根据国务院和国家卫生健康委员会对医院信息化建设的指导意见,在病理检查流程中,将语音识别技术与病理信息系统紧密结合,通过智能语音识别技术优化信息处理流程,进一步提升病理业务智能化管理效率,最终达到减负增效的目的.调研病理科室工作场景、工作流程和工作习惯,寻找痛点,梳理语音识别技术应用于病理业务的研究路线和方法,结合现有病理信息系统,开发智能病理语音方案,实现病理业务的语音控制、语音录入、语音复核.智能病理语音方案在中日友好医院病理科取得了可观的效果,其识别准确率达97％,使用量持续增长.智能病理语音录入方案的引入,将人工智能技术与病理信息系统融合,优化病理业务流程,提升病理科智能化水平,提高相关工作人员的工作效率.

Objective. The present study aimed to explore the clinicopathological characteristics, potential heterogeneity and prognostic factors in synchronous bilateral breast cancer (SBBC). Methods. We performed a retrospective review and paired comparison of the clinicopathological characteristics of 114 patients with SBBC in the Peking Union Medical College Hospital from January 2008 to September 2019. The prognostic significance of triple negativity status and coexistence ductal carcinoma in situ (DCIS) with bilateral invasive ductal carcinomas of no special type (IDC-NST) was analyzed in SBBC. Results. Most bilateral lesions on both sides were of IDC-NST, grade 2, luminal subtype, and stage I. Although most lesions were concordant between the left and right side, discordances were observed in histological type (25 cases, 21.9%), histological grade (31 cases, 27.2%), pTNM (61 cases, 53.5%), molecular subtypes (20 cases, 17.5%), and immunohistochemical staining of ER (18 cases, 15.8%), PR (26 cases, 22.8%), and HER2 (12 cases, 10.5%). Moreover, there was no significant difference in disease-free survival (DFS) and overall survival (OS) between IDC-NST with coexisting DCIS on both sides and IDC-NST with coexisting DCIS on one side or pure IDC-NST. SBBC with triple negativity on both sides exhibited a significantly shorter DFS and OS when compared with triple negativity on one side or non-triple negativity on both sides (p<0.001), and remained an independent prognostic factor by multivariate analysis. Conclusions. A considerable proportion of discordance in clinicopathological characteristics is observed in SBBC, supporting the necessity of comprehensive pathological examination including immunohistochemical testing on both sides in clinical practice. Moreover, SBBC with triple negativity on both sides is a prognostic for poor survival.

目的 探讨同时性双侧乳腺癌(SBBC)和异时性双侧乳腺癌(MBBC)临床病理特征的一致性及对预后的影响.方法 回顾性分析北京协和医院2010年10月至2020年12月收治140例双侧乳腺癌(BBC)患者的临床资料.根据两侧肿瘤发病间隔时间将患者分为MBBC组(39例)和SBBC组(101例).收集患者的初诊年龄、乳腺癌家族史、手术方式、肿瘤直径、淋巴结转移情况、TNM分期、组织学类型、组织学分级、雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体2(HER-2)表达情况和Ki-67指数等临床和病理资料.比较SBBC组与MBBC组患者的初诊年龄和乳腺癌家族史,两侧肿瘤分子亚型的分布情况、临床病理特征的一致性情况及对BBC患者总生存期的影响.结果 MBBC组初诊年龄小于SBBC组[(48±11)岁比(54±13)岁],MBBC 组第一癌 TNBC 型比例高于 SBBC 组[30.8％(12/39)比 12.9％(13/101)](均P＜0.05).SBBC组第一癌和第二癌肿瘤组织学分级、ER和HER-2表达情况的一致率均高于MBBC组[69.3％(70/101)比46.2％(18/39)、85.1％(86/101)比56.4％(22/39)、89.1％(90/101)比69.2％(27/39)](均P＜0.05).多因素分析结果表明,双侧肿瘤TNM分期均为Ⅲ期(比值比=60.391,95％置信区间:2.101～1 735.475)、双侧为TNBC型(比值比=23.057,95％置信区间:5.671～93.746)或一侧为TNBC型(比值比=4.643,95％置信区间:1.030～20.934)均为BBC患者总生存期的危险因素(均P＜0.05).结论 与SBBC组比较,MBBC组患者更年轻,分子亚型TNBC比例更高,双侧肿瘤分子亚型的一致性较低;双侧TNM分期均为Ⅲ期以及双侧或一侧分子亚型为TNBC型均为BBC患者总生存期的危险因素.

患者女性,65岁,因左乳疼痛半年余,以左乳肿物性质待查于2019年11月收入中日友好医院.查体:左乳外上象限触及质硬肿物,大小约3cmx2cm,界欠清,活动度欠佳.超声检查:左乳见一低回声结节,形态欠规则,大小约2cm×1.7cm×1.3cm. 病理检查:肉眼观察术中送检乳腺组织一块,大小4cm×3.5cm×2cm,切面见一灰粉色实性肿物,大小2cm×2cm×1.5cm,质硬、界欠清(图1,见封底).术中冰冻病理诊断:乳腺浸润性癌,倾向腺样囊性癌.遂行左乳改良根治术.

