基质金属蛋白酶2,9及金属蛋白酶组织抑制剂1在肾盂移行细胞癌中的表达及意义

目的 探讨基质金属蛋白酶2（MMP-2），9（MMP-9）及金属蛋白酶组织抑制剂1（TIMP-1）表达与肾盂移行细胞癌分级、分期及预后的关系。方法 采用免疫组化SP法检测117例肾盂移行细胞癌标本MMP-2，MMP-9发TIMP-1表达水平。患者中男97例，女20例。平均年龄59岁。肿瘤病理分级：G123例、G273例、G321例；TNM病理分期：Ta22例、T127例、T221例、T325例、T422例。结果 肾盂癌组织MMP-2表达阳性率81．2％（95例），MMP-9表达阳性率72．6％（85例），TIMP1表达阳性率72．6％（85例），阳性表达强度和阳性细胞分布不均匀，主要位于肿瘤细胞的胞质，随肿瘤分级、分期增加，MMP-2、MMP-9阳性表达率呈递增趋势，FL与预后相关，差异有统计学意义（P〈0．05）。TIMP-1阳性表达率随分级、分期增加呈递减趋势，但其差异无统计学意义（P〉0．05），TIMP-1表达强度与患者的生存时间无明显相关性。单因素方差分析发现MMP-9／TIMP-1比值与肿瘤临床病理分级、分期密切相关，随着分级、分期增加呈递增趋势（P〈0．05）。结论 MMP-2及MMP-9检测在肾盂癌病理分级、分期中有重要价值。MMP-2、MMP-9及MMP-9／TIMP-1比值在肾盂癌的预后判断中有重要意义。     

基质金属蛋白酶及其抑制剂与脑肿瘤健袭转移的关系

细胞外基质（ECM）在维持正常组织结构与功能，及细胞生长、分化过程中起非常重要作用。肿瘤细胞的生长、侵袭及转移，必须通过基质成分的改变及破坏得以实现。而MMPs（martrixmetalloproteinase）与TIMPs（tissueinhibitorofmetalloproteinase）是维系ECM平衡关系之酶系，在肿瘤侵袭转移中发挥重要作用。MMP在此过程中作用概括为：（１）破坏局部组织结构，促进肿瘤生长；（２）破坏基底膜屏障利于肿瘤转移；（３）通过对细胞外基质改建促进肿瘤新生血管形成，TIMP通过抑制MMP发挥作用。基质金属蛋白酶（MMP）１．MMP结构性质…     

CD147与基质金属蛋白酶-2、血管内皮生长因子在人膀胱移行细胞癌中的表达及其临床意义

目的 探讨膀胱移行细胞癌（BTCC）组织中细胞外基质金属蛋白酶诱导因子（CD147）与基质金属蛋白酶-2（MMP-2）、血管内皮生长因子（VEGF）的表达及其临床意义。方法采用免疫组织化学链霉菌抗生物素．蛋白过氧化酶（SP）法检测72例BTCC组织和12例正常膀胱组织CD147与MMP-2、VEGF的表达，分析CD147和MMP-2、VEGF间及其与BTCC部分临床生物学特性的相关性。结果 BTCC组织中有CD147、MMP-2、VEGF表达，其阳性率分别为68．1％、76．4％、70．8％。CD147表达与病理分级显著相关，与临床分期未见相关；MMP及VEGF表达与病理分级和临床分期显著相关；CD147表达与MMP-2、VEGF表达呈显著正相关（r=0．558，P〈0．01；r=0．406，P〈0．01）。结论 CD147在BTCC的浸润与转移中起重要作用，是新的治疗靶点。     

