骨巨细胞瘤内多核巨细胞的超微结构观察

本文观察了六例骨巨细胞瘤,探讨了多核巨细胞的超微結构改变,其组织发生有迹象表明由单核基质细胞融合形成的。根据形态特征、恒定存在和生物学行为综合分析,认为多核巨细胞也是骨巨细胞瘤的实质瘤细胞。     

肺软组织恶性巨细胞瘤(附1例病例报告)

软组织恶性巨细胞瘤较少见,发生于肺内者国内尚未见报道。对于其组织学来源尚无定论。本文报告1例肺软组织恶性巨细胞瘤,其主要组成为破骨细胞样巨细胞及单核性瘤细胞,组织学上颇似骨巨细胞瘤。通过特殊染色及免疫组化研究,确定其组织来源为组织细胞。     

少见部位的骨巨细胞瘤

本文报告66例少见部位的骨巨细胞瘤,着重X线诊断的分析探讨。男41例,女25例。平均年龄31.5岁。发病部位分布广泛,66例分布于23个骨部位。跟骨巨细胞瘤有单房和多房两种基本表现形式。脊椎巨细胞瘤具有明显的侵袭性,有的肿瘤表现颇似脊椎结核。巨细胞瘤易跨越关节。文中深入地分析了肱骨、股骨颈巨细胞瘤的X线表现。对16例骨包壳进行了详细观察,认为骨壳不是骨皮质膨胀变薄,而是肿瘤刺激骨膜形成的反应性新生骨。     

颌骨中心性巨细胞肉芽肿

通过11例中心性颌骨巨细胞肉芽肿的临床病理分析,认为本组均为良性非肿瘤性病损。组织学以小而形状不整的多核巨细胞分布于富有细胞血管纤维结缔组织的基质中为其特征。     

骨巨细胞瘤的细胞生物学

目的 探讨骨巨细胞瘤中多核巨细胞和单核基质细胞的起源及在肿瘤中的作用,方法 应用免疫组织化学方法检测50例骨巨细胞瘤手术标本的增殖细胞核抗原（PCNA）、巨噬细胞抗原（CD68）、波形蛋白、抗糜蛋白酶（AACT）、抗胰蛋白酶（ACT）以及溶菌酶的表达和分布状况。结果 多核巨细胞主要表达CD68、AACT、ACT以及溶菌酶,无一表达PCNA;单核基质细胞可分为两种类型,以纤维母细胞型占优势,主要表达波形蛋白和PCNA;组织细胞型主要表达CD68、AACT、ACT以及溶菌酶。结论 多核巨细胞并非肿瘤细胞,它可能来自单核巨噬细胞系统,单核基质细胞中的纤维母细胞型为肿瘤的主要增殖成分,可能来自间充质。     

骨巨细胞瘤Jaffe分级的PCNA评价

目的观察骨巨细胞瘤Ｊａｆｆｅ组织分级与瘤细胞增殖的关系。方法应用免疫组化ＡＢＣ法对２７例不同组织级别的骨巨细胞瘤进行增殖细胞核抗原（ＰＣＮＡ）检测。结果ＰＣＮＡ的阳性反应仅见于基质细胞的胞核中，多核巨细胞呈阴性反应。不同组织级别的骨巨细胞瘤之间，ＰＣＮＡ阳性检出率无显著差别（Ｐ＞０．０５）。结论骨巨细胞瘤Ｊａｆｆｅ分级系统与肿瘤细胞的增殖情况无关；多核巨细胞非肿瘤细胞。     

ULTRASTRUCTURAL INVESTIGAT10N OF GIANT CELL TUMOR OF BONE

The surface and internal ultrastructure of multinuclear giant cells and stromal cells are studied in 3 cases of giant cell tumors of bone by means of scanning electronmicroscope and transmission electronmicroscope. The fibroblast- like type of stromal cells was the principal stro- mal cell and has the function of forming collagen. Like the fibroblastic type of stromal cells, the multinuclear giant cells can also be deemed as true tumor cells. Various surface ultrastruct- ural configurations of the multinuclear giant cells can be attributed more to heightened me- tabolism than to manifestation of malignancy.     

