Mucosal malignant melanoma of the head and neck is one of the rarely malignant diseases. The standard therapy for mucosal melanoma of the head and neck is radical surgery associated with adjuvant radiation. The immunotherapy and chemotherapy are confirmed effective in some degree. Molecular staging and targeted therapy will be the new tendency in the future.

The afferent and efferent connections of middle suprasylvian gyrus (MSS) were studied in 18 cats by means of anterograde and retrograde transport of horseradish peroxidase (HRP). 0.1～0.4?l of saline solution containing 50％ HRP and 2％ DMSO (dimethylsulfoxide) was injected into the cortical areas (areas 5, 7, LS, 21, 19) of MSS according to the map of Heath and Jones (1971). The frozen sections were processed with TMB method. Each cortical area of MSS has reciprocal connections with ipsilateral pulvinar (PUL), lateral posterior nucleus (LP) and posterior nucleus (PN) of the lateral nuclear group of thalamus and central medial nucleus (NCM), paracentral nucleus (PC) and central lateral nucleus (CL) of the intralaminar nuclear group. The cortical areas in rostral part of MSS have additional connections with posterior nuclear group (PO), central median nucleus (CM), parafascicular nucleus (PF), ventral anterior nucleus (VA) and ventral lateral nucleus (VL). Labeled terminals are more packed in lateral nuclear group than in intralaminar nuclear group. In nuclear reticularis (R), zona incerta (ZI) and ventral nucleus of lateral geniculate body (GLv) only labeled terminals could be found.In addition, labeled terminals were found in caudate nucleus, putamen, pretecrum, colliculus superior and nuclei pontis and labeled cells could be seen in locus caeruleus, amygdala and nuclei raphe. Both labeled cells and terminals were present in claustrum bilaterally, but notably ipsilaterally.

All the cortical areas in MSS except for area 7 have reciprocal connections with primary sensory areas of the cerebral cortex (SⅠ, SⅡ) and with some thalamic nuclei which are related with specific sensations (e. g. layer B of lateral geniculate nucleus, medial interlaminar nucleus, medial part of posterior nuclear group).Area 7 lying in the central part of MSS, has close connections with its surrounding areas and is thus indirectly connected with the specific sensory system.Both homotopic and heterotopic callosal connections exist for some cortical areas of cat's MSS. The heterotopic callosal connections of a given cortical area are always corresponding to the areas which have ipsilateral connections with the given area.Most of the labeled cells are found in layer Ⅲ of cerebral cortex and are pyramidal in shape, the rest are in layer Ⅱ, Ⅳ,Ⅴ and Ⅵ. The labeled terminals (and/or preterminals) are distributed to all layers of cortex, predominantly in superficial layers (Ⅰ～Ⅲ).

Objective:To investigate the distant metastasis after primary treatment of papillary thyroid cancer (PTC) in children and adolescents.Methods:A retrospective analysis of 180 cases (54 boys and 126 girls, with an age range of 6-18 years) with PTC treated at the Chinese Medical Academy Cancer Hospital and Zhejiang Cancer Hospital from January 1, 2001 to December 31, 2014 was performed. Patients’ clinical and pathological data were collected. The follow-up results were statistically analyzed. The distant metastasis rate during the follow-up period was analyzed by the Kaplan-Meier method. Log-Rank test was used for univariate analysis and Cox regression model was established in multivariate analysis.Results:Twenty-four cases (13.3%) had distant metastases during following-up with a median of 92 months. The Log-Rank test showed that the younger age ≤15 years old (χ 2=11.803, P=0.001), the larger tumor diameter >20 mm (χ 2=5.776, P=0.016), multifocal (χ 2=11.205, P=0.001), bilateral tumor distribution (χ 2=19.804, P=0.001), invaded capsule (χ 2=10.808, P=0.001), and bilateral lymph nodes metastasis (χ 2=6.278, P=0.012) were risk factors for distant metastasis after initial treatment. The Cox regression analysis showed that age ≤15 years (hazard ratio [95% confidence interval]: 4.08[1.504-11.111], P=0.006) and bilateral tumor distribution (hazard ratio [95% confidence interval]: 4.77[1.903-11.966], P=0.001) were independent risk factors for distant metastasis after initial treatment. The risk factors for local recurrence and distant metastasis were similar, but the local recurrence could not be a significant predictor for distant metastasis. It was indicated that distant metastasis rate was lower in patients with total thyroidectomy in multifocal lesions groups (χ 2=5.891, P=0.015). Conclusions:Age, tumor size, invaded capsule, bilateral lymph nodes metastasis, multifocal and bilateral lesions are factors for predicting distant metastasis after primary treatment of PTC in children and adolescents. Total thyroidectomy is recommended for patients with multifocal and bilateral lesions.