乳腺伴大汗腺分化的癌临床病理特征及预后分析

目的：探讨乳腺伴大汗腺分化的癌临床病理特点及影响其预后的因素。方法收集乳腺伴大汗腺分化的癌标本70例和同期诊断为非特殊型浸润性癌283例患者的临床病理资料,比较两组预后差异,并对患者年龄、肿瘤大小、淋巴结转移、组织学分级、分期、免疫组化等因素与预后的关系进行统计学分析。结果乳腺伴大汗腺分化的癌平均发病年龄(56．17±12．41岁)比非特殊型浸润性癌(52.77±11．07岁)高(P=0．039);与非特殊型浸润性癌相比,乳腺伴大汗腺分化的癌具有更低的腋窝淋巴结转移率,较低的ER、PR阳性率(P<0．05);乳腺伴大汗腺分化的癌患者与非特殊型浸润性癌患者相比,5年总生存率(P=0．221)和无病生存率(P=0．378)差异无统计学意义;单因素生存分析显示肿瘤大小、淋巴结转移、病理学分期、淋巴结外软组织浸润与乳腺伴大汗腺分化的癌患者预后有关(P<0．05),Cox多因素分析结果显示,淋巴结转移与乳腺伴大汗腺分化的癌患者不良预后有关(P<0．05)。结论乳腺伴大汗腺分化的癌与浸润性癌临床病理特征不同,但预后无统计学意义。淋巴结转移可作为乳腺伴大汗腺分化的癌患者预后不良的指标,早诊断、早治疗是改善其预后的关键。     

头皮鳞样小汗腺导管癌临床病理学分析

目的探讨头皮鳞样小汗腺导管癌的临床病理和免疫表型特征及诊断与鉴别诊断。方法通过HE及免疫组化染色观察1例鳞样小汗腺导管癌,并结合文献讨论。结果肿瘤位于头皮,实性真皮结节,组织学表现为小汗腺分化合并鳞状上皮成分,后者呈显著的不典型增生伴角质囊肿形成和鳞状旋涡。免疫表型：CK7、GCDFP-15阳性,34βE12、CD10阴性。结论鳞样小汗腺导管癌是一种非常罕见的低度恶性肿瘤,局部切除后可复发,未见转移报道。组织学上主要应与具有鳞状上皮或导管分化的皮肤附属器肿瘤相鉴别。肿瘤广泛切除是首选治疗方法。     

粒细胞集落刺激因子在非小细胞肺癌组织中的表达及其临床病理意义

目的 观察粒细胞集落刺激因子(G-CSF)在非小细胞肺癌(NSCLC)中的表达并探讨其临床病理意义.方法 收集解放军总医院2001 - 2010年伴有大量粒细胞浸润的NSCLC 53例,同时选用无粒细胞浸润的NSCLC 61例作对照,共114例.观察癌组织中粒细胞浸润情况,同时用免疫组织化学(EnVision法)检测癌组织中G-CSF的表达情况.对G-CSF表达情况及其与NSCLC临床病理特征的关系进行统计学分析,并随访全部患者,分析G-CSF表达对预后的影响.结果 114例NSCLC中55例癌细胞表达G-CSF.其中大细胞癌41例(41/54,75.9％),腺癌9例(9/30,30.0％),鳞状细胞癌5例(5/30,16.7％).G-CSF表达与癌组织中粒细胞浸润、组织学类型、坏死、肿瘤分级、局部淋巴结转移和远处转移、复发密切相关(P＜0.01),而与原发肿瘤大小无密切关联(P＞0.05);表达阳性者发生坏死、淋巴结转移、远处转移复发的相对危险度分别是阴性者的5.57、6.28和5.24倍(P＜0.05).阳性者与阴性者中位生存期分别为42和62个月,5年生存率分别为0和12.1％,生存期间的差异具有统计学意义(P＜0.01).结论 部分NSCLC能产生G-CSF,且以大细胞癌最常见.产生G-CSF的NSCLC组织分化差,异型性明显,恶性度高;易发生广泛坏死,常伴有粒细胞浸润;易发生淋巴结转移、远处转移和复发;生存率低,预后差.     

