High-grade appendiceal mucinous neoplasm (HAMN) has been separated from appendiceal adenocarcinoma recently as an independent entity and categorized into appendiceal mucinous neoplasms. These neoplasms demonstrate distinct histological characteristics, including architectures and appendiceal mural changes similar to low-grade appendiceal mucinous neoplasm but with high-grade cytology, and no infiltrative invasion. Overt mucinous feature are not evident in some cases as the high-grade neoplastic epithelium may show intracytoplasmic mucin reduction. Occasionally, the neoplastic epithelial cells show florid proliferation and tubulovillous configuration and may be misdiagnosed as appendiceal tubulovillous adenoma. We report the case of a 67-year-old woman with appendicular dilatation and luminal mucin. She underwent an ileocecoectomy. The appendiceal lesion was found histologically to be a HAMN, which closely resembled appendiceal tubulovillous adenoma. The tumor cells demonstrated wild-type p53 expression and mismatch repair proficiency by immunochemistry. Molecular testing showed 1 KRAS mutation, 2 PIK3CA mutations, and 1 BRCA2, EP300, TGFBR2, CHD4, CREBBP, FANCC, PKHD1 mutation each in the tumor. The patient was followed up for 1 year with no evidence of disease.

Infantile hepatic hemangioma and hepatoblastoma are the most common benign and malignant tumors of the liver in the neonatal and early childhood periods, respectively. However, the simultaneous occurrence of these 2 tumors in the same liver lesion is very rare. We report a case of a newborn infant diagnosed with a liver mass by ultrasound examination 4 days after birth. Serum alpha-fetoprotein (AFP) was elevated for his age (32,881.7 ng/mL). The liver mass was resected. Macroscopically, an externally protruding mass measuring 6 × 4 × 3.5 cm was identified. Microscopically, we observed the coexistence of infantile hepatic hemangioma and epithelial hepatoblastoma components within the tumor. The infantile hepatic hemangioma component was composed of multiple small vascular channels lined by endothelial cells. In the hepatoblastoma component, tumor cells were arranged in a 2- to 3-cell-thick trabecular formation. Immunohistochemistry indicated that the tumor cells in the infantile hepatic hemangioma component expressed CD34, CD31, FLI1, and ERG, and those in the hepatoblastoma component expressed hepatocyte, keratin AE1/AE3 and keratin 8, glypican 3, glutamine synthetase, and AFP. Pathological examination confirmed the presence of an infantile hepatic hemangioma combined with epithelial hepatoblastoma (fetal type). The boy did not undergo chemotherapy after the operation. Regular follow-up through serum AFP levels and liver ultrasound for 16 months to date show that the serum AFP levels decreased continuously to normal levels, with no signs of tumor recurrence or metastasis. The coexistence of infantile hepatic hemangioma and hepatoblastoma is rare. Hepatoblastoma should be considered in neonates with liver tumors and elevated AFP.

〓 Objectives: To analyze the pathological and clinical features of nasal respiratory epithelial adenomatoid hamartoma（REAH）, and summarize the diagnostic points, to improve the experience of diagnosis and treatment. Methods:The clinical data of 16 patients with REAH were analyzed retrospectively. The clinical manifestations, pathological features, imaging features, surgical treatment and prognosis were summarized. Results:16 cases of REAH were studied, 10 cases（62.50%） were associated with sinusitis, 1 case（6.25%） was associated with inverted papilloma, 1 case（6.25%） was associated with hemangioma. 5 cases（31.25%） had a history of nasal sinus surgery, including 1 case with 3 times of nasal sinus surgery, 1 case with 2 times of nasal sinus surgery, 3 cases with 1 time of nasal sinus surgery; 10 cases（62.50%） occurred in the bilateral olfactory cleft, 2 cases（12.50%） in the unilateral olfactory cleft, 3 cases（18.75%） in the unilateral middle turbinate, 1 case（6.25%） in the nasopharynx. All 16 patients were pathologically diagnosed as REAH. In the patients with lesions located in bilateral olfactory fissures, symmetrical widening of olfactory fissures and lateral displacement of middle turbinate were observed on preoperative sinus CT. The average width of bilateral olfactory fissures was （9.9±2.70） mm. The ratio of wide to narrow olfactory cleft was 1.21 ± 0.19. There was no significant difference in Lund-Mackay score between the two sides（P>0.05）. All patients underwent surgery under general anesthesia and nasal endoscopy. The follow-up period ranged from 1 to 66 months, and no recurrence occurred. Conclusion:Preoperative diagnosis of REAH is facilitated by the combination of clinical manifestations and endoscopic and imaging features. Endoscopic complete resection can achieve a good therapeutic effect.

