More attention for high-risk pathological features for stage Ⅱ colorectal cancer required / 中华病理学杂志

Stage Ⅱ (T3-4N0M0) accounts for 25% of colorectal cancer and five-year survival is between 70% and 80%. However, 25% of patients develop distant metastases and have a survival rate similar to that of stage Ⅲ disease. However, whether or not to give adjuvant chemotherapy is still a controversial issue. As a result, there has been a lot of interest in the identification of the pathological factors underlying the poor prognosis associated with this stage, in order to establish a firmer basis for the administration of adjuvant chemotherapy. But not all high-risk factors are equal for stage Ⅱ colorectal cancer, variability still exists in the management and outcomes of high-risk patients. Here be introduced and commented on thinking and understanding about its controversy and evolution for the attention of the working pathologist and gastroenterologist doctors.

Correlation between tumor cell proliferation and prognosis of primary cutaneous malignant melanoma in 127 patients / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate the correlations among Ki-67 expression, mitosis and other clinicopathological parameters of primary cutaneous malignant melanoma, and search for prognostic factors of malignant melanoma.</p><p><b>METHODS</b>Totally 127 cases of primary cutaneous malignant melanoma were collected from Beijing Cancer Hospital. Immunohistochemical study for Ki-67 was performed, and the mitosis was calculated referring to "hot spot" method recommended by the seventh edition of the American Joint Committee on Cancer (AJCC) melanoma staging system. The correlations of Ki-67 expression, mitosis and other clinicopathological parameters were analyzed, and the survival analysis of all these risk factors including TNM and Clark level was conducted based on follow up data.</p><p><b>RESULTS</b>The expression level of Ki-67 was associated with necrosis and Breslow thickness (P < 0.05). Mitosis was correlated with Clark level and Ki-67 expression (P < 0.05). Univariate analysis indicated Ki-67 expression level (P = 0.043), mitosis (P = 0.030) and TNM stage (P < 0.001) might influence the survival of patients. However, multivariate analysis showed that the TNM staging was the only independent prognostic factor affecting survival.</p><p><b>CONCLUSIONS</b>The prognosis of patients with primary cutaneous malignant melanoma was closely related to the TNM staging at the fist examination. Ki-67 expression and mitosis are two important clinicopathological parameters of primary cutaneous malignant melanoma.</p>

Expression and prognostic significance of galectin-1 and galectin-3 in benign nevi and melanomas / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the expression and prognostic significance of galectin-1 and galectin-3 in different melanocytic lesions.</p><p><b>METHODS</b>The expression of galectin-1 and galectin-3 in 39 cases of benign nevus, 58 cases of primary cutaneous melanoma, 24 cases of primary mucosal melanoma, 69 cases of melanoma with lymph node metastasis and 8 cases of melanoma with distant metastasis were studied by immunohistochemistry and tissue microarray.</p><p><b>RESULTS</b>The expression of galectin-1 and galectin-3 was higher in benign nevi than in melanomas (P < 0.01). The nuclear expression of galectin-3 was higher in primary cutaneous melanomas than in primary mucosal melanomas or melanomas with metastases (P < 0.01, respectively). The expression correlated with age of patients (P < 0.05), necrosis (P < 0.05) and survival time (P < 0.01). Clark's level also correlated with survival time in patients with cutaneous melanomas (P = 0.037). TNM staging was the only independent prognostic factor for melanomas (P < 0.01).</p><p><b>CONCLUSIONS</b>The expression of galectin-1 and galectin-3 is decreased in melanomas. The decrease in nuclear expression of galectin-3 may represent a poor prognostic factor for melanomas. TNM staging is an independent prognostic factor which influences the survival time.</p>

