Background: Aberrant Bcl-2 transcription is closely related with nodal diffuse large B-cell lymphoma (DLBCL), however, the relationship between Bcl-2 and primary gastrointestinal DLBCL (PGI-DLBCL) was not fully studied.Aims: To investigate the relationship between Bcl-2 gene amplification and protein expression and clinicopathological characteristics, immunophenotype and prognosis of PGI-DLBCL.Methods: Clinical data was collected from 136 PGI-DLBCL patients receiving surgical treatment, and a telephone interview was conducted for survival information.Bcl-2 gene amplification and protein expression in tumor tissue were determined by fluorescence in situ hybridization and immuno-histochemistry, respectively, and relationships between Bcl-2 and clinicopathological characteristics, immunophenotype and prognosis of PGI-DLBCL were analyzed.Results: Among 136 PGI-DLBCL patients, 33 (24.3%) showing gene amplification and 90 (66.2%) showing protein expression of Bcl-2;gene amplification was correlated with primary tumor location, Ann Arbor stage, serum lactate dehydrogenase level, B symptom and International Prognostic Index (IPI) score (P<0.05), while protein expression was correlated with primary tumor location and immunophenotype (P<0.05).5-year overall survival (OS) in patients positive for Bcl-2 gene amplification and patients with non-GCB immunophenotype and positive for Bcl-2 protein expression were inferior to those negative ones (41.5%vs.71.5%, P<0.05;54.6% vs.84.6%, P<0.05).In Bcl-2 gene amplification or protein expression positive patients, 5-year OS of CHOP chemotherapy was inferior to that of rituximab combined with CHOP chemotherapy (48.6%vs.80.3%, P<0.05;66.4%vs.83.4%, P<0.05).Conclusions: Detection of Bcl-2 gene amplification is useful for prediction of prognosis in PGI-DLBCL.Both patients with Bcl-2 gene amplification and non-GCB patients with Bcl-2 protein expression have a poorer prognosis.Rituximab may improve the prognosis in patients with Bcl-2 gene amplification or protein expression.

Objective The objective of this study was to investigate the clinicopathological features and rational treatment of primary fallopian tube cancer(PFTC).Methods The clinical and pathological data of 39 patients with primary fallopian tube cancer from January 2006 to July 2016 in Beijing Tongren Hospital of Capital University were retrospectively analyzed.Results There were 39 cases of undifferentiated carcinoma,including 1 case of undifferentiated and transitional cell carcinoma,37 cases of undifferentiated adenocarcinoma,or 29 cases of simple adenocarcinoma and 10 cases of mixed type.Among them,7 cases were treated with clear cell carcinoma,endometriosis in 2 cases,combined with transitional cell carcinoma in 1 case.Extra-pelvic metastases were the most common site of the omentum with 17 cases.The preoperative test CA125 was increased in 13 cases and 38 patients received postoperative chemotherapy.The 5-year overall survival rate of 39 patients was 51.3%.Univariate analysis showed that postoperative pathologic stage(Ⅰ~Ⅱ vs.Ⅲ,P<0.001),intraoperative residual lesion size(P<0.001),omentum metastasis(P<0.001),ovarian metastasis(P=0.034),retroperitoneal lymph node metastasis(P=0.018)and preoperative CA125 elevation(P=0.002)were associated with prognosis,while age(P=0.310)and pathological grade(P=0.663)were not associated with prognosis.Multivariate analysis showed that the number of patients with postoperative lymph node metastasis(P=0.018)and preoperative CA125 elevation(P=0.002)were correlated with prognosis(HR=1.202,95% CI:2.354~63.290,P=0.003) and pathological stage(HR=3.810,95% CI:1.202~12.079,P=0.023).They were associated with prognosis as independent prognostic factors.Conclusion Tumor pathologic staging and omentum metastasis are important prognostic factors influencing the prognosis of patients with primary fallopian tube cancer.Early diagnosis and complete operation can improve the prognosis of patients.

