外周原始神经外胚叶肿瘤的临床病理

目的探讨外周原始神经外胚叶肿瘤(pPNET)的病理学特征、诊断及鉴别诊断。方法应用免疫组化方法,对我院1996年~2006年间10例病理诊断为外周原始神经外胚叶肿瘤患者的年龄、性别、发病部位、病理特征及免疫组化表型进行回顾性临床病理分析。结果pPNET好发于儿童及青年,肿瘤沿身体长轴分布,细胞呈小圆形,部分为梭形,密集呈巢状排列,由纤维结缔组织分割成分叶状或腺泡状,常形成Homer-Wrigh菊形团结构,血管丰富,易出血及坏死。免疫组化CD99及至少2项神经性标记阳性。结论pPNET是来源于神经外胚叶组织的小细胞恶性肿瘤,免疫组化染色对诊断和鉴别诊断是必不可少的。     

恶性外周原始神经外胚层瘤免疫组织化学研究

目的　探讨恶性外周原始神经外胚层瘤 (PNET)的临床病理学特征和意义。方法　采用光镜和免疫组织化学 Dako Envision二步法 ,对 14例外周 PNET进行观察。结果　光镜下肿瘤组织由小圆形细胞构成 ,有 Homer- Wright(H- W)菊心团的排列 ;免疫组织化学标记 14例均有肿瘤细胞膜 CD99(MIC2 )强阳性及肿瘤细胞质 NSE强阳性。并有其他不同神经标记的表达 ,如 Cg A,Syn,MBP,部分病例有 Vim和 S- 10 0的阳性表达。结论　原始神经外胚层瘤 (PNET)是一种高度恶性的小圆形细胞肿瘤 ,诊断与其他骨与软组织的小圆细胞类肿瘤的鉴别诊断具有一定意义 ,PNET的治疗效果与方法仍有待探讨     

Dermatofibrosarcoma protuberans following tanning bed use

Dermatofibrosarcoma protuberans (DFSP) is a rare, slowly growing, malignant dermal tumor first described by Darier and Ferrand in 1924. It typically occurs in individuals aged 20 to 40 years and frequently arises on the trunk. Although the cellular origin of DFSP is not entirely clear, dermal stem cells or undifferentiated mesenchymal cells with fibroblastic, muscular, and neuroectodermal features have been implicated. DFSP is a locally aggressive tumor with a high recurrence rate, largely attributed to the spread of tumor by direct local invasion through peripheral and deeply penetrating neoplastic cells into subcutaneous tissue and muscle. As such, there is growing evidence that Mohs micrographic surgery is the treatment of choice. Although reports of chromosomal aberrations and gene mutations have been described in the literature, excessive sun exposure is not regarded as a risk factor for the development or progression of DFSP. We describe a case of DFSP in a patient with a history of prolonged tanning bed use.     

Immunocytochemical detection of members of the caspase cascade of apoptosis in childhood medulloblastomas

During the process of programmed cell death (PCD), the cell disintegrates into small, membrane-bound apoptotic bodies. Caspase-3 is ubiquitously expressed in normal and neoplastically-transformed human cells and serves as an executioner in the apoptotic or PCD pathway. During our immunocytochemical study, a sensitive, four-step, alkaline phosphatase-conjugated antigen detection technique was employed. The results demonstrated the presence of apoptotic activity within the cellular microenvironment of childhood medulloblastoma/primitive neuroectodermal tumor. The observations identified the cytoplasmic presence of caspase-3 in more than 20% of neoplastic cells. The immunocytochemical expression pattern demonstrated a translocation tendency from the cytoplasm to the cell nuclei in the apoptotic cells in about 5% of the tumor cells. Caspase-3 presence was also detected in the tumor infiltrating lymphocytes (TILs), representing the host's immune, mostly CD8+, cytotoxic, tumor-associated antigen (TAA)-directed effector cells. This phenomenon may play an important role in these tumors' maintenance of immune privilege and evasion of immune attacks. We suggest that the grade and intensity of apoptosis may not only have diagnostic and prognostic significance, but could also play a leading role in the biological (fourth modality) antineoplastic treatment of these highly malignant, neuroectodermal brain tumors.     

