肾上腺

20061599 嗜铬细胞瘤诊疗对策／宫大鑫…∥中国肿瘤临床．-2005，32（19）．-1112-1115 回顾性分析1982年1月至2002年12月221例嗜铬细胞瘤的临床表现、体征，实验室检查，影像学检查和病理检查资料。结果：该组病例男99例，女122例；平均年龄43．7岁。3例体检发现肿瘤，15例因消化道症状发现肿瘤，3例于其他疾病随访中发现肿瘤，195例因血压增高发现肿瘤。176例为症状功能性嗜铬细胞瘤，21例为静止型嗜铬细胞瘤，15例为肾上腺外嗜铬细胞瘤（其中8例为多发性嗜铬细胞瘤），17例诊断为多发性嗜铬细胞瘤。13例为恶性嗜铬细胞瘤。结论：实验室检查对症状功能性嗜铬细胞瘤的诊断意义较大。影像学检查有助于肾上腺偶发瘤中发现静止型嗜铬细胞瘤。肾上腺外嗜铬细胞瘤常常多发。肾上腺外多发、复发嗜铬细胞瘤有较高的恶变倾向，手术是治疗各种嗜铬细胞瘤的首选方法。表1参12     

恶性嗜铬细胞瘤的临床特点（附6例报告）

我院经手术治疗的嗜铬细胞瘤４０例，其中出现转移病变并经手术及病理确诊为恶性嗜铬细胞瘤者６例，占１５％。２例为肾上腺嗜铬细胞瘤，４例为肾上腺外嗜铬细胞瘤，本文就恶性嗜铬细胞瘤的发病率、诊断依据及临床特点进行了讨论。     

嗜铬细胞瘤组织端粒酶活性表达与患者预后的关系

目的：探讨嗜铬细胞瘤中端粒酶活性表达与患者预后的关系。方法：利用放射自显影为基础的端粒重复序列扩增方法,对23例嗜铬细胞瘤及6例正常肾上腺髓质标本的端粒酶活性表达进行检测,结合随访结果进行分析。结果：23例嗜铬细胞瘤标本中端粒酶活性表达2例,其余21例嗜铬细胞瘤及6例正常肾上腺髓质标本均未见端粒酶活性表达。2例端粒酶阳性表达的嗜铬细胞瘤均为肾上腺外嗜铬细胞瘤,并均在术后半年至1年出现多发转移。另1例端粒酶阴性表达者也在术后出现了临床原位复发及双肺多发转移。结论：端粒酶活性可作为潜在恶性嗜铬细胞瘤的一个重要标识,对于恶性嗜铬细胞瘤的诊断及预后有一定参考价值。     

Heparanase-1表在恶性嗜铬细胞瘤中的达及其意义

目的：探讨类肝素酶（Heparanase）成为一种预判肾上腺恶性嗜铬细胞瘤指标的可能性。方法：选取经手术治疗且具有完整的临床、病理和随访资料的肾上腺嗜铬细胞瘤患者的存档石蜡标本27例，其中良性嗜铬细胞瘤10例（良性组），恶性嗜铬细胞瘤17例（恶性组）。另取5例因良性肾疾患行肾切除时获取的同侧正常肾上腺组织作为对照组。采用免疫组织化学技术检测良、恶性嗜铬细胞瘤及正常肾上腺髓质组织中Heparanase-1的表达情况。结果：Heparanase-1在肾上腺恶性嗜铬细胞瘤中表达最高（76.5％），在肾上腺良性嗜铬细胞瘤中表达较低（30.0％），在正常肾上腺髓质组织中无表达，恶性组与良性组及恶性组与正常组之间Heparanase-1的表达差异有统计学意义（P〈0.05）。结论：Heparanase-1有望成为预判肾上腺恶性嗜铬细胞瘤的一种指标。     

