涎腺腺样囊性癌中Cyclin D1、MMP-7和PRB2/p130表达及意义

目的探讨Cyclin D1、MMP-7和PRB2/p130蛋白在涎腺腺样囊性癌组织中的表达及与涎腺腺样囊性癌生物学行为的关系。方法应用免疫组化SP法检测46例涎腺腺样囊性癌和30例正常涎腺组织中Cyclin D1、MMP-7和PRB2/p130蛋白的表达。结果 Cyclin D1、MMP-7和PRB2/p130在涎腺腺样囊性癌中的阳性率分别为71.74%、67.39%、63.04%;Cyclin D1和PRB2/p130蛋白在涎腺腺样囊性癌中的表达与病理类型有关(P<0.05),MMP-7在涎腺腺样囊性癌中的表达与病理类型无关(P>0.05);Cyclin D1、MMP-7和PRB2/p130蛋白在涎腺腺样囊性癌复发组中的阳性率与无复发组相比,差异有显著性(P<0.05);Cyclin D1与PRB2/p130在涎腺腺样囊性癌中的表达呈负相关,与MMP-7表达呈正相关。结论 Cyclin D1、MMP-7和PRB2/p130蛋白的异常表达在涎腺腺样囊性癌发生、发展和复发中起重要作用,联合检测多个指标可能对患者预后的判断有指导意义。     

Tenascin-C和CD9在涎腺肿瘤中的表达

目的:探讨Tenascin-C(Tn-C)和CD9在涎腺肿瘤中的表达及其在涎腺肿瘤中鉴别诊断的价值.方法:应用免疫组织化学SP显色法检测Tn-C、CD9在多形性腺瘤(PA)、腺样囊性癌(ACC)、黏液表皮样癌(MEC)和腺泡细胞癌(ACCa)中的表达.结果:Tn-C、CD9在4种涎腺肿瘤中均有表达,Tn-C在多形性腺瘤...     

类似于乳腺分泌性癌的涎腺肿瘤:迄今尚未描述的一种涎腺肿瘤

作者报道了16例具有乳腺分泌性癌组织病理学和免疫组织化学特征的涎腺肿瘤。这是一种迄今尚未描述和明确认识的涎腺肿瘤,具有涎腺腺泡细胞癌(AciCC)和低级别囊腺癌两者相似的结构特征,极其类似于乳腺分泌性癌。     

腺样囊性癌的研究进展

腺样囊性癌(adenoid cystic carcinoma,ACC)一直被认为是一种良性涎腺肿瘤,1943年,Dockerty和Mayo才强调了该肿瘤的恶性本质[1].不同部位的ACC发病率、年龄、性别甚至生物学行为上均有一定差异[2-3],大涎腺的ACC由于病例数相对较多已经得到了关注,而大涎腺外的ACC较为少见,人们对其研究较少,在此作者复习了相关文献并分别按部位综述如下.     

涎腺腺样囊性癌66例临床分析

目的探讨涎腺腺样囊性癌部位、分期、治疗方法与复发及转移关系。方法对66例涎腺腺样囊性癌患者的病历资料作临床分析。结果腮腺23例,舌下腺14例,颌下腺6例,腭部12例,颊部8例,舌根3例。治疗方法,腮腺腺腺样囊性癌行全腮腺摘除13例,腮腺浅叶+部分深叶摘除9例,腮腺浅叶摘除1例;保留面神经18例,面神经切除5例;行肩胛舌骨上淋巴清扫15例。颌下腺、舌下腺、颊部、舌根腺样囊性癌均行腺体及局部扩大切除+同侧肩胛舌骨上淋巴清扫术;腭部腺腺样囊性癌行局部扩大切除+同侧肩胛舌骨上淋巴清扫术6例,单纯行局部扩大切除2例;术后放疗60例,同时行术后放化疗3例。术后复查3~10年,局部复发8例,远处转移9例。临床分期,Ⅰ期10例、Ⅱ42期例、Ⅲ期8例、Ⅳ期6例。结论颌下腺、舌下腺、颊部、舌根、腭部腺样囊性癌应同期行局部扩大切除+同侧肩胛舌骨上淋巴清扫术;腮腺腺腺样囊性癌如无神经受损症状及术中肿物与神经无明显粘连可保留面神经,术前检查如淋巴结无明显肿大可不作颈淋巴清扫术。术后均应行放疗。术后化疗效果如何本组病例不明确。Ⅲ、Ⅳ期较Ⅰ、Ⅱ期复发、转移为高。     