膀胱移行细胞癌组织环氧化酶2和基质金属蛋白酶2 mRNA的表达及相关性

目的:探讨膀胱移行细胞癌组织环氧化酶2(COX-2)和基质金属蛋白酶2(MMP-2)mRNA的表达及两者的相关性。方法:应用RT-PCR方法检测42例膀胱移行细胞癌组织(其中Ta~T1期18例,T2~T4期24例;G1级12例,G2级19例,G3级11例;有转移26例,无转移16例)和5例正常对照膀胱组织COX-2、MMP-2 mRNA的表达,并分析与肿瘤分级分期和转移的关系以及两者的相关性。结果:COX-2 mRNA在Ta~T1期相对表达量为1.038±0.484,T2~T4期为1.489±0.584,均显著高于正常对照膀胱组织(0.460±0.224,P均<0.05);COX-2 mR-NA在G1、G2、G3级分别为0.920±0.442,1.338±0.584,1.632±0.515,均显著高于正常对照膀胱组织(0.460±0.224,P均<0.05)。MMP-2 mRNA在Ta~T1、T2~T4期分别为1.107±0.384,T2~T4期为1.604±0.425,均显著高于正常对照膀胱组织(0.423±0.227,P均<0.05);MMP-2 mRNA在G1、G2、G3级分别为0.971±0.370,1.445±0.378,1.755±0.387,均显著高于正常对照膀胱组织(0.423±0.227,P均<0.05)。COX-2与MMP-2 mRNA表达在有转移及无转移肿瘤组织中分别为1.591±0.455vs0.815±0.430,1.676±0.339vs0.927±0.228,P均<0.01。COX-2与MMP-2 mRNA的表达呈显著正相关(r=0.703,P<0.01)。结论:COX-2与MMP-2 mRNA在膀胱移行细胞癌组织高表达,且随肿瘤分级分期及转移而表达增加,二者在膀胱移行细胞癌的发生发展过程中可能具有协同作用。     

基质金属蛋白酶-2与胃癌的侵袭转移

细胞外基质和基底膜重塑是癌细胞侵袭转移过程中的关键环节,需借助于蛋白降解酶的表达和激活。基质蛋白酶主要有以下数种：丝氨酸蚩白酶类,包括血浆酶原激活剂;半胱氨酸蛋白酶类,包括组织蛋白酶D在内的溶酶体酶;金属蛋白酶类(metalloproteioases)。金属蛋白酶类在肿瘤侵袭过程中的作用近年来倍受关注,大量证据表明基质金属蛋白酶,特别是基质金属蛋白酶-2(matrix metalloproteinase-2．MMP-2)在肿瘤细胞介导的细胞外基质降解中起关键作用,临床研究表明,MMP-2活性和表达的增加与人类多种恶性肿瘤侵袭转移潜能及预后密切相关。     

MMP2及MMP9在膀胱移行细胞癌尿液中的表达及与侵袭转移关系的研究

目的探讨MMP2及MMP9在膀胱移行细胞癌患者尿液中的表达,并研究它们与膀胱移行细胞癌侵袭转移之间的关系。方法采用酶联免疫吸附法(ELISA)定量检测尿液中MMP2及MMP9的含量,并分析其表达水平与膀胱移行细胞癌临床分期和病理分级之间的关系。结果MMP2在膀胱移行细胞癌患者尿液中的含量明显高于非癌症患者,二者差异有统计学意义(P<0.01);MMP9在膀胱移行细胞癌患者尿液中的含量也明显高于非癌症患者(P<0.01)。MMP9在膀胱移行细胞癌患者尿液中的含量与肿瘤临床分期呈显著正相关(r=0.51361,P<0.01);与肿瘤病理分级也呈显著正相关(r=0.47378,P<0.01)。MMP2在膀胱移行细胞癌者尿液中的含量与肿瘤临床分期呈正相关(r=0.32271,P<0.01);而与肿瘤病理分级不相关(r=0.29818,P>0.05)。MMP2和MMP9在膀胱移行细胞癌患者尿液中的含量呈显著正相关(r=0.55674,P<0.01)。结论膀胱移行细胞癌患者尿液中增高的MMP2及MMP9与肿瘤细胞侵袭能力密切相关。进一步研究对指导临床治疗、判断预后有重要意义。     

基质金属蛋白酶及其组织抑制物表达与壶腹癌侵袭转移的关系

我们应用免疫组织化学方法观察壶腹癌中基质金属蛋白酶(matrix metalloproteinase，MMP)MMP-2、MMP-9及其组织抑制物(tissue inhibiton of metalloproteinase，TIM)TIMP-1和TIMP-2的表达，报告如下。     

