Objective By analyzing the clinical manifestations and pathologic features of Erdheim-Chester's disease (ECD) to improve the recognition of the disease.Methods The clinical characteristics,diagnosis and treatment of a young male with ECD were reported and the related literature was reviewed.Results A previously healthy young male patient with bilateral exophthalmos,blurred vision of right eye,polyuria and hypertension without obvious causes for nine months were admitted into our hospital.He developed low back pain two months ago.Thoracic vertebra Magnetic resonance imaging (MRI) showed multiple nodules extending from the 2th-7th thoracic vertebrae intra-medullary.MRI of the brain showed multiple masseswith abnormal intensities within the retro-ocular intraconal muscle cone,sellar and cavernous sinus,maxillary sinus.Biopsy specimens from the right orbital lesion demonstrated proliferation of fibrous connective tissue and fat tissue infiltrating with lymphocytes,plasma cells,eosinophils,foam cells,spindle cells,and multinucleated giant cells accompanied by fat necrosis.Immunohistochemistry showed infiltrated lymphocytes stained positive for CD68,CD20,CD3,LCA and negative for CD1a,S-100 protein and langerin.The clinical symptoms of exophthalmos and low back pain relieved after treated with methylprednisolone and interferon-α.Conclusion Understanding the characteristics of ECD can help to make the correct diagnosis and treatment.

患者男,68岁.因体检B超发现右肾占位性病变20 d于2013年2月入院.患者无明显腰痛、肉眼血尿等症状,有高血压病史.入院CT示右肾中部可见类圆形低密度影,大小约18.2mm×17.8 mm,髓质期及肾盂期强化程度低于正常肾实质,考虑肾癌可能性大.随后行腹腔镜下右肾部分切除术.

患者男，58岁。曾因发热就诊于外院，胸部CT示右肺中叶占位性病变。患者无胸闷、憋气、咳嗽、咳痰、盗汗、乏力等症状。经抗炎治疗，体温恢复正常。外院肺穿刺活检诊断为“腺癌”，为进一步诊治于2012年2月转入青岛大学医学院附属医院。查胸部CT示：右肺中叶肿块，大小约7.7 cm ×5.2 cm，内侧段支气管分支阻塞，右侧胸膜局部增厚，未见大血管及气管侵犯；纵隔内未见明显肿大淋巴结，考虑肺癌。遂行右肺中叶切除、上叶楔形切除及淋巴结清扫术。术中见肿瘤约10 cm ×8 cm，局部侵及上叶前段及心包外脂肪。

Objective:To investigate the expression of TLR4 and β-tubulin Ⅲ in epithelial ovarian carcinoma and the relation to the clinicopathological variables.Methods:The expressions of TLR4 and β-tubulin Ⅲ were determined by immunohistochemical SP method in 50 cases of epithelial ovarian carcinoma and 10 cases of normal ovarian tissues.They were divided into two groups:drug-sensitive group(n=25)and drug-resistance group(n=25).Results:The positive rates of TLR4 and β-tubulin Ⅲ in 50 ovarian cancer tissues were 62% and 60%,which were significantly higher than those in normal tissues(20%,10%,P<0.05).The positive rates of TLR4 and β-tubulin Ⅲ in drug-resistance group were 80%and 80%,which were higher than those in drug-sensitive group(44%,40%,P<0.05).The expression of TLR4 was associated with differentiation、lymph node metastasis and FIGO stage(P<0.05).The expression of β-tubulin Ⅲ was associated with differentiation and lymph node metastasis(P<0.05).The expression of TLR4 was positively correlated with the expression of β-tubulin Ⅲ(r=0.286,P<0.05).Conclusion:The expressions of TLR4 and β-tubulin Ⅲ are related to chemotherapy resistance of epithelial ovarian carcinoma.

