胰头恶性无功能胰岛细胞瘤1例

胰头恶性无功能胰岛细胞瘤１例赵玉梅，王独秀，叶兆祥天津市肿瘤医院放射科（天津市３０００６０）胰岛细胞瘤良性多，恶性少；功能性内分泌肿瘤多，无功能胰岛细胞瘤少；发生在胰体尾多，胰头少。本文报告１例如下：患者，女性，１８岁。１９８９年偶然发现右上腹肿物，...     

SV40大T抗原在人脑肿瘤中的表达

目的　检测 Ｓ Ｖ４０ 早期区域基因编码产物大 Ｔ 抗原（ Ｔａｇ）在人脑肿瘤中的表达，探讨 Ｓ Ｖ４０ 与人脑肿瘤发生的病因学关系。方法　采用免疫共沉淀、银染色及 Ｗｅｓｔｅｒｎ印迹检测 ６５ 例人脑肿瘤组织、８ 例正常人脑组织及 ２ 株人脑胶质瘤细胞系中 Ｔａｇ 的表达。结果　 Ｔａｇ 在 ８ 例室管膜瘤、２ 例脉络丛乳头状瘤及 ２ 株人脑胶质瘤细胞系中全部表达；垂体腺瘤 Ｔａｇ 阳性率为 ９０％ （９／１０），星形胶质细胞瘤７３％ （１１／１５），脑 膜瘤 ７０％ （７／１０），多形性 胶质母细胞 瘤５０％ （４／８），髓母细胞瘤 ３３％ （２／６）；５ 例少枝胶质细胞瘤、１例松果体瘤及 ８ 例正常人脑组织无 Ｔａｇ 表达。结论　 Ｓ Ｖ４０感染与人脑肿瘤的发生有一定关系。     

垂体腺瘤的TS分期

目的：在临床实践中对垂体腺瘤进行分期，并以指导临床治疗。方法：依据肿瘤的大小及患者内分泌情况进行分期，以Ｔ表示肿瘤的大小，Ｓ表示内分泌紊乱的程度，临床分期：Ⅰ期Ｔ１Ｓ１；Ⅱ期Ｔ２Ｓ１；Ⅲ期Ｔ３Ｓ１；Ⅳ期Ｔ４Ｓ１、Ｔ１～４Ｓ２。结果：分析了自１９７５～１９９０年收治的６３１例垂体瘤患者，控制率为：Ⅰ期９４．７％，Ⅱ期９２．９％，Ⅲ期８４．６％，Ⅳ期６３．３％。经统计学处理：Ⅰ期、Ⅱ期与Ⅲ期间，Ⅰ期、     

鼻咽癌放疗后甲状腺功能损伤

目的：分析鼻咽癌放疗对甲状腺功能的影响。方法：１９９２年１月～１９９６年１２月，对５０例鼻咽癌患者放疗后甲状腺功能进行了前瞻性研究，采用放免法测定放疗前、放疗终及放疗后不同时期血清ＴＴ３、ＴＴ４、ＦＴ３、ＦＴ４及ＴＳＨ水平。结果：放疗后，血清ＴＴ３即明显低于放疗前的水平。放疗后１年，ＴＴ４及ＦＴ３水平亦降低，放疗后３年，ＴＴ３、ＴＴ４、ＦＴ３、ＦＴ４均明显低于疗前水平（Ｐ＜０．０５）。放疗后，血清ＴＳＨ水平并无明显升高，放疗３年后，总体呈下降趋势（Ｐ＞０．０５）。放疗终８％的患者ＴＳＨ高于正常水平，至放疗后１年达１９．６％，同时，放疗后１年、２年及５年，血清ＴＳＨ水平低于正常者为４．３％、１１．４％及２８．６％。５年中共发生９例临床甲状腺功能低下甲低病例，其中，ＴＳＨ低于正常者４例，位于正常者４例，高于正常者１例。结论：鼻咽癌放疗后，甲状腺功能受损及垂体功能低下是造成临床甲低的两个主要因素。     

Ⅲ期肺癌外科治疗适应证的初步分析

２年手术治疗肺癌５５例，术后病理分期，Ⅲ期肺癌２８例（占５０．９％），其中Ⅲ＿ｂ期３例。术前有７例行支气管动脉灌注化疗。２８例中，手术切除１９例，占６７．９％，无手术死亡。２年随访，中位存活期１１个月。２年累积存活率６９．０％。本文提出了Ⅲ期肺癌各亚组的手术适应证，包括（１）周围型肺癌侵犯壁层胸膜或胸壁或伴有Ｎ＿２者；（２）、中央型肺癌距隆重＜２．０ｃｍ者，或肿瘤侵犯上腔静脉或肺血管主干者；（３）小细胞肺癌属于Ｔ＿３Ｎ＿（０－１）Ｍ＿０者。     

