Objective To study the characteristics of clinical and laboratory findings in patients with adrenocorticotropic hormone(ACTH)independent macronodular adrenocortical hyperplasia(AIMAH).Methods The clinical and laboratory findings of 7 cases of AIMAH admitted between 1997 and 2005 were reviewed retrospectively.Results 5 of the 7 patients showed typical clinical features of Cushing's syndrome,including moon face,central obesity,hypertension,etc.A part of patients had hypokalemia(43%)and secondary diabetes mellitus(71%).There was lowering of plasma ACTH levels,and an increased cortisol secretion or disturbance in or circadian rhythm.In 6 patients,a low dose or high dose of dexamethasone suppression tests failed to suppress cortisol secretion.CT scan showed bilateral macronodular adrenal hyperplasia.Pituitary MR imaging for pituitary was negative in 6 patients.Unilateral total adrenalectomy was performed in 2 cases.4 cases were treated by bilateral adrenalectomy.One patient died of stroke before operation.5 cases received glucocorticoid replacement therapy after operation.Pathologic examination showed diffuse yellow or brown nodules measuring 0.3 cm～7.0 cm in diameter in all the specimems of 6 patients who undement operation.There was no recurrence in all the patients ofter surgery during the follow-up period.No Nelson syndrome occurred in these 6 patients postoperatively.Conclusion AIMAH is a rare cause of Cushing's syndrome with unique clinical,CT image and pathological findings.Bilateral adrenalectomy in one stage or in stages,or unlateral adremectomy is indicated on the basis of clinical and CT findings.

Objective To study clinicopathologic features of ALK-positive large B-cell lymphoma.Methods The clinical data,histopathological characteristics,immunophenotype and fluorescence in situ hybridization (FISH) result of a patient with ALK-positive large B-cell lymphoma were analyzed and discussed combined with related literatures.Results A 30-years-old male patients with the left neck lymphadenectasis was studied.Histological evaluation revealed the tumor grew in sheets in the nodal,with round nuclei,dispersed chromatin,a single prominent central nucleolus and moderate amounts of eosinophilic to amphophilic cytoplasm.The neoplastic cells exhibited immunoblastic/plasmablastic morphology.Immunohistochemistry measurement showed that the tumor cells were marked positively by CD138,ALK-1,CD45RO,CD4,Perforin,CD117 and Kappa proteins,while negatively by CD3,CD8,CD20,CD30,CD38,CD57,CD79a,Pax-5,EMA and AE1/AE3 proteins.FISH test demonstrated the presence of ALK gene translocation.The patient was given 4 cycles of CHOP chemotherapy after surgery.However,the conditions deteriorated after 4 months.Now the patient continued to receive treatment.Conclusion ALK-positive large B-cell lymphoma represents a distinct variant of diffuse large B-cell lymphoma,and the tumor has special histological features along with a distinct immunophenotype and ALK gene rearrangement.

Objective To investigate the significance and expression of PTEN, MLL in T lymphoblastic lymphoma/leukaemia(T-LBL/ALL). Methods Seventy-six cases of T-LBL/ALL were studied by using immunohistochemical EnVision method for PTEN. Fluorescence in-situ hybridization (FISH) for MLL gene (located on chromosome 11q23) was performed to detect its breakage and amplification. Results Among the 76 cases ofT- LBL/ALL, the positive rate of PTEN was 64.47 % (49/76), lower than that in reactivated lymphoid tissue (100 %, 20/20) (λ2= 19.220, P ＜0.05). PTEN expression was reversely correlated to theclinical stage, Ki-67 index and LDH level (P ＜0.05). Among the 76 cases, MLL gene with breakage of 11q23 was detected in 13 cases (17.11%), and amplification in 18 cases (23.68 %). Survival rate ot MLL gene breakage group was lower than that of non-breakage group (25.0 %, 43.6 %). Survival rate of MLL gene amplification group was lower than that of non-amplification group too (17.1%, 42.7 %). Both of breakage and amplification were related to prognosis ( λ 2 = 11.357, λ 2 = 4.533; P ＜0.05). Conclusion Anti-oncogene PTEN down-regulation may play an important role on the development and proceeding of T-LBL/ALL. MLL gene with breakage and amplification of 11q23 are helpful to predict prognosis of T-LBL/ALL. The case with MLL gene breakage and amplification of T-LBL/ALL may have a poor prognosis. It hints this group maybe a subtype of T-LBL/ALL.

