Prognostic roles of lymph node micrometastasis in non-small cell lung cancer

Objective

This study aimed to confirm the prognostic roles of lymph node (LN) micrometastasis (LNMM) in non-small cell lung cancer (NSCLC) through a meta-analysis.

Metastatic glioblastoma in cervical lymph node after repeated craniotomies: report of a case with diagnosis by fine needle aspiration

Head and neck metastasis from glioblastoma is rare event usually seen in patients with previous and repeated surgery. We present the case of a 35 yr-old-female suffering from metastatic glioblastoma in cervical lymph node that was diagnosed by fine needle aspiration. During the last 4 yr, she had four separate craniotomies for the recurrent brain tumors. Cytological diagnosis was made by light microscopy with immunostaining with glial fibrillay acid protein. Chemotherapy with vincristine and procarbazine was performed. The cervical masses were decreased in size and some disappeared while the intracranial glioblastoma continued to grow during chemotherapy. We discuss possible explanations for these different courses after chemotherapy in extraneural metastatic glioblastoma and primary intracranial glioblastoma.     

rIL—2激活的人胃癌引流区淋巴结淋巴细胞的体内外抗肿瘤抗转移活性

外科手术中切除的人胃癌引流区淋巴结经细胞分离器分离之后.能获得大量的淋巴细胞(TdLNL)。将TdLNL与基因重组IL—2(rIL—2)共同培养5天后,TdLNL对同种AniP—973肿瘤细胞产生了明显的体外杀伤。同时,rIL—2激活的TdLNL还能抑制An(?)p—933在BALB/c nu/nu裸小鼠皮下的生长和自发性肺转移。     

胃癌淋巴结微转移的组织学诊断及其间质反应的研究

目的 从组织学上确定胃癌淋巴结微转移灶并观察其间质反应。方法 １７份胃癌标本（１０８７枚淋巴结）中曾诊断为有微转移灶（微灶）的７１枚淋巴结,连续切片６０份以上行免疫组织化学ＳＡＢＣ法染色（ＣＫ１８,上皮膜抗原,平滑肌肌动蛋白）,观察微灶和非微灶的周围间质反应。另取２０枚有明显转移的淋巴结作对照观察。结果 ７１枚属微灶的淋巴结经再次连续切片后微灶消失的占３４％（２４枚）,仍属微灶但癌细胞增多的占４９     

胰腺癌组织中内分泌细胞及其意义研究

４２例胰腺癌嗜银和亲银染色发现１９例４５．２％含内分泌细胞（ＥＣ），其中ＥＣ阳性率≥５０％４例；高分化腺癌ＥＣ阳性率（５／２０例，２５％）低于中、低分化腺癌（１２／１９例，６３．２％）和粘液癌（２／２例，１００％），组织学分级Ｉ级病例ＥＣ阳性率（５／１８例，２７．８％）低于Ⅲ级病例（７／８例，８７．５％）；ＥＣ阳性病例间质肥大细胞数明显高于ＥＣ阴性病例；发生转移病例ＥＣ阳性率（８／１４例，５７．１     

Limitations in molecular detection of lymph node micrometastasis from colorectal cancer.

Colorectal cancer patients with lymph node metastasis have a shorter survival and may require adjuvant therapy after surgery of the primary tumor. It is supposed that a more reliable diagnosis can be achieved using tumor-specific DNA mutations for the detection of metastasizing cells. To design a practical approach for a molecular diagnosis of micrometastasis, we applied direct DNA sequencing to screen 48 early stage colorectal carcinomas for the most frequent mutations of the KRAS, P53, and APC tumor genes. KRAS mutations were detected as frequently as described earlier. In contrast, the frequency of P53 and APC hot spot mutations was unexpectedly low, compared with previous studies using other screening methods or including advanced tumor stages. Not more than 31% of early stage tumors showed a mutation in at least 1 of the selected hot spot codons. Applying mutant-enriched polymerase chain reaction (PCR), the mutation of the primary tumor was detected in lymph node DNA from 2 of the KRAS-positive patients. In 1 patient, the result was not verified by subtractive iterative PCR, a principally different molecular method with high sensitivity and specificity. Our data suggest that screening for suitable markers for a molecular detection of occult lymph node metastasis cannot be restricted to small-sized hot spot regions of a few tumor genes and possibly must include tumor-specific epigenetic changes. Furthermore, restriction enzyme-based methods such as mutant-enriched PCR are not suitable to detect any mutation with equal efficiency and they should be carefully controlled to avoid false-positive detection of marker mutations in lymph node DNA.     

