茅台酒与肝病关系的流行病学调查及病理组织学研究

目的探讨贵州茅台酒(下称茅台酒)与肝病的关系。方法①饮茅台酒组99例与非饮酒组33例按3:1配对,进行流行病学调查,并对饮茅台酒职工组的23名自愿者行肝穿刺活检.②60只Wistar大鼠随机分为3组,分别给予茅台酒和普通白酒、生理盐水灌胃连续8wk、12wk,分批处死动物,测血清ALT、AST、总胆红素(TBil)、AKP,剖腹取肝脏测肝系数、GSH、MDA及肝病理组织学检查.80只小鼠随机分为4组,分别给予茅台酒、乙醇、生理盐水灌胃,连续4wk后处死动物取血测ALT,剖腹取肝脏测肝系数、MDA.结果 99例饮茅台酒组和33例非饮酒组有肝病症状、脾大、ALT增高、A/G倒置、门静脉增宽的检出率分别为1.0％(1/99)、1.0％(1/99)、1.0％(1/99)、1.0％(1/99)、0(0/99)和0(0/99)、0(0/99)、0(0/99)、0(0/99)、0(0/99),茅台酒组与非饮酒组无明显差异(P>0.05);23例饮茅台酒组职工作肝穿刺活检均有轻重不同肝细胞脂肪变性,但均无明显的肝纤维化、肝硬化的表现.茅台酒组与普通白酒组相比,大鼠、小鼠肝脏MDA(A值)分别为0.33±0.10、0.49±0.23和0.61±0.22、0.66±0.32,茅台酒组明显降低(P<0.05);大鼠肝脏GSH分别为0.12mg.g^(-1)±0.06mg.g^(-1)和0.08mg.g^(-1)±0.02mg.g^(-1),茅台酒组明显增高(P<0.05).普通白酒组20只大鼠灌胃8wk后均可见肝细胞索排列紊乱,肝细胞脂肪变性和肝纤维结缔组织增生形成宽窄不等的纤维间隔,12wk后纤维结缔组织进一步增生,并有早期肝硬化表现;而用茅台酒灌胃大鼠8wk和12wk均有肝细胞脂肪变性,全部均无明显肝细胞坏死、肝纤维化、肝硬化。结论茅台酒可致脂肪肝但不引起明显的肝纤维化及肝硬化,有增加肝脏的脂质抗氧化作用。

Location of Highly Pathogenic Porcine Reproductive and Respiratory Syndrome Virus in Tissues of Natural Cases

[ Objective] The aim of this study was to provide a theoretical basis for the prevention and treatment of highly pathogenic porcine reproductive and respiratory syndrome （HP-PRRS）. [Method] Antigen location and histopathological observation in natural cases infected by highly pathogenic porcine reproductive and respiratory syndrome virus （HP-PRRSV） were analyzed by immunohistochemistry and H. E. staining. [Result] The virus antigen mainly existed in epithelial calls, and also a few in mecrophages, lymphocytes and brain nerve cells. [ Conclusion] The cell and tissue tropism of HP-PRRSV strain in natural cases is different from that of previous strains.

Relationship Between Histopathology and Clinical Prognosis of Invasive Pituitary Adenoma

Objective: To study the relationship between histopathology and clinical prognosis of invasive pituitary adenoma subjected to transsphenoidal surgery. Methods: The enrolled were 82 patients with invasive pituitary adenomas undergoing transsphenoidal surgery during Jan. 2000 - May 2003 in our department with full MR imaging findings, pathology data and follow-up information. The follow-up duration was 5-30 months. Results: MR imaging findings of invasive pituitary adenoma included: depression of the sellar floor, involvement of sphenoid sinus and cavernous sinus, breakthrough of diaphragma sellae, encasement of internal carotid artery, etc. Pathological examination revealed that the invasion rate of dura in sella turcica was the highest among the structures around tumor. Pituitary adenoma apoplexy was found in 20 cases (24.4%). The total removal rate for PRL-secreting adenomas was significantly lower than that for non-secreting adenomas (P<0.01), but non-, GH-, ACTH-secreting adenomas had no significant differences. The recurrence rate of PRL-secreting adenomas was higher than that of non- and GH-secreting adenomas (P<0.05). Conclusion: Among invasive pituitary adenomas, the therapeutic effects of non-and GH-secreting pituitary adenomas are better than that of PRL-secreting adenomas. Invasive biological behaviors of invasive pituitary adenomas result in radical operation failure and postoperative recurrence.

