Synchronous ipsilateral renal cell and transitional cell carcinoma

The coexistence of multiple and synchronous primary neoplasms in the genitourinary system has only rarely been described in the literature. We present the case of a 78-year-old man with haematuria as the initial presentation, finally proven to be transitional cell carcinoma (TCC) combined with renal cell carcinoma (RCC). Intravenous urography (IVU), CT and arterial angiography studies revealed a space-occupying nodule at the right upper renal pelvicalyces showing mild enhancement with contrast medium. Another strong contrast medium enhancing exophytic tumour was found at the lower pole of kidney; there were hypodense foci and calcified components in this lesion. A right nephroureterectomy was performed. Pathological diagnosis was a papillary TCC and a clear cell type RCC. This is a rare case of combined renal malignancies diagnosed by imaging.     

肾透明细胞癌与肾乳头状癌、嫌色细胞癌MRI表现的对照研究

目的 探讨MR动态增强扫描对肾癌亚型的鉴别诊断价值.方法 搜集77例经病理证实的肾癌患者资料,其中透明细胞癌(CCRCC)55例,乳头状癌(PRCC)14例,嫌色细胞癌(CRCC)8例,回顾性分析各亚型肿瘤患者MR平扫及动态增强扫描表现并与病理对照,根据肿瘤及肾皮质增强前后的皮质期、实质期及延迟期信号变化,分别进行百分比测量、肿瘤-肾皮质增强指数计算,并采用单因素方差分析和LSD法进行比较.结果 CRCC多数信号均匀(7/8);CCRCC及PRCC多数信号不均(分别为51/55和13/14)、常见坏死(36/55和7/14),PRCC最常见出血(9/14)及囊变(9/14).动态增强各期CCRCC强化程度最高,强化模式呈"快进快退",CRCC轻至中度强化,PRCC强化最轻,两者均呈渐进性延迟强化.CCRCC、PRCC及CRCC皮质期信号变化分别为(296.15±60.27)%、(79.70±18.84)%和(119.56±40.76)%,实质期分别为(236.33±58.31)%、(122.81±27.35)%和(163.06±33.91)%,延迟期分别为(216.83±46.72)%、(117.55±20.63)%和(179.72±32.89)%;三者皮质期的肿瘤-皮质增强指数分别为1.26±0.34、0.33±0.12及0.54±0.10,实质期分别为0.92±0.23、0.41±0.23及0.62±0.15,延迟期分别为0.76±0.14、0.35±0.11及0.69±0.12,各亚型增强各期的信号变化(F值分别为940.931、124.515、38.194,P值均＜0.01)、肿瘤-皮质增强指数(F值分别为798.625、78.308、73.699,P值均＜0.01)差异均有统计学意义.3种亚型的MRI表现与病理学所见基本相符.结论 CCRCC、PRCC及CRCC的MRI动态增强有一定特征性的表现,与其病理特点密切相关,在肾癌亚型的鉴别诊断上有着较高的临床应用价值.

Abstract：

Objective To investigate the differential diagnostic features of subtypes of renal cell carcinoma(RCC) using dynamic contrast-enhanced MRI(DCE-MRI).Methods The MRI appearances of 77 RCCs, including 55 clear cell RCCs(CCRCC),14 papillary RCCs(PRCC) and 8 chromophobe RCCs(CRCC), were retrospectively analyzed and compared with findings of pathology. DCE-MRI was conducted in each case after intravenous administration of contrast agent. Region of interest measurements (cortical, nephrographic and delayed Phases) of signals within tumor and uninvolved renal cortex were used to calculate percentage signal intensity change and tumor-to-cortex enhancement index, and the data was analyzed by AVONA and t test. Results On unenhanced and enhanced MRI, most CRCCs showed homogeneous signal(7/8). CCRCC and PRCC often show inhomogenous signal with necrosis(36/55, 7/14). Hemorrhage and cystic degeneration were often found in PRCC (9/14). On the cortical, nephrographic and delayed phase images, CCRCCs showed greater signal intensity change[(296.15±60.27)%, (236.33±58.31)% and (216.83±46.72)%,respectively than PRCCs (79.70±18.84)%, (122.81±27.35)% and (117.55±20.63)%, respectively], and CRCCs showed intermediate change [(119.56±40.76)%, (163.06±33.91)% and (179.72±32.89)%, respectively].A phenomenon of quick staining and quick fainting was observed in CCRCCs. Both of CRCCs and PRCCs showed delayed enhancement. The tumor-to-cortex enhancement index at the cortical, nephrographic and delayed phases was highest for CCRCCs (1.26±0.34, 0.92±0.23 and 0.76±0.14, respectively), lowest for PRCCs (0.33±0.12, 0.41±0.23 and 0.35±0.11, respectively), and intermediate for CRCCs (0.54±0.10, 0.62±0.15 and 0.69±0.12, respectively,P＜0.01). The degree of enhancement was significantly different among the 3 subtypes at the every contrast enhanced phase (F=940.931, 124.515 and 38.194, P＜0.01), so was the tumor-to-cortex enhancement index(F=798.625,78.308 and 73.699, P＜0.01). There was a good consistency between MR appearances of the 3 RCC subtypes and pathological characteristics. Conclusion DCE-MRI could distinctly show imaging features of CCRCC, PRCC and CRCC, which were related to their pathological characteristics, and these features were helpful in predicting a specific subtype of RCC.     