T1～4N0M0期非小细胞肺癌根治术后是否需要辅助治疗

目的　探讨非小细胞肺癌（ Ｎ Ｓ Ｃ Ｌ Ｃ） Ｎ０ Ｍ０ 期根治术后不同病理及不同 Ｔ 分期的转归及治疗。方法　行根治术后病理为 Ｎ Ｓ Ｃ Ｌ Ｃ 的 Ｔ１ ～４ Ｎ０ Ｍ０ 期３５４ 例。男性２８５ 例,女性６９ 例。鳞癌１９１例,腺癌１６３ 例。鳞癌中 Ｔ１ Ｎ０ Ｍ０ 期２７ 例, Ｔ２ Ｎ０ Ｍ０ 期１３４ 例, Ｔ３ Ｎ０ Ｍ０ 期２８ 例, Ｔ４ Ｎ０ Ｍ０ 期２ 例。腺癌中 Ｔ１ Ｎ０ Ｍ０ 期４２ 例, Ｔ２ Ｎ０ Ｍ０ 期１０８ 例, Ｔ３ Ｎ０ Ｍ０ 期１０ 例, Ｔ４ Ｎ０ Ｍ０ 期３ 例。结果　全组５ 年生存率为５３ ．７ ％ ,鳞癌为５９ ．７ ％ ,腺癌为４６ ．６ ％ 。鳞癌中 Ｔ１ Ｎ０ Ｍ０ ～ Ｔ４ Ｎ０ Ｍ０ 期５ 年生存率分别为７０ ．４ ％ ,６４ ．９ ％ ,２８ ．６ ％ 及０／２（ Ｐ＜ ０ ．０５） ;局部复发率分别为１４ ．８ ％ ,９ ．７ ％ ,２１ ．４ ％ 及０／２（ Ｐ＞ ０ ．０５） ;远地转移率分别为１１ ．１ ％ ,２３ ．９ ％ ,５０ ．０ ％ 及２／２（ Ｐ＜ ０ ．０５） 。腺癌中 Ｔ１ Ｎ０ Ｍ０ ～ Ｔ４ Ｎ０ Ｍ０ 期５ 年生存率分别为６１ ．９ ％ ,４４ ．４ ％ ,２０ ．０ ％ 及０／３（ Ｐ＜ ０ ．０５） ;局部复发率     

bcl-2和p53的表达在膀胱癌预后判断中的意义

以免疫组织化学染色的方法,研究ｐ５３和ｂｃｌ－２蛋白在膀胱癌中表达,以及与病理临床表现之间的关系。方法：应用抗ｐ５３和ｂｃｌ－２的单克隆抗体,以标准的ＬＳＡＢ方法,共分析了１３１例患者的肿瘤标本。结果：ｐ５３染色阳性的肿瘤为８６例（６５．６％）,Ｇ３级阳性的比例（８４．１％）,明显高于Ｇ１－２级（５６．３％）,Ｐ＝０．００１２）;浸润型（Ｔ２－４）肿瘤阳性的比例（７５．８％）明显高于浅型肿瘤（５５     

慢性乙型肝炎e系统状态与肝纤维化及癌变的关系

目的：为了弄清慢性乙型肝炎病程中乙型肝炎病毒ｅ系统状态和纤维化进展及其癌变的关系。方法：分别比较慢性乙型肝炎不同纤维化分期以及原发性肝癌组的ＨＢｅＡｇ或抗－ＨＢｅ或抗性率。结果：ＨＢｅＡｇ阳性率在慢性乙型肝炎纤维化Ｓ１、Ｓ２、Ｓ３和Ｓ４分期中分别为８５．２％（２３／２７）、７２．７％（２４／３３）、６３．３％（１９／３０）和５０％（１２／２４），原发性肝癌组为１９．４％（６／３１）；Ｓ１和Ｓ４组比较，以及原发性肝癌组和Ｓ１、Ｓ２、Ｓ３且比较存在统计学差异（Ｐ〈０．００５－０．０１），抗－ＨＢｅ阳性率在Ｓ１、Ｓ２、Ｓ３和Ｓ４分期中分别为１１．１％（３／２７）、２１．２％（７／３３）、２６．７％（８／３０）和３７．５％（９／２４），原发性肝癌组为６１．３％（１９／３１）；Ｓ１和Ｓ４组比较，以及原发性肝癌组和Ｓ１、Ｓ     

