ObjectiveTo investigate the expression and clinical significance of GATA-3 and H3K27me3 in Tibetan patients with bladder urothelial carcinoma (BUC).MethodsBUC and normal bladder tissues were collected retrospectively from January 2016 to December 2021 in the People's Hospital of Tibet Autonomous Region. The expression of GATA-3 and H3K27me3 in both tissues was detected by immunohistochemical method, and the clinical and pathological characteristics were statistically analyzed.ResultsA total of 70 patients with BUC were selected, including 51 males and 19 females, with an average age of (60.5±12.0) years. At the same time, 20 normal bladder tissue samples were collected during the same period. All cases were Tibetan patients. Immunohistochemistry results showed that the high expression rate of GATA-3 in BUC and normal bladder tissue was 70.0%(49/70) and 100%(20/20), respectively. High expression of GATA-3 was associated with male, low pathological grade, and non-invasive tissue(all P < 0.05). The high expression rate of H3K27me3 in BUC and normal bladder tissue was 45.7%(32/70) and 20.0%(4/20), respectively. High expression of H3K27me3 was only associated with male (P=0.011).ConclusionsThe expression of GATA-3 was down regulated in Tibetan BUC patients, and significantly down regulated with the increase of tumor grade, suggesting that GATA-3 may be involved in the occurrence and development of BUC and related to its malignancy, providing reference for clinical diagnosis and treatment as well as judging disease prognosis. The expression of H3K27me3 in Tibetan BUC patients was higher than that in normal bladder tissue, suggesting that H3K27me3 may be a new immune marker for diagnosis of BUC.

目的 探讨Ber-EP4免疫组化染色在皮肤基底细胞癌中的表达及在鉴别诊断中的意义.方法 收集本院近3年来病理确诊皮肤基底细胞癌患者20例作为研究组,并收集同时期病理确诊的其他皮肤病变35例作为对照组,全部病例均行常规苏木精-伊红染色和免疫组化Ber-EP4染色,并观察组织病理表现及免疫组化表达结果.结果 研究组均可见肿瘤细胞与表皮基底部相连,均成团、巢或条索排列,细胞大小较一致、核质比增高,周边细胞呈栅栏状排列,可见核分裂象;免疫组化方面:研究组18例(90.0％)Ber-EP4呈阳性表达,其中2例为复发病例;对照组中7例(20％)Ber-EP4呈阳性表达,其中鳞癌和脂溢性角化病全部阴性.两组差异有统计学意义(P＜0.01).结论 Ber-EP4对于皮肤基底细胞癌的诊断有一定价值,有助于基底细胞癌与皮肤鳞癌、脂溢性角化病的鉴别诊断.

目的 探讨西藏高原地区改良苏木精-伊红(Hematoxylin-eosin,HE)病理染色技术在病理诊断中的应用和效果.方法 选取我院2014年5月～2015年4月期间病理诊断的切片500例为常规组,选取2019年2月～2020年1月期间病理诊断的切片500例为改良组,全部病理切片均进行HE染色.常规组采用常规HE病理染色技术,改良组采用改良HE病理染色技术,在光镜下观察两种病理染色技术的染色效果并进行评估效果.结果 改良组染色合格率为94％,常规组为70％,两组差异具有统计学意义(p＜0.05);改良组切片合格率为92.00％,常规组62.67％,两组差异具有统计学意义(p＜0.05).结论 改良组HE病理染色技术提高了高原地区病理切片染色合格率,更加有助于病理诊断,值得推广和应用.

1 病例简介 患者女性,藏族,56岁.主因"无明显诱因出现左侧大腿包块2年,加重1月".患者于2年前发现左侧大腿包块,局部发硬,疼痛不明显,给予口服药对症治疗,无明显好转.1月前因包块增大于当地医院住院.患者既往无明确外伤史.入院查体发现左下肢局部肿块,大小15x10cm,质硬,无移动,周围皮肤无发红,触痛及压痛不明显,左侧膝关节及远端活动及感觉良好.左侧胫骨CT示;左侧大腿中远端软组织内高密度团块影,考虑为晚期骨化性肌炎可能.病理切片:成骨及成软骨病变,部分区域纤维组织增生,局灶细胞增生活跃,不除外皮质旁骨肉瘤可能.入院影像学检查显示左侧股骨下段周围见团块致密影,大小约17.1×10.0cm,境界不清,与左股骨下段分界不清,邻近骨皮质增厚,髓腔内见斑片密度增高影(图1).行左侧大腿包块切除术手术,术中所见:皮下深筋膜见肿块,无明显包膜,肿块表面大部区域较光滑,大小约16×17cm,质地较硬,肿块两端质地相对较软,边界不清;包块与股骨远端皮质相连,部分骨皮质变薄.因肿块无法完整切除,手术切除肿块三分之二送病理检查.病理诊断:病变符合皮质旁骨肉瘤.

