T_2期直肠癌淋巴结转移的相关临床病理因素分析

探讨T2期直肠癌淋巴结转移及跳跃性转移的特点。本研究回顾性分析231例T2期直肠癌患者淋巴结转移及51例发生淋巴结转移患者中跳跃性淋巴结转移与临床病理资料之间的关系,用χ2检验和Fisher’s精确概率法分析其相关因素。研究发现高中分化T2期直肠癌发生淋巴结转移及跳跃性淋巴结转移率相对较低,进行局部切除的可行性较大。

胃癌全胃切除术73例临床病理分析

目的:探讨全胃切除术患者的临床病理特点与淋巴结转移的关系。方法:回顾分析我科2004年1月至2006年4月因胃癌行全胃切除术患者的临床及病理资料,进行分析总结。结果:73例胃癌全胃切除术中,淋巴结转移率为83.6%,转移度为35.7%。每例患者平均检取淋巴结数29.03枚,平均转移淋巴结数10.44枚。随肿瘤直径、浸润深度和浆膜受侵面积的增加,胃癌的淋巴结转移率、转移度依次呈递增趋势(P<0.01);在不同的浆膜反应类型、大体分型、生长方式、组织学类型及淋巴结分型下,胃癌的淋巴结转移率、转移度也有显著差异(P<0.01)。结论:对胃癌全胃切除术而言,应按胃癌的临床病理特点,选择合适的淋巴结清除范围。

Expression of p16 gene and Rb protein in gastric carcinoma and their clinicopathological significance

AIM:To analyze the correlation between the protein expression of p16 and Rb genes in gastric carcinoma (GC), to investigate the role of p16 gene in invasion and lymph node metastasis of GC, and to examine the deletion and mutation in exon 2 of p16 gene in GC. METHODS: The protein expression of p16 and Rb genes was examined by streptavidin-peroxidase conjugated method (S-P) in normal gastric mucosa, dysplastic gastric mucosa and GC. The deletion and mutation of p16 gene were examined by polymerase chain reaction (PCR) and polymerase chain reaction single strand conformation polymorphism (PCR-SSCP) respectively in normal gastric mucosa and GC. RESULTS: The positive rates of P16 and Rb protein expression respectively were 96% (77/80) and 99% (79/80) in normal gastric mucosa, 92% (45/50) and 80% (40/50) in dysplastic gastric mucosa, 48% (58/122) and 60% (73/122) in GC. The positive rates of P16 and Rb protein expression in GC were significantly lower than that in normal gastric mucosa and dysplastic gastric mucosa (P<0.05). The positive rate of P16 protein expression in mucoid carcinoma (10%, 1/10) was significantly lower than that in poorly differentiated carcinoma (51%, 21/41), undifferentiated carcinoma (58%, 15/26) and signet ring cell carcinoma (62%, 10/16) (P<0.05). The positive rates of P16 protein in 30 cases of paired primary and lymph node metastatic GC were 47% (14/30) and 17% (5/30) respectively, being significantly lower in the later than in the former (P<0.05). There was no mutation in exon 2 of p16 gene in the 25 freshly resected primary GCs. But five cases in the 25 freshly resected primary GCs displayed deletion in exon 2 of p16 gene. The positive rate of both P16 and Rb proteins was 16% (14/90), and the negative rate of both P16 and Rb proteins was 8% (7/90) in 90 GCs. The rate of positive P16 protein with negative Rb protein was 33% (30/90). The rate of negative P16 protein with positive Rb protein was 43% (39/90). There was reverse correlation between P16 and Rb expression in 90 GCs CONCLUSION: The loss protein expression of p16 and Rb genes is related to GC. The loss expression of P16 protein is related to the histopathologic subtypes and lymph node metastasis of GC. Expression of P16 and Rb proteins in GC is reversely correlated. The deletion but not mutation in exon 2 of p16 gene may be involved in GC.

Clinico-pathological significance of extra-nodal spread in special types of breast cancer

Objective: To investigate the significance of extra-nodal spread in special histological sub-types of breast cancer and the relationship of such spread with prognostic parameters.Methods: A total of 303 breast cancer cases were classified according to tumor type, and each tumor group was subdivided according to age, tumor diameter, lymph node metastasis, extra-nodal spread, vein invasion in the adjacent soft tissue, distant metastasis, and immunohistochemical characteristics [estrogen receptor(ER), progesterone receptor(PR) existence, p53, c-erbB-2, and proliferative rate(Ki-67)]. The 122 cases with extra-nodal spread were clinically followed up.Results: An extra-nodal spread was observed in 40%(122 cases) of the 303 breast cancer cases. The spread most frequently presented in micro papillary carcinoma histological sub-type(40 cases, 75%), but least frequently presents in mucinous carcinoma(2 cases, 8%). Patients with extra-nodal spread had a high average number of metastatic lymph nodes(8.3) and a high distant metastasis rate(38 cases, 31%) compared with patients without extra-nodal spread.Conclusion: The existence of extra-nodal spread in the examined breast cancer sub-types has predictive value in forecasting the number of metastatic lymph nodes and the disease prognosis.

Clinicopathological Characteristics as Predictive Factrs for Lymph Node Metastasis in Submucosal Gastric Cancer

OBJECTIVE To identify clinicopathological characteristics as predictive factors for lymph node metastasis in submucosal gastric cancer, and in addi- tion to establish objective criteria as indications for endoscopic submucosal dissection (ESD). METHODS Data from 130 patients with submucosal gastric cancer were collected, and the relationship between their clinicopathological characteris- tics and the presence of lymph node metastasis was retrospectively analyzed by multivariate analysis. RESULTS In the multivariate logistic regression model, a tumor size of 2 cm or more and an undifferentiated histologic type were found to be inde- pendent risk clinicopathological characteristics for lymph node metastasis. Among 130 patients with submucosal carcinoma, no lymph node metastases were observed in 17 patients who showed neither of the two risk clinicopath- ological characteristics. Lymph node metastasis occurred in 61.1% (22/36) of the patients who had both risk clinicopathological characteristics. CONCLUSION A tumor size of 2 cm or more and an undifferentiated histologic type were significantly and independently related to lymph node metastasis in submucosal gastric cancer. It is rational for the paitients with neither of these two independent risk clinicopathological characteristics to undergo an ESD.

