肺微小瘤的临床病理学观察

目的 观察肺微小瘤的临床病理学、影像学特点,探讨其免疫组织化学(免疫组化)特征及鉴别诊断.方法 采用组织学、免疫组化及组织化学技术对1例肺微小瘤进行光镜观察及免疫标记,并结合相关文献对其临床表现、影像学、组织形态和免疫组化特点等进行综合分析.结果 患者男性,61岁,肿瘤组织学表现为散发多灶性镜下结节,呈簇状、巢状或索团状,分布于支气管扩张症受损的支气管壁旁及细小支气管周围,瘤细胞呈圆形或短梭形,大小较一致,核圆或卵圆形,染色深,未见核分裂及坏死.免疫组化染色示:细胞角蛋白、神经元特异性烯醇化酶、神经突触素、嗜铬粒素、5-羟色胺、胃泌激素及降血钙素均阳性,细胞嗜银性强.结论 原发于支气管周围的微小瘤较为罕见,临床影像学特征不明显,可能是肺类癌发生的早期阶段,免疫组化染色有助于该肿瘤的诊断,应与神经内分泌细胞增生、类癌、小细胞癌、微小肺脑膜瘤样结节及小副神经节瘤等鉴别.手术切除预后较好.     

肾类癌2例报告并文献复习

目的：探讨肾类癌的组织学发生、临床特征、鉴别诊断及预后,提高肾类癌的诊断与治疗水平,方法：回顾性分析2例肾类癌患者的临床表现、诊断与治疗方法、临床病理特征,并复习相关文献。结果：行根治性肾切除术,术后病理检查证实均为肾类癌,随访1-2年,均生存、无复发及转移。结论：肾原发性类癌是一种罕见的肿瘤,诊断主要依据病理形态学检查和免疫组化。     

支气管类癌的诊断及外科治疗

目的探讨支气管类癌的临床特点、诊断及外科治疗。方法总结1980-2000年底经手术及病理证实的支气管类癌22例,其中气管类癌2例,支气管类癌20例,典型类癌17例,不典型类癌5例。22例病人行手术治疗24次(2例术后局部复发再手术),2例气管类癌均作气管袖式切除加端端吻合术,其中1例术后6年局部复发,再次手术行肿瘤刮除并加术后放疗。20例支气管类癌,2例主支气管类癌均作单纯支气管袖式切除加端端吻合术,其中左主支气管类癌病人术后11年复发,再次手术行左全肺及隆突切除重建术,15例作不同形式的肺切除术(一叶或双叶肺切除11例,肺叶切除加支气管袖式切除3例,左全肺切除1例),3例周围型类癌行肺楔形切除术。结果无手术死亡,5年生存率81.3%,3例不典型类癌分别于术后10、16、22个月死于远处转移。2例初次手术后6年、11年局部复发病人再手术后已2年、3年仍存活。结论支气管类癌是一种低度恶性肿瘤,好发于段以上支气管,平均发病年龄较肺癌轻。主要症状为反复咯血和呼吸道感染。X线以及CT检查,纤支镜检查对诊断有价值。提倡保守的外科治疗,即以肺叶或袖式肺叶切除为主要手术方式,尽量避免全肺切除。手术切除后,一般预后良好,但不...     

儿童原发性支气管肺癌4例及支气管腺瘤2例报告

儿童原发性支气管肺癌及支气管腺瘤较为罕见,本文现将4例儿童原发性支气管肺癌及2例支气管腺瘤.报告如下。临床资料国内原发于儿童的肺癌及支气管腺瘤,尤其在病理学方面的资料,尚未见有报导。哈尔滨医科大学病理解剖教研室于1961-1981年尸体解剖及哈尔滨医科大学附属第二医院外科手术切除原发性支气管肺癌330例中,儿童肺癌4例(1.2％),性别:男2例,女2例,年龄分别为4,10,13及16岁.均系尸体解剖材料.手术切除支气管腺瘤共8例,发生于儿童者2例,性别:男1     

