【摘要】 目的 发现提示早期Ⅴ型狼疮性肾炎（lupus nephritis，LN）的指标。 方法 2004年 1月-2009年11月24例经肾活检诊断为Ⅴ型LN患者，与同期50例膜性肾病伴抗核抗体（antinuclear antibody，ANA）阳性患者、50例膜性肾病ANA阴性患者，以及13例膜性肾病ANA阳性且肾组织荧光为“满堂亮”患者的一般资料、肾病表现、肾脏病理以及实验室指标进行比较。 结果 Ⅴ型LN与膜性肾病ANA阴性的患者相比，两组的性别、起病年龄、血红蛋白、补体水平、内皮和系膜增殖的比例等有明显差异。膜性肾病ANA阳性患者的临床和病理表现更接近于ANA阴性的膜性肾病，但其性别比仍以女性居多。而膜性肾病ANA阳性伴“满堂亮”的患者在性别、肾病表现、血红蛋白、补体水平等方面与Ⅴ型LN更为接近。 结论 膜性肾病ANA阳性患者具有异质性，其中肾脏病理表现为“满堂亮”的患者可能系早期Ⅴ型LN。【Abstract】 Objective To find out the clinical and pathological characteristics of early pure class Ⅴ lupus nephritis (LN). Methods A total of 24 patients with pure class Ⅴ LN diagnosed between January 2004 and November 2009 were included, and were compared with 50 antinuclear antibody (ANA)-positive patients with membranous nephropathy (MN) and 50 ANA-negative patients with MN. The clinical and pathological characteristics, laboratory test results were compared between the two groups. Then, 13 patients with "full house" fluorescence in renal biopsy specimens were chosen from the group of ANA-positive membranous nephropathy, whose clinical characteristics and laboratory test were compared with class Ⅴ LN patients. Results There were significant differences in sex ratio, age, positive rate of hepatitis B surface antigen (HBsAg), levels of hemoglobin, white blood cell, platelet,complement, endothelial and mesangial proliferation between class Ⅴ LN and ANA-negative MN group. However, the sex ratio, levels of white blood cell, platelet were similar between class Ⅴ LN and ANA-positive MN group. The renal biopsy specimens in patients with ANA-positive MN with "full house" fluorescence were similar with those in the patients with class Ⅴ LN in sex ratio, renal injury, hemoglobin and complement and the positive rate of hepatitis B surface antigen. Conclusion The demographic information and clinical manifestations in patients with class Ⅴ LN were similar to those in patients with ANA positive MN, especially in the patients wiht ANA-positive MN with "full house" fluorescence in renal biopsy specimens.
摘要:目的：探讨皮肤平滑肌肉瘤的临床病理特点和诊断要点及预后。方法:对2例皮肤平滑肌肉瘤组织病理学、免疫组化观察,并复习相关文献。结果: 例1为皮下平滑肌肉瘤,具有结节型的生长形态,瘤细胞丰富,异型性较大,核分裂活跃；例2为真皮平滑肌肉瘤,具有弥漫型的生长形态,瘤细胞较少,分化好,核分裂象不明显。免疫组化2例均表达SMA、MSA、Vim,1例灶性表达Desmin。2例随访迄今均无复发及转移。结论:皮肤平滑肌肉瘤少见,可分为真皮和皮下两种类型,两者具有不同的组织起源和预后特点,我们要注意区分,诊断除核分裂象计数外,尚需进行综合评估,对某些病例建议采用恶性潜能未定的平滑肌肉瘤的诊断,治疗首选外科手术切除。Abstract: Objective: To investigate the clinic pathological features diagnosis main point and prognosis of cutaneous leiomyosarcoma（CLMS）.Methods:Histopathology,immunohistochemical stainings observation were analyzed in two cases of CLMS and the related literatures were reviewed. Results:Case 1 was subcutaneous leiomyosarcoma with tubercular growth pattern,rich tumor cell,big heterogeneous type,active mitotic；Case 2 was dermis leiomyosarcoma with diffuse growth pattern,few tumor cell,well differentiated,no more mitotic. Immunohistochemically,the two cases reacted positively with smooth muscle action、MSA and Vim,Case 1 also expressed desman partially. The two cases were revisited to date,no recurrences and metastases.Conclusion:Cutaneous leiomyosar coma is a rare tumor,subdivided into dermis and subcutaneous forms because of their different tissue origins and prognosis features. We must discriminate between them. Diagnosis need synthetic appraisal besides mitotic counts and “smooth muscle tumor of uncertain malignant potential” should be used for diagnosis of certain cases.Primary treatment for cutaneous leiomyosarcoma is surgical excision.
目的:探讨肾上腺节细胞神经瘤的CT表现特征，以提高此病CT诊断的准确性。方法:回顾性分析8例经病理确诊为节细胞神经瘤的CT表现，并与病理结果对照研究。结果:8例肿瘤边界均清晰，无周围组织和血管侵犯征象。CT平扫呈均匀稍低密度，CT值约18～35 HU，其中内有点状钙化者3例（37.5%）。CT增强扫描有轻度强化，CT值约30～45 HU。CT征象符合病理表现。结论:肾上腺节细胞神经瘤有一定的CT表现特点，多层螺旋CT扫描有助于提高肾上腺节细胞神经瘤诊断的准确性。
ObjectiveTo analyze the CT features of solid pseudopapillary tumor of pancreas (SPTP). MethodsEight patients with SPTP received triple phasic contrast-enhanced CT, and its consistency with pathological findings was analyzed. ResultsSPTP manifested as a solitary and exogenous mass, with a heterogeneous pattern composed of solid and polycystic parts. The shape of SPTP was spherical in four patients, oval in two patients, and shallow lobulation in another two patients. In contrast-enhanced phase images, the solid parts showed mild to moderate enhancement in both arterial and portal phases. Complete capsule was showed in seven patients, and nodules were found in the wall of mass in five patients. Hemorrhage was seen in two patients and calcification was showed in five patients. The dilation of pancreatic duct was found in one patient, liver metastases was showed in one patient, and the invasion of tumor to posterior gastric wall was found in one patient. Pseudopapillary structure, hemorrhage, necrosis, and cystic degeneration were showed in all patients by histological study. ConclusionSPTP has certain characteristic CT imaging manifestations consistent with histological features, which is helpful for the diagnosis and differential diagnosis of SPTP.
