胃蛋白酶原联合放大染色内镜在早期胃癌诊断中的应用

目的：探讨乳胶增强免疫比浊法测定血清胃蛋白酶原（PG）Ⅰ、PGⅡ以及PGⅠ/PGⅡ比值在胃癌筛查中的价值,以及联合人工智能电子染色内镜（FICE）在早期胃癌中的诊断价值。方法：全部患者行胃蛋白酶原普查,如发现异常,即行普通胃镜检查,普通胃镜下发现可疑病变者（如溃疡、胃癌、息肉等）再以人工智能电子染色内镜＋靶向活检,最后明确病变。正常对照组85例。根据组织病理学及胃镜检查结果,将受检者分为5组,即慢性萎缩性胃炎组105例、慢性胃炎伴瘤变组33例、胃良性溃疡组53例、早期胃癌组48例、进展期胃癌组90例。确定胃良性病变的PGⅠ及PGⅡ、PGⅠ/PGⅡ比值参考值范围,并与正常对照组相比较。比较慢性胃炎与胃癌,早期胃癌与进展期胃癌,胃癌术前术后PGⅠ及PGⅡ、PGⅠ/PGⅡ的变化。结果：胃良性溃疡组患者血清PGⅠ及PGⅡ比对照组升高,PGⅠ/PGⅡ比值降低（P〈0.05）。慢性胃炎组比对照组PGⅠ下降,PGⅡ升高,PGⅠ/PGⅡ比值降低。胃癌患者血清PGⅠ及PGⅠ/PGⅡ比值较慢性胃炎组均显著降低（P〈0.05）,其中早期胃癌与进展期胃癌组相比PGⅠ及PGⅠ/PGⅡ比值均无显著差异（P〉0.05）。胃癌患者手术后PGⅠ及PGⅡ值均降低,PGⅠ/PGⅡ比值升高（P〈0.05）。血清PGⅠ、PGⅡ检测结合FICE放大胃镜技术对早期胃癌早诊率达80%。结论：乳胶增强免疫比浊法测定血清PG可作为大规模人群胃癌的普查手段,无创,便于推广;胃蛋白酶原联合放大染色内镜可提高早期胃癌诊断率。     

胃蛋白酶原与胃泌素-17在胃癌前病变筛查中的价值

目的 探讨血清胃蛋白酶原Ⅰ、Ⅱ（PGⅠ、Ⅱ）与胃泌素-17（G-17）在胃癌前病变中的诊断价值。方法 回顾性分析2018年1月~10月我院收治的消化道患者98例,根据胃镜检查及病理结果分为胃溃疡组32例、萎缩性胃炎组21例、肠上皮化生组25例、低级别上皮内瘤变组20例,另选取同期我院检查的健康体检者30名作为对照组。应用ELISA法检测比较五组血清PGⅠ、PGⅡ、胃蛋白酶原比值PGR,（PGI/PGⅡ）、G-17水平。结果 与对照组比较,胃溃疡组PGⅠ、PGⅡ、G-17升高[（131.83±24.62）μg/L vs（95.29±23.47）μg/L]、[（15.31±6.65）μg/L vs（10.93±2.35）μg/L]、[（15.34±4.22）pmol/L vs（9.31±2.48）pmol/L],萎缩性胃炎组、肠上皮化生组、低级别上皮内瘤变组PGⅠ、PGR降低,差异有统计学意义（P＜0.05）。结论 血清PGⅠ、PGR、G-17可作为胃癌及其癌前病变筛查的指标。     

西安地区健康人群血清胃泌素-17生物参考区间的建立

目的建立西安地区健康人群血清胃泌素-17生物参考区间,为临床相关疾病的诊断提供可靠的实验室依据。方法根据NCCLSC28-A2健康参考个体的设置条件要求,收集西安地区年龄13~89岁标本共计10039份,采用酶联免疫吸附试验(ELISA)对10039例健康体检者血清胃泌素-17水平进行检测,并按年龄以及性别分组,根据统计学方法确立各组参考区间。结果西安地区健康人群血清胃泌素-17水平呈偏态分布;不同性别血清胃泌素-17检测结果差异有统计学意义;不同年龄组之间血清胃泌素-17水平也存在一定差异。结论西安地区不同性别及年龄组的健康人群血清胃泌素-17水平存在差异,建议各实验室按不同性别、年龄分组建立血清胃泌素-17的生物参考区间以满足临床需要。     

