目的 探讨CD117在肺基底样细胞鳞状细胞癌(BSCC)与小细胞肺癌(SCLC)中的鉴别诊断作用。方法 免疫组织化学检测CD117在肺BSCC与SCLC中的表达情况,并进行统计学分析,同时文献复习CD117在这两种肿瘤中的表达情况。结果 CD117在SCLC中特异性高表达(阳性率为78%),并且具有高的敏感度、特异度、阳性预测值及阴性预测值(分别为100%、78.2%、68.7%、100%),与文献报道一致(阳性率37%～100%);而在BSCC中未见有CD117的表达,文献未见有CD117在BSCC中表达情况报道。结论 CD117有可能成为鉴别诊断BSCC与SCLC的重要指标之一。但由于本报道例数有限,还需要更大型的研究进一步证明CD117在鉴别诊断二者中的敏感度及特异度。

Objective To investigate the role of CD117 in differentiating basaloid squamous cell carcinoma (BSCC) from small cell carcinoma (SCLC) in lung. Methods Immunohistochemistry staining of CD117 and statistic data were analyzed in BSCC and SCLC, and relevant literature were reviewed. Results CD117 was specifically expressed in high level ( positive rate 78%) in SCLC with high sensitivity, specificity, positive predictive value and negative predictive value (respectively 100%、78.2%、68.7%、100%), which was highly consistent with literature reports (positive rate 37%-100%). CD117 was not detected in BSCC in our report and it was the same as in literatures. Conclusion Although our results showed that it was possible that the expression of CD117 would play an important role in differentiating BSCC from SCLC, due to limited cases in number, more studies are needed to elucidated the sensitivity and specificity.

目的 以临床病例为研究对象,探讨年龄与性别对鼻咽癌自我病情延误的影响,寻找鼻咽癌科普宣教的重点靶标人群。方法 收集2015年4月—2015年12月广州医科大学附属肿瘤医院放疗科鼻咽癌病区收治的经活检病理确诊初治鼻咽癌患者62例(年龄28～77岁,中位年龄49岁),记录患者主诉症征出现至病理确诊鼻咽癌其相关症状的持续时间,采用t检验和Pearson相关分析探讨性别及年龄对鼻咽癌确诊前相关症征持续时间的影响。结果 62例患者确诊前均自我发现鼻咽癌相关症征,其中43例(69.4%)发现鼻咽原发灶相关症状,35例(56.5%)发现颈部淋巴肿大症状。Pearson相关分析显示,鼻咽癌确诊前颈部淋巴结肿大持续时间与年龄呈正相关(P＜0.05);t检验结果显示,男性患者鼻咽癌确诊前症状持续时间大于女性患者(P＜0.05)。结论 年龄较大和男性人群鼻咽癌自我病情延误较为严重,应该作为包括临床症状在内的鼻咽癌科普宣教的重点人群。

目的 分析KRAS基因突变在左半结肠、右半结肠癌分布几率的差异性。方法 回顾性分析我院病理科分子实验室2015年到2017年间接收的537例结肠癌手术标本,用ARMS-PCR法进行了KRAS基因的检测,并对左右半结肠腺癌KRAS基因突变比例进行χ²检验,P＜0.05为差异有统计学意义。结果 537例中有187(34.82%)例为右半结肠腺癌,左半结肠腺癌有350(65.18%)例。KRAS基因突变检测阳性例数为240例,阳性率为44.69%;右半结肠腺癌KRAS基因突变阳性数为114例,阳性率为60.96%;左半结肠癌KRAS基因突变阳性数为126例,阳性率为36.00%。双侧结肠腺癌KRAS基因突变差异有统计学意义。结论 右半结肠癌的患病例数低于左半结肠癌,右半结肠癌KRAS基因突变阳性率较左半结肠癌高,本研究为区分左右半结肠癌的分子靶向治疗提供了数据支持。

Objective To analyze the differences distribution of KRAS gene mutations in the left hemi colon cancer and right hemi colon cancer. Methods Retrospectively to analyse the 537 colorectal cancer patients who were received by our molecular laboratory of pathology from 2015 to 2017, ARMS-PCR method was used to detect the KRAS gene. The ratio of KRAS gene mutation in left and right hemi colon cancer was tested by χ² test, P<0.05 was considered statistically significant. Results There were 187(34.82%) patients with right hemi colon cancer; and there were 350 (65.18%)patients with left half hemi colon cancer. The KRAS positive patients were 240 cases, which were 44.69% in total. The positive patients with right hemi colon cancer were 114 cases which had a higher rate of 60.96%, the left hemi colon cancer patients were 126 cases with a lower rate of 36.00%. Conclusion The number of right hemi colon cancer was lower than the number of left hemi colon cancer. And the KRAS gene mutation in right hemi colon cancer had more positive than left hemi colon cancer. This study provides a number aid for treating right and left colon cancer in the subsequent molecular targeted drug therapy.