目的探讨5-羟色胺再摄取抑制剂(SSRIs)相关性低钠血症及脑桥中央髓鞘溶解症(CPM)的临床特点,分析其发生机制。方法对3例服用SSRIs引起低钠血症及CPM的老年患者的临床资料进行回顾性分析。结果本组3例均为女性,年龄分别为75、67、78岁。1例院前诊断为抑郁症,2例住院时呈抑郁焦虑状态。分别于服用西肽普兰2周、舍曲林3 d、舍曲林2 d后出现低钠血症,颅脑MRI检查提示CPM。主要表现为嗜睡、四肢肌力增高或减低、神经病理征阳性。其中2例CPM是由于快速补钠引起,另1例可能与低血浆渗透压及糖尿病、腹泻等多因素有关。经相应治疗后,意识均恢复正常,肌力得到不同程度恢复。结论老年患者服用SSRIs后低钠血症发生率较高,以女性多见。快速纠正低钠在CPM的发病中起重要作用。应谨慎应用SSRIs,严格掌握剂量。若患者在开始服用SSRIs初期出现无法解释的症状加重时应及时检查血钠并纠正,避免导致不可逆脑损害。

Objective To summarize the experiences in using Leica Fully Automated Staining/Coverslipping Workstations.Methods Used of Leica Fully Automated Staining/Coverslipping Workstations.in accordance with established protocols for routine paraffin section for automatically staining and mounting,and analyses the results.Results Hematoxylin-eosin(HE) staining evenly and clear contrast.Conclusion Leica Fully Automated Staining/Coverslipping Workstations has the advantages of simple operation,efficiency staining,stable effect,and improve the working environment.

Objective To study the expression and its clinical significance of TLR4 and P-gp in epithelial ovarian cancer(EOC) tissues.Methods Fifty cases of EOC were evenly divided into two groups as chemotherapy-sensittive group and chmotherapy-resistant group,and 10 normal ovarian tissues were collected to serve as the control.The expression of TLR4 and P-gp was detected in the three groups by using immunochemistry SP method.Results The positive rates of TLR4 and P-gp in 50 EOC tissues were much higher than that in normal tissue,62% and 46% vs 20% and 10%,respectively(χ2=5.939,4.500;P0.05).The expressions of TLR4 and P-pg in chemotherapy-resistant group were much higher than that in the sensitivity group(χ2=6.876,6.522;P0.05).The expression of TLR4 was correlated with pathology grading,clinical staging,and 1ymph node metastasis(χ2=6.848,6.376,5.433;P0.05),and that of P-gp was correlated with differentiation and 1ymph node metastasis(χ2=9.071,6.402;P0.05).There was a positive correlation between the expressions of TLR4 and P-gp(r=0.392,P0.01).Conclusion The high expression of TLR4 and P-gp and its correlation are closely associated with chemotherapy resistance and prognosis of epithelial ovarian cancer.

病人,女,32岁;因孕26+2周,下腹痛4d入院.查体:病人有男性化体征.专科检查:右侧子宫旁可扪及一直径约10 cm包块,质较硬,活动,无压痛.产科B超检查示:中期妊娠,单活胎,子宫右侧低回声团,腹水(少量).入院后在硬膜外麻醉下行右卵巢剥除术,术中见:右卵巢内囊实性包块,约11 cm×10 cm×10 cm大小,粘连于侧腹膜,范围约5 cm×5 cm大小,蒂部无扭转,右侧输卵管系膜见囊性包块,约3 cm×3 cm大小,其内为清亮液体,子宫直肠凹内可见淡黄色游离液体约300 mL.病理检查大体观:灰白结节样包块一个,大小12.0 cm×9.0 cm×4.5 cm,包膜完整,切面灰白,质稍脆,部分区域血管丰富,灰红出血.镜检:增生的卵泡膜黄素细胞呈脑回样排列或实性生长,大小形态较一致,圆形肥硕,细胞核位于中央,嗜酸性胞浆内可见大小不一的空泡和小滴(图1).免疫组化:α-inhibin(+)、calretinin(+)、CD99(+)、PLAP( - )、HMB45(-)、SMA(- )、CK(-)、EMA(-)、血管CD34(+)(图2).病理诊断:右侧卵巢妊娠黄体瘤(大小12.0 cm×9.0 cm×4.5 cm),部分区域伴坏死.

