Objective:To analyze the application of bronchoscopy combined with rapid on-site cytologic evaluation(C-ROSE).Methods:Retrospective study of 240 cases who were performed with bronchoscopy at the Second Affiliated Hospital of Nanjing Medical University in 2020. There were 79 cases in C-Rose group and 161 cases in non-C-Rose group. The diagnostic yield and the secondary examination rates between C-ROSE group and non C-ROSE group were also compared.Results:Compared with the gold standard, the pulmonologist′s interpretation of sample adequacy, identification of benign and malignant lesions, and diagnosis of lung cancer were all highly consistent, the Kappa value were 0.904, 0.970, 0.794 respectively. When C-ROSE was applied to bronchoscopy, the diagnostic efficacy was pretty good, the sensitivity was 100%, the specificity was 97.83%, the diagnostic accuracy was 98.61%, the positive predictive value was 96.30% and the negative predictive value was 100%. The diagnostic yield of malignant disease was statistically higher in C-ROSE group than that in non C-ROSE group(92.86% vs. 73.21%, P<0.05). There was no statistical difference between the two groups in the total diagnostic yield and the benign disease diagnostic yield. The secondary examination rate of malignant disease was statistically lower than that in non C-ROSE group(7.14% vs. 26.79%, P<0.05).Conclusion:Pulmonologists can master C-ROSE technique after short time of systematic training. A trained pulmonologist can reliably carry out C-ROSE to interpret sample adequacy, distinguish between benign and malignant lesions, help improve the diagnostic yield and reduce the secondary examination rate. C-ROSE technique is effective-cost, it worthy of wide use in most hospitals.

目的 应用免疫组化和实时荧光定量PCR(real-time fluorescence quantitative PCR,qRT-PCR)技术检测结直肠癌中BRAF V600E突变,比较这两种技术在结直肠癌中的应用价值.方法 总结113例结直肠癌标本BRAF V600E免疫组化和qRT-PCR的结果 ,以测序为金标准,评价这两种技术在结直肠癌BRAF V600E突变检测中的应用价值.结果 113例结直肠癌标本中,免疫组化检测阳性19例,阴性82例,不确定诊断12例.其中19例阳性标本经测序确认BRAF V600E突变6例,未突变13例;12例不确定诊断病例经测序确认1例突变,11例未突变.免疫组化阳性检出率为16.81％,阴性检出率为72.57％,不确定诊断例数占检测例数的10.62％.113例结直肠癌标本同时行qRT-PCR检测,结果 突变7例,未突变106例,阳性检出率为6.19％,阴性检出率为93.8％,无不确定诊断,与测序结果 一致,符合率达100％.以测序为金标准,比较这两种技术在结直肠癌检测BRAF V600E中的应用价值,免疫组化和qRT-PCR技术的灵敏度、特异度、阳性预测值、阴性预测值、假阴性率、假阳性率、准确率分别为100％、86.32％、31.58％、100％、0、13.68％、87.13％和100％、100％、100％、100％、0、0、100％.经配对χ2检验这两种检测方法差异有显著性(P<0.00001).结论 在结直肠癌BRAF V600E检测中,qRT-PCR较免疫组化有更高的准确性.

目的 探讨非典型官颈腺细胞(AGC)在宫颈细胞学中的应用情况.方法 2012年1月～2019年8月选取南京医科大学第二附属医院病理科经液基薄层细胞检测检查的AGC病例34例,与其组织学结果进行对照并分析.结果 宫颈腺上皮异型增生7例(20.59％),宫颈腺癌2例(5.88％),子宫内膜腺癌4例(11.76％),高度鳞状上皮内病变累及腺体9例(26.47％),低分化鳞状细胞癌2例(5.88％),宫颈管内膜慢性炎7例(20.59％),子宫内膜息肉2例(5.88％),宫颈腺上皮微腺型增生1例(2.94％).根据病变类型,分为腺上皮病变组(13例)和鳞状上皮病变组(11例),两组年龄构成比较,差异有统计学意义(P＜0.05).结论 AGC在官颈组织学对照中,若为良性或者癌前病变,多数为官颈管腺上皮异形增生以及较大比例的需要鉴别的高度鳞状上皮内病变累及腺体;若为恶性,则多数为宫颈腺癌或子宫内膜腺癌及需要鉴别的低分化鳞癌.此外,不同病变类型可能与年龄有关系,40岁以上是腺上皮病变的高发年龄段.

Objective To investigate the expressions of matrix metalloproteinases (MMP-9) in colorectal carcinoma, and to analyze correlation between MMP-9 and invasion and metastasis of colorectal carcinoma. Methods 99 cases of colorectal carcinoma patients received radical resection in the Second Affiliated Hospital of Nanjing Medical University and Yancheng NO.3 People's Hospital from January 2007 to December 2010 were enrolled in our study. The expressions of MMP-9 in colorectal carcinoma and normal colorectal tissues were detected by using tissue chip technology combined with immunohistochemistry SP assay. The relations between the expressions of MMP-9 and clinicopathological features of colorectal carcinoma were analyzed. Results In colorectal carcinoma, the expression levels of MMP-9 was significantly higher than those of normal colorectal tissues (P<0.001). Patients with high stage of invasive depth, lymph node metastasis, and high linical stage showed obvious higher positive rates of MMP-9 than those of patients with low stage of invasive depth, without lymph node metastasis, and with low linical stage (P<0.05). It showed obvious negative correlation among MMP-9 and survival of patients with colorectal carcinoma. Patients with higher MMP-9 expression level in carcinoma tissues showed higher death rates (P < 0.05). Conclusion The expression of MMP-9 in colorectal carcinoma is closely related to the depth of tumor invasion, lymph node metastasis. MMP-9 can relex the progress of colorectal carcinoma, and judge the prognosis of patients with colorectal carcinoma.

