甲状腺乳头状癌伴神经内分泌分化细胞的超微结构观察

目的:观察甲状腺乳头状癌伴神经内分泌分化细胞的超微结构特征.方法:对手术切除石蜡包埋的103例甲状腺乳头状癌,分别进行CgA、Syn、NSE免疫组化标记,CgA、Syn、NSE阳性的乳头状癌66例分别进行电镜观察.临床病理参数包括:乳头状癌细胞分化程度、核特征、砂粒体、年龄、肿瘤直径、淋巴结转移、包膜及周围组织侵犯.用STATA8.0医学统计软件对资料进行统计分析.结果:18.2%的甲状腺乳头状癌病例电镜下可找到神经内分泌颗粒.乳头状癌细胞分化程度及肿瘤的大小与神经内分泌分化有关(P<0.05),其余参数与神经内分泌分化无关.结论:部分甲状腺乳头状癌存在神经内分泌分化现象,伴神经内分泌分化的肿瘤组织分化较差、体积较大.     

Primary sarcomatoid carcinoma of the mandibular gingiva: clinicopathological and radiological findings

Sarcomatoid carcinoma is a rare, malignant biphasic neoplasm with an epithelial and a spindle cell component. Primary sarcomatoid carcinomas arising from mandibular gingiva are known to be extremely rare, with only one case reported to date. Herein, we discuss the radiographic and computed tomographic appearances and pathological features of primary mandibular sarcomatoid carcinoma, which was confirmed by clinicopathology, in a 72-year-old man. In addition, we present a brief review of the relevant literature.     

甲状腺系膜切除术在老年甲状腺乳头状癌病人中央区淋巴结清扫中的应用效果

目的:探讨甲状腺系膜切除术在老年甲状腺乳头状癌病人中央区淋巴结清扫中的效果.方法:甲状腺乳头状癌病人134例,随机分为观察组和对照组各67例,对照组行常规中央区淋巴结清扫,观察组行甲状腺系膜切除术清扫中央区淋巴结.术后观察2组淋巴结转移情况、呛咳、声带麻痹、手足麻木及血肿等并发症发生情况,测定术后甲状腺旁水平及血钙水平.结果:观察组淋巴结复发转移率为5.97%,对照组为16.42%,2组淋巴结复发转移率差异无统计学意义(P>0.05);观察组术后并发症总发生率为10.93%,对照组为22.39%,2组术后并发症发生率差异无统计学意义(P>0.05);与治疗前比较,2组治疗后甲状旁腺水平及血钙水平均显著降低(P<0.01),与观察组比较,对照组甲状旁腺水平及血钙水平下降更明显(P<0.01).结论:甲状腺系膜切除术在甲状腺乳头状癌者中央区淋巴清扫中应用效果良好,淋巴结复发转移率低,并发症少,无明显的甲状旁腺损伤及低血钙症,值得临床推广应用.     

趋化因子CXCL14在甲状腺乳头状癌中的表达水平及其临床意义

目的  探讨趋化因子CXCL14在甲状腺乳头状癌中的表达及其与临床病理的关系。方法  采用免疫组织化学方法、蛋白印迹法（Western blot）检测120例甲状腺乳头状癌、40例结节性甲状腺肿及40例正常甲状腺组织中CXCL14的表达水平,并分析其与甲状腺乳头状癌的临床病理特征的关系。结果  免疫组织化学结果表明,甲状腺乳头状癌组织中CXCL14蛋白阳性率（20.83%）较结节性甲状腺肿（85.00%）、正常甲状腺组织（75.00%）明显降低,差异有统计学意义（P <0.05）。Western blot结果表明,CXCL14蛋白在甲状腺乳头状癌组织中的表达量为（0.823±0.143）,明显低于结节性甲状腺肿组织（1.211±0.012）和正常甲状腺组织（1.219±0.004）,差异有统计学意义（P <0.05）。CXCL14蛋白的表达与甲状腺乳头状癌的包膜浸润、淋巴结转移、肿瘤临床分期及肿瘤分化有关（P <0.05）。CXCL14高表达组的甲状腺乳头状癌患者的生存率明显高于CXCL14低表达组（P <0.05）。结论  CXCL14蛋白的表达可能成为判断甲状腺乳头状癌恶化程度及预后的指标。

     

Hepatocellular carcinoma with colonic metastasis

Hepatocellular carcinoma with colonic metastasis is rare. It mainly occurs by direct invasion and presents with bloody stools. We describe a patient with haematogenous metastasis to the rectum who presented with tenesmus. To our knowledge, such an association has not been reported previously. Colonic metastasis should be considered when patients with hepatocellular carcinoma present with bloody stools or tenesmus.     

