Clinicopathological characteristics and prognosis of gastric signet ring cell carcinoma

BACKGROUND The clinicopathological features and prognosis of gastric signet ring cell carcinoma(GSRC)remain controversial,particularly with regard to sensitivity to postoperative adjuvant therapy.AIM To compare the pathological features of GSRC with those of gastric adenocarcinoma of different degrees of differentiation and the differences in survival prognosis between the different disease processes.METHODS By screening gastric cancer patients from 2010 to 2015 in the database of Surveillance,Epidemiology and End Results,and collecting the clinicopathological and prognostic data of gastric cancer patients who underwent surgery from January 2014 to December 2016 in the Second Affiliated Hospital of Nanchang University,we analyzed the general pathological characteristics of GSRC by the chi-square test.Univariate and multivariate analyses were conducted to compare the factors affecting the survival and prognosis of early and advanced gastric adenocarcinoma.The Kaplan-Meier curves were plotted to reveal the survival difference between early and advanced GSRC and different differentiated types of gastric adenocarcinoma.The prognosis model of advanced GSRC was established with R software,and the area under curve(AUC)and C-index were used to assess the accuracy of the model.RESULTS Analysis of pathological features revealed that signet ring-cell carcinoma(SRC)was more frequently seen in younger(<60 years),female,and White patients compared to non-SRC patients.SRC was less commonly associated with early gastric cancer(EGC)(23.60%vs 39.10%),lower N0(38.61%vs 61.03%),and larger tumour sizes>5 cm(31.15%vs 27.10%)compared to the differentiated type,while the opposite was true compared to the undifferentiated type.Survival prognostic analysis found no significant difference in the prognosis of SRC patients among EGC patients.In contrast,among advanced gastric cancer(AGC)patients,the prognosis of SRC patients was correlated with age,race,tumour size,AJCC stage,T-stage,and postoperative adjuvant therapy.The predictive model showed that the 3-year AUC was 0.787,5-year AUC was 0.806,and C-index was 0.766.Compared to non-SRC patients,patients with SRC had a better prognosis in EGC[hazard ratio(HR):0.626,95%confidence interval(CI):0.427-0.919,P<0.05]and a worse prognosis in AGC(HR:1.139,95%CI:1.030-1.258,P<0.05).When non-SRC was divided into differentiated and undifferentiated types for comparison,it was found that in EGC,SRC had a better prognosis than differentiated and undifferentiated types,while there was no significant difference between differentiated and undifferentiated types.In AGC,there was no significant difference in prognosis between SRC and undifferentiated types,both of which were worse than differentiated types.A prognostic analysis of postoperative adjuvant therapy for SRC in patients with AGC revealed that adjuvant postoperative radiotherapy or chemotherapy significantly improved patient survival(34.6%and 36.2%vs 18.6%,P<0.05).CONCLUSION The prognosis of SRC is better than that of undifferentiated type,especially in EGC,and its prognosis is even better than that of differentiated type.SRC patients can benefit from early detection,surgical resection,and aggressive adjuvant therapy.

Chylous ascites arises after chemotherapy of gastric signet ring cell carcinoma: A case report and review

Chylous ascites, a rare clinical condition resulting from the disruption of the abdominal lymphatic system, usually diagnosed by paracentesis when the patients suffer ascites as primary symptom. The conditions, in which chylous ascites arise after chemotherapy of solid tumor, are rarely reported. In this paper we present a quite rare case of chylous ascites arising after chemotherapy of gastric signet ring cell carcinoma.

Identification of key genes and pathways in gastric signet ring cell carcinoma based on transcriptome analysis

BACKGROUND Gastric signet ring cell carcinoma(GSRCC)is one of the most malignant tumors.It has the features of high invasiveness,rapid progression,and resistance to chemotherapy.However,systematic analyses of mRNAs have not yet been performed for GSRCC.AIM To identify key mRNAs and signaling pathways in GSRCC.METHODS A transcriptome analysis of two GSRCC and two non-GSRCC samples was performed in this study.Differentially expressed mRNAs and pathways were identified based on the KEGG and PANTHER pathway annotations.The interactive relationships among the differential genes were mapped with the STRING database.Quantitative real-time polymerase chain reaction was used to validate the key gene expression in GSRCC.RESULTS About 1162 differential genes(using a 2-fold cutoff,P<0.05)were identified in GSRCC compared with non-GSRCC.The enriched KEGG and PANTHER pathways for the differential genes included immune response pathways,metabolic pathways,and metastasis-associated pathways.Ten genes(MAGEA2,MAGEA2B,MAGEA3,MAGEA4,MAGEA6,MUC13,GUCA2A,FFAR4,REG1A,and REG1B)were identified as hub genes in the protein-protein interaction network.The expression levels of five genes(MAGEA2,MAGEA3,MAGEA4,MAGEA6,and REG1B)showed potential clinical value.CONCLUSION We have identified the potential key genes and pathways in GSRCC,and these hub genes and pathways could be diagnostic markers and therapeutic targets for GSRCC.

