Microinvasive carcinoma (MIC) of the breast is a rare lesion. The clinicopathologic features and biologic behavior of MIC are unclear. Whether MIC is a distinct entity or an interim stage in the progression from ductal carcinoma in situ (DCIS) to invasive breast carcinoma (IBC) remains to be determined. A retrospective review of clinicopathologic features and analysis of the expression of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER-2), and Ki-67 in patients with MIC (90 cases), DCIS (268 cases) and IBC (1504 cases) was performed. Most MICs (93.3%) exhibited an intermediate to high nuclear grade, and this proportion was larger than that of DCIS (62.7%, P < 0.001) or IBC (85.4%, P = 0.036). The incidence of sentinel lymph node metastasis in MIC (12.5%) was higher than that of DCIS (1.6%, P < 0.001), but much lower than that of IBC (39.7%, P < 0.001). MICs had higher expression of HER-2 and lower expression of ER and PR compared to DCIS and IBC; and MIC was more likely to present with a HER-2+ subtype. Furthermore, DCIS exhibited greater HER-2 overexpression or gene amplification (P < 0.001) levels and lower proliferation index of Ki-67 (P < 0.001) compared to IBC. Our results suggest that the clinicopathologic and molecular phenotype of MIC are different from DCIS and IBC. Thus, MIC may be a distinct entity rather than an interim stage in the progression from DCIS to IBC. The prognosis of MIC and the biologic behavior of this uncommon subset need to be further explored.

目的 探讨围产期胎儿髓外造血(extramedullary hema-topoiesis,EMH)瘤样增生的临床病理学特征、病变病因及发病机制.方法 回顾性分析2例胎儿EMH瘤样增生的临床表现、病理学特征及免疫表型等,并复习相关文献.结果 患胎经产检多次后均显示不同程度瘤样组织增大,例1已有全身多处增生迹象;例2右侧肾上腺肿物渐进增大,且超声检查显示伴有明显出血.此发病部位较为罕见,为右肾上腺、后纵隔脊柱旁等全身部位.尸检活检示全身多处实性灰白色肿物,镜下见红细胞系、粒细胞系、巨核细胞系三系造血细胞弥漫增生;免疫表型:红细胞系CD235α(+),粒细胞系MPO(部分+),巨核细胞系CD61(部分+),CD15(+),Ki-67增殖指数为90％,vimentin、CD43、CD30、CD56、CK、MyoD1、S-100、NSE、Syn、CD99均(-).结论 胎儿 EMH 瘤样增生是一种特殊的罕见良性病变,而临床表现及超声影像学缺乏诊断依据,所以正确诊断占位性病变具有重要临床指导意义和诊断价值,避免误诊及过度治疗.

目的 实性乳头状癌(SPC)是一种少见的特殊类型乳腺癌,占所有乳腺癌的1.3％,病理组织学有其独特特点.本研究探讨SPC临床病理特征及免疫表型,从而进一步了解这种少见类型的肿瘤.方法 收集广东省妇幼保健院2014-2019年诊断的49例SPC患者,回顾性分析其临床病理特征及免疫表型.结果 本组患者的中位数年龄为58岁(范围20～78岁);其中21例为原位SPC,28例为SPC伴浸润;35(71.4％)例患者行前哨淋巴结活检,仅1例发现孤立性肿瘤细胞,余34例未发现淋巴结转移.免疫组化显示所有病例ER弥漫强(+)、HER-2(-),48(98％)例患者PR(+),48例表达神经内分泌指标突触素和/或嗜铬素A;Ki-67表达水平差异较大(增殖指数1％～80％),其表达水平与患者年龄相关,年龄＜58岁的患者Ki-67高表达率为60.9％(14/23),显著高于年龄≥58岁组15.4％(4/26,P=0.001),而Ki-67表达水平与SPC是否伴浸润无关.结论SPC是一种少见类型的乳腺癌,好发于老年妇女,也可发生于年轻女性,SPC具有其独特的组织学特点,通常表达激素受体和神经内分泌标志物,Ki-67表达水平与SPC患者年龄密切相关,较年轻患者的Ki-67表达水平显著高于年老组,而年轻SPC患者中Ki-67高表达的预后意义还有待进一步深入研究.

