患者女性,61 岁,因发现头颈部多发皮肤结节于2021年7月29日就诊于北京世纪坛医院耳鼻喉科.查体:患者前额、眉弓、头皮、下颏、双侧颈部及项部多发小结节,无破溃及糜烂,遂行手术切除.患者于2002年确诊为升结肠腺癌,行手术切除并化疗.2009 年患者发现右侧鼻翼肿物,病理证实为高分化鳞状细胞癌(squamous cell carcinoma,SCC)后行放疗.2015 年病理检查为降结肠癌行手术切除并行化疗,同年患者后背部有肿物,切除后病理诊断为皮脂腺腺瘤.2021 年6 月患者右侧鼻翼有肿瘤,病理诊断为高分化SCC,同年患者复查肠镜发现直肠息肉,确诊为管状腺瘤.该患者有癌症家族史.

精准医学时代的发展,推动了病理研究的深入,临床对病理报告中信息内涵的要求也越来越高,尤其需要能够指导临床治疗及预后判断的病理指标.早在1982年,美国解剖和外科病理主任协会(Association of Directors of Anatomic and Surgical Pathology,ADASP)就指出,对于各种类型肿瘤报告的客观要求,是以统一的形式按照完整性、术语化以及序列化的原则来表示[1].因此,推动实施肿瘤病理报告标准化,与时俱进不断深化和细化,使病理报告既有写实性、依靠性,更有前瞻性、引导性,一直是临床病理工作的重要指导思想和工作方法.

乳腺梭形细胞病变(breast spindle cell lesions,BSCL)包括的范围较广泛,从反应性病变到高级别恶性肿瘤均可发生.细胞形态温和的BSCL包括梭形细胞成分伴良性上皮成分的双相型病变、梭形细胞成分伴恶性上皮成分的双相型病变、单纯梭形细胞成分的单相型病变,由于不同性质的病变形态学表现极为相似,鉴别诊断较为困难.该文现结合BSCL最新研究进展,并结合其临床特征、影像学特点及免疫表型作一简述.

目的 探讨喉鳞状细胞癌(LSCC)中人乳头瘤病毒(HPV)及细胞周期相关蛋白p16的表达及意义.方法 收集北京同仁医院2005-01-01-2011-12-31 LSCC病例资料332例,回顾性分析其临床病理学特点,采用聚合酶链反向点杂交(PCR-RDB)方法检测HPV16 DNA,构建组织芯片并采用免疫组织化学法染色观察细胞周期相关蛋白p16的表达,比较HPV阳性组和HPV阴性组临床病理学特点的差异,分析高危型HPV16与p16的关系;采用RNAscope方法检测HPV16 E6/E7 mRNA的表达,观察在LSCC中是否具有转录活性的HPV,从而明确LSCC是否与HPV有关联.结果 在332例LSCC中有45例(45/332,13.6％)检测到高危型HPV,其中40例(40/332,12.0％)检测到HPV16,HPV 16阳性与淋巴结内肿瘤囊性转移有关联,χ2=9.774,P=0.004;T1患者HPV16阳性率高于T4患者,P=0.011;组织学分级也对患者是否表达HPV16 DNA有一定的影响,P=0.049.与LSCC患者年龄、性别、是否吸烟/饮酒、TNM分期及肿瘤大小等均无统计学意义的关联,均P>0.05.在332例LSCC中36例(36/332,10.84％)p16阳性表达,其中女性阳性率高于男性,差异有统计学意义的关联,χ2=4.841,P=0.04;但与年龄、是否吸烟/饮酒、TNM分期、肿瘤部位、组织学类型、组织学分级及淋巴结转移无统计学意义的关联,均P>0.05.HPV16表达与p16表达有统计学意义的关联,χ2=3.944,P=0.047.但是p16与HPV16的表达并不完全一致,其敏感性仅为20％(8/40).332例LSCC均检测了HPV 16 E6/E7 mRNA的表达,染色结果均为阴性.结论 部分LSCC中伴有HPV16的感染,但HPV16并不是一个主要的致癌因素,且LSCC中p16表达并不是HPV16感染的替代性指标.

