Fine-needle aspiration cytology of an endometrioid-like variant of yolk sac tumor.

A 36-year-old male with a history of immature teratoma and embryonal carcinoma of the testis was admitted to the hospital for abdominal pain and fever. A CT scan revealed a large right abdominal mass. The patient's serum alpha-fetoprotein (AFP) was 46.8 ng/ml (reference < 25 ng/ml). Fine-needle aspiration (FNA) of the mass revealed malignant glandular cells. Chemotherapy was instituted, followed by resection of the large abdominal mass. The tumor was grossly encapsulated, consisting of large areas of necrotic, hemorrhagic tissue surrounded by smaller, multiloculated cysts. Microscopically, the tumor had a villoglandular pattern and variably stratified tall columnar cells. A prominent feature of the columnar cells was supranuclear and subnuclear vacuolization. Intracytoplasmic PAS-positive, diastase-resistant hyaline globules were occasionally present. AFP by immunoperoxidase was prominent within the tumor. This recurrence of the previously diagnosed testicular teratoma with embryonal carcinoma represents a yolk sac tumor with components strongly resembling endometrioid carcinoma, a variant only recently described in eight cases of ovarian origin (Clement et al.: Am J Surg Pathol 1987; 11(10):767-778). We believe this is the first reported case of an endometrioid-like variant of testicular yolk sac tumor and also the first report of the FNA cytology findings in this variant.     

Transport of Proteins Across the Human Placenta

PROBLEM: The transport of various proteins across the human placenta was investigated by comparing maternal and fetal concentrations of tetanus antigen (TT-AG), anti-tetanus (TT)-immunoglobulin G (IgG) (following maternal vaccination), IgA, human chorionic gonadotropin (hCG), human placental lactogen (hPL), and alpha-fetoprotein (AFP) at term. METHOD OF STUDY: The concentrations of the six proteins were determined using enzyme-linked immunosorbent assay in serum of maternal venous and umbilical (fetal) vein samples obtained at delivery from uncomplicated term pregnancies (n = 16). RESULTS: The ratios (mean ± standard deviation) of fetal (umbilical) to maternal level were 1.41 ± 0.33 (anti-TT-IgG), 0.91 ± 0.37 (TT-AG), 0.002 ± 0.001 (IgA), 0.003 ± 0.001 (hCG), and 0.008 ± 0.004 (hPL), while the maternal:fetal concentration ratio of AFP was 0.002 ± 0.002. IgA, hCG, hPL, and AFP showed a close correlation between maternal and fetal levels varying between r² = 0.47 to 0.73 (P < 0.004–0.0001). Because AFP is produced by the fetus while IgA originates in the mother, the appearance of small amounts of these two proteins in the maternal or fetal compartment, respectively, suggests a slow rate of diffusion following a high concentration gradient. The detection of hCG and hPL in fetal serum is also interpreted as diffusion from the maternal into the fetal blood. Anti-TT-IgG has a significantly higher concentration in the fetal as compared with the maternal serum, which is in line with the well-documented active transfer of IgG. Fetal TT-antigen levels were similar to maternal concentrations, showing a close correlation (r² = 0.74, P < 0.0001) between the two proteins. CONCLUSIONS: The correlation between maternal and fetal concentrations of various proteins like IgA (150,000 Da), hCG (42,000 Da), and hPL (21,000 Da) suggests passive diffusion of these macromolecules across the placenta from the maternal to the fetal side, albeit at a slow rate. A similar process is postulated for AFP (70,000 Da) diffusing in the opposite direction from the fetus to the mother. There was no significant difference between the transplacental fetomaternal gradient of IgA and hCG and the maternal-fetal gradient of AFP. In view of the substantially larger volume of circulating maternal as compared with fetal blood, a significantly higher rate of crossing of AFP as compared with the other proteins must be assumed. It is uncertain whether a difference in the rate of transplacental transfer in the two directions or an additional source of AFP production in the maternal compartment explains the high maternal level. Anti-TT-IgG concentration is significantly higher in fetal than in maternal serum suggesting active transfer from the mother to the fetus. Furthermore, there is considerable transfer of TT-AG and a close correlation of fetal:maternal ratios of anti-TT-IgG (150,000 Da) and TT-AG (150,000 Da) could be an indication for a specific transfer of the antigen antibody complex.     