联合检测胃蛋白酶原、胃泌素-17及CEA、CA19-9在胃癌诊断中的应用

目的 探讨胃蛋白酶原Ⅰ、Ⅱ(PG Ⅰ、PGⅡ)及PG Ⅰ/PGⅡ的比值(PGR)、胃泌素-17(G-17)和CEA、CA19-9几项指标联合检测在胃癌诊断中的临床价值.方法 选择瑞金医院卢湾分院经胃镜检查确诊的185例胃疾病患者为研究对象,以组织病理学检查结果将受检者分为3组,即浅表性胃炎组85例、萎缩性胃炎组50例、胃癌组50例.采用时间分辨荧光免疫分析法检测PG Ⅰ和PGⅡ,然后计算出PGR的值,采用放射免疫分析法检测G-17,采用电化学发光免疫分析法检测CEA及CA19-9.比较不同分组间各指标的差异,最后绘制各指标检查胃癌及胃炎的ROC曲线.结果 在PG Ⅰ、G-17、CEA及CA19-9这四项指标中,浅表性胃炎组和萎缩性胃炎组与胃癌组的差异均有统计学意义(P＜0.05),而浅表性胃炎组与萎缩性胃炎组的差异均无统计学意义(P＞0.05).在PGⅡ和PGR这两项指标中,各组间的差异均无统计学意义(P＞0.05).将PG Ⅰ、G-17及CEA、CA19-9单独测定对胃癌的诊断价值的结果与联合测定对胃癌的诊断价值的结果进行比较并用ROC曲线进行分析,线下面积分别为0.742、0.699、0.614、0.520和0.850.结论 PG Ⅰ、G-17及CEA、CA19-9联合检测可提高胃癌的诊出率,对胃癌的诊断具有较为重要的临床意义.     

年龄对胃部常见良性疾病患者的胃蛋白酶原及胃泌素-17水平的影响

研究年龄对胃部常见良性疾病患者的胃蛋白酶原(PG)及胃泌素-17（G-17）水平的影响。方法 收集2016年1月~2017年12月在安徽医科大学附属安庆医院消化内科住院患者的病历作为研究材料,根据疾病将其分为慢性非萎缩性胃炎（CNAG）组、胃息肉组及胃溃疡组,共收集2638份符合条件的病历。将上述三组疾病按照年龄进一步分为高龄亚组（≥60岁）及低龄亚组（＜60岁）,每个亚组按男女性别再分为两个次级亚组。按照随机数字表法,将符合条件的患者资料随机分到每个次级亚组中,每组40例,一共收集480例资料作为样本进行分析。使用双抗体夹心法的酶学免疫分析技术检测各组患者的胃蛋白酶原Ⅰ（PGⅠ）、胃蛋白酶原Ⅱ（PGⅡ）及G-17水平,并计算出PGⅠ/PGⅡ的比值PGR。结果 在CNAG及胃息肉组中,高龄亚组的PGⅠ、PGⅡ和G-17水平均高于低龄亚组、PGR水平低于低龄亚组,差异有统计学意义（P＜0.05）。在胃溃疡组中,高龄亚组的PGⅠ、PGⅡ及G-17水平均高于低龄亚组、PGR水平低于低龄亚组,差异无统计学意义（P＞0.05）。结论 在CNAG及胃息肉组中,年龄对胃蛋白酶原及G-17水平有影响,但在胃溃疡组中,年龄对胃蛋白酶原及G-17水平的无明显影响。     