骨巨细胞瘤体外培养及其生物学特性的观察

１９８３～１９９２年作者通过组织培养，组化及免疫组化、电镜、细胞遗传学，动物接种等方法，对骨巨细胞瘤（ＧＣＴ）的生物学特性进行研究，认为ＧＣＴ的基质细胞有两种，即间叶性基质细胞及巨噬细胞性基质细胞，巨噬细胞性基质细胞可能为许多种不同的巨噬细胞混合体，这两种类型细胞在瘤组织内互相依赖存活。在体外培养见巨噬细胞性基质细胞逐渐减少而消亡，间叶性基质细胞则在没有巨噬细胞性基质细胞的情况下也容易老化及消亡，故目前尚未有本瘤的细胞株建立。多核巨细胞是一反应性及终末性细胞，可能由于基质细胞分泌目前尚末清楚的细胞因子，吸引血中破骨细胞前身的单核巨噬细胞到瘤组织内，并促进其分化成破骨细胞样多核巨细胞。     

应用单抗GCF-5观察骨巨细胞瘤细胞成分

采用免疫细胞化学和免疫电镜方法,以我室制备的抗骨巨细胞瘤(GCT)肿瘤细胞的单克隆抗体GCF-5,对41例GCT及其它肿瘤细胞进行观察,结果表明:41例中的35例GCT标本与GCF-5结合呈阳性反应;除1例骨肉瘤细胞系(OS-732)细胞为阳性反应外,其它骨肿瘤均为阴性反应。经免疫金染色后电镜下,在阳性细胞表面可见金颗粒,证明GCF-5抗体是抗细胞表面抗原的单克隆抗体,GCF-5与GCT中部分基质细胞(STC)结合,除与一些双核细胞和核数少的多核巨细胞(MGC)结合外,与绝大多数的MGC不发生反应,但能与GCT体外培养、多次传代后的MGC发生反应。均支持本作者以前的观点,即GCT中的MGC与STC各自包含两种截然不同的细胞成分:肿瘤细胞和与肿瘤免疫有关的细胞,仅肿瘤细胞成分能在体外培养中生长、增殖。     

CONTRAST STUDY ON MULTINUCLEATED GIANT C,FLLS IN GIANT CELL TUMORS OF BONE AND OTHER MULTINUCLEATED CELLS

By means of tissue culture, electron microscopy, cytochemistry, indirect immunofluorescence and immunohistochemistry, the multinucleated giant cells(MGCs) in 12 giant cell tumors of bone (GCT) were studied in contrast with osteoclasts (OCs), foreign body giant cells (FGCs) and inflammatory giant cells (IGCs). The findings in the majority of MGCs were identical with those in OCs, suggesting that they most probably derived from the same precursor. Continuous in vitro culture revealed two kinds of MGCs, which were designated preliminarily as short-lived MGCs and long-lived MGCs for their difference in morphology and in several biological features, which suggests two kinds of MGCs exist in GCT. We conclude that the short-lived conform to the typical MGCs known generally to the pathologists, while the long-lived are deemed to be closely related to the neoplastic elements of the tumor.     

骨巨细胞瘤体外原代培养及特性

目的观察骨巨细胞瘤体外培养细胞的形态生长特性及DNA倍体含量。方法取手术切取的骨巨细胞瘤新鲜标本8例,以组织培养法进行原代培养,观察细胞形态、生长曲线,FCM分析其倍体含量。结果骨巨细胞瘤原代培养种可见3种细胞;多核巨细胞可以长期培养。FCM分析显示:5例复发及2例原发病例是二倍体或亚二倍体,1例原发病例是非整倍体。结论单核梭形细胞是骨巨细胞瘤的主要肿瘤性成分;FCM无助于骨巨细胞瘤的预后判断。     

人骨巨细胞瘤细胞系GCT-0404的建立和生物学特性

目的:研究骨巨细胞瘤细胞体外培养的生物学特性,并建立人骨巨细胞瘤细胞系. 方法: 采用原代组织块培养法培养骨巨细胞瘤手术标本,对存活细胞进行形态学观察、免疫组织化学染色、细胞周期检查、核型分析、裸鼠移植. 结果: 建立人骨巨细胞瘤细胞系GCT-0404,其形态学表现、免疫组织化学染色均符合骨巨细胞瘤纤维母细胞样基质细胞的特征. 经过近1 a的体外培养,现已传代100次,细胞倍增时间39.7 h,细胞周期测定G1期为67.5%,G2期为8.9%,S期为23.6%. 染色体具有三倍体核型. 裸鼠移植成瘤率100%,无支原体污染. 结论: 人骨巨细胞瘤细胞系GCT-0404可以用于对骨巨细胞瘤的研究.     