CD10在皮肤附属器肿瘤中的表达及在区分皮肤转移性肾细胞癌鉴别诊断中的潜在作用

外科病理诊断中肿瘤发生皮肤转移并不少见，其提示肿瘤复发或发生结外扩散。某些恶性肿瘤如肾细胞癌发生皮肤转移的临床症状可能会导致皮肤原发性恶性肿瘤的诊断。有3％～11％肾细胞癌可发生皮肤转移，而皮肤转移性肾细胞癌的形态学特点与皮肤原发的附属器肿瘤特别是具有透明细胞分化者难以鉴别。为了确定CD10在各种皮肤附属器病变中的表达以及其在区分转移性肾细胞癌中的价值，作者研究了57例原发性附属器肿瘤，其中小汗腺分化31例，大汗腺分化16例，皮脂腺分化10例、正常皮肤3例和4例皮肤转移性肾细胞癌。结果发现CD10表达于正常皮肤的皮脂腺，小汗腺和大汗腺上皮表达阴性，而汗腺周围的肌上皮细胞表达CD10。     

大肠癌细胞粘液分泌功能分化与浸润,转移的关系

目的：观察不同组织类型的大肠癌粘液分泌功能与浸润、转移的关系以及基底膜主要成分ＣｏｌⅣ的表达情况。方法：对４２４例大肠癌进行临床病理分析及ＩＶ型胶原免疫组化标记。结果：大肠癌组织粘液含量越高，浸润越深，淋巴结及远处转移率越高；粘液含量与癌组织分化程度关系不大；癌组织中ＣｏｌⅣ普遍缺失，粘液含量越高，ＣｏｌⅣ缺失越明显。结论：大肠癌粘液分泌功能分化与侵袭、转移能力呈正相关，这种能力可能与ＣｏｌⅣ等基底膜物质的缺失有关     

甲状腺癌转移灶失分化影响因素分析

目的：分化型甲状腺癌（DTC）转移灶失分化的患者预后较差。本文研究DTC转移灶的影响因素。方法：回顾性分析在我科行131I治疗有转移的DTC患者121例。转移灶通过18F-FDG肿瘤显像、131I-SPECT/CT、CT、MRI、B超等影像学手段结合血清HTg诊断,部分通过手术病理证实。转移灶摄碘情况通过大剂量131I治疗后全身显像上观察。根据转移灶摄碘情况将患者分为摄碘组和不摄碘组（失分化组）,分析相关影响因素。结果：51例（42.1%）患者转移灶不摄碘。单因素分析提示,淋巴结转移灶较远处转移更容易发生失分化（χ2=4.338,P〈0.05）,而肺转移和骨转移之间无明显差异（χ2=1.509,P〉0.05）。双变量logistic回归模型提示导致转移灶不摄碘的危险因素有：乳头状癌（OR=0.059;95%CI 0.010,0.037;P〈0.01）、年龄（OR=1.050;95%CI 1.019,1.082;P〈0.01）、转移发生时间（OR=4.122;95%CI 1.421,11.894;P=0.000）和复发（OR=4.299;95%CI 2.132,7.685,P=0.000）。结论：DTC患者中淋巴结转移灶较远处更容易发生失分化不摄碘,但是远处转移中肺转移和骨转移发生失分化的几率无明显差异。年龄、乳头状癌、转移发生时间和复发是影响失分化的危险因素。     

130例颈淋巴结转移癌的临床病理分析

对１３０例颈淋巴结转移癌从部位、组织学类型，分化程度及组织学特点等方面进行临床病理分析，旨在发现原发部位与转移癌之间的关系，以便及早查出原发癌。１材料和方法收集我院１９８０～１９９７年经病理诊断的颈淋巴结转移癌１３０例，标本经１０％福尔马林固定，常规...     