Objective To explore the clinicopathological and immunohistochemical features, diagnosis and treatment,prognosis of hepatoid adenocarcinoma of the stomach with neuroendocrine tumor.AFP, Syn, CgA, Ki-67, P53 were stained by immunohistochemistry and follow-up was conducted by telephone.Methods Hepatoid adenocarcinoma of the stomach with coexisting neuroendocrine tumor was identified in 13 cases from June 2004 to June 2014 in Ren Ji Hospital.Results Among the 13 cases of hepatoid adenocarcinoma of the stomach coexisting with neuroendocrine tumor patients, there were 7 males and 6 females, with an median age of 62 years.Tumors located in the gastric cardia in 2 cases, in the gastric antrum in 8 cases and in the gastric body in 3 cases.Tumor ranged from 1-19 cm.The follow-up rate was 100％.The median overall survival rate was 12 months, two patients died of liver metastasis and one patient died of anastomotic recurrence.Serum AFP increased in 10 patients with hepatoid adenocarcinoma of the stomach coexisted with neuroendocrine tumor.The structure consisted of hepatoid cell differentiation and adenocarcinoma differentiation and neuroendocrine differentiation area by histological microscope examination.Immunohistochemical staining showed that tumor regional AFP, Syn, CgA, Ki-67, P53 were positive.Conclusions Hepatoid adenocarcinoma of the stomach coexisting with neuroendocrine tumor is very rare, it is made up of three structures : hepatoid cell differentiation, adenocarcinoma differentiation and neuroendocrine differentiation area.Diagnosis relies on immunohistochemical and histological examination.

Objective To compare the clinical efficacy of Freka trelumina (FT) vs.feeding jejunostomy (FJ) in carrying out postoperative early enteral nutrition (EEN) in old patients with gastric cancer.Method 168 old gastric cancer cases were derided into FT group (n =54) with EEN, FJ group (n =50) with gastric tube and EEN, and total parenteral nutrition (TPN) group (n =64).Results Compared with TPN group, postoperative body weight, serum albumin and prealbumin level in FT and FJ groups were significantly higher, intestinal function recovery time, days of postoperative hospitalization and costs were significantly lower.The incidence of cough, sputum and sore throat of patients in FT group were significantly higher than those in FJ and TPN groups (P ＜ 0.05).Conclusions Postoperative EEN through FT and FJ was effective to improve nutritional parameter, accelerate intestinal function recovery, reduce the number of days of postoperative hospitalization, total costs, anastomotic stomal leak and gastroparesis rate.

Objective To analyze the clinico-pathological characteristics and prognostic factors of patients with gastric neuroendocrine carcinoma(G-NEC).Methods Clinical data of 40 cases of G-NEC form January 2003 to August 2013 at Ren Ji Hospital of Shanghai Jiaotong University were analyzed.Tumors were classified into different grades and stages according to the 2010 WHO classification and the 2006 European neuroendocrine tumor society (ENETS).Follow-up was conducted by telephone.The survival curves were drawn using Kaplan-Meier method.Univariate analysis was performed by the Log-rank test and multivariate analysis was performed by the COX proportional hazards model.Results Among the 40 G-NECs patients,29 were male(72％) and 11 were female(28％),with an median age of 61 years.Tumors located in the gastric cardia in 20 cases,in the gastric antrum in 11 cases and in the gastric body in 9 cases.Tumor ranged from 1 cm-20 cm.All patients were G-NEC (G3).Follow-up rate was 100％ (40/40).The median overall survival rate was 12 months,and one-year survival rate was 82％.Immunohistochemically G-NEC cells were positive for CgA and Syn in 11 cases.Gender (x2 =5.673,P ＜ 0.05),Ki-67 index (x2 =8.612,P ＜ 0.05),and lymphnode involvement (x2 =0.559,P ＜ 0.05) were prognostic factors of G-NEC patients.Conclusions The symptoms of G-NEC are nonspecific.Its diagnosis relies on pathological examination and immunohistochemistry.Syn and CgA are the most important markers.Female gender,lower Ki-67 index and lower lymph node metastasis predict a survival advantage.

