33例印戒细胞癌的临床分析

目的探讨胃印戒细胞癌的临床病理特征及预后。方法回顾性分析166例胃癌患者中印戒细胞癌与非印戒细胞癌的临床病理特征及术后生存情况的差异。结果 166例胃癌中印戒细胞癌为33例(19.9%),非印戒细胞癌133例(80.1%),两者性别、病变部位、分化程度、肿瘤浸润深度、淋巴结转移、有无远处转移及临床分期等差异均无统计学意义(P>0.05);而两者年龄分布差异显著(P=0.032),印戒细胞癌中60岁以下患者更多见;印戒细胞癌中侵犯神经的比例也明显高于非印戒细胞癌(P=0.021)。印戒细胞癌患者的4年生存率为42.4%,明显低于非印戒细胞癌患者的66.2%(P<0.05)。结论相对于非印戒细胞癌,胃印戒细胞癌的发病年龄轻,神经侵犯比例高,预后差。     

胃印戒细胞癌临床病理特点的分析

目的：通过对胃印戒细胞癌和非印戒细胞癌患者病例资料的对比,了解胃印戒细胞癌的临床病理特点。方法：回顾性分析2000年1月至2014年12月间第四军医大学附属西京医院经术后病理确诊的5481例胃癌患者的病例资料,根据组织学分型将其分为印戒细胞癌组和非印戒细胞癌组,对两组患者的临床病理资料进行对比分析。结果：印戒细胞癌与非印戒细胞癌在年龄、性别、肿瘤位置及大小、TNM分期、浸润深度、淋巴结转移情况上存在差异（P＜0．05）,在远处转移方面无显著差异（P＞0．05）。早期胃印戒细胞癌的淋巴结转移率高于非印戒细胞癌。结论：胃印戒细胞癌多发生于年轻女性患者,好发部位以胃中下1／3部位多见,早期即可出现较高的淋巴结转移率。     

人胃印戒细胞癌组织差异表达基因克隆的研究

目的:分离胃印戒细胞癌组织差异表达基因,探讨人胃印戒细胞癌发生的分子机制。方法:采用抑制性消减杂交技术(SSH),构建人胃印戒细胞癌组织cDNA 消减文库;随机挑选部分阳性克隆测序,与GenBank中的已知序列进行基因同源性分析,并进一步探讨基因功能。结果:成功构建高消减效率的人胃印戒细胞癌组织cDNA消减文库,并分离出多个差异表达基因片段:其中1 条与染色体序列相似,可能代表未知的新基因序列,已被GenBank 接收(注册号:CN446913);其他多为已知的肿瘤相关基因的部分片段。结论: 1 )SSH技术是分离差异表达基因的有效方法;2)胃印戒细胞癌的发生发展与多种基因表达异常有关;     

Adriamycin and Cisplatin induce apoptosis in 2 lines of human gastric-cancer cells (mkn-28 and hsc-39)

Many anticancer agents induce an active process that leads to cell death, known as, apoptosis, in sensitive tumor cells. The fragmentation of DNA, an indicator of apoptosis, was analyzed in two different lines of human gastric cancer cells (HSC-39 and MKN-28) that had been exposed to adriamycin and cisplatin. The fragmentation of DNA was detected in HSC-39 cells (signet ring cell gastric carcinoma) after a 1-h incubation with 0.18 mu M and after a 6-h incubation with 0.09 mu M adriamycin, as well as after a 1-h incubation with 1.67 mu M cisplatin. However, in MKN-28 cells (moderately differentiated gastric adenocarcinoma), the fragmentation of DNA was not detected after a 6-h incubation with 0.18 mu M adriamycin or a 6-h incubation with 3.33 mu M cisplatin. The results suggest that signet ring cell gastric carcinoma is more sensitive to adriamycin and to cisplatin than moderately differentiated gastric adenocarcinoma.     

