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Preoperative neoadjuvant therapy of rectal cancer has been widely promoted, and postoperative standardized pathological assessment has gradually attracted widespread attention. Accurate pathological examination plays an indicating role in the diagnosis and treatment of rectal cancer, which can not only evaluate the effects of neoadjuvant chemoradiation and surgical resection, but also guide postoperative adjuvant therapy and assess the prognosis. Tumor regression grade (TRG) and TNM staging are the bases of routine pathological diagnosis of rectal cancer, and they are closely related to patient survival and prognosis. At present, TRG evaluation methods for neoadjuvant chemoradiation include NCCN, AJCC, Becke, Mandard, Dowrak/Rodel, MSKCC, and RCRG. However, there is still no universally accepted best standard. The commonly used classifications in practice are AJCC and NCCN TRG grading standards. The prerequisite for accurate TRG classification is a detailed and standardized pathological assessment, which includes both gross assessment of the specimen and microscopic examination. How to evaluate the therapeutic response to lymph node metastasis after neoadjuvant therapy and improve the assessment consistency among pathologists are the two major issues that remain to be resolved.
Subject(s)
Humans , Chemoradiotherapy , Neoadjuvant Therapy , Neoplasm Staging , Prognosis , Rectal Neoplasms , Pathology , Therapeutics , Treatment OutcomeABSTRACT
Soft tissue tumors have specific morphologies. In many cases, differential diagnoses pose a challenge, and as such, immuno-histochemical and molecular methods are often needed. With the development of molecular genetics, the discovery of new diagnostic antibodies and genetic targets, and the emergence of further applications to clinical practice, clinically individualized and precision treatments have also been widely used. In the future, however, we must further investigate the molecular mechanisms of soft tissue tumors to improve their diagnosis and treatment.
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Purpose To investigate the clinicopathologic features, diagnosis and differential diagnosis of primary gastric inflammatory myofibroblastic tumor ( IMT) . Methods Four cases of gastric IMTs were studied by clinicopathologic analysis, immunohistochemistry and in situ hybridization, and the related literature was reviewed. Results In four cases there are two males and two females, age range from 21 to 51 years old, and tumor size ranged from 1. 5 to 6. 5 cm in the greatest dimension. Histologically, these tumors were composed of varied spindle cells and chronic inflammatory cells, in a myxoid or hyalinized stroma. Occasionally, there were calcifica-tion and ossification areas. Most of the spindle cells had bland appearance and a minority of the tumor cells showed mild atypia. One to two mitotic figures were recognized in 10 high power fields ( HPFs) in 1 to 2 patients. Smooth muscle actin staining was observed in all tumors and ALK staining observed in two tumors. One tumor focally expressed CD34. S-100, desmin, CD68, CD117 and DOG1 was negative in all IMTs. The patients were followed up from 24 to 66 months, and none of them had tumor relapsed or metastasis. Conclu-sions Primary gastric IMTs have an intermediate behavior, and a few cases have malignant potential. It should be distinguished from other spindle cell lesions similar to IMT.
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Objective To investigate lymphovascular invasion (LVI) in mid-low rectal cancer following neoadjuvant therapy. Methods A total of 297 consecutive patients with mid-low rectal cancer received radical surgery from August 2002 to August 2005 at Beijing Cancer Hospital. All patients were divided into the neoadjuvant therapy group and a control group according to whether they underwent preoperative radiotherapy or radiochemotherapy. Histological assessment of tumor specimens was made, and correlation of LVI and prognosis was analysed using the chi-square test. The disease-free survival rate and overall survival rate were analysed by the Kaplan-Meier survival curve. Results The overall positive rate of LVI was 23.9% (71/297). The positive rates of LVI in neoadjuvant therapy group and control group were 21.5% (31/144) and 26. 1% (40/153), respectively,with no significant difference between the groups ( x2 = 0.872, P ＞ 0.05). In the neoadjuvant therapy and control groups, LVI was significantly associated with pathologic T and N stages as well as the degree of histological differentiation (x2 =13.490, 27.401,7.323;16. 188, 21.623, 16.534, P＜0.05). In the control group, LVI was closely associated with local recurrence (x2 =4. 010, P ＜0.05 ), whereas this was not the case in the neoadjuvant therapy group (x2 =0.000, P＞0.05). LVI was significantly associated with distal metastasis in both the neoadjuvant therapy and control groups (x2 = 4.950, 14. 332, P ＜ 0.05 ). The disease-free and overall survival rates of patients with LVI were 46.4% (26/56) and 56.7% (34/60), which were significantly lower than 75.1%(148/197) and 79.4% ( 166/209 ) of those with no LVI, respectively ( x2 = 16. 720, 12.660, P ＜ 0.05 ).Conclusions Neoadjuvant therapy does not significantly reduce LVI;however, the biological behaviour of LVI has changed. Patients with LVI may benefit from neoadjuvant radiotherapy.
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Objective:To investigate if downregulation of two mitotic checkpoint proteins, MAD2 and p55CDC, is a frequent event in human prostate cancer and whether decreased expression of these two proteins are associated with progression of prostate cancer. Methods: Using immunohistochemistry technique, the expressions of MAD2 and p55CDC proteins are examined in 46 benign prostate hyperplasia (BPH) and 65 prostate cancer tissues. Differential expressions were compared first between BPH and prostate cancer specimens, and then among prostate cancer samples with different Gleason grades. Results: We found that down regulation of MAD2 and p55CDC expressions was significant in prostate cancer (96% and 83%, respectively) compared to BPH (19.5% and 4.3%, respectively) ( P