病人,男,44岁.因大便次数及性状改变1个月余于2016年11月21日入院,伴尿频,无尿急、尿痛,无腹痛腹胀及脓血便.体格检查:神志清楚,心肺听诊(-),头面部、胸部及上腹正中可触及直径0.5 ~5 cm不等的柔软包块,以上腹正中肿物最大(图1),直径约5 cm,腹壁包块,质软,边界清,活动度可.

目的 探讨结肠癌及癌前病变中增殖诱导配体(APRIL)和caspase-3蛋白的表达及其作用机制.方法 收集2009年8月～2015年4月东莞市石碣医院和广州市暨南大学附属一院病理科结肠癌切除及结肠镜活检标本共190例,其中正常结肠黏膜25例,结肠腺瘤伴轻、中、重度不典型增生各25例,结肠癌40例.采用SP法免疫组化方法检测各组黏膜中APRIL和caspase-3蛋白表达情况.结果 在正常结肠黏膜、结肠腺瘤伴轻度不典型增生、伴中度不典型增生、伴重度不典型增生和结肠癌中,APRIL的表达呈逐渐增高趋势,caspase-3的表达呈递减趋势,差异有统计学意义(x2=21.49、12.79,P＜0.05).APRIL的阳性表达与结肠癌患者的组织分化、淋巴结转移以及浸润程度有关(P＜0.05),而caspase-3的阳性表达与结肠癌患者的肿瘤淋巴结转移(TNM)分期、淋巴结转移有关(P＜0.05).经Spearman等级相关分析,40例结肠癌中APRIL和caspase-3表达呈明显的负相关性(r=-0.512,P＜ 0.05).结论 APRIL的过表达和caspase-3的表达下降可能在结肠癌的发生发展过程中发挥重要作用,两者表达具有一定相关性.

患者女，47岁。因间断性头晕头痛2年余，加剧4h入院。既往有高血压病和脑动脉硬化史。曾行阑尾切除术，有家族高血压史及乙肝病史。入院体检：血压145/99mmHg（1mmHg=0.133kPa），体温36.5℃,脉搏75次/min，R19次/min，神清，腹平软，未触及包块，四肢肌力正常，颅神经（-），心肺（-），无黄疸。血常规：白细胞12.04×109/L，中性0.81，血淀粉酶75.5U/L，尿淀粉酶545.2U/L。大小便常规正常，潜血试验阴性。其它实验室检查：总胆固醇5.94mmol/L，载脂蛋白A2.13g/L，胆碱酯酶14977U/L。头颅CT：右底节区隙性梗死。腹部B超：胰头实性占位性病变（考虑来源于腹膜后)，肾，肝，脾未见异常。腹部CT：胰头见4.8cm×3.3cm分叶状肿块，密度不均匀，增强后呈明显环形强化，壁厚薄不均匀，病变与钩突分界不清，不除外恶变可能。临床诊断：高血压，高血脂；脑动脉硬化；胰腺肿块待查，考虑恶性可能性大。外科手术行胰头、十二指肠加部分胃切除，术中见肿物居于胰头，约4cm×4cm大小，质硬，可活动。肝脏及腹腔内其他脏器未见异常。病理检查：十二指肠与胰头间见一约4.0cm×4.0cm×5.0cm 近圆形肿物（图1）,镜下见肿瘤主要由梭形细胞构成，细胞呈束状或编织状排列，基质大量胶原纤维，并见玻璃样变。肿瘤细胞不同程度浸润胰腺组织中，并见胰腺组织萎缩，肿瘤无侵犯肠壁肌组织（图2）。免疫组织化学：vimentin（++）（图3）， Desmin（-），SMA（-），S-100（-）， NSE（-），CD34（-），CD117（-）。诊断：韧带样型纤维瘤伴囊性变。

患者，女，20岁，因发现外阴肿物4月，头皮肿物1周于2012年10月31个日入院。4个月前发现外阴肿物，未予特殊处理，肿物逐渐增大。1周前发现头皮肿物，伴头痛头晕入住我院颅脑外科。患者既往史、月经史及家族史均无特殊。入院体格检查：体温36.8℃，脉搏79次／min，呼吸12次／min，血压120／73 mmHg。意识清楚，双侧瞳孔等大等圆，对光反射灵敏，心肺腹检查未见异常，颌下及腋窝末触及肿大淋巴结。右额头皮下可触及一约5 cm ×4 cm大小肿物，质中，活动度可，边界清楚，少许压痛。妇科检查：左侧外阴阴道口2点钟位与小阴唇处见一约8 cm ×10 cm ×10 cm肿物，向体表突出，表面黏膜紧张，肿物质中，有触痛（图1）。

Objective To investigate the expression and clinical significance of a proliferation-inducing ligand (APRIL) and X-linked inhibitor of apoptosis protein (XIAP) in colon carcinoma,colon adenoma and normal colon mucosa. Methods The expression of APRIL and XIAP was detected by immunohistochemical EnVisionTM plus non-hiotin tech-nique in 60 cases of colon carcinoma and 30 cases of colon adenoma,30 cases of normal colon mucosa. Results The positive expression rates of APRIL and XIAP in colon carcinoma,colon adenoma and normal colorectal mucosa de-creased gradually.There was significant difference among the three groups (P<0.01).The expression of XIAP were close-ly related to Dukes clinical stage,lymph node metascasis and the degree of infiltration (P<0.01).The expression of APRIL were closely related to differentiation degree,lymph node metascasis and the degree of infiltration (P<0.01). Conclusion The high expression of APRIL and XIAP may play important roles in the carcinogenesis of colon carcino-ma and it is involved in the metastasis and infiltration.

