目的 分析肺肝样腺癌(HAL)的临床病理特征、诊断、免疫表型、基因检测及治疗预后等。方法 对1例HAL临床及影像学、组织学形态、免疫组化及基因检测结果等进行观察,并结合相关文献综合分析。结果 患者为48岁吸烟男性,镜下肿瘤具有肝细胞样和腺样分化特征,血清AFP升高。免疫组化: Hepatocyte,AFP, Arginase-1均阳性,ARMS-PCR法均未检测到EGFR,ALK/ROS1,KRAS及BRAF突变。结合相关文献分析: HAL常见于有吸烟史的男性,血清AFP值升高也是该肿瘤的一个特点。肿物多见于肺上叶,体积较大,易发生淋巴结和远处转移,预后相对较差。结论 HAL非常少见,易误诊,其诊断需结合形态学特点、临床病理特征及免疫组化结果等。

Objective To explore the clinicopathologic characteristics, diagnosis, immunophenotype, gene detection and prognosis of primary hepatoid adenocarcinoma of the lung (HAL). Methods A case of hepatoid adenocarcinoma of the lung was analyzed with clinical manifestations, histology, immunohistochemical staining and gene detection, and relevant literatures were reviewed. Results The patient was a 48-years-old man with smoking history. Microscopically, the tumor has the characteristics of hepatocellular carcinoma and adenoid differentiation, also serum AFP was elevated. The immunohistochemical results showed that Hepatocyte, AFP and Arginase-1were positive. No mutations were detected for EGFR, ALK/ROS1, KRAS and BRAF by ARMS-PCR. Combining with literature analysis, HAL is common in males and most patients with this tumor are smokers. Serum AFP in very high levels has been a distinguishing feature of this tumor. HAL usually presents as a large bulky solitary mass in the upper lobe. Lymph nodes and distant metastases are prone to occur. Therefore, the prognosis is very poor. Conclusion HAL is a rare malignant tumor and easy to be misdiagnosed. The diagnosis of primary hepatoid adenocarcinoma of the lung should be combined with morphological features, clinicopathological features and immunohistochemical findings.

目的 研究对比胃癌患者术前胃镜活检病理与外科术后病理的异同并进行观察。方法 选取我院消化科于2016年7月—2017年12月收治的64例胃癌患者作为此次研究对象,术前均展开胃镜活检,术后展开外科病理检查,判断两种诊断方法的异同。结果 胃癌确诊率对比,术前胃镜活检后确诊胃癌患者占比85.9%(55/64),疑似胃癌患者占比10.9%(7/64),排除胃癌患者占比3.1%(2/64),术前胃镜活检确诊率85.9%,低于术后病理诊断95.3%,组间比较差异无统计学意义(P>0.05);胃镜活检病理结果对比,术前胃镜检查黏液腺癌占比35.9%,乳头状腺癌占比51.6%,均高于术后病理检查的25.0%、28.1%,组间比较差异具有统计学意义(P＜0.05);胃镜活检分化程度结果对比,胃镜病理与术后病理检查结果对比有明显差异,具有统计学意义(P＜0.05)。结论 对胃癌进行诊断时,尽管术前胃镜活检病理检查与外科术后病理检查结果存在差异,但术前胃镜活检对胃癌确诊率较为理想,可作为术前诊断参考,外科术后病理检查对全面评估胃癌病情具有较高应用价值,值得在临床中应用。

目的 探讨结肠原发性腺鳞癌和鳞癌的临床病理特征、诊断、发病机制及预后。方法 分析2例结肠原发性腺鳞癌和鳞癌的临床特点、组织学、免疫组化及基因检测特点,并结合相关文献进行讨论。结果 2例患者均因右下腹隐痛入院,平均年龄69岁,肿瘤均位于右半结肠。腺鳞癌可见腺鳞两种成分随机混合在一起,鳞癌成分免疫组化结果示CK5/6,P63均阳性,基因检测结果(ARMS-PCR法):腺鳞癌KRAS 2号外显子突变,BRAF未突变,鳞癌KRAS和BRAF均未突变。腺鳞癌患者术后放弃治疗1个月后死亡,鳞癌患者5个月后死于肝转移。结论 结肠原发性腺鳞癌/鳞癌非常少见,其临床症状与腺癌相似,但临床过程却更具侵袭性,预后相对较差,所以在临床中需得到重视。

