回顾性分析浙江省绍兴市文理学院2例甲状腺髓样癌细胞穿刺病例,总结其细胞病理特点,讨论甲状腺髓样癌的细胞学诊断及鉴别诊断要点.甲状腺髓样癌组织类型多,细胞形态多样,缺乏典型形态特征,须与Hürthle细胞(嗜酸细胞)肿瘤、甲状腺乳头状癌、透明变小梁状肿瘤、低分化癌及其他神经内分泌肿瘤,如副神经节瘤和甲状旁腺腺瘤相鉴别,但甲状腺髓样癌往往可见特征性的"盐和胡椒"染色质,可见淀粉样物,降钙素、TG等标志物异常表达,为其比较典型的病理学特征.

Objective:To investigate the infection incidence of women with high-risk human papillomavirus(HPV) A9 in Quzhou, and to analyze its clinical significance in cervical cancer screening by combining with liquid-based cytology(TCT).Methods:A total of 9 010 patients were collected from January 2017 to May 2018 in the Maternal and Child Health Hospital of Quzhou.HPV detection was performed by Cervista method.In combination with TCT, cervical biopsy was carried out under vaginal microscopy.Results:Among 9 010 patients, 1 401 patients were HPV positive, and the A9 group had the highest rate for inspection(6.98%). The experiment data of the A9 group indicated that the portions of cervical intraepithelial lesions in liquid-based cytology NILM, ASC-US, LSIL, ASC-H, HSIL, SCC were 5.96%, 80.10%, 100.00%, 100.00%, 100.00%, respectively.Its coincidence rate with histology increased as liquid-based cytology increased, associated with high-grade lesions.Conclusion:A9 group infection is the most important cause of cervical intraepithelial lesions in Quzhou.High-risk HPV test, especially A9 group infection combined with TCT, can effectively improve the accuracy of cervical cancer screening.

目的 探讨子宫炎性肌纤维母细胞瘤(IMT)的临床病理特征.方法 收集2016年8月于浙江省衢州市妇幼保健院和2019年5月于浙江省绍兴文理学院附属医院治疗的2例子宫炎性肌纤维母细胞瘤患者的临床资料,分析其病理特点并复习相关文献.结果 2例肿瘤分别位于子宫底部及子宫后壁,肿瘤边界较清,但无包膜,轻-中度异型,镜下肿瘤由粘液样肌纤维母细胞成分和平滑肌成分相互交错分布,瘤组织呈长梭形,胞质偏嗜碱性,见小核仁,核分裂像2-4/50HPF,间质呈结节状筋膜炎样粘液间质,可见弥漫分布的炎症细胞浸润及不同结构的薄壁且扩张的小血管,免疫组化均表达SMA、Desm、ALK,部分表达CKpan、CD68、CD10、ER、PR,而HMB45、P16、P53均阴性.结论 IMT在子宫少见,是一种低度恶性潜能的间质肿瘤,易误诊、漏诊,明确诊断需结合病理形态学和免疫组化分析.

患者女性,60 岁,因右侧输尿管结石入院,自诉偶有右腰部酸胀感,无发热,无尿频、尿急、尿痛,无肉眼血尿;查体:心肺听诊无殊,腹软,未及包块,未及压痛、反跳痛,右肾区轻叩痛,左肾区无叩痛;腹部 CT 示右肾实质内见直径 1.6 cm等低密度结节影突出肾轮廓,增强后动脉期强化类似肾皮质,后期密度减低,呈相对略低密度,报告提示右肾占位,肾癌可能.行右肾部分切除术,送病理检查.

目的 探讨胎盘间叶发育不良(PMD)的临床及病理特点.方法 收集PMD 3例,对其临床资料、超声检查及病理特征进行回顾性分析.结果 3例胎盘病理大体观察均见胎儿面绒毛膜血管扩张、迂曲,似有胶样物质环绕;镜下干绒毛显著扩张、水肿,未见滋养细胞增生;免疫组化见水肿绒毛细胞滋养细胞P57(+),绒毛间质细胞P57(-),Ki-67<15％.结论 PDM较为罕见,易与部分性水泡状胎块混淆,诊断须依靠病理检查.