妇科癌症患者免疫功能的监测及临床意义

目的通过监测妇科恶性肿瘤、良性肿瘤患者及健康对照者的免疫功能探讨其临床意义。方法分别对上述三类人员外周血的CD3+、CD4+、CD8+、CD4+/CD8+、CD19+和NK细胞进行流式细胞学检测,并对各组结果比较分析,了解妇科恶性肿瘤患者免疫功能的变化规律。结果妇科恶性肿瘤组中CD3+、CD4+、CD4+/CD8+和NK细胞与良性肿瘤组及健康对照组存在显著性差异,恶性肿瘤组中Ⅲ～Ⅳ期中的CD3+、CD4+、CD4+/CD8+、CD19+和NK细胞各项指标与Ⅰ～Ⅱ期组及良性肿瘤组、健康组存在显著性差异。结论妇科恶性肿瘤患者的免疫功能处于抑制状态且其抑制程度与肿瘤分期相关。通过检测以上指标有助于妇科良、恶性肿瘤的鉴别诊断、确定分期、估计预后、监测复发、指导肿瘤的免疫治疗等。     

恶性肿瘤患者外周血T淋巴细胞CD25的测定与临床检验学研究

目的探讨恶性肿瘤患者T淋巴细胞CD25＋水平的临床意义。方法用流式细胞仪检测70名正常人和274例恶性肿瘤患者外周血CD4＋CD25＋和CD8＋CD25＋水平。结果恶性肿瘤患者外周血CD4＋CD25＋水平比正常人高,差异有统计学意义（P〈0.05）;恶性肿瘤患者外周血CD8＋CD25＋水平与正常人比较,差异无统计学意义（P〉0.05）。其中,食管癌、肝癌和肺癌的CD4＋CD25＋水平与正常人比较,差异有统计学意义（P〈0.05）;肠癌、胃癌和鼻咽癌的CD4＋CD25＋水平与正常人比较,差异无统计学意义（P〉0.05）。结论恶性肿瘤患者外周血CD4＋CD25水平的增高可作为恶性肿瘤免疫诊断的参考指标。     

薏苡仁酯对高龄恶性肿瘤患者Treg细胞的影响

目的探讨薏苡仁酯(coixenolide)对高龄恶性肿瘤患者外周血调节性T细胞(Treg)的作用。方法检测30例80岁以上老年恶性肿瘤患者(肿瘤组)薏苡仁酯治疗前后外周血Treg占总CD4+T细胞比例和血IL-2mRNA变化。结果与30例健康老年人(对照组)进行比较。结果肿瘤组外周Treg占总CD4+T细胞比例、血IL-2mRNA水平均明显高于对照组(P<0.01)。肿瘤组外周血Treg比例与血IL-2mRNA水平呈正相关(r=0.921,P<0.01)。肿瘤组在薏苡仁酯治疗2个周期后,外周血Treg、IL-2mRNA水平较治疗前明显下降(P<0.01)。结论薏苡仁酯可能通过下调IL-2分泌和Treg数目解除免疫抑制而发挥抗肿瘤作用。     

T lymphocyte subsets and immunoglobulins in intracranial tumor patients before and after treatment, and based on histological type of tumors

