胃肠道透明细胞肉瘤样肿瘤/恶性胃肠道神经外胚层肿瘤2例临床病理学特征

目的探讨胃肠道透明细胞肉瘤样肿瘤/恶性胃肠道神经外胚层肿瘤(clear cell sarcoma-like tumor of the gastrointestinal tract,CCSLTGT/malignant gastrointestinal neuroectodermal tumor,MGNET)的临床病理学特征。[HTH]方法收集2例CCSLTGT/MGNET的临床资料,采用HE、免疫组化、FISH及二代测序法进行检测,并复习相关文献。[HTH]结果临床表现为腹痛(2/2)、腹部肿块(2/2)、血便(2/2),发热(1/2),肿瘤细胞呈实性、片状排列,部分区域呈菊形团样结构,细胞卵圆形、短梭形或上皮样,胞质嗜酸性或透明样,核分裂象8~10个/10 HPF,可见散在分布的破骨样多核巨细胞,未见肿瘤性坏死。免疫表型:肿瘤细胞表达SOX10(2/2)、S-100(2/2)、Syn(1/2)、CD56(2/2)和CD99(1/2),Ki67增殖指数为30%~70%。FISH检测均显示EWSR1基因重排(2/2)。1例二代测序检测到EWSR1-CREB1基因融合和FANCL基因Exon10-11缺失突变。[HTH]结论CCSLTGT/MGNET属于非常罕见的恶性间叶源性肿瘤,具有独特的形态学、免疫表型和分子遗传学特征,需与其他胃肠道恶性肿瘤鉴别。

17例非典型/恶性孤立性纤维性肿瘤临床病理特征及预后评价

目的探讨非典型/恶性孤立性纤维性肿瘤(SFT)复发转移的临床病理因素。方法收集福建医科大学附属第一医院颅外非典型/恶性SFT病例17例,分析比较临床病理特征中单因素和多因素风险分层模型与肿瘤复发转移的关系。结果非典型/恶性SFT患者17例,获得随访资料15例,其中复发2例,转移3例。肿瘤高核分裂象、坏死、浸润性边界与术后复发转移具有相关性(P<0.05);SFT传统恶性指标(P=0.017)和Georgiesh风险模型(G-score)(P=0.017)对肿瘤预后预测具有统计学意义,优于Demicco多因素风险模型(D-score)。比较G-score和D-score风险分组差异,17例中,13例为同一风险组,差异4例,其中复发转移3例,在G-score中的风险分组均高于D-score分组。SFT相关基因CD 34在高分险组中表达局灶丢失。结论核分裂计数≥4个、坏死、浸润性边界、传统恶性指标>3项与SFT的不良预后有关,相较于单因素,多因素风险模型具有更高的预后预测价值。

艾灸对恶性肿瘤患者免疫功能影响的Meta分析

目的运用循证医学方法评价艾灸对恶性肿瘤患者免疫功能的影响。方法通过对中国生物医学文献数据库、中国知网、维普数据库、万方数据库的检索,对符合要求的RCT文献进行Meta分析。结果纳入13个临床试验,共计978例患者,对免疫球蛋白[免疫球蛋白G(Ig G)、免疫球蛋白A(Ig A)、免疫球蛋白M(Ig M)]、免疫细胞[CD3、CD4、CD8和自然杀伤细胞(NK细胞)]、红细胞C3b受体(Rbc-C3bR)花环的形成率、白细胞介素-2(IL-2)等9项免疫指标进行Meta分析,其中CD3、CD4、Ig G、Ig A、Rbc-C3bR花环的形成率、IL-2等6项指标与对照组相比,差异有统计学意义;Ig M、CD8和NK的Meta分析结果显示差异无统计学意义。结论艾灸在一定程度上可以提高肿瘤患者的免疫功能,但还需要更多的研究数据支持。