Histopathological Observation of Colibacillosis in Laying Hens

[Objective] This study aimed to investigate the histopathological changes of hens with colibacillosis.[Method] Epidemiological investigation,clinical symptoms observation,pathological autopsy,laboratory diagnosis and paraffin-embedded tissue section were performed to diagnose the laying hens from a farm in Changli County,affected by a disease similar to pericarditis and perihepatitis in clinical symptoms.[Result] The pathogen isolated from those hens was E.coli.The histopathological changes of the diseased hens included myocardial cell degeneration and inflammatory cell infiltration in heart,fibrotic perihepatitis,necrotic hepatitis in liver,decreased lymphoid cells and inflammatory cell infiltration in spleen,lung congestion,lung room full of erythrocytes,hyaline degeneration in glomerular capillary and small intestinal epithelial cell shedding.[Conclusion] This study will provide scientific basis for the diagnosis and control of colibacillosis in poultry.

Histopathological Observation of Cynoglossus semilaevis Günther Infected with Red Abdominal Shell Disease

The histopathological changes in various organs of Cynoglossus semilaevis Günther infected with red abdominal shell disease were observed by dissection and HE staining. In the ill C. semilaevis, the body surface was congestive and bleeding;the skin in the blind side ulcerated with extravasated blood; the gill filaments ulcerated with a lot of mucus; the liver, pancreas and spleen were swelling and bleeding with extravasated blood; the small intestine was congestive and bleeding. Degeneration and necrosis, and submucosal bleeding occurred in the skin of C. semilaevis infected with red abdominal shell disease. There was red blood cell infiltration and deposition in the space among muscle fibers. Epithelial degeneration and necrosis occurred in the parotid gland. The efferent branchial artery was congestive. The myocardial fibers had a loose structure, and a large area of fracture appeared. The liver cells were swelling with degeneration and necrosis and concentrated nucleus. A large area of the renal interstitial was broken down and necrotic. The submucosa of the small intestine had necrosis and hemorrhage.

Prognostic Impact of Histopathologic Response after Neoadjuvant Chemotherapy in Stage Ⅲ_A Non-small Cell Lung Cancer

Objective： To investigate prognostic impact of histopathologic response induced by neoadjuvant chemotherapy in patients with stage ⅢA non-small cell lung cancer （NSCLC）. Methods： Forty patients with stage ⅢA NSCLC underwent two cycles of neoadjuvant chemotherapy with mitomycin, vindosine, and cisplatin followed by surgery. Histopathologic response in resection of the tumor was examined after surgery. Tumor regression was classified as grade Ⅳ, grade Ⅲ, grade Ⅱ, and grade Ⅰ according to the extent of tumor necrosis and the extent of the vital tumor tissues. The tumor regression grading was correlated with the survival time of the patients. Results： After two cycles of chemotherapy, 19 （47.5%） of 40 patients had objective response （2 complete and 17 partial response）. In 40 resected tumor specimens, 2 （5%） were classified as regression grade Ⅳ, 16 （40%） as regression grade Ⅲ, 18 （45%） as regression gradeⅡ, and 4 （10%） as regression grade Ⅰ. The rate of complete surgical resection was significantly higher in patients with tumor regression grade Ⅲ-Ⅳ （〈10% vital tumor tissue）（P〈0.05）. The median survival time in patients classified as having tumor regression grade Ⅲ-Ⅳ was significantly longer than that in patients who had regression grade Ⅰ-Ⅱ （P〈0.05）. The 3-year survival rate in patients with regression grade Ⅲ-Ⅳ was markedly higher than that in patients who had regression grade Ⅰ-Ⅱ （P〈0.05）. Conclusion： The extent of tumor regression induced by neoadjuvant chemotherapy is a critical issue for successful therapeutic approach in patients with stage ⅢA NSCLC. In resected specimens of tumors after chemotherapy, the presence of marked tumor regression （regression grade Ⅲ-Ⅳ） is predictive for superior survival time.

