目的 探讨与分析核磁弥散成像（DWI）及表观弥散系数（ADC）值在肝内非肿瘤性病变诊断与鉴别诊断中的价值。方法 选择2020年8月—2023年5月厦门大学附属第一医院收治的120例肝脏占位性病变患者为研究对象,所有患者均给予常规MRI与DWI,记录图像质量、信号特征,计算ADC值,评价诊断效能。结果 120例患者中,病理诊断为肝内非肿瘤性病变70例（非肿瘤组：肝脓肿32例、肝囊肿28例、肝炎性假瘤10例）,肝内肿瘤性病变50例（肿瘤组：肝血管瘤38例,肝癌12例）。非肿瘤组与肿瘤组的图像质量优良率分别为94.29%（66/70）与88.00%（44/50）,组间比较差异无统计学意义（χ²=1.509,P>0.05）。非肿瘤组的磁共振信号特征多为高信号（62.86%）,肿瘤组多为低信号（60.00%）,两组比较差异有统计学意义（χ²=45.691,P<0.05）。在b值为400 s/mm²和800 s/mm²条件下,非肿瘤组的ADC值（0.84±0.17、0.77±0.14）均低于肿瘤组（1.29±0.24、1.19±0.34）,差异有统计学意义（t=12.029、9.302,P<0.05）。DWI判断为肝内非肿瘤性病变68例,DWI在肝内非肿瘤性病变的鉴别诊断灵敏度与特异度分别为95.71%（67/70）和98.00%（49/50）,ROC曲线显示DWI在肝内非肿瘤性病变的诊断曲线下面积为0.895。结论 DWI在肝内非肿瘤性病变中的图像显示质量高,可通过信号特征与ADC判断病灶状况,对鉴别肝内非肿瘤性病变具有较高的诊断效能。

Objective To investigate and analyze the value of diffusion weighted imaging（DWI）and apparent diffusion coefficient（ADC）in the diagnosis and differential diagnosis of non neoplastic liver lesions．Methods A total of 120 patients with liver focal lesions admitted to the First Affiliated Hospital of Xiamen University from August 2020 to may 2023 were selected．All patients were given conventional MRI and DWI,the image quality and signal characteristics were recorded,the ADC value was calculated,and the diagnostic efficiency was evaluated．Results Among the 120 patients,70 cases were pathologically diagnosed as non neoplastic lesions（non tumor group,32 cases of liver abscess,28 cases of liver cyst,10 cases of hepatitis pseudotumor）,and 50 cases were neoplastic lesions（tumor group,38 cases of hepatic hemangioma,12 cases of liver cancer）．The excellent and good image quality rates of non tumor group and tumor group were 94.29%（66/70）and 88.00%（44/50）,respectively,and there was no significant difference between the two groups（χ²=1.509,P>0.05）．The MRI signal characteristics of non tumor group were mostly high signal（62.86%）,while the tumor group were mostly low signal（60.00%）,and the difference between the two groups was statistically significant（χ²=45.691,P<0.05）．When the b value was 400 s/mm² and 800 s/mm²,the ADC value of non tumor group（0.84±0.17,0.77±0.14）was significantly lower than that of tumor group．The difference was statistically significant（t=12.029,9.302,P<0.05）．Sixty-eight patients were diagnosed as non neoplastic lesions by DWI．The sensitivity and specificity of DWI in the differential diagnosis of non neoplastic lesions were 95.71%（67/70）and 98.00%（49/50）,respectively．The ROC curve shows that the area under the diagnostic curve of DWI for non tumor lesions in the liver was 0.895．Conclusion sDWI has high image quality in the diagnosis of non neoplastic lesions in the liver．Doctors can judge the status of lesions by signal characteristics and ADC,which has high diagnostic efficiency in the identification of non neoplastic lesions in the liver．

目的 探讨多原发恶性肿瘤(MPMN)的临床特点,提高该类型肿瘤的认识,为临床诊断及治疗提供一定的经验。方法 分析2021年12月广州市第一人民医院呼吸与危重症学科二区收治的1例乳腺、甲状腺及肺三重多原发恶性肿瘤的临床特点及诊治经过,并结合相关文献进行回顾分析。结果 该例首患乳腺导管内癌并予手术切除,9年后再同时患肺癌及甲状腺癌,最终确诊为三重多原发恶性肿瘤。结论 通过对多原发恶性肿瘤的临床特点的分析研究,可一定程度提高临床医生对MPMN的认知以及早期临床鉴别的能力,亦为肿瘤患者早期诊断、早期治疗提供更好的时机,改善患者生活质量。

