Abstract:

Objective：To investigate the diagnosis and treatment of thyroid cancer.
Methods：Retrospective analysis of the clinical data of 236 patients with  thyroid cancer who underwent surgical treatment in our hospital from 2002-2008 was conducted.
Results：Solid thyroid nodules or cystic-solid nodules were found in 225 patients (95.53%) by B-ultrasonography (BUS)  preoperatively, among them, micro-calcification  within nodules was found in 78 cases (33.05%).  B ultrasound-guided fine-needle aspiration biopsy was performed in 81 cases, and had positive rate of 87.65%. Intraoperative frozen section was examined in 221 cases, among which 208 cases of thyroid cancer were diagnosed, a positive rate of 94.11%. Postoperative pathological examination confirmed lymph node metastasis in 68 cases (28.81%). Partial thyridectomy was performed in 15 cases, ipsilateral lobectomy in 44 cases, and radical resection in 177 cases. In 25 cases who was misdiagnosed before operation, and correct diagnosis was comfiromed by pathological examination  after partial resection or ipsilateral lobectomy, then a secondary or more surgical procedures were performed, with residual cancer rate of 56.0% (14/25).
Conclusions：BUS finding of thyroid nodules containing micro-calcification has important significance  for thyroid cancer diagnosis, and in combination with B ultrasound-guided fine-needle aspiration biopsy could significantly improve the accuracy of preoperative diagnosis. Intraoperative frozen section diagnosis is an important method for confirmation of thyroid cancer. Ipsilateral total lobectomy+ isthmectomy+ contralateral subtotal lobectomy+ selective neck dissection is the main surgical method for thyroid cancer. For misdidanosed cases, a secondary operation should be performed as early as possible.

Abstract:

Objective：To investigate the clinicopathologic characteristics and therapy of thyroid carcinoma in children.
Methods：A retrospective review of the clinical data of 26 childhood patients with thyroid carcinoma treated in the Second Affiliated Hospital, Nanchang University from Jan 1990 to Dec 2005 was conducted.

Results：There were 15 girls and 11 boys in this series. All cases were diagnosed by histological evaluation: papillary carcinoma was diagnosed in 14, follicular carcinoma in 9, papillary follicular carcinoma in 2 and medullary carcinoma in 1. Cervical lymph node metastasis was found in 21 patients (80.8%). Among them, 1 underwent tumor enucleation, 5 underwent unilateral lobectomy and unilateral central compartment lymph node clearance, 15 underwent unilateral lobectomy and unilateral neck dissection, and 5 underwent neartotal or total thyroidectomy and bilateral neck dissection. All patients were followed up with tumor-free survival in 24 cases. The 5- and 7-year survival rate was 96.2% and 91.6%, respectively.Three patients required intravenous calcium supplementation postoperatively, but there was not a single case of permanent hypoparathyriodism or recurrent nerve paralysis during follow-up.
Conclusions：Almost thyroid carcinoma in children are differentiated carcinomas,  the prognosis is significantly better after surgical treatment.

Abstract:

Objective：To explore the operative procedures for thyroid microcarcinoma.
Methods：The clinical data of 116 cases of thyroid microcarcinoma were retrospectively analyzed.
Results：There were various operative procedures used in the treatment of 116 cases of thyroid microcarcinoma that included subtotal thyroidectomy, partial thyroidectomy and ipsilateral lobectomy. The recurrence rate and metastasis rate were closely related with the range of operation.  Four cases of postoperative tumor recurrence and metastasis occurred in the patients who underwent only ipsilateral partial lobectomy.
Conclusions：The selection of operative procedure for thyroid microcarcinoma must be determined according to the tumor location and the number (single or multiple). It is recommended to perform ipsilateral lobectomy plus isthmectomy or  subtotal and neartotal thyroidectomy with or without central lymph node dissection for thyroid microcarcinoma.

