Diagnostic value of ultrasound-guided core needle biopsy for soft tissue tumors / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the diagnostic value and pitfalls of ultrasound-guided core needle biopsy (CNB) of soft tissue tumors.</p><p><b>METHODS</b>One hundred and six cases of CNB specimens encountered during the period from 2007 to 2012 were enrolled into the study. The pathologic diagnosis using CNB was compared with that using surgical specimens. Diagnostic accuracy was analyzed using Chi-square test, with respect to the histologic pattern (such as spindle cell and myxoid), biologic behavior (benign versus malignant) and immunohistochemical results. The 59 cases of sarcoma were subdivided into three grades according to FNCLCC grading system.</p><p><b>RESULTS</b>Histologic diagnosis could be made in 84.0% (89/106) cases. Thirteen cases were non-diagnostic on CNB. There were 4 cases on CNB showing diagnostic discrepancy with surgical specimens. Four cases of "benign lesions" on CNB found to be myxoid liposarcoma and lipoma-like liposarcoma upon resection. In general, myxoid pattern (9/17) seen on CNB showed less diagnostic correlation with surgical specimens, as compared to spindle cell and other histologic patterns (P < 0.01). The rate of diagnostic correlation was 79.7% (49/59) for the 59 cases of sarcoma studied, with grade 2 and grade 3 sarcoma showing better correlation (in contrast to 7/17 for grade 1 sarcoma) (P < 0.01). Comparative analysis showed no significant difference between benign/borderline tumors and sarcomas. The application of immunohistochemical study did not result in significant improvement in diagnostic accuracy on CNB.</p><p><b>CONCLUSIONS</b>Ultrasound-guided CNB is a reliable tool in pathologic diagnosis of soft tissue tumors and shows a high accuracy rate especially for high-grade sarcoma. Tumors with myxoid pattern, lipomatous tumors and grade 1 sarcomas are associated with lower diagnostic accuracy on CNB. Correlation with clinicoradiologic findings would also be helpful in diagnostic evaluation and surgical planning.</p>

Contrast-enhanced ultrasound of hepatocarcinogenesis in liver cirrhosis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Hepatocellular carcinoma (HCC) often occurs in association with liver cirrhosis. A stepwise carcinogenesis for HCC has been proposed. The purpose of this study was to observe the enhancement pattern of hepatocellular nodules in cirrhotic patients using contrast-enhanced ultrasound (CEUS) and to correlate patterns of enhancement at CEUS with the diagnosis of hepatocellular nodules using pathologic correlation as the gold standard.</p><p><b>METHODS</b>Ninety-three cirrhotic patients with indeterminate hepatocellular nodules at ultrasound, underwent biopsy of each indeterminate nodule. Patients with nodules found to have pathologic diagnoses of regenerative nodules (RNs), dysplastic nodules (DNs), or DNs with focus of HCC (DN-HCC), were enrolled in this study. Enhancement patterns of all nodules were examined throughout the various vascular phases of CEUS and classified into five enhancement patterns: type I, isoenhancement to hepatic parenchyma at all phases; type II, hypoenhancement in the arterial phase, and isoenhancement in the portal venous phase and late phase; type III, iso-to-hypoenhancement in arterial and portal venous phase, and hypoenhancement in the late phase (washout); type IV, slight hyperenhancement in the arterial and portal venous phase and hypoenhancement in the late phase (washout); and type V, partial hyperenhancement in the arterial phase and hypoenhancement in the late phase; and another partial iso-to-hypoenhancement in the arterial and portal venous phase and hypoenhancement in the late phase (washout). The correlation between the contrast enhancement patterns and the pathological diagnoses was analyzed by the chi-squared test.</p><p><b>RESULTS</b>Totally 132 lesions were examined with CEUS in 93 patients. Pathologic diagnoses included 45 DN, 68 RN, and 19 DN-HCC. The enhancement patterns observed were as follows: type I, 49 (37.1%); type II, 27 (20.5%); type III, 28 (21.2%); type IV, 9 (6.8%); type V, 19 (14.4%). Nodules with type I enhancement showed dysplasia in 5 (10.2%) cases; nodules with type II were dysplastic in 11 (40.7%) of cases; nodules with type III enhancement pattern were dysplastic in 22 (78.6%), and those with type IV enhancement contained dysplasia in 7 (77.8%) of cases. Type V enhancement corresponded to DN-HCC in 19 (100%) of cases. CEUS enhancement pattern was correlated with likelihood of dysplasia at pathologic analysis (Trend chi-square test, P < 0.001). Pathological diagnosis was HCC in the enhanced area and hepatocyte dysplasia in the un-enhanced area in the 19 DN-HCC.</p><p><b>CONCLUSION</b>Pattern of enhancement at CEUS correlates with the pathologic diagnosis of hepatocellular nodules in liver cirrhosis, and may be helpful in predicting the progress from RN to HCC nodules.</p>

