Objective To evaluate the characteristics of two angiographic manifestation of ocular fundus in choroidal metastatic carcinomas. Methods Fundus fluoresein angiography (FFA) and indocyanine green angiography (ICGA) were performed on 17 patients (24 eyes) with choroidal metastatic carcinomas, and the characteristics of these two kinds of angiograms were analyzed and compared each other. Results According to various clinical features, e.g., locations of metastatic tumor in ocular fundus, disease course, and different kinds of original malignancy, the findings of ocular fundus were divided into (1) Isolation type: FFA showed pinpoint and mottled leaks against hypofluorescence background, increased and confluent fluoresecence in later stage. ICGA showed the similar images as in FFA, except later appearance of leaks and the choroidal vesseles could be seen beneath the thin metastatic tumor mass.(2) Diffusion type: Tumors showed hypofluorescence in early stage and uneven ill-defined hyperfluorescence both in FFA and in ICGA. (3) Small metastatic carcinomas: Hypofluorescence in early stage and mild mottled hyperfluorescence were found in FFA as well as in ICGA. Conclusion Both FFA and ICGA are helpful in the diagnosis of choroidal metastatic tumors and ICGA may be conducive if there are some troubles in diagnosing the tumors with FFA. (Chin J Ocul Fundus Dis, 2002, 18: 92-95)
Objective To evaluate the therapeutic effects of percutaneous microwave ablation (MWA) for metastatic liver cancer. Methods Ultrasound-guided percutaneous MWA technique was used to treat 27 cases of hepatic metastases with 69 nodules 〔0.9-13.2 (3.0±2.0) cm in diameter〕. Local therapeutic effect, local and distant recurrence rate and survival rate were evaluated respectively. Results The complete ablation (CA) rate which was used to evaluate the local therapeutic effects was 92.8% (64/69), with 100% (34/34), 92.3%(24/26) and 66.7% (6/9) in a diameter of nodules lt;3.0 cm, 3.0-5.0 cm and ≥5.0 cm respectively. The CA rate was lower in the group of a diameter of nodules ≥5.0 cm as compared with other two groups (Plt;0.05). The local recurrence rate was 9.4% (6/64), with 2.9% (1/34), 16.7% (4/24) and 16.7% (1/6) in a diameter of nodules lt;3.0 cm, 3.0-5.0 cm and ≥5.0 cm respectively. The intrahepatic distant recurrence rate was 44.4% (12/27). The follow-up time after MWA was 3－34 (17.0±8.7) months. During the follow-up period, 6 months, 1 and 2-year cumulative survival rate was 88.9%, 63.0% and 34.4% respectively, with a mean survival time of 17.8 months, and with a median survival time of 19.0 months.Conclusion Percutaneous MWA treatment offers satisfactory local tumoricidal efficacy to metastatic liver cancer and the patients with recurrence and new metastases can be therapy repeatedly to improve long-term survival.
ObjectiveTo systematically review the efficacy and safety of 89SrCl2 for bone metastases.MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 12, 2016), MEDLINE, CBM, VIP, CNKI and WanFang Data were electronically searched from inception to December 2016 to collect randomized controlled trials (RCT) about 89SrCl2 in the treatment of bone metastases. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 19 RCTs involving 1 899 patients were included. The results of meta-analysis showed that: compared to the group without 89SrCl2, group of 89SrCl2 combined with other treatments had benefits for complete relief of bone pain (RR=1.53, 95%CI 1.16 to 2.01, P=0.002), total relief of bone pain (RR=1.33, 95%CI 1.22 to 1.45, P<0.001), bone metastases complete response rate (RR=1.61, 95%CI 1.20 to 2.16, P=0.002), bone metastases total response rate (RR=1.61, 95%CI 1.26 to 2.08, P<0.001), improvement of quality of life (RR=1.44, 95%CI 1.06 to 1.97, P=0.02). The proportion of pain flare (RR=10.35, 95%CI 2.01 to 53.37, P=0.005), leucopenia (RR=2.49, 95%CI 1.84 to 3.37, P<0.001) and thrombocytopenia (RR=2.64, 95%CI 1.76 to 3.97, P<0.001) in the 89SrCl2 group were higher than that in the control group.Conclusion89SrCl2 combined with the other treatments is better for bone metastases than without 89SrCl2. Due to the limited quantity and quality of included studies, the above results should be verify by more high quality studies.
