SEVEN CASES OF EPITHELIAL OVARIAN CARCINOMA WITH BRAIN METASTASIS

Objective To summarize the clinical characteristics, treatment, and prognosis of brain metastasis in patients with epithelial ovarian carcinoma. Metbods Retrospective analysis was conducted in 7 cases of brain metastases of epithelial ovarian carcinoma from January 1986 to March 2007 in Peking Union Medical College Hospital for summarizing therapy results and prognosisaffecting factors. Results Incidence of brain metastases of epithelial ovarian carcinoma was about 0. 66% （7/1 055 ）. Serous adenocarcinoma was the predominant pathological type in 4 cases and the subsequent was adenocarcinoma in 3 cases. All the patients were diagnosed at late stage, 6 cases with the International Federation of Gynecology and Obstetrics （HGO） stage Ⅲc and 1 with FIGO stage IV. The mean duration from diagnosis of ovarian carcinoma to brain metastasis was 32.7 ± 20. 0 months （range, 23-73 months）. Single metastasis focus occurred in 43% of cases and multiple metastases in 57% of cases. Fifty-seven percent of patients presented extracranial metastasis. Serum CA125 played a role in monitoring reoccur- rence and brain metastases. The average survival time was about 12 months. Better treatment with prolonged survival could be achieved by combination of operation and chemotherapy or combination of radiotherapy with chemotherapy. Concltusions As a rare condition, brain metastasis of epithelial ovarian carcinoma is rising in incidence with improved treatment of ovarian carcinoma and prolonged survival. However, brain metastasis indicates bad prognosis which can be improved by combined therapy.     

Correlation between elevated FOXP3 expression and increased lymph node metastasis of gastric cancer

Background FOXP3 was thought to express in the T-cell lineage exclusively until recently when FOXP3 was shown to be expressed by cancer cells. It was indicated that FOXP3 may play a wider role in biology by endowing tumor cells with immune suppressive activity. However, researches between FOXP3 and lymph node metastasis of gastric cancer were relatively infrequent, so the present work was aimed to investigate the relationship between FOXP3 expression and lymph node metastasis in human gastric cancer.Methods A total of 122 gastric cancer patients were enrolled in this study, and gastric tumor specimens and lymph nodes were acquired. Thirty patients who had chronic superficial gastritis diagnosed by gastroscopy contemporaneously in the Peking University People＇s Hospital were chosen randomly as the control group. Immunohistochemistry was performed to evaluate FOXP3 expression. A survival analysis on the 122 patients was then performed. Then, NCI-N87cell lines were used to confirm FOXP3 expression in gastric carcinoma cells. Finally, evaluation of FOXP3 expression in gastric tumor and peritumor tissues in 12 patients were conducted using immunohistochemistry and Western blotting. A X2 test or Fisher＇s exact test （bilateral） was conducted to compare the percentage of positive percentage staining between groups. Kaplan-Meier analysis was performed for survival analysis.Results FOXP3 was expressed by gastric cancer cells and peritumor epithelial cells. FOXP3 expression was increased in primary tumors （58.2%） than that in control group （26.7%）. In the lymph-node metastasis group, the incidence of lymph node metastasis which was less than 60% had a significant upregulation of FOXP3 in primary tumors and lymph nodes.However, the frequency of FOXP3 expression had no relationship with survival.Conclusion FOXP3 probably has a relationship with lymph node metastasis of gastric cancer.     

Renal metastases of choriocarcinoma. A clinicopathological study of 31 cases.

From 1949 through 1978, 31 patients with renal metastasis were diagnosed in a total of 448 cases of choriocarcinoma admitted to our hospital, giving an incidence of 6.9%. Renal metastasis was invariably preceded by pulmonary metastases and usually accompanied by other visceral metastases, indicating that renal metastasis is the result of dissemination of tumor cells secondarily from lung metastasis through the general circulation and should be categorized as arterial metastasis. Pyelogram is useful in the presence of medullary invasion by the tumor. Renal metastatic tumors are very sensitive to chemotherapy. Good response to chemical agents may be due to high drug concentration attained in the kidney tissue during excretion. Since successful treatment of renal metastasis by chemotherapy alone may be obtained, patients can be spared a major operation without jeopardizing the prognosis.

