| The purpose of this study was to evaluate the blood flow imaging status of renal tumors. Color Doppler energy was used to assess tumor blood flow in stage clear cell renal cancer. Levovist was injected evenly via peripheral vein under control of electronic pump.Using histograms of tware, blood flow area ratio of renal tumors was measured. The blood vessel was highlighted in sections by von Willebrand factor (vWF) immunohistochemistry. While MVD has value in prognostic valuation for stage RCC, and was significant associate with the stage of renal carcinoma and it was associate with the expression of VEGF and Endostatin also, but MVD was significant relationship with the serum levels of VEGF and Endostatin, so the value of MVD in diagnosis of renal carcinoma was highly.Serum levels of VEGF and Endostatin have the relationship, when the echo-angiography, VEGF levels were highly correlated with Endostatin levels among the renal cell carcinoma patients but not in the controls. Additionally, VEGF was found to be significantly related to MVD and primary tumor volume. Neither the levels of VEGF and endostatinn nor the MVD were correlated with the tumor grade of RCC.Serum VEGF and Endostatin level elevate in the stage clear cell RCC and correlate with the tumor size. It has some potential value as an adjuvant for diagnosis and in assessment of prognosis. While if MVD has value in prognostic valuation for early stage RCC. The expression of VEGF and Endostatin in renal cancer determined its relationship to clinical and pathological factors. Renal cancer tissues were studied by immunohistochemical technique. The expression rate of VEGF and Endostatin in neoplastic tissues were highly increased, VEGF and Endostatin expression was focuses din cell membranes and cytoplasms.The expression of VEGF and Endostatin tumor size, cell type or grades of cancer, it was associated with clinical stages. Moreover, the patients with VEGF and Endoststin positive tumors had a shorter survival than those with VEGF and Endoststin negative tumors. Expression of VEGF has an important influence on the biological behavior of renal cancer; it might serve as an indicator to the metastasis and prognosis of renal cancer.More, we used the MVD and echo-angiography, we can get a rapidly conclusion. It might play an important role in the tumor genesis and progression of RCC. And also we can evaluate the effectiveness of the therapy of anti-Vascular-ization in renal carcinoma.Ⅰ Protein expression and clinical significance of vascular endothelial growth factor, endostatin and microvessel density in clear renal cell carcinomaObjective:To investigate the protein expression and its clinical significance of vascular endothelial growth factor (VEGF), Endostatin (ES) and microvessel density (MVD) in clear renal cell carcinoma (CRCC)Materials and methods:The serum protein expression of VEGF and ES was evaluated with enzyme-linked immunosorbent assay (ELISA) in60CRCC confirmed pathologically cases and30healthy controls. Meanwhile, the protein expression of VEGF, ES and MVD in60CRCC confirmed pathologically cases and30normal kidney tissues was assessed in tissues using immunohistochemical staining by two senior pathology doctors in double blind manner. The relationship between VEGF, ES, MVD and pathologic characteristics was determined with SPSS13.0software and P value<0.05was considered as statistically significant.Results:(1) Serum VEGF (0.22±0.12ng/ml vs0.08±0.02ng/ml, P<0.01) and ES (65.87±20.03ng/ml vs37.85±18.49ng/ml, P<0.01) levels of CRCC cases were significantly higher than those of controls, but not associated with pathological stage and tumor differentiation (P>0.05).(2) The expression of VEGF in CRCC was remarkably higher than that of normal kidney tissue (76.7%vs23.4%, χ2=32.673, P<0.01). The VEGF expression in60CRCC cases was not associated with clinical pathologic characteristics including sex and histological grade, while its expression in late stage (Ⅲ-Ⅳ) was higher than that of early clinical stage (Ⅰ-Ⅱ)(84.7%vs72.1%,x2=25.731, P<0.05).(3) The expression of ES in CRCC was significantly higher that of normal kidney tissue (77.2%vs34.8%,x2=13.591, P<0.01). Besides ES expression in cases with late stage (Ⅲ-Ⅳ) was higher than those with early clinical stage (Ⅰ-Ⅱ)(83.7.%vs76.8%,x2=3.691, P<0.05).(4) The mean MVD in CRCC was significantly higher than that in normal tissues (34.76±11.78vs17.75±8.53,t=8.124,P<0.01). Meanwhile the mean MVD in cases with late stage (Ⅲ-Ⅳ) was higer than those with early stage (Ⅰ-Ⅱ)(45.39±59.67vs27.64±8.13,P<0.01).(5) There were statistically significant correlation between VEGF and MVD (r=6.271, P<0.05), ES and MVD (r=12.024, P<0.05) and VEGF and ES (r=8.571,P<0.05)II Diagnostic value of contrast-enhanced ultrasonography in clear renal cell carcinomaObjective:To evaluate the diagnostic value of contrast-enhanced ultrasonography (CEUS) in CRCC and its relationship to the tumor pathologic characteristics.Methods:CEUS features of40CRCC patients confirmed pathologically were analyzed retrospectively. A contrast-specific mode and a sulfur hexafluoride-filled microbubble contrast agent were used for CEUS. The enhancement pattern, the homogeneity of enhancement, the presence of perilesional enhancement, the washing in and washing out pattern, time-intensity curve, the process of enhancement (i.e. diffuse, centrifugal or centripetal enhancement) and pathological findings were evaluated.Results:Quantitative analysis of the time-intensity curve showed that the time-to-peak (TTP) of the lesions was shorter than that of normal renal parenchyma (P<0.05), the mean value of the up slope rate of the absolute value of lesions was higher than that of the ipsilateral normal renal parenchyma (P<0.05), and the mean value of descent slope rate of the absolute value of lesions was lower than that of the ipsilateral normal renal parenchyma (P<0.05). Enhancement pattern of clear renal cell carcinoma were categorized into four models:type Ⅰ "fast in and out"(11/40,27.5%); type Ⅱ "fast in and slow out"(17/40,42.5%); type Ⅲ "Simultaneous in and out"(7/40,17.5%); and type Ⅳ "slow in and out"(5/42,12.5%); Heterogeneous (27/40,67.5%) and diffuse (33/40,82.5%) enhancement presents in most cases; In type Ⅰ to Ⅲ, the presence of pathology was associated with low differentiation, abundant vasculature and few mesenchymal tissue, while high differentiation, few vasculature and abundant mesenchymal were observed in type Ⅳ. There was a positive correlation between peak intensity and MVD in CRCC (P<0.05)Conclusions:(1) Serum VEGF and ES levels of CRCC cases were significantly increased than those of controls.(2) The protein expression of VEGF, ES and MVD in CRCC was higher than that in normal kidney tissue, and correlates with clinical stages. Those data suggest that VEGF, ES and MVD play important roles in oncogenesis and progression of CRCC.(3) There is a significantly correlation between VEGF, ES and MVD in CRCC, indicating both VEFG and ES are key regulators in CRCC angiogenesis.(4) Time-intensity curves can provide accurate information of blood perfusion of CRCC. CEUS; type Ⅰ "quick in and out", type Ⅱ "quick in and slow out", heterogeneous and diffuse enhancement accounted for the major cases; different types correlates with different pathologic charateristics; our data indicates CEUS plays vital role in diagnosis of CRCC. |
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