涎腺肿瘤、牙源性肿瘤中WT-1的表达

目的探讨肾母细胞瘤基因-1(Wilms tumoRgene-1,WT-1)在涎腺肿瘤、牙源性肿瘤中的表达。方法采用免疫组化SP法检测141例涎腺肿瘤、84例牙源性肿瘤中WT-1的表达,分析其在涎腺肿瘤及牙源性肿瘤诊断中的应用价值。结果WT-1在多形性腺瘤、基底细胞腺瘤、癌在多形性腺瘤中、腺样囊性癌、腺泡细胞癌中阳性率分别为92.86%、75.86%、69.23%、53.33%、46.43%;在成釉细胞瘤、牙源性腺样瘤、牙源性角化囊肿、成釉细胞癌中阳性率分别为13.33%、7.69%、0、0。结论WT-1在正常涎腺组织中主要表达于导管上皮细胞,在涎腺肿瘤中主要表达于肿瘤性肌上皮细胞,在牙源性肿瘤中几乎不表达,其有望成为鉴别涎腺肿瘤及牙源性肿瘤的免疫组化标志物。     

涎腺基底细胞腺瘤和腺癌与腺样囊性癌的比较观察

目的 研究涎腺基底细胞腺瘤和基底细胞腺癌与腺样囊性癌的形态学特征、免疫表型和鉴别诊断。方法 对5例基底细胞腺瘤，5例基底细胞腺癌和7例腺样囊性癌进行了免疫组化和双重免疫电镜(2例)的观察。结果 基底细胞腺瘤和基底细胞腺癌在免疫表型方面非常相似；基底细胞腺瘤(癌)与腺样囊性癌之间在免疫表型和超微结构方面有一定的差别。结论 基底细胞腺瘤和基底细胞腺癌的鉴别诊断基于两者的生长方式和组织学特征。免疫组化和免疫电镜观察有助于基底细胞腺瘤(癌)与腺样囊性癌的鉴别诊断。     

涎腺癌分子病理研究及临床应用进展

涎腺癌是一组异质性恶性肿瘤。世界卫生组织（2017）头颈部肿瘤分类将涎腺癌分为22种组织病理学亚型,临床最常见亚型包括黏液表皮样癌、腺样囊性癌、涎腺导管癌、腺泡细胞癌和分泌性癌等。涎腺癌各亚型组织形态学重叠,诊断和鉴别诊断困难。涎腺癌的主要治疗方式是手术切除,酌情术后放射治疗。对于局部进展、复发和转移性病例,治疗方式有...     

趋化因子SDF-1α及其受体介导涎腺腺样囊性癌细胞的趋化与侵袭

探讨趋化因子SDF-1α及其受体CXCR4对涎腺腺样囊性癌细胞趋化与侵袭活性的促进作用。采用RT-PCR法检测涎腺腺样囊性癌肺高、低转移细胞株ACC-M和ACC-2中CXCR4 mRNA的表达;Boyden趋化小室法检测在SDF-1α作用下ACC-M细胞和ACC-2细胞的趋化与侵袭活性;检测CXCR4 mAb对ACC-M细胞和ACC-2细胞趋化活性和侵袭活性的抑制作用。结果显示:2株涎腺腺样囊性癌细胞中均存在不同程度CXCR4 mRNA的表达,其在肺高转移细胞株ACC-M中的表达显著高于肺低转移细胞株ACC-2;SDF-1α对2种细胞均具有趋化活性和侵袭活性,且对ACC-M细胞的趋化活性和侵袭活性显著强于ACC-2细胞;CXCR4 mAb能够抑制涎腺腺样囊性癌细胞的这种趋化活性和侵袭活性。趋化因子SDF-1α及其受体CXCR4能够介导涎腺腺样囊性癌细胞的趋化与侵袭。     

