原发性肝细胞癌微小转移研究近况

原发性肝癌预后恶劣，与其容易全身转移及术后复发率高有关，早期寻找肝癌患者周围血是否有肝癌细胞，发现肝外微小转移对指导治疗、判断预后非常重要。本文综述细胞学、免疫组织化学和分子生物学在寻找肝癌患者细胞方面的进展，特别是用ＰＣＲ检测外周血癌细胞方面的进展，特别是用ＰＣＲ检测外周血甲胎蛋白ｍＲＮＡ和白蛋白ｍＲＮＡ对发现肝癌细胞的微小转移有着重要的作用。     

肝细胞癌侵袭转移机制研究进展

原发性肝癌中最常见的是肝细胞癌（ｈｅｐａｔｏｃｅｌｌｕａｒ ｃａｒｃｉｎｏｍａ, ＨＣＣ）,对肝细胞癌侵袭转移机制的深入研究,有助于发现能准确估计肝癌原发灶转移能力的特异标记物、制定有效防止肿瘤转移的对策,为早期诊断、综合治疗和估计预后提供依据。 一、细胞外基质及基底膜降解系统与肝细胞癌局部侵袭 细胞外基质（ｅｘｔｒａｃｅｌｌｕｌａｒ ｍａｔｒｉｘ,ＥＣＭ）及基底膜（ｂａｓｅｍｅｎｔ ｍｅｍｂｒａｎｅｓ,ＢＭｓ）的主要成分是结构蛋白和糖胺多糖（ｇｌｙｃｏｓａｍｉｎｏｇｌｙｃａｎｓ,ＧＡＧ）,前者包括胶…     

肝细胞癌转移的研究进展

由于肝细胞癌（ＨＣＣ）切除术后的高复发率，ＨＣＣ治疗的总体预后迄今仍无突破性改观．除了ＨＣＣ病灶多中心发生的因素外，更主要的原因在于ＨＣＣ极易早期门脉转移导致肝内肿瘤播散，而且因肝内转移而复发的肝癌较多中心发生的ＨＣＣ预后差［１］．ＨＣＣ侵袭转移涉及肿瘤本身的生物学特性，并与肝脏的组织和解剖学特点有关．１　肝内转移和门静脉癌栓由于ＨＣＣ容易早期肝内播散及高度恶性的特点，患者往往在尚未出现远处转移时即告不治，因此临床上ＨＣＣ肝外转移相对较少．ＨＣＣ转移能力与肿瘤的增殖活性和分化程度有密切关系．肝内…     

以颈椎压迫症状为首发表现的肝细胞癌伴椎管转移1例报告

我国每年死于肝细胞癌(HCC)患者约38.3万人,占全球肝癌死亡人数51%[1],死亡率居于我国癌症死因第2位,仅次于肺癌[2]。肝癌最常见的转移部位为肝内转移、肺、局部淋巴结、骨骼及肾上腺[3],罕见有椎管转移。现报道1例以脊髓压迫症状为首发表现的HCC伴椎管转移患者。     

整合素与肝细胞癌的侵袭与转移

整合素［１］家族为粘附分子中一类由一个ａｌｆａ亚单位与一个ｂｅｔａ亚单位以非共价键连接而成的异二聚体胯膜糖蛋白．目前已知的亚单位有２５种ａｌｆａ亚单位及１１种ｂｅｔａ亚单位,形成２０余种不同的整合素．ａｌｆａ,ｂｅｔａ亚单位氨基端的球形域相互连接构成整合素胞外配基结合区．Ａｌｆａ亚单位胞外域较长,含钙离子结合区,胞内域则较短．Ｂｅｔａ亚单位的特点是胞外域含有胱氨酸的重复序列,胞内域较长．可通过与纽带蛋白等结合完成细胞内外双向信号的传递．１　肿瘤细胞的侵袭与转移胞外基质配体相结合的识别位点已经确认…     