Objective To investigate the expression and its significance of H3K27me3 in Tibetan patients with gastric cancer. Methods Clinical and pathological data were retrospectively collected from Tibetan patients with gastric cancer in the Tibet Autonomous Region People's Hospital from August 2019 to August 2021 and Tibetan non-gastric cancer patients during the same period. The expression of H3K27me3 in gastric cancer tissues, corresponding adjacent normal gastric mucosa and normal gastric mucosa of Tibetan patients with non-gastric cancer tissues was detected by immunohistochemical method, and the differences of H3K27me3 expression between gastric cancer patients with different clinical and pathological characteristics was compared. Results A total of 54 Tibetan gastric cancer patients and 55 Tibetan non-gastric cancer patients who met the inclusion and exclusion criteria were enrolled. H3K27me3 was localized in the nucleus, and the nucleus showed brownish-yellow granular staining when positively expressed. The high expression rate of H3K27me3 in gastric cancer tissues was significantly higher than that in adjacent normal gastric mucosa tissue[64.8%(35/54) vs. 29.6%(16/54), P < 0.001]and normal gastric mucosal tissue of Tibetan patients with non-gastric cancer[64.8%(35/54) vs. 34.5%(19/55), P=0.002], and the high expression rate of H3K27me3 in the adjacent normal gastric mucosa tissue was not significantly different from that in normal gastric mucosal tissue of Tibetan patients with non-gastric cancer(P=0.683). H3K27me3 expression in gastric cancer tissues was not related to gender, age, degree of differentiation, depth of invasion, maximum tumor size, Lauren's classification, lymph node metastasis, vascular and nerve invasion and TNM stage. Conclusions H3K27me3 is highly expressed in gastric cancer tissues of Tibetan people in Tibet. There is no significant difference in H3K27me3 positive expression cells in adjacent tissues and normal gastric mucosa. The significance of H3K27me3 in Tibetan patients with gastric cancer is uncertain and requires further investigations.

目的:探讨免疫组织化学染色D2-40及生长抑素受体2(Somatostatin Receptors 2,SSTR2)在藏族人群脑膜瘤中的表达情况及诊断和鉴别诊断意义.方法:收集2019—2020年期间西藏自治区人民医院病理科存档的34例全部脑膜瘤病例的患者临床及病理资料.34例病例均经SSTR2、D2-40、AR、ER、PR、EMA、GFAP、S-100、Ki-67等免疫组织化学染色.收集同时期病理科存档的15例神经系统间叶源性肿瘤病例(神经鞘瘤12例,孤立性纤维性肿瘤3例)作为对照组,对照组全部病例均经SSTR2、D2-40免疫组化染色.结果:34例脑膜瘤病例中32例为颅内占位,2例为椎管内占位.显微镜下,31例为WHO I级脑膜瘤,3例为WHOⅡ级脑膜瘤.免疫组织化学染色结果显示脑膜瘤组31例(31/34,91.2％)D2-40阳性表达,32例(32/34,94.1％)SSTR2阳性表达;对照组11例(11/15,73.3％)D2-40阳性表达,15例SSTR2均为阴性.SSTR2在脑膜瘤组和对照组的表达差异有统计学意义(P<0.05).结论:SSTR2和D2-40在超过90％的藏族人群脑膜瘤病例中阳性表达,有助于脑膜瘤的辅助诊断.SSTR2有助于脑膜瘤与其他神经系统间叶源性肿瘤的鉴别诊断.

