Alpha-fetoprotein-producing rectum adenocarcinoma:A case report

A case with an Alpha-fetoprotein-producing(AFP-producing) carcinoma originating from the rectum was described.A 41-year-old man,who underwent a palliative surgery for rectal carcinoma,was diagnosed with occupying liver lesions and a remarkable AFP elevation(3484.61 ng/mL),and the AFP declined obviously 10 days after the palliative surgery.So we carried out a biopsy of the liver lesions.The histopathology was reported as low differentiation adenocarcinoma.The immunohistochemistry of the tumor cells via liver biopsy showed:Villin,CDX-2 was positive,Glypican-3 was partial positive,CK7,CK20,AFP,Hepatocyte were all negative.The initial histopathology was reported as an AFP-producing rectum adenocarcinoma with liver metastasis,which was a rare disease.So far,only 17 reports,none has been reported in China.Then,we summarize the characteristic of the disease:diagnosed with hepatic metastasis,raised serum AFP and a poor outcome,in addition to primary symptoms.This kind of disease is highly malignant.

Extramammary Paget’s Disease Manifested by Intraepithelial Adenocarcinoma of the Vulva and Anus Combined with Invasive Adenocarcinoma of the Ampullary Part of the Rectum

The Object of the Study: The author of the given paper describes an unusual combination of two diseases: extramammary Paget’s disease manifested by intraepithelial adenocarcinoma of the vulva and anus combined with invasive adenocarcinoma of the ampullary part of the rectum and describes the atypical manifestations of these diseases. The Content: The content of this research paper includes a description of the patient, an analysis of the clinical picture, diagnostic methods and therapeutic interventions used, a report of the following disease, and the result of the presented case. The Result of the Research Work: The result of the research work is the analysis of a clinical case with two different tumors, where such a combination of tumors is rarely described in the literature. Moreover, no large specific sample with this combination of diseases is available. Patient Characteristics: The given case report describes a patient of the Palliative Care Unit of the Gerontology Clinic with a primary diagnosis of C20-rectal adenocarcinoma in the background of the anal canal, perineal skin Paget’s disease, stage IV. The presented complications of the patient’s primary diagnosis are multiple metastases in the liver;status post palliative chemotherapy;hepatomegaly;metastases to abdominal lymph nodes, inguinal lymph nodes;metastases at Th12, L4 level;pain syndrome. The presented above combination of diagnosed diseases is very rare. Applied Diagnostics: In October 2021, it was performed diagnostic manipulation: biopsy and the pathologist have provided a microscopic description. The first tissue fragment had a pronounced electrothermal lesion and the epithelial structures were not valuable. The second skin tissue fragment was covered with hyperplastic and acanthotic epithelium;its basal and middle layers contained multiple large cells proliferates extending into the medial epidermis, and the cytoplasm of these cells reacted positively with PAS (Periodic Acid Schiff reaction). It needs to be noted that the patient had previously had several years of biopsies from the perineal and anal epidermis, where Paget’s disease had also been diagnosed. The performed immunohistochemistry showed these cells to be CK20 positive, CK7 rare positive and p16 negative. The following pathohistological findings were made: morphological and immunohistochemical picture is consistent with Paget’s disease. According to the ICD-10, the patient was diagnosed with C51 malignant neoplasm of the female external genitalia. Using imaging diagnostics, it became clear that the patient’s rectal adenocarcinoma had progressed to metastatic stage with distant liver metastases in the background of anal canal, perineal skin Paget’s disease. Therapeutic Plan of the Patient: Based on the patient’s main diagnoses, the complications of the principal diagnosis, the patient’s overall severe condition, pain syndrome, age and comorbidities, palliative chemotherapy was approved as a therapeutic option in council of doctors. Monitoring and Outcome of the Patient: The patient’s general condition was becoming worse over time, and she was diagnosed with exitus latalis in December 2022. At that time, the patient was discharged from hospital and was on palliative care at home under the control of her family physician.

