Thymic clear cell carcinoma

We report a 42-year-old man with a rare thymic clear cell carcinoma. Marked nodal metastases involved right hilar, mediastinal, and left supraclavicular regions. Complete resection including thymothymectomy, cervicomediastinal nodal dissection, and right upper lobectomy with hilar lymphadenectomy was successful. Postoperative chemoradiation therapy was uneventful. The patient had no recurrence or metastasis until brain metastasis occurred 1 year after surgery.     

Tubulocystic clear cell adenocarcinoma arising within the prostate

Neoplasms resembling ovarian common epithelial-type tumors, including clear cell adenocarcinomas, rarely occur in the lower urinary tract of men. When they do, they develop in the urethra or urinary bladder. We report a case of such a tumor arising within the prostate of a 47-year-old man. The tumor was a cystic mass in the left posterolateral region of the prostate. Histologically, the tumor was chiefly composed of tubulocystic and papillary glands lined by glycogen-rich, cuboidal or hobnail cells with clear to eosinophilic cytoplasm. The tumor cells were strongly positive for pan-cytokeratin, low molecular weight cytokeratin, and epithelial membrane antigen, and focally positive for high molecular weight keratin. The tumor did not immunohistochemically express prostate-specific antigen (PSA) and prostatic acid phosphatase. Serologically, the patient had increased levels of CA125 instead of PSA. The clinical as well as the pathologic features are consistent with a clear cell adenocarcinoma as seen in the female genital tract rather than a typical prostatic adenocarcinoma.     

原发性膀胱透明细胞癌(附二例报告并文献复习)

目的：探讨原发性膀胱透明细胞癌的临床、病理、组织化学特性和诊治方法。方法：回顾分析2例患者临床资料，结合文献复习讨论。结果：2例肿瘤发生于膀胱右侧壁近膀胱颈处，以血尿就诊。组织学以大片透明样癌细胞、腺管样结构为特征。电镜下癌细胞核大而畸形，细胞器较少，部分癌细胞内有细胞内微小腺腔。免疫组化示PAS（＋）、AB（＋）。1例行膀胱部分切除术，30个月后出现淋巴结转移；1例行肿瘤电切术，15个月后未见复发。结论：此病以血尿为主要症状，病理检查才能确诊，应与转移性癌及肾源型腺瘤相鉴别，治疗以根治性手术为主，预后较其他非尿路上皮癌好。     

透明细胞型肝癌的临床病理特点及预后

目的 探讨透明细胞型肝癌(primary clear cell carcinoma of the liver,PCCCL)的临床病理特点及预后影响因素.方法 回顾性分析1996年1月至2006年3月手术治疗的214例PCCCL患者的临床病理特点及预后因素.结果 PCCCL患者的1,3,5年的总生存率分别为90.2％、70.6％和55.9％,显著优于非透明细胞型肝癌(non-clear cell hepatocellular carcinoma,NHCC)患者(82.8％、62.7％和47.7％,P=0.001).本组患者PCCCL肿瘤显著小于NHCC(x2=4.37,P=0.04),血管侵犯显著少于NHCC(x2=9.42,P=0.002),而高分化肿瘤所占的比例则显著高于NHCC(x2 =4.30,P=0.04).甲胎蛋白水平,肿瘤大小,肝硬化及血管侵犯是影响PCCCL患者总生存率和无瘤生存率的独立预后因素.结论 PCCCL为肝细胞肝癌的一种少见的病理类型,具有与NHCC不同的临床病理特点.手术切除是PCCCL最佳治疗手段,预后显著好于NHCC.     

Transitional cell carcinoma occurring in ureterocele

A case of transitional cell cancer developing in a ureterocele stump several years after a heminephroureterectomy is described. The role of ultrasonography in establishing the diagnosis is emphasized. This case illustrates the potentially dangerous effect of leaving a defunetionalized ureteral stump and ureterocele. Recommendation is made for removal of the ureteral stump and ureterocele at the time of heminephroureterectomy to prevent the aforementioned complication.     

