Study of 7 Cases of Giant Cell Tumor of Soft Tissue

Background

Primary giant cell tumour of soft tissues is a distinct but uncommon group of neoplasms morphologically identical to osseous giant cell tumor.

Methods

7 patients with painless growing soft tissue mass, having no attachment to underlying bone, were identified in a four years retrospective study from two zonal hospitals of armed forces. Histopathology of these lesions revealed admixture of multinucleated giant cell with mononuclear cells. All patients were treated by surgical resection and followed up for recurrence. Results : There were 5 male and 2 female patients in the age group of 18 to 56 years. All lesions were superficial, circumscribed and involved extremities except one. Histologic transition between benign and malignant lesion was present in only one of the 7 patients that recurred after three months of surgery for which she had to be operated again. 2 of our 7 cases were lost in follow up.

Conclusion

Primary giant cell tumour of soft tissues usually present as a painless mass and needs to be differentiated from other giant cell rich soft tissue tumors. Benign clinical course is expected if the lesion is excised adequately. Its biological behaviour to have low malignant potential is recognized; but this cannot be predicted and metastasis does occur rarely.Key Words: Giant cell tumour of soft tissue, Giant cell tumour of bone, Malignant fibrous histiocytoma     

pcDPG基因治疗甲状旁腺功能减退症的实验研究

目的构建甲状旁腺激素(PTH)基因的重组真核表达质粒,评价体外转染后PTH基因的表达与生物学活性,同时观察其对甲状旁腺功能减退动物的基因治疗作用。方法(1)从人胚甲状旁腺组织中克隆PTH基因,拓扑法构建其重组真核表达质粒pcDNA3.1-PTH-GFP(pcDPG),并采用酶切、聚合酶链反应(PCR)及DNA测序鉴定;(2)用脂质体转染pcDPG入293细胞,观察绿色荧光蛋白(GFP)表达并计算转染率,同时逆转录-聚合酶链反应(RT-PCR)验证PTH基因的表达;(3)纯化转染细胞上清中PTH蛋白,进行生物学活性鉴定;(4)建立甲状旁腺功能减退症的家兔模型,将pcDPG质粒以肌肉注射进行分组治疗,监测血钙、磷和PTH值及存活时间,通过形态学观察各器官的病理变化。结果(1)酶切与PCR结果与预期相同,测序结果与文献中序列同源性为99.3%;(2)细胞转染后24h即可见GFP表达,随时间延长而表达增强,48h转染率达38.9%和62.5%,同时RT-PCR见PTH基因表达;(3)纯化的PTH蛋白可对抗甲状旁腺切除小鼠的抽搐症状;(4)模型兔术后第2d血钙(1.71mmol/L±0.09mmol/L,1.73mmol/L±0.03mmol/L,1.75mmol/L±0.03mmol/L,1.65mmol/L±0.04mmol/L)明显低于术前(2.82mmol/L±0.21mmol/L,P<0.05),术后第2d PTH值(5.03pg/ml±0.05pg/ml,5.04pg/ml±0.05pg/ml,5.03pg/ml±0.07pg/ml,5.29pg/ml±0.03pg/ml)也明显低于术前(11.63pg/ml±1.60pg/ml),但是术后第2d血磷增高(P<0.05),pcDPG质粒大、中剂量组治疗后48h血钙、磷与PTH值均恢复至正常。结论脂质体介导的质粒pcDPG体外转染率较高,能表达有活性的PTH蛋白,同时对甲状旁腺功能减退家兔有较好的疗效,从而为甲状旁腺功能减退症基因治疗的进一步研究奠定了基础。     

图像法DNA分析在骨肿瘤穿刺活检的应用

应用图像分析仪测定35例骨肿瘤穿刺组织的肿瘤细胞核DNA含量。结果表明恶性骨肿瘤DNA含量高于良性,良恶性之间差异非常显著。骨巨细胞瘤DNA指数广泛分布在良恶性之间,显示出“中间性肿瘤”的特征。骨巨细胞瘤复发组含量显著高于无复发组,提示DNA含量与肿瘤生物学行为有密切关系。术前穿刺DNA含量分析,有助于对肿瘤增殖能力的了解,作为术式选择,良、恶性肿瘤的鉴别和预后估计的参考。穿刺DNA图像分析法的开展是可行的,具有一定的临床价值。     

