Extent Of Tumor Invasion Research Articles

Tripartite Motif-Containing 29 Expression in Squamous Cell Carcinoma

Dear Editor: Tripartite motif-containing 29 (TRIM29), also known as the ataxia telangiectasia group D complementing gene, is reduced in certain cancers by some reports, although, others report higher expression of TRIM29 in several cancers. While the exact functions of TRIM proteins have yet to be specified, they undergo viral replication, and participate in signal transduction and development in many human diseases, especially cancer. A few members of the TRIM family are associated with cellular growth and processes, such as transcriptional regulation, cell growth, apoptosis, development and oncogenesis1. Several TRIM proteins play many roles in the cellular processes, including the development and growth of diseases, but the physiological and pathological functions of TRIM29 have not been confirmed; while its presence in the cell membrane has been observed2. TRIM29 is typically expressed in the placenta, lung, thymus, prostate, testis, and colon, but not in the heart, brain, skeletal muscle, pancreas, spleen, ovary, or the small intestine, as measured by Northern blot analysis3. There have not been many studies on TRIM29, but it is assessed that TRIM29 expression is suppressed in breast and prostate cancer4-6. In a study by Schlomm et al.7, cDNA microarray analysis on prostatic cancer cells and noncancerous prostatic cells conducted using laser microdissection, resulted in 216 different genes, with TRIM29 as one of the downregulated genes. Similarly, Ernst et al.4 reported that TRIM29 was shown to be downregulated. Liu et al.6 reported that TRIM29 functions as a tumor suppressor in nontumorigenic breast cells and invasive estrogen receptor positive breast cancer using cDNA microarray analysis. TRIM29's functions may differ depending on the cell type, but there have not been any studies on the role of TRIM29 on tumorigenesis. TRIM29 over-expresses in lung, bladder, colorectal, ovarian, gastric, pancreatic and endometrial cancers and in multiple myeloma, and recent studies show that TRIM29 is associated with tumor invasion and lymph node metastasis. A recent report correlated TRIM29 expression in gastric cancer and poor histological grade, large tumor size, extent of tumor invasion, and lymph node metastasis8. The Institutional Review Board of Seoul Soonchunhyang University Hospital reviewed and approved this research protocol, which involved the use of tissue samples. We analyzed a total of 6 normal skin tissues and 18 malignant skin tumor tissues, including 6 malignant melanoma (MM), 6 squamous cell carcinoma (SCC), and 6 basal cell carcinoma (BCC), using Western blot and immunohistochemistry. The human MM cell line G361 served as a positive control for the TRIM29 expression. The human MM cell line G361 was not expressed for TRIM29 protein. In this study, TRIM29, which indicates the metastatic potentiality in gastric cancer, was measured in BCC, SCC and MM cancers, using Western blot and immunohistologic method. The results show that the expression of TRIM29 was not expressed in 6 cases of BCC with slow growth and poor metastasis. In 6 cases of SCC, which is aggressive and locally invasive, but not metastatic cancer, the expression of TRIM29 was strongly positive (Fig. 1A). In the 6 cases of MM, which is invasive and has distant sites metastatic potential through hematogenous and lymphagenous paths, TRIM29 protein was not expressed. Fig. 1 (A) TRIM29 protein was expressed on squamous cell carcinomal, normal skin tissue by western blot analysis. (B) The score of relative TRIM29 expression amount in western blotting. TRIM29: tripartite motif-containing 29, MM: malignant melanoma, SCC: squamous ... In all six MM and BCC, TRIM29 was not expressed (data not shown). The amount of expression in Western blotting is displayed graphically (Fig. 1B). Immunohistochemical study showed that the staining pattern of TRIM29 in normal human skin tissues mirrored those of a Western blot analysis (Fig. 2). Fig. 2 Immunohistochemical analysis of tripartite motif-containing 29 (TRIM29) expression in (A) malignant melanoma, (B) squamous cell carcinoma, (C) basal cell carcinoma, and (D) normal skin tissue. Only squamous cell carcinoma displayed TRIM29 expression. ... The exact function and mechanism of TRIM29 during tumor genesis have not been confirmed. The possible roles and mechanisms of TRIM29 protein expression in malignant skin cancers will be examined in additional studies.

