抑癌基因PTEN在口腔涎腺腺样囊性癌组织中的表达

目的　从蛋白水平研究抑癌基因 10号染色体缺失的磷酸酯酶及张力蛋白同源物 (PTEN ) ,在口腔涎腺腺样囊性癌中表达及其意义。方法　采用免疫组织化学方法检测 3 4例腺样囊性癌 (其中筛孔型 14例 ,管状型 11例 ,实体型 9例 )组织中PTEN的表达。结果　 3 4例腺样囊性癌PTEN蛋白表达阴性率为 17.6% ( 6/ 3 4) ,筛孔型、管状型、实体型表达阳性率分别为 14 .3 % ( 2 /14 ) ,18.2 % ( 2 / 11)和 2 2 .2 % ( 2 / 9) ,各型之间阳性率无显著性差异 (P >0 .0 5 )。结论　涎腺腺样囊性癌组织中存在抑癌基因PTEN表达缺失 ,PTEN在部分腺样囊性癌病变发展中起作用 ,PTEN表达异常与腺样囊性癌分型以及临床病理特征无关     

多药耐药基因在涎腺粘液表皮样癌中的表达及意义

目的探讨涎腺粘液表皮样癌多药耐药基因MDR1/P-gp的表达情况及其临床意义。方法应用免疫组织化学技术(EnVision法)检测36例涎腺粘液表皮样癌(其中高分化组21例、低分化组各15例)以及15例正常涎腺组织中MDR1/P-gp的表达。结果MDR1/P-gp在粘液表皮样癌及正常涎腺组织中均有不同程度表达,阳性部位主要见于细胞膜。高分化粘液表皮样癌、低分化粘液表皮样癌和正常涎腺组织MDR1/P-gp表达阳性率分别为81.0%(17/21)、73.3%(11/15)和26.7%(4/15),组间两两比较均具有显著性差异(P<0.01)。结论MDR1/P-gp是涎腺粘液表皮样癌多药耐药产生的重要细胞机制,检测MDR1/P-gp可为临床拟定化疗方案提供依据,也可作为判断涎腺粘液表皮样癌组织分化程度及预后的参考指标。     

E钙粘素在涎腺腺样囊性癌中的表达及其意义

背景与目的:近年来关于上皮型钙粘素与肿瘤关系的研究比较多,但不同研究得到的结果差异较大,而且近年来的研究显示,E钙粘素在肿瘤转移过程中的作用可能具有多面性.本文旨在研究E钙粘素在涎腺腺样囊性癌中的表达水平,探讨E钙粘素与涎腺腺样囊性癌的神经侵犯、局部复发、远处转移以及预后的关系.方法:采用免疫组化技术检测55例涎腺腺样囊性癌组织标本和20例正常涎腺组织中E钙粘素的表达.应用Kaplan-Meier法进行生存分析,组间比较用log-rank检验,两组比率的比较采用χ2检验.结果:本组患者的5年和10年生存率分别为78.2%和51.4%:E钙粘素在正常涎腺组织中的阳性率(90.0%)显著高于涎腺腺样囊性癌组织(63.6%)(P＜0.05);E钙粘素在有神经受侵、局部复发及远处转移者的肿瘤组织中的阳性率(50.0%、52.4%及47.8%),均低于无神经受侵、无局部复发及无远处转移者(71.4%、70.6%及75.0%).结论:E钙粘素在涎腺腺样囊性癌组织中表达下调;其表达水平与神经侵犯、局部复发及发生远处转移相关.     

58例大涎腺腺样囊性癌的临床分析

目的 探讨大涎腺腺样囊性癌的治疗方法及与复发、转移、预后的特点.方法 根据治疗方法将58例大涎腺腺样囊性癌分为综合治疗组和单纯手术组两组,分析其临床分期、病变部位、治疗及复发、转移、预后.结果 综合治疗组比单纯手术组复发率低(P<0.05)、远处转移率低、生存率高,其中5年生存率两组比较差异有统计学意义(P<0.05);10年生存率两组比较差异有统计学意义(P<0.01).结论 综合治疗组复发率低,生存率高;肿瘤的复发与神经侵袭有关;肿瘤肺部转移发生率较高.     