所谓肺硬化性血管瘤的临床病理及免疫表型研究

目的探讨肺硬化性血管瘤的临床病理特征、免疫表型特点及组织来源。方法应用免疫组化检测26例肺硬化性血管瘤中TTF-1、EMA、Vim、CD34、CD31、CD68、Ⅷ因子、SMA、CK5/6、CK-L、CK-H、CgA、PR及ER的表达,观察病理组织学特征并进行随访。结果肺硬化性血管瘤细胞成分及组织结构复杂,部分病例镜下结构类似类癌、孤立性纤维性肿瘤及非黏液型支气管肺泡癌。肿瘤实质由上皮样细胞及卵圆形细胞构成,组织结构可见实性区、乳头区、血管瘤样区及硬化区。间质可发生脂肪化生及骨化。免疫组化示：两种细胞均表达TTF及EMA,上皮样细胞表达CK、卵圆形细胞表达Vimentin、ER、PR,个别表达Syn。随访未见因肿瘤死亡的病例。结论肺硬化性血管瘤可能起源于呼吸道的原始多潜能干细胞,具有向肺泡Ⅱ型细胞分化的特点。病理诊断中需与类癌、孤立性纤维性肿瘤及非黏液型支气管肺泡癌鉴别。虽有个别病例出现淋巴结转移,但临床预后良好。PR的表达可能与女性的高发病率有关。     

支气管类癌

支气管类癌(bronchial carcinoid)是起源于支气管上皮组织嗜银细胞的恶性肿瘤,变称肺类癌。近年经电镜和组织免疫化学研究认为类癌和未分化小细胞癌均来自支气管上皮的嗜银细胞(kultshitsky cell),故又有人称支气管嗜银细胞瘤(bronchial argentaffinoma),这些细胞浆内含有神经内分泌功能。属少见病,术前易误诊、漏诊,部分病例可诱发类癌综合征,该肿瘤应进一步引起广大医务工作者重视,本文仅将近年来有关支气管类癌的情况简要综述如下。     

卵巢甲状腺肿10例临床病理分析

目的探讨卵巢甲状腺肿的临床和病理学特征，为其病理诊断和治疗提供依据。方法回顾性分析10例确诊患者的临床资料，作临床病理分析，免疫组化染色和电镜观察，总结其临床表现特点和病理学特征。结果良性卵巢甲状腺肿9例．大体呈实性、囊实性、囊性，均由类癌和甲状腺滤泡组织构成，组织学类型有单纯型、腺瘤型、囊性变型。恶性卵巢甲状腺肿1例，呈囊实性，组织学类型为甲状腺乳头状癌。免疫表型10例NSE、Syn均阳性，8例CgA、降钙素阳性，2例5-HT阳性；TG、TFF-1滤泡区阳性，类癌区阴性。全部10例均存活，无复发。结论卵巢甲状腺肿类癌是一种伴有甲状腺滤泡分化的低度恶性神经内分泌癌，罕见，恶性变的诊断标准同甲状腺癌。免疫组化有助于诊断，恶性者可借鉴甲状腺癌的治疗方案。预后良好。     

子宫颈小细胞癌临床病理分析

子宫颈小细胞癌是一种罕见而独特的原发于子宫颈的神经内分泌癌,占子宫颈癌的2%[1]。其组织来源不清,命名混乱,名称繁多,直到1997年,美国癌症研究会的一个研究小组根据与发生于肺的同类肿瘤在形态上的相似性将其分为典型类癌、不典型类癌、大细胞神经内分泌癌和小细胞癌四类,使子宫颈小细胞癌有了明确的归类和描述[2]。与普通的子宫颈癌相比,小细胞癌恶性程度高,具有高度侵袭性,早期容易发生远处转移,预后极差。本文报告4例,并结合文献对其临床病理、免疫组化和诊断进行探讨。1材料与方法收集贵阳医学院病理科2004年1月至2006年12月常规病理…     

多房性囊性肾细胞癌4例病理特征及免疫组化分析

目的探讨多房性囊性肾细胞癌的临床病理特征,诊断及鉴别诊断,提高对该病的认识。方法选择多房性囊性肾细胞癌4例,复习临床资料,切片光镜镜检,免疫组化标记,并复习相关文献。结果 4例大体均呈多囊性改变,镜下显示囊内衬单层或复层透明细胞,囊内亦见透明细胞小巢,细胞核级Ⅰ级,数量少,免疫组化CK、CK7、EMA、CD10、Vimentin阳性,CD68阴性,Ki67低表达。随访患者无复发。结论多房性囊性肾细胞癌是一种罕见的肾细胞癌亚型,有特殊的病理特征,预后良好,注意与多种良性肾囊肿性疾病及肾细胞癌囊性变鉴别。     