Objective To evaluate two different histopathological classification systems (Fletcher and Miettinen) for the risk in cases of gastrointestinal stromal tumors (GIST). Methods One hundred and sixty-five GIST cases with complete clinicopathologic and follow-up data were evaluated for their biologic potential by the histopathological classification systems of Fletcher, and among those, 164 cases GIST were evaluated by the histopathological classification systems of Miettinen. The implication of two classification systems were compared by survival analysis. Results Evaluated by Fletcher histopathological classification system, 59 cases (35. 8%) were graded as high risk, 49 cases (29. 7%) as intermediate risk, 43 cases (26. 1%) as low risk and 14 cases (8. 5%) were very-low risk. Evaluated by Miettinen's system, 68 cases (41.5%) were as high risk, 23 cases (14. 0%) were intermedatie risk, 60 cases (36. 6%) were low risk and 13 cases (7. 9%) were very-low risk. Evaluated by both two systems, the survival time and disease-free survival time of high risk GIST were lower than those of very-low, low and intermediate risk GIST(P <0. 05), the survival time and disease-free survival time of intermediate risk GIST were lower than those of low risk GIST(P<0. 05). According to Fletcher's system, in the high risk GIST, the disease-free survival time of small intestinal, colonic and rectal GIST was lower than that of gastric GIST(P = 0. 022), and in the intermediate risk GIST, the survival time of small intestinal, colonic and rectal GIST was lower than that of gastric GIST(P =0. 032). According to Miettinen's system, in the risk subgroup of GIST, the survival time and disease-free survival time of gastric, small intestinal, colonic and rectal GIST has no statistical difference(P > 0. 05). Conclusions Fletcher histopathological classification system is simple and easy to use, while Miettinen's system for evaluating biological potential by anatomic site is more accurate and predictive in the selection of high risk patients for target adjuvant treatment.

Objective To investigate the efficacy and toxicity of neoadjuvant regional arterial chemotherapy in the treatment of advanced gastric cancer. Methods The clinical data of 158 patients with advanced gastric cancer and with the same clinical stages who were admitted to Renji Hospital of Shanghai Jiaotong University from February 2002 to May 2005 were retrospectively analysed. Preoperative regional arterial chemotherapy was applied to 76 patients (test group) and the remaining 82 patients only received surgical treatment (control group). The chemotherapy regimen was epirubicin (50 mg/m2) + cisplatin (60 mg/m2) + 5-fluorouracil (1000 mg/m2).This regimen was modified to oxaliplatin (130 mg/m2) + 5-fluorouracil (1000 mg/m2) since 2003, and surgery was performed 6-11 days after the chemotherapy. All patients received postoperative intravenous chemotherapy.The clinical effects, radical resection rate, operative complications and long-term survival of the two treatment methods were evaluated. All data were analysed using the chi-square test and Kaplan-Meier analysis. Results The radical resection rate was significantly higher at 86% (65/76) in the test group compared with 71% (58/82)in the control group ( x2 = 5.01, P ＜ 0. 05 ). The toxicity of the chemotherapy in the test group was mild. The postoperative complication rate was 20% (15/76) in the test group and 16% (13/82) in the control group, with no significant difference between the two groups (x2 = 0.41, P＞0.05). The median survival time was 41 months in the test group and 23 months in the control group. The 5-year overall survival rate was higher in the test group (44.6%) than that in the control group (29.1%) (x2 =3.95, P＜0. 05). Conclusions Neoadjuvant regional arterial chemotherapy is well tolerated by patients with advanced gastric cancer. It is also effective for increasing the radical resection rate and improving the long-term survival.

Objective To investigate the relationship between tumor subclassifieation and the clinicopathologic features and prognosis of patients with gastrointestinal diffuse large B-cell lymphoma (DLBCL). Method From June 2000 to June 2007, 63 gastrointestinal DLBCL cases were enrolled. Immunohistochemical staining was performed to detect CDIO, Bcl-6 and MUM1 expression. Tumors were subclassified according to CDIO, Bcl-6 and MUM1 expression. Results CD10 expression was positive in 13 cases. Bcl-6 expression was positive in 53 cases. MUM1 expression was positive in 52 cases. According to the expression of CD10, Bcl-6 and MUM1, 17 cases(27%) were of germinal center B cell-like (GCB) DLBCL and 46 cases (73%) were of non-GCB. There was a significant difference in local lymph node metastasis between GCB group and non-GCB group, but there was no significant difference in terms of tumor size and infiltrate depth between the two subgroups. The survival time of patients in GCB group(76 months) was significantly longer than that of non-GCB group (28 months). Among cases receiving postoperative chemotherapy (CHOP), the survival of GCB group (76 months) was longer than non-GCB group (24 months). All 4 GCB cases and 4 non-GCB cases under R-CHOP chemotherapy are alive (22 ～ 47 months). Conclusion Gastrointestinal DLBCL subclassification is closely correlated with local lymph node metastasis, and this in combination with the expression of CD10 could be used to predict the prognosis of patients with gastrointestinal DLBCL.

