Mixed adenoneuroendocrine carcinoma of gastrointestinal tract: Report of two cases

Mixed adenoneuroendocrine carcinoma(MANEC) is a rare tumor of the gastrointestinal tract that consists of a dual adenocarcinomatous and neuroendocrine differentiation, each component representing at least 30% of the tumor. To date, only seven cases have been reported in the cecum, and less than 40 in the stomach. Our first case was diagnosed in a 74-years-old female as a polypoid lesion of the cecum with direct invasion in the transverse colon, without lymph node metastases. The second case was diagnosed in the stomach of a 46-years-old male as a polypoid tumor of the antral region that invaded the pancreas and presented metastases in 22 regional lymph nodes. The metastatic tissue was represented by the glandular component. In both cases, the tumor consisted of a moderately-differentiated tubular adenocarcinoma(with mucinous component in Case 1) intermingled with neuroendocrine carcinoma. Ki67 index was lower than 20% in Case 1, respectively higher than 20% in Case 2. The neuroendocrine component was marked by synaptophysin and neuron specific enolase, being negative for Keratins 7/20. The neuroendocrine component represented 60% in Case 1, and 40% in Case 2, respectively. The glandular components were marked by carcinoembryonic antigen, maspin and keratin 20/7(Case 1/2). Both cases were proved to be microsatellite stable. Independently by the localization and tumor stage, MANECs appear to be highly malignant tumors, with high risk for distant metastases. The aggressiveness seems to depend on the endocrine component, independent of its proportion. The neuroendocrine component could be a dedifferentiated adenocarcinoma with a neuroendocrine phenotype.     

鼻咽癌患者外周血中CK20 mRNA的表达及其临床意义

目的研究鼻咽癌(NPC)患者外周血中CK20mRNA表达并探讨其临床意义。方法采用巢式逆转录和多聚酶链反应方法,对NPC伴颈淋巴结转移组19例和NPC颈部淋巴结无转移组13例(共计32例)CK20mRNA表达进行检测。CT证实两组患者均无远处转移病灶。对照组1为8例非肿瘤患者外周血;阳性对照分别为B95-8细胞株和NPC组织。结果NPC伴颈淋巴结转移组CK20mRNA阳性表达率为21.1%(4/19),颈部淋巴结无转移组为7.7%(1/13),两组间阳性表达率比较差异无显著性意义(P>0.05)。CK20mRNA阳性表达与鼻咽癌国际抗癌联盟分期无关。对照组1均为阴性表达。结论NPC患者外周血中CK20mRNA的阳性表达作为NPC细胞血行播散的指标可能是有价值的,有助于评估NPC患者的预后。     

Orbital metastasis of keratinizing squamous cell cervical carcinoma with giant cells. A case report

A case of orbital metastasis of cervical keratinizing squamous cell carcinoma is presented. The patient, in remission from primary cervical and ovarian cancers, presented with complaints of left eye ptosis and pain. Examination revealed the presence of a moderately tender mass along the left supra-temporal orbital rim and downward displacement of the left globe. Computed tomography revealed a poorly circumscribed mass with superior lateral wall bone loss. Excised tissue contained invasive, poorly differentiated nests of pan keratin and epithelial membrane antigen-positive squamous cells with numerous pleomorphic multinucleated giant cells. Multiple treatment regimes were unsuccessful, and the patient expired due to disease complications after 3 months.     

细胞角蛋白与肿瘤的关系

细胞角蛋白（CK）具有维持正常细胞形态和功能的重要作用。临床上,细胞角蛋白被作为肿瘤标记物用于多种肿瘤的诊断。近年来许多研究发现细胞角蛋白的异常表达、磷酸位点的基因突变以及过度磷酸化与肿瘤的发生机制相关,研究两者之间的关系,对于肿瘤的诊断、治疗、预后有重要的作用。     

Phenotypic plasticity of neoplastic ovarian epithelium: unique cadherin profiles in tumor progression

The mesodermally derived normal ovarian surface epithelium (OSE) displays both epithelial and mesenchymal characteristics and exhibits remarkable phenotypic plasticity during post-ovulatory repair. The majority of epithelial ovarian carcinomas (EOC) are derived from the OSE and represent the most lethal of all gynecological malignancies, as most patients (approximately 70%) present at diagnosis with disseminated intra-abdominal metastasis. The predominant pattern of EOC metastasis involves pelvic dissemination rather than lymphatic or hematologic spread, distinguishing EOC from other solid tumors. Acquisition of the metastatic phenotype involves a complex series of interrelated cellular events leading to dissociation (shedding) and dispersal of malignant cells. A key event in this process is disruption of cell-cell contacts via modulation of intercellular junctional components. In contrast to most carcinomas that downregulate E-cadherin expression during tumor progression, a unique feature of primary well-differentiated ovarian cancers is a gain of epithelial features, characterized by an increase in expression of E-cadherin. Subsequent reacquisition of mesenchymal features is observed in more advanced tumors with concomitant loss of E-cadherin expression and/or function during progression to metastasis. The functional consequences of this remarkable phenotypic plasticity are not fully understood, but may play a role in modulation of cell survival in suspension (ascites), chemoresistance, and intraperitoneal anchoring of metastatic lesions.     

