血清中性粒细胞/淋巴细胞比值与胃肠间质瘤患者预后的关系及其临床意义

目的检测中性粒细胞/淋巴细胞比值（NLR）在胃肠间质瘤（GIST）患者术前血清中的高低情况并分析其与预后的关系。方法采用回顾性的方法分析符合纳入条件的42例GIST患者术前3 d血常规中NLR及其病理切片中各免疫组织化学检测结果,并通过生存分析了解NLR与GIST患者预后的关系。结果 42例GIST患者中有22例NLR≥2.5（高NLR组）,20例NLR〈2.5（低NLR组）。NLR与GIST患者临床病理特征中核分裂像（χ2=9.45,P=0.002）和肿瘤大小有关（P=0.041）。高NLR组的GIST患者的3年生存率明显低于低NLR组的患者,其差异有统计学意义（χ2=5.44,P=0.022）。单因素分析结果显示,NLR、核分裂像及肿瘤大小与患者3年生存率有关（P〈0.05）;多因素分析结果显示,NLR和核分裂像是GIST患者3年生存率的独立危险因素（P=0.018,P=0.000）。结论 NLR和细胞核分裂像是影响GIST患者预后的独立危险因素,其对GIST患者的预后有一定预测价值。     

肾脏孤立性纤维瘤临床、影像学及病理诊断(附2例报告及文献复习)

目的:探讨肾孤立性纤维瘤的临床、影像学及病理特征,并进行诊断和鉴别诊断,提高对该肿瘤的诊断水平。方法:对2例肾孤立性纤维瘤进行临床症状,影像学资料以及病理分析,并结合文献讨论。结果:2例肿瘤均位于左肾,1例来源于肾实质,1例与左肾盂关系密切,临床、影像学诊断为左肾癌,均行左肾根治性切除术,肿瘤大体为球形或表面略分叶状的包块,边界清楚,包膜完整。镜下梭形细胞呈束状、旋涡状或不规则状排列,部分与胶原纤维混杂,部分呈血管外皮瘤样结构。细胞无明显异型,核分裂象未见。免疫组化示肿瘤细胞CD34及CD99阳性,S100,SMA,CKpan,P63,HMB45均为阴性,确诊为肾脏孤立性纤维瘤,2例均随访6个月无复发转移。结论:肾孤立性纤维瘤是一种少见的肾脏肿瘤,临床及影像学上易误诊为肾癌或肾盂癌,免疫组化CD34阳性表达是其病理学特征性表现,根治性切除及术后长期随访是治疗肿瘤的必要手段。     

Giant Fibrous Tumor Misdiagnosed as Traumatic Hemothorax

Solitary fibrous tumors of the pleura are neoplasms of the mesenchymal tissue of the pleural mesothelium. The most frequent symptoms are dyspnea, coughing and chest pain. A 45-year-old female patient presented after a thoracic contusion. A radio-opaque image was evidenced on chest X-ray. At the initial hospital, a hemorrhagic fluid was aspirated at thoracocentesis and the patient was transferred to our hospital with diagnosis of traumatic hemothorax. A thoracic CT showed a tumoral formation filling two-thirds of the left hemithorax. The transthoracic biopsy finding was compatible with a fibrous tumor. The patient was taken for surgery and the large pleural tumor was excised. In conclusion, a large pleural fibrous tumor was initially mistaken for hemothorax. A CT-scan revealed the tumoral nature of the thoracic opacity.     

p53抑制剂对热化疗损伤结肠上皮细胞p53、Bax和MDM2表达的影响

目的 探讨p53抑制剂PFT-α（pifithrin alpha，PFT-α）对热化疗诱导原代培养结肠上皮细胞凋亡及p53靶基因Bax和MDM2表达的影响。方法 原代培养结肠上皮细胞分为正常对照组、热化疗组和PFT-α加热化疗组，运用顺铂联合温热（43℃）处理结肠上皮细胞30min，对比加入不同浓度的PFT-α后，Annexin V-FITC／PI染色，流式细胞仪检测细胞凋亡。MTT法分析PFT-α对热化疗杀伤DLD1细胞的影响。Western blot检测结肠上皮细胞的p53、Bax和MDM2蛋白表达。结果 热化疗导致结肠上皮细胞发生凋亡，Bax和MDM2蛋白表达明显高于对照组。PFT-α作用于顺铂联合温热处理结肠上皮细胞后，细胞凋亡率下降呈剂量依赖性，同时p53在结肠上皮细胞胞核／胞质表达比例下降，Bax和MDM2的表达逐渐降低。热化疗杀伤肿瘤细胞的效应并未受到低剂量PFT-α影响。结论 PFT-α对热化疗损伤结肠上皮细胞具有保护作用，其机制可能与改变p53核转位和抑制促凋亡基因Bax和MDM2的表达相关，抑制p53可作为克服热化疗抗肿瘤治疗副效应的新策略。     

Radiofrequency-ablation of unresectable primary and secondary liver tumors: results in 88 patients

Background and aims Radiofrequency-ablation (RFA) is increasingly used for destruction of unresectable primary and secondary liver tumors. We report our experience in the use of RFA for the management of unresectable hepatic malignancies. Patients and methods Between February 2000 and December 2004 we have undertaken 120 RFA procedures to ablate 426 unresectable primary or metastatic liver tumors in 88 patients. RFA was performed via laparotomy (n=68), laparoscopy (n=9) or a percutaneous approach (n=43). Primary liver cancer was treated in seven patients (8%) and metastatic liver tumors were treated in 81 patients (92%). All patients were followed to assess complications, treatment response and recurrence of malignant disease. Results Procedure-related complication rate was low (3.4%). During a mean follow-up of 21.2 months, 15 patients had local tumor progression (17%), 21 patients (23,9%) had new malignant disease and 27 patients (30.7%) died from intervention-unrelated complications of their malignant disease. Additional liver lesions were identified in 27 (35%) of 77 cases by intraoperative ultrasound. Thirty-six patients received simultaneous resection and RFA. Conclusion RFA is a safe, well-tolerated and effective treatment for patients with unresectable primary and secondary liver malignancies.     

Primary Stromal Tumor of the Omentum: Report of a Case

We report the case of a primary extragastrointestinal stromal tumor (EGIST) found in the omentum of a 65-year-old woman. The resected specimen, which measured 6 cm at its largest point, consisted of an outer solid part and inner uniloculated cysts. Microscopically, the tumor was characterized by interlacing bundles of elongated spindle cells, with the nuclei showing a focal palisading pattern; however, skenoid fibers were not observed anywhere and mitoses were absent. Immunohistochemically, the tumor was negative for smooth-muscle actin, desmin, and S-100 protein, but it was positive for CD117 and CD34. The microscopic features were consistent with a gastrointestinal stromal tumor.     

Angiomyofibroblastoma-like tumors (cellular angiofibroma)

Angiomyofibroblastoma-like tumor (cellular angiofibroma) is a rare, circumscribed, slow-growing mesenchymal tumor that occurs predominantly in the vulva, perineum, and pelvis of women. We report two cases of this tumor in men arising as paratesticular masses of the scrotum, summarize the history of this tumor, and discuss why efforts should be made to differentiate it from aggressive angiomyxoma. Recommended treatment is complete surgical excision with long-term follow up exams, as local recurrence may occur many years after resection of the lesion.