It has been reported that nervous system and peripheral immune system communicate with each other and the peripheral immune status is depressed in some intracranial tumor (ICT) patients pre operatively. Little is known about the immune status of intracranial tumor patients during the post operative survival period. We thus investigated total T cells (CD 11+), helper/inducer (CD4+) T cells, suppressor/cytotoxic (CD8+) T cells, B cells (CD19+) and serum immunoglobulins in peripheral blood in certain ICT patients before and after treatment, and based on the histological type of the tumors. Post treatment analysis were conducted 30 days after surgical removal of tumor tissue in benign brain tumor patients and 30 days after chemo therapy (CT)/radiotherapy (RT) following surgical removal of tumor tissue in malignant brain tumor patients. Decreased CD11+, CD4+ and increased CD8+ T cell counts were observed in both benign and malignant tumor cases before treatment compared with control subjects. After treatment, CD4+ T cell count increased and CD8+ T cell count decreased than their pre treatment levels. Serum IgA and IgG levels were decreased in both benign and malignant brain tumor patients before treatment than in control subjects. Serum IgM level has been increased in both benign and malignant tumor patients before and after treatment than in control subjects. Anaplastic malignant astrocytoma, medulloblastoma and glioblastoma multiforme patients showed higher IgM level than astrocytoma, meningioma and ependymoma patients. In conclusions, the depressed host cellular immunity in benign and malignant tumor patients before treatment may be due to the changes in CD4+ and CD8+ counts in addition to tumour specific immunosuppressive factors. Treatment procedures such as surgery, CT and RT may play certain role in the post operative depressed immunosuppression in malignant tumor patients. Humoral immune mechanism (CD19+) in the ICT patients was less markedly affected.     

儿童非典型畸胎样/横纹肌样瘤临床病理分析

目的探讨儿童非典型畸胎样/横纹肌样瘤（AT/RT）的临床病理特征、免疫组化表型、诊断及鉴别诊断。方法分析AT/RT患者临床表现、病理形态和免疫组化染色特征。结果男2例,女2例,年龄3～15岁,平均年龄6.7岁;影像学检查肿瘤均位于幕上,其中1例位于脑室内。组织学上,肿瘤由横纹肌样细胞及肿瘤间叶组织和（或）原始神经外胚层成分构成,未见类似上皮样组织分化。免疫组化染色示波形蛋白、上皮细胞膜抗原、S-100、神经元特异性烯醇化酶和突触素阳性,且所有病例均显示INI1蛋白表达缺失。结论 AT/RT是好发于儿童的罕见的高度恶性胚胎性肿瘤,其形态及免疫组化表型多样,需与多种肿瘤相鉴别。免疫组化检测INI1表达失活为诊断该病的敏感性及特异性指标。     

Atypical apoptosis in L929 cells induced by evodiamine isolated from Evodia rutaecarpa

Two alkaloids, evodiamine and rutaecarpine, isolated from the dried fruits of Evodia rutaecarpa Bentham were evaluated in vitro for antiproliferation activity on tumor cells versus human peripheral blood mononuclear cells (PBMC). Evodiamine had more potent cytotoxic effects on five tumor cell lines (human malignant melanoma A375-S2, human cervical cancer HeLa, human breast adenocarcinoma MCF7, human acute monocytic leukemia THP-1, murine fibrosarcoma L929) than rutaecarpine. Moreover, evodiamine did not affect PBMC viability for a 36 h culture period. Although apoptotic bodies were observed in evodiamine-treated L929 cells stained with Hoechst 33258, DNA fragmentation as a hallmark of apoptosis was not found. Caspases were involved in the protection of L929 cells against cell death. Evodiamine initiated atypical apoptosis in L929 cells by cycle arrest at the G0/G1 phase.     

提高天然人白细胞介素-2效价的研究

由不同浓度的植物血凝素(PHA)、羧甲基茯苓多糖(CMP)、葡萄糖酸钙组成的复合诱生剂刺激人外周血单个核细胞(PBMC)产生的白细胞介素-2(IL-2)比单独用PHA刺激产生的IL-2活性高.诱生时间采用24h预温,然后37℃、5%CO_2旋转培养36～48h,可使产生的IL-2效价比单用PHA刺激48h提高15倍左右.这种复合诱生剂诱生的IL-2经临床使用,证实安全、有效.临床未发生明显副作用.37例恶性肿瘤IL-2治疗组总缓解率86.5%.比非IL-2治疗37例恶性肿瘤组总缓解率62.2%差异显著.     

