| ObjectivesTo analyse the change in the incidence of adrenocortical disease, to summarize the clinical charicteristics of hyperplasia, adenoma and carcinoma in adrenocortical glomerular zone and fascicular zone(n=408), and to investigate the correlation between clinic and pathology.MethodsStatistic analysis was performed on data of biopsies rate,constituent ratio,mean diagnostic age,sex proportion and correlation between clinic and pathology in adrenocortical diseases in the Department of Pathology from 1993 to 2005 in The General Hospital of Tianjin Medical University with Run test,ANOVA, t or t' test and Chi-square test.Results1.The total number of biopsies in 13 years was 122 926 cases (average 9456 cases/year).The numbers of total adrenal diseases,adrenocortical diseases are 610(mean rate 0.50%)and 408(0.33%). The variance in biopsies rate of adrenal diseases and adrenocortical diseases in 13 years has no tendency.2.The numbers of adrenocortical glomerular, fascicular,reticular diseases are 212(constituent ratio 51.96%),194(47.55%) and 2(0.49%). The constituent ratio in adrenocortical glomerular, fascicular and reticular zone has no tendency.3. The numbers of hyperplasia,adenoma, carcinoma in adrenocortical glomerular zone are 50(constituent ratio 23.58%),159(75.00%), 3(1.42%).The numbers of hyperplasia, adenoma, carcinoma in adrenocortical fascicular zone are 84(43.30%), 93(47.94%), 17(8.76%).The constituent ratio also has no tendency.4.The mean diagnostic age of adrenocortical glomerular hyperplasia (47.2, 46.3), adenoma(46.6, 43.7), carcinoma(65.0, 61.5) between male and female has no difference.The mean diagnostic age of adrenocortical fascicular hyperplasia (34.2, 39.0) between male and female also has no difference,but the mean diagnostic age of adrenocortical fascicular adenoma (47.9, 39.9) and carcinoma (52.3, 35.3) in male is higher than that in female.5.In clinical examination,radiography show that the mean diameter of adrenocortical glomerular adenoma, carcinoma is smaller than that of fascicular adenoma, carcinoma.Endocrine test show that serum aldosterone in glomerular adenoma is higher than that in hyperplasia,while serum potassium is lower than that in hyperplasia, there is no significant difference in serum rennin between them. Serum potassium and serum cortisol in fascicular adenoma and carcinoma is higher than that in hyperplasia, while uric corticsol in adenoma is lower than that in hyperplasia and carcinoma.In addition,there are 316 in 408 adrenocortical diseases expressing hypertension(mean 183/113 mmHg).The mean blood pressure in glomerular disease is 186/114 mmHg,and 178/113 mmHg in fascicular disease.There are no significant differences in systolic and diastolic pressure between glomerular hyperplasia, adenoma, carcinoma, fascicular hyperplasia, adenoma, carcinoma.6.Base on the endocrine chemical test and clinical manifestation, the patients are divided into two groups, including functional and nonfunctional. The results show that the proportion of functional in benign [hyperplasia, adenoma(glomerular 80.0%,76.1%,fascicular 71.4%,61.3%)] is higher than that of nonfunctional (glomerular 20.0%, fascicular 38.7%). It is contrary to carcinoma (glomerular 0 100.0%, fascicular 23.5%,67.5%).7.Hypertension can be found in both adrenocortical glomerular and fascicular diseaseas(91%,64%).In functional diseases,the proportion of the patients with typical endocrine manifestations and hypertension is higher than that of the patients with typical endocrine manifestations but not hypertension(glomerular 93.8%,6.2%,fascicular 66.1%,33.9%).In patients with glomerular disease,the mean blood pressure in patients with typical manifestation and hypertension is 185/113 mm Hg,in patients with fascicular disease,the mean blood pressure in patients with typical manifestation and hypertension is 173/110 mm Hg.The difference is significant between the systolic pressure(P＜0.05),the former is higher than the latter.8.The diameter of the functional adenoma in adrenocortical glomerular is smaller than that of nonfunctional ones(1.7 cm vs.2.1 cm).While the diameter of functional adenoma in adrenocortical fascicular is bigger than that of nonfunctional ones(2.6 cm vs.2.2 cm),the difference is significant(P＜0.05).Conclusions1.The incidence of adrenal diseases,adrenocortical diseases, adrenocortical glomerular diseases and fascicular diseases in 13 years is merely not influenced by environment.The incidence may be only influenced by internal and genetic factors.2.The clinical manifestation,check(including radiate,endocrinologic chemical examination,hypertension) between adrenocortical glomerular disease and fascicular disease has many significant differences.3. Base on the endocrine chemical test and clinical manifestation, the patients are divided into two groups, including functional and nonfunctional.Benign lesions in glomerular and fascicular disease are more functional, and malignant lesions are more non-functional.4.The proportion of patients with hypertension in glomerular, fascicular functional diseases is higher than that in non-functional diseases.The blood pressure in patients with primary aldosteronism is a little higher than that in Cushing's syndrome.5.The diameter of functional glomerular adenoma is smaller,while the diameter of functional fascicular adenoma is bigger. ObjectsThe occurrence and progression of thyroid malignant tumor, one of endocrine neoplasms and about 1%～2% of overall malignant carcinoma, have certain relation with some factor such as age, sex, former thyroid lesions, living environment, heredity, radiation, and so on. Its biologic behavior is influenced significantly by cell adhesion molecules and regulation of autoimmune response of organism. 