Clinicopathological observation of gastric cancer with pathological complete response following neoadjuvant chemotherapy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To observe the clinicopathological characteristics of gastric cancer with pathological complete response(pCR) following neoadjuvant chemotherapy.</p><p><b>METHODS</b>Data of gastric cancer patients who received neoadjuvant chemotherapy from 2002 to 2008 in the Beijing Cancer Hospital were reviewed. Five cases were found to have pCR. The slides were reviewed by two experienced pathologists independently. Histological structure, morphology of tumor cells, morphology and quantity of stromal cells were evaluated.</p><p><b>RESULTS</b>Structure of the gastric wall was distinguishable in all the 5 cases, while distortion and rupture of muscular layer were found in 2 cases. Exudative inflammatory reaction was present in the whole gastric wall including the serosa layer. Three patients had ulcerative lesions with epithelial layer shedding, and atypical hyperplasia was found around the border of the ulcer, and vascular endothelial cells were swollen. Residual distorted necrotic tumor cells resided in 1 case only and no residual tumor cells was present in the other 4 patients. Significant hyperplasia of fibroblasts was present in 4 cases, large amount of lymphocytes infiltration in 3 cases including concurrent plasma cell infiltration in 1 case, multinucleated giant cell reaction in the muscular layer of 1 case, and foam cells aggregation in 1 case with mucinous adenocarcinoma. In addition, there were 2 cases with pCR had lymph node metastasis.</p><p><b>CONCLUSIONS</b>For cases with pCR following neoadjuvant chemotherapy, heterogeneity of stromal cells reaction is found in previous tumor site. Furthermore, the response of primary tumor does not necessarily parallel to that of lymph nodes.</p>

Epidermal growth factor receptor gene mutations and clinicopathologic correlation in 309 patients with non-small cell lung cancer / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate the epidermal growth factor receptor (EGFR) gene mutation profile and related clinicopathological features in Chinese patients with non-small cell lung carcinoma (NSCLC).</p><p><b>METHODS</b>Optimized oligonucleotide probe method was applied to detect EGFR mutations involving exons 18 - 21 using formalin fixed paraffin embedded tissue specimens of 309 NSCLC patients. The relationship between EGFR mutations and clinicopathological features were analyzed.</p><p><b>RESULTS</b>The overall EGFR mutation rate was 34% (105/309) in this study cohort. Mutation rates in male and female were 30.4% (56/184) and 39.2% (49/125), respectively. The mutation rate was higher in patients less than 60 years of age, non-smokers and adenocarcinoma subtype than in their counterparts (P<0.05), with the percentage of 40.5% (87/215), 40.2% (51/127), 38.8% (78/201), respectively. The EGFR mutation types included exon 18 G719X mutation (5.7%, 6/105), exon 19 deletion (39.0%, 41/105) and exon 21 L858R mutation (55.2%, 58/105). In large cell undifferentiated carcinomas and squamous cell carcinomas, EGFR mutation rates were 22.2% (58/105) and 3/14, respectively. The overall mutation rate of exon 18 was low, but the proportion of its mutation was higher in squamous and adenosquamous carcinomas than in adenocarcinomas.</p><p><b>CONCLUSIONS</b>There is a higher EGFR mutation rate in female, age of less than 60 years, non-smoker and adenocarcinoma among Chinese patients with NSCLC. Optimized oligonucleotide probe method is a sensitive and convenient method for the detection of EGFR mutations.</p>

Comparison of pathologic and clinical characteristics of young and old patients with advanced rectal cancer after neoadjuvant radiotherapy / 中华外科杂志

<p><b>OBJECTIVES</b>To address the difference of pathologic and clinical characteristics of the young and the middle-aged and elderly patients with advanced rectal cancer after neoadjuvant radiotherapy.</p><p><b>METHODS</b>A total of 252 patients undergoing radical surgery from January 2000 to January 2005 were included in this study. The patients were divided into two groups according to the age at diagnosis:young-patient group (< 40 years) and old-patient group (≥ 40 years). The pathologic and clinical materials were collected and the oncologic outcome was compared between the two arms.</p><p><b>RESULTS</b>A total of 252 patients were included in this study, included 54 patients in young-patient group and 198 patients in old-patient group, respectively. There was no significant difference in gender, clinical stage and pretreatment serum carcinoembryonic antigen (CEA) between the two groups. However, the proportion of mucinous and signet-ring cell cancer was significantly higher in young-patient group (20.4% vs. 4.0%, P < 0.05), and furthermore, the proportion of pathologic stage later than IIIA was also significantly higher in the young-patient group (61.1% vs. 42.9%, P < 0.05). There was no significant difference in local recurrence rate between the patients who received neoadjuvant radiotherapy and those who did not in the young-patient group, whereas the difference was observed significant in the old-patient group (3.3% vs. 11.2%, P < 0.05). There was no significant difference in both the disease free survival and overall survival between the two arms (5y-DFS: 63.3% vs. 68.5%, P > 0.05; 5y-OS: 73.5% vs. 72.9%, P > 0.05).</p><p><b>CONCLUSIONS</b>Rectal cancer in young patients has poorer histologic differentiation and more advanced pathologic stage, but the long-term survival is similar to that in middle-aged and elderly patients. The local control effect of neoadjuvant radiotherapy on rectal cancer in young patients still need to be further investigated.</p>

