Objective Multicystic renal cell carcinoma(MCRCC)appears to be a distinct subtype of renal cell carcinoma with characteristic gross and microscopic features.To explore the clinical and pathological features of MCRCC in order to find out its difference from renal clear cell carcinoma undergoing cystic change(RCCCC),and to propose prognosis criteria for therapeutic modalities.Methods From 1999 to 2003 32 patients were identified to have renal carcinoma,and they received radical or partial nephrectomy in the authors' institution.The pathological diagnosis was either MCRCC(n=21)or renal cell carcinoma associated with features of cystic changes(n=11).All specimens were reviewed histologically by two independent pathologists.The clinicopathologic and follow-up prognosis data on MCRCC and RCCCC were collected for study.Results 21 patients with MCRCC were 17 men and 4 women.The mean age at the time of surgery was 49 years(range 37 to 67 years).15 MCRCC patients with follow-up data were still alive with a mean follow-up time of 61 months(ranged 31 to 73)and no evidence of recurrence and metastasis was discovered.The mean survival time for 7 of the 11 patients with RCC was 32 months(ranged 18 to 63).There was significant difference in survival time between the two groups(P

Objective To study the histological and immunohistochemical features of primary and metastatic ovarian mucinous adenocarcinoma. Methods 24 cases of primary ovarian mucinous adenocarcinoma and 16 cases of metastatic mucinous adenocarcinoma (5 gastric, 5 appendix, 6 colorectal) with definite diagnosis were included in this study. All the tissue sections with either HE staining or immunohistochemical staining with CK7 and CK20 monoclonal antibodies were studied. Results All the 24 primary mucinous adenocarcinoma were positive for CK7 and only 3 cases showed focal positive for CK20. Among the 16 secondary mucinous adenocarcinoma, 6 colorectal and 5 appendiceal metastatic adenocarcinoma were positive for CK20 and only one metastasis showed focal positiveness for CK7. The five gastric metastatic mucinous adenocarcinoma showed strong CK7 expression and four of them were CK20 positive. Conclusions The primary and secondary mucinous adenocarcinoma of the ovary had different immunohistochemical features. CK7 and CK20 were valuable markers in the differentiation of these two entities.

Objective To investigate the histological features of papillary renal cell carcinoma, and to explore the relationship between nuclear grading and prognosis. Methods The pathological slides and clinical data of 13 cases of papillary renal cell carcinoma were reviewed. The pathological features were scrutinized and nuclear grading was conducted according to Fuhrman grading system. Immunohistochemical staining for CK7, EMA, and vimentin was also respectively done. The correlation between nuclear grade and prognosis was analysed. Results The age range of the patients was from 35 to 67 (average 53) years. 10 were male and 3 were female. Most of the tumors were located in the upper pole (5cases) or lower pole (5cases). Three were located in the middle part of the kidney, with some inclination to either pole. All the tumors were well circumscribed with a size ranged from 2cm to 6.3cm (average 3.5cm) in diameter. Hemorrage and cystic change were obviously seen in large tumors. Microscopically, the tumors were composed of papillary or tubular structures, with hemorrhage, foamy macrophages and cystic change as prominent features. 6 cases were multifocal. Fuhrman nuclear grade Ⅰ or Ⅱ was made in 6 cases, and Ⅲ or Ⅳ in 7 cases. All the tumors were positive for CK7, EMA and vimentin. The patients were followed up for 28 to 102 months (average 52 months). 3 patients died of tumor recurrence or metastasis after the operation at 36, 41 and 50 months, respectively, while others survived without tumor up to now. The three dead patients were graded Ⅲ or Ⅳ by Fuhrman nuclear grading system. Conclusion Papillary renal cell carcinoma was different from other renal carcinoma variants in that they, usually have a better prognosis.

Objective To evaluate the oncologic risks of skin sparing breast conserving surgery for carcinoma of breast at early stage.Methods Serial sections of skin overlying the tumor were done for pathological examination in 50 cases of early stage breast cancer after skin sparing breast conserving operation.Results In 50 cases of breast conserving surgery,the extent of skin removal was 0.5-1.0cm in 21 cases,1.0-1.5cm in 25 cases,and 1.5-2.0cm in 4cases.Skin involvement was found in one patient with stage Ⅱ breast cancer,and the rate of skin involvement was 2%.Skin involvement was closely related with the changes in skin overlying the tumor,but not with the tumor size,pathologic types or axillary lymph node metastasis.Conclusion The rate of skin involvement in early stage breast cancer is rare,therefore if there are no abnormal clinical manifestations in the skin,skin sparing breast conserving surgery is safe.