原发性肝细胞癌肿瘤标志物研究进展

肝癌是造成世界癌症负担的一个主要因素,近几十年来,许多国家的发病率都有所上升,肝癌的病理类型主要为肝细胞癌（HCC）,是绝大多数肝癌诊断和死亡的原因。本文主要对于原发性HCC肿瘤标志物甲胎蛋白、异常凝血酶原、甲胎蛋白异质体-3比率、循环DNA、高尔基蛋白-73、骨桥蛋白、磷脂酰肌醇蛋白多糖-3对HCC致癌机制、检测疗效、其相关治疗靶点、切除术后生存、复发率及相关GALAD模型研究进展进行综合论述。     

层粘蛋白在人原发性肝细胞癌转移中的意义

目的了解层粘蛋白（ＬＮ）在原发性肝细胞癌（ＨＣＣ）转移中的作用和价值．方法应用放射免疫分析法（ＲＩＡ）、免疫组化和图象分析分别对１２例ＨＣＣ有转移者和１２例ＨＣＣ无转移者血清和癌组织中ＬＮ进行测定，并进行相关分析．结果ＨＣＣ有转移组患者血清中ＬＮ含量（μｇ／Ｌ）１７８±３２，显著高于ＨＣＣ无转移组１４０±２３（Ｐ＜００１）．ＨＣＣ有转移组患者组织中ＬＮ平均Ａ（ＯＤ值）为０１７±００６，显著低于ＨＣＣ无转移组０２６±００５（Ｐ＜００１）．组织中ＬＮ与血清ＬＮ含量成明显的负相关关系．免疫组化结果显示，ＬＮ不仅存在于间质中，还存在于癌细胞中；ＬＮ亦可排列成窦状，尤以ＨＣＣ转移者组织中为明显．结论ＬＮ在ＨＣＣ转移过程中具有双重作用，血清ＬＮ含量升高可作为衡量ＨＣＣ转移的一个简便而有用的指标     

上皮间质转化及相关信号通路在原发性肝细胞癌转移中的研究进展

上皮间质转化(epithelial-mesenchymal transition,EMT)现象是指上皮细胞失去上皮表型,获得间质细胞表型的过程.存在于胚胎发生、器官纤维化和肿瘤转移过程中.在原发性肝细胞癌的转移中存在这一现象.本文重点介绍了TGF-β通路、Wnt(wingless-type)/β-catenin通路、Hedgehog通路的组成及其在原发性肝细胞癌的上皮间质转化过程中起到的重要调控作用.此外,还谈及了其他调控因子,如NF-κB通路、Notch通路、转录因子、microRNA、CHD1L、ARHGEF9、乙肝病毒X基因(hepatitis B virus X gene,HBX)、细胞外基质等也参与了EMT的发生.研究EMT的分子机制是一个有前景的课题,可以为原发性肝细胞癌的治疗提供新的靶点,更好地理解靶向治疗中的耐药机制.     

DLC-1基因表达与肝细胞癌复发转移的关系

目的已报道人类染色体8p缺失可能与肝癌转移有关,本文应用实时定量聚合酶链反应(RQ- PCR)研究位于8p的DLC-1基因mRNA表达与肝细胞癌侵袭转移的关系。方法收集51例复旦大学中山医院外科手术切除的肝细胞癌(HCC)及癌旁正常组织标本,根据临床病理学指标,分为高低侵袭性两组,用RQ-PCR对不同侵袭性HCC之间的DLC-1基因表达进行分析。对不同侵袭转移潜能MHCC97-L、MHCC97-H、HCCLM3、Hep3B及HepG2肝癌细胞系用同样方法分析DLC-1基因的表达差异。结果非转移细胞系Hep3B和HepG2与转移细胞系MHCC97-L、MHCC97-H和HCCLM3之间DLC—1基因表达差异有统计学意义(P相似文献   

肝细胞癌伴吲哚菁绿排泄障碍1例报告

吲哚菁绿(indocyanine green,ICG)清除试验能反映肝脏摄取、处理和排泄ICG的全过程,可有效评价肝储备功能,是反映肝功能储备的理想指标[1]。ICG排泄障碍的患者极为罕见,目前为止,全球文献报道只有8例,其中只有4例合并肝细胞癌。     

Metastasis of hepatocellular carcinoma to the ovary: a case report and review of the literature