21世纪以来,精准医学飞速发展,多学科会诊模式逐渐兴起,临床病理学在其中成为不可或缺的一部分.这就要求我们培养出具有更强临床思维能力的优秀的住院医师.2018-09,国家教育部、卫生健康委员会等部门联合发布《关于加强医教协同实施卓越医生教育培养计划2.0的意见》,明确指出在医学教育中要提升学生临床实践技能,开展基于问题导向的小组讨论式教学法,完善以能力为导向的评价体系.首都医科大学附属北京世纪坛医院病理科作为首批规范化培训基地之一,目前已培养合格病理住院医师数十名,同时完成了大量其他临床科室住院医师在病理科的规范化培训工作.而传统的基于授课的教学方法(lecture-based learning,LBL)显然已经不能满足目前的培训工作,因此我们初步尝试将LBL及案例教学法(case-based learning,CBL)与思维导图的教学方法相结合,通过精选典型病理切片,将讲授、讨论、实践有机结合,并引导住院医师利用思维导图主动将知识要点进行梳理、归纳和总结,进而提高住院医师的诊断思维能力.

目的 探讨青年女性乳腺浸润性导管癌(IDC)及其分子亚型的临床病理学特点.方法 收集首都医科大学附属北京世纪坛医院病理科2014-01-01-2019-09-30确诊的乳腺IDC 680例,比较同期青年女性(≤40岁)乳腺IDC与中老年(＞40岁)女性IDC在肿瘤大小、部位、分期、组织学分级、淋巴结转移、ER、PR、HER-2,Ki-67,p53及CK7等临床病理指标方面的差异,分析青年女性IDC不同分子亚型与以上临床病理学指标的关系.免疫组化采用EnVision法,HER-2(2+)病例采用免疫荧光原位杂交检测进一步明确分子亚型.结果 680例IDC中,青年女性83例,占12.2％;与中老年组相比,青年组淋巴结转移个数及肿瘤细胞增殖指数Ki-67明显增高,高分化肿瘤病例数明显减少(P＜0.05);青年女性IDC中,三阴型较其他类型肿瘤分化差(P＜0.001),肿瘤细胞增殖指数Ki-67表达高(P＜0.05);HER-2过表达型淋巴结转移个数多(P＜0.05).结论 青年女性IDC具有更高的侵袭性,分子亚型为三阴型及HER-2过表达型者预后差.

Hepatoid adenocarcinoma is a peculiar but aggressive type of extrahepatic adenocarcinoma that morphologically resembles hepatocellular carcinoma. To date, only a handful of cases have been described in the colon. Here, such a case is reported and pertinent literature is reviewed. Characteristic features of the tumor include large polygonal cells with marked nuclear atypia, prominent nucleoli and eosinophilic granular or clear cytoplasm arranged in trabeculae and solid nests or sheets. The tumor was immunohistochemically positive for AFP, CDX-2 and hepatocyte paraffin 1.

AIMS:To demonstrate clinicopathologic features of Stewart-Treves syndrome (STS) including clinical manifestations, morphology, immunophenotype (especially c-MYC amplification), differential diagnosis, pathogenesis, treatment and prognosis.METHODS AND RESULTS:17 cases of STS were retrospectively archived, involving 6 cases of postmastectomy, 3 cases of postoperative cervical cancer and 8 cases of chronic lymphatic obstruction without history of malignancy. Seven of 9 cancer patients had undergone radiotherapy. All the patients presented with lymphedema as the first sign. The lesions appeared as multiple reddish blue macules or nodules with polypoid and coalesce. Microscopic examination revealed infiltrative proliferation of irregular vessels in dermis and subcutaneous tissue. The tumorous endothelial cells displayed pleomorphism in morphology. The heteromorphic tumor cells expressed CD34, CD31, ERG, D2-40, c-MYC and factor VIII. Despite various treatment modalities, all cases died in an average of 13.6 months, with 1 case of loss to follow-up.CONCLUSIONS:STS is an extremely rare malignancy that arises from congenital or secondary chronic lymphedema. STS uniquely overexpressed c-MYC. In spite of poor prognosis, early detection is important to facilitate a full range of available therapies, even an opportunity for curative treatment. A low threshold for biopsy and early referral to an experienced multidisciplinary team are highly recommended for optimum management.