Background Gastric cancer (GC) is a major cause of cancer-related death in China. Immunotherapies based on PD-1/PD-L1 inhibitors have improved the survival of some patients with GC. Epstein–Barr virus (EBV) infection, mismatch repair (MMR) deficiency, and tumor immune microenvironment (TIME) markers (such as CD3, CD8, and PD-L1) may help to identify specific patients who will respond to PD-1/PD-L1 inhibitors. Considering racial heterogeneity, the pattern of TIME markers in Tibetan patients with GC is still unclear. We aimed to identify the prevalence of EBV infection and the MMR status and their association with immune markers in Tibetan GC to aid in patient selection for immunotherapy. Materials and Methods From 2001 to 2015, we retrospectively collected 120 tissue samples from consecutive Tibetan GC patients and constructed tissue microarrays. EBV infection was assessed by Epstein–Barr-encoded RNA (EBER) in situ hybridization, and MMR protein levels were measured. Immune markers (including CD3 and CD8) in intraepithelial, stromal, and total areas were detected by immunohistochemistry (IHC). PD-L1 expression was assessed by the combined positive score (CPS). We also analyzed the relationships of EBV infection and MMR status with immune markers. Results Of the 120 samples, 11 (9.17%) were EBV positive (+), and 6 (5%) were MMR deficient (dMMR). PD-L1 CPS ≥1% was found in 32.5% (39/120) of Tibetan GC patients. EBV infection was associated with higher numbers of CD3+ T cells (P < 0.05) and CD8+ T cells (P < 0.05) and higher PD-L1 expression (P < 0.05). For the limited number of dMMR patients, no significant relationship was observed between dMMR and TIME markers (P > 0.05). Conclusions In Tibetan GC patients, the rates of EBV infection, dMMR, and positive PD-L1 expression were 9.17%, 5%, and 32.5%, respectively. EBV infection was associated with the numbers of CD3+ T cells and CD8+ T cells and PD-L1 expression within the tumor. These markers may guide the selection of Tibetan GC patients for immunotherapy.

目的 总结西藏地区患者经手术切除病理确诊为颅内寄生虫病的临床特征、影像学特点、病理类型及治疗情况.方法 回顾性分析西藏自治区人民医院病理科2014-06-2021-06期间存档的经手术切除的9例颅内寄生虫病病例,收集临床资料,病理切片经光镜下重新阅片,记录病理形态学表现.结果 9例患者,男女比例5:4,年龄9～74岁,均来自农牧区.主要临床表现为间断性头痛、恶心、呕吐等颅内压增高症状.影像学检查5例为颅内单发性占位,4例为多发性占位;病灶最大径2.5～12 cm.4例脑棘球蚴病病例术前诊断可疑寄生虫病,5例脑囊虫病病例术前诊断不明确.9例均手术治疗,其中5例病理诊断为脑囊虫病(3例为脑室型,2例为脑实质型),4例为脑棘球蚴病(3例为脑细粒棘球蚴病,1例为脑泡状棘球期病).8例患者术后好转出院,3例患者有随访资料(平均随访60个月),均无复发,5例患者失访;1例泡状棘球蚴病患者术后病情缓解不明显,随访22个月后死亡.结论 西藏地区采取手术治疗的颅内寄生虫病较少见,其主要病理类型为囊虫病和棘球蚴病.

西藏自治区地处高原,平均海拔超过4000m,气压低且含氧量也低,加上日照时间长、气候干燥、日夜温差大等特点,病理制片技术与平原地区大有不同,很多平原地区的经验在高原地区应用有局限性.近年来,在"组团式"援藏专家的帮扶下,病理诊断与技术水平都有了很大的提升,特别是病理制片技术有了质的飞跃.笔者总结了近年来所在医院的病理技术改进方法,旨在积累经验并提高高原地区病理技术水平.

