胃癌细胞DNA含量、AgNOR计数与其生物学特性关系的研究

本文使用图像分析技术测定了正常胃粘膜、萎缩性胃炎、不典型增生及胃癌共８９例细胞ＤＮＡ相对含量及ＤＮＡ倍体分布;并用银染方法对８９例细胞核仁形成区嗜银蛋白进行定量分析。结果显示：不典型增生往往可观察到与胃癌相似的ＤＮＡ核型即高异倍体的出现,高异倍体的出现可能是重要的癌前标志;在胃粘膜病变中,ＡｇＮＯＲ值随病变异型程度的加重而递增,各组间差异均有非常显著性意义（Ｐ＜０．０１）。早期癌、浸润癌和转移癌间,以及癌转移过程中粘膜层、肌层、淋巴结内癌细胞ＤＮＡ含量无明显差异;ＡｇＮＯＲｓ计数均值差异亦无非常显著性意义（Ｐ＞０．０５）。随癌细胞分化程度升高,ＤＮＡ含量增多及异倍体出现率升高;各期胃癌除粘激腺癌与分化型腺癌差异无显著性意义外,余各型胃癌ＡｇＮＯＲｓ值随分化程度升高而增多,差异有显著性意义（Ｐ＜０．０５或Ｐ＜０．０１）。因此,ＤＮＡ含量及倍体分析,ＡｇＮＯＲｓ计数与胃癌的生物学行为密切相关,可作为胃癌早期诊断,癌前病变预测以及组织分级的一种重要指标。     

淋巴道转移相关标志物与癌

肿瘤早期的淋巴道转移是恶性肿瘤患者高死亡率的主要原因,其机制复杂,一直是肿瘤研究的难点. 肿瘤淋巴道转移特异性蛋白标记物的发现有助于揭示恶性肿瘤早期发病机制、早期临床诊断和治疗. 本文综述了近年来肝癌、胃癌、食管癌、结肠癌、乳腺癌、肺癌、鼻咽癌和前列腺癌淋巴道转移研究所取得的蛋白质组学成果,并对发现的与以上几种肿瘤淋巴道转移相关的蛋白标记物及其在肿瘤的发生、浸润、转移及病人预后中作用及机制进行了探讨.     

超快速CT模拟胃镜的临床应用初探

目的：探讨模拟CT胃镜对常见胃部病变的应用价值。材料和方法：对50例已行内镜检查的患者行CT模拟胃镜检查,男33例,女17例,年龄24－70岁之间。全部病例均经手术或胃镜病理证实。将获得的二维图像输送至工作站,使用Insight软件包进行三维重建。结果：早期胃癌和进展期胃癌检出率分别为60％、100％,检出息肉3例,恶性淋巴瘤、平滑肌瘤和平滑肌肉瘤各1例,排除了3例胃镜诊断的粘膜下隆起病变,仅检出了7例溃疡中的2例。结论;模拟CT胃镜是探查胃部新生物的一种有效的诊断方法。     

拉曼光谱技术在肿瘤检测中的应用

癌症是威胁人类健康和生命的严重疾病之一,早期诊断与及时治疗是提高癌症患者生存率的最有效途径。激光拉曼光谱技术作为一种非侵入性的检测技术,可以无损伤地提供丰富的分子结构特征和物质成分信息,从分子水平上反映癌变组织与正常组织之间的结构差异,从而可用于癌症的早期诊断。综述了激光拉曼光谱技术在皮肤癌、鼻咽癌、肺癌、胃癌、结肠癌、乳腺癌及前列腺癌诊断中的研究进展,并对拉曼光谱技术在癌症诊断中的发展方向和应用前景作了进一步的展望,为癌症的早期检测和诊断技术的应用研究提供参考依据。     

THE CYTOLOGICAL DIAGNOSIS OF GASTRIC CANCER

Established centers find that cytological study of gastric washings with saline or chymotrypsin, adequately performed, is a valuable diagnostic tool in the detection of early and curable gastric carcinoma.Our experience with a small series of 150 patients, studied by saline gastric washing, has emphasized the difficulties of collection and the particular importance of obtaining, by repeated washings if necessary, an adequate specimen of gastric epithelial cells for diagnosis, before an opinion is given.It seems likely that the cytological method will be of future value in study of the natural history of gastric malignant disease and in detection of its surface lesions in their earliest form in asymptomatic, known-susceptible persons. Further, it should become a complementary part of the “stomach profile” in gastric diagnostic problems, where roentgenologic and gastroscopic studies may be expected to reveal the older, necrotic, or infiltrative lesions; cytological study, the earlier and more superficial stages of disease.     

