MNNG诱发大鼠腺胃粘膜不典型增生与 高分化腺癌形态定量分析

目的探寻大鼠腺胃粘膜不典型增生与高分化腺癌的形态定量参数指标,探讨大鼠实验性胃癌与人类胃癌形态定量指标的异同性。方法利用HPIAS-1000型图象分析系统对以MNNG诱发的大鼠腺胃粘膜不典型增生及高分化腺癌进行形态定量研究。结果大鼠腺胃粘膜不典型增生与高分化腺癌8项形态定量参数指标经统计学处理比较,其中核面积、核周长、核等效直径、核体积、核长径,核形状因子8项形态定量指标（P<0.01）有高度显著性差异,而核短径和核长短径比值（P>0.05）无显著性差异。结论这些形态定量参数指标对区别大鼠腺胃粘膜不典型增生与高分化腺癌有一定价值,形态定量参数指标也是随着癌前病变、癌的顺序逐渐递增;大鼠腺胃粘膜上皮癌变与人类胃粘膜上皮癌变有着相似的形态学变化过程。     

An update on atypical large glandular proliferations of the prostate

The differential diagnosis of prostatic atypical large gland proliferations includes several benign and malignant entities. This review focusses on issues relevant to the practising pathologist, particularly around areas of controversy such as high-grade prostatic intraepithelial neoplasia (HGPIN) and intraductal carcinoma of the prostate (IDCP). HGPIN is a putative precursor of prostate cancer, but its clinical relevance is as a surrogate marker of unsampled prostate cancer, thereby identifying patients who would benefit from a prompt repeat biopsy. The incidence of missed prostate cancer is much lower in contemporary practice due to pre-biopsy MRI and extended sampling protocols so HGPIN is currently less important. It is however important to distinguish HGPIN from PIN-like carcinoma and IDCP. PIN-like carcinoma is considered a histological subtype/variant of acinar prostate carcinoma and should be graded as Gleason pattern 3. A diagnosis of cribriform HGPIN should not be made in needle biopsies as such a proliferation may represent IDCP. This review discusses controversies related to the diagnosis, reporting and management of IDCP. A personalized approach to management of patients with isolated IDCP in needle biopsies that is based on the histological and radiological features of an individual case is outlined.     

Esophageal adenocarcinoma after sleeve gastrectomy: actual or potential threat? Italian series and literature review

BackgroundSleeve gastrectomy (SG) leads to esophageal mucosal damage in an elevated percentage of cases, configuring a clinical condition of Barrett’s esophagus (BE) in a proportion as high as 15–18.8%. BE may rarely evolve into esophageal adenocarcinoma (EAC).ObjectivesTo raise awareness of BE as a precancerous lesion which may progress toward malignancy after this popular bariatric procedure.SettingBariatric referral centers, Italy.MethodsAll patients referred to our bariatric center who developed an EAC after SG between 2012 and 2019 were reviewed and consecutively included in this study. The available scientific literature regarding this complication is additionally reviewed.ResultsThe 3 male patients comprised in this case series underwent laparoscopic SG between 2012 and 2015 in different bariatric referral centers. Age and body mass index at baseline ranged from 21–54 years and 43.1–75.6 kg/m², respectively. All patients were lost to follow-up early after surgery (3.7 ± 1.4 months), and were diagnosed with EAC at a mean of 27.3 ± 7.6 months after SG. The 4 reported cases in the scientific literature developed an EAC at a mean of 32.5 ± 23 months from SG. Overall, a diagnosis of EAC was made approximately 30.3 ± 17.1 months postoperatively, which seems relatively and worryingly early after surgery.ConclusionAlthough the rate and probability of progression from BE to EAC is still not well defined, assuming that the rising popularity and execution of SG leads to a growth in the BE incidence, then the preoperative identification and stratification of cancer risk factors in this subset of patients is strongly encouraged. Clinical and endoscopic follow-ups are essential to allow for prevention and early diagnosis and for epidemiologic data collection purposes.     

Diagnosis of metastatic lesions to the stomach by salvage cytology

Summary Secondary neoplasms of the stomach are rare and are often clinical and diagnostic problems. Three patients with bleeding volcano-like ulcers were diagnosed by combined endoscopic salvage cytology and surgical biopsy as having metastatic submucosal lesions from hematologic spread. The combination of endoscopic appearance, clinical findings, and tissue and cytologic examination can lead to the correct diagnosis. The results from these cases support the utility of this cytologic technique in combination with biopsy in this clinical setting.     

LAK细胞体外杀伤直肠腺癌细胞的扫描电镜观察

应用扫描电镜观察体外LAK细胞与直肠腺癌细胞相互作用时的形态学变化。结果表明:LAK细胞与HR8348细胞均具有主动互相趋向运动,效靶细胞借其细胞突起及微绒毛相互接触。LAK细胞及肿瘤细胞的细胞突起及微绒毛由早期的平面接触逐渐发展为犬牙交错状结合。效靶细胞紧密结合后,靶细胞鼓泡,细胞膜出现环形穿孔。互相接触,结合的微绒毛及细胞突起在靶细胞的溶解过程中起到一个物理微桥的作用。LAK细胞分泌的杀伤物质通过微桥介导靶细胞的溶解。效靶细胞互相结合的微绒毛间形成关闭小室,它可能与维持局部杀伤物质浓度有关。     

Phase II evaluation of esorubicin (4′ deoxydoxorubicin) in pancreatic adenocarcinoma: A Southwest Oncology Group study

Summary Esorubicin (4 deoxydoxorubicin) is a new analogue of the anthracycline, doxorubicin. This compound lacks the hydroxyl group at 4 position on the amino sugar of the anthracycline. Phase II study was designed to determine the clinical response rate and to define the qualitative and quantitative toxicities of esorubicin in patients with adenocarcinoma of the pancreas. Fifty-eight patients with inoperable adenocarcinoma of the pancreas were entered on the study, 47 were evaluable for response, and 57 were evaluable for toxicity. The dose of esorubicin was 30 mg/m² for good risk patients and 25 mg/m² for poor risk patients every 21 days and administered IV push through a side arm of a running IV. Diphenhydramine, 50 mg is administered IM prior to the administration of the drug to block local venous reaction. Subsequent doses of esorubicin were modified according to granulocyte and platelet nadirs and the drug was not administered until recovery of platelets (> 100,000/ul) and wbc (> 3000/ul). Three partial responses, 20 stable, and 31 with increased disease were observed. Forty-seven had severe granulocytopenia (< 250), and two patients had severe thrombocytopenia (< 25,000). One patient experienced a decrease in left ventricular ejection fraction with a total dose of 180 mg/m². The dose of esorubicin in this study demonstrated that the drug has minimal activity in adenocarcinoma of the pancreas but the toxicity is tolerable. Search should continue for single agents with activity in this disease.