肝癌间质及癌旁病变的病理分析

目的　研究肝癌间质及癌旁病变的临床病理意义。方法　在 2 0例肝癌组织标本中取 45个癌结节 ,分别在癌结节中间、癌旁肝组织等部位取组织 4块 ,连续切片 ,显微镜下观察。结果　 19个结节有完整窦内皮细胞围绕癌巢 ,其中癌结节肉眼小于3cm者 13个 ,大于 3cm者 6个。 2 6个癌结节无完整窦内皮细胞围绕癌巢 ,其中癌结节直径大于 3cm者 2 4个 ,小于 3cm者 2个。2 0例中有 13例合并肝硬化 ,17例有乙型肝炎病毒感染和HBsAg阳性。 结论　病理连续切片 ,显微镜下观察肝癌间质及癌旁病变是预测肝癌患者预后的重要病理学指标     

内乳淋巴结在乳腺癌治疗中的重要性

目的探讨乳腺癌术后内乳淋巴结复发的原因,强调内乳淋巴结在乳腺癌治疗中的重要性。方法回顾性分析40例以内乳淋巴结转移为首先复发的女性乳腺癌患者的临床资料、初发病时的临床特征、手术方式、术后病理分期以及治疗经过。结果40例患者内乳淋巴结复发与患者年龄、经期状况、手术方式无关(P>0.05)。而与原发肿瘤直径、部位、腋窝淋巴结阳性数、临床病理分期相关(P<0.05)。结论位于乳腺内侧区、中央区的大块肿瘤(>3cm),腋窝淋巴结阳性数多(>3),且临床病理分期晚(IIb IIIab)的乳腺癌患者,内乳淋巴结转移机率较高,须加强术后综合治疗。     

胃癌10和11组淋巴结转移及其清扫

目的：研究胃癌脾门淋巴结(No．10)和脾动脉周围淋巴结(No．11)转移规律，进一步探讨No．10和11清扫的必要性和方法。方法：1991年-2000年132例行全胃切除，D2以上淋巴结清扫的胃癌患者，回顾性研究临床病理资料，包括性别、年龄、肿瘤部位、大小、浸润深度、病理类型、其他淋巴结转移等对No．10和11转移的影响，比较全胃切除和全胃联合脏器切除的并发症发生率。结果：胃癌具有较高的No．10或11淋巴结转移率(18．9％)，Logistic回归分析表明，胃癌部位、病理类型、浸润深度和大小弯淋巴结转移五项临床病理指标影响No．10和U转移率。联合脏器切除的并发症发生率(32％)明显高于单纯全胃切除(11．2％)，联合肢体尾切除增加肠下脓肿发生率，而脾切除并不增加全胃切除的危险性。结论：No．10和11在胃癌有较高的转移率和特定的转移规律，预防性和治疗性的清扫实属必要，联合左侧肢体尾加脾切除增加手术危险性，应严格掌握的适应证。而保留胰腺，切除脾血管和脾清扫No．10．和ll淋巴结合理可靠。     

术前血清降钙素检测在评估甲状腺髓样癌不同区域淋巴结转移中的临床价值

目的　探讨术前血清降钙素（calcitonin,Ctn）在评估甲状腺髓样癌（medullary thyroid carcinoma,MTC）不同区域淋巴结转移中的临床应用价值。方法　回顾性研究2009年1月~2020年1月在浙江省肿瘤医院头颈外科接受初次手术的128例MTC的病例资料,分析术前血清Ctn和不同区域淋巴结转移的关系,并制作受试者工作特征曲线 （receiver operating characteristic curve,ROC）评价血清Ctn预测MTC颈部中央区、颈侧区和上纵隔淋巴结转移的临床价值。结果　128例MTC颈部中央区、颈侧区及上纵隔淋巴结转移率分别为53.91%、45.31%及14.84%。术前血清Ctn在MTC中阳性率为96.09%。伴淋巴结转移MTC的术前血清Ctn显著高于无淋巴结转移者（P 均<0.005）,且其表达水平与MTC淋巴结转移数目正相关（P 均<0.001）。术前血清Ctn预测MTC颈部中央区、颈侧区和上纵隔淋巴结转移的ROC曲线下面积分别为0.809、0.846及0.803,当取界值分别为287.6、303.1、747.75 pg/ml时,血清Ctn预测上述三个区域淋巴结转移的敏感性为85.50%、93.10%、94.40%,特异性为71.20%、70.00%、62.70%。结论　术前血清Ctn在MTC中阳性率极高,其表达水平在评估MTC不同区域淋巴结转移方面具有较高的临床应用价值。     