Objective To study the clinicopathologic features, diagnosis, pathogenesis and prognosis of primary colon adenosquamous carcinoma and squamous cell carcinoma. Methods We analyzed clinical features, histological morphology, immunohistochemical results and gene mutation. Besides, relevant literatures were also reviewed. Results The two patients with an average of 69 years were admitted to the hospital due to abnormal pain. The tumors were all located in the right hemicolon. Adenosquamous carcinoma contained both components that mixed haphazardly. Immunohistochemistry showed that both CK5/6 and P63 were positive in squamous cell carcinoma. KRAS exon 2 mutations and BRAF wide-type were found in adenosquamous carcinoma patient, while KRAS and BRAF wide-type were found in squamous cell carcinoma patient using ARMS-PCR method. Adenosquamous carcinoma patient abandoned treatment and died after one month and the other died of liver metastasis in five months after surgery. Conclusion Primary colon adenosquamous carcinoma and squamous cell carcinoma are very rare. They have the similar clinical symptoms, more invasive clinical processes and worse prognosis compared with adenocarcinoma, therefore should be valued in clinic.

目的 探讨乳腺癌原发病灶超声声像图特点及病理分子分型与腋窝淋巴结转移的相关性。方法 回顾性分析106例接受乳腺超声检查及腋窝淋巴结活检,病理确诊为乳腺癌的患者资料。超声观察乳腺癌原发病灶的位置、大小、有无钙化、纵横比、内部血流、腋窝淋巴结声像图特点,结合临床病理学特点,分析与腋窝淋巴结转移相关的因素。结果 超声诊断未见明显异常的腋窝淋巴结75例,可疑的腋窝淋巴结31例;病理证实腋窝淋巴结未转移70例,转移36例。灵敏度66.7%、特异度90%、阳性预测值77.4%、阴性预测值84%。单因素分析显示原发肿块的位置、最大径、腋窝淋巴结淋巴门消失、ER表达与腋窝淋巴结转移有关(P<0.05 )。多因素分析显示原发肿块的位置、腋窝淋巴结淋巴门消失与腋窝淋巴结转移有关(P<0.05)。结论 腋窝淋巴结常规超声检查结合乳腺癌原发病灶超声声像图及病理分子分型有助于评估腋窝淋巴结状态。

Objective To analyse the ultrasonographic features and pathological molecular typing of the primary lesions and axillary lymph node (ALN) of breast cancer related to axillary lymph node metasta-sis(ALNM). Methods The Grey-scale and color Doppler ultrasound and axillary lymph node biopsy were performed in 106 patients with breastcarcinomas. The observed features included the position,the most dimen-sion,inner calcification,aspect ratio,the type of blood supply of the primary tumor and axillary lymph node image. Combining with the clinicopathological features, we analyzed the factors associated with axillary lymph node metastasis. Results Ultrasound found normal axillary lymphnodes in 70 patients and abnormal in 31 patients. Pathology confirmed axillary lymph node metastasis in 36 patients, and no metastasis in 70 patients.The sensitivity, specificity, positive predictive value, negative predictive value were 66.7%, 90%, 77.4% and 84% r-espectively.Univariate analysis showed that the location, maximum diameter, lymphnode with disappearance hilus and ER expression were related to axillary lymph node metastasis (P< 0.05). Multivariate analysis showed that the location of primary mass and lymph node with disappearance hilus were related to axillary lymph node metastasis (P< 0.05). Conclusion Axillary lymph node routine ultrasound examination combined with ultrasonographic and pathological molecular typing of primary breast cancer is helpful to evaluate axillary lymph node status.

目的 回顾性分析不同病理类型乳腺黏液腺癌的超声声像图特征,从而提高术前乳腺黏液腺癌不同亚型的超声诊断准确率。方法 分析43名患者共44例手术切除或穿刺活检证实为乳腺黏液腺癌病灶的声像图资料,包括病灶的边界、边缘、形态、回声类型、生长方向、钙化、后方回声、血流分级、腋窝淋巴结形态,并对病灶进行BI-RADS分类。将超声声像图特征与手术或活检后病理结果进行对比,总结出不同亚型的乳腺黏液腺癌的超声声像图特征。结果 44例乳腺黏液腺癌病理类型分为21例单纯型黏液腺癌和23例混合型黏液腺癌,混合型黏液腺癌大多数表现为病灶边界不清(73.9%)、边缘模糊毛刺(73.9%)、形状不规则(91.3%)、以及内部回声不均匀(87%)、病灶内钙化更多见(52.2%)。混合型黏液腺癌的淋巴结转移率明显高于单纯型黏液腺癌(P<0.05)。对比术前病灶的BI-RADS分类及术后病理诊断,超声对恶性病灶诊断准确率68%,单纯型黏液腺癌和混合型黏液腺癌的诊断准确率分别为48.6%、87%。结论 不同病理类型乳腺黏液腺癌间具有一些不同的声像图特征。混合型黏液腺癌大多数表现为病灶边界不清、边缘模糊毛刺、形状不规则、回声不均匀、病灶内钙化多见;单纯型乳腺黏液腺癌通常表现为边界清晰、形态规则、钙化少见、淋巴结转移少等良性肿块声像特征,超声对其误诊率较高,需提高警惕。