113 thyroid carcinoma(PTC) cases from the paraffin specimen of 1962～2004 years randomly, including PTC(n=65,with 35 non-metastasis and 30 with lymph node metastasis) and follicular thyroid carcinoma(FTC) (n=48,with 25 well differentiated type and 23 pooly-differentiated type).We investigates the expression of VEGF,TGF in these two histotypes of thyroid carcinoma and involved lymph node,using immunohistochemical staining. Our aim is to detect the relationship between their expression and clinic-pathologic features of thyroid follicular-derived carcinoma such as histotype, degree of differentiation, invasion, metastasis and prognosis.MethodsANOVA and t(t') test were used for comparing the mean age in these cases, Chi-square test for the positive rate of staining, Spearman correlations for the relationship among every targets. We can offer some evidences for early diagnosis, estimating benign or malignant carcinoma and evaluating prognosis.RESULT1. Mean age of PTC and FTC in male was older than that in female(P＜0.05),mean age of PTC was younger than that of FTC(P＜0.05);the number of female of PTC and FTC were more than that of male,male/female ratio of PTC and FTC were 1:3.21,1:2.86 respectively,and the female ratio of PTC was higher than that of FTC(P＜0.01). 2. VEGF,TGFβ1 were main expressed in the cancer cell cytoplasm. The positive mass of PTC was main nigger-brown or palm yellow grain with suffused distribution. The positive mass of FTC was main yellow or straw yellow grain with suffused or diffused distribution. The infiltrating lymphocyte in PTC and FTC did not express VEGF and TGFβ1.3. The positive rate of VEGF in PTC(89.2%) was lower than that of FTC(89.6%).The positive rate of VEGF in PTC(88.6%) with non-metastasis was lower than that in PTC with metastasis(90.0%). In PTC with metastasis,the positive rate of VEGF in primary(90.0%) is lower than that of metastatic lesions (93.3%).In FTC,the positive rate of well-differentiated is lower than that of poorly-differentiated ones.The differences are all no significant(P＞0.05).4. The positive rate of TGFβ1 in PTC(75.4%) was lower than that of FTC(85.4%).The positive rate of TGFβ1 in PTC without metastasis(74.3%) is lower than that of FTC without metastasis(76.7%).In PTC with metastasis,the positive rate of TGFβ1 in metastasis focus(83.3%) was higher than that of primary focus(76.7%).In FTC,the positive rate of TGFβ1 in well-differentiated ones(84.0%) is lower than that of poorly-differentiated ones(87.0%).The differences are all no significant(P＞0.05).5. The positive of VEGF(89.4%) in all PTC and FTC is higher than that of TGFβ1(79.6%).The positive rate of VEGF(89.2%) in all PTC is higher than that of TGFβ1(75.4%).The positive of VEGF(90.0%) in PTC with metastasis is higher than that of TGFβ1(76.7%),and the positive rate of VEGF(90.0%) in primary locus is higher than that of TGFβ1 (76.7%).The positive rate of VEGF(88.6%) in no-metastasis one is higher than that of TGFβ1(74.3%).The differences are all significant(P＜0.05),and there is a positive correlation between them (P＜0.05).The positive rate of VEGF(93.3%) in metastatic lesions is higher than that of TGFβ1(83.3%).The difference is no significant(P＞0.05),and there is no correlation between them. 6. The positive rate of VEGF(91.7%) in all FTC is higher than that of TGFβ1(87.5%),the difference is no significant and there is no correlation between them.The positive rate of VEGF(88.0%) in well differentiated is higher than that of TGFβ1(84.0%),the difference is no significant(P＞0.05) and there is no correlation between them(P＞0.05).However, the positive rate of VEGF(91.3%) in poorly differentiated is higher than that of TGFβ1(87.0%),the difference is significant(P＜0.05),and there is a positive correlation between them(P＜0.01).Conclusions1. Male mean age of PTC and FTC older than that of female(P＜0.05),male mean age of PTC was younger than that of FTC(P＜0.05);the number of female of PTC and FTC were more than that of male,male/female ratio of PTC and FTC were 1:3.21,1:2.86 respectively, and the proportion of female in PTC was higher than that in FTC(P＜0.01).2. The expression of VEGF, TGFβ1 had positive correlation with malignant degree of thyroid carcinoma, and the negative correlation with differentiated degree of thyroid carcinoma, the expression of VEGF had positive correlation with TGF,but the expression of TGFβ1 was lower than that of VEGF.3. The aggregate analysis of VEGF, TGFβ1 was very important to clinic for detecting, treating, and evaluating prognosis of carcinoma. The specific relationship of VEGF,TGFβ1 need further research. |
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