目的 探讨结肠原发性腺鳞癌和鳞癌的临床病理特征、诊断、发病机制及预后。方法 分析2例结肠原发性腺鳞癌和鳞癌的临床特点、组织学、免疫组化及基因检测特点,并结合相关文献进行讨论。结果 2例患者均因右下腹隐痛入院,平均年龄69岁,肿瘤均位于右半结肠。腺鳞癌可见腺鳞两种成分随机混合在一起,鳞癌成分免疫组化结果示CK5/6,P63均阳性,基因检测结果(ARMS-PCR法):腺鳞癌KRAS 2号外显子突变,BRAF未突变,鳞癌KRAS和BRAF均未突变。腺鳞癌患者术后放弃治疗1个月后死亡,鳞癌患者5个月后死于肝转移。结论 结肠原发性腺鳞癌/鳞癌非常少见,其临床症状与腺癌相似,但临床过程却更具侵袭性,预后相对较差,所以在临床中需得到重视。

Objective To study the clinicopathologic features, diagnosis, pathogenesis and prognosis of primary colon adenosquamous carcinoma and squamous cell carcinoma. Methods We analyzed clinical features, histological morphology, immunohistochemical results and gene mutation. Besides, relevant literatures were also reviewed. Results The two patients with an average of 69 years were admitted to the hospital due to abnormal pain. The tumors were all located in the right hemicolon. Adenosquamous carcinoma contained both components that mixed haphazardly. Immunohistochemistry showed that both CK5/6 and P63 were positive in squamous cell carcinoma. KRAS exon 2 mutations and BRAF wide-type were found in adenosquamous carcinoma patient, while KRAS and BRAF wide-type were found in squamous cell carcinoma patient using ARMS-PCR method. Adenosquamous carcinoma patient abandoned treatment and died after one month and the other died of liver metastasis in five months after surgery. Conclusion Primary colon adenosquamous carcinoma and squamous cell carcinoma are very rare. They have the similar clinical symptoms, more invasive clinical processes and worse prognosis compared with adenocarcinoma, therefore should be valued in clinic.

目的 探讨鼻咽癌(NPC)放疗致鼻窦炎发生的临床特征、影响因素。方法 回顾性分析2014年1月—2017年6月期间,我院收治的228例NPC患者临床资料,根据患者是否进行放疗,将患者分为非放疗组(106例)和放疗组(122例)。对比分析两组鼻咽癌致鼻窦炎的临床特点,以单因素和多因素Logistic分析鼻咽癌患者放疗后发生鼻窦炎的影响因素。结果 放疗组患者鼻窦炎发生率为81.97%,高于非放疗组患者鼻窦炎发生率54.72%,差异有统计学意义(P＜0.05)。放疗组鼻窦炎累及部位发生率从高到低,依次为后组筛窦、蝶窦、前组筛窦、窦口鼻道复合体、额窦以及上颌窦。放疗组患者鼻窦炎后组筛窦、蝶窦累及率高于非放疗组患者,差异具有统计学意义(P＜0.05)。单因素分析结果显示,放疗后鼻窦炎的发生,与患者年龄是否＞50岁,病程是否＞2年,是否存在鼻腔侵犯,肿瘤分期,是否使用滴鼻剂及是否进行鼻咽冲洗有关,差异有统计学意义(P＜0.05)。多因素Logistic回归分析结果显示,患者病程＞2年,存在鼻腔侵犯以及T3+T4期肿瘤是NPC放疗后鼻窦炎发生的独立危险因素;使用滴鼻剂和鼻咽冲洗是NPC放疗后鼻窦炎发生的保护因素。结论 NPC放疗后具有较高的鼻窦炎发生率,并且主要累及后组筛窦和蝶窦,对于病程＞2年、存在鼻腔侵犯以及T3+T4期肿瘤的患者,应积极采取措施预防鼻窦炎的发生,使用滴鼻剂和鼻咽冲洗是预防NPC放疗后鼻窦炎发生的有效措施。