Objective Retrospectively evaluate the sonographic features of different types of mucinous breast carcinoma to improve the preoperative ultrasound diagnostic accuracy rate. Methods Sonographic features of 44 cases of MBC proven by pathological biopsy were analyzed, including the margin,lesion boundary,shape,echo pattern,lesion growth pattern, calcification, posterior acoustic feature,blood flow, lymph node form and data system(BI-RADS)classification for the lesion to sum up the different subtypes of breast ultrasonic ultrasonographic features of mucinous carcinoma. Results 21 cases of pure mucinous carcinoma (PMBC)and 23 cases of mixed mucinous carcinoma(MMBC)were founded. MMBC were more likely to have unclear boundary (73.9%), indistinct or spiculate of margin(73.9%), irregular shape (91.3%), heterogeneous internal echo (87%), more calcification in lesions(52.2%). Lymph node metastasis in MMBC was obviously higher than that of PMBC(P<0.05). Compared with preoperative of the BI-RADS classification and pathological diagnosis, ultrasonography in diagnosing accuracy rate was 68% in malignant lesions, 48.6% in PMBC and 87% in MMBC. Conclusion There are some different ultrasonographic characteristics in different types of breast mucinous carcinoma.MMBC are more likely to have unclear boundary, indistinct or spiculate of margin, irregular shape, more calcification in lesions. On the contrary, PMBC has a circumscribed boundary, abrupt interface edge, rare calcification, rare lymph node metastasis and are easily misdiagnosed as benign lesions. We should pay more attention to avoid misdiagnosis in ultrasonography.

目的 探讨直肠神经内分泌肿瘤的临床病理特征。方法 回顾性分析46例直肠神经内分泌肿瘤患者的临床病理资料,对不同病理分级的患者在性别、年龄、肿瘤直径、浸润深度、肝及淋巴结转移等方面进行比较。结果 直肠神经内分泌肿瘤男性多见,肿瘤多位于直肠中下段。免疫组化检测显示CgA、Syn、CD56阳性率分别为40.0%、97.8%、100%。36例Ki-67阳性指数≤2％,6例Ki-67阳性指数在3％～20％,4例Ki-67阳性指数＞20％。不同病理分级的肿瘤与患者年龄、肿瘤直径、浸润深度、淋巴结及肝转移相关,与性别不相关。结论 直肠神经内分泌肿瘤缺乏临床特异性症状,联合CgA、Syn和CD56染色可提高直肠神经内分泌肿瘤的诊断率。病理分级对预测肿瘤浸润深度、肝或淋巴结转移有重要参考价值。

Objective To investigate the pathological and clinical significance of 46 cases of rectal neuroendocrine tumors(NET). Methods Retrospectively analyzed the clinical and pathological feature of 46 patients with rectal NET, and assessed possible interactions between different pathological grades and gender, age, tumor diameter, depth of invasion, lymph node and liver metastasis. Results Rectal NET appeared more frequently in males than in females. Most tumors located in middle and distal third of rectum. The positivity rates of immunohistochemical marker CgA, Syn, CD56 were 40.0%, 97.8%, 100.0%, respectively. The cases of Ki-67 positivity rate under 2%, ranged between 3%-20%, above 20% were 36, 6, 4, respectively. Different pathological grades were significantly correlated with age, tumor diameter, depth of invasion, lymph node and liver metastasis, but not with gender. Conclusion Rectal NET had nonspecific symptoms. Combined immunohistochemical staining, such as CgA, Syn and CD56, was important in the evaluation of rectal NET. Pathological grading might be very useful for prediction of invasion depth, lymph node and liver metastasis.