A Case of Bone Marrow Recurrence from Gastric Carcinoma after a Nine-year Disease-free Interval

We present a case of very late and unusual recurrence of gastriccancer. Nine years following total gastrectomy for gastric carcinoma,a 57-year-old man presented with disseminated intravascularcoagulation associated with bone marrow recurrence. The primarytumor was a signet ring cell carcinoma invading the subserosallayer with lymph node metastasis. The patient was treated withsequential administration of methotrexate and 5-fluorouraciland went into remission. After treatment, he survived 10 months.Autopsy revealed diffuse bone marrow infiltration and distantlymph node metastasis with signet ring carcinoma cells.     

A rare case of poorly differentiated endocrine cell carcinoma of the stomach with signet ring cell differentiation

There have been few reports of the dual differentiation of different cell types within the same gastric tumor. Here, we report a rare case of poorly differentiated endocrine cell carcinoma with an associated differentiated signet ring cell population arising in the stomach. The histological appearance of the tumor by light microscopy matched the phenotype of endocrine cell carcinoma and signet ring cell differentiation with mucinous lakes. Cells with a phenotype intermediate between the two differentiated cell types were also seen in the tumor. Both the endocrine cell carcinoma and the signet ring cells were diffusely positive for chromogranin A and synaptophysin, a finding that is consistent with endocrine differentiation by immunohistochemical examination. The patient’s postoperative clinical course had a poor prognosis, with aggressive tumor progression. Paraaortic lymph node recurrence was found 6 months after the operation, and the patient died of the primary disease 16 months after the surgical treatment.     

Metastatic signet ring cell carcinoma to the breast from stomach]

Metastatic tumors in the breast are quite rare and constitute 0.5 to 6% of all breast malignancies. They often occur in a polymetastatic context. The most frequent primitive tumors are lymphoma, leukaemia and malignant melanoma. The gastric origin is seldom reported. We report here the observation of a 40-years woman operated in urgency for an acute abdominal syndrome. A gastric tumor was discovered intraoperatively with ovarian metastasis and peritoneal carcinosis. The pathological examination revealed a gastric signet ring cell carcinoma with an infiltration of the right ovary. Four months later, the patient presented with a lump of the right breast. The histologic examination corresponded to a mammary metastasis by a signet ring cell carcinoma from stomach. The objective of our work is to discuss through this observation the anatomoclinical and evolutionary characteristics of breast metastasis.     

一种新认识的胃癌癌前病变：人胃粘膜球样异型增生的组织病理学特点

Histopathologic features of globoid dysplasia of human gastric epithelium were described by means of observation of serial paraffin sections of 53 cases of globoid dysplasia. It was divided into three grades according to the architecture and cellular atypia. Penetration of outer layer globoid dysplastic cells through the basement membrane of "double layers structure" appeared in typical globoid dysplasia Grade III and infiltration of globoid dysplastic cells into stroma as well as the formation of incipient focus of signet ring cell carcinoma were described. The twinkling scene of infiltration of the globoid dysplastic cells into lamina propria through the basement membrane and the damage of basement membrane by globoid dysplastic cells were shown by Gordon Sweet's stain. Through the analysis of background lesions of the globoid dysplasia, a conclusion can be made that the globoid dysplasia might be an important precancerous lesion of the signet ring cell carcinoma of the stomach.     

A clinicopathological study of early mucinous adenocarcinoma of the stomach

From 1963 to 1986, 1126 cases (1300 lesions) of early gastric carcinoma were treated at Fukui Prefectural Hospital. Mucinous adenocarcinomas comprised 16 lesions in this series. These cases of mucinous adenocarcinoma were younger than all the other early carcinomas of the stomach and they often were locted in the lower third of the stomach. Macroscopically, most were types "Iia + IIc". Dividing them into 3 grouping: papillary, tubular, and signet ring cell types, depending on the microscopic appearance of the intramucosal carcinoma, the signet ring cell group differed from the other two as to age, macroscopic appearance, and region it occupied. An immunochemical study showed that CA19-9 stained positively in a mucous lake, much like a carcinoma cell, but that CEA stained little.     