Clinicopathological and prognostic differences between mucinous gastric carcinoma and signet-ring cell carcinoma

Objective： To analyze the differences in clinicopathologic characteristics and prognosis between mucinous gastric carcinoma （MGC） and signet-ring cell carcinoma （SRCC）. Methods： Clinicopathologic and prognostic data of 1,637 patients with histologically confirmed MGC or SRCC who received surgical operations in the Department of Gastroenterological Surgery, Beijing Cancer Hospital between December 2004 and December 2009 were retrospectively collected and analyzed. The clinicopathological features were analyzed statistically using Z2 test. Survival was analyzed using the Kaplan- Meier method and multivariate analysis of Cox proportional hazards regression model （backward, stepwise）. Results： A total of 181 patients with gastric cancer （74 MGC, 107 SRCC） were included. MGC, when compared with SRCC, was featured by senile patients, stage III and I~, upper third stomach, large tumor size, positive lymph node metastasis, and positive lymphatic vascular invasion （P〈0.05）. The overall 5-year survival rate showed no difference between the two groups （48.8% vs. 44.8%, P〉0.05）. However, the survival rate for MGC patients was significant lower than that for SRCC patients when compared among the age 〈60 years, negative distant metastasis, and tumor localized at upper third stomach （P〈0.05）. Multivariate Cox proportional hazards models revealed that distant metastasis was a significant independent prognostic indicator in MGC group, and lymph node metastasis and distant metastasis was significant independent prognostic indicators in SRCC group. Conclusions： While compared with SRCC, MGC is associated with a more aggressive tumor biologic behavior. There is no statistically significant difference in distant metastasis, an independent prognostic indicator for both MGC and SRCC, which might be the reason for no significant difference of the overall survival rate between the patients with MGC and SRCC.

Signet-ring cell carcinoma of the stomach: Impact on prognosis and specific therapeutic challenge

While the incidence of gastric cancer has decreased worldwide in recent decades,the incidence of signetring cell carcinoma(SRCC) is rising. SRCC has a specific epidemiology and oncogenesis and has two forms: early gastric cancer,which can be resected endoscopically in some cases and which has a better outcome than non-SRCC,and advanced gastric cancer,which is generally thought to have a worse prognosis and lower chemosensitivity than non-SRCC. However,the prognosis of SRCC and its chemosensitivity with specific regimens are still controversial as SRCC is not specifically identified in most studies and its poor prognosis may be due to its more advanced stage. It therefore remains unclear if a specific therapeutic strategy is justified,as the benefit of perioperative chemotherapy and the value of taxanebased chemotherapy are unclear. In this review we analyze recent data on the epidemiology,oncogenesis,prognosis and specific therapeutic strategies in both early and advanced SRCC of the stomach and in hereditary diffuse gastric cancer.

Diagnosis of small intramucosal signet ring cell carcinoma of the stomach by non-magnifying narrow-band imaging: A pilot study

AIM: To examine the efficacy of non-magnifying narrow-band imaging(NM-NBI) imaging for small signet ring cell carcinoma(SRC).METHODS: We retrospectively analyzed 14 consecutive small intramucosal SRCs that had been treated with endoscopic submucosal dissection(ESD) and 14 randomly selected whitish gastric ulcer scars(control). The strength and shape of the SRCs and whitish scars by NM-NBI and white-light imaging(WLI) were assessed with Image J(NIH, Bethesda).RESULTS: NM-NBI findings of SRC showed a clearly isolated whitish area amid the brown color of the surrounding normal mucosa. The NBI index, which indicates the potency of NBI for visualizing SRC, was significantly higher than the WLI index(P = 0.001), indicating SRC was more clearly identified by NM-NBI. Although the NBI index was not significantly different between SRCs and controls, the circle(C)-index, as an index of circularity of tumor shape, was significantly higher in SRCs(P = 0.001). According to the receiveroperating characteristic analysis, the resulting cut-off value of the circularity index(C-index) for SRC was 0.60(85.7% sensitivity, 85.7% specificity). Thus a lesion with a C-index ≥ 0.6 was significantly more likely to be an SRC than a gastric ulcer scar(OR = 36.0; 95%CI: 4.33-299.09; P = 0.0009).CONCLUSION: Small isolated whitish round area by NM-NBI endoscopy is a useful finding of SRCs which is the indication for ESD.