患者男性,15岁,2019年4月劳累后出现腰痛,活动后加重,休息可缓解,行走、起床困难,无昼夜规律,2020年4月上述症状加重,查血常规:白细胞、血小板正常,HGB 119g/L;CRP 7.17mg/dl(0～0.8),ESR 54mm/h (0～15).随后四肢及头部出现散在鲜红色皮疹.2020年7月无明显诱因出现右侧胸痛及背痛,伴间断发热,最高体温38.6℃.2020年10月因肺部感染就诊于中日友好医院呼吸与危重症医学科.入院后查外周血,结核感染的T淋巴细胞斑点试验T-SPOT(-),抗核抗体谱+类风湿关节炎抗体谱+血管炎抗体谱均为(-),HLA-B27(-).

卵巢微囊性间质肿瘤是一种罕见的肿瘤,具有独特的形态学特征及免疫表型,生物学行为倾向于良性.本文报道北京协和医院于2018年6月收治的1例卵巢微囊性间质肿瘤患者,积极进行手术治疗后,经过18个月随访,目前患者一般状态良好,无特殊不适,无复发或转移迹象.现探讨卵巢微囊性间质肿瘤的临床病理学特征、免疫表型及鉴别诊断,为广大医学研究者和临床工作者提供资料和参考.

患者,女,29岁.因“体检发现甲状腺结节1年余”入院.专科查体:甲状腺右叶下极近气管旁可触及一直径约2.0cm结节,结节表面光滑,质硬,无触痛,活动度良好,可随吞咽活动;颈部未触及明显肿大淋巴结.甲状腺听诊区、颈动脉听诊区未闻及明显血管杂音;甲状腺及颈部淋巴结超声提示:甲状腺右叶下极见低回声,大小约2.3cm×1.6cm×1.6cm,形态欠规则,部分边界不清,内回声不均,内见少许无回声,另可见多处点状强回声;CDFI:周边见短条状血流信号,内部见血流信号穿入.气管旁见数个低回声淋巴结,较大者位于右侧气管旁,大小约1.1 cm×0.6 cm,皮髓质分界不清,内可见多个点状强回声,部分后伴彗星尾,入院后行甲状腺癌根治术(双侧甲状腺全部切除+第Ⅵ区淋巴结清扫);术中探查腺体:右叶下极可探及直径约1.5 cm结节,质硬,未侵出被膜;切除结节送冷冻病理,结果“(右侧)甲状腺乳头状癌”.

胃肠道透明细胞肉瘤(clear cell sarcoma of gastrointestinal tumour,CCS-GT),是一种罕见的恶性肿瘤,目前文献报道不足百例,只有少数文献对其病理学特征和免疫组织化学表型进行了总结,但在超声等影像学检查方面描述有限.本文报告一例具有详细临床病理资料的回肠透明细胞肉瘤,并复习相关文献,以提高我们对该疾病的认识.

e12582 Background: After primary surgical resection, quite a proportion of breast cancer survivors would experience local recurrence within 5 years. Whether local recurrent tumors arise independently or from the primary tumors, which is critical for diagnosis and appropriate treatment, remains a clinical dilemma. Phylogenetic analysis between the primary and recurrent tumor provides a new strategy helpful for determining the origin of the local recurrent tumor. Methods: DNA was extracted from FFPE samples of the primary and recurrent tumors from 12 patients with recurrence of ipsilateral breast tumor. Phylogenetic analysis between the primary and recurrent tumors in the same individual was performed based on whole exome sequencing. PyClone and SciClone were employed to detect subclones. Results: The median time to recurrence of the 12 patients was 15 months (9 to 52 months). 9 (75%) of the 12 patients recurred within 2 years. Each patient had one shared somatic mutation clone between the primary and recurrent tumor, with shared somatic mutation number ranging from 5 to 59. This observation suggests that the recurrent tumor maybe originate from the primary tumor. Conclusions: The shared somatic mutation clone indicates the primary and recurrent tumor could be of the same origin and the recurrent tumor was metastasis from primary lesion. This may provide some information to help selecting the most appropriate treatment for patients.

乳腺是人体的成对器官,受到同样的内分泌或其他致癌因素的影响,双侧乳腺之间又有淋巴交通,这使得双侧乳腺可以同时或者异时发生乳腺癌.双侧乳腺癌是指两侧乳腺都发生原发性癌;两侧乳腺癌发生时间间隔小于6个月称为同时性双侧乳腺癌( synchronous bilateral breast cancer, SBBC),而超过6个月出现对侧乳腺癌,则认为是异时性双侧乳腺癌(metachronous bilateral breast cancer, MBBC).