Objective To investigate the efficacy and safety of cryotherapy combined with balloon dilatation through electronic bronchoscope in the management of airway occlusion caused by scar stenosis type of tracheobronchial tuberculosis (TBTB). Methods From December 2008 to May 2016, 98 cases of airway occlusion caused by scar stenosis of TBTB were diagnosed by microbiology, histopathology, CT (computer tomography), bronchial reconstructions and bronchoscopy. All patients underwent routine anti-tuberculosis chemotherapy and cryotherapy through bronchoscope. The patients whose airways were reopened successfully received balloon dilatation through bronchoscope subsequently. The treatment effects were estimated by indexes including clinical efficacy, modified medical research council (mMRC) dyspnea scale and complications. Results Among the 98 patients, airway occlusion in 87 cases were reopened successfully by cryotherapy for (10 ± 4) times,and then these patients received balloon dilatation through bronchoscope for (7±3) times subsequently. The total effective rates were 76.53％and 72.45％after 3 and 12 months after the treatments respectively. Analysis of the disease courses of patients with different therapeutic efficacy showed that the median disease course was 3 months in healed cases, 5 months in effective cases and 9 months in ineffective cases. There was a significant difference between the ineffective and the total effective cases in disease courses (t=-15.012,P<0.01). The average of mMRC score changed from (3.8±0.5) before the procedure, to (1.1 ± 0.7), (1.2 ± 0.7) and (1.2 ± 0.7) immediately, 3 and 12 months after the treatments. The difference was significant between the scores before and after therapy (t=30.398-31.058, P<0.01), but not among the 3 scores after treatments. No serious complications were observed in all cases. Conclusions Cryotherapy combined with balloon dilatation through electronic bronchoscope was a very safe and effective method in the management of airway occlusion caused by scar stenosis of tracheobronchial tuberculosis. A shorter course of disease indicated more benefits for patients.

Objective To determine and compare the difference in expression status of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER2) in primary breast cancer and metastatic lesions.Methods 46 patients with biopsy reports or available samples of the primary foci of tumor and distant metastases were included in the final analysis.Biopsy samples were re-stained by using immunohistochemical methods to determine the status of receptor (if did not recorded in previous reports) and re-examined by 2 independent pathologists.The expression of ER, PR and HER2 receptors in primary and metastatic lesions, and the difference of the total survival were observed.Results The discordance rates for receptor expression status of primary tumor and distant metastases for ER, PR, and HER2 were 19.6%, 44.4% and 12.8%, respectively.There was no statistically significant difference in overall survival stage due to discordance in receptor expression between primary tumor and metastatic sites (P>0.05) had been found, although a tendency toward worse survival time was observed in patients with discrepancy in HER2 expression.Conclusion This study showed the receptor discordance rates of expression between primary and metastatic breast cancer sites in ER, PR, and HER2 receptors were 19.6, 44.4 and 12.8%, respectively.Re-biopsy and IHC for evaluation of metastatic sites for receptor status may change decision of treatment in patients with relapsed/progressed breast cancer.

Objective In this study, we evaluated the impact of obesity on clinical outcomes of Triple-negative breast cancer (TNBC) patients.Methods The data of 1,680 breast cancer patients were collected from Department of Oncology, Yanqing District and Daxing District Hospital from Dec.2005 to Dec.2015.The body mass index (BMI) of 105 TNBC patients was calculated with weight at the time of diagnosis and height.The patients were classified into groups with a BMI of<25 (normal/underweight), 25.0~29.9 (overweight) or ≥30 (obese).Overall survival (OS) was assessed.Results After a mean follow-up of 28.4±16.4 months, there were 12 recurrences (11.4%) and 4 deaths (3.8%).The mean BMI in premenopausal patients was significantly lower than in postmenopausal patients (P<0.05).The survival analyses of all the patients did not demonstrate any differences in OS in obese as compared to non-obese patients.However, we showed that obesity was associated with a poorer OS for postmenopausal TNBC patients (P<0.05).Conclusion Obesity is related to a poorer OS in postmenopausal TNBC patients.