血清中PGⅠ、PGⅡ及G-17检测在胃癌早期诊断中的应用

目的 研究血清中胃蛋白酶原Ⅰ（PGⅠ）、胃蛋白酶原Ⅱ（PGⅡ）及胃泌素-17（G-17）检测在胃癌早期诊断中的应用价值。方法 选择2017年1月~2019年1月本院收治的胃病患者98例,其中胃癌患者48例设为观察A组,萎缩性胃炎患者50例设为观察B组,另选取同期体检健康者50例设为对照组,分别行PGⅠ、PGⅡ及G-17检测,并以胃镜或手术结果为对照,分析PGⅠ、PGR（PGⅠ/PGⅡ）及G-17单项及联合诊断结果。结果 PGⅠ、PGR及G-17联合诊断的准确度高于单项检测,差异有统计学意义（P＜0.05）;联合诊断敏感性高于PGR、G-17单项检测,差异有统计学意义（P＜0.05）;对照组、观察B组、观察A组PGⅠ、PGR依次下降,PGⅡ依次升高,差异有统计学意义（P＜0.05）;观察A组G-17高于观察B组,差异有统计学意义（P＜0.05）。结论 血清中PGⅠ、PGⅡ及G-17单项检测在胃癌早期诊断中均具有一定价值,但联合检测可进一步提高诊断准确性,应用价值更高。     

血清胃蛋白酶原Ⅰ、Ⅱ与胃泌素联合检测对胃癌诊断的临床意义

探索血清PGⅠ、PGⅡ及GAS的联合检测对胃癌诊断的意义.采用RIA方法测定了190名正常人和129例胃病患者的血清PGⅠ、PGⅡ和GAS水平,其中68例为胃癌患者.结果表明,胃癌患者血清PGⅠ水平和PGⅠ/PGⅡ比值明显低于对照组,但GAS水平却明显升高.PGⅠ、PGⅡ和GAS联合检测,对胃癌诊断的灵敏度可达94.2%,特异性达到73.4%.提示血清PGⅠ、PGⅡ和GAS的检测可作为胃癌的初步筛查手段,提高了胃癌的检出率.     

血清PDCD4、ZEB1、G-17联合检测对早期胃癌的诊断价值

目的 探究血清程序性细胞死亡因子4(PDCD4)、E盒结合锌指蛋白1(ZEB1)、胃泌素-17(G-17)联合检测对早期胃癌（GC）的诊断价值。方法 将本院收治的136例GC患者、82例萎缩性胃炎患者分别设为GC组、萎缩性胃炎组,另选取同期136例体检健康者设为对照组。比较各组血清PDCD4 mRNA、ZEB1 mRNA及G-17、糖类抗原19-9(CA19-9)、癌胚抗原（CEA）水平。根据GC患者病情进展程度将其分为早期GC组（80例）和进展期GC组（56例）,比较早期GC组、进展期GC组患者血清PDCD4 mRNA、ZEB1 mRNA及G-17、CA19-9、CEA水平;分析血清PDCD4 mRNA、ZEB1 mRNA、G-17、CA19-9、CEA单独或联合检测对早期GC的诊断价值。结果 与对照组相比,萎缩性胃炎组、GC组患者血清PDCD4 mRNA表达水平降低（P<0.05）,ZEB1 mRNA、G-17水平升高（P<0.05）;与萎缩性胃炎组相比,GC组患者血清PDCD4 mRNA表达水平降低（P<0.05）,ZEB1 mRNA、G-17、CA19-9、C...     