结直肠癌同时及异时性远处转移的临床病理特征

目的:回顾性分析结直肠癌同时性与异时性远处转移患者的临床病理特征及预后影响因素.方法:收集2010年1月至2015年12月间128例结直肠癌远处转移患者完整的临床病理资料,根据转移发生的时间分为两组:同时转移组(79例)、异时转移组(49例).比较两组临床病理特征,分析影响远处转移患者预后的因素.结果:同时性远处转移患者与肿瘤原发部位(P=0.025)、浸润深度(P=0.002)、分化程度(P=0.008)及脉管癌栓(P=0.012)有关;同时性远处转移患者中位生存期为19(12~28)个月,异时性远处转移患者中位生存期为20(13~28)个月,两组之间差异无统计学意义(P=0.866);多因素生存分析结果提示,肿瘤浸润深度(P<0.001)、肿瘤分化程度(P=0.002)、脉管癌栓(P=0.006)及转移器官数量(P=0.001)是影响远处转移预后的独立因素.结论:根据结直肠癌不同时期发生远处转移患者表现出的临床病理特点,可以有效估计可能发生远处转移的患者及预后情况.     

肝细胞癌nm23H1基因遗传不稳定性与临床病理特征的相关性研究

目的： 研究人类17号染色体D17S396位点微卫星不稳定性和杂合性缺失，对肝细胞癌nm23H1蛋白表达的影响，阐明nm23H1基因遗传不稳定性与肝细胞癌及临床病理特征的关系，为揭示nm23H1基因作用机制和肿瘤发生、转移机理提供实验依据。方法： 采用石蜡包埋组织抽提DNA，PCR-单链构象多态性（PCR-SSCP），常规银染，Envision免疫组织化学和Leica-Qwin计算机图像分析等方法进行nm23H1基因遗传不稳定性研究。 结果： ① 48例肝细胞癌D17S396位点遗传不稳定性的发生率为35.42%。LOH的发生率在有无淋巴结或远处转移和有无肝内转移或门静脉栓的癌组织中有显著差异（P<0.01），临床TNM分期Ⅲ期LOH的发生率显著高于Ⅰ、Ⅱ期（P<0.01）。此外，在侵袭转移高危组LOH的发生率显著高于侵袭转移低危组 (P<0.01)。MSI检出率与肝细胞癌临床病理参数均无关。② nm23H1蛋白阳性率为56.25%，nm23H1蛋白阳性率在Edmondson分级Ⅲ +Ⅳ组低于Ⅰ+ Ⅱ组（P<0.01） ，在有淋巴或远处转移组显著低于无淋巴或远处转移组（P<0.01）,TNM分期Ⅲ期显著低于Ⅰ+Ⅱ期（P<0.01）；在侵袭转移高危组中nm23H1蛋白阳性率显著低于侵袭转移低危组 (P<0.01)。此外，计算机图像定量分析显示，在各临床病理参数影响下，nm23H1蛋白的表达强度没有差异。③ LOH阳性组中nm23H1蛋白阳性率为27.27％，显著低于LOH阴性组64.86％，两者差异显著（P<0.05）。结论： nm23H1基因的MSI和LOH通过相互独立的途径调控肝细胞癌的发生和转移，后者可抑制肝细胞癌局部nm23H1蛋白的表达，并赋予肝细胞癌高转移、预后差的特性。提高肝细胞癌局部nm23H1蛋白的表达，可减缓肿瘤的侵袭转移倾向，并改善预后。     

31例乳腺粘液腺癌临床病理与预后的关系

目的：探讨乳腺粘液腺癌的临床病理特征及其与预后的关系。方法：收集我院乳腺粘液腺癌存档标本３１例，其中单纯型２６例，混合型５例。对其组织学类型、粘液量、淋巴结状态、雌激素受体水平以及生存率进行回顾性分析。结果：（１）单纯型给型的淋巴结转移率及５年生存率，差异均有显著性；（２）癌实质中粘液含量与预后无明显关系；（３）１０例单纯型雌激素受体检测阳性率为８０．０％。结论：单纯型和混合型有不同的生物学行为；     