Comparative analysis of cytopathologic and histopathologic diagnosis in the transbronchial needle aspiration specimens / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the cytopathologic features of transbronchial needle aspiration (TBNA) samples and to evaluate the role of cytopathology in the diagnosis and staging of lung carcinomas, as compared to histopathology.</p><p><b>METHODS</b>Three hundred seventy-four cytology specimens were collected by TBNA using 21-gauge needle, including 65 lung masses and 309 lymph nodes. Direct smears and liquid-based thin-layer preparations were performed for each case. The correlation between cytology and histopathologic diagnoses were analyzed.</p><p><b>RESULTS</b>The sensitivity, specificity, false positive rate, false negative rate and accuracy of cytopathology in diagnosing lung carcinomas by TBNA was 95.7% (88/92) (266/278), 100% (96/96), 0 (0/96), 4.3% (12/278) and 96.8% (362/374), respectively. Overall 62.8% (167/266) of the cases were precisely typed, including 95.7% (88/92) of small cell carcinoma, 73.5% (25/34) of squamous cell carcinoma and 67.9% (53/78) of adenocarcinoma. There was no statistical difference in the diagnostic accuracy of cytopathology between lung mass aspiration and mediastinal lymph node aspiration, as well as between subcarinal lymph node aspiration and other lymph node aspiration (all P > 0.05). There was also no statistical difference in the diagnostic accuracy between direct smears and liquid-based preparations (χ(2) = 0.11, P > 0.05).</p><p><b>CONCLUSIONS</b>Cytopathology of TBNA specimens is accurate and sensitive for diagnosing pulmonary carcinomas. In most cases, the lung carcinoma can be precisely typed. TBNA is useful for diagnosing and staging lung carcinomas.</p>

ICAM-1 469K/E gene polymorphisms increase the risk of gastric dysplasia / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the influence of ICAM-1 469K/E gene polymorphisms on the risk of atrophic gastritis and dysplasia.</p><p><b>METHODS</b>The ICAM-1 469K/E gene polymorphisms in a total of 372 subjects were detected by polymerase chain reaction-direct sequencing. All of the subjects were from Linqu County, a high risk area of gastric cancer in Shandong Province of northern China. All cases were initially diagnosed as normal or superficial gastritis at the beginning of this study. After a 5-year follow-up, the cases were subdivided into no progression group (no histological progression, n=137), progression group I (progressed to severe chronic atrophic gastritis, n=194) and progression group II (progressed to low-grade dysplasia, n=41).</p><p><b>RESULTS</b>In all 372 subjects, the frequencies of KK, KE or EE genotype of ICAM-1 K469E were 50.5%, 39.2% and 10.2%, respectively. No significant differences were observed in the ICAM-1 469K/E genotype frequencies between the progression group I and no progression group (P>0.05). The frequencies of KK genotype (68.3%) were significantly higher in the progression group II than in the no progression group (49.6%, P=0.035), and also than in the progression group I (47.4%, P=0.015). An increased risk of the progressing to dysplasia from normal or superficial gastritis was found in the individuals with ICAM-1 469KK genotype [odds ratio (OR)=2.21, 95%CI, 1.10-4.42].</p><p><b>CONCLUSION</b>ICAM-1 469K/E gene polymorphisms are significantly associated with the risk of gastric low-grade dysplasia, but not related with severe chronic atrophic gastritis in a population with high risk of gastric cancer in Linqu County, Shandong Province, China.</p>

