胰腺间变性癌1例

患者女,85岁。因上腹部不适、腹泻入院。CT:左上腹胰尾、脾脏、胃后壁间见大小约6.6 cm×4.5 cm的软组织肿物,平扫密度略不均匀(图1),CT值33~43 HU;增强后不均匀强化(图2),CT值66~100 HU;病灶与脾脏及胰尾分界不清,脾门受压,脾静脉局部显示不清,胰管未见异常扩张。腹腔及腹膜后未见明显肿大淋巴结。CT诊断:左上腹恶性肿瘤,考虑来     

宫颈癌病理特征与预后的关系探讨

目的探讨病理特征与宫颈癌患者预后的关系。方法回顾性分析402例手术治疗的宫颈癌患者的病理资料,随防5年。结果（1）单因素分析显示：死亡组高临床分期、低肿瘤细胞分化、肿瘤体积大、伴有淋巴结转移和脉管癌细胞阳性的构成比高于生存组,且差异均有统计学意义（P均〈0．05）。（2）临床分期[相对危险度（relativerisk,RR）=2．077,95％CI：1．521-2．835]、细胞分化（RR=0．639,95％CI：0．487-0．839）和淋巴结转移（RR=3．616,95％CI：2．293-5．702）是影响预后的独立病理因素。（3）Ⅰa、Ⅰb、Ⅱa和Ⅱb期患者的5年生存率分别是94．7％、88．O％、71．7％和65．5％,差异有统计学意义（P=0．000）。癌细胞低分化、中分化、高分化者的5年生存率分别足71．0％、81．2％和86．5％,差异有统计学意义（P=0．004）。有、无淋巴结转移者5年生存率分别是63．2％和86：3％,差异有统计学意义（P=0．000）。结论临床分期、肿瘤分化程度,盆腔淋巴结转移情况是影响宫颈癌手术治疗预后的重要因素,重视宫颈癌的普查,做到早诊断早治疗,术中彻底清除阳性淋巴结可改善预后。     

人乳头瘤病毒和单纯疱疹病毒与宫颈癌的关系

目的探讨人乳头瘤病毒（HPv）和单纯疱疹病毒（HSV）等对宫颈癌的病因学作用。方法应用聚合酶链反应（PCR）-核酸内切酶分型检测宫颈癌活检组织中HPV—DNA和HSV—DNA基因,以正常宫颈组织作对照。结果在宫颈癌活检组织中HPV-16,18,35型和HSV—Ⅱ型阳性率分别为38．9％争36．2％,与正常妇女宫颈组织阳性率均为3．2％比较,差异均有非常显著意义（P〈0．001）。结论HPV-16,18型和HSV-Ⅱ型是诱发宫颈癌的重要病原因子。     

Human papillomavirus infection among Egyptian females with cervical carcinoma: relationship to spontaneous apoptosis and TNF-alpha.

OBJECTIVES: This study was designed to detect HPV type-16 in Cervical carcinoma (CC) tissue specimens. The results were correlated with clinicopathological parameters of the carcinoma, with spontaneous apoptosis and with immunoreactivity to TNF-alpha antibodies. METHODS: Fresh frozen tissue specimens representing 30 cases of cervical carcinoma as well as 20 normal cervical tissues (NCT) were the subjects of this study. HPV-16 DNA was detected by Polymerase Chain Reaction (PCR). The occurrence of spontaneous apoptotic cell death was analyzed by the apoptosis assay. Apoptotic cells were also counted by light microscopy and the apoptotic index (AI) was calculated. Electron microscopy was used to confirm the morphology of apoptotic cells. TNF-alpha was quantified using EIA kit. RESULTS: HPV-16 DNA was more frequent in CC than in NCT. No correlation was observed between HPV infection and grade, stage or pathologic type of CC. The occurrence of spontaneous apoptosis was significantly higher in CC than in NCT, where it was correlated to advanced tumor stage and tumor pathology being more in adenocarcinoma (AC) than in squamous cell carcinoma (SCC). Moreover, AI was negatively correlated to HPV-16 infection. TNF-alpha levels were significantly higher in CC vs. NCT, where they were positively correlated to advanced tumor stage. TNF-alpha levels were correlated to DNA fragmentation and AI (r = 0.47 and 0.57 respectively). A cut-off value for TNF-alpha was calculated to be 9.1 pg/mg protein (using ROC curve). At the determined cut-off point the sensitivity was 70% and the specificity was 80%. CONCLUSIONS: HPV infection, high levels of TNF-alpha and spontaneous apoptosis were strongly associated with malignant phenotype of cervical tissues. Rate of spontaneous apoptosis was higher in AC compared to SCC. On the other hand, HPV negativity was correlated with AI. Moreover, TNF-alpha and apoptotic cell death were correlated to each other as well as to tumor progression. No correlation was detected between TNF-alpha and HPV-16 infection.     

