原发性肝细胞癌微血管侵犯的术前预测模型构建及临床意义

目的构建原发性肝细胞癌(HCC)微血管侵犯(MVI)的术前预测模型并验证其准确性。方法回顾性分析2017年1月至2019年6月行肝切除术的160例HCC患者的临床病理资料,观察患者MVI情况。采用SPSS20.0软件对数据进行处理分析,计数资料采用χ^2检验;计量资料采用t检验;采用单因素和多因素Logistic回归分析影响MVI的独立危险因素,并构建HCC患者MVI的术前预测模型,通过描绘受试者工作特征曲线(ROC)并计算曲线下面积(AUC)从而来评估模型的预测能力,并以术后病理诊断结果为金标准对预测模型进行验证。结果在160例患者中,有MVI者86例,无MVI者74例。对单因素分析有统计学意义的资料进行Logistic多因素分析,结果显示:肿瘤直径、瘤周低回声晕环、甲胎蛋白(AFP)水平、血小板与淋巴细胞比值(PLR)水平、循环肿瘤DNA(ctDNA)浓度是HCC的MVI独立危险因素。根据Logistic回归分析各变量的回归系数构建预测模型,通过绘制ROC曲线,计算出AUC值为0.914(95%CI 0.820~0.962),当最佳临界值为0.069时对HCC患者MVI具有预测价值,灵敏度为86.5%,特异度为87.9%,约登指数为0.74。以术后病理诊断为金标准,验证预测模型,灵敏度为88.4%,特异度为93.2%,两者灵敏度和特异度无统计学差异(P>0.05)。结论基于Logistic多因素回归分析建立预测模型具有较高的灵敏度和特异性,对HCC微血管侵犯的患者具有较高的预测价值,可为HCC患者的术前治疗方案、手术规划提供参考。     

Parathyroid Carcinoma: A Single-Institution Experience with an Emphasis on Histopathological Features

Parathyroid carcinoma (PC) is a rare malignancy that poses a diagnostic challenge on histologic examination. We analyzed various clinicopathologic features of PC. Pathology reports and slides were reviewed to evaluate the diagnostic histopathologic features of archived cases of PC from the years of 2004–2018. The study cohort comprised twenty cases of PC. The median age was 49 years (range 21–73 years) with equal gender distribution (M:F = 1:1). Most patients presented with symptoms of hypercalcemia (n = 7, 54%). Serum calcium and serum parathyroid hormone were elevated in all but one patient. The right inferior parathyroid was commonly involved (n = 8/14, 57%). The mean tumor size was 2.4 cm (range 0.8–3.5 cm). On frozen section examination, PC was diagnosed in 8 out of 9 cases. Vascular (n = 19/20, 95%) and soft tissue invasion (n = 10/20, 50%) were the most common characteristic histologic findings. Capsular invasion was identified in all cases. Perineural invasion or metastasis at presentation was absent in all cases. Other histological features noted were intratumoral fibrous bands (70%), nodular growth pattern (70%), moderate nuclear atypia (30%), prominent nucleoli (20%), and necrosis (20%). Regional lymph nodes were negative for metastatic disease in all cases (n = 10). Eight out of 16 patients received adjuvant radiotherapy. Follow-up was available in 16 cases (median 21.5 months). Two patients died of disease. Vascular and soft tissue invasion are the most common diagnostic histologic features of PC. Capsular invasion is important to distinguish PC from its benign counterparts. Intraoperative frozen section examination can be used for accurate diagnosis and surgical management.     

Predictive model containing PI-RADS v2 score for postoperative seminal vesicle invasion among prostate cancer patients

BackgroundSeminal vesicle invasion (SVI) is considered to be one of most adverse prognostic findings in prostate cancer, affecting the biochemical progression-free survival and disease-specific survival. Multiparametric magnetic resonance imaging (mpMRI) has shown excellent specificity in diagnosis of SVI, but with poor sensitivity. The aim of this study is to create a model that includes the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) score to predict postoperative SVI in patients without SVI on preoperative mpMRI.MethodsA total of 262 prostate cancer patients without SVI on preoperative mpMRI who underwent radical prostatectomy (RP) at our institution from January 2012 to July 2019 were enrolled retrospectively. The prostate-specific antigen levels in all patients were <10 ng/mL. Univariate and multivariate logistic regression analyses were used to assess factors associated with SVI, including the PI-RADS v2 score. A regression coefficient-based model was built for predicting SVI. The receiver operating characteristic curve was used to assess the performance of the model.ResultsSVI was reported on the RP specimens in 30 patients (11.5%). The univariate and multivariate analyses revealed that biopsy Gleason grade group (GGG) and the PI-RADS v2 score were significant independent predictors of SVI (all P<0.05). The area under the curve of the model was 0.746 (P<0.001). The PI-RADS v2 score <4 and Gleason grade <8 yielded only a 1.8% incidence of SVI with a high negative predictive value of 98.2% (95% CI, 93.0–99.6%).ConclusionsThe PI-RADS v2 score <4 in prostate cancer patients with prostate-specific antigen level <10 ng/mL is associated with a very low risk of SVI. A model based on biopsy Gleason grade and PI-RADS v2 score may help to predict SVI and serve as a tool for the urologists to make surgical plans.     