Metastasis of hepatocellular carcinoma (HCC) to the ovary is notably rare. We present a case of HCC metastasis to the ovary with a review of the literature, which includes only 7 reported cases. A 43-year-old hepatitis B virus carrier was admitted with a right ovarian cystic mass. She had been diagnosed with HCC 2 years prior, for which she underwent transarterial chemoembolization followed by right posterior sectionectomy. Eight months after the hepatectomy, the first intrahepatic recurrence was detected and treated with transarterial chemoembolization. An additional intrahepatic recurrence occurred 12 months after transarterial chemoembolization and was managed with left medial sectionectomy and intra-operative radiofrequency ablation. Over the following 3 months, the patient developed elevated alpha-fetoprotein, and positron emission tomography showed a cystic mass in the right side of the pelvic cavity with focal hypermetabolic activity, which suggested a site of recurrent HCC. An exploratory laparotomy was performed, and a soft, ovoid cystic mass was identified in the right ovary. There was no evidence of metastases in the liver, left ovary, or peritoneum. Because of the absence of tumor on the surface of the ovary and the lack of peritoneal seeding, the mode of metastasis was thought to be hematogenous. Therefore, a right salphingo-oophorectomy was performed. The pathological features showed metastatic HCC with clear resection margins. Although metastasis of HCC to the ovary is very rare, it should be suspected in a female patient with a lower abdominal mass and an elevated serum AFP level in the absence of other demonstrable metastases.     

Hepatocellular carcinoma with chronic B-type hepatitis complicated by autoimmune hemolytic anemia： A case report

A 57-year-old man consulted a local hospital because of a persistent slight fever. At the age of 37 years he was diagnosed having B-type hepatitis, but left the liver dysfunction untreated. Twenty years later, he was diagnosed having chronic hepatitis B, hepatocellular carcinoma (HCC) and macrocytic anemia, and referred to our hospital for further investigation. A HCC with a maximum diameter of 5.2 cm was detected in segment 8. Results of blood tests included 1.8 mg/dL serum total bilirubin, 0.9 mg/dL bilirubin, less than 10 mg/dL haptoglobin, 7.9 g/dL hemoglobin, 130 fL MCV, and 14.5% reticulocytes. A bone marrow sample showed erythroid hyperplasia. The direct Coombs test gave a positive result. We diagnosed the anemia as autoimmmune hemolytic anemia (AIHA), for which prednisolone could not be administered due to positivity for HBsAg and HBeAg. After preparation of washed blood cells for later transfusion, the patient underwent systematic resection of segment 8. The cut surface of the resected specimen demonstrated an encapsulated yellow-brownish tumor measuring 52 mm × 40 mmwhich was diagnosed pathologicaly as moderately differentiated HCC. On the 9th postoperative day, the patient's temperature rose to 38℃, and exacerbated hemolysis was observed. The maximum total bilirubin value was 5.8 mg/dL and minimum hemoglobin level was 4.6 g/dL. He tolerated this period without blood transfusion. Currently he is being followed up as an outpatient, and shows no signs of HCC recurrence or symptoms of anemia. AIHA associated with HBV infection has been described in only three previous cases, and the present case is the first in which surgery was performed for accompanying HCC.     

Hepatocellular carcinoma and focal nodular hyperplasia associated with norethandrolone-therapy: A case report

Summary A 33-year-old woman was treated for severe aplastic anemia with norethandrolone over a period of four years, with a cumulative dose of 25 g. In the fifth year of therapy two intrahepatic tumors were detected and were classified as hepatocellular carcinoma and as focal nodular hyperplasia, respectively.     

