Endometrial hepatoid adenocarcinoma: a rare cause of elevated serum α-fetoprotein.

Hepatoid adenocarcinoma is a rare and unusual tumor in the female genital tract. Hepatoid adenocarcinoma resembles hepatocellular carcinoma morphologically but develops in extrahepatic organs, and usually demonstrates foci of adenocarcinoma of the primary organ. Tumor cells often stain positive for anti-α-fetoprotein antibody, and may be associated with elevated serum α-fetoprotein, which may be useful as a tumor marker to guide treatment. There is little reliable information to guide clinical management of these unusual tumors and prognosis is poor despite multi-modal treatment. This report describes the diagnosis and treatment of this tumor in a postmenopausal woman.

[Preliminary study on the relationship between tubal intraepithelial carcinoma of the fimbria and pelvic high-grade serous carcinoma].

OBJECTIVE: To explore the relationship between tubal intraepithelial carcinoma (TIC) of the fimbria and pelvic high-grade serous carcinoma. METHODS: All 34 cases of pelvic high-grade serous carcinoma with clear fimbria were evaluated from January 2009 to June 2010, including ovarian carcinoma (n = 26), tubal carcinoma (n = 7) and peritoneal carcinoma (n = 1). Among of these ovarian carcinomas, 12 cases were surface deposits and the other 14 cases within ovarian parenchyma. All 42 cases of non high-grade serous carcinoma in this period including 13 endometrioid ovary carcinomas, 11 clear cell ovary carcinomas, 11 mucinous ovary carcinomas, 6 low-grade serous ovary carcinomas, 1 low-grade serous tubal carcinoma, were also collected as a reference. The presence of tubal intraepithelial carcinomas was assessed. Based on the presence of TIC, high-grade serous ovary carcinomas were divided into TIC positive(+) and TIC negative(-) groups, and the clinical and pathological features of them were also evaluated. RESULTS: Fifteen cases (44%) were identified TIC in 34 high-grade pelvic serous carcinomas, and all of them were in the fimbria only, while none of TIC was found in control cases. There were significant difference between the two groups (χ(2) = 23.086, P = 0.000). Eleven cases (42%) were identified TIC in all 26 high-grade ovarian serous carcinomas, in which 8 cases with unilateral ovary carcinomas were associated with ipsilateral TIC, 2 cases with bilateral ovary carcinomas associated with unilateral TIC and one case with bilateral ovary carcinoma was associated with bilateral TIC. Four TIC (4/7) were identified in 7 cases with high-grade tubal serous carcinomas, and there was no presence of TIC in the 1 high-grade serous peritoneal carcinoma. Of all 26 high-grade ovarian serous carcinomas, 6/11 cases were surface deposits, and 5/11 were parenchyma tumors in TIC(+) group while 6/15 cases were surface deposits and 9/15 were parenchyma tumors in TIC(-) group, in which there were correlated in distribution of TIC between the two groups (P > 0.05). The average diameter of ovarian cancer were 6.9 and 6.5 cm between the two groups with no significant differences (t = 0.409, P = 0.690). CONCLUSION: TIC is specific to high-grade serous carcinomas and maybe have something to do with the pathogenesis of pelvic serous carcinomas.

[Clinicopathologic analysis of uterine epithelioid trophoblastic tumor].

OBJECTIVE: To study the clinicopathologic features, immunophenotype, differential diagnosis and prognosis of uterine epithelioid trophoblastic tumor(ETT). METHODS: From 2000 to 2007, 5 ETTs cases were diagnosed in the affiliated Women's Hospital, School of Medicine, Zhejiang University. The pathologic characteristics and immunophenotype of the tumors were analyzed by histological examination and immunohistochemistry of CK18, p63, inhibin-alpha, HCG, HPL, PLAP and Ki-67. The clinical prognostic factors were evaluated based on a following-up data with a period of 11 - 50 months. RESULTS: The overall prevalence of ETT was 0.48% among all the gestational trophoblastic diseases patients received in the same period. Five ETT patients were in the reproductive ages with a median of 33 years. Histologically, the tumor showed an invasive, nodular growth consisting of uniform mononuclear trophoblastic cells. There were zones of hyaline material in the tumour nests. Necrosis was commonly seen with a characteristic geographic pattern. Immunohistochemically, all cases displayed a diffuse CK18 and p63 positivity, to be either positive focally or negative for HCG, HPL and PLAP staining. Inhibin-alpha staining was positive or negative either in the 5 cases. Two patients died of the tumour relapse: one died after 1 year with the tumor having a high mitotic activity (averagely 15 mitotic figures per 10 high-power fields), and the other died of lung metastasis 2 years after the diagnosis. CONCLUSIONS: ETT is a rare trophoblastic disease with distinct clinicopathological features and immunostaining patterns. A high mitotic index and lung metastasis are indicators for an unfavorable prognosis.

