Intracranial Metastasis of Testicular Seminoma in an HIV-Positive. Case Report and Review

We present what appears to be the first case of an intracranial metastasis from testicular seminoma in an HIV-positive patient. The computed tomography and magnetic resonance imaging appearance of the lesion mimicked meningioma or lymphoma. A significant increase in the risk of testicular seminoma has been reported in AIDS patients. Whenever there is lymph-node involvement upon diagnosis of testicular seminoma, intracranial metastases may appear. After surgical removal of an intracranial metastasis from testicular seminoma, radiotherapy should be considered. Chemotherapy is to be included in the treatment of intracranial metastases from testicular seminoma with systemic involvement.     

睾丸精原细胞瘤的临床治疗

1975年3月至1987年12月我院收治了经病理证实的睾丸精原细胞瘤病例109例，Ⅰ期73例，Ⅱ期28例，Ⅲ期5例，Ⅳ期3例。治疗方法均为术后加放疗，中晚期的13例会并N-甲酰溶肉瘤素化疗，预后与分期有关。3、5、8年生存率为82．6％、771％、66．7％。主要死因为血道转移．1987年以后对ⅡB期、Ⅲ期于放疗前后采用了以顺铂为主的有计划的联合化疗。结果提示：对于Ⅰ、ⅡA。期患者，单纯隔下放疗即可，ⅡB。、Ⅲ期应放疗合并卡铂为主的联合化疗。     

Stem Cell Origin of Testicular Seminoma

IntroductionA major question concerning cancer is its cells of origin. We hypothesized that distinct cancer subtypes arise from unique cancer-initiating cells. By performing a microarray meta-analysis of seminomas and spermatogonial stem cells, we investigated a putative cell of origin for seminoma.Materials and MethodsWe obtained published microarray data for 6 human adult germ cell lines, 16 embryonic stem cell lines, 3 normal testicular tissue samples, and 40 seminomas from the Gene Expression Omnibus database. By assessing correlations between various tissue microarrays, we determined the number of transitional events and the distance between seminomas and human spermatogonial stem cells.ResultsOur meta-analysis showed that spermatogonial stem cells correlated similarly with seminoma (95% CI of Spearman ρ, 0.33-0.44) and with normal somatic testicular tissue cells (95% CI, 0.39-0.40), which suggests parallel paths of cellular origins.ConclusionAnalysis of our results suggests that a unique cancer subtype, namely seminoma, may have originated from an undifferentiated cell with stemness features rather than from a differentiated cell that acquired stemness features.     

睾丸精原细胞瘤免疫表型及临床病理分析

目的探讨睾丸精原细胞瘤的免疫表型、临床病理特征、诊断和鉴别诊断。方法通过光镜观察和多种免疫组化标记，分析8例睾丸精原细胞瘤病理组织学特征和免疫组化在诊断和鉴别诊断中的意义。结果8例睾丸精原细胞瘤，平均年龄41．4岁，巨检肿瘤均呈类长椭圆形，最大径平均10．4cm，包膜完整，切面灰白色鱼肉状；镜下均表现为典型精原细胞瘤的病理组织学特征；免疫组化PLAP、D2-40、CD117均为强阳性（8／8），其中2例HCG—α阳性，1例CD30阳性：而AFP、CK—LMW及Vim均为阴性（8／8）。结论睾丸精原细胞瘤好发于中年男性，其诊断主要依据典型的病理组织学特征和免疫组化检测，免疫标记物PLAP、D2-40、CD117、CD30、HCG和AFP在诊断和鉴别诊断中具有重要作用。     

The Role of Bipedal Lymphangiography in Testicular Seminoma

Determining the extent of intra-abdominal spread of testicular seminoma by radiographic studies is an essential step in planning rational treatment following orchidectomy. CT scanning is generally accepted as being superior to lymphangiography in assessing the retroperitoneal space. We reviewed the relative contribution of these two procedures in a retrospective analysis of 73 consecutive patients with testicular seminoma managed at Westmead Hospital between January 1980 and September 1987. Abdominal CT scans and bipedal lymphangiography (LAG) were carried out in 72 and 51 patients respectively, 50 patients undergoing both procedures. We found concordance between the two techniques to be 88%. Upstaging occurred in 5 patients using CT (10%), 7 patients using LAG (14%), and in 8 patients (16%) when both tests were utilised. Four patients were upstaged by both techniques while the remaining 4 patients were upstaged using one technique alone. Serum ß-HCG was not a reliable screen for residual disease. Residual disease in the few patients with an elevated serum ß-HCG was easily detected by CT scanning. We conclude that there is a continuing role for LAG in assessing patients with clinical Stage I seminoma when the abdominal CT scan is equivocal or normal.     

