胃癌CEA免疫组织化学和粘液组织化学的研究

 从胃大部份切除证实胃癌118例中,CEA产生性胃癌占86.14%,CEA非产生性胃癌占13.56%。胃癌组织类型与CEA阳性率有关,印戒细胞癌、粘液腺癌阳性率100%;管状腺癌阳性率92.86%;乳头状腺癌阳性率88.98%;低分化腺癌阳性率85.2%;未分化癌阳性率50%。CEA产生性胃癌,经粘液组织化学染色证实属酸性粘液者41.2%,CEA非产生性胃癌属酸性粘液者18.8%,两者比较存在着显著差异。     

胃癌活检的组织学分型及鉴别诊断(附151例病理分析)

本文报告151例胃癌活检的病理组织学分型及组织化学研究。组织学类型包括乳头状腺癌16例,管状腺癌12例、低分化腺癌55例、印戒细胞癌29例、粘液癌19例、未分化癌6例、混合型11例、腺棘癌1例及不能分型者2例。AB/PAS 染色:肠型75例、胃型10例、混合型28例及不着色者38例。结果表明:组织学分型与粘液染色性质不完全一致,无论肠型或胃型癌在组织学上都可为高分化腺癌或低分化腺癌。认为 Lauren 的分型须要进一步研究。在实践上,作者基本同意全国胃癌协作组对胃癌的分型。本文讨论了胃癌与胃粘膜增生性病变的鉴别诊断。     

胃癌手术切缘病理分析及p53、Ki67检测对比

目的　分析胃癌手术切缘的病理组织学改变 ,探讨与胃癌预后的关系。方法　通过病理组织学和免疫组化方法 ,对 10 0例胃癌手术切除标本上、下两端切缘进行病理组织学观察 ,及检测p5 3、Ki6 7,对比分析肿瘤的分化程度、肿瘤距切缘长度的关系。结果　病理组织学观察 10 0例中乳头状腺癌 /管状腺癌 (分化较好 ) 4 3例 ,低分化腺癌 /印戒细胞癌 (分化较差 ) 5 7例。切缘有癌残留的 19例 (上切缘 14例 ,下切缘 4例 ,1例两端切缘均有癌残留 ) ,2例管状腺癌 ,17例低分化腺癌 /印戒细胞癌。切缘无癌残留 81例 ,加前 19例中无癌残留切缘共计切缘 180个 (上切缘 85个 ,下切缘 95个 ) ,分化较好组切缘 84个 ,分化较差组切缘 96个。无癌残留切缘中有p5 3阳性表达的 18个 ,Ki6 7阳性表达 4 4个 ,低分化腺癌 /印戒细胞癌组切缘长度 <2 5cm组表达显著。结论　胃癌手术切缘癌残留与切缘长短及肿瘤分化程度有关。胃癌切缘做p5 3、Ki6 7检测 ,对观测胃癌预后有临床应用价值     

人胃癌上皮钙粘附素免疫组化表达的临床病理学评价

为探讨上皮钙粘附素与癌肿浸润及转移的关系,作者应用免疫组化分析121例胃切除的胃癌患者,术前均未接受化放疗。男性77例,女性44例,平均年龄62岁。临床病理学分类依据日本胃癌研究会标准。分化型包括乳头状腺癌、分化好及中分化管状腺癌,未分化型包括低分化腺癌及印戒细胞癌,上皮钙粘附素免疫组化用ABC法,并将其分为正常型及异常型。用Chispuare试验分析定量     

CD147在胃癌组织中的表达及临床意义

目的了解CD147在胃癌组织中的表达,探讨CD147在胃癌进展中的作用及临床意义.方法应用免疫组化SP法检测123例胃癌组织中CD147的表达.结果CD147在黏液腺癌、乳头状腺癌、管状腺癌、低分化腺癌和印戒细胞癌中的表达率分别为62.5%、81.48%、81.48%、86.21%和95.83%,印戒细胞癌的阳性表达率明显高于黏液腺癌,P=0.011.表达强度与临床分期、淋巴结有无转移有关,Ⅲ～Ⅳ期阳性表达率(94.44%)明显高于Ⅰ～Ⅱ期阳性表达率(51.52%),P=0.000;淋巴结转移组阳性表达率(89.69%)与无淋巴结转移组阳性表达率(57.69%)差异有统计学意义,P=0.000;CD147高表达与患者术后生存期＜3年相关,P=0.036.结论CD147与胃癌的侵袭、转移密切相关,CD147的检测可作为评价胃癌恶性程度和判断预后的重要指标.     

