Clinical Analysis And Pathology Research Of Multiple Primary Malignant Neoplasms

[objective]To study the clinical characteristics,diagnosis and treatment strategy of the Multiple Primary malignant neoplasms(MPMNs).[methods]155 cases of MPMNs admitted to our hospital between Jan.1975 and Apr.2006 were studied respectively.The relationship between clinical data and prognosis of MPMNs with the second primary colorectal carcinoma(SPCC)were analyzed by SPSS12.0.[results]Out of them 148 patients were male,7 patients were female.The age of first primary carcinoma ranged from 44 to 91 old-year,the mid-age 70 old-year.The age of second primary carcinoma ranged from 54 to 91 old-year,the mid-age 77old-year.While 26 cases were synchronous MPMNs,129 cases were metachronous MPMNs.There were 355 malignant cases in the 155 MPMNs patients.Among the cases,there were 192 cases in alimentary system and 63 cases in uropoietic system and 55 cases in respiratory tractsuch,and another 45 cases in thyreoidine,breast,hystera,limbs,oral and maxillofacial region,pharynx nasalis,encephalon and hematological system.The most possible organs of the MPMNs occurred in the same organ or the same system.The principle of treatment of the MPMNs was surgery.The overall 1-,3-,5-year survival rates of MPMNs were 77.42%,45.16%及30.97%respectively.Kaplan-Meier and Log-rank univariate analysis showed that interval time,pathological type,complete resection and pathological staging were closely associated with survival rates(P＜0.05);while age,gender,organ of first carcinoma were not associated with survival rates.Cox model multivariate analysis indicated that interval time and complete resection were closely associated with survival rates.[conclusions]The common locations of MPMNs were closely associated with alimentary system,respiratory tract and uropoietic system.On condition that active therapy was operated,the 1-,3-,5-year survival rates of MPMNs were still rather high. Patients with MPMNs must be submitted to a long-term and careful follow-up. Regular check-up,early detection,early diagnosis,active and effective treatment can help to improve the survival quality of MPMNs patients. [Objective]Colorectal carcinoma is one of the most frequent tumors in China.While the mechanism of its occurrence is not clarifed,it is important to study the tumorigenesis in order to make early diagnose and decide treatment method.Colorectal tumorigenesis is a complex processing involving mutations of many genes,so normal cells have a complete gene repair system in order to protect the stability of genome.Mismatch repair (MMR)is an important method in the whole repair system,and among them,hMSH2 and hMLH1 are the most important genes.In this study,we detected the different protein expressions of mismatch repair genes hMSH2 and hMLH1 in SCC and MMPCC to analyze the roles of their abnormal expressions in colorectal carcinogenesis. [Method]30 patients of SCC with clear pathological diagnosis were collected from PLA 306 hospital,and 25 patients of MMPCC were collected from PLA 301 hostpital. Among these cases,Immunohistochemistry was used to detect the protein expressions of hMSH2 and hMLH1.SPS12.0 statistic software was used to analyze the correlation of their abnormal expressions to MMPCC.[Results]There was significant different expression of hMLH1 protein between the SCC group and MMPCC group.While the rates of hMSH2 expression in SCC group and MMPCC group were no significant distinctness.The expressions of hMLH1 in MMPCC group had no relationship with sex,differentiation,infiltrate depth and lymph node metastasis,but associated with age and carcinoma organ.The expressions of hMSH2 in MMPCC group had no relationship with sex,age,differentiation,infiltrate depthand carcinoma organ,but associated with lymph node.[Conclusions]1.The expressions of hMSH2 and hMLH1 proteins in colorectal carcinoma were down-regulated.There were different expression of hMLH1 in SCC and MPCC.2.The incidence of DNA mismatched may be increased as the age increasing.The expression of hMLH1 protein was down-regulated in elder patients of MMPCC,which indicated the opportunity of mismatch increases with age.It may be the MMPCC's nosogenesis.3.The expression of hMLH1 have significant distinctness between distant-colon and close-colon.The incidence of DNA mismatched was common in mucous of right-side colon.The phenomenon showed that the diffient position of colon have diffient nosogenesis.4.The lower expression of hMSH2,the more metastasis common phenomenon to caicinoma.5.Detecting the expressions of hMLH1/hMSH2 are very helpful to predict the MMPCC.