Comparison of Clinical and Ultrasonographic Features of Poorly Differentiated Thyroid Carcinoma and Papillary Thyroid Carcinoma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The clinical behavior and management of poorly differentiated thyroid carcinoma (PDTC) are very different from papillary thyroid carcinoma (PTC). By comparing the clinical and ultrasonographic features between the two tumors, we proposed to provide more possibilities for recognizing PDTC before treatment.</p><p><b>METHODS</b>The data of 13 PDTCs and 39 age- and gender-matched PTCs in Peking Union Medical College Hospital between December 2003 and September 2013 were retrospectively reviewed. The clinical and ultrasonic features between the two groups were compared.</p><p><b>RESULTS</b>The frequencies of family history of carcinoma, complication with other thyroid lesions, lymph node metastases, recurrent laryngeal nerve injuries, and distant metastases were higher in PDTCs (30.8%, 61.6%, 69.2%, 23.1%, and 46.2%, respectively) than those in PTCs (2.6%, 23.1%, 25.6%, 2.6%, and 2.6%, respectively) (P < 0.05). The mortality rate of PDTCs was greatly higher than PTCs (P < 0.01). Conventional ultrasound showed that the size of PDTCs was larger than that of PTCs (3.1 ± 1.9 cm vs. 1.7 ± 1.0 cm). Clear margins and rich and/or irregular blood flow were found in 92.3% of PDTCs, which differed substantially from PTCs (51.7% and 53.8%, respectively) (P < 0.05).</p><p><b>CONCLUSIONS</b>PDTC is more aggressive and its mortality rate is higher than PTCs. Accordingly, more attention should be given to suspicious thyroid cancer nodules that show large size, regular shape, and rich blood flow signals on ultrasound to exclude the possibility of PDTCs.</p>

Comparative study between primary mediastinal B-cell lymphoma and non-mediastinal diffuse large B-cell lymphoma by immunoglobulin gene rearrangement and Epstein-Barr virus infection detection / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate the differences between primary mediastinal B-cell lymphoma (PMBCL) and non-mediastinal conventional diffuse large B-cell common lymphoma (DLBCL) in immunoglobulin gene rearrangement and EB virus infections.</p><p><b>METHODS</b>Twenty cases of PMBCL and 30 cases of non-mediastinal DLBCL were collected from September, 2000 to May, 2011. Pathological data were retrospectively analysed. Immunoglobulin heavy chain and light chain gene rearrangements and EBER in-situ hybridization were performed.</p><p><b>RESULTS</b>Six of 20 cases of PMBCL showed monoclonal gene rearrangement, all of which were weakly detected. Twenty-seven of 30 cases of ordinary diffuse large B-cell lymphoma showed monoclonal gene rearrangement, which were strongly detected (90.0%). Only 1 of 20 cases PMBCL and 2 of 30 cases of DLBCL were positive for EBER in-situ hybridization.</p><p><b>CONCLUSIONS</b>The detection rate of immunoglobulin gene rearrangement is significantly lower in PMBCL than that of non-mediastinal DLBCL. However, EB virus infection rates are very low in both types of lymphomas.</p>

Pulmonary lymphomatoid granulomatosis: an immunohistochemical and gene rearrangement study / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the immunophenotype and gene rearrangement pattern of pulmonary lymphomatoid granulomatosis.</p><p><b>METHODS</b>Nine cases of pulmonary lymphomatoid granulomatosis, included 5 cases of open lung biopsy, 3 cases of lobectomy specimen and 1 case of autopsy, were retrospectively analyzed by immunohistochemistry, in-situ hybridization for Epstein-Barr virus-encoded RNA, immunoglobulin and T-cell receptor gene rearrangement studies.</p><p><b>RESULTS</b>The age of patients ranged from 3 to 59 years. The male-to-female ratio was 3: 6. Histologically, all cases showed lymphocytic infiltration surrounding the blood vessels and in the perivascular areas. Most of these lymphoid cells expressed T-cell marker CD3. There were also variable numbers of CD20-positive B cells. The staining for CD56 was negative. According to the WHO classification, there were 4 cases of grade I , 1 case of grade II and 4 cases of grade III lesions. Six cases had gene rearrangement studies performed and 3 of them demonstrated clonal immunoglobulin gene rearrangement (including 1 of the grade II and 2 of the grade III lesions). No T-cell receptor gene rearrangement was detected.</p><p><b>CONCLUSIONS</b>Pulmonary lymphomatoid granulomatosis may represent a heterogeneous group of lymphoproliferative disorders. Some of the cases show B-cell immunophenotype and clonal immunoglobulin gene rearrangement, especially the grade II and grade lesions. They are likely of lymphomatous nature.</p>