造血干细胞移植治疗白血病及其他恶性肿瘤112例临床研究

报告造血干细胞移植治疗白血病及其他恶性肿瘤１１２例，其中急性白血病９１例，慢性粒细胞白血病１２例，恶性淋巴瘤７例，骨随瘤及神经母细胞瘤各１例。１１２例中自体骨髓移植（ＡＢＭＴ）１４例，净化自体骨髓移植（ＰＡＢＭＴ）２５例，自体外周血干细胞移植（ＡＢＨＳＣＴ）４０例，异基固骨髓移植（Ａｌｌｏ－ＢＭＴ）２４例，胎肝造血干细胞移植（ＦＬＨＳＣＴ）９例，３年无病生存率（ＤＦＳ）及复发率分别为６８．３２％、６７．５７％、６９．５４％、５７．１２％、３３．３３％和３０．７６％、２６．８０％、２０．０８％、１３．００％、６２．５０％。同期化疗患者３年ＤＦＳ率及复发率分别为７．３８％及７６．４％。五个移植组疗效明显优于化疗组。     

原发性肝细胞癌多染色体杂合性丢失研究

研究原发性肝细胞癌（ＨＣＣ）５对染色体３８个位点等位基因杂合性丢失（ＬＯＨ），ＬＯＨ与肝癌的临床病理改变和肝炎病毒的关系。方法：用ＰＣＲ微卫星多态性分析检测肝癌ＬＯＨ。结果发生高频率ＬＯＨ的位点有染色体１ｐ的Ｄ１Ｓ１８６（这，４８．１％）和Ｄ１Ｓ２４３（１ｐ３６．３，５１．６％）；染色体９ｎ２４的Ｄ９Ｓ５４（６１．８％），９这的Ｄ９Ｓ１７４７（５２．％）和ＤＤ９Ｓ１７５２（５１．８％）ＷＵＧ ＨＫ     

Functional classification of pituitary adenoma

Pituitary adenoma may be calssified in light of the hormones produced. 225 surgical specimens were labeled with anti-sear of GH, PRL. ACTH, TSH, FSH and LH by immunohistochemical technique (ABC method). Data indicated that 100 out of 225 cases (44.5%) were monohormonal adenomas, including 24 GH, 39 PRL, 1 FSH and 9 LH, 77 (34.2%) were multi-hormonal adenomas, including 28 positive for 2 hormones, 30 positive for 3 hormones, 19 positive for 4 or more different hormones, and the remaining 48 (21.3%) were nonfunctional adenomas. In comparison with Kovacs series, factors which might participate in the mechanism of developing monohormonal or multi-hormonal adenomas are discussed.     

Reproducibility of serum pituitary hormones in women

Endogenous pituitary hormones are commonly used in clinical and epidemiologic studies and some of them are thought to influence the risk of several diseases in women. In most studies, endogenous levels of pituitary hormones are usually assessed at a single point in time, assuming that this single measurement represents the long-term biomarker status of the individual. Such an assumption is rarely tested and may not always be valid. This study examined the reproducibility of the following pituitary hormones: adrenocorticotropic hormone (ACTH), growth hormone, follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid-stimulating hormone (TSH), and prolactin, measured using the Luminex xMap method in sera of healthy premenopausal and postmenopausal women. The study included 30 premenopausal women with three yearly samples and 35 postmenopausal women with two repeated yearly samples randomly selected from an existing prospective cohort. Analysis of intraclass correlation coefficients suggested higher reproducibility in postmenopausal women compared with premenopausal women for the following hormones: FSH (0.72 and 0.37, respectively), LH (0.83 and 0.44, respectively), and growth hormone (0.60 and 0.35, respectively). The intraclass correlation coefficients were relatively high and similar between postmenopausal and premenopausal women for ACTH (0.95 and 0.94, respectively), TSH (0.85 and 0.85, respectively), and prolactin (0.72 and 0.69, respectively). This study found that serum concentrations of FSH, LH, and growth hormone are stable in postmenopausal women and that ACTH, TSH, and prolactin are stable in both premenopausal and postmenopausal women, suggesting that a single measurement may reliably categorize average levels over at least a 2-year period.     