静脉注射羧基化单壁碳纳米管在大鼠腋窝淋巴结的积聚

背景：基于碳纳米管的淋巴靶向示踪和治疗是肿瘤靶向诊疗的研究热点之一,评价碳纳米管对腋窝淋巴结的聚集作用,能够为开发淋巴特异性更高、生物兼容性更好的纳米示踪剂和药物载体提供实验依据。 目的：观察静脉注射羧基化单壁碳纳米管在SD大鼠腋窝淋巴结的积聚作用,并评价其对血液细胞的影响。 方法：将64只SD大鼠随机均分为两组,实验组尾静脉注射羧基化单壁碳纳米管2 mg/kg,空白对照组尾静脉注射5%葡萄糖溶液1 mL/kg,3次/周,设定7,60,90,120 d(120 d为给药90 d后停药30 d)共4个周期,每个周期结束时每组随机抽取8只大鼠,采集腹主动脉血液进行血常规检测,观察腋窝淋巴结变化,采集实验组120 d淋巴结标本进行透射电子显微镜观测。 结果与结论：与空白对照组相比,实验组7 d的腋窝淋巴结无明显黑染;随着给药周期的增加,实验组大鼠淋巴结肿大、质地变硬、黑染加深,伴随血液中性粒细胞百分数显著升高(P < 0.01或P < 0.001);停药30 d后,腋窝淋巴结缩小、黑染局部褪去,中性粒细胞百分数下降。停药30 d后,透射电子显微镜观测证实实验组大量羧基化单壁碳纳米管被淋巴细胞吞噬,形成大量吞噬泡。表明尾静脉注射羧基化单壁碳纳米管对SD大鼠腋窝淋巴结的短期靶向示踪作用较弱,长期静脉注射会逐渐在大鼠腋窝淋巴结形成积聚,并引起中性粒细胞增多;停止给药后,羧基化单壁碳纳米管能够被淋巴结缓慢清除。 中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程     

胃癌转移淋巴结的显影进展

 为了在胃癌根治术中施行精确的淋巴结切除,对术前及术中的淋巴结转移的检查评估手段提出了挑战。以往的CT、PET-CT和MRI等都存在准确率较低、特异性欠佳、以及假阴性率较高等缺点,为了实现这个目标先后发展出了红外线电子内窥镜、高分辨率PET-CT、MRI等设备及高分子纳米复合微粒分子靶向显影剂。     

Microsatellite instability status does not predict total lymph node or negative lymph node retrieval in stage III colon cancer

The relationship between higher total lymph node resection number in colorectal cancer resection specimens and improved overall survival is well known. Recent studies describe an association between a high rate of microsatellite instability and a high total lymph node count in colorectal cancer. Higher lymph node retrieval may potentially explain the improved survival seen in cancers with microsatellite instability. We investigate whether these associations can be validated in a cohort of American Joint Committee on Cancer stage III colon cancers. Medical records from 200 cases of stage III colon cancer resection specimens were reviewed, and sufficient tissue was available for 168. Expression of DNA mismatch repair proteins was determined by immunohistochemistry, and microsatellite status, by polymerase chain reaction. The mean total lymph node count in cases with microsatellite instability versus microsatellite stable tumors (15.9 versus 16.9; P = .664) and the mean number of negative lymph nodes in each respective category (12.2 versus 13.6; P = .522) were not significantly different. There was no difference between microsatellite stable cases and cases with microsatellite instability when total lymph node counts (P = .953) or negative lymph node counts (P = .381) were analyzed with respect to percentage of cases above and below the medians. This cohort of stage III colon cancers does not support a significant relationship between microsatellite status and a higher retrieval of total or negative lymph nodes. Although microsatellite instability is associated with improved overall survival in our cohort (P = .026), the reason for this does not appear to be related to higher numbers of retrieved lymph nodes.     