目的 探讨围产期胎儿胼胝体发育不全病因及发病机制.方法 采用超声及MRI检查胎儿胼胝体病发育不全者205例,对胎儿尸体解剖确诊胎儿胼胝体异常者14例进行分析.结果 205例胼胝体异常患者,超声检查发现胼胝体发育不良142例,胼胝体缺如63例;MRI诊断胼胝体发育不良113例,胼胝体缺如92例;染色体检查有9例存在染色体拷贝数变异;14例尸体解剖存在胝体发育不良9例,5例胼胝体缺如.结论 在超声诊断及MRI结合有助于胼胝体发育不全或缺失的筛查,胎儿尸体解剖对胼胝体异常诊断提供有利依据,具有重要的临床诊断价值.

通过分析4例雄激素不敏感综合征(androgen insensitivity syndrome,AIS)的临床病例特点、鉴别诊断、治疗及预后,综合复习相关文献.4例患者均为完全型AIS,年龄15～33岁,其中2例存在性腺肿瘤,均位于腹腔,肿瘤类型包括精原细胞瘤、Sertoli-Leydig细胞肿瘤(高分化)及纤维瘤(1例),Sertoli细胞腺瘤(1例).所有患者均行性腺切除手术.AIS的诊断需要结合临床特征、影像学检查及染色体核型分析等方面综合考虑.

目的 探讨肾上腺畸胎瘤的临床病理及免疫表型特征.方法 对3例肾上腺畸胎瘤进行临床病理观察,行CK、WT-1、S-100、Syn、CgA、CD56、CD99、MyoD1、desmin、CD34、Ki-67免疫组化标记并随访,并复习相关文献.结果 患儿3例,均为孕产检查中发现肾上腺肿瘤.肿物切面囊实性,镜下肿瘤实性,表面被覆复层上皮,其内见较多软骨及钙化成分,偶见淋巴细胞及少许神经纤维.其中1例镜下另见幼稚的软骨、横纹肌、神经上皮和原始神经管.成熟性畸胎瘤WT-1、Syn、CK、CgA、MyoDl、desmin、CD34血管呈阳性,CD56、S-100、CD99均阴性,Ki-67增殖指数5％,未成熟性畸胎瘤Ki-67增殖指数70％.结论 肾上腺畸胎瘤是一种罕见肿瘤.

Objective To investigate the clinical manifestations and imaging and pathological features of intradiaphragmatic extralobar pulmonary sequestrations(IDEPSs),and to improve clinician and pathologist understandings about the disease. Methods The clinical and imaging data of 28 children diagnosed with IDEPSs by operation and pathology in Guangdong Provincial Maternal and Child Health Hospital were retrospectively analyzed,and the pathological analysis was performed. Results The average age of the 28 patients was(4±0.9)months old. The clinical manifestations were not specific. The CT findings were intradiaphragmatic solid or cystic-solid masses. Abnormal blood supply in the arteries of systemic circulation was found in 25 patients(89.3%). The histopathological examination showed disordered structure of lung tissues and malformation of thick-walled vessels in interstitial tissues,with chronic inflammatory changes,including 5 (17.9%) cases complicated with congenital intrapulmonary airway malformation. Conclusion The clinical symptoms of IDEPSs are barely characteristic. CT scan is an important tool for its preoperative diagnosis,whereas postoperative histopathology may provide definite evidence for the confirmed diagnosis.