患者女性,45岁,因"不孕18年"来本院就诊.病史采集:18年前曾行中孕引产,后不孕.经多次检查、治疗(经腹超声检查、输卵管通液等)及人工授精一次,曾多次见宫腔内似有异物,未处理.近年反复发热、脓性白带,按妇科炎症及不孕治疗无效.

患者女,45岁,反复发热、流脓性白带十余年,加重1周.既往月经规律,孕1产0.18年前中孕引产后继发不孕,曾多次在各级医院检查(经腹妇科超声检查、输卵管通液等)、治疗.

由国际癌症研究机构(IARC)最新出版的2004年版WHO肿瘤分类<泌尿系统和男性生殖器官病理和人体遗传学>一书中,MATIGNONI和AMIN将肾血管平滑肌脂肪瘤(AML)的组织学分型、定义、病因学、遗传学、良恶性评估和预后进行了较1998年版更为详细的描述.

Objective To improve the skills of diagnosis and treatment of renal chromophobe cell carcinoma(RCCC).Methods We retrospectively analyzed the clinical data of four cases with RCCC,including three males and one female,whose age ranged from 34 to 76 years,with a mean of 52 years.Results Three cases with RCCC underwent radical nephrectomies.One case underwent partial nephrectomy.The pathological examination confirmed the diagnosis of RCCC postoperation.The pathological TNM stage of RCCC was as follows: pT1a NxM0 in one case,and pT1bN0M0 in three cases.The pathological grade of RCCC was G1 in 3 cases and G2 in one case.Immunohistochemical stain was performed.There were positive staining for CK8(cytokeratin subtypes),negative for Vimentin and positive for Hale's colloidal iron in the carcinoma cells.All four cases were followed up.The duration of follow-up was from four months to eight years(average four years).All four cases had been surviving and there had been no recurrences or metastases during postoperative follow-up.Conclusion RCCC is a distinct subtype of renal cell carcinoma that exhibits low-degree malignancy.The radiologic imaging plays an important role in diagnosis of RCCC.The definite diagnosis depends on histopathologic examination.The prognosis is more favorable than the other subtypes of renal cell carcinoma after operation.

国内外文献对肺平滑肌瘤病的命名及生物学行为的评价存在争议,有文献称其为肺多发性平滑肌瘤、肺平滑肌瘤性错构瘤或良性转移性平滑肌瘤,也有学者认为是子宫分化好的平滑肌肉瘤的肺转移灶.本文报告1例经胸腔镜切除,组织学诊断为肺平滑肌瘤病的病例,并复习相关文献.

Objective To clarify the clinical relationship between EGFR expression and angiogenesis in ovarian epithelial carcinoma.Methods The EGFR protein expression and MVD by immunohistochemistry PV-6000 technique in 67 ovarian specimens were detected,including 9 normal,10 benign,9 borderline and 39 malignant samples.Results(1) EGFR positive rate and MVD in the borderline and malignant ovarian specimens were higher than that in the normal and benign ones(P<0.01).(2)There was correlation between EGFR positive expression and clinical stage,for example,stage Ⅲ~Ⅳ had higher positive expression rate than stageⅠ~Ⅱ(P<0.05);MVD had no correlation with the clinico-pathologic parameters.(3)There was a significant correlation between EGFR positive expression and MVD(r=0.685,P<0.01).Conclusion EGFR may participate in the angiogenesis and development of ovarian epithelial carcinoma,which could be a usefully biological marker for ovarian neoplasms.

