目的 探讨原发心脏弥漫大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)的临床病理特点、诊断、治疗及预后.方法 回顾性分析5例原发心脏DLBCL的临床病理资料,分别行HE染色、免疫组化EnVision两步法染色,应用原位杂交以及荧光原位杂交(fluorescence in situ hybridization,FISH)进行检测,并复习相关文献.结果 镜下见肿瘤细胞为大淋巴样细胞,弥漫性浸润性生长,核分裂象多见.肿瘤细胞弥漫表达CD20、PAX5,Ki-67增殖指数60％～95％,CD5阳性且C-MYC和BCL-2双表达1例.FISH检测未检出MYC、BCL-2、BCL-6基因断裂分离.2例行肿物切除/活检,未行化疗,分别于术后2、3个月死亡;3例行肿物切除/活检及R-CHOP方案化疗,分别随访2、10、38个月,预后良好.结论 原发心脏DLBCL属于罕见的高度侵袭性恶性肿瘤,除特征性的病理形态学改变,需结合临床表现、免疫表型及分子遗传学检测以提高诊断的准确性,并进行规范治疗.

目的 观察原发性睾丸淋巴瘤(primary testicular lymphoma,PTL)的磁共振成像(magnetic resonance imaging,MRI)特点,探讨原发性睾丸淋巴瘤的磁共振成像影像诊断思路及鉴别诊断.方法 回顾性分析经手术病理证实的9例PTL的MRI表现,术前均行平扫及增强检查,分析影像特点,并与手术病理结果对照分析.结果 原发性睾丸淋巴瘤形态欠规则,T2WI上呈混杂等高信号,T1WI上呈等或稍低信号,可见小片状T1WI高信号出血灶,增强后可见不均匀中度-明显强化,呈渐进性,ADC呈低信号.结论 磁共振成像上原发性睾丸淋巴瘤具有一定的特异性,掌握MRI特点有助于疾病的诊断和鉴别诊断.

患儿男性,13岁,反复头痛3个月余,加重半个月.头颅后枕部触及肿物.2018年8月CT示右侧斜坡、枕骨基底部及枕骨大孔右侧壁不规则形虫蚀状骨质破坏伴软组织肿块,大小4.8 cm ×2.5 cm ×2.3 cm,病灶内见多发细小钙化,边界不清(图1),考虑颅底软骨肉瘤.9月入院,全麻下行肿瘤切除术.取少量组织送检,术中冷冻病理报告:成骨性肿瘤.

目的 探讨肺肠型腺癌(pulmonary enteric adenocarcinoma,PEAC)的临床病理特征、诊断、鉴别诊断及预后.方法 回顾性分析15例PEAC的临床资料、病理形态、免疫表型、分子特征等,并复习相关文献.结果 镜下见肿瘤细胞呈高柱状,假复层排列成腺样、筛状、乳头状或实性结构,腺腔内可见坏死物及核碎裂,类似结直肠腺癌的形态.肿瘤细胞CK7(13/15)、CDX2(12/15)、CK20(6/15)、MUC2(1/2)、TTF1(7/15)、Napsin A(4/15)及SPB(1/8)阳性.EGFR基因突变率为12.5%(1/8),为21号外显子L858R突变;未发现EML4-ALK融合基因和ROS1融合基因.随访4~57个月,3例分别于术后5、19、36个月死亡,12例生存状态良好.结论 PEAC是肺腺癌的少见变型,其组织学形态与结直肠腺癌相似,详细的临床病史、组织学的异质性及免疫表型是诊断与鉴别诊断的依据,EGFR、EML4-ALK等肺腺癌常见基因突变在PEAC中少见,预后有待长期密切的随访.

术中冷冻制片是病理技术员必须熟练掌握的一项基本技能操作,与常规病理制片不同,其要求技术员在短时间内制作出精良的切片以供病理医师做出及时准确的诊断,为临床手术提供可靠依据.福建医科大学附属协和医院自2005年来开展了乳腺癌保乳手术,作为近年来手术量逐步递增的一项术式,与传统乳腺癌改良根治术相比,该术式具有创伤小、痛苦小的特点,其在保留乳房外形完整性的同时,又兼顾了术后的功能恢复,配合术后综合治疗,疗效可以和乳腺癌根治术相媲美.而且保留大部分乳房显著提高了患者的生活质量.保乳手术由外科医师切取各切缘经病理医师判断是否有癌组织侵犯,对明确手术方案至关重要.但由于大多数切缘标本中含较多脂肪组织,制出冷冻切片经常不完整,在实际工作中不断探讨,作者摸索出一种新的方法,能提高保乳手术切缘(尤其含脂肪成分多而腺体少或者只含有脂肪组织)冷冻切片的完整性,从而减少因制片原因造成的漏诊,现就本项技术操作方法的改进和体会作如下探讨.

Objective To evaluate the diagnostic value of endobronchial ultrasound guided transbronchial needle aspiration(EBUS - TBNA)in lung and mediastinum space occupying lesions. Methods 154 patients with lung and mediastinum space occupying lesions found by CT underwent EBUS - TBNA. All samples were analyzed by cytological smears and histopathological exminations. Results Among the 154 biopsy specimens,147 cases had histological com-parison. 109 cases were diagnosed as malignant lesions,9 cases as benign lesions and 5 cases as suspicious carcino-ma. Overall sensitivity,specificity and accuracy were 95. 5% ,100% and 95. 9% respectively using histological and clinical diagnosis. Conclusion The combination of cytology and histology in EBUS - TBNA is accurate,sensitive and specific for diagnosis and staging lung and mediastinum space occupying lesions.

Objective To study the expression of insulin-like growth factor Ⅱ mRNA-binding protein 3 ( IMP3 ) and its clinicopathological significance in breast cancer.Methods The Maxvision immunohistochemistry was used to detect the expression of IMP3 protein in 103 cases of breast cancer and the adjacent normal breast tissues.Stem-loop real-time RT-PCR was used to detect the expression level of IMP3 mRNA in 30 cases of breast cancer and the matched non-tumor adjacent tissues.The relationship between the expression of IMP3 and the clinicopathological features of breast cancer was analyzed.Results 62 cases were infiltrative ductal carcinoma,3cases were invasive lobular carcinoma,9 cases were microinfiltrative intraductal carcinoma,and 29 cases were special type of carcinoma.The difference of IMP3 expression between breast cancer group and normal breast tissue group had statistical significance( t =19.630,P =0.000)by t test.For infiltrative ductal carcinoma patients,IMP3 expression had no significant relation with age,tumor size,lymph node metastasis,histological grade,pTNM stage,ER,PR,or HER-2 ( P ＞ 0.05 ).IMP3 mRNA expression level of was significantly higher in tumor tissues than in the adjacent normal tissues (P ＜ 0.05 ).No significant association was found between the expression of IMP3 and the histological grade,tumor size,lymph node metastasis ( P ＞ 0.05 ).Conclusion It is possible that IMP3 plays an important role in the generation,progression,invasion and metastasis of breast cancer.