骨肉瘤细胞核DNA含量测定及其临床意义

应用流式细胞分析术测定５４例骨肉瘤的细胞核ＤＮＡ含量，探讨其与病理和临床特点的关系。结果表明：１０例为ＤＮＡ二倍体，４４例为异倍体。ＤＮＡ指数与骨肉瘤Ｘ线分级、肿瘤大小和外科分期有明确关系；Ｓ期细胞百分数、增殖指数与骨肉瘤外科分期也有明确相关性。预后分析表明：ＤＮＡ二倍体、低异倍体、Ｓ期细胞百分数＜２０％、增殖指数＜３５％的骨肉瘤息者有较高的三年生存率。     

多发性嗜铬细胞瘤八例报告

报告我院经手术及病理证实的多发性嗜铬细胞瘤8例,其中双侧肾上腺嗜铬细胞瘤4例,单侧肾上腺多发嗜铬细胞瘤2例,肾上腺及肾上腺外多发嗜铬细胞瘤1例,肾上腺外多发嗜铬细胞瘤1例,共计19个肿瘤。本文对肿瘤的定性、定位及治疗进行了讨论。     

骨肉瘤,骨巨细胞瘤P53基因蛋白表达的定量研究

作者应用流式细胞测量及免疫荧光技术对骨肉瘤和骨巨细胞瘤细胞Ｐ５３基因蛋白表达进行了定量研究，探讨了Ｐ５３蛋白表达与ＤＮＡ倍体、细胞增殖活性和病理学及预后的关系。结果显示，骨肉瘤和Ⅲ级骨巨细胞瘤均为ＤＮＡ异倍体，Ｐ５３蛋白均为高表达，ＤＮＡ含量（ＤＩ值）、ＰＩ值和Ｐ５３蛋白表达量（ＦＩ值）明显高于Ⅰ、Ⅱ级骨巨细胞瘤，并与骨巨细胞瘤组织学分级密切相关。Ｐ５３蛋白的表达量与骨肉瘤、骨巨细胞瘤的预后相关     

嗜铬细胞瘤合并肾上腺节细胞神经瘤 1 例

目的：分析嗜铬细胞瘤合并肾上腺节细胞神经瘤的临床特点及诊治思路。方法：总结分析 1 例嗜铬细胞瘤合并肾上腺节细胞神经瘤的诊断与治疗经过。结果：该例患者临床症状不明显,影像学检查提示神经鞘瘤可能,肿瘤性质不明, 考虑神经鞘瘤可能,行后腹腔镜下肾上腺肿瘤切除术后,术后病理学检查回复示混合性嗜铬细胞瘤和肾上腺节细胞神经瘤。结论：嗜铬细胞瘤合并肾上腺节细胞神经瘤是一种罕见的良性肿瘤,如临床症状不典型者,可通过实验室及影像学初步判断, 并借助病理结果进一步确诊,其主要的治疗方法为手术切除。     

静止型嗜铬细胞瘤和非静止型嗜铬细胞瘤的比较

目的：提高对静止型嗜铬细胞瘤的诊断和治疗水平。方法：回顾性分析12例静止型嗜铬细胞瘤和同期105例非静止型嗜铬细胞瘤的临床资料。结果：12例静止型嗜铬细胞瘤患者的血压、尿儿茶酚胺(CA)、尿香草基苦杏仁酸(VMA)均正常或略高于正常值；静止型嗜铬细胞瘤常见于肾上腺偶发瘤及上腹部肿物诊断中，以女性及右侧偏多，肿瘤多呈球形，直径大多＜2cm或＞5cm，瘤体中常见液化坏死，并且面积较大；所有病例均进行手术治疗，其中6例术中血压无上升，3例有轻度上升，3例发生高血压危象，无一例死亡。结论：静止型嗜铬细胞瘤在临床上具有潜在的危险性，应充分认识，术前充分准备，术中及时妥善处理。     

