目的 探讨甲状腺微小乳头状癌(PTMC)的高细胞亚型和经典型的临床病理特征差异及颈部淋巴结转移的危险因素.方法 选取2018年10月-2020年12月于中国人民解放军联勤保障部队第901医院收治的85例PTMC患者的临床病理资料,对病理切片行伊红-苏木精染色.比较经典型和高细胞亚型的形态学特征和临床病理特征,并分析其中78例行颈部淋巴结清扫的患者颈部淋巴结转移的危险因素.结果 与经典型相比,高细胞亚型形态学特征中的肿瘤细胞的高/宽度比＞2的比例较高,差异有统计学意义(x2=32.929,P＜0.05).临床病理特征中高细胞亚型瘤体直径＞5 mm、包膜侵犯和颈部淋巴结转移率均高于经典型,差异有统计学意义(x2=5.749、4.653、5.313,P均＜0.05).颈部淋巴结转移单因素分析显示,年龄、肿瘤直径、肿瘤多灶性和包膜侵犯是其淋巴结转移的危险因素(x2=5.453、4.953、9.455、13.043,P均＜0.05).多因素分析显示,高细胞亚型、肿瘤多灶性和包膜侵犯是影响颈部淋巴结转移的独立危险因素(OR=5.081、4.510、4.360,P均＜0.05).结论 PTMC的高细胞亚型侵袭性强,易发生颈部淋巴结转移.手术切除并行预防性中央区淋巴结清扫是较好的治疗方案.

目的 探讨伴血清甲胎蛋白升高的胃癌(AFP-produ-cing gastric cancer,AFPGC)的临床病理学特征.方法 收集胃癌手术切除标本976例,筛选术前血清AFP＞10 ng/mL的胃癌患者.采用免疫组化EliVision法检测SALL4、GPC3、AFP、CDX2、p53、HER-2的表达;FISH 法检测 HER-2基因扩增,分析其临床病理学特征.结果 976例胃癌中有32例AFPGC,依据组织学特征可分为5个亚型:肝样腺癌12例,伴肠母细胞分化的胃腺癌14例,弥漫型2例,卵黄囊瘤样型1例,混合型3例.32例AFPGC均不同程度表达原始胚胎分子标记SALL4、GPC3、AFP,阳性检出率分别为75.0％、62.5％、53.1％.三种标志物共阳性者8例,两种标志物共阳性者13例,仅有一种标志物阳性者11例.与单一表达组相比,共表达组血清AFP水平、脉管侵犯、淋巴结转移、病理分期和p53表达更高.32例AFPGC中24例表达CDX2(75％),19例表达p53(59.4％),HER-2基因扩增共7例(21.9％).结论 SALI4、AFP 和 GPC3是诊断 AFPGC 有用的分子学标志物,共表达原始胚胎分子表型的胃癌侵袭性更强.

上皮-肌上皮癌又称腺肌上皮瘤,透明细胞腺瘤;透明细胞癌;恶性肌上皮瘤;管状实性腺瘤等,是一种低度恶性肿瘤,发病率很低,老年男性多发,主要发生于大小涎腺,80％发生于腮腺,小涎腺发生率在1％ -2％ [1] ,支气管的上皮-肌上皮癌发生率更低,原发于支气管的上皮-肌上皮癌发源于支气管黏膜下层腺体,大部分起源于大支气管内,多数有气道阻塞症状,支气管的上皮-肌上皮癌国内外少有报道. 现将我科收治的1例气管上皮-上皮癌治疗报道如下,探讨其发病情况、病理特征及免疫组化特点、临床表现、诊断及鉴别诊断、治疗及预后.

1临床资料患者女性,63岁,农民,因"确诊纵隔型肺鳞癌19个月,发现左乳腺包块1周"于2015年7月8日入院。2013年11月在无明显诱因下出现咳嗽、胸闷、气喘症状,于2013年12月1日入住解放军第一〇五医院肿瘤三科,2013年12月2日在超声引导下给予纵隔肿块穿刺活检,2013年12月4日病理结果显示:鳞癌（图1A）;免疫组织化学结果显示:CD117阳性,CD5弱阳性,34βE12阳性,CK7阴性,CK20阴性,

