黏蛋白1在胆囊癌中的表达和意义

目的 探讨黏蛋白1（MUC1）在原发性胆囊癌组织中的表达及其在胆囊癌诊断和免疫治疗中的意义。方法 采用免疫组化方法检测42例原发性胆囊癌组织和17例正常胆囊组织中MUC1的表达。结果 MUC1在胆囊癌组织中的阳性表达率为76．19％，明显高于正常胆囊组织（29.41％），两组存在统计学差异（P〈0．05）。MUC1在胆囊癌组织中阳性表达率与胆囊癌组织病理类型、组织学分化、淋巴结转移及Nevin分期也有相关关系。但与有无合并胆囊结石无相关关系。结论 MUC1可作为胆囊癌患者预后评价指标，有可能作为肿瘤微转移的诊断及免疫治疗的靶抗原。     

LI-钙黏蛋白和E-钙黏蛋白在结肠癌中的表达及意义

探讨LI-钙黏蛋白(LI-cadherin)和E-钙黏蛋白(E-cadherin)在结肠癌组织中的表达及临床意义。2011年7月—2012年12月在山东大学齐鲁医院胃肠外科行手术治疗的结肠癌患者78例(结肠癌组),肠镜检查正常者56例(正常组),用免疫组织化学技术检测正常结肠黏膜和结肠癌组织中LI-钙黏蛋白和E-钙黏蛋白的表达。结肠癌组E-cadherin表达异常者与正常组相比显著增高(P0.05);结肠癌组LI-cadherin表达阳性率为69.2%,显著低于正常组(92.9%,P0.05)。E-cadherin和LI-cadherin表达与结肠癌临床病理因素关系显示,分化程度越低,E-cadherin异常表达明显升高,LI-cadherin表达阳性率降低(P0.05)。Dukes分期越高,E-cadherin异常表达明显升高,LI-cadherin表达阳性率显著降低(P0.05)。发生淋巴结转移的患者E-cadherin异常表达率为67.5%,显著高于未发生淋巴结转移者(39.5%);LI-cadherin在淋巴结发生转移者阳性率为62.5%,显著低于未发生转移者(76.3%,P0.05)。LI-cadherin和E-cadherin异常表达与结肠癌的发生密切相关,表达的异常可能成为结肠癌恶性程度以及是否转移的参考指标。     

cyclin E和p27kip1蛋白在胆囊癌组织中的表达及其意义

目的　探讨cyclinE和 p2 7kip1蛋白在胆囊癌组织中的表达及其意义。方法　采用免疫组化SP法检测 4 1例胆囊癌和 15例慢性胆囊炎组织中cyclinE及p2 7kip1蛋白的表达 ,并分析两者的表达与胆囊癌临床病理特征的关系。结果　cyclinE在胆囊癌组织中的表达阳性率为 6 1.0 % (2 5 / 4 1) ,显著高于慢性胆囊炎的 2 0 .0 % (3/15 ) ,P<0 .0 5 ;胆囊癌组织中p2 7kip1蛋白的表达阳性率为 5 3.7% ,低于慢性胆囊炎的 10 0 % (P<0 .0 5 )。cyclinE的表达与胆囊癌TNM分期呈正相关 (r =0 .314 ,P<0 .0 5 ) ,p2 7kip1蛋白的表达则随胆囊癌TNM分期进展、组织学分化程度的降低而逐渐下降 (P<0 .0 5 ) ,cyclinE与 p2 7kip1蛋白表达之间呈负相关 (r =- 0 .342 ,P<0 .0 5 )。结论　cyclinE蛋白高表达和 p2 7kip1蛋白表达下降导致细胞周期的调控异常 ,可能参与了胆囊癌的发生、发展过程。     

DLC-1在胆囊癌中的表达及意义

目的 检测肝癌缺失基因(deleted in liver cancer I,DLC-1)蛋白在胆囊癌中的表达及意义.方法 应用免疫组织化学方法,观察48份胆囊癌及15份胆囊炎组织中DLC-1表达结果.结果 DLC-1在胆囊癌中的表达显著低于正常黏膜,与临床分期、肿瘤分级、淋巴和远处转移均有相关性.结论 DLC-1的阳性表达可作为预测胆囊癌转移潜能的生物学指标并有望成为基因治疗的靶点.     