Objective To explore the clinical characteristics of multiple primary malignant neoplasms (MPMN), to improve the understanding of this type of tumors, and to provide some experience for clinical diagnosis and treatment. Methods The clinical characteristics, diagnosis and treatment of a case with triple MPMN of breast, thyroid and lung treated in the Respiratory and Critical Care Department (Area 2) of Guangzhou First People's Hospital in December 2021 were analyzed retrospectively. Results The breast intraductal carcinoma was the first tumor of that case and had been resected, and 9 years later, lung cancer and thyroid cancer occured at the same time, which were diagnosed as triple MPMN. Conclusions The analysis and study of the clinical characteristics of MPMN can improve the clinicians' cognition and the ability of early clinical differentiation, and provide a better opportunity for early diagnosis and early treatment of tumor patients, and improve their quality of life.

N⁶-甲基腺苷(N⁶-methyladenosine, m⁶A)修饰是真核生物信使 RNA中最丰富的表观遗传修饰,其失调会导致mRNA异常生物学行为如翻译和降解紊乱,从而调控肿瘤发生发展。近期研究表明m⁶A在免疫调控过程中可发挥重要作用,其不仅可调节免疫细胞的活化,还在肿瘤微环境中免疫应答发挥重要调控作用,从而影响免疫治疗效果。越来越多的证据表明m⁶A修饰可能是肿瘤免疫治疗的重要潜在干预靶点。本文阐述了免疫细胞中m⁶A修饰调控及其在肿瘤免疫微环境中相关调节作用,并进一步探讨了靶向m⁶A调控蛋白在肿瘤免疫治疗中的干预策略及潜在治疗价值。

N⁶-methyladenosine (m⁶A) modification is the most abundant epigenetic modification in eukaryotic messenger RNA (messenger RNA). Its dysregulation drives abnormal transcription and translation processes, which promotes the occurrence and development of tumors. Studies have shown that m⁶A modification can regulate the activation of immune cells and their infiltration into the tumor microenvironment (TME), which may affect the efficiency of immunotherapy. Therefore, m⁶A modification may be a potential target for tumor immunotherapy. This paper describes the modification of m⁶A in immune cells and the antitumor immune response associated with TME, and explores the potential therapeutic value of targeting m⁶A regulators in tumor immunotherapy.

目的 学习母细胞性浆细胞样树突细胞肿瘤(BPDCN)的临床病理及免疫表型特征,总结该少见肿瘤的病理诊断经验。方法 回顾分析2例BPDCN患者临床资料,通过苏木素-伊红(HE)染色分析肿瘤组织及细胞形态,通过免疫组织化学染色分析肿瘤免疫表型,通过流式细胞学检测骨髓有无肿瘤侵犯,并结合文献分析。结果 本报道中1例为97岁女性,临床以皮肤瘀斑结节为首发症状,肿瘤细胞真皮内弥漫浸润,不侵犯表皮,细胞中等大小,核形不规则,核仁不明显。另1例为69岁男性,临床以淋巴结肿大为首发症状,淋巴结结构完全破坏,肿瘤细胞弥漫浸润,细胞呈中等大小的母细胞样,核仁明显。2例免疫表型均表达CD123、CD4、CD56、TDT,不表达B系、T系淋巴细胞及髓系标志物,肿瘤均累及骨髓。结论 BPDCN是一种罕见的淋巴造血肿瘤,临床常以皮肤病变或淋巴结肿大为首发症状,临床过程具高度侵袭性,通常伴有骨髓侵犯。该肿瘤需与具有母细胞形态的淋巴系肿瘤和白血病相鉴别,诊断需结合临床信息、HE形态及免疫组化结果综合判断。

