Objective:To develop an online interactive cytopathological training program, and to evaluate it for improving the cytopathological diagnostic ability of endoscopists in endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreas.Methods:A total of 5 500 cytopathological images were collected from 194 patients with pancreatic solid mass who underwent EUS-FNA in Nanjing Drum Tower Hospital from August 2018 to August 2019. The cell type in each cytopathological picture was labeled by senior cellular pathologists, which was used to build a learning and testing platform for online interactive cytopathological training. Five endoscopists without cytopathological background were invited to participate in this training. Sensitivity, specificity, positive predictive value and negative predictive value of endoscopists in differential diagnosis of cancer and non-cancer before and after training were compared to evaluate the effect of the online interactive cytopathological training program on improving the ability of endoscopists in diagnosis of cytopathology.Results:A cytopathological training platform for endoscopists to learn and take online test was successfully built. Before training, sensitivity, specificity, positive predictive value, negative predictive value and accuracy of diagnosis of cancer and non-cancer for endoscopists were 0.55 (95% CI: 0.53-0.58), 0.32 (95% CI: 0.30-0.35), 0.43 (95% CI: 0.41-0.45), 0.44 (95% CI: 0.41-0.47) and 0.43 (95% CI: 0.42-0.45), respectively. After training, the above indicators were 0.96 (95% CI: 0.95-0.97), 0.70 (95% CI: 0.68-0.73), 0.74 (95% CI: 0.72-0.76), 0.95 (95% CI: 0.94-0.96) and 0.81 (95% CI: 0.80-0.83), respectively, which were significantly improved compared with those before ( P<0.001). Conclusion:The online interactive cytopathological training program can improve the understanding and diagnostic ability of endoscopists in pancreatic cytopathology, help to implement rapid on-site evaluation in the process of EUS-FNA, and improve the diagnostic efficiency of EUS-FNA.

患者女性,63岁,因乏力、纳差、腹胀不适半年余入院.患者半年前无明显诱因出现双下肢乏力,伴上腹部饱胀不适、食欲不佳.2017年6月5日于当地医院检查,胸椎MRI示:胸1椎体前方、椎体、椎管及椎间孔内占位性病变,压迫脊髓,胸9、胸12莫氏结节形成;遂于2017年6月7日就诊于南京鼓楼医院,胸腹部CT平扫+增强示:胸廓入口处右上后纵隔占位,T1-2椎体骨质破坏,考虑孤立性纤维瘤可能(图1).

内镜超声的应用明显提高了消化道病变的诊断水平,内镜超声引导下细针穿刺(endoscopic ultrasonography guided fine needle aspiration, EUS-FNA)可以对消化道病变同时进行超声、细胞学涂片及组织学活检,更好地帮助诊断及指导治疗,因此胃肠道间质瘤(gastrointestinal stromal tumor, GIST)诊断水平明显增高.GIST主要发生于胃和肠道,是胃肠道最常见的间叶源性肿瘤[1].食管原发性GIST较为少见,约占食管间叶性肿瘤的25％,仅占GIST总病例的不到1％[2].关于食管原发性GIST行EUS-FNA细胞学诊断的病例,国内缺乏其细胞学相关报道,现将南京大学医学院附属鼓楼医院收治的1例食管原发性GIST报道如下.

南京大学医学院附属南京鼓楼医院收治1例容易误诊的肺转移性上皮样恶性周围神经鞘膜瘤(epithelioid malignant peripheral nerve sheath tumor,EMPNST).患者,女,40岁,无明显诱因出现咳嗽,咳白色泡沫样痰半月余.X线及胸部CT见右中肺多发结节影.自诉出生时发现全身多处散在皮肤浅棕色斑块,20年前曾有右小腿包块神经纤维瘤切除史,而后包块复发逐渐增大至今,MRI示右胫腓骨软组织内多发团块状混杂信号影,在南京大学医学院附属南京鼓楼医院行右胫腓骨肿物切除.HE镜下肺肿瘤呈结节状、细胞弥漫性分布伴大片坏死;细胞呈上皮样、印戒样、多边形;胞质淡伊红染,部分细胞质透亮;细胞核浆比高,核梭形或卵圆形,部分细胞核显著异性,核呈空泡状,可见突出的嗜酸性核仁,核分裂象易见.免疫标记示瘤细胞Vim(++),EMA(弱+),S-100(+),CK-pan(散在+),INI-1(局灶-),而LCA,TTF-1,SOX-10,CD68,HMB45均阴性表达,Ki-67增殖指数约30％.胫腓骨软组织肿瘤细胞弥漫阳性表达S-100和SOX-10,CD34(局灶+),INI-1局灶阴性,而CK-pan,EMA,Desmin,SMA,MyoD1和LCA均阴性.患者未行放疗及化疗,随访3个月后因肿瘤转移去世.肺转移性EMPNST难以诊断,需要结合其临床病史及相关免疫组织化学检查与其他相关上皮样肿瘤鉴别,必要时需结合分子检查进一步鉴别诊断.