睾丸精原细胞瘤的疗效及预后因素分析

作者分析了５０例睾丸精原细胞瘤的疗效及预后因素。术后单纯放疗２４例，放疗加化疗１３例，两组的５年、１０年生存率分别为９１．７％及８４．３％，Ｐ＞０．０５，单纯化疗１３例，５年生存率为９０．９％，与放疗、化疗组相比，Ｐ＞０．０５。年龄＜４０岁和≥４０岁的病例的５年、１０年生存率分别为９５．７％和６８．８％，Ｐ＜０．０５。结果表明，Ⅰ期睾丸精原细胞瘤病例手术后宜行单纯放疗，若复发，可行放疗加化疗；年龄较轻的病例生存率较高；β－绒毛膜促性腺激素水平、隐睾及隐睾部位与生存率关系不大。     

108例睾丸精原细胞瘤术后放疗分析

目的 :分析睾丸精原细胞瘤手术加放射治疗的预后因素。方法 :1988年 5月～ 1995年 5月收治 10 8例睾丸精原细胞瘤术后患者 ,所有病例均经病理证实 ,皆采用60 Co放射治疗。结果 :总 5年生存率为 79 6% ( 86/ 10 8)。其中Ⅰ期为 98 1% ( 53/ 54) ,Ⅱ期 80 6% ( 2 9/ 36) ,Ⅲ期 2 2 2 % ( 4 / 18) ,Ⅰ、Ⅲ期比较 (P <0 0 1)。术后至放疗间隔时间 <1个月为 98 3% ( 57/ 58) ,>1个月为 58 0 % ( 2 9/ 50 ) ,(p <0 0 5)。放射剂量以 2 6～ 35Gy者预后为最好 ,与 <2 5Gy和 >35Gy比较 (P <0 0 5)。结论 :睾丸精原细胞瘤术后放疗的时机应在 1个月之内 ,放射剂量以 2 5～ 35Gy为佳 ;年龄及肿瘤部位对预后均未见明显影响。     

Testicular Seminoma in Denmark 1976-1980 Results of Treatment

Over a five-year period the DATECA Study included 554 consecutive patients with seminoma, representing practically all cases in the country. The stage distribution was: stage I 424 patients, stage II 110 patients, and stage III 17 patients. Typical seminoma was registered in 515 patients, anaplastic seminoma in 26 patients, and spermatocytic seminoma in 13 patients. The treatment was postoperative irradiation except in a few very advanced cases who received chemotherapy. Three-year corrected survival was: stage I 99 per cent, stage II 89 per cent, and stage III 65 per cent. Anaplastic seminoma showed a singnificantly higher rate of metastatic spread than typical seminoma and the prognosis was worse. Treatment-related complications were few, but adjuvant bleomycin combined with irradiation of advanced seminoma resulted in 2 deaths from pneumonitis.     

睾丸精原细胞瘤78例临床分析

目的：对78例精原细胞瘤患者的治疗结果及其预后因素加以分析。方法：1983年7月至1992年4月收治78例睾丸精原细胞瘤，均经病理证实为纯精原细胞瘤。78例中74例手术治疗，63例术后放疗，43例联合化疗。结果：中位随访6.6年（随访期5-10年），根据《现代肿瘤学》的分期标准。Ⅰ期44例。Ⅱ期21例。Ⅲ期3例。Ⅳ期10例。全组5，10年生存率分别为；Ⅰ期93.2%,87.0%,Ⅱ期66.7%,60.0%,Ⅲ期33.3%,33.3%,Ⅳ期0，0。结论：临床分期，放疗剂量及联合化疗是影响预后的重要因素。强调高位精索加睾丸切除术及术后预防放疗DT2500cDy为Ⅰ期患者首选治疗方案，Ⅱ期以上患者应术后放疗加联合化疗。     

人胃肠道癌肝脏和卵巢及子宫颈转移的器官特异性分子病理学机制比较研究

对比研究人胃肠道癌倾向于肝脏和卵巢及子宫颈转移的生物学行为特征,探讨其器官特异性转移的分子机理。方法:分别对12例人胃肠道癌肝转移和23例卵巢及子宫颈转移癌进行粘蛋白分泌功能检测,雌/孕激素受体(ER/PgR)和层粘蛋白(LN)及基膜型纤维粘连蛋白(FN)的免疫组化检测。另对其中26例胃癌及其肝脏、卵巢转移灶进行细胞功能分化分型及转移相关粘附分子(CD44v6)、突变型p53(mp53)蛋白免疫组化检测和DNA倍体分析。结果:胃肠道癌肝转移灶90.0%癌细胞无粘液分泌功能,其LN和基膜型FN阳性率均较相应原发灶降低,且分布极性消失或倒置。胃肠道癌卵巢及子宫颈转移病例全部癌细胞均有不同程度粘液分泌功能分化,其ER和PgR阳性率显著高于相应原发灶。胃癌肝转移癌细胞以异倍体为主(75.0%),75.0%病例呈吸收功能分化,癌细胞LN、mp53、CD44v6均高于卵巢转移病例;胃癌卵巢转移癌细胞以二倍体为主,85.7%病例呈吸收-粘液分泌功能双向分化,雌激素依赖性显著强于肝转移癌(P<0.05)。结论:人胃肠道癌向肝脏、卵巢及子宫颈转移具有不同的分子生物学机制:推测“LN-LN受体”连接纽带可能是人胃肠道癌肝脏转移的分子机制之一;“雌激素-雌激素受体”亲和纽带伴粘液分泌功能分化则可能在人胃肠道癌的卵巢及子宫颈转移过程中起重要作用     

