乳腺癌的早期诊断的体会

目的探讨乳腺癌的早期诊断方法。方法40岁以上、直径2cm以下乳房纤维瘤行手术切除活检；触不到肿块的乳头血性溢液行导管切除活检；40岁以上乳房囊性增生病行区段切除活检；不明原因的腋下肿大的淋巴结切除活检。结果乳房纤维瘤6．8％为早期癌；乳头血性溢液58.3％(7／12)为乳头状瘤；乳房囊性增生病10.3％为早期癌；不明原因的腋下肿大的淋巴结60．0％(3／5)为早期癌。结论对40岁以上乳房纤维瘤行切除活检；对触不到肿块的乳头溢液行导管切除活检；对40岁以上乳房囊性增生病行区段切除活检；对不明原因的腋下肿大的淋巴结切除活检可早期诊断乳腺癌。     

Inducible nitric oxide synthase expression is related to angiogenesis, bcl-2 and cell proliferation in hepatocellular carcinoma

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Microsatellite alteration and its characteristics in colorectal carcinoma

Objective: To determine the role of microsatellite alterations in carcinogenesis of colorectal carcinoma (CRC). Methods: Alterations of 10 microsatellite loci from 5 different chromosomes were detected in 92 colorectal cancers and their paired normal mucosa by PCR, denatured polyacrylamide gel electrophoresis and silver staining. Associations of microsatellite alterations with clinopathologic parameters were statistically clarifield. Results: Alterations of microsatellite were classified into microsatellite instability type I, type II and loss of heterozygosity (LOH). The carcinoma with ≧30% loci microsatellite alterations was defined as replication error(RER) positive tumors. Of 92 cases, 14 were RER+. Microsatellite alterations of P53₍₁₎ and D18S363 loci (64.29%) was most commonly identified in the RER+ tumors. RER+ were more commonly seen in poorly differentiated carcinomas and tended to occur in mucoid carcinomas. The type of microsatellite alterations varied in different histological types of CRC. Conclusions: Microsatellite alteration is a common molecular event in CRC. Different microsatellite loci showed various biologic significance. P53₍₁₎ and D18S363 should be essentially detected loci that can show the RER status of tumors. Project supported by the National Natural Science Foundation of China(No. 39770297) and Key Project of Zhejiang Committee of Science and Technology(No. 961103076)     

宫颈上皮内肿瘤及宫颈鳞状细胞癌组织中HPV16感染与hTERT，P21^wafl和Ki67表达关系的分析

为了探讨宫颈鳞状细胞癌（SCC）及宫颈上皮内肿瘤（CIN）组织中入乳头瘤病毒（HPV）16感染及端粒酶反转录蛋白（hTERT）、抑癌基因P21^wafl和增生抗原Ki67表达的关系及其意义，在130例正常宫颈组织及宫颈上皮内瘤样病变和宫颈鳞状细胞癌组织中，利用组织芯片技术，结合原位杂交技术，检测HPV16感染及结合免疫组织化学技术检测hTERT，Ki67，P21^wafl的表达．结果表明：1）CINⅡ级、CIN Ⅲ级、原位癌、浸润性鳞癌组织HPV16杂交信号阳性率显著高于正常宫颈组织（P均〈0．05），浸润性鳞癌HPV16阳性率也显著高于CIN（Х^2=5．670，P=0．017）．2）hTERT在CINⅡ级、CINⅢ级、原位癌、浸润性鳞癌组织中的表达都显著高于正常宫颈组织（P均〈0．05），浸涧性鳞癌hTERT表达率也显著高于原位癌及CIN（Х^2=18．870，P=0．000；Х^2=66．390，P=0．000）．CIN三级之间相比差异也具显著统计学意义（Х^=30．468，P：0．000）．3）P21^wafl在浸润性鳞癌组织中的阳性率显著低于正常宫颈组织（P〈0．05），但与CIN相比差异无显著统计学意义（P〉0．05）．CIN三级之间P21^wafl表达差异也无显著统计学意义（P〉0．05）．4）随着宫颈病变组织学严重程度的增加，Ki67表达逐渐增加（P〈0．05）．5）HPV16感染率与hTERT表达之间呈正相关（P〈0．05，r=0．339），与P21”“表达之间呈负相关（P〈0．05，r=0．337），与Ki67表达无相关性（P〉0．05）：hTERT与P21^wafl之间呈负相关（P〈0．05，r=-0．248），与Ki67表达呈正相关（P〈0．05，r=0．398）；P21^wafl与Ki67表达呈负相关（P〈0．05，r=-0．446）．可见：在宫颈上皮内肿瘤及宫颈鳞状细胞癌组织中，hTERT，P21^wafl，Ki67表达改变可能与HPV16感染有关，且几者之间互相作用，共同影响CIN的发展及宫颈鳞癌的发生．这些指标综合分析可能为阐明HPV16的恶性转化机制以及为提高宫颈鳞癌及其癌前病变诊断率提供参考依据．组织芯片技术是高效的研究基因及其表达产物的技术平台．     

Association of hypomethylation of LINE-1 repetitive element in blood leukocyte DNA with an increased risk of hepatocellular carcinoma

