口腔黏膜软组织移植模型的建立及其免疫病理学特征

目的:建立适用于免疫学研究的口腔黏膜软组织移植(oral mucosal soft tissue transplant,OMT)模型并探讨其主要的免疫病理学特征。方法:将0.3～0.5 cm的Balb/C小鼠全舌组织移植到Wistar大鼠颊黏膜下。连续观察移植后90 d内其一般健康状况、生存率、体重变化、移植局部症状及脾脏肿胀等大体情况;检测血常规,血清C3、C4、IgA、IgG及IgM含量;组织学观察移植局部变化并在此基础上提出OMT的病理学分级标准。结果:该模型局部急性排斥症状明显,主要为颊黏膜肿胀渗出、引流淋巴结肿胀、中性粒细胞密集浸润及移植物破坏等。上述症状始于术后1 d,7～15 d到达高峰,而后逐渐缓解,慢性炎细胞替代中性粒细胞并呈修复状态。病理分级相应从G3、G4、G2到G0。其全身症状不显著。结论:初步建立OMT模型并明确其免疫病理特征:天然免疫与获得性免疫协同作用;急性排斥占主导。

胃肠道外上皮样细胞型间质肿瘤1例

某患者：男性，33岁。因腹部疼痛、腹部包块一月入院。B超、CT和MRI发现腹膜后巨大包块。既往无特殊病史。术中见肿瘤位于腹膜后，边界清楚，有包膜，肿瘤呈灰红色，与胃、肠无粘连，大小约19cm×11cm×10cm，局部坏死出血。

A practical approach to the diagnosis of autoimmune pancreatitis

Autoimmune pancreatitis is a disease characterized by specific pathological features,different from those of other forms of pancreatitis,that responds dramatically to steroid therapy.The pancreatic parenchyma may be diffusely or focally involved with the possibility of a low-density mass being present at imaging,mimicking pancreatic cancer.Clinically,the most relevant problems lie in the diagnosis of autoimmune pancreatitis and in distinguishing autoimmune pancreatitis from pancreatic cancer.Since in the presence of a pancreatic mass the probability of tumour is much higher than that of pancreatitis,the physician should be aware that in focal autoimmune pancreatitis the first step before using steroids is to exclude pancreatic adenocarcinoma.In this review,we briefly analyse the strategies to be followed for a correct diagnosis of autoimmune pancreatitis.

Sclerosing cholangitis associated with autoimmune pancreatitis differs from primary sclerosing cholangitis

AIM:To clarify the characteristic features of biliary le-sions in patients with autoimmune pancreatitis(AIP) and compare them with those of primary sclerosing cholangitis(PSC) .METHODS:The clinicopathological characteristics of 34 patients with sclerosing cholangitis(SC) associated with AIP were compared with those of 4 patients with PSC.RESULTS:SC with AIP occurred predominantly in el-derly men.Obstructive jaundice was the most frequent initial symptom in SC with AIP.Only SC patients with AIP had elevated serum IgG4 levels,and sclerosing diseases were more frequent in these patients.SC pa-tients with AIP responded well to steroid therapy.Seg-mental stenosis of the lower bile duct was observed only in SC patients with AIP,but a beaded and pruned-tree appearance was detected only in PSC patients.Dense infi ltration of IgG4-positive plasma cells was de-tected in the bile duct wall and the periportal area,as well as in the pancreas,of SC patients with AIP.CONCLUSION:SC with AIP is distinctly different from PSC.The two diseases can be discriminated based on cholangiopancreatographic findings and serum IgG4 levels.