The Efficacy of Lateral Neck Sentinel Lymph Node Biopsy in Papillary Thyroid Carcinoma

Although occult lymph node metastasis to the lateral neck compartment is common in papillary thyroid carcinoma, the incidence and patterns of lateral neck node metastasis in papillary carcinoma are not known. We hypothesized that sentinel lymph node biopsy (SLNB) with radioisotope in the detection of occult lateral neck node metastasis would be useful in characterizing metastasis in papillary carcinoma. Ninety-four patients with papillary thyroid carcinoma were included from June 2009 to March 2010 for lateral neck SLNB. Preoperative lymphoscintigraphy was obtained after intratumoral injection of a (99m)Tc-tin colloid under ultrasound guidance. Total thyroidectomy or lobectomy preceded SLN detection to avoid radioactivity interference with the primary tumor, after which SLNB was performed in the lateral neck nodes. In the cases where metastasis was detected in SLNs upon frozen biopsy, an immediate modified radical neck node dissection was performed. A total of 174 SLNs were identified in 60 patients (63.8%). The identification rate of the SLNs with isotope increased with time. Sentinel lymph node metastasis was found in 19 patients (31.7%). This clinically occult metastasis was only related to the total number of metastatic LNs in the central compartment. Patient age, gender, tumor size, location, extent of tumor invasion, multiplicity, and presence of thyroiditis were not related to metastasis in the lateral compartment. Detection of lateral neck SLNs upon biopsy with radioisotope was also feasible in level II and contralateral neck. Sentinel lymph node biopsy is a useful method for evaluating the occult lateral neck lymph node status in patients with papillary thyroid carcinoma, especially in the cases of central neck node metastasis.

Expression and Clinical Significance of l-Plastin in Colorectal Carcinoma

Introductionl-plastin, an actin-binding protein, is upregulated in many tumours, including colorectal carcinoma. This study evaluated the expression of l-plastin in plasma and colorectal tumour tissue and analysed the correlation between clinicopathological staging and prognosis. Materials and MethodsEnzyme-linked immunosorbent assay was used to detect l-plastin in the plasma of 120 colorectal carcinoma patients and 40 control subjects. Immunohistochemistry analyses were also used. ResultsThe rate of positive l-plastin expression was significantly higher in colorectal carcinoma patients than in control subjects, and was significantly higher in tumour tissues than in the tissues surrounding the tumour. l-Plastin expression also is correlated with tumour grade and size, and lymph node metastasis. However, there was no correlation with the extent of tumour invasion or distant metastasis. Conclusionl-Plastin may be a useful marker for screening colorectal carcinoma and determining the prognosis of patients with colorectal carcinoma, and for genetic therapy and targeted therapy of colorectal carcinoma.

Outcomes of salvage laryngectomy after initial radiation failure in laryngeal squamous cell carcinoma

To investigate survival outcomes of salvage surgery preformed for laryngeal squamous cell carcinoma that recurred or progressed after radiotherapy alone. A review of 72 patients who underwent salvage laryngectomy for laryngeal cancer failed in initial radiation therapy between 1996 and 2005 was performed. The tumor persistence occurred in 50 cases and recurrence in 22 cases. All patients received salvage total laryngectomy and radical neck dissection. Survival analysis was performed by using Kaplan-Meier method, Log-rank test and Cox proportional hazard model. Thirty patients developed a postoperative complication after salvage surgery. Pharyngocutaneous fistula occurred in 15(20.8%) patients. During 5 years after salvage surgery, the rates of tumor recurrence, distant metastasis and second malignancy were 34.7%, 22.2% and 6.9%, respectively. Kaplan-Meier analysis showed that overall 3 year and 5 year survival rates of those patients after operation were 45.8% and 36.1%, respectively. Univariate analysis indicated that N restage, tumor persistence/recurrences after radiotherapy, surgical margin status, level of tumor invasion, pathologic N stage, extracapsular nodal spread and invasion of nonlymphotic structures were significantly associated with overall survival. Multivariate analysis showed the most significant prognostic factors were tumor persistence or recurrence after radiotherapy, surgical margin status and level of tumor invasion. Surgical salvage remains the gold standard for management after failure of initial radiation therapy. The extent of tumor invasion must be assessed sufficiently before operation, and the surgical margin status must be identified in operation by using a frozen sectioning approach, especially in patients with tumor invasion to muscle/cartilage and tumor persistence after radiotherapy.

