胰腺转移性肾透明细胞癌的临床病理特征和预后分析

目的探讨胰腺转移性肾透明细胞癌患者的临床病理特征和预后。方法回顾性分析2000年1月至2018年12月在北京协和医院收治的经病理确诊的18例胰腺转移性肾透明细胞癌患者的临床病理资料。结果18例患者中,男11例,女7例;确诊肾透明细胞癌的平均年龄为51.4岁。其中左肾8例(44.4%),右肾10例(55.6%);同时性转移3例,异时性转移15例,从确诊肾透明细胞癌到发现胰腺转移的中位发生转移的时间为156个月,主要临床表现有腹痛、黄疸、消化道出血、恶心、乏力、体重下降等。其中胰腺单病灶患者7例(38.9%),多病灶患者11例(66.1%),9例患者(50.0%)除胰腺外还同时存在其他部位转移。5例患者行胰腺转移灶切除,15例患者服用靶向药物治疗。随访时间1~361.5个月,平均随访时间为171.7个月,死亡5例,生存13例,中位生存时间为122个月,5年生存率为81.4%。是否为同时性转移、是否为10年后复发、纪念斯隆-凯特琳癌症中心模型预后评分以及国际转移性肾细胞癌联合数据库评分是影响胰腺转移性肾透明细胞癌患者预后的因素。结论胰腺转移性肾透明细胞癌罕见,但预后较好,尤其是10年后复发转移至胰腺的患者,行手术切除胰腺转移灶未发现明显的生存获益。     

Metastatic renal clear cell carcinoma in the parotid gland: A study of immunohistochemical profile and cell adhesion molecules (CAMs) expression in two cases

Metastasis of renal cell carcinoma (RCC) may involve any organ, including the parotid salivary gland. While the definition of salivary gland neoplasms with clear cell transformation can be concluded by the synchronous presence of areas showing typical morphology, sometimes the definition of a metastatic RCC in the parotid is difficult and the application of immunohistochemistry may support the clinical and radiographic observations in the final diagnosis. The aim of this paper was to describe the heterogeneous immunohistochemical features and, furthermore, to characterize the pattern of expression of cell adhesion molecules (CAMs) E-cadherin, β4-integrin, desmoglein-2, ICAM-1 and CD44s (HCAM) in two cases of metastatic parotid RCC.     

Multilocular Cystic Renal Cell Carcinoma：A Series of 8 Cases and Review of the Literature

OBJECTIVE To study the clinical, pathologic and imaging features of multilocular cystic renal cell carcinoma （MCRCC） and to review the diagnosis and treatment of this subtype of renal cell carcinoma （RCC）. METHODS The data from 8 cases （mean age, 49.4; 5 men and 3 women） who had been treated from 2004 to 2006, were reviewed retrospectively. Radiologic and pathologic documents were evaluated. For treatments, radical nephrectomy was conducted in 4 patients, partial nephrectomy in 2 and laparoscopic nephrectomy in 2. RESULTS Postoperative pathological findings confirmed the diagnosis of MCRCC. The stage of all 8 cases was pT1. For pathologic grade, 7 cases were G1 and 1 case was G2. Seven patients available for follow-up had survived tumor-free during the mean time of 8 months. CONCLUSION MCRCC is an uncommon subtype of RCC, it has a lower malignant potential and a better prognosis compared with other types of RCC. Nephron-sparing surgery may be an appropriate treatment options for MCRCC.     

Two cases of malignant thymoma presenting as an anterior neck mass and misdiagnosed as thyroid carcinoma

Two cases of malignant thymoma presenting as an anterior neck mass are reported. Both tumors were initially diagnosed as thyroid carcinoma. The lesions were not ectopic thymomas and had invaded the thyroid gland from the mediastinum. Careful preoperative examination is important to distinguish thyroid cancer from invasive thymoma. Received: December 17, 1997 / Accepted: October 15, 1998     

Evaluation and management of thyroid incidentalomas detected prior to the parathyroid surgery

Background

We investigated the management of thyroid incidentalomas associated with cases of parathyroid lesions in order to suggest a practical approach to their management from a surgical point of view.

