案例审查肿瘤生物标志物诊断预后预测性159bmj h3449 full.pdf

BMJ2015;351:h3449doi:10.1136/bmj.h3449(Published3July2015)Page1of4

ENDGAMES

CASEREVIEW

Tumourbiomarkers:diagnostic,prognostic,and

predictive

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AbigailShawfourthyearmedicalstudent,MarcusDBradleyconsultantneuroradiologist,Sean

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Elyanconsultantoncologist,KathreenaMKurianconsultantneuropathologist

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UniversityofBristolMedicalSchool,BristolBS81TH,UK;InstituteofClinicalNeurosciences,Bristol;GloucestershireOncologyCentre,Cheltenham

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GeneralHospital,Cheltenham,UK;DepartmentofNeuropathology,SouthmeadHospital,Bristol

A63yearoldwomanpresentedwithaonemonthhistoryof

difficultyspeakingandimbalance.Shehadbeendiagnosedwith

breastcancertwoyearsearlierandhadbeentreatedwithsurgery,

chemotherapy,andradiotherapy.Thiswasfollowedbyayear

oftrastuzumab(Herceptin)andcontinuoustamoxifentreatment.

icresonanceimaging(figure)ofthebrainshowedthat

shehadalargesolitaryroundedenhancingmasslesioninthe

leftinferiorparietallobe.Itwaspresentatthegrey-white

interfaceandtherewatensivesurroundingvasogenic

oedema.Thelesionwasavidlyenhancedaftertheadministration

ofgadolinium(notshown).Theappearancesweresuspicious

ofasolitarybrainmetastasis,butthedifferentialdiagnoses

includedaprimaryintrinsicmalignantbraintumour.

T2weightedaxialicresonanceimageofthebrain

showingaroundedlesionintheleftinferiorp