Purpose To investigate the mutation status of KRAS and PIK3CA gene in colorectal cancer (CRC) primary lesions and corresponding liver metastasis and its clinical significance.Methods The gene mutations of KRAS and PIK3CA were detected in 58 cases of primary lesions of CRC and corresponding liver metastasis tissue by real-time PCR.Results The mutation rates of KRAS were 31.03％ (18/58) and 25.86％ (15/58) in primary lesions of CRC and corresponding liver metastasis tissue,respectively,in which G12D was most commonly detected.The mutation rates of PIK3CA were 8.62％ (5/58) and 10.34％ (6/58) respectively,in which the most common mutation site was E545K.Only one case carried simultaneously both mutations of KRAS (G12D) and PIK3CA (E545K).The mutation of KRAS and PIK3CA had a good consistency between primary lesions and liver metastasis.Univariate analysis showed that the mutation of KRAS was related to the primary lesion of tumor location,the quantity of metastasis and the types of tumor (P ＜ O.05),PIK3 CA mutation was associated with the synchronous/metachronous liver metastasis and the quantity of metastasis (P ＜ 0.05).Multivariate Cox regression analysis showed that synchronous/metachronous liver metastasis and the mutation of KRAS were influencing factors for prognosis of CRC.The overall survival of patients with CRC who had simultaneous liver metastases was longer than those with heterotopic liver metastases;the overall survival of KRAS wild-type mutant patients was longer than those of mutant patients (P ＜ 0.05).Conclusion The G12D site of KRAS gene has the highest mutation frequency in CRC,KRAS/PIK3CA mutation has a good consistency of the primary lesions of CRC and corresponding liver metastasis.Primary lesions can be as the source of molecular detection.To achieve individualized treatment,we need to reassess the genetic status of metastasis based on the choice of targeted therapy for precision medicine.

Objective · To investigate antiemetic effect of aprepitant for moderately chemotherapy-induced nausea and vomiting in patients with gastrointestinal cancer. Methods · From 2014 July to 2015 August, 130 cases of gastrointestinal cancer patients were collected in Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, who received moderate emetogenic risk of chemotherapy for at least four courses. One hundred and nine patients were treated with aprepitant, palonosetron and dexamethasone on day 1, and aprepitant and dexamethasone on day 2 and 3. Twenty-one patients only received aprepitant and dexamethasone on day 1 and dexamethasone on day 2 and 3 in the first course of chemotherapy. During subsequent courses of chemotherapy they received aprepitant and treated in the same way as 109 patients. MASCC antiemetic tool (MAT) was used to evaluate the intensity of nausea. The primary endpoint was complete response (CR, no emesis and use of no rescue antiemetics) during the overall study phase (0-120 h after chemotherapy) at the second course. The secondary endpoint was complete protection (CP, CR plus no significant nausea) during the overall, acute (0-24 h), and delayed (24-120 h) phases at the second course. Results · The CR rates were 90.0%, 94.6% and 90.8% of patients in the overall, acute and delayed phases, respectively. The corresponding CP rates were 83.8%, 87.8% and 84.6 %, respectively. The CR rate increased from 42.9% to 57.1% during acute phase and increased from 9.5% to 90.5% during delayed phase for 21 patients after treatment with aprepitant. The main adverse reactions include constipation, anorexia and hiccups. Conclusion · Aprepitant combined with palonosetron and dexamethasone can effectively prevent moderately chemotherapy-induced nausea and vomiting in patients with gastrointestinal cancer. Aprepitant therapy can effectively maintain antiemetic effect in patients with many chemotherapy courses.

Objective To investigate the correlation of pathology factors and prognosis of gastrointestinal stroma tumors (GIST). Methods The expression of CD117, CD34, SMA, S-100 and Ki-67 in 91 GIST cases were studied by Envision method of immunohistocbemistory;Sequently, the relationship of the location, the size, the hemorrhage, cellular necrosis, stroma mucus, the mitosis, Ki-67 expression and the prognosis were analyzed by SPSS 12.0. Results The positive rate of CD117, CD34, SMA, S-100 were 80.21%, 73.63 %, 34.07 %, 7.69 % respectively. There had significant difference between the location, the mitosis, Ki-67 expression and the prognosis; but no significant difference between the location, the hemorrhage, cellular necrosis, stroma mucus, CD117 expression and the prognosis. Conclusion The tumor's size, mitosis, and Ki-67 expression are associated with prognosis; CD117 expression and prognosis. Even more, Ki-67 expression may be a more precise factor to judge the tumor's biological behaviour compared to the mitosis. As a wally classified method, the Flecther classification is worth to spread.