Expression and amplification of CerbB-2 oncogene in gastric adenocarcinoma and its significance

Objective To investigate the significance of CerbB-2 oncogene in the occurrence and development of gastric adenocarcinoma. Methods By using immunohistochemistry and fluorescence in situ hybridization, 60 cases of gastric adenocarcinoma tissue, 60 cases of normal margin of mucosal tissue and 30 cases of normal gastric mucosa tissue were detected for the expression and amplification of CerbB-2. Results The positive rate of CerbB-2 expression in gastric adenocarcinoma tissues, normal margin of mucosal tissues and normal gastric mucosa tissues were 31.7 %, 8.33 % and 3.33 %; The positive rate of CerbB-2 amplification of these were 28.3 %, 5 % and 0. There were significant differences between gastric adenocarcinoma tissues and the others in the expression and amplification of CerbB-2. The expression and amplification of CerbB-2 in gastric adenocarcinoma tissues had no correlation with age,gender,tumor size or tumor differentiation degree of patients' (P >0.05), but were correlated with the extent of tumor invasion, lymph node metastasis, distant metastasis and clinical stage(P <0.05). Conclusion CerbB-2 is closely related to the occurrence and development of gastric adenocarcinoma, and can be considered as an important index for determining the biological behavior of gastric cancer. Key words: Stomach neoplasms; Adenocarcinoma; CerbB-2; In situ hybridization, fluorescence

Clinical significance of preoperative serum interleukin-6 and C-reactive protein level in breast cancer patients

BackgroundBreast cancer is a disease that continues to plague females during their entire lifetime. IL-6 and CRP are found to be elevated in various inflammatory and malignant diseases and their levels are found to correlate with the extent of the disease. The primary objective of this study was to determine the preoperative serum levels of IL-6 and CRP in breast carcinoma, and to correlate them with the staging of the disease and the prognosis.Methods59 female patients admitted for breast cancer were identified for the study and were subjected to thorough evaluation. Serum levels of IL-6 were assessed via Enzyme-Linked Immuno-Sorbent Assay (ELISA), and CRP was measured via immunoturbidimetry. Histological findings included tumour size, lymph node (LN) metastasis, and tumour staging. Relevant investigations were made to find out the presence of distant metastasis. Statistical analysis of the data was then processed.ResultsIncreases in cancer invasion and staging are generally associated with increases in preoperative serum IL-6 levels. IL-6 and CRP levels correlated with LN metastasis (P < 0.001, P < 0.001) and TNM stage (P < 0.001, P < 0.001). Tumour invasion and the presence of distant metastasis is associated with higher IL-6 levels (P = 0.001, P = 0.009). When we established the cutoff value for IL-6 level (20.55 pg/dl) by ROC curve, we noted a significant difference in overall survival (OS; P = 0.008). However, CRP evidenced no significance with regard to patient's OS levels. Serum IL-6 levels were correlated positively with CRP levels (r2 = 0.579, P < 0.01)ConclusionSerum levels of IL-6 correlates well with the extent of tumor invasion, LN metastasis, distant metastasis and TNM staging thus enveloping all aspects of breast cancer.

Influence of Surgical Trauma on Neopterin Concentrations in Gastric Carcinoma Patients

Impairment of immune surveillance in the immediate postoperative period may accelerate the growth of tumor cells that remain despite radical resection in advanced cases. The present study was undertaken to evaluate the impact of major surgical trauma on host cellular immunity of gastric carcinoma cases. Sixty-eight consecutive patients with gastric carcinoma were divided into three subgroups according to the classification of the American Joint Committee on Cancer Staging, and they underwent surgery with a curative intent. Thirty-eight cancer-free patients served as controls, and they underwent surgical management for benign diseases. Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) risk adjustment system was used to estimate the operative and physiological scores of patients. Plasma cortisol, serum interleukin-6 and high-sensitive C-reactive protein levels were determined in order to assess the severity of trauma-related inflammatory response. The frequency of increased neopterin concentrations of cancer patients was estimated by comparison with the average values of controls. Response of interleukin-6 to surgery was closely related with the postoperative cortisol of cancer patients, but not correlated with neopterin and high-sensitive C-reactive protein levels. Although the extent of tumor invasion might have gradually decreased the macrophage response to surgical trauma, the overall increase in postoperative neopterin levels of cancer cases was highly significant. However, maximal frequency of increased neopterin concentration was obtained in advanced group. Macrophages might recognize the traumatic challenges in every stage of gastric cancer. Increasing individual neopterin concentration was not solely specific for tumor growth, but it was partially predictive of immune competence even in advanced cases.

