Objective To investigate the short-term efficacy of CT-guided microwave ablation(MWA)combined with percutaneous vertebroplasty(PVP)for spinal metastases,and to analyze the risk factors for postoperative cement leakage.Methods The clinical data of 50 patients with spinal metastases(74 diseased vertebrae in total),who were treated with CT-guided MW A combined with PVP at the authors'hospital from January 2020 to June 2023,were retrospectively analyzed.Numerical Pain Rating Scale(NRS),daily morphine consumption(DMC)and Activity of Daily Living Scale(ADL)were used to evaluate the short-term efficacy.Regular postoperative CT reexamination was carried out to assess the condition of local tumor control and bone cement leakage.Univariate analysis and multivariate binary logistic analysis of gender,age,maximum diameter of metastatic lesion,type of metastasis,Tomita classification of primary tumor,level of affected vertebrae,injected volume of bone cement,injection side,pathological fracture,and posterior vertebral wall rupture were performed to determine the risk factors for postoperative occurrence of bone cement leakage.Results The preoperative,and the postoperative one-day,one-week,one-month,3-month and 6-month NRS were(7.24±1.41),(4.76±1.45),(3.42±1.34),(2.86±0.90),(2.20±0.57),(1.66±0.72)points respectively.The preoperative,and the postoperative one-day,one-week,one-month,3-month and 6-month DMC were(110.40±94.61),(66.10±51.23),(47.30±37.49),(32.90±22.84),(25.60±18.97),(15.36±13.43)mg respectively.The preoperative,and the postoperative one-week,one-month,3-month and 6-month ADL were(40.80±11.45),(53.20±6.68),(60.40±5.14),(62.90±4.75),(64.80±4.51)points respectively.The differences in NRS,DMC,ADL between their preoperative values and postoperative 6-month values were statistically significant(all P＜0.05).Postoperative 6-month imaging follow-up check revealed that tumor was controlled in 46 patients and the tumor recurrence rate was 8％(4/50),and mild bone cement leakage occurred in 17 of 74 vertebrae(22.97％).Multivariate regression analysis indicated that pathological fracture(OR=9.581,95％CI=2.292-40.055,P=0.002)and rupture of posterior wall of vertebra(OR=5.105,95％CI=1.041-25.022,P=0.044)were the independent risk factors for bone cement leakage,the pathological fracture(OR=35.333,95％CI=4.029-309.840,P=0.001)was the independent risk factor for cortical bone cement leakage.No independent risk factor for vascular bone cement leakage was observed.The rupture of posterior wall of vertebra(OR=48.400,95％CI=4.725-495.753,P=0.001)was the independent risk factor for leakage of bone cement in spinal canal.Conclusion MW A combined with PVP can rapidly relieve pain,improve the ability of daily activity and quality of life of patients with spinal metastases,which can be further improved within 6 months after treatment.The combination use of MW A and PVP carries lower incidence of bone cement leakage.The pathological fracture and posterior wall rupture of vertebra are the independent risk factors for bone cement leakage.

Objective:To study the clinicopathological features, diagnosis and differential diagnosis of myeloid sarcoma of the breast.Methods:Ten cases of myeloid sarcoma (MS) and 19 cases of diffuse large B cell lymphoma (DLBCL) of the breast were selected from Peking University People′s Hospital from February 2005 to September 2019. The cases were evaluated by microscopy and immunohistochemistry basing on WHO classification (2008 and 2017).Results:For the 10 cases of MS, the mean and median age was 33.8 and 31 years (range 23 to 47 years) respectively. All patients presented with breast masses; six presented with B symptoms (6/10); and LDH level was elevated in four patients. The largest tumor dimension was 1.0 to 5.3 cm (mean 2.7 cm). All 10 patients had history of acute myeloid leukemia (AML), and in one patient, the AML occurred after chemotherapy for hydatidiform mole. One case was classified as M0, four were M2, two were M4 and three were M5. For the AML, all patients received chemotherapy and nine were treated by allogeneic hematopoietic stem cell transplant (allo-HSCT) and the breast masses occurred4 months to 2 years post-transplant. Using Ann Arbor staging, five cases were stage Ⅰ, three were stage Ⅱ, and 2 were stage Ⅳ. The MS was found in the left breast (two cases); right breast (three cases) and both breasts (five cases). Lymphocyte in peripheral blood, B symptom and site of lesion had statistical significance between myeloid sarcoma and DLBCL( P<0.05). The tumor cells were primitive, expressing MPO, CD43, CD117, etc. All ten patients had follow-up information, and the median survival period was 14.4 months (range 1 to 50 months). Seven patients died. The prognosis of patients with MS was worse than DLBCL( P=0.002). Conclusions:The clinical history, pathologic morphology, immunophenotyping and molecular studies are very important for diagnosing MS tumors in the breast, and MS may occur after allo-HSCT for AML. Tumor resection, chemotherapy, radiotherapy and donor lymphocyte infusion are recommended for treatment. The prognosis is poor.

Objective: To evaluate the effects of staining with carbon nanoparticles on the identification of parathyroid glands and lymph nodes during thyroid carcinoma surgery combined with lymphadenectomy. Methods: A total of 194 patients with papillary thyroid carcinoma who underwent thyroidectomy combined with lymphadenectomy from April 2016 to January 2018 were reviewed. Of them 104 cases were injected with carbon nanoparticles in operation area (nanocarbon group) and other 90 cases without the injection of carbon nanoparticles were as control group. The incidence of mistakenly dissection of parathyroid glands and the levels of serum calcium and parathyroid hormone in 1 day, 3 days, 1 month and 6 months after surgery were compared between two groups of patients. Chisquare and ranksum test were used to analyze 2 data. Results: There were no significant differences in age, gender, tumor size, operation time, extrathyroidal invasion and multifocality between two groups. Compared with control groups, nanocarbon group showed a significantly lower incidence of mistakenly dissection of parathyroid glands (8 cases vs 2 cases, 8.9% vs 1.9%,χ²=4.9, P=0.026) and a significantly lower incidence of hypoparathyroidism (41 cases vs 28 cases, 45.5% vs 26.9%, χ²=7.3, P=0.007). The number of lymph nodes dissected from central compartment was 791 in nanocarbon group and 536 in control groups, with a statistically significant difference (Z=-2.2, P=0.028). There was a significant difference in the number of lymph nodes removed from the right neck Ⅵb level between nanocarbon group and control group (41 nodes vs 93 nodes, Z=-2.1, P=0.034). Conclusion Treatment with nanocarbon can significantly facilitate the identification of the parathyroid during total thyroidectomy combined with central compartment lymphadenectomy, reduce the incidence of postoperative hypoparathyroidism, and improve the dissection of lymph node in the central compartment.