Rituximab in autologous stem cell transplantation for follicular lymphoma

Contamination of stem cell harvests with residual tumor cells is a significant problem hampering the success of autologous peripheral blood stem cell transplantation in non-Hodgkin's lymphoma (NHL). Techniques have therefore been introduced to attempt to remove these cells, either in vivo, prior to harvesting, or ex vivo, before reinfusion into the patient. Rituximab is a human-mouse chimeric anti-CD20 monoclonal antibody that has been administered to patients prior to stem cell harvesting, to purge the blood of residual malignant cells. Clinical studies have shown that rituximab is safe to use during stem cell mobilization since administration did not adversely affect the yield of CD34+ stem cells or the functional capability of these progenitors. Rituximab was also effective in purging stem cell harvests of malignant cells. Translocation of the bcl-2 gene was found in a significantly smaller proportion of stem cell harvests from patients who had received a purging infusion of rituximab than controls. Rituximab may also be useful as salvage therapy following post-transplant relapse or as maintenance therapy for patients in remission. Prospective randomized trials will ultimately define the role of rituximab in the autologous transplantation setting.     

寡核苷酸的摄取与血液肿瘤细胞种类和增殖活性的关系

目的探讨血液肿瘤细胞摄取寡核苷酸与其种类和活性的关系。方法流式细胞仪测定细胞内的平均荧光强度。结果经过0.60 μmol·L^-1 荧光素FITC标记的G3139作用4 h后，血液系统肿瘤患者外周血及骨髓单个核细胞对G3139的摄取能力明显高于正常人；不同来源的血液肿瘤细胞株摄取G3139的能力不同，单核细胞、B淋巴细胞和髓系粒细胞来源的白血病细胞的摄取能力明显高于T淋巴细胞来源的白血病细胞；经过全反式维甲酸作用的HL60细胞的增殖活性明显受到抑制，同时细胞摄取G3139的能力明显下降。结论血液肿瘤细胞具有摄取寡核苷酸的能力，这种摄取能力与其细胞种类和细胞增殖活性有关。     

Atypical apoptosis in L929 cells induced by evodiamine isolated from Evodia rutaecarpa

Two alkaloids, evodiamine and rutaecarpine, isolated from the dried fruits of Evodia rutaecarpa Bentham were evaluated in vitro for antiproliferation activity on tumor cells versus human peripheral blood mononuclear cells (PBMC). Evodiamine had more potent cytotoxic effects on five tumor cell lines (human malignant melanoma A375-S2, human cervical cancer HeLa, human breast adenocarcinoma MCF7, human acute monocytic leukemia THP-1, murine fibrosarcoma L929) than rutaecarpine. Moreover, evodiamine did not affect PBMC viability for a 36?h culture period. Although apoptotic bodies were observed in evodiamine-treated L929 cells stained with Hoechst 33258, DNA fragmentation as a hallmark of apoptosis was not found. Caspases were involved in the protection of L929 cells against cell death. Evodiamine initiated atypical apoptosis in L929 cells by cycle arrest at the G0/G1 phase.     

耳廓背部神经鞘膜瘤误诊为耳廓脂肪瘤1例

耳廓肿物是常见的外耳疾病,以耳廓假性囊肿、脂肪瘤、疱疹多见,但耳廓恶性神经鞘膜瘤在临床上非常罕见,它是一种恶性程度非常高的软组织肉瘤。倘若临床上见到耳廓背部实性包块缺乏疼痛、麻木等症状很难令人想到是耳廓恶性神经鞘膜瘤,往往会误诊为＂脂肪瘤＂,笔者曾接诊1例耳廓恶性神经鞘膜瘤患者误诊为耳廓皮下脂肪瘤,后经手术病理确诊的临床经验,现报道如下。     

胸壁巨大上皮样血管肉瘤的临床病理分析

目的探讨发生于胸壁上皮样血管肉瘤的临床病理特征、病理诊断及鉴别诊断。方法对1例原发于胸壁的上皮样血管肉瘤进行组织形态学、免疫组织化学分析,并复习相关文献。结果肿瘤大体形态有主瘤结及卫星瘤节的特点,镜下观察其瘤细胞呈上皮样排列,异型性明显,免疫组化结果显示Vim强阳性,CD31阳性,CD34阳性。结论发生于胸壁的上皮样血管肉瘤较少见,术前确诊较困难,须与原发于胸膜的恶性间皮瘤、转移癌、恶性黑色素瘤等鉴别。     