CD147在胃癌组织中的表达及临床意义

目的：了解CD147在胃癌组织中的表达,探讨CD147在胃癌进展中的作用及临床意义.方法：应用免疫组化SP法检测123例胃癌组织中CD147的表达.结果：CD147在黏液腺癌、乳头状腺癌、管状腺癌、低分化腺癌和印戒细胞癌中的表达率分别为62.5%、81.48%、81.48%、86.21%和95.83%,印戒细胞癌的阳性表达率明显高于黏液腺癌,P=0.011.表达强度与临床分期、淋巴结有无转移有关,Ⅲ～Ⅳ期阳性表达率（94.44%）明显高于Ⅰ～Ⅱ期阳性表达率（51.52%）,P=0.000;淋巴结转移组阳性表达率（89.69%）与无淋巴结转移组阳性表达率（57.69%）差异有统计学意义,P=0.000;CD147高表达与患者术后生存期＜3年相关,P=0.036.结论：CD147与胃癌的侵袭、转移密切相关,CD147的检测可作为评价胃癌恶性程度和判断预后的重要指标.     

消化道内镜活检病理诊断食管癌、胃癌临床病理分析

目的:探讨食管癌及胃癌临床及病理特征.方法:对我院1998年～2002年间经消化内镜取活检,并经病理切片确诊的食管癌672例、胃癌520例临床病理资料进行回顾性分析.结果:食管癌以进行性咽下困难、咽下疼痛、食物返流为主,肿瘤大体形态以髓质型为主,发生部位以食管中段多见,病理组织学形态以低分化、中分化鳞癌多见.胃癌则以上腹痛、食欲减退、消瘦、贫血、黑便为其主要的症状.青年组(＜40岁)以上腹痛及黑便为主,病程短,胃底及贲门部多发,大体分型多为Borrmann Ⅲ型、Ⅳ型,病理组织学显示以低分化腺癌、印戒细胞癌、未分化癌为主;其他年龄组(＞40岁)临床症状以上腹饱胀不适、食欲减退、消瘦、贫血为主,病程长,幽门部多发,大体分型多为Borrmann Ⅰ型、Ⅱ型,病理组织学显示多为乳头状腺癌、管状腺癌.结论:食管癌患者以食管中段多发为主,并以低分化鳞癌多见.青年组胃癌与其他年龄组胃癌相比较,其浸润能力强,恶性程度高,分化程度低,病情进展快,预后差.临床医师应该认识到消化道内镜活检是提高食管癌、胃癌确诊率的重要手段.     

胃印戒细胞癌临床病理特征和生物标志的研究现状

胃印戒细胞癌占原发性胃癌的3.4％～39％,是一种含有大量黏液的特殊胃癌类型,具有恶性程度高、分化差、胃壁内弥漫浸润性生长、进展速度快、预后差的特点。除了早期诊断、尽早手术切除外,放化疗等治疗策略对印戒细胞癌的控制均不理想。近年来发现胃印戒细胞癌具有特殊的生物学特征,长期以来人们对其认识并不十分科学。因此,本文将近年来胃印戒细胞癌相关的临床病理特征和生物标志等内容作一综述,以期为其诊断和治疗提供新的思路与策略。     

