不同病理类型局部晚期(ⅠB2及ⅡA2期)宫颈癌的预后情况分析

目的探讨不同病理类型局部晚期(ⅠB2、ⅡA2期)宫颈癌的预后情况。方法选取169例ⅠB2、ⅡA2期宫颈癌(鳞状细胞癌149例,腺癌或腺鳞癌20例)患者,根据治疗模式的不同将其分为同期放化疗组、根治性手术组、新辅助化疗+根治性手术组。比较不同病理类型及不同治疗模式局部晚期宫颈癌患者的2年无复发生存率,分析120例接受过根治性手术的局部晚期宫颈癌患者的病理类型与其他临床特征的关系,并比较新辅助化疗+根治性手术组中不同病理类型局部晚期患者对新辅助化疗的反应。结果截至随访结束,随访超过2年者137例,2年无复发生存率为83.9%(115/137),其中,鳞状细胞癌患者的2年无复发生存率高于腺癌或腺鳞癌患者(P﹤0.05)。同期放化疗组、根治性手术组、新辅助化疗+根治性手术组患者的2年无复发生存率分别为77.3%、87.0%、87.2%。接受根治性手术或新辅助化疗后行根治性手术+术后辅助放疗和(或)化疗的120例宫颈癌患者中,肌层浸润情况与局部晚期宫颈癌患者的病理类型可能有关(P﹤0.05)。接受新辅助化疗+根治性手术+术后辅助放疗和(或)化疗的62例患者中,鳞状细胞癌患者58例,包括CR患者14例,PR患者40例,SD患者4例;腺癌/腺鳞癌患者4例,包括CR患者1例,PR患者3例。鳞状细胞癌患者与腺癌/腺鳞癌患者对新辅助化疗的反应比较,差异无统计学意义(P﹥0.05)。结论局部晚期宫颈癌患者的近期预后较好,腺癌或腺鳞癌患者的预后较鳞状细胞癌患者差。对于病理类型为腺癌/腺鳞癌的局部晚期宫颈癌,建议在治疗方式上较鳞状细胞癌更激进,不建议保留卵巢功能,更倾向于以根治性手术为主的综合治疗,可望改善患者预后。     

Adenosquamous carcinoma of the gallbladder warrants resection only if curative resection is feasible

BACKGROUND: Adenosquamous/squamous cell carcinoma of the gallbladder generally has been considered a lethal disease. The objective of this study was to clarify the effectiveness of resection for patients with adenosquamous/squamous cell carcinoma of the gallbladder. METHODS: Twenty-nine patients who underwent resection for either adenosquamous carcinoma (n = 28 patients) or squamous cell carcinoma (n = 1 patient) were analyzed retrospectively. Sixteen patients underwent radical resection, whereas the other patients underwent primary tumor resection alone. To elucidate the factors that influenced postresectional survival, 10 variables (age, gender, presence or absence of gallstones, size of the primary tumor, lymphatic vessel invasion, blood vessel invasion, perineural invasion, TNM stage, residual tumor status, and type of resection) were examined. RESULTS: Twenty-three patients (79.3%) were categorized with T3 or T4 tumors that invaded adjacent organs. The outcome after undergoing radical resection (cumulative 5-year survival rate, 48.6%) was significantly better compared with the outcome of patients after undergoing primary tumor resection alone (cumulative 3-year survival rate, 7.7%; P = 0.004). The outcome after undergoing resection was better in 14 patients who had no residual tumor (cumulative 5-year survival rate, 62.9%) compared with the outcome in 15 patients who had residual tumor (cumulative 5-year survival rate, 0%; P < 0.001). Univariate analysis revealed that residual tumor status (P < 0.001), type of resection (P = 0.004), patient age (P = 0.012), and blood vessel invasion (P = 0.017) were significant prognostic factors. Residual tumor status (P = 0.026) was the only significant independent prognostic factor. CONCLUSIONS: Adenosquamous/squamous cell carcinoma of the gallbladder warrants resection only if potentially curative (R0) resection is feasible.     