目的 评估快速现场评价(ROSE)技术对肺占位病变良恶性的判断价值,以及对支气管镜活检取材质量的影响.方法 2017年6月1日至2017年12月30日,在胸部CT表现为肺占位性病变的患者中行支气管镜下活检,并留取活检组织开展ROSE技术,由经过3个月细胞病理学培训的呼吸科专科医师进行ROSE判读,判读结果与后续的常规病理检查结果进行比对.回顾性分析同时期CT表现为肺占位行支气管镜活检、但未行ROSE的病例,比较两组病例常规病理报告提示取材质量的差别.结果 共纳入101例患者行支气管镜下活检并行ROSE,呼吸科专科医师的判读结果与后续常规病理结果相比,恶性病变的一致率为84.1％,良性病变的一致率为93.8％,一致性检验提示两者具有较好的一致性(κ值为0.66,P＜0.01).开展ROSE的病例组与未行ROSE的病例组相比,最终常规病理报告显示取材满意的比例无显著性差异(98.0％比94.5％,P=0.14).结论 ROSE技术应用在支气管镜活检中能够较好地判断肺占位病变的良恶性.经过短期细胞病理学培训的呼吸科专科医师有能力进行快速现场细胞学评价,从而避免了需要细胞病理医师现场参与诊断的困难.

Objective To evaluate the value of high-risk human papillomavirus(HR-HPV) DNA detection for cervical precancerous lesions screening in Nanjing.Methods A total of 10 221 cervical samples were performed using multiplex polymerase chain reaction for HR-HPV detection(12 HR types and individual HPV-16/HPV-18 types) and parallel Thinprepcytologic test(TCT),and meanwhile,187 colposcopic biopsy were also performed.Results HR-HPV positive rate in 10 221 samples was 10.15%(1037/10 221),of which HPV 12 types(unspecified) was the most common infective type with the rate of 7.86%.Stratified by age,HR-HPV positive rate in those <45 years old was much lower than those≥45 years old with statistic significance(P=0.020).The detected rate of high-grade cervical intraepithelial neoplasia(CIN) showed tendency to ascend after 45 years old compared with those before 45 years old(P=0.006).TCT showed that HR-HPV positive rate was 54.22%(199/367)in abnormal cytology group,higher than 8.50%(838/9854)in normal cytology and chronic inflammation group(P=0.000).Compared with 12 HR types,HPV-16/-18 types showed even more closer with the ascend of cytological lesion(P=0.0000).Moreover,a significant correlation was observed between 16 type and the ascending grade of CIN(P=0.003).Conclusion HR-HPV based screening should be moved forward to 25 years.Moreover,as a high-risk population,women older than 45 years should be closely followed.HPV-16 infection plays an important role in inducing higher grade of cytological lesions which then progress to cervical precancerous lesions.HR-HPV DNA detection can be an alternative screening method to increase the coverage of cervical precancerous lesions screening.

Objective:To investigate the ThinPrep cytolosy test effect in bloody pericardial effusion specimens,improving the cell production quality and the diagnostic accuracy.Methods:Fresh bloody pericardia1 effusion within two hours,we did the same specimen by Slide and ThiuPrep cytolosy test,Hematoxylin Eosin staining.Results:The effect of the ThinPrep cytolosy test was better than Slide.Conclusion:The ThinPrep cyto]osy test can improve the diagnosis.

Endoscopic retrograde cholangiocretography ( ERCP ) and routine cytology are general approaches for pre?oprative dignosis of suspected pancreatic duct cancer patients. Routine cytology is with high specificity and low sensitivity. The detection of ane?uploidy of 3/7/17 and loss of p16 by fluorescence in situ hybridization( FISH) has revolutionized how laboratories diagnose cholangio?carcinoma and pancreatic adenocarcinoma with increasing sensitivity and minimal decreases in clinical specificity. Although using FISH for diagnostic aim has been more than ten years in foreign, it has not applied to clinical diagnosis in China. Our hospital has promoted this technique and published an article in Chinese Journal of Pathology. However, many peers in other hospitals wonder detailed meth?ods and criterion of this technique, so we provide the information to detect pancreatobiliary cancers in FISH.