涎腺粘液表皮样癌56例临床分析

粘液表皮样癌是涎腺恶性肿瘤中最常见的一种,占涎腺肿瘤的12.0％,占涎腺恶性肿廇的28.8％。我科自1983～1997年共收治涎腺上皮性肿瘤435例,其中粘液表皮样癌56例,占12.9％。本文对56例涎腺粘液表皮样癌进行回顾分析,并对发病年龄、临床表现、手术方法和诊断等问题进行了讨论。     

Tubulocystic carcinoma of the kidney: a new entity among renal tumors

Tubulocystic carcinoma is a tumor entity, which is not yet included in the WHO-classification of renal tumors. We report a series of 11 cases of this tumor, 6 of which were examined in by immunohistochemistry using a panel of five antibodies (CK7, CK34betaE12, CK19, CD10 and P504S). All patients were men. Each had renal tumor stage of pT1N0M0, with a diameter of 1.7 to 7 cm (mean, 3.3 cm). None of the patients presented with recurrence or metastases. Grossly, tumors were microcystic masses with a bubble-wrap appearance. Histological features included cysts and small tubules, separated by delicate septa and lined by flat to columnar or hobnail cells. The cyst and tubule epithelium showed immunohistochemical characteristics of both proximal and distal tubules. Tubulocystic carcinoma is a distinctive kidney tumor, with noteworthy macroscopic and microscopic characteristics, which can be distinguished from other cystic kidney tumors, including cystic nephroma, multilocular cystic renal cell carcinoma and some solid tumors with extensive cystic changes. More cases are needed to ascertain its prognosis. Tubulocystic carcinoma should be considered as a new subtype of renal cell carcinoma in the next revision of the WHO classification.     

Cystic forms of typically solid pancreatic tumors

In addition to the well-known cystic lesions, the differential diagnosis of pancreatic cysts also includes cystic counterparts (or cystic change in) otherwise typically solid tumors of this organ. Pancreatic endocrine neoplasms (islet cell tumors) and ductal adenocarcinomas sometimes undergo cystic degeneration, the latter usually due to necrosis. Also, although acinar cell carcinoma is typically a solid tumor, its rare cystic counterpart, "acinar cell cystadenocarcinoma," has been reported. A rare variant of pancreatic ductal adenocarcinoma referred to as "large-duct-type" is characterized by microcystic ectasia of the invasive glands and may mimic other cystic tumors at the microscopic level. Secondary tumors, although exceedingly rare, may also potentially fall into the differential diagnosis of pancreatic cysts. Often, the morphological characteristics of these lesions are identical to those of their solid counterparts, and their diagnosis is not difficult if one is aware of their existence. This review focuses on these cystic counterparts of otherwise characteristically solid pancreatic neoplasms. Solid pseudopapillary tumor, in which cystic degeneration is so common that "cystic" has been a part of many alternate terms assigned to this neoplasm, is discussed in another article of this issue of Seminars in Diagnostic Pathology.     

The 2012 ISUP Vancouver and 2016 WHO classification of adult renal tumors: changes for common renal tumors

In the past decade, the histological classification of renal neoplasia has undergone significant changes. Many new entities with distinct clinical, pathological and genetic features have been identified. In addition, common and established tumor entities have been further refined with regard to their pathological and genetic features. These changes have been incorporated in the 2012 International Society of Urological Pathology Vancouver classification and also in the 2016 World Health Organization classification. This article will focus on the new discoveries of clinical, pathological and molecular characteristics of the common renal tumors, including clear cell renal cell carcinoma, multilocular cystic renal neoplasm of low malignant potential, papillary renal cell carcinoma, chromophobe renal cell carcinoma, mucinous tubular and spindle cell renal cell carcinoma, collecting duct carcinoma, renal medullary carcinoma, papillary adenoma, oncocytoma, metanephric tumors, angiomyolipoma, and mixed epithelial and stromal tumor.     