Primary sarcoma of the ovary: clinicopathological characteristics, prognostic factors and evaluation of therapy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The primary ovarian sarcoma is a very rare malignancy. The objective of this study was to further investigate the clinicopathologic features and outcome in patients with primary sarcoma of the ovary.</p><p><b>METHODS</b>Between 1988 and 2007, 24 patients with primary ovarian sarcoma who underwent treatment at Peking Union Medical Hospital were reviewed retrospectively. Response to treatment, progression and overall survival were analyzed.</p><p><b>RESULTS</b>Patients with ovarian sarcoma had a mean age of (54.3 ± 10.3) years, and 16 of them were postmenopausal. The most common symptom was abdominal pain, present in 14 patients. Of the 24 patients, 16 patients were pathologically diagnosed as carcinosarcoma (known as malignant mixed mesodermal tumor (MMMT)), 2 as ovarian leiomyosarcoma (LS) and 6 patients as ovarian endometrial stromal sarcoma (ESS). The patients in optimal debulking group had a median survival period of 28 months and 1-year survival rate of 71%. The patients in suboptimal debulking group had a significantly lower median survival of 6 months (P = 0.02) and 1-year survival rate of 29%. Among the patients, 23 patients received chemotherapy and most of regimens were based on platinum, 3 patients received chemoradiation. The mean number of courses of combined chemotherapy was 6.6 ± 5.0, and the response was unsatisfactory. The median survival for the entire group was 18.7 months. The one-year survival rate was 58%, and two-year survival rate only 29%.</p><p><b>CONCLUSIONS</b>Ovarian primary sarcoma has a poor overall prognosis. Optimal debulking surgery appears to be of prognostic significance. There is a clear need for further study to explore the role and the regimen of platinum-based chemotherapy in primary ovarian sarcoma.</p>

Diagnosis and treatment of 166 patients with early gastric cancer / 中国医学科学院学报

<p><b>OBJECTIVE</b>To summarize our experiences in the diagnosis and treatment of early gastric cancer (EGC).</p><p><b>METHODS</b>The clinicopathological data of the 166 EGC inpatients who were treated in our hospital from January 1999 to January 2009 were retrospectively analyzed and their treatment outcomes were followed up.</p><p><b>RESULTS</b>Surgical treatment for ECG accounted for 9.04% (176/1946) among all the surgeries performed for gastric cancers. Among the analyzed 166 cases, 9 asymptomatic patients were diagnosed by routine examination, 29 (17.47%) had a history of gastric ulcer or chronic gastritis, and 20 (12.05%) had a family history of esophageal or gastric cancer. Of 64 patients who received double-contrast gastric X-ray examination, 57 patients (89.06%) were found to be with abnormalities. Endoscopy revealed lesions in lower third, middle third, and upper third of the stomach in 115 patients (69.28%), 26 patients (15.66%), and 25 patients (15.06%), respectively. A total of 126 patients received D(0) or D1 operations and 40 patients received operations more than D+1 operation. As shown by post-operative pathological examinations, the mean diameter of the lesions was (2.52±1.62) cm; 75 patients (45.18%) had mucosal gastric cancer, 91 (54.82%) had submucosal gastric cancer, 20 patients with submucosal gastric cancer had lymph node metastasis, and 8 patients had lymphatic vessel involvement. The overall 5-year survival rate was 70.0% and 89.7% among patients with or without lymph node metastasis (P=0.002). Univariate analysis revealed that depth of tumor invasion (submucosa) and lymphatic vessel involvement were significantly correlated with lymph node metastasis (P=0.000, P=0.001). Multivariate analysis showed that lymphatic vessel involvement was significantly correlated with lymph node metastasis (odds ratio: 15.67; 95% confidence interval, 3.40-72.14).</p><p><b>CONCLUSIONS</b>The proportion of EGC patients undergoing gastrectomy is relatively low among all gastric cancer patients. Lymph node metastasis is a key prognostic factor for EGC. A proper staging of gastric cancer, a precise evaluation of the depth of infiltration, and appropriate and standardized treatment are important to improve the outcomes.</p>

