Reassessment and clinicopathological prognostic factors of malignant fibrous histiocytoma of soft parts

Recently, the category of malignant fibrous histiocytoma (MFH) has been under discussion and new entities resembling MFH have appeared. To clarify the recent situation regarding MFH, we reassessed previously diagnosed MFH cases in accordance with the most up-to-date diagnostic criteria, which included allied tumors. We carefully reassessed 428 cases that had been diagnosed in our institute during the past 28 years. Moreover, we searched for clinicopathological prognostic factors among the cases that were finally diagnosed as MFH. Among the 428 cases, 138 cases had their diagnoses changed. The revised cases included 78 leiomyosarcomas (57%; ordinary leiomyosarcoma, 45 cases; pleomorphic leiomyosarcoma, 23 cases; myxoid leiomyosarcoma, 10 cases), 12 liposarcomas (9%; pleomorphic liposarcoma, 11 cases; dedifferentiated liposarcoma, one case), seven dermatofibrosarcoma protuberans (5%), six unclassified sarcomas (4%), five primary or metastatic carcinomas (4%), four low-grade fibromyxoid sarcomas (3%), four inflammatory myofibroblastic tumors (3%), three rhabdomyosarcomas (2%), three malignant peripheral nerve sheath tumors (2%), three acral myxoinflammatory fibroblastic sarcomas (2%) and two atypical fibroxanthomas (1.5%). Among the 1974 soft tissue sarcomas registered in our institute, MFH (428 cases) had been the most common sarcoma, followed by liposarcoma, leiomyosarcoma and rhabdomyosarcoma. However, after reassessment, leiomyosarcoma proved to be the most common soft tissue sarcoma (322 cases), followed by 290 MFH, 273 liposarcomas and 202 rhabdomyosarcomas. Among these 290 cases finally diagnosed as MFH, survival data were available in 189 cases. Tumor location in the abdominal cavity, the retroperitoneum or the head and neck (P = 0.0024), tumor size of 5 cm or more (P < 0.0001), deep tumor location (P < 0.0001), high histological grade (grade 3) based on the French Federation of Cancer Centers' grading system (P = 0.0007), and high stage (stage III or IV) based on the American Joint Committee on Cancer (AJCC) staging system (P < 0.0001) were significantly worse prognostic factors by univariate analysis. In multivariate analysis, deep tumor location and high AJCC stage were independent adverse prognostic factors. We conclude that leiomyosarcoma is the most important differential diagnosis for MFH, especially pleomorphic leiomyosarcoma from storiform-pleomorphic type and myxoid leiomyosarcoma from myxoid type. Tumor depth and AJCC stage are the most important predictive prognostic factors in MFH.     

Langerhans cells in human lung tumours: an immunohistological study

In an immunocytochemical study of 41 human lung tumours we have shown that Langerhans cells can be reliably identified using the anti-CD1 monoclonal antibody NA1/34. Langerhans cells are present in all the main varieties of human lung tumour although they are infrequent in both small cell carcinoma and carcinoid tumour. There is considerable variation in numbers of Langerhans cells in both adenocarcinomas and squamous cell carcinomas. In this study tumours were divided into those with high numbers of Langerhans cells (greater than 2 per high power field) and those with low numbers (less than 2 per high power field). Analysing these results against patient survival showed a markedly worse survival in those tumours with a high number of Langerhans cells for all the tumours as a single group and for squamous cell carcinoma as a single entity.     