Abstract:

Objective： To discuss the feasibility of total thyroidectomy (TT) for hyperthyroidism.
Methods：The clinical data of 31 hyperthyroidism patients treated with total thyroidectomy  from January 2001 to June 2010 were analyzed retrospectively, and compared with 56 patients treated with subtotal thyroidectomy (ST).
Results：There was no postoperative bleeding or recurrence occurred in TT group, but in ST group, postoperative bleeding occurred in 3.6%, and the postoperative recurrence rate was 26.8%, both were was significantly higher than that in TT group (P＜0.05, P＜0.01). On the contrary,  only 27 cases (48.2%) suffered from temporary hypothyroidism in ST group, which was significantly less than the TT group in which all cases had hypothroidism. There was no case of permanent hypoparathyroidism in the two groups, and no significant difference in the incidence of recurrent laryngeal nerve between the groups (P>0.05).  
Conclusions：Total thyroidectomy is superior to subtotal thyroidectomy for hyperthyroidism, with the advantages of less recurrence and less postoperative complications.

Abstract:

Objective：To discuss the mechanism of  elevated postoperative serum parathyroid hormone (PTH) levels with normocalcemia in patients who undergoing successful parathyroidectomy for primary hyperparathyroidism.
Methods：PTH levels were measured in 97 patients 6 months after parathyroidectomy. The 25-OH-vitamin D levels, serum alkaline phosphatase levels, osteocalcin and bone densitometry were evaluated before operation and 6 months after surgery. PTH reactivity to calcium loading was tested six months postoperatively.
Results：Thirty patients had elevated PTH levels with normocalcemia after parathyroidectomy. Before surgery, these patients had higher PTH and creatinine levels, lower vitamin D levels, and more extensive change of bone than those with normal postoperative PTH levels. There were 67 patients whose PTH was normal after surgery with normal renal function and vitamin D levels, and without change in bones condition.
Conclusions：The elevated PTH levels after surgery for primary hyperparathyroidism is an adaptive reaction to renal dysfunction or vitamin D deficiency.

Abstract:

Objective：To explore the diagnosis and treatment of primary hyperparathyroidism (PHPT) and secondary hyperparathyroidism (SHPT).
Methods：The clinical data of 15 PHPT patients and 26 SHPT patients admitted to our hospital in 19 years were analyzed. Diagnosis relied on serology, imaging, 99mTc-MIBI and clinical manifestations. Patients were given surgical and non-surgical treatment according to the different conditions.
Results：Serum parathyroid hormone (PTH) of 41 patients was elevated, serum calcium of PHPT patients was elevated, and serum calcium of SHPT patients was reduced. Ultrasonography and 99mTc-MIBI in diagnostic accuracy was 73.17% and 85.71% respectively.  Fifteen patients with PHPT and 3 patients with SHPT underwent surgery, with no one case of recurrence. Twenty-three patients with SHPT underwent non-surgical treatment, with alleviation of disease process in all cases.
Conclusions：PTH and serum calcium is the main basis for qualitative diagnosis of HPT, localization diagnosis relies on Ultrasonography and 99mTc-MIBI. Surgical treatment is effective for PHPT. Patients with SHPT can mainly undergo non-surgical treatment, and choose surgery only when non-surgical treatment is ineffective.

Abstract:

Objective：To evaluate the cancer-residual status in the margins following Mammotome biopsy for early-stage breast cancer.
Methods：A total of 283 patients with nonpalpable breast lesions underwent high-frequency ultrasound-guided mammotome biopsy. Among them, the margins status of patients with breast cancer finally diagnosed by mammotome biopsy was evaluated.
Results：In total, 52 breast cancer patients were diagnosed by mammotome biopsy,   included 38 cases of ductal carcinoma in situ(DCIS) and 14 cases of invasive ductal carcinoma. There were 43 cases of negative margins and 9 cases of positive margins.The 9 cases with positive margins underwent lumpectomy for residual carcinoma. Of these 9 cases, 5 cases had negative margins and 4 cases had positive margins after lumpectomy, and the latter 4 cases with positive margins underwent simple mastectomy with a diagnosis of extensive intraductal component(EIC). The diagnosis by Mammotome biopsy was consistent with biopsy in 48 cases.
Conclusions：High-frequency ultrasound-guided Mammotome biopsy is a safe and effective method to diagnose early-stage breast cancer of nonpalpable breast lesions, and could effectively excise the lesions.  

