目的 探讨非特殊型乳腺癌中罕见亚型之伴大汗腺分化的癌(ACB)的临床病理特征、免疫表型特点,并与浸润性导管癌(IDC)进行鉴别及病理分析.方法 回顾性分析沈阳二四五医院、辽阳辽化医院病理科2010年1—12月的手术病例中的24例ACB和24例浸润性导管癌的临床病理特征、免疫组化标记结果,进行病理分析并复习相关文献.结果 ACB平均发病年龄(57.07±10.45)岁,比浸润性导管癌的(50.46±9.18)岁高(P<0.05);ACB的免疫标记雌激素受体(ER)、孕激素受体(PR)阴性为主,表皮生长因子(HER-2)阴性多见,仅极少数阳性,而浸润性导管癌的ER、PR、HER-2的阳性率明显高于ACB(P<0.05);ACB特征性恒定表达雄激素受体(AR)和GCDFP-15.结论 乳腺伴大汗腺分化的癌是乳腺癌中罕见特殊亚型,有特征性的临床病理特征,乳腺病变中伴有大汗腺改变的多为良性,极易漏诊恶性病变,应从细胞形态和组织结构仔细辨别出伴大汗腺分化的癌,有非常重要的意义.

目的 探讨子宫内膜去分化癌的临床特征、病理组织学及免疫表型特点,对其诊断及鉴别诊断,进行综合性分析,加深对该病的认识.方法 回顾性分析6例2015年1月至2020年6月沈阳二四五医院和中国医科大学附属盛京医院病理科的子宫内膜去分化癌,观察其临床病理特点,并复习相关文献.结果 6例子宫内膜去分化癌患者平均年龄(59.83±5.15)岁,镜下见两种肿瘤细胞形态,一种是低级别子宫内膜样腺癌成分,另一种是未分化的圆形、卵圆形类似肉瘤样形态的细胞.免疫组化染色显示,未分化区域Vimentin均(+)、ER、PR均(-),上皮性标记CK(pan)、EMA局灶弱(+),CD56及Syn局部(+),5例P53为野生型,1例为(-,无义突变);低级别子宫内膜样腺癌区域Vimentin均(+)、ER、PR均(+)、CK(+),4例微卫星不稳定:MLH1和MSH2(-).结论 子宫内膜去分化癌是一种罕见类型的子宫原发的恶性上皮性肿瘤,具有特殊的临床病理组织形态特点,加深对该病的认识,可以提高病理诊断准确性,并能指导临床治疗.

目的 探讨p27和Mcmp4在结直肠息肉和腺癌组织中的表达情况.方法 应用免疫组化SP法分别检测80例增生性息肉、低级别腺瘤、高级别腺瘤、腺癌中p27和Mcmp4的表达情况.结果 p27在增生性息肉、低级别腺瘤、高级别腺瘤、腺癌阳性率分别为91.2％(73/80)、88.8％(71/80)、41.3％(33/80)、36.3％(29/80),增生性息肉和低级别腺瘤两组比较差异无统计学意义,低级别腺瘤和高级别腺瘤、腺癌组间比较差异具有统计学意义(P<0.05).Mcmp4在增生性息肉、低级别腺瘤、高级别腺瘤、结直肠腺癌阳性率分别为32.5％(26/80)、35％(28/80)、82.5％(66/80)、86.3％(69/80),增生性息肉和低级别腺瘤两组比较差异无统计学意义,低级别腺瘤和高级别腺瘤、腺癌组间比较差异具有统计学意义(P<0.05).结直肠病变中p27和Mcmp4的阳性表达呈负相关(P<0.05).结论 p27和Mcmp4在结直肠息肉、腺瘤、腺癌的进展中发挥重要作用,联合检测p27和Mcmp4在结直肠息肉病变中的表达,可以作为结直肠腺癌及异型增生的重要生物学标记物.

