转化生长因子β1及Ki-67核抗原在涎腺黏液表皮样癌中的表达和意义

目的 研究转化生长因子β1(transforming growth factor-β1,TGF-β1)、Ki-67核抗原在涎腺黏液表皮样癌(mucoepidermoid carcinoma,MEC)中的表达和意义.方法 应用免疫组织化学SP法检测20例涎腺多形性腺瘤(pleomorphic adenoma,PA)、45例涎腺MEC(29例高分化、16例中低分化)组织中TGF-β1和Ki-67核抗原的表达.结果 涎腺MEC中TGF-β1(39/45)、Ki-67核抗原(43/45)的表达高于PA,差异有统计学意义(P＜0.05);TGF-β1在中低分化MEC中的表达(16/16)高于高分化MEC(23/29)及PA(12/20),差异有统计学意义(P＜0.05),而TGF-β1在高分化MEC(6/23)与PA(8/12)中的表达差异无统计学意义(P＞0.05);在MEC中Ki-67核抗原的表达随TGF-β1表达增强而上升(P＜0.05),二者呈显著正相关(r=0.55,＜0.001).结论 TGF-β1的高表达在涎腺MEC的分化及恶性增殖过程中可能起重要作用.

Abstract：

Objective To investigate the expression and significance of transforming growth factor-β1 (TGF-β1)and Ki-67 nuclear antigen in salivary gland mucoepidermoid carcinoma. Methods The expression of TGF-β1 and Ki-67 nuclear antigen in 20 cases of salivary gland pleomorphic adenoma and 45 cases of mucoepidermoid carcinoma were detected by the streptavidin-peroxidase immunohistochemical method. Results Expression of TGF-β1 (39/45) and Ki-67 nuclear antigen (43/45) in mucoepidermoid carcinoma was significantly higher than in pleomorphic adenoma ( P ＜ 0.05 ). TGF-β1 expression was significantly higher in moderately/poorly differentiated mucoepidermoid carcinoma ( 16/16 ) than that in well differentiated mucoepidermoid carcinoma (23/29) and pleomorphic adenoma (12/20) ( P ＜ 0.05 ), but not different between well differentiated mucoepidermoid carcinoma (6/23) and pleomorphic adenoma (8/12)(P ＞ 0.05 ). The expression of Ki-67 was increased with the increment of TGF-β1 expression in mucoepidermoid carcinoma (P ＜ 0.05 ). Conclusions The high expression of TGF-β1 may play an important role in cell differentiation and malignant proliferation of mucoepidermoid carcinoma.     

延长锁骨上岛状皮瓣在修复舌鳞状细胞癌术后缺损中的应用

目的 评价延长锁骨上岛状皮瓣(extended supraclavicular fasciocutaneous island flap,eSIF)修复舌癌术后缺损的可靠性.方法 22例经病理证实的舌癌患者,男17例,女5例,年龄26～73岁,平均(52.9±12.4)岁.应用eSIF修复,皮岛面积(4 cm×6 cm)～(8 cm×14 cm),平均5.5 cm×8.7 cm.结果 20例皮瓣成活率91%(20/22),其中2例皮瓣边缘坏死.舌外形恢复,语音、吞咽功能良好;瘢痕隐蔽,肩功能运动不受影响.随访观察5～16个月,18例生存良好;2例术后半年对侧颈淋巴结转移,经挽救性手术,目前仍存活;2例患者分别于术后8和10个月死于远处转移.结论 eSIF是修复舌癌术后缺损的可靠方法.

Abstract：

Objective To assess the reliability and usefulness of the extended supraclavicular fasciocutaneous island flap (eSIF)for reconstructing soft tissue defects followinng tongue cancer ablation.Methods Twenty-two tongue defects in 22 patients with tongue cancer were repaired with eSIF after resection of the tongue malignant tumours. The sizes of the skin paddle ranged from ( 4 cm× 6 cm ) to (8 cm× 14 cm)( average: 5.5 cm × 8.7 cm). Results The eSIF survived in twenty cases, including two cases with minimal partial necrosis. The patients were follwed up for 5-16 months. Eighteen patients were alive with disease free,two were alive with disease and two died of a lung and liver metastasis. Conclusions The eSIF is reliable for reconstructing oral defects following the ablation of advanced oral malignant tumors.     

