Colorectal Neoplasms ; genetics ; Humans ; Mass Screening ; Microsatellite Instability

Beijing ; Humans ; Internship and Residency ; Pathology, Clinical ; education

Objective:To study the clinicopathological features of mixed epithelial and stromal tumor of the kidney(MESTK). Methods:Clinical and pathological characteristics of one case of MESTK was stu-died. Results:A case of MESTK which uncommonly occurred in a 16-year old adolescent male presented with dysuria and a large mass in the right renal region without a history of estrogen/progestogen treatment and/or obesity or urogenital surgery. Radiology revealed a large cystic/solid mass within the right kidney. Grossly, it was well demarcated and had a solid and cystic appearance on sectioning. Microscopically, the tumor was composed of a mixture of stromal and epithelial components. The epithelial component was composed of flat to columnar cells forming glands or tubules. The stromal components essentially consisted of bland, loosely packed spindle cells in an edematous and myxoid background. In some areas, there were smooth muscle cells forming bands and fascicles but no ovarian-type stroma was present. Immunohistochemical staining revealed that the epithelial components were positive for AE1/AE3 and focally positive for estrogen receptor(ER),progesterone receptor(PR), CD10 and Vimentin, whereas the stromal components were positive for ER, PR, Desmin and smooth muscle actin(SMA). Both epithelial and stromal components were negative for HMB-45, S-100,?-inhibin and WT-T. Five months after resection, the patient was well without evidence of recurrence. Conclusion:MESTK occurred in a pubertal male, as in the current case, supports the hypothesis that proliferation of remnants of the primitive mesenchyme in the kidney in situation of sex-steroid abnormity may play an important role in the pathogenesis of male MESTK.

BACKGROUND:Recent studies have shown that adipose-derivedmesenchymal stem cells (ADMSCs) not only have multilineage differentiation potential, but also exert an important role in blood sugar balance and hormone production.OBJECTIVE:To observe the differentiation potential of human ADMSCs (hADMSCs) into functional islet-like cells and the therapeutic effect of hADMSCs transplantation in diabetic rats.METHODS:PDX-1 gene was transfected into hADMSCs by adenovirus. Cell differentiation and insulin secretion were identified and detected by dithizone staining and ELISA, respectively. Twenty male Sprague-Dawley rats were randomly divided into control group (n=4), diabetes group (n=8) and transplantation group (n=8). Rats in the latter two groups were subjected to making diabetic models by 65 mg/kg streptozotocin injection. Afterwards, rats in the transplantation group were given PDX-1 transfected ADMSCs via the tail vein.RESULTS AND CONCLUSION:At 15 days after transfection, the number of insulin positive cells and insulin secretion were both increased significantly (P < 0.05). Fasting glucose levels in the transplantation group decreased significantly (P < 0.05), while the body weight increased significantly (P < 0.05). In the diabetic group, the fasting glucose level still maintained at a high level, and the body weight of rats was significantly decreased. These results implicated that PDX-1 gene could induce hADMSCs differentiating into functional islet-like cells. PDX-1 transfected ADMSCs transplantation is effective in treating diabetic rats, but the mechanism needs further study.

Purpose To investigate the clinicopathologic characteristics of colorectal metastatic tumors. Methods Cases which were clinically diagnosed as metastatic tumors to the colorectum were retrieved from the data base of the Department of Pathology, Peking U-niversity Third Hospital. The clinicopathologic features were studied and immunohistochemical stains were performed on some of the ca-ses for differential diagnosis. Results Fifty three cases which showed intestinal wall involvement were studied. In 43. 4% (23/53) of them, only serosa/subserosa was involved and mucosal involvement was observed in 37. 7% (20/53) of the cases. Sigmoid colon and rectum were the most frequently involved intestinal segments (24/53, 45. 3%). Female reproductive system was the most common ori-gin of the metastatic tumors (33/53, 62. 3%), followed by the digestive system (15/53, 28. 3%). The most common histological type was ovarian serous carcinoma (22/53, 41. 5%). 96. 2% (51/53) of the metastatic tumors were centrally located at the serosa/subserosa or the muscular propria and prominent lymphovascular invasion was observed in 26. 4% (14/53) of the cases. In cases with mucosal involvement, 35% ( 7/20 ) had foci that were lack of desmoplastic reaction, 20% ( 4/20 ) exhibited in-situ growth and/or paradoxical maturation of tumor cells which led to misdiagnosis in 2 of the 17 pre-operative biopsies. Conclusions Metastatic carcino-ma in the colorectum can be highly informed by predominantly involving the serosa/subserosa or muscular propria and prominent lym-phovascular invasion. In-situ growth and paradoxical maturation of tumor cells in the mucosa are diagnostic pitfalls in pre-operative co-lonic biopsy and should be aware in practice.