FAP-1和RAC-1在胆囊癌组织中的表达及其临床意义

目的 探讨Fas相关磷酸酯酶1（FAP-1）和RAC-1在胆囊癌中的表达及其与胆囊癌侵袭转移之间的关系.方法 应用免疫组化SP技术,检测30例胆囊癌组织中FAP-1和RAC-1的表达.分析其与胆囊癌侵袭转移之间关系.结果 30例胆囊癌组织中FAP-1和RAC-1的表达与胆囊癌的侵袭转移能力密切相关,FAP-1和RAC-1的表达具有高度协同性.结论 FAP-1和RAC-1的表达能反映胆囊癌的侵袭转移能力,联合检测两种蛋白在胆囊癌组织中的表达,可以更准确判断胆囊癌的恶性程度和生物学行为.     

HMGB1在胆囊癌组织中的表达及意义

探讨高迁移率族蛋白B1(high mobility group box protein-1,HMGB1)在胆囊癌组织中的表达及临床意义。采用免疫组织化学方法测定胆囊癌和非癌组织中HMGB1的表达。胆囊癌组织中HMGB1阳性表达率为83.33%(25/30),明显高于非癌组织中HMGB1表达率16.67%(5/30,P0.05)。HMGB1表达与胆囊癌的Nevin分期有关,在Ⅲ、Ⅳ、V期中的表达高于在Ⅰ、Ⅱ期中的表达(P0.05)。HMGB1可能与胆囊癌的发生、侵袭、转移有关。     

Survivin和p27kipl在胆囊癌中的表达及相关性研究

目的 检测胆囊癌中Survivin和p27kip1的表达,研究它们与胆囊癌临床病理特征的关系.并探讨两者的相关性.方法 采用免疫组织化学技术检测50例胆囊癌组织、20例胆囊息肉、20例胆囊炎组织中Survivin和p27kip1表达.结果 50例胆囊癌组织中39例Survivin蛋白表达阳性,22例p27kip1蛋白表达阳性.二者表达呈负相关系;Survivin在胆囊息肉和胆囊炎标本中不表达,p27kip1在胆囊息肉和胆囊炎标本中呈高表达;Survivin在胆囊癌中的表达与病人性别、年龄、病理分级、Nevin分期、淋巴结转移无关(P>0.05),p27kip1在胆囊癌中的表达与病理分级、Nevin分期、淋巴结转移有关(P<0.05),而与年龄、性别无明显相关性.结论 Survivin和p27kip1表达异常可能在胆囊癌的发生、发展中起重要的作用,二者在胆囊癌的发生、发展中可能有相互作用;Survivin在胆囊癌中的高表达提示其可能与肿瘤的发生有关;p27kip1有可能成为判断胆囊癌预后的有效指标之一.     

SHH和上皮型钙黏蛋白在慢性结石性胆囊炎组织中的表达及其意义

目的 探讨Sonic Hedgehog(SHH)信号通路中SHH蛋白和上皮型钙黏蛋白(E-cadherin)在慢性结石性胆囊炎中的表达及其临床意义.方法 选取广州军区武汉总医院2005年2月至2010年5月间经病理确诊、且术后病理蜡块保存完好的慢性结石性胆囊炎患者术后的组织标本120例,其中慢性轻度胆囊炎45例、慢性中度胆囊炎45例、慢性重度胆囊炎30例,另取36例胆囊癌标本作为阳性对照,所有患者均签署知情同意书.采用免疫组织化学链霉亲和素-生物素-过氧化物酶复合物(SABC)法检测组织中SHH和E-cadherin蛋白的表达.结果 各组间SHH和E-cadherin阳性颗粒的平均灰度和阳性单位值差异均有统计学意义(P＜0.01),SHH和E-cadherin阳性颗粒的平均灰度和阳性单位值与胆囊结石的大小(直径＞3 cm或直径≤3 cm)差异有统计学意义(P＜0.01),与性别、年龄等因素均无关(P＞0.05).各组结石性胆囊炎组织中的SHH与E-cadherin阳性颗粒的平均灰度和阳性单位值之间呈显著负相关(r平均灰度=-0.73,r阳性单位=-0.75,P＜0.01).结论 SHH和E-cadherin蛋白在慢性结石性胆囊炎和胆囊癌组织中均呈活化状态,提示SHH信号通路和E-cadherin对慢性结石性胆囊炎向胆囊癌的发展转化可能有重要影响.     