甲状腺乳头状癌超声表现与病理学对照分析(附35例报告)

目的 探讨甲状腺乳头状癌(papillary thyroid carcinoma,PTC)超声图像特征及其病理学基础.方法 回顾35例PTC患者术前彩色多普勒超声的二维及血流显像图表现,并与病理对照分析.结果 PTC超声图像表现为边界不清、不规则、无包膜;低回声区、可见微钙化;彩色血流丰富、形态紊乱主要位于肿块内部;颈部淋巴结内部可出现囊性变.其上述特征相应的病理基础为:癌组织无包膜、浸润性生长、间质成分少、有乳头状突起;细砂状微小钙化;颈部淋巴结内有泡沫状巨噬细胞及胶质;在间质内有密集成簇或呈岛状分布的微血管.结论 超声有助于对PTC的诊断,其典型图像特征是有病理基础可循的.     

76例淋巴细胞性甲状腺炎合并甲状腺乳头状癌临床病理分析

目的:探讨淋巴细胞性甲状腺炎合并甲状腺乳头状癌的临床病理特点。方法:对我院2004～2006年手术切除的572例淋巴细胞性甲状腺炎、甲状腺乳头状癌及淋巴细胞性甲状腺炎合并甲状腺乳头状癌的病理资料进行回顾性分析。结果:淋巴细胞性甲状腺炎、甲状腺乳头状癌及淋巴细胞性甲状腺炎合并甲状腺乳头状癌的平均发病年龄分别为45.2岁、43.3岁及39.9岁,均女性多于男性。甲状腺乳头状癌病例中有68例发生周围淋巴结转移(36%)。淋巴细胞性甲状腺炎合并甲状腺乳头状癌病例中19例发生周围淋巴结转移(25%)。淋巴细胞性甲状腺炎合并甲状腺乳头状癌的发病率占慢性淋巴细胞性甲状腺炎的19.9%,占甲状腺乳头状癌的28.6%。结论:淋巴细胞性甲状腺炎与甲状腺乳头状癌的关系密切,合并发生率较高(19.9%)。淋巴细胞性甲状腺炎合并甲状腺乳头状癌的周围淋巴结转移率(25%)低于单纯性甲状腺癌(36%)。提示淋巴细胞性.甲状腺炎合并甲状腺癌的预后要比单纯性甲状腺癌的预后好。     

Surgical management of parapharyngeal lymph node metastasis of thyroid carcinoma: a retrospective study of 25 patients

Background  Parapharyngeal lymph node (PPLN) metastasis from thyroid carcinoma is rare. We describe the clinical features, diagnosis, and surgical treatment of this condition.

Methods  Twenty-five patients with PPLN metastasis from thyroid carcinoma were treated at our institution from January 1999 to December 2010, including 22 patients with papillary carcinoma, two with medullary carcinoma, and one with follicular carcinoma. Of these, 16 had a history of surgical treatment prior to PPLN metastasis. Of the nine patients without a history of surgical treatment, five had widespread cervical lymph node metastases and four had occult papillary thyroid carcinoma. PPLN metastasis was diagnosed by enhanced computed tomography in 22 cases.

Results  Resection of metastases was performed via a transcervical approach in 23 patients and a transmandibular approach in two patients. After a median follow-up time of 31 months (range: 6–130 months), nine patients developed distant metastases, and six of these died of their disease. The 5-year survival rate was 63.8%.

Conclusions  PPLN metastasis from thyroid carcinoma may occur in patients: with previous neck dissection, with widespread metastases to cervical lymph nodes prior to initial treatment, and with occult thyroid carcinoma. Enhanced computed tomography is helpful for diagnosis in the first two presentations. Surgical resection remains the mainstay of treatment for this disease. PPLN metastasis has a tendency to be associated with distant metastases and a poor prognosis.