卵巢甲状腺类癌临床病理探讨

目的探讨卵巢甲状腺类癌的临床病理特征、诊断及鉴别诊断。方法对2例发生在卵巢甲状腺类癌病例应用免疫组化Syn,CgA,S-100,CT,Vimtime,Tg,CK,NSE,P63,Ki67,CEA,α—inhibin进行检测,并结合相关文献进行讨论。结果2例患者均为绝经后女性,例1患者以盆腔包块为主要表现,伴有便秘,血CA199升高,例2患者因手术切除其他肿瘤及附件,送病理活检发现。2例患者巨检肿瘤均为单纯型。镜检肿瘤均由甲状腺组织及类癌组织构成,类癌为梁状与岛状混合型。免疫组化：2例患者类癌细胞Syn（2／2＋）,CgA（2／2＋）,NSE（1／2＋）,Ki67（3％＋,5％＋）,CK（I／2＋）,S-100（2／2-）,CEA（2／2-）,P63（2／2-）,CT（2／2-）,Vimtime（2／2-）,Tg（2／2-）,α-inhibin（2／2-l甲状腺滤泡Tg（2／2＋）,CK（2／2＋）,Vimtime（1／2＋）,Syn（2／2-）,CgA（212-）,NSE（2／2-）,Ki67（2／2-）。S-100（2／2-）,CEA（2／2-）,P63（2／2-）,CT（2／2-）,α-inhibin（2／2～）。2例患者均为I期,例1患者术后行化疗,例2术后未做任何治疗,分别随访57个月及2个月,均未见复发及转移。结论卵巢甲状腺类癌是-种非常罕见的具有独特临床病理学特征的高度特殊性生殖细胞肿瘤,伴有甲状腺组织分化,一般预后良好,要与小圆形细胞肿瘤鉴别,结合免疫组化,可与之鉴别。     

Late recurrent pulmonary typical carcinoid tumor: case report and review of the literature

Carcinoid tumors are uncommon pulmonary neoplasms. They are classified histologically as either atypical or typical. Atypical carcinoids are aggressive malignancies that require radical surgical resection and have a guarded prognosis with a propensity to metastasize and recur. Typical carcinoids are low-grade malignancies with relatively less metastatic or recurring potential and are usually treated with simple excision. Recurrence of a typical pulmonary carcinoid tumor more than a decade after initial resection is very rare. A patient with recurrence of a typical carcinoid tumor 11 years after resection of the primary lesion with one involved lymph node is reported here. Late recurrences are rare in both atypical and typical varieties, but are much more common in atypical carcinoids. The patient reported here represents the fifth case of recurrence of a typical carcinoid tumor more than ten years after resection. This suggests that, after resection of a typical carcinoid neoplasm, patients should be monitored carefully, especially if lymph node metastases are present at the time of surgery.     

12例支气管肺类癌的X线诊断

目的：分析支气管肺类癌的X线表现特点。方法：回顾性分析12例经手术病理证实的支气管肺类癌的X线平片及CT表现。结果：肺类癌为单发类圆形，边界清晰，密度均匀，多有分叶改变，转移少见，无钙化。CT像上肿块密度、边缘与相邻组织关系更为清晰。结论：支气管肺类癌缺乏X线特征，难与肺癌和肺部其它肿瘤性病变相鉴别，最后诊断需要病理证实。     