目的：探讨超声引导下细针抽吸细胞学（ FNAC）在诊断乳腺癌腋窝淋巴结转移中的临床应用价值。方法回顾89例乳腺癌患者，分析超声判断腋窝淋巴结异常者行腋窝淋巴结FNAC的检查结果，并与手术后病理检查对比分析，评价超声及FNAC判断乳腺癌腋窝淋巴结转移的敏感度、特异度、准确度、阳性预测值、阴性预测值。结果89例超声影像学腋窝淋巴结异常的乳腺癌患者FNAC阳性率60.7％，阴性率为39.3％。其中43例腋窝淋巴结FNAC后行手术治疗患者的淋巴结阳性率46.5％；21例淋巴结纵横径比值（ L／T）＜1.7患者转移率为95.2％，高于L／T≥1.7患者的63.6％，两者差异有统计学意义；FNAC判断乳腺癌腋窝淋巴结转移的敏感度为55.9％（19／34）、特异度为88.9％（8／9）、准确度为62.8％（27／43）、阳性预测值为95％（19／20）、阴性预测值为34.8％（8／23）；其中腋窝淋巴结L／T＜1.7患者FNAC敏感度为75％（15／20）， L／T≥1.7患者敏感度为28.6％（4／14），两者差异有统计学意义。结论超声及FNAC判断乳腺癌腋窝淋巴结转移具有一定的临床价值；腋窝淋巴结L／T＜1.7时FNAC敏感度更高。

目的 探讨乳腺化生性癌(MBC)的临床病理特征、免疫组化及鉴别诊断,为临床诊断及治疗提供依据.方法 回顾性分析2003-2014年间广东省妇幼保健院经手术和病理检查确诊的MBC 8例,讨论其组织起源、病理特点、鉴别诊断及治疗与预后.结果 8例患者年龄33 ～58岁(平均44岁),肿瘤直径1～5 cm.3例伴软骨肉瘤样化生,3例为鳞状细胞癌,1例同时伴有软骨肉瘤和鳞状细胞癌化生,1例为肌上皮癌亚型.8例中2例伴有腋窝淋巴结转移.结论 MBC罕见,不易明确诊断,预后较差,ER、PR和HER-2多呈(-).目前治疗主要是手术和放疗.因此,进一步理解MBC的病理学和生物学特点对于该病的诊断及治疗具有重要意义.

Purpose To investigate the clinicopathological characteristics and differential diagnosis of spindle cell rhabdomyosarcoma ( SCRM) . Methods Three cases of SCRMs were analyzed by gross examination, microscopy and immunohistochemistry. Relevant lit-eratures were reviewed to summarize the diagnostic features of SCRM and its differential diagnosis. Results All the 3 cases were male infants aged from 2 days to 4 years. 2 cases were located in paratesticular and 1 in back. Tumors were all well-circumscribed but unen-capsulated, with white-gray cut surface, firmed and sized 2. 0 to 6. 0 cm in diameter. Histologically, tumors displayed invasive growth but were well-circumscribed. Tumor cells were spindle to round with eosinophilic cytoplasm and fascicular, storiform, wavy appear-ance. Horizontal structure and striated muscle brood cells were observed in some cells or local regions. A small amount of collagen fi-brils were observed in the mesenchymal components. The nucleus were long or fine wavy with unconspicuous nuclear atypia, mitosis could be occasional observed. Immunohistochemically, tumor cells were positive for vimentin, desmin, myogenin and MyoD1. CK,α-inhabin, AFP, CD34 and S-100 were negative. Conclusions SCRM is a rare and new type of rhabdomyosarcoma that commonly oc-curred in infant. It should be differentiated from other tumors, such as infantile fibromatosis, congenital fibrosarcoma, fibrosarcoma, leiomyosarcoma, triton tumor, malignant melanoma of promoting the fibrous tissues.

