目的 回顾性分析乳腺导管原位癌(DCIS)患者的临床病理资料,探讨伴微浸润的DCIS中肿瘤浸润淋巴细胞(TILs)的分布情况.方法 74例乳腺DCIS患者作为研究对象,不伴微浸润的DCIS(pure-DCIS)共42例作为对照组,伴微浸润的DCIS(mi-DCIS)32例作为实验组,分析其临床病理资料及TILs分布的差异,并进一步对mi-DCIS组原位癌及微浸润区域的TILs密度进行对比.结果 400倍高倍镜下,mi-DCIS组热点区域及平均值区域TILs百分比分别为57.50(18.75,80.00)％,8.00(5.00,15.00)％,pure-DCIS组分别为5.00(1.00,16.25)％,1.00(1.00,5.00)％,无论是热点区域还是平均值,mi-DCIS组TILs百分比均高于pure-DCIS组(P均<0.001).mi-DCIS组中微浸润灶处平均TILs比例为15.00(5.00,50.00)％,高于原位癌区域8.00(5.00,15.00)％,差异有统计学意义(P=0.004).结论 相较于pure-DCIS,mi-DCIS中TILs的分布密度明显增高;mi-DCIS中,微浸润灶处TILs的分布情况较整体有上升的趋势.

[目的]大脑淋巴瘤病(LC)是中枢神经系统淋巴瘤(PCNSL)的特殊类型,目前报道较少,预后较其它类型的PCNSL差,早期诊断对判断预后十分重要.本文报道经脑立体定向活检明确病理的大脑淋巴瘤病3例,以提高临床医师对大脑淋巴瘤病的认识.[方法]回顾性分析2017年1月-2020年7月间,中山大学附属第三医院岭南医院确诊为大脑淋巴瘤病3例患者的临床表现、影像学、神经病理特征.[结果]3例患者分别为44、61和64岁男性,出现进展性认知下降、视物模糊、下肢乏力等神经功能障碍表现,脑部核磁共振(MRI)发现双侧大脑弥漫性脑白质病变,表现为长T1长T2信号影,T2液体衰减反转恢复序列(T2-FLAIR)呈高信号,弥散加权序列(DWI)不均匀稍高,增强扫描强化不明显,经立体定向穿刺脑组织活检取材,镜下可见弥漫性B细胞浸润,CD20(+),结合影像学特征,均确诊为B细胞来源的大脑淋巴瘤病.[结论]大脑淋巴瘤病为中枢神经系统淋巴瘤的特殊类型,影像诊断困难,极易误诊,对于双侧大脑半球弥漫性病变、同时累及深部脑白质和灰质结构、无强化或小斑片状强化为影像学表现的患者,注意与此病相鉴别,尽早病灶活检,明确病理诊断,对患者的早期诊断及预后具有重要意义.

目的 探讨超声引导下同轴套管针穿刺活检联合超声造影在肝脏占位性病变中的应用价值.方法 回顾性分析2018年3月至2019年3月在中山大学附属第三医院采用超声引导下同轴套管针穿刺联合超声造影行肝脏肿物穿刺活检的165例患者临床资料.其中男109例,女56例;平均年龄(56±11)岁;病灶直径(3.4±1.2)cm.患者均签署知情同意书,符合医学伦理学规定.采用超声引导下同轴套管针穿刺联合超声造影进行肝脏肿物定位穿刺活检.观察穿刺和取样情况、病理诊断、穿刺后并发症等指标.结果 同轴套管针一次穿刺可多点、多次、多方向取样.穿刺成功率100％(165/165),平均取样次数为3～4次.病理结果确诊率为100％(165/165),其中肝细胞癌98例,胆管细胞癌12例,炎性假瘤3例,上皮源性肿瘤2例,结核2例,结节性肝硬化9例,转移瘤18例,海绵状血管瘤3例,肝腺瘤5例,炎症性改变5例,局灶性结节性增生6例,胆管错构瘤1例,透明血管型Castleman病1例.穿刺后并发症包括局部轻度疼痛,发生率33.9％(56/165);出血,发生率0.6％(1/165).结论 超声引导下同轴套管针穿刺联合超声造影进行肝脏肿物穿刺活检操作简单易行,能清晰显示穿刺目标,辨认病灶活性,且可一次穿刺,多点取材,穿刺成功率高,并发症发生率低,具有较高临床应用价值.

High-volume metastatic hormone-sensitive prostate cancer refers to primarily patients with a high burden of disease including the presence of visceral metastases or at least 4 bone metastases and at least one bone metastasis outside the spine or pelvis. In this case, on the basis of docetaxel combined with endocrine therapy, cytoreductive prostatectomy was performed after bone metastases were effectively controlled. Comparing preoperative puncture pathology and postoperative pathology, the primary lesions were considered to achieve pathological complete response.