乳腺癌与乳腺增生病某些内分泌激素的差异及其临床意义

目的通过比较乳腺癌与乳腺增生病患者内分泌激素变化,对内分泌激素与免疫系统的关系进行初步分析. 方法随机选取绝经前和绝经后的乳腺癌患者各28例、乳腺增生病患者各22例,在治疗前采血样,对垂体激素6项（PRL、GH、TSH、ACTH、FSH、LH）和性类固醇激素3项（E2、P、T）进行检测,采用秩和检验,正态近似法（Wilcoxon法）对结果行统计学分析. 结果绝经前乳腺癌患者FSH 水平高于乳腺增生患者,其它垂体激素（PRL,GH,TSH,ACTH,LH ）和性类固醇激素（E2,T,P）水平无显著性差异（P〉0.05）.绝经后乳腺癌患者ACTH水平高于乳腺增生病患者,其它垂体激素（PRL,GH,TSH,FSH, LH）和性类固醇激素（E2,T, P） 比较含量无显著差异（P〉0.05）.结论绝经前乳腺癌患者血浆中的FSH和绝经后乳腺癌患者ACTH水平高于乳腺增生病患者,说明乳腺癌患者内分泌激素与免疫系统之间正常规律被打破.下丘脑-垂体-肾上腺轴（HPA）短、长反馈失调,使免疫功能受抑制;雌激素诱导癌细胞基因突变,雄激素刺激细胞的敏感性增加,加速乳腺癌的发展.     

Identification of luteinizing hormone-releasing factor and alpha subunit of glycoprotein hormones in ductal carcinoma of the mammary gland

The immunoperoxidase technique was used to identify luteinizing hormone-releasing factor (LRF) and the alpha subunit of glycoprotein hormones in ductal carcinoma of the mammary gland. Eleven tumors were studied, using antisera against LRF and alpha subunit, and against the beta subunits of hCG, LH, FSH and TSH. Six of the tumors were both LRF- and alpha-positive and three were negative. One tumour was LRF-positive/alpha-negative, and one was LRF-negative/alpha-positive. None of the anti-beta subunit antisera gave positive staining, and normal breast tissue as well as chronic cystic mastopathy (five cases) were negative with all antisera tested. The results with the anti-alpha and anti-beta subunit antisera suggest that the material stained is free alpha subunit rather than any of the native glycoprotein hormones which share the common alpha subunit.     

Pancreatic polypeptide in islet cell tumors. Morphologic and functional correlations

Twelve islet cell tumors and one islet cell hyperplasia were studied with immunocytochemical and radioimmunoassay methods. With immunocytochemical staining, all six insulinomas, one mixed insulinoma-glucagonoma, and four gastrinomas were positive for insulin, insulin and glucagon, and gastrin, respectively. Pancreatic polypeptide (PP) was positive in three insulinomas and one mixed insulinoma-glucagonoma. All of the tumors were positive for neuron-specific enolase (NSE). Radioimmunoassays of tissue extracts further disclosed that all functioning tumors contained more than one pancreatic hormone. PP concentrations of two insulinomas and one mixed insulinoma-glucagonoma were higher than that of normal control pancreases. A study of protein meal-stimulated PP secretion revealed that three of the insulinoma cases and two gastrinoma cases exhibited higher plasma PP levels than the age-matched controls. The findings suggest that: both functioning and nonfunctioning islet cell tumors derive from neuroendocrine cells positive for NSE; all functioning islet cell tumors appear to contain PP in the tumor tissue as a minor component; as many as 70% of the patients with islet cell tumors present with abnormally higher plasma PP levels after protein meals; and a study of meal-stimulated PP secretion may well be used as a marker for the presence of functional islet cell tumors.     

Effects of Hypophysectomy on Patients With Advanced Breast Cancer in Relation to Pituitary Hormone Reserve Before and After the Operation

In four patients with advanced breast cancer, the TSH, prolactin,LH and FSH reserve was measured, before and after hypophysectomy,by stimulation with TRH and LH-RH. Two out of the four patientswere objectively improved following the operation. It was foundthat the clinical effects of hypophysectomy did not correlatewith changes in secretion of any of these pituitary hormones.In addition, the complete absence of pituitary hormones afteroperation did not necessarily mean that treatment had been effective. ^*This study was supported by Grants for Cancer Research andfor Specific Diseases from the Ministry of Health and Welfareand by a Grant-in-Aid for Cancer Research from the Ministryof Education, Science and Culture, Japan     

Differential Action of Glycoprotein Hormones: Significance in Cancer Progression

Growth of multicellular organisms depends on maintenance of proper balance between proliferation and differentiation. Any disturbance in this balance in animal cells can lead to cancer. Experimental evidence is provided to conclude with special reference to the action of follicle-stimulating hormone (FSH) on Sertoli cells, and luteinizing hormone (LH) on Leydig cells that these hormones exert a differential action on their target cells, i.e., stimulate proliferation when the cells are in an undifferentiated state which is the situation with cancer cells and promote only functional parameters when the cell are fully differentiated. Hormones and growth factors play a key role in cell proliferation, differentiation, and apoptosis. There is a growing body of evidence that various tumors express some hormones at high levels as well as their cognate receptors indicating the possibility of a role in progression of cancer. Hormones such as LH, FSH, and thyroid-stimulating hormone have been reported to stimulate cell proliferation and act as tumor promoter in a variety of hormone-dependent cancers including gonads, lung, thyroid, uterus, breast, prostate, etc. This review summarizes evidence to conclude that these hormones are produced by some cancer tissues to promote their own growth. Also an attempt is made to explain the significance of the differential action of hormones in progression of cancer with special reference to prostate cancer.     