涎腺腺样囊性癌患者生存及预后的独立影响因素分析

目的 探讨涎腺腺样囊性癌患者预后的独立影响因素以及生存状况.方法 回顾性分析确诊为涎腺腺样囊性癌的200例患者临床资料,采用单因素及多因素的Logistic回归进行相关危险因素的分析,探讨影响涎腺腺样囊性癌预后的独立危险因素.并运用Kaplan-Meier的生存曲线对肿瘤切除术后患者的生存情况进行分析.结果 通过单因素分析:年龄、手术切缘是否干净、病理类型、神经是否受侵、临床分期是影响患者预后的因素;多因素分析:切缘阳性、病理类型为实体型、神经受侵、临床分期属于晚期是影响预后的独立危险因素.本研究患者的复发率为34.00％,远处转移率为46.00％,总死亡率为58.00％,肿瘤相关死亡率为48.00％,5年生存率为68.00％,10年生存率为56.00％.结论 切缘阳性、病理类型为实体型、神经受侵、临床分期属于晚期作为影响预后的独立危险因素,影响涎腺腺样囊性癌的预后.     

头颈部腺样囊性癌的治疗现状

头颈部腺样囊性癌约占所有涎腺来源的恶性肿瘤的10%,占头颈部所有恶性肿瘤的1%[1].大涎腺是腺样囊性癌的好发部位,其次是口腔和鼻腔,老年人多见,≥65岁患者占41.2%,男: 女为1: 1.3[2].组织学上根据肿瘤生长形态可分为3个亚型:管状型、筛状型、实性巢型,不同亚型的生物学行为有所不同.一般认为管状型预后较好,而实性巢型预后差,筛状型预后介于二者之间.因头颈部腺样囊性癌的发病率低,临床上无法进行大规模前瞻性随机对照研究,本文在复习近年发表的文献基础上,对头颈部腺样囊性癌的治疗做一综述.     

5-LOX和VEGF在涎腺肿瘤组织中的表达及意义

涎腺肿瘤是口腔颌面部的常见肿瘤,其发生、发展与肿瘤组织的血管形成及细胞的增殖活性密切相关。近期研究结果表明,5-脂氧合酶(5-LOX)可能通过多个途径促进肿瘤的发生,血管内皮细胞生长因子(VEGF)是重要的促血管生成调节因子,在许多肿瘤组织尤其是恶性肿瘤中高度表达。然而迄今为止,有关5-LOX在涎腺肿瘤中的表达和作用报道不多。本实验采用免疫组化方法,通过检测5-LOX和VEGF在涎腺肿瘤的表达情况,探讨它们在涎腺肿瘤发生、发展中的重要作用。1资料与方法1.1资料收集2005年～2009年大庆油田总医院口腔颌面外科手术切除的60例涎腺肿瘤组织及20例正常涎腺组织存档标本。其中男性33例,女性27例,年龄18～64岁,平均年龄41岁;其中良性肿瘤32例,包括多形性腺瘤18例,腺淋巴瘤14例;恶性肿瘤28例,包括恶性混合瘤7例,腺样囊性癌12例,黏液表皮样癌9例;正常涎腺组织为因外伤致涎瘘而摘除腮腺组织12例,腺淋巴瘤中远离瘤旁组织8例。患者术前均未行放疗、化疗,术后均有明确的病理学诊断。将涎腺肿瘤组织和正常涎腺组织置于10%多聚甲醛液中固定,常规石蜡包埋,连续切片,片厚4μm。1.2主要试剂兔5-LOX多克隆抗体...     