Expression of Embryonic Stem Cell Marker Oct-4 and Its Prognostic Significance in Rectal Adenocarcinoma

Objective： Recent evidence suggests that Oct-4 is highly expressed in several cancers, and its expression contributes to tumor growth. In this study, we investigated the level of Oct-4 expression in rectal adenocarcinoma, and evaluated the prognostic significance of Oct-4 expression in these cases. Methods： The immunohistochemical expression of Oct-4 was evaluated in 52 formalin-fixed paraffin-embedded postoperative rectal adenocarcinoma tissue samples. The impact of the immunoreactivity of Oct-4 in regard to clinical outcome was determined by Kaplan-Meier and log-rank. Results： The expression level of Oct-4 ranged from 0 to 18.5%. There was no significant association between Oct-4 expression and gender （P=0.772）, age （P=0.123）, clinical stage （P=0.391）, and histological grade （P=0.056）. The 3-year local recurrence-free rates with negative and positive expression of Oct-4 were 83.5% and 75.0%, respectively （P=0.583）. The 3-year metastasis-free rates with negative and positive expression of Oct-4 were 88.6% and 61.9%, respectively （P=0.035）. The 3-year overall survival rates with negative and positive expression of Oct-4 were 77.9% and 49.0%, respectively （P=0.037）. Conclusion： The results suggest that embryonic stem cell marker Oct-4 expression may have prognostic significance in patients with rectal adenocarcinoma. However, to confirm this more and larger studies are required.

Comparison between colorectal low- and high-grade mucinous adenocarcinoma with MUC1 and MUC5AC

AIM:To explore useful prognostic factors for mucinous adenocarcinoma(MAC) in the colon and rectum.METHODS:MAC was divided into low-and high-grade types based on the degree of structural differentiation;low-grade MAC arisen from well to moderately differentiated adenocarcinoma and papillary carcinoma,and high-grade MAC from poorly differentiated adenocarcinoma and signet ring cell carcinoma.Immunohistochemically,the expression of 2 types of MUC1(MUC1/DF and MUC1/CORE),MUC2,2 types of MUC5AC(MUC5AC/CHL2 and HGM),MUC6,CDX2,and CD10 was examined in 16 cases of MAC consisting of 6 low-and 10 high-grade types.RESULTS:MUC1/DF3 was expressed in 3 of 6 low-grade MAC(50) and 10 of 10 high-grade MAC(100).MUC1/CORE was expressed in 1 of 6 lowgrade MAC(16.7) and 7 of 10 high-grade MAC(70).MUC2 was expressed in all MAC regardless of the grade.MUC5AC was expressed in 6 of 6 low-grade MAC(100) and 4 of 10 high-grade MAC(40).HGM was expressed in 5 of 6 low-grade MAC(83.3) and 6 of 10 high-grade MAC(60).Expression of MUC6 and CD10 was undetected in all MAC regardless of the grade.CDX2 was expressed in 5 of 6 low-grade MAC(83.3) and 7 of 10 high-grade MAC(70).Taken together,MUC1/DF3 was expressed significantly more frequently in high-grade MAC than in low-grade,and MUC5AC/CHL2 was expressed significantly more frequently in low-grade MAC than in high-grade.CONCLUSION:It is proposed that MUC1/DF3 and MUC5AC/CHL2 immunostaining is useful to discriminate high-grade MAC from low-grade MAC.

直肠碰撞瘤临床病理分析

目的:探讨直肠碰撞瘤的临床病理和免疫组化特征,提高对该病的诊断和鉴别诊断。方法:回顾性分析2例直肠碰撞瘤的临床病理资料,观察其组织学形态和免疫表型,并复习相关文献。结果:2例患者中,男性1例,女性1例,年龄分别为72岁和69岁,临床主要表现为便中带血、大便不尽、直肠肿块和排便习惯改变等表现。镜下可见肿瘤由中分化腺癌和神经内分泌肿瘤(NET G1)碰撞形成。免疫组化:腺癌细胞MLH1(+)、MSH2(+)、MSH6(+)、PMS2(+),神经内分泌肿瘤细胞CD56(+)、CgA(+)、Syn(+)。结论:直肠腺癌和神经内分泌肿瘤形成的碰撞瘤很少见,临床表现缺乏特异性,临床及病理医师应当充分认识该病,避免延误诊断和治疗。