目的 分析子宫内膜非典型息肉样腺肌瘤(APA)临床病理特征.方法 收集APA 6例,对其临床资料、病理特征及随访结果进行回顾性分析.结果 本文6例中3例为低危型APA,3例为高危型APA.APA内膜腺体密集,结构复杂,细胞存在不同程度的非典型性,伴有桑椹状鳞化,肌纤维间质成分丰富,内膜固有间质成分稀疏.免疫表型:SMA和Des间质(+)、ER、PR腺上皮均(+)、CD10(-)、有5例P53(+)、P63(-)、Ki-6715％～30％(+)、CK5/6(+).随访6例,1例行子宫全切,随访3年健在;1例宫腔镜术后5个月复发,再次行宫腔镜治疗,术后随访无复发,其余4例随访至今均无殊.结论 APA属于良性肿瘤,其上皮存在轻至重度不典型增生腺体,不排除恶变可能,须长期随访.

目的 探讨梭形细胞未分化肉瘤临床病理特征、诊断与鉴别诊断.方法 对2例梭形细胞未分化肉瘤进行光镜检查及免疫组化检测并复习相关文献进行讨论.结果 2例患者,年龄53岁和83岁,镜下肿瘤细胞由卵圆形、短梭形细胞组成,细胞排列密集,见散在多核瘤巨细胞,核异型性明显,免疫组化检查:Vim(+);CD163(+);Bcl-2、Desmin、CD68、CD99、CKpan、S-100、SMA均(-).结论 梭形细胞未分化肉瘤是一种罕见的软组织恶性肿瘤,单从组织形态学上难以与癌、恶性外周神经鞘瘤、多形性脂肪肉瘤、梭形细胞为主的淋巴瘤等相鉴别.明确诊断需充分取材,全面的免疫组织化学检查等进行综合判断.

Objective To explore the role of bisphenol A in ovarian cancer cell migration and its molecular mechanism.Methods The human OVCAR-3 ovarian cancer cell line was chosen as research materials in this study.The 8 μm pore size Boyden chambers and QMC Chemotaxis Cell Migration Assay were adopted for OVCAR-3 cell migration analysis.The molecules involved in cell migration were measured by real-time fluorescent quantitative PCR,western blot and SensoLyte 490 Assay kits.The molecular mechanism of cell migration induced by bisphenol A was studied by the inhibition of ERK1/2 and PI3K molecules using their corresponding inhibitors.Results After 24 h incubation with bisphenol A (40 nM and 100 nM),the OVCAR-3 cell migration was markedly enhanced (P＜0.001).Not only were the gene and protein expression levels of MMP-2,MMP-9 and N-calcium were significantly increased (P＜0.05,P＜0.01 or P＜0.001) by bisphenol A,but also the activities of MMP-2 and MMP-9 were obviously enhanced (P＜0.01),indicating these three molecules were engaged in the cell migration caused by bisphenol A.Upon the inhibition of ERK1/2 or PI3K,the OVCAR-3 cell migration invoked by bisphenol A was offset,and the protein expression levels of MMP-2,MMP-9 and N-calcium as well as the activities of MMP-2 and MMP-9 were decreased.Conclusion The role of bisphenol A in ovarian cancer cell migration was achieved via ERK1/2 and PI3K signaling pathways.

目的 探讨绒毛膜羊膜炎的相关发病因素及其对新生儿结局的影响和处理对策.方法 回顾性分析83例绒毛膜羊膜炎的产妇(观察组)和同期排除绒毛膜羊膜炎产妇142例(对照组)的一般资料,分析孕期影响因素,统计母婴并发症.结果 两组孕产妇在围产期保健、孕20周前访视、胎膜早破、死胎发生率方面差异有显著性(P＜0.05);两组胎儿的出生孕周、出生体重差异无统计学意义(P＞0.05),Apgar评分、早产率、低体重率差异有统计学意义(P＜0.05).观察组比对照组更易出现血糖不稳定及心、脑损伤(P＜0.05).结论 胎膜早破易引起绒毛膜羊膜炎,不利于妊娠结局;建议加强孕产期保健宣传,提倡孕期访视及正规产检.

