目的 探讨原发性甲状腺鳞状细胞癌的诊断和治疗。方法 回顾性分析我院收治的1例原发性甲状腺鳞状细胞癌典型病例，并结合相关文献复习，探讨其诊断和治疗。结果 该例肿瘤侵及甲状软骨、环状软骨和喉，行甲状腺癌联合喉扩大切除术。术后发生甲状旁腺功能低下和手足抽搐，术后第15天出院。随访1年健康生存，未见复发和远处转移。结论 原发性甲状腺鳞状细胞癌罕见，早期诊断困难，恶性程度高，积极手术是首选的治疗方法。放射治疗可延缓肿瘤的生长、转移。
Objective To explore the role of versican (VCAN) in ESCC prognosis based on bioinformatics data. MethodsFirst, three RNA microarray datasets of ESCC were downloaded from GEO database, which were then integrated and used to explore differentially expressed genes (DEGs). The subsequent analysis was conducted based on the results of these DEGs: (1) The STRING database was used to construct a protein-protein interaction (PPI) network; (2) molecular complex detection software was used to analyze the modules of the PPI network, of which the most significant modules were chosen, and hub genes were the genes included in the chosen modules; (3) high-throughput RNA sequencing data from TCGA and GTEx databases were used to verify the expression of these hub genes to confirm whether they were differentially expressed; (4) the survival curve analysis of confirmed DEGs was conducted to select genes that had significant influence on the survival of ESCC; (5) TIMER database was used to analyze the relationship between the gene expression of VCAN and the abundance of tumor-infiltrating immune cells (TIICs) and gene markers in these cells; (6) Targetscan and miRDB software were used to predict the miRNAs that could regulate VCAN, and Cytoscape software was used to construct the regulatory network. ResultsA total of 630 DEGs and 32 hub genes were found, of which VCAN was an up-regulated DEG, and high expression of VCAN was significantly associated with poor prognosis of ESCC. Moreover, VCAN could also play a role in the immune microenvironment of ESCC, which was mainly manifested by a significant positive correlation between the abundance of VCAN and the abundance of M2 macrophages gene markers, some of which had been reported to be associated with poor prognosis of ESCC. Finally, we also found that VCAN could be regulated by 15 miRNAs in ESCC, some of which had been reported to be associated with ESCC prognosis. ConclusionThis study provides direct and indirect comprehensive evidence for the role of VCAN in ESCC prognosis. The direct evidence is that the survival curve shows that highly expressed VCAN is significantly associated with the poor prognosis of ESCC, and the indirect evidence is that VCAN is positively related to some markers which indicate poor prognosis in the ESCC immune microenvironment, and VCAN can be regulated by some prognostic miRNAs in ESCC.
ObjectiveTo compare the clinical efficacy of modified Ivor-Lewis esophagectomy, which preserves azygos vein, thoracic duct and peripheral tissues, and classic Ivor-Lewis esophagectomy, which resects these tissues, in the treatment of esophageal cancer, so as to evaluate whether it is necessary to resect azygos vein, thoracic duct and peripheral tissues in esophagectomy for esophageal cancer.MethodsPatients scheduled for surgical treatment of thoracic esophageal cancer in Department of Thoracic Surgery of Sichuan Cancer Hospital from June 2011 to June 2013 were randomly assigned to the retention group and the resection group, each including 100 patients. The retention group included 87 males and 13 females with an average age of 60.53±7.72 years. In the resection group, there were 80 males and 20 females with an average age of 60.69±7.69 years. Patients in the two groups were compared for the duration of surgery, intraoperative blood loss, postoperative thoracic drainage volume, postoperative complications, and number of dissected lymph nodes, etc. Postoperative relapse and survival rates at 1, 3 and 5 years postoperatively were also followed up and compared for patients in the two groups.ResultsThere was no statistical difference between the two groups in general patient characteristics, number of dissected lymph nodes, or postoperative pathological stage, etc. (P>0.05). Compared to the resection group, there were shorter duration of surgery, less intraoperative blood loss, and less thoracic drainage volume in the first 3 days following surgery in the retention group, with statistical differences (P<0.05). There was no statistical difference between the two groups in type or site of relapse or metastasis (P>0.05). The survival rates at 1, 3, and 5 years postoperatively was 78.7% vs. 81.3%, 39.4% vs. 37.5%, and 23.4% vs. 17.7%, respectively, in the retention group and the resection group, with no statistical difference (P>0.05).ConclusionModified Ivor-Lewis esophagectomy preserving azygos vein, thoracic duct and peripheral tissues could reduce surgical trauma, would not increase postoperative relapse or metastasis, and could produce long-term efficacy comparable to that of extended resection.