目的:探讨胰腺实性-假乳头状肿瘤(solid-pseudopapillary neoplasms,SPN)的内镜超声引导下细针穿刺(endoscopic ultrasound-guided fine needle aspiration,EUS-FNA)细胞学特征、免疫细胞化学特点及鉴别诊断.方法:对7例EUS-FNA细胞学诊断为SPN并经组织病理学证实病例进行细胞病理学和免疫细胞化学观察,并复习文献.结果:SPN的EUS-FNA结果显示细胞量大都丰富,肿瘤细胞温和、小而一致,细胞呈圆形或形似浆细胞.细胞核圆形或卵圆形,核膜光滑,染色质细颗粒状,分布均匀,核仁不明显.胞浆常较丰富,苍白至粉红色颗粒状,其内可见空泡.肿瘤细胞或散在分布,或形成玫瑰花环(腺泡样)结构,或形成特征性的具有纤维血管轴心的乳头状结构.5例肿瘤行免疫细胞化学染色,结果显示:5例vimentin、progesterone receptor (PR)、β-catenin、CD10、α-1-antitrypsin阳性;4例CD56强阳性,1例局灶弱阳性;3例CD99核旁点状阳性;synaptophysin强弱不等的阳性;2例chromogranin A弱阳性;2例cytokeratin AE1/AE3散在阳性.结论:胰腺SPN的EUS-FNA细胞形态学特点主要表现为小而一致的肿瘤细胞散在分布或形成具有纤维血管轴心的乳头状结构.鉴别诊断包括胰腺神经内分泌肿瘤、腺泡细胞癌等.免疫细胞化学β-catenin呈核阳性表达,CD10、CD56、vimentin、PR阳性及CD99核旁点状阳性表达可有助于SPN的诊断.

Objective:To urge the awareness of penile metastatic carcinoma and to investigate the procedures of diagnosing penile tumors.Methods: Fine-needle aspiration(FNA) cytology from the penile nodule was performed in one case.Results: The smears showed a highly cellular aspirate consisting of columnar neoplastic cells which showed glandular pattern in some areas.Necrosis could be appreciated all over the smears.Considering the history of rectal adenocarcinoma,the cytological diagnosis was metastatic rectal adenocarcinoma of penile.Conclusion: Secondary tumors of the penis are rare.The most frequent symptoms of secondary tumors of the penis are nodule(s) and/or priapism.FNA is a safe,minimally invasive,effective,and highly accurate procedure in diagnosing penile lesions,and thus FNA can be the first choice for diagnostic approach to penile nodules.

Objective To investigate the cytological features and differential diagnosis of carcinoma showing thymus-like differentiation(CASTLE) of the thyroid gland.Methods The fresh specimen of a case of CASTLE of the thyroid gland underwent cytological and histological examination such as smears,frozen sections,paraffin hematoxylin-eosin staining and immunostaining sections,which were analyzed by light microscopy for contrast diagnosis.Results Examination of the smears showed that small sheets and clusters of poorly-differentiated malignant cells intermixed with benign-looking small lymphocytes.The tumor cells had an increased nuclear-cytoplasmic ratio,focally prominent atypia,a little amphophilic cytoplasm,indistinct cell borders,roundish-to-ovoid vesicular nuclei,small but prominent nucleoli,occasional macronuclei,and very sparse mitotic figures.Conclusions Cytological examination is of help in diagnosing CASTLE of the thyroid gland,while its cytological features closely resemble those in malignant lymphoma and metastatic lymphoepitheliod carcinoma in cervical lymph nodes and differentiations are required in the diagnosis of CASTLE.

甲状腺结节在人群中的发病率较高,超过8%的成年人甲状腺可触及结节.对甲状腺结节及时恰当的处理和治疗依赖于临床各学科的通力协作.如果临床检查结果提示甲状腺结节是功能性结节,一般需要临床治疗;而如果甲状腺结节为非功能性的,则需要进行细针吸取(FNA)细胞病理学诊断检查.FNA具有安全、快捷、准确、经济等特点,是目前公认的明确非功能性甲状腺结节性质和指导下一步临床处理的首选方法.在甲状腺结节处理方面尤为重要的是针对FNA诊断结果做出及时、正确、恰当的处理.

