前列腺癌CT表现与癌组织中雄激素受体的相关性研究

目的 探讨前列腺癌CT表现与病理改变及癌组织中雄激素受体(AR)表达的相关性,为前列腺癌临床治疗及估计预后提供影像学依据.资料与方法 搜集40例经CT检查和病理证实的前列腺癌患者资料,应用免疫组织化学法检测病理组织中AR表达,并行肿瘤组织学病理分级,再与CT表现对照分析.结果 AR表达阴性10例(25%),阳性30例(75%).不同病理分级癌组织中AR表达率有显著性差异(P<0.05),其中高分化阳性表达率为100%,中分化为87%,低分化为60%.CT分期评估A/B期22例,C期10例,D期8例.不同CT分期的前列腺癌组织中AR表达率有显著性差异(P<0.05).CT分期与临床分期无显著性差异(P>0.05).CT上肿块外形、密度改变与AR表达无关(P>0.05),而肿瘤的大小与AR的表达呈负相关.结论 前列腺癌组织中AR表达与前列腺癌的病理分级呈负相关;AR阳性表达随CT分期的升高而减少,CT上前列腺外形和肿瘤密度不能反映前列腺癌组织中AR的表达情况.     

肾透明细胞癌CT分期与PCNA和bcl-2表达的相关性探讨

目的:分析肾透明细胞癌的CT分期与增殖细胞核抗原(PCNA)和bcl 2表达的关系。方法:对51 例经手术病理证实的肾透明细胞癌,采用免疫组化LDP法检测肿瘤标本中PCNA和bcl 2的表达,并对肿瘤进行病理分级,分析其与术前CT分期的关系。结果:PCNA表达与CT分期及病理各分级间具有相关性(P<0.05),在CT分期中Ⅰ期与Ⅲ期、Ⅰ期与Ⅳ期、Ⅱ与Ⅲ期、Ⅱ与Ⅳ期、Ⅰ Ⅱ与Ⅲ Ⅳ期的PCNA表达差异有显著性意义(P<0.05),而bcl 2 表达与肿瘤病理分级及CT分期均无明显相关(P>0.05)。结论:PCNA的表达与肾透明细胞癌的CT分期、病理分级具有相关性,能较为客观、准确的反映肾透明细胞癌的恶性程度,对选择治疗方法有重要的参考价值。     

周围型肺癌的CT征象与E-cadherin表达的相关性研究

目的 探讨周围型肺癌CT征象与E钙黏附蛋白(E-cad)表达间的关系. 方法 本组58例周围型肺癌患者,均采用螺旋扫描.标本4 μm连续切片,采用免疫组织化学S-P法检测肿瘤组织E-cad的表达.实验数据经SPSS10.0统计软件包进行统计学处理. 结果 E-cad异常表达32例,细胞分化Ⅰ～Ⅱ级组和Ⅲ～Ⅳ级组阳性表达率分别为40.63%和73.08%,2组间比较差异具有统计学意义(P＜0.05).肺癌E-cad的异常表达与肿瘤的大小、棘突征、胸膜侵犯、淋巴转移明显相关(P<0.05).而与毛刺征、血管集中征、空洞征、胸膜凹陷征、分叶征无关(P>0.05). 结论 E-cad异常表达在肺癌的发生、发展及CT表现中可能起重要作用.     

螺旋CT及E-cad表达在胃癌术前分期中的价值

目的探讨CT扫描及E-cad表达相结合在胃癌术前分期诊断中的意义。方法应用CT增强扫描对66例胃癌进行术前分期;对66例胃切除标本进行E-cad表达分析,与手术及术后病理结果对照,以探讨二者在胃癌术前分期中的价值。结果 CT增强扫描对胃癌T分期准确度为81.8%,N分期准确度为89.4%,综合判断CT对于胃癌肿瘤原发灶、淋巴结和转移情况分期（TNM分期）准确度为80.3%。胃癌组织中E-cad表达阳性率为65.15%。胃癌病理分期Ⅲ、Ⅳ期者其癌组织的E-cad阳性表达率明显高于Ⅰ、Ⅱ期（P〈0.05）;浸润深度为T3、T4胃癌患者其癌组织的E-cad阳性表达率明显高于浸润深度为T1、T2者（P〈0.01）。结论 CT增强扫描及E-cad检测都有利于胃癌术前分期的判断,两者结合有利于提高分期诊断的准确率。     

