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颈部Castleman病1例报道

胰腺癌组织中 Beclin-1 mRNA 和 miR-216a 的表达及 VEGF 蛋白表达与 p-MAPK-ERK1/2信号通路的关系

目的 探讨腺癌、鳞癌、黏液性囊腺瘤、慢性胰腺炎和正常胰腺组织中胰腺癌相关基因的表达。 方法 回顾性收集 2012 年 1 月至 2017 年 4 月期间于湖北医药学院附属东风医院肝胆胰外科住院行手术治疗的 40 例胰腺疾病患者的术中标本，其中腺癌、鳞癌、黏液性囊腺瘤、慢性胰腺炎和正常胰腺组织各 8 例。采用实时荧光定量 PCR 和基因芯片法检测 5 组组织中 Beclin-1 mRNA 和 microRNA（miR）-216a 的表达。对以上组织行原代细胞培养，分为空白对照组和 PD98095 组（加入 PD98095 抑制剂），采用 Western blot 法检测细胞中血管内皮生长因子（VEGR）与磷酸化细胞外调节蛋白激酶 1/2（p-ERK1/2）的表达。 结果 与正常对照组比较，腺癌组和鳞癌组组织中 Beclin-1 mRNA 和 miR-216a 的表达水平较低（P<0.05），腺癌组、鳞癌组、黏液性囊腺瘤组和慢性胰腺炎组组织中 Beclin-1 mRNA 和 miR-216a 的表达水平比较差异无统计学意义（P>0.05）。与同类组织的空白对照组比较，腺癌组和鳞癌组加入 PD98095 后，细胞中 p-ERK1/2 和 VEGF 蛋白的表达水平下调（P<0.05），但黏液性囊腺瘤组、慢性胰腺炎组和正常对照组加入 PD98095 前后细胞中 p-ERK1/2 及 VEGF 蛋白的表达水平变化不大（P>0.05）。 结论 Beclin-1 mRNA、miR-216a 和 VEGF 蛋白的表达与胰腺癌的发生发展可能有关。

Diagnosis and treatment of occult carcinoma of the thyroid with neck lymph node metastasis as the first symptom

Objective To investigate the optimal diagnosis and treatment strategy of occult carcinoma of the thyroid (OCT) with neck lymph node metastasis as the first symptom. Method In order to discuss the optimal diagnosis and treatment strategy of OCT with neck lymph node metastasis as the first symptom, we collected 35 cases and analyzed their characteristics, diagnostic methods, operative schemes, metastasis situation, and death situation. Results Of the 35 cases, 28 cases went to hospital because of swollen lymph nodes, and other 7 cases were discovered by color Doppler ultrasound in medical examination. Thyroid nodules were found by color Doppler ultrasound in 32 cases, 3 cases were found no thyroid nodule. Lymph node of 23 cases were determined by ultrasound-guided fine-needle aspiration biopsy (US-FNAB), and 16 cases (69.56%) were diagnosed as metastasis of thyroid carcinoma or suspicious metastasis by US-FNAB. Thyroid biopsy were done in 21 cases, and 11 cases (52.38%) were diagnosed as thyroid carcinoma or suspicious thyroid carcinoma by fine needle aspiration biopsy. Of the 35 cases, 19 cases were performed total thyroidectomy and functional neck lymph node dissection, 11 cases were performed resection of unilateral thyroid and isthmus and regional neck lymph node dissection, 5 cases were performed nonstandard operations. All cases were followed up for 3–10 years after operation, and the median time was 7-year. During follow up period, 10 cases suffered from reccurrence. Among them, 3 cases reoccurred in the nonstandard operation group, 5 cases reoccurred in resection of unilateral thyroid and isthmus and regional neck lymph node dissection group, 3 cases reoccurred in total thyroidectomy and functional neck lymph node dissection group. There were 3 cases died. Among them, there was 1 case in each group of nonstandard operation group, resection of unilateral thyroid and isthmus and regional neck lymph node dissection group, and total thyroidectomy and functional neck lymph node dissection group. The recurrence rate of total thyroidectomy and functional neck lymph node dissection group was markedly lower than those of resection of unilateral thyroid and isthmus and regional neck dissection group (χ2=4.751,P<0.05) and nonstandard operation group (χ2=5.874,P<0.05). While there was no significance difference of the recurrence rate between the resection of unilateral thyroid and isthmus and regional neck dissection group and nonstandard operation group (χ2=0.291,P>0.05). There was no significance difference in the mortality among the three groups (P>0.05). Conclusion US-FNAB and intraoperation rapid frozen pathological section are important methods for diagnosis of OCT with neck lymph node metastasis as the first symptom, and standard operation is an principal treatment method for it.