甲状旁腺超声检测对尿毒症继发甲状旁腺功能亢进的诊治意义

目的:探讨高分辨率超声对尿毒症继发性甲状旁腺功能亢进(甲旁亢)的诊断价值及与血清甲状旁腺素(PTH)间的相关性.方法:对55例尿毒症患者进行甲状旁腺的超声检查,并测定血清PTH、钙、磷水平.结果:55例中52例患者(94％)测到增大的甲状旁腺64枚,其中测及2枚以上者11例(20％).多枚甲状旁腺患者,甲状旁腺体积、血清PTH及磷水平均较单枚患者明显增加(P<0.01),上述指标随病程的延长变化更加明显;但血清钙水平并无明显变化.结论:尿毒症甲状旁腺的大小与血清PTH及磷水平存在一定关系.超声对尿毒症继发性甲旁亢患者的甲状旁腺肿大有诊断价值.     

Secondary hyperparathyroidism associated with multiple brown tumor: a case report

Brown tumour represents a serious complication of hyperparathyroidism.Definitive diagnosis is based on histological examination, clinical,radiological and laboratory data.Here we report a case of multiple brown tumours localised in collarbone,rib and in the distal ulna due to secondary hyperparathyroidism in a 37-year-old women with chronic renal failure.The clinical management of brown tumour aimed primarily to reduce the elevated parathyroid hormone levels by pharmacological treatment.In our experience,clinicians usually consider brown tumor of hyperparathyroidism is caused by giant cell lesions in maintenance hemodialysis recipients,and multiple brown tumours are rarely seen in these patients.     

纤维支气管镜检查对痰瘤细胞阴性肺癌的诊断价值

痰瘤细胞阴性，经纤维支气管镜检查并获得组织学诊断的４０例肺癌患者，做了纤支镜肉眼直视下观察癌组织局部特殊表现，并对痰瘤细胞阴性的原因进行了探讨。     

Optimising gene therapy of hypoparathyroidism with hematopoietic stem cells

Background The treatment of hypoparathyroidism (HPT) is still a difficult clinical problem, which necessitates a new therapy. Gene therapy of HPT has been valuable, but how to improve the gene transfer efficiency and expression stability is a problem. This study was designed to optimize the gene therapy of HPT with hematopoietic stem cells (HSCs) recombined with the parathyroid hormone (PTH) gene. Methods The human PTH gene was amplified by polymerase chain reaction (PCR) from pcDNA3.1-PTH vectors and inserted into murine stem cell virus (MSCV) vectors with double enzyme digestion (EcoRI and XhoI). The recombinant vectors were transfected into PA317 packaging cell lines by the lipofectin method and screened by G418 selective medium. The condensed recombinant retroviruses were extracted and used to infect HSCs, which were injected into mice suffering from HPT. The change of symptoms and serum levels of PTH and calcium in each group of mice were investigated. Results The human PTH gene was inserted into MSCV vectors successfully and the titres were up to 2×10（7） colony forming unit (CFU)/ml in condensed retroviral solution. The secretion of PTH reached 15 ng·10（-6）·cell（-1） per 48 hours. The wild type viruses were not detected via PCR amplification, so they were safe for use. The mice suffering from HPT recovered quickly and the serum levels of calcium and PTH remained normal for about three months after the HSCs recombined with PTH were injected into them. The therapeutic effect of this method was better than simple recombinant retroviruses injection.Conclusions The recombinant retroviral vectors MSCV-PTH and the high-titre condensed retroviral solution recombined with the PTH gene are obtained. The recombinant retroviral solution could infect HSCs at a high rate of efficiency. The infected HSCs could cure HPT in mice. This method has provided theoretical evidence for the clinical gene therapy of HPT.     

