结直肠印戒细胞癌及黏液腺癌临床与预后差异分析

目的 探讨结直肠黏液腺癌与印戒细胞癌临床病理特点和预后及其关系。方法 分析中山大学附属第一医院胃肠胰外科1994-2007年收治的2089例原发性结直肠癌中的黏液腺癌144例,印戒细胞癌25例的临床资料,比较结直肠黏液腺癌与印戒细胞癌临床病理特点和预后及其之间的关系。 结果 黏液腺癌占结直肠癌的5.45%,印戒细胞癌占1.19%;黏液腺癌与印戒细胞癌相比, 印戒细胞癌发病年龄更年轻, 女性易发病, 黏液腺癌好发于结肠而印戒细胞癌好发于直肠（P<0.01）;但在肿瘤直径、淋巴结转移和远处转移和浆膜浸润﹑脏器侵犯﹑根治性切除率﹑中晚期比例等方面二者差异无统计学意义（P>0.05）;印戒细胞癌与黏液腺癌总体存活率相比差异有统计学意义（P<0.05）,可根治手术组总体存活率相比差异有统计学意义（P<0.05）。 结论 印戒细胞癌与黏液腺癌是生物学行为相近而且具有独特的癌变机制的肿瘤,结直肠黏液癌尤其是印戒细胞癌是结直肠癌独立的预后危险因素,其预后差的原因可能与其发生部位和独特的病理类型有关。     

阑尾黏液性囊腺癌的CT诊断

目的：探讨阑尾黏液性囊腺癌的 CT 表现特征。方法回顾性分析5例经手术及病理证实的阑尾黏液性囊腺癌的 CT资料,并复习相关文献。结果5例均表现为右下腹囊性肿块,4例呈不规则分叶状,1例管状。最大横径约27~146 mm,局部侵犯邻近肠管而边界欠清晰。囊壁厚薄不均匀,内壁欠规则并见小结节或乳头状突起;3例囊内见纤维分隔。囊内可见较多黏液,密度欠均匀,平均 CT 值约19.3~34.6 HU。增强显示囊壁及分隔较明显强化4例,中等强化1例。3例肿瘤边缘脂肪间隙较清晰,2例合并急性炎症导致邻近脂肪间隙较模糊。3例囊壁见细微点状钙化,3例邻近淋巴结肿大。结论CT 可以显示阑尾黏液性腺癌的一些病理特征,对其诊断及鉴别有较大价值。     

大肠黏液腺癌临床病理特征的分析

目的深入分析大肠黏液腺癌独特的临床病理特征以指导临床诊断治疗,提高患者的预后。方法回顾性分析117例大肠黏液腺癌和424例大肠非黏液腺癌的临床和病理资料,并对各种临床和病理资料进行统计学分析。结果 (1)与非黏液腺癌相比,大肠黏液腺癌好发的年龄段偏低(平均年龄<50岁);(2)黏液腺癌好发于右半结肠,尤其是升结肠,但非黏液腺癌好发于左半结肠和直肠,且更多发于乙状结肠;(3)黏液腺癌瘤体相对较大(直径>5cm),分化程度更差;(4)黏液腺癌的分期相对较晚,更易向周围浸润生长,更易发生淋巴转移和远处转移;(5)蛋白nm23、p53在黏液腺癌中的阳性表达率更低。结论大肠黏液腺癌是一类预后较差的大肠癌,对大肠黏液腺癌应该采用更加积极全面的治疗方式。     

Histological discrimination of malignancy in mucinous ovarian tumours

Eight histological features were measured quantitatively in a group of 77 ovarian mucinous carcinomas and a group of 28 benign mucinous cystomas. These were compared with the duration of survival of the patients and the clinical staging of the tumours. Using the method of discriminant function analysis it was possible to identify a group of tumours of 'borderline malignancy'. Although single histological features were inadequate indicators of prognosis a combination of three features proved fairly accurate.     

Evaluation of prostatic cancer histology and grade distribution: experience with the Colorado Central Cancer Registry

Although well-defined grading schemes for prostatic adenocarcinoma have been developed, they are not yet universally accepted by practicing surgical pathologists. The complexity of these schemes often leads surgical pathologists to develop their own modified Broders scheme. This study compared the grade distribution as obtained by a community of surgical pathologists with that obtained using the National Prostatic Cancer Project (NPCP) and Gleason grading schemes. In 1978, 308 cases of prostate cancer were reported to the Colorado Central Cancer Registry (CCCR) from the Denver Standard Metropolitan Statistical Area. Two hundred eighteen of these cases were regraded. The grade distribution as reported by the CCCR revealed a predominance of low-grade tumors (grade I-41%, grade II-28%, grade III-17%, grade IV-3%). Regrading of these same cases revealed a shift to higher grades (NPCP: grade I-14%, grade II-11%, grade III-37%, grade IV-29%; Gleason: pattern scores less than 6-30%, score 6-24%, score 7-12%, score 8-11%, score 9-10%, score 10-4%). Twenty-one cases of histologic variants which were not originally diagnosed were also noted (six mucinous, 12 ductal, two endometroioid, one squamous). There were 18 cases in which no evidence of carcinoma was confirmed. These results suggest that there is a tendency to underestimate grade and potentially malignant behavior when well-defined prostatic cancer grading schemes are not applied.     

COEXISTING TUBERCULOSIS AND CARCINOMA OF THE COLON

Four cases of coexisting tuberculosis and carcinoma of the colon (CTCC) are reported. All the patients were female and the mean age was 49 ± 11 years. The tumour involved the right colon in three patients and the distal transverse colon in the other. The two lesions coexisted at the same site in two patients. Mucinous carcinoma was the predominant type seen in three patients. The characteristics of patients with CTCC were compared with those of 54 patients who had carcinoma of the colon (CC) and 17 patients with tuberculosis of the colon (TC) seen during the same period. All the four CTCC patients were female, compared with 13 of 54 patients with CC (P < 0.001). These two groups were similar in mean age, anatomic sites and histopathological tumour types. The CTCC patients were significantly older than the TC patients (49 ± 11 years vs 34 ± 10 years, P < 0.05). The sex distribution of TC patients was similar to that of CTCC patients, 14 of 17 patients being female. All TC lesions were confined to the right colon. The present study showed a high frequency of carcinoma in patients with colonic tuberculosis, signifying the need for epidemiological and histopathological investigations into the aetiological relationship between the two diseases, the possibility of which was suggested recently by Japanese researchers. The relevant literature on 58 previously reported patients with CTCC was reviewed.