目的统计分析石油企业女工高危型HPV感染与CIN发病情况。方法4046名石油企业女工采用HC2杂交捕获法检测宫颈脱落细胞的高危型HPV DNA，HPV阳性者进行宫颈组织学活检。结果4046名女工中587例HPV阳性，感染率为14.51%，阳性病例集中于41~50岁年龄组，年龄分布有显著性差异(<0.05)，HPV阳性者发现91例CIN，年龄分布无显著性差异(p>0.05)。结论高危型HPV感染与CIN或宫颈癌发生、进展的关系密切，回顾性分析研究与进一步随访可以为宫颈癌预防提供多中心样本资料。

目的观察腹部脂肪肉瘤的MRI影像学特点，提高对腹部脂肪肉瘤的MRI诊断的认识。方法报道两例经手术病理证实的腹部脂肪肉瘤的MRI特点并与病理进行对照。结果腹部脂肪肉瘤均较大，MRI信号特点是T1WI上为低～高信号，信号不均匀，T2WI上为高信号，其中含脂肪信号多的脂肪肉瘤恶性程度相对较低。结论不同组织亚型的腹膜后脂肪肉瘤的MRI表现不同，取决于其组织学成分其形态、内部成分和周边结构，是诊断腹膜后脂肪肉瘤的重要特征。

目的 探讨无功能性甲状旁腺癌的临床病理特征.方法 对1例无功能性甲状旁腺癌进行临床病理特点分析和免疫组化标记,选用的抗体为上皮膜抗原(EMA)、细胞角蛋白(CK)、甲状腺球蛋白(TG)、甲状腺转录因子-1(TTF-1)、甲状旁腺激素(PTH),并进行相关文献复习.结果 患者为老年女性,肿物位于右侧甲状腺近被膜处,呈灰白色实性,组织学见癌细胞呈梁状,胞浆较丰富,部分区域胞浆透明,免疫组化显示EMA(+)、CK部分(+)、TG(-)、TTF-1(-)、PTH(+).结论 无功能性甲状旁腺癌是一种罕见恶性肿瘤,其诊断和鉴别诊断主要依据组织形态学和免疫组织化学特征.

Objective Through the epidemiological investigation of the self-rescue and mutual aid knowledge mastered by Hongwei district residents in Liaoyang city,to obtain scientific conclusion and provide consultation for the government and the relevant departments.Methods A scientific and rational questionnaire was made.Then the patients,family members or chaperones that will to accept the investigation were investigated.In addition,the sample investigation was marched of community resident(including the questionnaire survey and practical exercises,etc).Results The rate of the respondents never attended first-aid training was 88.2%,there were no significantly different between the different age groups and different professional(P > 0.05),there were significantly different among all kinds of first aid skills and master degree(P < 0.01).There were no significantly different between different age groups on the general condition of mastering the call of first aid(P > 0.05),but significantly different between the different profession(P < 0.01).The persons which have the desire to undergo training was 90.0%.There were no significantly different between age and profession(P > 0.05).Conclusion The present situation of self-rescue and mutual aid of Hongwei district residents is not optimistic.The proportion of basic first aid skill knowledge is poor,the proportion of residents take part in first aid training is fewer,there are many residents who would accept the training.As a result,the knowledge and abilities of self-rescue and mutual aid in Hongwei distric residents should be improved,and the training content should be set up according to different situation to avoid the wasting of resources,considering the different needs,different age,occupation and administrative duties.

目的观察肺硬化性血管瘤合并肺腺癌的临床病理学特征、免疫组化表型。方法分析2例肺硬化性血管瘤合并肺腺癌的临床表现,对标本进行常规病理学(HE法)和免疫组织化学染色(SP法)。结果肺硬化性血管瘤合并肺腺癌均表现复杂的组织学图像,硬化性血管瘤区可以见到乳头状结构、"血管瘤"样结构、实性区、硬化性改变,腺癌区纤维组织增生,其间见癌细胞排列呈腺管样结构,2例肿瘤细胞免疫组化TTF-1、EMA、CK均(+),Syn、MC、Vimentin均(-)。结论肺硬化性血管瘤合并肺腺癌是罕见肿瘤,其预后难以评估。