The correlation between polymorphisms of Toll-like receptor 2 and Toll-like receptor 9 and susceptibility to gastric cancer / 中华预防医学杂志

<p><b>OBJECTIVE</b>To explore the relationship between the polymorphisms of Toll-like receptor 2 (TLR2) and TLR9 and the susceptibility to gastric cancer.</p><p><b>METHODS</b>A population-based case-control study was conducted at Linqu county, Shandong province, China, including a total of 248 cases of gastric cancer. Another total of 496 age and sex-matched controls were randomly selected from the same cohorts. TLR2 rs3804099 and TLR9 rs187084 were detected by polymerase chain reaction-restriction fragment length polymorphism method. Odds ratios (ORs) and 95% confidence interval (CI) were computed from logistic regression models after adjusting for age, sex, Helicobacter pylori (H. pylori) infection and smoking status.</p><p><b>RESULTS</b>The frequencies of TT, TC and CC genotype on TLR2 rs3804099 in control group were 43.5% (216/496), 46.6% (231/496) and 9.9% (49/496), respectively; whereas those in case group were 53.2% (132/248), 39.9% (99/248) and 6.9% (17/248), respectively. Significant differences in the frequencies of TLR2 rs3804099 were found between case and control groups (χ(2) = 6.665, P = 0.036). It was found that compared with the TT genotype, TC + CC genotype carriers obviously less susceptible to gastric cancer (OR = 0.68, 95%CI: 0.50 - 0.93). Joint effects analysis indicated that the TLR2 rs3804099 TT genotype carriers and H.pylori infectors had higher susceptibility to gastric cancer(OR = 3.42, 95%CI: 2.16 - 5.42), compared with TC + CC genotype carriers and non-H.pylori infection group. The frequencies of TT, TC and CC genotype on TLR9 rs187084 in control group were 33.3% (165/496), 49.0% (243/496) and 17.7% (88/496), respectively; whereas those in case group were 35.9% (89/248), 50.0% (124/248) and 14.1% (35/248), respectively. No significant association with gastric cancer was observed for TLR9 rs187084 polymorphism (χ(2) = 1.684, P = 0.431).</p><p><b>CONCLUSION</b>Our findings indicate that TLR2 rs3804099 is closely associated with susceptibility to gastric cancer.</p>

Role of KAI1 gene expression and loss of heterozygosity of KAI1 in metastatic potential and prognosis of pancreatic cancer / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate the role of KAI1 gene expression and loss of heterozygosity (LOH) of KAI1 in metastatic potential and prognosis of pancreatic cancer.</p><p><b>METHODS</b>The expression of KAI1 gene was studied by immunohistochemistry for CD82 on paraffin-embedded tumor tissues. The LOH of KAI1 gene was detected by microdissection, polymerase chain reaction (PCR) and denaturing high performance liquid chromatography (DHPLC).</p><p><b>RESULTS</b>The positivity rate of CD82 in primary pancreatic cancer was 76% (47/62). CD82 expression was significantly higher (P < 0.01) in earlier tumor stages (I and II), as compared to the advanced tumor stages ( III and IV) in which nodal or distant metastases were present. The expression rate of CD82 in patients who survived for more than one year was higher than that in patients who survived for less than one year (P < 0.05). The percentage of LOH at D11S1344 and D11S1326 loci was 17%.</p><p><b>CONCLUSIONS</b>The abnormal expression of CD82 which participates in malignant progression of pancreatic cancer is probably associated with LOH of KAI1 gene. Detection of CD82 expression and LOH of KAI1 gene may carry potential clinical significance in evaluating the metastatic potential and prognosis of pancreatic cancer.</p>

Association between promoter methylation of cyclooxygenase-2 and expression, and precancerous gastric lesions in a high-risk population / 中华预防医学杂志