Targeted magnetic nanoparticles used as probe for magnetic resonance molecular imaging of tumor / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the feasibility of in vivo tumor detection using magnetic resonance (MR) molecular imaging with targeted magnetic nanoparticles as imaging probe.</p><p><b>METHODS</b>Targeted probe was synthesized by covalently linking the recombinant human gonadotropin releasing hormone analog (the targeting portion) with the ultrasmall superparamagnetic iron oxide nanoparticles (the imaging portion). The imaging portion served as the control material. The in vitro tumor cell experiment and the in vivo experiment using nude mice bearing tumors were carried out to test the targeting ability of the probe. In the in vitro experiment, the targeting probe and control materials were incubated separately with A549 cells which had high affinity to gonadotropin releasing hormone. Then the cells were taken out and lysed. The resultant solution was then subjected to MR imaging. The T2 value of the solutions was measured and compared. In the in vivo experiment, the targeting probe was administered into nude mice bearing A549 tumors. Dynamic MR imaging was carried out to measure the signal and T2 value of the tumor. The control material was also administered into control group of nude mice, and dynamic magnetic resonance imaging was performed. The T2 value of the tumor in both groups were recorded and compared.</p><p><b>RESULTS</b>Both the in vitro and in vivo experiments proved the targeting ability of targeted probe. Compared with control material, the targeting probe had higher combining ability with tumor cells.</p><p><b>CONCLUSION</b>MR molecular imaging of tumor can be realized by using targeting magnetic nanoparticles.</p>

Gastric small cell carcinoma: 6 cases report and review of literature / 中华外科杂志

<p><b>OBJECTIVE</b>To report the management experiences of of gastric small cell carcinoma.</p><p><b>METHODS</b>The clinicopathological data of 6 cases of gastric small cell carcinoma treated from 1997 to 2007 were retrospectively reviewed. And meanwhile review the relevant literature.</p><p><b>RESULTS</b>All the 6 cases were male with an average age of 56.5 years (range, 40-66 years). All the patients received surgery and 4 of them received postoperative adjuvant chemotherapy. Two cases were followed up, one lived without recurrence for 4 years all along, the other one died of recurrence and extensive metastasis 9 months after operation. In the literature, 164 male and 59 female patients have been reported to date, with an average age of 64.2 yrs (range, 42-84 years). Tumor located in the fundus in 97 cases, 55 in gastric body,54 in gastric antrum. In gross, 137 cases were classified as ulcerative type, 47 were protruded type. The average tumor diameter was 6.23 cm (range, 0.8-17.0 cm). Among 223 cases, only 43 survived more than 1 year.</p><p><b>CONCLUSIONS</b>It is difficult to make a definite diagnosis before or during the operation for gastric small cell carcinoma. The radical operation could be done according to other gastric cancer and the lymph node dissection could be simplified. Postoperative chemotherapy with the same scheme as lung small cell carcinoma may help improving the outcome.</p>

