Refractory pleural small cell carcinoma in never smoker. A case report

A 47-year-old woman who had never smoked was evaluated for chest wall pain, cough and dyspnea that proved to be due to neoplastic right pleural disease with effusion. Cytological examination of the pleural fluid and histological analysis of a biopsy specimen of the pleural mass obtained during thoracoscopy were consistent with a diagnosis of small cell carcinoma. The patient was treated with two lines of chemotherapy and with octreotide, but without any clinical or radiological benefit. Since there was immunohistochemical overexpression of epidermal growth factor receptor, the patient was treated with gefitinib. Despite an initial clinical improvement she died due to disease progression. This case of a refractory pleural small cell carcinoma, which is an extremely rare disease, is the first reported in a never smoker and the first to be fully characterized for EGFR status.     

MOC-31在胸膜间皮瘤与肺癌鉴别诊断中的应用

 目的　研究MOC 31在胸膜间皮瘤与肺癌鉴别诊断中的应用价值。方法　采用免疫组化 (S P)方法对 81例非小细胞肺癌 (non smallcelllungcarcinomaNSCLC) 13例胸水脱落的肺癌细胞 ,9例上皮型胸膜间皮瘤和 2 2例胸水脱落的间皮细胞进行MOC 31检测。结果　MOC 31在NSCLC、胸水脱落的癌细胞、胸膜间皮瘤及胸水脱落的间皮细胞的阳性率分别为 98.8%、84 .6 %、11.1%及 9.1%。MOC 31在NSCLC及胸水中肺癌细胞的阳性率 ,明显高于间皮瘤及胸中间皮细胞的阳性率 (P <0 .0 0 1) ,而间皮瘤与胸水间皮细胞的阳性率无统计学差异 (P >0 .0 5 )。结论　MOC 31在胸膜间皮瘤与NSCLC的鉴别诊断中有重要的参考价值。对判定胸水的性质也有重要意义。     

Chemoimmunotherapy of small cell bronchogenic carcinoma.

Thirty-one patients with small cell bronchogenic carcinoma were treated with a regimen of cyclophosphamide, Adriamycin and vincristine. Radiotherapy was given to patients with limited disease. Nonspecific immunotherapy consisting of BCG scarification was administered after each chemotherapy course. The results of treatment for this group were compared with those for a group of 45 patients treated similarly but with no immunotherapy. Therapeutic results, expressed in length of survival and rate of response, were similar. Myelosuppression was not modified by the addition of BCG scarification. This study showed no benefit from the use of such nonspecific immunotherapy.     

局限期食管小细胞癌有外科参与的综合治疗

食管小细胞癌(ScEC)是最为常见的肺外小细胞癌，早期易发生转移，治疗后复发率高，预后差。以化疗为基础的、有外科参与的综合治疗可能是目前对局限期SCEC的一种好的治疗方式，外科手术作为一种有效的治疗手段，在局限期食管小细胞癌的综合治疗中仍具有不可替代的作用。     

Chemotherapy in small cell bronchial carcinoma

A 60% complete remission rate in localized stage and 30% rate in metastatic stage are obtained with chemotherapy in small cell lung carcinoma. Chemotherapy can be combined with radiotherapy. Some alternating, high dose and maintenance regimens are discussed.     

Semenogelins are ectopically expressed in small cell lung carcinoma.

Two proteins recovered from cell surface adhesion complexes in a small cell lung carcinoma (SCLC) cell line were identified as fragments of the seminal plasma proteins semenogelin I and semenogelin II. Association of both proteins with the adhesion complexes was induced by epidermal growth factor. Expression of semenogelins was previously thought to be highly specific to seminal vesicles, but Western blot analysis demonstrated that semenogelin II is widely expressed in SCLC cell lines and occasionally in other malignant cell lines. Although semenogelin expression is normally restricted to males, two SCLC cell lines from female patients were also positive for semenogelin II expression. Immunohistochemical analysis demonstrated diffuse expression of semenogelins in 12 of 13 SCLC tumors and focal expression in a minority of lung squamous and adenocarcinomas. Semenogelins were secreted into the medium by cultured SCLC cells, which suggested that these proteins may be useful markers for detecting residual tumor burden or recurrence of SCLC after treatment.     