恶性肿瘤化疗的护理体会

为了提高肿瘤病人化疗的护理质量,现将我院1997年11月－1999年2月收治的150例肿瘤化疗患者的护理特点报告如下。

区域热疗联合胸腔灌注顺铂治疗恶性胸腔积液近期疗效分析

目的:观察热疗联合胸腔灌注顺铂治疗恶性胸腔积液的临床疗效及毒副反应。方法:39例均为恶性胸腔积液患者,21例合并有局部疼痛。全部患者均采用中心静脉导管胸腔闭式引流,尽量引流尽胸水。将顺铂(DDP)60mg^80mg溶解于生理盐水40ml^60ml中注入胸腔,立即予以胸腔区域热疗。使用NRL-002型内生场热疗机进行加热,加温时对鼓膜、直肠及胸腔内进行测温。治疗时间以胸腔内温度上升至40℃以后开始计时,治疗时间60min^90min。热疗2次/周,胸腔灌注化疗1次/周,每个疗程热疗4次~8次。结果:39例中,CR 24例,PR 8例,有效率为82.1%。疼痛完全缓解9例,中度缓解7例,轻度3例缓解。脂肪硬结发生率为12.8%。消化道反应、骨髓抑制轻微。结论:热疗联合胸腔灌注顺铂治疗恶性胸腔积液是一种有效的治疗手段,值得在临床推广应用。

1999-2008年抚州市19种常见恶性肿瘤住院病例分析

目的:分析抚州市恶性肿瘤住院病例发生特征,为卫生管理部门和疾病控制部门制定肿瘤防治规划和措施提供依据。方法:回顾性调查分析1999-2008年抚州市19种常见恶性肿瘤住院病例,以ICD10编码作为疾病诊断分类标准,按出院时第一诊断进行登记,用构成比统计处理。结果:1999-2008年10年间恶性肿瘤住院病例位居前5位的恶性肿瘤依次是胃癌、肝癌、肺癌、肠癌和白血病,且连续10年保持不变。男性多于女性,比值为2.41∶1。乡村占63.18%,城市占36.82%,构成比呈逐年增多的趋势,从2005年起显著增多,31～70岁年龄段人群占84.04%。结论:建议针对不同地区恶性肿瘤的发病特点,综合治理,减少或消除致病因素,加强健康教育,参考不同癌肿平均发病年龄开展肿瘤普查,做到"早发现"、"早诊断"、"早治疗",以减少发病和改善恶性肿瘤治疗疗效。

Effect of Platelet Activation and Endothelial Cell Injury on Malignant Cancer

Objective: To study the effects of platelet activation and endothelial cell injury on the patients with malignant tumor and their prognoses.Methods: Radioimmunity and ELISA methods were employed to detect the TXB2, GMP-140, vWF, cGMP and FN in 78 cases of malignant tumor and 40 healthy control persons.Results: The levels of TXB2, MP-140 and cGMP were increased in intestinal cancer group, lung cancer group and hepatic cancer group, while FN decreased in intestinal cancer and lung cancer group. cGMP was positively related to TXB2, GMP-140, vWF in malignant tumor group. FN was decreased in the group complicated with infection and the group with metastasis, while the other indexes increased. GMP-140, vWF and cGMP was decreased after operation except for the increasing of FN.Conclusion: Activations of platelet and injury of endothelial cells developed in patients with malignant tumor, and both of them affected the metastasis and prognosis of malignant tumor. Key words platelet activation - epithelium injury - malignant tumor - metastasis This work was supported by grants from Guangdong Medical Science foundation (A2000633).