Twist在涎腺腺样囊性癌中的表达及其临床意义

目的 探讨转录因子Twist在涎腺腺样囊性癌中的表达水平及其与各临床病理因素的关系.方法 采用免疫组化方法检测48例涎腺腺样囊性癌、18例多形性腺瘤和10正常腮腺组织中Twist蛋白的表达情况,分析Twist表达与腺样囊性癌临床病理因素的关系.结果 Twist在涎腺腺样囊性癌组织中的表达水平明显高于多形性腺瘤和正常腮腺组织(P<0.05).Twist表达与腺样囊性癌的病理分型、嗜神经侵袭、术后复发及远位转移有相关性(P<0.05).结论 Twist蛋白表达可能与涎腺腺样囊性癌的分化调节、嗜神经侵袭及远位转移有关.检测Twist的表达水平对判断腺样囊性癌患者的预后有一定的参考价值.     

Ezrin在涎腺腺样囊性癌组织中的表达

目的:探讨Ezrin在涎腺腺样囊性癌组织中的表达及意义。方法:用免疫组织化学SP法检测Ezrin在涎腺腺样囊性癌组织和正常涎腺组织中的表达,分析其在涎腺腺样囊性癌组织中的表达与肿瘤的侵袭性、复发、转移和预后的关系。结果:Ezrin在涎腺腺样囊性癌和正常涎腺组织中的阳性率表达分别为44.68%和9.09%,P<0.05;在癌细胞中主要为胞质内表达,染色深,而在正常涎腺组织则主要为细胞膜表达,染色浅或阴性。Ezrin的表达强度与有无神经受侵、有无发生局部复发及远处转移相关,P<0.05。Ezrin表达阳性组和阴性组的5年累积生存率分别为66.70%和100.00%,10年累及生存率分别为27.83%和95.00%,阳性组较阴性组预后差,P<0.05。结论:Ezrin的表达强度与涎腺腺样囊性癌的发生、侵袭性、复发和转移性有关,且Ezrin阳性表达预示患者预后不良。     

人涎腺腺样囊性癌嗜神经侵袭超微结构的观察研究

目的:通过电镜检测来进一步探索人涎腺腺样囊性癌嗜神经侵袭的超微形态特征.方法:将人涎腺腺样囊性癌Acc-M细胞系注射入5只裸鼠双侧臀部肌肉内,切取其中发生神经侵袭并出现功能障碍的荷瘤;通过透射电镜检测来观察腺样囊性癌的嗜神经侵袭过程. 结果:肿瘤细胞破坏神经外膜及神经束膜,进入神经纤维之间,并以吞噬的方式对神经纤维进行侵袭,致使髓鞘、轴突发生变性、溶解而被吸收.结论:涎腺腺样囊性癌细胞在对神经的侵袭过程中具有一定的吞噬作用,且这种现象在神经侵袭中起了很重要的作用.     

Lung carcinoma with spindle and/or giant cell： a clinicopathological analysis of 17 cases

Objective: Lung carcinoma with spindle and (or) giant cell (LCSG) is a rare epithelial malignant tumor. The aim of our study is to investigate the clinicopathological and prognostic characteristics of 17 cases of LCSGs. Methods: Among 421 patients underwent resection of lung carcinomas, 17 cases of LCSG were studied for clinical, gross and histological parameters. Follow-up information was obtained and analyzed to clarify prognostically significant parameters. Results: The LCSG patients consisted of 15 males and 2 females, with the age ranging from 45 to 78 years (median, 58 years); 5 cases of stage Ⅰ, 3 of stage Ⅱ, 9 of stage Ⅲ by pathological TNM staging; 2 cases of exclusively spindle cell carcinoma, 5 cases of lung carcinoma with spindle cell, 10 cases of lung carcinoma with giant-cell carcinoma. Cough, chest distress, or chest pain were the most common presenting symptoms, occurring in 15 patients (88.2%). Of 5 patients in stage Ⅰ, 4 were alive and free of relapse for more than 5 years. The difference in survival was statistically significant between LCSG and squamous cell carcinoma patients (median survival, 36 vs. 61 months; P = 0.027). Lymph node metastasis and carcinoma with giant cell were the hazardous factors impacting postoperative prognosis of LCSG patients. Conclusion: LCSG patients in early stage may have an optimistic outcome. Lung carcinomas with giant cell displayed multiple cell components in histopathology, and poor outcome due to more lymph node involved.     