Overexpression of the M2 isoform of pyruvate kinase is an adverse prognostic factor for signet ring cell gastric cancer

AIM:To investigate M2 isoform of pyruvate kinase(PKM2) expression in gastric cancers and evaluate its potential as a prognostic biomarker and an anticancer target.METHODS:All tissue samples were derived from gastric cancer patients underwent curative gastrectomy as a primary treatment.Clinical and pathological information were obtained from the medical records.Gene expression microarray data from 60 cancer and 19 noncancer gastric tissues were analyzed to evaluate the expression level of PKM2 mRNA.Tissue microarrays were constructed from 368 gastric cancer patients.Immunohistochemistry was used to measure PKM2 expression and PKM2 positivity of cancer was determined by proportion of PKM2-positive tumor cells and staining intensity.Association between PKM2 expression and the clinicopathological factors was evaluated and the correlation between PKM2 and cancer prognosis was evaluated.RESULTS:PKM2 mRNA levels were increased more than 2-fold in primary gastric cancers compared to adjacent normal tissues from the same patients(log transformed expression level:7.6 ± 0.65 vs 6.3 ± 0.51,P < 0.001).Moreover,differentiated type cancers had significantly higher PKM2 mRNA compared to undifferentiated type cancers(log transformed expression level:7.8 ± 0.70 vs 6.7 ± 0.71,P < 0.001).PKM2 protein was mainly localized in the cytoplasm of primary cancer cells and detected in 144 of 368(39.1%) human gastric cancer cases.PKM2 expression was not related with stage(P = 0.811),but strongly correlated with gastric cancer differentiation(P < 0.001).Differentiated type cancers expressed more PKM2 protein than did the undifferentiated ones.Well differentiated adenocarcinoma showed 63.6% PKM2-positive cells;in contrast,signet-ring cell cancers showed only 17.7% PKM2-positive cells.Importantly,PKM2 expression was correlated with shorter overall survival(P < 0.05) independent of stage only in signet-ring cell cancers.CONCLUSION:PKM2 expression might be an adverse prognostic factor for signet-ring cell carcinomas.Its function and potential as a prognostic marker should be further verified in gastric cancer.

Testicular metastasis from gastric carcinoma:A case report

Gastric cancer(GC) is the most prevalent malignancy in the world,especially in China.GC has been postulated to spread via several different routes,including through hematogenous channels,lymphatic vessels,the seeding of peritoneal surfaces,direct extension through the gastric wall,and retrograde extension through the vas deferens or lymphatics.Testicular metastasis is rare.We show here a 53-year-old patient with GC who underwent a radical total gastrectomy approximately 22 mo ago after he presented with a sensation of heaviness and swelling of the right hemiscrotum.The diagnosis of metastatic adenocarcinoma was made after a rightside orchiectomy.We report the first case of testicular metastasis from gastric adenocarcinoma in China's Mainland and summarize the clinicopathologic features of the disease based on previously published papers.

胃癌患者术前血清CA72-4、CYFRA21-1水平与生存预后的关系

目的 通过研究不同肿瘤标志物水平、不同病理状态下胃癌患者的预后生存情况,找到影响患者生存预后的危险因素。方法 收集2018年12月至2021年1月在解放军总医院第一医学中心行手术治疗的164例胃癌患者临床资料,并随访患者生存情况,分析影响胃癌患者生存的风险因素。结果 生存时间≤2年的胃癌患者血清CYFRA21-1、PGII水平明显高于生存时间>2年组,差异具有统计学意义(P=0.002、0.023)。胃癌患者在CA72-4≤10U/mL、CYFRA21-1≤4.0ng/mL、TNM分期为I+II期、Lauren分型为肠型、非印戒细胞癌中1、2、3年生存率较高,在CA72-4>10U/mL、CYFRA21-1>4.0ng/mL、TNM分期为III+IV期、Lauren分型为弥散型、印戒细胞癌中生存率较低,差异具有统计学意义(P=0.0001、0.0007、<0.0001、<0.0001、0.0002)。血清CA72-4、CYFRA21-1水平、印戒细胞癌、TNM分期是影响胃癌患者生存的风险因素(P=0.001、<0.001、<0.001、<0.001)。结论 血清高CA72-4、CYFRA21-1水平、印戒细胞癌、TNM分期较晚是胃癌患者生存预后的风险因素。