Lymphocyte induced macrophage cytotoxicity: characterization of the macrophage cytotoxicity-inducing lymphocyte

The phenotype of lymphocytes, obtained from mice immunized with allogeneic tumor cells, with the capacity to induce macrophage cytotoxicity was determined. Macrophage cytotoxicity was induced, either by incubating the macrophages with Macrophage Arming Factor (MAF) containing supernatants of cultures of sensitized lymphocytes and tumor cells (arming) or by incubating the macrophages directly with sensitized lymphocytes and tumor cells (activation). The MAF producing or activating capacity of the lymphocytes was not only "triggered" by the sensitizing tumor cells but also by normal cells and other tumor cells bearing the H-2 determinants of the sensitizing tumor cell. The capacity to render macrophages cytotoxic was not reduced after treatment of the lymphocytes with mitomycin-C or treatment with anti-murine Ig and complement. This capacity of the lymphocytes was abrogated after treatment with anti-T-cell serum or anti-Thy 1.2 serum and complement. After treatment with anti-Lyt 1 or anti-Lyt 2 serum and complement, the activating capacity was significantly reduced and the MAF producing capacity of the lymphocytes abrogated. Mixing the Lyt 1 depleted and Lyt 2 depleted lymphocytes or addition of normal lymphocytes to the Lyt 1 depleted or Lyt 2 depleted populations did not restore the MAF producing and activating capacities. This indicated that the lymphocytes inducing macrophage cytotoxicity in this allogeneic system are Lyt-1+2+ T-lymphocytes, which do not need to divide prior to perform their action.     

胃癌淋巴结转移影响因素临床分析

背景:胃癌是常见的消化道恶性肿瘤,淋巴结转移是其最主要的转移方式,亦是影响根治性切除术后胃癌患者预后的重要因素。目的:探讨胃癌淋巴结转移与患者临床病理特点之间的相关性。方法:对2007年1月～2008年1月在浙江省诸暨市人民医院行胃癌根治术的72例病例行回顾性分析,总结其临床病理特点。结果:性别、年龄和肿瘤部位与胃癌淋巴结转移均不相关(P0.05);胃癌的TNM分期越晚,淋巴结转移率越高(P0.01);脉管内有癌栓者的淋巴结转移率显著高于脉管内无癌栓者(84.2%对52.8%,P0.05):肿瘤浸润浆膜和浆膜外者的淋巴结转移率显著高于肿瘤浸润浆膜以内者(86.4%对28.6%,P0.01);低分化胃癌的淋巴结转移率显著高于高中分化胃癌(75.0%对39.3%,P0.01)。多因素Logistic回归分析显示,TNM分期和肿瘤浸润深度是胃癌淋巴结转移的危险因素,RR分别为9.000和9.335。结论:肿瘤的TNM分期和浸润深度是影响胃癌淋巴结转移的主要因素。     