微卫星位点TP53、D9S1747、D9S162及RPS6的杂合性缺失与口腔鳞状细胞癌的关系

目的 检测微卫星位点TP53(位于17p13区)、D9S1747、D9S162、RPS6(均位于9p21区)在口腔鳞状细胞癌中的杂合性缺失(1oss of heterozygosity,LOH)和微卫星不稳定(microsatellite instability,MI)与临床病理因素及预后的关系.方法 取71例符合纳入标准的口腔鳞状细胞癌病变组织,用基因组DNA快速提取纯化试剂盒提取肿瘤组织及对应正常淋巴结或外周血的DNA,聚合酶链反应(PCR)变性电泳检测上述位点的基因变化.结果 所有位点在癌组织中的LOH和MI总发生率为68%(48/71);TP53(17p13)为56%(35/63),9p21(RPS6+D9S1747+D9S162)为59%(40/68);9p21的LOH、MI与WHO组织学分级和淋巴结转移有关(P＜0.05);17p13的LOH、MI与WHO组织学分级(P＜0.01)和临床分期有关(P＜0.05);TP53(17p13)和9p21在肿瘤组织中的LOH和MI对口腔鳞状细胞癌的预后有显著影响(P＜0.05);TP53(17p13)LOH阳性组术后生存率显著低于阴性组(P＜0.01);9p21的LOH和MI阳性组术后生存率显著低于阴性组(P＜0.05).结论 所检测位点的LOH和MI与口腔鳞状细胞癌的病理分级、临床分期和淋巴结转移有关;癌组织中TP53的变化是口腔鳞状细胞癌预后较差的独立影响因素.

Abstract：

Objective To investigate the correlation between the frequency of molecular abnormalities of 4 loci at chromosomal 9p21 (D9S1747 ,D9S162, RPS6) and 17p13 (TP53) and the clinical characteristics and prognosis. Methods The oral squamous cell carcinoma(OSCC) lesions in 71 patients were manually microdessected. Genomic DNA from these lesions and normal lymphnode tissu or peripheral blood of the same patients were extracted using the Watson's tissue kit. The loss of heterozygosity(LOH) and microsatellite instability (MI) of 17p13 and 9p21 were analyzed by PCR-page electrophoresis after DNA extraction. Results LOH and MI were detected in the OSCC of 48 patients (68%). The LOH and MI frequency at chromosomes 17p13 and 9P21 were 56% (35/63) and 59% (40/68) respectively. The LOH and MI frequency at 9p21 was significantly associated with WHO grading ( P ＜ 0.01 ) and lymphonode metastasis (P ＜0.01 ). The LOH and MI frequency at 17p13 was significantly associated with clinical stage (P ＜ 0.05 ). TP53 genetic aberration and 9p21 genetic aberration were significant prognostic factors for OSCC. The prognosis was poor in the LOH and MI positive group of chromosome 17p13 and 9p21. The frequency of LOH and MI at TP53 was the only independent factor for overall survival ( P ＜ 0.05 ).Conclusions The LOH and MI of 17p13 and 9p21 were related to clinical stage and lymphonode metastasis. LOH of TP53 was an independent prognostic factor for OSCC.     

唾液腺恶性多形性腺瘤HER2基因扩增与临床病理特征及预后的关系

目的: 检测唾液腺恶性多形性腺瘤（malignant pleomorphic adenoma,MPA）中人上皮生长因子受体2（human epithelial growth factor receptor 2,HER2）蛋白表达、基因扩增情况,分析其与肿瘤临床病理及患者预后的相关性,以期评估其作为靶向治疗位点的可能性。方法: 应用免疫组织化学染色法检测140例MPA患者肿瘤组织中HER2蛋白的表达,对HER2基因扩增情况不明确者（HER2 2+）行荧光原位杂交,确定基因扩增状态。统计140例患者临床病理资料并进行随访,应用SPSS16.0软件包中的Kaplan-Meier、Cox比例风险模型,分析HER2基因扩增与MPA肿瘤临床病理及患者预后的相关性。结果: 140例MPA患者中,HER2阳性率为25%。腺癌亚型MPA中,HER2阳性率达到40.5%（32/79）,显著高于肌上皮癌亚型MPA（4.9%,3/61）（P<0.05）。HER2阳性与肿瘤患者性别、组织学分级及N分期显著相关。生存分析显示,HER2阳性患者总生存率及疾病别生存率低。结论: HER2基因过表达及扩增与MPA肿瘤细胞恶变亚型显著相关,并且提示MPA患者较差的预后状态。     