目的 探讨肾集合管癌(CDC)的临床病理特征、诊断、鉴别诊断及预后.方法 回顾性分析8例CDC患者的临床病理特征、免疫组化结果,并复习相关文献.结果 男性5例,女性3例,年龄38～78岁,平均年龄59岁;临床主要表现为肉眼血尿,发热,厌食乏力;大体检查肿瘤主要位于肾髓质,单发,最大径为3.8～6.3 cm,切面灰白色、质硬;镜下肿瘤细胞呈管状、管状乳头状、微乳头、实性及条索状排列,可见肉瘤样区域,间质促纤维组织增生,伴多量淋巴细胞、浆细胞及中性粒细胞浸润;细胞异型性明显,呈多边形或鞋钉状,核仁显著,核分裂象多见;免疫组化结果阳性表达情况为 CK19(8/8)、CK7(8/8)、34βE12(7/8)、E-cadherin(7/8)和 Vimentin(7/8),FH 和SMARCB1(INI-1)均未缺失;随访3～57个月,4例于术后12个月内死亡,1例于术后36个月内死于肺纤维化,2例存活,1例失访.结论 CDC是一种罕见的侵袭性肾细胞癌,预后极差.需要结合大体表现、组织形态及免疫表型与浸润性尿路上皮癌、SMARCB1缺陷型肾髓质癌、FH缺陷型肾细胞癌、乳头状肾细胞癌等鉴别.

BACKGROUND Kaposi sarcoma and post-transplant lymphoproliferative disorder have been occasionally reported in post-liver transplant patients. However, the simultaneous occurrence of these two diseases in the same lymph nodes is very rare.CASE SUMMARY We report the case of a 19-mo-old boy, who presented with intermittent fever and enlarged cervical lymph nodes after liver transplantation. Six cervical lymph nodes were biopsied, and the histopathological examinations revealed multifocal hyperplasia of spindle cells around small blood vessels, extravasated erythrocytes, and heavy infiltration of plasma cells in the cortex and medulla of the lymph nodes. The immunohistochemical analyses of spindle cells revealed positive expression of CD34, CD31, erythroblast transformation-specific-related gene, friend leukemia integration 1, and human herpesvirus-8. The lymphoproliferative lesions expressed CD38, CD138, and multiple myeloma 1. Epstein-Barr encoded RNA in situ hybridization demonstrated Epstein-Barr virus-positive lymphoid cells. Finally, we diagnosed the coexistence of Kaposi sarcoma and post-transplant lymphoproliferative disorder（plasmacytic hyperplasia） in the same lymph nodes. Treatment strategy included anti-CD20 monoclonal antibody（rituximab） and discontinuation of the immunosuppressant therapies. Lymph node biopsies during follow-up examinations revealed lymphoid hyperplasia.CONCLUSION The rare coexistence of Kaposi sarcoma and post-transplant lymphoproliferative disorder in the same lymph nodes post-liver transplantation possibly associates with immunodeficiency and Epstein-Barr virus and human herpesvirus-8 coinfection.