FICE内镜、胃蛋白酶原Ⅰ、胃蛋白酶原Ⅱ水平检测对胃癌及萎缩性胃炎的诊断价值

目的 探讨智能分光比色内镜(Fuji intelligent chromo endoscope,FICE)、胃蛋白酶原Ⅰ(pepsinogen Ⅰ,PGⅠ)、胃蛋白酶原Ⅱ(pepsinogenⅡ,PGⅡ)对胃癌及萎缩性胃炎的诊断价值.方法 随机选取2013年10月至2014年9月于我院进行治疗的160例胃癌(gastric carcinoma,GC)患者及200例萎缩性胃炎(chronic atrophic gastritis,CAG)患者.采用酶联免疫法(ELISA)检测以上患者及100例正常人的PG Ⅰ、PGⅡ水平及PGR(PG Ⅰ/PGⅡratio)变化.将360例患者随机分为两组,白光内镜组及FICE内镜组,分别180例.所有患者再次进行胃镜检查,白光内镜组不染色而仅肉眼观测常规取活检;FICE内镜组在FICE内镜下染色后在可疑病灶处取活检.结果 与正常人比较,GC、CAG患者的PG Ⅰ及PGR水平显著降低,差异具有统计学意义(P＜0.01),PGⅡ水平比较差异不具有统计学意义(P ＞0.05);GC组和CAG组PG异常检出比例显著高于健康组,差异具有统计学意义(P＜0.01);FICE内镜组阳性检出率(93.3％)显著高于白光内镜组(61.7％),两组比较差异具有统计学意义(P＜0.01).结论 FICE内镜较白光内镜检出率更高,FICE内镜联合胃蛋白酶原Ⅰ、胃蛋白酶原Ⅱ水平检测可进一步提高胃癌及萎缩性胃炎的检出率,有助于早期筛查及预防,具有非常重要的临床价值.     

胃蛋白酶原、胃泌素-17及Hp-IgG抗体对胃癌、萎缩性胃炎患者胃粘膜状况的血清学评价

目的 应用血清PG Ⅰ、G-17和PG Ⅰ/PGⅡ比值及Hp感染状况,对早期胃癌、萎缩性胃炎患者胃粘膜状况的评价,探讨胃癌高危人群的非侵袭性血清学筛查方法.方法 内镜和组织病理学确诊胃癌患者65例,内镜确诊萎缩性胃炎患者70例、正常对照组50例.ELISA法检测各组血清PG Ⅰ、PGⅡ、G-17及Hp-IgG.结果 胃体萎缩时,胃癌组血清PG Ⅰ水平及PG Ⅰ/PGⅡ比值降低,与对照组比较均具显著差异(P＜0.01),与胃炎组比较亦均有显著差异(P＜0.05).多灶性萎缩性时,胃癌组血清PG Ⅰ水平和PG Ⅰ/PGⅡ比值显著降低,与正常对照组比较具非常显著差异(P＜0.01和P＜0.001),与胃炎组比较亦具有显著差异(P＜0.05和P＜0.01),血清G-17水平显著降低,与正常对照组和胃炎组比较具有统计意义(P＜0.001和P＜0.05),且多灶性萎缩病变在胃癌中的比例明显多于胃炎组.而Hp感染不影响胃癌患者血清PG Ⅰ和G17的水平.结论 低水平血清PG Ⅰ、PG Ⅰ/PGⅡ比值和G-17提示患者可能有胃癌高风险的多灶性萎缩病变,血清PGs和G-17的检测可作为胃粘膜萎缩的非侵袭性检查方法.     

不同胃黏膜病变患者的血清胃蛋白酶原变化

目的：探讨胃溃疡、十二指肠球部溃疡、非萎缩性胃炎、萎缩性胃炎、胃癌患者胃蛋白酶原(pepsinogen,PG)Ⅰ、PGⅡ水平和PGⅠ/PGⅡ比值变化。方法：选择2015年1月至2015年10月因消化道症状行胃镜检查的门诊及住院患者共133例,根据胃镜检查及组织病理学结果,将受检者分为5组。非萎缩性胃炎组42例、萎缩性胃炎组33例、胃溃疡组20例、十二指肠球部溃疡组23例、胃癌组15例、比较各组血清PGⅠ、PGⅡ水平。结果：与非萎缩性胃炎组相比,胃溃疡、十二指肠球部溃疡患者PGI明显升高(P<0.05),胃溃疡PGII明显升高(P<0.05),萎缩性胃炎组、胃癌组血清PGⅠ及PGⅠ/PGⅡ水平降低(P<0.05)。结论：血清PGⅠ、PGⅡ水平以及PGⅠ/PGⅡ比值对提高消化性溃疡、胃癌前病变及胃癌的诊断有重要的临床价值。     