早期胃腺癌原代细胞适配子的筛选与鉴定

胃腺癌是消化道最常见的恶性肿瘤之一,由于没有针对早期胃腺癌有效的诊断方法,目前胃腺癌手术治疗还主要针对中晚期患者,预后差. 本文应用cell-SELEX技术,筛选早期胃腺癌原代细胞的适配子,为早期胃腺癌的诊断提供新的思路. 从早期胃腺癌组织中分离得到早期胃腺癌原代细胞,应用体外合成全长88 bp中间含52 bp随机序列的单链DNA文库,通过对PCR扩增条件的优化,借助生物素-链霉亲和素磁珠系统,经cell-SELEX反复筛选,可获得针对早期胃腺癌原代细胞的特异性适配子.经12轮cell-SELEX筛选,ssDNA文库与早期胃腺癌原代细胞的亲和力由1 560上升到4 336,表明亲和力较高的适配子得到逐步富集. 经克隆和测序,应用软件分析可知,30个克隆子中编号为C17和C27的2个序列完全一致,具同源性,二级结构预测可知单链DNA形成不同的茎环结构可能是适配子与早期胃腺癌原代细胞作用的结构基础. 特异性分析显示,胃腺癌原代细胞组与正常胃粘膜上皮细胞、空白对照组之间荧光强度值差异非常显著（P＜001）;正常胃粘膜上皮细胞组与空白对照组之间差异不显著（P＞005）. 经亲和力测定,各适配子与早期胃腺癌原代细胞的解离系数达到nmol/L,具有很高的亲和力.利用cell-SELEX技术成功筛选到早期胃腺癌原代细胞的适配子,为胃腺癌的早期诊断与治疗药物靶点方面的研究奠定了实验基础.     

Filamentous organisms in benign and malignant gastric cytology brushings

Review of 143 gastric brushing specimens from two centres in patients with a subsequent histological diagnosis on biopsy or gastrectomy specimens revealed filamentous organisms (FOs) in a large number of benign and malignant gastric brushings. The presence of FOs in significant numbers of brushings of benign gastric lesions contradicts the previously reported strong association of FOs with only gastric carcinoma, and questions the importance of finding these organisms in gastric brushing and biopsy material.     

Paranuclear blue inclusions of small cell carcinoma of the stomach: report of a case with cytologic presentation in peritoneal washings

BACKGROUND: Primary gastric small cell carcinoma is a rare but important entity. We describe a case that we diagnosed by peritoneal washing cytology. CASE: A 70-year-old male presented with upper abdominal discomfort and underwent endoscopic evaluation. Gastric endoscopy revealed a diffuse, infiltrating tumor from the body to the antrum. Total gastrectomy with lymph node dissection and intraoperative peritoneal washing cytology were carried out. Peritoneal washing cytology showed the presence of many undifferentiated malignant small cells with a necrotic background. The tumor cells were small and round, with naked, hyperchromatic nuclei and finely granular chromatin. Some tumor cells contained paranuclear blue inclusions (PBls) in the cytoplasm. The tumor cells were positive for neuron-specific enolase and synaptophysin on immunocyto-chemistry. Carcinoembryonic antigen, alpha-fetoprotein (AFP) and leukocyte common antigen were negative. Pathologic diagnosis after the operation was moderately to poorly differentiated adenocarcinoma and small cell carcinoma containing AFP-positive cells. CONCLUSION: The prognosis of primary gastric small cell carcinoma is usually poor. Our patient died of multiple liver metastases and peritonitis carcinomatosa 69 days after surgery. When a gastric small cell carcinoma is suspected in peritoneal washings, immunocytochemical demonstration of neuroendocrine differentiation is required to arrive at the final diagnosis.     

乳腺内不可触及病灶的定位活检应用价值

目的:探讨乳腺内不可触及病灶(NPBL)的定位活检技术及其在乳腺癌早期诊断中的临床应用价值。方法:对彩超发现的4459个和钼靶发现的25个NPBL分别行麦默通旋切和钩丝定位活检,确定病灶的病理类型。结果:4459个NPBL中3196个病灶为乳腺腺病或伴纤维腺瘤样结节(71.7%),1198个为纤维腺瘤(26.9%),11个为分叶状肿瘤(0.2%),17个为导管内乳头状瘤(0.4%),9个为乳腺导管原位癌,5个为导管原位癌伴微浸润,23个为浸润性癌(恶性占0.8%)。25个钼靶发现的NPBL中乳腺腺病13例(52%),导管原位癌7例,导管原位癌伴微浸润2例,浸润性癌3例(恶性占48%)。结论:超声引导下麦默通和钼靶引导下钩丝定位切除可以对NPBL做出定性诊断,具备创伤小、手术时间短和定位精准等特点,对提高乳腺癌的早期诊断率、降低死亡率具有一定的临床应用价值。     

Polyarthritis associated with gastric carcinoma.