目的 探讨脾脏硬化性血管瘤样结节性转化(sclerosing angiomatoid nodular transformation,SANT)的临床病理特征.方法 分析8 例SANT 患者的临床影像表现、病理组织学特征、免疫组织化学特点及临床预后,并复习相关文献.结果 男性3 例,女性5 例,年龄28～62 岁,平均年龄46.7 岁.6 例无明显临床症状.大体检查:病变单发、边界尚清、无包膜,最大径为2.0～9.0 cm,切面灰白色、红棕色、灰黄色,多结节状.镜下于纤维硬化间质内见多个血管瘤样结节,结节由窦样腔隙、圆形、不规则管腔的血管形成,管腔内衬肥胖内皮细胞,结节内及结节间散在不等量浆细胞、淋巴细胞、肌纤维母细胞及组织细胞浸润,免疫组织化学染色显示结节内含不同类型的小血管,血管衬覆内皮细胞的CD31、CD34、CD8 表达有差异.随访17～98 个月均无复发和转移.结论 SANT 现在认为是一种脾脏少见的良性血管增生性硬化性瘤样病变,具有特征性病理学形态及免疫组化特点,大部分患者无明显临床症状.确诊需手术后病理.脾脏切除可治愈,预后良好.

BACKGROUND QT interval prolongation can induce torsades de pointes (TdP), a potentially fatal ventricular arrhythmia. Recently, an increasing number of non-cardiac drugs have been found to cause QT prolongation and/or TdP onset. Moreover, recent findings have demonstrated the key roles of systemic inflammatory activation and fever in promoting long-QT syndrome (LQTS) and TdP development. CASE SUMMARY A 30-year-old woman was admitted with a moderate to high-grade episodic fever for two weeks. The patient was administered with multiple antibiotics after hospitalization but still had repeating fever and markedly elevated C-reactive protein. Once after a high fever, the patient suddenly lost consciousness, and electrocardiogram (ECG) showed transient TdP onset after frequent premature ventricular contraction. The patient recovered sinus rhythm and consciousness spontaneously, and post-TdP ECG revealed a prolonged QTc interval of 560 ms. The patient's clinical manifestations and unresponsiveness to the antibiotics led to the final diagnosis of adult-onset Still's disease (AOSD). There was no evidence of cardiac involvement. After the AOSD diagnosis, discontinuation of antibiotics and immediate initiation of intravenous dexamethasone administration resulted in the normal temperature and QTc interval. The genetic analysis identified that the patient and her father had heterozygous mutations in KCNH2 (c.1370C>T) and AKAP9 (c.7725A>C). During the 2-year follow-up period, the patient had no recurrence of any arrhythmia and maintained normal QTc interval. CONCLUSION This case study highlights the risk of systemic inflammatory activation and antibiotic-induced TdP/LQTS onset. Genetic analysis should be considered to identify individuals at high risk of developing TdP.

目的 探讨原发性皮肤 γδT细胞淋巴瘤(PCGD-TCL)的临床病理特点.方法 回顾性分析2007～2018年间首都医科大学附属北京友谊医院病理科诊断的11例PCGD-TCL患者的临床病理特征、免疫组化结果,并复习相关文献.结果 11例PCGD-TCL患者中,男性7例,女性4例;年龄为13～63岁,平均35.8岁.临床表现为皮肤浸润性斑块、皮下结节或肿块,其中6例伴有溃疡形成.11个病例中,8例显示肿瘤细胞浸润真皮及皮下组织,2例显示肿瘤细胞仅浸润真皮,1例显示肿瘤细胞浸润表皮及真皮.瘤细胞中等大小,染色质粗块状.免疫组化结果显示,阳性表达情况为CD2(5/7)、CD3(11/11)、CD5(3/10)、CD7(4/9)、TIA-1(9/9)、粒酶B(9/9)、TCRαβ(0/11)、TCRγδ(11/11)、CD56(10/11).11例行EB病毒原位杂交检测均为阴性.结论 PCGD-TCL是一种非常少见的皮肤T细胞淋巴瘤,确诊需要依靠病理形态学及免疫组织化学,其中TCRγδ 的表达更具有诊断意义.