玉屏风对口腔扁平苔藓患者唾液表皮生长因子含量的影响

Objective To examine the effect of mouthwash Yupingfeng on the level of salivary epidermal growth factor(sEGF)in ora]lichen planus(OLP).Methods The level of sEGF Was measured by mdioimmunoassay with ligand 125I-EGF.The saliva samples were taken from the normal control group and the OLP patients before and after treatment with Yupingfeng.Results The levels of sEGF in OLP patients before treatment with Yupingfeng were(4.09±3.64)μg/L,which was significantly hisher than that in normal control[(2.15±1.62)μg/L,P=0.013],and(2.57±1.19)μg/L after treatment,which was significantly lower than before treatment(P=0.05).Condusions Yupingfeng can modulate the level of sEGF in OLP patients.     

玉屏风对口腔扁平苔藓患者唾液表皮生长因子含量的影响

Objective To examine the effect of mouthwash Yupingfeng on the level of salivary epidermal growth factor(sEGF)in ora]lichen planus(OLP).Methods The level of sEGF Was measured by mdioimmunoassay with ligand 125I-EGF.The saliva samples were taken from the normal control group and the OLP patients before and after treatment with Yupingfeng.Results The levels of sEGF in OLP patients before treatment with Yupingfeng were(4.09±3.64)μg/L,which was significantly hisher than that in normal control[(2.15±1.62)μg/L,P=0.013],and(2.57±1.19)μg/L after treatment,which was significantly lower than before treatment(P=0.05).Condusions Yupingfeng can modulate the level of sEGF in OLP patients.     

玉屏风对口腔扁平苔藓患者唾液表皮生长因子含量的影响

Objective To examine the effect of mouthwash Yupingfeng on the level of salivary epidermal growth factor(sEGF)in ora]lichen planus(OLP).Methods The level of sEGF Was measured by mdioimmunoassay with ligand 125I-EGF.The saliva samples were taken from the normal control group and the OLP patients before and after treatment with Yupingfeng.Results The levels of sEGF in OLP patients before treatment with Yupingfeng were(4.09±3.64)μg/L,which was significantly hisher than that in normal control[(2.15±1.62)μg/L,P=0.013],and(2.57±1.19)μg/L after treatment,which was significantly lower than before treatment(P=0.05).Condusions Yupingfeng can modulate the level of sEGF in OLP patients.     

锥形束CT转化头颅侧位片定点精确性的研究

Objective In this study, we compared the precision of landmark identification using cephalograms from cone-beam computed tomographic (CBCT) volumes and conventional lateral cephalograms (Ceph). Methods Twenty pre-orthodontic patients were radiographed with conventional Ceph and CBCT techniques. CBCT data was uploaded into InvivoDental software 5.0 to generate cephalograms(CCB). Three observers plotted 23 landmarks using computer displays of CCB and Ceph views during separate sessions. Absolute differences between CCB and Ceph of all observers were measured. The absolute difference between each observer was also measured. ANOVA and paired t tests were used to analyze variability differences. Results The difference of landmark identification between CCB and Ceph were significant at P＜0.05 calculations. 8 landmarks variability was statistically greater than Ceph views. The variability of CCB for each observer was consistently greater than in Ceph. The overall correlation of CCB and Ceph measurements was excellent at 0.99.Conclusions The CCB displays of CBCT volume images provide generally more precise identification than Ceph. More precise location of basion, porion, orbitale, ANS, A point, Gonion and tooth apex overcomes the problem of superimposition of these bilateral landmarks seen in Ceph. Greater variability of certain landmarks is probably related to inadequate definition of the landmarks in the third dimension.     

锥形束CT转化头颅侧位片定点精确性的研究

Objective In this study, we compared the precision of landmark identification using cephalograms from cone-beam computed tomographic (CBCT) volumes and conventional lateral cephalograms (Ceph). Methods Twenty pre-orthodontic patients were radiographed with conventional Ceph and CBCT techniques. CBCT data was uploaded into InvivoDental software 5.0 to generate cephalograms(CCB). Three observers plotted 23 landmarks using computer displays of CCB and Ceph views during separate sessions. Absolute differences between CCB and Ceph of all observers were measured. The absolute difference between each observer was also measured. ANOVA and paired t tests were used to analyze variability differences. Results The difference of landmark identification between CCB and Ceph were significant at P＜0.05 calculations. 8 landmarks variability was statistically greater than Ceph views. The variability of CCB for each observer was consistently greater than in Ceph. The overall correlation of CCB and Ceph measurements was excellent at 0.99.Conclusions The CCB displays of CBCT volume images provide generally more precise identification than Ceph. More precise location of basion, porion, orbitale, ANS, A point, Gonion and tooth apex overcomes the problem of superimposition of these bilateral landmarks seen in Ceph. Greater variability of certain landmarks is probably related to inadequate definition of the landmarks in the third dimension.     