黏蛋白3和黏蛋白4在结石相关肝内胆管细胞癌中的表达及意义

目的:探讨黏蛋白3(MUC3)和黏蛋白4(MUC4)在结石相关肝内胆管细胞癌(ICC)组织中的表达及临床意义。方法:用免疫组化法检测MUC3、MUC4在24例正常胆管组织、44例肝内肝管结石胆管组织、38例结石相关ICC组织中的表达,分析两者表达与ICC患者临床病理因素及预后的关系。结果:MUC3与MUC4在3种组织中的表达均有统计学差异(均P0.05),在正常胆管组织、结石患者胆管组织,结石相关ICC组织中MUC3的表达阳性率依次降低(79.2%、56.8%、36.8%),而MUC4的表达阳性率则相反(29.2%、79.5%、86.8%)。两者的表达均与结石相关ICC患者的肿瘤组织学分级、有无淋巴结转移有关,且MUC4的表达与门静脉有无浸润有关(均P0.05)。结石相关ICC患者中,MUC3阳性表达者术后生存率明显高于阴性患者,MUC4阳性表达患者术后生存率明显低于阴性表达患者(均P0.05)。结论:在结石相关ICC组织中,MUC3表达降低,而MUC4的表达升高,两者表达的变化与结石相关ICC的进展、侵袭及转移紧密相关。     

Incidental carcinoma gall bladder during laparoscopic cholecystectomy for symptomatic gall stone disease

Introduction  Carcinoma gall bladder (CaGB) is a disease with high mortality and is usually diagnosed as an incidental case among patients undergoing laparoscopic cholecystectomy (LC) for symptomatic gall stone disease. Methods  A total of 3205 LC done between January 2004 and August 2007 for symptomatic gall stone disease were retrospectively searched for incidental CaGB (detected on histopathology). None of these cases had preoperative suspicion of malignancy and their whole data was analyzed with special attention to preoperative and intraoperative findings which could raise suspicion of CaGB. In November 2007, patients were followed up telephonically about their present status of health. Results  Nineteen patients (14 female and 5 male) with incidental CaGB (incidence 0.59%) were detected. Mean age of the patients was 56 years. Only two of these patients had clinical jaundice and both had common bile duct (CBD) stones. The majority of the patients were in early pathological stages (pT) and none was in pT3 and pT4 stage. Seventeen patients could be followed up telephonically in November 2007 and of those 14 patients were alive at a mean follow-up duration of 21.2 months, with one of them having evidence of metastatic disease. Conclusion  Gall bladder (GB) malignancy may be curable if diagnosed in early stages as an incidental finding and LC may not worsen the prognosis in such cases. In our series, incidental CaGB was detected in 0.59% patients undergoing LC. No association could be found between preoperative and intraoperative findings that could raise a suspicion of malignancy of gall bladder and so use of retrieval bag as a routine measure in cases with bile spillage may reduce the incidence of port-site metastasis.     

Laparoscopic management of a two staged gall bladder torsion

Gall bladder torsion (GBT) is a relatively uncommon entity and rarely diagnosed preoperatively. A constant factor in all occurrences of GBT is a freely mobile gall bladder due to congenital or acquired anomalies. GBT is commonly observed in elderly white females. We report a 77-year-old, Caucasian lady who was originally diagnosed as gall bladder perforation but was eventually found with a two staged torsion of the gall bladder with twisting of the Riedel’s lobe (part of tongue like projection of liver segment 4A). This together, has not been reported in literature, to the best of our knowledge. We performed laparoscopic cholecystectomy and she had an uneventful post-operative period. GBT may create a diagnostic dilemma in the context of acute cholecystitis. Timely diagnosis and intervention is necessary, with extra care while operating as the anatomy is generally distorted. The fundus first approach can be useful due to altered anatomy in the region of Calot’s triangle. Laparoscopic cholecystectomy has the benefit of early recovery.     

膀胱癌中乙酰肝素酶的表达和临床意义

目的探讨国人膀胱癌乙酰肝素酶的表达水平及其与膀胱癌发生、发展、转移和复发的关系。方法应用免疫组化EnVisionZ．步法研究58例膀胱癌患者中乙酰肝素酶蛋白的表达水平，10例正常膀胱黏膜为对照组。结果乙酰肝素酶在膀胱癌中阳性表达22例（37．9％），其表达率与肿瘤的病理分级、临床分期、复发和淋巴结转移有相关性（P〈0．05）。结论乙酰肝素酶蛋白的异常表达可作为膀胱癌患者发生和发展的预后参数。     

New scoring system for differentiating xanthogranulomatous cholecystitis from gall bladder carcinoma: a tertiary care centre experience

Background

Xanthogranulomatous cholecystitis (XGC) is an uncommon variant of chronic cholecystitis, characterized by a focal or diffuse destructive inflammatory process. The importance of XGC is that it mimics gall bladder carcinoma (GBC) both preoperatively and intra‐operatively, as it can present with pericholecystic infiltration, hepatic involvement and lymphadenopathy. As a result of a misdiagnosis, which is not infrequent, the patient may undergo an unnecessary radical cholecystectomy rather than only a cholecystectomy, which is associated with a greater morbidity and mortality. The main aim of the study is to formulate a simple preoperative scoring system for diagnosis of XGC which might benefit patients by avoiding radical procedures.

