[醫如往常] Senior Clerkship Day 117: Pathology: Post radiation sarcoma

Triple Cancer

SPC 吳醫師

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病人無法躺平

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Oral mass for 2 years

89 y/o woman1

1) Nasopharyngeal carcinoma, unknown stage and type, status post radiotherapy in 195X, 

2) Tongue cancer, squamous cell carcinoma, pT1N0M0 stage I, status post left partial glossectomy in 200X

3) Post-irradiation sarcoma, pT2, hospice care, with progression in 2016

4) Lung cancer, adenocarcionoma, early stage, status post lobectomy 15 years ago, 

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Radiation induced sarcoma

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Radiation induced encephalomalacia

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Lung lobectomy

Psmomma body

Lymphadenoma

NPC

CK5 6

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NPC

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Keratin

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Post radiation sarcoma

CK, pan CK, SMA, DESMIN, S 100, myogenin, H3k27me3 (-)

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CD99, INI1, p53, ki67 +

P16, HHV8, EBV -

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RIS

至少要照四年以上才會長

Mitosis

C myc gene

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[醫如往常] Senior Clerkship Day 96: Lab Medicine: ERCA mutation

ERCA mutation molecular diagnosis 俞教授

Ovarian cancer 2nd most common

15% familial BRCA1, 2

No hot spot

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BRCAness phenotype

Platinum

PARP inhibitor

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Oraparib 亞洲上市

台灣沒有

Hazard ratio 0.35

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>3000 kinds

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Germline 18%

Somatic 7% both alleles mutation in cancer cells

• Mutation >50%
• Wild type homozygous mutations

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Capture-based method (ion torrent)

Long range PCR， 分成十段overlap 10k segments

Singapore也要送臺灣做NGS

台灣可以做tissue, 很先進

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大部分用MiSeq

Illumina 只能用blood, 不能tissue

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Setup of BRCA Database

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Founder mutation

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五階mutation

1. Pathogenic 用藥很有效
2. Pathogenic-like
3. Variant of uncertain genecity 人數最多
4. Non-pathogenic
5. Normal-like

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BRCA functional mutation: positive

Other mutation 只能註記有

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之後主流

Immunooncology (IO)

Head and neck, 人數跟lung相當

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IHC Synchronization也是努力的目標

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研究比較有信譽

• 中科院
• 浙江
• 華西
• 復旦

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協和沒有Protocol

data就出來了

data跟西方一模一樣

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