玉屏风对口腔扁平苔藓患者唾液表皮生长因子含量的影响

Objective To examine the effect of mouthwash Yupingfeng on the level of salivary epidermal growth factor(sEGF)in ora]lichen planus(OLP).Methods The level of sEGF Was measured by mdioimmunoassay with ligand 125I-EGF.The saliva samples were taken from the normal control group and the OLP patients before and after treatment with Yupingfeng.Results The levels of sEGF in OLP patients before treatment with Yupingfeng were(4.09±3.64)μg/L,which was significantly hisher than that in normal control[(2.15±1.62)μg/L,P=0.013],and(2.57±1.19)μg/L after treatment,which was significantly lower than before treatment(P=0.05).Condusions Yupingfeng can modulate the level of sEGF in OLP patients.     

Utility of neck dissection for management of carcinoma of the parotid gland

To validate the use of neck dissection as part of the management of patients with parotid carcinomas, we retrospectively reviewed pathological and clinical data from the head and neck pathology archive at Guy’s and St Thomas’ Hospital on all patients who had primary parotid carcinomas resected between 1992 and 2014. The main outcome measure was the incidence of metastatic disease. A total of 54 of the 82 patients identified had neck dissections. Nodal metastases were detected in 10 with high-grade, invasive carcinoma ex-pleomorphic adenomas, two with salivary duct carcinomas, one with a high-grade adenocarcinoma not otherwise specified (NOS), one with an adenoid cystic carcinoma, and one with a high-grade acinic cell carcinoma. No metastases were found in those with a low-grade acinic cell carcinoma, low-grade mucoepidermoid carcinoma, epithelial-myoepithelial carcinoma, or non-invasive carcinoma ex-pleomorphic adenoma. The findings of this study support the use of routine neck dissection for the treatment of high-grade, invasive carcinoma ex-pleomorphic adenoma, salivary duct carcinoma, high-grade adenocarcinoma NOS, adenoid cystic carcinoma, and high-grade acinic cell carcinoma.     

涎腺膜性基底细胞腺瘤的临床病理研究

目的 探讨涎腺膜性基底细胞瘤的临床病理特点及生物学行为。方法 对１２例患者进行临床病理分析。结果 肿瘤由大小及形态不一的上皮团块所组成,团块外周细胞呈栅栏状排列,由玻璃样变的基底膜样物质围绕。４例伴头皮皮肤圆柱瘤,８例为多灶性肿瘤,１例恶变伴颈淋巴结转移。结论 诊断时应注意与实性型基底细胞腺瘤、基底细胞腺癌、实性型腺样囊性癌以及基底样鳞状细胞癌相鉴别。治疗应作全腮腺切除,并严密随访。     

83例涎腺恶性多形性腺瘤临床病理分析

作者总结分析８３例恶性多形性腺瘤的临床病理特点。患者平均年龄５３岁，男女之比为１．２：１，肿瘤部位依次为腮腺４７．９％，颌下腺２４％、腭部２０％，肿瘤中恶性成份为癌型７６例，癌肉瘤７例。明显影响预后的因素有（１）肿瘤部位；（２）组织学亚型，（３）肿瘤分化程度，（４）浸润状况，（５）淋巴结有无转移。患者５年生存率为５２．７％，恶性程度明显高地其它常见型涎腺癌。作者认为多形性腺瘤是它的癌前病变，早期切     