基质金属蛋白酶与结直肠癌的侵袭和转移

结直肠癌的侵袭和转移是一个相当复杂的过程。基质金属蛋白酶（MMPs）其抑制剂（TIMPs）是细胞外基质降解过程中的重要酶类,与多种病理过程尤其是肿瘤的侵袭和转移有着密切的关系,并在此过程中发挥着重要的作用。现就MMPs、TIMPs的生物学作用及其与结直肠癌侵袭和转移的关系进行综述。     

基质金属蛋白酶-9及其抑制因子在肾细胞癌组织中的表达和意义

目的　探讨基质金属蛋白酶 9(MMP 9)和金属蛋白酶组织抑制因子 1(TIMP 1)在肾细胞癌中的表达及其与临床病理参数之间的关系。方法　采用免疫组织化学链霉菌抗生物素蛋白过氧化酶 (SP)法检测 5 5例肾细胞癌中MMP 9和TIMP 1的表达情况。结果　MMP 9、TIMP 1蛋白在肾细胞癌和正常肾组织中的阳性表达率各为 63 .63 %和 10 .0 0 % (P <0 .0 5 ) ;60 .0 0 %和10 .0 0 % (P <0 .0 5 )。在肾癌中 ,MMP 9蛋白表达与肿瘤Robson分期、肾包膜侵袭和淋巴结转移密切相关 (P <0 .0 5 ) ,而与组织学类型无关 (P >0 .0 5 ) ;TIMP 1蛋白表达与肾细胞癌的临床病理参数无关 (P >0 .0 5 )。结论　MMP 9蛋白高表达参与了肾癌的发展 ,MMP 9和TIMP 1的平衡失调可能在肾癌的侵袭转移中发挥重要作用。     

MMP-2和MMP-9在膀胱移行细胞癌组织中的表达及临床意义

目的：探讨膀胱肿瘤组织巾MMP-2及MMP-9表达与膀胱移行细胞癌（TCCB）临床病理分期分级的关系。方法：选择同济医院2004年1～12月间手术治疗的TCCB患者38例作为实验组,以16例附带癌旁正常黏膜或膀胱镜下活检正常膀胱黏膜作为对照组。运用免疫组织化学SP法检测MMP-2及MMP-9在膀胱组织中的表达。结果：MMP-2和MMP-9在实验组的表达显著高于对照组（P〈0．01）,且与肿瘤临床分期呈显著正相关（r=0．51361,P〈0．01）,与肿瘤病理分级也呈正相关（r=0．59818,P〈0.05）。结论：TCCB患者膀胱组织中高表达的MMP-2及MMP-9与肿瘤细胞侵袭和转移密切相关,联合检测MMP-2及MMP-9,对TCCB的早期诊断及判断预后有参考价值。     

Extensive cutaneous metastasis of transitional cell carcinoma of the bladder

Cutaneous metastasis of bladder carcinoma is extremely rare. Iatrogenic implantations have been the main cause in the majority of cases of transitional cell carcinoma with cutaneous metastasis. Otherwise, primary cutaneous metastasis is accepted as the late manifestation of systemic spread. The present paper describes a case of relatively early and extensive skin metastasis of transitional cell carcinoma in a 78-year-old man. The patient had a histopathological diagnosis of poorly differentiated (grade III) muscle invasive transitional cell carcinoma with a staging of T2NOMO 6 months prior to presenting. He presented to our outpatient clinic with a 3-month history of skin lesions as multiple, rubbery subcutaneous nodules. Radiological reinvestigation revealed no other metastatic site (including bone and lung), except for a metastatic nodule in the liver. The present paper reports an interesting and rare case of extensive skin metastasis of transitional cell carcinoma as the primary complaint.     

Clinical study of transitional cell carcinoma of the prostate associated with bladder transitional cell carcinoma