Objective To inverstigate the expression of GB3 and its significance in the testicular germ cell tumor(TGCT),testicular carcinomain-situ(CIS),and the preinvasive stage of TGCT.Methods 62 cases of TGCT and 14 cases of CIS were studied.The expression of GB3 was performed by immunohistochemistry with anti-GB3 monoclonal antibody 38-13.Results The expression of GB3 was detected in 54 TGCL cases(87%),and in 11 CIS cases(78.6%),27 /54 TGCLs and 8/11 CISs,no reaction was seen in germ cells and Sertoli cells.Conclusion GB3 may play a role in TGCLs.It is also a tumour-associated marker of TGCT and especially useful for the detection of CIS lesion.

Objective To investigate the expression of VEGF in thyroid tumors and analyze the correlation with tumor angiogenesis.Methods The expression of VEGF and MVD was detected with immunohistochemical Elivision TM plus non-hiotin technique in 140 cases of papillary thyroid carcinoma and 50 cases of thyroid benign tumor,20 cases of normal tissues,and to analyze the relationships between HIF-1α,VEGF with tumor angiogenesis.Results The positive expression rates of VEGF and MVD in papillary thyroid carcinoma were significantly higher than those in thyroid benign tumor tissues and normal tissues respectively(P 0.05).The expression of VEGF and MVD were positively related to lymph node metascasis,AJCC clinical stage and the degree of infiltration(P 0.05).Positive correlation was found among the expression of VEGF and MVD(r=0.564,P 0.05).Conclusion The detection of VEGF and MVD may act as markers of diagnosis and predicting biological behavior of papillary thyroid carcinoma.

Objective To investigate the expression of caspase-3 in colon carcinoma,colon adenoma and normal colon mucosa and its clinical significance.Methods The expression of caspase-3 was detected with immunohistochemical EnVision in 60 cases of colon carcinoma,30 cases of colon adenoma and 30 cases of normal colon mucosa.Results The positive expression rates of caspase-3 in colon carcinoma,colon adenoma and normal colorn mucosa were 18.3％(11/60),50.0％(15/30),86.7％(26/30).There was significant difference among three groups(P＜0.01).The expression of caspase-3 was closely related to Dukes clinical stage,differentiation degree,lymph node metastasis and the degree of infiltration(P＜0.01).Conclusion The low expression of caspase-3 may play an important role in the carcinogenesis of colon carcinoma and it is involved in the metastasis and infiltration.

目的观察RECK和MMP-9蛋白在肾细胞癌组织中的表达,探讨两者在肾细胞癌侵袭和转移中的关系。方法采用免疫组化SP法检测57例肾细胞癌手术切除标本中RECK、MMP-9蛋白表达情况。结果 RECK在肾细胞癌组织中的阳性表达率为47.4%,明显低于癌旁正常组织(P<0.01);而MMP-9在肾细胞癌组织中的阳性表达率为80.7%,明显高于癌旁正常组织(P<0.01)。RECK和MMP-9蛋白表达与肿瘤的组织学分级、临床病理分期和淋巴结转移密切相关。两者表达水平呈负相关(r=-0.614,P<0.05)。结论 RECK和MMP-9蛋白表达与肾细胞癌的侵袭和转移密切相关,可作为评价肾细胞癌预后的生物学指标。

Objective To study toxic effect of introuterine exposure TCDD in early pregnancy on renal structure in neonatal rat.Methods The pregnant 13 d SD rats were divided into randomly comtrol,cornoil,and toxied group.The light and electron microscopy were used to observate cell and subcelluar structue of kidney in neonatal rats.Results There were no found any pathological feature in control and corn oil group rats.In toxied group,renal unit was clearly seen but renal tubule expansion and mitochondrion swelling were obviously in epithelial cells of renal tubule.As the dose toxin increase the pathological damage was obviously serious,for example,renal capsule expansion and there red blood cell leakage and serious damage mitochondrion.Conclusion The renal structure in filial rat is damaged seriously as early pregnancy of intrauterine exposure to TCDD and the damage is more obvious as the toxin dose increaseing.