目的 探讨宫颈腺癌(uterine cervix adenocarcinoma)伴宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)3的临床与病理学特征.方法 对1例宫颈腺癌伴CIN3进行液基细胞学、组织学检查及免疫组化染色,并复习相关文献.结果 患者50岁,宫颈液基细胞学检查发现原位腺癌(adenocarcinoma in situ,AIS)及高级别鳞状上皮内病变(high-grade squamous intraepithelial lesion,HSIL)结构.宫颈活检结果为高分化腺癌伴CIN3,术后病理显示宫颈高分化腺癌伴CIN3,双侧卵巢Brenner瘤.免疫组化标记宫颈腺癌及CIN3两种病变p16、Ki-67均强阳性.结论 宫颈腺癌伴CIN3是一种十分少见的恶性肿瘤,液基细胞学普查对宫颈肿瘤的早期发现具有重要价值.

幼年性息肉病(Juvenile polyposis syndrome, JPS)是一种以消化道多发性幼年性息肉为特征的少见疾病[1].

目的幼年性息肉病是一种少见疾病.目前认为其息肉局部可发生不典型增生改变,然而其不典型增生的分子机制尚不清楚.该文旨在探讨幼年性息肉病不典型增生的病变机制.方法应用免疫组化检测5例幼年性息肉病的24枚不典型增生息肉和儿枚无不典型增生息肉标本以及5例小儿正常结肠粘膜、32例单发结、直肠幼年性息肉和10例大肠癌标本的增殖细胞核抗原(PCNA)、P53蛋白(DO-7)和P21 waf1蛋白的表达;应用原位杂交方法检测上述标本P53 mRNA的表达.结果PCNA标记指数均值、P53阳性表达率、P53阳性面积以及P53 mRNA阳性表达率在幼年性息肉病不典型增生组均明显高于无不典型增生组;P21 waf1阳性表达在上述两组间比较差异无显著性;P53蛋白、P53 mRNA与PCNA表达呈明显正相关.结论PCNA、P53基因异常与幼年性息肉病不典型增生的形成有关,P53基因参与诱导细胞增殖.

目的探讨增殖细胞核抗原与幼年性息肉病不典型增生改变的关系.方法应用免疫组织化学方法检测了5例幼年性息肉病的24枚不典型增生息肉和11枚无不典型增生息肉标本、32例单发结直肠幼年性息肉、5例正常小儿结肠粘膜和10例大肠癌标本的增殖细胞核抗原(proliferating cell nuclear antigen,PCNA)的表达.结果PCNA标记指数(PCNA labelling index,PCNA LI)均值在幼年性息肉病不典型增生组显著高于无不典型增生组.结论PCNA与幼年性息肉病不典型增生密切相关,推测这种高增殖活性是幼年性息肉病不典型增生发生发展的病理基础.

目的:研究抑癌基因P16、周期素D1(Cyclin D1)、视网膜母细胞瘤(Rb)蛋白在胃癌前病变(不典型增生和肠化)及胃癌组织中的表达.方法:采用免疫组化法检测10例正常胃黏膜,15例胃不典型增生,15例胃黏膜肠化生,30例胃癌组织中P16、Cyclin D1、Rb蛋白的表达,并结合胃癌临床资料进行分析.结果:P16蛋白阳性表达,正常胃黏膜90%,不典型增生86.67%,肠化86.67%,胃癌36.67%,胃癌组与正常对照组及胃癌前病变组(不典型增生及肠化)间差异均有极显著意义(P＜0.01).Cyclin D1蛋白阳性表达,正常胃黏膜10%,不典型增生20%,肠化20%,胃癌53.33%,胃癌组阳性率与其他3组相比差异有显著性(P＜0.05).Rb蛋白在正常胃黏膜、肠上皮化生、不典型增生及胃癌组织中阳性率分别为90%、80%、80%、50%,其中胃癌组阳性率与正常胃黏膜组相比差异有显著性(P＜0.05).P16、Cyclin D1蛋白与胃癌分化程度、淋巴结转移与否、远处转移与否呈一定的相关性.结论:P16、Cyclin D1、Rb基因在胃癌的发生中起一定的作用;P16、Cyclin D1、Rb蛋白的检测在胃癌的早期诊断中具有一定的价值,并有助于胃癌的预后判断.