透明细胞乳头状肾细胞癌的影像学表现

目的探讨透明细胞乳头状肾细胞癌(CCPRCC)的影像学表现。方法分析15例CCPRCC患者CT及MRI影像特征,采用独立样本t检验比较肿瘤与肾皮质之间平扫CT值、ADC值差异。结果15例均为单发,边界清晰,大小为(3.1±1.9)cm。13例为实性肿瘤,其中11例伴囊变,2例为囊性肿瘤。4例CT平扫呈等或稍低密度,4例呈稍高密度;6例密度不均匀,1例伴细条状钙化;8例CT值为(38.4±10.6)HU,与肾皮质比较差异无统计学意义(P>0.05)。8例MRI平扫T1WI呈稍低或低信号,3例伴发结节状、灶状高信号;8例T2WI以混杂高信号为主,5例边缘见包膜;7例DWI呈稍高信号;9例肿瘤ADC值(2.22±0.30)×10-3 mm2/s高于肾皮质,两者差异具有统计学意义(P<0.05)。增强扫描13例实性肿瘤中9例呈“快进快出”强化,4例呈持续或渐进性强化;2例囊性肿瘤增强扫描呈囊壁及中心分隔强化。结论CCPRCC好发于中老年人,肿瘤易发生囊变,出血、钙化少见,弥散受限不明显,增强扫描以“快进快出”强化为主,确诊仍需依靠组织病理学。     

Fluorodeoxyglucose cell incorporation as an index of cell proliferation: evaluation of accuracy in cell culture

The use of fluorodeoxyglucose (FDG) and positron emission tomography (PET) is recognized as an accurate tool for the specific diagnosis and staging of cancer. It has also been proposed for the monitoring of anticancer therapy. FDG cell incorporation reflects glycolytic activity whereas inhibition of cell proliferation corresponds to an efficient cancer treatment. The relationship between FDG incorporation and cell proliferation has yet to be demonstrated. Therefore, we aimed to correlate the effects of the toxic agents bleomycin and unlabelled meta-iodobenzylguanidine (mIBG) on cellular metabolism and proliferation. We determined the in vitro metabolic and cytotoxic effects of bleomycin and mIBG by measuring the incorporation of fluorine-18 FDG (%U_FDG) and hydrogen-3 thymidine (%U_THY) in cells of the human premonocytic line U937 in the presence of increasing concentrations of these agents. Proliferation rate of these cells was studied by means of limiting dilution analysis. %U_THY appeared more sensitive to bleomycin or mIBG-mediated cell injury than %U_FDG. After 1 h of exposure to 0.5 M bleomycin, %U_THY was significantly reduced to 62.0% ± 10.4% of control value whereas %U_FDG remained unchanged (91.6% ± 5.3%). Similar results were obtained after 1 h of exposure to increasing concentrations of mIBG (1 M to 1 mM). After 20 h of exposure to bleomycin, %U_THY and %U_FDG were significantly reduced as a function of concentration. After 20 h of exposure to mIBG, a transient increase in %U_FDG up to 149.3% ± 11.2% with 50 M mIBG was further followed by a reduction to 20.1% ± 6.7% with 0.5 mM (P < 0.001). The clonogenic efficiency was reduced as a function of bleomycin (ANOVA, n=255, P) or mIBG concentration (n=80, P) and nearly abolished with 0.1 M bleomycin or 0.1 mM mIBG. In conclusion, %U_THY appears to be a more sensitive index of cytotoxicity in vitro and more accurately relates to cell proliferation than %U_FDG. Correspondence to: D.O. Slosman, Nuclear Medicine Division, Geneva University Hospital, CH-1211 Geneva 14, Switzerland     

一种改进的用于测定细胞周期的细胞制备方法

目的 :减少细胞的聚集数量 ,提高测试效率和结果的准确性。方法 :在用酒精固定细胞时分别加入终浓度为 0 % ,1.5 % ,3% ,6 %和 12 %的小牛血清 ,置 - 2 0℃分别固定细胞 1d ,3d和 7d。比较了不同浓度的血清和保存不同时间粘连细胞的数量及对细胞周期分析结果的影响。结果 :加入血清可明显减轻细胞的粘连 ,减少了细胞的聚集数量 ,尤以 3%小牛血清组最佳。样品可不必过滤 ,在上机测试时 ,进样针不堵塞 ,上样速度快 ,细胞周期分析更准确。随着保存时间的延长 ,聚集细胞的数量有增加的趋势。结论 :在制备用于测定细胞周期的样品时 ,固定细胞的过程中加入终浓度为 3%的小牛血清是一种简单的、能有效地保护细胞膜使细胞不易粘连的技术措施 ,且固定细胞的时间不宜超过 7d。     