原发性食管小细胞未分化癌

目的 了解原发性食管小细胞未分化癌（ＰＥＳＣ）的临床生物学特性及影响患者预后的重要因素,探讨合理的手术指征及综合治疗措施。方法 对４７例ＰＥＳＣ患者的外科治疗结果进行回顾性研究,并与食管鳞癌及腺癌进行对比分析。结果 ＰＥＳＣ患者的手术切除率、手术并发症率及手术死亡率分别为９３．６％、１７．０％和２．１％,与食管鳞癌及腺癌相似。影响其预后的主要因素为病变分期和淋巴结转移,肿瘤长度、侵袭深度及手术性质     

原发性小细胞食管癌

原发性小细胞食管癌(PESC)系食管少见肿瘤,恶性程度高,易早期转移.PESC的组织来源和病因尚未确定,近年来其来源于食管黏膜的原始多潜能干细胞的观点引起人们的注意.PESC的免疫表型具有上皮和神经内分泌双重特性,对其诊断较有意义的标志物主要包括神经元特异性烯醇化酶(NES)和突触素(Syn)等.     

Donor-derived small cell lung carcinoma in a kidney transplant recipient.

BACKGROUND: Transplantation of donor-derived malignancies during organ transplantation fortunately is very rare. Discontinuation of immunosuppressive medications under these circumstances has previously resulted in complete tumor rejection. Ectopic adrenocorticotropic hormone (ACTH) production may result in Cushing syndrome and is not an uncommon paraneoplastic feature of small cell carcinoma of the lung. Theoretically, in the organ transplantation setting, the resulting high cortisol levels could suppress a tumor-rejection immune response. However, to the authors' knowledge, no such clinical scenario has been described in the literature published to date. METHODS: A 25-year-old living related kidney transplant recipient presented with Cushing syndrome 32 months after transplantation. The donor had been diagnosed with small cell carcinoma of the lung 22 months earlier. On further evaluation, the kidney recipient was diagnosed with donor-derived small cell lung carcinoma of the transplanted kidney. She was found to have extensive disease involving the liver and retroperitoneum. Despite discontinuation of immunosuppressive medications, the disease progressed and cortisol levels remained elevated during 6 weeks of observation. RESULTS: The patient received six cycles of cisplatin and etoposide, which resulted in resolution of her hypercortisolemia and a complete remission of her donor-derived small cell carcinoma. At last follow-up, she was 12 months from completing her therapy and continued in complete remission. CONCLUSIONS: Donor-derived small cell carcinoma and ectopic ACTH production can occur in a patient after kidney transplantation.     

Induced morphological changes in human small cell lung carcinoma cells.

Several theories suggest that lung carcinomas are not totally separate entities, but are derived from a common precursor, probably of endodermal origin. The histological classification of lung cancers is complex, with much overlap between groups broadly designated as small cell (SCLC), squamous cell, adenocarcinoma and all others simply termed non-small cell. It is shown here that in vitro exposure of classic, non-adherent SCLC lines to 10 microM 5' bromodeoxyuridine (BrdU) results in a rapid cell-line dependent change to a morphology consistent with an adherent, non-small cell phenotype. Accompanying this morphological shift is a decreased expression of the amplified N-myc protooncogene. These induced changes underline the morphological relatedness of lung carcinoma cell lines.     

Neurotensin in human small cell lung carcinoma

High levels of neurotensin-like immunoreactivity were found in human small cell lung carcinoma lines. No immunoreactivity was present in non-small cell carcinoma lines and only low amounts in postmortem human lung tissue. The immunoreactive material co-eluted with synthetic neurotensin on two different chromatographic systems. No evidence was obtained for the presence of specific neurotensin binding sites in any of the small cell carcinoma lines examined. The results suggest that small lung cell carcinoma lines may be useful for studying the biosynthesis of human neurotensin.     

Genetic changes in small cell lung carcinoma

Small cell lung carcinoma (SCLC) accounts for approximately 15% of all lung cancer cases. Despite a frequently good response to first-line treatment with chemotherapy and/or radiotherapy, early relapse occurs in the majority of patients and 5-year survival is only about 5%. Therefore, there is a need to develop novel treatments to improve the outcome of patients with SCLC. To fulfil this need, it is critical to gain further understanding on the molecular basis of SCLC and specifically to identify novel therapeutic targets. Clinical trials with molecularly targeted agents have been performed with little success in the past, but recently many promising oncogenic pathways have been discovered and novel targeted therapies are under evaluation. In this review, we summarise the most relevant genetic and signalling pathway alterations reported to date in SCLC and discuss the potential therapeutic implications of such events.     