目的 探讨皮下脂膜炎样T细胞淋巴瘤(SPTCL)的临床病理特点、鉴别诊断、治疗和预后情况.方法 回顾性分析57例SPTCL的临床病理特征及免疫组化结果,并复习相关文献.结果 57例中女性32例,男性25例,平均年龄25.9岁(年龄范围1～64岁).组织学显示,在皮下脂肪组织内见异型的淋巴细胞浸润,仅1例小灶累及真皮.瘤细胞小～中等大、核形不规则.免疫组化结果显示CD2(35/39)、CD3(57/57)、CD5 (30/39)、CD7(33/37)、CD4(4/57)、CD8(56/57)、TIA-1 (46/46)、粒酶B(52/53)、TCRαβ (46/46)(+).46例行EBER原位杂交检测均为(-).51例患者获得随访,结果5例患者死于该疾病,其中4例伴有噬血细胞综合征(HPS),1例不伴有HPS.结论 SPTCL多见于儿童及青年.典型的病理形态学为肿瘤细胞围绕脂肪细胞形成花环状结构;免疫组化结果为CD3、CD8、TCRαβ、细胞毒性标记物(TIA1和粒酶B)(+).不伴有HPS的SPTCL患者生存率明显高于伴有HPS患者.

目的 探讨卵巢浆黏液性肿瘤的临床病理学特点和病理学分类.方法 采用回顾性研究,收集2015年10月至2019年2月首都医科大学附属北京友谊医院收治的27例卵巢浆黏液性肿瘤患者,分析其临床病史、病理分型及镜下特点,并复习相关文献.结果 27例患者中,16例为良性,10例为交界性,1例为恶性.良性者年龄为19～78岁,中位年龄42岁,半数(8/16)为体检时发现,其余表现为腹痛、压迫症状等,镜下显示囊肿被覆混合细胞型单层上皮,其中3例伴局灶上皮增生.交界性者年龄为24～58岁,中位年龄37岁,半数(5/10)为体检时发现,其余表现为痛经、腹痛等,镜下表现为复杂分支的乳头结构,逐级分支形成更小的乳头,最后形成脱落的上皮细胞簇,由混合型上皮组成,其中1例伴有微小浸润.恶性者年龄为26岁,因阴道不规则出血1个月查B超显示盆腔巨大囊实性占位,镜下以膨胀性侵袭为主,伴小灶毁损性间质浸润,由混合型上皮组成,较为突出的是广泛的脉管内癌栓.结论 卵巢浆黏液性肿瘤较少见,是2014版世界卫生组织女性生殖器官肿瘤学分类新增加的一类卵巢上皮性肿瘤,分为良性、交界性与恶性,其形态学、免疫表型及分子生物学改变有一定的特殊性,但与卵巢浆液性肿瘤、子宫内膜样肿瘤有一定的重叠.

Objective To explore the correlation between TOP2A and ovarian serous carcinoma,and to analyze their clinical and pathological significance. Methods Retrospective analysis of 61 OSC surgical specimens and corresponding clinicopathological data of Pinggu District Hospital in Beijing during January 2000 to January 2017 were carried out. Immunohistochemical staining was used to detect the expression level of TOP2A protein and fluorescence in situ hybridization (FISH) was used to detect the genetic changes of TOP2A. The correlation between results of statistical analysis and corresponding clinic pathological data was analyzed by Spearman level correlation analysis. Results In 61 cases of ovarian serous carcinoma,which was diagnosed as low grade iin 20 cases(32. 8％) and high grade in 41 cases (67. 2％),and their TOP2A protein was positively expressed in 48 cases (78. 7％) and highly expressed in 31 cases (50. 8％). The expression of TOP2A protein was significantly increased in high grade OSC (P = 0. 006) and expression in specimens of late clinical stage (P = 0. 001). The results of FISH test showed that amplification of TOP2A gene was present in 36 cases (59. 0％). The statistical analysis showed that TOP2A gene was more likely to be amplified in high level of OSC(χ2 = 10. 358,P ＜ 0. 05),clinical stages in III and IV (χ2 = 10. 134,P ＜ 0. 05). In addition,the expression of TOP2A protein was positively correlated with the amplication of TOP2A gene (r = 0. 412,P = 0. 006). Conclusion The positive expression of TOP2A protein and amplification of TOP2A gene in OSC patients may be related to the malignancy of OSC and the occurrence and development of tumor.