病理学是一门连接基础医学和临床医学的桥梁学科,是从形态学角度来阐明疾病的本质及发生、发展规律的学科,即从疾病形态结构(包括肉眼及显微镜下观察)的改变来认识疾病的本质,研究其发生、发展的规律,从而为防治疾病打下理论基础[1].病理学是一门形态学科,因此实验课具有很强的直观性和实践性,通过对标本的观察,加深对理论知识的理解,为今后学习临床医学课程打下基础.这就需要带教老师采用正确的教学方法,激发学生们的学习兴趣,使学生们牢固掌握这门知识.本人通过带教本科的病理实验课,发现采用LBL教学法+CPC教学法能够很好的激励学生,达到预期的实验效果.

OBJECTIVE:To investigate the role of human papillomavirus (HPV) in laryngeal squamous cell carcinoma (LSCC) and analyse the relationship between HPV and the expression of cell cycle-related proteins. DESIGN:The study consisted of LSCC between 2005 and 2011 in Tongren Hospital. Clinical data such as age, sex, smoking/alcohol consumption, and TNM stage were collected. HPV DNA and cell cycle-related proteins were assessed in terms of clinical features. SETTING:Single-centre study. PARTICIPANTS:A total of 332 LSCC patients were included in the study. MAIN OUTCOME MEASURES:The presence of genotype-specific HPV DNA was evaluated using PCR-RDB in formalin-fixed paraffin-embedded tissues. All samples were also evaluated for p16INK4A , p21WAF1/CIP1 , P53, Cyclin D1, and Ki67 immunohistochemical staining by tissue microarray. RESULTS:HPV DNA was detected in 45 of 332 (13.55%) patients with LSCC, with HPV-16 being the predominant genotype. The presence of HPV-16 DNA was significantly associated with basaloid squamous cell carcinoma and cystic lymph node metastasis (P < 0.05). Of the 332 patients, 36 (10.84%) were scored as p16INK4A positivity and they were more likely to be female (P < 0.05). Cyclin D1-positivity and p21WAF1/CIP1 -positivity were observed in 60.24% (200/332) and 40.66% (135/332), respectively. In 114 cases (34.33%), LSCCs had moderate- to -strong p53 accumulation, which was correlated with TNM stage (P < 0.05). HPV-16 DNA was correlated with p16INK4A and manifested a higher Ki-67 labelling index and p21WAF1/CIP1 expression than HPV-16-negative tumours (P < 0.05). No relationship was observed between Cyclin D1or P53 expression and HPV-16 infection (P > 0.05). CONCLUSION:HPV DNA was detected in 13.55% patients with LSCC, with HPV-16 being the predominant genotype and it was correlated with p16INK4A and manifested a higher Ki-67 labelling index and p21WAF1/CIP1 expression than HPV-16-negative tumours.

Objective: To investigate the clinical pathologic characteristics of extranodal follicular dendritic cell sarcoma (FDCS). Methods: We collected 7 cases of extranodal FDCS, HE staining, immunohistochemical study were performed. The V600E mutation of BRAF in 7 cases were detected by real-time PCR and EBER in situ hybridization was performed on 4 cases. Results: Among the 7 cases of FDCS, 5 cases were male and 2 cases were female, the median age was 55 years old, including 4 cases of low-grade FDCS and 3 cases of high-grade FDCS. The tumor location of 2 cases was in mediastinum, the tumor locations of others were in nasopharynx, kidney, lung, rectum and liver, respectively. The results of immunohistochemistry showed that, the tumor cells were diffusely or focally positive for CD21, CD23, CD35, D2-40, EGFR and CXCL13, but negative for S-100, CD68, HMB45, SMA, Desmin, CD117, Dog-1, CD34, CD30, EMA and CK.Five cases were positive for PD-L1 and the its expression in high-grade FDCS were higher than that in low-grade FDCS.Two cases of low-grade FDCS were positive for BRAF V600E, but the BRAF V600E mutation weren't detected in all of 7 cases. The result of EBER in-situ hybridization showed that only the nasopharynx FDCS was positive.The follow-up information of 5 patients were available (7~43 months), 4 patients died and 1 still alive with rectum metastasis. Conclusions: FDCS is a rare malignant disease with relapse and metastatic tendency. The combined applications of the first-line antibodies including CD21, CD23, CD35 and second-line antibodies including D2-40, CXCL13, EGFR are helpful for its diagnosis and differential diagnosis. The high expression of PD-L1 implicates the potential benefit of FDCS patients acquired from immunotherapy.

