α-Methylacyl-CoA racemase (P504S) is a useful marker for the differential diagnosis of solid pseudopapillary neoplasm of the pancreas.

The differential diagnosis of solid pseudopapillary neoplasm (SPN) from some other nonductal pancreatic tumors may be difficult because of similarities in morphological features. Therefore, immunohistochemical staining is frequently necessary. α-Methylacyl-CoA racemase (AMACR) is a diagnostically useful marker for prostatic cancer and papillary renal cell carcinoma. The aim of this study was to investigate AMACR as a new immunohistochemical marker to differentiate SPNs from other nonductal pancreatic tumors. We investigated immunohistochemical staining for AMACR in 26 SPNs, 21 pancreatic neuroendocrine tumors, and 7 acinar cell carcinomas. All cases of SPN showed granular cytoplasmic expression of AMACR, whereas all cases of pancreatic neuroendocrine tumors and acinar cell carcinomas were negative for this immunohistochemical marker. Hence, our findings demonstrate for the first time that AMACR is a useful immunohistochemical marker for the differential diagnosis of SPNs.

[Three-step sperm retrieval for 73 non-obstructive azoospermia patients].

OBJECTIVE: To investigate the value and clinical application of the Three-Step Sperm Retrieval method in improving the sperm retrieval rate for non-obstructive azoospermia (NOA) patients. METHODS: Seventy-three NOA patients underwent Three-Step Sperm Retrieval in the following order of procedures: testicular fine needle aspiration (TFNA), testicular sperm extraction (TSE), and microdissection testicular sperm extraction (MD-TSE). The testicular tissue obtained from each step was observed for spermatozoa under the 400-fold inverted microscope. If spermatozoa were found in one step, the operation would be stopped; otherwise, the next step would be carried out. The testicular tissue was subjected to pathological examination. RESULTS: Spermatozoa was found in the testicular tissue in 38.4% of the cases (28/73) at TFNA as the first step, in 52.1% (38/73) at TFNA and TSE, and in 64.4% (47/73) at TFNA, TSE and MD-TSE. Pathological examination showed 25 of the cases to be Sertoli cell-only syndrome, 21 to be sperm maturation arrest and the other 27 to be hypospermatogenesis, in which spermatozoa were found in 10, 14 and 23 cases, respectively. CONCLUSION: The Three-Step Sperm Retrieval method can significantly improve the sperm retrieval rate for NOA patients. And the sperm retrieval rate is associated with the pathological type of the testicular tissue, a higher rate with hypospermatogenesis.

Frequent germline mutation in the BRCA2 gene in esophageal squamous cell carcinoma patients from a low-risk Chinese population.

BACKGROUND: The incidence of esophageal squamous cell cancer (ESCC) is strikingly variable by geographic area, which reflect different exposures to risk factors, including genetic predisposition. Previous studies of ESCC patients from several high-risk populations suggested that BRCA2 might play a role in the etiology. This study was conducted to screen for mutations of BRCA2 gene in ESCC cases from a low-risk population. METHODS: Forty-seven ESCC patients from a low-risk area of Southeast China were screened for mutations in the entire coding region of the BRCA2 gene by direct sequencing. RESULTS: No somatic mutations were observed in tumors. In total, 9 germline missense point mutations, each in one patient, were identified in male sporadic patients, with a mutation frequency of 19%. Of the 9 mutations, 7 were of heterozygous, while the remaining 2 were homozygous. Screening of an additional 94 healthy controls for the 9 mutations identified in ESCC cases showed that there was only 2 (2%) positive individuals, each carrying one of the mutations. Thus the mutation frequency in ESCC cases (19%) was significantly higher than that in healthy controls (OR = 10.9, 95% CI = 2.2-52.8, P = 0.003). No significant associations were observed for germline BRCA2 mutations with age, sex, cigarette smoking, alcohol drinking and family history of cancer. CONCLUSION: This series of cases from a low-risk Chinese population presented the highest frequency of germline BRCA2 mutations in ESCC reported to date, highlighting possible etiology roles in this population.

KRAS and BRAF mutations in prostate carcinomas of Chinese patients.

Aberrance in the RAS/RAF/MEK/MAPK pathway is reportedly important in many tumor types, including prostate carcinoma. Continuous activation of the pathway can be caused by mutations of upstream targets such as KRAS and BRAF. However, rates of KRAS and BRAF mutations in prostate carcinoma are reported to vary in different populations. To date, there has been no such report in Chinese patients. In this study, we examined 121 samples of prostate carcinoma in Chinese subjects for mutations at codons 12 and 13 of KRAS and codon 600 of BRAF by means of the mutant-enriched polymerase chain reaction-coupled sequencing method. The identified KRAS and BRAF mutations were analyzed for association with tumor differentiation and clinical stage. The result showed that KRAS mutations were detected in 9.1% (11 of 121) of prostate carcinomas, while no BRAF mutation was found in any case studied. No association was found between KRAS mutation and clinicopathological characteristics of the tumors. Our study suggests that mutations of KRAS, not BRAF, may play a role in the pathogenesis of prostate carcinoma in Chinese patients.