支气管肺隔离症是一种先天肺发育异常性疾病,相对比较少见,占先天性肺畸形的0.15％～6.40％[1],误诊率较高.现收集9例成人支气管肺隔离症患者的临床资料分析如下,旨在探讨其临床、病理特征,提高对本病的认识水平. 1 临床资料 1.1 病例资料 收集首都医科大学附属北京友谊医院2013年1月至2017年12月经手术明确诊断为支气管肺隔离症的病例共9例,其中男性5例,女性4例,年龄19～61岁,中位年龄31岁,病程10 d～20余年.9例患者中5例表现为反复的肺部感染症状,如咳嗽、咳痰、发热等,另外4例无症状,为体检时偶然发现.

目的 增加对病理组织类型为伴有骨及软骨分化的乳腺梭形细胞化生性癌的了解,并增加相关诊治经验.方法 讨论1例伴有骨及软骨分化的乳腺梭形细胞化生性癌,自术前检查至术后16个月诊治经过,结合其余文献所涉及的相似病理组织学情况进行研究.结果 该例患者经术后病理多次取材、染色以及与外院专家会诊,最终确诊为伴有骨及软骨分化的乳腺梭形细胞化生性癌,术后随访16个月,未见局部复发及远处转移.结论 伴有骨及软骨分化的梭形细胞化生性癌是一种罕见的乳腺化生性癌,其临床表现与非特殊类型浸润性乳腺癌相似,在影像学上亦无特异表现.术前诊断困难,容易漏诊及误诊.需要术后多次取材及多块组织进行上皮标记物免疫组化染色,才能确诊,其预后的判断和临床治疗方案参照普通乳腺化生性癌制定

Objective To investigate the prognostic factors of renal cell carcinoma and to establish a prognostic model for patients with non-metastasis renal cell carcinoma (RCC) after operation.Methods We retrospectively reviewed the clinical data of patients with RCC who underwent radical or partial nephrectomy from January 2008 to December 2012,including 392 males (67.6％) and 188 females (32.4％),with an average age of 56 years(range 24-86 years).The average diameter of tumor was 4.8 cm (range 1.5-17.5 cm).The pathological slides of tumor tissue were reviewed by pathologist,and the tissue microarray (TMA) were constructed.The immunohistochemical staining of TMA were carried out.All patients were followed up the prognosis information of the overall survival (OS),cancer specific survival (CSS) and progression free survival (PFS).Based on these data,univariate and multivariate analysis and survival analysis were performed.Independent prognostic factors related to different follow-up endpoints of patients were screened out.A Nomogram prognostic model for RCC was established and verified.Internal validation were performed by boots value analysis.Results Among 580 cases,160 cases (27.6％) accepted nephron sparing surgery and 420 cases (72.4％) radical nephrectomy,included 514 cases (88.6％) of laparoscopic surgery and 66 cases (11.4％) of open surgery.There were 468 cases of clear cell carcinoma (80.7％),56 cases of papillary carcinoma (9.7％),32 cases of chromophobe cell carcinoma (5.5％),24 patients with other subtypes of cancer cells (4.1％).In pathological staging,stage Ⅰ,Ⅱ,Ⅲ,Ⅳ were 442 cases (76.2％),88 cases (15.2％),48 cases (8.3％),2 cases (0.3％),respectively.There were 424 cases (73.1％) with high expression of CA9,and 156 cases (26.9％) with low expression.The median followup was 66 (4-82) months,and 41 cases (7.1％) were lost of follow-up.For 3 and 5 years,OS,CSS and PFS were 83.4％,88.2％,72.4％ and 69.6％,73.0％,55.8％ respectively.Multivariate analysis showed that tumor pathological subtypes,tumor stage,tumor diameter and positive expression of carbonic anhydrase 9 (CA9) were independent prognostic factors associated with the survival of RCC patients.The Nomogram prognostic model was established by the above four factors.The established Nomogram prognostic model for RCC patients was verified by Harrell's consistency index,and the c-index of OS,CSS and PFS of RCC patients were 0.72 (95％ CI 0.69-0.75),0.77 (95％ CI 0.74-0.81),0.79 (95％ CI 0.76-0.83),respectively.Conclusions Tumor pathological subtypes,staging,tumor diameter and CA9 are independent risk factors for patients with non metastatic renal cell carcinoma.The established Nomogram prognostic model certified by internal validation should be tested by large samples and multicenter studies need tested.

