Four hundred and eighty two paients suffering from intrahepatic bile duct stone undergoing lobectomy and segmental resection (from 1975 to 1994,9) has reported. 63% of the patient in this group underwent 1-5 operations, including different types of biliary-intestinal anastomosis (21.6%). 482 cases underwent different types of hepatectomy, including left lateral-lobetomy 321 cases (66.6%),left hemihepatectomy 80 cases(16.6%), right hemihepatectomy 19 cases (3.9%), and multiple segmental resections 39 cases (8.1%, including Ⅴ+Ⅷ 11 cases, Ⅵ+Ⅶ 28 cases). Other type hepatectomy combined with guadrate lobectomy 20 cases (4.1%). Postoperative complication rate was 10.2%, including diliary fistula. hemobilia and subdiaphragmatic and resectional surface infectioin, 85% of the patients were followed up with an excellent result of 88%. The authors emphsize that hepatic lobectomy nad segmental resection is the core of treatment and selection of operative methods depends on clinical-patholigic types of the disease.
To investigate the relationship between clinicopathological features and lymph node metastasis in the primary gastric cancer and affer the basis for deciding appropriate extent of lymph node dissection, a total of 192 patients who underwent curative gastrectomy and lymph node dissection for gastric cancer were analyzed retrospectively. Result: The total rate of lymph node metastasis was 60.4%, with 28.9% of the resected lymph nodes involved. The lymph node metastasis of C, M, A region and the whole stomach were 64.6%, 57.7%, 59.1% and 90.9% respectively. The rates of the lymph node metastasis increased successively in carcinoma of early, middle and late stages (Ｐ＜0.05), the rate of the infiltrative tumor (Borr Ⅲ，Ⅳ) being 76.5% which was significantly higher than that of the circumscribed tumor (Borr Ⅰ，Ⅱ) (43.2%)。 Relating with the tumor size ＜4cm in diameter showed lesser rate, while 4-8 cm and ＞8cm in diameter showed increasingly higher metastaticrate (Ｐ＜0.01). As a result, we should decide the appropriate extent of lymph node dissection during the operation on the basis of clinicopathological stages, type of Borrmann’s, site and maximum diameter of gastric cancer along with the state of lymph node metastasis in carcinoma of different region of the stomach.
Objective To investigate the clinicopathological characteristics of proximal gastric cancer (PGC). MethodsThe clinical course and pathologic feature of 118 PGC patients were analyzed, and compared with those of 310 distal gastric cancer (DGC) patients. ResultsThe incidence of PGC was lower than DGC, the percentage of Ⅲ,Ⅳ stages and undifferentiated type in the PGC group were significantly higher than in DGC. For the surgical procedure, patients in the PGC had significantly higher percentages of total gastrectomy and other organ resection than in DGC. The percentage of patients with positive margin and lymph node metastasis in PGC was also significantly higher than in DGC. Esophageal invasion and lymph node metastasis were much more in PGC. The 5year survival of patients with PGC was significantly lower than that with DGC. No significant differences were found between the two groups with respect to the mortality rates and complications. Conclusion The relatively poor prognosis associated with PGC is mainly from advanced cases and esophageal invasion. Early detection and treatment is the most important strategy to improve the survival of patients with PGC.