Objective To investigate the influence of CO2-insufflation pressure on invasion potential of the colon cancer cells. Methods With an in vitro artificial pneumoperitoneum model, SW1116 human colon cancer cells were exposed to CO2-insufflation of 5 different pressure groups: 6, 9, 12, 15 mm Hg and control group, respectively for 1 h. The invasion capacities of SW1116 cells exposed to CO2-insufflation of 5 different pressure groups were detected by cell adhesion/invasion assay in vitro. Results Immediately following exposure to 15 mm Hg CO2 insufflation, the invasion of SW1116 cells decreased significantly compared to the cells before exposure. At the 0 h time point, the cells exposed to 15 mm Hg were significantly less invasive than those exposed to the other insufflation pressure (P＜0.05), and the cells exposed to 6 mm Hg were more invasive than cells exposed to the other insufflation pressure (P＜0.05). And 72 h after exposed to CO2-insufflation, the differences between the pressure groups were not significant. Conclusion CO2-insufflation induced a temporary change in the invasion capacity of cancer cells in vitro, higher pressure of CO2-insufflation inhibits the invasion potential.
Objective To observe the clinical and pathological characteristics of choroidal metastatic carcinoma from lung carcinoma.Methods The clinical and pathological data of 6 patients with choroidal metastatic carcinoma from lung carcinima were analysed retrospectively.Results All the 6 patients had severe visual impairment, including 3 with severe ophthalmalgia. Flat neoplasm were seen in the posterior pole of the eyes in all the 6 patients and retinal detachment were found in 5 patients. Fundus fluorescein angiography (FFA) examination had been performed on 1 patient and blocked fluorescence and hyperfluorescence were seen in the lesion with pinpoint fluorescein leakage loop around it. CT examination had been performed on 3 patients and the shadow of flat homogenous tumor was seen. MRI examination had been performed on 1 patient and high signal intensit ies on T1W and low signal intensities on T2W were found. In all the 6 patients with primary lung carcinoma, 5 were diagnosed with adenocarcinoma and 1 with cellule carcinoma through pathological examination, and 5 patients were diagnosed with choroidal metastatic carcinoma from adenocarcinoma and 1 with choroidal metastatic carcinoma from cellule carcinoma through pathological examination.Conclusion Rapid visual acuity decrease, severe ophthalmalgia, flat neoplasm in ocular fundus and secondary retinal detachment are the main clinical characteristics of the choroidal metastatic carcinoma from lung carcinoma. Most histopathologica l manifestations of the metastatic carcinoma like that of the primary focus, and adenocarninoma is the most common histoclassification. (Chin J Ocul Fundus Dis，2003，19：333-404)
ObjectiveTo observe the clinical characteristics and survival rate of the patients with extraocular retinoblastoma (RB). MethodsThis is a retrospective case analysis. From November 2003 to May 2015, 38 eyes of 31 patients with RB in the extra-ocular stage from 213 RB patients were enrolled in this study. There were 18 males and 13 females. Bilateral lesions were observed in 7 patients and unilateral lesions were observed in 24 patients.19 patients were diagnosed at less than 2 years old, 10 patients at 2 to 5 years old, and 2 patients at age over 5 years old. First visit time was less than 1 month in 12 patients, from 1 to 3 months in 15 patients, over 3 months to 6 months in 4 patients. Medical history and family history were record at the first visit. All patients underwent orbital CT, MRI, double color Doppler imaging and wide angle digital retinal imaging system. CT and (or) MRI examination detected tumor extraocular invasion. Histopathological examination showed that there were tumor cells invasion of the scleral, optic nerve root and optic nerve. Chemotherapy was done after surgery. In the extra-ocular stage, 3 to 6 rounds of intensive chemotherapy combined with