Genitourinary small-cell carcinoma: a single-institution experience

Background

Small-cell carcinomas (sccs) of the genitourinary (gu) tract are rare systemic diseases, and there is no standard treatment strategy for patients with this malignancy. The objectives of the present study were to report the management and outcome of patients with scc of the gu tract treated at a tertiary-care institution from 1982 to 2009.

Methods

In a chart review of all patients diagnosed with scc of the gu tract between 1982 and 2009, data on demographics, clinical and pathologic characteristics, treatment, and patient outcomes were collected.

Results

The 58 patients identified had scc in the following primary sites: urinary bladder (n = 35), prostate (n = 17), and upper urinary tract (n = 6). In 38 patients (66%), the scc was of pure histology; in the remainder, histology was mixed. Overall, 28 patients had limited-stage disease; 24 had extensive-stage disease; and staging was unknown in 6 patients. Median survival for the entire cohort was 7.5 months, with extensive-stage disease being identified as a poor prognostic factor (survival was 22.0 months for limited-stage patients and 4.1 months for extensive-stage patients, p < 0.001). Based on site, prostate patients fared worst, with a median survival of only 5.1 months. Compared with best supportive care, treatment was associated with better outcomes (median survival: 12.3 months vs. 2.3 months, p < 0.0001).

Conclusions

Small-cell cancer of the gu tract is an aggressive cancer, with a poor prognosis overall. Although there is no standard of care, patients should be treated using a multimodality approach analogous to that used in the treatment of small-cell lung cancer.     

Prognostic factors in invasive gallbladder carcinoma

The medical records of 52 patients from the University of Wisconsin Hospital and Clinics with carcinoma of the gallbladder were examined retrospectively. The cases were reviewed for factors in their medical history, presenting physical examination, laboratory data, therapy, pathological grade, and histology that might effect median survival. Only a prior complaint of anorexia, an elevated lactic dehydrogenase (LDH), or advanced pathologic stage at time of diagnosis provided significant prognostic information. Combining pathologic stage and histologic grade additively provided the most significant prognostic information [1]. Division of gallbladder carcinoma patients in future clinical trials by this combined (stage and grade) stratification scheme may prove helpful in assessing the efficacy of new therapies. The knowledge that anorexia and elevated LDH are poor prognostic findings may assist physicians in counseling patients with this malignancy.     

原发性胆囊癌的诊断分析

目的通过对36例原发性胆囊癌的诊断分析提高该病的诊断水平。方法对我院1990年1月~2004年7月间收治的36例原发性胆囊癌的诊断进行回顾性分析。结果36例原发性胆囊癌中,22例(61.11%)有胆道疾病史,术前诊断胆囊癌26例,占72.22%,B超、CT及MRI术前诊断率分别为69.44%、76.47%和85.00%。结论提高对原发性胆囊癌的认识,联合运用BUS、CT等检测手段可明显提高本病的早期诊断;加强对高危人群定期监测随访,是预防胆囊癌的关键。     

Primary carcinoma of the gallbladder in Taiwan

To define more precisely the prognostic index for patients with primary carcinoma of the gallbladder in Taiwan, we retrospectively reviewed the data of 74 patients with gallbladder carcinoma treated over a period of 15 years, from 1979 to 1993. Of these patients, 75% had Nevin stage V gallbladder cancer. The most common presenting complaint was abdominal pain, followed by jaundice, fever, and nausea and vomiting. Accurate preoperative diagnosis was made in 29.7% of the patients. Ultrasonography and computed tomography had a diagnostic accuracy of 34.0% and 40.9%, respectively. The most common histologic type was adenocarcinoma. Liver was the organ most commonly invaded (51.9%) by direct extension and/or metastases, followed by regional lymph nodes (38.5%). The overall 5-year survival rate was 4.1%. Age, sex, white cell count, hemoglobulin, SGOT, SGPT, total bilirubin, alkaline phosphatase, and cholelithiasis were not significant prognostic factors. Patients with cancers confined in the gallbladder wall (stages I, II, III) had a better (P < 0.05) cumulative survival rate than did those with regional lymph nodes and distant metastases. Cholecystectomy or extended surgery had a better survival rate than did palliative surgery, but there was no significant difference between cholecystectomy and extended surgery. High index of suspicion of the disease and earlier surgical treatment may improve patient survival. © 1996 Wiley-Liss, Inc.     