A New Superagonist of GnRH for Inhibition of Ovulation in Women

The serum concentrations of calcium, albumin and parathyroid hormone (PTH) and the plasma levels of ionized calcium were determined in 124 healthy subjects, 89 patients with primary hyperparathyroidism (HPT), 23 of whom had the syndrome of multiple endocrine neoplasia type 1 (MEN-1) and 43 patients who had hypercalcaemia of other causes than HPT (non-HPT), in most cases due to widespread malignancies. The total serum calcium was corrected for the serum albumin concentration (CaM). Healthy females over the age of 50 had higher CaM, than younger females and the women of all ages also had, higher serum PTH levels than males. For all study groups both the intra- and inter-diurnal variations were small for all the studied variables. Discriminant function and optimal discriminatory limits were calculated with the help of computer programs. A consideration of all the individuals in the discriminant analysis, revealed that measurements of CaM alone separated most HPT patients both from the healthy subjects and from the non-HPT patients. However, when only those who had borderline values (defined as CaM between 2. 45 and 2. 75 mmol/l) were included it turned out that measurements of ionized calcium markedly improved the delineation of mild HPT from the healthy subjects and that, in addition, PTH measurements helped to exclude those with non-HPT hypercalcaemia. The optimal discriminatory levels of serum calcium were calculated as the levels which caused the minimum loss in terms of misclassification when attention was paid to the relative importance of false positive to false negative classifications and to the prevalence of HPT. The optimal discriminatory level for serum calcium for a weighting ratio between false positive to false negative of 1:1, and a prevalence of HPT of 1 %, was calculated to be 2. 68 mmol/l and for a prevalence of 50 % 2. 56 mmol/l. In the latter situation a weighting ratio of 10:1 for false positive to false negative gave a level of 2. 63 mmol/l while a weighting ratio of 1:10 corresponded to an optimal discriminatory level of 2. 47 mmol/l.     

Paraneoplastic polyarthritis in association with metastatic neuroendocrince tumour of the adrenal gland

Paraneoplastic polyarthritis is a rare manifestation described in association with various solid tumours. We describe the clinical presentation, diagnostic evaluation, differential diagnosis, and management of a 28-year-old woman who presented with fever, weight loss, and symmetrical polyarthritis, subsequently diagnosed to have a metastatic neuroendocrine tumour of the adrenal gland with paraneoplastic polyarthritis. Paraneoplastic polyarthritis must be considered in polyarthritis unexplained by common aetiologies. The unusual presentation of this case, alerts us about the atypical presentation of these tumours. To the best of our knowledge, this is the first case study of a neuroendocrine tumour presenting as paraneoplastic polyarthritis.     

Median sternotomy for parathyroid adenoma

Most mediastinal parathyroid tumours lie within the thymus gland and may be retrieved when cervical thymectomy is carried out in the course of neck exploration for primary hyperparathyroidism (HPT). We report 4 patients, each of whom required sternotomy for removal of a true mediastinal parathyroid adenoma. Subtraction isotope scintigraphy suggested the presence of a mediastinal tumour prior to cervical exploration in 2 individuals and prior to re-exploration in a third. When localisation before initial exploration for HPT suggests a parathyroid tumour within the chest, consideration should be given to proceeding to sternotomy at first operation if a comprehensive neck exploration, including cervical thymectomy, fails to uncover the adenoma. Uniquely, one of our patients underwent sternotomy for HPT when 23 weeks pregnant.     

人胚甲状旁腺细胞移植供体胎龄的选择

目的研究人胚甲状旁腺细胞移植治疗甲状旁腺功能低下(HPI)中供体最佳胎龄段.方法将12周～32周龄水囊引产的死胎(死亡时间＜2h)的甲状旁腺切取后进行体外培养,定期测量培养液中甲状旁腺激素(PIH)水平,同时对甲状旁腺细胞进行光镜电镜检查,以确定最适合甲状旁腺细胞移植的供体胎龄段.结果16周～24周龄供体的甲状旁腺细胞经体外培养后,其分泌Pm功能良好,其细胞形态及其超微结构保持良好.结论16用～24周龄的供体最适合作甲状旁腺细胞移植.     