Adenosquamous carcinoma of the colon presenting with hypercalcemia

A rare adenosquamous carcinoma of the colon occurred in a 41-year-old patient. Its presentation with hypercalcemia, in the absence of osseous metastases, has not been described previously. The hypercalcemia in this case was due to the elaboration of a parathyroid hormone-like substance by the tumor. The general characteristics of primary adenosquamous and squamous cell carcinomas of the colon are presented. These tumors present with advanced disease, in younger patients, and follow a highly aggressive course, as compared with adenocarcinomas of the colon. The cause of the malignancies, in the light of current theories regarding their genesis, is discussed.     

Carcinome épidermoïde pur de la vésicule

Squamous cell carcinoma accounts for less than 2% of gallbladder carcinomas, and is characterised by an invasive growth, a reduced tendency for lymph node metastasis, an increased tendency for hepatic infiltration or liver metastasis and a poorer prognosis than adenocarcinoma. Because of diagnostic delays, this tumour is generally diagnosed in advanced stages. We describe 4 cases of pure squamous cell carcinoma; the authors discuss diagnosis and therapeutic difficulties of these tumours. In both histological types of gallbladder carcinoma, treatment depends on the grade of local and regional invasion and tumour spread at diagnosis.     

Predicting aggressive outcome in T1N0M0 breast cancer

Despite the excellent overall prognosis, unpredictable breast cancer recurrences and deaths also occur among T1N0M0 patients. We have evaluated clinically applicable methods for identifying aggressive outcome in T1N0M0 breast cancer. The material is based on aggressive T1N0M0 invasive ductal and lobular carcinomas diagnosed in Turku University Hospital and Jyv?skyl? Central Hospital, Finland, during 1987-1997. We studied all the T1N0M0 breast cancers that had led to recurrency or death (n=21, 95% T1cN0M0) during the follow-up period (4-14 years). The study is based on statistical analyses of matched case-control data in which the prognostic factors of each individual patient with aggressive disease were compared with control patients (n=45) individually matched by tumour size, age at diagnosis, histological type of tumour and length of follow-up. The cancer cases were examined for clinically applicable conventional and immunohistochemical pathologic prognostic factors. High Ki-67 immunopositivity was the strongest prognosticator of breast cancer death or recurrence in T1N0M0 breast cancer. Also, high p53 immunopositivity, low oestrogen receptor immunopositivity and Her-2/neu oncogene amplification by chromogen in situ hybridisation were reliable indicators of unfavourable outcome. Our statistical methods also allowed us to determine for the present material a range of clinical significance for each immunohistochemical prognostic feature with the associated relative risk for breast cancer death and recurrence. The paper suggests guidelines for predicting aggressive outcome in T1N0M0 breast cancer.     

Laryngeal carcinoma in patients 40 years of age and younger

Between 1950 and 1985, 570 patients with squamous cell carcinoma of the larynx were diagnosed and treated in the Otolaryngology Department of the Beilinson Medical Center. Of these, 20 patients (2.8%) were aged 40 years or younger. Twelve patients (60%) had glottic carcinoma in Stage I (T1N0M0) when initially diagnosed, one patient had supraglottic carcinoma in Stage I (T1N0M0) and seven patients (35%) had laryngeal carcinoma in Stage II (T2N0M0) and III (T3N0M0). Patients with T1N0M0 received only radiotherapy. Three patients with T2N0M0 underwent total laryngectomy and also received postoperative radiotherapy. Four patients with the tumor in T3N0M0 received pre-operative and postoperative radiotherapy in addition to total laryngectomy. The 5-year survival rate for T1N0M0 and T2N0M0 was 100% and for T3N0M0 66%. Although a high percentage of the young patients presented for treatment with advanced disease, the survival rate compared the same or favorably with rates in older patients. This supports the concept of aggressive treatment when there is a recurrence or second primary, particularly because it is well tolerated in the young age group who do not exhibit many of the conventional risk factors and therefore, have a better prognosis.     