目的 探讨肝婴儿型血管内皮瘤(IHHE)转变为血管肉瘤的可能性及肝移植手术时机的选择.方法 回顾1例有IHHE病史且行肝移植术后发现肿瘤恶变为血管肉瘤患儿的临床特点、病理特征,分析IHHE及血管肉瘤的组织形态、免疫组织化学表达特征.以"肝移植""肝婴儿型血管内皮瘤""血管肉瘤"及"临床病理"为检索词(包括中英文),对生物医学文献数据库(PubMed)、中国生物医学文献服务系统(SinoMed)、中国期刊全文数据库(CNKI)、万方数据知识服务平台、维普中文科技期刊数据库进行检索,收集并分析检索到的IHHE恶变为血管肉瘤的资料.结果 该例为4岁男性患儿,IHHE综合治疗后2年余,因腹胀、身目黄染就诊.MRI显示肿瘤复发,遂行"同种异体原位移植术".病理活组织检查见肿瘤由2种结构构成,部分为典型血管肉瘤,部分区域则表现为婴儿型血管内皮瘤的形态特征,但组织结构更为复杂,且细胞异型性较普通的IHHE大,2种不同类型结构区域之间可见移行过渡.患儿病情重,于肝移植术后第17日死于肺部感染及心力衰竭.文献复习的3例IHHE转为血管肉瘤患儿经类固醇、IFN或化学治疗等治疗后,均因病情加重死亡.结论 IHHE可恶变为血管肉瘤,故应对患儿作长期随访,及时正确诊断,给予合理化治疗,肝移植手术的具体时机须由临床及病理医师共同商榷,是否应放宽移植的手术指征以期获得更好的预后值得讨论.

目的 探讨2型糖尿病患者下肢动脉超声结果与颈动脉超声结果的相关性,及两者与心脑血管疾病(CCVD)的相关性.方法 选择338例2型糖尿病患者为研究对象,以问卷调查方式收集基本信息,并进行体格测量、生化检查和下肢动脉、颈动脉超声检查,对收集的信息进行横断面分析.结果 Gamma相关性分析显示,下肢动脉病变与颈动脉病变有关(Gamma=0.602,P<0.001).Logistic回归显示,在校正年龄、病程、高血压病的影响后,颈动脉病变与CCVD相关(OR=2.58,95％CI 1.13～5.89,P<0.05),下肢动脉病变也与CCVD相关(OR=5.34,95％CI 2.34～12.17,P<0.05).结论 2型糖尿病患者下肢动脉病变与颈动脉病变有关,下肢动脉病变等级越高,颈动脉病变等级也越高,且两者均与CCVD的发生相关.

目的 探讨卵巢交界性粘液性肿瘤(MBT)伴上皮内癌及反应性肉瘤样附壁结节临床病理特征、诊断及鉴别诊断.方法 回顾本院1例卵巢交界性粘液性肿瘤(MBT)伴上皮内癌及肉瘤样附壁结节患者的临床及影像学资料,分析附壁结节组织形态、免疫组化表达特征并复习相关文献.结果 本院就诊患者女性,24岁,腹部增大伴腹胀3个月.CT显示子宫前方巨大囊实性包块(大小共204×149mm),考虑左侧附件来源病变(囊腺瘤？交界性囊腺瘤？).术后病理示卵巢交界性粘液性肿瘤伴上皮内癌及内瘤样附壁结节.结论:MBT中的附壁结节很少见,同时伴有上皮内癌的则更为罕见,此时附壁结节的性质易造成误诊,需要充分认识,避免过度治疗.

Objective: To investigate the value of stereotactic biopsy in the accurate diagnosis of lesions in the brain stem and deep brain. Methods: A total of 29 consecutive patients who underwent stereotactic biopsy of brainstem and deep brain lesions between May 2012 and January 2018 were retrospectively reviewed. The Cosman-Roberts-Wells (CRW) stereotactic frame was installed under local anesthesia. Thin-layer CT and MRI scanning were performed. Target coordinates were calculated by inputting CT-MRI data into the radionics surgical planning system. The individualized puncture path was designed according to the location of the lesions and the characteristics of the image. Target distributions were as follows: 12 cases of midbrain or pons, 2 cases of internal capsule, 3 cases of thalamus, 12 cases of basal ganglia. The biopsy samples were used for further pathological and/or genetic diagnosis. Results: Twenty-eight of the 29 cases (96.6%) were diagnosed accurately by histopathology and genomic examination following stereotactic biopsy. Pathological results were as follows: 8 cases of lymphoma, 7 cases of glioma, 4 cases of demyelination, 2 cases of germ cell tumor, 2 cases of metastatic tumor, 1 cases of cerebral sparganosis, 1 case of tuberculous granuloma, 1 case of hereditary prion disease, 1 case of glial hyperplasia, 1 case of leukemia. The accurate diagnosis of one case required a combination of histopathology and genomic examination. Undefined diagnosis was still made in 1 cases (3.45%) after biopsy. After biopsy, there were 2 cases (6.9%) with symptomatic slight hemorrhage, 1 case (3.45%) with symptomatic severe hemorrhage, and 1 cass (3.45%) with permanent neurological dysfunction. No one died because of surgery or surgical complications. Conclusions: Stereotactic biopsy is fast, safe and minimally invasive. It is an ideal strategy for accurate diagnosis of lesions in brain stem and deep brain.