早期胃癌临床诊治的若干问题

胃癌是全球范围内死亡率最高的恶性肿瘤之一,而胃癌的早期发现和规范化治疗是改善胃癌患者的重要手段。随着医疗技术的发展,早期胃癌的检出率逐年提高,并且手术方式逐渐从传统开腹根治术向内镜切除和腹腔镜手术过渡。本课题组通过多年系列研究,联合国内外最新发现对早期胃癌临床生物学特征、分期系统评估和综合治疗方案等方面进行深入研究,为指导早期胃癌临床诊治提供科学依据。     

Implication of Reprimo and hMLH1 gene methylation in early diagnosis of gastric carcinoma

DNA methylation has been recently recognized as a novel tumor marker. This study investigated the methylation status of Reprimo and hMLH1 gene in both plasma and tissue samples from gastric cancer patients, in an attempt to investigate their diagnostic implications in gastric cancer. A total of 180 tissue and plasma samples (including 50 cases of gastric cancer, 50 dysplasia, 50 chronic atrophic gastritis with intestinal metaplasia and 30 normal controls) were collected for detecting DNA methylation status of Reprimo and hMLH1 genes using MSP method. Tissue protein expression levels were further tested by immunohistochemical (IHC) staining. The positive rate of DNA methylation rate was, in ascending sequence, gastritis tissue, dysplasia tissue and gastric carcinoma tissue. All those tissues had significantly elevated DNA methylation level compared to normal group (P < 0.05). Expression level of Reprimo and hMLH1 proteins were, however, decreased in pathological tissues compared to normal ones (P < 0.05). A significantly negative relationship existed between protein level and promoter region methylation level. The DNA methylation occurred in promoter regions of both Reprimo and hMLH1 genes depressed the protein expression, and may participate in the occurrence and progression and gastric cancer. The combined assay of serum Reprimo and hMLH1 DNA methylation levels thus had critical importance in the early diagnosis and gastric cancer.     

Predicting lymph node status in patients with early gastric carcinoma using double contrast-enhanced ultrasonography

Introduction

Double contrast-enhanced ultrasonography (DCUS) is a new method we used in predicting lymph node metastasis (LNM) in patients with early gastric cancer.

Material and methods

Seventy-six patients with early gastric cancer diagnosed by gastroscope and confirmed by pathology after operation were examined using DCUS preoperatively. Group N1 included 15 patients with LNM and group N0 61 patients without LNM.

Results

In group N1, 13 patients (87%) had marked hyperenhancement during early arterial phase using DCUS, and 2 patients (13%) were unmarked as hyperenhancement. In group N0, 24 patients (39%) had marked hyperenhancement during early arterial phase using DCUS, and 37 patients (61%) had unmarked hyperenhancement. The sensitivity and specificity of marked hyperenhancement in predicting LNM in patients with early gastric cancer was 86.7% and 60.7% respectively, and the Youden’s index was 0.474. The κ value of this method was 0.89.

Conclusions

Double contrast-enhanced ultrasonography is a new valuable method to evaluate LNM at an early stage of gastric cancer and prognosis of early gastric cancer preoperatively.     

血清IL-2和FasL在胃癌患者中的表达

目的检测胃癌患者血清白细胞介素2（IL-2）和Fas配体（FasL）的表达,探讨其与胃癌临床及病理指标的关系。方法42例胃癌患者血清标本,其中男性26例,女性16例;年龄35～80岁,平均年龄60.0岁。同期正常对照者血清标本40例,其中男性25例,女性15例;年龄36～78岁,平均年龄58.8岁。应用酶联免疫吸附分析（ELISA）检测胃癌患者和正常对照者血清标本中IL-2和FasL的表达,作对比分析。同时采用单因素方差分析和Spearman相关分析探寻血清IL-2和FasL的表达与胃癌病理类型、病理分期及TNM分期的关系。统计分析采用SPSS16.0软件,P〈0.05为差异有统计学意义。结果胃癌患者血清IL-2的表达显著低于正常对照者[（211.3±119.0）ng/mL vs（287.9±79.9）ng/mL;P=0.001];胃癌患者血清FasL的表达显著高于正常对照者[（2.7±1.0）ng/mL vs（1.9±1.2）ng/mL;P=0.001]。Spearman相关分析显示胃癌患者血清IL-2与FasL之间无显著相关关系。结论血清IL-2和FasL表达与胃癌的发病密切相关,可作为协同判断胃癌发病的指标。     