Histopathological features of invasion of breast invasive ductal carcinoma and safety of breast-conserving surgery

In order to investigate the relationship between the extent of tumor invasion and the tumor size, axillary lymph nodes metastasis, Her-2 gene overexpression, and histologic grading in breast invasive ductal carcinoma as well as the optimal extent of excision during the breast-serving surgery, the clinical data of 104 patients with breast invasive ductal carcinoma who had received modified radical mastectomy were analyzed. The correlation analysis on invasive extent, which was evaluated by serial sections at an interval of 0.5 cm from 4 different directions taking the focus as the centre, and the tumor size, axillary lymph nodes metastasis, Her-2 gene overexpression, and histologic grading was processed. There was a significant correlation between invasive extent and tumor size (r=0.766, P<0.01), and lymph nodes metastases (r=0.574, P<0.01), but there was no significant correlation between invasive extent and Her-2 expression (r=0.106, P>0.05), and histologic grading (r=0.228, P>0.05). The 100% negative rate of infiltration in patients without nipple discharge with tumor size <2, 2-3 and >3 cm was obtained at 1.5, 2.0 and 2.5 cm away from the tumor respectively. It is concluded that the performance of breast-serving surgery in patients with breast invasive ductal carcinoma should be evaluated by tumor size in combination with axillary lymph nodes involvement to decide the possibility of breast-serving and the secure excision extent.

Correct Diagnosis of Vascular Encasement and Longitudinal Extension of Hilar Cholangiocarcinoma by Four-Channel Multidetector-Row Computed Tomography

Accurate diagnosis of local invasion of hilar cholangiocarcinomas is challenging due to their small size and the anatomic complexity of the hepatic hilar region. On the other hand, the correct diagnosis of local invasion is essential for assuring the possibility of curative surgery. The purpose of this study was to evaluate the feasibility of four-channel multidetector-row computed tomography (MDCT) in the assessment of vascular and bile duct involvement, by which we could obtain useful information for the surgical management of hilar cholangiocarcinoma. The subjects were 18 patients for whom the extent of tumor invasion was surgically and pathologically confirmed. All patients underwent preoperative multiphasic CT scanning by MDCT. Arterial and portal dominant phases were acquired using a detector configuration of 1.25 mm X 4 mm, and both axial and multiplanar reconstructed images were interpreted. Longitudinal extension was evaluated up to second-order branches. Vascular invasion is considered to be the degree of tumor contiguity to the hepatic arteries and portal vein and was graded by CT. The longitudinal extension was correctly diagnosed in 14 patients (77.8%). Hepatic artery invasion was correctly diagnosed in 17 patients with sensitivity of 100% and specificity of 90%, respectively. Portal vein invasion was correctly diagnosed in 47 of 51 branches with sensitivity and specificity of 92.3% and 90.2%, respectively. Multiplanar reconstructed images contributed to the correct diagnosis for both vascular encasement and longitudinal tumor extension. In conclusion, MDCT is useful in preoperative evaluation of hilar cholangiocarcinoma, especially when combined with multiplanar reconstructed images.

A multivariate analysis of the prognostic factors of grade III gliomas

Glioma is the most common type of malignant brain tumor and the prognosis of glioma is still poor. Moreover, the prognosis of patients diagnosed with grade III gliomas varies significantly. In this study, we assessed the factors that contribute to the prognosis of patients with grade III gliomas. Data from 97 patients with grade III glioma who received surgery from 2000 to 2005 were included in this study. Kaplan-Meier survival analysis and Cox regression analysis were used to analyze the prognostic effects of 16 different factors selected from clinical characteristics, results from neuroimaging and pathological examinations, as well as different treatment schemes. The results indicated that age, preoperative Karnofsky Performance Scale score, extent of tumor invasion, tumor resection degree, residual tumor shown by postoperative magnetic resonance imaging (MRI), and postoperative radiotherapy and chemotherapy all correlated with patient prognosis. Furthermore, Cox multivariate analysis also showed the age (P < 0.01), extent of tumor invasion (P < 0.01), residual tumor shown by postoperative MRI (P < 0.05), and postoperative radiotherapy (P < 0.05) significantly correlated with patients' prognosis. Age, postoperative radiotherapy and residual tumor indicated by MRI after surgery correlated significantly with the prognosis of patients with grade III glioma. The extent of tumor invasion may be an independent prognostic factor for patients with grade III glioma.