不同病理亚型胃印戒细胞癌的临床预后分析

目的探讨不同病理亚型胃印戒细胞癌(GSRC)患者的临床病理特征、预后及其影响因素。方法回顾性收集2016年1月-2018年12月兰州大学第二医院收治的经病理确诊的232例GSRC患者的临床资料。按照WHO诊断标准进行分类,其中胃纯印戒细胞癌(pGSRC)36例,胃混合印戒细胞癌(mGSRC)196例,随访截至2022年9月30日。应用Kaplan-Meier法进行生存分析,单因素及多因素Cox回归分析影响GSRC患者预后的危险因素。结果pGSRC和mGSRC患者中位生存时间分别为41.0(6.0~70.0)个月、24.0(2.0~74.0)个月。Kaplan-Meier生存分析显示,合并糖尿病、合并贫血、神经侵犯、脉管侵犯、T分期、N分期、GSRC病理类型、CA125和肿瘤直径可影响GSRC患者根治术后总生存期(OS)(P<0.05),而Her-2、是否接受化疗等对GSRC患者根治术后OS无明显影响(P>0.05)。单因素Cox回归分析显示,合并糖尿病(P=0.031)、合并贫血(P=0.028)、肿瘤直径>5 cm(P=0.009)、神经侵犯(P=0.002)、脉管侵犯(P=0.002)、病理类型为mGSRC(P=0.039)、T_(2)-T_(4)分期(P=0.001)、N_(1)-N_(4)分期(P=0.004)、p TNMⅢ期(P=0.044)、淋巴结清扫数目>30个(P=0.044)和CA125阳性(P=0.009)是GSRC患者根治术后预后的影响因素。多因素Cox回归分析显示,mGSRC病理类型(P=0.035)、T_(2)-T_(4)分期(P=0.003)和CA125阳性(P=0.010)是GSRC患者根治术后预后不良的独立危险因素。结论与pGSRC相比,mGSRC在确诊时pTNM分期较高,侵袭性较强,中位生存时间较短。mGSRC病理类型、T_(2)-T_(4)分期和CA125阳性是GSRC患者预后不良的独立危险因素。

胃印戒细胞癌的临床研究进展

近年来胃癌发病率有所下降,但胃印戒细胞癌发病率显著升高。相较于非印戒细胞癌,晚期胃印戒细胞癌的预后较差,这与其分子病理学特征及化疗耐药密切相关。胃印戒细胞癌的分子表达谱有望成为潜在的治疗靶点及生物标志物。现本文就胃印戒细胞癌的分子病理学特征及其治疗的最新进展进行综述。

基于淋巴结阳性率的胃印戒细胞癌预后模型的建立与验证

目的探讨淋巴结阳性率(LNR)在胃印戒细胞癌(GSRCC)预后中的价值,并构建基于LNR的预后列线图进行验证。方法收集并整理了SEER数据库和江苏大学附属宜兴医院GSRCC患者数据,分别作为训练集和验证集。利用Kaplan-Meier法绘制生存曲线,通过单因素和多因素Cox模型进行预后分析。构建基于LNR的预后列线图,并在验证集中进行验证。结果与低LNR患者相比,高LNR患者肿瘤分期更晚,中LNR患者化疗比例更高(P<0.05)。训练集低、中、高LNR患者的5年癌症特异性生存率分别为71.1%、30.7%、8.9%,差异有统计学意义(P<0.05)。验证集低、中、高LNR患者的5年癌症特异性生存率为85.0%、53.2%、17.9%,差异有统计学意义(P<0.05)。多因素回归分析显示,年龄、肿瘤大小、T分期、LNR、Stage分期、化疗是影响GSRCC预后的独立预后因素。进一步构建列线图模型,该模型在内部抽取和外部验证方面都具有较好的预测一致性。在内部验证中,1、3、5年生存率的曲线下面积(AUC)分别为0.787、0.848、0.855,外部验证的AUC分别为0.724、0.729、0.737。结论LNR对GSRCC具有独立的预后价值,以LNR为基础的列线图模型可被视为GSRCC预后的重要预测指标。