子痫前期患者血清AFP、D-二聚体、PLGF水平对母体及妊娠结局影响

目的:分析子痫前期(PE)患者血清甲胎蛋白(AFP)、D-二聚体(D-dimer)及胎盘生长因子(PLGF)水平对母体及妊娠结局的影响。方法:将本院2016年1月-2018年9月收治的330例PE患者分轻度PE组(n=117)、重度PE组(n=213),另选同期本院住院待产的正常妊娠产妇30例为对照组,检测各组孕妇血清AFP、D-dimer、PLGF水平,绘制受试者工作特征(ROC)曲线分析对PE的诊断预测效能;Spearman相关性分析各检测指标与病情的相关性;对PE患者妊娠结局的预测效能。结果:PE组与对照组AFP比较无差异(P>0.05),但D-dimer水平PE组高于对照组,PLGF低于对照组(P<0.05);D-dimer AUC值最高(387.51μg/L),预测PE的敏感度、特异度为80.6%、100.0%;PLGF AUC值次之(217.33pg/ml),预测PE的敏感度为96.7%,高于D-dimer。不同病情严重程度的PE患者血清AFP、PLGF水平未见差异(P>0.05),但D-dimer轻度PE组低于重度PE组(P<0.05)。AFP与PE病情程度未见相关性(r=0.093,P=0.078),D-dimer与PE病情程度正相关(r=0.796,P=0.000),PLGF与PE病情程度负相关(r=0.114,P=0.031)。PE患者中,母体发生并发症、胎儿结局不良者血清D-dimer水平高于无并发症、胎儿结局良好者(P<0.05),AFP、PLGF未见差异(P>0.05);D-dimer对PE患者并发症可发挥一定预测效能,以579.53μg/L为cut-off,预测PE患者并发症的敏感度、特异度为80.9%、61.9%,另两项血清指标对妊娠结局的预测效能不佳。结论:血清AFP、D-dimer、PLGF3个指标中,D-dimer对PE的预测价值及其与PE病情的相关性最为显著,用于预测PE患者母体并发症具有一定敏感度,但特异度不佳。     

Yolk sac tumor with a unique uniform hepatoid pattern histology

Abstract Background: Yolk sac tumors (YST) exhibit several different histological subtypes and the mechanisms of cellular differentiation and prognosis of each subtype remain unknown.
Results: We report two infants with sacrococcygeal YST; one represented a typical histological subtype and the other showed a hepatoid subtype with uniform histology. The isoform of alpha-fetoprotein (AFP) in the patient with the hepatoid pattern was examined by lectin-affinity Immunoelectrophoresis and represented as a YST. but not hepatocellular, subtype. The patient with typical YST responded well to VAB-6 combination chemotherapy. However, this regimen was only partially effective to the patient with the pure hepatoid histological subtype, and an etoposide with ifosfamide and cisplatin (VIP) regimen as a salvage chemotherapy combined with complete tumor resection was useful to achieve complete remission (CR). Both of the patients have been in CR for more than four years.     

Alpha-fetoprotein and Sertoli-Leydig cell tumor

Gard GB, Mulvany N, Quinn MA. Alpha-fetoprotein and Sertoli-Leydig cell tumor. Int J Gynecol Cancer 1998; 8 : 499–503.
The association between a Sertoli-Leydig cell tumor and a raised serum alpha-fetoprotein (AFP) is an uncommon occurrence which has only been previously described in 20 patients. We report a 17-year-old patient who presented with a pelvic mass and a raised serum AFP. At laparotomy she had a FIGO stage IA moderately differentiated Sertoli-Leydig cell tumor which required no further treatment. We have reviewed the literature relating to AFP production by Sertoli-Leydig cell tumors. When serum AFP is raised at diagnosis it appears to be a reliable tumor marker, hence a baseline level should be documented on all patients with Sertoli-Leydig cell tumor.     