An Orthotopic Model of Papillary Thyroid Carcinoma in Athymic Nude Mice

To develop a reproducible orthotopic model of papillary thyroid carcinoma for the BRAF(V600E) mutation (GenBank NM004333) and an RET/PTC rearrangement (GenBank M31213) that recapitulates the clinical picture in humans. In vitro and in vivo study. Department of Head and Neck Surgery, M. D. Anderson Cancer Center. Eight- to 12-week-old athymic female nude mice. Either BRAF-mutated or RET/PTC1-rearranged papillary thyroid carcinoma cells were injected into the thyroid glands of athymic female nude mice. The mice were euthanized when the tumor burden exceeded 1.0 cm or when they exhibited significant morbidity. Tumorigenicity, extent of tumor invasion and metastasis, cell invasion and migration, and median survival. All the BRAF-mutated cell lines and 1 selected RET/PTC1-rearranged cell line were 100% tumorigenic in mice. These mouse tumor models exhibited a wide range of biological potential, including laryngeal invasion, lymph node metastasis, and pulmonary metastasis, thus reflecting the clinical spectrum of papillary carcinoma. An orthotopic model of papillary thyroid carcinoma was successfully established in nude mice using BRAF-mutated and RET/PTC1-rearranged cell lines. These models mimic the human disease and will thus be useful for evaluating the clinical potential of novel targeted therapies.

Endoscopic Mucosal Resection (EMR) for Colorectal Lesions and Lesion-lifted Condition as an Indicator of the Tumor Invasion

Utility and safety of EMR for colorectal lesions and lesion-lifted condition as an indicator of the tumor invasion were investigated. We investigated 672 cases and 708 lesions treated between 1993 and 2006. We classified the lesion-lifted condition at the time of submucosal fluid injection, using four categories: completely lifted/soft, completely lifted/hard, incompletely lifted, and non-lifting. The pit patterns and lifted conditions were related to tumor pathology and the extent of tumor invasion, and often corresponded to particular macroscopic types of tumors. Early colorectal cancer was treated in 231 cases by EMR alone, while 29 cases received additional colectomy after EMR because of an unfavorable pathology. Complications after EMR included bleeding in 19 cases (2.8%) and abdominal pain in 3 (0.4%). There were no cases of perforation. Recurrence occurred in 5 cases (2.2%) (4 cases were cured by re-EMR; one case required surgical resection) out of 231 cancer cases.

CK19 and CD99 Immunoexpression Profile in Goblet Cell (Mucin-Producing Neuroendocrine Tumors) and Classical Carcinoids of the Vermiform Appendix

The immunoexpression of CK19 recently has been identified as a marker of poor prognosis in pancreatic endocrine tumors and hepatocellular carcinoma. Conversely, the loss of expression of CD99 has been suggested to play a role in the tumorigenesis and dedifferentiation and is associated with poor outcome in some malignancies. The purpose of this study was to explore CK19 and CD99 immunostaining in mucin-producing neuroendocrine (goblet cell) and classical carcinoids of the appendix. Eighteen goblet cell carcinoids (GCCs) and 20 classic carcinoids were stained with CK19, CD99, and Ki-67, and these results were correlated with known pathological features of aggression: extent of invasion, mitoses, necrosis, and histological pattern. All 18 GCCs were CK19 strongly positive, whereas 16/20 classic carcinoids were also CK19 positive. Fourteen of 18 GCCs and 14/20 classic carcinoids were CD99 positive. CK19/CD99 immunoexpression did not correlate with extent of tumor invasion and mesoappendiceal extension, mitotic activity, Ki-67 labeling index, presence of extracellular mucinous pools dissecting muscle, and angiolymphatic and perineural/neural invasion. There is no difference in the immunostaining for CK19 and CD99 between GCCs and classic carcinoids, and both types of neuroendocrine tumor show the same extent of expression of both markers.