Clinicopathologic study of primary marginal zone B-cell lymphoma of MALT type and lymphoid hyperplasia of lung / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the clinicopathologic features, immunohistochemical findings and immunoglobulin heavy chain (IgH) gene rearrangement results of primary pulmonary mucosa-associated lymphoid tissue lymphoma (MALToma) and reactive lymphoid hyperplasia.</p><p><b>METHODS</b>Twenty cases, included 13 cases of pulmonary MALToma and 7 cases of pulmonary lymphoid hyperplasia, encountered during the period from 1989 to 2007, were retrospectively analyzed. The samples were paraffin-embedded and stained with hematoxylin and eosin. Immunohistochemical study and semi-nested polymerase chain reaction for IgH gene rearrangement were performed.</p><p><b>RESULTS</b>The 13 cases of primary pulmonary MALToma were composed of a spectrum of lymphoid cells, including lymphocyte-like cells, centrocyte-like cells and mononuclear B cells with plasmacytoid differentiation. They often had diffuse or marginal zone growth patterns. Lymphoid follicles with neoplastic colonization were apparent. The lymphoma cells spread along alveolar septa and bronchovascular bundles. Vascular invasion was noted in 9 cases, pleura involvement in 6 cases and nodal involvement in 2 cases. Lymphoepithelial lesions (LEL) were identified in 9 cases of pulmonary MALToma. Immunohistochemically, the lymphocytes in LEL were CD20-positive and CD3-negative. On the other hand, LEL was also present in 2 of the 7 cases of lymphoid hyperplasia studied, with a mixture of CD20-positive B cells and CD3-negative T cells. Eight of the 9 cases of primary pulmonary MALToma were positive for IgH gene rearrangement, while all of the 7 cases of lymphoid hyperplasia were negative.</p><p><b>CONCLUSIONS</b>Histologically, the cell population of primary pulmonary MALToma is similar to that of extranodal MALToma occurring in other organs. LEL, though commonly observed in pulmonary MALToma, are not specific and can also be seen in cases of reactive lymphoid hyperplasia. The immunophenotype of intraepithelial lymphocytes in pulmonary MALToma and reactive lymphoid hyperplasia is different. The presence of a monotonous population of CD20-positive intraepithelial lymphocytes supports a diagnosis of MALToma. IgH gene rearrangement study is also useful in differentiating both entities.</p>

Effects of Jinmaitong capsule on nerve growth factor in diabetic rats / 中国中药杂志

<p><b>OBJECTIVE</b>To study the effects of Jinmaitong Capsule (JMT) on the expression of NGF and NGF mRNA in STZ-induced diabetic rats.</p><p><b>METHOD</b>Fifty SZT-induced diabetic rats were randomly divided into 5 groups including model group, low-dose JMT group (treated with JMT similar to the quintupling dose of adult recommended dosage), middle-dose JMT group (treated with JMT similar to the decuple dose of adult recommended dosage), high-dose JMT group (treated with JMT similar to the twenty-fold dose of adult recommended dosage) and Neurotropin group (treated with Neurotropin similar to the decuple dose of adult recommended dosage). Ten normal rats matching with weight and age served as normal control group. All rats were given intragastric administration for 16 weeks and then killed. Body weight and blood glucose were detected before and at the 4, 8, 12, 16th week after treatment. The hydrothermal tail-flick and pain threshold to mechanical stimulation with Von Frey filament were carried out before death. The expression of NGF and NGF-mRNA in sciatic nerve were detected by SABC immunohistochemical method and real-time fluorogenetic quantitative PCR respectively.</p><p><b>RESULT</b>The blood glucose levels of STZ-DM rats were much higher than those of normal rats (P < 0.01). In all the treated groups, there were no significant differences among them compared each other or compared with model group. And it got the same result when concerning about body weight no matter how the rats were dealt with. Hydrothermal tail-flick test: The tail-flick latency of STZ-DM rats were much longer than those of normal rats (P < 0.01 or P < 0.05). Compared with model group, the time shortened significantly in low, middle-dose of JMT groups and Neutrophin group. Compared with normal group, the pain thresholds of model group decreased extremely (P < 0.01). Compared with model group, the threshold values of low-dose, middle-dose JMT group and neutrophin group raised strikingly (P < 0.05). The levels of NGF-mRNA expression in STZ-DM rats were much lower than those of the normal rats (P < 0.01). Compared with model group, NGF-mRNA expression of middle-dose JMT group and Neurotropin group upregulated noticeably (P < 0.01). The integrated option density of NGF expression in STZ-DM rats was much lower than the normal (P < 0.01 or P < 0.05). And the levels of NGF in all the treated groups increased notably compared with model group (P < 0.05 or P < 0.01). There were no significant differences among middle-dose JMT group and Neutrophin group.</p><p><b>CONCLUSION</b>Traditional Chinese medicine JMT could up-regulate the expression of NGF and NGF-mRNA in sciatic nerve.</p>