目的 :探讨产前早、中孕期超声检查对胎儿全前脑畸形的诊断价值.方法 :搜集我院2011-2014年超声诊断的13~26孕周胎儿全前脑畸形病例,对其超声声像图及引产后尸检结果进行回顾性分析.结果 :产前诊断13~26孕周胎儿全前脑畸形的共26例,均经引产后病理证实.结论 :产前超声对胎儿全前脑畸形具有重要的诊断价值,该病特有的颅脑声像图特征和大多伴有颜面部畸形的特点,有助于诊断及鉴别诊断.

OBJECTIVE To study TCT ,FQPCR ,P16 protein combined detection in early diagnosis of cervical canc‐er ,so as to provide a reference for early prevention and treatment of cervical cancer .METHODS Totally 1786 fe‐male patients with cervical abnormalities during Oct .2012 to Oct .2013 were performed with thinprep cytology test (TCT ) and fluorescent quantitation polymerase chain reaction (FQPCR) test to detect human papillomavirus (HPV) infection and expression of P16 protein . The software SPSS 17 .0 was used for statistical analysis . RESULTS Totally 198 cases were detected positive for HPV accounting for 11 .09% ,including high‐risk HPV (38 .38% ) and low‐risk HPV (61 .62% ) .The expression of P16 was significantly increased along with CIN Ⅱ , CIN Ⅲ and SCC (P<0 .05) .CONCLUSION Patients with cervical abnormalities have higher HPV‐positive detec‐tion rate .P16 protein expression increased with aggravation of cervical lesions .FQPCR ,TCT ,P16 combined de‐tection contributes to screening of precancerous lesions and cervical cancer .

目的：探讨胎儿宫内发育迟缓与胎盘临床病理因素的关系。方法回顾性分析宫内发育迟缓组与正常对照组胎盘的病理资料，比较其差异。结果宫内发育迟缓组的新生儿体质量与胎盘体质量明显低于正常组（ P＜0.01），而宫内发育迟缓组中无血管绒毛，绒毛梗死及合体结节增多明显高于正常组（均 P＜0.05）。结论胎盘中的合体结节增多、无血管绒毛、绒毛梗死的发生是发生宫内发育迟缓胎盘因素的重要原因。

Objective To evaluate the application of thin cytology test(TCT) and Hybrid Capture 2- high risk HPV- DNA test (HC2- HPV- DNA) combined with p16 immunocytochemical staining in screening of early cervical cancer. Methods Total 815 women underwent TCT and HC2- HPV- DNA testing, the specimens with at least one abnormal finding were subject to p16 im-munocytochemical examination, and biopsy under colposcopy was also performed for these patients. Results The positive rate of both HC2- HPV- DNA test and p16 expression increased with the degree of cervical lesions(P<0.01). Simultaneous detection of TCT and HC2- HPV- DNA increased the detection rate of cervical cancers and cancer precursor lesions. Incorporation of these two tests with p16 Immunocytochemical staining improved the specificity of detection. Conclusion TCT and HC2- HPV- DNA detec-tion combined with immunocytochemical staining for p16 can improve the specificity of cervical cancer screening.

目的：探讨肝细胞生长因子（HGF）在妊娠期肝内胆汁淤积症（ICP）胎盘组织中的表达及其在ICP胎儿宫内缺氧中的意义。方法：采用免疫组化的方法检测30例IC P胎盘（其中重度组15例、轻度组15例）和20例正常妊娠胎盘的HGF的表达。结果：ICP重度组胎盘组织中的 HGF的表达明显低于正常妊娠组和ICP轻度组（P＜0．01），且其表达与ICP分级之间存在等级相关（rs＝0．59，P＜0．01），轻度组和正常妊娠组无统计学意义（P＞0．05）。结论：ICP组胎盘组织中 HGF表达的降低，可能影响妊娠期胎盘血管形成和滋养细胞的增殖，使胎儿胎盘单位缺血、缺氧引起胎儿慢性缺氧，当在宫缩等急性缺氧应激下发生失代偿时可能导致胎儿不良结局。

目的 探究p16蛋白、高危型乳头状瘤病毒DNA(HC2-HPV-DNA)检测联合薄层液基细胞学检查(TCT)在宫颈癌早期及癌前病变筛查中的应用价值.方法 采用TCT联合HC2-HPV-DNA对妇科门诊4 752例患者进行检测分析.对其中一项或者两项异常者共524例患者进行阴道镜及病理学活检,并将病理蜡块行p16免疫组化检查.结果 HC2-HPV-DNA阳性率随着宫颈病变严重程度的增加而升高,差异有统计学意义(P＜0.05).p16表达水平与宫颈级别呈正相关.p16检测CIN Ⅱ级以上病变(CIN Ⅰ+)的阳性率随着宫颈病变程度的增加,其表达强度越高,差异有统计学意义(P＜0.05).HC2-HPV-DNA与TCT、p16联合检测,对CINI以上病变诊断的敏高性、特异性、准确性均较单独应用时显著提高.结论 HC2-HPV-DNA与TCT、p16联合应用可提高宫颈癌早期及癌前病变诊断的准确性.