Tripartite Motif-Containing 29 (TRIM29) Is a Novel Marker for Lymph Node Metastasis in Gastric Cancer

Tripartite motif-containing 29 (TRIM29) belongs to the TRIM protein family, which has unique structural characteristics, including multiple zinc finger motifs and a leucine zipper motif. TRIM29, also known as ataxia telangiectasia group D complementing gene, possesses radiosensitivity suppressor functions. Although TRIM29 has been reported to be underexpressed in prostate and breast cancer, its expression in gastrointestinal cancer has not been studied. By use of real-time reverse transcriptase-polymerase chain reaction, we analyzed TRIM29 mRNA expression status with respect to various clinicopathological parameters in 124 patients with gastric cancer. An immunohistochemical study was also conducted. The expression of TRIM29 was far higher in gastric cancer tumor tissue. Increased TRIM29 mRNA expression was markedly associated with such parameters as histological grade, large tumor size, extent of tumor invasion, and lymph node metastasis. In the TRIM29 high-expression group, it was an independent predictor for lymph node metastasis. Furthermore, patients with high TRIM29 mRNA expression showed a far poorer survival rate than those with low TRIM29 mRNA expression. TRIM29 expression may serve as a good marker of lymph node metastasis in gastric cancer.

Invasive and interventional uses of endoscopic ultrasound

Endoscopic ultrasound (EUS) was introduced in the 1980s primarily for the local staging of gastrointestinal (GI) malignancy, and for which it now has an established role in upper GI, pancreatic and rectal cancers. EUS T-staging in oesophageal cancer (which assesses the extent of tumour invasion into/through the oesophageal wall) is said to have accuracies in the region of 80–90%, with lymph node (N) staging accuracy of 75% [1]. Hence diagnostic EUS complements other imaging modalities such as CT and MRI, and features regularly in multidisciplinary meetings for upper GI and pancreatic cancers. It is also used in biliary disorders; for example, the demonstration of microlithiasis and choledocholithiasis. However, it is the interventional capability of EUS which is perhaps likely to see the most growth in the next decade. When first introduced, the prototype mechanical sector scanning endoscopes had only 180 images. 360 imaging became possible when Olympus (Tokyo, Japan) introduced the GF-UM3 and a number of electronic radial scanning endoscopes are now available for diagnostic work. Around 1990, the Pentax Corporation (Tokyo, Japan) developed an electronic convex curved linear-array scope – the FG32UA. This echoendoscope had a 2 mm working channel overlapping the imaging plane which allowed fine needle aspiration biopsy. Subsequently, Pentax-Hitachi have developed instruments with a 180 imaging field that have 3.2 mm and 3.8 mm working channels which allow introduction of 8.5 F and 10 F devices, respectively. Olympus in conjunction with Aloka have introduced linear echoendoscopes with 7 F and 10 F working channels. Thus EUS guided biopsy and drainage is available and a plethora of papers on EUS in general, but also invasive/interventional EUS in particular, has appeared in the literature in recent years [2]. The proximity of mediastinal structures, the pancreas, adrenal glands and the hepatobiliary system to the luminal GI tract gives the operator access to all of these areas, and hence allows procedures which impact on several different organ systems. The following is a brief outline of the range of interventional/therapeutic procedures which can be performed.

Syringoid eccrine carcinoma with apparently aggressive transformation: case report and review of the literature