In a 68-year-old man who had polyarthritis associated with gastric carcinoma surgical resection of the tumour was accompanied by prompt resolution of the arthritic syndrome. In 11 years of follow-up the arthritis has remained in complete remission and there has been no recurrence of the carcinoma. An awareness that polyarthritis may be a presenting manifestation of an underlying carcinoma may, especially in an elderly person, lead to early recognition and treatment of the malignant disease.     

Microcystic adnexal carcinoma (sclerosing sweat duct carcinoma)

Microcystic adnexal carcinoma (MAC) is a recently described malignant neoplasm of the adnexal structures of skin that shows a marked propensity for early infiltrative and locally aggressive growth. Its banal clinical appearance may lead to a delay in diagnosing the tumor by biopsy, and its multifaceted histologic features may lead to an incorrect tissue diagnosis. Confusion with benign tumors and less aggressive malignancies can lead to inadequate initial treatment and extensive recurrences. We describe three cases of microcystic adnexal carcinoma and review the clinical and histologic features, treatment, and prognosis of this neoplasm.     

超声随访在肝硬化结节恶变筛查及诊断中的价值研究

目的:研究超声随访在肝硬化结节恶变筛查及诊断中的价值。方法:选取我院收治的乙肝后肝硬化患者83例,均采取超声检查,观察超声随访在肝硬化结节恶变筛查及诊断中的应用价值。结果:本组83例随访发现,出现肝硬化伴增生性结节患者演变小肝癌21例。增生性结节患者的增生性结节直径与小肝癌患者肿块直径比较,差异无统计学意义(P0.05)。增生性结节患者的回声情况与小肝癌患者比较,差异有统计学意义(P0.05)。超声随访发现,结节由112个增加至126个,结节数量增加。肝硬化结节14例,在超声引导下行肝穿刺活检,成功13例,失败1例,病理诊断肝硬化结节患者9例,肝癌患者3例,与超声的检查结果相同。结论:超声随访在肝硬化结节恶变的筛查诊断中具有较高的临床价值,可在早期提供较为准确的检查结果,帮助医师做出诊断,及早治疗以改善预后。     

Differential diagnosis of lymph node aspirates by intermediate filament typing of tumor cells

Twenty-one lymph node aspirates for which a differential diagnosis was difficult or not possible by light microscopy alone were selected for further study by intermediate filament typing. The use of four monoclonal antibodies specific for different keratin subsets or for vimentin resulted in a definitive diagnosis in all instances. The results show that use of these antibodies can improve the accuracy of cytologic diagnosis and provide further evidence that intermediate filament typing can help differentiate (1) malignant melanoma from adenocarcinoma, (2) malignant lymphoma from small-cell anaplastic carcinoma and (3) squamous-cell carcinoma from adenocarcinoma. Intermediate filament typing can also be used to identify very small numbers of carcinoma cells in specimens that are apparently negative for tumor cells by light microscopy. The method is quick, relatively simple, reliable and unambiguous, provided that appropriate questions are asked and antibodies with well-defined specificities are used.     

饮食和生活习惯与胃癌的相关性研究进展

胃癌是起源于胃粘膜上皮细胞的恶性肿瘤。近年来,虽然大部分国家胃癌发生率呈下降趋势,但我国胃癌的发病率和死亡率仍居高不下。胃癌的发生是多因素共同参与的复杂过程,如与种族、遗传、年龄、性别、幽门螺旋杆菌感染、饮食等因素相关,其中饮食及生活习惯被认为与胃癌的发生关系密切。而且早期胃癌的预后相对良好,降低发生率是防治胃癌的一项关键措施。因此,通过了解饮食及生活习惯因素与胃癌之间的关系,可以加强胃癌的一级预防,从而改善胃癌患者预后。本文就高盐、高脂饮食,蛋白质、蔬菜水果摄入以及吸烟、饮酒等因素与胃癌关系的研究进展进行综述,以期对胃癌的预防奠定一定基础。     

Utility of imprint cytology for early presumptive diagnosis in clinically suspicious cervical cancer