Objective To explore the clinicopathologic characteristics,diagnosis and differential diagnosis,prognosis and treatment of adrenal cortical carcinoma.Methods Clinical data,pathological changes and immunohistochemical staining were observed in 6 patients with adrenal cortical carcinoma.Results There were six cases including four women and two men,aged from 23 to 60 years,average age of 53 years;3 cases were functioning and 3 cases were nonfunctioning.Microscopic examination showed that the tumor cells were polygonal,rich and eosinophilic cytoplasm,and coarse granular nuclear chromatin;tumor cells arranged in nests or sheets and invaded into the capsule.Immunohistochemical staining showed that tumor cells positively expressed Melan-A,inhibin-α and p53,negatively expressed Cg-A;two of them negatively expressed MSH2 and MSH6,and positively expressed MLH1 and PMS2.Conclusion The diagnosis of adrenocortical carcinoma is based on clinical features and main histopathologic architectural changes.Immumohistochemical staining may be helpful in diagnosis and differential diagnosis of adrenocortical carcinoma.It is essential to enhance awareness of pathological characteristics of adrenal cortical carcinoma to avoid misdiagnosis.

Objective To systematically evaluate and compare the safety and effectiveness of Nedaplatin combined chem-otherapy and Carboplatin combined chemotherapy for the treatment of terminal Non-Small Cell Lung Cancer( NSCLC) . Methods PubMed/Medline,EmBase,Cochrane Library,CBM,VIP and WanFang Data were retrieved and retrieval time was from construction date to September 2015,screening for random control trials( RCT) comparing Nedaplatin combined chemotherapy and Carboplatin combined chemotherapy in the treatment of terminal NSCLC. Literature was screened according to inclusion and exclusion criteria, data were extracted,quality evaluation was completed and Meta analysis was done by Stata 12. 0. Results 3 RCTs were included in this study,totally 161 cases. Results of Meta analysis showed that the objective remission rate difference of Nedaplatin com-bined chemotherapy and Carboplatin combined chemotherapy was not statistically significant(P>0. 05). As for incidence of 1 to 4 grade liver function impairment,3 to 4 grade neutropenia or leukopenia,3 to 4 grade thrombocytopenia,3 to 4 grade nausea and vomiting and 2 to 4 grade alopecia,Nedaplatin combined chemotherapy and Carboplatin combined chemotherapy showed no statisti-cally significant difference ( P >0. 05 ) . Conclusion ComparingNedaplatin combined chemotherapy with Carboplatin combined chemotherapy in the treatment of terminal NSCLC,the objective remission rates of the two groups are similar and there is no signifi-cant difference between the two groups in terms of adverse reactions. Influenced by the number of included studies and patient pop-ulation,the mentioned conclusion needs further verification by more high-quality RCTs.

目的 探讨胰腺混合性腺泡-神经内分泌癌(MAEC)的临床病理特征.方法 分析1例胰腺混合性腺泡-神经内分泌癌的临床表现、病理形态学特征及免疫组化特点,并结合文献进行讨论.结果 患者男性,54岁.无明显诱因出现乏力,伴纳差,偶有反酸嗳气、腹胀.CT及MRI检查提示胰尾部、脾门区及脾实质内占位性病变,边界不清.行胰腺体尾部、脾及部分胃切除术.肿瘤组织由腺泡细胞癌及神经内分泌肿瘤两种组织学形态组成,两种成分穿插混合生长.神经内分泌肿瘤CD56、CgA和Syn(+);腺泡细胞癌亦CD56和Syn(+);但仅散在个别细胞CgA(+).腺泡状区域bcl-10和CAM5.2弥漫性强(+),而梁索状区域弱(+).Ki-67增殖指数均为3％.术后给予化疗,8个月后出现肝转移,目前随访15个月,患者一般状态良好.结论 胰腺混合性腺泡-神经内分泌癌非常罕见,易与胰腺腺泡细胞癌、神经内分泌肿瘤、胰腺实性假乳头状肿瘤及胰母细胞瘤等混淆.

OBJECTIVE:To study the expression and clinical significance of CD147 in the patients of parathyroid carcinoma.METHODS:Fourteen cases of parathyroid carcinoma encountered during the period from 2012 to 2015 were enrolled. Thirty three cases of parathyroid adenoma encountered during the same period were enrolled. The expression of CD147 in parathyroid carcinoma and parathyroid adenoma was studied by means of immunohistochemistry (EnVision method).RESULTS:CD147 positive color was brown and yellow, and positive position was located mainly in the cytomembrane, and a small amount of cytoplasm was appeared. Among 14 cases of parathyroid carcinoma, 11 cases of CD147 positive score was 3+ , 3 cases of CD147 positive score was 2+ ; Among 33 cases of parathyroid adenoma , 8 cases of CD147 positive score was 2+ , 15 cases of it was 1+ , 10 cases of it was negative. CD147 was highly expressed in parathyroid carcinoma tissues, and the expression of CD147 was significantly different from the expression of parathyroid adenoma(P<0.05).CONCLUSION:CD147 immunohistochemical staining can help to diagnose parathyroid carcinoma.