Objective To investigate the clinical features and influencing factors of nasosinusitis caused by nasopharyngeal carcinoma (NPC) radiotherapy. Methods The clinical data of 228 NPC patients admitted to our hospital from January 2014 to June 2017 were retrospectively analyzed. According to whether the patients were treated with radiotherapy, the patients were divided into non-radiotherapy group (106 cases) and radiotherapy group (122 cases). The clinical characteristics of nasosinusitis were analyzed and compared. Univariate and multivariate logistic analysis was used to analyze the influencing factors of nasosinusitis after radiotherapy in patients with nasopharyngeal carcinoma. Results The incidence of sinusitis was 81.97% in the radiotherapy group, which was higher than that in the non-radiotherapy group (54.72%). The difference was statistical significance (P<0.05). The incidence of sinusitis involvement in the radiotherapy group was in the order of ethmoid sinus, sphenoid sinus, anterior ethmoid sinus, sinus ostium and nasal tract sinus complex, frontal sinus, and maxillary sinus. The incidences of ethmoid sinus and sphenoid sinus in the post-nasal sinusitis group were higher than that in the non-radiotherapy group (P<0.05). Univariate analysis showed that the occurrence of sinusitis after radiotherapy was related to whether the patient's age was > 50 years, whether the disease duration was >2 years, whether there was nasal invasion, tumor staging, whether nasal drops were used, and whether nasopharyngeal irrigation was performed. Multivariate logistic regression analysis showed that patients with a disease course of >2 years had nasal invasion and T3+T4 tumors were independent risk factors for sinusitis after NPC radiotherapy; use of nasal drops and nasopharyngeal washing were protective factors. Conclusion There is a higher incidence of sinusitis after radiotherapy of NPC, and mainly affects the ethmoid sinus and sphenoid sinus in the posterior group. Patients with a disease course of >2 years, with nasal invasion, and T3+T4 tumors should actively take measures to prevent the occurrence of sinusitis. The use of nose drops and nasopharyngeal washing is an effective measure to prevent the occurrence of sinusitis after NPC radiotherapy.

目的 回顾性分析不同病理类型乳腺黏液腺癌的超声声像图特征,从而提高术前乳腺黏液腺癌不同亚型的超声诊断准确率。方法 分析43名患者共44例手术切除或穿刺活检证实为乳腺黏液腺癌病灶的声像图资料,包括病灶的边界、边缘、形态、回声类型、生长方向、钙化、后方回声、血流分级、腋窝淋巴结形态,并对病灶进行BI-RADS分类。将超声声像图特征与手术或活检后病理结果进行对比,总结出不同亚型的乳腺黏液腺癌的超声声像图特征。结果 44例乳腺黏液腺癌病理类型分为21例单纯型黏液腺癌和23例混合型黏液腺癌,混合型黏液腺癌大多数表现为病灶边界不清(73.9%)、边缘模糊毛刺(73.9%)、形状不规则(91.3%)、以及内部回声不均匀(87%)、病灶内钙化更多见(52.2%)。混合型黏液腺癌的淋巴结转移率明显高于单纯型黏液腺癌(P<0.05)。对比术前病灶的BI-RADS分类及术后病理诊断,超声对恶性病灶诊断准确率68%,单纯型黏液腺癌和混合型黏液腺癌的诊断准确率分别为48.6%、87%。结论 不同病理类型乳腺黏液腺癌间具有一些不同的声像图特征。混合型黏液腺癌大多数表现为病灶边界不清、边缘模糊毛刺、形状不规则、回声不均匀、病灶内钙化多见;单纯型乳腺黏液腺癌通常表现为边界清晰、形态规则、钙化少见、淋巴结转移少等良性肿块声像特征,超声对其误诊率较高,需提高警惕。