     

乳头状甲状腺癌TSHR基因转录表达和启动子区甲基化研究

目的观察抑癌基因促甲状腺激素受体(TSHR)在乳头状甲状腺癌(PTC组)中的表达,分析其启动子甲基化与肿瘤发生的关系。方法选择50例PTC和32例良性甲状腺肿瘤(对照组,包括20例结节性甲状腺肿,12例甲状腺腺瘤)患者,对两组患者手术获取的标本提取RNA后,反转录为cDNA,进行PCR检测TSHR基因的表达情况;运用甲基化特异性PCR(MSP)检测上述组织中TSHR基因启动子区甲基化的情况。结果PTC组患者中有34例(68%)TSHR基因启动子发生甲基化,16例(32%)TSHR基因mRNA表达缺失;对照组患者中有7例(21.9%)TSHR基因启动子发生甲基化,4例(12.5%)TSHR基因mRNA表达缺失。PTC组织TSHR基因启动子甲基化率及TSHR基因mRNA表达缺失率均显著高于对照组(χ2值分别为16.61和4.02,P<0.05)。34例发生了TSHR基因启动子甲基化的PTC患者中,有14例(41.2%)TSHR mRNA表达缺失;16例未发生甲基化的PTC患者中,2例(12.5%)发生了mRNA表达缺失,二者mRNA表达缺失率差异有统计学意义(χ2=4.11,P<0.05)。TSHR基因mRNA在...     

Upregulation of glucosylceramide synthase protein in papillary thyroid carcinoma

Background Glucosylceramide synthase （GCS） can reduce ceramide levels and help cells escape ceramide-induced apoptosis, thus leading to multidrug resistance （MDR）. However, its expression and clinical significance in thyroid neoplasms still remain unclear. We aimed to elucidate the expression of GCS and explore its correlation with the clinicopathological characteristics in papillary thyroid carcinomas （PTCs）. Methods We retrospectively investigated GCS protein expression level in tissue specimens obtained from 108 consecutive PTC patients by immunohistochemistry and Western blotting. Results GCS was weakly positive or negative in normal follicular cells, but it was frequently overexpressed in PTC cells. GCS overexpression was associated with primary tumor size, local infiltration, lymph node metastasis, and local recurrence, but not associated with gender, age, pathological variants, tumor multifocality, tumor stage or distant metastasis. Western blotting also showed that GCS protein levels were much higher in PTCs＇ tissues than in normal thyroid tissues. Conclusion GCS was upregulated in PTCs and might be an independent factor affecting prognosis.     

甲状腺乳头状癌合并桥本甲状腺炎的临床和病理特点分析

目的:总结甲状腺乳头状癌(PTC)合并桥本甲状腺炎(HT)的临床及病理特点.方法:收集43例PTC合并HT病人(观察组),并选取同期仅诊断为PTC病人45例(对照组),比较2组病人的临床及病理特点.结果:观察组病人出现甲状腺肿大以及颈部压迫症状较对照组病人明显增多(P<0.01);2组病人甲状腺肿块、颈部疼痛、声音嘶哑、吞咽困难等症状差异均无统计学意义(P>0.05);观察组女性、年龄≤44岁病人所占比例均高于对照组(P<0.05);2组病人淋巴结转移、临床分期、癌肿类型、癌灶数、预后等差异均有统计学意义(P<0.05~P<0.01).结论:与单纯PTC相比,PTC合并HT以颈部肿大或颈部压迫症状较多见,中青年及女性病人发病率高,淋巴结转移少,临床分期早,预后较好.     

肝再生磷酸酶-3在甲状腺乳头状癌中的表达及意义

目的:观察肝再生磷酸酶-3(phosphatase of regenerating liver 3,PRL-3)在甲状腺乳头状癌中的表达情况,并分析PRL-3的表达与各种临床病理特征的关系及意义?方法:应用real-time PCR及免疫组化SP法探索PRL-3 mRNA及蛋白在甲状腺乳头状癌原发灶?癌旁组织?淋巴结转移灶中的表达情况?结果:PRL-3 mRNA在原发灶及淋巴结转移灶中的表达均明显高于癌旁组织(P < 0.05),PRL-3蛋白的阳性率在原发灶及淋巴结转移灶高于癌旁组织 (P < 0.05)?原发灶组织中PRL-3的阳性率在有淋巴结转移组高于无淋巴结转移组 (P < 0.05),肿瘤直径>2 cm的阳性率高于肿瘤直径≤2 cm (P < 0.05)?结论:PRL-3与甲状腺乳头状癌的肿瘤大小及淋巴结转移密切相关?PRL-3在甲状腺乳头状癌中的高表达可以预测淋巴结转移,有望成为预测甲状腺乳头状癌淋巴结转移的分子标志物?     