P-glycoprotein activity in renal clear cell carcinoma

BackgroundThe mechanism by which renal cancer patients show poor response to chemotherapy has not been well understood. The aim of this study was to evaluate the functional activity of P-glycoprotein (P-gp) in renal clear cell carcinoma (RCCC) and its possible role in chemotherapy resistance.MethodsWe studied 11 patients who underwent radical nephrectomy due to RCCC; from each patient we obtained a sample from the cancer tissue, and another from normal renal tissue. These biopsies were mechanically disaggregated to allow individual cells analysis. Cells were incubated with daunorubicin (a fluorescent drug extruded by P-gp) at 37°C and 4°C for 30 min. P-gp activity was analyzed using flow cytometry. Results were expressed as the percentage of cells with P-gp activity (i.e., low fluorescence).ResultsThe analysis of renal cells showed that there was no significant difference in size between normal and cancer cells; however there were clusters of cells with different granularities. We divided the cells according to their granularity. The proportion of cells capable of extruding daunorubicin was significantly higher on tumor cells than in normal renal cells independently of the cell granularity. Our results are congruent with those obtained when mRNA or immunohistochemical test were used. This is the first report quantifying the P-gp activity from fresh samples obtained from kidney cancer in humans.ConclusionsPercentage of cells extruding daunorubicin in RCCC is elevated, indicating that P-gp activity may contribute to multidrug resistance in RCCC.     

肾透明细胞癌孤立转移瘤的手术治疗

目的探讨肾透明细胞癌转移瘤的手术治疗及预后。方法回顾性分析5例肾透明细胞癌转移瘤行手术治疗患者的临床资料。本组5例,男3例,女2例,发病年龄42～73岁。转移部位:肺转移3例(其中1例肺转移2次),骨转移1例,脑转移1例(该患者发生2次脑转移),局部复发1例,鼻腔转移1例(该患者发生4次鼻腔转移)。均手术切除患肾及转移瘤。结果随访7月～16年,3例存活大于15年,1例已存活超过1年,1例肾切除术后7月死亡。结论对肾透明细胞癌孤立的转移瘤和局部复发灶应积极手术切除,可以延长患者生存期和提高生活质量。     

DCC protein expression in clear cell renal cell carcinoma

OBJECTIVES: To investigate whether the expression of protein from the "deleted in colorectal cancer" (DCC) gene, which predicts a poor outcome for patients with colorectal carcinoma, can also serve as a prognostic factor in renal cell carcinoma (RCC). PATIENTS AND METHODS: The expression of DCC was evaluated immunohistochemically in 94 paraffin-embedded tumour samples from patients with stage T1, T2, and T3 clear cell RCC. The mean follow-up was 52.3 months. The endpoints of the study were recurrence of disease and death from disease. RESULTS: The under-expression of DCC protein was detected in 63% of patients who died from the disease and in 36% with no evidence of disease. DCC protein under-expression was detected in all patients with T1 tumours who died from the disease, in half the T2 tumours and in two-thirds of T3 tumours. CONCLUSION: DCC protein under-expression correlated with more aggressive tumour behaviour and a greater risk of death from RCC. However, a larger cohort of patients should be assessed before drawing definitive conclusions.     