The clinical course of lung carcinoma in patients with chronic lymphocytic leukemia.

BACKGROUND: Although patients with chronic lymphocytic leukemia (CLL) have an increased risk of developing second primary malignancies, including lung carcinoma, there is virtually no information about their clinical outcomes. To evaluate this, the authors reviewed their 20-year institutional experience with CLL patients who also had lung carcinoma. METHODS: The records of patients with diagnoses of both CLL and lung carcinoma seen between January 1977 and July 1998 were reviewed. The data collected included patient demographics, the tumor histology and stage, the type of treatment for both CLL and lung carcinoma, the presence of a third malignancy, the disease status at last follow-up, and the first site of relapse. Survival was calculated by the Kaplan-Meier method. RESULTS: From January 1977 to July 1998, 1329 patients with CLL were seen at Memorial Sloan-Kettering Cancer Center. Twenty-six (1.9%) also had lung carcinoma (19 males and 7 females). The median age of patients at the time CLL was diagnosed was 61 years, and for patients with lung carcinoma it was 68 years. Twenty-two patients (85%) were current or former smokers. Histologically, the lung carcinomas included 6 squamous cell carcinomas, 19 nonsquamous carcinomas, and 1 small cell carcinoma. Ten patients (38%) had a third malignancy; these malignancies included melanoma, basal cell carcinoma, laryngeal carcinoma, and colon carcinoma. Thirteen patients underwent surgical resection and 13 were treated nonsurgically for lung carcinoma. A poor performance status precluded surgery for 3 patients with Stage I tumors and limited chemotherapy for all patients with advanced disease. The median survival following the diagnosis of lung carcinoma for patients treated surgically was 25 months, and for those treated nonsurgically it was 6 months. CONCLUSIONS: Approximately 2% of patients with CLL develop lung carcinoma. In this study, 85% of the patients were smokers. These patients had a high risk of a third primary malignancy. Lung carcinoma was diagnosed a decade after CLL. Patients who develop both diseases die of lung carcinoma and not CLL or other solid tumors. CLL and poor performance status limit treatment, particularly for patients with unresectable lung carcinoma.     

甲状腺癌相关多原发癌的临床及病理特征分析

目的:分析甲状腺癌相关多原发癌的临床及病理特征。方法:回顾性分析2014年12月至2018年8月西京医院甲乳血管外科确诊并收治住院的2 867例甲状腺癌患者临床及病理资料,从中筛选出49例甲状腺癌作为第二原发癌的多原发癌患者,分析其临床及病理特征。结果:首发癌为乳腺癌最常见,占71.7%,其次为宫颈癌、卵巢癌、肺癌等。以肿瘤发生时间分类:同时性多原发癌13例（26.5%）,异时性多原发癌36例（73.5%）。但同时性与异时性多原发甲状腺癌的多灶性、病灶大小及淋巴结转移情况差异均无统计学意义。合并甲状腺癌的多原发癌患者与单发性甲状腺癌患者相比,≥45岁比例（75.5% vs 45.9%,P<0.01）、女性比例（98.0% vs 75.6%,P<0.01）及有恶性肿瘤家族史患者比例（20.4% vs 9.6%,P<0.05）均明显提高。甲状腺癌作为第二原发癌的微小病灶（≤1 cm）更多（81.6% vs 58.6%,P<0.01）,具有更低的侵袭性;单侧病灶的比例高（79.6% vs 70.5%）,淋巴结转移的比例低（42.9% vs 49.8%）,但两组间的差异均无统计学意义。结论:年龄≥45岁且有家族史的女性恶性肿瘤患者,尤其是乳腺癌患者,建议其在治疗后的复查期间进行甲状腺癌筛查。     

The clinical course of nonsmall cell lung carcinoma in survivors of Hodgkin disease