Abstract:

Objective：To explore the effect of sequential endocrine therapy in breast cancer patients whose expression of ER and PR was negative preoperatively and was converted to positive by neoadjuvant chemotherapy (NAC).
Methods：The clinical study was carried out in 97 cases of breast cancer whose ER and PR statue were converted from negative to positive after NAC. after NAC the 97 cases were divided into sequential endocrine therapy group and control group. The sequential endocrine group was treated with TAM 10mg Bid for 5 years, the control group was treated with placebo. 
Results： In sequential endocrine treatment group, the 3-and 5-year disease-free survival was 74.5%(38/51) and 60.7%(31/51)  respectively, and the 3-and 5-year overall survival was 80%(41/51) and 74.5%(38/51)  respectively. In control group, the 3-and 5-year disease-free survival was respectively 52.2%(24/46) and 39.1%(18/46), and the 3-and 5-year overall survival was respectively 60.9%(28/46) and 50.0%(23/46). The corresponding values were significantly higher in sequential endocrine therapy group than in control group.
Conclusions： The disease-free and overall survival are significantly increased by applying sequential endocrine therapy in breast cancer patients whose expression of ER and PR has been converted from negative to positive by neoadjuvant chemotherapy.

Abstract:

Objective：To investigate the relationship between the amplification status of breast cancer HER-2 gene/TOP2A gene and the efficacy of anthracyclines treatment.
Methods：Paraffin-embedded tissues from 58 breast cancer patients who received neo-adjuvant chemotherapy regimen called FEC were selected. Fluorescent in situ hybridization assay (FISH) was taken to detect the amplification status of HER-2 gene/TOP2A gene. The efficacy of chemotherapy was evaluated according to the RECIST rule after 4 cycles, then Spearman′s rank correlation test was used to assess the relationship between the amplification status of HER-2 gene/TOP2A gene and the efficacy of chemotherapy.
Results：Amplification of HER-2, TOP2A and co-amplification of them was detected in 19 patients（19/58,32.8%）,11 patients（11/58,19.0%）, and 11 patients (11/58,19.0%）respectively. The amplification of HER2, TOP2A and co-amplification of them all had closely correlation with the efficacy, the Spearman′s rank correlation coefficient was 0.52, 0.53 and 0.56 (P＜0.05) respectively.
Conclusions：Both HER-2 and TOP2A gene amplification can predict the response to chemotherapy based on anthracyclines independently in breast cancer. However, co-amplification of HER-2 and TOP2A may predict the efficacy of treatment based on anthracyclines more accurately.

Abstract:

Objective：To study the clinical value of preservation of intercostobrachial nerve (ICBN)  during modified radical mastectomy.
Methods：From January 2005 to January 2009, 372 cases of modified radical mastectomy were performed in our hospital, among them,  ICBN was preserved in 93 cases (preserve group), and not preserved ICBN in 279 cases (resected group) All of the patients were followed-up  for a year.
Results：At 1,3 and 12 months after surgery, the incidence of  ipsilateral medial upper arm and axillary paresthesias in ICBN preserve group was significantly lower than that in the resection group, and the difference was significant (P＜0.05); at 3, 6, 12 months after surgery local axillary recurrence rate in the two groups showed no significant difference (P＞0.05).
Conclusions：Preservation of ICBN in  modified radical mastectomy has the advantage of decrease in ipsilaleral arm and armpit paresthesia with improvement in quality of life after surgery, and does not affect surgical outcome. It is worthy of widespread clinical  application.

