Adenocarcinoma of the pancreas

Infiltrating ductal adenocarcinoma of the pancreas is a real enigma. On one hand, it is one of the most deadly of all of the solid malignancies. On the other hand, the neoplastic glands can be remarkably well-differentiated, and it can be difficult to distinguish between a reactive non-neoplastic gland and a gland of invasive adenocarcinoma. In this review, we will present diagnostic criteria that one can “hang your hat on” when establishing the diagnosis of infiltrating ductal adenocarcinoma of the pancreas. We will also review clinically important features of the disease, and, with the impending incorporation of molecular genetics into everyday practice, we will emphasize clinical applications of cancer genetics.     

胰腺囊实性肿瘤八例临床病理学观察

目的 观察胰腺囊实性肿瘤的临床病理特点,分析其分化表型,探讨其组织发生。方法 组织学、免疫组化和电镜技术。结果 ８例患者均为女性,年龄１４￣３３岁,平均２５．３岁,手术后均无复发。肿瘤较大,有包膜,由实性肿瘤与囊性坏死区混合组成。组织学上,肿瘤细胞较一致,均由实性片块、假乳头样及两者的过渡型生长方式组成。瘤细胞退变、出血、泡沫细胞和胆固醇裂隙常见。免疫组化：８例均表达α－１－抗胰蛋白酶和溶菌酶,６     

Mucinous adenocarcinoma of posterior urethra. Report of a case

Primary carcinoma of the male urethra accounts for less than 1% of malignancies in males. Mucinous adenocarcinoma of the urethra is extremely rare, and its biologic behavior is not well known. We report a case of mucinous adenocarcinoma showing the histologic features of colloid adenocarcinoma that appears to have evolved either by neoplastic degeneration of goblet cells found in the urethral epithelium or by malignant degeneration of persistent glandular elements of uretheritis cystica and glandularis.     

胰腺癌组织中内分泌细胞及其意义研究

４２例胰腺癌嗜银和亲银染色发现１９例４５．２％含内分泌细胞（ＥＣ），其中ＥＣ阳性率≥５０％４例；高分化腺癌ＥＣ阳性率（５／２０例，２５％）低于中、低分化腺癌（１２／１９例，６３．２％）和粘液癌（２／２例，１００％），组织学分级Ｉ级病例ＥＣ阳性率（５／１８例，２７．８％）低于Ⅲ级病例（７／８例，８７．５％）；ＥＣ阳性病例间质肥大细胞数明显高于ＥＣ阴性病例；发生转移病例ＥＣ阳性率（８／１４例，５７．１     

Mucinous (so-called colloid) carcinomas of lung.

We present 24 cases of primary mucinous (so-called colloid) carcinomas of the lung. The patients were between 33 and 81 yr old (median: 57 yr), including 15 men and nine women. The lesions were discovered incidentally on chest X-ray, where they presented in diverse forms. No predilection for a particular lobe or pulmonary segment was observed. The tumors varied from 0.5 to 10 cm in greatest diameter. Grossly, the tumors were poorly circumscribed, soft, tan-to-gray mucoid lesions. Microscopically, they showed intra-alveolar pools of mucin containing small clusters of atypical cells floating in the mucin, and foci of neoplastic columnar epithelium lining scattered alveoli. Seven cases showed areas of solid, well-differentiated malignant glands adjacent to pools of mucin. In two cases, lymph node metastases were found at surgery. Eleven (57%) of 19 patients were alive over a follow-up period ranging from 2 to 192 mo; one of them had metastases to bone and another had intrapulmonary recurrence. Eight patients died with/of their tumors, two of them with known metastases to bone and/or brain, and one with recurrence after 2 yr of initial diagnosis. No follow-up was obtained in five patients. Although the extent of clinical evaluation varied, no other primary neoplasms (i.e., breast, gastrointestinal tract, or other organs where primary mucinous carcinomas are known to occur) were observed. These tumors probably represent a variant of bronchioloalveolar carcinoma and share the prognosis of that neoplasm. However, because of their often bland cytologic features and paucity of malignant cells, they may be difficult to diagnose as neoplasms.     