Objective Retrospectively evaluate the sonographic features of different types of mucinous breast carcinoma to improve the preoperative ultrasound diagnostic accuracy rate. Methods Sonographic features of 44 cases of MBC proven by pathological biopsy were analyzed, including the margin,lesion boundary,shape,echo pattern,lesion growth pattern, calcification, posterior acoustic feature,blood flow, lymph node form and data system(BI-RADS)classification for the lesion to sum up the different subtypes of breast ultrasonic ultrasonographic features of mucinous carcinoma. Results 21 cases of pure mucinous carcinoma (PMBC)and 23 cases of mixed mucinous carcinoma(MMBC)were founded. MMBC were more likely to have unclear boundary (73.9%), indistinct or spiculate of margin(73.9%), irregular shape (91.3%), heterogeneous internal echo (87%), more calcification in lesions(52.2%). Lymph node metastasis in MMBC was obviously higher than that of PMBC(P<0.05). Compared with preoperative of the BI-RADS classification and pathological diagnosis, ultrasonography in diagnosing accuracy rate was 68% in malignant lesions, 48.6% in PMBC and 87% in MMBC. Conclusion There are some different ultrasonographic characteristics in different types of breast mucinous carcinoma.MMBC are more likely to have unclear boundary, indistinct or spiculate of margin, irregular shape, more calcification in lesions. On the contrary, PMBC has a circumscribed boundary, abrupt interface edge, rare calcification, rare lymph node metastasis and are easily misdiagnosed as benign lesions. We should pay more attention to avoid misdiagnosis in ultrasonography.

目的 研究鳞癌抗原(SCC-Ag)的表达对宫颈癌手术治疗后临床转归的预测价值。方法 选取我院2014年4月—2015年9月实施宫颈癌手术的患者52例,分别于手术前后分析所有患者的鳞癌抗原表达,对患者进行1年的随访,以发生癌细胞转移、复发或死亡为研究终点,比较预后良好的患者与预后差的患者鳞癌抗原的表达的不同。结果 Ia、Ib1、Ib2、IIa、IIb期宫颈癌患者术后SCC-Ag水平较手术前均显著降低(P＜0.05);纳入本次研究的患者宫颈癌术后复发或转移发生率为15.38%,转归良好的患者为84.62%,预后良好的患者术后SCC-Ag水平(0.91±0.27)ng/mL较发生复发或转移的患者(1.37±0.57)ng/ml显著较较低(P＜0.05)。结论 宫颈癌患者术后血清SCC-Ag水平与肿瘤的应答之间具有关联性,术后SCC-Ag水平高的患者复发与转移发生率显著高于SCC-Ag水平低的患者,鳞癌抗原的表达对宫颈癌手术后患者的转归情况具有预测价值,临床应予以重视。

目的 研究PF诱导化疗联合调强放疗及二维放疗对鼻咽癌近远期疗效影响的回顾性分析。方法 回顾性分析2008年1月—2008年12月中山大学附属肿瘤医院收治的101例鼻咽癌患者治疗情况,按照治疗方案技术分为调强组(n=42)和二维组(n=59)。比较两组患者临床疗效,近期毒副反应及生存情况。结果 放疗结束时调强组患者总缓解率92.86%与二维组77.97%比较差异有统计学意义(P<0.05)。调强组Ⅲ-Ⅳ级胃肠道反应26.19%及黏膜炎14.29%发生率与二维组比较显著较少,差异有统计学意义(P<0.05)。两组患者远期毒副反应及生存率比较无显著差异(P>0.05)。结论 PF诱导化疗联合调强放疗治疗鼻咽癌患者,近远期临床疗效好,毒副反应少。

Objective To study the effects of PF induced chemotherapy combined with intensity modulated radiation therapy and two-dimensional radiotherapy on the short and long term curative effects in nasopharyngeal carcinoma. Methods The treatment condition of 101 cases of patients with nasopharyngeal carcinoma who were treated in the Tumor Hospital Affiliated to San Yat-sen University between January and December 2008 were retrospectively analyzed. According to different treatments, the cases were divided into the intensity modulated group and the two-dimensional group. The clinical curative effects, short-term toxic and side effects and survival status were compared between the two groups. Results At the end of radiotherapy, the total remission rate in the intensity modulated group was 92.86% while in the two-dimensional group was 77.97% (P<0.05). In the intensity modulated group, the incidence rates of grade Ⅲ-Ⅳgastrointestinal tract reactions (26.19%) and mucositis (14.29%) were significantly lower than those in the two-dimensional group (P<0.05). There was no significant difference in long-term side effects and survival rate between the two groups (P>0.05). Conclusion PF induced chemotherapy combined with intensity modulated radiation therapy in the treatment of patients with nasopharyngeal carcinoma has good short and long-term curative effects and few toxic and side effects.