Objective To explore the clinicopathological features,differential diagnosis and treatment of granular cell tumor in digestive tract. Methods Nine cases of granular cell tumor in digestive tract diagnosed in this hospital during 2009 to 2016 were collected for this study. The clinical characteristics,pathological features and immunological expressioin were analyzed,and their morphological features were studied by gross examination,light microscopy and immunohistochemical exaination,and accompanied with review of related literatures. Results Five cases were males and four females,the average age of these patients was 52 ± 9 years old (with age range of 39 to 67 years old). The size of tumors ranged from 0. 2 to 1. 2 cm in greatest dimension,and their average diameter was 0. 56 ± 0. 28 cm. All these patients received endoscopic mucosal endoscopical resection,the growth pattern was nested or solid with infiltrative margin,tumor cells had abundant eosinophilic cytoplasm with a small central nucleus,mitosis and necrosis were absent in all cases. Immunohistochemically,all cases showed positive for S - 100,CD68 and Vimentin expression. Conclusion Granular cell tumor in digestive tract is a rare neoplasm of neural derivation,most commonly occur in esophageal,rarely occur in stomach and colon. Its dignosis depends on pathomorphological examination and immunophenotyping. Endoscopic mucosal resection is recommended as a therapeutic method.

Objective To explore the clinicopathological features and differential diagnosis of transparent cell renal papillocarcinoma (TCRPC). Methods The clinical data,pathlogical features and followed - up results of 4 patients diagnosed as TCRPC during 2014 and 2016 and related literatures were retrospectively reviewed. Results Patients in study group comprised 2 men and 2 women,aged from 39 to 60 years old with mean age of 40 years old. Among them,1 case complicated with transparent cell renal carcinoma (case 1). The morphological features of these tumors were as follows:their diameters were from 1. 0 to 4. 0 cm,their characteristic structures under microscopy showed cyst formation in these tumors,with nipple or alveolar sructure which covered with transparent cytoplasm tumor cells. Their nuclear always arranged away from the basement membrane. CA - IX,34βE12 and CK7 were positive in 4 cases,and CA - IX showed cup - like distribution. TFE3 and CD117 were not expressed in any tumor. All these patients were followed up for 7 to 23 months without local recurrence of tumor. No lymph node or distant me-tastasis had been detected. Conclusion Transparent cell renal papillocarcinoma (TCRPC)is a new type of renal malignant tumor with better prognosis. It has clinical significance to differentiate TCRPC from transparent cell renal carcinoma and papillary renal cell carcinoma.

The trapping of IgM-containing immune complexes (ICs) by follicular dendritic cells (FDCs) serves as an important step in promoting germinal center (GC) formation. Thus, the deposition of IgM-containing ICs on FDCs can be detected by antibodies recognizing IgM. The present investigation provides the first comprehensive report on the IgM staining pattern in follicular lymphoma (FL, n = 60), with comparisons to reactive follicular hyperplasias (RFH, n = 25), demonstrating that immunohistochemical staining for IgM in paraffin-embedded sections seems to be an additional tool for differentiating between FL and RFH. In RFH, IgM highlighted processes of FDCs, with stronger and more compact staining in light than in dark zones, with occasional very dim staining of GC B cells. In FL, IgM expression patterns were of three types. Pattern I (38 cases) stained tumor cells within neoplastic follicles, with no staining of FDCs. Pattern II (15 cases) stained neither tumor cells nor FDCs. Pattern III (7 cases) stained tumor cells with (3 cases) or without (4 cases) IgM expression; however, variable and attenuated IgM expression was observed on FDCs in each case. Interestingly, significant numbers of IgD+ mantle cells were preserved around the neoplastic follicles in these 7 cases. The data suggested that a complete or considerable loss of IgM expression in FDCs, reflecting the loss of IgM-containing ICs in FDCs, is a typical feature of FL. Increased IgM expression by GC B cells can also serve as an indicator of immunophenotypic abnormality in FL.