Primary carcinoma of the gall bladder: a review of a 16-year period at the University Hospital

A review of the most relevant clinical data of patients with primary carcinoma of the gall bladder referred to our hospital over a 16-year-period has indicated that this is the third most common and aggressive cancer of the gastrointestinal tract. The disease occurs predominantly in elderly females who often present with extremes of clinical symptoms indicating benign biliary disease on the one hand and incurable malignant disease on the other. Laboratory and roentgenographic data tend to confirm the clinical diagnosis of this almost entirely incurable disease. The overall 5-year survival of the patients with primary carcinoma of the gall bladder is less than 1%; a majority of the patients are dead in less than 6 months.     

Small cell carcinoma of the gallbladder: Report of two cases

Two Taiwanese patients with gallbladder small cell carcinoma are reported. One is a 79 year-old male, the other, a 86 year-old female. They both presented with the symptom/signs of acute cholecystitis and underwent cholecystectomy. An intramural mass in the gallbladder neck region was found in the first patient, while the second patient had a transmural indurated tumor in the gallbladder body with extension to the neck region. Characteristic histological and immunohistochemical features of small cell carcinoma were present in both, and electron dense neurosecretory granules were identified in the second. To our knowledge, the second patient is the oldest ever reported. The first patient received chemotherapy directed toward the initial erroneous diagnosis of non-Hodgkin s lymphoma and developed liver metastasis in two months. The second patient did not receive chemotherapy due to her poor general condition and local recurrence occurred in six weeks. Both passed away three and five months after surgery, respectively.     

Adenosquamous/squamous cell carcinoma of the gallbladder

BACKGROUND AND OBJECTIVES: Adenosquamous/squamous cell carcinoma is a rare histopathologic subtype of gallbladder malignancy. Its clinical features have rarely been described, and its differences from the major histopathologic subtype, adenocarcinoma, remain uncertain. METHODS: All patients with gallbladder carcinoma were retrospectively reviewed. Patients with a histopathologic subtype of either adenosquamous (n = 12) or squamous cell (n = 2) carcinoma were categorized to group I, and patients with adenocarcinoma were categorized to group II. The clinical characteristics and outcomes of these two groups were compared. RESULTS: The two groups were generally no different in clinical features. However, tumor stages of group I patients were significantly advanced (P = 0.048) and included liver involvement (P = 0.008). The outcomes of advanced-stage patients in group II were not different from group I (P = 0.413). Nevertheless, patients in both groups with advanced stage pT who had undergone curative resection showed significantly better survival curves than patients who had undergone non-curative resection (P = 0.003). CONCLUSIONS: Patients with adenosquamous/squamous cell carcinoma of the gallbladder were generally similar to those with adenocarcinoma in clinical characteristics, but had a tendency for liver infiltration. Although the two histopathologic subtypes of the gallbladder carcinoma had similar poor outcomes, better survival could be obtained by performing curative resection for these patients.     

Coexistent gallbladder carcinoma in Mirizzi syndrome

A 52‐year‐old woman presented with right upper quadrant pain and obstructive jaundice. Computed tomographic scan showed Mirizzi syndrome type 1 and a thickened and calcified gallbladder wall, raising the possibility of coexistent gallbladder carcinoma that was later confirmed on histology post‐cholecystectomy.     