一氧化氮合酶在骨肉瘤和骨巨细胞瘤中的表达及其与预后的关系

目的：探讨骨肉瘤和骨巨细胞瘤组织中一氧化氮合酶（nitric oxide synthase,NOS)的表达及其预后的关系。方法：用免疫组化法测定Ⅱ型iNOS在37例骨恶性肿瘤中的表达。结果：iNOS在骨肉瘤和骨巨细胞瘤的阳性表达率分别72．7％，58．8％。两组之间无差异（P＞0．05）。iNOS与骨巨细胞瘤病理分级呈现正相关（P＜0．05）。结论：iNOS与恶性骨肿瘤恶性度有关，与骨巨细胞瘤病理分级呈现正相关。对肿瘤的生长，分化及预后有重要作用。     

多价阳离子脂质体介导重组基因pCKM-mPTH治疗甲状旁腺功能低下症的实验研究

目的探讨多价阳离子脂质体介导的pCKM-mPTH质粒治疗甲状旁腺功能低下症(HPT)的最佳方案。方法用DNaseⅠ敏感性试验测定脂质体对质粒的保护作用,用不同比例的脂质复合物及裸质粒进行体内外转染,收集细胞培养液和血清,采用放射免疫法测定其甲状旁腺激素(PTH)含量。结果脂质复合物比例为2∶1时,即对DNA有明显的保护作用;在体外转染实验中,复合物比例在3∶1时PTH表达量最高,为每24小时(16.4±4.8)pg/10 000细胞,而在此比例下pCKM-mPTH质粒达20μg/100μl时,模型体内PTH的血清浓度最高,为35.9 pg/m l±2.2 pg/m l。结论与裸质粒相比,多价阳离子脂质体更适宜于作为HPT基因治疗的非病毒载体,而其介导重组质粒pCKM-mPTH直接转染肌肉的良好效能取决于脂质复合物的构成比例和剂量。     

DIAGNOSIS AND TREATMENT OF MALIGNANT PANCREATIC ENDOCRINE TUMOUR

Objective To summarize our experience in the diagnosis and treatment of malignant pancreatic endocrine tumour. Methods We retrospectively reviewed 36 cases of malignant pancreatic endocrine tumours in our hospital from July 1987 to April 2002, and summarized its clinical features. Results Liver metastasis was the main malignant manifestation of malignant pancreatic endocrine tumours (incidence rate 72.2%). Removals of primary lesion and isolated hepatic metastatic lesion were means of curative therapy. Interventional chemotherapy was an important adjuvant treatment. Conclusion Comprehensive therapy plays an important role in improving the prognosis of malignant pancreatic endocrine .     

骨盆巨细胞瘤影像学表现与病理结果对照分析

目的与病理结果对照,总结骨盆巨细胞瘤的影像学表现。方法回顾性分析10例经手术或骨穿刺病理证实的骨盆巨细胞瘤影像学检查资料,与病理结果进行对照,总结骨盆巨细胞瘤的影像学特征。结果术前拟诊准确率X线平片为50％（5／10）、CT为85．7％（6／7）;平片对骨嵴特征、骨壳完整性及软组织肿块的显示较差,CT能准确显示骨质破坏区内皂泡状骨嵴及单层或多层骨壳影以及骨壳的吸收变薄、中断或消失;病理诊断为2级以上的骨巨细胞瘤在CT上均可见骨壳中断、消失及软组织肿块形成。结论CT能够清晰显示巨细胞瘤瘤灶内骨嵴及周围骨包壳的细微改变,对骨盆骨巨细胞瘤的定性及分级诊断具有重要价值。而X线平片的诊断符合率较差。     

Malignant transformation in a fatal case of giant cell tumour of the sacrum.

Most giant cell tumours can be treated by local surgery and only rarely are they life threatening. We report a case of a giant cell tumour of the sacrum causing irresectable and fatal small bowel obstruction following malignant transformation of the tumour. The role of radiotherapy in this transformation is discussed.     