Endothelial cell chimerism by fluorescence in situ hybridization in gender mismatched renal allograft biopsies / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The blood vessels of a transplanted organ are the interface between donor and recipient. The endothelium in the blood vessels is thought to be the major target for graft rejection. Endothelial cells of a transplanted organ can be of recipient origin after transplantation. In this study, we tested whether endothelial chimerism correlated with the graft rejection and cold ischemia.</p><p><b>METHODS</b>We studied the biopsy samples from 34 renal transplants of female recipients who received the kidney from a male donor for the presence of endothelial cells of recipient origin. We examined the tissue sections of renal biopsy samples by fluorescence in situ hybridization (FISH) for the presence of endothelial cells containing two X chromosomes using a biotinylated Y chromosome probe and digoxigenin labelled X chromosome probe, and then analyzed the relationship between the endothelial cell chimerism and the rejection and cold ischemia.</p><p><b>RESULTS</b>Endothelial chimerism was common and irrespective of rejections (P > 0.05). The cold ischemic time of chimerism group was longer than no chimerism group ((14.83 +/- 4.03) hours vs (11.27 +/- 3.87) hours, P < 0.05).</p><p><b>CONCLUSIONS</b>There is no correlation between the percentage of recipient endothelial cells in vascular endothelial cells and the type of graft rejection. The endothelium damaged by ischemic injury might be repaired by the endothelial cells from the recipient.</p>

Advances in primary thyroid lymphoma / 中国医学科学院学报

Primary thyroid lymphomas (PTLs) are closely correlated with the autoimmune reaction of thyroid. However, the molecular mechanisms of PTLs are still unclear. It is really necessary to improve the ability to differentiate between benign and malignant PTLs along with the introduction of some new molecular biology methods. The diagnosis and prognosis of PTLs depend on their histological features, pathological classification, and clinical stages. Customized therapy of PTLs becomes possible with the further advances in lymphoma's pathological classification, clinical stages, and international prognosis index standard.

Diagnosis and treatment of chronic lymphocytic thyroiditis coexistent with thyroid malignancy / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the principles of diagnosis and treatment of chronic lymphocytic thyroiditis (CLT) coexistent with thyroid malignancy.</p><p><b>METHODS</b>The clinical data of 52 patients with CLT, including clinicopathologic features, treatment, and prognosis were retrospectively analyzed. Among these 52 patients, 40 patients had coexisting thyroid carcinoma (TC group) and 12 had coexisting thyroid lymphoma (TL group).</p><p><b>RESULTS</b>These two thyroid malignancies accounted for 13.87% of all the CLT inpatients during this period, in which 10.67% were CLT with carcinoma and 3.20% were CLT with lymphoma. Significant differences existed between TC group and TL group in sex (P = 0.008) , age (P = 0.000), and B-mode ultrasound findings (P = 0.000). Most patients in TC group received total lobectomy of one lobe and subtotal lobectomy of the other side, of which some received elective lymphadenectomy. The operations varied among patients in TL group, and most of them received chemotherapy after surgery. The median follow-up was (35.51 +/- 39.84) months for 37 patients in TC group, and 36 patients survived with a median period of (34.50 +/- 39.91) months; the median follow-up was (39.50 +/- 29.00) months for 12 patients in TL group, and 10 patients survived with a median period of (44.70 +/- 28.78) months.</p><p><b>CONCLUSIONS</b>CLT with thyroid malignancies are not uncommon in clinical practice. While thyroid carcinoma accounts for majority of these malignancies, its clinicopathologic features, treatment, and prognosis differs with thyroid lymphoma. Surgery may be appropriate for CLT patients with rapid thyroid enlargement or nodule, and for patients with solitary solid nodule or nodules with calcification revealed by B ultrasound.</p>