局部进展期胃印戒细胞癌术后腹膜转移及预后因素分析

目的探讨局部进展期胃印戒细胞癌(SRCC)术后腹膜转移、预后及相关影响因素。方法回顾性分析2012-01—2018-12于郑州大学第一附属医院行根治性手术后发生复发转移的357例局部进展期胃癌患者的临床资料,分析腹膜转移情况及预后的影响因素。结果357例患者中,94例为SRCC(SRCC组),发生腹膜转移65例(69.1%);263例为非SRCC(NSRCC组),发生腹膜转移126例(47.9%)。2组差异有统计学意义(P=0.001)。SRCC组65例发生腹膜转移的患者中,55例(84.6%)发生于术后2 a内,其中Ⅲ期46例(83.6%),Ⅱ期和Ⅰ期9例(16.4%)。差异有统计学意义(P<0.05)。NSRCC组126例发生腹膜转移的患者中,105例(83.3%)发生于术后2 a内,其中Ⅲ期102例(97.1%),Ⅱ期和Ⅰ期3例(2.9%)。差异有统计学意义(P=0.001)。SRCC组患者的中位总生存期(OS)为23个月,3 a生存率为25.5%;NSRCC组患者分别为26个月和38.1%。差异有统计学意义(P<0.05)。SRCC组内腹膜转移者中位OS为19个月,3 a生存率为20%;NSRCC组内腹膜转移者分别为23个月和34.9%。差异均有统计学意义(P<0.05)。2组非腹膜转移者的总生存期及3 a生存率差异无统计学意义(P=0.15)。单因素分析结果显示,SRCC、腹膜转移、肿瘤直径、肿瘤分期、脉管侵犯是患者预后的影响因素;多因素分析结果显示,腹膜转移、肿瘤直径和分期是影响预后的独立危险因素。结论局部进展期胃癌根治性术后复发转移率较高,其中SRCC患者的腹膜转移率较高,多发生在术后2 a内,且以Ⅲ期较多见。SRCC患者的预后较NSRCC差,可能与术后高腹膜转移率有关。

含有印戒细胞成分胃癌的临床病理特征及预后的研究进展

胃癌作为一项全球性健康挑战,特别是印戒细胞癌(SRCC)这一亚型,正呈现出不断上升的发病趋势。根据世界卫生组织(WHO)的标准,SRCC主要由超过50%的印戒细胞(SRC)构成。然而,临床上常见的胃癌往往只含有较少的SRC,进而形成了所谓的混合印戒细胞癌(mSRCC)。这种病变日益影响到年轻群体,尤其是年轻女性。研究显示,与SRCC相比,mSRCC患者的平均年龄通常更高。此外,性别因素在此类疾病中也显得格外重要,年轻女性更易患有胃SRCC和mSRCC。从生物学角度来看,胃纯SRCC与mSRCC之间差异显著,高SRC比例的胃癌拥有更好的肿瘤浸润深度、癌症分期、淋巴结转移、周围组织侵犯和切除率等多个方面。相比之下,胃mSRCC的预后通常不如纯SRCC。对于仅限于黏膜的早期胃SRCC,其淋巴结和远处转移风险较低,而晚期胃SRCC则显示出更强的侵袭性和较差的预后,SRC的百分比被强调为晚期胃癌的一个独立预后因素。本文综述了近年来关于含SRC成分的胃癌的临床与病理特征、预后等方面的研究进展,旨在为含SRC胃癌的深入研究和临床治疗策略提供基于证据的深入见解,以期为发展针对含有SRC的胃癌的更有效的综合治疗策略和定制化治疗方案提供科学依据和策略指导。