Objective To analyze the clinicopathological features and immunohistochemical expression of meningiomas in the Tibetan population in Tibet,and improve the understanding of meningiomas. Methods The clinical and pathological data of all the meningiomas diagnosed by pathology in Tibet Autonomous Region People's Hospital from April 2013 to March 2021 were analyzed retrospectively.All the cases underwent immunohistochemical staining of trimethylation of lysine 27 on histone H3 (H3K27me3),mucin 4 (MUC4),somatostatin receptor 2 (SSTR2),progesterone receptor,epithelial membrane antigen,glial fibrillary acidic protein,vimentin,S-100,P53,and Ki-67.The histopathological features and the staining results were observed under a light microscope. Results A total of 116 cases of meningiomas were included in this study,with the male-to-female ratio of 1.0∶2.6 and the age of 4-73 years.The main clinical symptom was headache.The imaging examination showed that 114 cases had single lesions and 2 cases had multiple lesions.The tumors were located in the cranium (108 cases) and spinal canal (8 cases).The maximum diameter of the tumors ranged from 0.3 cm to 10.0 cm,with a mean of (5.7±2.2) cm.In terms of microscopic grading and histological types,the 116 cases included 111 cases of WHO grade Ⅰ (including 53 cases of fibrous type,20 cases of meningothelial type,24 cases of transitional type,10 cases of psammomatous type,etc.),4 cases of WHO grade Ⅱ (3 cases of atypical type and 1 case of clear cell type),and 1 case of WHO grade Ⅲ (papillary type).The immunohistochemical staining showed H3K27me3 expression absent in 9 cases (9/116,7.8%),MUC4 positive in 64 cases (64/116,55.2%),SSTR2 positive in 101 cases (101/116,87.1%).Eighty cases had follow-up results,among which 71 cases had no recurrence,while 9 cases recurred. Conclusions Meningioma is the most common tumor in the central nervous system in the pathological file of Tibet.It mainly attacks the middle-aged female patients,occupying the parasagittal sinus,falx,and convex surface of the brain.Fibrous meningioma of WHO grade Ⅰ is common,while the meningiomas of WHO grades Ⅱ and Ⅲ are rare.The expression degree of MUC4 is higher in meningothelial and transitional meningiomas but lower in fibrous meningiomas.There may be no correlation between the absence of H3K27me3 expression and prognosis.

Objective To investigate the expression of androgen receptor(AR)and its correlations with different molecular subtypes and clinicopathological features of breast invasive carcinoma of no special type(IBC-NST)in females of Tibetan ethnic minority in Tibet.Methods This study enrolled 54 female patients of Tibetan ethnic minority with IBC-NST surgically removed in the Tibet Autonomous Region People's Hospital from December 2015 to March 2021 for retrospective analysis.The clinical and pathological data of all the enrolled patients were collected.The immunohistochemical method was employed to determine the expression of AR,cell proliferation marker antigen (Ki-67),estrogen receptor(ER),human epidermal growth factor receptor 2(HER-2),and progesterone receptor(PR).For those with unclear HER-2 results,fluorescence in situ hybridization was employed for the determination.The relationship of AR expression with molecular subtypes and clinicopathological features was then analyzed.Results The expression of AR in Tibetan female patients with IBC-NST was correlated with ER(χ2=8.200,P=0.004),PR(χ2=9.900,P=0.003),and molecular subtype(χ2=11.690,P=0.009)and not correlated with tumor location,age,size,histological grade,lymph node metastasis,vascular invasion,clinical stage,or expression of HER-2 and Ki-67(all P>0.05).Molecular subtype was correlated with histological grade(χ2=24.970, P=0.001),clinical stage(χ2=9.035, P=0.029),and lymph node metastasis(χ2=9.691,P=0.021).Conclusions The positive expression rate of AR in the triple-negative IBC-NST patients of Tibetan ethnic minority was significantly lower than that in ER-or PR-positive patients in Tibet.Molecular subtype was correlated with histological grade,clinical stage,and lymph node metastasis.

病理切片技术是病理学的重要组成部分,病理诊断受限于病理切片,制作一张标准合格的病理切片是保证病理诊断结果精准的前提,也是临床病理质量控制的重要环节.西藏自治区处于高海拔地区,病理技术的发展面临着比内地更大的挑战.近年来,随着国家医疗"组团式"援藏的深入开展,文章总结近年来西藏自治区病理常规技术质控现状,并提出改进和对策,以促进西藏病理技术的发展,提高西藏病理诊断水平.