Objective To investigate the prognostic factors of esophageal squamous cell carcinoma（ESCC） by multivariate analysis of clinicopathologic features of ESCC between long-term and short-term survivals after esophagectomy. Methods The clinicopathologic features of randomly selected 126 cases with ESCC were analyzed with binary logistic regression, 48 cases of which was divided into long-term survival group（≥5 years） and 78 cases into short-term survival group（≤1 year） according to the follow-up. Results Under univariate analysis, the differences between two groups on tumor pathologic grading, metastasis to lymph node, depth of tumor invasion and length of tumor were significant （Plt;0.01）, however, that on age, gender, location of tumor and status of residues were not （Pgt;0. 05）. Multivariate analysis showed that tumor pathologic grading, metastasis to lymph node, depth of tumor invasion and length of tumor correlated with the prognosis of ESCC （Plt;0. 05）. Their risk coefficient were 2. 943, 2. 641, 2. 126 and 1. 728, respectively. Age, gender, location of tumor and status of residues did not correlated with the prognosis of ESCC （Pgt;0. 05）. Correlation analysis indicated that depth of tumor invasion was positively related to the length of tumor （r=0. 488, Plt;0. 001）, metastasis to lymph node was positively related with depth of tumor invasion and tumor pathologic grading （r=0. 216, P=0. 014; r=0. 238, P=0. 007）. Conclusions The main prognostic factors of ESCC are tumor pathologic grading, metastasis to lymph nodes, depth of tumor invasion and length of tumor,Tumor pathologic grading is high risk factor for prognosis of ESCC,while length of tumor is low risk factor. Age and gender of patients, location of tumor and status of esophageal residues are non-risk factors.
Objective To investigate the clinical significance and expression of T helper cell secretory cytokines in esophageal squamous cell carcinoma tissues, which provide theoretical basis of reasonable and effective therapy for patients with esophageal carcinoma. Methods Fifty-six specimens of patients who underwent esophageal carcinoma resection were divided into two groups. Group A (n=28) included grade Ⅰand Ⅱ specimens of esophageal squamous cell carcinoma, group B (n=28) included grade Ⅲ and Ⅳ specimens of esophageal squamous cell carcinoma. Control group included 6 specimens of esophagitis. The expression of tumor necrosis factor alpha (TNF-α), interleukin 10 (IL-10) and transforming growth factor beta (TGF-β) in all specimens were detected. Results The positive expression of TNF-α,TGF-β and IL-10 in group A and group B were significantly higher than those in control group(Plt;0.01); the positive expression of TNF-α in group A was higher than that in group B, while the positive expression of TGF-β and IL-10 were lower than those in group B (Plt; 0.01). There was negative correlation between the positive expression of TNF-α and IL-10, TGF-β(Plt;0.01), and positive correlation between TGF-β and IL-10 (Plt; 0.01). The positive expression of TNF-α in patients of survival period in 3 years was lower than that exceed 3 years(F=36.25 ,Plt;0.01),while the positive expression of IL-10 and TGF-β in the patients of survival period in 3 years were higher than those exceed 3 years(F=29.29,26.69;Plt;0.01). Conclusion By the way of changing the level of cytokines secretion from T helper cells, esophageal squamous cell carcinoma tissues destroyed the balanced condition of patient’s immune system, which made esophageal carcinoma tissues escape the attack from the patient’s immune system and promote the invasion into surrounding tissues.