肾上腺外嗜铬细胞瘤

目的：探讨肾上腺外嗜铬细胞瘤的诊断和治疗。方法：回顾性分析１６例本病患者的临床资料。结果：肾上腺外嗜铬细胞１６例，占同期嗜铬细胞瘤２３．７％，１２例有高血夺癍状，无症状４例。全部病例均手术切除肿瘤，无手术并发症。结论：血和尿儿茶酚胺及其代谢产物测定对本病定性有很高的诊断价值，定位诊断依靠Ｂ超和ＣＴ。术前应使用肾上腺素能受体阻滞剂控制血压和心率，并扩充血容量。恶生嗜铬细胞瘤的诊断主要靠长期的临床随访     

Flow cytometric analysis of DNA aneuploidy in adrenal tumors]

Nuclear DNA content of paraffin-embedded tissue from 38 adrenal neoplasms and 9 histologically normal adrenal glands was analyzed using flow cytometry. Histological diagnosis of thirty-eight adrenal neoplasms were 3 adrenocortical carcinomas, 20 adrenocortical adenomas and 15 pheochromocytomas. In 33 cases (87%) of the 38 tumors the determination of DNA ploidy was possible. All 9 control specimens showed DNA diploid pattern in DNA histogram. In adrenocortical neoplasms the incidence of DNA aneuploidy was 0% (0 of 17) in adenomas and 100% (2 of 2) in carcinomas. All 17 adrenocortical adenomas which showed DNA diploid pattern are clinically benign. On the other hand, both 2 cases of adrenocortical carcinoma which showed DNA aneuploidy died within 1 year. These data suggest that DNA aneuploidy may be useful as a prognostic factor in adrenocortical neoplasm. With regard to pheochromocytoma, DNA aneuploidy was detected in 4 of 14 patients (29%). However, all 14 cases were clinically benign. In pheochromocytoma DNA aneuploidy was not found to be correlated with prognosis.     

Prognostic significance of DNA ploidy in colorectal cancer: a prospective flow cytometric study

A prospective study of prognostic factors has been carried out in a group of 123 consecutive patients with colorectal cancer. The fate of all patients is known at 3 years after operation. Clinical and pathological data were recorded at the time of presentation and operation, and the patients have been subject to regular postoperative review. DNA ploidy status was determined by flow cytometry. In all, 39 (33 per cent) patients had DNA diploid tumours and 80 (67 per cent) patients had DNA aneuploid tumours. In four cases, tumour material was not obtained. The patients with DNA aneuploid tumours had a worse prognosis than those with DNA diploid tumours, but this was only seen in those patients classified as Dukes' B. In a Cox's regression analysis, the surgeon's assessment of operability was the strongest predictor of survival, followed by the pathological classification and the patient's age. After these factors had been considered, the DNA ploidy status conferred no independent survival value.     

Pheochromocytoma: nuclear deoxyribonucleic acid patterns studied by flow cytometry

Nuclear deoxyribonucleic acid (DNA) ploidy studies with paraffin-embedded archival tumor specimen blocks were performed by flow cytometry on extracted nuclei from 75 pheochromocytomas. Clinical details, specifically including histologic findings, biochemical studies, and ultimate fate, were investigated. Preparation of paraffin-embedded tissue specimens was carried out by the technique of Hedley et al. and stained with propidium iodide according to the method of Vindel?v et al. Twenty-three tumors showed a normal DNA histogram, 31 showed significant increase in the 4C (DNA tetraploid) peak, and 21 exhibited a DNA aneuploid peak. To define a subset of patients who had either died as a result of pheochromocytoma or had been followed for a minimum of 10 years, 13 patients were excluded. Of the remaining 62 patients, all of the 18 patients with a normal DNA histogram followed a benign clinical course, including normal fractionated urinary catecholamines. However, eight (31%) of the 26 patients classified DNA tetraploid/polyploid and seven (39%) of the 18 patients exhibiting a DNA aneuploid peak had evidence of malignancy; these two groups had significantly more malignant tumors (p less than 0.05 and p less than 0.02, respectively) than the normal DNA group. Flow cytometric DNA ploidy measurements of isolated nuclei seem to provide useful prognostic information for patients with pheochromocytoma.     