目的 研究细胞周期调控因子E2F-1和p16蛋白与宫颈上皮内瘤变及宫颈鳞癌的表达及其临床意义。方法 通过免疫组化SP法检测宫颈上皮内瘤变Ⅰ-Ⅱ级(CINⅠ-Ⅱ级)、宫颈上皮内瘤变Ⅲ级(CINⅢ级)、宫颈鳞癌各40例中E2F-1和p16蛋白的表达情况,并用20例慢性宫颈炎组织作对照。结果 E2F-1蛋白在CINⅠ-Ⅱ级、CINⅢ级和宫颈鳞癌组中阳性率分别为17.5%、67.5%和80.0%, 3组间有差异(χ²=37.278,P<0.001)。p16蛋白表达阳性率分别为27.5%、70.0%和82.5%,3组间差异有统计学意义(χ²=27.708, P<0.001)。CINⅠ-Ⅱ级与CINⅢ级组及宫颈鳞癌组比较均有差异,但CINⅢ级与宫颈鳞癌组间无差异。p16蛋白的表达与E2F-1蛋白表达有正相关关系;在鳞癌组中E2F-1与p16的异常表达与组织学分级、临床分期有关(P<0.05)。结论 子宫颈鳞癌的形成与E2F-1 、p16蛋白过表达是呈正相关关系,E2F-1 、p16 蛋白可能作为子宫颈鳞癌及CIN的标志物,对子宫颈癌筛查和预防有重要意义。

Objective To explore the clinicopathologic significance of the protein expression of cell cycle regulators E2F-1 and P16 in cervical intraepithelial neoplasia(CIN) and cervical squamous cell carcinoma(SCC). Methods Immunohistochemical technique S-P was used to determinate the expression of E2F-1 and P16 protein in 40 cases with CINⅠ-Ⅱ, 40 cases with CINⅢ and 40 cases with cervical squamous cell carcinoma. Results The positive rate of E2F-1 protein expression in CINⅠ-Ⅱ, CINⅢ and cervical squamous cell carcinoma was 17.5%,67.5% and 80.0%, respectively. There were significant differences among the three groups(χ²=37.278,P<0.001). The positive rate of P16 protein expression in CINⅠ-Ⅱ, CINⅢ and cervical squamous cell carcinoma was 27.5%,70.0% and 82.5%, respectively. There were significant differences among the three groups (χ²=27.708, P<0.001). The group with CINⅢ and cervical squamous cell carcinom compared with the group withCINⅠ-Ⅱ did have differences. But there were no significant differences in the group with CINⅢ and the group with cervical squamous cell carcinoma. The relative expressions between P16 and E2F-1 showed positive correlation. In the cervical squamous cell carcinoma group, the abnormal expression of E2F-1 and p16 were correlated with the histological grade and clinical stage. Conclusion It showed positive correlation between very high expression of p16 protein and E2F-1 infection in CIN and SCC. p16 protein and E2F-1 can be an indicator in SCC and CIN,which has very significance in preventing and screening of cervical cancer.

目的 观察miR-9在胃癌组织中的表达水平及其与临床病理的相关性。方法 采用实时荧光定量PCR方法分别检测28例胃癌及正常胃组织中miR-9的表达水平,并分析其表达情况与临床病理资料的关系。结果 胃癌组织miR-9的表达水平[0.0078(0.0031~0.0142)]显著低于相应正常胃组织[0.0177(0.0084~0.0311), P<0.05],尤其是伴淋巴结转移者[0.0021(0.0006～0.0685)]miR-9表达水平明显降低。结论 胃癌组织中miR-9低表达,且与胃癌淋巴结转移有关。

Objective To investigate the correlation between the level of miR-9 expression and clinicopathology in gastric carcinoma. Methods The expression of miR-9 in 28 cases of gastric carcinoma tissues and normal gastric tissues were detected by quantitative real-time PCR, and the relationship between the expression and clinicopathology was analyzed. Results The expression of miR-9 expression in gastric carcinoma tissues [0.0078(0.0031~0.0142)] was significantly lower compared with the corresponding normal gastric tissues [0.0177(0.0084~0.0311), P<0.05], especially in lymph node-invasive carcinoma [0.0021(0.0006～0.0685)]. Conclusion miR-9 was down regulated in gastric cancer tissues, which was significantly associated with lymph node metastasis.