Clinical Research on the Changes of Plasma TFPI and uPA System in Malignant Tumor

Objective: To investigate the expression levels and significance of TFPI, uPA, uPAR and PAI in malignant patients. Methods: The levels of TFPI, uPA and uPAR were measured by using ELISA and the level of PAI was determined by method of chromogenic substrates in 44 patients with malignant solid tumors (group A1) and 30 patients with acute leukemia (AL, group A2). Results: The levels of TFPI, uPA, and uPAR in group A1 were higher than those in normal control group (group B). TFPI, uPAR levels in group A2 were higher than those in group B, while the level of PAI in group A2 was lower than that in group B. Among the groups, TFPI was increased in the combined infection group; PAI decreased in the hemorrhage group; TFPI, uPA, uPAR and PAI increased in relapsing and metastasis group; TFPI decreased in one-week dead group, while uPA and uPAR increased. Conclusion: The patients with malignant solid tumor and AL had different anticoagulation or fibrinolysis states. TFPI, uPA, Upar and PAI can be used to evaluate the disease condition and the prognosis.

nm23H1 expression and its role in the evolution of non-gastrointestinal malignancies

The role of nm23H1 genetic instability is not limited to gastrointestinal malignancies.A similar close relationship exists between nm23H1 genetic instability and other non gastrointestinal systemic malignancies.For instance,in oral malignant melanomas with lymphoid metastasis,the nm23H1 expression is significantly lower in contrast to tumors with no lymphoid metastasis.Similarly,increased metastasis is seen in non small cell lung cancers following down regulation of nm23H1 in conjunction with KAI-1 down regulation. There is an inverse relationship between tumor stage and metastasis and nm23H1 expression in individuals with prostate carcinomas and a similar relationship exists between microsatellite instability of the nm23H1 gene and ovarian carcinogenesis.For instance,nearly 70.5%of stageⅠ-Ⅱovarian tumors express nm23H1 in sharp contrast to only 25%of stageⅢ-Ⅳovarian tumors.As is clearly evident,nm23H1 has a major role in gastrointestinal and non-gastrointestinal carcinogenesis.The coming few years will hopefully see the development of new strategies by virtue of which we can alter nm23H1 expression and thus decrease the risk of metastasis in malignant tumors.

Contrast-enhanced sonography versus biopsy for the differential diagnosis of thrombosis in hepatocellular carcinoma patients

AIM:To clarify which method has accuracy:2nd gen-eration contrast-enhanced ultrasound or biopsy of portal vein thrombus in the differential diagnosis of portal vein thrombosis.METHODS:One hundred and eighty-six patients with hepatocellular carcinoma and portal vein thrombosis underwent in blinded fashion a 2nd generation contrast-enhanced ultrasound and biopsy of portal vein thrombus;both results were examined on the basis of the follow-up of patients compared to reference-standard.RESULTS:One hundred and eight patients completed the study.Benign thrombosis on 2nd generation contrast-enhanced ultrasound was characterised by progressive hypoenhancing of the thrombus;in malignant portal vein thrombosis there was a precocious homo-geneous enhancement of the thrombus.On follow-up there were 50 of 108 patients with benign thrombosis:all were correctly diagnosed by both methods.There were 58 of 108 patients with malignant thrombosis:amongst these,52 were correctly diagnosed by both methods,the remainder did not present malignant cells on portal vein thrombus biopsy and showed on 2nd generation contrast-enhanced ultrasound an inho-mogeneous enhancement pattern.A new biopsy during the follow-up,guided to the area of thrombus that showed up on 2nd generation contrast-enhanced ultra-sound,demonstrated an enhancing pattern indicating malignant cells.CONCLUSION:In patients with hepatocellular carcinoma complicated by portal vein thrombosis,2nd generation contrast-enhanced ultrasound of portal vein thrombus is very useful in assessing the benign or malignant nature of the thrombus.Puncture biopsy of thrombus is usually accurate but presents some sampling errors,so,when pathological results are required,2nd generation contrast-enhanced ultrasound could guide the sampling needle to the correct area of the thrombus.