OBJECTIVE: To determine the utility of imprint cytology (IC) in providing an early presumptive diagnosis of clinically suspected cervical carcinoma. STUDY DESIGN: A total of 219 clinically suspicious cervical cancer cases underwent Pap test, punch biopsy and IC at the same sitting. Correlations were performed between these diagnostic modalities to determine the sensitivity and specificity of IC in diagnosis of cervical cancer. RESULTS: The overall accuracy of IC in detecting cervical cancers was 96.2%. About 78% of squamous cell carcinomas (SCC), 60% of adenocarcinomas and 100% of small cell carcinoma could be accurately typed on imprints. Twelve malignant lesions were diagnosed on IC among 26 unsatisfactory biopsies. Although there was no false positive result, 3.5% false negative diagnoses were given on IC. The sensitivity and specificity of imprint smear cytology to detect malignancy was 96.2% and 100%. Agreement between imprint cytology and Pap smear diagnosis of malignancy was 95.3%. kappa Statistics revealed excellent agreement between imprints and biopsies and between imprints and Pap smears in diagnosis of malignant lesions. CONCLUSION: IC can be used as an adjunctive technique for an early and reliable preliminary presumptive diagnosis of cancer of the uterine cervix.     

胃癌组织中HER2 基因及p53蛋白表达及其临床意义

目的:研究胃癌组织中HER2基因及P53蛋白表达情况,分析其对临床诊疗的意义与价值。方法:选取2013年7月到2015年7月我院确诊的胃癌患者110例,检测患者胃癌组织中的HER2蛋白表达与基因扩增,及P53蛋白的表达情况,分析HER2基因扩增与P53蛋白表达与病理关系间的关系。结果:HER2基因扩增率为17.3%(19/110),HER2蛋白表达率为42.7%(47/110),P53蛋白表达率为58.2%(64/110),其中HER2蛋白表达3+、2+者HER2基因的扩增比例分别为3/4、6/9与1+表达者的3/16比较具有统计学意义(P0.05);HER2基因扩增和P53蛋白表达与胃癌淋巴结转移以及浸润程度有关(P0.05);相关性分析显示:HER2基因扩增与P53蛋白表达具有正相关关系(P0.05)。结论:胃癌组织中HER2基因扩增和P53蛋白协同表达,促进胃癌浸润和淋巴结转移,对胃癌早期诊断具有重要参考价值。     

Oncological principles of surgery in the periorbital region

The aim of this study is to describe the most common malignant periorbital tumours and principles of their surgical treatment. The most common malignant tumours of the eyelids are: basocellular carcinoma, squamocellular carcinoma, sebaceous carcinoma and malignant melanoma. The primary treatment of periorbital tumours is surgery, other methods are cryotherapy or radiotherapy. Malignant tumours of the eyelids are fairly rare. Diagnosis in some of the cases is difficult, since the first signs of the tumours are small changes on the eyelid margin or eyelid skin. Focal loss of the eyelashes could be the first sign of a malignant tumour. General oncological principles are valid also in the surgery of periorbital region. Eyelids have special anatomical structure and their main role is protection of the eyeball. Therefore, early diagnosis and total tumour removal--regardless of the anatomical borders--as well as immediate reconstruction are important in the treatment of eyelid tumours.     

Ultrastructural aspects of human liver tumours collected by thin needle aspiration biopsy

Fourteen liver tumor samples, obtained by echographically-guided thin needle aspiration biopsy were electron microscopically studied, pointing out the ultrastructural aspects that allowed the diagnosis of primary and secondary liver neoplasia, and those providing indications for malignancy degrees. Criteria of electronoptic differential diagnosis between dysplastic and malignant lesions are presented. The paper suggests that electron microscopy may be helpful in establishing the forms of liver carcinoma, difficult to be determined only by cytologic examination, and for the early diagnosis mandatory to increase the resectability rate of malignant hepatoma.     

胃癌和甲状腺疾病相关性研究进展

胃癌是我国常见的恶性肿瘤之一。多种因素与胃癌的发生相关,如环境、饮食、幽门螺杆菌感染、慢性萎缩性胃炎和肠上皮化生等。随着对胃癌研究的深入,国外学者发现胃癌的发病率在碘摄入不足或者摄入过多的地区有逐渐增高的趋势,而碘是甲状腺疾病发病的重要因素。最新的研究发现,胃癌和甲状腺疾病的关系可能受到地域因素的影响,但目前缺乏对此关系的大样本临床研究。本文试对这些研究的最新进展作一综述。