目的 评价鞘内注射雷帕霉素对CCI神经病理性痛大鼠的痛阈及脊髓背角胶质细胞表达的影响。方法 健康雄性SD大鼠30只随机分为6组:①CCI组:CCI术后14天处死;②正常对照组:不做任何处理; ③前对照剂组:鞘内置管3天后行CCI术,术后4小时后鞘内给同体积生理盐水,连给3天; ④前给药组:鞘内置管3天后行CCI术,术后4小时鞘内给雷帕霉素溶液,连给3天; ⑤后对照剂组:鞘内置管3天后行CCI术,术后7天鞘内给同体积生理盐水,连给3天;⑥后给药组:鞘内置管3天后行CCI术,术后7天鞘内给雷帕霉素溶液,连给3天。各组于CCI术前1天和术后第2、4、6、8、10、12、14天测机械痛阈和热痛阈。术后14天测痛后用多聚甲醛灌注大鼠,取L4~5脊髓,免疫组化染色,星形胶质细胞标记蛋白(GFAP)检测星形胶质细胞表达变化,并定量分析。结果 与对照组相比,CCI手术组热痛阈和机械痛阈从CCI手术后第4天开始下降(P<0.05);前后给药对照剂组与CCI组相比,差别无统计学意义(P>0.05)。前给药组痛阈从CCI手术后第4天开始上升并持续至手术后第14天,与CCI组相比,差别有统计学意义 (P<0.05)。与CCI组相比,后给药组痛阈从CCI第8天开始上升并持续至手术后第14天,差别有统计学意义(P<0.05)。 与正常对照组比较,CCI组、前、后对照剂组手术侧脊髓背角GFAP染色阳性区平均光密度与阳性面积均有增加,差别有统计学意义(P<0.05)。前、后给药组手术侧GFAP染色阳性区平均光密度与阳性面积与CCI组比较,均有明显降低,差别有统计学意义(P<0.05)。结论 鞘内注射雷帕霉素可缓解大鼠神经病理性痛,并抑制脊髓背角胶质细胞的激活。

Objective To evaluate the effects of intrathecal injection of rapamycin on pain threshold and spinal cord gliacyte activation in rats of neuropathic pain. Methods Healthy 30 male SD rats were randomly divided into 6 groups(n=5 in each group): ① control group without operation or intrathecal injection. ②CCI group without intrathecal injection. ③ intrathecal injection of rapamycin 10 μg(10 μL) 4 hours after CCI operation and the next 2 days once a day. ④ intrathecal injection of NS10 μL 4 hours after CCI operation and the next 2 days once a day. ⑤ intrathecal injection of rapamycin 10 μg(10 μL) 7 days after CCI operation and the next 2 days once a day.⑥ intrathecal injection of NS10 μL 7 days after CCI operation and the next 2 days once a day. Mechanical and thermal threshold were tested 1 day before the CCI operation and 2^th、4^th、6^th、8^th、10^th、12^th、14^th days after the CCI operation for all the rats. Lumbar segment of spinal cords was removed for determination of glial fibrillary acidic protein(GEAP) in spinal cord by immuohistochemistry dyeing and assay in the 14th day after CCI operation for all the rats. Results Mechanical and thermal hyperalgesia emerged on 4th day and maintained till 14th day after CCI operation(P<0.05). After intrathecal injection of rapamycin 4 hours or 7days after CCI, mechanical and thermal threshold significantly increased compared to intrathecal injection of NS(P<0.05). And the sum area of GFAP positive and the mean density of GFAP positive area in the dorsal horn of operation side greatly increased in rapamycin treated groups compared NS treated groups(P<0.05). Conclusion Intrathecal injection of rapamycin may attenuate CCI induced hyperalgesia and inhibit the activation of astrocyte.

目的 探索锌剂治疗大鼠慢性细菌性前列腺炎(CBP)的机理及影响。方法 健康成年雄性大鼠100只,随机分为正常对照组(n=20)、CBP模型对照组(n=20)、CBP锌剂治疗组(n=20)、CBP左氧氟沙星治疗组(n=20)及CBP锌剂与左氧氟沙星混合治疗组(n=20)。采用消痔灵及大肠埃希菌制备CBP大鼠模型。CBP锌剂治疗组、CBP左氧氟沙星治疗组及CBP混合治疗组给予相应药物灌胃治疗,正常对照组及CBP模型对照组给予无菌生理盐水灌胃。疗程10 d,分别于2 d、4 d、6 d、8 d、11 d取各组大鼠前列腺,检测细菌数量并分离鉴定细菌性质。于4 d、9 d、14 d、20 d、28 d取各组大鼠前列腺,进行组织病理学检测。结果 CBP各治疗组大鼠前列腺组织的细菌数量与模型对照组相比均明显降低(P﹤0.05)。CBP混合治疗组大鼠前列腺内细菌在治疗8 d后不能检出。4～6 d CBP混合治疗组大鼠前列腺组织的细菌数量与CBP锌剂治疗组相比明显降低(P﹤0.05)。正常对照组大鼠前列腺病理学检查未见明显病理变化;模型对照组大鼠前列腺组织表现为慢性炎症的病理变化;各治疗组大鼠前列腺慢性炎症改变均有不同程度缓解,其中混合治疗组的慢性炎症明显减轻。结论 锌剂具有活化提高前列腺组织细胞抗菌能力的作用,有利于前列腺组织炎性病理损害的缓解以及损伤组织的修复,与敏感抗生素结合治疗CBP具有更显著的治疗效果。