Histological grading and prognosis in dogs with mammary carcinomas: application of a human grading method

The human "Elston and Ellis grading method" was used in dogs with mammary carcinoma to examine its relation to prognosis in this species, based on a 2-year follow-up period. Of the 85 cases examined, 27(31.8%) had well-differentiated (grade I), 28 (32.9%) had moderately differentiated (grade II) and 30 (35.3%) had poorly differentiated (grade III) carcinomas. Two years after mastectomy, significant differences in survival between cases with different tumour grade were found; thus, survival was worse in dogs with grade III carcinomas than in those with grade II (P<0.05) or grade I (P<0.001) tumours. However, in dogs with simple carcinomas which had a less favourable prognosis than that of other carcinomas (P<0.001), there was no significant difference in survival between grade II and grade III cases (P=0.878), both having a very poor prognosis. Undifferentiated (grade III) carcinoma cases had a 21-fold increased risk of death as compared with differentiated (grade I and II) carcinoma cases. An increased risk (about 10-fold) was also associated with undifferentiated simple carcinomas as compared with differentiated ones. The predictive value of histological grade was not influenced by tumour size or age of the dog at mastectomy; nodal metastasis, however, worsened the prognosis (P<0.001). Routine use of this human grading method would help the clinician to make a more accurate prognosis in the interests of post-surgical management in dogs with mammary carcinomas.     

Sebaceous gland and sweat gland carcinomas of the skin. Clinicopathological study and significance of c-erbB-2 oncoprotein expression.

Thirteen sebaceous gland carcinomas and 10 sweat gland carcinomas were examined to elucidate any important histological parameters influencing their prognosis, and the relationship between immunohistochemical expressions of c-erbB-2 oncoprotein and survival of the patients was analyzed. Sebaceous gland carcinomas with vacuolated cytoplasm in more than 50% of whole tumor area, with necrosis, and without lymphoid cell infiltration in tumor nests and stroma had a higher incidence of tumor recurrence and tumor-related death than tumors with vacuolated cytoplasm in 50% or less of whole tumor area (p < 0.01), without necrosis, and with lymphoid cell infiltration in tumor nest and stroma (p < 0.05). Sweat gland carcinomas of all cases with fatal outcomes demonstrated tubular differentiation in 20% or less of whole tumor area, lymphatic permeation and desmoplastic reaction. Three sebaceous gland carcinomas and three sweat gland carcinomas were positive for c-erbB-2 oncoprotein. Two of three sebaceous gland carcinomas, and all three sweat gland carcinomas developed tumor recurrence and ended in tumor-related deaths. Sweat gland carcinomas with c-erbB-2 expression had significantly shorter survival than those with negative immunostain (p < 0.01). Cytoplasmic appearance, tumor necrosis, and lymphoid cell infiltration in tumor nests and stroma of sebaceous gland carcinoma, and tubular differentiation, lymphatic permeation, and growth patterns of sweat gland carcinoma are considered to closely correlate to the prognosis. Immunohistochemically detected c-erbB-2 oncoprotein may be an indicator of bad prognosis.     

Sebaceous Gland and Sweat Gland Carcinomas of the Skin Clinicopathological Study and Significance of c-erbB-2 Oncoprotein Expression