子宫颈癌的发病率在世界范围内居女性恶性肿瘤的第2位,在一些发展中国家和地区仍居第1位.由于宫颈癌存在一个较长的、可逆转的癌前病变期,早期宫颈癌患者治愈率高达90.00%,因此对宫颈癌的筛查研究一直受到人们的关注[1].本研究应用液基薄层细胞学对门诊患者进行宫颈病变的筛查,同时作问卷调查,分析衢州市妇科门诊就诊患者的宫颈病变特征及宫颈癌筛查的现状,现报道如下.

[目的]探讨宫颈腺上皮病变的细胞学形态特点.[方法]分析52例细胞学诊断宫颈腺上皮异常病例的细胞学资料和组织学资料,以组织学诊断作为标准,对细胞学诊断的准确性进行评估,并分析宫颈腺上皮病变与年龄、月经状况的关系.[结果]52例宫颈腺上皮病变中正常和炎症20例,宫颈和内膜病变32例,阳性检测准确率为61.5%,假阳性率为38.5%.其中内膜病变为18例,细胞学诊断内膜病变的敏感性为34.6%.[结论]①宫颈腺上皮相对少见,细胞学诊断特异性低,尤其是诊断AIS时要慎重.②腺上皮病变的细胞学特征主要是细胞核的改变和典型的三维立体结构排列.③腺上皮病变发病年龄偏高,绝经是高危因素之一.

[Purpose] To investigate the expression of vimentin in gastric cancer and its significance. [Methods] The expression of vimentin in 79 cases with gastric cancer was detected by immunohistochemical method. The relationship between vimentin expression and clinicopathological parameters was analyzed. [Results] Of 79 cases with gastric cancer, 38 cases vimentin were expressed positively. The positive rate in poorly-differentiated/undifferentiated group (60.5%,26/ 43) was higher than that in well-moderately differentiated group(33.3%, 12/36)(P0.05); and the positive rate in lymph node metastasis group (59.3%, 32/54) was higher than that in no lymph node metastasis group (24.0%,6/25)(P0.05). Vimentin predicted the lymph node metastasis with the sensitivity of 59.3% and specificity of 76.0%. [Conclusions] Vimentin expression is related to cancer differentiation, histologic type and lymph node metastasis in gastric cancer. Thus, vimentin expression might be used as a potential biomarker for lymph node metastasis.

<正>宫颈癌是最常见的妇科恶性肿瘤之一,发病率在女性恶性肿瘤中居第2位,仅次于乳腺癌。对宫颈癌前病变和早期癌的及时高效筛查和正确处理是防治宫颈癌的关键。宫颈阴道细胞学检查是子宫颈癌筛查的好方法,简便易行、无创伤、经济有效且可多次重复。

目的:探讨浙西妇女宫颈病变的特征及宫颈癌筛查的现状.方法:应用液基细胞学(TCT)对3247例门诊就诊妇女(门诊组)和1187例妇女病普查的妇女(普查组)进行宫颈病变的筛查,对细胞学异常者行阴道镜检查和活组织病理学检查.结果:①门诊组、普查组宫颈病变总检出率分别为21.53%和12.05%,两组差异有统计学意义(P<0.01).②门诊组细胞学异常检出率为7.85%(255/3 247),普查组检出率为5.14%(61/1 187),两组差异有统计学意义(P<0.01).③细胞学检查阳性者316例,经组织病理学检查有CIN以上病变为57.91%(183/316).结论:门诊就诊妇女宫颈病变的发病率较高,筛查覆盖率低.常规对就诊妇女进行宫颈癌的机会性筛查,是提高宫颈癌筛查效率和覆盖率的切实可行方法.