Objective To explore the zinc agent in the treatment of chronic bacterial prostatitis (CBP) rats and the effect. Methods 100 healthy adult male rats, were randomly divided into normal control group (n=20), CBP model group (n=20), CBP zinc treatment group (n=20), CBP levofloxacin treatment group (n=20) and mixed treatment group of CBP zinc and levofloxacin (n=20). Preparation of the CBP rat model was made by Xiaozhiling and E.coli system. CBP zinc treatment group, CBP levofloxacin treatment group and CBP mixed treatment group were given the appropriate drugs for treatment,besides,the normal control group, CBP model control group were given sterile saline. It took 10d. Rats in each group at 2d, 4d, 6d, 8d, 11d were detected, including the number of bacteria and the bacteria isolation and identification properties. The pathological study in 4d, 9d, 14d, 20d, 28d and prostate of rats in each group were detected. Results The prostate tissue of the CBP group rats in the treatment of bacterial number compared with the model control group decreased significantly (P<0.05). CBP mixed treatment of prostate were not detected in bacteria after 8d treatment.4 - 6 days of CBP treatment of prostate tissue in rats of the treatment group compared with the quantity of bacteria and CBP zinc decreased significantly (P<0.05). Normal control group rats pathological prostate pathology examination showed no significant pathological prostate tissue; The model control group rats showed chronic inflammatory pathological changes; The treatment group rat prostate inflammatory changes were alleviated chronic inflammation, which mixed treatment group were significantly reduced. Conclusion Zinc enhances prostate tissue antibacterial ability, is conducive to the inflammation in prostate tissue response and the repair of damaged tissue. Sensitive antibiotics combined with treatment of CBP have a significant therapeutic effect.

目的 观察miR-9在胃癌组织中的表达水平及其与临床病理的相关性。方法 采用实时荧光定量PCR方法分别检测28例胃癌及正常胃组织中miR-9的表达水平,并分析其表达情况与临床病理资料的关系。结果 胃癌组织miR-9的表达水平[0.0078(0.0031~0.0142)]显著低于相应正常胃组织[0.0177(0.0084~0.0311), P<0.05],尤其是伴淋巴结转移者[0.0021(0.0006～0.0685)]miR-9表达水平明显降低。结论 胃癌组织中miR-9低表达,且与胃癌淋巴结转移有关。

Objective To investigate the correlation between the level of miR-9 expression and clinicopathology in gastric carcinoma. Methods The expression of miR-9 in 28 cases of gastric carcinoma tissues and normal gastric tissues were detected by quantitative real-time PCR, and the relationship between the expression and clinicopathology was analyzed. Results The expression of miR-9 expression in gastric carcinoma tissues [0.0078(0.0031~0.0142)] was significantly lower compared with the corresponding normal gastric tissues [0.0177(0.0084~0.0311), P<0.05], especially in lymph node-invasive carcinoma [0.0021(0.0006～0.0685)]. Conclusion miR-9 was down regulated in gastric cancer tissues, which was significantly associated with lymph node metastasis.

目的 分析总结12例原发性肺淋巴上皮瘤样癌(LELC)的临床病理特点。方法 回顾性分析12例肺LELC患者的临床病理资料。结果 12例肺LELC患者的组织学标本中,肿瘤细胞均明显表达HCK,原位杂交EBER阳性率为91.7%。全组中位生存期61.3个月,2年和5年生存率分别为84.6%和57.7%。结论 原发性肺LELC临床罕见,发病可能与EB病毒感染有关,经及时治疗有较好的预后。

Objective To investigate the pathological and clinical significance of 12 cases with primary Lymphoepithelioma-like carcinoma of the lung (LELC). Methods Retrospectively detectded and analyzed the clincalpathological feature of 12 cases of LELC of the lung. Results Histological study showed that tumor cells were significantly expressed HCK by immunohistochemistry staining and showed out 91.7% positive rate of EBER by situ hybridization. In this series, the median survival time was 61.3 months. The overall 2 and 5 year survival rates of the 12 cases were 84.6% and 57.7%. Conclusion Pulmonary LELC is very rare. It may be associated with Epstein-Barr virus infection, and has a batter prognosis after therapy.