Precursors of endometrial clear cell carcinoma

The recognition of morphologically identifiable lesions which may confer an increased risk for subsequent development of an invasive malignancy offers an opportunity to investigate and better understand the molecular-genetic etiopathogenesis of the well-developed tumor, and potentially, to administer a therapeutic intervention before its development. In contrast to uterine endometrioid and serous carcinomas, very little is known about the potential precursor lesions of endometrial clear cell carcinoma (ECCC). In our routine practice, we have noted the presence of a spectrum of atypical glandular changes in the endometria adjacent to ECCC or endometrial carcinomas with a clear cell component, which on the basis of current criteria, would not qualify for any specific designation. We hypothesize that these lesions represent the earliest morphologically recognizable precursor lesions of ECCC and systematically characterize their clinicopathologic features herein. Thirty archived cases of pure ECCC (n=14) or mixed endometrial carcinomas with a >10% clear cell component (n=16) were retrieved and the "normal" endometria adjacent to the malignancies were evaluated in detail. Thirty-eight benign uteri and 30 uteri with classic endometrial endometrioid carcinoma (EEC) served as controls. All cases were reviewed in a blinded fashion. Putative precursor lesions (PPL) were searched for and identified microscopically. The lesions were typically isolated glands or surface epithelium (within an otherwise normal endometrial region) that displayed cytoplasmic clarity and/or eosinophilia with varying degrees of nuclear atypia. Twenty-seven (90%) of the 30 cases had at least 1 PPL. In contrast, PPL were identified neither in the benign uteri nor in endometrioid carcinoma control groups (P<0.001). A total of 67 foci of PPL were identified in the 27 cases with an average of 2.5 foci per case. The immunohistochemical expression of p53, mib-1, estrogen receptor (ERs), and progesterone receptor in the benign endometria, ECCC, and the PPL were evaluated on all 27 cases. The mean p53 scores for the benign endometria, PPL, and ECCC were 0, 4.5, and 6.2, respectively. Parallel values for mib-1 were 15%, 45%, and 63%. ER/progesterone receptor indices for benign endometria, PPL, and carcinoma were 90/80, 21.52/4.61, and 11/4, respectively.The PPL described herein have a morphologic and immunophenotypic profile which seems to be distinct from both the benign endometria in which they reside and the adjacent areas of ECCC. The high frequency of association of these lesions with ECCC, their frequent occurrence as isolated lesions within otherwise "benign-appearing" endometria, and their continuous spectrum of nuclear atypia from minimum (grade 1, cytologic atypia falls short of ECCC cells) to maximum (grade 3, cytologically identical to ECCC cells), argues in favor of our hypothesis that these may represent precursor lesions of ECCC. Further studies are required to conclusively define the nature of these lesions. However, such studies can only be performed if diagnostic surgical pathologists recognize, highlight, and segregate these lesions for further analysis.     

Squamous cell carcinoma occurring in hidradenitis suppurativa

A patient is described who had severe hidradenitis suppurativa of the perineum for three years. Excision of the involved area demonstrated a well-defined squamous cell carcinoma. A review of the literature shows only 12 reported cases of squamous cell carcinoma occurring in patients with hidradenitis suppurativa; most patients developing cancer in chronic inflammatory lesions have had longstanding disease. In this case there was a short interval between disease onset and the occurrence of a squamous cell carcinoma.     

Tyrosine kinase expression profile in clear cell renal cell carcinoma

Purpose

To profile different tyrosine kinase (TK) expression patterns in clear cell renal carcinoma (ccRCC).

Methods

We analysed mRNA expression levels of 89 receptor and non-receptor TK in corresponding cancer and normal renal tissue from 5 patients with ccRCC using the TaqMan Low-Density Array technology. In order to confirm aberrant TK expressions, a subsequent analysis of 25 ccRCC and corresponding normal renal tissues was performed, applying quantitative real-time PCR. To confirm mRNA expression levels on protein level, we studied ERBB4 and HCK using immunohistochemistry.

Results

A total of 12 TK were significantly upregulated in ccRCC (ABL2, FLT1, BTK, HCK, JAK3, CSF1R, MET, JAK1, MATK, PTPRC, FYN and CSK), coherently 7 TK demonstrated a down-regulation (ERBB4, PDGFRA, NRTK3, SYK, ERBB2, FGFR3 and PTK7). These findings were validated by the utilization of RT-PCR for ABL2, FLT1 BTK, HCK, JAK3, CSF1R, MET, JAK1, MATK and vice versa for ERBB4 and PDGFRA. Immunohistochemistry revealed ERBB4 expression to be significantly lower in ccRCC in comparison to papillary RCC, chromophobe RCC, renal oncocytoma and normal renal tissue (P?P?P?=?0.023), but similar to chromphobe RCC (P?=?0.470), sarcomatoid RCC (P?=?0.754) and normal renal tissue (P?=?0.083). Neither ERBB4 nor HCK were correlated (P?>?0.05) with clinical–pathological parameters.

Conclusion

TK constitute valuable targets for pharmaceutical anti-cancer therapy. ERBB4 and HCK depict significantly lower expression levels in renal cancer tissues.     