Stromal differences in salivary gland tumors of a common histopathogenesis but with different biological behavior: a study with picrosirius red and polarizing microscopy

Salivary gland neoplasms - pleomorphic adenoma, polymorphous low-grade adenocarcinoma, and adenoid cystic carcinoma - share a common histogenetic trait, but differ markedly in their biological properties. The objective of the study was to assess the polarization colors of picrosirius red-stained stromal collagen fibers in these salivary gland neoplasms to evaluate their possible role in the histopathogenesis of the tumors and to evaluate the potential usefulness of this approach as a diagnostic tool. Ten cases of each tumor type and 10 cases of mucous extravasation phenomenon (control) were examined using picrosirius red staining and polarizing microscopy. In each case, at least 50 thin ( approximately 0.8 microm) and 50 thick (1.6-2.4 microm) collagen fibers were counted and classified as green-yellow or yellow-orange, the mean percentage was calculated and statistical differences analyzed by one-way ANOVA. Results showed a similar thin fiber distribution in all tumor types and controls (82-88% green-yellow, 12-18% yellow-orange, p>0.05). Thick fibers showed a different distribution in polymorphous low-grade adenocarcinoma and adenoid cystic carcinoma (approximately 50% green-yellow) compared to pleomorphic adenoma and mucous extravasation phenomenon (approximately 13% green-yellow) (p=0.001). Thick fiber distribution was similar in polymorphous low-grade adenocarcinoma and adenoid cystic carcinoma (p>0.05). We conclude that with picrosirius red staining and polarizing microscopy, stromal collagen fibers differ significantly in pleomorphic adenoma from those in polymorphous low-grade adenocarcinoma and adenoid cystic carcinoma, but not from mucous extravasation phenomenon. Similarity between polymorphous low-grade adenocarcinoma and adenoid cystic carcinoma may indicate that these tumor types represent a single entity with a broad spectrum of biological behavior.     

Extensive extranodal metastases of basal-like breast cancer with predominant myoepithelial spindle cell differentiation

A differentiation towards myoepithelial cells has been demonstrated in several types of lesions in the breast. These include multifocal myoepitheliomatosis, the rare mixed tumor or pleomorphic adenoma, adenoid cystic carcinoma, adenomyoepithelioma and myoepithelial carcinoma (malignant myoepithelioma). Myoepithelial carcinoma is the only lesion purely composed of myoepithelial cells. All these tumors are benign and/or of low-grade malignancy, with the exception of malignant myoepithelioma. In contrast to the statement of the current World Health Organization (WHO), recent studies have reported that regional and distant metastases may occur in about 50% of pure myoepithelial carcinomas. The presented case of a breast carcinoma with dominant myoepithelial/spindle cell differentiation in a 58-year-old woman is an excellent example to document the highly aggressive biological behavior of this tumor phenotype. Despite an extensive chemotherapy and radiotherapy, the tumor was rapidly progressive, forming a finally exulcerating local tumor relapse and widespread metastases to the myocardium, lungs, liver, kidneys and skin. Similarities in morphology and biological behavior compared to patients with “triple-negative” (hormone receptor and Her2) monophasic sarcomatoid carcinomas and pure spindle cell sarcomas are discussed.     

纳秒脉冲肿瘤消融的研究进展

目前,癌症仍然是全世界人类死亡的主要原因,而且患者人数不断上升。探索新型有效的癌症治疗手段刻不容缓。本文阐述了癌症的十个主要生物学特征,介绍了纳秒脉冲靶向癌症生物学特征的肿瘤消融的独特优点：包括诱导细胞凋亡,抑制血管生成,破坏肿瘤微环境等,并重点综述了纳秒脉冲肿瘤消融在皮肤黑色素瘤、基底细胞癌、鳞状细胞癌、肝细胞癌以及其他肿瘤中的研究应用。最后对纳秒脉冲的临床应用前景进行了展望。     

Cystic Squamous Cell Carcinoma of the Thyroid A Possible New Subgroup of Intrathyroidal Epithelial Thymoma

In the thyroid gland, both squamous cell carcinoma and intrathyroidal epithelial thymoma are rare tumors with squamous features, but their prognoses differ; the former is usually fatal, and the latter is favorable. We describe a 38-yr-old female patient with a cystic tumor diagnosed cytologically as squamous cell carcinoma, who was treated with subtotal thyroidectomy. The tumor was located intrathyroidally in the middle third of the left lobe, and no invasion to the surrounding tissues was found. Histologic examination disclosed a cyst lined by epithelial cells with squamous cell differentiation. The tumor cells had ill-defined cell borders and large nuclei with prominent nucleoli. Invasion of the tumor capsule, a few mitoses, and infiltration of lymphocytes in the tumor periphery were noted, but neither necrosis nor metastasis to lymph nodes was observed. The patient has been free from recurrence for 3 yr after thyroid lobectomy. We propose that this type of cystic intrathyroidal squamous cell carcinoma may represent a cystic variant of intrathyroidal epithelial thymoma.     