Study on vasculogenic mimicry in malignant esophageal stromal tumors

AIM: To investigate whether malignant esophageal stromal tumors contain PAS-positive patterned matrix-associated vascular channels, which are lined by tumor cells, but not vascular endothelial cells. That is vasculogenic mimicry (VM) independent of tumor angiogenesis. METHODS: Thirty-six tissue samples of malignant esophageal stromal tumors were analyzed. Tissue sections were stained for Vascular endothelial growth factor (VEGF), CD31 and periodic acid Schiff (PAS). The level of VEGF, the microvascular density (MVD) and the vasculogenic mimicry density (VMD) were determined. RESULTS: PAS-positive patterned matrix-associated vascular channels were detected in 33.3% (12/36) of tumor samples. Within these patterned channels, red blood cells were found. The level of VEGF and the MVD in tumors containing patterned channels were significantly higher than those in tumors not containing patterned channels (P < 0.05). At the same time, the malignant degree of tumors was higher, the proportions of tumors containing patterned channels were not only more, but also in the each kind of tumors containing patterned channels. CONCLUSION: In malignant esophageal stromal tumors, a VM mechanism causes some tumor cells to deform themselves and secrete extracellular matrix; thus, PAS-positive patterned matrix-associated vascular channels appear and supplying blood to the tumors to sustain their growth and metastasis.

Mouse models of pancreatic cancer

Pancreatic cancer is one of the most lethal of human malignancies ranking 4th among cancer-related death in the western world and in the United States,and potent therapeutic options are lacking.Although during the last few years there have been important advances in the understanding of the molecular events responsible for the development of pancreatic cancer,currently specific mechanisms of treatment resistance remain poorly understood and new effective systemic drugs need to be developed and probed.In vivo models to study pancreatic cancer and approach this issue remain limited and present different molecular features that must be considered in the studies depending on the purpose to fit special research themes.In the last few years,several genetically engineered mouse models of pancreatic exocrine neoplasia have been developed.These models mimic the disease as they reproduce genetic alterations implicated in the progression of pancreatic cancer.Genetic alterations such as activating mutations in KRas,or TGFb and/or inactivation of tumoral suppressors such as p53,INK4A/ARF BRCA2 and Smad4 are the most common drivers to pancreatic carcinogenesis and have been used to create transgenic mice.These mouse models have a spectrum of pathologic changes,from pancreatic intraepithelial neoplasia to lesions that progress histologically culminating in fully invasive and metastatic disease and represent the most useful preclinical model system.These models can characterize the cellular and molecular pathology of pancreatic neoplasia and cancer and constitute the best tool to investigate new therapeutic approaches,chemopreventive and/or anticancer treatments.Here,we review and update the current mouse models that reproduce different stages of human pancreatic ductal adenocarcinoma and will have clinical relevance in future pancreatic cancer developments.

Primary intestinal malignant fibrous histiocytoma:two case reports

Malignant fibrous histiocytoma (MFH) occurs most commonly in the extremities and trunk, but rarely in the intestine. Here we report two cases of primary intestinal MFH. The first case was a 70-year old man admitted for recurrent right lower quadrant abdominal pain. At laparotomy, a tumor was found originating from the cecum, with a suspicious metastatic nodule on the surface of the right lobe of the liver. A right hemicolectomy was performed followed by an ileotransverse end-to-end anastomotic reconstruction. The second case was a 43-year old man with intussusceptions of the small intestine. An emergent laparotomy revealed 4 pedunculated masses in the small bowel and a partial resection of the small intestine was performed. Though the symptoms were not typical, based on histological and immunohistochemical studies, the patients were diagnosed as MFH of the intestine. They were not treated with chemotherapy or radiotherapy and both died within 3 mo. MFH of the intestine is an extremely rare neoplasm with an aggressive biological behavior. The pathogenesis of this disease has not been clarified to date. Complete surgical excision is preferred, adjuvant chemotherapy or radiotherapy may be advisable.

