乳腺癌钼靶X线表现与癌组织骨桥蛋白、骨连接蛋白表达的相关性研究

目的 检测骨桥蛋白（OPN）、骨连接蛋白（ON）在乳腺癌组织中的表达，探讨二者与乳腺癌钼靶X线征象的关系。资料与方法 采用免疫组织化学S-P法检测61例浸润性乳腺癌、8例导管内乳头状瘤和21例乳腺纤维腺瘤组织中OPN、ON的表达，并分析与钼靶X线表现及临床病理的关系。结果 61例乳腺癌组织OPN、ON高表达率分别为72．13％和77．05％，明显高于乳腺良性肿瘤（x^2=6．310，x^2=13．126，P〈0．05）；钙化组乳腺癌OPN、ON高表达率分别为87．50％和91．67％，与无钙化组比较，有显著性差异（x^2=4．649，x^2=4．781，P〈0．05）；钼靶片中肿块表现、毛刺征和腋下淋巴结转移及其他各项临床病理表现与OPN、ON高表达均无统计学意义（P〉0．05）。结论 OPN、ON在乳腺癌组织中高表达，钼靶X线表现在一定程度上反映了肿瘤组织中OPN、ON的表达水平，对评估乳腺癌生物学行为和预后具有一定的参考价值。     

乳腺癌组织中骨桥蛋白和骨连接蛋白的表达及其与微钙化形成的关系

目的探讨骨桥蛋白（osteopontin，OPN）和骨连接蛋白（osteonectin，ON）在乳腺癌组织中的表达及其与微钙化形成的关系。方法根据钼靶X线片中微钙化的有无及数目的多少（20枚），将93例乳腺癌分为无钙化组、少量钙化组、大量钙化组，用免疫组织化学方法检测各组OPN、ON的表达水平及其与微钙化的关系。同时，选取3例含微钙化的乳腺癌组织行组织病理连续切片和透射电镜观察。结果组织切片显示：钙化不仅出现于坏死灶内，生长活跃的癌细胞巢内及周围组织同样可见颗粒状钙化；透射电镜观察显示：生长活跃的乳腺癌细胞胞质内可见深电子密度的钙盐颗粒；乳腺癌组织中OPN、ON高表达（79．6％、77．4％）且与钼靶片中微钙化的出现相关，随着钙化数目的增多，两者表达程度逐渐增强，钙化组与无钙化组比较差异有统计学意义（χ^2值分别为11．454、5．540，P值均〈0．05）；多钙化组与无钙化组比较，差异也具有统计学意义（χ^2值分别为13．738、7．659，P值均〈0．05）。免疫组织化学染色显示钙化周围OPN、ON高表达。结论乳腺癌组织中OPN、ON高表达，且表达水平与微钙化密切相关。OPN、ON可能参与了乳腺癌微钙化的形成过程。     

乳腺癌钼靶X线表现与ER、PR和P53表达的相关性探讨

目的 探讨乳腺癌的钼靶X线表现与乳腺癌癌细胞中雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)及P53蛋白表达的相关性.方法 收集乳腺癌患者60例术前行钼靶X线检查,术后标本行免疫组织化学染色测定 ER、PR及P53蛋白表达情况,分析钼靶X线征象与ER、PR及P53蛋白表达的相关性.结果 在60例乳腺癌中,有肿块组ER、PR及P53阳性表达率均高于无肿块组,2组PR表达有统计学差异(χ2=6.213,P=0.013);其中有毛刺组ER、PR阳性表达率高于无毛刺组,且有统计学意义(χ2=6.673、3.873,P<0.05);钙化组ER、PR及P53阳性表达率高于无钙化组,均有统计学差异(χ2=7.330、5.984、4.671,P<0.05);有淋巴结转移组PR阳性表达率低于无淋巴结转移组,P53阳性表达率明显高于无淋巴结转移组,有统计学意义(χ2=6.213、5.978,P<0.05).结论 乳腺癌钼靶X线征象在一定程度上反映了ER、PR及P53的表达状况.     

乳腺癌的ER、PR、C-erbB-2和P53表达与钼靶X线表现相关性研究

目的 探讨乳腺癌的ER、PR、C-erbB-2和P53表达与钼靶X线表现之间的相关性.方法 对66例原发性乳腺癌患者术前行乳腺钼靶X线形态学分析,术后标本行免疫组织化学染色测定癌细胞ER、PR、C-erbB-2和P53表达情况,并分析与钼靶X线表现之间的关系.结果 66例乳腺癌中,癌肿毛刺状边缘与癌细胞ER阳性表达之间呈正相关关系（P＜0.01）;乳腺癌钙化与癌细胞C-erbB-2和P53阳性表达之间呈正相关关系（P＜0.01）,而与癌细胞ER和PR阳性表达水平之间呈负相关（P＜0.01）;乳腺癌结构紊乱与癌细胞ER阳性表达水平之间呈负相关（P＜0.01）,而与PR、C-erbB-2和P53阳性表达水平之间均无明显相关性;淋巴结转移与癌细胞ER和PR阳性表达之间呈正相关关系（P＜0.01）.结论 乳腺癌的钼靶X线表现与ER、PR、C-erbB-2和P53表达之间存在一定相关性,可根据乳腺癌钼靶X线表现对癌灶的生物学行为和预后进行评估.     