BACKGROUND: The objective of this study was to document the natural history of second lung carcinomas, common second tumors that arise in survivors of Hodgkin disease (HD). METHODS: The data bases of the Memorial Sloan-Kettering Cancer Center were searched to retrieve those patients who were listed with a diagnosis of both lung carcinoma and HD. Information was extracted regarding their HD (including age at diagnosis and treatment received) and their lung carcinoma (including smoking history, latency from HD, histology, disease stage, treatment received, treatment response, and survival). RESULTS: Twenty-one lung carcinomas were diagnosed in 19 patients, with a median latency of 13 years from the time of diagnosis of HD. Only five patients underwent complete resection, and four patients were alive and disease free at the last follow-up. In contrast, the median survival of 14 patients with unresectable disease was 3 months. No major objective responses were documented after chemotherapy. Poor performance status and prior thoracic radiotherapy limited treatment in patients with advanced disease. All patients had either received radiotherapy to the chest for HD or had a history of smoking; 74% of patients had both risk factors for the development of lung carcinoma. CONCLUSIONS: In patients with a history of HD, survival after the development of lung carcinoma is poor. Because surgical resection can lead to long-term survival, early detection is crucial. HD survivors, especially those with a history of smoking, should undergo careful surveillance for second primary lung carcinomas and other diseases. Patients who are diagnosed with HD should abstain from smoking. Physicians should assess specifically the smoking status of all HD patients and prescribe a smoking cessation program.     

支气管肺泡灌洗液脱落细胞端粒酶hTERT基因表达的检测

背景与目的:肺癌患者中端粒酶活性常呈阳性,常规检测端粒酶活性的方法易发生假阳性,端粒酶hTERT基因表达水平可反映端粒酶活性高低。本研究采用相对定量PT-PCR法检测肺癌支气管肺泡灌洗液脱落细胞端粒酶hTERT的表达情况,为肺癌的早期诊断、鉴别诊断提供帮助。方法:采用纤维支气管镜收集了20例可疑肺肿瘤患者支气管肺泡灌洗液,对脱落细胞分别送病理检测和RT-PCR相对定量法检测端粒酶hTERT基因表达,并随访术后病理检测情况,同时检测10例非肺癌病人的支气管肺泡灌洗液标本作为对照。结果:20例可疑肺癌经术后病理检测证实有19例为不同类型的肺癌,1例为炎性假瘤。在19例肺癌的支气管肺泡灌洗液中16例检出不同程度的端粒酶hTERT基因表达,细胞病理检测仅发现11例,阳性率分别为84.2%和57.9%,两者有显著性差异(P<0.01)。10例非肺癌病人的支气管肺泡灌洗液中均无端粒酶hTERT基因表达。结论:采用RT-PCR方法检测支气管肺泡灌洗液中端粒酶hTERT基因表达,较细胞病理检测有更高的敏感性,有助于肺癌的早期诊断和鉴别诊断。     

Lung Cancer in Chromate Workers--Analysis of 11 Cases

We have experienced 11 cases of lung carcinoma in workers ata chromate factory during the past 14 years. All patients weremales. The age of onset ranged from 41 to 68 years. Ten of the11 were heavy smokers. The time of exposure to chromate wasfrom 17 to 29 years and the average was 23.9 years. Seven patientshad perforation of their nasal septa. The primary sites of thecancers were from the lobar to the subsegmental bronchi. Therewere nine squamous cell carcinomas and three small cell carcinomas.Four squamous cell carcinomas were hilar type early stage cancersand two of them were found in one patient at the same time.The chromium content of the lung tissue in the seven patientstested was from 13.9 to 2,368.4 µg/g of dry tissue andwas higher than that of lung cancer or non-lung cancer caseswithout chromate exposure. There was no severe dysplasia ofthe bronchial epithelium in these 11 patients.     