Dural metastasis of nasopharyngeal carcinoma: rare,but worth considering

Metastasis of nasopharyngeal carcinoma (NPC) to the dura, an extremely rare condition, can be symptomatically silent and mistaken for a benign entity radiographically. Missed diagnosis can lead to serious consequences or prove immediately fatal. We report a woman with dural metastasis of NPC that mimicked a meningioma on radiography. Craniectomy with tumour resection was performed due to rapid progression from the onset of symptoms to disability. The patient was still alive two years after surgery. This case emphasises the need to keep in mind the possibility of dural metastasis of NPC in patients with abnormal imaging features. This would not only avoid wrong and optimistic diagnosis, but also allow for appropriate treatment in a timely manner. To our knowledge, this is the first report of metastasis of NPC to the dura. We provide detailed information on the neoplastic lesion, which masqueraded as a benign entity and caused potentially fatal consequences.     

成纤维细胞激活蛋白在甲状腺乳头状癌间质中的表达及意义

目的:探讨成纤维细胞激活蛋白(FAP)在甲状腺乳头状癌(PTC)中的表达及意义。方法:采用免疫组织化学SP法检测66例2010年1月²013年10月间收集的甲状腺乳头状癌和10例正常甲状腺中的表达情况。结果:FAP在甲状腺乳头状癌间质成纤维细胞中表达,阳性率为86.36%;而在正常甲状腺间质及PTC癌细胞中不表达。甲状腺乳头状癌间质中FAP表达与肿瘤TNM分期(χ2=20.823,P<0.01)及淋巴结转移(χ2=11.853,P<0.01)有关。结论:PTC间质中FAP的表达对PTC的侵袭、转移具有较好的预测价值。     

miR-150在甲状腺乳头状癌中的表达水平及意义

目的检测miR-150在甲状腺乳头状癌的表达,探究miR-150在甲状腺乳头状癌的早期筛查和诊断方面的作用。方法选取内蒙古医科大学附属医院甲状腺病变患者110例。采用Real-time PCR方法检测miR-150在甲状腺癌组织和非癌组织间的表达,记录患者相关的临床病理资料,比较甲状腺癌组织和非癌组织间miR-150的表达差异。结果当设置甲状腺乳头状癌组织中mi R-150表达为0.00±0.00时,结节性甲状腺肿、结节性甲状腺肿伴腺瘤样增生、结节性甲状腺肿伴慢性淋巴细胞性甲状腺炎的表达为1.88±0.48、1.50±0.35、1.37±0.34。miR-150在甲状腺乳头状癌组织中的表达明显著低于状腺非癌组织(P0.01),但在伴有淋巴结癌转移的标本中稍高于非淋巴结癌转移的标本,但未发现有统计学意义。miR-150表达的AUC为0.867,其诊断甲状腺乳头状癌的灵敏性为76.2%,特异性为76.7%。结论 miR-150结合其他的临床指标可能成为诊断甲状腺乳头状癌的一种新的肿瘤标志物,对区分甲状腺乳头状癌和结节性甲状腺肿时具有较好的诊断价值,其表达与病灶转移与否之间没有明显的相关性。     

甲状腺乳头状癌中央区淋巴结转移的危险因素分析

目的 探讨甲状腺乳头状癌（PTC）中央区淋巴结转移（CLNM）的危险因素。方法 选取 2016 年8 月—2018 年12 月在锦州医科大学附属第一医院行手术治疗的303 例PTC 患者临床资料，回顾性 分析患者性别、年龄、体重指数（BMI）、肿瘤最大直径、肿瘤数量、肿瘤位置、被膜侵犯情况、甲状腺 球蛋白抗体（TgAb）及促甲状腺激素（TSH）等因素对CLNM 的影响。结果 303 例患者中，116 例发生 CLNM，总转移率为39.27%。单因素分析结果显示，性别、年龄、BMI、肿瘤最大直径、肿瘤数量、是否 被膜侵犯及CLNM 率比较，差异有统计学意义（P <0.05）。多因素Logistic 回归分析显示，性别[Ol ^ R=0.454 （95% CI ：0.224，0.921）]、年龄[Ol ^ R=0.957（95% CI ：0.936，0.978）]、肿瘤最大直径[Ol ^ R=1.438（95% CI ： 1.117，1.852）] 及被膜侵犯[Ol ^ R=0.399（95% CI ：0.230，0.691）] 是PTC 患者发生CLNM 的危险因素。受 试者工作特征曲线显示，年龄为45.5 岁、肿瘤最大直径为0.75cm 时约登指数最大，对应的曲线下面积分别为 0.643 和0.691，敏感性分别为0.620（95% CI ：0.580，0.706）和0.695（95% CI ：0.632，0.750），特异性分别为 0.682（95% CI ：0.580，0.706）和0.720（95% CI ：0.632，0.750）。结论 PTC 发生CLNM 与多个因素有关， 当患者为男性、年龄<45.5 岁、肿瘤最大直径≥ 0.75 cm 及存在被膜侵犯时，CLNM 发生可能性大，建议行 中央区淋巴结清扫。     