[Desmoplastic small round-cell tumor of the paratesticular region: a case report and review of the literature].

OBJECTIVE: To investigate the clinical and pathological features of paratesticular desmoplastic small round cell tumor (DSRCT), and to improve the diagnosis and treatment of the disease. METHODS: One case of paratesticular DSRCT was studied retrospectively and a considerable amount of related literature from Medline and Chinese journals reviewed. The patient was a 27-year-old man presenting with a painless testicular mass in the left hemiscrotum. On physical examination, a cystic mass was palpable while the testis was not in the left hemiscrotum. RESULTS: During the operation the paratesticular area was found full of multiple nodular tumor masses of various sizes ranging from 0.5 cm to 1.5 cm in diameter. Pathological examination showed the characteristic histological pattern of nests of small undifferentiated cells embedded in a dense fibrous stroma. The tumor presented an immunohistochemical feature of epithelial, mesenchymal as well as neural multidirectional differentiation. Following testicular tumor orchiectomy, chemotherapy was performed with DDP, VP16, ifosfamide and EPI. Three years follow-up found no tumor recurrence. CONCLUSION: Desmoplastic small round cell tumor has a specific clinicopathologic stigmata, usually occurring in young males, for which surgical resection with chemotherapy is the treatment of choice. DSRCT located in the paratesticular region may have a better prognosis than its more frequently abdominal counterpart.

Brunner's gland adenoma of duodenum: a case report and literature review.

AIM: To analyze the clinicopathological features of Brunner's gland adenoma of the duodenum. METHODS: A rare case of Brunner's gland adenoma of the duodenum was described and related literature was reviewed. RESULTS: Brunner's gland adenoma of the duodenum appeared to be nodular hyperplasia of the normal Brunner's gland with an unusual admixture of normal tissues, including ducts, adipose tissue and lymphoid tissue. We suggested that it might be designated as a duodenal hamartoma rather than a true neoplasm. CONCLUSION: The most common location of the lesion is the posterior wall of the duodenum near the junction of its first and second portions. It can result in gastrointestinal hemorrhage and duodenal obstruction. Endoscopic polypectomy is a worthy treatment for benign Brunner's gland adenomas, as malignant changes in these tumors have never been proven.

[Dynamic observation of vascular endothelial growth factor (VEGF)/VEGF-receptors expression in acute leukemia].

OBJECTIVE: To investigate the expression of vascular endothelial growth factor (VEGF)/VEGF-receptors and its relation to bone marrow angiogenesis in acute leukemia patients before and after chemotherapy. METHODS: Bone marrow biopsies from 122 cases with different stages of human acute leukemia were immunostained with anti-vascular endothelial growth factor, anti-fms-like tyrosine kinase (Flt-1) and anti- kinase-domain insert containing receptor (KDR) antibodies with envision two-step immunohistochemical staining method. RESULTS: The expression of VEGF and KDR protein in remission patients was 5.3 (3.3 - 9.0) and 2.0 (1.0 - 4.0) being significantly lower than newly diagnosed untreated patients 6.0 (3.3 - 12.0) and 5.3 (3.3 - 8.0) (P < 0.05, 0.01). However nonsignificant decrease was shown among non-remission patients. In relapsed patients the expression of VEGF and KDR was significantly increased as compared with that in newly diagnosed patients. Flt-1 staining levels were in the same range between the newly diagnosed untreated patients and control group (P > 0.05), but significantly increased in remission or relapse patients, being 3.3 (1.7 - 5.3) in the remission group and 3.3 (2.0 - 5.3) in the relapse group (P < 0.01). Expression of VEGF and KDR protein was significantly higher in patients with a high degree of bone marrow microvessel counts as compared with those with a low degree and the expression correlated well with microvessel counts (P < 0.01). There was a positive correlation of the percentage of bone marrow blasts with VEGF and KDR expression in AML patients (r = 0.429, 0.359; P = 0.005, 0.02), and with VEGF expression in ALL patients (r = 0.522; P = 0.03). CONCLUSION: VEGF and its two specific cellular receptors are expressed in both haematopoietic cells and endothelial cells. VEGF may be a autocrine factor and modulates the angiogenic reaction in bone marrow as a paracrine factor. VEGF and its cellular receptor KDR may constitute promising targets for antiangiogenic and antileukemic treatment strategies.