患者,男性,76岁.查体发现左肾占位半个月入院.患者因左侧腰部不适来诊,行彩超发现左肾肿瘤,肾实质内可见低回声团,边界欠清,形态不规则,可见多处钙化.血清学检测男性肿瘤标志物CEA、AFP、PSA、CA125、CA19-9均无明显异常.无肉眼血尿,不支持肾盂肿瘤诊断;无尿频、尿急、尿痛的尿路刺激症状,不支持尿路感染诊断;无咳嗽、咳痰,以及影像检查结果提示无肺部结节,除外肺部肿瘤转移可能;无腹痛、腹胀,无恶心、呕吐等胃肠道症状,结合腹部超声检查均无胃肠道阳性体征.虽肿瘤较大,但患者体重近期无明显减轻,无典型恶病质体征.手术采用腹腔镜下后腹腔左肾癌根治性切除术.术中见肾门处肿大淋巴结,肿瘤略突向腹侧,并累及腹膜,将患肾及受累腹膜一并切除.该病例已取得患者知情同意.

目的 探讨化浊行血汤联合常规治疗对脑梗死恢复期患者临床疗效.方法 180例患者随机分为对照组A、对照组B、观察组,每组60例,对照组A给予常规治疗,对照组B给予化浊行血汤治疗,观察组给予常规治疗+化浊行血汤,疗程12周.检测临床疗效、NIHSS评分、FMA评分、血清神经营养因子(Gal-1、BDNF、NGF)、血清炎症因子(IL-6、CXCL-16、GDF-15)、不良反应发生率变化.结果 观察组总有效率高于对照组A、对照组B(P<0.05).治疗后,3组NIHSS评分、血清炎症因子降低(P<0.05),FMA评分、血清神经营养因子升高(P<0.05),以观察组更明显(P<0.05).3组不良反应发生率比较,差异无统计学意义(P>0.05).结论 化浊行血汤联合常规治疗可安全有效地改善脑梗死恢复期患者神经功能障碍,提高生活质量,其作用机制可能与增强神经营养因子保护作用,降低炎症因子水平有关.

目的 探讨原发睾丸弥漫大B细胞淋巴瘤(PTDLBCL)MRI表现,并与病理组织学对照.方法 选取6例经手术病理证实的原发睾丸弥漫大B细胞淋巴瘤的MRI及病理资料.结果 PTDLBCL主要临床表现为老年男性,一侧睾丸无痛性、进行性肿大,血液生化指标不具特异性;MRI征象常为一侧睾丸单发类圆形异常信号,T1WI呈等信号或低信号,T2WI呈稍高信号,DWI呈明显高信号,ADC值低,边界尚清,增强扫描显示病变呈不均匀较明显强化;病理表现为肿物界限不清,质地细腻呈鱼肉状,镜下睾丸小叶结构消失,肿瘤细胞于睾丸实质内弥漫浸润性生长,生精小管被破坏,瘤细胞体积较大,细胞异型明显,核分裂象多见.免疫组化肿瘤细胞至少表达一种B细胞标志物.结论 老年男性,一侧睾丸无痛性、进行性肿大的结节,MRI呈T1WI等信号或低信号,T2WI稍高信号,DWI明显高信号,ADC值低,提示原发睾丸弥漫大B细胞淋巴瘤的诊断.

目的 探讨肺腺癌组织中KISS1、E-cadherin和vimentin蛋白表达的临床病理特征及预后意义.方法 应用免疫组化SP法检测肺腺癌中KISS1、EMT相关分子标志物(E-cadherin和vimentin)的表达,并分析三者表达与患者预后的关系.结果 KISS1在肺腺癌中(50/103,48.5％)的阳性率显著低于癌旁组织(90/103,90.3％,P<0.05).肺腺癌组织中KISS1、E-cadher-in、vimentin在肿瘤低分化、Ⅲ+Ⅳ期、淋巴结转移组中的表达,与肿瘤高+中分化、Ⅰ+Ⅱ期、无淋巴结转移组相比,差异有统计学意义(P<0.05).KISS1与E-cadherin的表达呈正相关(r=0.534,P<0.001),与vimentin的表达呈负相关(r=-0.611,P<0.001).肺腺癌患者3年生存率KISS1、E-cadherin阳性组显著高于阴性组,vimentin阳性组显著低于阴性组(P<0.05).结论 KISS1、E-cadherin、vimentin可能在肺腺癌的浸润、转移中发挥重要作用;三者的表达均与预后有相关性,联合检测可作为肺腺癌预后的评判指标.

患者男性,28岁,因体检发现左侧睾丸占位1个月入院.患者无类癌综合征,无睾丸外伤史、内分泌疾病及第二性征特征.查体左侧睾丸触及一硬块,相对固定.超声检查示左侧睾丸增大,睾丸实质回声不均匀,其间见一个强回声区,直径4.5 cm,界限清楚.右侧睾丸正常(图1).