目的 分析散发型淋巴管肌瘤病(S-LAM)的临床及病理特点,提高对该病的认识.方法 对11例经病理证实的S-LAM进行回顾性分析,采用SMA、vimentin、HMB45、Ki-67、CD34、D2-40、ER和PR等抗体进行免疫组化染色,并复习文献.结果 11例均为女性,表现为乳糜性胸或腹水,有胸闷、呼吸困难、气促等症状;病程中均有多个部位累及,包括肺、腹膜后、淋巴结.胸部CT示两肺散在或弥漫分布囊腔影,直径0.2 ～2cm,囊壁薄而清晰;腹膜后受累者CT显示囊性低密度影.11例均有月经不调,其中3例合并子宫肌瘤,1例合并卵巢畸胎瘤、肾血管平滑肌脂肪瘤及肝血管瘤,1例合并小肠胃肠间质瘤,2例合并肝囊肿.免疫组化显示11例HMB45均(+),5例ER灶性(+),8例PR局灶(+).随访5～ 60个月,患者均存活,且症状缓解.结论 LAM的临床表现无特异性,CT表现有一定的特异性,最终确诊依赖于组织病理,熟悉这些特点有助于早期诊断,但预后差.

Purpose To assess the clinical and pathological features of small gastrointestinal stromal tumours (sGIST).Methods To reevaluated the clinical,histological and immunohistochemical parameters of 21 sGISTs.The standard immunohistochemical panel antibodies were studied on the tumor sections.All data were compared with clinical sGIST.Results There were a total of 7 females and 14 males of sGISTs.The median age was 63 years old.The tumors were predominantly located in the stomach showing a spindle cell morphology and the tumor sizes ranged from 0.5 cm to 1.5 cm.9 sGISTs combined with malignant tumors,which were gastric cancer have been incidentally detected during surgery.As the lesions were small in size,with infrequent bleeding,necrosis,mucosal invasion,ulceration and less mitotic index,sGISTs reoccurred less compared with clinical sGIST.p53,Ki-67 labeling index and microvascular density (MVD) in sGIST were significantly lower than clinical sGIST (P ＜ 0.05).Conclusion sGIST may occure with digestive tract cancer synchronously.p53,Ki-67 labeling index and MVD were lower than clinical GIST,which means better prognosis.

目的 探讨肾移植后淋巴组织增生性疾病(PTLD)的临床病理学特征,提高对该疾病的诊治水平.方法 报道2例肾移植后PTLD,采用CD20、CD3、CD45RO、CD79a、bcl-6、CD10、Mum-1和Ki-67等抗体进行免疫组化染色,并进行EBV原位杂交检测,同时结合文献复习进行讨论.结果 2例患者肾移植术后均采用三联免疫抑制疗法,PTLD诊断时间分别为3年和16年.2例病理组织学类型均为单型性PTLD,其中1例为外周T细胞性淋巴瘤,1例为弥漫性大B细胞性淋巴瘤,均无特异性临床表现.确诊后均将免疫抑制剂减量,其中1例辅以利妥昔单抗治疗.1例患者确诊后短期内死亡,另1例患者生存.结论 PTLD是发生在器官移植后具有独特形态和临床特征的淋巴组织增生性疾病,预后较差,采用免疫抑制剂减量和抗利妥昔单抗治疗有效.