Histopathological Study on Chickens Artificially Infected with Infectious Laryngotracheitis

[Objective] This study aimed to investigate the histopathological changes in chickens artificially infected with infectious laryngotracheitis（ILT）. [Method] Through ar- tificial injection of allantoic liquid containing ILTV into chickens to induce infectious laryngotracheitis, the clinical symptoms in infected chickens were observed; tissues of trachea, lungs, heart, liver, kidney and spleen were collected from dead chickens, and prepared into paraffin sections, followed by histopathological observation under a microscope. [Results] This disease occured in the inoculated chickens 3d later, with a morbidity rate of 95%. The main symptoms were dyspnea, asthma and coughing up of bloody exudate; yellowish-white pseudomembrane was observed on dissected larynx trachea; swelling, haemorrhage, and further erosion were observed on the in- fected tracheal mucosa, resulting in death of chickens, with the mortality rate of 25%; histopathological observation showed that parenchymal organs exhibited exuda- tive inflammation; swelling, degeneration, necrosis and shedding of epithelial cells were observed; disturbance of blood circulation occured.[Conclusion] This study pro- vides reference bases for the treatment of ILT.

Clinico-pathologic significance of neuroendocrine cells in gastric carcer tissue

AIMS To elucidate the biological and clinicopathological signifi- cance of neuroendocrine(NE)cells in gastric carcinoma(GC). METHODS One hundred and eighty-nine cases of various histo- logical types of GC were observed using light microscopy, histochemistry,immunohistochemistry and electron microscopy. Of them 127 patients were followed up. RESULTS Chromogranin A(CgA)positive GC was demonstrat- ed in 85 cases(45.0%).The typos of NE cells in GC were probed using 9 kinds of hormone antibodies 49 cases(67.2%) contained more than one hormone.NE cells were found more often in poorly differentiated GC than in well differentiated ones(P<0. 01).Expression of some kinds of hormone Was relative to the dif- ferentiation and histological types of GC.BOM,CT(P<0.01) GAST and 5-HT(P<0.05)were more expressed in poorly differ- entiated cases than in well defferentiated ones.Nineteen cases of the matastatic foci in regional lymph nodes were found to have CgA positive cancer cells.The presence of HCG in matastatic lymph nodes was more often observed than that of other hormone (P<0.01).The survival rate of patients with NE positive GC was 38.9% and negative GC 52.7%.Five of 7 patients(71. 4%)with somatostatin positive GC still survived at follow up of 33-66 months,but 4 patients with HCG positive GC died in 12-29 months. CONCLUSIONS The NE cells occur more frequently in poorly differentiated GC.Certain hormones appear to be related to the metastasis and prognosis.

Histopathological Observation of Canine Distemper in Raccoon Dogs

In this study, histopathological changes in the heart, liver, spleen, lung, kidney and other organs of raccoon dogs died of canine distemper were observed. According to the results, the lung of infected raccoon dogs exhibited severe hemor- rhage and emphysema; the liver was congested and degenerated; the spleen was enlarged; the exhibited severe hemorrhage and hyaline degeneration. Multiple organs of infected raccoon dogs were congested and hemorrhaged with tissue damage, in- flammatory cell infiltration and a series of pathological changes. This study laid a solid foundation for clinical diagnosis and treatment of canine distemper in raccoon dogs.

Epidemiological and histopathological study of relevance of Guizhou Maotai liquor and liver diseases