Increasing evidence has demonstrated that changes in plasma nuclear matrix proteins are specific markers of cancer. Furthermore, proteomic analysis has revealed that calponin-h2 is upregulated in human breast cancer tissue, but is absent in healthy and benign controls. However, the roles of levels of plasma calponin-h2 in the diagnosis of breast cancer and its association with clinicopathological parameters remain to be elucidated. In the present study, the plasma levels of calponin-h2 in patients with breast cancer, benign breast disease and in healthy controls were examined using an enzyme-linked immunosorbent assay. The expression levels of calponin-h2 in invasive breast cancer and normal breast tissues were measured using immunohistochemistry. Statistical analyses examined the association between the levels of plasma calponin-h2 and clinicopathological parameters. The results demonstrated that the plasma level of calponin-h2 in breast cancer was significantly higher than those in the healthy control and benign breast disease groups (P<0.05). The combination of calponin-h2, carcinoembryonic antigen, carbohydrate antigen 15-3 improved the diagnosis of breast cancer. The plasma levels of calponin-h2 PR-breast cancers was significantly higher, compared with PR+ breast cancers (P=0.033), and the plasma levels of calponin-h2 in patients with breast cancer aged >50 years was significantly higher than in patients ≤ 50 years of age (P=0.001). No association was found between the level of plasma calponin-h2 and other clinicopathological parameters of breast cancer. Taken together, these results indicated that calponin-h2 may be a useful marker of breast cancer.

Objective:To compare the clinicopathologic and ultrasonographic characteristics of patients with Luminal A and Luminal B breast carcinoma. Methods: Clinicopathologic and ultrasonographic features of 97 patients with Luminal A and 54 patients with Luminal B breast carcinoma confirmed by pathology and immunohistochemical assay were analyzed retrospectively. Results:Luminal B breast carcinoma was associated with higher cancer grading ( P= 0. 007 ), more pronounced lymph node metastasis ( P= 0. 027 ), unclear boundaries (P=0.039), microcalcification (P=0.016) and higher blood supply (P=0.011) compared with Luminal B breast carcinoma. Conclusion: Luminal A and Luminal B breast carcinomas differ considerably in terms of clinicopathologic and ultrasonographic features and has a role in guiding prognostic evaluation and establishing therapeutic protocols.

Objective To investigate the correlations of microinvasion( MI) with other clinicopathologic parameters in the patients with breast ductal carcinoma in situ( DCIS). Methods The clinical data of totally 131 patients with DCIS treated in our hospital from October 2006 to October 2012 were retrospectively analyzed. Spearman correlation analysis was applied to detect the correlation between DCIS-MI,lymph node metastasis and pathologic grades. Fisher's exact test was used to detect the correlation between DCIS-MI and lymph node metastasis,and analyze the influence of operation methods,pathologic grades,DCIS-MI and axillary lymph node dissection on recurrence. Results( 1) In 131 cases of DCIS,there were 60 cases in low grade of DCIS( 45. 8%),60 in intermediate grade( 45. 8%) and 11 in high grade( 8. 4%). The microinvasion was found in 12,31 and 8 cases in each pathologic grade respectively,which implied that DCIS-MI was correlated with pathologic grades( r = 0. 375,P = 0. 000).( 2) Seventy-six patients received sentinel lymph node biopsy and lymph node metastasis was found in 3 cases; 56 patients received axillary lymph node dissection and lymph node metastasis was found in 5 cases. The incidence of axillary lymph node metastasis was related with DCIS-MI( P=0. 015),but not correlated with pathologic grades( r=0. 154,P=0. 107).( 3) During the follow-up of 3-72 months,1 case died of apoplexy,3 cases experienced a local recurrence and none died of breast cancer. The recurrence of DCIS was not related with operation methods,pathologic grades,DCIS-MI and axillary lymph node dissection( P = 0. 359,1. 000,1. 000,0. 260). Conclusion The patients with higher pathologic grades of DCIS have a higher risk of DCIS-MI; the patients with DCIS-MI have a higher risk of axillary lymph nodemetastasis.