AIMS To investigate the frequency and transcriptional activity of HPV and its correlation to p16 and p21 expression in basaloid squamous cell carcinoma (BSCC) of the larynx. METHODS We evaluated tissues from 29 patients with BSCC of the larynx for the expressions of p16 and p21 proteins by immunohistochemistry (IHC) and for HPV E6 and E7 mRNA by RNA in situ hybridization (ISH). The presence of genotype-specific HPV DNA was evaluated using PCR-RDB in formalin-fixed paraffin-embedded tissues. P16 and p21 expression and HPV DNA status were correlated with clinicopathological features. RESULTS HPV DNA was detected in 8 of 29 (27.59%) patients, with HPV-16 being the predominant genotype. P16 and p21-positivity were observed in 7/29 (24.14%) and 8/29 (27.59%) patients, respectively. HPV was not correlated with p16 expression (P > 0.05). However, p21 expression was significantly higher in HPV-positive tumors than in HPV-negative tumors (P < 0.05). No cases exhibited transcriptionally active HPV in our series. CONCLUSION Our findings suggest that a small fraction of BSCC of the larynx is HPV DNA-positive in this Chinese population, p21 expression was significantly higher in HPV-positive tumors, and no cases were HPV transcriptionally active in this small cohort. Further research of HPV and its role in BSCC of the larynx are warranted.

Objective To investigate the clinicopathological features of the carcinoma arising in phyllode tumors of the breast.Methods Morphological observation and immunohistochemistry using Envision method were performed on 5 cases of carcinoma arising in phyllodes tumors of the breast from January 2000 to may 2017.Results All 5 patients were female,aged 26 ～ 58 years (median age 53),and all the masses increased rapidly in short time.2 cases arose from benign phyllode tumors including DCIS,LCIS and ILC;3 DCIS arose from borderline phyllode tumors.Immunohistochemistry showed all malignant epithelial components were diffusely positive for ER and PR,and DCIS was positive for p120 and Ecadherin,LCIS was positive for p120 and negative for E-cadherin;mesenchymal component all expressed CD34 and 2 cases were also Bcl-2 positive.All patients were alive without recurrence and metastasis followed by 4 ～ 72 months.Conclusion Carcinoma arising from phyllode tumors of the breast is rare and characterized by in situ and invasive carcinoma in a background of phyllode tumor of the breast.The immunohistochemical features of malignant epithelial component are similar to ordinary breast cancer,but with better prognosis.Because of its rarity,there is no standardized treatment prescription for this disease.

Objective: To study the significance of HPV and cell cycle related proteins in basaloid squamous cell carcinoma (BSCC) of the larynx. Methods: Twenty-nine cases of laryngeal BSCC from Beijing Tongren Hospital from January 2005 to December 2011 were reviewed. HPV typing by polymerase chain reaction-reverse dot blot (PCR-RDB) and p53, Ki-67, p16, p21 and cyclin D1 expression by immunohistochemistry were performed. The relationship between these indicators, various pathologic parameters (TNM, tumor size, tumor site and lymph node metastasis) and HPV status was analyzed. Results: There were 27 male and 2 female patients. The median age was 62 years. Lymph node metastasis and supraglottic tumor location were slightly higher than that of "usual" SCC, but not statistically significant (P>0.05). HPV DNA was detected in 27.6% (8/29) of the laryngeal BSCC, and all were HPV16. The expression of HPV was not related to age, alcohol consumption, tumor stage and tumor size. p53 was expressed in 31.0%(9/29) of laryngeal BSCC, and these cases were more likely supraglottic and had lymph node metastases (P<0.05). p16 staining was seen in 24.1% (7/29) of laryngeal BSCC, and these cases showed slightly higher rate of lymph node metastasis compared to p16 negative cases. The expression rates of p21 and cyclinD1 were 27.6% (8/29) and 69.0%(20/29), respectively, which were not related to age, tumor size, stage, lymph node metastasis, smoking and drinking. There were only 3 p16+ /HPV+ cases, which showed higher p21 and Ki-67 index compared to the HPV negative group (P<0.05). Conclusion: Some laryngeal BSCC expresses HPV DNA, possibly indicating an association with HPV; but p16 expression is not a reliable indicator for HPV infection.

病理学是一门联系基础医学和临床医学之间的桥梁,具有内容庞杂、理论抽象等特点,因此病理住院医师在规培过程中会存在诸多问题,而带教老师要在带教过程中发现问题、解决问题,最终将其培养成合格的病理医生.