大肠癌组织p16蛋白表达与临床病理关系的探讨

 目的研究大肠癌组织p 16蛋白表达及其与临床病理学特征的关系.方法采用免疫组织化学ABC法检测53例大肠癌组织中p 16蛋白的表达.结果大肠癌组织中p 16蛋白表达率为35.8%,p 16表达随肿瘤分化程度的降低而减弱(P＜0.05).Dukes分期,AB期p 16表达率高于CD期,分别为51.5%和10.0%,有显著性差异(P＜0.05).结论p 16蛋白表达缺失与大肠癌发生有关,并可作为临床判断肿瘤分化程度及Dukes分期的重要参考指标.     

膀胱移行细胞癌的CT分期与Ki-67和MVD表达的相关性探讨

目的:探讨膀胱移行细胞癌(BTCC)的CT分期与Ki-67和微血管密度(MVD)表达的关系.方法:对56例经手术病理证实的BTCC,采用LDP免疫组化法,检测肿瘤标本中Ki-67和MVD表达,并分析其与术前CT分期的关系.结果:①Ki-67 LI与MVD计数呈显著的正相关关系(r＝0.583,P=0.000);②不同病理分级间Ki-67LI、MVD计数均有显著性差异(F值分别为18.599、21.951,P均＜0.05);③不同CT分期间Ki-67LI、MVD表达总的来说有差别(F＝7.912、6.744,P＜0.05),经两两比较除Ⅰ期与Ⅱ期无差别(F＝-5.23、0.23,P＝0.537、0.955)外,Ⅰ期与Ⅲ期、Ⅰ期与Ⅳ期、Ⅱ期与Ⅲ期、Ⅱ期与Ⅳ、Ⅲ期与Ⅳ期比较均有显著性差异(P均＜0.05).结论:BTCC的CT分期、病理分级与Ki-67和MVD的表达具有相关性,能较为客观、准确的反映BTCC的恶性程度,对选择治疗方法有重要的参考价值.     

CD44v6,E-cad在周围型肺癌中的表达及其与CT表现的关系

目的:研究CD44v6,E-cad在周围型非小细胞性肺癌(non small cell lung cancer,NSCLC)中的表达,探讨其与CT表现的关系。方法:利用免疫组化法检测41例手术切除并经病理证实的周围型NSCLC中CD44v6,E-cad蛋白的表达强度,并分析其与CT表现的相关性。结果:周围型NSCLC组织中CD44v6,E-cad的阳性表达率分别为68.3%和43.9%。、CD44v6阳性表达率与肿瘤分化程度、临床分期以及分叶征、毛刺征、胸膜浸润和纵隔淋巴结增大呈正相关(P<0.01或0.05)。E-cad阳性表达与肿瘤分化程度、临床分期、分叶征、毛刺征、胸膜浸润,纵隔淋巴结增大以及肿瘤大小呈显著负相关(P<0.01或0.05)。肺癌组织中的CD44v6阳性与E-cad阴性表达有显著相关性。结论:肺癌组织中的CD44v6高表达与E-cad失表达与肺癌的发生发展,转移和预后有一定关系。有分叶征、毛刺征、胸膜浸润和纵隔淋巴结增大的肺癌CD44v6高表达而E-cad失表达,提示具有较强的侵袭转移潜能,预后较差。     