Anaplastic, insular, and medullary carcinoma of the thyroid

Anaplastic carcinoma, insular carcinoma and medullary carcinoma (both familiar and sporadic forms) represent the 7-25% of all thyroid tumors. Anaplastic carcinoma is one of most aggressive human tumors and the therapeutic options proposed have failed to improve the prognosis of these patients. Insular carcinoma is a not well known thyroid neoplasia described for the first time in 1984 and showing intermediate biological behaviour between differentiated and anaplastic forms. Medullary carcinoma arises from parafollicular"C" cells of the gland and then may be considered a neuroendocrine tumor. Choice therapy is surgery, tiroxine is only substitutive, familiar screening is mandatory. Chemotherapy (dacarbazine or cisplatin and doxorubicine), radiotherapy and recently octreotide anologues, may be useful for relapsing not operable forms.     

血清层粘连蛋白与宫颈上皮内瘤样病变及宫颈癌的关系

目的　研究血清层粘连蛋白(Laminin ,LN)与宫颈上皮内瘤样病变(CIN)及宫颈癌的关系,并进一步探讨手术和放疗两种治疗方法对血清层粘连蛋白的影响。方法　用酶联免疫吸附试验(enzymelinkedimmunosorbentassay ,ELISA)方法测定11例健康妇女和6 2例宫颈病变患者血清LN含量。结果　CINⅠⅡ级病人血清LN值与正常健康妇女血清LN值无显著差异(P >0 .10 ) ;CINⅢ级病人及宫颈浸润癌患者治疗前血清LN值显著高于正常组(P <0. 0 5 )。经过手术或放疗治疗后其血清LN值显著下降(P <0 . 0 5 ) ;宫颈浸润癌患者其血清LN值与其临床病理期别(F =3 0 20 . 0 5 )及有无淋巴结转移(P >0. 10 )无关而与癌变细胞组织学分化程度有关,即随分化程度降低其血清LN值有升高的趋势。结论　血清LN值可以作为宫颈癌早期诊断指标,并作为肿瘤细胞分化程度的参考。     

Anaplastic carcinoma of the thyroid: a clinicopathologic study of 82 cases

Anaplastic carcinoma of the thyroid accounts for about 10% to 15% of all thyroid carcinomas in the United States. Its lethality is evidenced by a 5-year survival rate of 3.6% and a median survival of 4 months. Rapid growth of a thyroid mass, frequently in a preexisting goiter, is the most common manifestation; the diagnosis should be considered and expeditiously pursued in all patients who present with this finding. Relatively favorable prognostic features seem to be unilateral tumors, a tumor diameter of less than 5 cm, no invasion of adjacent tissue, and absence of nodal involvement. For resectable lesions, thyroid lobectomy with wide margins of adjacent soft tissue on the side of the tumor seems to constitute a safe, appropriately aggressive surgical approach. Total thyroidectomy and radical neck dissection results in an increased complication rate and has no advantage over a more conservative approach. Radiotherapy, chemotherapy, immunotherapy, and combination radiotherapy and chemotherapy need further evaluation.     

Screening for cervical carcinoma

At present, cytological examination of cervical smears is the method used to screen the female population for cervical abnormalities. This employs the Papanicolaou staining technique and cell morphology to detect abnormal cells from the susceptible transformation zone of the cervix. However, with the recent discovery of a possible link between human papillomavirus (HPV) infection and cervical cancer, a test to determine the presence of HPV infection may be appropriate. Tests are still at a developmental stage and at present used only for research purposes. Various DNA-DNA or DNA-RNA hybridisation techniques are employed in experimental screening studies, and these involve probing cells or DNA extracted from cells for HPV DNA using radio-labelled probes.     

宫颈癌与血清鳞状细胞癌抗原及促红细胞生成素关系分析

目的 探究宫颈癌与血清鳞状细胞癌抗原(SCC-Ag)及促红细胞生成素(EPO)的相关性.方法 回顾性分析2018年1月至2019年12月海南医学院第二附属医院收治的60例宫颈癌患者的病例资料,作为观察组,将同期50名健康体检者作为对照组,46例宫颈CINⅢ级患者作为宫颈CINⅢ组.检测3组SCC-Ag、EPO水平,并探...     