Gene rearrangement studies in Hashimoto's thyroiditis and primary lymphoma of thyroid / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the immunoglobulin gene rearrangement patterns in Hashimoto's thyroiditis (HT) and primary thyroid lymphoma (PTL), and to analyze the relationship between the two diseases.</p><p><b>METHODS</b>Formalin-fixed and paraffin-embedded tissues of 11 cases of PTL and 38 cases of HT as well as their clinical data, were retrieved. The latter group was further subcategorized into classic HT and suspicious PTL. Gene rearrangement studies for immunoglobulin heavy chains and light chains were carried out by polymerase chain reaction (PCR) using VH, FR3A and FR3kappa primers.</p><p><b>RESULTS</b>There was an increasing trend in immunoglobulin gene rearrangement rate for classic HT (10.7%), suspicious PTL (40.0%) and PTL (72.7%) groups. In general, a female predilection was observed. This sex predilection however was less obvious in the PTL group. There was no relationship between serum antibody (both thyroglobulin and thyroid peroxidase) titers and gene rearrangement patterns.</p><p><b>CONCLUSIONS</b>HT and PTL show morphologic overlaps and may not be clearly distinguished on the basis of light microscopy alone. PCR-based immunoglobulin gene rearrangement study may be helpful in the detection of cases with early lymphomatous transformation of HT.</p>

Clinicopathologic study of 10 cases of osteomalacia or rickets-associated mesenchymal tumors / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the clinicopathologic features of osteomalacia or rickets-associated mesenchymal tumors.</p><p><b>METHODS</b>The clinical and pathologic findings of 10 cases of osteomalacia or rickets-associated mesenchymal tumors were evaluated. Hematoxylin and eosin stain, immunohistochemistry and histochemistry were performed on the archival paraffin sections.</p><p><b>RESULTS</b>Amongst the 10 patients studied, 6 were males and 4 were females. Their age at the time of operation ranged from 28 to 69 years ( mean = 45.6 years). A history of long-standing bone pain, arthralgia, limitation in movement, hypophosphatemia and hyperphosphaturia was present in all cases. The duration of symptoms ranged from 2 to 27 years (mean = 9.6 years). The tumor size ranged from 1 to 7 cm (mean size = 3.52 cm). Microscopically, the tumors were composed of various mesenchymal cells, including spindled fibroblast-like cells, adipocytes, chondroid cells and mucinous cells. The background was rich in blood vessels. In 8 of the 10 cases, there was also dystrophic calcification in an unusual flocculent or "grungy" pattern. Peripheral woven bone shell formation was noted in 2 cases and non-urate crystal deposition in 2 cases. Mitotic figures were rare in 9 cases. In 1 of the 10 cases however, mitotic figures and bizarre cells were commonly encountered. On immunohistochemical study, the tumor cells were all positive for vimentin. There was focal positivity for smooth muscle actin and CD34 in 5 and 3 cases respectively. The staining for desmin, S-100 and AE1/AE3 was negative. Ki-67 proliferation index was less than 4% in 8 cases and 30% in 1 case. Alcian blue-positive mucinous matrix and mucinous degeneration around vessels were noted in 8 cases.</p><p><b>CONCLUSIONS</b>Most of the osteomalacia or rickets-associated tumors are either benign or low-grade malignant mesenchymal tumors. They can be mistaken as other neoplasms due to the morphologic heterogeneity present. Thorough understanding of the associated clinical features and laboratory investigation results is helpful in arriving at the correct diagnosis.</p>