CLINICOPATHOLOGICAL CHARACTERISTICS OF ADVANCED COLORECTAL CANCER 30mm OR SMALLER IN DIAMETER

Objective To investigate the clinicopathological characteristics of advanced colorectal cancer which was 30 mm or smaller in diameter. Methods Retrospective analysis documented 80 patients with small advanced colorectal cancer from May 1985 to May 2002. According to the diameter of tumors, all patients were divided into three groups: Group A (10 mm or less), Group B (11-20 mm), Group C (21-30 mm). Considering the number of patients in Group A was smaller, we combined Group A with Group B as Group D. Then various clinicopathological characteristics were compared between Group C and Group D. Results The most common site of small advanced colorectal cancer was sigmoid colon and rectum that accounted for 36.2% and 35.0% of all cases. The average diameter of total tumors was 23.3 mm. Type 2 was the most common macroscopic type (63.7%) and the moderate differentiation was seen in 77.5% of cases. Thirty-eight (47.5%) cases had lymph node metastasis. Three (3.8%) cases had liver metastasis and three (3.8%) cases had peritoneal metastasis. The frequency of lymph node metastasis was found significantly different between Group C and Group D (54.2% vs. 28.6%, P<0.05), as well as between the groups with different depth of invasion (P<0.05). Curability A resection was performed in 69 (86.2%) cases. Conclusions Tumor size and depth of invasion are related to lymph node metastasis in small advanced colorectal cancer. However, the small size of tumor may not always be a.reliable parameter for estimating the risk of lymph node metastasis. Small colorectal cancers also do not always mean the early stage. Surgeons should be aware of the features of small advanced colorectal cancers to select ideal management and perform perfect resection.

Clinical pathology of nodal micrometasteses in non-small cell lung cancer

Objective： To explore whether the conventional pathologic stages of some non-small cell lung cancer （NSCLC） patients were underestimated. Methods： 195 lymph node samples were taken from 25 NSCLC patients during the operations. Firstly, each resulting tissue block was processed for routine paraffin embedding. Then the 6- 10 serial sections were chosen, each 5/am thick, from every paraffin block of the lymph node. Finally, the first and the second last sections of each lymph node were stained by hematoxylin eosin （HE）, and the other serial sections were used for the immunohistochemical （IHC） staining examination with the monoclonal antibody against cyokeratin 19. Results： With HE staining, 30 of the 195 regional lymph nodes revealed dominant nodal metastases, and none showed micrometastases. IHC staining was performed on 135 lymph nodes that were identified as free of metastases by HE staining, 31 showed micrometastases; none showed gross nodal metastases. There was a significant difference between HE staining staging and IHC staining staging （P〈0.05）. Conclusion： Conventional HE staining can accurately detect gross nodal metastases in the lymph nodes of NSCLC patients, but is unfit for detecting lymph nodal micrometastases. IHC staining analysis can significantly facilitate the detection of occult micrometastatic tumor cells in lymph nodes, and its assessment of nodal micrometastases can provide a refinement of TNM stage for NSCLC patients. Our results provide a rationale for extensive lymph nodes sampling

SOLID PSEUDOPAPILLARY TUMOR OF THE PANCREAS:CLINICAL AND COMPUTED TOMOGRAPHIC FINDINGS WITH PATHOLOGIC CORRELATION IN 21 CASES

Objective To correlate the clinical and imaging features of the solid pseudopapillary tumor (SPPT) of the pancreas with the pathologic diagnosis. Methods The computed tomographic findings in 21 patients (18 women and 3 men) with pathologically proven solid pseudopapillary tumor of the pancreas were reviewed retrospectively. Two radiologists reviewed images for location, size and morphology, capsule and margin, density, enhancement pattern, calcification, dilatation of pancreatic duct, lymphadenopathy, vascular invasion, distant metastasis, and recurrence. Results On CT, the lesion presented as solitary, round (28.57%), oval (57.14%), or lobulated (14.28%) mass in pancreatic head (47.62%) with complete capsule (85.71%). Lesions smaller than 4cm in maximum diameter (47.62%) presented as predominantly solid mass whereas lesions greater than 4cm in diameter (52.28%) presented as heterogenous mass. On contrast administration, the viable solid portion of the tumor showed mild peripheral enhancement in arterial phase [enhancement degree<20Hounsfield unit (HU)] with progressive fill in during the portal and hepatic parenchyma phase (enhancement degree 20-40HU). Eighteen lesions (85.7%) had complete capsule. Two lesions (9.5%) had areas of high density (>60HU) on plain CT which due to hemorrhage. Dilatation of the pancreatic duct was rare (25%), and distant metastasis, regional lymphadenopathy, and tumor recurrence were absent. Nine patients (42.85%) had an abdominal CT follow-up for 24.55months (range, 2-60months) post-surgery without recurrence or distant metastasis. Conclusion Solid pseudopapillary tumor of the pancreas usually occurs in young females in the pancreatic head or tail. On CT, they manifest as moderate vascular mixed tumor, progressive enhancement of the viable solid portion, distinct tumor margin with capsule formation, and absence of regional lymphadenopathy.