Effect of preoperative biliary drainage on malignant obstructive jaundice:A meta-analysis

AIM: To evaluate the effect of preoperative biliary drainage (PBD) on obstructive jaundice resulting from malignant tumors. METHODS: According to the requirements of Cochrane systematic review, studies in the English language were retrieved from MEDLINE and Embase databases from 1995 to 2009 with the key word "preoperative biliary drainage". Two reviewers independently screened the eligible studies, evaluated their academic level and extracted the data from the eligible studies confirmed by cross-checking. Data about patients with and without PBD after resection of malignant tumors were processed for meta-analysis using the Stata 9.2 software, including postoperative mortality, incidence of postoperative pancreatic and bile leakage, abdominal abscess, delayed gastric emptying and incision infection.RESULTS: Fourteen retrospective cohort studies involving 1826 patients with malignant obstructive jaundice accorded with our inclusion criteria, and were included in meta-analysis. Their baseline characteristics were comparable in all the studies. No significant difference was found in combined risk ratio (RR) of postoperative mortality and incidence of pancreatic and bile leakage, abdominal abscess, delayed gastric emptying between patients with and without PBD. However, the combined RR for the incidence of postoperative incision infection was improved better in patients with PBD than in those without PBD (P < 0.05). CONCLUSION: PBD cannot significantly reduce the post-operative mortality and complications of malignant obstructive jaundice, and therefore should not be used as a preoperative routine procedure for malignant obstructive jaundice.

Pancreatic metastases from renal cell carcinoma:The state of the art

Pancreatic metastases are rare,with a reported incidence varying from 1.6%to 11%in autopsy studies of patients with advanced malignancy.In clinical series,the frequency of pancreatic metastases ranges from 2%to 5%of all pancreatic malignant tumors.However,the pancreas is an elective site for metastases from carcinoma of the kidney and this peculiarity has been reported by several studies.The epidemiology,clinical presentation,and treatment of pancreatic metastases from renal cell carcinoma are known from singleinstitution case reports and literature reviews.Thereis currently very limited experience with the surgical resection of isolated pancreatic metastasis,and the role of surgery in the management of these patients has not been clearly defined.In fact,for many years pancreatic resections were associated with high rates of morbidity and mortality,and metastatic disease to the pancreas was considered to be a terminal-stage condition.More recently,a significant reduction in the operative risk following major pancreatic surgery has been demonstrated,thus extending the indication for these operations to patients with metastatic disease.

Clinicopathological significance of p53 and mdm2 protein expression in human pancreatic cancer

AIM: To study the clinicopathological significance of p53 and mdm2 protein expression in human pancreatic cancer. METHODS: To investigate the expression of p53 and mdm2 in pancreatic cancer by immunohistochemistry, and the relationships between the p53 and mdm2 protein expression and clinicopathological parameters in pancreatic cancer.RESULTS: The positive expression of p53 protein was found in 40 of 59 patients (67.8%) and that of mdm2 protein in 17 of 59 patients (28.8%). No obvious relationships were found between p53 as well as mdm2 expression and sex, tumor site, TNM staging and histological differentiation. p53 expression was increased in patients younger than 65 years old, while mdm2 had no relationship with age. The survival time of the patients with the positive expression of p53 and mdm2 proteins was obviously shorter than the other groups. CONCLUSION: Both p53 and mdm2 presented relatively high expression in human pancreatic cancer. The overexpression of p53 and mdm2 might reflect the malignant proliferation of pancreatic cancer and their co-expression might be helpful to evaluate the prognosis of the patients with pancreatic cancer.