AIM: To explore the relevance of Maotai liquor and liver diseases. METHODS: Epidemiological study was conducted on groups of subjects, each consisting of 3 subjects from the Maotai liquor group consisting of 99 individuals and one from the non-alcoholic control group consisting of 33 individuals. Liver biopsy was performed on 23 volunteers from Guizhou Maotai Distillery who had a constant and long history of drinking Maotai liquor. Experimental histopathological study was conducted as follows: sixty male Wistar rats were divided into 3 groups randomly and fed with Maotai liquor, ordinary white wine, and physiological saline respectively for a period of 8 and 12 weeks. The rats were sacrificed in batches, then serum ALT, AST, TBil, and AKP were measured. Rat livers were harvested to measure the liver indexes, GSH, and MDA. Histopathological examinations were also performed. Another eighty mice were randomly divided into 4 groups and fed with Maotai (at different dosages of 10 ml.kg(-1) and 20 ml.kg(-1)), ethanol, and physiological saline. The animals were sacrificed after 4 weeks and serum ALT was determined. Then the livers were harvested and liver indexes and MDA were measured. RESULTS: The incidence rate of hepatic symptoms, splenomegaly, liver function impairment, reversal of Albumin/Globulin and increased diameter of portal veins in the Maotai liquor group were 1.0% 1/99 , 1.0% 1/99 , 1.0% 1/99 , 1.0% 1/99 , 0 0/99 and 0 0/99 , 0 0/99 ,0 0/99 , 0 0/99 , 0 0/99 , respectively. There was no significant difference between the Maotai group and the non-alcoholic control group P】0.05 . Various degree of fatty infiltration of hepatocytes was found in the 23 volunteers receiving liver biopsy, but there was no obvious hepatic fibrosis or cirrhosis. A comparison was made between the Maotai liquor group and the ordinary white wine group. It was found that hepatic MDA in rats and mice were 0.33+/-0.10 and 0.49+/-0.23 respectively in Maotai group and 0.61+/-0.22 and 0.66+/-0.32 in the ordinary white wine group; MDA had an obvious decrease in the Maotai liquor group (P【0.05); hepatic GSH were 0.12 mg.g(-1)+/-0.06 mg.g(-1) in rats of the Maotai liquor group and (0.08+/-0.02)mg.g(-1) in white wine group, it was obviously increased in the Maotai liquor group (P【0.05). After the 20 rats had been fed with ordinary white wine for 8 weeks consecutively, disarranged hepatocyte cords, fatty infiltration of hepatocytes, and fibrous septa of varying widths due to hepatic connective tissues proliferation were observed; after 12 weeks, the fibrous tissue proliferation continued and early cirrhosis appeared. Compared with the ordinary white wine group, fatty infiltration was observed in the 8-week and 12-week groups, but no necrosis or fibrosis or cirrhosis was found in the Maotai liquor group (P【0.05). CONCLUSION: Maotai liquor may cause fatty liver but not hepatic fibrosis or cirrhosis, and it can strengthen lipid peroxidation in the liver.

Heterotopic pancreas in the stomach:A case report and literature review

Ectopic pancreas is defined as pancreatic tissue found outside the usual anatomic location of the pancreas. It is often an incidental finding and can be found at different sites in the gastrointestinal tract. It may become clinically evident when complicated by pathologic changes such as inflammation, bleeding, obstruction, and malignant transformation. In this report, a 40 years old woman with epigastric pain due to ectopic pancreatic tissue in the stomach is described. The difficulty of making an ac- curate diagnosis is highlighted. The patient has remained free of symptoms since she underwent wedge resection of the lesion three years ago. Frozen sections may help in deciding the extent of resection intraoperatively. Al- though ectopic pancreas is rare, it should be considered in the differential diagnosis of a submucosal gastric tumour.

Expression transformation of claudin-1 in the process of gastric adenocarcinoma invasion

AIM: To investigate the relation of expression transfor-mation of claudin-1 with invasiveness and metastasis of gastric carcinoma. METHODS: By using immunohistochemistry, expres-sion of claudin-1 in mucosa and invasive front of 136 gastric adenocarcinoma cases and proliferative index (Ki-67) were detected and analyzed. RESULTS: In mucosa, the claudin-1 over-expression rate of mucinous adenocarcinomas (including signet-ring cell carcinomas) was the highest. It was nega-tively related with the differentiation but positively related with the invasiveness and metastasis of gastric cancer. In invasive front, the claudin-1 over-expression rate was positively related with the differentiation, in-vasiveness and metastasis of gastric carcinoma. The expression transformation of claudin-1 was found in gastric carcinoma. The expression of claudin-1 in inva-sive front was transformed in 28/136 gastric carcinoma cases. The transformation rate in highly differentiated tubular adenocarcinomas was the highest (51.5%, 17/33). The deeper was the invasiveness, the higher was the transformation rate. The claudin-1 expression transformation rate in serosa and omenta was signifi -cantly higher (92.9%) than in tunica muscularis of in-vasive gastric cancer cases, as well as in patients withlymph node metastasis than in those without lymph node metastasis. CONCLUSION: Up-regulation of claudin-1 expres-sion and its transformation in invasive and metastatic gastric carcinoma suggest that claudin-1 participates in the transformation of biological behaviors in neo-plasms. Further study is needed to elucidate the pre-cise mechanism and the relation of claudin-1 expres-sion with the neoplasm progress.