Abstract:

Objective：To detect the expression of hMAM in sentinel lymph node (SLN) of breast cancer, and to evaluate the clinical significance.
Methods：The SLN of 32 patients with breast cancer was successfully detected with methylene blue, and both SLN and non-SLN were examined by hematoxylin and cosin staining(HE staining).Then SLN were examined by RT-PCR and Western Blot for the expression of  hMAM.
Results：Detection rate of SLN metastases was 18.75% by HE staining, 37.50%  for hMAM mRNA by applying RT-PCR and 28.13% for hMAM by applying Western Blot.There was a significant difference between RT-PCR or Western Blot methods and routine pathological examination (P＜0.05) for the detection rate of SLN metastases.
Conclusions：Utilization of RT-PCR instead of histopathological examination to detect the expression of hMAM mRNA in SLN can greatly enhance the accuracy diagnose rate of micrometastases of the SLN in breast cancer. hMAM mRNA may be potential tumor marker for detecting micrometastasis of SLN breast cancer.

Abstract:

Objective：To explore a molecular subtype system for accurately predict the prognosis of breast cancer.
Methods：Seventy cases of invasive breast cancer were divided into a groups: (1) Group A, 35 cases. These patients died within five years after diagnosis; (2) Group B, 35 cases. These patients were still alive 10 years after diagnosis. The two groups was matched at fields of ages, diagnosis, therapeutic regimens and so on. Immunohistochemistry based on tissue chip was used to detect the expression of 17 molecular biomarkers; hierarchical clustering algorithm was applied to cluster the 17 molecular biomarkers into several subgroups, and survival and clinicopathologic parameters were analyzed and compared in different subgroups.
Results：Seventeen molecular biomarkers were clustered into four subgroups：ERα related subgroup, PR related subgroup, proliferation related subgroup and HER-2 related subgroup. There was a significant difference in median survival time among the four subgroups: Median survival time of ERα related subgroup, PR related subgroup, proliferation related subgroup and HER-2 related subgroup was 142, 126, 88 and 77months, respectively, (P=0.044). In a multivariate Cox model, the average death risk between the consecutive subgroups increased 1.623 folds. There were low positive correlations in tumor long diameter among four subgroups (Cramer Coefficient of Contingency was 0.377).
Conclusions：A  new molecular subtype of breast cancer has been found by using immunohistochemistry based on tissue chip and hierarchical clustering algorithm. Molecular subtype of ERα related subgroup, PR related subgroup, proliferation-related subgroup and HER-2 related subgroup can predict patient′s death risk accurately, and could be as a new molecular classification for predicting the prognosis in breast cancer patients.

Abstract:

Objective：To discuss the significance of mammography and ultrasonography in breast cancer screening, and search of an appropriate method  for breast cancer screening.
Methods：A group of 387 women aged from 35 to 69 who were suspected to be an abnormal breast were chosen to undergo mammography,the positive diagnosis and uncertain cases then had ultrasonography, and the positive cases by ultrasonography underwent biopsy to confirm the diagnosis of breast cancer.
Results：Among the 387 cases, 83.22% of breasts contained more than 50% glands, 22 cases were positive and 75 cases were uncertain by mammography.The results of 22 positive cases were comfirmed by mammography and ultrasonography, and 3 cases among the 75 uncertain cases by mammogrophy were positive by ultrasonography. Biopsy was performed in 25 cases and 17 of them were confirmed to be breast cancer, while 2 cases of breast cancer had reached stage III. The sensitivity of mammography and ultrasonography was respectively 72.73% and 68.0%; there was no statistically significant differences（P＞0.05） between the 2 methods.
Conclusions：Most of the checked breasts in our series were dense, and mammography was not superior to ultrasonography in dense breasts.