原发性甲状腺鳞状细胞癌2例病例报道并文献复习

原发性甲状腺鳞状细胞癌是一种临床罕见的甲状腺恶性肿瘤,其恶性程度高,侵袭力强,临床上早期诊断困难,根治手术难度较大,预后极差,中位生存期约6个月。治疗上以手术为主。对于不能行手术治疗的患者,可行放射治疗,放射治疗在一定程度上可提高局控率,化疗方面没有显示明显的优势。     

北京城区女性乳腺癌发病死亡和生存情况20年监测分析

目的 探讨北京城区乳腺癌发病率、死亡率及生存率的变化特点,为乳腺癌的预防与控制提供依据。方法 利用1982-2001年北京城区肿瘤登记报告资料,并结合1982年1月1日至1983年12月30日和1987年1月1日至1988年12月30日两个时期新发病例的随访资料,对北京城区女性乳腺癌的发病率、死亡率、生存率进行比较分析。结果 1982-2001年北京城区女性乳腺癌发病率及世界标准人口标化率呈逐年上升趋势,平均每年递增4．6％和4．9％。其流行特征：（1）年龄别发病率呈现一条由低到高的双峰曲线;（2）20年间各年龄组发病率均呈增高趋势;（3）35～64岁截缩发病率高达95．3／10万;（4）1982-1983年和1987-1988年两个时期相比,5年观察生存率（OSR）从62．0％上升到68．7％,相对生存率（RSR）由66．3％增长到74．2％;（5）20年间,死亡率一直在8／10万～10／10万的水平上波动。结论 北京城区女性乳腺癌发病率呈逐年上升的流行趋势,死亡率呈平稳状态,5年生存率在不断提高。北京市乳腺癌的二级预防是有效果的。     

甲状腺癌术中喉返神经损伤因素及预防措施

目的:探讨喉返神经损伤在甲状腺癌手术中的发生原因及预防措施。方法:收集本科2009年1月至2013年1月收治的126例甲状腺癌患者的临床资料,分析喉返神经术中损伤的主要原因、预防措施及损伤后补救措施。结果:126例甲状腺癌患者中,喉返神经总损伤率为4.0%（5例）,其中永久性损伤2例（1.6%）,暂时性损伤3例（2.4%）。术后纤维喉镜检查均显示单侧声带运动障碍,经扩血管、营养神经、维生素药物等治疗后,3例术后6月内声带运动障碍消失,而2例术后随访1年未见功能恢复。结论:甲状腺癌术后喉返神经的损伤与癌肿在环甲关节区域侵及的范围、手术方式相关。术者的临床经验、术中与家属沟通后的手术方式选择及手术精细技巧对喉返神经的保护具有重要意义。     

Long survival in an untreated solitary choroid plexus metastasis from renal cell carcinoma: case report and review of the literature

Brain metastases from renal cell carcinoma (RCC) are rare. Among them, the metastases localized only in the choroid plexus are exceptional and only six cases are reported in the literature. Here we report on a patient with a single choroid plexus metastasis from RCC which presented an unusual biological behaviour. For several years, such metastasis was interpreted as a benign intraventricular tumor and was not treated. Four years after the initial neuroradiological evidence, because of the appearance of symptoms, the brain metastasis was excised. We think that this unusual biological behaviour of the tumor determined the late inset of the neurological symptoms, despite the location at the choroid plexus that usually leads to an early obstructive hydrocephalus. To our knowledge, this 46months survival is the longest survival of a patient affected by a single choroid plexus metastasis from RCC.     

Progression-free survival and overall survival of patients with clear cell carcinoma of the ovary treated with paclitaxel-carboplatin or irinotecan-cisplatin: retrospective analysis

Background Irinotecan hydrochloride, a topoisomerase I inhibitor, has been preliminarily recognized as an effective agent against clear cell carcinoma of the ovary (CCC), but there are few clinical data. Our aim was to compare progression-free survival (PFS) between patients treated with irinotecan hydrochloride and cisplatin (CPT-P) and those with treated with paclitaxel and carboplatin (TC). Methods One hundred and seventeen patients at International Federation of Gynecology and Obstetrics (FIGO) stages Ic (ascites/malignant washing) – IV were identified by scanning the medical records of ten Japanese hospitals. After complete surgical staging procedures including lymphadenectomy, 35 patients received CPT-P and 82 patients received TC. The PFS and overall survival of the two groups were compared using the Kaplan-Meier method. Results There was no significant difference in median age, performance status, FIGO stage, rate of optimal cytoreduction, or follow-up period between the CPT-P and TC groups. Two-year and 5-year PFS was 48% and 40%, respectively, in the TC group and 55% and 55%, respectively, in the CPT-P group (P = 0.31). Multiple regression analysis revealed that only residual tumor was an independent prognostic factor for PFS (P < 0.01). Conclusion CPT-P showed a potential therapeutic effect, at least no less than that of TC therapy. Although there was no significant survival benefit in the present retrospective analysis, we recommend that the CPT-P regimen be evaluated in a larger, prospective, clinical trial.     