KIT is highly expressed in adenoid cystic carcinoma of the breast, a basal-like carcinoma associated with a favorable outcome.

Recent biological studies have classified breast carcinomas into HER2-overexpressing, estrogen receptor-positive/luminal, basal- and normal-like groups. According to this new biological classification, the objectives of our study were to assess the clinical, morphologic and immunophenotypic characteristics of adenoid cystic carcinoma of the breast in order to classify this subtype of breast carcinoma. A total of 18 cases of adenoid cystic carcinoma were identified from the Institut Curie files. Clinical information was available for 16 patients with a median follow-up of 6.5 years. Morphologically, all tumors were graded according to the system defined by Kleer and Oberman (histologic and nuclear grade). Immunophenotype was assessed with anti-ER, PR, HER-2, KIT, basal (CK5/6) and luminal cytokeratins (CK8/18) and p63 antibodies. One out of 18 tumors was nuclear grade 1 (16%), nine were nuclear grade 2 (50%) and eight were nuclear grade 3 (44%). All cases were estrogen receptor, progesterone receptor and HER-2 negative. Epithelial cells were strongly positive around glandular lumina with one or both cytokeratins, identifying the coexistence of CK5/6+ cells, CK5/6 and CK8/18+ cells, CK8/18+ cells and p63+ cells. All cases (100%) were also KIT positive. In all, 15 patients were treated by surgery. Nine of them received adjuvant radiotherapy. Follow-up was available for 16 patients. In all, 14 patients were alive. Two of them, initially treated by surgery only, presented a local recurrence. Two patients died (one of them treated by radiation therapy only died from her disease). Our study shows that adenoid cystic carcinoma of the breast is a special, estrogen receptor, progesterone receptor, HER-2 negative and highly KIT-positive, basal-like breast carcinoma, associated with an excellent prognosis. This highly specific immunophenotype could be useful to differentiate adenoid cystic carcinoma of the breast from other subtypes of breast carcinoma such as cribriform carcinoma.     

Gamma knife radiosurgery for malignant tumors.

Between May 1990, and June 1994, 79 patients with malignant tumors were treated radiosurgically using a Leksell gamma unit at Asan Medical Center. Of these patients, 57 were metastatic brain tumor, 12 were glioblastoma multiforme (GM), 4 were primitive neuroectodermal tumor, 3 were malignant germ cell tumor, 2 were recurrent lymphoma, and 1 was adenoid cystic carcinoma of the orbit. Among 57 patients with metastatic tumors, 28 patients harboring 60 tumors were followed clinically and radiographically. The median marginal dose for these tumors was 30 Gy and the median survival rate was 15 months. Twenty-one tumors disappeared and 32 tumors decreased in size during 2 to 6 months after radiosurgery on computed tomographic or magnetic resonance imaging scans. All 12 patients with GM were treated with conventional radiation (6,240 approximately 6,500 cGy) after surgical resection or biopsy prior to radiosurgery (13 approximately 15 Gy to margin). The results were varied. Radiosurgical treatment of two recurrent lymphomas and three recurrent mixed germ cell tumors after radiation and chemotherapy provided rapid clinical improvement with disappearance of the tumor. However, new lesions appeared in two lymphomas and one mixed germ cell tumor within 3 to 4 months. One patient with adenoid cystic carcinoma of the orbit, who was treated radiosurgically prior to resection, is alive without recurrence 31 months after the treatment. Gamma knife radiosurgery appears to be the best alternative method to surgical excision plus radiation therapy for single and multiple cerebral metastases. It also provides rapid palliation of symptoms due to recurrent malignant tumors. And it may have an adjuvant role in the treatment of some tumors delaying local recurrence, if given prior to resection. However, the preliminary results for the malignant gliomas were inconclusive.