[Differential expression of secretagogin and glucose-related protein 78 in colorectal carcinoma: a proteome study].

OBJECTIVE: To identify the differentially expressed proteins or peptides and potential biomarkers of tumorigenesis for colorectal cancers. METHODS: Immobilized pH gradient two-dimensional gel electrophoresis (2-DE) was used to separate and obtain the differentially expressed protein spots between colorectal cancers and matched normal mucosa. Liquid chromatography/mass spectrometry (LC-MS/MS) was used to characterize these proteins. Selected candidate proteins were further studied by Western blot, semi-quantitative RT-PCR and immunohistochemical staining. RESULTS: Thirty-five protein spots showed marked expression changes (more than 5-fold) in colorectal carcinoma compared to normal mucosa. Fifteen proteins were up regulated and 20 were down regulated. Fourteen of these proteins were identified by tandem mass spectrometry, among which secretagogin (SCGN) was down-regulated and glucose-related protein (GRP) 78 was up-regulated in the tumors. The SCGN down-regulation was further supported by Western blot and RT-PCR analyses. Immunohistochemistry revealed that SCGN was strongly expressed in neuroendocrine cells of the colonic crypts and 53 of 54 (98%) neuroendocrine tumors. At protein level, although GRP78 was up regulated in colorectal carcinoma, there was no difference in the mRNA expression level between the tumor and paired normal mucosa. CONCLUSIONS: The 2-DE combined with MS is a powerful tool for screening potential tumor biomarkers. The differentially expressed candidate proteins identified by 2-DE may be of significance in understanding the tumorigenesis of the colon cancer. SCGN is a potential biomarker for neuroendocrinal differentiation. GRP78 up-regulation in colorectal carcinomas may be related to its post-translational modification.

[Bioinformatic analysis of adenoma-normal mucosa SSH library of colon].

We established a colonic adenoma-normal mucosa suppressive subtraction hybridization (SSH) library in 1999. In this study, we wanted to explore the expression profile of all candidate genes in this library. We developed an EST pipeline which contained two in-house software packages, nucleic acid analytical software and GetUni. The nucleic acid analytical software, an integrator of the universal bioinformatics tools including phred, phd2fasta, cross_match, repeatmasker and blast2.0, can blast sequences of differential clones with the downloaded non-redundant nucleotide (NR) database. GetUni can cluster these NR sequences into Unigene via matching with the downloaded Homo Sapiens UniGene database. Sixty-two candidate genes in A-N library were obtained via the high throughput automatic gene expression bioinformatics pipeline. Gene Ontology online analysis revealed that ribosome genes and immunity-regulating genes were the two most common categories in the KEGG or Biocarta Pathway. We also detected the expression of 2 genes with highest hits, Reg4 and FAM46A, by semi-quantitative RT-PCR. Both genes were up-regulated in 10 or 9 out of 10 adenomas in comparison with the paired normal mucosa, respectively. The candidate genes in A-N library would be of great significance in disclosing the molecular mechanism underlying in colonic adenoma initiation and progression.

[The correlation between polymorphisms of matrix metalloproteinase-2 and -9 genes and colorectal cancer of Chinese patients].

OBJECTIVE: To investigate whether the polymorphisms of matrix metalloproteinase-2 (MMP-2) and -9 (MMP-9) promoters contribute to the development and progression of colorectal cancer in Chinese population. METHODS: the PCR-based denaturing high-performance liquid chromatography or PCR-restriction fragment length polymorphism technique respectively was applied to analyze the MMP-2 -1306C/T and MMP-9 -1562C/T polymorphisms in normal group (126 individuals) and colorectal cancer group (126 cases). Genotype frequencies were compared between patients and matched controls, and the association of genotypes with clinical-pathological parameters was studied. RESULTS: The frequency of the CC genotype in the MMP-2 gene polymorphism was significantly increased in colorectal cancer patients when compared with controls (P<0.05), and individuals with the CC genotype had an increased risk of developing colorectal cancer compared to those with CT+TT genotypes (OR: 1.959; 95%CI: 1.055-3.637). Significant correlation was found between the depth of tumor invasion and MMP-2 -1306C/T polymorphism in colorectal cancer patients. However, the genotype frequencies of MMP-9 -1562C/T in colorectal cancer patients were similar to those in control subjects. CONCLUSION: Our results indicate that MMP-2 -1306 C/T polymorphism may be associated with genetic susceptibility to colorectal cancer and the invasive capability of colorectal cancer in Chinese patients. And it is easier for the CC genotype cancer to invade through bowel wall.