目的 探讨附睾乳头状囊腺瘤的临床病理学特征、免疫表型、诊断及鉴别诊断,提高对附睾乳头状囊腺瘤的认识.方法 对西藏自治区人民医院收治的这1例附睾乳头状囊腺瘤的临床资料、影像资料、大体形态、组织结构、免疫组化染色结果进行观察和分析,并结合文献复习.结果 临床检查显示阴囊处无痛性肿块,B超示左侧附睾体可探及中等低回声结节,考虑炎性病变;大体灰红囊性,大小4cm×3cm×2.5cm,包膜完整,切面呈囊性,囊内为暗红色胶样物,边界清;镜下扩张的导管和小囊肿被覆柱状上皮,以纤维血管间质为轴心的乳头状腺样结构,囊腔内可见乳头,囊内见嗜伊红样物质;免疫组织化学标记物染色结果示AE/AE 3(+),EMA(+),Ki-67(index1％),P53(-),MC(-),Calretinin(-),CD 10(-).结论 附睾乳头状囊腺瘤罕见,可伴有VH L综合征,确诊主要靠病理形态学特征结合免疫组化表型综合判断.

Objective To investigate the clinicopathological features and immunohistochemical phenotypes of brain metastatic carcinoma in Tibetan patients. Methods The clinical and pathological data of all patients with brain metastases from 2014 to 2020 in Tibet Autonomous Region People's Hospital were retrospectively analyzed,including 13 cases of brain metastatic carcinoma.All cases were diagnosed and classified by immunohistochemical staining. Results 13 cases(9 males and 4 females)of brain metastatic carcinoma,aged 26-62 years old,present with headache,dizziness,nausea and vomiting clinically.Four patients had a medical history of tumor,and among the 9 patients with no history of tumor,7 present space occupying lesions in both the brain and other organs.Imaging data could be found in 10 cases,including 4 cases of single lesion and 6 cases of multiple lesions.Primary tumors were identified in 11 cases(8 located in the lung,including 4 cases of adenocarcinoma,3 cases of small cell carcinoma,and 1 case of squamous cell carcinoma;1 case of urothelial carcinoma of the renal pelvis;1 case of thyroid papillary carcinoma;1 case of uterine choriocarcinoma),whereas the primary tumor was unknown for the other 2 cases(1 case of small cell carcinoma and 1 case of adenocarcinoma). Conclusions Brain metastatic carcinoma are more common among middle-aged and elderly people in Tibet.Most of the cases have no history of tumor,with the initial site at the brain metastatic lesions.The most common primary site is the lung,and the primary site of some cases is unknown.Multiple lesions are common in brain metastatic carcinoma,especially in the cerebral hemisphere.For older patients with multiple brain space occupying lesions,the possibility of brain metastatic carcinoma increases.

目的 观察结肠血管脂肪瘤的临床,影像及病理学特征,提高对结肠血管脂肪瘤的认识.方法 对西藏自治区人民医院收治的这例结肠血管脂肪瘤的临床资料及病理特征进行回顾分析.结果 结肠血管脂肪瘤临床无特异性症状,CT示:升结肠至结肠肝曲肠壁呈环形增厚,横结肠右侧类圆形脂肪密度影;大体肿块实性、灰黄、质软;镜下:见成熟脂肪细胞及增生毛细血管.结论 血管脂肪瘤是常见的良性肿瘤,发生在结肠者少见,术前诊断主要依据影像及内镜检查,病理检查是明确诊断的最可靠指标.

目的:对比自然低氧分压环境(青藏高原)和普通氧分压环境(华北平原)中恶性黑素瘤(恶黑)患者肿瘤组织中缺氧诱导因子(HIF)-1α和HIF-1β的表达差异.方法:收集2008-2017年青藏高原46例藏族恶黑患者的肿瘤组织(石蜡包埋组织标本)及临床病理资料,并选取华北平原11例汉族患者作为对照,采用全自动免疫组化机进行HIF-1α及HIF-1β染色,由2名病理医师分别对其量化评估并进行统计学分析.结果:HIF-1α和HIF-1β在高原及平原恶黑患者肿瘤组织中均有表达.HIF-1α在两组中表达均较低,并且高原组显著高于平原组,差异有统计学意义(P＜0.05);HIF-1β在两组的表达均较HIF-1α高,差异有统计学意义(P＜0.05),但两组间的表达差异没有统计学意义(P＞0.05).结论:该研究首次证实HIF-1α在高原缺氧环境中的恶黑患者肿瘤组织中的表达高于平原组患者,可能对高原恶黑的发生、发展以及治疗反应等方面有重要影响.