不同转移潜能人肝癌细胞株趋化因子受体谱差异表达

目的对比观察不同转移潜能人肝癌细胞株趋化因子受体谱差异性表达。方法Pre- mier软件设计18对趋化因子受体引物,RT-PCR分析SMMC-7721、MHCC97-L、MHCC97-H和HCCLM6细胞侵袭转移潜能逐渐增强的人肝癌细胞株趋化因子受体谱。结果4组不同转移潜能细胞株趋化因子受体表达谱存在明显差异（P＜0．01）,其中CCR10、CXCR4、CXCR6表达随转移潜能增加逐渐降低。HCCLM6表达谱中CCR3、CCR4、CCR10、CCR12及XCR1比SMMC-7721表达明显降低甚至缺失（P＜0．01）,而CXCR1（P=0．006）、CXCR5（P=0．003）表达高于低转移潜能组SMMC-7721。MHCC97-H和MHCC97-L比较,除CXCR2、CXCR6、XCR1外差异均有统计学意义,其中CCR1（P=0．002）、CCR2（P=0．004）、CCR5（P=0．046）表达高于MHCC97- L。CXCR4在模板减量时只能在SMMC-7721组检测到。结论高低转移潜能肝癌细胞株趋化因子受体表达在mRNA水平存在差异性表达,与肝癌细胞株差异性转移潜能相关。     

Isolated splenic metastases from gastric carcinoma:A case report and literature review

Isolated metastases to the spleen from gastric carcinoma is very rare.Only a few cases have been reported in the literature.We herein present a case of isolated splenic metastases in a 62-year-old man,occurring 12 mo after total gastrectomy for gastric carcinoma.The patient underwent a laparoscopic exploration,during which two lesions were found at the upper pole of the spleen,without involvement of other organs.A laparoscopic splenectomy was performed.Histological examination confirmed that the splenic tumor was a poorly differentiated adenocarcinoma similar to the primary gastric lesion.The postoperative course was uneventful and the patient has been well for 9 mo,with no tumor recurrence.The clinical data of 18 cases of isolated splenic metastases from gastric carcinoma treated by splenectomy were summarized after a literature review.To our knowledge,this is the first reported case of isolated splenic metastases undergoing laparoscopic splenectomy.     

Extraskeletal myxoid chondrosarcoma metastatic to the pancreas： A case report

Extraskeletal myxoid chondrosarcoma (EMC) is a low-grade sarcoma characterized by developing metastases and local recurrence in high rate. It is mainly deep seated in the proximal extremities.The most common metastatic sites are the lungs,soft tissues,lymph nodes,bones and the brain. To our knowledge,no case of clearly defined EMC has been reported to date developing a metastasis in the pancreas.We describe a case of a man suffering from EMC who developed a single pancreatic metastasis 20 years after the initial diagnosis.A 49-year-old man was submitted to surgical excision of an EMC, in left thigh, 20 years ago. Fourteen years after the initial diagnosis a local recurrence in left thigh occurred. Multiple lesions of metastatic origin,in both lungs, were excised via thoracotomies until the time being. In 2003, as a part of a periodically performed imaging control, an abdominal CT scan was performed revealing a solid lesion in the pancreas. Distal pancreatectomy was performed. The histopathology of the excised specimen proved to be the one of metastatic lesion of EMC. The above-mentioned case of EMC is, as far as we know, the first one described developing a certain pancreatic metastasis.     

Emergency laparoscopic partial splenectomy for ruptured spleen: A case report

Splenic rupture is a common consequence of blunt abdominal trauma. Emergency splenectomy is indicated when conservative management is not effective. With better understanding of the immunologic function of the spleen, surgeons have begun to perform the splenic-preserving surgery. However, it is technical challenge to perform emergency laparoscopic partial splenectomy for patient with spleen rupture. A 15-year-old male patient suffered from grade III spleen injury basing on the American association for the surgery of trauma splenic injury scale. Conservative treatment failed to success basing on the dramatically decreased hemoglobin level. During the laparoscopic exploration, we found that two individual ruptures were associated with the upper pole of spleen. An emergency laparoscopic partial splenectomy was successfully carried out. The operative time was approximate 150 min and the estimated blood loss was 200 mL. The post-operative course was uneventful and the patient was discharged on the 7^th post-operative day.     

结直肠癌脾转移3例

目的:探讨结直肠癌脾转移的临床特征及诊治.方法:回顾分析河北医科大学附属唐山工人医院2003-2008年3例结直肠癌脾转移的临床特征、诊断、治疗及预后.结果:3例结直肠癌脾转移患者,1例结肠癌术后行PET/CT检查确诊,其余2例均诊断为脾脓肿,2例行脾切除术,1例行剖腹探查术确诊,术后2 wk死亡1例,其余2例已存活2...