卵巢上皮癌临床分期及治疗方案分析

目的分析卵巢上皮癌不同分期及治疗方案的疗效。方法对汕头大学医学院附属肿瘤医院81例卵巢上皮癌按FIGO分期及两种不同治疗方案的生存情况和副作用进行对比研究,采用Kaplan-Meier方法进行生存分析。结果早期生存率为95.7%,晚期生存率为62.1%,早期生存率显著高于晚期（P=0.006）; TP方案与CP方案的生存率分别为89.1%和59.5%,TP方案高于CP方案,但两者生存率比较差异无统计学意义（P〉0.05）,两组方案骨髓抑制及消化道反应的毒副作用无明显差异,TP方案出现Ⅰ、Ⅱ度手足麻木并发症; 脂质体紫杉醇加卡铂对腹膜后淋巴结转移有较好化疗效果。结论早期诊治是提高卵巢上皮癌生存率的关键,TP方案和CP方案均为目前有效治疗卵巢上皮癌的可选择方案,具有靶向作用的脂质体紫杉醇联合铂类药物对腹膜后转移淋巴结可能有较好的疗效。     

The Genomic Heritage of Lymph Node Metastases: Implications for Clinical Management of Patients with Breast Cancer

Background Metastatic breast cancer is an aggressive disease associated with recurrence and decreased survival. To improve outcomes and develop more effective treatment strategies for patients with breast cancer, it is important to understand the molecular mechanisms underlying metastasis. Methods We used allelic imbalance (AI) to determine the molecular heritage of primary breast tumors and corresponding metastases to the axillary lymph nodes. Paraffin-embedded samples from primary breast tumors and matched metastases (n = 146) were collected from 26 patients with node-positive breast cancer involving multiple axillary nodes. Hierarchical clustering was used to assess overall differences in the patterns of AI, and phylogenetic analysis inferred the molecular heritage of axillary lymph node metastases. Results Overall frequencies of AI were significantly higher (P < 0.01) in primary breast tumors (23%) than in lymph node metastases (15%), and there was a high degree of discordance in patterns of AI between primary breast carcinomas and the metastases. Metastatic tumors in the axillary nodes showed different patterns of chromosomal changes, suggesting that multiple molecular mechanisms may govern the process of metastasis in individual patients. Some metastases progressed with few genomic alterations, while others harbored many chromosomal alterations present in the primary tumor. Conclusions The extent of genomic heterogeneity in axillary lymph node metastases differs markedly among individual patients. Genomic diversity may be associated with response to adjuvant therapy, recurrence, and survival, and thus may be important in improving clinical management of breast cancer patients.     

Characteristics of Expression of Matrix Metalloproteinases (MMP-2 and MMP-9) in Glottic Squamous Cell Carcinoma and Benign Vocal Fold Lesions

ObjectivesThe aim of this study was to investigate expression profile of matrix metalloproteinases (MMP-2 and MMP-9) in glottic squamous cell carcinoma (SCC) and benign vocal fold lesions (BVFLs) and to correlate it with clinical and pathological features.MethodsThe immunohistochemical expression of MMP-2 and MMP-9 was investigated in specimens taken from 217 patients group, including vocal fold polyps (n=39), recurrent respiratory papillomatosis (n=30), laryngeal keratosis (n=36), glottic SCC (n=112), and the normal tissue of vocal fold (n=12, control group). The expression of MMP-2 and MMP-9, both in epithelium and stroma cells, was graded on a semiquantitative scale, ranging from 0 (no expression) to 18 points (high expression).ResultsExpressions of both, MMP-2 and MMP-9 were significantly higher in the glottic SCC group comparing with BVFL group. Significant higher expression of parenchymal MMP-2 (P<0.001) and stromal MMP-9 (P=0.01) was revealed in the group of moderate/poorly differentiated glottic SCC comparing with well differentiated glottic SCC group. Expression of stroma MMP-2 was found to be correlated with nodal metastasis (P=0.030). Expressions of both, MMP-2 and MMP-9 were not correlated with clinical stage, tumor T value, smoking, alcohol use, age in the glottic SSC patients group. The MMP-2 stroma value of 11.2 points was determined as the optimum point (limiting value) for separating BVFL and glottic SCC patient groups.ConclusionOur results suggest that expressions of both MMP-2 and MMP-9 are up-regulated already in the development of BVFL, the next determinant step is concerned with occurrence of malignization. Limiting value of stroma MMP-2 demonstrates prognostic importance of MMP-2 in glottic SCC carcinogenesis.