Objective This study aimed to explore the relationship between serum lipid and lipoprotein levels and occurrence of breast cancer, and relationship between serum lipid and lipoprotein levels and clinicopathological characteristics of breast cancer patients. Methods Clinical data of 788 patients with breast cancer and 395 patients with benign breast disease were retrospectively collected, who received treatment in The First Affiliated Hospital of Chongqing Medical University from January 2014 to March 2016, and to explore the relationship between levels of total cholesterol (TC)/triglyceride (TG)/high density lipoprotein cholesterol (HDL-c)/low density lipoprotein cholesterol (LDL-c) and occurrence of breast cancer/ clinicopathological characteristics of breast cancer patients. Results ① Influencing factors that affected the occurrence of breast cancer: multifactor logistic analysis showed that, height (OR=0.950, P=0.006), body mass index (OR=1.062, P=0.041), and serum LDL-c level (OR=1.349, P=0.016) were independent influencing factors for occurrence of breast cancer, people had high body mass index and higher level of serum LDL-c had high risk of breast cancer, but people had high height had low risk of breast cancer. ②Association analysis of serum lipid and lipoprotein levels and clinicopathological characteristics of breast cancer patients: the serum TC level was correlated with expression of progesteronereceptors (PR) and lymph node metastasis status (P<0.05), the serum TC levels of patients with negative-expression of PR and lymph node metastasis were slightly higher than that of patients with positive-expression of PR and non-lymph node metastasis; the serum TG level was associated with body mass index (P<0.05), that the serum TG level of patients with body mass index≥25 kg/m2was slightly higher than that of patients with body mass index<25 kg/m2; the serum HDL-c level was correlated with the body mass index and diameter of the tumor (P<0.05), the serum HDL-c level of the patients with body mass index≥25 kg/m2 was slightly lower than that of patients with body mass index<25 kg/m2, the serum HDL-c level of patients with the tumor diameter≤2 cm was slightly higher than that of patients with the tumor diameter >2 cm; the serum LDL-c level was correlated with body mass index, expression of estrogenreceptors (ER) and PR, and molecular typing ( P<0.05), the serum LDL-c level was slightly higher in patients with body mass index≥25 kg/m2, negative expression of ER and PR, and non Luminal type patients, comparing with patients with body mass index<25 kg/m2, positive expression of ER and PR, and Luminal type patients. Conclusions High level of serum LDL-c is strongly associated with occurrence of breast cancer, and levels of serum lipid and lipoprotein are associated with expression of hormone receptor, molecular type of breast cancer, and status of lymph node, but it needs further randomized controlled studies to confirm.
The effects of preoperative selective arterial perfusion chemotherapy (PSAPC) in the treatment of 20 cases of histologically confirmed gastric cancers is reported in which 12 patients were operated on, and a comparison with that of general chemotherapy in 10 cases of gastric cancers (as controls) was made. In the PSAPC group, besides the improvement of clinical symptoms and singns, the cancer cells of lesions in situ and metastatic lymph nodes have different degrees of degeneration and necrosis. This result show significant differences in two group comparison (Plt;O.01). We conclude that the PSAPC has good short-term effect and little side-effect. It can improve the resection rate and radical resection rate, and prevent the iatrogenic metastasis and implantation during operation, and decrease the postoperative recurrence of the patients with gastric cancer.
ObjectiveTo investigate the clinicopathologic and epidemiological characteristics of patients with gastric cancer at our hospital in the past six years． Methods A total of 958 patients with gastric cancer were selected from January 2004 to December 2009 and clinicopathologic characteristics such as basic data, pathological type, tumor location, and TNM stage were retrospectively analyzed. ResultsOf the 958 patients，697 cases (72.8%) were male and 261 cases (27.2%) were female, and the age ranged from 26 to 91 years old (mean 62.6 years old). The occurrence rate of gastric cancer was higher in the patients of 46-65 years old (49.4%, 473/958) than that in the patients of ≥66 years old (42.3%, 405/958) and ≤45 years old (8.3%, 80/958). Regarding pathologic type, the majority of advanced gastric cancers (70.1%) were Borrmann Ⅱ, the adenocarcinoma and signetring cell carcinoma accounted for 82.3% and 7.8%, respectively. The cancer of gastric cardia accounted for 53.0%. Stagestratified analysis revealed that the majority of gastric cancers (47.4%) were stage Ⅲ. Conclusion①A prevalence of gastric cancer is found in middle, elderly male patients. Poorly differentiated adenocarcinoma in cardia is prominent. ②Patients with high malignant ganstrie cancer are younger. ③The majority of patients who underwent the surgical treatments have advanced or metastatic tumor, therefore it is necessary to improve the early diagnosis of gastric cancer.