A 65-year-old man presented with a 20-year history of a lesion on his lower abdomen. The lesion had started as an indolent papule that slowly developed to form an extensive plaque. Physical examination revealed a flat-topped, elevated, well-demarcated, erythematous plaque measuring 7 cm × 5 cm in diameter (Fig. 1). The lesion had an elastic, hard induration beneath the plaque and was fixed to the underlying tissue. Inguinal lymphadenopathy was present. Hematologic and biochemical investigations were all within the normal ranges. The patient underwent incision biopsy. Figure 1. Clinical appearance of the lesion. An indurated plaque can be seen on the lower abdomen Download figure to PowerPoint A biopsy specimen, measuring 2.7 cm, revealed that the tumor was located in the dermis, and consisted of solid nests and small cords in a dense fibrocollagenous stroma. The tumor located in the upper dermis consisted mainly of solid nests with calcified central necrosis (Figs 2 and 3). The tumor located in the deep dermis consisted of small cords forming luminal, tubular, and tadpole-shaped structures, resembling those of syringoma (Figs 2 and 3). Solid tumor nests consisted of tumor cells which were basaloid and polymorphic, with hyperchromatic nuclei. A few mitotic figures were observed. A palisading arrangement of tumor cells was not observed at the periphery of the solid tumor nests. Keratinous cysts and follicular differentiation were not observed. No apocrine differentiation, such as decapitation secretion, was observed. There were no connections between the tumor nests and the epidermis. The extent of tumor invasion could not be determined from the biopsy specimen because the tumor had spread beyond the edges of the excision. Immunohistochemical analysis showed diffuse nuclear and cytoplasmic positivity for S-100 protein (1 : 1000; Dakopatts, Glostrup, Denmark) and focal positivity for carcinoembryonic antigen (CEA, 1 : 500; Mochida, Tokyo, Japan). Figure 2. The tumor consisted of solid undifferentiated nests and small cords forming tubular structures in a dense fibrocollagenous stroma (original magnification, ×40) Download figure to PowerPoint Figure 3. The tumor located in the upper dermis consisted mainly of solid undifferentiated nests with calcified central necrosis. Small cords forming tubular structures resembling those of syringoma can also be observed (original magnification, ×200) Download figure to PowerPoint The extent of tumor spread was evaluated by computed tomography (CT) and magnetic resonance imaging. The primary tumor had infiltrated the rectus abdominis muscle, and multiple metastases, up to 1 cm in diameter, were observed in the lungs, right bronchus, para-aortic lymph nodes and Th11, right S1, and bilateral ilium. CT scan revealed no continuity between the tumor and the prostate. After consulting a urologist, the possibility of prostate cancer was ruled out. After diagnosis and evaluation of tumor spread, the patient was treated with seven cycles of combination chemotherapy as follows: 5-fluorouracil (350 mg/m2 intravenously) on days 1–5, epirubicin (40 mg/m2 intravenously) on day 1, mitomycin C (3.5 mg/m2 intravenously) on day 1, vincristine sulfate (0.7 mg/m2 intravenously) and carboplatin (300 mg/m2 intravenously) on day 2, every 21–28 days. The treatment was relatively well tolerated without major complications. After seven courses of chemotherapy, evaluation by CT showed no change in the size of the primary lesion, or in the size and number of distant metastases. It is now 6 months since the last course of treatment and the patient appears to have stable disease.

Usefulness of Preoperative Endobronchial Ultrasound for Airway Invasion around the Trachea: Esophageal Cancer and Thyroid Cancer

Background: It is important to confirm preoperative tracheobronchial invasion to enable the selection of the most appropriate treatment. Objective: This study was performed to compare the usefulness of computed tomography (CT), magnetic resonance image (MRI) and bronchoscopy by endobronchial ultrasonography (EBUS) for the assessment of invasion of thyroid or esophageal cancer in cases with suspected tracheobronchial invasion. Methods: In cases with suspected contact between the tumor and tracheobronchial wall, CT, MRI and EBUS indicated deformity of the tracheobronchial wall due to the adjacent mass. The final diagnosis was based on surgical and histological results, and/or clinical follow-up. Results: Fifty-four patients were included in this study. Based on the findings of CT, MRI and EBUS, invasion was suspected in 29, 28 and 25 patients, respectively. Seventeen patients did not undergo surgery based on the results of CT, MRI and bronchoscopy with EBUS. Final diagnosis was intact trachea or bronchial adventitia in 26 patients and invasion in 28 patients. The sensitivity and specificity of CT, MRI and EBUS for invasion were 59 and 56, 75 and 73, and 92 and 83%, respectively. The accuracy of EBUS was significantly greater than that of CT in the present study (p = 0.0011). The accuracy of EBUS was significantly different from that of CT and MRI in the surgically treated patients (p = 0.005 and p = 0.032, respectively). Conclusion: EBUS is the most useful technique for determining the depth and extent of tumor invasion into the airway wall. The combination of MRI and EBUS will contribute to surgical planning in patients with esophageal and thyroid cancer.