Knockdown of the nucleosome binding protein 1 inhibits the growth and invasion of clear cell renal cell carcinoma cells in vitro and in vivo

Background

The nucleosome binding protein 1 (HMGN5/NSBP1) is a member of the HMGN protein family and is highly expressed in several kinds of cancer. Nevertheless, the role of NSBP1 in clear cell renal cell carcinoma (ccRCC) remains unclear. This study aimed to confirm the oncogenic role of NSBP1 in ccRCC using in vitro and in vivo models and explore the mechanism by which NSBP1 contributes to ccRCC tumorigenesis.

Methods

NSBP1 expression was detected in renal tissues from 152 ccRCC patients by immunohistochemistry, and examined in ccRCC cell lines by RT-PCR and Western blot analysis. ccRCC cells were transfected by NSBP1 RNAi and cell viability, apoptosis and invasion were detected by cell vitality test, flow cytometry and transwell assay in vitro. Xenograft in nude mice was also employed to examine the tumorigenesis of ccRCC cells depleted of NSBP1.

Results

Immunohistostaining showed strong immunoreactivity of NSBP1 in all ccRCC tissues and NSBP1 expression level was associated with tumor grade (p = 0.04). NSBP1 expression at mRNA and protein levels was high in ccRCC cell lines. Knockdown of NSBP1 induced cell cycle arrest and apoptosis, and inhibited invasion in 786-O cells. Western blot analysis demonstrated increased expression of Bax and decreased expression of Bcl-2, CyclinB1, VEGF, VEGFR-2, MMP-2, MMP-9, c-fos and c-jun in 786-O cells depleted of NSBP1. In vivo study further showed that knockdown of NSBP1 affected the tumorigenesis of ccRCC cells in nude mice.

Conclusions

NSBP1 plays oncogenic role in ccRCCs by promoting cell proliferation and invasion, and could be exploited as a target for ccRCC treatment.     

Hyalinizing clear cell carcinoma: case series and comprehensive review of the literature

BACKGROUD:

Hyalinizing clear cell carcinoma (HCCC) is an uncommon malignant salivary gland tumor that was characterized only recently as a distinct entity. Because of its histologic similarity to several other primary and metastatic tumors and its purported favorable clinical outcome after local resection, it is important to recognize the features of this unusual tumor.

METHODS:

The authors present 8 new, fully characterized cases of HCCC and systematically reviewed 44 other cases of HCCC reported in the English language literature from 1980 to 2008. Historic cases were reviewed, and available data regarding morphology, special stains, demographics, clinical presentation, radiographic findings, management, and outcomes were extracted. Data from the current series were compared with the earlier published literature.

RESULTS:

To the best of the authors' knowledge, this was the largest reviewed series of HCCC and included a total of 52 cases. The findings, which included key histologic features, clinical presentation, and outcome, generally were consistent with what was reported previously. However, the current review revealed that 25% of patients reported in the literature had metastatases at initial presentation, including 10 of 44 patients who had metastases to regional lymph nodes and 1 patient who had metastasis to the lung. The authors were unable to identify any specific histologic features that would predict this behavior.

CONCLUSIONS:

The current results indicated that HCCC is less indolent than was believed previously; therefore, regional lymph node dissection should be considered in conjunction with wide local excision for patients with HCC. Cancer 2009. © 2008 American Cancer Society.     

Hürthle cell carcinoma of the thyroid: Retrospective review of 62 patients treated at the Royal Marsden Hospital between 1946 and 2003

Introduction

Previous studies have included Hürthle cell carcinoma (HCC) as a variant of follicular thyroid carcinoma in analysis of clinical outcome and others have failed to adequately distinguish between benign and malignant Hürthle cell neoplasms. The aim of this study was to report our experience of histologically confirmed malignant HCC, identifying patient, tumour and treatment factors that predict outcome.

Methods

A retrospective review was undertaken of all patients treated with HCC between 1946 and 2003. Study end-points were disease-free survival (DFS) and cause-specific survival (CSS). Demographic, pathological and treatment-related factors were all correlated with the study end-points.