The expression of Elf-1 and Ki-67 and their correlations in non-small-cell lung cancer

Objective: Elf-1 is a member of the proto-oncogenes Ets-related transcription factor family and over-expressed in many human tumors, Ki-67 is an important nuclear antigen associated with cell proliferation. This study investigated the expression of Elf-1 and Ki-67 in non-small-cell lung cancer(NSCLC) and studied their correlation with the clinicopathological features. Methods: Tissue microarray from 64 cases lung cancer tissue and 10 cases normal lung tissue was constructed, immunohistochemical method was used to evaluate the protein expressions of Elf-1 and Ki-67, correlations of the expression of Elf-1 and Ki-67 to clinicopathological features of NSCLC were analyzed. Results: Expression of Elf-1 and Ki-67 in NSCLC tissues were significantly higher than in normal lung tissues(P < 0.05), the positive rate of Elf-1 and Ki-67 was 73.44% and 64.06% in NSCLC group, Overexpression of Elf-1 in NSCLC was significantly related to histopathological grading, different clinical staging and the intensity of ELF-1 expression was significantly higher in the group with lymph node metastasis than that without(P < 0.05). Overexpression of Ki-67 was also closely related to tumor differentiation, clinical stages and lymph node metastasis(P < 0.05). In addition positive correlation was found between the expressive intensity of Elf-1 and Ki-67(τ = 0.295, P = 0.018). Conclusion: The high expression and positive correlation of Elf-1 and Ki-67 in NSCLC suggest that they probably play a role in onset and progression of lung cancer, united detecting their expression could be used as an valuable molecular biological index for predicting the malignant behavior and early diagnosis of NSCLC.

Clinical and Pathological Features of Riedel's Thyroiditis

Objective To evaluate the clinical and pathological features of Riedel's thyroiditis(RT),and current diagnostic and treatment methods for that disease.Methods Five RT cases identified by surgery and pathological examinations at Peking Union Medical College Hospital from 1985 to 2009 were analyzed and compared with the cases reported in the literature in terms of clinical and pathological features.Immunohistochemical staining of kappa and lambda light chains was carried out for RT tissues from all the five patients.Results All the five cases were females,aged 45-55 years.Elevation of serum thyroid autoantibodies was found in only one patient,who had longer disease duration than the others.Pathological examination revealed invasive fibrosclerosis of the thyroid follicles,thyroid capsule,and the surrounding tissues.In RT tissues,the number of cells containing lambda chains was a little higher than those containing kappa chains.Conclusions RT is a rare disease which might be more common in middle-aged females than in other populations.Pathological features include the destruction of thyroid follicle,extension into surrounding tissues by inflammatory cells and fibrous tissues.Immunohistochemical staining of kappa and lambda chains could help diagnose RT.

Clinical characteristics and prognostic analysis of gastroenteropancreatic neuroendocrine neoplasm(GEP-NEN)

Objective： The aim of the study was to analyze the clinicopathologic characteristics of gastroenteropancreatic neuroendocrine neoplasm （GEP-NEN） and to explore the prognostic factors for patients and differences of immunohisto- chemical markers between neuroendocrine tumor （NET） and neuroendocrine carcinoma （NEC）. Methods： Retrospective reviews were conducted for the charts of 119 patients with GEP-NEN at the Affiliated Hospital of Qingdao University （China） from August 2003 to December 2013. Kaplan-Meier method was used to do the overall survivals analysis for the patients at different levels of predictive factors. Meanwhile, Cox proportional hazard model was used to select independent risk factors of surJival. Analysis of variance was used to compare the expression of immunohistochemical markers among different patho- logical grades. Results：Among 119 patients, pancreas （45/119, 37.82%） and rectum （33/119, 27.73%） were mostly involved. The onset age of GEP-NEN in female group was younger than that of the male group. There were 13 deaths （10.92%） during 18.9 （0.1-133.4） months follow-up period. Multivariate analysis indicated that neural invasion, gender and pathological grades of NET and NEC were independent risk factors. In neuroendocrine neoplasm （NEN）, Syn expression in G2 was higher than G1 and G3, while CgA showed no significant difference. All markers showed no significant differences between NET and NEC. Conclusion： GEP-NEN may occur at multiple sites of digestive system and lack specific clinical manifestations. Syn expression detected for the prognosis of G1, G2 and G3 tumors have clinical significance. Neural invasion, sex and patho- logical grades were independent prognostic factors for GEP-NEN patients. No significant difference was found in different pathological grades of NET and NEC.