Clinical analysis of rectal neuroendocrine carcinoma:a report of 16 cases / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To study the clinical data and surgical treatment strategy of rectal neuroendocrine carcinoma (NEC).</p><p><b>METHODS</b>Sixteen cases of rectal NEC and 222 cases of rectal carcinomas receiving surgical treatment in Beijing Cancer Hospital from 2003 to 2007, were analyzed retrospectively.</p><p><b>RESULTS</b>Among the 16 rectal NEC patients, 4(25%) received Miles surgery, 7(43.8%) Dixon surgery, 2 combined multiple organ resection and 3 local resection. Lymph note metastases occurred in 11 cases(68.8%) and distant metastases in 7 cases (43.8%). Among the 222 rectal carcinoma patients, 43(19.4%) received Miles surgery, 152(68.5%) Dixon surgery, 12 palliative operation, 6 colostomy and 9 just received laparotomy. Lymph note metastases occurred in 125 cases (56.3%). In rectal NEC group, postoperative 1-, 2- and 3-year survival rates were 62.5%, 25.0% and 0.63% respectively, which were significantly lower than 83.1%, 61.7% and 46.1% in rectal carcinoma group(all P<0.01).</p><p><b>CONCLUSIONS</b>Rectal NEC is a rare disease. More vascular invasion, lymph node and distant organ metastases are found in rectal NEC than rectal carcinoma, and the prognosis of rectal NEC is worse than rectal cancer.</p>

Clinicopathologic analysis and expression of cyclin D1 and p53 of ovarian borderline tumors and carcinomas / 中华妇产科杂志

Objective To study the clinicopathologieal features and expression of cyclin D1 and p53 in epithelial ovarian tumors,and to investigate the correlation between pathogenesis of ovarian cancer and epithelial borderline tumors.Methods Fifty four cases of ovarian borderline tumors and 45 cases of ovarian carcinomas from the People's Hospital,Peking University were reviewed retrospectively.The clinical data and pathological findings were analyzed.Immunohistochemical study of cyclin D1 and p53 was performed in all 99 cases.Results(1)In borderline tumors,the age of patients ranged from 14-82 (mean age=42.5)years.International Federation of Gynecology and Obstetrics(FIGO)stage of borderline tumors was stage Ⅰ in 48 cases,stage Ⅱ in 3 cases,and stage Ⅲ in 3 cases.In ovarian carcinomas,the age of patients ranged from 26-80(mean age=53.5)years.FIGO stage of carcinoma was stage Ⅰ in 6 cases, stage Ⅱ in 8 cases,stage Ⅲ in 26 cases,and stage Ⅳ in 5 cases.In follow-up of 54 cases with borderline tumors the 5-year survival rate was 98% and of 45 cases with carcinomas a 5-year survival rate of 51% was noted.(2)In 54 cases of borderline tumors,mucinous types accounted for 56%(30/54)and serous types accounted for 30%(16/54).There were 5 cases with micropapillary pattern,3 cases with peritoneal implants,3 cases with lymph node involvement,6 cases with microinvasion,one case with intraepithelial carcinoma,and one case with mural nodules.In 45 cases of carcinomas,serous carcinoma was the most (49%,22/45).The remainder included 3 cases of mucinous types,8 cases of endometrioid types,6 cases of transitional cell types,3 cases of mixed phenotype and 3 cases of undifferentiated types.(3) Overexpression of cyclin D1 and p53 was observed in 31%(14/45)and 56%(25/45)of ovarian carcinomas, respectively.There was a significant association between p53 overexpression and tumor grade.In the borderline tumor group,69%(37/54)had overexpression of cyelin D1 and 6%(3/54)had overexpression of p53.There were significant differences in expression of cyclin D1 and p53 between conventional serous borderline tumors and high-grade serous carcinomas(cyclin D1:91% vs 26%;p53:0 vs 58%).However, micropapillary serous borderline tumors and low-grade serous carcinomas showed remarkably similar expression of cyelin D1 and p53.Conclusions Epithelial ovarian borderline tumors are distinct from ovarian cancer in clinical progress and prognosis,and histological types.Overexpression of cyclin D1 is common in ovarian borderline tumors and low grade carcinomas.And overexpression of p53 is more common in high grade ovarian carcinomas.Conventional serous borderline tumors are distinct from high-grade serous carcinomas in pathogenesis.Micropapillary serous borderline ovarian tumors may be closely related to low grade serous carcinomas.