影响胰腺癌预后的因素分析

目的　探讨影响胰腺癌预后的决定因素。 方法　应用流式细胞仪检测胰腺癌ＤＮＡ倍体６２ 例,采用免疫组织化学法检测ｐ２１ 、ｐ５３ 在胰腺癌中的表达,应用Ｃｏｘ 比例风险模型对其预后因素进行分析。 结果　本组共有６２ 例经手术和病理学检查证实的胰腺癌病人,其中胰腺癌患者二倍体２５ 例,四倍体１１ 例,预后较好,平均生存期分别为２８ 个月和３０ 个月,非四倍体异倍体者２６ 例平均生存期仅为５ 个月。胰腺癌组织ｐ２１ 阳性率为８９％ ,ｐ５３ 阳性率为５１％ 。二者表达均与临床分期密切相关;单因素分析发现,ＤＮＡ倍体、后腹膜浸润、手术方式、肝转移、临床分期、ｐ２１ 表达、十二指肠浸润等与预后密切相关,多因素分析中仅ＤＮＡ倍体和临床分期是独立预后决定因素。 结论　ＤＮＡ倍体和临床分期是胰腺癌独立预后的决定因素     

Malignancy of gastric cancer according to DNA ploidy pattern and tumor markers

Microfluorometric analysis of DNA content was performed on samples from 172 gastrectomy specimens of cancer. Histograms of DNA content were classified into three ploidy patterns; type I, II and III. Also, immunocytochemical examination for tumor markers (CEA, AFP and hCG) was performed. Type I was predominant in intramucosal carcinoma. Type III was predominant in differentiated carcinomas, in elevated type of early carcinomas and in gross type 1 and 2 of advanced carcinomas. Prognostic serosal factor exerted a greater influence on the prognosis than ploidy pattern. But in the patient without prognostic serosal factor, type III had a poorer prognosis than the other types because of vessel invasion, lymph node metastasis and liver metastasis. AFP and hCG were highly positive in type III. Furthermore type III cancer producing more than two tumor markers had an extremely poor prognosis. Analysis of ploidy pattern and tumor markers may prove to be a highly useful adjunct in the evaluation of malignancy in gastric cancer.     

Clinical significance of nuclear DNA content in human gastric tumors. A static cytometry study in 87 cases

In recent years the abnormal DNA content of cancer cells and the ploidy model have played an important role in biological and medical research aimed at achieving a more accurate diagnostic and prognostic assessment. Static cytometry was studied in histological sections using an image analyser which enabled the DNA content of cancer cells coloured using Feulgen's method, the elective method for nucleic acids, to be evaluated. A high percentage of aneuploidy in human gastric tumours was found to be correlated with a low degree of histological differentiation (G3), with tumoral invasion of the lowest tissue strata and neighbouring lymph nodes, and with a negative prognosis. The practical clinical application of DNA evaluation therefore allows cases which evolve more rapidly since they possess a greater tumoral aggressiveness to be identified (aneuploid tumours).     

ras突变和rasP21蛋白表达与尿路上皮肿瘤预后关系

应用聚合酶链式反应加单链多态性分析(PCR-SSCP)及流式细胞木和细胞免疫荧光技术检测52倒尿路上皮肿瘤K-ras基因突变及rasP21蛋白表达和DNA含量变化,研究ras突变和rasP21蛋白表达及DNA倍体异常与尿路上皮肿瘤预后关系。K-ras基因突变5例(9.65),rasP21蛋白阳性表达36例(69.2％);异倍体22例(42.3％),二倍体30例(57.7％);DNA倍体异常和rasP21蛋白表达随肿瘤病理分级和分期的上升而增加,与肿瘤预后呈正相关(P<0.01);异倍体肿瘤其rasP21蛋白表达率明显高于二倍体肿瘤(P<0.01)。DNA倍体异常和rasP21蛋白表达对尿路上皮肿瘤预后有预测意义。     