BACKGROUND: Adipose-derived mesenchymal stem cells (ADMSCs) can improve the liver function of rats with liver failure, which illustrates the important research value in the field of tissue engineering and cell transplantation.OBJECTIVE: To evaluate the therapeutic potential of human ADMSCs in heart failure rats and to discuss the possible biological mechanisms involved.METHODS: Heart failure rats were randomized into model and ADMSCs groups, which were given normal saline or DAPI-labeled human ADMSCs (3.0×106) via the tail vein. At 1, 3, 7 days after transplantation, we detected the biochemical indexes for liver function in rats. At 3 days after transplantation, the serum levels of cytokines, such as tumor necrosis factor α and interleukin-10, were detected, the histomorphological changes in the liver were observed by hematoxylin-eosin staining, and the protein expression of proliferating cell nuclear antigen was detected by western blot. RESULTS AND CONCLUSION: We found that human ADMSCs could migrate to the liver and lung tissues in rats after the transplantation via the tail vein. At 1 and 3 days after transplantation, the levels of serum alanine aminotransferase and aspartate aminotransferase were significantly reduced in the ADMSCs group as compared with the model group (P< 0.05); furthermore, the secretion of tumor necrosis factor α and interleukin-10 was significantly suppressed at 3 days after cell transplantation (P < 0.05). The results of hematoxylin-eosin staining indicated a significant improvement in liver degeneration and necrosis. The expression of proliferating cell nuclear antigen protein in the ADMSCs group was significantly up-regulated compared with the model group. To conclude, human ADMSCs can inhibit the inflammatory reaction and up-regulate the expression of proliferating cell nuclear antigen, to promote the regeneration of liver cells and he recovery of liver function.

Objective To investigate the effect of folic acid combined with Helicobacter pylori (Hp) eradication therapy on chronic atrophic gastritis.Methods From December 2009 to March 2011 at the First Affiliated Hospital of Nanjing Medical University,184 patients with endoscopic and pathological diagnosis of chronic atrophic gastritis (90 Hp positive and 94 Hp negative) were selected.Hp positive patients were divided into group A and group B.Forty-three patients in group A were treated with standard triple Hp eradication therapy and follow by folic acid therapy for three months.Forty-seven patients in group B and Hp negative patients received three months of folic acid therapy.The clinical symptoms of each group were scored before treatment,one month after folie acid therapy and three months after folic acid therapy and analyzed by t test. Patients of each group received gastroscopy before treatment and three months after medicine withdrawal. Endoscopic scores,pathological scores and t test were recorded.The serum levels of pepsinogen ( Ⅰ,Ⅱ ) and gastrin 17 in venous blood of 55 Hp negative patients were detected by enzyme-linked immunosorbent assay (ELISA) method before treatment and three months after medicine withdrawal.Results Compared with three months therapy (1.15 ± 0.03),after one month folic acid therapy (1.55 ± 0.04) was statistically significant in clinical symptoms score of all patients (t =8.18,P＜0.01).By the end of therapy,clinical symptom score of group A (1.06 ± 0.04) was lower than that of group B (1.56 ±0.08),and the difference was significant (t=6.00,P＜0.01).There was significant difference in endoscopic scores of all patients between before treatment (1.57±0.95) and after treatment (1.00±0.76,t=11.12,P＜0.01).The differences in each pathological score of all patients (inflammatory scoring,active scoring,atrophy scoring,intestinal metaplasia scoring,atypical hyperplasia degree scoring) were significant between before treatment and after treatment (t=5.51,6.90,7.53,6.34,2.90,respectively,all P＜0.01).The serum level of pepsinogen Ⅰ before treatment of 55 Hp negative patients [(1.03±0.19) nmol/L] was lower than that after treatment [(2.24±0.33) nmol/L],and the difference was statistically significant (t=3.19,P＜0.01).After treatment the level of gastrin 17 [(0.86±0.05) nmol/L] was higher than that before treatment [(0.47±0.05) nmol/L],and the difference was statistically significant ( t =5.33,P＜ 0.01 ).Conclusion Folic acid in combination with Hp eradication therapy can be favorable to atrophic gastritis,which may promote the secretion of pepsinogen and gastrin.