目的 探讨子宫内膜小细胞癌(SCC)合并浆液性乳头状癌(PSC)的临床病理特征、诊断与鉴别诊断.方法 分析1例原发性子宫内膜小细胞癌合并浆液性乳头状癌的临床表现、病理形态学特征及免疫组化特点,并结合文献进行讨论.结果 患者女性,60岁.因绝经后不规则阴道出血入院.B超及MRI示子宫腔内实性占位性病变.行广泛全子宫、双附件切除及盆腔淋巴结清扫术.镜下肿瘤组织由SCC及PSC 2种组织学形态组成,2种成分穿插混合生长.SCC中,CD56和TTF-1(+),NSE、CgA和Syn(-);CK、EMA、p16和p53两种成分均弥漫强(+).患者术后给予放、化疗,随访6个月状况良好,无复发和转移.结论 原发性子宫内膜SCC合并PSC非常罕见,易与子宫内膜腺癌伴去分化、子宫癌肉瘤、腺肉瘤、子宫内膜间质肉瘤、淋巴瘤等混淆.

目的 探讨甲状腺肿瘤石蜡包埋组织中BrafV600E基因突变状态及其与年龄、性别、发病部位、病理组织学分型的关系.方法 采用实时荧光PCR技术检测144例甲状腺石蜡组织中BrafV600E基因突变.结果 122例甲状腺癌中发现BrafV600E基因突变77例,突变率为63.1％.BrafV600E基因突变与年龄、性别、肿瘤良恶性、甲状腺微小乳头状癌以及肿瘤大小密切相关(P＜0.01),与肿瘤的被膜侵犯及广泛转移有关(P＜0.05).22例良性甲状腺病变组织中BrafV600E基因均未检测到突变.结论 BrafV600E基因可以作为甲状腺良、恶性肿瘤鉴别诊断中的一个重要生物标记物,其在甲状腺乳头状癌中的突变率与患者年龄、性别、肿瘤性质及肿瘤大小有关.

目的 探讨黏液样脂肪肉瘤的影像学及病理学特征.方法 采用免疫组化法对15例黏液样脂肪肉瘤进行染色,观察其影像学特征,并复习相关文献.结果 15例患者术前CT显示肿物为界限清楚的低密度影,MRI显示SE T1WI上为低信号,而T2WI上为明显高信号,类似于水的密度或信号,影像学检查缺乏特异性诊断,不易分辨肿物性质.组织学形态:由不同成熟阶段的脂肪母细胞、黏液样基质及毛细血管网组成,部分区域具有“肺水肿样”特征.免疫表型:脂肪母细胞S-100阳性,免疫组化标记CD34可见“鸡爪样”的小血管.结论 黏液样脂肪肉瘤影像学特征往往表现为低密度水肿样影像,诊断无特异性,病理检查可明确诊断.

目的 探讨肺原发肌上皮癌与鳞状细胞癌共存的肺复合癌临床病理学特征.方法 采用HE及免疫组化EnVision法观察1例肺原发肌上皮癌与鳞状细胞癌共存病例的临床病理学特征,并复习相关文献.结果 该例为肺原发肌上皮癌与鳞状细胞癌共存.胸部CT及支气管镜均提示右肺下叶支气管处结节.癌组织呈实性片状及梁状结构排列,肿瘤细胞形态多样.免疫表型:CK、vimentin、p63、SMA、S-100和Calponin阳性.邻近支气管黏膜可见鳞状细胞癌,免疫表型:CK、CK5/6和p63阳性,vimentin、SMA阴性.结论 肺原发肌上皮癌与鳞状细胞癌共存的肺复合型恶性肿瘤罕见,确诊需结合影像学、病理组织学及免疫表型.治疗以手术切除为主,对放、化疗均不敏感.

近年来,随着免疫抑制剂、广谱抗生素等的广泛应用,以及结核病、艾滋病等免疫缺陷性疾病患者的增多,侵袭性肺真菌感染的临床报道也逐渐增多[1-3],但侵袭性肺真菌感染被同时误诊为肺癌及肺结核者少见.为提高影像科、结核科及呼吸科等医务工作者对此病的认识,避免误诊误治的发生,现对1例肺部曲霉感染误诊为肺癌及肺结核患者的诊治经过进行回顾性分析,同时结合相关文献进行复习.

Purpose To investigate the significance of TKTL1 expression in invasive ductal carcinoma(IDC) of breast.Methods The expression of TKTL1 was detected in 54 cases of IDC and 10 cases of ductal carcinoma in situ(DCIS) by immunohistochemical staining.The relationship between the TKTL1 expression and pathologic features(ER,PR,histological grade,tumor size,vessel invasion,nerve invasion and lymph node metastasis) were also analyzed.Results(1) The expression of TKTL1 had no significant difference between IDC and DCIS(P0.05).(2) The expression of TKTL1 was positively correlated with lymph node metastasis(P=0.047),but had no relationship with ER,PR,tumor size,vessel invasion,nerve invasion and histological grade(P0.05).Conclusions Overexpression of TKTL1 may correlated with invasion and lymph node metastasis in IDC.