orbital radiotherapy were done. The average follow-up period was (25.5±4.5) months after treatment. The cumulative survival rate was observed after 6 months, 1 and 5 years after treatment, and the relationship between the initial age, time, sex, single eye, tumor and survival time of the patients was analyzed. ResultsThe extraocular RB accounted 14.55% of all RB patients in this study. There is no family history of RB, no special history. There were 15 patients with leukocoria and yellow-white reflection in the pupil; 5 patients with lacrimation, swelling, photophobia and exophthalmos; 11 patients with strabismus. The cumulative survival rate at 6 months, 1, 5 years after treatment was (78.0±9.0)%, (62.0±11.0)%, (57.0±11.0)% respectively. The average survival time was (53.9±7.8) months; the cumulative survival rate was (59.3±11.3)%. When the age of first visit was less than 1 month, 1-3 months, 3-6 months, the median survival time was 78, 15 and 18 months respectively, the cumulative survival rate was 100.0%, (40.0±21.9)% and (25.0±21.7)%, respectively. The survival time of the newly diagnosed patients at 1 month was more than at 1 to 6 months, and the difference was statistically significant (t=9.20, P < 0.05). Conclusions14.55% of all RB patients was extraocular RB in this study. One of the most common clinical manifestations is leukocoria at the first visit. The cumulative survival rate of extraocular RB is lower, while the survival rate of patients with the age of first visit time was less than 1 month is higher.
ObjectiveTo observe the effect of systemic chemotherapy on conditions of tumor infiltrating,metastasis and disease-specific survival (DSS) for advanced retinoblastoma (RB). MethodsForty-one patients with advanced RB who received enucleation were enrolled in this study. There were 26 males and 15 females, age at diagnosis was ranged from 2 to 72 months, with a mean of 23.08 months. There were 16 bilateral patients and 25 unilateral patients; 13 group D eyes and 28 group E eyes. 16 patients received enucleation as the primary treatment (operation group), 25 eyes received chemotherapy before enucleation (chemotherapy group). There was no significant statistical difference between two groups for the gender, unilateral and bilateral, international staging or diagnostic age (P>0.05). The histopathology report was performed to assess the risk of postoperative tumor-node-metastasis staging (pTNM) in each patient, and the extent of tumor invasion in the optic nerve, choroid and anterior chamber was divided into 3 levels of low risk, medium risk and high risk. Five deaths were all in the group E with chemotherapy before enucleation. Using R software survival analysis software package survfit function, the application of Kaplan-Meier estimation method, DSS of RB children was calculated from the time of diagnosis, up to the date of the death of patient. DSS differences between chemotherapy, operation group and eye removal time (more than 3 months, less than 3 months) in group E RB children were analyzed. ResultsThe proportion of high risk pTNM stage in chemotherapy group was significantly lower than the operation group. But there was no significant difference between the two groups in the overall risk classification (χ2=3.130,P=0.077). For group D eyes, the overall risk classification in chemotherapy group was significantly lower than the operation group (χ2=5.870,P=0.015). There was no significant difference between the two groups in the overall risk of group E eyes (χ2=0.020,P=0.889). The DSS in chemotherapy group and operation group were 0.71 and 1.00, respectively; the difference was significant (χ2=3.700,P=0.05). The DSS in children whose enucleation delayed for more than 3 months and children whose enucleation performed within 3 months were 0.64 and 1.00, respectively; the difference was significant (χ2=4.800,P=0.028). ConclusionSystemic chemotherapy did not reduce the risk of tumor invasion and metastasis in patients with advanced RB. Instead, it will reduce the DSS in group E eyes of RB.