Global DNA hypomethylation has been associated with increased risk for cancers of the colorectum, bladder, breast, head and neck, and testicular germ cells. The aim of this study was to examine whether global hypomethylation in blood leukocyte DNA is associated with the risk of hepatocellular carcinoma (HCC). A total of 315 HCC cases and 356 age-, sex- and HBsAg status-matched controls were included. Global methylation in blood leukocyte DNA was estimated by analyzing long interspersed element-1 (LINE-1) repeats using bisulfite-polymerase chain reaction (PCR) and pyrosequencing. We observed that the median methylation level in HCC cases (percentage of 5-methylcytosine (5mC)=77.7%) was significantly lower than that in controls (79.5% 5mC) (P=0.004, Wilcoxon rank-sum test). The odds ratios (ORs) of HCC for individuals in the third, second, and first (lowest) quartiles of LINE-1 methylation were 1.1 (95% confidence interval (CI) 0.7–1.8), 1.4 (95% CI 0.8–2.2), and 2.6 (95% CI 1.7–4.1) (P for trend <0.001), respectively, compared to individuals in the fourth (highest) quartile. A 1.9-fold (95% CI 1.4–2.6) increased risk of HCC was observed among individuals with LINE-1 methylation below the median compared to individuals with higher (>median) LINE-1 methylation. Our results demonstrate for the first time that individuals with global hypomethylation measured in LINE-1 repeats in blood leukocyte DNA have an increased risk for HCC. Our data provide the evidence that global hypomethylation detected in the easily obtainable DNA source of blood leukocytes may help identify individuals at risk of HCC.     

Combining proteomics, serum biomarkers and bioinformatics to discriminate between esophageal squamous cell carcinoma and pre-cancerous lesion

Objective

Biomarker assay is a noninvasive method for the early detection of esophageal squamous cell carcinoma (ESCC). Searching for new biomarkers with high specificity and sensitivity is very important for the early detection of ESCC. Serum surface-enhanced laser desorption/ionization-time of flight mass spectrometry (SELDI-TOF-MS) is a high throughput technology for identifying cancer biomarkers using drops of sera.

Methods

In this study, 185 serum samples were taken from ESCC patients in a high incidence area and screened by SELDI. A support vector machine (SVM) algorithm was adopted to analyze the samples.

Results

The SVM patterns successfully distinguished ESCC from pre-cancerous lesions (PCLs). Also, types of PCL, including dysplasia (DYS) and basal cell hyperplasia (BCH), and healthy controls (HC) were distinguished with an accuracy of 95.2% (DYS), 96.6% (BCH), and 93.8% (HC), respectively. A marker of 25.1 kDa was identified in the ESCC patterns whose peak intensity was observed to increase significantly during the development of esophageal carcinogenesis, and to decrease obviously after surgery.

Conclusions

We selected five ESCC biomarkers to form a diagnostic pattern which can discriminate among the different stages of esophageal carcinogenesis. This pattern can significantly improve the detection of ESCC.     

CT检查在鼻咽癌放疗前后疗效判断中的临床价值

通过60例鼻咽癌放疗前后不同时期的CT扫描图像观察，发现鼻咽癌放疗后各阶段CT征象具有不同特点，并随时变化呈现一定的规律性，以鼻咽改变最为复杂，容易误诊为复发。掌握其变化规律，对鉴别放疗后复发具有重要价值。     

Breast metastasis from small cell lung carcinoma

Breast metastases from extramammary neoplasms are very rare. We presented a 66 year-old female with metastasis of small cell lung carcinoma to the breast. She presented with consolidation over the left upper lobe of her lung undetermined after endobronchial or video-assisted thoracoscopic surgery (VATS) biopsy, and this was treated effectively after antibiotic therapy at initial stage. The left breast lumps were noted 4 months later, and she underwent a modified radical mastectomy under the impression of primary breast carcinoma. However, the subsequent chest imaging revealed re-growing mass over the left mediastinum and hilum, and cells with the same morphological and staining features were found from specimens of transbronchial brushing and biopsy. An accurate diagnosis to distinguish a primary breast carcinoma from metastatic one is very important because the therapeutic planning and the outcome between them are different.     

Hand-assisted laparoscopic nephroureterectomy: Initial case report

Nephroureterectomy with removal of a bladder cuff was performed successfully on a 47-year-old man for transitional cell carcinoma of the right renal pelvis using hand-assisted laparoscopy. The results showed that hand-assisted laparoscopic nephroureterectomy is an efficacious alternative to open surgery and provides the urologist new to laparoscopy a shorter learning curve compared with standard laparoscopy.     

腹腔镜下早期卵巢癌全面分期手术40例临床分析

目的探讨腹腔镜下早期卵巢癌全面分期手术的手术方法,评估其安全性、可行性和临床效果。方法对40例腹腔镜下早期卵巢癌全面分期手术患者的临床资料进行回顾性分析。结果所有病例均在腹腔镜下完成全面分期手术,平均手术时间182 min,术中平均出血量172 mL,平均切除盆腔淋巴结及腹主动脉旁淋巴结15.3个,术后平均肛门排气时间2.5 d,近期观察无严重手术并发症。结论腹腔镜下进行早期卵巢癌全面分期手术具有创伤小、出血少、恢复快、并发症少、术后病率低、住院时间短、临床效果好,方法可行。