目的 探讨印戒样细胞变化与印戒细胞癌的组织学特点、免疫表型、诊断及鉴别诊断.方法 对2例子宫颈癌中印戒样细胞进行病理学分析,采用免疫组化EnVision法检测CK、CK7、E-cadherin、CEA、p53、Ki-67、vimentin、p16、p63、ER、PR表达并复习相关文献.结果 印戒样细胞变化与印戒细胞癌在形态上相似.印戒样细胞变化分非瘤性和肿瘤性印戒样细胞变化,子宫颈鳞癌和绒毛状管状腺癌可伴发非瘤性印戒样细胞变化.非瘤性印戒样细胞变化的细胞局限在基膜内,印戒细胞癌细胞在固有层内或更深组织内呈浸润性生长.非瘤性印戒样细胞变化免疫组化标记E-cadherin阳性,Ki-67低增殖指数和p53阴性,而印戒细胞癌E-cadherin阴性,Ki-67增殖指数高和p53阳性.肿瘤性印戒样细胞变化与肿瘤类型相关.结论 印戒样细胞变化的细胞在形态上与印戒细胞癌细胞相似,需仔细观察组织学结构,并结合病变器官,借助于免疫组化(CK、E-cadherin、CEA、p53等)和特殊染色(D-PAS)有助于做出正确的诊断.

Objective To investigate the application of ADx-ARMS method on the K-ras in colorectal carcinoma gene mutation detection.Methods 40 cases of colorectal cancer specimens from April to August in 2012 in Beijing Shijitan Hospital Affiliated to Capital Medical University were selected.ADx-ARMS method was used to detect 7 hotspot mu tations of K-ras gene in colorectal cancer paraffin tissue;the relationship between the mutations of K-ras gene and age,gender,histopathologic type,differentiation degree with paraffin-embedded tissues were analyzed.Results 14 patients with K-ras gene mutation were found in 40 cases of colorectal cancer specimens,the mutation rate was 35.0%.No relationship was found between the K-ras mutations and age,pathological typing(P 0.05);positive relationship were found between the K-ras mutations and gender(P 0.05),colorectal adenocarcinoma differentiation(P 0.01).Conclusion Effect of ADx-ARMS method in detecting the K-ras gene mutation is satisfaction,it is worthy of clinical application.

Objective To investigate relationship of K-ras gene mutations and age,gender,histopathologic type and differentiation degree in paraffin-embedded tissues of colorectal cancer.Methods By using ADx-ARMS method K-ras 7 hotspot mutation was detected in 82 cases of colorectal cancer paraffin tissue.Results 82 cases of colorectal cancer specimens were found in 30 patients with K-ras gene mutation,and the mutation rate was about 36.59%.K-ras mutations were not related with age,sex,pathological typing and colorectal adenocarcinoma differentiation(P>0.05).Conclusion The rate of K-ras gene mutation in colorectal cancer is not associated with patients' age,sex,the degree of tumor differentiation and pathological typing.

AIM To investigate the expression and clinical significance of calcium-binding protein S100A9 in the patients of breast cancer. METHODS The serum S100A9 level from 39 cases of preoperative breast cancer, 15 postoperative patients, and 10 healthy women was detected by ELISA. Immunohistochemistry was used to detect the S100A9 expression in 12 specimens of breast cancer tissues. RESULTS The serum S100A9 level was significantly higher in the preoperative breast cancer patients than that in the healthy women (P<0.01) and the postoperative breast cancer patients(P<0.01). The serum S100A9 level of the breast cancer patients with lymph node metastasis was significantly higher than those without lymph node metastasis (P<0.01). S100A9 level in the serum was related to patient age, tumour size, histological grade, and pathological type (P<0.01). The expression of S100A9 protein in breast cancer tissues was significantly higher than that in paracancerous benign breast tissues. CONCLUSION The expression of S100A9 significantly increases in the serum and tissues of patients with breast cancer, which indicates that S100A9 may function as a marker of diagnosis and treatment effect in breast cancer.