消化道内镜活检病理诊断食管癌、胃癌临床病理分析

目的:探讨食管癌及胃癌临床及病理特征。方法:对我院1998年～2002年间经消化内镜取活检,并经病理切片确诊的食管癌672例、胃癌520例临床病理资料进行回顾性分析。结果:食管癌以进行性咽下困难、咽下疼痛、食物返流为主,肿瘤大体形态以髓质型为主,发生部位以食管中段多见,病理组织学形态以低分化、中分化鳞癌多见。胃癌则以上腹痛、食欲减退、消瘦、贫血、黑便为其主要的症状。青年组(<40岁)以上腹痛及黑便为主.病程短,胃底及贲门部多发,大体分型多为Borrmann Ⅲ型、Ⅳ型.病理组织学显示以低分化腺癌、印戒细胞癌、未分化癌为主;其他年龄组(>40岁)临床症状以上腹饱胀不适、食欲减退、消瘦、贫血为主,病程长,幽门部多发,大体分型多为Borrmann I型、Ⅱ型,病理组织学显示多为乳头状腺癌、管状腺癌。结论:食管癌患者以食管中段多发为主,并以低分化鳞癌多见。青年组胃癌与其他年龄组胃癌相比较,其浸润能力强,恶性程度高,分化程度低,病情进展快,预后差。临床医师应该认识到消化道内镜活检是提高食管癌、胃癌确诊率的重要手段。     

青年人胃癌187例临床病理特征分析

[目的]探讨青年人胃癌的临床病理特点。[方法]回顾性分析1999年1月至2008年12月青年人（35岁以下）胃癌的临床病理资料,并与同期180例老年人（≥75岁）的临床病理资料对比分析。[结果]35岁以下青年人胃癌占全部胃癌的5.4%,男女比例0.56∶1。肿瘤最常见位置为胃下1/3;Bormann分型以溃疡型和浸润溃疡型为主。93.6%胃癌病理类型为低分化癌、黏液腺癌和印戒细胞癌;Ⅲ～Ⅳ期占64.2%。19.7%患者一级亲属有胃癌家族史。与75岁以上老年人胃癌相比,性别比例、肿瘤位置、肿瘤分化和胃癌家族史等方面有明显差异。[结论]青年人胃癌恶性程度高,应加强青年人胃癌的早期诊断和治疗研究,以期提高预后。     

A case of primary adenosquamous carcinoma of the stomach preoperatively diagnosed by endoscopic biopsy

A 53-year-old complained of upper abdominal pain. A diagnosis of Borrmann III type gastric cancer in the posterior part of the corpus region was made by X-ray and endoscopy, and primary adenosquamous carcinoma was preoperatively diagnosed by endoscopic biopsy. Subtotal gastrectomy was performed. The part of the adenocarcinoma adjacent to squamous-cell carcinoma was poorly differentiated. Adenosquamous carcinoma of the stomach is rare. Furthermore, preoperative diagnosis by endoscopic biopsy is extremely unusual, having been reported in 7 cases in Japan including ours. And in 5 cases out of 6, region of the adenocarcinoma was the poorly differentiated type.     

The correlation between the productive capacity of carcinoembryonic antigen (CEA) and prognosis in gastric cancer

In 130 resected specimens of gastric cancer, CEA was stained by the enzyme labeled antibody method. The positive rate of CEA stain was 74.6% and higher in well differentiated adenocarcinoma, mucinous adenocarcinoma, and signet ring cell carcinoma. The positive rate was lower in poorly differentiated adenocarcinoma. The 5-year survival rate was higher in the CEA (-) group in stage II, and higher in the CEA (+) group in stage III (p less than 0.05) and stage IV. This suggests that the correlation of the CEA stain and the prognosis varies with the stage of cancer.     

A rare case of poorly differentiated endocrine cell carcinoma of the stomach with signet ring cell differentiation

There have been few reports of the dual differentiation of different cell types within the same gastric tumor. Here, we report a rare case of poorly differentiated endocrine cell carcinoma with an associated differentiated signet ring cell population arising in the stomach. The histological appearance of the tumor by light microscopy matched the phenotype of endocrine cell carcinoma and signet ring cell differentiation with mucinous lakes. Cells with a phenotype intermediate between the two differentiated cell types were also seen in the tumor. Both the endocrine cell carcinoma and the signet ring cells were diffusely positive for chromogranin A and synaptophysin, a finding that is consistent with endocrine differentiation by immunohistochemical examination. The patient’s postoperative clinical course had a poor prognosis, with aggressive tumor progression. Paraaortic lymph node recurrence was found 6 months after the operation, and the patient died of the primary disease 16 months after the surgical treatment.     