目的 探讨乳腺浸润性导管癌、普通型导管增生和低级别导管原位癌组织中CD44+/CD24-和CK5/6的表达和意义.方法 采用免疫组织化学染色检测30例乳腺浸润性导管癌中CD44 +/CD24-、CK5/6和P63的表达、30例乳腺普通型导管增生组织中CD44 +/CD24-、CK5/6、34βE12和CK8的表达和30例低级别导管原位癌中CD44 +/CD24-、CK5/6的表达.结果 30例乳腺浸润性导管癌中24例呈CD44+/CD24-,30例普通型导管增生中9例呈CD44 +/CD24-和30例低级别导管原位癌中19例呈CD44 +/CD24-,3组相比具有统计学意义.浸润性导管癌中CD44+/CD24-表型与患者的年龄、月经状况、肿瘤大小、淋巴结转移、组织学分级、ER、PR和HER-2无相关性.30例乳腺浸润性导管癌中6例表达CK5/6,30例乳腺普通型导管增生中全部表达CK5/6,30例低级别导管原位癌中8例表达CK5/6,3组相比具有统计学意义.结论 CD44+/CD24-和CK5/6联合使用可用于鉴别乳腺浸润性导管癌、普通型导管增生和低级别导管原位癌.

目的 探讨原发性肝细胞癌(hepatocellular carcinoma,HCC)中肝干细胞标志物的表达及其与上皮细胞-间质转化(epithelial-mesenchymal transition,EMT)的关系.方法 采用免疫组化法检测72例HCC中肝干细胞标志物CK19、EpCAM、CD133、CD90的表达及其与EMT相关蛋白E-cadherin、vimentin和Snail的关系.结果 HCC组织中CK19、EpCAM、CD133、CD90阳性率分别为31.9％(23/72)、40.3％ (29/72)、51.4％ (37/72)、41.7％(30/72),有镜下癌栓和门静脉癌栓组中CK19、EpCAM、CD133、CD90阳性率均高于无镜下癌栓和无门静脉癌栓组,Ⅲ+Ⅳ期、肿瘤数目多发的HCC中EpCAM、CD133、CD90阳性率高于Ⅰ+Ⅱ期和单发的HCC;＜46岁、组织学Ⅲ+Ⅳ级、血清AFP≥350 ng/ml的HCC中CK19阳性率高于其相应对照组.E-cadherin与其余两种EMT标志物均呈负相关(vimentin:r=-0.572,P=0.004;Snail:r=-0.597,P=0.003),CK19、Ep-CAM、CD90阳性HCC组中vimentin阳性强度均高于阴性组,CD133阳性HCC组中E-cadherin阳性强度低于CD133阴性组,vimentin、Snail阳性强度均高于CD133阴性组.结论 与CK19、EpCAM、CD90相比,CD133阳性的肝癌干细胞与EMT的关系更加密切,CD133可作为同时针对HCC肝干细胞和EMT的治疗靶点.

Purpose:To improve the knowledge of solitary fibrous tumors(SFTs) on clinic,pathology and imageology.Methods:MRI/CT appearances of 19 patients with SFTs confirmed by pathology were analyzed retrospectively and the relevant literatures were reviewed.Sixteen patients were performed CT examination,including 10 cases of routine enhancement scans and 4 cases of dynamic enhancement scans and 2 cases of plain scans.Both plain MRI scans and enhancement MRI scans were performed in 7 patients,including 1 case of dynamic enhancement scan.Results:Eight patients were male and 12 patients were female.Of all the patients,80% were above 50 years old.Of all the lesions,40% were located in the pleura,30% were located in the abdominal-pelvic cavity.Four lesions were malignant in histology.On CT,most of the tumors were lobular and solid;the margins of most tumors were smooth;1 case of tumor was cystic and some tumors had calcification(most calcification was distributed in the periphery of tumors and was punctate/commashaped);and most of the lesions demonstrated heterogeneous enhancement(whirlpool like or patch like or in "geographic pattern");and some of the tumors were showed with "collateral feeding vessels".On MRI,most tumors were lobular in shape and with well-defined margins;most tumors were solid and no tumor was cystic;all the tumors demonstrated heterogeneous enhancement;most tumors showed mainly iso-intensity on T2WI and were mixed with slightly hypo-intensity.The tumors showed early and persistent enhancement in 4 cases of CT and 1 case of MRI.Conclusion:SFTs are rare mesenchymal tumors that usually occurred in the patients over 50 years of age.They are found almost in every part of human body.SFTs in different location have similar imaging appearances,most of them are solid and very few of them are cystic.Given their unpredictable biologic behavior with reports of recurrent or metastatic disease,complete surgical excision and long-term imaging follow-up for them is recommended.