Anaplastic carcinoma showing rhabdoid features combined with ovarian mucinous borderline cystadenoma: a case report and literature review

Anaplastic carcinoma in an ovarian tumor (ACOT) is rare. There have been a few controversial cases illustrating the clinical characteristics and prognostic factors of ACOT, which are not well known. A 60-year-old Chinese woman presented with a large pelvic tumor. A transvaginal ultrasound examination showed a large single ovarian cystic tumor with mural nodules and ascites. A gross ovarian mass with a size of approximately 20 × 10×15 cm³ was found. The content of the ovarian cyst was light yellow and chocolate-like, and a large grayish mural nodule of approximately 10 cm was found on the cyst wall. Histological diagnosis of ovarian mucinous borderline cystadenoma with a mural nodule of anaplastic carcinoma showing rhabdoid features and International Federation of Gynecology and Obstetrics (FIGO) stage IIIa was made. Fifteen months after surgery, the patient had received six courses of paclitaxel and carboplatin. She is still alive without any recurrence of the tumor. Findings from the present case suggest that patients with ACOT and FIGO stage IIIa would benefit from surgery and chemotherapy of paclitaxel and carboplatin. We also review the clinical features and survival rate of patients with ACOT using the Surveillance, Epidemiology, and End Result database, and summarize previously reported treatments.     

Squamous cell carcinoma subverts adjacent histologically normal epithelium to promote lateral invasion

Recurrent and new tumors, attributed in part to lateral invasion, are frequent in squamous cell carcinomas and lead to poor survival. We identified a mechanism by which cancer subverts adjacent histologically normal epithelium to enable small clusters of cancer cells to burrow undetected under adjacent histologically normal epithelium. We show that suppression of DMBT1 within cancer promotes aggressive invasion and metastasis in vivo and is associated with metastasis in patients. Cancer cells via TGFβ1 and TNFα also suppress DMBT1 in adjacent histologically normal epithelium, thereby subverting it to promote invasion of a small population of tumor cells. The sufficiency of DMBT1 in this process is demonstrated by significantly higher satellite tumor nests in Dmbt1^−/− compared with wild-type mice. Moreover, in patients, invasion of small tumor nests under adjacent histologically normal epithelium is associated with increased risk for recurrence and shorter disease-free survival. This study demonstrates a crucial role of adjacent histologically normal epithelium in invasion and its important role in the tumor microenvironment and opens new possibilities for therapeutic strategies that reduce tumor recurrence.     

Cervical zygapophyseal joints: geometrical parameters and relationship to cervical kinematics

The relationship was examined between the height and slope of the cervical zygapophyseal joints and the patterns of motion of the cervical vertebrae. The height and orientation of the C₃---C₇ superior articular processes were measured in lateral radiographs of 40 normal subjects. The C₄-C₆ facets were oriented at approximately 40° to the vertical, while the C₃ and C₇ facets were more steeply oriented. The heights of the superior articular processes were found to increase at progressively lower vertebral levels. Contrary to published views, the slope of the superior articular facets has no bearing on the pattern of motion of the cervical vertebrae. No relationship was found between slope of the facets and the location of the instantaneous axes of rotation of the cervical vertebrae. In contrast the height of the articular processes was perfectly related to the location of the axes of rotation. Articular height, but not slope, is a major determinant of the patterns of motions of the cervical vertebrae.

This study provides data necessary to confirm or deny the putative roles of the cervical zygapophyseal joints in determining motion of the cervical spine in the sagittal plane.     

阴道镜下活检结合子宫颈管搔刮术诊断宫颈上皮异型性改变的研究

目的探讨一种能早期、准确诊断宫颈癌的方法。方法运用电子阴道镜结合子宫颈管搔刮术对100例患者进行检查,根据其宫颈糜烂程度分为3组,1度为轻度糜烂组,2度为中度糜烂组,3度为重度糜烂组。采用SAS统计软件包(6.12版)分析子宫颈糜烂程度与上皮异型性程度的关系及其子宫颈管内上皮异型性改变发生率的差异。结果3组患者之间发生子宫颈上皮异型性严重程度有显著性差异,子宫颈糜烂程度越严重,其宫颈上皮异型性越明显,P<0.05;3组中均发现子宫颈管内上皮异型性改变者,但各组间颈管内上皮异型性改变发生率无显著性差异,P>0.05。结论采用电子阴道镜下活检结合子宫颈管搔刮术,能有效诊断子宫颈上皮异型性改变,可作为早期诊断宫颈癌的常规方法。     

A study of the morphological parameters of cervical squamous epithelium

Electrical impedance spectroscopy is a technique that has been investigated as a potential method for the diagnosis of epithelial carcinomas. Finite element modelling can provide an insight into the patterns of current flow in normal and pathological epithelium and hence aid in the process of probe design optimization. In order to develop a finite element model of the structure of normal and precancerous cervical squamous epithelium, it was first necessary to obtain the mean values and ranges of a number of morphological tissue parameters. The most important parameters in discriminating normal from neoplastic tissue were identified as being cell size and shape distribution, nuclear-to-cytoplasmic volume ratio and volume of extracellular space. A survey of the literature revealed an absence of reliable quantitative data for these parameters. We therefore present the results of our own basic image analysis on normal and pathological tissue sections, which we hope will be of use to other workers wishing to model cervical squamous epithelium, or other similar tissue structures.