Duodenal duplication with bile duct obstruction and keratinaceous casts

We report an unusual case of duodenal duplication presenting in a newborn with duodenal and bile duct obstruction. The duplication and biliary tract were filled with keratinaceous casts. To our knowledge, such an association has not been previously reported; this case demonstrates the importance of confirming bile duct patency during operations to remove duodenal duplications.     

Microglandular hyperplasia: a model for the de novo emergence and evolution of endocervical reserve cells

BACKGROUND: Microglandular hyperplasia (MGH) of the cervix in human beings is associated early with gland proliferation and terminates in mature squamous metaplasia. Using antibodies to basal cell markers, we analyzed biopsies with MGH to profile the distribution and evolution of reserve cells and their relationship to these epithelial components. DESIGN: Serial sections of 24 MGHs were subdivided into (1) early MGH with microacinar proliferation, abundant subnuclear vacuoles, and a paucity of supporting stroma and (2) late MGH with more prominent supporting stroma and/or squamous metaplasia. Serial sections were stained with antibodies to p63, bcl-2, and keratin-5. RESULTS: Three patterns of p63 staining were observed corresponding to the age of the MGH: (1) scattered staining of columnar cells, (2) focal subcolumnar staining in a reserve cell distribution, and (3) linear subcolumnar arrays of p63-positive reserve cells that in some MGHs expanded into a squamous metaplasia. Early acinar proliferations showed weak and focal columnar cell staining followed by focal subcolumnar p63-positive cells. In late lesions, p63 staining was compartmentalized to the extraglandular (or subcolumnar) areas. Stainings of p63, bcl-2, and keratin-5 were concordant. Staining for keratin 14, which localizes to squamous cells, was variable. CONCLUSIONS: The immunohistochemical profile in MGH indicates that reserve cells are created in adulthood during specialized columnar proliferations. This columnar to reserve cell transition may produce a stable population of reserve cells or a transition to squamous metaplasia. Similar patterns are seen in cervical neoplasia, suggesting a link between benign and neoplastic cervical epithelial differentiation.     

A novel mutation of keratin 9 gene (R162P) in a Japanese family with epidermolytic palmoplantar keratoderma

Epidermolytic palmoplantar keratoderma (EPPK) is an autosomal dominant inherited skin disorder characterized by hyperkeratosis of the skin over the palms and soles. Mutations in keratin 9 gene (KRT9) have been demonstrated in EPPK. In this study, we screened a Japanese family with EPPK for KRT9 mutation by polymerase chain reaction amplification of genomic sequences, followed by heteroduplex analysis and direct nucleotide sequencing. The mutation consisted of a G-to-C transversion at codon 162 in exon 1, which was located in the hot spot of the mutations that have been reported previously (R162Q and R162W). However, the amino acid substitution was proline for arginine (R162P) in the 1A rod domain, the highly conserved helix initiation motif of keratin 9. Our result illustrates the repertoire of KRT9 mutation underlying the occurrence of EPPK in a Japanese family and is an important contribution to the investigation of the genotype/phenotype correlation.     

胃癌阻断新技术降低癌细胞血行转移的临床研究

目的　评价胃癌阻断技术降低胃癌门静脉血内癌细胞播散的效果。方法　 2 3例胃癌患者 ,8例术中未采用胃癌阻断技术者为常规手术组 ,15例采用胃癌阻断技术者为阻断组 ,术前、术中抽门静脉血及阻断区域胃网膜静脉弓内静脉血 ,应用RT -PCR技术测定静脉血内CK19mRNA表达情况。结果　切除胃癌病灶之前 ,门静脉血内CK19mRNA的总阳性率为 34 7% ( 8/ 2 3) ,常规组和阻断组的阳性率分别为 37 5 % ( 3/ 8)和 33 3% ( 5 / 15 ) ;术中牵拉胃癌病灶时 ,常规组门静脉血CK19mRNA的阳性率为 87 5 % ( 7/ 8) ,而阻断组的阳性率为 6 7% ( 1/ 15 ) ,两组差异有统计学意义 (P <0 0 5 ) ;阻断组 15例患者癌灶阻断区域网膜血管弓内静脉血CK19mRNA均阳性。结论　术中采用胃癌阻断技术能有效的阻断胃癌细胞播散 ,防止手术操作引致的癌细胞远处转移     