胃印戒细胞癌与胃混合印戒细胞癌患者临床病理资料及预后对比分析

目的通过对比分析胃印戒细胞癌(SRCC)与胃混合印戒细胞癌(mixed-SRCC)的临床病理资料及预后情况,为胃癌的个体化、精准化治疗提供参考。方法接受根治性手术切除的含印戒细胞成分的胃癌患者481例,其中胃SRCC 161例、胃mixed-SRCC 320例。比较胃SRCC、胃mixed-SRCC的临床病理资料及预后。分析胃SRCC、胃mixed-SRCC的预后影响因素。结果胃SRCC肿瘤直径>5 cm、肿瘤位于胃下1/3、淋巴结转移阴性、浸润深度T1a者比例高于mixed-SRCC(P均<0.05);早期胃SRCC远端胃切除术、肿瘤直径>5 cm、浸润深度T1a、病理分期ⅠA期者比例高于早期胃mixed-SRCC,进展期胃SRCC淋巴结转移阴性、脉管侵犯阴性者比例高于胃mixed-SRCC(P均<0.05)。胃SRCC患者总体3年生存率及进展期患者3年生存率高于胃mixed-SRCC患者(P均<0.05)。淋巴结转移(HR=0.407,95%CI 0.177~0.937,P=0.035)、浸润深度(HR=4.409,95%CI 1.269~15.322,P=0.020)、病理分期(HR=4.365,95%CI 1.546~12.324,P=0.005)是胃SRCC预后的独立影响因素;淋巴结转移(HR=0.241,95%CI 0.137~0.424,P<0.001)、病理分期(HR=3.496,95%CI 1.311~9.321,P=0.012)是胃mixed-SRCC预后的独立影响因素。结论与胃mixed-SRCC相比,胃SRCC浸润深度相对较浅,病理分期较早,总体预后更好。胃mixed-SRCC相较于胃SRCC具有更强的淋巴结转移倾向,且淋巴结转移与mixed-SRCC不良预后相关;进展期胃mixed-SRCC的预后差于胃SRCC。

术前白蛋白与纤维蛋白原比值对可根治性切除术后胃印戒细胞癌预后的预测价值

目的分析可根治性切除胃印戒细胞癌患者术前白蛋白与纤维蛋白原比值对预后的预测价值。方法回顾性分析行根治性切除术胃印戒细胞癌的173例患者的临床病例资料。绘制受试者工作特征(ROC)曲线计算白蛋白/纤维蛋白原比值(AFR)临界值,分为低AFR组(n=50)和高AFR组(n=123),对比2组临床病理资料及不同AFR表达水平总生存期(OS)的差异,采用Cox回归分析对胃印戒细胞癌患者预后因素进行单多因素分析。结果AFR预测胃印戒细胞癌患者预后的ROC曲线下面积0.603(95%CI:0.512~0.695,P<0.05),最佳截断值为11.49,敏感度和特异度分别为0.44和0.79(P<0.05)。AFR低水平组与AFR高水平组在患者年龄、肿瘤直径、肿瘤部位、肿瘤T分期、TNM分期、Borrmann分型上差异有统计学意义(P<0.05)。低AFP组患者的3年、5年累积生存率分别为50.8%和40.3%,高AFR组患者的3年及5年累积生存率分别为72.0%和65.3%,低AFR组患者的预后明显差于高AFR组患者(P<0.05)。单因素Cox回归分析结果显示,年龄、术前贫血、肿瘤大小、T分期、TNM分期及术前AFR影响胃印戒细胞癌患者预后(P<0.05);多因素Cox回归分析结果显示,年龄及术前AFR是胃癌患者预后的独立危险因素(P<0.05)。结论术前AFR是胃印戒细胞癌患者的独立预后因素,术前低水平AFR患者预后不佳,为其应用于预测胃印戒细胞癌患者的长期生存提供了临床依据。

宫颈黏液腺癌的诊治进展

宫颈黏液腺癌是宫颈恶性肿瘤中一种罕见的、特殊的组织学类型,其分类主要有宫颈胃型腺癌、宫颈肠型腺癌和宫颈原发印戒细胞型腺癌等。由于宫颈黏液腺癌的发病机制与人乳头瘤病毒(human papilloma virus,HPV)感染之间的不确定性,因此难以通过常规宫颈癌筛查加以提示。同时,宫颈黏液腺癌的病因及发病机制均不明确,且缺乏典型临床表现及早期诊断方法,临床病理特征及治疗与宫颈普通腺癌有所不同,导致患者易错过最佳治疗时机,因此宫颈黏液腺癌较宫颈普通型腺癌的预后差。近年来,由于对HPV疫苗的普及,宫颈黏液腺癌相对发病率较前略有升高,关于宫颈黏液腺癌的研究越来越受到重视,综述宫颈黏液腺癌的国内外相关研究,探讨宫颈黏液腺癌的相关发病机制、临床特征及治疗,以期为宫颈黏液腺癌的临床诊治提供参考。