Racial differences in the anatomical distribution of colorectal cancer:a study of differences between American and Chinese patients

AIM: To compare the racial differences of anatomical distribution of colorectal cancer (CRC) and determine the association of age, gender and time with anatomical distribution between patients from America (white) and China (oriental).METHODS: Data was collected from 690 consecutive patients in Cleveland Clinic Florida, U.S.A. and 870consecutive patients in Nan Fang Hospital affiliated to the First Military Medical University, China over the past 11years from 1990 to 2000. All patients had colorectal adenocarcinoma diagnosed by histology and underwent surgery.RESULTS: The anatomical subsite distribution of tumor,age and gender were significantly different between white and oriental patients. Lesions in the proximal colon (P＜0.001) were found in 36.3 % of white vs 26.0 % of oriental patients and cancers located in the distal colon and rectum in 63.7 % of white and 74 % of oriental patients (P＜0.001). There was a trend towards the redistribution from distal colon and rectum to proximal colon in white males over time, especially in older patients (＞80 years).No significant change of anatomical distribution occurred in white women and Oriental patients. The mean age at diagnosis was 69.0 years in white patients and 48.3 years in Oriental patients (P＜0.001).CONCLUSION: This is the first study comparing the anatomical distribution of colorectal cancers in whites and Chinese patients. White Americans have a higher risk of proximal CRC and this risk increased with time. The proportion of white males with CRC also increased with time.Chinese patients were more likely to have distal CRC and developed the disease at a significantly earlier age than white patients. These findings have enhanced our understanding of the disease process of colorectal cancer in these two races.

Impact of endoscopic ultrasound-guided fine needle biopsy for diagnosis of pancreatic masses

AIM： To evaluate the diagnostic accuracy of histological evaluation of pancreatic tissue samples obtained by a modified method for recovering and processing the endoscopic ultrasound （EUS）-guided fine needle aspiration （FNA） material in the differential diagnosis of pancreatic solid masses. METHODS： Sixty-two consecutive patients with pancreatic masses were prospectively studied. EUS was performed by the linear scanning Pentax FG-38UX echoendoscope. Three FNAs （22G needle） were carried out during each procedure. The materials obtained with first and second punctures were processed for cytological study. Haterials of the third puncture were recovered into 10% formol solution by careful injection of saline solution through the needle, and processed for histological study. RESULTS： Length of the core specimen obtained for histological analysis was 6.5±5.3 mm （range 1-22 mm）. Cytological and histological samples were considered as adequate in 51 （82.3%） and 52 cases （83.9%）, respectively. Overall sensitivity of both pancreatic cytology and histology for diagnosis of malignancy was 68.4%. Conbary to cytology, histology was able to diagnose tumours other than adenocarcinomas, and all cases of inflammatory masses. Combination of cytology and histology allowed obtaining an adequate sample in 56 cases （90.3%）, with a global sensitivity of 84.21%, specificity of 100% and an overall accuracy of 90.32%. The complication rate was 1.6%.CONCLUSION： Adequate pancreatic core specimens for histological examination can be obtained by EUS-guided FNA. This technique is mainly useful for the diagnosis of different types of pancreatic tumours and evaluation of benign diseases.