两例睾丸恶性淋巴瘤误诊为精原细胞瘤临床分析

患者１ ,男性 ,７７岁 ,发现左睾丸无痛性肿大５个月入院。体检 :一般可 ,神清 ,全身皮肤无黄染及皮疹 ,全身浅表淋巴结未触及肿大 ,心、肺无异常体征。左侧睾丸肿大 ,大小约７ｃｍ×６ｃｍ×６ｃｍ ,质硬 ,表面光滑 ,可活动 ,无压痛 ,与周围皮肤无粘连 ,双下肢无水肿 ,Ｂ超及“左睾丸占位性病变” ,ＣＥＡ升高 ,为５３μｇ／Ｌ,β ｈＣＧ正常。睾丸穿刺活检病理示 ,肿瘤细胞为圆形、卵圆形 ,较大 ,胞浆少 ,核深染 ,呈弥漫状排列 ,其间散在少数淋巴细胞。诊断 :左侧睾丸恶性肿瘤 ,精原细胞瘤可能性大 ;免疫组化标记排除上皮性肿瘤 ,淋巴瘤 ,…     

Ⅰ期睾丸精原细胞瘤85例术后放疗临床分析

[目的]比较Ⅰ期睾丸精原细胞瘤术后分别采用单纯腹主动脉旁及同侧髂血管淋巴引流区（狗腿野）照射与单纯腹主动脉旁照射的毒性反应及远期治疗效果。[方法]1994～2004年收治的Ⅰ期单纯精原细胞瘤85例，术后单纯狗腿野（DL组）放疗53例；单纯腹主动脉旁野（PA组）放疗32例。[结果]术后放疗3年无复发生存率DL组为98．1％（52／53），PA组为93．8％（30／32）。两组3年生存率DL组为100％，PA组为96．9％。两组差异无显著性（P〉0．05）。两组胃肠道反应及骨髓抑制DL组高于PA组，但差异无显著性（P〉0．05）。[结论]对Ⅰ期睾丸精原细胞瘤术后患者，单用PA野放疗并不降低长期生存率，且PA野放疗引起的骨髓抑制、胃肠道反应较DL野放疗为低。     

Mechanisms of Cadmium Carcinogenicity in the Gastrointestinal Tract

Cancer, a serious public health problem in worldwide, results from an excessive and uncontrolled proliferationof the body cells without obvious physiological demands of organs. The gastrointestinal tract, including theesophagus, stomach and intestine, is a unique organ system. It has the highest cancer incidence and cancerrelatedmortality in the body and is influenceed by both genetic and environmental factors. Among the variouschemical elements recognized in the nature, some of them including zinc, iron, cobalt, and copper have essentialroles in the various biochemical and physiological processes, but only at low levels and others such as cadmium,lead, mercury, arsenic, and nickel are considered as threats for human health especially with chronic exposureat high levels. Cadmium, an environment contaminant, cannot be destroyed in nature. Through impairmentof vitamin D metabolism in the kidney it causes nephrotoxicity and subsequently bone metabolism impairmentand fragility. The major mechanisms involved in cadmium carcinogenesis could be related to the suppression ofgene expression, inhibition of DNA damage repair, inhibition of apoptosis, and induction of oxidative stress. Inaddition, cadmium may act through aberrant DNA methylation. Cadmium affects multiple cellular processes,including signal transduction pathways, cell proliferation, differentiation, and apoptosis. Down-regulation ofmethyltransferases enzymes and reduction of DNA methylation have been stated as epigenetic effects of cadmium.Furthermore, increasing intracellular free calcium ion levels induces neuronal apoptosis in addition to otherdeleterious influence on the stability of the genome.     

Chromosomal Aberrations in Lymphomas of the Gastrointestinal Tract

B-cell lymphomas of the gastrointestinal (GI) tract have represented a field of extensive research ever since a close association was shown with chronic inflammatory processes such as Helibacter pylon infection. Much evidence has accumulated to suggest that the mucosa-associated lymphoid tissue (MALT) induced by inflammation and autoimmune processes is the environment which gives rise to the small cell lymphomas of the GI tract (e.g. extranodal marginal B-cell lymphoma according to REAL). The small B-cell lymphoma may then progress to the large cell variants. Hence, B-cell lymphomas of the GI tract may present a model for lymphomagenesis and progression. In this review, recent cytogenetic data are discussed which yield new insights into the biology of gastrointestinal lymphomas.