涎腺肿瘤中P~(53)和P~(185)蛋白表达及意义

目的 :探讨P5 3 和P185 蛋白在涎腺肿瘤的表达及其与肿瘤生物学特性的关系。方法 :采用免疫组化SP法检测 2 0例多形性腺瘤、12例腺淋巴瘤、19例恶性多形性腺瘤和 2 5例腺样囊性癌中P5 3 蛋白和P185 蛋白。结果 :两者在恶性多形性腺瘤中的阳性率显著高于在多形性腺瘤中的阳性率 (p <0 0 5 ) ,晚期恶性涎腺肿瘤的P5 3 阳性率显著高于早期恶性涎腺肿瘤 (p<0 0 5 ) ;有淋巴结转移的恶性涎腺肿瘤中P185 的阳性率显著高于无淋巴结转移者 (p <0 0 5 )。结论 :P5 3 和P185 蛋白在多形性腺瘤恶变过程中起着一定作用 ;P5 3 蛋白检测可作为判断涎腺恶性肿瘤临床分期和估计预后的参考指标 ;P185 蛋白检测可作为判断涎腺恶性肿瘤有无淋巴结转移的参考指标     

The role of neck dissection in the eradication of salivary carcinomas]

From 1955 to 1984, radical neck dissection (RND) had been done in 300 salivary carcinoma patients, 114 of which had regional lymph node metastasis, with a 38% metastatic rate. Respective 3, 5, 10, 15, 20 year survival rates were 76, 64, 47, 35, 35% in a 3 to 20 years follow-up study in 283 patients (94.33%). The following four points are concluded: 1. The metastatic rate is determined not only on tumor staging, but more to its typing (pathologic behaviour). 2. Elective RND gave a better prognosis than therapeutic and negative metastasis has a better survival chance than positive where the low level metastasis is the worst. 3. According to pathologic typing, Elective RND is indicated for undifferentiated adenocarcinoma, high malignant mucoepidermoid carcinoma, squamous cell carcinoma, adenocarcinoma and papillary cystic adenocarcinoma, therapeutic RND for malignant pleomorphic adenoma, acinic cell carcinoma and mucoepidermoid carcinoma. 4. Unilateral RND is indicated for all but sublingual and buccal tumors.     

nm23基因在涎腺恶性肿瘤中表达的意义

为了探讨ｎｍ２３基因在涎腺恶性肿瘤中表达的意义，作者应用免疫组织化学方法检测了４０例涎腺恶性肿瘤ｎｍ２３基因表达情况，并分析了ｎｍ２３基因表达变化与涎腺恶性肿瘤的临床病理及其转移的关系。结果发现，ｎｍ２３低表达者其肿瘤转移率为８１８％，而ｎｍ２３高表达者其肿瘤转移率只有３４％，两者差异有高度显著性（Ｐ＜０．００５）；ｎｍ２３低表达与肿瘤大小、部位、病理类型无显著相关性（Ｐ＞０．０５）。结果表明ｎｍ２３基因在抑制涎腺恶性肿瘤转移方面起重要作用。     

VEGF-C在舌鳞癌中的表达及其意义

目的：探讨具有促进淋巴管内皮细胞增殖与毛细淋巴管增生的VEGF—C在舌癌病变中的表达及与临床相关因素和淋巴道转移的关系。方法：采用免疫组化方法及图像分析，检测80例舌鳞癌中VEGF—C的表达，并分析表达水平与肿瘤病理分级、临床分期、颈淋巴转移、预后之间的关系。结果：舌鳞癌组织VEGF—C表达明显高于正常舌黏膜及良性肿瘤；其表达强度与病理分级、淋巴结转移密切相关，与患者的预后有关，但与临床分期无关。结论：肿瘤VEGF—C诱导癌周淋巴管增生是发生区域淋巴结转移的重要因素之一，检测VEGF—C可作为淋巴道转移及判断预后的指标之一。     

口腔鳞状细胞癌组织中P16蛋白的免疫组化定量分析

目的　探讨P16蛋白在口腔鳞状细胞癌(鳞癌)组织中的表达及与口腔鳞癌发生发展的关系。方法　采用免疫组化S -P法,对5 6例口腔鳞癌组织、30例癌旁组织及10例正常口腔黏膜中P16蛋白的表达进行检测,应用全自动图像分析仪对染色结果进行定量测定。结果　口腔鳞癌组织中P16蛋白的表达量低于癌旁组织及正常黏膜(P <0 .0 5 ) ,口腔鳞癌Ⅲ级低于Ⅰ、Ⅱ级(P <0 .0 5 )。颈淋巴结转移组低于无颈淋巴结转移组(P <0 .0 5 )。结论　P16蛋白在口腔鳞癌组织中的表达常为缺失,说明其作为抑癌基因在口腔鳞癌的发生中起作用。P16蛋白的表达程度越低,分化越差,肿瘤越易于浸润和转移。