<正>病例资料患者,女,42岁,自述左上腹痛3d,疼痛性质为持续性胀痛,并向左侧腰背部放射,伴恶心呕吐,呕吐物为胃内容物。病程中患者饮食睡眠差,大小便正常。查体:左上腹深压痛,无反跳痛及肌紧张。实验室检查肿瘤指标未见明显增高。超声:腹膜后实性占位,性质待定。上腹部CT检查示胰腺尾部见一类圆形肿块,大小约4.2cm×

髓系肉瘤(myeloid sarcoma,MS)是一种罕见的发生于髓外的由未成熟髓细胞构成的局限性肿瘤.大多数情况下可找到急性髓系白血病(AML)的证据,称为AML髓外浸润;罕见情况下表现为局部孤立性肿块,并经体检、影像学及实验室检查证实为髓外唯一的髓系肿瘤,称为孤立性MS[1].我院收治1例孤立性MS,现报告如下.

Objective To analyze the relationship of CAS protein expression with proliferative index,apoptosis index and clinical parameters in breast cancer tissues.Methods Immunohistochemistry for CAS expression,ki-67(proliferative index) and TUNEL(apoptosis index) were examined in 20 usual ductal hyperplasia(UDH),20 atypical ductal hyperplasia(ADH),10 ductal carcinoma in situ(DCIS),53 invasive ductal carcinoma(IDC) and 14 normal breast tissues.Results CAS expression increased in order in the normal breast tissues,UDH,ADH,DCIS and IDC,with the positive rates of CAS protein being 14.3%(2/14),25.0%(0/20),40.0%(8/20),60.0%(6/10),and 75.5%(40/53),respectively(χ2=29.382,P=0.000).CAS protein expression was correlated with histological grade,mitotic activity,and lymph node metastasis of IDC(P0.01,P0.05),and not with patient age,tumor volume or grade.CAS protein expression was positively correlated with ki-67 index(r=0.439,P=0.003),and not with the apoptosis index(r=0.248,P=0.083).Conclusion CAS protein expression is associated with cell proliferation index in breast cancer tissues.

Purpose To investigate the clinicopathological characteristics,differential diagnosis and pathogenesis of sclerosing angiomatoid nodular transformation of spleen(SANT).Methods 5 cases of SANTs of spleen were studied by using routine hematoxylin-eosin staining(HE) and immunohistochemical staining.Results Macroscopically,grey white and grey brown multinodular lesion could be easily found and had a well-demarcated boundary.Microscopically,all of cases were characterized by multiple angiomatoid nodules of various sizes in a fibrosclerotic stroma.In the center of the angiomatoid nodules,vascular spaces with its diverse formed such as slit-like,irregular-shaped as well as slightly dilated vascular spaces lined by plump endothelial cells and interspersed with a population of spindly cells or ovoid cells.Immunohistochemically,the lining cells of the small capillaries expressed CD34,CD31,but not CD8.The endothelial cells of sinusoid expressed CD8 and CD31,but not CD34 while those of small veins only expressed CD31,but not CD34 and CD8.The spindle cells were vimentin(+),SMA(+) and desmin(-).The infiltrating inflammtery cells within the stroma were CD68(+).Conclusions Sclerosing angiomatoid nodular transformation is a rarely encountered benign lesion of the spleen,which has its own clinicpathological features.It should be distinguished from other angiomatoid tumors and tumor-like lesions.

A 50-year-old man admitted to the hospital complaining of bowel bleeding and having a sense of foreign matter coming off for about 10 years.Specialty examination:A smooth,flexible and no tenderness mass was revealed at lithotomic position 11.Pathological examination:The tumor was composed of various shaped cystic,tubular and papillary structures with a fibro-vessel axis in the low magnification.In the high magnification,it was easily observed the tubular and papillary structures lined with double layer of cells,the inner layer was tall columnar cells,and the outer layer was flat myoepithelial cells.Pathological diagnosis:hidradenoma papilliferum of the anus.The patient was underwent mass resection and he recovered well six month postoperatively.