Abstract:

Objective：To explore the effect of multidrug resistance (MDR) of human breast cancer Adriamycin resistant cell line MCF-7/ADM by interference gene DJ-1 expression.
Methods：DJ-1 shRNA plasmid was transfected into MCF-7/ADM cells by lipofectamine 2000; The mRNA and protein expression level of MDR1 was detected by RT-PCR and Western blot, respectively. The cellular sensitivity to chemotherapeutics was measured by MTT.
Results：Compared with blank and negative control groups  MDR1 mRNA and P-gp expression were reduced  after MCF-7/ADM cells interfered by DJ-1  sh′RNA,  (all P＜0.01). The chemosensitivity assays revealed that the transfected cells sensitivity to chemotherapeutics adriamycin was  increased 2.68 fold.
Conclusions：DJ-1 shRNA effectively reverses the multidrug resistance of human breast cancer Adriamycin resistant cell line MCF-7/ADM, which provides a novel approach for reversing breast cancer MDR.

Abstract:

Objective：To study the level of inhibitory member of the ASPP family (iASPP) in invasive lobular breast carcinoma (ILBC) and its clinical significance.
Methods：The expression of iASPP-mRNA in the ILBC was analyzed by RT-PCR, then the average optional density of RT-PCR products was assayed by Quality one soft-ware. The relationship between the level of iASPP-mRNA and clinical pathological factors was analyzed.
Results：The iASPP-mRNA was expressed in 34 cases of ILBC (87.2%), but there were no expression in adjacent tissues of the tumor. The expression of iASPP-mRNA in cancer tissues was markedly higher than that in adjacent tissues (P＜0.01).  There  was significant difference between the  patients aged≤45 years group and ＞45 years group (P＜0.01), between TNM stage Ⅲ、Ⅳ cases and stage Ⅰ、Ⅱ cases (P＜0.01), and between lymph node metastasis cases and none lymph node metastasis cases (P＜0.01). There was no difference between the expression of iASPP-mRNA and the expression of estrogen receptor (ER) or progesterone receptor (PR).
Conclusions：iASPP-mRNA is over-expressed in ILBC, and the detection of iASPP may be useful in the diagnosis, individual treatment and predicting the prognosis of ILBC.

Abstract:

Objective：To compare the results of direct suture and tension-free open repair with  artificial mesh after excision of abdominal desmoid tumor.
Methods：The patients included 2 groups: Seven cases were treated by direct suture after excision of abdominal desmoid tumor from 1990 to 2002 (group A); 9 cases were treated with wide excision and artificial mesh was used for repair of abdominal wall defect  from 2003 to 2010 (group B).
Results：The mean time to ambulation was more than 72 hours in group A, and 6 to 12 hours in group B; the mean hospitalization time was 14 days in group A and 9 days in group B, respectively. During the follow-up (7 to 20 years), there was one patient with incisional hernia and one patient with tumor recurrence in group A; while in the follow-up period(6 months to 7 years), there was no incisional hernia or tumor recurrence in  group B. 
Conclusions：Surgical resection of abdominal desmoid tumor and repair of abdominal wall with artificial mesh is an easy, safe, and effective method.

Abstract:

Objective：To review the clinical manifestations, pathology, diagnosis, and therapy of sclerosing angiomatoid nodular transformation(SANT) of spleen.
Methods：The clinical manifestations, pathology, expression of immunohistochemistry, and the  follow-up survey of 2 cases of SANT were  analyzed, and the related literature was reviewed.
Results：The morphological features of SANT under microscope were as follows: Multiple angioloma-like granuloma  nodules were observed. The nodules appeared as compact or mucoid-degenerated fibrous connective tissue, and tumour cells in the nodules were orbicular-ovate or short spindle-shaped with rich cytoplasm. Cladodromous or crack-like irregular capillary vessels were detected. There were numerous plasmocytes, lymphocytes, and erythrocytes in the interstitium. The cell morphology was mild with no-atypia, and  nuclear division was rarely seen. There were no specific immunological characteristics. The two cases of SANT had no relapse or metastasis during the 6-months to 1-year follow-up after splenectomy.
Conclusions：SANT is an infrequent hyperplatic and benign lesion of spleen which has a remarkably pathologic characteristic appearance. However, it might be mistdiagnosed clinically as other diseases, such as splenic cancer, inflammatory pseudotumor, hamartoma, etc. The effective therapy of SANT is splenectomy which has a good prognosis.