青年人胃癌187例临床病理特征分析

[目的]探讨青年人胃癌的临床病理特点。[方法]回顾性分析1999年1月至2008年12月青年人（35岁以下）胃癌的临床病理资料,并与同期180例老年人（≥75岁）的临床病理资料对比分析。[结果]35岁以下青年人胃癌占全部胃癌的5.4%,男女比例0.56∶1。肿瘤最常见位置为胃下1/3;Bormann分型以溃疡型和浸润溃疡型为主。93.6%胃癌病理类型为低分化癌、黏液腺癌和印戒细胞癌;Ⅲ～Ⅳ期占64.2%。19.7%患者一级亲属有胃癌家族史。与75岁以上老年人胃癌相比,性别比例、肿瘤位置、肿瘤分化和胃癌家族史等方面有明显差异。[结论]青年人胃癌恶性程度高,应加强青年人胃癌的早期诊断和治疗研究,以期提高预后。     

胃粘液癌的肿瘤增殖与DH7识别抗原的表达

应用免疫组化ＡＢＣ法，分析单克隆抗体ＤＨ７识别抗原在１９例胃粘液癌中的表达。结果显示有腺样结构的粘液腺癌阳性率为１００％（９／９），无腺样结构的粘液细胞癌（即印戒细胞癌）阳性率仅为２０％（２／１０），其中２例阳性均属粘液细胞癌的前期——单核细胞样癌细胞形式，而另８例所见的后期印戒样癌细胞均为阴性。提示，粘液癌的肿瘤增殖发生于腺样结构的癌组织和单核细胞样癌组织中，而非发生于散在的印戒样癌细胞中，后者乃是肿瘤增殖后期的终末期癌细胞形式，从而验证了粘液细胞癌从前期单核样癌细胞到后期印戒样癌细胞的这一形态演化过程。     

A clinicopathological study of early gastric cancers with a diameter larger than five centimeters

Out of a total of 1,112 resected early gastric carcinomas, 181 that were larger than 5 cm in diameter have been pathologically investigated. Of these, intramucosal and submucosal carcinomas amounted to 68 (37.6%) and 113 (64.4%), respectively. The incidence of their location, shown as a percentage, was 37.8% in the antrum, 57.4% in the corpus, and 4.8% in the fundus (11% in the anterior wall, 13.2% in the posterior wall, 68.1% in the lesser curvature, and 7.7% in the greater curvature). Grossly, the incidence of a type IIc carcinoma was 46.5% and that of a IIc + III type was 20.5%, respectively. Microscopically, in the intramucosal cases, signet ring cell carcinomas were the most frequent histological type, whereas in the invasive submucosal cases, the carcinomas were the intestinal metaplastic type. Lymphatic invasions, venous invasions, and lymph nodal metastases amounted to 32.6%, 6.1%, and 11.6%, respectively. In the early gastric carcinomas, the larger the tumor size, the more likelihood of a signet ring cell carcinoma than a intestinal metaplastic type, and it appeared that a signet ring cell carcinoma had infiltrated the propria mucosae for a longer time when compared to either an intestinal metaplastic type carcinoma or a poorly differentiated tubular adenocarcinoma.     