乳腺癌钼靶X线微钙化与癌细胞ER、PR表达关系的研究

目的分析钼靶片中乳腺癌微钙化与ER、PR表达及临床病理关系,评价微钙化征象预测ER、PR表达的可行性。方法乳腺癌病例115例,钼靶X线片由3位有经验的影像诊断医师阅片,明确钙化并根据钙化及相关表现分组。免疫组化采用SP法,根据癌细胞核内染色判断ER、PR表达情况。各钙化组分别与ER、PR表达情况进行比较分析。结果乳腺癌钼靶片中微钙化的有无、微钙化数目、钙化类型与肿瘤细胞ER、PR表达无明显相关性(P>0.05)。乳腺癌微钙化多见于导管癌,占53.33%,是钼靶片中无肿块表现乳腺癌的主要X线征象。微钙化表现与乳腺癌临床TNM分期无关(P>0.05)。乳腺癌钼靶片微钙化表现常伴腋下淋巴结转移(24/47例),而钙化数目较少(<20枚)的乳腺癌更易伴有腋下淋巴结转移(16/24例)。结论微钙化在钼靶片乳腺癌诊断中,特别是在早期癌以及无肿块表现的乳腺癌诊断中具有重要意义。但是,微钙化表现与ER、PR表达无明显相关性,尚不能作为乳腺癌ER、PR表达的预测指标。     

乳腺癌钙化灶与ER、PR及c-erbB-2表达的关系

目的探讨乳腺癌钙化灶的特征与乳腺癌组织雌激素受体(ER)、孕激素受体(PR)及癌基因(c-erbB-2)表达的关系。资料与方法观察分析56例乳腺癌钼靶片中微小钙化灶的特征并采用免疫组织化学的方法检测乳腺癌组织中ER、PR及c-erbB-2的表达情况。结果钙化灶呈线样或段样分布的乳腺癌PR阳性率明显低于非线样或段样分布者,两者PR的表达差异有统计学意义(χ2=13.176,P<0.05),而钙化灶的形态、钙化区范围、钙化灶数目、钙化灶的密集度、钙化灶是否合并肿块与ER、PR及c-erbB-2的表达,钙化灶是否呈线样或段样分布与ER及c-erbB-2的表达差异均无统计学意义。结论钙化灶的分布特征与PR表达之间存在一定的相关性,从乳腺癌钼靶片上可粗略预测乳腺癌组织PR的表达情况,从而为临床内分泌治疗、判断疾病的预后等提供依据。     

乳腺癌钼靶X线征象与病理及激素受体表达的关系

目的 探讨乳腺癌的钼靶X线征象与激素受体ER和PR之间的相关性.方法 回顾性分析60例经乳腺钼靶X线摄影、手术及病理证实的乳腺癌的X线表现.术后标本应用免疫组织化学染色测定乳腺癌原发灶癌细胞ER和PR表达情况,并分析其与钼靶X线征象之间的关系.结果 60例乳腺癌中,乳腺癌X征象钙化与癌细胞ER阳性表达之间相关(P＜0.01);PR阳性表达水平与钙化和肿块边缘有毛刺征象的癌细胞之间有相关性(P＜0.0 1).结论 乳腺癌钼靶X表现与激素受体ER和PR之间存在一定的相关性.通过乳腺癌的钼靶X线表现可以预测ER和PR的表达,为临床内分泌治疗方案的选择提供客观依据.     

乳腺癌X线表现与P53、CerbB-2、Ki-67表达的相关性研究

目的:探讨乳腺癌的钼靶X线表现与P53、CerbB-2、Ki-67表达的关系,旨在为乳腺癌的早期诊断及预测预后提供依据.方法:97例乳腺癌患者术前行乳腺钼靶摄影,术后测定乳腺癌组织中P53、CerbB-2、Ki-67的表达水平,分析其表达与X线表现的关系.结果:97例乳腺癌中,肿块62例,占63.91%;单纯钙化8例,占0.82%;结构紊乱27例,占27.84%.P53阳性表达56例,占57.73%;CerbB-2 63例,占64.95%.肿块组Ki-67增殖指数为29.64±3.15,并随肿瘤体积增大而增高.局部密度增高伴钙化组P53、CerbB-2、Ki-67表达高于不伴钙化组, P53表达差异有显著性意义(χ2＝5.571,P<0.05).结论:乳腺癌的一些重要钼靶X线征象与P53、CerbB-2、Ki-67之间存在密切的关系,从一定程度上反映了癌细胞的生物学行为和预后,对早期诊断和治疗有一定的意义.     