肝细胞癌CT强化类型与病理、MVD、VEGF的相关性研究

目的 探讨肝细胞癌(HCC)CT动态增强表现的强化类型与瘤内MVD及VEGF表达之间的关系.方法 运用免疫组化SP法,检测45例经手术切除并病理证实的肝细胞癌瘤内MVD及VEGF的表达,所有病例术前均行CT平扫及增强扫描.结果 (1)病理分级、MVD及VEGF间的关系:Ⅰ、Ⅱ、Ⅲ级和Ⅳ级的MVD分别为22.9±12.6、36.7±16.2、51.1±17.3和67.8±21.4,VEGF阳性表达率分别为28.6%(2/7)、53.3%(8/15)、90.9%(10/11)和100.0%(12/12),Ⅰ级与Ⅲ/Ⅳ级和Ⅱ级与Ⅳ级之间的MVD、VEGF阳性表达率差异显著(P＜0.05),Ⅰ级与Ⅱ级、Ⅱ级与Ⅲ级和Ⅲ级与Ⅳ级之间的MVD,VEGF阳性表达率无显著性差异(P＞0.05).(2)动脉供血型、双重供血型及少血供型肝细胞癌的MVD分别为70.6±22.9、65.7±21.6和25.1±13.5,VEGF阳性表达率分别为85.1%(23/27)、63.6%(7/11)和28.6%(2/7).动脉供血型和双重供血型、双重供血型和少供血型之间VEGF阳性表达率差异均无显著性(P＞0.05),动脉供血型或动脉供血型和双重供血型合并组与少供血型之间VEGF阳性表达率差异有显著性(P＜0.05);动脉供血型和双重供血型的肝细胞癌,其MVD计数均高于少血供型,组间有显著性差异(P＜0.01),动脉供血型与双重供血型MVD计数无显著性差异(P＞0.1).结论 MVD及VEGF表达可在一定程度上反映HCC的分化程度及血供分型.     

磁共振扩散加权成像与直肠癌病理预后因素的相关性研究

目的 探讨磁共振扩散加权成像ADC值与直肠癌病理预后因素的相关性.方法 回顾性搜集45例经病理证实且未行辅助治疗而直接手术治疗的直肠癌患者的病理资料,并根据病理分化程度、T分期、N分期以及脉管、周围神经及直肠系膜筋膜受侵犯状态和免疫组织化学EGFR及P53表达情况进行分组.测量直肠癌的肿瘤组织b=800 s/mm2时的ADC值,分析各组之间肿瘤ADC值的相关关系.结果 高、中、低分化组的ADC值依次降低,且差异具有统计学意义(P=0.016).直肠癌N+组的ADC值低于N0组,差异具有统计学意义(P =0.037).而不同病理T分期、脉管及周围神经受侵、直肠系膜筋膜受侵及癌结节不同分组间肿瘤平均ADC值的差异无统计学意义.EGFR、P3表达阳性组的平均ADC值均低于表达阴性组,但差异均无统计学意义(P＞0.05).结论 直肠癌的ADC值与肿瘤的分化程度及淋巴结转移具有相关性,可有望通过ADC值的定量描述来评估肿瘤的生物学行为.     

MRI与CT成像差异对鼻咽癌T分期以及原发肿瘤靶区体积影响的研究

目的 探讨鼻咽癌MRI和CT成像差异对鼻咽癌T分期的影响及对原发肿瘤靶区体积的影响.资料与方法 比较101例经病理诊断为鼻咽低分化鳞癌的患者的MRI和CT表现,应用其差异比较鼻咽癌靶区的体积对放射治疗效果的影响.结果 咽后淋巴结、头长肌、蝶骨、枕骨斜坡、鼻窦等处的病灶在MRI的发现率高于CT(P<0.05).对鼻咽癌的T分期,MRI和CT之间有差异(P<0.05).根据MRI表现勾画的鼻咽癌靶区体积大于根据CT表现勾画的鼻咽癌靶区体积(P<0.05).结论 MRI对发现鼻咽癌、鼻咽癌分期及勾画鼻咽癌原发肿瘤靶区体积优于CT.     

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.     

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...     

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.