Enhanced and persistent levels of interleukin (IL)‐17+CD4+ T cells and serum IL‐17 in patients with early inflammatory arthritis

Prognosis of patients with early inflammatory arthritis (EIA) is highly variable. The aim of this study was to compare, longitudinally and cross-sectionally, the levels of cytokine-expressing cells in peripheral blood (PB) from patients with EIA to those in established rheumatoid arthritis (RA) and healthy controls (HC). PB mononuclear cells from HC (n = 30), patients with EIA (n = 20) or RA (n = 38) were stimulated with phorbol myristate acetate (PMA)/ionomycin for 3 h, and stained for cell markers and cytokines. Serum cytokines and chemokines were measured by Luminex. Patients with EIA were reassessed at 6 and 12 months. The percentage of interleukin (IL)-17⁺interferon (IFN)-γ⁻CD4⁺ T cells [T helper type 17 (Th17)] was increased in RA and EIA versus HC. Serum IL-1β, IL-2, IL-4 IL-17 and macrophage inflammatory protein (MIP)-1α were increased in RA and EIA versus HC. IL-1Ra, IL-15 and IFN-α were increased in EIA versus HC. IL-6 and tumour necrosis factor (TNF)-α was increased in RA but not EIA versus HC. Disease activity scores in EIA patients improved over 12 months'' treatment. Th17 percentage at baseline was correlated with both rheumatoid factor (RF) titre and functional deficit at 12 months. Baseline levels of serum granulocyte–macrophage colony-stimulating factor (GM-CSF), IL-6 and IL-8 were correlated with Larsen score at 12 months. There were no significant changes in cytokine-expressing CD4⁺T cells over time, although the percentage of IL-6⁺ monocytes increased. IL-17⁺CD4⁺ T cells and serum IL-17 levels are increased in EIA. IL-6-expressing monocytes increase during the first year of disease, irrespective of disease-modifying anti-rheumatic drug (DMARD) therapy. We observed incomplete clinical responses, suggesting EIA patients need more intensive early therapy.     

Gastric or intestinal phenotypic expression in the carcinomas and background mucosa of multiple early gastric carcinomas

AIMS: The differences in phenotypic expression between multiple early gastric carcinomas (EGCs) and solitary EGCs were evaluated in this study. METHODS AND RESULTS: Fifty-three cases (53 lesions) of solitary EGCs and 50 cases (112 lesions) of multiple EGCs were studied. According to the classification of intestinal metaplasia, the phenotypes of carcinomas and background mucosa were classified into four categories-complete intestinal type, incomplete intestinal type, gastric type and unclassified type-based on the combination of expression of CD10 (small intestinal brush border), MUC2 (intestinal goblet cell), HGM (gastric foveolar epithelium) and Con A (gastric pyloric glands). The incidence of gastric-type carcinomas (48%) and the incidence of incomplete intestinal-type background mucosa (75%) among the multiple EGCs was higher than among the solitary EGCs. There was a significant difference in distribution of phenotypic expression of carcinomas and background mucosa between the solitary EGCs and the multiple EGCs, the latter being associated with incomplete intestinal metaplasia. CONCLUSIONS: Both the carcinomas and the background mucosa of multiple EGCs have an unstable status, since they more commonly possess the hybrid phenotype of the stomach and the small intestine than does solitary EGC. Such instability is considered to contribute to a high neoplastic potential and the multiple occurrence of carcinomas.     