乳腺癌的相关影像学表现与B淋巴细胞瘤基因表达的关系

目的　探讨乳腺癌的钼靶X线表现与B细胞淋巴瘤基因 (bcl 2和bax)表达的关系 ,旨在为乳腺癌的早期诊断、预测预后提供依据。方法　 5 4例乳腺癌和 2 6例乳腺良性病变均经病理证实 ,且所有患者均行乳腺钼靶X线摄影。利用免疫组织化学技术测定这些乳腺癌和乳腺良性病变组织中bcl 2和bax的表达水平。比较它们在乳腺癌和乳腺良性病变中的表达并且分析其表达与乳腺癌的钼靶X线表现的关系。结果　乳腺癌中bcl 2和bax的表达均高于其他两种乳腺良性病变 (χ2 =15 116、11 36 1,P <0 0 5 )。结节状肿块中bcl 2和bax的表达均高于其他形态肿块组 (χ2 =10 35 8、12 818,P <0 0 5 ) ;肿块边缘有“毛刺征”的bcl 2和bax的表达均高于无“毛刺征”组 (χ2 =10 996、10 6 6 7,P <0 0 5 ) ;钙化形态为泥沙样者 ,其组织bcl 2的表达较在其他钙化形态中为高 (χ2 =10 4 0 5 ,P <0 0 5 ) ;病变内有簇状钙化者的bcl 2表达较仅表现为肿块者高 (χ2 =6 84 1,P <0 0 5 )。结论　乳腺癌的一些重要钼靶X线征象与bcl 2和bax的表达之间存在密切的关系 ,乳腺癌的钼靶X线表现从一定程度上反映了癌细胞的生物学行为和预后 ,对早期诊断和治疗有一定的意义     

乳腺癌线样或线样分支状钙化与病理类型和分子表达的关系

目的：探讨乳腺癌线样或线样分支状钙化与组织病理学及分子表达之间的关系及临床意义,评价微钙化预测乳腺癌组织病理类型及分子亚型的可行性。方法：回顾性分析150例钙化型乳腺癌（非肿块）患者的病例资料,由两位高年资医师根据钙化形态（线样钙化或非线样钙化）进行分组,分析钙化形态与乳腺癌病理类型（乳腺导管原位癌、浸润性导管癌）及分子表达[雌激素受体（ER）、孕激素受体（PR）和人表皮生长因子相关基因（HER2）]的关系。结果：乳腺导管原位癌（DCIS）中线样或线样分支状钙化组中伴局部微浸润的比例明显高于非线样或线样分支钙化组（27／37VS9／22,P〈0．05）;线样或线样分支状钙化组中雌激素受体（ER）的表达率低于非线样或线样分支状钙化（8／22VS22／34,P〈0．05）,而HER2的过表达率高于非线样或线样分支状钙化组（17／39VS12／17,P〈O．05）。结论：线样或线样分支状钙化与乳腺癌病理类型和分子表达具有一定的相关关系,可以为乳腺癌治疗策略的制定和预后预测的提供参考。     

细胞自噬与肿瘤发生发展

自噬是真核生物中一种高度保守的胞内降解途径.其主要通过溶酶体或液泡进行饥饿状态下的营养动员,清除受损蛋白质、细胞器和胞内病原体.自噬主要包括巨自噬、分子伴侣介导自噬(CMA)和微自噬.自噬已被证实与多种人类疾病相关,其在肿瘤发生发展中具有重要意义.近年研究中,对于自噬和肿瘤关系有了进一步的认识,该文就自噬分子机制、调控...     

Physiologic and pathologic calcifications and ossifications in the face and neck

The aim was to give a systematic presentation of physiologic and pathologic calcifications and ossifications in the face and neck with a special emphasis on clinical relevance. In a sometimes subacute setting one should recognize specific calcifications which often lead to important diagnoses such as fungal sinusitis or sclerosing labyrinthitis. In a more chronic situation intraocular calcifications in small children are pathognomonic for retinoblastoma. Juxtatumoral sclerosis of the laryngeal cartilage in laryngopharyngeal carcinoma is usually caused by tumor infiltration of the cartilage resulting in a higher tumor stage and, this way, has a major impact on the therapeutical strategy. Calcified lymph nodes are mainly unspecific but can be the result of tuberculosis or metastases of thyroid cancer. Cross-sectional imaging methods, most of all computed tomography, are ideally suited to reveal head and neck calcifications and ossifications, especially those which are clinically relevant.     