Primary localized malignant biphasic mesothelioma of the liver in a patient with asbestosis

We report a case of primary localized malignant biphasic mesothelioma of the liver in a 66-year-old man associated with asbestosis. The tumor was detected as a hepatic nodule, 4 cm in diameter, in the right lobe (S8 segment) on CT scan. Histopathological examination demonstrated an intrahepatic tumor with central necrosis consisting of a papillary epithelioid pattern on the surface of the liver, microcystic (microglandular or adenomatoid) pattern mainly in the subcapsular area and sarcomatoid pattern intermingled with microcystic pattern in the major part of the hepatic nodular tumor. Tumor cells, especially of epithelioid type, showed distinct immunoreactivity for mesothelial markers (WT-1, calretinin, D2-40, CK5/6, mesothelin, thrombomodulin) and no immunoreactivity for epithelial (adenocarcinoma) markers (CEA, CD15, BerEP4, BG8, MOC31). P53 immunoreactivity was detected focally in papillary epithelioid tumor cells and extensively in microcystic and sarcomatoid components, suggesting that the papillary epithelioid mesothelioma arose on the surface of the liver, and tumor cells showing microcystic and sarcomatoid patterns invaded and grew into the liver. To date, this is the first case of primary localized malignant biphasic mesothelioma of the liver, since all three primary hepatic mesotheliomas reported so far were epithelioid type.

Review:Proteomic technology for biomarker profiling in cancer: an update

The progress in the understanding of cancer progression and early detection has been slow and frustrating due to the complex multifactorial nature and heterogeneity of the cancer syndrome. To date, no effective treatment is available for advanced cancers, which remain a major cause of morbidity and mortality. Clearly, there is urgent need to unravel novel biomarkers for early detection. Most of the functional information of the cancer-associated genes resides in the proteome. The later is an exceptionally complex biological system involving several proteins that function through posttranslational modifications and dynamic inter-molecular collisions with partners. These protein complexes can be regulated by signals emanating from cancer cells, their sur-rounding tissue microenvironment, and/or from the host. Some proteins are secreted and/or cleaved into the extracellular milieu and may represent valuable serum biomarkers for diagnosis purpose. It is estimated that the cancer proteome may include over 1.5 million proteins as a result of posttranslational processing and modifications. Such complexity clearly highlights the need for ultra-high resolution proteomic technology for robust quantitative protein measurements and data acquisition. This review is to update the current research efforts in high-resolution proteomic technology for discovery and monitoring cancer biomarkers.

Synchronous incidental gastrointestinal stromal and epithelial malignant tumors

AIM:To investigate the incidence of incidental gastrointestinal stromal tumor (GIST) and its etiopathogenesis.METHODS: From January 1, 2000 to December 31, 2007, 13 804 cases of gastrointestinal epithelial malignant tumor (EMT) and 521 cases of pancreatic adenocarcinoma (PAC) were successfully treated with surgery at the Department of General Surgery and the Department of Thoracic Surgery, West China Hospital, Sichuan University, China. The clinical and pathologic data of 311 cases of primary GIST, including 257 cases with clinical GIST and 54 cases of incidental GIST were analyzed.RESULTS: Of the 311 patients, 54 had incidental GIST, accounting for 17.4%. Of these tumors, 27 were found in 1.13% patients with esophageal squamous cell carcinoma (ESCC), 22 in 0.53% patients with gastric adenocarcinoma (GAC), 2 in 0.38% patients with PAC, 2 in 0.03% patients with colorectal adenocarcinoma, and 1 in one patient with GAC accompanying ESCC, respectively. Patients with incidental GIST presented symptoms indistinguishable from those with EMT. All incidental GIST lesions were small in size, and the majority had a low mitotic activity while only 1.9% (5/257) of clinical GIST lesions had a high risk.CONCLUSION: Incidental GIST may occur synchronously with other tumors and has a high prevalence in males. Surgery is its best treatment modality.

Endoscopic polypectomy: A promising therapeutic choice for esophageal carcinosarcoma

Esophageal carcinosarcoma is a rare malignant tumor composing of both carcinomatous and sarcomatous elements. Endoscopic therapy is less invasive and may represent an alternative to esophagectomy for superf icial esophageal carcinosarcoma. Here, we report a 61-year-old male who was diagnosed as esophageal carcinosarcoma and underwent endoscopic polypectomy with well tolerance and favorable prognosis. We also present a brief review of the literature.