Thirteen sebaceous gland carcinomas and 10 sweat gland carcinomas were examined to elucidate any important histological parameters influencing their prognosis, and the relationship between immunohistochemical expressions of c-erbB-2 oncoprotein and survival of the patients was analyzed. Sebaceous gland carcinomas with vacuolated cytoplasm in more than 50% of whole tumor area, with necrosis, and without lymphoid cell infiltration in tumor nests and stroma had a higher incidence of tumor recurrence and tumor-related death than tumors with vacuolated cytoplasm in 50% or less of whole tumor area (p < 0.01), without necrosis, and with lymphoid cell infiltration in tumor nest and stroma (p < 0.05). Sweat gland carcinomas of all cases with fatal outcomes demonstrated tubular differentiation in 20% or less of whole tumor area, lymphatic permeation and desmoplastic reaction. Three sebaceous gland carcinomas and three sweat gland carcinomas were positive for c-erbB-2 oncoprotein. Two of three sebaceous gland carcinomas, and all three sweat gland carcinomas developed tumor recurrence and ended in tumor-related deaths. Sweat gland carcinomas with c erbB 2 expression had significantly shorter survival than those with negative immunostain (p < 0.01). Cytoplasmic appearance, tumor necrosis, and lymphoid cell infiltration in tumor nests and stroma of sebaceous gland carcinoma, and tubular differentiation, lymphatic permeation, and growth patterns of sweat gland carcinoma are considered to closely correlate to the prognosis. Immunohisto-chemically detected c erbB 2 oncoprotein may be an indicator of bad prognosis. Acta Pathol Jpn 42: 585–594, 1992.     

PCNA和c-erbB-2在喉良恶上皮的表达及其临床病理意义

目的探讨PCNA和c-erbB-2在喉良恶性上皮中的表达程度及其与病理分级和预后的关系。方法应用免疫组织化学方法探讨10例单纯性增生、30例异型增生及40例喉鳞状细胞癌的PCNA、c-erbB-2表达。结果单纯性增生PCNA指数为7.0%,轻、中、重度异型增生PCNA指数分别为13.2%、19.4%、26.6%。高、中、低分化鳞癌PCNA指数分别为32.7%、55.4%、78.3%。单纯性增生、异型增生和鳞癌间PCNA指数存在显著的统计学差异(P<0.01)。但高分化鳞癌与重度异型增生间PCNA指数无统计学差异。c-erbB-2在单纯性增生及异型增生中均无表达,在鳞癌中有表达,但在高、中、低分化鳞癌间无显著差异。对40例喉鳞癌随访5年,有16例死亡,其中13例PCNA指数>78%,即PCNA指数越高,分化越差,预后越差。结论PCNA具有较好的客观性评价异型增生的程度和鳞癌分化程度,与患者预后密切相关。c-erbB-2不能作为异型增生和癌的分级的指标。     

22例儿童甲状腺癌临床病理分析

为探讨儿童甲状腺癌的临床病理特点、预后相关因素,回顾性总结了22例儿童甲腺状癌患者的临床病理特征及预后.结果显示,22例经病理组织学检查证实为儿童甲状腺癌的患者中,有4例为术前穿刺标本病理诊断为甲状腺癌,18例为术中病理冰冻切片诊断为甲状腺癌.22例均行手术切除治疗,其中19例为乳头状癌,2例为滤泡癌,1例髓样癌,淋巴...     

pT1期肺腺癌间质浸润的分级及预后意义

目的 探讨TNM病理分期T1(pathologic-T1,pT1)期肺腺癌中间质浸润分级的预后意义.方法 选择具有完整临床病理及随访资料结果 的pT1期肺腺癌85例,根据间质浸润在肿瘤中的部位将每例肿瘤中间质浸润的程度分为1-3级,分析各间质浸润级别病例的临床病理特征及预后.结果 间质浸润各级别肿瘤的病例数为1级:17例(20%),2级:12例(14%),3级:56例(66%).临床病理特征:肿瘤大小及淋巴血管侵犯率除1级病例小于3级病例(P值分别为0.005及0.018)外其余各级病例间的差异无统计学意义.淋巴结转移率及病理学分期在1级和2级病例完全相同并低于3级病例(1级与3级P值分别为0.007及0.002;2级与3级P值分别为0.027及0.021).性别、年龄及吸烟史各级病例间的差异无统计学意义.预后:本组病例5年总生存率是63%.1-3级病例的5年生存率分别为100%、83.3%及46.6%,2级与3级病例间的差异有统计学意义(P=0.027),随访期间病死率1-3级病例分别为0、16.7%及42.9%,1级与3级病例间的差异有统计学意义(P=0.001),而与2级病例间的差异无统计学意义.单因素预后分析提示间质浸润分级(P=0.001)、病理学分期(P<0.001)、淋巴血管侵犯(P<0.001)及淋巴结转移(P<0.001)与预后相关.多因素预后分析提示仅病理学分期(P<0.001)为独立预后因素.结论 间质浸润分级是一个与肿瘤预后及其他预后因素均密切相关组织学分级系统,它可作为pT1期肺腺癌预后分类的标准之一.     