Objective To investigate the relationship between the latest WHO criteria of thymic epithelial tumours(TET) and the incidence of MG,Osserman classfication and postoperative prognosis of myasthenia gravis(MG). Methods To analyse the pathological sections of 105 patients with thymoma from 1974 to 2000 with Levine-Rosai's clinicopathological classification,traditional histological classification and WHO classification respectively,and analyse and compare their relevance with the incidence,Osserman classification and postoperative prognosis of MG.Results (1)The cases with benign tumors of type A and type AB were more than those of type B.(2)Type B3 more likely accompanied MG than type A and type AB (P

Objective To study the expression of survivin, an apoptosis inhibitor gene,in bladder carcinoma,and to investigate its clinical and pathological implications. Methods We detected the expression of survivin in 60 cases (48 men and 12 women) of bladder carcinoma and 10 cases of non-tumor bladder tissues (controls) by immunohistochemistry (SP) method.The mean age of the 60 cases at diagnosis was 59 years.The pathological grading showed Grade Ⅰ in 16 cases,Grade Ⅱ in 24 and Grade Ⅲ in 20.The clinical staging showed T 1 in 13 cases,T 2 in 15,T 3 in 21 and T 4 in 11.Of the 60 cases,21 developed relapse. Results The overall positive rate of survivin in 60 cases of bladder carcinoma was 60.0% (n=36).No survivin was found in 10 cases of non-tumor bladder tissues.The positive rate of survivin in Grade Ⅰ cases of bladder carcinoma was 37.5%(6/16),in Grade Ⅱ and Ⅲ cases of bladder carcinoma was 66.7%(16/24) and 70.0%(14/20);the difference of positive rates between Grade Ⅰ and Grade Ⅱ,Grade Ⅲ cases was significant (P0.05).The positive rate of survivin in cases of relapse was 80.9% (17/21). Conclusions Survivin may play an essential role in bladder carcinogenesis and serve as a marker for prognosis of bladder cancer.

Objective To study the pathological features and clinical significance of sarcomatoid change of renal cell carcinoma. Methods The specimens of 16 cases of sarcomatoid renal cell carcinoma admitted to our hospital were reviewed, and stress of observation was put on the the morphology and the number of the sarcomatoid components, and then their relation with clinical course, staging, and prognosis was retrospectively analyzed. Results Among the 16 cases of renal cell carcinoma with sarcomatoid transformation, 9 cases were conventional clear cell carcinoma, 3 cases were papillary renal cell carcinoma, 2 cases were chromophobic cell carcinoma, and 2 cases were collecting tubule carcinoma. In 9 cases the sarcomatoid elements were over 50% of total tumor area, while in the other 7 cases the sarcomatoid elements were less than 50%. The TNM stage among the 9 cases with more than 50% sarcomatoid elements were T2 (1/9), T3 and T4 (8/9). The TNM stage among the 7 with less than 50% sarcomatoid elements were T2 (4/7), T3 and T4 (3/7). The sarcomatoid area resembled malignant fibrous histiocytoma or fibrosarcoma. The average survival period of the patients was 19 months (8-154). Cases with over 50% sarcomatoid elements survived for 14 months in average, while the cases with less than 50% sarcomatoid area survived for 27 months in average. The difference was significant (P

Objective To study the clinicopathological and imaging features,key points of diagnosis and prognosis of endolymphatic sac tumor.Methods Seven cases of endolymphatic sac tumor were studied with routine histopathological,immunohisochemical staining and CT,MRI scanning.Patients' prognosis and life quality were aesessed by follow-up.Results The clinical symptoms of patients were progressive sensorineural deafness,tinnitus,vertigo and affection of cranial nerves.CT revealed reticular of moth-eaten bony destruction of the petrosal region,and MRI revealed a region of high-signal intensity void of vascular flowing signals.The histopathologic examination of the tumor presented a papillary-cystic pattern.The tumor cells were round or cubaid in shapen,with nuclei in similar shape and size.There were cyst-like structares filled mith pinkish gelatinous.Tumor cells were roundor cuboid in shape,and some of them contained clear cytofrlasm.There was materials,which were stained strongly with PAS.Hemorrhage,cholesterol crystal and foreign body giant cells were found in the tumor stroma with abundant small blood vessels and extravasation of blood,cells with intracellular hematin,and giant cells collagen.There was also proliferation of fibrous connective tissues.Necrosis and bone destruction were also found in some cases.Immunohistochemical results showed that CK and NSE were positive in all the tumors,and CD56 and S-100 were positive in part of cases,GFAP,EMA,CgA,TG and Syn were negative in all the specimens.One patient had received radiotherapy after partial resection.Relapse occurred only in one patient two years after the first surgery,and no metastasis or relapse occurred in the rest of patients.Conclusions Endolymphatic sac tumor is a rare neoplasm.The diagnosis relies mainly on histopathological and immunohisochemical findings.The patients often have good prognosis.