目的探讨CK19与PTEN在甲状腺乳头状癌及甲状腺乳头状增生的表达。方法 Eli VisionTMSuper法检测48例甲状腺乳头状癌和48例甲状腺乳头状增生中CK19与PTEN的表达,分析其敏感度(Sen)、特异度(Spe)、准确度(Acc)、阳性预测值(+PV)、阴性预测值(-PV)。结果 CK19与PTEN的以上指标分别依次为100%、69.45%、85.02%、76.27%、100%;93.77%、100%、96.87%、100%、94.11%,序列试验Spe为100%、Sen为93.77%。结论 CK19与PTEN可作为鉴别甲状腺乳头状癌及甲状腺乳头状增生的主要分子标记物,联合检测效果更好。

Objective: To investigate liquid-based cervical cytology and expression of Ki-67 and PTEN in the clinic significance of cervical intraepithelial neoplasia to provide guidance for clinical treatment.Methods: 1 330 patients were detected by liquid-based cervical cytology(LCT),antitypical squamous cells were found in 61 cases,24 cases were cervical intraepithelial neoplasia by biopsy,in which CINⅠwere 11,CINⅡ-CINⅢ were 13,Ki-67 and PTEN were detected by immmunohistochemical method(Ultrasensitive TMHRP) in 24 cases of CIN and 20 cases cervicitis.Results: In cervicitis,Ki-67 and PTEN expression rates were 5% and 100% respectively.In CINⅠ,Ki-67 and PTEN expression rates were 18.2% and 72.7% respectively,which was no significantly difference with cervicitis(P>0.05).In CINⅡ-CINⅢ,Ki-67 and PTEN expression rates were 76.9% and 15.4% respectively,which was significantly diference with CINⅠ(P<0.05).Correlation association was found between Ki-67 and PTEN in CIN(r=-0.818,P<0.05).Conclusion: Liquid-based cervical cytology and expression of Ki-67,PTEN can be used as important markers to distinguish benign cervical lesions,it plays important role in evaluating the risk of CIN.

目的 观察分析1例大网膜异位妊娠的病例.方法 对1例腹痛女性患者进行化验检查、超声检查,并急诊进行剖腹探查.结果 尿HCG(+),彩超提示左附件区包块,考虑宫外孕,剖腹探查见卵巢、输卵管正常,大网膜远端见一大小约3.5cm×3.5cm 大小的包块,术后病理诊断大网膜异位妊娠.结论 大网膜异位妊娠为罕见病例,为避免漏诊误诊发生危及患者生命,应及时剖腹探查.

Objective:To explore the young female low-grade malignant endometrial interstitial sarcoma to improve the understanding of the disease.Methods:The clinic,B ultrasonic,pathology and immunohistochemical characteristics of 13 cases young women low-grade malignant endometrial interstitial sarcoma were retrospectively analyzed.Results:In the 13 cases of young female low-grade malignant endometrial interstitial sarcoma,9 cases were preoperativly clinical diagnozed as uterine fibroids,2 cases of uterine muscle adenopathy,2 cases of endometrial polyps,postoperative pathologic diagnosis were low-grade malignant endometrial interstitial sarcoma.Conclusion:It is difficult to identify the difference between young women low-grade malignant endometrial interstitial sarcoma preoperative clinical with other tumors which happened in the womb,it is easy to be misdiagnosed,diagnose pathological and immunohistochemical to mark.

目的:探讨伴破骨细胞样巨细胞的肝内胆管未分化癌的临床病理特征.方法:对1例伴破骨细胞样巨细胞的肝内胆管未分化癌进行临床、病理及免疫组化观察.结果:患者,女性,67岁,切除标本见肿物大小约4cm×3cm×2.5cm,实性、质较硬,镜下肿瘤组织由分化差的上皮样细胞构成,肿瘤组织内见较多的破骨细胞样多核巨细胞,免疫组化显示上皮样细胞CK7(+)、CK20(-)、EMA(+)、Vim(-)、CD68(-);多核巨细胞仅Vim(+)、CD68(+).结论:伴破骨细胞样巨细胞的肝内胆管未分化癌是肝内胆管癌的一个亚型,预后极差,破骨细胞样巨细胞可能为反应性多核巨细胞.