腮腺癌中血管内皮生长因子和血管内皮生长因子受体3表达与淋巴结转移

目的:研究血管内皮生长因子C及受体3(VEGF-C、VEGFR-3)在腮腺癌中的表达及其与淋巴结转移的关系。方法:采用免疫组织化学SP法检测62例腮腺癌标本组织中VEGF-C、VEGFR-3的表达,并计算其阳性表达率。结果:VEGF-C、VEGFR-3在腮腺癌中显著表达,其阳性率分别是51.6%、48.4%,与淋巴结转移密切相关。结论:VEGF-C、VEGFR-3与淋巴结转移有相关性,为肿瘤细胞淋巴道转移提供了条件,可以作为判断腮腺癌患者预后的一个重要指标。     

Foamy gland adenocarcinoma of the prostate: incidence, Gleason grade, and early clinical outcome

Foamy gland carcinoma is a variant of prostatic acinar adenocarcinoma characterized by abundant foamy cytoplasm and often pyknotic nuclei. Limited data exist regarding outcome and the clinicopathologic attributes of this variant. We screened 477 radical prostatectomies for foamy gland carcinoma to determine the incidence, amount, and Gleason grade/score of foamy gland carcinoma within the prostate. Time until prostate-specific antigen biochemical recurrence after radical prostatectomy was compared for both foamy and control/nonfoamy cases. For validation of incidence, Gleason grade, and pathologic stage, a second series of 100 consecutive radical prostatectomies was screened for foamy gland carcinoma. Foamy gland carcinoma was found in 69 (14.5%) of 477 cases. The median Gleason score of the foamy component was 7, which was not significantly different from the Gleason score of the nonfoamy component within those cases or the 408 nonfoamy cases. The most common Gleason score was 7 (44/69). There was no difference between foamy gland and nonfoamy gland cases in recurrence rate (23% versus 22%) or the average time to prostate-specific antigen recurrence (130 versus 151 months). In the second series, foamy gland carcinoma was found in 23% of cases and had a median Gleason score of 7; and the most common Gleason score was 7 (11/23). Foamy gland carcinoma exists in a significant subset of prostatic carcinomas. This variant does not appear to harbor a different prognosis compared with usual acinar adenocarcinoma, but diagnostic recognition of foamy gland carcinoma is important because there is a Gleason grade 4 element in the majority of cases.     

Grading system of lymphatic invasion according to D2-40 immunostaining is useful for the prediction of nodal metastasis in squamous cell carcinoma of the uterine cervix

AIMS: To determine the relationship between lymphatic invasion detected by D2-40 immunostaining and nodal metastasis in squamous cell carcinoma (SCC) of the cervix. METHODS AND RESULTS: Seventy-five cases of FIGO stage IB to IIB SCC of the cervix, treated by radical hysterectomy and lymph node dissection, were examined. Immunohistochemistry for D2-40 was performed. Overestimation of lymphatic invasion on conventional histological examination was demonstrated by assessment of D2-40 immunoreactivity in 22 cases. A significant difference in lymphatic invasion detected by D2-40 immunostaining was found between the metastatic group (30 cases) and the non-metastatic group (45 cases) (P < 0.001). A grading system (grade 0-2) of lymphatic invasion according to D2-40 immunostaining was devised. Subsequently, the frequency of nodal metastasis significantly increased in accordance with the grade of lymphatic invasion (P < 0.001) and in eight cases with grade 2, seven cases (87.5%) had nodal metastasis. CONCLUSIONS: In cervical SCC, a grading system for lymphatic invasion according to D2-40 immunostaining is useful for the prediction of nodal metastasis and grade 2 lymphatic invasion is a strong predictor of nodal metastasis.