Objective To investigate the clinic-pathological characteristics and prognosis of 48 female cases with peritoneal pseudomyxoma(PMP).Methods The clinicopathologic features and follow-up data of 48 female patients with PMP diagnosed in the General Hospital of People's Liberation Army from Jan.1982 to Dec.2011 were retrospectively reviewed.The relationship between clinic-pathological characteristics and prognosis were analyzed using log-rank test and Cox proportional hazards model.Results (1) Clinicopathologic features:the mean age of the 48 cases was 58.8 years (range from 24 to 79 years).Symptoms:abdominal distention and abdominal discomfort were the main symptoms.Imaging examinations showed nonspecific abdominal and pelvic lesions in most cases.Treatment:all the 48 patients underwentlaparotomy and cytoreductive surgery (CRS),in which 15 (31％) patients with completeness of the cancer resection (CCR)-1,24(50％) cases with CCR-2,and CCR-3 in 9(19％) cases.Six (12％) cases were treated by intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin,20 (42％) patients were treated with different options postoperative adjuvant chemotherapy.Pathological types:the cases were histologically classified into 3 subcategories:disseminated peritoneal adenomucinosis (DPAM),peritoneal mucinous carcinomatosis (PMCA),and PMCA with intermediate or discordant features (PMCA-I/D),which were 22 (46％) cases,9 (19％) cases and 17 (35％) cases,respectively.Appendiceal tumors:44(92％) cases underwent appendectomy,in which 38 cases presented appendiceal tumors (including 20 cases of low-grade appendiceal mucinous adenoma and 18 cases of appendiceal mucinous adenocarcinoma),2 cases were diagnosed as appendicitis,4 cases with unknown pathologic diagnosis.And the other 4(8％) cases,who didn't undergo appendectomy at the first operation,presented peritoneal tumor recurrence and appendiceal mucinous tumors 1,11,32 and 85 months after surgery,respectively.Parenchymal organs involved:ovarian involving was happened in 34 (71％)patients including 15 cases with the right ovary involving,13 cases in both sides,and 6 cases involving the left side.The other parenchymal organs in 10(21％) cases.(2) Prognostic factors:11 patients died,31 survived and 6 cases were lost to follow-up.The mean survival time was 99 months(ranged from 1 to 312 months).The 3-year,5-year and 10-year survival rates were 73.3％,68.0％ and 46.6％,respectively.Univariate statistical analysis showed that age,pathological type and parenchymal involvement were significantly relationship with the survival time (all P ＜ 0.05).But the operation times,appendiceal tumor type,ovarian involvement,CCR,intraperitoneal HIPEC and post-operative adjuvant chemotherapy were not significantly correlate with survival time (all P ＞ 0.05).Multivariate analysis showed that age and pathologic type were independent prognostic factors (P ＜ 0.05).Conclusions No specific clinical features presented in PMP.CRS with HIPEC should the recommended treatment.Both ovaries exploration and appendectomy should be carried out routinely in CRS.The 10-year overall survival of PMP is low.Age,pathological type and parenchymal organs involvement other than ovarian are correlated with the prognosis.And the pathological type and age are independent prognostic factors of PMP.

Objective To evaluate the application of contrast-enhanced transrectal ultrasound ( CETRUS) to identify prostate cancer(PCa) from benign prostatic hyperplasia(BPH). Methods A total of 86 patients with focal prostatic disease detected by trans rectal ultrasound(TRUS) were enrolled in this study.Each patient underwent grey-scale TRUS, CE-TRUS, and targeted-biopsy of prostateunder ultrasound guidance successively on the same day. The criteria of perfusion pattern would be statistically analyzed among groups divided by pathological findings. Every patient's images of CE-TRUS were observed and features of perfusion pattern were recorded by two doctors who were blind to any clinical data of patient.Then these features recorded by two doctors were compared, if the features were coherent, they would be recorded as final results,and otherwise two doctors would consult till the features were coherent. Results Compared with BPH group, the enhancement features of PCa group were rapid enhancement, increased enhancement, heterogeneous enhancement, well-defined boundary of lesion after enhancement, asymmetric appearance of intraprostatic vessels, rapid decrease, perfusion defect areas within lesions and the roughly discontinuous juncture between enhancement and no enhancement area within lesions. Conclusions There was significant difference in enhancement pattern between BPH and PCa groups, observing enhancement pattern could help to identify prostate cancer from benign prostate hyperplasia.