病例简介:患者女,60岁.食管胃贲门交界处肿物,2年前出现间断腹部烧灼感,位于下腹部,伴恶心,按胃炎治疗后效果不佳.当地医院行胃镜活检,病理诊断为(贲门)低分化腺癌,建议外院会诊,后于北京市某三甲医院会诊,诊断(贲门)间变型浆细胞瘤,期间行超声内镜检查见贲门病变处正常管壁结构消失,可见低回声病变,内部回声欠均匀,形态不规则,呈菜花状,高低不平,浆膜层可疑受累,面积大小约3.9 cm×3.3 cm.经我院普外科会诊考虑为孤立性肿瘤,结合患者状况暂时不进行化疗,2017年3月于我院行全胃及部分食管切除术(术后送病理).同时腹膜后可见多发低回声结节,与胰腺关系密切(未送检).

Objective To explorte the clinical and pathological features and differential diagnosis of hepatoid adenocarcinoma of stomach (HAS)and its differential diagnosis. Methords The clinical data including history and clinical manifestations in 3 cases of HAS were analyzed, and the pathological features were examined by light microscopy and immunohistochemical staining,and related medical literatures had been re-viewed. Results The average age of these 3 cases of HAS was 70 years old,2 cases were males,and 1 case was female. Serum level of Alpha -fetoprotein (AFP)was elevated in all these 3 cases before treatment. The morphological manifestions including common gastric adenocarcinoma and hepatoid adenocarcinoma two types of lesions. Tumor emboli can be seen in vessels and lymph nodes. Immunohistochemical staining showed that tthere were 2 types of lesions in the area of hepatoid adenocarcinoma,a part of tumor cells expressed AFP,Glypican-3,hepatocytes,TTF -1 (liver),but CEA was negative. in these patients. Two patients were at stage Ⅲ,and 1 patient with stage Ⅱaccording to criteria of clinicopatho-logical staging. All these 3 cases received radical resection,liver metaastaasis was found in 1 patient with poor condition,1 patient was generally in good condition,and 1 patient was missed in follow-up. Conclusion Hepatoid adenocarcinoma in stomach is a rare specific entity with elevat-ed serum level of AFP,metastases in liver and lymph nodes are common. The prognosis of patients with HAS is poor,and curative effect is good with early diagnosis. Special attention should be paid to HAS.

Fluorescence in situ hybridisation (FISH) is a molecular cytogenetic technique, which is regularly applied to formalin-fixed paraffin-embedded (FFPE) tissue sections of a variety of cancers to assess chromosomal aberrations. However, high-quality FISH requires optimal enzymatic digestion, and insufficient digestion is not noted until the hybridisation signals are evaluated in the fluorescence microscope. As a consequence, FISH results may be unreliable, and the experiment might have to be repeated. To solve this problem, we developed a new method for real-time evaluation of enzymatic tissue digestion. Termination of enzyme activity at the proper time facilitates successful hybridisation, and experiments do not have to be repeated. We first performed FISH on 20 FFPE samples, which had been pepsin digested for different times, and this revealed distinct morphological changes within the nucleus and perinuclear space that were detectable by light microscopy. These observations suggested that the presence of intact and clear bare nuclei, surrounded by a translucent perinuclear space, might serve as an indicator of adequate digestion. We developed a protocol for assessment of this indicator, based on morphological features, and applied this to a collection of 400 tissue samples, partly of breast cancer and partly of different types of lymphoma, prior to FISH. The FISH success rate was 99.5% (398/400), which was significantly higher than that of the conventional method. In all successful cases, morphological signs of adequate digestion were paralleled by easily interpretable FISH signals. This new method for the real-time assessment of digestion quality improved the success rate of FISH and in addition was simple and rapid.