Differential expression of CD44v6 in adenocarcinoma of the pancreas: an immunohistochemical study

Alternative splicing gives rise to numerous CD44 isoforms, some of which seem to have a role in tumour metastasis. Specifically, a variant form of CD44 with sequences encoded by exon v6 (CD44v6) confers metastatic potential when transfected into a nonmetastasizing cell line of rat pancreatic adenocarcinoma. This study has investigated standard CD44 (CD44s) and CD44v6 expression immunohistochemically in 6 samples of normal pancreatic tissue, 4 of tissue affected by chronic pancreatitis, and 24 of tissue from metastasizing and nonmetastasizing pancreatic adenocarcinomas. In addition, 18 samples from lymph node or visceral metastases were included in the study. CD44s was expressed in nonneoplastic tissue and in tissue from pancreatic adenocarcinomas. In contrast, CD44v6 was not detected in any of the normal tissue or chronic pancreatitis specimens, whereas 54% of pancreatic adenocarcinomas and 55% of metastases expressed this variant exon. Although it is not clear whether CD44 isoforms containing exon v6 play a part in malignant progression in the human exocrine pancreas, it seems plausible that the expression of multiple isoforms containing this and other variant exon confers a selective advantage on pancreatic adenocarcinoma.     

阑尾杯状细胞腺癌临床病理学观察

目的探讨阑尾杯状细胞腺癌(goblet cell adenocarcinomas,GCA)的临床病理学特征及免疫表型特征,分析其生物学行为。方法收集北京大学第一医院2015—2018年诊断的7例GCA的临床资料,进行形态学观察,按照2019年WHO消化系统肿瘤分类第5版重新分级,并行免疫组织化学EnVision法染色及电镜观察,随访患者并复习相关文献。结果7例患者中男性2例,女性5例;年龄48~72岁,中位年龄58岁。1例为阑尾游离端出现局限性肿物,切面灰白实性,质地中等;其余6例阑尾弥漫增粗;镜下观察均可见低级别GCA,5例同时伴有高级别GCA,3例分级为1级,3例分级为2级及1例分级为3级。6例可见神经侵犯,1例可见脉管癌栓。免疫组织化学染色嗜铬粒素A、突触素、CD56、广谱细胞角蛋白、癌胚抗原、细胞角蛋白20、MLH1、MSH2、MSH6和PMS2均阳性,Ki-67阳性指数5%~50%,p53在高级别GCA的表达强度及阳性细胞数高于低级别GCA。随访14~46个月,6例患者生存,1例患者死亡。结论GCA为阑尾较少见的肿瘤,同时具有神经内分泌及腺上皮的分化,生物学行为从惰性到高度侵袭性均可。     

表达反义细胞周期蛋白cyclinD1载体对胰腺癌细胞生长和凋亡的影响

目的观察反义细胞周期蛋白ｃｙｃｌｉｎＤ１对胰腺癌细胞生长的影响。方法采用Ｓｏｕｔｈｅｒｎｂｌｏｔ和Ｎｏｒｔｈｅｒｎｂｌｏｔ方法检测了５株人胰腺癌细胞系中ｃｙｃｌｉｎＤ１的扩增及表达情况，发现ＰＣ７细胞中基因有扩增及过度表达。我们构建了反义（ＡＳ）ｃｙｃｌｉｎＤ１的表达载体，采用ｌｉｐｏｆｅｃｔｉｎ转染方法转染ＰＣ７细胞，获得转化细胞系ＰＣ７／ＡＳｃｙｃｌｉｎＤ１。经Ｎｏｒｔｈｅｒｎｂｌｏｔ、Ｗｅｓｔｅｒｎｂｌｏｔ检测转化细胞系，表明有外源反义ｃｙｃｌｉｎＤ１的表达，而内源性ｃｙｃｌｉｎＤ１ｍＲＮＡ表达及蛋白合成下调，并进行了细胞凋亡分析。结果转化细胞系细胞恶性生物学行为及表型部分逆转，细胞生长速度、ＤＮＡ合成及细胞增殖和代谢能力均明显下降，软琼脂集落形成能力减低。流式细胞术分析发现细胞被阻滞于Ｇ１期，ＤＮＡ凝胶电泳、原位凋亡检测发现凋亡细胞增多。结论通过反义ＲＮＡ技术，下调在细胞周期调控中起重要作用的ｃｙｃｌｉｎＤ１的表达，可使胰腺癌细胞恶性表型部分逆转。     

胰母细胞瘤的临床及病理学观察

目的 探讨胰母细胞瘤的临床病理、免疫组化特点和组织起源。方法 对１４例胰母细胞瘤患儿（男９例,女５例,年龄１．５￣８岁）,用ＨＥ、过碘酸雪夫（ＰＡＳ）、粘液卡红染色和免疫组化ＬＳＡＢ方法进行观察。