患者男性,54岁,因体检发现右肾上腺肿物5个月入院.平日自诉偶感腰部不适,未触及腰腹部肿块,无尿频、尿急、尿痛及肉眼血尿,全身浅表淋巴结未触及肿大.腹部CT平扫:右侧肾上腺区见类圆形结节灶,边界清晰,与邻近肾上腺外侧支分界欠清,大小约29 mm×25 mm,结节内密度尚均匀,CT值约41 Hu(图1A).

笔者在对1名2岁幼儿死亡遗体进行法医病理学检验鉴定时,发现遗体有双肺解剖学变异,为积累国人解剖学大数据以及为临床肺手术提供参考资料,现将此案例报道如下.本例肺标本存在分叶变异,其中左肺3叶,右肺4叶(图1).

目的 观察Xp11.2易位/TFE3基因融合相关性肾癌3例的临床病理学特征.方法 对已诊断明确的3例Xp11.2易位/TFE3基因融合相关性肾癌的免疫组化特征、病理学、影像学特征、临床特征进行回顾性分析,评估Xp11.2易位/TFE3基因融合相关性肾癌的病理学特征和预后转归情况.结果 3例病人均为男性,平均年龄58岁(42～68岁);肿瘤直径3.2～5.0 cm,平均直径4 cm;肿瘤切开切面为灰黄或灰红色,大体标本呈实性,部分区域出现出血.1例大体标本为囊实性.镜检为腺泡状、巢状、乳头状结构,由嗜酸性或透明细胞构成,边界清晰,间质内含有数量不等的砂砾体,核仁明显,染色质呈囊泡状.免疫组化显示3例病例肿瘤细胞TFE3、vimentin均呈弥漫性阳性,HMB45、Melan-A、CD10、RCC、E-cad均呈不同程度阳性,CD117、CK7均呈阴性,Ki67阳性率平均10％.结论 Xp11.2易位/TFE3基因融合相关性肾癌是一种罕见的恶性肿瘤,主要根据免疫组化标记TFE3、组织病理学、年龄确诊,治疗方式为手术治疗,预后尚可.

目的 构建一种经济实用的免疫组化组织微阵列对照体系,并介绍组织微阵列蜡块、切片的简易制作方法.方法 根据实际临床工作经验,在遵循国际特殊专家委员会建议、免疫组织化学检测技术共识的基础上构建组织微阵列对照体系;利用临床病理外检中满足临床诊断后剩余组织,常规脱水处理,镜下筛选目的区域,用废旧一次性病理刀片,将组织目的区域切成约0.2 cm×0.2 cm×0.2 cm的小组织块,根据组织微阵列对照体系,用尺寸较小的包埋磨具(约0.7 cm×0.7 cm)将目的组织包埋,制成组织微阵列蜡块并标记编号;组织微阵列蜡块冷冻后切片,切片厚度2～2.5μm,蜡片贴裱于免疫组化专用粘附性载玻片据底端0.5 cm处中央,用铅笔标记阳性对照组织微阵列的编号,72℃烤片15～30 min或室温自然凉片至干燥,制成组织微阵列切片.结果 构建了5个组织微阵列对照体系;制作了5种组织微阵列蜡块;制作了5种组织微阵列切片.结论 5个组织微阵列对照体系,设计科学合理,可满足百余种抗体的阴性及阳性对照;组织微阵列蜡块的制作方法简单,无需特殊仪器设备,组织来源充足;组织微阵列切片的制作简单易行.该免疫组化组织微阵列对照体系的构建经济实用,其蜡块、切片的制作方法简单,可操作性强,值得在实际临床工作中推广.