Objective To summarize the diagnostic experiences of blastic plasmacytoid dendritic cell neoplasm (BPDCN) based on the study of its clinicopathological features and immunophenotypes. Methods The clinical data of 2 patients with BPDCN were collected, the structure alteration and cell morphology were observed by HE staining, the immunophenotype of tumor cells were studied by immunohistochemistry staining and flow cytometry was adopted to confirm the bone marrow involvement. Results Two patients, one of whom was a 97 year-old female, presented with cutaneous ecchymosis nodules as the first symptom. The epidermis, but not the dermal, was diffusedly infiltrated by tumor cells, which were medium-sized with irregular nuclei without prominent nucleoli. The other case was a 69 year-old male with lymph node enlargement as the first symptom. The skin was normal, but the lymph nodes were invasively destroyed by tumor cells, which were medium-sized blast-like with prominent nucleoli. The immunophenotypes of the two patients were both positive for CD123, CD4, CD56 and TDT, but negative for B, T lymphocyte derived and myeloid origin markers, both of which involved bone marrow. Conclusions BPDCN is a rare form of hematological neoplasm, skin symptoms or lymph node enlargement may be presented as the initial symptom, the clinical course were highly aggressive with high frequency of bone marrow involvement. The blastic-like lymphoma and leukemia entities should be considered into account for differential diagnose. The precise diagnosis of BPDCN should be established by integrating histomorphology, immunophenotype and clinical presentation information comprehensively.

肿瘤相关巨噬细胞（TAMs）是肿瘤微环境中最丰富的免疫细胞之一,M2-TAMs在肿瘤发生、发展、转移和治疗过程中发挥重要作用,被认为是肿瘤治疗中的重要靶点。已有的研究表明,通过将促肿瘤的M2-TAMs重编程为促炎的M1-TAMs可实现抑制肿瘤生长和转移。本综述在介绍TAMs与肿瘤治疗相关背景的基础上,重点关注纳米药物重编程TAMs增强抗肿瘤的研究进展。本文将从TAMs靶向递送各种活性物质进行重编程TAMs和纳米药物介导的异常肿瘤微环境调节的间接重编程TAMs两种方式,综述近年来基于纳米药物递送系统的调控策略及典型例子。

Tumor associated macrophages（TAMs）is one of the most abundant immune cells in the tumor microenvironment．M2-TAMs play an important role in tumor genesis,progression,metastasis and treatment,and is additionally a very important target in tumor therapy．Previous studies have shown that inhibition of tumor growth and metastasis can be achieved by reprogramming M2-TAMs to M1-TAMs．On the basis,this review focuses on the analysis progress of nano-drug reprogramming TAMs to boost anti-tumor．In this paper,we reviewed two methods of reprogramming TAMs for targeted delivery of various active substances and indirect reprogramming TAMs for abnormal tumor microenvironment regulation mediated by nanomedicine．The regulatory strategies and typical samples of nanomedicine delivery systems in recent years were summarized.

目的 探讨桥小脑角肿瘤微创切除术中应用神经内镜对其功能恢复及预后的影响,以便临床寻找出更有效的治疗方案,进而改善患者预后。方法 本次研究对象为赣州市人民医院2017年6月—2022年1月收治的82例桥小脑角肿瘤患者,用随机数字表法将其分为对照组（41例）和实验组（41例）。对照组患者给予常规显微手术治疗,实验组患者给予神经内镜辅助常规显微手术治疗,2组患者均于术后观察8周。比较2组患者肿瘤全切率,手术时间、住院时间及住院费用,术前及术后2、4、8周格拉斯哥预后量表（GOS）评分,以及术后8周内并发症发生情况。结果 肿瘤全切率：实验组患者术后8周（90.24%）与对照组（73.17%）相比,处于更高水平;手术时间、住院时间：实验组患者与对照组相比,处于更短水平;GOS评分：术前至术后2周,2组患者评分均呈下降趋势,术后2周至8周,2组患者评分呈升高趋势,其中实验组术后2、4、8周与对照组相比,处于更高水平,差异有统计学意义（P<0.05）;并发症总发生率：术后8周内,实验组患者（4.88%）与对照组（17.07%）相比,差异无统计学意义（P>0.05）。结论 桥小脑角肿瘤微创切除术中应用神经内镜,可有效缓解患者的临床症状,优化手术相关指标,减轻神经功能受损,提高肿瘤全切率,改善预后,且安全性高。