     

Anaplastic carcinoma of pancreas：report of 6 cases and literature review

Objective:To investigate clinicopathological features,diagnosis and treatment of anaplastic carcinoma of the pancreas and to review relevant literature on this entity. Methods..A retrospective clinical analysis was made in 6 cases of anaplastic pancreatic carcinomas admitted from 1989 to 2001. Results:Anaplastic pancreatic carcinoma was found in 5 men and 1 woman with a mean age of 61.5 years. Tumor location was in the head of the pancreas in 3 patients,body and tail in 3 cases. Tumors were surgically resected in all patients, by pancreaticoduodenectomy in 1, by pancreaticoduodenectomy combined resection and reconstruction of superior mesenteric vein (SMV) in 1, by pancreaticoduodenectomy combined resection and reconstruction of SMV and superior mesenteric artery (SMA) in 1,by distal pancreatectomy in 2,by distal pancreatectomy combined total gastrotectomy in 1. Liver metastasis was found in one patient. Follow-up suggested the prognosis was poor with a mean survival of 5.5 months after operation. All patients were dead with tumor recurrence and liver metastasis. Conclusion:Histologically,anaplastic pancreatic carcinoma is characterized by pleomorphic cell carcinoma consisting of pleomorphic giant/small cells and spindle cells,or osteoclast-like giant cell tumor composed of pleomorphic small cells,or pleomorphic giant cell carcinoma with osteoclastoid giant cells,and demonstrates aggressive biological behavior. Invasions to adjoined organ and metastasis are usual. The prognosis of this tumor appears to be very poor.     

Prognostic significance of MDR-1 P-glycoprotein expression in breast cancer

Objective: To investigate the expression of MDR-1 P-glycoprotein(MDR-1 Pgp) in breast cancer and analyze its correlation to the biological behavior and prognosis of the disease. Methods:The expression of MDR-1 Pgp was examined in 75 cases of breast cancer patients by using three different monoclonal antibodies(JSB1, C219 and C494) with S-P immunohistochemisty. These patients were followed up for 5 years, and the correlation between MDR-1 Pgp expression, survival rate and lymph metastasis was analyzed. Results: Positive detection of MDR-1 Pgp by JSB1, C219 and C494 in 75 cases of breast cancer was 86.7%, 48% and 85.3%, respectively. MDR-1 Pgp expression was not related to ages of patients (P > 0.05). JSB1-detected expression of MDR-1 Pgp was related to lymph node metastasis(P < 0.05); while C219 and C494 were not(P > 0.05). The patients with MDR-1 Pgp expression positively detected by either two of the three antibodies, had five-year survival rate that was significantly higher than those positively detected by all the three antibodies(P < 0.05). Conclusion:Three antibodies should be used simultaneously to detect MDR-1 Pgp expression in breast cancer. Positive MDR-1 Pgp expression in breast cancer detected by all the three antibodies may represent a poor prognosis; while positive MDR-1 Pgp detection by JSB1 and C494 is associated with lymph metastasis.     

Inhibition of lymphangiogenesis,nodal and lung metastasis by dihydroartemisinin in mice bearing Lewis lung carcinoma

Objective：To investigate the activity of anti-malarial dihydroartemisinin （DHA） on tumor growth, lymphangiogenesis, nodal and lung metastasis and survival in mice bearing Lewis lung carcimoma （LLC）. Methods： The models of C57BL/6 mice transplantation tumors were established via subcutaneous injection of LLC cells and divided into 4 groups： control group, DHA group, DHA＋ferrous sulfate （FS） group and FS group, with 25 mice in each group. Tumor volumes and weights, nodal and lung metastasis, and survival were monitored. Tumor lymphatic microvessel density （LMVD） was determined by lymphatic vessel endothelial hyaluronan receptor-1 （LYVE-1） immnohistochemistry. After LLC cells were treated with DHA or DHA＋FS, protein and mRNA levels of vascular endothelial growth factor （VEGF） -C were evaluated by Western blotting and real time quantitative RT-PCR, respectively. Results： Oral administration of DHA or DHA＋FS inhibited lymph node and lung metastasis, and prolonged survival. However, no significant tumor growth retardation effect was observed when mice were treated with DHA alone. The inhibited tumor metastasis was related to the decreased LMVD in the peritumoral regions, but not in the intratumoral regions. DHA significantly down-regulated the expression of VEGF-C protein and mRNA in LLC cells. Conclusion： DHA effectively inhibits LLC transplantation tumor lymphangiogenesis, nodal and lung metastasis, and may be a promising chemotherapeutic agent for controlling lung cancer metastasis by decreasing VEGF-C expression.     

Experimental radiotherapy and metastasis of human lung cancer xenografts in nude mice.