Use of Transcranial Magnetic Stimulation with Measurement of Motor Evoked Potentials in the Acute Period of Hemispheric Ischemic Stroke

Functional derangements in the brain during the acute period of ischemic hemispheric stroke (IS) were assessed in terms of the severity of the motor neurological deficit in the acute period of IS and neurophysiological measures of motor evoked potentials (MEP) using transcranial magnetic stimulation (TCMS). A total of 52 patients (23 women, 29 men, mean age 58.5 ± 8.7 years) were studied. Patients were divided into two subgroups: group 1 consisted of 29 patients with good functional outcomes from the acute period; group 2 consisted of 23 patients with poor functional outcomes. The use of TCMS for recording MEP demonstrated increases in the latency of the M response both after stimulation of the projection of the motor area of the cortex of the lesioned hemisphere and after stimulation of the spinal cord. There were increases in the central motor conduction time (CMCT) in the lesioned hemisphere of the brain and a negative correlation was seen between the severity of the neurological defect and CMCT on the one hand (r = –0.65 to –0.78; p < 0.001) and, on the other, the latency of the M response in TCMS of the motor zone of the cortex on the side of the hemispheric stroke (r = –0.65 to –0.79; p < 0.001). The increases in the latency of the M response and CMCT have prognostic significance for early assessment of the outcome of IS.     

Elevation of serum sex hormone-binding globulin in females with fulminant hepatitis B virus infection

Amongst adults exposed to the hepatitis B virus (HBV), the infection pursues a fulminant course more frequently in females, while conversely a chronic carrier state is more frequent in males. Because of these differences in sex ratio, we investigated the relationship between the outcome of HBV infection and serum concentrations of sex hormone-binding globulin (SHBG), a circulating glycoprotein that exerts an important influence on the balance of free sex hormones. SHBG levels were significantly elevated in females with fulminant HBV infection compared to females with either uncomplicated acute or chronic HBV infection (P less than .05 and P less than .001, respectively). That this was not a nonspecific effect of fulminant hepatitis was confirmed by the significantly higher levels in this group than in age-matched females with fulminant hepatitis unrelated to HBV (P less than .05). In contrast, four of 15 female HBsAg carriers had SHBG values in the male range, and these included three of four patients who had acquired HBV as adults. SHBG levels were normal in all male groups. These results suggested that for adults the hormonal environment may be important in determining the course of HBV infection.     

Interdependent effect of angiotensin-converting enzyme and platelet-activating factor acetylhydrolase gene polymorphisms on the progression of immunoglobulin A nephropathy

In order to investigate the interdependent action of the insertion/deletion polymorphism of the angiotensin-converting enzyme (ACE) gene and polymorphism in exon 11 (C1136-->T; Ala379Val) of the platelet-activating factor acetylhydrolase (PAF-AH) gene, which encodes a functional antagonist of PAF, on the progression of immunoglobulin A (IgA) nephropathy, we analysed both polymorphisms in patients with primary IgA nephropathy, who were followed-up for longer than 3 years. During the follow-up (87.3 +/- 50.0 months), the disease progressed in 38 of the 191 patients (19.9%). The D allele of the ACE gene in the absence of the T allele of the PAF-AH gene did not affect the prognosis [odds ratio (OR), 3.6; 95% confidence interval (CI), 0.8-16.4] and neither did the T allele in the absence of the D allele (OR, 3.0; 95% CI, 0.4-24.2). However, the presence of both was a significant prognostic factor (OR, 6.6; 95% CI, 1.4-31.3). After adjusting for other risk factors, the presence of both proved to be an independent risk factor (OR, 4.5; 95% CI, 1.6-12.7). These results suggest that the interdependent effects of ACE and PAF-AH polymorphisms on the progression of IgA nephropathy might be more important than the effect of the individual polymorphisms.     

Diffuse sclerosing variant of papillary thyroid carcinoma: A clinicopathologic and immunophenotypic analysis of 22 cases