目的 探讨盐霉素对乳腺癌干细胞增殖和凋亡的影响及其作用机制.方法 体外培养MCF-7细胞形成微球体,取第3代微球体细胞,分别加入CD44-FITC、CD24-PE,采用流式细胞术检测乳腺癌干细胞百分比.取第3代微球体细胞,分别给予0、0.5、2、5、7、9μmol/L盐霉素干预12、24、48 h,采用MTT法检测乳腺癌干细胞盐霉素干预后细胞活性;取第3代微球体细胞,分别给予0、2.5、5、9μmol/L盐霉素干预24 h,倒置相差显微镜下观察乳腺癌干细胞形态学变化;取第3代微球体细胞,分别给予0、2、5、9μmol/L盐霉素干预24 h,分别采用FITC-Annexin V/PI双染法、PI单染法检测乳腺癌干细胞凋亡率和细胞周期;取第3代微球体细胞,分别给予0、0.5、2、5、9μmol/L盐霉素干预24 h,采用Western blotting法检测凋亡相关蛋白Caspase-3、Caspase-9、PARP、β-catenin、Survivin、Bcl-2、Bax表达.结果 经流式细胞仪鉴定,在悬浮微球细胞中CD44+/CD24-/low表型的乳腺癌干细胞比例为(87.0±0.4)％,在MCF-7细胞中为(40.1±1.0)％,二者比较P<0.05.不同浓度盐霉素均能抑制乳腺癌干细胞存活,并且其抑制作用呈时间和浓度依赖性(P均<0.05).倒置相差显微镜下观察,盐霉素干预后乳腺癌微球体逐渐解聚,密度降低,细胞大小不一、极度不规则,肿瘤细胞内部出现颗粒,细胞出现水肿、固缩,细胞碎片产生,并且随着盐霉素浓度升高,凋亡现象越来越明显.随着盐霉素浓度升高,乳腺癌干细胞凋亡率逐渐升高,并且在凋亡过程中可能伴G2/M期阻滞(P均<0.05).随着盐霉素浓度升高,乳腺癌干细胞Caspase-3、Caspase-9、PARP活性片段以及Bax表达逐渐升高,而β-catenin、Survivin、Bcl-2表达逐渐降低(P均<0.05).结论 盐霉素能够抑制乳腺癌干细胞增殖并诱导其凋亡,其机制可能与抑制β-catenin-Survivin-Caspase-3通路和干扰Wnt信号通路活性有关.

The study of pathological diagnosis is a cumulative process.For pathology postgraduates,it is the basis of employ-ment and task,which requires pathology postgraduates not only master of the professional books,but also accumulate experi-ence in clinical practice.In this paper,we will talk about how to improve the pathological diagnosis level of pathology post-graduates.

We previously showed that hepatitis B virus (HBV) X protein (HBx) could promote the trimethylation of histone H3 lysine 9 (H3K9me3) to repress tumor suppressor genes in hepatocellular carcinoma (HCC). In this work, we analyze 23,148 human promoters using ChIP-chip to determine the effects of HBx on H3K9me3 enrichments in hepatoma cells with transfection of HBx-expressing plasmid. Immunohistochemistry for HBx and H3K9me3 was performed in 21 cases of HBV-associated HCC tissues. We identified that H3K9me3 immunoreactivity was significantly correlated with HBx staining in HCC tissues. ChIP-chip data indicated that HBx remarkably altered promoter enrichments of H3K9me3 in hepatoma cells. We identified 25 gene promoters, whose H3K9me3 enrichments are significantly altered in hepatoma cells transfected HBx-expressing plasmid, including 19 gaining H3K9m3, and six losing this mark. Most of these genes have not been previously reported in HCC, and BTBD17, MIR6089, ZNF205-AS1 and ZP1 have not previously been linked to cancer; only two genes (DAB2IP and ZNF185) have been reported in HCC. Genomic analyses suggested that genes with the differential H3K9me3 enrichments function in diverse cellular pathways and many are involved in cancer development and progression.

In recent years,with the improvement and development of histochemical technique of immunohistochemical,enzymology testing is gradually developed in forensic laboratories. In the study and practice of forensic medicine,enzymology testing technology is showing wider applicative prospect. A lot of research results show that enzymology testing has played an important role in those research field including estimation of postmortem interval,wound age,the cause of death,as well as body fluid analysis and species identification. Here is to make a review of the study in recent decades to provide reference for the related research.