目的 探讨CD105和VEGF与大肠发生、发展的关系及其临床意义.方法 采用免疫组化SP法检测92例大肠癌组织中CD105和VEGF表达.结果 CD105和VEGF 在无浆膜侵犯、无淋巴结转移组的阳性表达分别为38.09%、23.52%和42.86%、55.88%,在伴有浆膜侵犯、淋巴结转移组的阳性表达分别为78.00%、84 48%和76.00%、87.93%,CD105和VEGF的表达在两组间比较差异均有统计学意义(P<0.05).结论 CD105和VEGF在大肠癌发生、发展过程中发挥重要作用,联合检测上述基因蛋白对预测大肠癌生物学行为及预后有重要意义.

随着超声影像技术的发展,超声引导下粗针穿刺活检(needle core biopsy,NCB)技术在肝脏疾病诊断中的作用越来越重要.

对我们所遇腹腔肿物误诊4例分析如下. 1 病历摘要 例1:女,48岁.发现盆腔包块半个月伴尿频,彩超示"左卵巢囊实性肿物",术前诊断:盆腔实性肿物,怀疑卵巢恶性肿瘤,拟在硬膜下麻醉加全麻行剖腹探查术.麻醉成功后切开腹壁各层组织,剪开腹膜见距回盲部约60 cm处肠壁表面有一12cm×9 cm×8 cm囊实性、坏死状、无完整包膜之肿物.子宫及双附件未见异常,术中考虑恶性肿瘤,切除瘤体送冰冻病理,冰冻病理诊断为间叶来源恶性肿瘤.行肿物及其两侧小肠各7cm切除.

Objective To investigate the diagnostic significance of the expression of Ki-67 and PTEN in endometrioid adenocarcinoma.Methods The Ki-67 and PTEN expression was detected in 49 cases of endometrioid adenocarcinoma,and 17 cases of endometrial hyperplasia by SP immunohistochemical staining.Results Both Ki-67 and PTEN showed higher level expression in endometrioid adenocarcinoma.There was a significant difference in the expression of Ki-67 and PTEN between endometrioid adenocarcinoma and endometrial hyperplasia(P<0.05) and between different FIGO stages and invasion depth(P<0.05).Conclusion Ki-67 and PTEN may play an important role in the development of endometrioid adenocarcinoma.The detection of Ki-67 and PTEN is significant to evalute the progosis of endometrioid adenocarcinoma.

目的 探讨转化生长因子-β1(TGF-β1)在卵巢上皮性癌的表达. 方法 应用免疫组化SP法检测80例卵巢上皮性癌的表达. 结果 80例卵巢上皮性癌中年龄≤60岁阳性表达率为42.1%(26/62),>60岁的阳性表达率为43.8%(10/22),两者比较差异无统计学意义(P=0.82);在浆液性癌的阳性表达率明显高于黏液性癌和子宫内膜样癌(χ2=8.16,P=0.02);在不同FIGO分期的表达差异有统计学意义(χ2=10.30,P=0.05).结论 TGF-β1的表达与卵巢上皮性癌的侵袭和转移密切相关,可以作为评价卵巢上皮性癌的重要生物学指标.

为探讨甲状腺上皮样血管内皮瘤的病理形态特征、免疫表型和鉴别诊断,对2例甲状腺上皮样血管内皮瘤进行临床资料分析、随访,并观察其病理形态及免疫组织化学染色分析。2例甲状腺上皮样血管内皮瘤均位于甲状腺下极,实性,切面暗红色,镜下由增生的血管内皮细胞构成,具有上皮样细胞形态,胞浆较丰富,嗜酸性,多呈空泡状,细胞间可见血管腔,免疫组化:CD34（+）、Vim（+）、细胞角蛋白（cytokeratin,CK）（-）、甲状腺球蛋白（thyroid globulin,TG）（-）。上皮样血管内皮瘤是一种罕见的甲状腺肿瘤,其生物学行为属于低度恶性。

目的:观察乙醇所致精神障碍继发硬膜下血肿(CSDH)临床病理特点.方法:对1例CSDH死亡患者进行尸体解剖,镜下观察组织学变化.结果:解剖发现硬膜下凝血块,显微镜检查见蛛网膜下腔出血,浅层脑实质见灶性出血.结论:影像学检查是乙醇所致精神障碍继发CSDH诊断和鉴别诊断的最有效方法.