胃印戒细胞癌发展及预后与幽门螺杆菌感染的关系研究

目的探究胃印戒细胞癌发展及预后与幽门螺杆菌(HP)感染的关系。方法回顾性分析2019年10月至2020年10月本院收治的80例胃黏膜病变患者的临床资料。比较不同胃黏膜病变患者HP阳性率,比较不同病理特征(临床分期、分化程度、淋巴结转移、TNM分期和Lauren分型)胃印戒细胞癌患者HP阳性率,采用Spearman系数分析胃印戒细胞癌与HP感染的相关性,比较胃印戒细胞癌组织和癌旁组织HP相对感染量,采用Kaplan-Meier法分析胃印戒细胞癌患者HP相对感染量与生存率的相关性。结果胃印戒细胞癌患者的HP阳性率高于慢性浅表性胃炎(P<0.05),其他病变患者HP阳性率两两比较差异均无统计学意义。进展期患者HP阳性率高于早期患者,差异有统计学意义(P<0.05);高分化患者HP阳性率高于中、低分化患者,差异有统计学意义(P<0.05);TNM分期Ⅳ期患者HP阳性率高于Ⅰ、Ⅱ、Ⅲ期患者,差异有统计学意义(P<0.05);Lauren分型为混合型患者HP阳性率高于肠型、弥漫型患者,差异有统计学意义(P<0.05)。经Spearman相关性分析显示,胃印戒细胞癌与HP感染呈正相关(r>0,P<0.05)。胃印戒细胞癌癌组织HP相对感染量[(12.41±4.31)]高于癌旁组织[(8.79±2.17)],差异有统计学意义(P<0.05)。Kaplan-Meier生存分析显示,HP相对感染量与胃印戒细胞癌生存率呈负相关(r<0,P<0.05)。结论胃印戒细胞癌发展及预后与HP感染率密切相关,HP阳性感染率升高,会增加胃印戒细胞癌发生风险,且患者预后越差,临床应予以重视。

胃印戒细胞癌组化、免疫组化与超微结构观察

目的 :探讨胃印戒细胞癌的组化、免疫组化特性与超微结构特征的相关性 ,为胃印戒细胞癌发生发展和诊断提供依据。方法 :对 5 3例胃印戒细胞癌的病理标本进行AB -PAS组化染色及CEA免疫组化检测 ,同时进行电镜超微结构观察。结果 :癌细胞呈现三种形态 :单核细胞样、浆细胞样及印戒细胞样。分泌三种粘液 :肠型酸性粘液、胃型中性粘液和混合型粘液 ,并可同时见于癌组织的不同区域中。本组胃印戒细胞癌组织中CEA均呈强阳性。癌细胞超微结构分为三种形态 :暗细胞型、粘液型、微囊型。结论 :印戒细胞癌的主要特征为CEA性粘液分化 ,印戒细胞癌的三种形态反映CEA性粘液发生、演变至终末期发展的全过程 ;CEA肿瘤特异性表达。

胃上皮异型增生在印戒细胞癌发生中的作用

目的:探讨上皮异型增生在胃印戒细胞癌发生中的作用。方法:以42例早期胃印戒细胞癌为研究材料,AB-PAS(奥辛蓝-过碘酸雪夫)染色观察印戒细胞和癌旁异型增生所含黏液的组织化学特性;免疫组化染色检测两者表达胃和肠上皮标志物MUC5AC,MUC6,MUC2,CD10的情况,并将印戒细胞和异型增生分为G型(胃型)、GI型(胃肠型)、I型(肠型)和U型(未分化型)四类,统计并比较印戒细胞、癌旁异型增生的类型。以20例早期肠型胃癌作为对照。结果:AB-PAS染色显示,印戒细胞所含的黏液主要为中性及混合性黏液,癌旁异型增生上皮分泌的黏液成分与印戒细胞一致;免疫组织化学染色显示,印戒细胞的分类以G型为主,癌旁异型增生G型更多见,而I型少见;G型、GI型异型增生可向印戒细胞癌移行,且在GI型异型增生移行为印戒细胞癌时,肠上皮标志物的表达逐渐下降。结论:印戒细胞癌的发生与上皮异型增生有关,而伴有胃型上皮分化的异型增生可能是印戒细胞癌的癌前病变。