BACKGROUND: Transitional cell carcinoma of the prostate in patients with bladder cancer appears to influence the prognosis and affects the decision about therapeutic modality. Therefore, it is important to characterize transitional cell carcinoma associated with bladder cancer. METHODS: From April 1980 to December 1998, 81 male patients underwent total cystoprostatectomies for transitional cell carcinoma of the bladder. The 81 cystoprostatectomy specimens were examined to clarify the characteristics of prostatic involvement by transitional cell carcinoma. The extent, origin, mode of spread and risk factor of prostatic involvement as well as the prognosis were investigated. In 13 of 15 patients with prostatic involvement the prostate was examined by sequential step sections. RESULTS: Prostatic involvement was observed in 15 of 81 patients (18.5%). Prostatic urethral involvement, invasion to prostatic duct/acinus, prostatic stromal invasion and extraprostatic extension and/or seminal vesicle involvement were recognized in 12 (80%), 14 (93.3%), six (40%), and five (33.3%) of the 15 patients, respectively. Twelve of the 15 patients (80%) with prostatic involvement had papillary or non-papillary tumors (i.e. carcinoma in situ) both in the prostatic urethra and prostatic duct. In 10 of these 12 patients (88.3%), there was contiguity between prostatic urethral and ductal tumors. Seven of the 23 patients (30.4%) with carcinoma in situ of the bladder showed prostatic involvement, which increased to 50% in the presence of carcinoma in situ of the trigone or bladder neck. CONCLUSIONS: Eighty per cent of the patients with prostatic involvement showed papillary or non-papillary tumors both in the prostatic urethra and prostatic duct. There was a high level of contiguity between both tumors. Patients with carcinoma in situ of the trigone or bladder neck revealed significantly higher incidence of prostatic involvement.     

膀胱移行细胞癌DNA测定的临床意义

应用图像分析技术对３７例膀胱移行癌细胞核ＤＮＡ含量进行测定，３５例得到随访，结果发现，膀胱移行细胞癌ＤＮＡ含量和异倍体出现率随种瘤恶性程度的增加而明显升高，肿瘤的复发和病人存活时间与肿瘤异倍体出率亦明显相关。结果表明，ＤＮＡ含量测定对膀胱瘤的诊断及预后是一个可靠指标。     

Micropapillary variant of transitional cell carcinoma of the bladder

A 77-year-old man visited the Kobe City General Hospital complaining of macroscopic hematuria. A computed tomography scan found a bladder tumor with left iliac and para-aortic lymph node metastasis. Two courses of cisplatin, cyclophosphamide and doxorubicin chemotherapy resulted in a minimal response. Radical cystectomy and a retroperitoneal lymph node dissection with bilateral ureterocutaneostomy reconstruction were then performed. A pathological examination revealed a micropapillary variant of transitional cell carcinoma (Grade 3, pT1pN2M1). The patient died of pelvic recurrence 7 months after the initiation of chemotherapy. Peritonitis carcinomatosa and lung metastases were observed at autopsy.     

PTEN在膀胱移行细胞癌中的表达及其临床意义

日曲探讨膀胱移行细胞癌中PTEN的表达及其临床意义。方珐应用免疫组织化学（S-P）法对50例膀胱移行细胞癌组织和10例正常膀胱黏膜中PTEN蛋白的表达进行检测。结果膀胱癌组织中PTEN蛋白阳性表达率为54．0％（27／50），明显低于正常膀胱组织100．0％（10／10），两组间的差异有统计学意义（P〈0．01）；且其表达水平在不同病理分级、临床分期间也有显著差异（P〈0．01）。结论PTEN蛋白表达的缺失可能在膀胱移行细胞癌的发生及进展过程中起着重要作用，并影响其生物学行为；检测PTEN蛋白表达水平有助于膀胱癌的诊断和预后判断。     

Cardiac metastasis from a transitional cell carcinoma diagnosed by two-dimensional echocardiography

We report a rare case of symptomatic cardiac metastasis from a transitional cell carcinoma of the renal pelvis. A 57-year-old man presented with severe anemia, inflammation, hypoxemia and disseminated intravascular coagulation. Computed tomography revealed a large tumor in the left renal pelvis with multiple lymph node metastases. Two-dimensional echocardiography revealed large tumors in the right ventricle. The patient suddenly died because of the obstructive mass of the right ventricular outflow tract. Histopathological examination showed high-grade transitional cell carcinoma in the left renal pelvis and the right ventricle. There are only three cases of cardiac metastases from a transitional cell carcinoma reported in the literature.     