氟尿嘧啶联合紫杉醇和奥沙利铂方案一线治疗晚期胃印戒细胞癌的疗效及安全性评价

目的:评价氟尿嘧啶联合紫杉醇和奥沙利铂方案（POF方案）一线治疗晚期胃印戒细胞癌的临床疗效及安全性。方法:68例既往未接受过治疗的初治晚期胃印戒细胞癌患者一线采用POF方案化疗:紫杉醇135 mg/m2静脉滴注3 h,亚叶酸钙400 mg/m2（左亚叶酸钙200 mg/m2）静脉滴注2 h,同步奥沙利铂85 mg/m2滴注2 h,接着持续静脉滴注氟尿嘧啶2 200~2 400 mg/m2 46 h(使用便携式泵),14天为一个周期。结果:所有患者均可评价安全性及生存期,66例患者可评价近期疗效。疾病控制率89.4%,客观缓解率48.5%。平均随访13.2个月,中位无进展生存时间(PFS)7.0个月(95%CI:6.85~7.15个月),中位总生存时间(OS)10.6个月(95%CI:9.86~11.3个月)。主要的III/IV级不良反应为中性粒细胞减少(22.1%)和外周神经毒性(10.3%)。结论:晚期胃印戒细胞癌患者一线应用POF方案治疗是安全、有效的。     

58例胃印戒细胞癌的临床病理特征及预后因素分析

目的 探讨胃印戒细胞癌的临床特征及预后因素.方法 回顾性分析2005至2009年经本院手术病理证实的58例胃印戒细胞癌患者的临床病理资料,并对影响预后的因素进行统计学分析.结果 手术病理是胃印戒细胞癌的主要确诊方法 ,胃镜活检病理与手术病理符合率为62.1%.胃印戒细胞癌多见于女性,主要治疗方法 是手术切除.本组患者总...     

Early gastric cancer induced by N-ethyl-N'-nitro-N-nitrosoguanidine in a cynomolgus monkey six years after initial diagnosis of the lesion

A signet ring cell carcinoma in the gastric antrum of a Cynomolgus monkey induced by N-ethyl-N'-nitro-N-nitrosoguanidine was sequentially studied by endoscopy, biopsy, and autopsy. The carcinoma was first detected on the angulus of the stomach at the 38th month as a slightly elevated lesion. Sixty-one months later this tumor was found to be still in the "early" (intramucosal) stage. Another, independent, initial gastric cancer was also discovered. This is the first example of an induced gastric carcinoma remaining in the "early" stage during a six-year follow-up period after the initial histologic diagnosis.     

Germline E-cadherin gene mutations: is prophylactic total gastrectomy indicated?

BACKGROUND: The CDH1 gene encodes E-cadherin, an epithelial cell adhesion molecule. Germline CDH1 mutations recently were identified in families with hereditary diffuse gastric carcinoma in a pattern suggestive of autosomal dominant inheritance with incomplete penetrance. METHODS: The proband was a woman age 47 years with a strong family history of diffuse gastric carcinoma. A germline E-cadherin gene mutation was identified in this patient, her brother, and three first cousins. All five family members underwent endoscopic evaluations, which were negative for malignancy, and elected to undergo a prophylactic total gastrectomy with Roux-en-Y esophagojejunostomy. RESULTS: Pathologic examination of the proband's stomach revealed several microscopic foci of intramucosal signet ring cell adenocarcinoma in the cardia and proximal gastric body. Postgastrectomy specimens from the proband's brother and three first cousins all showed intramucosal signet ring cell adenocarcinoma in various regions of the stomach. Immunoperoxidase studies performed on gastric tissue from these five patients demonstrated diminished or absent E-cadherin reactivity in the cancerous mucosa. CONCLUSIONS: Although total gastrectomy was performed as a prophylactic intervention, occult gastric carcinoma was discovered in all five patients. Thus, total gastrectomy should be curative for gastric carcinoma in these patients. Based on their successful outcomes and the lack of efficacious surveillance methods for diffuse gastric carcinoma, prophylactic total gastrectomy may be the management of choice for germline E-cadherin gene mutation carriers. However, prophylactic total gastrectomy should be undertaken cautiously because the procedure may be associated with considerable morbidity.     