眼球经济时代,传媒必须以"快"制胜,只有在报道中抢占先机,才能吸引观众.本论文第一部分对突发性新闻现场直播的相关情况作了介绍,第二部分交代了现场直播快速反应的积极意义,第三部分分析了突发性新闻现场直播快速反应的现状及存在问题,第四部分则提出了效解决措施,第五部分揭示了突发性新闻事件现场直播快速反应对我们的启示并对其未来发展做出预测.论文指出媒体在现场直播中必须有所作为,做到反应迅速,而对于突发性新闻事件的报道不仅要"快",还要抓住热点,展开深入报道和后续报道.

目的 分析散发型淋巴管肌瘤病(S-LAM)的临床及病理特点,提高对该病的认识.方法 对11例经病理证实的S-LAM进行回顾性分析,采用SMA、vimentin、HMB45、Ki-67、CD34、D2-40、ER和PR等抗体进行免疫组化染色,并复习文献.结果 11例均为女性,表现为乳糜性胸或腹水,有胸闷、呼吸困难、气促等症状;病程中均有多个部位累及,包括肺、腹膜后、淋巴结.胸部CT示两肺散在或弥漫分布囊腔影,直径0.2 ～2cm,囊壁薄而清晰;腹膜后受累者CT显示囊性低密度影.11例均有月经不调,其中3例合并子宫肌瘤,1例合并卵巢畸胎瘤、肾血管平滑肌脂肪瘤及肝血管瘤,1例合并小肠胃肠间质瘤,2例合并肝囊肿.免疫组化显示11例HMB45均(+),5例ER灶性(+),8例PR局灶(+).随访5～ 60个月,患者均存活,且症状缓解.结论 LAM的临床表现无特异性,CT表现有一定的特异性,最终确诊依赖于组织病理,熟悉这些特点有助于早期诊断,但预后差.

Purpose To assess the clinical and pathological features of small gastrointestinal stromal tumours (sGIST).Methods To reevaluated the clinical,histological and immunohistochemical parameters of 21 sGISTs.The standard immunohistochemical panel antibodies were studied on the tumor sections.All data were compared with clinical sGIST.Results There were a total of 7 females and 14 males of sGISTs.The median age was 63 years old.The tumors were predominantly located in the stomach showing a spindle cell morphology and the tumor sizes ranged from 0.5 cm to 1.5 cm.9 sGISTs combined with malignant tumors,which were gastric cancer have been incidentally detected during surgery.As the lesions were small in size,with infrequent bleeding,necrosis,mucosal invasion,ulceration and less mitotic index,sGISTs reoccurred less compared with clinical sGIST.p53,Ki-67 labeling index and microvascular density (MVD) in sGIST were significantly lower than clinical sGIST (P ＜ 0.05).Conclusion sGIST may occure with digestive tract cancer synchronously.p53,Ki-67 labeling index and MVD were lower than clinical GIST,which means better prognosis.

头颈部鳞癌是人体第六位常见的恶性肿瘤，每年全世界大约新增40万病例，约占所有恶性肿瘤的3.5％。大部分头颈部鳞癌起源于口腔、口咽、鼻咽、下咽和喉。头颈部鳞癌预后很差，5年生存率＜50％，其主要危险因素包括吸烟和饮酒［1］。人乳头状瘤病毒（ HPV）是双链 DNA病毒，约含有8000个碱基对，已发现180余种HPV亚型，并根据HPV与宫颈癌的关系，将HPV分为高危型HPV （ HPV 16，18，31，33，35，39，45，51，52，56，58，59，68，73和82）和低危型HPV （ HPV 26，30，34，53，66，67，69，70，73，82，85）。高危型HPV亦可导致其他部位的肿瘤，每年在全球范围内约有60万例HPV相关性肿瘤发生。近年来发现一组HPV相关的头颈部鳞癌，该组病例能够检测出高危型HPV DNA（约95％为HPV 16），与HPV阴性的头颈部鳞癌相比，具有较好的预后，并且对放疗、化疗反应更加敏感［2］。据此推测有两个途径可导致头颈部鳞癌，一个与吸烟、饮酒相关，而另外一个则与HPV介导相关。本文就HPV与头颈部鳞癌的相关研究进展做一综述。