Clear cell chondrosarcoma

The clinical, radiologic, and histopathologic features of three cases of clear cell chondrosarcoma are described. On radiographs, this rather benign-appearing tumor resembles a chondroblastoma when it occurs at the end of a long bone, and may occasionally show a calcified matrix. However, it has distinctive tumor cells with a centrally placed vesicular nucleus surrounded by clear cytoplasm. The lesion has a low-grade malignancy and is amenable to en bloc surgical resection, which results in a much better prognosis than that of conventional chondrosarcoma.     

Langerhans cell histiocytosis

Langerhans cell histiocytosis (LCH) is a complex disease entity comprised of three distinct clinical syndromes that demonstrate indistinguishable histology. These syndromes are: eosinophilic granuloma, which is predominantly osseous or pulmonary; Hand-Schûller-Christian’s disease, which involves multiple organ systems and, most typically, the skull base; and Letterer-Siwe’s disease, the most severe disease manifestation, which typically involves the abdominal viscera. This article reviews our current understanding of Langerhans cell histiocytosis by discussing the history, histology, etiology, and treatment of the disease. It focuses on the radiographic findings and imaging modalities that are the most useful in disease diagnosis and management.     

Littoral cell angioma

Littoral cell angioma (LCA) is an extremely rare primary splenic tumor. There are few MRI and scintigraphic characteristics described. These characteristics may be most helpful in differentiating LCA from other primary vascular tumors. We present a 54-year-old woman found on CT to have a 7-cm mass within an enlarged spleen. LCA was diagnosed by ultrasound (US)-guided biopsy. She was successfully treated with laparoscopic splenectomy. The CT, MRI, US, and Tc99m-RBC scan characteristics are described along with histologic and immunohistochemical correlation.     

Endothelial cell biology

The endothelium is not a passive blood-compatible lining for the containment of blood cells and plasma, but rather it is a metabolically active tissue that subserves a wide range of functions relating to vascular homeostasis. This article reviews the current understanding of endothelial cell biology in terms of the molecules and biochemical pathways involved. These regulate coagulant and thrombotic properties of the vessel wall, vascular tone, and hence blood flow and pressure; changes in solute permeability and leukocyte traffic during the generation of inflammatory and immune responses; and finally the processes of vessel growth and angiogenesis. The review concludes with a consideration of how these functional properties can be disturbed, and their possible consequences, in response to irradiation, intravascular contrast media, or angioplasty.     

Merkel cell carcinoma

Merkel cell carcinoma is a rare malignant neoplasm of the skin which is locally invasive and frequently metastasizes to lymph nodes, liver, lungs, bone, and brain. Computed tomographic and pathologic findings in an elderly woman with Merkel cell carcinoma of the buttock and regional nodal metastasis are reported. The presence of calcitonin and neuron-specific enolase within the tumor supports the theory that Merkel cell carcinoma is a neuroendocrine tumor derived from the APUD (amine precursor uptake and decarboxylase) system.     

电离辐射对不同肿瘤细胞细胞周期的影响

目的 研究电离辐射对不同肿瘤细胞细胞周期的影响为肿瘤放疗及化疗提供科学依据。方法 处于细胞周期各时相的细胞百分数采用流式细胞术进行检测。结果 研究表明：电离辐射作用后,ＨｅｌａＳ３和Ｓ１８０细胞发生了Ｓ和Ｇ２期阻滞,而ＤＬ－４细胞则发生Ｇ１和Ｇ２期阻滞,Ｂ１６各时相细胞数无列出较高的辐射抗性。结论 电离辐射作用后,不同肿瘤细胞的辐射抗性、即辐射敏感性有较大差异。其细胞周期的变化规律亦不相同。     

敲低PES1基因抑制舌癌细胞的生长

目的：构建稳定表达PES1 shRNA的舌癌细胞系,研究敲低PES1基因对舌癌细胞生长的影响。方法在293 T细胞中包装并获得敲低PES1基因的病毒,然后将病毒感染Tca8113、SCC6和SCC153种舌癌细胞并筛选稳定克隆,Western印迹检测PES1蛋白的表达水平;利用生长曲线检测敲低PES1对舌癌细胞生长的影响,流式细胞术检测敲低PES1对舌癌细胞周期的影响。结果成功构建稳定表达PES1 shRNA的舌癌细胞系,敲低PES1基因能够抑制舌癌细胞的生长,使细胞周期阻滞在G0／G1期,敲低PES1抑制cyclin D1的表达。结论敲低PES1抑制舌癌细胞的生长,诱导细胞周期阻滞在G0／G1期,抑制cyclin D1的表达,因此PES1可能成为舌癌基因治疗的靶标。