Objective To study the clinical topography of lateral ligament of the rectum.MethodsDissection in the mesorectal plane was performed on cadavers of semi-pelvis sectioned in the sagittal plane. Results Ten of 14 semi-pelvises had substantial connective tissue between the mesorectum and the pelvic side wall. Eight of 10 lateral ligaments had middle rectal artery. Six of 8 middle rectal arteries run in the lateral ligament. The median height of the lateral ligament above the denticulate line was 14 mm (ranging 10～44 mm). Eight of 12 surgical cases had lateral ligament bilaterally, the remaining had lateral ligament unilaterally. Histologically the lateral ligament was composed of connective tissue. It consisted of vessel and nerve. The outer diameter of vessel in the lateral ligament was no more than 1.5 mm. Conclusions 1. The lateral ligament of the rectum presents in most people. The site and structure of lateral ligament was not constant, especially in vascular tissue. 2. Half of the cadavers have middle rectal artery. The rectal artery was tiny. Most of middle rectal artery runs in the lateral ligament. 3. The nerve in the lateral ligament was the part of rectal nerve plexus.

Objective: To investigate the expression of co-stimulatory molecule CD86 and inducible costimulator(ICOS) in the intestinal mucosa of Crohn disease (CD) and to exlpore its pathologic significance. Methods: Expression of co-stimulator CD86 and ICOS was examined by immunohistoehemistry on paraffin embedded tissue from patients with CD (30 cases) and normal controls (20 cases). The subsets of lamina propria mononuclear cells (LPMC) were also analysed via immunostaining for CD4, CD8 and CD20. Results: Increased amount of CD86 or ICOS positive LPMC was observed in the lesional area of CD when compared with the essentially normal area of CD and normal controls (q = 9. 23 ,P ＜0. 01 and q =5. 46 ,P＜0. 01). In addition, the expression of CD86 or ICOS was higher in intestinal epithelium of CD than that in normal controls (H = 24. 93, P＜0. 01 and H = 4. 66, P＜0. 01 ) , whereas no significant difference was seen between the diseased and the essentially normal area of CD. The amount of CD4 or CD8 positive lymphocytes in lamina propria, epithelium and small vascular walls was also significantly increased in CD than that in normal controls (P＜0. 05 or P＜0. 01). Conclusion: Increased amount of CD86 or ICOS positive LPMC and enterocytes in CD suggests that co-stimulatory molecules may play a role in the pathogenesis of CD. The enterocytes may act as non-specific antigen presenting cells in the process of cellular immunity activation in CD.

Objective To study the relationship between umbilical cord leptin levels and fetal growth as well as neonatal birth weight. Methods One hundred and forty - two neonates selected from February 2009 to June 2013 in Shangqiu First People's Hospital according to the different gestational age and birth weight were divided into 3 groups. Group A included 44 cases(small for gestational age,birth weight below the average weight of the 10th percentile at the same gestational age),23 boy cases,21 girl cases;group B included 56 cases(appropriate for gestational age,birth weight at the average weight of the 10th to 90th percentile at the same gestational age),30 boy cases,26 girl cases;group C included 42 cases(large for gestational age,birth weight above the average weight of the 90th percentile at the same gestational age),22 boy cases,20 girl cases. Neonatal body mass index,birth weight,placenta weight and umbilical lep-tin levels of three groups were compared. Results Neonatal birth weight,neonatal body length,body mass index and the placenta weight leptin levels in group A were significantly lower than those of group B,having statistically significant difference(all P ﹤ 0. 001);Neonatal birth weight,neonatal body length,body mass index and the placenta weight leptin levels in group C were significantly higher than those in group B,with statistically significant difference( all P ﹤0. 001). Neonatal birth weight in the boy group was obviously higher than that of the girl group,and the difference was statistically significant(P ﹤ 0. 001). Neonatal leptin levels in the boy group were significantly lower than that of the girl group,and the difference was statistically significant(P ﹤ 0. 001). There were positive correlations between the umbili-cal cord leptin levels and the neonatal birth weight,neonatal length,neonatal weight index and the placenta weight(r =0. 382,0. 276,0. 358,0. 412,all P ﹤ 0. 01). Conclusions The umbilical cord leptin levels are closely associated with neonatal birth weight and intrauterine growth retardation,and it can be used as one of the important indicators for reflec-ting neonatal birth weight and fetal growth.