Loss of membranous E-cadherin expression in pancreatic cancer: Correlation with lymph node metastasis,high grade,and advanced stage

Epithelial cadherin (E-cadherin) is a Ca²⁺-dependent cell-cell adhesion molecule that connects cells via homotypic interactions. Its function is critical in the induction and maintenance of cell polarity and differentiation, and its loss of downregulation is associated with an invasive and poorly differentiated phenotype in colon and other tumours. We have used an avidin-biotin immunoperoxidase technique to localize E-cadherin in microwave-treated, paraffin-embedded sections from 36 patients with pancreatic adenocarcinomas. E-cadherin was expressed by normal ductal and acinar cells with typical membranous staining at the intercellular junctions. Loss of normal surface E-cadherin expression was found in 19/36 (53 per cent) tumours compared to the adjacent normal ductal cells. Abnormal E-cadherin expression was found more frequently in poorly differentiated (grade III) (6/7, 86 per cent) than in well-differentiated tumours (grade I) (4/14, 28 per cent) (P=0·012). Membranous E-cadherin expression was also lost more frequently in primary tumours with lymph node (stage III) (14/23, 61 per cent) and distant metastasis (stage IV) (2/2, 100 per cent) compared with 3/11 (27 per cent) lymph node-negative tumours (stage I) (P=0·043). In conclusions, our data indicate that loss of membranous E-cadherin expression is associated with high grade and advanced stage in pancreatic cancer.     

A case of heterotopic pancreas in lymph node

Summary A case of pancreatic heterotopia in a lymph node is described. Small pieces of pancreatic tissue were found incidentally in four lymph nodes located around the common hepatic artery in a 65-year-old man. Both exo- and endocrine elements of the pancreas, together with ductal structures were found to constitute the heterotopic tissue. No authentic case of heterotopic pancreas in lymph node has been previously reported in the literature.     

规范化扩大盆腔淋巴结清扫术在前列腺癌根治术中的应用

目的 探讨前列腺癌根治术中扩大盆腔淋巴结清扫术(e-PLND)规范化技术及其临床疗效。方法 回顾性分析2004年1月—2014年12月127例前列腺癌行前列腺根治+e-PLND患者的临床资料。患者年龄47～78岁,平均66.2岁。术前前列腺特异性抗原(PSA)平均13.1 μg/L, Gleason评分平均6.8分。按前列腺癌危险因素分级:低危组49例、中危组46例、高危组32例;盆腔淋巴结按解剖部位分为5组9区:髂外、髂总、闭孔、髂内淋巴结组左右两侧分别为1个区,骶前淋巴结组为1个区。患者均在全身麻醉下经下腹正中切口行前列腺根治+e-PLND。比较低危组、中危组、高危组淋巴结转移率;比较淋巴结转移阳性患者中,不同解剖部位淋巴结组的转移率。观察术中、术后并发症发生情况。术后每3个月复查PSA,观察生化复发情况。采用Kaplan-Meier非参数法,统计患者3、5、10年总生存率。结果 本组127例,104例5组9区淋巴结均清扫,23例清扫闭孔、髂内、髂外、髂总淋巴结4组8区。共切除淋巴结2 727枚,每例切除淋巴结13～41 枚,平均21.5枚。127例中,共有26例(20.5%)发生56枚淋巴结转移,平均每例转移淋巴结2.2(1～9)枚。低危、中危、高危组患者淋巴结转移率分别为2.0%(1/49)、23.9%(11/46)、43.8%(14/32),差异有统计学意义(χ²=21.209, P<0.01)。26例淋巴结转移阳性患者中,不同解剖部位组淋巴结的转移率由高到低依次为髂内组57.7%(15/26)、闭孔组50.0%(13/26)、髂外组30.8%(8/26)、骶前组11.5%(3/26)、髂总组3.8%(1/26)。术中、术后并发症总发生率为15.0%(19/127),其中术中静脉损伤2例,术后淋巴瘘5例、淋巴囊肿10例、下肢深静脉血栓2例,均予相应对症处理后痊愈。术后无一例下肢淋巴水肿。术后根据UICC肿瘤TNM病理分期:pT1期13例,pT2期50例,pT3a期49例,pT3b期15例。术后117例获随访,随访时间12～123个月,平均42.7个月。发生生化复发27例(23.1%),其中因肿瘤复发远处转移死亡3例,其他原因死亡5例。本组3、5、10年累积生存率分别为88.9%(56/63)、78.0%(32/41)、11/18。结论 前列腺癌根治术中,规范化e-PLND能较彻底地清除转移淋巴结,较准确地定位易转移解剖区域,病理分期较准确,提升手术质量,提高患者生存率。     