Objective To investigate the expression of Her-2/neu protein in human prostate cancer cell line PC-3M,establish its animal model of tumor xenografts in nude mice,observe the histopathological features and detect the expression of Her-2/neu protein.Methods PC-3M cells were cultured to make cell blocks for immunohistochemical staining of Her-2/neu protein.Prostate cancer cell line PC-3M cells were subcutaneously implanted under the nape of nude mice.The paraffin slices of the removed tumor from xenografts were examined by hematoxylin-eosin staining for morphological features.The tumor slices and PC-3M cell blocks underwent immunohistochemical staining for the detection of Her-2/neu protein.Results PC-3M cells were immunopositive with Her-2/neu protein on the cell blocks.The tumor-formation rate was 100% in the nude mice after inoculation with PC-3M cells.Morphologically,the tumor cells showed the morphological features of poorly differentiated malignancy.Immunohistochemical staining revealed that the tumor cells were also immunopositive with Her-2/neu protein.Conclusion The tumor-formation rate is high by subcutaneous xenografts of PC-3M cells in nude mice.The tumor xenograft model retains the biological features of PC-3M cells and expresses Her-2/neu protein,which suggests that it might be a good animal model for the study of Her-2/neu protein in prostate cancer in vivo.

Objective To investigate the expression of interferon-γ(IFN-γ),interlukin-4(IL-4) and Fas/FasL in the labial salivary gland of patients with Sjgren's syndrome(SS) and its relationship with the infiltration of lymphocytes in the gland.Methods The expressions of IFN-γ,IL-4,Fas and FasL were examined by immunohistochemistry.HE labeling method was used to examine the infiltration of lymphocytes in salivary gland.Results The IFN-γ/IL-4 and Fas/FasL ratios in SS patients were higher than that in the normal control,and were correlated with the lymphocytic infiltration in salivary gland.Conclusion The elevation of IFN-γ/IL-4 and Fas/FasL ratios in labial salivary gland in patients with SS are related to the infiltration of lymphocytes,playing an important role in the process of glandular destruction and in the pathogenesis of SS.

目的评价ThinPrep液基细胞学检查诊断宫颈上皮病变的准确性.方法对64例宫颈病变受检者均行液基细胞学薄片检查,并采用双盲法与宫颈活检进行比较,细胞学诊断采用描述性诊断系统(TBS).结果64例液基细胞学检查与宫颈活检比较,液基细胞学检查对不同病变的检出率分别为:鳞状细胞癌(SCC)3/3;鳞状上皮内高度病变(HSIL)17/18,其中宫颈上皮内瘤变Ⅲ(CINⅢ)11/11,宫颈上皮内瘤变Ⅱ(CINⅡ)6/7;鳞状上皮内低度病变(LSIL)15/18.结论ThinPrep液基细胞学检查准确性高,尤其对鳞状上皮内高度病变其检出率达100%.

随甲状腺自身抗体检测和细针吸取细胞学(FNAC)诊断技术的广泛应用,慢性淋巴细胞性甲状腺炎的诊断率明显上升,成为儿童甲状腺肿大的常见病因.FNAC检查痛苦小,诊断周期短.我院对甲状腺疾病已常规行FNAC检查,本文就82例儿童慢性淋巴细胞性甲状腺炎的细胞学结果报道如下.

Objective To investigate the influence of chemotherapy on the phagocytosis of peripheral blood neutrophils in patients suffering from malignant tumor.?Method Harris staining was used to study the phagocytosis of peripheral blood neutrophils upon staphylococcus aureus in malignancy patients ( n =60) before and after chemotherapy and that in healthy blood donors ( n =40).?Result Compared with that of healthy donors (82.9%±1.7%), the rate of phagocytosis of neutrophils from malignancy patients (80.8%±1.1%) before chemotherapy was slightly decreased ( P 0.05), but the rate was markedly decreased (68.4%±3.2%, P 0.01) after chemotherapy.?Conclusion The phagocytotic function of neutrophils reflects the defense mechanism against pathogens and is related to the prognosis of the illness.

Objective To evaluate the CT-guided biopsy cytological examination of the lesions in the lung, mediastinum and pleura for classification and diagnosis. Methods CT-guided fine-needle (7～9 gauge) aspiration biopsy was performed in 41 patients with lung, mediastinial and pleural lesions. The specimens stained with hematoxylin-eosin and by Wright-Giemsa's method were observed under optical microscope. Results Only one needle biopsy failed in the 41 cases due to lack of the patient's cooperation. The procedure was well accepted by patients, its incidence of complications was low. The rate of diagnostic agreement was 91.1% (30/34) between cytological examination and surgical pathology. Conclusion CT-guided fine-needle aspiration cytology is an effective, reliable and accurate method for diagnosing lesions in the chest.