原发性直肠杯状细胞腺癌的临床病理研究

目的分析原发性直肠GCA的临床病理特征。方法收集原发性直肠GCA癌患者的临床资料,通过H&E染色、免疫组织化学染色、特殊染色、透射电镜及二代测序等方法分析直肠GCA的临床病理特征。结果肿瘤主要由短柱状/印戒样细胞、潘氏样细胞及神经内分泌样细胞组成,肿瘤细胞呈单个、管-筛状、簇状或菊形团样分布,伴神经及脉管侵犯。免疫组化结果:肿瘤细胞表达CKpan、CK20、CDX2、SSTR2及Syn;D⁃AB/PAS染色显示黏液阳性。透射电镜显示肿瘤细胞内存在黏液小泡及神经内分泌颗粒。二代测序显示ERBB2及P53错义突变。结论直肠GCA较罕见,本研究深入到电镜和分子层面分析该肿瘤的临床病理特征,为临床精准治疗提供依据。

钳蝎蝎毒组分Ⅱ对人直肠腺癌C1184细胞生长的影响

蝎毒组分Ⅱ（ＳｃｏｒｐｉｏｎＶｅｎｏｍｃｒｕｄｅⅡ，ＳＶＣⅡ）为河南马氏钳蝎粗毒（ＳＶＣ）经分离纯化后获得的有效成分之一。实验结果表明，以丝裂霉素作为阳性对照，ＳＶＣⅡ（４～２０μｇ／ｍｌ）对人直肠腺癌Ｃ１１８４细胞株有明显杀伤作用。与空白对照相比，ＳＶＣⅡ使细胞生长抑制率、细胞毒性和克隆形成抑制率增大（Ｐ＜０．０５或（Ｐ＜０．０１），并存在剂量效应关系，其半数抑制浓度分别为１１．２０μｇ／ｍｌ、１１．９３μｇ／ｍｌ和１７．３８μｇ／ｍｌ。从生长曲线可见，ＳＶＣⅡ对细胞生长呈剂量和时间依赖性抑制。ＳＶＣⅡ还能使细胞分裂指数下降。提示ＳＶＣⅡ具有抗癌细胞增殖作用。

直肠淋巴瘤与腺癌形成的碰撞瘤临床病理观察

目的介绍直肠碰撞瘤的组织学特点和临床表现,以提高对本病的认识。方法报道1例直肠淋巴瘤与腺癌碰撞瘤,进行组织学及免疫组化标记研究,并复习相关文献。结果患者女性,89岁。主要表现为低位性肠梗阻。在结直肠切除标本中,同一肿瘤内可见中分化管状腺癌和弥漫性大B细胞性淋巴瘤呈浸润性生长,两种成分界限清楚,彼此靠近,互相融合,形成碰撞瘤。腺癌表达上皮性标记物,而淋巴瘤表达B细胞抗体,PAX-5两者均呈(+)。结论肠道碰撞瘤十分罕见。直肠淋巴瘤与腺癌的碰撞瘤,代表了两种独立成分彼此碰撞。临床需要提高认识,识别这类罕见肿瘤,并根据不同成分制定合适的治疗方案。

N-cadherin和vimentin在直肠腺癌中的表达及其临床意义

目的探讨N钙黏蛋白(neuronal cadherin,N-cadherin)和波形蛋白(vimentin)在原发性直肠腺癌中的表达及其临床意义。方法选择手术切除并经病理证实的58例原发性直肠腺癌组织和距肿瘤5cm以上的正常直肠黏膜组织,采用免疫组织化学SP法检测组织中N-cadherin和vimentin的表达并与临床资料进行相关性分析。结果直肠腺癌组织中N-cadherin和vimentin阳性表达率[53.4%(31/58)、46.6%(27/58)]明显高于正常直肠黏膜组织[3.4%(2/58)、1.7%(1/58)](P<0.01);N-cadherin和vimentin的阳性率与肿瘤浸润深度、淋巴结转移、远处转移和TNM分期呈正相关(P<0.05),与肿瘤分化程度无相关性(P>0.05)。结论 N-cadherin和vimentin的表达与原发性直肠腺癌的转移密切相关,检测N-cadherin和vimentin的表达可作为判断直肠腺癌转移和预后的指标之一。