Case report of a successful stage reduction of gastric carcinoma preoperatively treated by combined chemotherapy of 5-FU(UFT) and cisplatin]

A 52-year-old woman was diagnosed to have IIc+IIa-like advanced gastric carcinoma in the upper stomach by X-ray and endoscopic examination with biopsy. CT scan revealed swelling of the para-aortic lymph nodes which was taken to be evidence of metastases of the gastric carcinoma. The patient was considered to have surgically non-curative gastric carcinoma (Stage IV), and preoperative chemotherapy was initiated. The regimen consisted of CDDP 50 mg (day 1-2, drip), 5-FU 750 mg (day 2-7, drip) and UFT 400 mg (from day 8 to the day before operation, oral). About one month after initiating treatment, total gastrectomy with lymph node dissection was performed. Histopathological examination of the section of the primary tumor revealed that only a few cancer cell nests (poorly differentiated adenocarcinoma) remained in the muscle and subserosal layer. In all of the lymph nodes which were suspected to have metastases preoperatively, cancer cells completely degenerated into mucinous lakes or foam cell nests. No liver metastasis nor peritoneal dissemination was detected, and this case was judged to be stage II after chemotherapy.     

Gastric adenocarcinoma associated with granulomatous gastritis. Case report and review of the literature

AIMS: We describe the fourth reported case of granulomatous gastritis associated with gastric adenocarcinoma, with a review of the literature and considerations about the prognostic implications of this association. RESULTS: A 48-year-old woman who had been suffering from gastritis for ten years was admitted to our institute for increasing left epigastric pain associated with vomiting. After an endoscopic biopsy had revealed an ulcerated signet ring cell carcinoma, the patient was submitted to subtotal gastrectomy with regional lymph node dissection. Pathological examination of the resected specimen revealed a superficial signet ring cell carcinoma (early cancer) associated with multiple granulomas. The granulomas, which were observed within the mucosa and the submucosa at the periphery of the carcinoma, were composed of CD68-positive, CD15-negative epithelioid and giant cells of the Langhans type, confirming their true histiocytic nature, and were also extensively found within the dissected lymph nodes. Since no ocular, skin, pulmonary or other gastrointestinal lesions were found and the granulomas were negative for acid-fast and fungal stain, a diagnosis of granulomatous gastritis was made. CONCLUSIONS: To the best of our knowledge this is the fourth example of gastric adenocarcinoma and granulomatous gastritis. These cases suggest an association between granulomatous gastritis and early gastric cancer.     

Pathology and prognosis of gastric carcinoma: well versus poorly differentiated type

BACKGROUND: The most important parameters predicting outcome of patients with gastric carcinoma are the depth of wall invasion and the status of lymph node metastasis, but the prognostic significance of histologic type is unclear. The aim of this study was to clarify the prognostic value of two major histologic types of gastric carcinoma, that is well and poorly differentiated types. METHODS: Histopathologic findings and outcomes of 504 patients with gastric carcinoma were evaluated by well and poorly differentiated types. Well differentiated gastric carcinoma (WGC) included papillary and tubular adenocarcinomas, poorly differentiated medullary carcinoma, and well differentiated mucinous carcinoma; whereas poorly differentiated gastric carcinoma (PGC) included poorly differentiated scirrhous carcinoma, signet ring cell carcinoma, and poorly differentiated mucinous carcinoma. RESULTS: Patients with WGC were characterized by old age, male predominance, tumor location in the lower third of the stomach, small tumor size, and liver metastasis; whereas patients with PGC were distinguished by their tumor location in the middle third of the stomach, serosal invasion, lymph node metastasis, advanced stage, and peritoneal dissemination. The overall 5-year survival rate for patients with WGC was higher than that for patients with PGC (76% vs. 67%; P = 0.058), especially for patients with >/= 10 cm tumors (42% vs. 14%; P = 0.017). The 5-year survival rate for patients with serosa positive but node negative tumors was higher in WGC patients than in PGC patients (83% vs. 59%; P = 0.086); whereas the 5-year survival rate for patients with serosa negative but node positive tumors was lower in WGC patients than in PGC patients (63% vs. 88%; P = 0.008). Multivariate analysis indicated that among pathologic variables of the tumor, histologic type (WGC vs. PGC) was one of the independent prognostic factors. CONCLUSIONS: Histologic type is important for estimating the tumor progression and outcomes of patients with gastric carcinoma. In addition to the depth of wall invasion and status of lymph node metastasis, histologic type, including well or poorly differentiated type, should be evaluated in the management of gastric cancer.     