Apoptosis and proliferation in gastric carcinoma: the association with histological type

We examined apoptosis in 33 gastric carcinomas using the terminal deoxynucleotydil transferase mediated dUTP-digoxigenin nick end labelling technique (TUNEL). Of the tumours, nine were well-differentiated, 13 moderately differentiated and 11 poorly differentiated. In addition, we also analysed MIB-1, a cell proliferation antigen. Morphologically, apoptotic tumour cells were more frequently observed in well-differentiated tumours. In addition, apoptotic signals of the TUNEL method were seen even in the nuclei of tumour cells which did not show apoptosis. The nick end labelling index was 51.0 ± 26.3 in the well-differentiated and moderately differentiated tumours and 28.0 ± 18.8 in poorly differentiated tumours. The mean of apoptotic body index and nick end labelling index were both significantly higher in well-differentiated and moderately differentiated tumours than in the poorly differentiated type ( P  < 0.0001, P  = 0.008). The MIB-1 labelling index and higher in poorly differentiated tumours than in the well-differentiated or moderately differentiated tumours, and labelled cells were more numerous in the superficial region than in the middle and deep regions of tumours. No apparent correlation was found between the nick end labelling index and the MIB-1 labelling index. The high number of apoptotic cells (the high Nick end labelling index) and low proliferation potentiality (the low MIB-1 labelling index) in well-differentiated gastric carcinomas may thus be related to their natural tendency to demonstrate slow growth.     

Loss of phenotypic expression is related to tumour progression in early gastric differentiated adenocarcinoma

AIMS : To evaluate the relationship between phenotypic expression and tumour progression as represented by macroscopic features, submucosal invasion and lymph node metastasis in early differentiated gastric adenocarcinoma. METHODS : One hundred and fifty-five cases of early gastric differentiated adenocarcinoma without any poorly differentiated components were studied. The mucosal and submucosal components of carcinomas and lymph node metastatic lesions were classified into four categories, gastric type (G-type), incomplete intestinal type (I-type), complete intestinal type (C-type) and unclassified type (U-type), based on the combination of the phenotypic expression of HGM (gastric foveolar epithelium), MUC 6 (gastric pyloric glands), MUC 2 (intestinal goblet cells) and CD 10 (small intestinal brush border). In addition, a new classification representing a phenotypic shift from mucosa to submucosa or from primary lesion to lymph node metastasis was established with the categories of preserved group (P-group), loss group (L-group) and acquired group (A-group). RESULTS : (1) In submucosal carcinoma, U-type was more common in the submucosa (39%) than in the mucosa (9%). (2) U-type was more common in the metastatic lesions (42%) than in the primary lesions (5%). (3) The submucosal component and lymph node metastatic lesions were classified as P-group in 48% and 43% of cases, respectively, and as L-group in 50% and 52% of cases, respectively. (4) Lymph node metastatic lesions comprising undifferentiated carcinoma were classified as L-group in 100% of cases. CONCLUSION : During the course of tumour progression, early differentiated adenocarcinoma at first tends to lose its phenotypic expression despite preserving its morphology, but subsequently morphological dedifferentiation occurs.     

Expression of pepsinogen II with androgen and estrogen receptors in human prostate carcinoma

The expression of pepsinogen II (PG II), an aspartyl proteinase usually involved in the digestion of proteins in the stomach, was immunohistochemically investigated in conjunction with androgen (AR) and estrogen receptor (ER) status in prostate adenocarcinomas. Of a total of 38 samples obtained from radical prostatectomies, 23 tumors (60.5%) were positive for PG II and there was a significant positive correlation to the expression of AR but not to ER. Cells positive for PG II were localized mainly to the peripheral zones of tumorous glands which, in normal prostate, are negative, and in areas also expressing AR. In addition, a significant correlation between AR and ER was detected in the prostate carcinomas examined, which suggests a hormone-dependent status. On the basis of these results, PG II expression might be closely related to hormonal alterations associated with the development of prostate tumors.