Head and neck infection and inflammation

This article discusses the imaging manifestations of infectious and inflammatory conditions of the head and neck. Special attention is paid to the sites, routes of spread, and complications of neck infections. Because the clinical signs and symptoms and the complications of these conditions are often determined by the precise anatomic site involved, anatomic considerations are stressed. Familiarity with the fascial layers, spaces of the neck, and the contents of each space is helpful for this discussion. The fascial layers of the neck are important barriers to infection, and once infection is established, the fascial layers play a part in directing its spread.     

Staging and surgical management of pancreatic and biliary cancer and inflammation

Management of benign and malignant diseases of the pancreas, liver, and biliary tract has made remarkable progress in the last two decades. Advances in minimally invasive surgery, interventional radiology, and diagnostic and therapeutic endoscopy have changed the treatment of common diseases such as cholelithiasis and more serious diseases such as pancreatic adenocarcinoma. Advances in biliary tract and pancreatic surgery have paralleled the advances in ultrasonographic imaging, CT, and MR imaging. This article outlines the surgeon's perspective on radiologic imaging and preoperative staging of benign and malignant biliary and pancreatic disease.     

The thyroid and parathyroid glands. CT and MR imaging and correlation with pathology and clinical findings

Thyroid imaging approach is based on the preliminary clinical evaluation. Lesions that are smaller than 2 cm should be assessed with US, which is capable of discriminating masses as small as 2 mm and distinguishing solid from cystic nodules. US-guided FNAB provides tissue for cytologic examination of thyroid nodules. CT and MR imaging are indicated for larger tumors (greater than 3 cm diameter) that extend outside the gland to adjoining structures, including the mediastinum, and retropharyngeal region. Metastatic lymph nodes in the neck and invasion of the aerodigestive tract are also in the realm of CT and MR imaging. Thyroid nodules are categorized on scintigraphy as hot or cold nodules. Hot nodules are rarely malignant, whereas cold nodules have an incidence of 10% to 20% of malignancy. Calcifications (amorphous, globular, nodular, and linear) occur in adenomas and carcinomas and have no differential diagnostic features except for psammomatous calcifications, which are a pathognomonic finding in papillary carcinomas and a small percentage of medullary carcinomas. Papillary carcinoma is the most common malignant tumor (80%) followed by follicular (20% to 25%); medullary (5%); undifferentiated; anaplastic carcinomas (< 5%); lymphoma (5%); and metastases. Lymph node metastases are common in papillary carcinoma, 50% at presentation, and less common in follicular carcinomas. The metastatic nodes in papillary carcinoma may enhance markedly (hypervascular); show increased signal intensity on T1-weighted images (increased thyroglobulin content or hemorrhage); and reveal punctate calcifications. Localized invasion of the larynx, trachea, and esophagus occurs predominantly in papillary and follicular carcinomas; the incidence is less than 5%. Ectopic thyroid tissue may be encountered in the tongue (foramen cecum); along the midline between posterior tongue and isthmus of thyroid gland; lateral neck; mediastinum; and oral cavity. Goiter and malignant tumors, notably papillary carcinoma, may develop in ectopic thyroid tissue. Carcinomas may also arise in thyroglossal duct cysts, which develop from duct remnants between the foramen cecum and thyroid isthmus. Infectious disease of the thyroid gland is not common and the CT and MR imaging findings are similar as described under neck infection. Other types of inflammatory disorders including Hashimoto's thyroiditis, granulomatous thyroiditis, and Riedel's struma display no specific imaging features. Imaging studies may, however, be indicated to confirm a suspected clinical diagnosis and assess compromise of the airway (Riedel's struma). HPT is a clinical diagnosis in which hypercalcemia is the most important finding. Parathyroid hyperplasia, adenoma, and carcinoma represent underlying lesions. To relieve the patient's symptoms surgical extirpation is indicated. The surgical success rate without imaging is 95%. The indications for imaging studies vary but it is generally agreed that reoperation after a previous failed surgical attempt and suspicion of an ectopic parathyroid adenoma should be investigated by imaging. These consist of US, nuclear medicine studies, CT and MR imaging. US and technetium sestamibi scanning have the highest accuracy rate for localizing an adenomatous gland at and near the thyroid gland. Ectopic adenomas, particularly if they are located in the mediastinum, are preferrably investigated with CT and MR imaging with gadolinium and fat suppression. Carcinomas and parathyroid cysts are optimally evaluated by CT and MR imaging. On MR imaging adenomas are low in signal intensity on T1-weighted images, high in signal intensity on T2-weighted images, and enhance post introduction of gadolinium.