Using a cell line derived from human lung cancer (AOI), we successfully established human xenografts in KSN nude mice, which showed high incidence of multiple spontaneous metastases. The highest incidence of metastasis in untreated hosts was observed in the spleen followed by the lungs and lymph nodes. The rate of metastasis reached 100% in the mice bearing large sized tumors, when metastasis to any organ or tissue was counted. Experimental radiotherapy caused remarkable redistribution of metastatic foci among different organs. Lung metastasis tended to decrease, while metastasis to the liver and the kidney was increased after radiotherapy. Radiation-induced production of cytokines was speculated to be responsible for such an alteration of metastasis pattern.     

Intratracheal administration of recombinant adenovirus containing IL-18 gene in treatment of experimental metastatic lung carcinoma

Objective: To study the treatment of experimental metastatic lung carcinoma by intratracheal injection of IL-18 gene recombinant adenovirus. Methods: (1)The mouse IL-18 mRNA was detected by RT-PCR, and the concentration of 1L-18 and associated cytokines in lung lavages and blood were determined by ELISA at different time points after intratracheal injection of IL-18 recombinant adenovirus. (2)The lung metastasis nodes, mouse survival periods and survival rates were evaluated. NK activity and CTL activity were determined by 51Cr 4 h release method. Results: (1)IL-18 mRNA was detectable in lung tissue 6 h after intratracheal use of IL-18 recombinant adenovirus, and the concentration of IL-18 in lung lavage was higher than that in peripheral blood. Neither IL-18 mRNA nor IL-18 was detectable in control group. (2) Intmtmcheal use of IL-18 recombinant adenovirus resulted in increased CTL and NK activity, longer survival time and higher survival rates compared with the control group, showing significant therapeutic effect on experimental lung metastasis. Conclusion: Intratracheal use of adenovirus vector containing IL-18 gene has therapeutic effect on the lung metastasis, denoting that gene therapy of lung diseases could be applied through airway directly with recombinant adenovirus.     

Analysis of clinicopathological factors associated with bone metastasis in breast cancer

Breast cancer is the second leading cause of cancer death in women today. Once breast cancer metastasizes to bone, mortality increases. Thus, there is an urgent need to identify patients with high risk of bone metastasis, and to find predictive factors for the occurrence of bone metastasis at an earlier stage of breast cancer. Three hundred and sixty patients with pathologically proved breast cancer visiting the Department of Nuclear Medicine for whole body bone scan from January 2006 and January 2009 were investigated in this study. Clinicopathological information was obtained, which consisted of age, menopausal status, clinical staging, lymph node stage, histological grade, the expression of estrogen receptor (ER), progesterone receptor (PR) and epidermal growth factor receptor 2 (HER2). Correlation between bone metastasis and the associated factors was tested by using the Chi-square test. A Cox multivariate analysis was used to assess the factors which independently contributed to survival after bone metastasis in breast cancer patients. Survival curves were drawn for metastasis-free interval and the independent factors which contributed to survival, using the Kaplan-Meier method. Twenty-four patients were excluded from subsequent analysis. Three hundred and thirty-six enrolled patients ranged in age from 22 to 77 years (mean, 47.8 years). ER/PR status [ER(+) vs. ER(-), χ2 =4.328, P=0.037; ER(+)PR(+) vs. ER(+)PR(-), χ2 =4.425, P=0.035] and histological grade (χ2 =7.131, P=0.028) were significantly associated with bone metastasis. ER status (χ2 =8.315, P=0.004) and metastasis-free interval (χ2=6.863, P=0.009) were independent prognostic factors for survival in breast cancer patients with bone metastasis. Our study suggested that ER/PR status and histological grade are risk factors for the development of bone metastasis in breast cancer patients. However, ER status and metastasis-free inter- val are independent prognostic factors for survival in breast cancer patients with bone metastasis. Breast cancer bone metastasis has its unique characteristics, which is helpful to choose the appropriate treat- ment for breast cancer patients with bone metastasis.     

Prognostic Factors in Patients with Pancreatic Carcinoma

To evaluate the major prognostic factors in patients with pancreatic carcinoma.Methods : 113 cases of a particular disease were retrospectively analysed and 9 factors for prognosis were studied by muitivaritate analysis with Cox proportional hazards survival model. Survival rate was calculated by Kaplan-Meier estimation. Results:In this group,survival time was 0.1 to 82 months,and the median survival time was 3 months.Overall survival rates at month 6,12,18,36 were 35.6%, 20.3%, 15.9% and 6.2%, respectively.Multivariate analyses revealed significant prognostic factors as follows:jaundice, metastasis, therapy method and synthetic therapy. Conchusion: The prognosis of pancreatic carcinoma is determined by various factors. Jaundice and metastasis are independent predictors of poor survival.Radical operation and synthetic therapy will improve the prognosis.