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食管下段胃底哑铃状畸胎瘤1例报道

Peutz-Jeghers综合征肠道息肉恶变的临床分析

目的探讨Peutz-Jeghers综合征肠道息肉恶变的临床诊治经验。 方法对2005～2015年期间所诊治的221例Peutz-Jeghers综合征患者中11例息肉恶变患者的临床病理资料进行回顾性分析。 结果11例PeutzJeghers综合征息肉恶变患者确诊时的中位年龄为31.36岁。行肠镜20例次，胃镜8例次，双气囊电子小肠镜19例次，胶囊内镜1例次。手术原因依次为肠梗阻、肠套叠、息肉恶变和消化道出血。癌变息肉分别位于十二指肠（4例）、小肠（4例）和结直肠（3例）。病理类型以管状腺癌（5例）和黏液腺癌（5例）最多见。本组11例患者均无手术死亡，1例术后发生腹部切口感染，经伤口换药等处置后出院。术后3例患者接受XELOX方案化疗，其余未作特殊治疗。1例术后失访，10例随访1个月至7年（中位随访期2.12年），其中4例术后1～3个月死于十二指肠癌肝肺转移、空肠腺癌肝转移和结肠癌肝肺多发转移，其余患者定期复查消化内镜或消化道造影等检查至今。 结论PeutzJeghers综合征息肉恶变患者年龄较小，早诊断、早治疗、定期复查可提高患者的检出率和临床治疗效果。

Expression of hMLH1, hMSH2 or hMSH6 in Sporadic Colorectal Cancer and Relationship of It's Expression to Clinicopathologic Parameters

ObjectiveTo detect the expression of hMLH1, hMSH2 or hMSH6 protein in sporadic colorectal carcinoma (SCRC) and analyze the relationship of its expression to clinicopathologic parameters of patients with SCRC. MethodsTwo hundred and sixty-three patients with SCRC were studied, who underwent surgery in the Department of General Surgery, the Air Force General Hospital; and the Department of Colorectal Surgery, Beijing Cancer Hospital from March 2008 to March 2012. All the patients were diagnosed by histological examination without chemoradiotherapy before operation. Immunohistochemistry was used to detect the hMLH1, hMSH2 or hMSH6 protein expression in the tumor tissues from 263 cases of SCRC. The relationship of its expression to clinicopathologic parameters was analyzed. ResultsThe loss rates of hMLH1, hMSH2, and hMSH6 expressions in the tumor tissues from 263 patients with SCRC were 13.3% (35/263), 12.2% (32/263), and 28.9% (76/263), respectively. The loss rates of hMLH1/hMSH2, hMLH1/ hMSH6, hMSH2/hMSH6, and hMLH1/hMSH2/hMSH6 expressions were 3.4% (9/263), 10.2% (27/263), 6.8% (18/263), and 3.4% (9/263) corresponding. The loss rate of hMLH1 expression in the high differentiated adenocarcinoma tissues was significantly higher than that of the moderate to low differentiated adenocarcinoma or mucous carcinomas tissues (P < 0.01). The loss rate of hMLH2 expression in the tissues of tumor size more than 5 cm was significantly higher than that in the tissues of tumor size less than 5 cm (P < 0.05). The loss rate of hMSH6 expression in the male patient was significantly higher than that of the female patient (P < 0.01) and which in the tumor tissues of less lymph node metastasis was significantly higher than that in the tissues of the more lymph node metastasis (P < 0.01). ConclusionsThe hMLH1, hMSH2, or hMSH6 gene expression deletion is common in SCRC and the relation with the clinical pathology of SCRC is obviously different from Lynch syndrome. Therefore, the effects of hMLH1, hMSH2, and hMSH6 expressions on the development, invasion, and metastasis of SCRC are different from Lynch syndrome too.