short-term side effects of DTC patients after receiving 131I treatment varied among the patients, and clinically more attention could be paid to such patients for individualized treatment, including early related drug prevention and psychological counseling, so as to reduce the incidence of adverse reactions.
Cutaneous metastasis from gallbladder cancer is relatively uncommon in clinical practice, and scalp metastasis is even rarer. Until now, only 6 cases have been reported previously. In this article, we documented a 59-year-old man, he was admitted because of solitary scalp nodule. After comprehensive examinations, he was diagnosed with gallbladder adenocarcinoma with scalp, multiple lymph node, liver metastases and ascites. The patient underwent intravenous and intraperitoneal infusion chemotherapy, in combination with best supportive treatment. In the end, the survival time was 3 months. To our knowledge, this is the third reported case of gallbladder cancer presented initially with scalp metastasis.
Lung cancer with Leptomeningeal metastasis has a poor prognosis, and for epidermal growth factor receptor(EGFR) mutation-positive patients with T790M negative after first-generation tyrosine kinase inhibitors resistance, guidelines recommend chemotherapy combined with anti-angiogenesis therapy. This article presented a female patient with EGFR L858R mutation and Iressa-resistant T790M negative leptomeningeal metastasis of lung cancer, who refused chemotherapy because of senior and could not tolerate the gastrointestinal reaction of chemotherapy. According to the multidisciplinary consultation and discussion opinions of the adiologist, neurosurgeon,radiotherapist and medical oncologist, the best curative effect of Osimertinib followed ventriculoperitoneal shunt was disease stability, and the overall survival time after diagnosis of leptomeningeal metastasis was more than 3 years.
Objective:To evaluate the efficacy, toxicity and the pattern of relapse associated with limited-field intensity-modulated radiotherapy (IMRT) for locoregionally advanced or recurrent papillary thyroid cancer (PTC) with residual disease.Methods:From October 2012 to May 2019, a retrospective analysis was conducted in 54 patients with locoregionally advanced or recurrent PTC treated with post-operative IMRT to the primary site with residual disease. For patients with local-only residual disease, the limited-field IMRT was administered. Elective lateral neck lymph node regions were not routinely irradiated.Results:The median follow-up was 82.3 months. All patients tolerated radiotherapy well. The acute adverse reactions associated with IMRT were mainly grade 1 to grade 2, and only 1 case had grade 3 radiation dermatitis. The estimated locoregional progression-free survival (LPFS) rate was 83% at 8 years. The estimated 8-year overall survival (OS) rate was 90%. Only 2 (4%) patients developed an isolated out-of-field nodal recurrence after limited-field RT.Conclusions:Post-operative limited-field IMRT provides durable LPFS and OS and low toxicity for patients with advanced or recurrent PTC with local-only residual disease. Out-of-field regional recurrence was rare. Further larger scaled study is warranted.
Gastric cancer is one of the most common malignant tumors of the digestive tract in China. Patients with advanced malignancies often develop metastases in liver, lung, adrenal glands, bone, brain, pelvic, retroperitoneal and peritoneal dissemination. Seminal vesicle metastasis is comparatively rare. In this case, a 69-year-old male patient who underwent subtotal gastrectomy with pathologic outcomes showing mucinous adenocarcinoma 11 years ago. In June 2020, she was admitted to hospital due to "progressive dysuria for 3 months, aggravation and urinary catheter for 2 days. With transperineal prostate biopsy, the pathological report showed mucinous adenocarcinoma. Immunohistochemical staining revealed CAM5.2(+), CEA(+), P5.4s(-), PSA(-). Combining with the history, the patient was diagnosed as seminal vesicle metastasis following subtotal gastrectomy. The docetaxel plus with tegafur regimen was given for 4 cycles. Anti-vomiting treatment and supportive therapy were taken during chemotherapy. The patient did not show significant nausea and vomiting, bone marrow suppression, or impaired liver function during the treatment period. The patient showed significant relief of dysuria after 2 cycles of medication, and had normal urination after removing the catheter, with CEA 12.8 ng/ml and CA19-9 508 ng/ml. Now the treatment continues in the follow-up.Gastric cancer is one of the most common malignant tumors of the digestive tract in China. Patients with advanced malignancies often develop metastases in liver, lung, adrenal glands, bone, brain, pelvic, retroperitoneal and peritoneal dissemination. Seminal vesicle metastasis is comparatively rare. In this case, a 69-year-old male patient who underwent subtotal gastrectomy with pathologic outcomes showing mucinous adenocarcinoma 11 years ago. In June 2020, she was admitted to hospital due to "progressive dysuria for 3 months, aggravation and urinary catheter for 2 days. With transperineal prostate biopsy, the pathological report showed mucinous adenocarcinoma. Immunohistochemical staining revealed CAM5.2(+), CEA(+), P5.4s(-), PSA(-). Combining with the history, the patient was diagnosed as seminal vesicle metastasis following subtotal gastrectomy. The docetaxel plus with tegafur regimen was given for 4 cycles. Anti-vomiting treatment and supportive therapy were taken during chemotherapy. The patient did not show significant nausea and vomiting, bone marrow suppression, or impaired liver function during the treatment period. The patient showed significant relief of dysuria after 2 cycles of medication, and had normal urination after removing the catheter, with CEA 12.8 ng/ml and CA19-9 508 ng/ml. Now the treatment continues in the follow-up.