The molecular pathogenesis and management of bronchial carcinoids

INTRODUCTION: In terms of well-differentiated neuroendocrine tumors (NETs), the lung is the second most common site of occurrence, after the gastro-entero-pancreatic axis, and comprises ～ 25% of all NETs which may occur in various parts of the body. Pulmonary NETs are classified into four groups including typical carcinoid tumors, atypical carcinoid tumors, small cell lung carcinoma and large cell neuroendocrine carcinomas. Among pulmonary NETs, typical and atypical carcinoid tumors of the lung are generally indolent, but do have a (albeit low) potential to metastasize. AREAS COVERED: The molecular biology and novel molecular pathways and drug targets in bronchial carcinoids are reviewed in this paper. A full data search is performed through PubMed over the years 2000 - 2010 with key words 'neuroendocrine tumors of the lung, bronchial carcinoid, lung carcinoid, foregut carcinoid, pulmonary carcinoid, pulmonary NETs, lung NETs, molecular biology, autoradiography, nuclear medicine, treatment'; all relevant publications are included, together with selected publications prior to that date. EXPERT OPINION: Although lying at the benign end of the spectrum of pulmonary NETs, bronchial carcinoids can metastasize, and the pathogenesis of these tumors is poorly understood. Several intracellular signaling pathways are under investigation to define new targets for the successful treatment of these tumors. In terms of treatment, further research should additionally focus on the already known but promising drug options.     

Therapeutic approach of carcinoid tumours of the lung.

In the carcinoid tumours of the bronchopulmonary tract surgical resection is still the primary goal. Many problems are, however, unclear: the extent of resection, formal lymph node dissection or not, the role of Video-Assisted Thoracic Surgery (VATS) and of the multidisciplinary approach. In the Department of Surgical Sciences and Applied Medical Technologies, "La Sapienza", Rome's University, from 1969 to 1994, we observed 18 patients with carcinoid tumours of the lung: 13 typical carcinoid (TC) and 5 atypical carcinoid (AC). In our series, the choice of therapeutic procedure was made on the basis of histological criteria and TNM classification. We performed 3 conservative and 10 extensive resections on typical carcinoid and 5 extensive resections on atypical carcinoid tumours. In our series VATS played a minor therapeutic role. Formal lymph node dissection was carried out on all our patients except in the cases of those with typical carcinoid tumours without enlarged hilar and mediastinal lymph nodes. The efficacy of adjuvant chemotherapy in carcinoid tumours treatment is controversial and will be confirmed by further trials. In bronchial carcinoid tumours the long-term prognosis is excellent. In our series the ten-year survival rate is 77 per cent in typical carcinoid and 40 per cent in atypical carcinoid cases.     

The molecular pathogenesis and management of bronchial carcinoids

Introduction: In terms of well-differentiated neuroendocrine tumors (NETs), the lung is the second most common site of occurrence, after the gastro-entero-pancreatic axis, and comprises ～ 25% of all NETs which may occur in various parts of the body. Pulmonary NETs are classified into four groups including typical carcinoid tumors, atypical carcinoid tumors, small cell lung carcinoma and large cell neuroendocrine carcinomas. Among pulmonary NETs, typical and atypical carcinoid tumors of the lung are generally indolent, but do have a (albeit low) potential to metastasize.

Areas covered: The molecular biology and novel molecular pathways and drug targets in bronchial carcinoids are reviewed in this paper. A full data search is performed through PubMed over the years 2000 – 2010 with key words ‘neuroendocrine tumors of the lung, bronchial carcinoid, lung carcinoid, foregut carcinoid, pulmonary carcinoid, pulmonary NETs, lung NETs, molecular biology, autoradiography, nuclear medicine, treatment’; all relevant publications are included, together with selected publications prior to that date.

Expert opinion: Although lying at the benign end of the spectrum of pulmonary NETs, bronchial carcinoids can metastasize, and the pathogenesis of these tumors is poorly understood. Several intracellular signaling pathways are under investigation to define new targets for the successful treatment of these tumors. In terms of treatment, further research should additionally focus on the already known but promising drug options.     

The Cytotoxic Effect of Emetine and CGP-74514A Studied with the Hollow Fiber Model and ArrayScan Assay in Neuroendocrine Tumors In Vitro

Emetine and CGP-74514A have previously shown antitumor activity in neuroendocrine tumor cell lines. The aim of this study was to investigate the cytotoxic activity of the drugs in a three-dimensional model and to study if the mechanism of the cytotoxic activity was induction of apoptosis. An in vitro hollow fiber model was used to study the cytotoxic effect and a multiparametric high-content screening assay was used for measurement of apoptosis. The human pancreatic carcinoid cell line, BON-1 and the human typical and atypical bronchial carcinoid cell lines NCI-H727 and NCI-H720 were tested. Emetine and CGP-74514A showed higher antitumor activity on NCI-H720 compared to NCI-H727 and 3 day cultures were more sensitive than the 14 day cultures. A time- and dose-dependent activation of caspase-3 and increase in nuclear fragmentation and condensation were observed for the drugs in NCI-H727 and BON-1 using a multiparametric apoptosis assay. These results were confirmed with nuclear morphological examinations on microscopic slides. Emetine and CGP-74514A showed antitumor activity and induced caspase-3 activation with modest changes in nuclear morphology, indicating induction of apoptosis.     