ObjectiveTo investigate the correlation between different RAS/BRAF mutation sites and the clinicopathological characteristics, metastatic sites, and prognosis of patients with colorectal cancer. MethodsA retrospective analysis was conducted on the clinicopathological data of 415 patients with stage Ⅰ –Ⅲ microsatellite stability (MSS) colorectal cancer who underwent radical surgery at the Department of Colorectal Surgery, The First Affiliated Hospital of Zhejiang University, and the Department of General Surgery, Gansu Provincial People’s Hospital, from March 1, 2017, to October 1, 2022, and had next-generation sequencing data. According to the presence and sites of RAS/BRAF mutations, patients were divided into five groups: RAS/BRAF wild-type group, KRAS G12 codon mutation group, KRAS G13 codon mutation group, BRAFV600E mutation group, and other RAS codon mutation group. The clinicopathological characteristics and prognostic differences between the four groups of RAS/BRAF mutant colorectal cancer patients and the RAS/BRAF wild-type colorectal cancer patients were compared. ResultsAmong stage Ⅰ –Ⅲ MSS colorectal cancer patients, there were 166 cases (40.0%) of wild-type RAS/BRAF without mutation, 124 cases (29.9%) of KRAS G12 mutation, 55 cases (13.3%) of KRAS G13 mutation, 23 cases (5.5%) of BRAFV600E mutation, and 47 cases (11.3%) of other RAS codon mutations. Clinicopathological characteristics analysis revealed that BRAFV600E mutation was associated with mucinous adenocarcinoma (P=0.033). Compared with the wild-type group, KRAS G12 mutation could increase the probability of metachronous lung metastasis (P=0.003) and reduce the probability of metachronous liver metastasis (P=0.013); the KRAS G13 mutation and other RAS mutations could increase the probability of metachronous lung metastasis (P=0.004, P=0.006). Univariate and multivariate Cox proportional hazards regression analysis showed that among the RAS/BRAF codon mutations, only KRAS G13 mutation was an independent prognostic factor for poor prognosis in stage Ⅰ –Ⅲ colorectal cancer. ConclusionsDifferent RAS/BRAF gene codon mutations are associated with distinct clinicopathological characteristics and organ metastatic sites in colorectal cancer. KRAS G13 codon mutation is an independent prognostic factor for poor prognosis in stage Ⅰ –Ⅲ colorectal cancer. It is recommended that routine detection of RAS/BRAF gene site mutations should be performed in stage Ⅰ –Ⅲ colorectal cancer patients to guide the follow-up management and help clinicians make rational clinical decisions after tumor recurrence.
【摘要】 目的 探讨卵巢两性母细胞瘤的临床及病理组织学特征。 方法 观察总结2004年3月-2008年3月6例卵巢两性母细胞瘤的临床及病理学特征，以及免疫组化染色结果。 结果 患者以月经紊乱、闭经、绝经后阴道出血为主要临床表现。肿瘤含两种成分，即颗粒细胞和Sertoli-Leydig细胞，两者均呈成熟性的组织学形态，1例伴有异源性分化成分。6例肿瘤呈α-inhibin和vimentin强阳性，3例呈CD99阳性，5例呈calretinin阳性，2例的Sertoli细胞呈CK阳性。4例患者有随访资料，随访期14～60个月，均无瘤存活。 结论 两性母细胞瘤以内分泌异常相关症状为主要临床表现，大部分患者诊断时处于临床1期，预后较好。对诊断为两性母细胞瘤的患者应进行长期的临床随访。【Abstract】 Objective To observe the clinical pathologic and immunophenotypic features of gynandroblastoma. Methods The pathologic samples of six patients with gynandroblastoma from March 2004 to March 2008 were observed and analyzed. Immuohistochemistry staining was performed by SP method using antibodies of α-inhibin,CD99,Vimentin,Calretinin,CK,EMA. Results The main clinical features included menstrual disorders, amenorrhea, and postmenopausal bleeding. The tumor was composed of ranulose cells and Sertoli cells, both of which were well differentiated. Strongly positive expression of α-inhibin and vimentin was found in all the patients, while CD99 (+) was in three, calretinin (+) was in five, and CK (+) of Sertoli cells was in two. Four patients were followed up for 14-60 months and all were tumor free. Conclusion The main clinical features of gynandroblastoma are estrogenic or androgenic manifestations. Nearly all the patients are diagnosed in stage 1 and have a good prognosis. Patients with gynandroblastoma should be followed up for a long period.