Objective To investigate the protective effects of flurbiprofen on cerebral ischemic-reperfusion injury in rats.Methods 36 male SD rats were randomly divided into 3 groups(12 rats each group):group A(ischemia/reperfusion,I/R),group B(I/R + Flurbiprofen 10 mg/kg),group C(I/R + Flurbiprofen 15 mg/kg).Flurbiprofen was injected intravenously just before middle cerebral artery occlusion(MCAO) and MCAO was lasted for 120 min.Neurologic examinations were performed at 24,48,72 h after reperfusion respectively.Infarct volume was determined by a computer image analyzer following the last neurologic examinations.Results Neurologic deficit scores(NDS) of group B and group C at 24,48,72 h after reperfusion were significantly greater than that of group A(P <0.05),there was no statistically significant difference between group B and group C.The percentages of infarction volume in group B and group C were significantly less than that in group A(P <0.01) at 72 h after reperfusion.Conclusion Flurbiprofen can significantly reduce neurologic injury induced by MCAO in rats.

患者女,68岁.因高血压病史12年,外院体检B超发现右肾上腺肿瘤1月入院.查体无特殊.既往有高血压病史12年,发现高血糖12年,长期口服降压药,血压控制在22.61 kPa/11.97 kPa左右,上下波动不大,血糖控制可,不伴头痛、头晕、心悸等不适.实验室检查:血糖(GLU)11.59 mmol/L、血尿素氮(BUN)10.63 mmol/L、尿酸(URIC)519.0 mmol/L.

术前诊断 左肾中下极占位,考虑肾癌并静脉血栓形成. 手术及病理 左肾大小12cm×6.0cm×5.5cm,周围为脂肪垫.

患者女,44岁.间歇无痛性全程血尿2个月,加重1天后入院.体检:双肾叩痛(+),余无特殊. CT表现:左肾下极见囊实混合性包块,与肾周筋膜界限不清,囊性部分内见不规则絮状、条状分隔,实性部分CT值约35 HU,增强后明显不均匀强化,CT值约86 HU,肾静脉内见部分充盈缺损(图1、2).

目的:研究着床窗期子宫内膜形态结构与性激素及其受体表达判断不明原因不孕患者的子宫内膜条件及黄体功能.方法:活检不明原因不孕55例及正常生育16例着床窗期子宫内膜行组织学天数及组织学分型;内膜扫描电镜观察胞饮突.检测黄体功能缺陷8例及子宫内膜反应不良6例着床窗期内膜性激素及其受体.结果:不孕组内膜的发育同步率(63.6%)明显低于正常生育组(93.8%),差异有统计学意义(P<0.05).不孕组子宫内膜胞饮突数量少,且发育明显滞后于正常生育组.黄体功能缺陷患者着床窗期子宫内膜孕激素受体表达与正常生育组无统计学差异(P>0.05);子宫内膜反应不良患者孕激素受体表达明显低于正常生育组,差异有统计学意义(P<0.05).结论:着床窗期子宫内膜发育同步性差,内膜容受性欠佳可能是部分不明原因不孕的病因之一.鉴别由黄体功能缺陷抑或子宫内膜反应不良引起的分泌期子宫内膜发育不良,是临床选择治疗方案的关键.

患者 女,60岁.半年前无明显诱因出现持续性上腹胀痛,伴恶心,无呕吐,口服止痛药后缓解,近半年食欲减退,消瘦. 体检:上腹剑突下压痛,肝区轻微叩痛,肝脾肋下未触及.

1病例 患者,女,48岁.陶"腹部不适,发现胰头占位性病变2年,近期肿块增大1月"人院.病程中无腹痛、腹泻、发热等症状.查体:腹平软,无压痛及反跳痛,右下腹可扪及一肿物,大小约9 cm × cm,边界不清,活动可.既往无胰腺炎病史,无外伤史.甲胎蛋白(AFP)、癌胚抗原(CEA、CA19-9)及鳞状细胞癌抗原(SCC)均为阴性.

1 病例 患者,男,37岁.无明显诱因出现右髋部疼痛3个月,行走劳累后明显加重,于当地医院以"类风湿"治疗,症状无明显好转,且疼痛逐渐加重,发病以来体重无明显下降.体查:右髋关节局部稍压痛,无肿胀,不伴下肢放射痛,右髋关节活动正常.双下肢肌力、肌张力、浅感觉及肢端血运正常.右侧"4"字试验(+),左侧正常;双侧直腿抬高试验(-),双侧巴氏征(-).实验室检查:潜血(ERY)50RBC/μL,尿白细胞(LEU)25 WBC/μL,尿蛋白(PRO)0.3 g/L,血红蛋白(HGB)171.0 g/L.影像诊断为骨巨细胞瘤(图1～5).病理检查(图6～7):大体见组织一块,约5 cm×5 cm,切面灰红色,均质.镜下见肿瘤细胞弥漫分布,细胞大小一致,圆或卵圆形,核偏位,胞浆丰富,红染,细胞分化成熟,间质少,瘤细胞之间为少量薄壁血管及纤维组织.免疫组化:Kappa(++),Lambda(-),CD68(-),L20(-),ucHL1少量细胞阳性.病理诊断:右股骨粗隆浆细胞瘤.

1病例 患者,男,53岁,咳嗽、咳痰、痰中带血20余天,清晨时症状加重.当地医院X线示"右肺阴影",抗炎治疗5 d后症状好转出院,出院后即再次出现上述症状.