Characteristics of non-small cell lung cancer 3 cm or less in diameter

We retrospectively investigated 308 cases of non-small cell lung cancer of ≥3 cm diameter. There were 204 adenocarcinomas, 78 squamous cell carcinomas, 15 large cell carcinomas, and 11 other carcinomas. According to TNM staging, there were one case stage 0, 208 stage I, 22 stage II, 49 stage IIIA, 15 stage IIIB, and 13 cases stage IV. T1 disease was seen in 262 cases, T2 in 19, T3 in 10, T4 in 16, and Tis in 1. No disease was seen in 217 cases, N1 in 30, N2 in 60, and N3 in 1. The 5-year survival rate of all case was 63%. There were statistically significant differences amont T status (T1 vs. T3, T4), N status (N0 vs. N1, N2), and M status (M0 vs. M1) (P < 0.01). The 5-year survival rates of cases with adenocarcinoma and squamous cell carcinoma were 60% and 64%, respectively. In 204 cases of adenocarcinoma, T3 disease was found in one case, T4 disease in 15 (7%), and nodal involvement (N1 + N2) was present in 69 (34%). In 78 cases of squamous cell carcinoma T3 was seen in 6 (8%), T4 in 1, and nodal involvement in 14 (18%). The incidence of T3 disease, T4, and N(+) varied significantly according to histology (P < 0.05). Our investigation suggested that cases of small-sized lung cancer were often at an advanced stage at detection, and that the spread of disease differed according to histology. The patient with small-sized lung cancer should be offered a standard operation regardless of histology.     

Surgical strategies in patients with gallbladder cancer: nihilism to optimism

INTRODUCTION: Gallbladder cancer is an aggressive disease with dismal results of surgical treatment and a poor prognosis. However, over the last few decades selected groups have reported improved results with aggressive surgery for gallbladder cancer. METHODS: Review of recent world literature was done to provide an update on the current concepts of surgical treatment of this disease. RESULTS: Long-term survival is possible in early stage gallbladder carcinoma. Tis and T1a gallbladder carcinoma can be treated with simple cholecystectomy only. However, in T1b and beyond cancers, aggressive surgery (extended cholecystectomy) is important in improving the long-term prognosis. Laparoscopic cholecystectomy should not be performed where there is a high index of suspicion of malignancy due to the frequent association with factors (such as gallbladder perforation and bile spill) which may lead to implantation of cancer cells and dissemination. Surgical resection for advanced carcinoma gallbladder is recommended only if a potentially curative R0 resection is possible. Aggressive surgery with vascular and multivisceral resection has been shown to be feasible albeit with an increase in mortality and morbidity. However, the true benefit of these radical resections is yet to be realized, as the actual number of long-term survivors of advanced gallbladder carcinoma is few. CONCLUSIONS: Surgery for gallbladder carcinoma, like other malignancies, has the potential to be curative only in local or regional disease. Pattern of loco-regional spread of disease dictates the surgical procedure. Radical surgery improves survival in early gallbladder carcinoma. The long-term benefit of aggressive surgery for advanced disease is unclear and may be offset by the high mortality and morbidity.     

Carcinome adéno-squameux de l’estomac. À propos de deux cas

Primary adenosquamous carcinoma of the stomach is extremely rare and accounts for less than 1% of gastric malignancies. It is particularly aggressive and generally results in a poorer outcome than other carcinomas. Microscopically, it consists of a mixture of two distinct components: adenocarcinoma and squarnous cell carcinoma. We present two cases of gastric adenosquamous carcinoma in two female patients, aged 63 and 70, and discuss the clinical and pathological characteristics of this unusual tumour.     

Supraglottic and glottic carcinomas. clinically and biologically distinct entities?

This study aimed to examine the clinical and biological differences in 198 patients with either T1-T2 local glottic or supraglottic squamous cell carcinomas. The patients with supraglottic cancer had a poorer prognosis, as well as more advanced and histologically aggressive tumours than the patients with glottic tumours. They also had lower levels of haemoglobin and a poorer nutritional and performance status. Expression of alpha-catenin, hyaluronan, CD44, p53, p21/WAF1 and bcl-2 in the primary tumour were not associated with the site of the laryngeal carcinoma. In supraglottic tumours, the rate of spontaneous apoptosis and mitotic indices were significantly higher than in glottic tumours. The results suggest that clinical parameters including the haemoglobin level of the patient together with the tumour cell kinetics (mitotic and apoptotic rates) may contribute to the aggressive nature of supraglottic carcinoma.     