Results

Sixty-two patients were followed up for a median (range) of 58 months (2–629). On multivariate analysis, only extent of surgery (p < 0.001) was an independent factor affecting CSS. Lymph node status (p = 0.008), presence of metastases at diagnosis (p = 0.005) and tumour stage (p = 0.009) were independent predictors of DFS.

Conclusions

HCC appears to be a separate entity from follicular thyroid carcinoma (FTC), with a more aggressive disease profile. Lymph node status, tumour stage, and the presence of metastases are independent predictors of DFS. Radical surgery may improve outcome in HCC.     

以骨转移为首发症状的分化型甲状腺癌的临床特征与生存分析

目的:探讨以骨转移为首发症状的分化型甲状腺癌(differentiated thyroid carcinoma,DTC)的临床特征,并进行生存分析。方法:对拟行131I治疗的1546例DTC患者的临床资料进行回顾性分析,收集以骨转移为首发症状的DTC患者的资料,分析骨转移情况,并进行生存分析。结果:DTC骨转移患者共120例,其中以骨转移为首发症状的DTC患者28例(23.3%,28/120),其中滤泡状癌20例、乳头状癌6例、乳头状癌滤泡亚型2例。临床症状表现为骨骼疼痛者26例(92.9%),其中腰椎病理性骨折1例,股骨病理性骨折2例。无骨痛者2例,分别为体检时发现枕骨和肋骨DTC转移。28例患者骨转移灶共73处,以骨盆和椎体转移最多见(63.0,46/73),其中12例患者伴有其他部位的远处转移(42.9%)。本组以骨转移为首发症状的DTC患者的5年和10年生存率分别为93.0%和71.0%;与甲状腺癌术后诊断为骨转移的DTC患者(92例)相比,以骨转移为首发症状诊断为DTC患者的20年生存率更高(P=0.012)。结论:部分DTC发病较为隐匿,当临床发现原因不明的局部骨骼疼痛、病理学骨折或骨质破坏时,应排除DTC骨转移可能。以骨转移为首发症状诊断为DTC患者的预后要优于甲状腺癌术后诊断为骨转移的DTC患者。     

MSCT多期扫描在肾脏乏脂肪血管平滑肌脂肪瘤与透明细胞癌鉴别诊断中的应用价值

目的 探讨肾脏乏脂肪血管平滑肌脂肪瘤(fpAML)和透明细胞癌(ccRCC)多排螺旋CT(MSCT)平扫及多期增强扫描表现,提高诊断准确率.方法 选取2015年1月至2019年12月江苏省中医院经手术病理确诊的fpAML和ccRCC患者各20例,测量肿瘤的短径和长径、CT平扫及多期增强的肿瘤CT值及邻近肾皮质的CT值,...     

1973-2013年上海市徐汇区甲状腺癌发病趋势和生存分析

背景与目的：近年来甲状腺癌发病率的迅速上升引起了广泛关注,可能与生活方式、老龄化和诊断技术水平提高等相关。本研究采用41年的甲状腺癌发病和随访资料,描述和分析上海市徐汇区居民甲状腺癌发病趋势及生存情况。方法：甲状腺癌发病资料来自上海市肿瘤登记报告系统,发病时间覆盖1973—2013年,用1973年人口构成计算标化发病率,采用自然样条回归模型分析甲状腺癌发病趋势,平均年度变化百分比(annual percentage change,APC)计算采用美国国立癌症研究所Jointpoint软件,生存率估计采用Kaplan-Meier法。结果：甲状腺癌的病理类型以乳头状癌为主(69.8%),1973—1978年和2009—2013年女性标化发病率分别是男性的2.51倍和2.70倍,男性发病年龄为(50.04±14.71)岁,女性发病年龄为(48.57±13.65)岁。去除老龄化因素,1981年以来甲状腺癌标化发病率呈上升趋势,1981—2004年平均每年上升8.46%(95%CI：5.9%~11.1%),2004—2013年快速增长,平均每年上升20.30%(95%CI：9.8%~31.7%)。甲状腺癌总体预后较好,2003—2013年5年生存率达95.21%,10年生存率89.09%;41年生存分析显示,女性生存率高于男性(χ2=15.43,P=0.0001)。结论：甲状腺癌在徐汇区的增长趋势与上海市及其他发达国家情况相似,虽然死亡率低,但发病率增长迅速,提示进一步研究相关危险因素,为制定防治策略打下基础。