Gonadal dysfunction in patients treated for metastatic germ-cell tumors

The effects of chemotherapy on endocrine function were assessed in 22 previously treated patients with germ-cell tumors and compared with the endocrine function of six previously untreated patients. Baseline and stimulated serum levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone, thyroid-stimulating hormone (TSH), prolactin, and thyroxine (T4) were obtained. Baseline LH levels were elevated in both groups of patients, whereas basal FSH levels were significantly elevated only in treated patients (P less than .001). Following gonadotropin-releasing hormone (GnRH), levels of LH (P = .051) and FSH (P = .003) were greater in treated patients than in untreated control patients. No abnormalities of thyroid function or prolactin responsiveness were observed. Patients younger than 25 years of age at the time of treatment had lower serum levels of LH and FSH following chemotherapy than patients older than 25. Evidence for partial recovery of gonadal function was present with patients treated more than 18 months before study having lower levels of LH and FSH than those patients studied less than 18 months after treatment. These data demonstrate that frequent gonadal dysfunction exists in untreated patients with germ-cell tumors and that chemotherapy induces additional injury to both Leydig cells and the germinal epithelium. Further studies with long-term follow-up are necessary to define the pattern of gonadal recovery and to assess the potential sequelae of endogenous gonadotropin hypersecretion.     

Effect of reproductive hormones on ovarian epithelial tumors: I. Effect on cell cycle activity

We examined the effects of the 4 major female reproductive hormones, estradiol (E2), progesterone (P4), follicle stimulating hormone (FSH), and luteinizing hormone (LH) on thymidine incorporation in benign and malignant ovarian epithelial tumors cultured in vitro. Treatment of these tumors with E2, FSH and LH resulted in increased thymidine incorporation while treatment with P4 inhibited growth as well as thymidine incorporation. The inhibitory effect of progesterone could not be reproduced by treating the cells with ligands for other steroid hormone receptors known to interact with P4 such as the mineralocorticoid and glucocorticoid receptors. All cells lines expressed at least the PR-A isoform of the progesterone receptor. ORG2058, R5020, RU486, and ZK98299 acted as progesterone receptor agonists with regard to their effect on thymidine incorporation. P4 down-regulated cyclin Bl expression and cdkl activity and up-regulated the p21 and p27 proteins. Expression of a reporter gene downstream to an AP-1 responsive element in a plasmid construct transfected into ovarian epithelial tumor cells was induced by P4 and inhibited by RU486. We conclude that P4 inhibits cell cycle activity in ovarian epithelial tumors, in part via down-regulation of the cdkl/cyclin B complex. This inhibitory effect may have therapeutic utility against ovarian epithelial tumors.     

Prospective hormone study of hypothalamic-pituitary function in patients with nasopharyngeal carcinoma after high dose irradiation

With the aim of evaluating the effect of high dose irradiation (6,500 cGy/36 fractions or higher) to pituitary fossa, a prospective study was carried out in patients with nasopharyngeal cancer by a serial determination of several hormones in the serum, before and after the course of radiation therapy (RT). The radiation treatment field was at least 1 cm above the skull base with bilateral parallel opposing fields. Hormone assays were performed three times on each patient: (1) prior to, (2) one month after, (3) 15-18 months after radiation therapy. The study included determination of serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), thyroid-stimulating hormone (TSH), cortisol, growth hormone (GH) and prolactin concentrations and LH-releasing hormone, thyrotrophin-releasing hormone stimulation and insulin tolerance tests were also carried out. Complete profiles were obtained in 24 patients (16 males and 8 females), aged 16-67 years. The results showed a significant decrease in the level of serum peak value of LH in males 18 months after therapy, and also in GH both one month and 18 months after therapy. A significant increase in the peak value of serum TSH observed after therapy. Decreased serum FSH, cortisol and prolactin levels were noted, but these did not reach statistical significance. The decrease in GH level appeared earlier and was more sensitive than that found for the other hormones, and could prove to be a useful parameter for clinical evaluation. None of the patients showed any clinically recognizable symptoms or signs of hormone deficiency in the 18-33 months following completion of the radiation therapy.