Expression of caveolin-1 is associated with poor prognosis of patients with squamous cell carcinoma of the lung

BACKGROUND: Caveolin-1, as a major component of caveolae, is involved in the regulation of cell cycle by impacting various signaling pathways. Previous studies of caveolin-1 in cancer showed two contrary results. In most in vitro studies, caveolin-1 played a role as a tumor suppressor. On the other hand, the elevated expression of caveolin-1 was often reported to be associated with poor clinical outcome in human studies. These results indicate differential biological functions of caveolin-1 depending on the development and progression stage of cancer in vivo. METHODS: To clarify the correlation between the clinicopathologic profiles of pulmonary squamous cell carcinomas and the expression of caveolin-1, 107 cases of formalin-fixed and paraffin-embedded tissues of pulmonary squamous cell carcinomas were immunohistochemically evaluated for the expression of caveolin-1 by the tissue-array method. RESULTS: Caveolin-1 was expressed in 34 cases (31.7%) among 107 cases of pulmonary squamous cell carcinoma. The expression of caveolin-1 was statistically correlated with pathologic stage (stage I and II vs. III; P<0.001), pT (T1 and T2 vs. T3 and T4; P=0.001), and pN (N1 vs. N2 and N3; P=0.0143). The patients with caveolin-1 expression in pulmonary squamous cell carcinomas showed a poorer prognosis than those in caveolin-1-negative group (P=0.0345). CONCLUSION: The expression of caveolin-1 is significantly correlated with advanced pathologic stage and poor prognosis in pulmonary squamous cell carcinoma. The results of current study suggest that the expression level of caveolin-1 may be a candidate factor for predicting prognosis in patients with pulmonary squamous cell carcinoma.     

Adenosquamous/squamous cell carcinoma of the gallbladder

BACKGROUND AND OBJECTIVES: Adenosquamous/squamous cell carcinoma is a rare histopathologic subtype of gallbladder malignancy. Its clinical features have rarely been described, and its differences from the major histopathologic subtype, adenocarcinoma, remain uncertain. METHODS: All patients with gallbladder carcinoma were retrospectively reviewed. Patients with a histopathologic subtype of either adenosquamous (n = 12) or squamous cell (n = 2) carcinoma were categorized to group I, and patients with adenocarcinoma were categorized to group II. The clinical characteristics and outcomes of these two groups were compared. RESULTS: The two groups were generally no different in clinical features. However, tumor stages of group I patients were significantly advanced (P = 0.048) and included liver involvement (P = 0.008). The outcomes of advanced-stage patients in group II were not different from group I (P = 0.413). Nevertheless, patients in both groups with advanced stage pT who had undergone curative resection showed significantly better survival curves than patients who had undergone non-curative resection (P = 0.003). CONCLUSIONS: Patients with adenosquamous/squamous cell carcinoma of the gallbladder were generally similar to those with adenocarcinoma in clinical characteristics, but had a tendency for liver infiltration. Although the two histopathologic subtypes of the gallbladder carcinoma had similar poor outcomes, better survival could be obtained by performing curative resection for these patients.     

Adenosquamous Carcinoma of the Gallbladder: A Clinicopathological, Immunohistochemical and Flow-cytometric Study of Twenty Cases

Twenty patients (7.4%) with adenosquamous carcinoma of the gallbladder were selected from 271 surgically resected gallbladder cancers. The 20 patients were composed of 8 men and 12 women with a mean age of 66.9 years. Histologically, all twenty tumors showed an abrupt transition between the adenocarcinoma (AC) and squamous cell carcinoma (SCC) areas, and well differentiated AC was also found in the peripheral area of the tumor. A histochemical and immunohistochemical study using alcian blue, periodic acid-Schiff, cytokeratins, involculin and tissue polypeptide antigen disclosed a different nature of the two components. DNA heterogeneity between the components was detected in 5 of 7 cases by flow cytometry. The positive rate of immunostaining for proliferating cell nuclear antigen in the SCC areas (mean 20.55%) was larger than that of the AC areas (mean 11.40%) ( P =0.0029), which indicated that the SCC areas had a greater proliferative capacity than AC areas. These results suggest that the SCC component of adenosquamous carcinoma of the gallbladder arose by a stepwise molecular progression of the pre-existing AC. Furthermore, the prognosis of adenosquamous carcinomas of the gallbladder (mean survival: 10 months) in the advanced stage (pTNM 2–4) was less favorable than those of papillary and well differentiated AC (mean survival: 99 months and 86 months) ( p <0.0001).     