Objective: To investigate the expression of p16, cyclin D1 and Rb protein in gastric carcinoma and premalignant lesions including dysplastic gastric mucosa and intestinal metaplasia gastric mucosa. Methods: Using SP immunohistochemical methods, the expression of p16, cyclin D1 and Rb proteins was detected in 10 specimens of normal gastric mucosa, 15 specimens of dysplastic gastric mucosa, 15 specimens of intestinal metaplasia gastric mucosa, 30 specimens of gastric carcinoma. The clinical characteristics of the 30 patients with gastric carcinoma were analysed to explore the relationship between the parameter detected and biological action of gastric cancer. Results: Expression of p16 protein was detected in 90% of normal gastric mucosa, 86.67% of dysplastic gastric mucosa, 86.67% of intestinal metaplasia gastric mucosa, 36.67% of gastric carcinoma. The positive rate of p16 protein expression in gastric carcinoma is significantly lower than that in normal gastric mucosa and gastric premalignant lesions mucosa (P<0.01). Expression of cyclin D1 protein was detected in 10% of normal gastric mucosa, 20% of dysplastic gastric mucosa, 20% of intestinal metaplasia gastric mucosa, 53.33% of gastric carcinoma. The positive rate of cyclin D1, protein expression in gastric carcinoma is significantly higher than that in normal gastric mucosa and gastric premalignant lesions mucosa (P<0.05). Expression of Rb protein was detected in 90% of normal gastric mucosa, 80% of dysplastic gastric mucosa, 80% of intestinal metaplasia gastric mucosa, 50% of gastric carcinoma. The positive rate of Rb protein expression in gastric carcinoma is significantly lower than that in normal gastric mucosa (P<0.05). The expression of p16, cyclin D1 gene were associated with the degree of differentiation of gastric carcinoma, lymphnodes metastasis and distant metastasis. Conclusion: p16, Cyclin D1 and Rb gene play important role in gastric carcinoma genesis. The expression of p16, cyclin D1 and Rb gene have some value to the diagnosis at earlier stage of gastric cancer. Detection of expression of p16, cyclin D1 gene would be helpful to judge the prognosis of gastric cancer.

Objective To investigate the dysplastic changes in juvenile polyposis syndrome (JPS)and to compare different morphologic characteristics between solitary colorectal juvenile polyps(JP) and JPS. Methods A total of 32 routine specimens from 32 cases with JP and 35 specimens from 5 cases with JPS were included in this research . Hematoxylin and eosin (HE) stained sections were used to evaluate the presence and grades of dysplasia. Results There was no dysplastic changes shown in 32 cases of solitary colorectal JP , but in 24 out of 35 JPS(68.6%), there were dysplastic changes from 4 out of 5 cases (16 mild grade, 7 moderate grade and 1 severe grade). Conclusions The pathological changes of polyps in JPS were different from those of polyps in JP. In the former the polyps was generally multiple, occasionally with non-typical dysplastic changes , which was considered to be a potentially precancerous condition; while those in the latter were benign lesions.

目的研究p16基因在胃癌组织中的表达及其与胃癌生物学行为的关系.方法采用免疫组化和原位杂交方法检测10例正常胃粘膜、30例胃癌组织中p16基因mRNA和蛋白的表达,并结合其临床资料进行分析.结果 p16基因mRNA和蛋白阳性表达率,在正常胃粘膜均为90%,而胃癌分别为43.33%和36.67%.胃癌组与正常对照组间差异均有显著意义(P＜0.05),p16基因mRNA和蛋白与胃癌分化程度、淋巴结转移与否、远处转移与否呈一定的相关性.结论 p16基因与胃癌发生有关,其表达产物检测可能有助于胃癌预后的判断.

目的:观察3例神经鞘黏液瘤的临床与病理学特征,以提高诊断率.方法:标本经10%福尔马林固定,常规处理,石蜡包埋切片,苏木精-伊红染色.并做酸性钙结合蛋白(S-100蛋白)免疫组化染色SP法,3,3'-二氨基联苯胺(DAB)为显示剂.结果:3例神经鞘黏液瘤的组织病理学形态基本一致,与文献上所报告的相同.除此以外,在病例1中发现了文献中未曾见到过的S-100蛋白阳性反应,具有特殊的神经样结构的组织病理学表现,如髓鞘质样和维罗凯体样的形态.结论:具有特殊的神经样结构的组织病理形态学的发现为神经鞘黏液瘤神经起源说提供了新的组织学证据,进一步支持它来源于外周神经鞘.

Objective: To investigate the expression of P16 protein in premalignant lesions and gastric carcinoma, including dysplastic gastric mucosa and intestinal metaplasia in gastric mucosa. Methods:The expression of P16 proteins were measured by SP immunohistochemical method in normal gastric mucosa (10 specimens), dysplastic gastric mucosa (15 specimens), intestinal metaplasia in gastric mucosa (15 specimens), gastric carcinomas (30 specimens). Results:The positive expression of P16 protein was 90% in normal gastric mucosa, 86. 67% in dysplastic gastric mucosa, 86.67% in intestinal metaplasia, 36.67% in gastric carcinoma. There were significant differences between gastic carcinoma group and the normal control group or the precancerous group (P 0. 01). Conclusion: P16 protein is associated with the occurrence of gastric carcinoma.