临床N0期乳头状甲状腺癌中心区淋巴结处理的效果分析

目的：探讨乳头状甲状腺癌颈部中心区淋巴结处理方式及原则。方法：回顾分析江苏省肿瘤医院1998至2007年收治的112例临床N0期乳头状甲状腺癌患者的临床资料。根治原发灶的同时,分析中心区淋巴结清扫术与术后颈淋巴结转移的关系。结果：全组总的5、10年累积生存率分别为100%和98%,累积颈部复发率分别为4.46%和8.93%。临床N0期乳头状甲状腺癌行Ⅵ区淋巴结摘除者65例,其中有22例淋巴结阳性,单纯腺叶切除术及腺叶切除＋Ⅵ区肿大淋巴结摘除术两种术式在随访中的颈淋巴结发生率无显著性差异。结论：临床N0期乳头状甲状腺癌5、10年累积生存率无差别,原发灶肿瘤无包膜以及多发病灶对中心区淋巴结转移有显著影响。Ⅵ区淋巴结转移率较高,应同时完成患侧腺叶切除＋Ⅵ区淋巴结清扫术,可减少颈淋巴结转移的发生。     

低氧诱导金属硫蛋白对甲状腺乳头状癌上皮间质转化的影响

目的 研究低氧诱导金属硫蛋白(metallothioneins,MTs)对甲状腺乳头状癌(papillary thyroid carcinoma,PTC)上皮间质转化(epithelial-mesenchymal transition,EMT)的影响.方法 以人甲状腺乳头状癌NPA细胞为研究模型,将其分为正常氧组(21%O2)、低氧组(5%O2)和MTs-siRNA干扰低氧组,Western blot、RT-PCR方法检测各组细胞MTs、上皮细胞钙粘蛋白(E-cadherin)和间质细胞波形蛋白(Vimentin)的表达,Transwell/Matrigel方法检测各组细胞侵袭转移细胞数.结果 低氧可诱导NPA细胞表达MTs,并伴随有EMT标志性分子E-cadherin表达的下调和Vimentin表达的升高,侵袭细胞数由正常氧组15.6±2.8增加到40.3±5.1,迁移细胞数由25.1±5.6增加到48.7±7.6,均有统计学差异(P<0.01);MTs靶向干扰可有效抑制低氧诱导的MTs蛋白表达,同时E-cadherin表达回升,Vimentin表达下降,侵袭细胞数仅增加到25.7±4.2,迁移细胞数仅增加到35.5±5.4,与低氧组比较均有统计学差异(P<0.05).结论 低氧所诱导表达的MTs对人PTC细胞发生EMT有促进作用,MTs靶向干扰可使EMT受到部分抑制.     

Unsuspected colorectal carcinoma on routine abdominopelvic computed tomography

Colorectal carcinoma is a common lethal disease with signs and symptoms that may be nonspecific. Computed tomography (CT) of the abdomen and pelvis with or without contrast is frequently performed for various general abdominal complaints, but unlike CT colonography, the large bowel may not be optimally prepared for evaluation. As such, careful and diligent assessment of the non-prepared colon in all CT images of the abdomen and pelvis is important, as it ensures that incidental colorectal malignancy is not missed, especially in older patients. This article gives an overview of multidetector CT imaging signs and subtle clues to aid in the diagnosis of colorectal carcinoma, as well as their pitfalls.     

甲状腺乳头状癌中央区淋巴结清扫的临床意义

[目的]探讨甲状腺乳头状癌行中央区淋巴结清扫的临床意义.[方法]2007年3月-2010年2月间行手术治疗的61例甲状腺乳头状癌患者中,因颈前区无痛性包块入院36例,颈淋巴结肿大入院5例,声音嘶哑就诊2例,体检发现甲状腺结节18例.行患侧叶、峡部全切、对侧叶大部切除术46例,甲状腺全切除术15例.传统根治性颈淋巴结清扫...