Objective:To explore the application value of systematic cardiopulmonary rehabilitation using simple medical device on severe bronchiectasis at stable phase in patients.Methods:This prospective cohort study included 125 patients with bronchiectasis who came from the Eighth People′s Hospital of Jinan city and Laiwu People′s Hospital of Jinan from June through October 2019, those patients were divided into control group ( n=58) and cardiopulmonary rehabilitation group ( n=67) by random number table.A systematic cardiopulmonary rehabilitation were perfromed using simple medical device.Contrast analysis in repeated measures analysis of variance were performed between groups, the 6-minutes walk test (6MWT), the first second forced expiratory volume (FEV 1) and a percentage of the predicted value (FEV 1%pred), a lower baseline % predicted forced vital capacity (FVC % pred), the change in the ratio of the forced expiratory volume in the first second to the forced vital capacity (FEV 1/FVC)%, bronchiectasis severity index (BSI) score, chronic obstructive pulmonary assessment test (CAT) score, self-rating anxiety scale (SAS) score, self-rating depression scale (SDS) score, and T lymphocyte subsets before treatment and on month 3, and month 6 were compared. Results:Over the intervention time, had gradually increased 6MWT, gradually increased FEV 1%pred, FVC%pred, CD3%, CD4%, CD4/CD8, as well as gradually decreased BSI score, CAT score, SAS score, SDS score were found in cardiopulmonary rehabilitation group; while gradually decreased 6MWT was found in control group.There were statistically significant differences in 6MWT, FEV 1%pred, FVC%pred, BSI, CAT, SAS, CD4%, CD8%, CD4/CD8 in intergroup, intertime and intertime interaction between groups.FEV 1/FVC and SDS have statistically significant differences in intergroup, intertime and intertime interaction between groups.While CD3 showed statistically significant differences only between groups, the differences were 6MWT ( F group=59.20, P<0.01, F time point=895.88, P<0.01, F group·time point=1 553.81, P<0.01); FEV 1%pred ( F group=3.90, P=0.05, F time point=173.23, P<0.001, F group·time point=124.61, P<0.001); FVC%pred ( F group=15.53, P<0.001, F time point=114.23, P<0.01, F group·time point=105.37, P<0.01); BSI score ( F group=61.62, P<0.001, F time point=259.79, P<0.01, F group·time point=428.18, P<0.01); CAT score ( F group=13.11, P<0.001, F time point=321.60, P<0.01, F group·time point=110.98, P<0.01); SAS score ( F group=13.13, P<0.001, F time point=336.26, P<0.01, F group·time point=140.11, P<0.01); CD4% ( F group=8.68, P<0.01, F time point=10.43, P<0.01, F group·time point=6.39, P<0.01); CD8% ( F group=18.31, P<0.01, F time point=13.11, P<0.01, F group·time point=4.12, P<0.05); CD4/CD8 ( F group=39.20, P<0.01, F time point=24.59, P<0.01, F group·time point=41.59, P<0.01) respectively.SDS score ( F time point=338.29, P<0.01, F group·time point=395.51, P<0.01), CD3% ( F group=14.37, P<0.01). Conclusions:Cardiopulmonary rehabilitation with simple equipment is capable of improving exercise endurance and pulmonary ventilation function, improving immune function and relieving anxiety and depression for patients with severe bronchiectasis at stable phase.

目的 探讨肺腺癌中肿瘤转移相关基因转录因子21(transcription factor 21,TCF21)、血管内皮生长因子(vascular endothelial growth factor,VEGF)的表达与微血管密度(mi-crovessel density,MVD)及预后的相关性.方法 采用免疫组化SP法检测肺腺癌及癌旁正常组织中TCF21、VEGF的表达及MVD值,结合临床病理特征进行相关性分析.结果 TCF21、VEGF在肺腺癌组织中的阳性率分别为45.1％(41/91)和60.4％(55/91);TCF21、VEGF 表达及 MVD 值与肺腺癌分化程度、TNM分期及淋巴结转移有相关性(P＜0.05).肺腺癌中TCF21阳性组MVD值低于阴性组(P＜0.05);肺腺癌中VEGF阳性组中MVD值高于阴性组(P＜0.05);肺腺癌组织中TCF21与VEGF表达呈负相关(r=-0.668,P＜0.05),与 MVD 值呈负相关(r=-0.542,P＜0.05);VEGF表达与MVD值呈正相关(r=0.468,P＜0.05).生存分析显示,TCF21阳性肺腺癌患者的生存期明显高于阴性患者;肺腺癌中VEGF阳性+MVD高表达组患者生存期明显低于阴性组.结论 TCF21可能在肺腺癌的血管生成中发挥重要作用,为肺腺癌的治疗提供新的预测指标和靶点;TCF21、VEGF、CD34均与患者预后有相关性,联合检测可作为肺腺癌恶性程度的评判指标.

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.