<p><b>OBJECTIVE</b>To evaluate the relationship between cyclooxygenase-2 (COX-2) methylation and expression, and precancerous gastric lesions.</p><p><b>METHODS</b>Methylation status of COX-2 was evaluated by quantitative denaturing high performance liquid chromatography (DHPLC) in 1201 subjects with different gastric lesions. COX-2 expression was assessed by immunohistochemistry and Helicobacter pylori (H pylori) infection status was determined by 13C-urea breath test (13 C-UBT).</p><p><b>RESULTS</b>The percent of COX-2 methylation was increased steadily with the severity of gastric lesions, showing 10.6% of which with superficial gastritis/chronic atrophic gastritis (SG/CAG), 11.8% with intestinal metaplasia (IM) and 13.8% with indefinite dysplasia/dysplasia (Ind DYS/DYS) (chi2 = 8.312, P = 0.016). Stratified analysis indicated that the percents of COX-2 methylation in subjects with H pylori negative still increased with the severity of gastric lesions,of 8.8% in SG/CAG, 10.6% in IM and 14.1% in Ind DYS/DYS (chi2 = 6.629, P= 0.036). Moreover,the methylated proportion of COX-2 was negatively associated with the expression in gastric lesions, from 13.3% with mild expression to 7.6% with strong expression (chi2 = 10.400, P = 0.015).</p><p><b>CONCLUSION</b>Our findings indicated that COX-2 methylation was significantly associated with precancerous gastric lesions and H pylori infection, suggesting that promoter methylation of COX-2 might play an important role in the progression of gastric lesions.</p>

Nuclear expression of S100A4 is associated with lymph node metastasis in gastric carcinoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the intracellular localization of S100A4 in gastric carcinoma cells and the relationship between S100A4 expression status and lymph node metastasis of gastric carcinoma.</p><p><b>METHODS</b>Western blotting analysis was performed to locate the expression of S100A4 protein in sub-fraction components of frozen tissues. S100A4 protein expression was also determined by immunohistochemical method in 131 samples of gastric cancer and 20 samples of matched metastatic lymph nodes.</p><p><b>RESULTS</b>Thirty-two of 131 (24.4%) gastric carcinoma showed positive S100A4 nuclear expression and 50/131 (38.2%) carcinoma showed positive cytoplasmic expression. In 32 samples with positive S100A4 nuclear expression, 30 (93.8%) carcinomas had positive lymph node metastases. S100A4 nuclear expression level was higher in gastric carcinoma with lymph node metastasis (29.1%) than that without lymph node metastasis (7.1%) (P=0.016).</p><p><b>CONCLUSION</b>Nuclear expression of S100A4 is associated with lymph node metastasis of gastric carcinoma.</p>

Application of multiparameter flow cytometry in diagnosis of non-Hodgkin lymphoma / 中华病理学杂志

<p><b>OBJECTIVE</b>To evaluate the role and application of flow cytometry in the diagnosis of non-Hodgkin lymphoma (NHL).</p><p><b>METHODS</b>Fresh cell samples from 40 cases of lymphoproliferative disorders were obtained by fine needle aspiration or excisional biopsies. Multiparameter flow cytometry was used to study the surface antigens of lymphoid cells. The immunophenotyping results were also correlated with morphologic features seen in the cytology preparations.</p><p><b>RESULTS</b>Of the 40 cases with histologic diagnosis of NHL, 37 cases (92.5%) had the lymphoma diagnosis confirmed by this method. The concordance rate for the 20 cases of B-cell NHL was 100%. As for the 17 cases with histologic diagnosis of T-cell NHL, 12 cases (66.7%) were correctly diagnosed as T-cell NHL using flow cytometry, while 2 cases (11.8%) were interpreted as B-cell NHL and the remaining 3 cases (17.6%) were undiagnosed.</p><p><b>CONCLUSION</b>Immunophenotyping by flow cytometry can serve as an ancillary technique in diagnosis and subclassification of NHL.</p>