Objective To summarize the application and advancement of liver transplantation for hepatic metastasis from neuroendocrine tumor. Methods Domestic and overseas publications on the study of liver transplantation for hepatic metastasis from neuroendocrine tumor in recent years were collected and reviewed. Results Liver transplantation can offer good relief of symptoms, long disease-free intervals, and potential cure in individual patients with hepatic metastatic tumor. Important selection criteria are well-differentiated tumors and a low proliferation rate (Ki67＜10%). Conclusion In carefully selected patients with metastatic neuroendocrine tumors, liver transplantation is an appropriate option.
Objective To approach histologically the degree of choroidal invasions of retinoblastoma and their relations with metastasis and prognosis. Methods The pathological sections of 297 enucleated eyeballs with retinoblastom from June 1985 to 1995 were reviewed under light microscope.For the sake of assessing the risk factors of the prognosis of the disease,the graduation of the choroidal invasion was in vestigated in particular,and the follow-up of this genesis were performed as well. Results According to the degree of affection of the intraocular tissues from the tumor cells especially the choroid as the crucial structure,the choroidal invasions were classified into the following 5 categories:0，prereactive phase of retinal pigment epithelium(144/297,48.48%).Ⅰ，reactive phase of retinal pigment epithelium(81/297，27.27%).Ⅱ, early phase of choroidal invasion( 29/297,9.76%).Ⅲ, middle phase of choroidal invasion(17/297,5.72%).Ⅳ， advanced phase of choroidal in vasion(26/297,8.75%).24.24% of cases were found in phases Ⅱ-Ⅳ (so called choroidal invasion).The mortality in patients with phases 0～Ⅲ was found to be 0.4% in the average follow-up period of 51.8 months,and inpatients with phase Ⅳ was found to be 12.0%. Conclusion The retinoblastoma patient with the advanced phase of choroidal invasion (choroida l invasion with great extent) had relative high metastatic rate and poor prognos is. (Chin J Ocul Fundus Dis,1999,15:88-90)
ObjectiveTo explore the relation between vascular endothelial growth factor （VEGF） and the formation of tumor thrombosis in the main trunks of portal vein (PVTT). MethodsTumor specimens were collected from 36 patients (16 patients with PVTT, the other patients without PVTT and metastasis) undergoing resection of hepatocellular carcinoma (HCC) and portal thrombectemy, PVTT specimens of 16 patients named group A1, the same patients’ with HCC named group A2, tumor specimens of the other patients named group B. In situ hybridization and immunohistochemistry were used to investigate VEGF mRNA, protein and microvessel density (MVD) on surgical specimens. The intensity was evaluated using a computer image analyzercell analysis system.ResultsVEGF mRNA expression was detected in the tumor’ cell of the specimens. The expression rates of VEGF mRNA in the group B, A2, A1 were 30%, 100%, 100% respectively, and the expression rates of VEGF mRNA in group A2 and A1 were higher than that in group B （P＜0.01）. The intensity of VEGF mRNA in group A2 （0.078 5±0.019 6） were lower than in group A1 （0.194 4±0.059 0） （P＜0.01）. VEGF protein expression was often detected in the tumor cell, vascular endothelial cell and fibroblast cells. Invasion was detected in small vein in group A2, more tumor cell colony detected in group A1. The expression rates of VEGF protein in group B, A2, A1 were same as VEGF mRNA; the intensity of VEGF protein in A1 （0.165 6± 0.034 5） was higher than in group A2 （0.108 1±0.024 3） （P＜0.01）. MVD in group B, A2, A1 was 31.9±14.4, 63.3±15.1, 116±27.6/view of 200 microscopefield, MVD in group A1 was higher than group A2 （P＜0.01）, higher in group A2 than in group B. There was a statistically significant correlation between the intensity of VEGF expression and MVD in group B,A2 and A1. ConclusionVEGF could play an important role in the invasion, metastasis of HCC and the formation of PVTT. Angiogenesis in tumor is correlated well with the progression of HCC.