鼻咽涂片中巨大裸核细胞的性质和形成的探讨

26例光镜电镜对照观察,证明鼻咽涂片中的巨大裸核癌细胞具有恶性肿瘤和鼻咽癌胞核的超微结构特点。DNA Feulgen 反应阳性,显示其为胞核成分,并非粘液或异物。透射电镜可见组织表面巨核癌细胞胞浆脱失,并有向巨大裸核癌细胞逐步过渡的形态改变,说明巨大裸核癌细胞系由巨核癌细胞胞浆脱失而来。     

骨巨细胞瘤的p16蛋白表达特点

目的 :探讨p16蛋白表达与骨巨细胞瘤发生的关系。方法 :采用免疫组织化学S P法检测 4 2例骨巨细胞瘤的p16蛋白表达。结果 :骨巨细胞瘤的p16蛋白表达缺失率为 6 6 .7% ,p16蛋白表达随骨巨细胞瘤恶性程度的上升而降低。骨巨细胞瘤的多核巨细胞有 3种染色状态。结论 :p16蛋白表达降低与骨巨细胞瘤的发生有关 ,骨巨细胞瘤的多核巨细胞可能存在不同种类。     

p~（53）、C－erb B_2和ras癌基因蛋白产物在骨巨细胞瘤中的表达

目的探讨ｐ~（５３）、Ｃ－ｅｒｂＢ_２和ｒａｓ癌基因蛋白产物在骨巨细胞瘤中的表达状况，了解该肿瘤的发病机制。方法应用免疫组化ＳＰ方法对５０例骨巨细胞瘤进行ｐ~（５３）、Ｃ－ｅｒｂＢ_２和ｐ~（２１）检测。结果５０例骨巨细胞瘤均不表达ｐ~（５３）和Ｃ－ｅｒｂＢ_２；ｒａｓ癌基因蛋白产物ｐ~（２１）仅在部分骨巨细胞瘤病例中表达，阳性率为２６％（１３／５０）。结论骨巨细胞瘤的发生可能与ｒａｓ癌基因的活化有关。     

p73在骨巨细胞瘤中表达的意义

目的：研究p73蛋白在骨巨细胞瘤中的表达,探讨其在骨巨细胞瘤发生、发展中的可能作用。方法：应用免疫组化S－P法检测40例骨巨细胞瘤石蜡标本中p73蛋白的表达情况。结果：p73在骨巨细胞瘤中表达阳性率为30.0％,对照组骨软骨瘤表达阳性率为20.0％,两组相比无显著差异（P＞0.05）。p73在骨巨细胞瘤Ⅰ～Ⅱ级组表达阳性率为17.9％,Ⅲ级组为58.3％,二者相比差异显著（P＜0.05）。结论：p73在Ⅲ级骨巨细胞瘤中表达明显增高,提示其在骨巨细胞瘤发生、发展中可能发挥重要作用,并可作为骨巨细胞瘤Jaffe分级的辅助指标之一。     