Background: The diffuse sclerosing variant of papillary thyroid carcinoma (DSV-PTC) is an uncommon tumor making up about 2% of all papillary thyroid carcinomas. Previous studies have not comprehensively evaluated these tumors in a large series of patients. Design: Twenty-two cases of DSV-PTC diagnosed between 1970 and 2000 were identified in the files of the AFIP. Histologic and immunohistochemical features were evaluated and patient follow-up was obtained. Results: The tumors affected 14 females and 8 males, aged 6 to 49 yr (mean, 18 yr), with males presenting at a mean older age than females (24 vs 14 yr). Symptoms included an enlarging mass in the thyroid, present for a mean of 9.5 mo. While a dominant tumor was identified in a single lobe, bilateral disease was common (n=16). The dominant mass ranged in size from 1.7 to 5.8 cm in diameter (mean, 3.8 cm). Histologically, all cases demonstrated a papillary carcinoma (conventional, solid, or follicular pattern) diffusely involving the gland. Extrathyroidal extension, lymphocytic thyroiditis, squamous metaplasia, increased fibrosis/sclerosis, and psammoma bodies were present to a variable degree. Both the papillary carcinoma and squamous metaplasia cells were strongly immunoreactive with CK19, thyroglobulin, and TTF-1. An increased number of S-100 protein immunoreactive dendritic cells were recognized. p53 was increased (>15%) in the tumor cells in 12 patients, while Ki-67 was increased in the tumor cells in two patients. Perithyroidal and cervical lymph node metastasis occurred in 18 (82%) patients. All metastases demonstrated histologic features similar to the primary. Complete resection (thyroidectomy in 18 patients) with lymph node dissection, yielded a 95% 5-yr survival without evidence of disease. One patient died of disease after a malignant transformation of the squamous metaplasia into squamous cell carcinoma. Conclusions: The recognition of DSV-PTC can be made with the following features: classic to solid foci of PTC, lymphocytic thyroiditis, squamous metaplasia, increased fibrosis, and innumerable psammoma bodies. DSV-PTC is more biologically aggressive than conventional PTC, but the patients’ survival is not significantly different. This diagnosis should lead the clinician to aggressively manage these patients (thyroidectomy and lymph node dissection) in an effort to achieve an excellent long-term clinical outcome.     

双胎妊娠围生儿预后相关因素分析

目的　探讨双胎妊娠新生儿窒息、围生儿死亡的相关因素。方法　回顾分析 2 5 5例双胎妊娠新生儿Apgar评分、新生儿窒息、围生儿死亡与孕周、新生儿体重、分娩方式的关系。结果　双胎妊娠孕 37～ 39+ 6w组Apgar评分最高、新生儿窒息率最低 ,≥ 2 5 0 0g组Apgar评分最高 ,新生儿窒息率、围生儿死亡率最低。孕周、新生儿体重 4组比较差异均有非常显著性(P <0 0 1)。剖宫产组比阴道分娩组Apgar评分高 ,新生儿窒息率、围生儿死亡率均低 ,2组比较Apgar评分、围生儿死亡率差异无显著性 (P >0 0 5 )。 2组比较新生儿窒息率差异有非常显著性 (P <0 0 1)。结论　双胎妊娠估计每个胎儿体重≥ 2 5 0 0g时 ,宜选择 37～ 39+ 6w终止妊娠为宜。加强孕期、围生期保健 ,积极防治各种并发症 ,适当放宽剖宫产指征 ,避免早产 ,减少低体重儿出生 ,是降低双胎围生儿死亡率、改善其预后的重要措施。     

原发性食管小细胞癌16例临床分析

目的探讨原发性食管小细胞癌的临床特点、治疗及预后。方法回顾分析16例原发性食管小细胞癌患者的临床资料。结果1年总生存率为56．2％，2年总生存率25．0％，3年总生存率12．5％。中位生存期15．7个月。结论对于原发性食管小细胞癌应采用以化疗占主要地位的综合治疗，局限期以手术联合化疗，广泛期以放疗联合化疗为宜。     

神经症患者 MMPI 的动态观察——MMPI 的临床应用及神经症与个性的探讨

本文总结了40例神经症患者 MMPI 的动态观察,结果发现显效组患者治疗后,所有临床量表都恢复了正常,而无效组则无变化,从资料的分析讨论中,归纳出 MMPI 对神经症有反映病理心理特点、严重度、转归、予后、病前个性及发病机理等多方面作用,并认为神经症的症状性质与患者的人格基础密切有关。