Inhibitory effects of saikosaponin-d on CCl_4-induced hepatic fibrogenesis in rats

AIM： To investigate the suppressive effect of saikosaponin-d （SSd） on hepatic fibrosis in rats induced by CCh injections in combination with alcohol and high fat, low protein feeding and its relationship with the expression of nuclear factor-κB （NF-κB）, tumor necrosis factor-alpha （TNF-α） and interleukins-6 （IL-6）. METHODS： Hepatic fibrosis models were induced by subcutaneous injection of CCh at a dosage of 3 mL/kg in rats. At the same time, rats in treatment groups were injected intraperitoneally with SSd at different doses （1.0, 1.5 and 2.0 mg/kg） once daily for 6 wk in combination with CCh, while the control group received olive oil instead of CCh. At the end of the experiment, rats were anesthetized and killed （except for 8 rats which died during the experiment; 2 from the model group, 3 in high-dose group, 1 in medium-dose group and 2 in lowdose group）. Hernatoxylin and eosin （HE） staining and Van Gieson staining were used to examine the changes in liver pathology. The levels of alanine aminotransferase （ALT）, triglyeride （TG）, albumin （ALB）, globulin （GLB）, hyaluronic acid （HA） and larninin （LN） in serum and the content of hydroxyproline （HYP） in liver were measured by biochemical examinations and radioimmuneoassay, respectively. In addition, the expression of TNF-α and IL-6 in liver homogenate was evaluated by enzymelinked immunosorbent assay （ELISA） and the levels of NF-κBp65 and I-κBa in liver tissue were analyzed by Western blotting. RESULTS： Both histological examination and Van Gieson staining demonstrated that SSd could attenuate the area and extent of necrosis and reduce the scores of liver fibrosis. Similarly, the levels of ALT, TG, GLB, HA, and LN in serum, and the contents of HYP, TNF-α and IL-6 in liver were all significantly increased in model group in comparison with those in control group. Whereas, the treatment with SScl markedly reduced all the above parameters compared with the model group, especially in the medium group （ALT： 412 ± 94.5 IU/L vs 113.76 ± 14.91 IU/L, TG： 0.95 ± 0.16 mmol/L vs 0.51 ± 0.06 mmol/L, GLB： 35.62 ± 3.28 g/L vs 24.82 ± 2.73 g/L, HA： 42.15 ± 8.25 ng/mL vs 19.83 ± 3.12 ng/mL, LN： 27.56 ± 4.21 ng/mL vs 13.78 ± 2.57 ng/mL, HYP： 27.32 ± 4.32 ug/mg vs 16.20 ± 3.12 ug/mg, TNF-a： 4.38 ± 0.76 ng/L vs 1.94 ± 0.27 ng/L, IL-6：28.24 ± 6.37 pg/g vs 12.72 ± 5.26 pg/g, respectively, P 〈 0.01）. SSd also decreased ALB in serum （28.49 ± 4.93 g/L vs 37.51 ± 3.17 g/L, P 〈 0.05）. Moreover, the expression of NF-KB p65 in the liver of treated groups was lower than that in model groups while the expression of I-κBa was higher in treated group than in model group （P 〈 0.01）. The expression of NF-κBp65 and TNF-a had a positive correlation with the level of HA in serum of rats after treatment with CCh （r = 0.862, P 〈 0.01; r = 0.928, P 〈 0.01, respectively）. CONCLUSION： SSd attenuates CCh-induced hepatic fibrosis in rats, which may be related to its effects of hepato-protective and anti-inflammation properties, the down-regulation of liver TNF-a, IL-6 and NF-κBp65 expression and the increased I-κBa activity in liver.

Prealbumin is predictive for postoperative liver insufficiency in patients undergoing liver resection