Une tumeur maligne primitive rarissime de la vésicule biliaire. Le carcinome épidermoïde

Carcinomas of the gallbladder are rare malignancies. They are mostly represented by adenocarcinoma. Pure squamous cell carcinoma is a rare histologic subtype characterized by a rapid growth, with local extension and a poor prognosis. We present a recent case of a 63-years-old man admitted with the complaints of pain in right hypochondrium. Computed tomography revealed a tumour in the gallbladder fossa region with infiltration of the liver. Cholecystectomy was achieved. Pathologic examination of the surgical specimen revealed a well differentiated squamous cell carcinoma.     

AJCC第八版Ⅲ期不同亚组分型的胆囊癌临床特征及预后分析—基于SEER数据库的研究

目的 研究美国癌症联合委员会(AJCC)第8版Ⅲ期胆囊癌(GBC)亚组分型的临床特征、治疗方式及预后.方法 收集3?485名AJCC第8版Ⅲ期胆囊癌患者的临床资料、随访结果并进行对比.绘制并比较ⅢA和ⅢB,T3N0M0(ⅢA)、T1～2N1M0(ⅢB)和T3N1M0(ⅢB)的Kaplan-Meier生存曲线.单因素和C...     

Small cell carcinoma of the urinary bladder. A clinicopathologic study of five cases

AIMS AND BACKGROUND: Small cell carcinoma of the bladder (SCCB) is a rare entity characterized clinically by an aggressive behavior with a high incidence of systemic metastases. We report the clinicopathologic findings of five cases. METHODS: We reviewed five consecutive patients with SCCB treated at our institute. In each case the following clinical data were recorded: age, sex, presenting symptoms, endoscopically determined location of the tumor, clinical staging, node involvement (if any), site of metastases (if any), treatment, follow-up and outcome. RESULTS: There were four male and one female patients, age range 42 to 68 years, mean 57.6 years. The clinical presentation was not different from conventional transitional cell carcinoma, with hematuria being the most frequent complaint (four cases). Microscopic examination revealed oat cells in three cases and an intermediate variant in one. At the time of diagnosis the tumors were staged as T3bN2M0, T2N2M0, T4N0M0, T3aN0M0, and T2N0M0. Primary therapy consisted of radical cystectomy alone (one case), transurethral resection (TUR) alone (one case), TUR with chemotherapy (two cases), or TUR with chemotherapy and radiotherapy (one case). Four patients died of progressive disease, with survival from the time of diagnosis ranging from 7 to 16 months (mean, 12.2 months). One patient died of myocardial infarction (unrelated to the primary disease) one month after diagnosis. CONCLUSION: Our study indicates that primary small cell carcinoma of the urinary bladder is as aggressive as its pulmonary counterpart and the overall prognosis of this tumor is very poor.     

Clinical Studies of Postoperative Arterial Infusion Chemotherapy in Patients with Pathologic T3 Esophageal Squamous Carcinoma

Multi-sample and multi-center studies have provided no evidence to indicate that preoperative chemo-radiation therapy can in- crease the 5 year survival rate of patients with esophageal squamous carcinoma, although some clinical studies have indicated tha…     

Radiation therapy on primary tumour of synchronous metastatic head and neck squamous cell carcinomas

