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Articole originale Jurnalul de Chirurgie, Iaşi, 2008, Vol. 4, Nr. 4 [ISSN 1584 – 9341] 8. Ring EJ, Oleaga JA, Freiman DB, Husted JW, Lunderquist A. Therapeutic applications of catheter cholangiography. Radiology. 1978; 128(2): 333-338. 9. Ferrucci JT Jr, Adson MA, Mueller PR, Stanley RJ, Stewart ET. Advances in the radiology of jaundice. AJR Am J Roentgenol. 1983; 141(1): 1-20. 10. Mueller PR, Ferrucci JT Jr, Teplick SK, vanSonnenberg E, Haskin PH, Butch RJ, Papanicolaou N. Biliary stent endoprosthesis: analysis of complications in 113 patients. Radiology. 1985; 156(3): 637-639. 11. Daniil C, Stanciu C, Balan G, Frasin M, Strat V, Târcoveanu E, Diaconescu MR, Dolinescu C, Burcoveanu C, Dragomir C, Stoian M. Radiologia intervenţională în icterele obstructive. Rev Med Chir Soc Med Nat (Iaşi). 1986; 2: 361-365. 12. Stanciu C, Daniil C, Strat V, Târcoveanu E. Drenajul biliar percutan extern in icterul obstructiv. Rev Med Chir Soc Med Nat (Iaşi). 1984; 3: 371-374. 13. Burcharth F, Efsen F, Christiansen LA, Hancke S, Jensen LI, Nielsen OV, Pedersen JH, Pedersen G. Nonsurgical internal biliary drainage by endoprosthesis. Surg Gynecol Obstet. 1981; 153(6): 857-860. 14. Pereiras RV Jr, Rheingold OJ, Huston D, Mejia J, Viamonte M, Chiprut RO, Schiff ER. Relief of malignant obstructive jaundice by percutaneous insertion of a permanent prosthesis in the biliary tree. Ann Intern Med. 1978; 89(5 Pt 1): 589-593. 15. Carrasco CH, Wallace S, Charnsangavej C, Richli W, Wright KC, Fanning T, Gianturco C. Expandable biliary endoprostheses: an experimental study. AJR Am J Roentgenol. 1985; 145(6): 1279-1281. 16. Daniil C, Balan G, Stanciu C et al. Percutaneous Biliary drainage and Endoprosthesis for malignant obstructive jaundice. In vol. 3th Congress of the Hungarian Radiol. Society (Budapesta): 1986. p. 121. 17. Lammer J, Mueller PR, Ferrucci JT. The biliary ducts: interventional techniques. In: Ferrucci JT, editor, Radiology on CD-ROM. New York: Lippincott Williams & Wilkins; 1999. 18. Lewis CA. Standards of Practice Committee. Quality improvement guidelines for percutaneous transhepatic cholangiography and biliary drainage. SCVIR, Draft 3, 1996. 19. Madoff DC, Wallace MJ. Palliative treatment of unresectable bile duct cancer Which stent? Which approach? Surg Oncol Clin N Am. 2002; 11: 923-939. 20. Cowling MG, Adam AN. Internal stenting in malignant biliary obstruction. World J Surg. 2001; 25: 355-361. 21. Lee BH, Choe DH, Lee JH, Kim KH, Chin SY. Metallic stents in malignant biliary obstruction: prospective long-term clinical results. AJR Am J Roentgenol. 1997; 168(3): 741-745. 22. Lammer J, Hausegger KA, Flückiger F, Winkelbauer FW, Wildling R, Klein GE, Thurnher SA, Havelec L. Common bile duct obstruction due to malignancy: treatment with plastic versus metal stents. Radiology. 1996; 201(1): 167-172. 23. Davids PH, Groen AK, Rauws EA, Tytgat GN, Huibregtse K. Randomised trial of selfexpanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet. 1992; 340(8834-8835): 1488-1492. 24. Gordon RL, Ring EJ, LaBerge JM, Doherty MM. Malignant biliary obstruction: treatment with expandable metallic stents–follow-up of 50 consecutive patients. Radiology. 1992; 182: 697-701. 25. Mathieson JR, McLoughlin RF, Cooperberg PL, Prystai CC, Stordy SN, MacFarlane JK, Schmidt N. Malignant obstruction of the common bile duct: long-term results of Gianturco- Rosch metal stents used as initial treatment. Radiology. 1994; 192(3): 663-667. 307