Objective To observe the drug distributional characteristics after regional arterial perfusion chemotherapy (RAC) during gastric cancer radical resection, postoperative histopathological change and clinical toxic and adverse reactions. Methods According to the indications of RAC, 60 patients admitted in this department from September 2007 to November 2008 were included and divided into treated group and control group randomly. Treated group underwent the treatment of RAC with the 100 ml perfusion fluid including 5-FU (1 000 mg/m2), MMC (10 mg/m2) and 2 ml methylene blue injection by which the control group were not treated. Then the methylene blue distributional characteristics during operation, postoperative histopathological changes of tumors and clinical toxic and adverse reactions were observed. Results In the treated group, after RAC with injection contained methylene blue by primary supply arterial, the tumor region colored immediately and then dropped slowly, but it presented blue during whole operation. After operation, light microscope examination revealed a mild change of karyopyknosis, nuclear swelling, coagulation of cytoplasm in cancer cells, mild hydropsia of intercellular substance, invasion of inflammatory cells and mild vasculitis in some cases. Transmission electron microscope showed that nuclear swelling or coagulation, nuclear heterochromatin agglutination, nuclear-week gap expansion, mitochondrial swelling, endoplasmic reticulum expansion, and Golgi complex expansion. AST of treated group increased apparently on the first day (Plt;0.01), and recovered normal on the third day (Pgt;0.05). There was no significant difference between the two groups in renal function, ALT, ALP, GGT, LDH of liver function, medullary restraining, ECG by bed or reaction of gastrointestinal tract (Pgt;0.05). And stomal leak was not found in two groups. Conclusions The RAC during radical resection of gastric cancer enables gastric tumor to expose to therapeutics during whole operation and depresses the activity of cancer cells. Its clinical toxicity is little, so it can be used as an important supplementary means to prevent intraoperational extension and postoperative recurrence.
Objective To analyse the clinico-pathological characteristics of young patients with colorectal cancer. Methods From January 1980 to January 2000, among 1 030 patients with colorectal cancer admitted for surgical treatment, 143 (13.9%) patients were ＜35 years of age. The clinicopathological data of these young patients were reviewed and compared with those of patients in the other age groups. Results In this series of young patients, males were predominat. Most of them were with poorly differentiated (37.8%) and muco-cellular (29.6%) adenocarcinoma. The mast common gross morphology was infiltrating type (56.6%) and colloid carcinoma type (31.5%). The majority of patients (89.5%) were in Dukes stage B and stage C. Conclusion The prognosis of young patients with colorectal cancer surgically treated is worse, due to the fact that most of them are in late stage and their cancers are worse in differentiation. To increase the awareness of cancer in the young is important for early diagnosis and treatment and better prognosis.
ObjectiveTo introduce the new nomenclature scheme of the International Working Group (1995) on hepatic nodules, and summarize the imaging features of various hepatic nodules in light of their pathological characteristics, and evaluate the diagnostic values of various imaging facilities.MethodsUltrasound, computed tomography(CT), magnetic resonance imaging(MRI), and angiographic CT were reviewed and introduced.ResultsMany of these types of hepatic nodules play a role in the de novo and stepwise carcinogenesis of hepatocellular carcinoma(HCC) in the following steps: regenerative nodule, lowgrade dysplastic nodule, highgrade dysplastic nodule, small HCC, and large HCC. Accompanying such transformations, there are significant alterations in the blood supply and perfusion of these hepatic nodules.ConclusionModern stateoftheart medical imaging facilities can not only delineate and depict these hepatic nodules, but also provide important clues for the characterization of focal hepatic lesions in most cases, thus facilitating the early detection, diagnosis and management of HCC in its early stage.
Objective To investigate the clinicopathological characteristics of proximal gastric cancer (PGC). MethodsThe clinical course and pathologic feature of 118 PGC patients were analyzed, and compared with those of 310 distal gastric cancer (DGC) patients. ResultsThe incidence of PGC was lower than DGC, the percentage of Ⅲ,Ⅳ stages and undifferentiated type in the PGC group were significantly higher than in DGC. For the surgical procedure, patients in the PGC had significantly higher percentages of total gastrectomy and other organ resection than in DGC. The percentage of patients with positive margin and lymph node metastasis in PGC was also significantly higher than in DGC. Esophageal invasion and lymph node metastasis were much more in PGC. The 5year survival of patients with PGC was significantly lower than that with DGC. No significant differences were found between the two groups with respect to the mortality rates and complications. Conclusion The relatively poor prognosis associated with PGC is mainly from advanced cases and esophageal invasion. Early detection and treatment is the most important strategy to improve the survival of patients with PGC.