Clinicopathologic Observation of 6 Cases with Neuroendocrine Carcinoma of the Urinary Bladder

OBJECTIVE To discuss the pathologic characteristics and theprognosis of neuroendocrine carcinoma of the bladder(NECB)in order to assist in making a precise diagnosis and to effectivelytreat the disease.METHODS Clinicopathologic features of the 6 cases with NECBwere analyzed retrospectively.The personal data of the patientsand the pathologic and immunohistochemical characteristics ofthe tumor were investigated.The follow-up of these patients wasconducted over a time period ranging from 3 months to 9 years.RESULTS Transurethral resection of the bladder tumorwas performed in all 6 patients.Based on the results of thepathologic examination,4 of the cases were diagnosed as smallcell neuroendocrine carcinoma and the other 2 were diagnosedas atypical carcinoid tumor.On immunohistochemical stainingall tumors expressed neuroendocrine markers includingneuronspecific enolase(CD56),synaptophysin(Syn)andchromogranin(CgA).In patients receiving partial cystectomyfollowed by postoperative chemotherapy,relapse was found in 4of the 6 cases on follow up.CONCLUSION NECB is a rare entity and a tumor with highmalignant potential and characteristic pathologic features.Hematuria is the cardinal symptom of NECB.Metastasis mayoccur at an early stage and the prognosis of the disease is poor.Final diagnosis of NECB depends on histopathologic examinationand immunohistochemical assays.Surgical excision combinedwith radiotherapy and chemotherapy is considered an effectivetreatment.

The expression of Twist in salivary adenoid cystic carcinoma and its clinicopathological significance

Objective:The purpose of this study was to investigate the expression of Twist in salivary adenoid cystic carcinoma (SACC) and the relations between Twist expression and the clinicopathological characteristics. Methods: The expression of Twist was examined immunohistochemically in 48 cases of SACC, 18 of pleomorphic adenoma and 10 of normal parotid gland. The relationship between Twist expression in SACC and the clinicopathological factors was analyzed. Results: Twist expression was significantly higher in SACC tissues compared with pleomorphic adenomas and normal parotid gland tissues (P<0.05). Twist expression levels in SACC were significantly associated with histological type, perineural invasion, postoperative recurrence, and distant metastasis (P<0.05), rather than age, gender, tumor site, tumor size, or clinical staging (P>0.05). Conclusion: Twist expression may be associated with tumor cell differentiation, perineural invasion and metastasis of SACC. Twist expression is a potential prognostic factor for disease survival of SACC.

The expression of HIF-1α and VEGF as well as their correlation with angiogenesis in esophageal squamous cell carcinomas

Objective： To investigate the correlations among the expressions of hypoxia-inducible factor-1α （HIF-1α）, vascular endothelial cell growth factor （VEGF） and microvessel density （MVD）, and their relationships to the clinicopathologic characteristics of esophageal squamous cell carcinomas （ESCC）. Methods： The expressions of HIF-1α, VEGF and MVD were detected by immunohistochemical method in 45 cases of ESCC, 30 intraepithelial neoplasia and 35 normal esophageal mucosal epithelia tissues. The correlations among the expressions of HIF-1α, VEGF and MVD, and their relationships to the clinicopathologic features of ESCC were analyzed. Results： The rate of positive expression of HIF-1α and VEGF which were 80% and 84% in ESCC were significantly higher than those in intraepithelial neoplasia and normal esophageal mucosal epithelium tissues （P 〈 0.01） and so did the MVD value which was71.10 ±15.02 in ESCC （P 〈 0.01）. The expression of HIF-1α and VEGF were positively correlated with the depth of tumor invasion, lymph node metastasis and TNM staging of ESCC. The expressions of HIF-1α were positively correlated with the expressions of VEGF and the value of MVD. Conclusion： Overexpression of HIF-1α is found in ESCC. HIF-1α may induce the angiogenesis in ESCC by upregulating the transcription of VEGF gene. It may play an important role in the carcinogenesis and aggression in ESCC, HIF-1α, VEGF and MVD may be a useful marker for evaluating the biological behaviors of ESCC.