AIM:To investigate the risk factors for postoperative liver insufficiency in patients with Child-Pugh class A liver function undergoing liver resection.METHODS:A total of 427 consecutive patients undergoing partial hepatectomy from October 2007 to April 2011 at a single center(Department of Hepatic SurgeryⅠ,Eastern Hepatobiliary Surgery Hospital,Shanghai,China) were included in the study.All the patients had preoperative liver function of Child-Pugh class A and were diagnosed as having primary liver cancer by postoperative histopathology.Surgery was performed by the same team and hepatic resection was carried out by a clamp crushing method.A clamp/unclamp time of 15 min/5 min was adopted for hepatic inflow occlusion.Patients' records of demographic variables,intraoperative parameters,pathological findings and laboratory test results were reviewed.Postoperative liver insufficiency and failure were defined as prolonged hyperbilirubinemia unrelated to biliary obstruction or leak,clinically apparent ascites,prolonged coagulopathy requiring frozen fresh plasma,and/or hepatic encephalopathy.The incidence of postoperative liver insufficiency or liver failure was observed and the attributing risk factors were analyzed.A multivariate analysis was conducted to determine the independent predictive factors.RESULTS:Among the 427 patients,there were 362 males and 65 females,with a mean age of 51.1 ± 10.4 years.Most patients(86.4%) had a background of viral hepatitis and 234(54.8%) patients had liver cirrhosis.Indications for partial hepatectomy included hepatocellular carcinoma(391 patients),intrahepatic cholangiocarcinoma(31 patients) and a combination of both(5 patients).Hepatic resections of ≤ 3 and ≥ 4 liver segments were performed in 358(83.8%) and 69(16.2%) patients,respectively.Seventeen(4.0%) patients developed liver insufficiency after hepatectomy,of whom 10 patients manifested as prolonged hyperbilirubinemia unrelated to biliary obstruction or leak,6 patients had clinically apparent ascites and prolonged coagulopathy,1 patient had hepatic encephalopathy and died on day 21 after surgery.On univariate analysis,age ≥ 60 years and prealbumin < 170 mg/dL were found to be significantly correlated with postoperative liver insufficiency(P = 0.045 and P = 0.009,respectively).There was no statistical difference in postoperative liver insufficiency between patients with or without hepatitis,liver cirrhosis and esophagogastric varices.Intraoperative parameters(type of resection,inflow blood occlusion time,blood loss and blood transfusion) and laboratory test results were not associated with postoperative liver insufficiency either.Age ≥ 60 years and prealbumin < 170 mg/dL were selected on multivariate analysis,and only prealbumin < 170 mg/dL remained predictive(hazard ratio,3.192;95%CI:1.185-8.601,P = 0.022).CONCLUSION:Prealbumin serum level is a predictive factor for postoperative liver insufficiency in patients with liver function of Child-Pugh class A undergoing hepatectomy.Since prealbumin is a good marker of nutritional status,the improved nutritional status may decrease the incidence of liver insufficiency.

DEC1 nuclear expression:A marker of differentiation grade in hepatocellular carcinoma

AIM: To investigate the expression patterns of human differentiated embryo chondrocyte 1 (DEC1) in hepatocellular carcinoma (HCC) and corresponding adjacent non-tumor and the normal liver tissues, the association between DEC1 expression and histopathological variables and the role of DEC1 in hepatocarcinogenesis. METHODS: The expression of DEC1 was detected immunohistochemically in 176 paraffin-embedded sections from 63 patients with HCC and 50 subjects with normal liver tissues. RESULTS: DEC1 protein was persistently expressed in the cytoplasm of hepatocytes in normal liver and HCC tissues. Compared with adjacent non-tumor liver tissues, HCC tissues showed high nuclear expression of DEC1 protein. However, high DEC1 nuclear expression was more frequently detected in well-differentiated (83.3%) than in moderately (27.3%) and poorly differentiated HCC (16.7%). Low DEC1 expression was associated with poor histological differentiation and malignancy progression. A correlation was found between the nuclear expression of DEC1 protein and histological differentiation (r = 0.376, P = 0.024). CONCLUSION: DEC1 is expressed in the cytoplasm of hepatocytes and because nuclear DEC1 expression is decreased with decreasing differentiation status of HCC, nuclear DEC1 might be a marker of HCC differentiation.