同侧肾脏同时发生透明细胞型与乳头状肾细胞癌

目的探讨同侧肾脏发病并且相对独立的透明细胞型和肾乳头状细胞癌的临床病理特点及免疫表型,提高对该肿瘤的认识和诊断水平。方法本研究回顾了2例病理诊断为透明细胞型合并肾乳头状细胞癌的临床资料,通过光镜和免疫组织化学染色,针对肾细胞癌相关蛋白标志物[包括 Vimentin、CD10、CK（AE1/AE3）、CK7、CK8/18、PAX2、PAX8、CAⅨ、AMACR]进行了观察和分析。结果2例患者为男性,年龄分别为70、63岁。2例患者的两处独立肿瘤均位于左侧肾脏,镜下观察均可见两处独立肿瘤,肿瘤间隔有正常肾脏组织,分别为乳头状肾细胞癌及透明细胞型肾细胞癌,且免疫组化显示2例患者肿瘤的表型一致。结论单侧肾脏肾透明细胞癌合并肾乳头状细胞癌是一种少见的临床现象,这种现象的存在以及类似的免疫组化表型提示透明细胞型肾细胞癌和乳头状肾细胞癌在发生过程中可能存在着内部的联系。     

索拉非尼治疗转移性肾透明细胞癌21例临床分析

目的 初步评价索拉非尼治疗转移性肾透明细胞癌的疗效和安全性.方法 应用索拉非尼治疗转移性肾透明细胞癌21例.中位年龄60(38～82)岁.18例曾接受免疫治疗和(或)化疗,3例应用索拉非尼为一线治疗.单一脏器转移14例,多脏器转移7例.至少具有1处可测量病灶.发现肾癌同时伴转移者10例,术后发现转移者11例,其中术后≤1年发现者4例,＞1年者7例.治疗方法:索拉非尼400 mg,口服,2次/d,直至肿瘤进展或出现不可耐受的不良反应.采用实体肿瘤疗效评价标准评价疗效,每8周评定1次.中位随访时间29(11～61)周.结果 部分缓解(PR)4例(19%),疾病稳定(SD)17例(81%),无死亡和出组病例.PR 4例中肺部转移灶缓解3例.最常见不良反应为手足皮肤反应18例(86%)、脱发2例(10%),口腔溃疡2例(10%)、高血压2例(10%)、发热1例(5%)和腹泻1例(5%).仅出现3级不良反应1例,未见4级不良反应.结论 索拉非尼治疗晚期肾透明细胞癌的有效率和疾病控制率均较高,不良反应多较轻.     

Gastric metastasis of clear cell renal carcinoma

We report the case of a patient operated in 2003 for renal clear cell carcinoma (CCRC), when left nephrectomy was performed. In the years following occur: lung (2004) and brain (2006) metastasis, pathological bone fracture in right femur (2007), which needed a complex treatment: polichimiotherapy, cobaltotherapy, right temporal metastasectomy, right femoral fixation with metal rod. In our clinic was hospitalised for serious upper gastrointestinal bleeding, severe anaemia (haemoglobin 5.8 g%, hematocrit 18.3%) produced by a ulcerated gastric metastasis. The inefficiency of medical treatment, patient and family desire to operate, have led us to practise Péan type gastrectomy necessary for palliative role (raising the hemorrhagic metastasis). Scarcity of the gastric metastasising of CCRC are discussed and also the surgical indication in the context of a plurimetastatic patient.     

卵巢透明细胞癌CT表现

目的分析卵巢透明细胞癌(OCCC)的CT表现。方法回顾性分析22例OCCC(26个病灶)的CT表现,包括肿瘤位置、形态、大小、边界、CT平扫和强化特征及有无肺动脉栓塞等。结果 4例病灶位于于双侧卵巢,18例病灶位于单侧卵巢。肿瘤呈类圆形或类椭圆形,边界清,有包膜,平均最长径(12.54±4.48)cm。26个病灶中,26.92%(7/26)为实性,3.85%(1/26)为囊性,69.23%(18/26)为囊实性。18个囊实性病灶中,12个为单房囊实性,实性成分呈结节状、球状、团片状、云絮状或分叶状向囊内突出,病灶平扫呈等或稍低密度(CT值28~47 HU)。增强扫描2个实性病灶和1个囊实性病灶实性成分动、静脉期均呈明显强化,23个(23/26,88.46%)病灶实性成分呈进行性中度到明显强化。囊实性病灶囊性成分和囊性病灶平扫及增强各期CT值为13~34HU。6例患者伴不同程度肺动脉栓塞。4例患者伴恶性腹腔积液。结论 OCCC好发于单侧,多表现为边界清晰的单房囊实性肿块,实性成分呈多种形态向囊内突出,增强扫描多呈进行性中度到明显强化,同时易伴发肺栓塞。