The prognostic significance of immunohistochemically detected lymph node micrometastases in colorectal carcinoma

Micrometastases have been detected by immunocytochemical means in the lymph nodes of patients with otherwise node-negative cancer of the colon and rectum. This study examines the incidence and prognostic significance of nodal micrometastases in Dukes' B carcinoma. Five hundred and fifty-nine lymph nodes from 77 cases of Dukes' B carcinoma were examined for lymph node micrometastases by immunocytochemical staining for cytokeratin AE1:AE3. Micrometastases were detected in 19 cases (25 per cent). Cell clusters were present in ten cases, the remaining nine cases displaying only single cells. The presence of micrometastases was unrelated to age (P = 0·06), sex (P = 0·32), tumour site (P = 0·37), tumour size (P = 0·67), or tumour differentiation (P = 0·66). Ten-year survival estimates by the Kaplan–Meier lifetable method was 47 per cent in patients with and without micrometastases (χ² = 0·35 and 1 df, P = ns). The presence of nodal micrometastases detectable only by immunocytochemistry in patients with Dukes' B colorectal cancer does not justify reassignment to a more advanced disease stage.     

淋巴结阴性乳腺癌患者HER2表达及其与预后相关性的Meta分析

目的评价淋巴结阴性乳腺癌患者HER2表达率的临床价值及其与预后的相关性。方法计算机检索相关文献,进行质量评价后按纳入和排除标准筛选文献,采用Excel和Revman4.2进行Meta分析,并按检测方法和是否接受术后辅助治疗进行分层分析。结果纳入56篇研究进行HER2阳性率的Meta分析,合并总阳性率为23.14%[19.54%,26.73%],免疫组织化学检测组合并阳性率为23.13%[19.49%,26.77%],荧光原位杂交(FISH)检测组合并阳性率为20.90%[15.54%,26.25%]。纳入7篇研究进行HER2表达与预后相关性的Meta分析,对淋巴结阴性乳腺癌患者无瘤生存期(DFS)合并相对危险度(RR)值为1.38[1.07,1.80],总生存期(OS)合并RR值为1.58[1.16,2.14],HER2阳性表达均有独立的负性预后价值(P<0.05)。根据检测方法进行分层分析亦有负性预后价值:免疫组织化学组DFS/OS合并RR值分别为1.16/1.37,FISH组DFS/OS合并RR值分别为1.98/2.33。根据是否接受术后辅助治疗进行分层分析,显示HER2阳性对未接受治疗组DFS/OS、接受治疗组OS有预后价值,对接受治疗组DFS缺乏预后价值;未接受辅助治疗组DFS/OS合并RR值分别为1.46/1.93,接受治疗组OS合并RR值为1.25。结论对于淋巴结阴性的乳腺癌患者,23.14%的HER2阳性率为靶向治疗提供了良好的临床应用前景。HER2的阳性表达提示     

B cells in murine cervical lymph nodes are conventional B-2 cells

We investigated the characteristic features of cervical lymph node B cells to determine whether their behavior differs from that of B cells located elsewhere, because cervical lymph nodes may be exposed to continual antigenic stimulation from the naso- and/or oropharynx. B cells were isolated from cervical lymph nodes, spleen and peritoneal fluid of mice, cultured in medium, and exposed to various stimuli. The expression of various surface molecules characteristic of lymphoid B cells was assayed by flow cytometry, and immunoglobulin secreted into the culture supernatants was evaluated by enzyme-linked immunosorbent assay. B220+ cells were cultured in medium alone or with lipopolysaccharide, and their entrance into S phase in response to stimuli was measured by proliferative assays. Phenotypic characteristics of cervical lymph node B cells included CD5 low, CD23high, CD43low, B7.1low, B7.2low, and Syndecan-1low. Unstimulated lymphoid B cells did not secrete immunoglobulin, but, upon stimulation, secretion of IgM was increased more than secretion of IgA and IgG. B cells actively entered S phase after 48 hr stimulation. These results show that B cells in cervical lymph nodes are conventional B2 cells, like splenic B cells.