Subtype classification and clinicopathological characteristics of gastric neuroendocrine neoplasms: an analysis of 241 cases / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To study subtype classification of gastric neuroendocrine neoplasm (NEN) and their clinicopathological characteristics in order to provide reference for clinical practice.</p><p><b>METHODS</b>Clinicopathological data of 241 gastric NEN patients (174 cases from China-Japan Friendship Hospital and 67 cases from The First Affiliated Hospital of Sun Yat-Sen University) between January 2011 and June 2016 were retrospectively summarized. According to serum gastrin, 24-hour intragastric pH monitoring and pathological grade, patients with gastric NEN were divided into 4 types: type I( (hypergastrinemia and achlorhydria, related to autoimmune chronic atrophic gastritis), type II( [hypergastrinemia and Zollinger-Ellison syndrome, related to gastrinoma or multiple endocrine neoplasia type I( (MEN-I()], type III( (sporadic disease with normal serum gastrin level), and type IIII( [poorly differentiated gastric neuroendocrine carcinoma (NEC) and mixed adenoneuroendocrine carcinoma (MANEC)]. Clinicopathological features, treatment and prognosis of 4 types were analyzed.</p><p><b>RESULTS</b>Of 241 gastric NEN cases, there were 86 cases (35.7%) in type I(, 7 cases (2.9%) in type II(, 61 cases (25.3%) in type III( and 87 cases(36.1%) in type IIII(. Among 86 cases of type I( gastric NEN, 73 cases (84.9%) were multiple lesions,tumor size of 66 cases (76.7%) was less than 1 cm, all the 86 cases were polypoid or granular lesions. 2 cases(2.3%)presented distant metastasis, 69 cases (80.2%) had pathological grading as NET G1; most of them received endoscopic surgery treatment and follow-up; somatostatin analogs(SSA) was used in patients with multiple lesions and repeated recurrence after endoscopic treatment. Among 7 cases of type II(, 4 cases were gastrinoma, 3 cases MEN-I(; 5 cases presented distant metastasis; treatment included surgery, SSA and proton pump inhibitor (PPI) therapy. Among 61 cases of type III( gastric NEN, 49 cases(80.3%) were single lesion,tumor size of 25 cases(41.0%) was more than 2 cm, 29 cases(47.5%) had lymph node metastasis or distant metastasis; treatment included endoscopic resection, surgery or SSA therapy according to the tumor staging. Among 87 patients of type IIII( gastric NEN, 74 cases(85.0%) had single lesion,tumor size of 51 cases (58.6%) was more than 2 cm; lesions were found in gastric cardia in 35 cases (40.2%); 65 cases (74.7%) had lymph node metastasis or distant metastasis; treatment included chemotherapy, or surgery plus chemotherapy. At the end of follow-up(June 30, 2016), 58 patients were dead, including 1 case of type I(, 12 cases of type III( and 45 cases of type IIII(. The overall survival rate of all the patients was 74.2%, and was 98.8%, 100%, 79.3%, 39.2% of types I(, II(, III(, IIII( respectively. The overall survival rate between type III( and type IIII( gastric NEN was significantly different(P = 0.000).</p><p><b>CONCLUSIONS</b>Subtype classification of gastric NEN is very significant for making therapeutic decisions and prognostic evaluation. Patients of type I( or type II( gastric NEN have good prognosis,while those of type III( and type IIII( have poor prognosis, and those of type IIII( have the worst prognosis.</p>

Transcriptional regulation of GCLC gene in human bronchus epithelial cells / 中国病理生理杂志

AIM:To investigate the transcriptional regulating function of the catalytic subunit(GCLC)gene of ?-glutamylcysteine synthase(?-GCS),the rate-limiting enzyme of glutathione(GSH)synthetic enzymes.METHODS:The regulating region of the human GCLC gene was cloned by PCR method to construct the wild type plasmid,which expressed luciferase reporting gene.Many mutated plasmids expressing luciferase reporting gene were also constructed by the method of exonuclease Ⅲ with S1 nuclease.The transcription regulation of GCLC gene was investigated by transient transfection of the wild type and the mutated plasmids through the observation of relative activities of luciferase.RESULTS:We found that the-2 515～-2 236 bp,-864～-838 bp,-769～-538 bp,-421～-341 bp regions upside from the transcriptional start site up-regulated the gene transcription are the new positive transcription-regulating regions and the-810～-769 bp(especial the-782～-769 bp)region is the negative transcription-regulating region,which is more precise than ever.CONCLUSION:The results of this experiment provide one good foundation to study the transcription management of the GCLC gene and GSH synthesis.