Duration of ENNG administration and its effect on histological differentiation of experimental gastric cancer

An experimental trial in the induction of canine gastric cancers was conducted to study the relationship between the histological differentiation of adenocarcinoma and the duration of administration of the carcinogen, N-ethyl-N'-nitro-N-nitrosoguanidine (ENNG). Twenty-three adult Beagle dogs were divided into three groups according to the duration of administration. Over 3 months administration, the total dose of ENNG per animal was 5.85 g, and only signet ring cell carcinomas and poorly differentiated adenocarcinomas were induced in the antral mucosa of the stomach in 5 of 10 recipients. During 6 and 9 months administration, the total doses per animal were 11.70 g and 17.55 g, well differentiated adenocarcinomas were observed in 12 of 13 animals and they coexisted with poorly differentiated adenocarcinomas and/or signet ring cell carcinomas. Atrophic hyperplastic gastritis and hyperplastic polyps were seen in the same stomach. The results of this study suggest that a greater amount of carcinogen, i.e., a higher total dose, is required for the development of well differentiated adenocarcinoma than for inducing poorly differentiated adenocarcinoma and signet ring cell carcinoma.     

Isolation of an amplified DNA sequence in stomach cancer

By use of the in-gel DNA renaturation method, the presence of amplified DNA sequences was demonstrated in KATO-III, a cell line established from a signet ring cell carcinoma of the stomach. A DNA fragment from one of these amplified regions in KATO-III cells was cloned and designated SAM0.2; the locus containing the SAM0.2 fragment was referred to as SAM. The SAM locus was shown to be amplified not only in KATO-III cells, but also in three of 24 surgical specimens of stomach cancers and in two of 13 xenografts of human stomach cancers, all of these specimens being poorly differentiated adenocarcinoma or mucinous adenocarcinoma of the stomach. The SAM locus was not amplified in 14 cell lines of cancers of other organs or in 42 surgical specimens of lung cancers.     

Mixed poorly differentiated adenocarcinoma in undifferentiated-type early gastric cancer predicts endoscopic noncurative resection

Background

Comparisons between surgical cases of mixed poorly differentiated adenocarcinoma and pure signet ring cell carcinoma have revealed higher frequencies of lymph node metastasis and submucosal invasion in the former. However, this comparison has not been reported for endoscopically treated cases. Therefore, we compared cases of curative and noncurative resection in patients who underwent endoscopic submucosal dissection to determine what factors could influence the curative resection rate.

Methods

We analyzed 268 undifferentiated-type early gastric cancers in 264 patients treated with endoscopic submucosal dissection in our hospital between March 2005 and March 2017, involving 229 and 39 cases of curative and noncurative resection, respectively. Treatment results were compared between 129 lesions of pure signet ring cell carcinoma and 139 lesions of mixed poorly differentiated adenocarcinoma.

Results

The overall curative resection rate was 85.4% (229/268). On comparing noncurative and curative resection cases, after excluding factors that determine curative resection (e.g., tumor diameter), we found that the former was associated with older age and significantly more mixed poorly differentiated adenocarcinomas, with odds ratios of 1.052 [95% confidence interval (CI), 1.017–1.089] and 2.746 (95% CI, 1.162–6.485), respectively, on multivariate analysis. The curative resection rate was significantly higher in pure signet ring cell carcinoma than in mixed poorly differentiated adenocarcinoma (93.8% vs. 77.7%, respectively).

Conclusion

Advanced age and mixed poorly differentiated adenocarcinoma predicted endoscopic noncurative resection.