外源性 AFP 对肝癌细胞增殖和抗凋亡的作用研究

目的：探讨外源性甲胎蛋白（ AFP）对体外培养的肝癌细胞系的生物学功能及意义。方法该实验选用了HepG2（AFP阳性）和HLE（AFP阴性）两种常见的肝癌细胞系,再加入不同浓度的外源性AFP处理24 h后,用MTT检测细胞的增殖情况;在这两种细胞系中加入凋亡诱导剂ATRA处理的同时加入外源性AFP,检测AFP对于细胞的抗凋亡能力的影响。结果在HepG2和HLE细胞中,加入不同浓度的外源性AFP后, MTT结果显示AFP可以明显促进肝癌细胞的增殖;而加入凋亡诱导剂ATRA之后,FCM结果显示细胞凋亡明显增加,加入外源性AFP后,细胞凋亡的情况明显好转,外源性AFP可以增强肝癌细胞的抗凋亡能力。结论外源性AFP不仅可以促进肝癌细胞系的增殖,同时还可以增强肝癌细胞的抗凋亡能力。     

血清GP73联合AFP和CA199检测在肝癌诊断中的临床意义

  目的  探讨血清高尔基体蛋白73 (GP73) 及其与甲胎蛋白(AFP) 和CA199联合检测对原发性肝癌(PHC) 诊断的价值。   方法  收集肝癌患者50例、肝炎患者20例、肝硬化患者20例、除肝癌外其他消化系统恶性肿瘤患者20例及健康对照者20例。用酶联免疫分析方法定量检测各组人群血清GP73, 用电化学发光法测定AFP和CA199。   结果  肝癌组血清GP73含量中位数(104.4μg/L) 明显高于肝炎组(22.7μg/L)、肝硬化组(53.8μg/L)、其他消化系统肿瘤组(41.4μg/L) 和对照组(19.3μg/L), P均 < 0.05。单项指标中GP73用于肝癌诊断的灵敏度、特异性和准确率均最高, 分别为72.0%、95.0%和86.2%, GP73/AFP/CA199平行实验灵敏度最高(92.0%), GP73+AFP+CA199系列实验特异性最高(100%), GP73/AFP平行实验准确率最高(87.7%)。ROC曲线分析GP73曲线下面积最大, 为0.824。三个检测指标之间相关性分析无统计学意义(P > 0.05)。   结论  GP73是一种新的更有效的肝癌诊断的血清标志物, 其联合AFP和CA199检测可提高对PHC的诊断价值。      

Ovarian Sertoli-Leydig cell tumor with heterologous gastrointestinal epithelium as a source of alpha-fetoprotein: a case report

Ovarian Sertoli-Leydig cell tumors (SLCT) are rare sex cord stromal neoplasms. To date there have been approximately 25 case reports of ovarian SLCT expressing alpha-fetoprotein (AFP). In such cases, AFP was immunohistochemically detected in the Sertoli cells, Leydig cells, or hepatocytes. This case report confirms heterologous gastrointestinal epithelium expression of AFP. A 20-year-old woman presented with complaints of abdominal enlargement and irregular menstrual cycles over one year. A right ovarian tumor was detected and the patient's serum AFP was elevated. A right salpingo-oophorectomy was performed. On microscopic examination, the tumor was composed of a fibrosarcoma-like area and a poorly differentiated SLCT area with heterologous gastrointestinal epithelium. Immunohistochemical analysis detected AFP in the gastrointestinal epithelium only. Postoperatively, serum AFP levels fell to normal. A recurrent tumor was discovered in the omentum after adjuvant chemotherapy, but serum AFP remained normal. A second laparotomy was performed and the recurrent tumor showed only fibrosarcoma-like features. The patient received second line chemotherapy and is currently in remission. This is the first case of AFP production by heterologous gastrointestinal epithelium in SLCT.     

α_1—抗胰蛋白酶异质体的测量新方法及其临床意义的探讨

本文对a_1-抗胰蛋白酶异质体的检测方法(小扁豆凝集素亲合交叉免疫电泳法)进行改进。改进后的方法操作流程短、成本低、结果清晰、操作简便、不需预测a_1-抗胰蛋白酶总浓度,适合于临床广泛应用。本文用该法对原发性肝癌、转移性肝癌,其它器官癌肿、肝硬化及正常人血清中的a_1-抗胰蛋白酶异质体进行分析,发现小扁豆凝集素结合型a_1-抗胰蛋白酶百分比(LCA-R-AAT％)原发性肝癌组明显高于其它各组,以LCA-R-AAT(％)>25％为阳性标准,则原发性肝癌诊断的敏感性、特异性、准确性分别为80.6％、86.2％和84.3％,与小扁豆凝集素结合型甲胎蛋白联合检测,可使原发性肝癌诊断的敏感性提高至100％(P<0.05),特异性和准确性分别为82.8％和89.9％(P均>0.05),表明LCA-R-AAT(％)的检测对原发性肝癌的诊断及鉴别诊断有一定的价值。