化生在胆囊癌组织发生中的意义

 我们应用组织化学和免疫组织化学技术对134例胆囊良恶性病变的各类化生及其化生与胆囊癌的关系进行研究。结果发现，胆囊粘膜上皮异型增生均发生在化生区内，且多数发生在肠上皮化生区内。癌旁组织与异型增生的化生改变相似。65.1%的胆囊癌可见化生改变，分化好的胆囊癌化生出现率高于分化差的胆囊癌(P<0.01)。我们认为胆囊粘膜上皮化生与胆囊癌的组织发生有重要关系，且肠上皮化生尤为重要。     

根治性切除及单纯胆囊切除对Ⅱ期胆囊癌疗效的Meta分析

目的运用Meta分析软件评价胆囊癌根治手术及单纯胆囊切除治疗Ⅱ期胆囊癌的远期疗效。方法通过Pubmed、WOS、万方、维普、中国生物文摘书库检索自1990年1月至2011年12月相关文献,Jadad质量评分评估文献所涉及研究的质量,治疗组为胆囊癌根治术后患者生存人数,对照组为单纯胆囊癌切除术后患者的生存人数,运用Meta分析评估两组患者1、3、5年的生存差异。结果10篇文献入选病例数共279例,其中根治组146例,单纯切除组133例。Meta分析结果显示：1年生存[OR=3．900,CI=（1．160,13．140）,P=0．030],3年生存[OR=2．780,CI=（1．060,7．310）,P=0．040],5年生存[OR=3．160,CI：（1．130,8．870）,P=0．030],两组差异均有统计学意义。结论同单纯胆囊切除术相比,根治性切除术可提高Ⅱ期胆囊癌术后的1、3、5年生存率。     

原发性胆囊癌误诊分析

目的分析原发性胆囊癌误诊原因,探索有效的预防措施。方法我院1995年1月至2006年5月共收治原发性胆囊癌患者46例,对其临床资料进行回顾性分析。结果术前明确诊断14例(占30.4%)。误诊32例(占69.6%),术中误诊6例(占13.0%)。合并胆囊结石者18例(占39.1%),胆囊息肉样病变8例(占17.4%)。术前诊断为胆囊结石、胆囊炎21例(占45.7%)。超声检查阳性率43.5%,CT检查阳性率66.7%,螺旋CT增强检查阳性率83.3%。结论误诊原因并发胆囊其它疾病;缺乏特异性临床表现,对发病情况认识不足;过分依赖影像学检查;术中对可疑病灶未做冰冻病理检查。预防措施熟悉胆囊癌的临床特点;可疑病例术前需完善检查;积极手术治疗癌前病变;术中可疑病灶应做冰冻病理检查。     

热休克蛋白（HSP70）在胆囊癌中的表达及其意义

目的探讨热休克蛋白（HSP70）与胆囊癌的发生及发展的关系。方法用免疫组化S P法检测45例胆囊癌中热休克蛋白的表达情况,并与41例慢性胆囊炎标本做对照。结果热休克蛋白（HSP70）在胆囊癌中普遍呈现高表达,而在慢性胆囊炎组织中不同程度地呈现弱表达;HSP70在胆囊癌组织中的表达明显高于慢性胆囊炎组（P〈0．01）,且强阳性表达高于后者（P〈0．01）。结论胆囊癌是HSP70高表达肿瘤,HSP70在原发性胆囊癌中普遍高表达,提示与胆囊癌的发生发展有关。     

原发性胆囊癌的超声诊断价值

目的　探讨原发性胆囊癌 (PCG)的术前诊断。方法　对近 6年来 2 4例经手术、病理证实为PCG的临床表现和超声图象特征进行回顾性分析。结果　 (1)、2 4例中 ,男 6例 ,女 18例 ,5 5岁以上者占 91.7%。 (2 )、主要临床表现为上腹痛 (91.7% )和黄疸 (4 5 .8% )。 (3 )、声像图显示胆囊壁不均匀性增厚 15例 (62 .5 % ) ,B超诊断符合率 5 8.3 %。结论　我们应重视 5 5岁以上腹痛、黄疸患者的临床表现和胆囊壁不均匀性增厚。超声对PCG术前诊断有一定的价值。     

抑癌基因PTEN蛋白在胆囊癌中的表达及临床病理意义

目的:研究抑癌基因PTEN蛋白在胆囊癌组织中的表达及临床病理意义。方法:应用免疫组化检测PTEN在20例慢性胆囊炎,30例胆囊癌中的表达,并结合临床病理资料进行分析。结果:PTEN蛋白在20例胆囊炎中全都呈阳性表达,而癌组织中PTEN的表达率为70.0%,癌组织中PTEN蛋白阳性表达与患者性别及年龄无明显相关性,但与组织分化程度明显相关。结论:PTEN蛋白在胆囊癌组织中阳性表达率降低,说明该基因表达下调可能在胆囊癌的发生发展中起重要作用。     