Articole originale Jurnalul de Chirurgie, Iaşi, 2008, Vol. 4, Nr. 4 [ISSN 1584 – 9341] ANTIGENUL Ki67 FACTOR DE PROGNOSTIC IN CARCINOAMELE GASTRICE Luminiţa Ivan Laboratorul de Anatomie-Patologică şi Prosectură, Spitalul Militar de Urgenţe, Iaşi Ki67 PROGNOSTIC FACTOR IN GASTRIC CARCINOMAS (Abstract): Aims: Despite their importance, prognostic factors in gastric cancer are not well known. Material and methods: The study included surgical specimens from 40 patients with gastric carcinoma. All specimens were fixed in 10% buffered neutral pH formaldehyde and paraffin embedded. Histological sections were stained using current techniques: haematoxylin-eosin, trichromic van Gieson, and Alcian blue. Laurén histological classification with two main types of gastric carcinoma: intestinal and diffuse was used to classify the specimens. We assessed the proliferative activity by determining the percentage of immunoreactive cells for Ki67 antigen (AM297 antibody Biogenex) and comparing the Ki67 index with histological type. Results: Immunoreactivity was positive for ki-67 in all cases: 12 cases of gastric carcinoma intestinal type – low to moderate index, 26 cases of gastric carcinoma diffuse type – moderate to high index and 2 cases of mixed gastric carcinomas – low to moderate index. Conclusions: The positive rates for Ki67 along with histologic differentiation give us useful information regarding the evolution and the prognosis of gastric cancer. These observations prove that a high proliferative activity is a prognostic factor for a highly malignant phenotype of the tumor. KEY WORDS: GASTRIC CANCER, Ki67 Corespondenţa: Dr. Luminiţa Ivan, Laboratorul de Anatomie-Patologică şi Prosectură, Spitalul Militar de Urgenţe, Iaşi, Str. Gen Berthlot nr. 6, Iaşi. * INTRODUCERE Adenocarcinoamele gastrice reprezintă 90-95% din toate tumorile maligne ale stomacului [1]. Corelaţiile endoscopice cu aspectele histopatologice au dus la apariţia formelor incipiente de adenocarcinom cu prognostic favorabil, complet diferit de carcinomul gastric avansat. De asemenea, datele epidemiologice, imunohistochimice (IHC) şi evolutive confirmă cele două variante histologice frecvente, carcinomul gastric de tip intestinal şi tip difuz (Lauren 1965 citat de [1]). Numeroase studii au prezentat IHC în vederea aprecierii prognosticului corelat cu produsele proteice ale genelor. Antigenul Ki67 este un marker al ciclului celular şi al proliferării celulare utilizat pentru estimarea coeficientului de proliferare într-o populaţie celulară [2]. Antigenul Ki67 este un antigen nuclear exprimat în toate fazele ciclului celular mai puţin în faza G0. Procentajul celulelor tumorale Ki67+ poate fi corelat cu parametrii de agresivitate sau de progresie tumorală. Datele din literatură referitoare la valoarea prognostică a indicelui de proliferare Ki67 în carcinomul gastric sunt reduse, de aceea, acest studiu îşi propune analiza IHC a activităţii proliferative exprimate prin procentul de celule imunoreactive pentru antigenul Ki67 corelat cu tipul histologic. * received date: 10.09.2008 accepted date: 25.09.2008 308
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