摘要:目的：探讨皮肤平滑肌肉瘤的临床病理特点和诊断要点及预后。方法:对2例皮肤平滑肌肉瘤组织病理学、免疫组化观察,并复习相关文献。结果: 例1为皮下平滑肌肉瘤,具有结节型的生长形态,瘤细胞丰富,异型性较大,核分裂活跃；例2为真皮平滑肌肉瘤,具有弥漫型的生长形态,瘤细胞较少,分化好,核分裂象不明显。免疫组化2例均表达SMA、MSA、Vim,1例灶性表达Desmin。2例随访迄今均无复发及转移。结论:皮肤平滑肌肉瘤少见,可分为真皮和皮下两种类型,两者具有不同的组织起源和预后特点,我们要注意区分,诊断除核分裂象计数外,尚需进行综合评估,对某些病例建议采用恶性潜能未定的平滑肌肉瘤的诊断,治疗首选外科手术切除。Abstract: Objective: To investigate the clinic pathological features diagnosis main point and prognosis of cutaneous leiomyosarcoma（CLMS）.Methods:Histopathology,immunohistochemical stainings observation were analyzed in two cases of CLMS and the related literatures were reviewed. Results:Case 1 was subcutaneous leiomyosarcoma with tubercular growth pattern,rich tumor cell,big heterogeneous type,active mitotic；Case 2 was dermis leiomyosarcoma with diffuse growth pattern,few tumor cell,well differentiated,no more mitotic. Immunohistochemically,the two cases reacted positively with smooth muscle action、MSA and Vim,Case 1 also expressed desman partially. The two cases were revisited to date,no recurrences and metastases.Conclusion:Cutaneous leiomyosar coma is a rare tumor,subdivided into dermis and subcutaneous forms because of their different tissue origins and prognosis features. We must discriminate between them. Diagnosis need synthetic appraisal besides mitotic counts and “smooth muscle tumor of uncertain malignant potential” should be used for diagnosis of certain cases.Primary treatment for cutaneous leiomyosarcoma is surgical excision.
ObjectiveTo compare the clinicopathological characteristics of breast invasive micropapillary carcinoma (IMPC) with different composition ratios, and analyze the relationship between proportion of micropapillary carcinoma components and the prognosis of IMPC. Methods The related data of 121 patients with invasive ductal carcinoma (IDC) complicated with IMPC who were treated in the Department of Breast Surgery, Affiliated Hospital of Southwest Medical University from August 2016 to August 2020 were collected. With micropapillary carcinoma accounting for 50%, the patients were divided into IMPC <50% group and IMPC ≥50% group. The correlation between related clinicopathological features and prognosis of patients was analyzed. Results There were 85 patients in the IMPC <50% group and 36 patients in the IMPC ≥50% group. The analysis results showed that there was no significant differences between the two groups in menstrual status, histological grade, molecular typing, TNM stage, age, immunohistochemical expression, neoadjuvant therapy, nerve invasion, nipple invasion, and skin invasion (P>0.05). The rate of lymphatic vessel invasion (LVI) in the IMPC ≥50% group was 83.33% (30/36), which was significantly higher than 61.18% (52/85) in the IMPC <50% group, and the difference between the two groups was statistically significant (χ2=5.684, P=0.017). Kaplan-Meier survival curve was drawn, and the analysis results showed that the 3-year cumulative disease-free survival (DFS) of IMPC patients was correlated with the number of lymph node metastasis and LVI (P<0.05). And with the estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, Ki-67, molecular typing, proportion of micropapillary carcinoma components and histological grade were unrelated (P>0.05). The results of multivariate Cox risk regression analysis showed that the number of lymph node metastases and LVI were independent prognostic factors affecting DFS in patients. Conclusions When the proportion of IMPC component is ≥50%, the LVI rate of tumor is higher than that of IMPC component <50%. The number of lymph node metastasis and LVI are independent prognostic factors affecting DFS in IMPC patients.