OBJECTIVETo investigate the expression of ET-1 mRNA in the lung of rats with hepatopulmonary syndrome.

METHODSMale Sprague-Dawley rats were divided into four groups: SO, IHPH, PHPH and PCS. Two weeks after production of rat models, all measurements were performed. Arterial blood gas was analyzed. The concentrations of NO and ET-1 in lungs were measured by using radioimmunoassay. In situ hybridization, ET-1 mRNA expressions were detected in lung tissue sections with digoxin-labeled ET-1 oligonucleotide probes. Liver and lung tissues and all the results of in situ hybridization were analyzed by one pathologist. At a magnification of 10 x 40, percent areas of positive stains were detected to indicate the expressions of ET-1 mRNA in the arteries, capillaries and branches.

RESULTSArterial blood gas analysis showed that PaO(2) (mmHg) decreased more significantly in IHPH (73.85 +/- 6.51) rats than in PHPH (97.39 +/- 1.33), PCS (95.23 +/- 2.22) and SO rats (99.05 +/- 0.75). Alveolar-arterial oxygen gradient (A-aG) (mmHg) increased more significantly in IHPH rats (32.99 +/- 6.57) than in PHPH (4.98 +/- 1.69), PCS (6.51 +/- 2.04) and SO rats (3.23 +/- 0.81). Changes of vascular active substance in plasma and lung indicated that the level of lung NO of IHPH (19.78 +/- 5.33) was increased significantly more than that of PHPH (13.21 +/- 3.99) and PCS (13.89 +/- 3.16). These levels in lung homogenate increased more significantly than those SO (8.71 +/- 1.68). The levels of ET-1 in IHPH rats (195.1 +/- 36.2) was significantly lower than in PHPH (234.8 +/- 71.0), PCS (240.4 +/- 66.5) and SO rats (271.8 +/- 40.6). ET-1 mRNA in situ hybridization showed that there was no significant difference in positive expression of ET-1 mRNA in alveolar arteries and small bronchi. The expression of ET-1 mRNA was significantly lower in alveolar capillary endothelia (5.12 +/- 1.27) than in PHPH (7.43 +/- 0.83), PCS (7.07 +/- 0.86) and SO (7.81 +/- 1.98) rats.

CONCLUSIONThe low expressions of ET-1 mRNA in HPS rat alveolar capillary endothelia accompanied by decreased ET-1 levels in lung may play an important role in the mechanism of HPS.

Animals ; Disease Models, Animal ; Endothelin-1 ; biosynthesis ; genetics ; Hepatopulmonary Syndrome ; metabolism ; pathology ; Image Processing, Computer-Assisted ; In Situ Hybridization ; Lung ; metabolism ; pathology ; Male ; Nitrates ; metabolism ; Nitrites ; metabolism ; RNA, Messenger ; biosynthesis ; Rats ; Rats, Sprague-Dawley

Objective To study the role of vascular mediators in the pathogenesis of hepatopulmonary syndrome in rats. Methods Male Sprague-Dawley (SD) rats were divided into four groups: SO (surgical control), IHPH (intrahepatic portal hypertension), PHPH (prehepatic) and PCS (portocaval shunt). Two weeks after pathological study, arterial blood gas and the concentrations of NO, glucagon, VIP and ET-1 in plasma and lung were determined. Results Lung structural alteration of rats induced by CCl 4 was of alveolar capillary dilation and angiogenesis, thickened alveolar septa and decreased alveolar capacity. There was no inflammation, edema, fibrosis, alveolar collapse and hyaline membrane formation in lung of all rats. PaO 2 ( mm?Hg)decreased more significantly in IHPH (73.85?6.51) rats than in PHPH (972?9?1.33), PCS (95.23?2.22) and SO rats (99.05?0.75). The level of lung NO of IHPH (19.78?5.33) was significantly increased than those of PHPH (13.21?3.99) and PCS (13.89?3.16) whose level in lung homogenate increased than those of SO (8.71?1.68). There was no difference of Glu and VIP levels in lung among all rats. The level of lung ET-1 in IHPH was significantly decreased than other rats. Conclusion Increased NO levels and decreased ET-1 levels in lung of HPS rats cause alveolar dilation and angiogenesis leading to mismatched ventilation-perfusion, and decrease of PaO 2.