柞蚕杀菌肽D对人直肠癌细胞的杀伤作用及机制

柞蚕杀菌肽D在0．05～200μg／mL浓度范围内对直肠癌细胞的生长有明显抑制作用；用氚标记的胸腺嘧啶核苷（3H-TdR）对癌细胞的掺入试验，发现能抑制细胞DNA的合成．导致3H-TdR掺入率明显下降。钙离子螯合剂Indo-1-AM能与癌细胞内钙离子螯合而产生特异性荧光，通过粘附细胞激光定量分析及筛选议的观察，发现杀菌肽能破坏细胞的钙离子通道，钙离子迅速逸出细胞外。采用电子显微镜观察直肠癌细胞超微结构的变化，发现杀菌肽首光破坏细胞膜致微绒毛收缩、融合，继而导致细胞器的破坏，最终细胞崩解死亡。正常猴肾细胞CV1，在1.00μg／mL浓度杀菌肽D作用48h，尚未发现不良影响。

大肠粘液腺癌临床和病理学特征探讨

本文通过对我院收治的288例大肠粘液腺癌的临床及病理学特征进行了总结分析，得出如下结论：①大肠粘液腺癌以直肠和升结肠部位多见；①大肠粘液腺癌病例中男性多于女性，直肠粘液腺癌青年组（≤30岁）校老年组(≥60岁）多见，而结肠粘液癌与之相反；③以浸润型生长方式为主；④淋巴转移率高（56．6％），易发生腹膜播种；⑤血行转移率低（3．82％），结肠血行转移率（10％）明显高于直肠组（1％）；术后5年生存率低（20．35％）。因此粘液腺癌是大肠癌预后不良的一种病理类型。

大肠侧向发育型肿瘤原代培养细胞的电镜观察

目的研究大肠侧向发育型肿瘤(LST)细胞经原代培养的细胞株的超微结构特点。方法将1例经肠镜切除的直肠LST细胞进行原代培养建株,然后进行扫描电镜及透射电镜观察,并与直肠腺癌及正常粘膜上皮细胞超微结构进行对照。结果LST原代培养的细胞表面被覆大量微绒毛,胞浆内有较多溶酶体、线粒体和吞噬颗粒,核异型性明显,核仁巨大,异型核沟。结论LST原代培养细胞具有高度恶性倾向。

人直肠腺癌细胞系HRC-99的建立及其生物学特性

目的:建立一人直肠癌细胞系并探讨其生物学特性方法:取人直肠癌新鲜手术标本,经组织块体外培养并克隆建系,命名为HRC-99.采用光镜、电镜、免疫组化、染色体核型分析及异种移植瘤实验对细胞系生物学特性进行观察. 结果:原位肿瘤、细胞系及移植瘤标本经光镜、电镜证实该细胞系具有腺上皮性恶性细胞特征,并观察了其体外生长曲线、倍增时间和分裂指数:免疫组化CEA和CK-20呈阳性表达;染色体核型分析众数为60,为亚三倍体,G显带出现标记染色体和染色体易位;裸鼠皮下异种移植形成移植瘤. 结论:HRC-99为一株新的来源于直肠中分化腺癌的细胞系.

直肠异位胰腺高分化腺癌1例

患者男,68岁,因＂外院体检肠镜发现直肠肿物＂入院。CT：S2～S5前方见囊状病灶约4cm×4cm×3cm,平扫呈低密度,增强后明显强化,并见分隔征象（图1A）。MRI：距肛缘约8cm处直肠右后壁见囊性分隔样肿块,以宽基底与直肠相连,平扫呈稍长T1长T2信号,DWI未见高信号;病变浸润肠壁全层，病变处直肠系膜筋膜间隙清晰，未见肿大淋巴结（图1B）。