眼窝内植入羟基磷灰石义眼台修复眼窝凹陷在临床上已广泛开展,围绕此方面的实验研究亦十分普遍[1].而目前关于羟基磷灰石义眼台的组织制片技术还不是十分成熟.羟基磷灰石义眼台组织十分坚硬,渗透力极差,脱钙、浸蜡时间较长,制作完整切片较困难.我们在实际工作中体会到,在制作常规石蜡切片时采用酸类混合脱钙技术,注意关键环节的处理,会取得满意效果.

目的:探讨淋巴管内皮细胞透明质酸受体-1(LYVE-1)在胃癌组织中的表达及临床意义.方法:采用组织芯片技术和免疫组化方法对85例胃癌组织和40例正常胃组织中LYVE-1的表达及淋巴管密度(LVD)进行检测.结果:LYVE-1的阳性产物表达于淋巴管内皮细胞胞质中,呈棕黄色染色.胃癌组织中LYVE-1阳性LVD显著高于正常胃组织(7.89±2.14 vs 1.15±1.62,P＜0.01);瘤周的LYVE-1阳性LVD明显高于瘤内组织(9.28±1.18 vs 4.75±1.19,P＜0.01);低分化(9.21±2.32)、Ⅲ-Ⅳ期(9.46±2.45)、有淋巴结转移(9.37±3.39)和远处转移(9.55±3.50)的胃癌组织中LYVE-1阳性LVD分别比高中分化(7.56±2.24)、Ⅰ-期(7.58±2.36)、无淋巴结转移(7.23±2.74)和远处转移(7.35±2.25)的明显增高(P＜0.01,P＜0.05).结论:胃癌组织内及瘤周的LYVE-1阳性LVD明显增高,提示胃癌组织内的新生淋巴管主要位于瘤周,从而促进了肿瘤淋巴道转移.应用组织芯片大规模高效检测临床组织标本是可行的,具有快速、方便、经济、准确的特点.

目的观察肺神经内分泌肿瘤的病理形态学特点,探讨其临床病理特征及其预后。方法收集197例肺神经内分泌肿瘤的临床相关资料,采用HE染色及免疫组化S-P法染色进行组织学分类研究并做临床分析。结果肺神经内分泌肿瘤可分为类癌、不典型类癌、大细胞神经内分泌肿瘤、小细胞癌,组织学形态明显不同,其临床预后亦不同。结论不同类型的肺神经内分泌肿瘤预后不同。

目的探讨锌及其他微量元素对儿童智商、认知功能和生长发育的影响。方法试验分为三组:单纯补锌组(Z),补锌+微量营养素组(Z+M),补微量营养素组(M)。比较三组发锌、智商和认知功能。结果试验前发锌平均含量为(2.28±0.74)μmol/g,低于正常值下限共24人,占受试总人数的22.22%。发锌含量与智商呈显著正相关(r=0.229,P<0.05,n=108)。补充试验后三个组发锌变化无显著性差别。Z+M组和M组智商、认知功能的改善好于Z组,Z+M组和M组的差别无统计学意义。结论受试儿童中锌缺乏并不占主要的地位,其他微量营养素的缺乏更应受到重视。同时补充锌和微量营养素可以改善儿童的智能发育。

肺纤维平滑肌瘤性错构瘤(fibroleiomyomatous hamartoma of the lung)在国内文献中罕有报道,在国外文献中是一个极具争议性的诊断,有学者认为是子宫良性转移性平滑肌瘤,也有学者认为是子宫分化好的平滑肌肉瘤的肺转移灶.本文报告1例经胸腔镜切除肺内结节,组织学诊断为肺纤维平滑肌瘤性错构瘤的病历及相关文献复习.

报道3例具有恶性特征或发生转移的肾血管平滑肌脂肪瘤(AML),对具有恶性病变性质的AML予以描述,并提出鉴别诊断.肾AML通常认为是良性肿瘤,主要由厚壁的血管、脂肪和增生的梭形细胞构成.显示X染色体非随机性克隆失活,其罕见的侵袭性生长方式及其复杂的临床过程最终导致肿瘤转移和患者死亡.