恶性外周神经鞘膜瘤15例临床分析

[目的]探讨分析恶性外周神经鞘膜瘤发病特点和临床症状特点.[方法]将我院2006年2月至2011年2月神经外科15例头颈部恶性外周神经鞘膜瘤患者为观察组,将同期18例良性头颈部神经纤维瘤患者为对照组.对照组患者均行手术治疗,观察组患者根据病情特点以及一般情况选择姑息手术+化疗或姑息手术+放疗.比较两组间患者肿瘤病灶组织形态学特点、早期临床症状、其他肿瘤合并情况以及生存率.[结果]观察组患者肿瘤病灶呈弥散性生长14例(93.33％),平均肿瘤大小(3.6±0.8)cm×(2.0±0.5)cm,病灶陈旧性出血10例(66.57％)明显高于对照组患者肿瘤病灶呈弥散性生长6例(33.33％),平均肿瘤大小(1.7±0.5) cm×(0.9±0.3) cm,病灶陈旧性出血2例(11.11％),差异有显著性(P＜0.05).(2)观察组患者早期临床症状疼痛15例(100％),运动障碍4例(26.67％),感觉障碍6例(40％)明显高于对照组患者早期临床症状疼痛7例(38.89％),运动障碍2例(11.11％),感觉障碍3例(16.67％),差异有显著性(p＜0.05).(3)观察组患者合并听神经瘤6例、脊膜瘤4例、胶质细胞瘤2例,合并率为80％,1年生存率73.33％,5年生存率为6.67％明显异于对照组患者合并听神经瘤1例、脊膜瘤1例、胶质细胞瘤0例,合并率为11.11％,1年生存率100％,5年生存率为97.56％,差异有显著性(P＜0.05).[结论]恶性外周神经鞘膜瘤较良性神经纤维瘤起病急,早期临床症状显著,病情发展复杂,治疗愈后不良,因此临床诊断治疗应给予高度重视.     

Dequalinium induces apoptosis in peripheral blood mononuclear cells isolated from human chronic lymphocytic leukemia

B-cell chronic lymphocytic leukemia (B-CLL) is an abnormal neoplasic proliferation of B cells, which accumulate mainly in the bone marrow and blood preventing both B cells development in the lymph nodes and the ability to fight against infection. The antitumor agents used in chemotherapy are aimed at inducing malignant cell death, thus limiting the growth and spreading of these cells. However, the lack of specificity for tumor cells exhibited by these agents causes undesirable side effects that have led to the investigation of new therapeutic strategies designed to specifically target malignant cells and thus trigger selective cell destruction. Dequalinium (DQA) is an antitumoral agent that selectively accumulates in the mitochondria and has been shown to display anticancer activity in cells from different malignancies. In the present study, the DQA-induced cytotoxicity in B-CLL cells was analyzed by measuring cell viability and cell death, either by necrosis or apoptosis. Our results support the importance of DQA as a selective and potential antileukemic drug with a higher cytotoxic effect on peripheral blood mononuclear cells from B-CLL patients than in those from healthy donors and encourage the performance of further studies in combination with other agents.     

CT曾强在鉴别肢体软组织良恶性病变的临床价值

目的 评估CT静态强化扫描对鉴别肢体软组织良恶性病变的诊断价值。方法 回顾分析38例肢体软组织病变的CT表现,良性病变12例,恶性病变为26例,全部病例均与手术及病理结果对照。结果 CT对肢体软组织病变的检出率为100％,本组结果显示,良性病变强化相对均匀,恶性病变强化不均,呈边缘强化明显,中间强化较差的表现。结论 在CT增强扫描测量肢体软组织病变边缘及中心部位的CT值变化程度对鉴别肢体软组织良恶性病变有帮助。