Electrical activity of red nucleus neurones investigated with intracellular microelectrodes

Summary Microelectrodes were inserted into the magnocellular portion of cat's red nucleus (RN), and some basic physiological properties of RN cells were examined by both extra- and intracellular recording. During stimulation of the rubrospinal fibres at the spinal segmental level, the RN cells were invaded antidromically, producing conspicuous field potentials within RN. The somatotopical distribution of RN cells was confirmed by comparing the field potentials induced from C₂ and L₁ levels. When recorded intracellularly, antidromic action potentials showed three-step configuration as those in motoneurones and were followed by a remarkable after-hyperpolarization. The conduction velocity along the rubrospinal fibres ranged from 41–123 m/sec, with the peak frequency at 91–100 m/sec. The membrane properties were examined in some RN cells by intracellular application of current steps. The total membrane resistance was 4 M on the average, and the membrane time constant 6 msec, respectively.Excitatory postsynaptic potentials (EPSPs) were induced monosynaptically in RN cells by stimulation of the nucleus interpositus of the contralateral cerebellum. Their time course was analyzed in comparison with that of the potentials produced by current steps. Stimulation in the ventrolateral nucleus of the thalamus evoked monosynaptic EPSPs via the collaterals of the interpositus axons which innervate RN and thalamus commonly. It was further shown that impulses in cortico-rubral fibres produced EPSPs in RN cells. These cerebral-evoked EPSPs were characterized by much slower time courses than those from the nucleus interpositus.     

Usefulness of basement membrane markers in tumoural pathology

The distribution of basement membrane (BM) markers, type IV collagen, laminin (LM), heparan sulphate proteoglycan (HSP) and fibronectin (FN) has been studied by indirect immunofluorescence using specific antibodies, in tumoural pathology. The disrupted pattern of BM by these markers in severe dysplastic lesions of the breasts, the bronchi and uterine cervix provides evidence for malignancy. In invasive carcinomas, there is generally a loss of these BM components, with FN persisting in the stroma. The loss of these markers in BM is concomitant and superimposable in double staining studies. In embryonic tumours, the presence of BM markers is related to a mesenchymal differentiation of malignant cells with pericellular FN and/or maturation towards organoid structures with BM. In sarcomas, there is a loss of the pericellular BM staining around most transformed muscular and Schwann cells and adipocytes. The persistence of this labelling in some well-differentiated areas can help to diagnose the nature of the sarcoma. The persistence of intercellular filaments of FN corresponds to the mesenchymal and/or sarcomatous nature of undifferentiated anaplastic proliferations.     

Type IV collagenases in invasive tumors

Summary The matrix metalloproteinases appear to be elevated in tumors with metastatic potential, and may well be involved in penetration of the basement membrane and degradation of extracellular proteins including type IV collagen. An imbalance between the 72 kDa and 92 kDa type IV collagenases and the associated tissue inhibitors of these metalloproteinases (TIMPs) may therefore have a role in the invasive phenotype. Cultured tumor cells with invasive potential secrete both type IV collagenases, though in tumors there is some evidence that the 72 kDa form at least may be produced by stromal cells at the invading tumor front rather than primarily by the tumor cells themselves, while the 92 kDa form may be synthesized in macrophages near the front. These collagenases are elevated in invasive as compared within situ tumor components, but their specific roles and prognostic significance are not yet established.     

肺癌侵犯膈肌6例外科治疗体会

对6例侵犯膈肌的非小细胞肺癌进行回顾性分析,其中肺叶切除4例,双肺叶切除1例,左全肺切除1例,6例均伴受侵膈肌切除+膈肌修复术,术后辅助化疗。结果表明,6例切除标本病理证实均为肺鳞状细胞癌侵犯膈肌,术前均未疑诊。2例N_0病人术后14、31个月健在,1例N_1病人术后25个月死亡。3例N_2病人分别于术后9、10、18个月死亡。因此,正确评价纵隔状态以采取不同的治疗组合是改善预后的关键。     

大肠癌上皮型钙粘蛋白表达及其与浸润转移的关系

目的　探讨上皮型钙粘蛋白 (E cad)表达与大肠癌 (CLI)浸润转移的关系。方法　选取 6 0例原发性CLI组织及相应癌旁正常组织 ,用免疫组化SP法和抗E cad抗体检测观察E cad的表达。结果　CLI组织中E cad总阳性率 55% ,正常大肠上皮组织全部表达 ,E cad的表达与癌组织分化程度、生长方式、浸润深度、淋巴结转移密切相关 (P <0 .0 1)。结论　CLI组织E cad丧失或低表达是其获得浸润转移能力的因素之一。E cad可作为一种新的CLI标志物 ,其表达对判断预后有一定价值     

P16蛋白表达与胃癌浸润转移的关系

目的 :研究抑癌基因P1 6在胃癌中的表达 ,探讨P1 6蛋白在胃癌浸润转移中的作用。方法 :采用链霉菌抗生物素蛋白过氧化物酶连接法 (SP法 ) ,检测 46例胃癌组织中P1 6蛋白的表达。结果 :P1 6表达与性别、年龄、浸润深度无显著意义 (P >0 .0 5) ;伴淋巴结转移胃癌P1 6蛋白表达阳性率为 6.9% ,无淋巴结转移胃癌为 35.3% ,差异有显著意义 (P <0 .0 5)。结论 :P1 6蛋白表达缺失可能与胃癌转移有关。     

人脑胶质瘤Tenascin基因表达与侵袭相关性

目的 探讨Ｔｅｎａｓｃｉｎ和Ｋｉ－６７在不同级别人脑胶质瘤细胞表达情况,分析它与胶质瘤细胞的侵袭相关性。方法 采用原位杂交和化学方法,检测不同级别人脑胶质瘤组织５０例中,Ｔｅｎａｓｃｉｎ和Ｋｉ－６７表达,以细胞核增殖抗原Ｋｉ－６７表达,经细胞核增殖抗原Ｋｉ－６７阳性细胞数分析胶质瘤细胞的增殖情况,结果 胶质瘤与其增生血管内皮细胞均表达Ｔｅｎａｓｃｉｎ,Ｔｅｎａｓｃｉｎ基因表达与肿瘤细胞增殖指数呈显