Purpose To ana1yze the expression features of 5-F1uorouraci1(5-FU)metabo1ic enzyme thymidy1ate synthetase(TS),thy-midine phosphory1ase( TP),dihydropyrimidine dehydrogenase( DPD)and its re1ationship with c1inicopatho1ogica1 factors and progno-sis in co1orecta1 cancer,in order to further exp1ore its potentia1 significance in guiding co1orecta1 cancer chemotherapy. Methods Es-tab1ishment of a tissue microarray containing 72 patients with co1orecta1 cancer,and 56 norma1 tissue( dista1 cut edge tissue near carci-noma)was used to detect TS,TP,and DPD by immunohistochemistry,and to ana1yze its re1ationship with c1inicopatho1ogica1 factors and prognosis of co1orecta1 cancer through statistica1 method. Results The expression of TS in co1orecta1 cancer was 1ower than that in norma1 tissue(P=0. 876),which was associated with TNM(P=0. 043)and positive1y corre1ated with patients’overa11 surviva1(P=0. 027),the expression of TP in co1orecta1 cancer was higher than that in norma1 tissue(P=0. 315)that was associated with 1ymph node metastasis(P=0. 009)and negative1y corre1ated with the prognosis of patients(P=0. 040),DPD expression in co1orecta1 canc-er was higher than that in norma1 tissue(P=0. 071),which was re1ated to the histo1ogic type(P=0. 029). Overa11 surviva1 was sig-nificant1y shortened in co1orecta1 cancer with DPD high expression( P=0. 011). Conclusions TS,TP and DPD might be app1ied as important index of prognosis in co1orecta1 cancer patients using 5-FU adjuvant chemotherapy. The expression of TS re1ated c1ose1y with the c1inica1 stage is a bio1ogica1 marker of tumor progression. TP expression is c1ose1y re1ated to 1ymph nodes metastasis and recur-rence,which is an important factor of postoperative recurrence and metastasis.

Purpose:To study whether immune factors are involved in the occurrence of immune thrombocytopenia in some malignancy. Methods:Platelet associated antibodies and immune function were examined in 30 cases of malignancy with thrombocytopenia in our hospital. Results:Platelet associated antibodies(pAIgG,pAIgA,pAIgM)increased significantly in 11 of 30 patients with malignancy,especially those with metastatic adenocarcinoma and in the middle or advanced stage. Bleeding is common in these patients. After being treated with corticosteroid, immunosuppressive drugs or immunoglobulin,the platelet count of the patients increased and the bleeding syndrome improved. Conclusions:Thrombocytopenia in malignancy is partly due to the abnormal immune reaction of the patients.

Objective To investigate the association of Her-2 protein expression and gene expression in gastric cancer by different methods,and to explore the effective approaches of Her-2 in gastric cancer detection.Methods Immunohistochemistry (IHC) was used to mark Her-2 protein in 68 cases of gastric cancer,and fluorescence in situ hybridization(FISH)wasused to detect the Her-2 gene amplification.Results Among 68 cases,IHC Her-2 protein in 12 cases(17.65 ％)was positive expression,including ++ 3 cases ++ 9 cases,+ 7 cases and-49 cases.By FISH,Her-2 gene in 11 cases(16.17 ％)was overexpression.Corresponding to the IHC results,FISH results was 3 cases(100 ％),8 cases(88.89 ％),0 cases,0 cases,respectively.Conclusion Her-2 protein expression and gene overexpression occur in gastric cancer.Her-2 protein expression in gastric cancer shows significant heterogeneity.Her-2 gene overexpression and Her-2 protein expression is correlated (P＜0.05).The differences of Her-2 expression in gastric cancer by IHC and FISH mostly occur in IHC++ groupe.Suggestion of Her-2 gene test should be given for patients with IHC++ who will be undertaken Her-2 gene therapy.

Objective To determine whether the CD133+ cancer stem cells lie in circumferential resection margin of rectal cancer,and to explore the relationship between CD133+ cancer stem cells and prognosis of rectal cancer.Methods The circumferential resection margin of rectal cancer was cut,one half of the tissue was stained HE for microscope observation.Both groups were labeled CD133 by immunohistochemistry.The tissues with positive circumferential resection margin were classified as experimental group,otherwise the control group.Another half was made into single cell suspension and used to detect CD133+ cancer stem cells by flow cytometry.The relapse of patients in the experimental group was following-up.Results Two cases were positive by immunohistochemistry in the experimental group (28 cases),showed that CD133+ cancer stem cells were in circumferential resection margin,but there was not marked difference compared with the control group (72 cases were all negative) (P =0.076).CD133+ cancer stem cells can be detected by flow cytometry,and the expression was higher in experimental group than that in the control group (5.19 ％ and 0.56 ％,Z =-7.739,P ＜ 0.01).In experimental group,the expression of CD133+ cancer stem cells in circumferential resection margin of relapse patients was significantly higher than that in patients without relapse,the difference was statistically significant [(6.57±1.72) ％ and (4.77±1.33) ％,t =3.038,P ＜ 0.05].Spearman rank correlation analysis showed that the proportion of CD133+ cancer stem cells in the experimental group was positively correlated with relapse (rs =0.473,P ＜ 0.05).Conclusion There are CD133 + cancer stem cells within circumferential resection margin of rectal cancer,and the expression of CD133+ cancer stem cells in experimental group is correlated with the postoperative recurrence.