Expression of COX-2, PCNA, Ki-67 and p53 in gastrointestinal stromal tumors and its relationship with histopathological parameters

AIM: To investigate the expression of Cyclooxygenase-2 (COX-2), proliferating cell nuclear antigen (PCNA), Ki-67 and p53 in gastrointestinal stromal tumors (GISTs) and its relationship with histopathological parameters. METHODS: Twenty-five GISTs were examined by light microscopy and immunohistochemistry. c-kit, CD34, SMA, S-100 protein, COX-2, PCNA, Ki-67 and p53 were detected immunohistochemically and the relationship was evaluated among histopathologic parameters such as mitotic index (MI), tumor grade, tumor size, COX-2, PCNA, Ki-67 and p53. RESULTS: COX-2 protein expression was found in 19 of 25 (76%) of the tumors, and expression was noted in the cytoplasm of the tumor cells. p53 was significantly related to MI and tumor grade but no relationship was found between COX-2, proliferation markers and MI, tumor grade and tumor size. CONCLUSION: COX-2 is expressed in most GISTs and it may play an important role in the proliferation and progression of these tumors or a useful marker to identify GIST. Although immunohistochemical assessment of p53 can be used for distinguishing the risk groups of GISTs, tumor size and mitotic rate should be considered at the same time.

Histological origin of pseudomyxoma peritonei in Chinese women:Clinicopathology and

AIM： To investigate the myxoma peritonei （PMP） histological origin of pseudo- n Chinese women. METHODS： The clinical and pathological data were reviewed for 35 women with PMP, and specimens of the peritoneal, appendiceal and ovarian lesions of each patient were examined using the PV-6000 immunohistochemistry method. Antibodies included cytokeratin （CK）7, CK20, mucin （MUC）-1, MUC-2, carbohydrate antigen （CA）-125, estrogen receptor （ER）, and progesterone receptor （PR）. RESULTS： Abundant colloidal mucinous tumors were observed in the peritoneum in all 35 cases. Thirty-one patients had a history of appendectomy, 28 of whom had mucinous lesions. There was one patient with appendicitis, one whose appendix showed no apparent pathological changes, and one with unknown surgical pathology. Ovarian mucinous tumors were found in 24 patients. The tumors were bilateral in 13 patients, on the right-side in nine, and on the left side in two. Twenty patients had combined appendiceal and ovarian lesions; 16 of whom had undergone initial surgery for appendiceal lesions. Four patients had undergone initial surgery for ovarian lesions, and relapse occurred in these patients at 1, 11, 32 and 85 mo after initial surgery. Appendi-ceal mucinous tumors were found in each of these four patients. Thirty-three of the 35 patients showed peritoneal lesions that were positive for CK20 and MUC-2, but negative for CK7, MUC-1, CA125, ER and PR. The expression patterns in the appendix and the ovary were similar to those of the peritoneal lesions. In one of the remaining two cases, CK20, CK7 and MUC-2 were positive, and MUC-1, CA125, ER and PR were negative. The ovaries were not resected. The appendix of one patient was removed at another hospital, and no specimen was evaluated. In the other case, the appendix appeared to be normal during surgery, and was not resected. Peritoneal and ovarian lesions were negative for CK20, MUC-2, CK7, MUC-1, CA125, ER and PR. CONCLUSION： Most PMP originated from the appendix. Among women with PMP, the ovarian tumors were implanted rather than primary. For patients with PMP, appendectomy should be performed routinely. The ovaries, especially the right ovaries should be explored.

Primary gastrointestinal lymphoma

Gastrointestinal tract is the most common extranodal site involved by lymphoma with the majority being non-Hodgkin type.Although lymphoma can involve any part of the gastrointestinal tract,the most frequent sites in order of its occurrence are the stomach followed by small intestine and ileocecal region.Gastrointestinal tract lymphoma is usually secondary to the widespread nodal diseases and primary gastrointestinal tract lymphoma is relatively rare.Gastrointestinal lymphomas are usually not clinically specific and indistinguishable from other benign and malignant conditions.Diffuse large B-cell lymphoma is the most common pathological type of gastrointestinal lymphoma in essentially all sites of the gastrointestinal tract,although recently the frequency of other forms has also increased in certain regions of the world.Although some radiological features such as bulky lymph nodes and maintenance of fat plane are more suggestive of lymphoma,they are not specific,thus mandating histopathological analysis for its definitive diagnosis.There has been a tremendous leap in the diagnosis,staging and management of gastrointestinal lymphoma in the last two decades attributed to a better insight into its etiology and molecular aspect as well as the knowledge about its critical signaling pathways.