甲状腺肿瘤cyclin E蛋白与PCNA的表达特点及相关性

目的：研究甲状腺肿瘤cyclinE蛋白及增殖细胞核抗原（PCNA）的表达特点及相关性。方法：采用免疫组织化学SABC法,检测68例甲状腺组织（其中癌旁“正常”甲状腺组织5例,甲状腺腺瘤16例,甲状腺癌47例）细胞中cyclinE与PCNA的表达。结果：cyclinE的异常表达是甲状腺肿瘤形成的早期事件,且cyclinE与PCNA标记指数呈显著的相关性（X2=24．218,P＜0．005）。结论：cyclinE的异常表达参与甲状腺肿瘤的发生与发展过程．其可能是通过改变细胞周期及促进细胞异常增殖而起作用的,cyclinE可做为组织细胞增殖的又一标志。     

X线、CT、MRI在骨巨细胞瘤诊断中的应用价值

目的：分析骨巨细胞瘤的X线、CT和MRI表现形式,进一步探讨骨巨细胞瘤的临床影像学表现。方法方便选取该院自2004年1月―2014年12月经病理证实的78例骨巨细胞瘤病例,对其的临床表现、临床症状、X线、CT和MRI的表现进行研究分析。结果发生于长管状骨骨端56例,其余22例为骨盆、脊柱及不规则骨,病灶呈偏心性囊肿膨胀性骨破坏,界限清楚锐利,有骨脊但无分隔,无钙化,富血供;MRI表现为病灶边缘清楚,T1WI为等、低信号,T2WI为不均匀高信号,CT增强及Gd-DTPA增强扫描肿瘤实体呈中度到明显强化。结论在临床骨巨细胞瘤诊断中,通过较为系统、仔细的分析骨巨细胞瘤的X线、CT和MRI表现,从而能为骨巨细胞瘤提供更多的诊断依据。     

Minimally invasive parathyroid exploration for solitary adenoma. Initial experience with an open, 'short incision' approach

BACKGROUND: In the vast majority of patients with primary hyperparathyroidism (HPT) the causative pathology is a benign solitary adenoma. The conventional surgical approach for HPT has involved bilateral cervical exploration with attempted identification of all four parathyroids and resection of enlarged glands. However, in recent years new techniques have permitted accurate preoperative localisation of the single parathyroid tumour in many patients. This has facilitated a focused unilateral operation to be performed in patients with a solitary parathyroid adenoma. More recently we have progressed to a minimally invasive surgical approach for such individuals in whom the tumour has been localised preoperatively. PATIENTS & METHODS: Between September 2004 and July 2006, 24 patients with proven HPT, underwent focused, unilateral cervical exploration through a short (2.5-3 cm) incision placed low on the appropriate side of the neck. Preoperatively, each patient had been shown to have a single focus of activity after parathyroid isotope scanning. RESULTS: There were 21 females and 3 males in the study group with a mean age of 61.5 years (range 25 - 84 years) at the time of operation. The approach was successful in 22 patients with a mean operating time of 49 minutes (range 22-85 minutes). Postoperatively, the serum calcium level returned to normal in every patient and has remained so during a mean follow up period of 11.5 months (range 1-22 months). No individual developed postoperative hypocalcaemia although one patient developed a temporary unilateral vocal cord paralysis. CONCLUSION: A short incision cervical approach for HPT due to solitary adenoma is a viable alternative for appropriately selected patients.     

巨骨细胞瘤患者MRI影像特点及病理分析

目的研究巨骨细胞瘤(GCT)患者MRI影像特征及病理特点。方法搜集我院2011年5月至2014年8月经手术病理证实的19例GCT患者的MRI表现和临床资料,分析患者的MRI征象并与病理结果对照。结果肿瘤在T_1WI上以中等信号为主,夹杂有低信号或高信号,T_2WI上呈中等或稍高信号。MRI可显示肿瘤内坏死、出血、含铁血黄素沉着等。结论 MRI可以提供丰富准确的影像学信息,提高GCT诊断的准确性,指导制定科学有效的治疗方案。