CYTOLOGICAL CHARACTERISTICS OF MAIN CELLULAR ELEMENTS IN BFNIGN AND MALIGNANT GIANT CELL TUMOR OF BONE

Cytological characterist;cs of three main cellular elements iii benign and malignant giant cell tumor of bone were investigated by cytochemistry, tissue ccilture. electron microscopy and microspectropho. toinetry. The macrophage (MO), as identified by EA rosette assay, and the multinucleated giant celf (MGC) had similar enzyme activities, which differed from those of the non rosette-forming cell (NRFC). MO and MGC of malignant giant cell tumor of bone (MCCT) did not proliferate in vitro while ;ts NRFC could maintain seri81 growtfi with concomi tant formation of some multinuclear cells which are clifferent from MCC in the light and eleccron of atypical MCCs were certain aspects. Under both microscope a small number found in MGCT. The;r nii clei varied in size and shape. The NRFC in MGCT showed more prominent ritypical ultrastructural features. Part of the NRFCs had aneuploid DNA content above 4C (-4C), which is generally consi dered as the evidence of rnalignancy. Some nuclei i" the MGCs of MGCT contained }40 DNA con tent, but not those in MGCs of benign giant cell tumor of bone. Usually, no aneupaoidy was detected in MO of all the samples with the exception of one MGCT sample. in which l O% M¢ contains :4C DNA content. Iri the in virro labelling, :II-TdR labelled NRFC were in varying percentage, but labelled MO and MGC were infrequently found. The circumstan tial evidences suggest a close relationship exists be. tween M¢ and MGC: but NRFC presents neoplastic featurea. The atypical giant cells in MGCT might be of tumor origin.     

IN VITRO TISSUE CUL,TURE STUDY ON GIANT CELL TUMOR OF BONE

In vitro tissue culture of 22 giant cell tumors (GCTs) of the bone in 19 cases was undertaken. Primary growth was successful in all. 11 were Grade I tumors, 10 Grade n and l Grade III. The average survival of the 3 grades of GCTs was in order 167.3, 219 and 625 days. Of these, 6 were postoperative recurrent GCTs, their life span ranging from 198 t0 6.25 days. It is apparent that the higher the pathologic grade of GCT, the longer the survival of cultured cells. Recurring tumors also manifested more active growth po- tential. This lends support to the view that the existing pathologic grading remains valuable for clinical reference. Multinucleated giant cell usually survived 3 weeks, occasionally 3 months. Growth of the stromal cells maint.ained from 5 weeks t0 8 months. The circumstantial evidence indicates that the stromal cells, not the giant cells, should be considered as the offending neoplastic invader.     

CYTOLOGIC OBSERVATION ON GIANT CELL TUMOR OF BONE

By combined immunologic, histochemical and other approaches, we studied the macro- phage content in 20 giant cell tumors of bone (GCT) as compared with that in 26 benign and malignant lesions of osseous and soft tissues. We found that many macrophages existed in GCvF. In the cell suspensions prepared by en- zymatic disaggregation, the percentage of macro- phge was apparently higher than in co.ntrol le- sions. After serial passage, macropha.ges and mult.inucleated giant cells (MGC) gradually de- creased in number, whereas spindle-shaped cells, which were negative for Fc, Cq recepitor and nonspecific esterase (NSE), maintained their growth. KeeIoin.g the cuture media uncha.nged for 7 t0 31 da.ys, cells containing Z t0 8 nuclei could be found in primary culture of macropha- ges isolated from GCT. Although Fc, C3 recep- tors and phagocytosis were not demonstrated in almost all MGC, some of them showed NSE ac- tivity and weak res.isitance to trypsin. It is worth noting that a few bi-, tri- and tetra-nucleated cells form.ed EA rosettes and phagocytosed E.A. The place of macrophages in GCT, their inter- relationship, ancl MGC are discussed.     

心脏跳动中巨大心脏二尖瓣置换术远期疗效

目的 :评价在浅低温体外循环心脏跳动中巨大心脏病人二尖瓣置换术的远期疗效。方法 :对 131例巨大心脏患者在心脏跳动中施行二尖瓣置换术 ,早期死亡 5例。术后随访到 111例 ,失访 15例 ,随访率 88.1% ,随访时间 0 .5～ 9.0年。随访方法是对病人采用信访、电话随访和门诊复查相结合进行长期随访。结果 :远期死亡 9例 ,死亡原因为心衰 5例、心律失常 2例、瓣周漏 1例、原因不明 1例。 3、6、9年累积生存率为 92 .3%、84 .1%、79.5 %。随访结果与术前及术后早期结果进行统计学处理 ,左室收缩末直径、左室舒张末直径及心功能等指标差异均有统计学意义 (P <0 .0 5 )。左房型及右室型远期疗效较好 ,全心型及左室型效果较差。结论 :在心脏跳动中行巨大心脏的二尖瓣置换手术切实可行 ,安全有效 ,心肌保护效果良好 ,远期效果满意。随访期间加强心功能支持和室性心律失常防治 ,有助于提高巨大心脏二尖瓣置换术的远期疗效