Clinicopathologic features and immunohistochemical analysis of 67 gastric adenoma patients

Objective： The aim of this study was to investigate the clinicopathologic features of gastric adenoma. Methods： Sixty-seven cases of adenoma diagnosis of gastric biopsy specimens using light microscopy, immunohistochemistry, and follow-up methods were studied. Results： Histopathology of gastric adenoma characteristics： nuclear anaplasia, showing increase of nuclear volume and irregular, and the emergence of one or more nucleoli, mitotic ≤ 2/10 high power field （HPF）. Structural changes in the gland： adenoma of the duct much more consistent, sometimes the size of the gland and irregular contour, might be associated with intestinal metaplasia. Increased significantly when the nuclear volume, mitotic 〉 2/10 HPF, irregular gland distortion, branched structures, suggesting the development of adenomas. Immunophenotype： tumor-associated carbohydrate antigens had a higher expression; adenomatous polyposis coli gene （APC） and carcinoembryonic antigen （CEA） expression of closely related with the formation of adenoma. Mucin muc-2 high expression was negatively correlated with muc-1 low expression, the combination of both can help to determine the development and changes in gastric adenoma. Survivin, Bcl-2, p21 and p53 protein expression rare cases, four were combined with the malignant transformation of gastric adenoma was important discriminant. Ki-67 positive cells 20%-40%, and could be used as degree of cell proliferation, a reference indicator of prognosis. Thirty-six to 49 months of follow-up results showed that cured 44.8% （30/67）, there adenomatous hyperplasia 35.8% （24167）, with the development of dysplasia showed 14.4% （11/67）, the development of intramucosal carci- noma were 3.0% （2/67）. Conclusion： Gastric adenomas occur significantly increased nuclear volume, mitotic 〉 2/10 HPF, ir- regular gland distortion, branch-like structure; immunohistochemical staining showed positive expression of muc-2 decreased, muc-1 positive expression; cell proliferation index Ki -67 〉 40%; p21, p53 protein expression occurred, suggesting a tendency to cancer, endoscopic mucosal resection should be as soon as possible.

The relationship between Bag-1 and gastric cancer clinicopathologic characteristic

Objective： The aim of our study was to investigate Bcl-2 antanogene-1 （Bag-l） expressions in gastric cancer and evaluate their clinical significance. Methods： Bag-1 expressions were studied by the immunohistochemical streptavidin- perosidase （S-P） method in 62 samples of gastric cancer tissues, 11 normal gastric tissues, and their clinical significance was analyzed. Results： The positive rate of Bag-1 expression in the gastric carcinoma tissues was 41.94% （26/62）, while it was 9.09% （1/11） in the normal gastric tissues （P = 0.046）. Though Bag-1 was positively related to the tumour pathological grade, lymph node metastasis and prognosis （P 〈 0.05）, it was not related to the sex, age, location, tumour diameter, depth of invasion （P 〉 0.05）. Conclusion： There are over expression of Bag-1 gene protein in gastric cancer, it is significance in prognosis of gastric cancer.

Analysis of clinicopathological and immunohistochemical features of 15 cases with olfactory neuroblastoma

Objective:We studied the clinicopathological and immunohistochemical features of olfactory neuroblastoma(ONB).Methods:The clinic pathological data and immunohistochemical features of 15 cases with ONB were analyzed retrospectively,and the related literatures were reviewed.Results:The tumors were all located in the nasal cavity in 15 cases.According to Kadish's staging system,7 cases were in stage A,5 cases in stage B,and 3 cases in stage C.The morphological features showed small round or ovoid tumor cells divided into pieces or trabeculae by connective tissues which were rich in capillaries.The tumor cells had round or oval nuclei and fine chromatins and lack of cytoplasma.Flexner rosette and Homer-Wright rosette were found in some cases.Acidophilic fibrins were composed of cytoplasmic projection among tumor cells.All cases were positive for NSE,Syn,CgA,1 case was positive for Vimentin,2 cases were positive for S-100,while CKpan,LCA and HMB45 were all negative.Conclusion:ONB is a type of very rare malignant tumors,which could be diagnosed by pathology,and immunohistochemistry is helpful in the diagnosis and differential diagnosis.