直肠黏液腺癌p53、nm23基因的表达及临床病理意义

目的:探讨直肠黏液腺癌(mucous adenocarcinoma,MUC)中p53及nm23的表达及临床意义.方法:应用免疫组织化学SP法检测37例直肠MUC及261例直肠非黏液腺癌(non-mucous adenocarcinoma,non-MUC)组织中p53及nm23蛋白的表达水平,并分析其与临床病理指标的关系.结果:MUC组p53、nm23高表达阳性率(16.2%、13.5%)分别明显低于non-MUC组(35.6%、29.9%).MUC组p53及nm23表达,与患者年龄、性别、肿瘤大小、浸润深度、淋巴结转移和临床分期均无相关性,nm23表达与p53表达无相关性.结论:p53和nm23在直肠MUC中的表达低,并且在直肠MUC的发生、发展中无明显作用.

结直肠黏液腺癌的MRI表现

目的:探讨结直肠黏液腺癌的MRI表现。方法:回顾性分析经病理证实为结直肠黏液腺癌的32例患者的临床资料和MRI图像,分析病灶位置、长度、肠壁增厚类型和厚度、MRI信号特点、强化方式和T2WI高信号区比例。结果:32例结直肠黏液腺癌中,5例位于升结肠,1例位于降结肠,4例位于乙状结肠,22例位于直肠。肿瘤长度从3.4~15.7cm,平均长度5.7cm,病变肠壁厚度从0.6~3.1cm,平均厚度1.9cm。32例肿块的T2WI图像上均可见到特征性的高信号区,23例病灶的高信号区超过肿瘤面积的50%。结论:结直肠黏液腺癌的MRI表现具有一定特征性,有助于提高诊断准确性。

直肠腺癌VEGF-C及VEGFR-3的表达与淋巴转移的关系

目的为探讨癌细胞淋巴管转移机理,观察血管内皮生长因子-C(VEGF-C)和血管内皮生长因子受体-3(VEGFR-3)在直肠腺癌组织及淋巴管的表达。方法取人直肠腺癌手术材料30例,用免疫组化方法检测癌区和癌周正常区VEGF-C和VEGFR-3的表达情况。结果VEGF-C主要表达在直肠腺癌的癌细胞胞浆,VEGFR-3主要在淋巴管内皮细胞有阳性表达,两者在癌区的表达率均高于正常区直肠组织;癌区淋巴管的平均面密度(33.81±5.67)高于正常区平均面密度(20.13±3.27)。结论VEGF-C和VEGFR-3在人直肠腺癌中的过表达,可能与淋巴管增生和扩张,促进癌细胞的淋巴转移有关。

直肠混合腺神经内分泌癌1例并文献复习

目的探讨直肠混合腺神经内分泌癌的组织病理学特点和临床表现,提高对本病的认识,更好地指导临床治疗。方法对1例直肠混合腺神经内分泌癌患者手术切除的标本进行常规HE染色和免疫组化染色,并复习相关文献。结果肿物位于直肠,距肛门口约3cm,大小为3.0cm×2.5cm×2.0cm,环绕肠腔呈浸润性生长。镜下肿瘤组织部分呈中到高分化的腺癌图像,部分呈小细胞癌图像,肿瘤侵及肠壁肌层。免疫组织化学标记腺癌部分为CAM5.2(+)、CEA(+),小细胞癌部分为CgA(+)、CD56(+)、syn(+)。结论直肠混合腺神经内分泌癌的发病率有升高趋势,正确认识其临床病理特征可以避免漏诊及误诊,并根据不同成分制定合适的治疗方案。

2例直肠癌综合治疗分析

对６２例直肠癌病人发病症状和综合治疗的近期疗效进行分析。结果：（１）对有大便习惯改变（８２３％）、便血（７１１％）症状的病人应及时行直肠指检及钡双重造影和内窥镜检查，以免误诊、漏诊。（２）术后放疗对降低局部复发率和延长复发时间有明确效果；姑息放疗对缓解病人疼痛、便血症状。

直肠腺癌伴骨化生1例并文献复习

目的:探讨直肠腺癌骨化生的病理学特征、发生机制及临床意义。方法:报道1例直肠腺癌伴有骨化生的病例,并复习文献。结果:在直肠腺癌中骨化生机制很多,目前没有明确。结论:骨化生只是一个组织学现象,和预后没有相关性。