Characterization of a novel transplantable orthotopic murine xenograft model of a human bladder transitional cell tumor (BIU-87)

For the evaluation of anti-human bladder cancer immunotoxin approaches, the orthotopic nude murine model that mimics the human counterpart is essential for preclinical evaluation of new treatment modalities. The objective of this study was to develop and characterize such a model. To accomplish this, the established human bladder transitional cell carcinoma (TCC) cell line, BIU-87, was transplanted orthotopically into immunodeficient nude mice. BIU-87 TCC cells were grown in monolayer cell culture and instilled intravesically as single cell suspensions into bladders that had been conditioned with mild acid washing. Tumor growth was assessed weekly by subjecting the mice to magnetic resonance imaging (MRI). At intervals following implantation and MRI tumor detection, the animals were sacrificed for necropsy, histological examination and immunocytochemical studies. The overall tumor establishment was 93% (52/56 mice) at 7–36 days, while in a subgroup of animals sacrificed at 12–13 days, 40 out of 42 animals (95%) developed TCC, the majority of which was superficial. Tumor stage was assessed by gross pathology and light microscopy. Histological examination of the tumor specimens confirmed the presence of grade II–III TCC. Immunocytochemistry confirmed that the tumor model maintained the features of BIU-87 cells. The changes seen on MRI correlated well with the extent of tumor invasion identified histologically. Carcinoma in situ could be detected histologically 7–9 days post-inoculation, and progressed to papillary tumor or invasive disease thereafter. The orthotopic BIU-87 TCC model is highly reproducible and is ideal for preclinical studies on experimental intravesical therapies.

Correlations between Expression of Estrogen and Androgen Receptors and the Clinical Characteristics of Prolactinoma

Objective: To study the correlations between estrogen receptor (ER) and androgen receptor (AR) and the clinical presentations of prolactinoma and investigate the effect of ER and AR expression on the pathogenesis of prolactinoma in sexual difference. Methods: The clinical data of 30 patients who had undergone transsphenoidal operations in Tongji Hospital from December 2000 to December 2001 were reviewed retrospectively. The clinical information included sex, age, serum-prolactin, size, tumor invasiveness, history of use of bromocriptine and frequency of recurrence. In 20 out of the 30 patients, the ER and AR expression was detected by using immunohistochemistry method. With help of Chi-square test, the relationship between ER, AR and the clinical presentations was analyzed. Results: The statistical values revealed that there was no significant correlation between the ER and AR expression levels with the clinical presentations such as sex, age, tumor size or tumor invasiveness among the 20 patients studied (P>0.05). Conclusion: The expression of ER or AR is not influenced by the clinical data of prolactinoma such as sex, age, tumor diameter or extent of tumor invasiveness. The tumor is more aggressive in males than in females. In maroadenoma or tumor with hyperprolactineamia (>200 ng/mL) simple surgical treatment can't successfully cure the prolactinoma. Post-operative bromocriptine therapy can't be determined by the sex of the patients, but is greatly related to the tumor size and serum-prolactin level before operation.

Thallium-201 versus Tc99m-glucoheptonate SPECT for evaluation of recurrent brain tumours: a within-subject comparison with pathological correlation

Thallium-201 (Tl-201) is the most commonly used tracer for functional imaging of recurrent brain tumours. However, the physical properties of Tl-201 are not particularly suitable for this application, thus, a technetium-99 (Tc99m) labelled alternative with more favourable physical properties has been sought. The aim of this study was to compare the ability of Tl-201 and Tc99m-glucoheptonate single photon emission computed tomography (SPECT) to detect viable recurrent tumour and differentiate post-radiation gliosis. Brain SPECT with Tl-201 and Tc99m-glucoheptonate was performed in 20 patients with malignant brain tumour in whom recurrent disease was suspected. Tracer uptake in the mass was defined as high, moderate or low and was correlated with histological verification of the lesion in all cases. Recurrent tumour was demonstrated in 17 patients by both Tl-201 and Tc99m-glucoheptonate SPECT and confirmed by surgical resection in all 17 patients. Three patients had no tracer uptake on either Tl-210 or Tc99m-glucoheptonate SPECT and surgical resection revealed only fibrotic tissue with areas of necrosis. Tc99m-glucoheptonate images were found to correlate more closely with the surgical findings with regard to the location of tumour margin, extent of tumour invasion and intratumoural necrosis. Tc99m-glucoheptonate brain SPECT is an accurate agent for SPECT imaging of recurrent brain tumours and may provide more information about the location of the tumour margin and its extent and intratumoural necrosis than Tl-201. Tc99m-glucoheptonate may be a viable replacement for Tl-201.