乳腺纯上皮化生性癌9例观察及文献复习

背景与目的:乳腺化生性癌十分少见。对此,本文旨在探讨乳腺纯上皮化生性癌的病理和临床特征以及治疗。方法:回顾性分析1997-2007年9例在我院治疗的女性乳腺纯上皮化生性癌病例。结果:患者中位年龄50岁(37～78岁),9例均行根治术或改良根治术,病理诊断为梭形细胞化生性癌6例,鳞癌3例。雌激素受体(ER)和/或孕激素受体(PR)阳性者2例。2例淋巴结转移。中位随访时间为25(3～112)个月,术后局部复发1例,远处转移3例,肺转移2例,2例患者死亡,1例带瘤生存。结论:本病以梭形细胞化生性癌多见,可同时表达上皮和间叶组织抗原,但较少表达ER和PR。患者多以无痛性肿块就诊,肿块局切复发率高。腋窝淋巴结转移少见,肺转移多见。手术治疗宜选择单纯乳房切除加前哨淋巴结活检。     

Nuclear dna Measurements on Thyroid Carcinoma in Young Patients

Nuclear DNA measurements were performed on thyroid carcinomas from 36 patients aged 20 years or less. Histologic material from the tumors were stained according to the Feulgen technique and measured with slide cytophotometry. Thirty-two of the 36 tumors were of papillary type, 3 were medullary carcinoma and 1 was a follicular carcinoma. of the 32 papillary carcinomas, 6 tumors (19%) were aneuploid and 26 (81 %) were diploid, including 2 cases with lung metastases at diagnosis. of the 3 medullary carcinomas, 2 were diploid and 1 aneuploid. the only follicular carcinoma was aneuploid. the patients were followed between 10 and 35 years, and 34 were alive at the end of the study. Two patients died, both had medullary carcinomas. One patient, with a diploid tumor, died during surgery. the other patient, with an aneuploid tumor, died 5 years after diagnosis of metastatic disease. Six patients had recurrences, all within 7 years. All the primary tumors and the corresponding recurrences showed a diploid DNA content. the results show that the majority of thyroid carcinomas in young patients exhibit diploid DNA profiles which is in agreement with the overall good prognosis in this patient category. However, since also patients with aneuploid tumors exhibited a similar good prognosis it seems that DNA measurements do not contribute additional prognostic information in young patients.     

鼻咽原发性腺癌的临床病理分析

背景与目的:鼻咽原发性腺癌非常少见,少有大宗病例的报道。本研究旨在探讨鼻咽原发性腺癌的临床病理特征。方法:复习中山大学肿瘤医院病理科24年鼻咽部癌活检资料;收集有较详细临床资料及蜡块保存较好的鼻咽部原发性腺癌标本39例,进行HE、PAS及Alcian蓝染色,光镜下进行形态学观察;收集177例鼻咽癌(WHO所定义的鼻咽癌,包括角化性鳞状细胞癌和非角化性癌)的临床资料作为对照。结果:(1)24年间鼻咽部癌活检病例共31791例,其中鼻咽腺癌153例,占0.48%。(2)39例鼻咽原发性腺癌患者中位年龄为46岁,发病高峰年龄段为40～49岁。(343.5%(17/39)的鼻咽原发性腺癌为女性。(4)39例鼻咽原发性腺癌中,就诊时局部病变超出鼻咽腔(T3)或/和侵犯破坏颅骨或/和颅神经(T4)者占60.53%,但颈淋巴结肿大者仅7例(占17.95%,7/39),与鼻咽癌的淋巴结转移率(76.84%,136/177)相比差异有显著性(P<0.01)。(5)39例鼻咽原发性腺癌中有普通型腺癌16例和涎腺型腺癌23例,前者包括低度恶性者9例和高度恶性者7例,后者包括腺样囊性癌17例,粘液表皮样癌6例。(6)其中7例普通型腺癌(包括所有5例乳头状腺癌)见到癌组织与鼻咽粘膜表面上皮直接过渡;4例粘液表皮样癌见到癌组织与鼻咽粘膜表面鳞化上皮直接过渡;2例腺样囊性癌见癌旁的小涎腺导管上皮增生、     

纤维支气管镜检查对肺癌的诊断价值

本文报告604例行纤支镜检查、经病理证实的肺癌424例。诊断率达70.2％。年龄19岁～81岁,男:女为6.9:1。病理类型以鳞癌最多见,176例(41.5％),小细胞癌95例(22.1％),腺癌84例(19.8％),其它69例(16.3％)。肺癌发生部位以肺上叶为多发部位,占41.5％,下叶27.6％。右肺多于左肺。