小分子肽CSNRDARRC与膀胱移行细胞癌组织特异性结合的研究

目的明确小分子肽CSNRDARRC与膀胱移行细胞癌组织结合的特异性及其结合位点。方法选用膀胱移行细胞癌、肾癌、胃癌及腺性膀胱炎石蜡组织块,分别为107、43、68、16例;进行连续切片、烤片、脱蜡、抗原修复,封闭,再采用免疫荧光技术加FITC-六氨基己酸-CSNRDARRC复合物,荧光显微镜定性分析,单纯加FITC作为阴性对照。采用SPSS13.0软件进行统计分析,P〈0.05为有显著性统计学差异。结果单纯FITC标记的各蜡块组织（阴性对照组）均未见有高亮荧光点,FITC-六氨基己酸-CSNRDARRC复合物标记的膀胱移行细胞癌组织有99例出现高亮荧光点,特异性为92.52%（99/107）,而在肾癌、胃癌及腺性膀胱炎组织分别有6例、5例、2例有荧光亮点,特异性分别为9.52%（5/43）,8.82%（6/68）,12.50%（2/16）,通过DAPI着色确定高亮荧光点主要定位于细胞核。CSNRDARRC与膀胱移行细胞癌组织的结合较其与肾癌、胃癌及腺性膀胱炎组织的结合有显著差异（P〈0.05）,而CSNRDARRC与肾癌、胃癌及腺性膀胱炎组织间结合比较无统计学意义（P〉0.05）。结论小分子肽CSNRDARRC与膀胱移行细胞癌特异性结合率显著高于其他肿瘤组织,但对其他组织仍有标记,且结合位点在细胞核内,这为该肽段对膀胱移行细胞癌临床诊断提供理论基础;为膀胱癌的治疗奠定一定的理论依据。     

Synchronous and multiple transitional cell carcinoma of the bladder and urachal cyst

Abstract:   Incomplete involution of the allantoic duct can result in different pathological forms of urachus which can give rise to inflammation or late malignant changes. Among urachal tumors, adenocarcinoma is most frequent, although other histological types can also be found. The synchronous presentation of a urachal transitional cell tumor, along with recurrent superficial bladder tumors has not been reported previously. We are reporting a 49-year-old male patient in whom transitional cell carcinoma of a urachal cyst was found with recurrent, multiple bladder tumors. The diagnosis of urachal cyst tumor was established according to ultrasonography and computed tomography. Most of the bladder tumors were resected transurethrally while open surgical excision of the urachal cyst with en bloc resection of the bladder dome was performed. Recurrent bladder tumors were afterwards treated with Bacillus Calmette Guerin (BCG) instillations. A year after surgery the patient has no signs of local recurrence or distant metastases of transitional cell carcinoma.     

Contemporary management of stage T1 transitional cell carcinoma of the bladder

PURPOSE: Transitional cell carcinoma involving the lamina propria (stage T1) is associated with a high recurrence and progression rate with implications for patient survival and quality of life. A better understanding of the natural history of and treatment alternatives for this tumor may improve the outcome in patients with this stage of bladder cancer. MATERIALS AND METHODS: Literature of the last decade was comprehensively reviewed in regard to clinical and pathological diagnosis, adjuvant treatments, prognosis, and the role and timing of cystectomy. The information was gathered from MEDLINE, current urology journals, abstracts from recent urological meetings and personal experience. RESULTS: High grade and the depth of lamina propria invasion are important prognostic factors. Early diagnosis and accurate pathological assessment are essential for determining the most adequate treatment pathway. Initial treatment consists of complete transurethral resection and adjuvant treatment with intravesical instillation of bacillus Calmette-Guerin (BCG). Immediate postoperative instillation of mitomycin C decreases the risk of recurrence possibly related to tumor implantation. Intravesical treatment does not substantially decrease the chance of progression. Lack of a complete response to BCG at 3 to 6 months, high grade, the depth of lamina propria invasion, the association of carcinoma in situ and prostate mucosa or duct involvement represent significant predictors for progression. Cystectomy should be suggested for recurrent stage T1 tumor after BCG, new onset or persistent carcinoma in situ, tumor located at a difficult site for resection, prostatic duct or stromal involvement and muscle invasion. CONCLUSIONS: High grade stage T1 transitional cell carcinoma is a highly malignant tumor. Complete resection followed by immediate mitomycin C instillation and 6 weekly BCG instillations results in an acceptably low recurrence and progression rate. Rigorous long-term surveillance and continuous reconsideration of radical cystectomy in concordance with the evolution of the disease are essential.