Objective To investigate the operative procedure and the effectiveness of cranial bone reconstruction after one-stage resection of scalp squamous carcinoma invading the skull. Methods Between January 2005 and December 2008,14 patients with scalp squamous carcinoma invading the skull were treated. There were 6 males and 8 females with a median age of 53 years (range, 29-76 years). The disease duration ranged from 3 to 8 years (mean, 6 years). The tumor locations were right temporal area in 2 cases, left temporal area in 2 cases, right frontal area in 3 cases, left frontal area in 1 case, right occi pital area in 1 case, left occi pital area in 2 cases, frontal area in 2 cases, and the top of the head in 1 case. Scalp lesions showed exogenous growth, and lesion diameter ranged from 5 to 12 cm (mean, 8 cm). TNM classification showed T4N0M0 tumor in all cases. MRI showed that tumors invaded the skull, 12 cases had smooth intradural side and 2 cases had brain involvement without lymph node metastasis or detected distant metastasis. Under general anesthesia, all the lesions of the scalp, skull, dura, and brain tissue were removed completely. The size defect of the scalp, skull, and dura ranged from 8 cm × 7 cm to 15 cm × 14 cm, from 5 cm × 4 cm to 12 cm × 12 cm, and from 4 cm × 4 cm to 9 cm × 8 cm, respectively, which were repaired with artificial patch, titanium metal, mesh, and local flaps, respectively. The donor site was repaired by spl it-thickness skin graft. Results The skin flaps and grafts survived and incision healed by first intention without cerebrospinal fluid leakage, intracranial and subdural hemorrhage, andother compl ications. All patients were followed up 2 to 5 years (mean, 4 years), and no recurrence was found. The compatibil ity of titanium mesh and local tissue was good. The patients had good hair growth without exposure of titanium mesh, seizures, partial paralysis, and other neurological damage performance. Conclusion After one-stage resection of scalp squamous carcinoma invading the skull, it is effective to reconstruct the skull with titanium mesh and to repair dural defects with artificial dura.
ObjectiveTo improve the knowledge of double primary lung cancer. MethodsA case of synchronous double primary lung cancers, who was diagnosed by bronchoscopic examination and immunohistochemical staining in our department in 2012, was analyzed retrospectively. The literatures were review with "double primary, lung cancer, squamous cell carcinoma, small cell lung carcinoma" as the research terms in Wanfang, CNKI and PubMed database. ResultsA 76-year-old male patient complained of intermittent cough, chest pain and wheezing over half a month. Chest computer tomography showed masslike lesion with high density in hilum of right lung. The patient received bronchoscopic examination, the pathological and immunohistochemical findings was squamous cell carcinoma and small cell lung carcinoma. The imaging manifestations and bronchoscopy findings were consistent with pathologic diagnosis. A total of 7 pieces of literature were retrived in above-mentioned databases. Seven patients had long smoke history and 6 were male. Four patients complained about couph and sputum, and 1 patient had chest pain. CT showed masses in the lung or hilus with or without stenosis and obliteration of the bronchus. Five patients were proven by bronchoscopy and biopsy. ConclusionDouble primary lung cancer has characteristics in radiologic features and bronchoscopy performance, so can be early diagnosed by bronchoscopy and histopathology.
The incidence and mortality of esophageal cancer in China rank the fifth and fourth, respectively, with squamous carcinoma accounting for more than 90%. Currently, the treatment of esophageal squamous carcinoma mainly includes surgery, chemotherapy, radiotherapy, and endoscopic treatment. However, the 5-year survival rate is only about 20%. At present, the treatment of esophageal squamous carcinoma seems to reach a plateau. Thus, it is urgent to develop new and more effective drugs and treatments. In this paper, the clinical research progresses of epidermal growth factor receptor (EGFR)- targeted therapy of esophageal squamous carcinomas were summarized, including anti-EGFR monoclonal antibodies, such as cetuximab and nimotuzumab, and EGFR-tyrosine kinase inhibitor, such as gefitinib, erlotinib, and ecclinib.