[Germline polymorphisms of Bat26 and its significance in gastric cancer microsatellite instability].

OBJECTIVE: To detect the germline polymorphic variations of Bat26 in Chinese and its significance in microsatellite instability (MSI) study of gastric cancers. METHODS: Bat26 was analyzed by PCR-based denatured polyacrymide gel electrophoresis-silver stain method in peripheral blood from 389 healthy people and 34 gastric cancers with matched normal mucosa. Eleven other microsatellite loci were also detected for gastric cancers. RESULT: (1) No Bat26 variations were identified in 423 genomic DNA from peripheral blood or normal mucosa by polyacrymide gel electrophoresis. (2) Two MSI-H cancers, oth Bat26+, were detected in 34 cases of gastric cancer. The alterations of Bat26 and MSI-H status were identical (P<0.05). (3) Compared with those of RER-cancers, MSI-H (RER+)cancers showed more obvious infiltration of intraepithelial lymphocytes and peri-tumoral lymphocytes, and more pushing borders (P<0.05). CONCLUSION: (1) The germline polymorphisms of Bat26 in Chinese people are quasimonomorphic. Thus, no matched genomic DNA is needed while Bat26 was selected for tumor MSI analysis. (2) Bat26 is an independent indicator of MSI-H gastric cancers with distinct clinicopathological features.

[Diagnostic accuracy and pitfalls in fine needle aspiration cytology of salivary glands: a study of 113 cases].

OBJECTIVE: To describe the fine needle aspiration cytology (FNAC) features of various salivary gland lesions and to analyze the respective diagnostic value and pitfalls. METHODS: 113 FNAC specimens of salivary gland lesions were reviewed and correlated with clinical and histopathologic findings. RESULTS: The FNAC diagnostic failure (2); non-neoplastic lesions (12); benign neoplasm (82) and malignant neoplasm (17). Cytologically, the distinction between cellular pleomorphic adenoma, adenoid cystic carcinoma and basal cell adenoma could be difficult due to their overlapping morphologic features. The cytologic patterns of primary lymphoepithelial carcinoma of the parotid were indistinguishable from those of metastatic nasopharyngeal undifferentiated carcinoma. The ultimate distinction relied on clinical correlation. The three inaccurately diagnosed cases of FNAC are, as follows: reactive lymphoid hyperplasia of lymph node mistaken as non-Hodgkin lymphoma, mucoepidermoid carcinoma diagnosed as "scanty atypical cells present" and primary lymphoepithelial carcinoma mistaken as benign lymphoepithelial lesion. On the basis of FNAC, 97.4% (110 /113) were correctly depicted as benign (95/96; 99.0%) or malignant (15/17; 88.2%). Furthermore, 90.3% (102 /113) (specificity = 91.9%; 102/111) were accurately diagnosed, including 91.7% (88/96) benign lesions (specificity = 92.6% ; 88/95) and 82.4% (14/17) malignant tumors (specificity = 87.5%; 14/16). CONCLUSIONS: FNAC is reliable in distinguishing benign and malignant salivary gland lesions. A specific cytologic diagnosis is often possible. On the other hand, due to the pitfalls in cytologic diagnosis of certain salivary gland tumors, tissue biopsy for histologic examination may be necessary.

[DHPLC analysis of microsatellite instability in gastric cancer].

To establish a fast, simple and solid method of studying microsatellite instability (MSI) in gastric cancer, a panel of 12 microsatellite sites, D1S548, D1S552, D5S346, TP53, IGF II R(G)(8), IGF II R(CT)(5), TGFbetaR II(GT)(3), TGFbetaR II(A)(10), hMSH3(A)(8), hMSH6(G)(8), BAX(G)(8) and Bat26, were detected by denatured polyacrymide gel electrophoresis-silver stain in 28 gastric cancers. Bat26 was also analyzed by denatured high performance liquid chromatograph (DHPLC) at 50 degrees in the DNASep Cartridge. Two MSI-H (7.14%) and 15 MSI-L cancers (53.6%) were identified in 28 gastric cancers. Bat26 was positive only in 2 MSI-H cancers. The alterations of Bat26 and MSI-H status were coincident (P<0.01). The two Bat26+ cancers were also confirmed by DHPLC. Results obtained from DHPLC and gel electrophoresis were completely consistent. Thus, DHPLC analysis of Bat26 site may be a favorable method of detecting MSI-H status in gastric cancer, and be of clinical importance.