手术操作与胃癌微转移的关系

目的探讨手术操作与胃癌微转移的关系。方法采用巢式逆转录-聚合酶链式反应（RT—PCR）技术检测70例胃癌病人手术前、后外周血细胞角蛋白（CK20）mRNA及癌胚抗原（CEA）mRNA的表达情况，并以20例健康志愿者作为阴性对照组，以10例胃癌组织作为阳性对照组。结果CK20mRNA及CEAmRNA在术前阳性表达率分别为32．9％和51．4％，而术后二者的阳性表达率分别为62．9％和70．0％，术后阳性率明显高于术前（X^2=12．62、5．06，P〈0．05）。20例健康志愿者无1例阳性表达。结论手术操作可以促使胃癌发生微转移。     

PET-CT、血清CEA及CYFRA21-1预测靶向药物对非小细胞肺癌疗效的研究

目的探讨PET-CT的标准摄取值(SUV)、血清癌胚抗原(CEA)、细胞角蛋白19的可溶性片段(CYFRA21-1)对靶向药物治疗非小细胞肺癌疗效的预测作用。方法对39例非小细胞肺癌患者在治疗前,进行EGFR基因突变、PET-CT SUV值、血清CEA、CYFRA21-1检测,治疗2周观察血清CEA、CYFRA21-1下降程度,计算以上各项指标与患者无进展生存期(PFS)及总生存期(OS)的关系。结果 SUV值≤5的患者及治疗2周后CEA水平下降≥50%的患者获得更佳的PFS及OS。但CYFRA21-1水平下降≥50%的患者,并未获得更长的PFS及OS。EGFR突变的患者SUV均值较EGFR野生型患者明显低(P<0.05)。治疗后EGFR基因突变的患者较野生型患者更可能获得CEA下降≥50%(P<0.05)。二元logistic回归分析结果表明,SUV值≤5为EGFR基因突变的独立预测因素(P<0.001)。结论 PET-CT的SUV值、用药前期CEA水平的变化,可以预测靶向药物治疗非小细胞肺癌的疗效。     

甲状腺乳头状癌CK19、Mesothelin、CD56表达及临床意义

目的观察甲状腺乳头状癌（PTC）的临床病理特征,检测相关免疫标记并探讨其在PTC中的应用价值。方法收集63例PTC、20例甲状腺良性乳头状增生性病变（BPH）,进行形态学观察,采用免疫组化SABC法检测细胞角蛋白19（CK19）、间皮细胞（Mesothelin）及CD56的表达。结果CK19、Mesothelin、CD56在63例PTC中阳性表达率分别为100．0％、95．2％、3．2％;在20例BPH中三者阳性表达率分别为35．0％、15．0％、90．0％。结论CK19和Mesothelin的阳性表达率在PTC与BPH之间比较差异有统计学意义（P〈0．05）,CD56阴性表达对两种病变的鉴别诊断有重要价值。联合应用三种标记物可以明显提高诊断的准确性和特异性。     

Localization of keratins 13 and 14 in the lingual mucosa of rats during the morphogenesis of circumvallate papillae

We used fluorescence immunohistochemistry, analysis of differential interference contrast (DIC) images and confocal laser-scanning microscopy in the transmission mode, after staining specimens with toluidine blue, to examine the localization of keratin 13 (K13) and keratin 14 (K14) in the lingual epithelium of fetal and juvenile Sprague-Dawley rats during the prenatal and postnatal morphogenesis of circumvallate papillae. No immunoreactivity specific for K13 and K14 was detected in the lingual epithelium of fetuses on day 15 after conception (E15), at which time the primitive rudiment of the circumvallate papillae was detectable by the thickening of several layers of cuboidal epithelial cells. On E17 and E19, the developing circumvallate papillae were clearly recognizable, consisting of a central papilla and the surrounding sulcus. No immunoreactivity specific for K13 and K14 was evident in the lingual epithelium around these structures at this time. K14-specific immunoreactivity was first detected in the basal layer of the epithelium of the circumvallate papillae on postnatal day 0 (P0) and K13-specific immunoreactivity was detected on P7. Morphogenesis of the circumvallate papillae progressed significantly from P0 to P14, and immunoreactivity specific for K13 and K14 was clearly recognizable after P7. The respective patterns of K13-specific and K14-specific immunoreactivity differed during the development of the circumvallate papillae: K13-specific immunoreactivity was generally evident in cells of the intermediate layer of the epithelium, while K14-specific immunoreactivity was detected in cells of the basal and suprabasal layers. The present results are discussed in the context of the previously determined localization of K13 and K14 in the dorsal epithelium of the anterior part of the rat tongue during its morphogenesis.