乙酰肝素酶在胆囊癌中的表达及临床意义

目的：探讨乙酰肝素酶（heparanase,Hpa）在胆囊癌中的表达及对预后的影响。方法：用免疫组化方法检测38例手术切除的胆囊癌标本中Hpa的表达,并分析其与临床病理特征的关系。结果：Hpa在胆囊癌,癌旁组织以及正常胆囊黏膜组织中表达率分别为63．2％,23．6％和0（P〉0．05）。单因素分析显示Hpa的表达增高与肿瘤分期晚（P=0．007）,淋巴结转移（P=0．040）以及肿瘤浸润深度（P=0．016）密切相关。高表达Hpa的患者3年生存率较低表达患者明显降低（20．8％VS50．0％,P=0．001）。多因素分析显示Hpa的表达不是胆囊癌预后的独立因素（P〉0．05）。结论：Hpa在胆囊癌中表达增高,并与患者预后呈负相关。Hpa的表达增高可以部分解释胆囊癌富于浸润和转移的生物学行为。     

超声和CT对胆囊癌的诊断价值

目的评价超声和CT对原发性胆囊癌的诊断价值。方法回顾性分析了155例经手术证实的胆囊癌的超声和CT检查资料,对超声和CT征象进行归纳总结。结果术前133例行B超检查,诊断符合率为57.9%(77/133);89例行CT检查,诊断符合率为70.8%(63/89)。结论超声和CT对胆囊癌的诊断有一定价值。疑似胆囊癌或进行胆囊癌临床分期时,CT较超声价值更大。     

Extrapulmonary small-cell carcinoma: a single-institution experience

BACKGROUND: Extrapulmonary small-cell carcinoma (EPSCC) has been recognized as a clinicopathological entity distinct from small-cell carcinoma (SCC) of the lung. This study aimed to review the clinical features, therapy and natural course of patients with EPSCC in Oriental single-institution series. METHODS: We retrospectively reviewed the medical records of patients with SCC between September 1995 and December 2002. Study eligibility required that patients had pathologically proven SCC in sites other than lung and normal radiological findings of the chest and normal sputum cytology or negative bronchoscopic findings. RESULTS: Twenty-four patients with EPSCC were identified and primary sites were various: uterine cervix in seven (29%), urinary bladder in five, colon or rectum in three, kidney in two and stomach, esophagus, pancreas, common bile duct, larynx, parotid gland, thymus in one each. Sixteen patients (66.7%) had limited disease (LD) and eight had extensive disease (ED). Patients with ED received mostly platinum-based chemotherapy, for which the response rate was 57%, but showed an aggressive natural history, with median overall survival (OS) of 9.2 months. Patients with LD were treated with a variety of therapeutic modalities. LD SCC of the cervix showed a favorable clinical course, with five patients being disease-free with a median follow-up of 28.4 months. Patients with LD SCC of sites other than cervix had an aggressive course with a median OS of 9.6 months. CONCLUSION: EPSCC was identified in various sites, with the most common primary site being the uterine cervix. Regardless of the primary site or disease stage, EPSCC of sites other than cervix was usually a fatal disease with a discouraging outcome for various treatment modalities.     

Lipid peroxidation product in bile from patients with carcinoma of the gallbladder: A preliminary study

Samples of gall bladder bile from patients with and without carcinoma of the gallbladder were examined for lipid peroxidation (free radical oxidation) products. 4-hydroxynonenal (HNE) was found in higher concentration in the bile of patients with carcinoma of the gall bladder. There was also a highly significant difference in the concentration of HNE among carcinoma of the gall bladder, cholelithiasis and control group of patients with miscellaneous abdominal disorders. This is the first study of lipid peroxidation in carcinoma of the gall bladder. © 1994 Wiley-Liss, Inc.