Objective To investigate the effect of neuroendoscope on functional recovery and prognosis of patients with cerebellopontine angle tumor after microinvasive resection,so as to find out more effective treatment and improve the prognosis of patients．Methods The subjects were 82 patients with cerebellopontine angle tumors admitted to Ganzhou People's Hospital from June 2017 to January 2022．They were divided into control group（n = 41）and experimental group（n = 41）by random number table method．Patients in the control group were treated with conventional microsurgery,while patients in the experimental group were treated with neuroendoscope assisted conventional microsurgery．All patients were observed for 8 weeks after operation．The total tumor resection rate,operation time,hospitalization time,hospitalization expense,Glasgow Outcome Scale（GOS）score before and 2,4,8 weeks after operation,and complications within 8 weeks after operation were compared between the two groups．Results Compared with the control group（73.17%）,the patients in the experimental group had a higher resection removal rate of tumor after 8 weeks of operation（90.24%）．Patients in the experimental group had a shorter operation time and hospital stay than those in the control group．From pre-operation to 2 weeks after operation,the GOS scores of patients in both groups showed a downward trend,and from 2 weeks to 8 weeks after operation,the scores of patients in both groups showed an upward trend,and the patients in the experimental group were at a higher level than those in the control group at 2,4,8 weeks after operation,the difference were statistically significant（P < 0.05）．Within 8 weeks after surgery,there was no significant difference in total incidence of complications between the experimental group（4.88%）and the control group（17.07%,P > 0.05）．Conclusions The application of neuroendoscope in the minimally invasive surgery of cerebellopontine angle tumor can effectively relieve the clinical symptoms of patients,optimize the operation-related indexes,reduce the damage of nerve function,increase the total resection rate of tumor,improve the prognosis,and with high safety．

目的 探讨慢性淋巴细胞白血病（CLL）合并第二肿瘤临床特征和预后。方法 回顾性分析2015年8月—2021年10月我院收治的58例CLL患者,其中有11例合并第二肿瘤,47例无合并第二肿瘤,分析两组病例的临床特征及其对预后的影响。结果 CLL合并第二肿瘤和无合并第二肿瘤患者在年龄、性别、白细胞计数、血红蛋白水平、淋巴细胞计数、血小板计数、乳酸脱氢酶（LDH）、β₂-微球蛋白（β₂-MG）水平、分期、单个基因缺失类型之间比较差异无统计学意义,但CLL合并第二肿瘤患者基因缺失个数较无合并第二肿瘤CLL患者组高（χ²=11.17,P=0.03）,且总生存期较短。结论 CLL合并第二肿瘤患者常伴有多个基因缺失,且预后差,当CLL患者伴有多个基因缺失时,在诊治过程中需警惕有无合并第二肿瘤。

Objective To investigate the prognosis and clinical characteristics of chronic lymphocytic leukemia（CLL）patients with second tumor．Methods A retrospective analysis was performed on 58 cases of CLL patients who were diagnosed in our hospital from August 2015 to October 2021．The clinical data of 11 CLL patients with second cancer and 47 CLL patients without second cancer were compared and analyzed．Results There were no significant differences in age,sex,white blood cell count,lymphocyte count,platelet count,the level of serum β₂-microglobulin and lactate dehydrogenase between two groups．However,in CLL patients with second cancer,the incidence of multiple genetic deletions was higher than those without second cancer（χ² =11.17,P =0.03）．The overall survival time was shorter in CLL patients with second primary cancer．Conclusions CLL patients with second tumor have a frequent multiple gene deletions and poor prognosis．Physicians should pay attention to second cancers when diagnosing the CLL patients with multiple gene deletions．

目的 分析在胃癌诊断中应用人表皮生长因子受体2（HER-2）结合肿瘤标志物检测的意义。方法 回顾性选取2019年6月—2021年6月我院收治的100例胃癌患者作为胃癌组,另选同期收治的60例胃良性肿瘤患者作为胃良性肿瘤组。比较HER-2与多项肿瘤标志物检测的诊断效能等。结果 胃癌组HER-2、糖类抗原（CA）125、CA72-4及CA19-9浓度与阳性表达率高于胃良性肿瘤组（P<0.05）。对于胃癌诊断,免疫组化指标HER-2检测的敏感度为72.00%,正确率为77.00%;多项肿瘤标志物检测的敏感度为77.00%,正确率为80.00%;二者联合检测的敏感度为89.00%,正确率为90.00%;相较于多项肿瘤标志物与HER-2单一检测,二者联合检验的正确率、敏感度更高（P<0.05）。结论 HER-2结合血清肿瘤标志物检验对胃癌的诊断价值较高。