Methods

A retrospective study was done from all the patients who underwent gall bladder and gall bladder‐related operations (benign and malignant), during a 5‐year time period from 2010 to 2014 in a tertiary care centre were reviewed (n = 462).

Results

Initial analyses of all the clinical and imaging parameters were done. Patients with a long history of recurrent abdominal pain with leucocytosis and who on imaging are found to have a diffusely thickened gall bladder wall, cholelithiasis, choledocholithiasis and submucosal hypoattenuated nodules are likely to have XGC while those with anorexia, weight loss, focal thickening of the gall bladder wall on imaging and dense local organ infiltration are more likely to have GBC. The presence of lymph nodes on imaging and the loss of a fat plane interface between the liver and gall bladder are not differentiating factors. A scoring system was made by taking statistically significant features (n = 13) of clinical and imaging parameters in initial assessment to identify the features of XGC. The same scoring system was subsequently applied to the patients who underwent cholecystectomy to study the effectiveness and the results were reviewed.

Conclusion

High value scores (≥11/13) helps in diagnosing XGC in preoperative setting. Hence, intra‐operative frozen section analysis can be avoided in such cases to differentiate XGC and GBC. However in difficult cases with high suspicion of malignancy based on clinical experience, definitive diagnosis still remains a histopathological examination to avoid radical resection in patients who have a benign condition.     

细胞角蛋白20表达与膀胱移行细胞癌复发的关系

目的　探讨细胞角蛋白 2 0 (CK2 0 )在膀胱移行细胞癌 (TCC)中的表达及临床意义。方法　应用免疫组化及图像分析技术检测 5 4例TCC中CK2 0的表达 ,并进行分组比较。结果　CK2 0的表达在有否复发组之间差异有极显著性意义 (P <0 .0 0 1)。结论　CK2 0的表达与TCC生物学行为密切相关 ,为临床预测TCC复发开辟了新方法。     

HRG-1基因在膀胱癌和正常膀胱组织中的表达

目的观察HRG-1基因在膀胱正常组织和膀胱癌组织中的表达,探讨HRG-1基因表达与膀胱肿瘤病理分级和临床分期的关系。方法应用免疫组化SP法检测63例膀胱癌和28例膀胱正常组织石蜡标本中HRG-1表达情况,并进行相关临床病理分析。结果在正常膀胱组织和膀胱癌组织中HRG-1表达有显著性差异（P〈0.05）;HRG-1的阳性表达与膀胱癌病例分级、临床分期之间有显著性差异（P〈0.05）。结论 HRG-1基因在膀胱癌组织中表达水平显著提高,提示该基因可能对膀胱肿瘤病理分级和临床分期有一定的指导意义。     

Bone metastases as the initial presentation of carcinoma of gall bladder: a rarity

Distant metastases are rare form of presentation of carcinoma gall bladder. Bony pain as initial presentation is quite unusual. A 50-year-old woman presented with the pain in right shoulder. Investigation showed metastatic adenocarcinoma in the head of humerus and the primary was found in the gall bladder. She received local radiotherapy for bone metastases and undergoing systemic chemotherapy. Carcinoma gall bladder is a common abdominal malignancy, mostly presenting in advanced stage with abdominal symptoms and obstructive jaundice. In presence of metastasis, the management is palliative and role of chemotherapy is limited for palliation symptoms.     

Bcl-2与VEGF在膀胱移行细胞癌的表达及其意义

目的:探讨凋亡抑制基因Bcl-2与血管内皮生长因子(VEGF)蛋白在膀胱移行细胞癌(TCC)组织的表达,以及二者表达与TCC生物学行为的相关性.方法:分别对45例TCC组织、34例相应的癌旁组织和10例正常膀胱组织,采用免疫组织化学法检测Bcl-2的表达,免疫蛋白印迹(Western Blotting)法检测VEGF蛋白的表达,并采用DNA原位末端标记(TUNEL)法检测细胞凋亡指数(AI).结果:Bcl-2和VEGF蛋白在45例TCC组织中的阳性表达率分别为51.1%和62.2%,均显著高于癌旁组织(7.9%和5.9%)(P<0.05);而在正常膀胱组织二者均无表达.同时,Bcl-2在VEGF表达阳性的TCC组织中呈高度表达,Bcl-2和VEGF的表达密切相关(x2=5.148,P<0.05).结论:提示Bcl-2可能参与TCC的发生和发展;Bcl-2可能通过上调VEGF的表达而促进TCC的转移,同时VEGF也可能通过诱导Bcl-2的表达而抑制肿瘤细胞的凋亡.     

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。