膀胱小细胞癌的研究进展

膀胱小细胞癌（small cell carcinoma,SCC）是一种少见的恶性肿瘤,占原发性膀胱癌的0.48%-1%。SCC在组织发生、病理特征、治疗和预后等方面与常见的移行细胞癌有很大差别。一般认为,膀胱SCC起源于膀胱内具有多种分化潜能的的干细胞。病理上,SCC由弥漫性分布的小圆形细胞组成,细胞胞质稀少,胞核深染,核仁不明显,缺乏间质反应;电镜下,胞质内细胞器稀少,出现致密核心的神经内分泌颗粒是其特征;SCC表达上皮性标志如EMA、角蛋白和CEA,以及神经内分泌标志如NSE和CM-A等。临床上,SCC多见于男性,男女发病率之比为4.8∶1,平均发病年龄〉60岁;无痛性肉眼或镜下血尿为常见的临床表现,多数患者就诊时已为中晚期病例。SCC应与分化较差的移行细胞癌、恶性淋巴瘤、恶性黑色素瘤以及类癌等细胞体积较小的肿瘤鉴别,确诊依靠病理和免疫组织化学检查。由于SCC是一种全身性疾病,易于早期发生转移,治疗上,应根据肿瘤分期和细胞类型,考虑以顺铂为基础的全身化疗,辅以手术或放射治疗,以延长患者生存时间。膀胱SCC预后较差,平均生存时间为19.6个月,5年生存率仅为8%。     

53例肺外小细胞癌的临床分析

背景与目的:小细胞癌主要发生于肺内,肺外小细胞癌(extrapulmonarysmallcellcarcinoma,ESCC)被认为是一类与肺小细胞癌不同的临床病理类型。本研究目的在于探讨ESCC的临床特征、治疗及预后。方法:回顾性分析1985年1月至2005年12月中山大学肿瘤防治中心收治的经病理证实的53例ESCC患者的临床资料,分析本组患者的发病情况,发病部位,病理诊断,肿瘤分期,治疗方法及预后。结果:53例ESCC患者中,男性39例,女性14例。中位年龄53岁(27～76岁)。53例ESCC中食管33例(62.3%),子宫颈5例,喉4例,鼻咽3例,上颌窦2例,直肠2例,舌下腺、甲状腺、胸膜和肝脏各1例。局限期患者40例(75.5%),广泛期患者13例(24.5%)。对于广泛期患者多给予含铂方案化疗,总有效率为69.2%;对于局限期患者采取不同的治疗模式,即手术 化疗 放疗者7例,手术 放疗者3例,手术 化疗者18例,放疗 化疗者6例,单独放疗者4例,单独化疗者2例。全组患者中位生存期(mediansurvivaltime,MST)为20个月,1年和3年生存率(overallsurvival,OS)分别为41.3%和31.4%。局限期患者和广泛期患者的MST分别为26个月和15个月,1年OS分别为51.1%和14.4%,3年OS分别为42.5%和0(P=0.017)。结论:ESCC可发生于人体不同部位,以食管ESCC最多见。局限期ESCC常采用综合治疗模式,化疗仍是广泛期ESCC的主要治疗手段。总体上,局限期ESCC预后明显较广泛期ESCC好。     

Pleural effusion in cancer patients. A prospective randomized study of pleural drainage with the addition of radioactive phsophorous to the pleural space vs. pleural drainage alone.

Sixty-seven patients with disseminated cancer were randomly allocated to treatment with continuous closed chest drainage removing all fluid for 72 hours (PD) or pleural drainage for 72 hours with the instillation into the pleural space of radioactive colloidal chromic phosphate (PD + 32P). Forty-nine patients had breast carcinoma, and the remaining 18 patients had other cancers. Four of 49 patients with breast cancer and 13 of 18 with other cancer were dead in 8 weeks from the onset of effusion. In the group of patients with breast cancer PD + 32P controlled the effusion in 12 of 22 (54%) and PD alone in 15 of 30 episodes (50%). In the nonbreast group of patients PD + 32P controlled the effusion in five of six evaluable episodes (83%), and PD alone was successful in two of nine (22%). In 33% of breast cancer patients and 25% of the nonbreast-cancer patients, systemic chemotherapy produced objective remissions. Pleural effusion did not recur in any of these patients.