PurposePatients with synchronous metastatic head and neck squamous cell carcinomas often present associated locoregional symptoms and a risk of life-threatening primary tumour progression. Few data have been published about the use of radiation therapy in the management of newly diagnosed metastatic disease associated with advanced locoregional disease. In this article, we aim to determine the role of radiation therapy of the primary tumour in the overall therapeutic strategy for these diseases. We further address radiation therapy modalities (technique, volumes, and fractionation) in such a context.Material and methodsWe conducted a literature survey on locoregional radiotherapy for newly diagnosed metastatic head and neck squamous cell carcinomas.ResultsSeveral retrospective studies have reported that locoregional radiotherapy is associated with improved overall survival of patients with synchronous metastatic head and neck squamous cell carcinomas. However, data about modalities such as timing of radiotherapy in the overall strategy, dose, fractionation and delineation volumes are scarce. Two schematic situations can be distinguished with respect to prognosis and treatment adaptations: polymetastatic/bulky or oligometastatic disease. In polymetastic/bulky disease associated with poor prognosis, standard-of-care is systemic therapy, but locoregional radiotherapy can be discussed either upfront, mainly for symptomatic palliation, or as consolidation after downsizing obtained by systemic therapy. As for oligometastatic disease, with the rise in use of efficacious and well-tolerated local ablative treatments of metastases, aggressive curative-intent locoregional radiotherapy can be considered with or without systemic therapy.ConclusionBecause locoregional disease is a major cause of disease failure in patients with synchronous metastatic head and neck squamous cell carcinomas, aggressive locoregional radiation therapy to the primary tumour may be discussed in the initial management of the disease where systemic therapy alone may not induce sufficient primary tumour reduction. With recent technological advances in radiotherapy, the delivery of radiotherapy is safe and feasible even in metastatic setting. Clinical trials assessing radiotherapy use for metastatic head and neck squamous cell carcinomas are warranted.     

Hypercalcemia-Leukocytosis syndrome and adenosquamous lung carcinoma: An overlooked conjugation

Hypercalcaemia and leukocytosis are two paraneoplastic conditions associated with poor prognosis. Adenosquamous carcinoma is a rare and aggressive histological subtype of lung cancer consisting of adenocarcinoma and squamous cell components. We report the case of a 57-year-old male smoker who was admitted to the Emergency Room with skull and neck tumefactions, confusion and deteriorated general condition. The complementary study in the ER revealed severe hypercalcaemia (19.8 mg/dL), leukocytosis (18.7 × 10⁹ /L) and extensive osteolytic lesions of the skull on cranioencephalic computer tomography (CT). The patient was stabilized and admitted. Thoracoabdominopelvic CT showed lung parenchyma consolidation with necrotic areas, supra and infradiaphragmatic adenopathies and scattered osteolytic lesions. Percutaneous lymph node biopsy was consistent with metastasis of adenosquamous lung carcinoma. The patients’ clinical situation evolved unfavourably after hospital-acquired infection. This case is characterized by a rare presentation of advanced stage adenosquamous lung carcinoma with scattered osteolytic lesions and severe hypercalcaemia-leukocytosis syndrome, an underrecognized marker of poor prognosis.     

胆囊原发性腺鳞癌一例临床病理分析并文献复习

目的：分析胆囊原发性腺鳞癌的临床病理特点、鉴别诊断及治疗预后.方法：对1例胆囊腺鳞癌的临床资料进行分析,并复习相关文献.结果：本病早期无特异临床表现,主要表现为右上腹疼痛合并胆囊内结石.组织学特点：肿瘤由鳞癌及腺癌两种成分构成.以鳞癌成分为主呈巢状结构,鳞癌细胞大小不等,异型性明显,胞浆丰富,边界清楚,核仁较明显,核分裂像可见,可见角化珠、单个细胞内角化及细胞间桥.腺癌成分较少,肿瘤细胞排列成不规则的腺体,异型性较明显.间质中淋巴细胞较丰富,部分腺癌与鳞癌间质有移行.免疫组化染色显示：部分癌细胞34βE12（＋＋）,部分癌细胞CK7（＋＋）、CEA（＋）、CA19-9（＋＋）、ki-67（＋）、p53（＋）、CK20（-）.结论：胆囊腺鳞癌是一种少见的胆囊肿瘤,其诊断主要依靠组织病理学和免疫组化标记.