阑尾类癌16例临床诊治分析

目的探讨阑尾类癌的临床特点及诊治经验。方法对1990年1月~2005年1月收治的16例阑尾类癌病人的临床资料进行回顾性分析。结果16例病人中无1例术前明确诊断,均为术中发现或术后病理确诊。肿瘤直径<1 cm 11例,1~2 cm3例。>2 cm 2例。12例肿瘤浸润深度限于黏膜下或肌层,2例侵及浆膜,2例浸润至阑尾系膜,其中1例伴局部淋巴结转移。采用单纯性阑尾切除术12例。右半结肠切除4例。获随访的13例病人中,11例情况良好,无复发和远处转移,死亡2例,其中1例为非肿瘤性死亡,另1例死于肿瘤转移。结论阑尾类癌术前难以做出明确诊断,手术是主要的治疗手段,手术方式应根据肿瘤大小、部位及浸润深度来决定,化疗效果有待进一步研究。     

Novel targets for the treatment and palliation of gastrointestinal neuroendocrine tumors

Gastrointestinal (GI) neuroendocrine tumors (NETs), for example, carcinoids, are rare neoplasms characterized by the production of bioactive markers, such as 5-HT and chromogranin A. With the exception of surgery, there are limited curative and palliative treatments available for this type of tumor. Therefore, there is a great need to develop new pharmacological strategies to reduce tumor burden and control symptoms in patients with metastatic carcinoid tumors and the carcinoid syndrome. In this review, several pathways thought to be involved in GI NET carcinogenesis are discussed, and novel approaches that are currently in development to target these pathways are highlighted.     

Hydrogen peroxide degradation and selective carbidopa-induced cytotoxicity against human tumor lines

The carcinoid tumor, an uncommon neuroendocrine neoplasm, is associated with serotonin overproduction as is more common small cell lung carcinoma (SCLC). alpha-Methyl-dopahydrazine (carbidopa), an inhibitor of the serotonin synthetic enzyme aromatic-L-amino acid decarboxylase, proved lethal to NCI-H727 lung carcinoid cells as well as NCI-H146 and NCI-H209 SCLC cells, but not to five other human tumor cell lines of differing origins [Gilbert JA, Frederick LM, Ames MM. The aromatic-L-amino acid decarboxylase inhibitor carbidopa is selectively cytotoxic to human pulmonary carcinoid and small cell lung carcinoma cells. Clin. Cancer Res. 2000;6:4365-72]. The mechanism of carbidopa cytotoxicity remained an unanswered question. We present data here that incubation of the catechol carbidopa (100 microM) in RPMI and DMEM culture media yielded molar equivalents of hydrogen peroxide (H2O2) within 2-4 h. Alkaline elution studies revealed carbidopa-dependent single-strand DNA breaks in sensitive carcinoid cells comparable to those induced by similar concentrations of H2O2. Neither compound induced significant DNA damage in carbidopa-resistant NCI-H460 large cell lung carcinoma cells. Furthermore, when carbidopa was incubated with a variety of tumor cell types, not only were decreased media H2O2 concentrations detected in the presence of cells, but cell lines least sensitive to carbidopa degraded exogenous H2O2 more rapidly than did sensitive cells. Implicated in these studies, pyruvate degraded H2O2 in RPMI in a dose- and time-dependent manner and reversed carbidopa-induced cytotoxicity to carcinoid cells. Extracellular pyruvate levels produced per h by resistant large cell lung carcinoma cells averaged four-fold that of sensitive carcinoid cells plated at equal density (24 h time course). Finally, carbidopa exposure (100 microM, 24 h) depleted extracellular pyruvate from sensitive carcinoid cells, but reduced pyruvate levels from resistant NCI-H460 cells less than 17%.