Early Gastric Cancer Induced by N-Ethyl-N'-nitro-N-nitrosoguanidine in a Cynomolgus Monkey Six Years after Initial Diagnosis of the Lesion

A signet ring cell carcinoma in the gastric antrum of a Cynomolgus monkey induced by N-ethyl-N′-nitro-N-nitrosoguanidine was sequentially studied by endoscopy, biopsy, and autopsy. The carcinoma was first detected on the angulus of the stomach at the 38th month as a slightly elevated lesion. Sixty-one months later this tumor was found to be still in the “early”(intramucosal) stage. Another, independent, initial gastric cancer was also discovered. This is the first example of an induced gastric carcinoma remaining in the “early’stage during a six-year follow-up period after the initial histologic diagnosis.     

胃肠道印戒细胞癌超微结构分型

通过对３８例胃肠道印戒细胞癌进行超微细胞结构观察，发现印戒细胞癌可有三种类型，即粘液型、微囊型和糖原型。结合粘液组化染色，作者对印戒细胞癌的细胞起源以及癌细胞不同形态表现的原因和意义进行了探讨，认为印戒细胞癌起源于具有多潜能分化的干细胞，癌细胞超微结构形态特征的变化是其畸形分化或功能代谢不同的具体表现。     

Signet ring cell carcinoma of the stomach.

Between 1965 and 1985, 51 of 1500 patients (3.4%) with gastric cancer who had gastric resection had signet ring cell gastric cancer. Patients with this form of cancer tended to be younger and female; the tumors were smaller and involved the stomach body, serosal invasion was less prominent, and lymph node metastases were less likely to be present. Early mucosal and submucosal cancer was present in 54.9% of the patients with the signet ring cell and in 24.6% with other types of gastric cancer. In 15.7% of patients with signet ring cell cancer, a noncurative resection was performed. The 5-year survival rate was 74.5% for patients with signet ring cell cancer and 52.4% for those with other types of gastric cancer (P less than 0.01). In patients with signet ring cell gastric cancer, the lesion is less extensive; thus, these patients probably can expect a longer survival time.     

Differential expression of peroxisome proliferator-activated receptor in histologically different human gastric cancer tissues

Gastric cancer cell lines express peroxisome proliferator-activated receptor gamma (PPARgamma), and treatment with PPARgamma ligands suppresses growth of subgroup of these cell lines. However, expression and subcellular distribution of PPARgamma in human gastric cancer tissues is still unknown. Therefore, expression and subcellular localization of PPARgamma were examined among different histological types of gastric cancer tissues. Immunohistochemical staining for PPARgamma was performed using biopsy specimens of human gastric cancer of various histological types, gastric adenomas, and intestinal metaplasia. All samples of intestinal metaplasia and most samples of gastric tumors, except for signet ring cell carcinoma, expressed PPARgamma in the epithelial cells. Most samples of signet ring cell cancer lacked PPARgamma expression. All samples of intestinal metaplasia expressed PPARgamma only in the cytosol. For adenoma, 90% was positive for PPARgamma in cytosol, and 40% was positive in nuclei, for well-differentiated adenocarcinoma, 80% was positive in cytosol, and 20% was positive in nuclei. For moderately differentiated adenocarcinomas, 70% was positive for cytosol, and 80% was positive for nuclei; for poorly differentiated adenocarcinoma, 30% was positive in cytosol, and 70% was positive in nuclei. The frequency of samples with positive cytosolic staining decreased as the differentiation stage turned from intestinal metaplasia to adenoma, well-, moderately-, and poorly-differentiated cancers. Simultaneously, there was a tendency toward an increased frequency of samples with positive nuclear PPARgamma staining as the differentiation stage transformed from intestinal metaplasia to poorly-differentiated cancer. There was a striking difference in subcellular localization according to the differentiation levels of gastric dysplastic cells. The findings also supported an intestinal metaplasia-adenoma-well-differentiated gastric cancer sequence, and signet ring cell cancer was suggested to be of a different lineage from other types of gastric cancers.