Objective To analyze the significance of human epidermal growth factor receptor 2（HER-2）combined with tumor marker in the diagnosis of gastric cancer．Methods A total of 100 patients with gastric cancer admitted to our hospital from June 2019 to June 2021 were retrospectively selected as the gastric cancer group, and 60 cases of gastric benign tumor admitted to our hospital during the same period were also selected．The diagnostic efficacy of HER-2 was compared with those of multiple tumor markers．Results The concentration and positive expression rate of HER-2, carbohydrate antigen（CA）125, CA72-4 and CA19-9 in gastric cancer group were higher than those in gastric benign tumor group（P<0.05）．For the diagnosis of gastric cancer, the sensitivity of the immunohistochemical indicator HER-2 detection was 72.00%, and the accuracy rate was 77.00%．The sensitivity and accuracy of detecting multiple tumor markers were 77.00% and 80.00%, respectively．The sensitivity of the combined detection of the two was 89.00%, and the accuracy was 90.00%．Compared to multiple tumor markers and HER-2 single detection, the combined test of the two had a higher accuracy and sensitivity（P<0.05）．Conclusions The detection of HER-2 combined with serum tumor markers has high diagnostic value for gastric cancer．

融合基因是指两个独立基因的编码区首尾相连所形成的且置于同一套调控序列控制的产物,研究表明许多癌症的发生与融合基因存在密切的联系。融合基因可作为癌症治疗的靶点,在癌症诊断及治疗领域中融合基因的研究具有重要意义。部分融合基因驱动癌症的机制已被初步揭示,但是有些真实存在的在肿瘤发生发展过程中有重要意义的融合基因由于工具和实验技术限制还未被发现。因此,对融合基因的分析预测研究方法逐渐成为关注的热点之一。本文探讨了目前常用的关于融合基因的分析工具及方法,为融合基因在癌症中的研究提供思路。

Fusion genes are the products of two independent genes whose coding regions are linked and controlled by the same set of regulatory sequences．Studies have shown that many cancers are closely linked to gene fusions．Fusion genes can be used as targets for cancer therapy,and the study of fusion genes is of great importance in cancer diagnosis and treatment．Some of the mechanisms of fusion genes driving cancer have been initially revealed,but there are more fusion genes which are important in the process of tumor development have not been discovered due to the limitation of tools and experimental techniques．Therefore,the analysis and prediction methods of fusion genes are becoming a hot topic of interest．In this paper,we discuss the commonly used analytical tools and methods on fusion genes to provide ideas for the study of fusion genes in cancer．

嵌合基因是指由两个或多个原本不连续的基因片段重组而成的新基因,它们可以通过基因组重排、转录诱导等机制产生。嵌合基因在正常生理和发育过程中具有重要的功能和调控作用。嵌合基因可以改变原有基因的表达水平、编码蛋白质的结构和功能、信号通路的激活和抑制等,从而促进肿瘤细胞的增殖、侵袭、转移和耐药性。近年来,随着高通量测序技术的发展和应用,越来越多的嵌合基因被发现和鉴定,它们在不同类型的肿瘤中具有不同的表达模式和功能作用,为肿瘤的分子诊断、预后评估和靶向治疗提供了新的机会和挑战。本文旨在对嵌合基因产生的机制、检测方法和在肿瘤中的功能和应用等方面进行综述,为进一步认识嵌合基因在肿瘤进展中的功能机制及其精准化治疗提供参考。

Chimeric genes refer to novel genes formed by the recombination of two or more originally non-contiguous gene fragments through mechanisms like genomic rearrangement and transcriptional induction．They play important roles in physiological and developmental regulation．Chimeric genes can alter the expression,structure and function of original genes,modulate signaling pathway activation and inhibition,and thereby promote tumor cell proliferation,invasion,metastasis and drug resistance．In recent years,with the development and application of high-throughput sequencing technologies,increasing numbers of chimeric genes have been discovered and identified．They demonstrate different expression patterns and functional roles in various tumor types,providing new opportunities and challenges for molecular diagnosis,prognostic assessment and targeted therapy of cancers．This review summarizes the mechanisms of chimeric gene formation,detection methods and their functions and applications in tumors,to provide insights into the functional mechanisms of chimeric genes in tumor progression and their implications for precision treatment．