The relationship of flow cytometric DNA analysis and clinicopathology in small-intestinal carcinoids

Paraffin-embedded archival tissue samples were used for nuclear deoxyribonucleic acid (DNA) content study by flow cytometry on 56 surgically resected, primary, small-intestinal carcinoid tumors. Sample preparation was carried out using the methods of Hedley and Vindelov. To reduce nuclear aggregation, a procedure of sonication was also performed. Nineteen (34%) cases were DNA diploid, 34 (61%) cases showed significantly increased 4C peak (DNA tetraploid), and only three (5%) cases were DNA aneuploid. Cell cycle phase analysis revealed that carcinoid tumors had significantly higher G2% than those of nontumor control tumors. However, there was no significant correlation between clinical parameters and both DNA ploidy pattern and cell cycle phase analysis. Although the difference in survival between patients with DNA nondiploid tumors and DNA diploid tumors was not significant, all of the patients with DNA aneuploid tumor had poor prognosis followed by death from carcinoid tumor.     

Flow cytometric analysis of the nuclear DNA content of hepatocellular carcinoma

The nuclear DNA content of 77 resected specimens from 65 cases of hepatocellular carcinoma (HCC) was measured by means of flow cytometry. The DNA index (DI) was calculated and the correlation between the DNA ploidy pattern and clinicopathological findings was studied. In the cases of HCC with a diameter of less than 5 cm, the 3-year survival rate of the aneuploid cases was 44.5 per cent, which was significantly lower than the 91.4 per cent of the diploid cases (p less than 0.001). Serum AFP levels were over 1000 ng/ml in 46.4 per cent of the aneuploid tumors and 18.5 per cent of the diploid tumors (p less than 0.05). The DI's were investigated in several sites of the same tumor and no difference was seen among the different sites in 16 out of 17 tumors. From 8 recurrent cases out of 12 who underwent a second resection, seven did not show any significant differences in DI from their primary tumor. On the other hand, four cases of second primary tumors showed different DI's to those of their first primary tumor. Intra-hepatic metastatic tumors exhibited the same DI's as their primary tumors. Thus, the nuclear DNA ploidy pattern may serve as a stable and valuable marker in predicting the malignant potential and prognosis of HCC.     

DNA analysis of meningiomas using paraffin-embedded surgical specimens in connection with clinical recurrence]

Meningioma includes some clinically malignant cases which grow multifocally or recur rapidly. To develop methodology to distinguish clinically malignant cases, we examined the nuclear DNA of meningiomas by flow cytometry using paraffin-embedded specimens. 52 surgical specimens were studied from 52 cases of meningioma. Among these cases, 3 multiple meningiomas that recurred multifocally within 3 years were included. Malignancy was assessed by the proliferative index (%S + %G2/M) and DNA ploidy of the specimens. Six cases were histologically malignant, while aneuploidy was observed in only 2 (33.3%). No significant correlation was observed when analyzing the 23.9% aneuploidy rate among benign cases. Moreover, three cases of clinically malignant meningiomas were all diploid. In contrast, the proliferative index of 19.82 +/- 9.45% among histologically malignant cases was significantly higher as compared to that for benign cases (11.50 +/- 5.49%). The proliferative index was 15% or more (average 22.02 +/- 6.01%) for patients with clinically malignant meningioma. This was considerably higher than the corresponding value for clinically benign meningiomas. Our analysis indicated that the assessment of benignancy or malignancy of meningioma on the basis of DNA ploidy alone is difficult. The proliferative index so obtained relates significantly to prognosis, apparently providing a useful prognostic assessment.