克服RT—PCR法检测肿瘤微转移的假阳性

为探讨克服ＲＴ－ＰＣＲ法检测恶性肿瘤微转移时出现假阳性的方法，作者运用该法检测了４０例非小细胞肺癌和２０例食管癌患者病理证实有转移的淋巴结中角蛋白１９（ＣＫ１９）基因的表达，同时还分别运用套式ＲＴ－ＰＣＥ或ＲＴ－ＰＣＲ法检测了１０例良性肺和食管肿瘤患者正常淋巴结中ＣＫ１９基因的表达。结果发现设立分别以未经逆转录的ＲＮＡ和基因组ＤＮＡ为模板的对照可观察到是否存在ＣＫ１９假基因的干扰所造成的假阳性，而在逆转录前用脱氧核糖核酸酶（ＤＮａｓｅ）消化ＲＮＡ可消除这种假阳性。运用套式ＲＴ－ＰＣＥ法测定ＤＮａｓｅ消化后的正常淋巴结ＲＮＡ可发现ＣＫ１９基因非法转录所致假阳性，调整方法灵敏度，使之刚好能区分正常和转移淋巴结是解决此类假阳性的合适办法。     

细胞角蛋白、CA125对子宫内膜癌淋巴结微转移的诊断价值

目的　研究细胞角蛋白 (cytokeratin ,CK)、CA12 5对子宫内膜癌淋巴结微转移的诊断价值 ,及其作为子宫内膜癌复发危险因素的临床意义。方法　采用免疫组化链霉菌抗生物素蛋白 过氧化物酶连接 (SP)法检测 5 0例子宫内膜癌患者的原发灶组织 5 0份和淋巴结 2 98枚中CK、CA12 5的表达情况 ,采用多元回归分析法对影响子宫内膜癌复发的危险因素进行分析。结果　 (1)CK、CA12 5在子宫内膜癌组织中的阳性表达率分别为 10 0 % (5 0 / 5 0 )和 78% (39/ 5 0 )。 (2 )HE染色检查有转移的淋巴结中 ,CK和CA12 5均呈强阳性表达的阳性表达率均为 10 0 % (16 / 16 )。HE染色检查无转移的淋巴结中 ,CK、CA12 5的阳性表达率分别为 15 % (4 3/ 2 82 )和 12 % (35 / 2 82 ) ,且均为弱阳性表达。 (3)Ⅰ、Ⅱ期子宫内膜癌患者淋巴结中 ,CK阳性与CK阴性表达者的复发率分别为 38%、0 ,两者比较 ,差异有显著性 (P <0 0 5 ) ;CA12 5阳性与CA12 5阴性表达者的复发率分别为 39%、4 % ,两者比较 ,差异也有显著性 (P <0 0 5 )。 (4 )多元回归分析结果显示 ,淋巴结中CK表达是影响Ⅰ、Ⅱ期子宫内膜癌复发的独立危险因素 ,而淋巴结中CA12 5表达和肌层浸润深度均为影响Ⅰ、Ⅱ期子宫内膜癌复发的相关因素。结论　在HE染色检查无转移的淋巴     

Electron-microscopic and immunohistochemical studies of eyelid reopening in the mouse

The development of the eyelids was studied in the mouse from birth to day 12. In transmission electron microscopy (TEM), the desmosome-mediated cell-to-cell adhesions were clearly observed from day 0 to 10 after birth in the junctional region where the upper and lower eyelids fuse. The keratinizing cells in the junctional region, especially in the middle area where the separation occurs by about day 12, gradually elongated toward both surfaces of the fused eyelid with development. In immunohistochemistry, the existing pattern of keratin-positive cells showed distinct developmental changes. Expression of keratin 1 started to extend from the epidermal surface to the junctional region by day 4, and reached the conjunctival part of the junctional region by about day 8. After day 10 keratin 1 began to disappear from the epidermal surface, and by about day 12 keratin 1 almost disappeared from the entire epithelium of the eyelids. Expression pattern of keratin 7 was very similar to that of keratin 1. These findings indicate that epithelial cell differentiation progresses from the skin through to the junctional region to conjunctiva, which may play a role in the eyelids, separation. Accepted: 10 April 2001