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关键词： 嗜酸性变   发病年龄   腺管   食管囊肿   囊腔   p63   免疫组织化学   基底细胞  

摘要： 目的探讨食管黏膜下腺导管腺瘤(ESGDA)的临床病理学特征、诊断和鉴别诊断。方法搜集并观察3例ESGDA组织形态学特点及免疫组织化学结果,复习相关文献进行分析。结果 3例ESGDA患者均为男性,发病年龄范围63~75岁,病变均位于食管下段。镜下观察:肿瘤由扩张的腺管或囊腔组成,腺管及囊腔衬覆双层上皮结构,腔缘内层腺上皮柱状、多层排列、上皮细胞嗜酸性变、局部呈乳头状突起。腺管与囊腔周围包绕一层连续的基底细胞层,肿瘤背景富含浸润的淋巴细胞,肿瘤细胞形态温和,异型性轻微。免疫组织化学:内层腺上皮细胞弥漫强阳性表达细胞角蛋白(CK)7、CK5/6、CK19、DOG1、CD117,不表达诸多黏蛋白,外层基底细胞表达CK5/6、p63、p40、平滑肌肌动蛋白。结论 ESGDA是一种罕见的食管良性腺上皮源性肿瘤,好发于食管下段,易误诊为食管囊肿、腺癌或唾液腺型肿瘤,认识并熟悉其组织形态学特征结合免疫组织化学检查有助于其诊断与鉴别诊断。

关键词： 以团队为基础的学习   思维导图   病理学  

摘要： 目的构建基于数字化切片的以团队为基础的学习(team-based learning,TBL)与思维导图相结合的口腔黏膜病病理教学模式,并探讨其应用效果。方法将修读口腔组织病理学的2017级口腔医学专业64名五年制本科生分为试验组和对照组,各32人。课前两组学生都通过在线课程自学。试验组采用TBL教学,对照组采用传统方法授课。通过对比试验组和对照组的成绩评价教学效果;发放教学效果问卷,评估学生对TBL的满意度,采用Likert 5级评价方式打分。采用SPSS软件2016进行统计学分析。结果TBL试验组教学效果优于对照组,学生对TBL教学方法表示满意。结论采用TBL与思维导图结合的教学模式,可以提高教学效果,培养学生的临床思维能力和团队合作能力,值得推广应用。

摘要： Purpose/Objective(s) The role of radiation for pancreatic cancer remains controversial with heterogeneous clinical response. Characterization of molecular biomarkers that predict radiosensitivity may help select patients for radiation therapy. The purpose of this study was to determine if somatic mutations and mutational frequency are associated with pathologic and survival outcomes in a cohort of patients with borderline resectable pancreatic cancer (BRPC) or locally advanced pancreatic cancer (LAPC) who were treated with neoadjuvant chemotherapy and stereotactic body radiotherapy (SBRT) followed by surgical exploration. Materials/Methods Patients treated with neoadjuvant chemotherapy and SBRT followed by surgical exploration from 2017-2019 and who consented to next generation sequencing (NGS) of their primary tumor were included in the study. Tissue samples were obtained with FNA at initial biopsy (n = 5) or from surgical specimen (n = 38). Univariate (UVA) and multivariable analyses (MVA) were performed to determine associations between somatic mutations and variant allele frequency (VAF) with pathologic and survival outcomes. Local response was defined as achieving complete response, marked response, or moderate response on pathology. Results A total of 43 patients underwent NGS of their primary tumor with either solid tumor panel (n = 35) or Foundation One (n = 8). Neoadjuvant therapy consisted of FOLFIRNOX (n = 36) and/or gemcitabine/abraxane (n = 11) followed by SBRT in 33 Gy in 5 fractions (range, 30-36 Gy/5 fractions). Surgical resection was performed in 35/43 patients and aborted in 8/43. Median follow-up time was 20.4 months. Median OS, PFS, DMFS, and LPFS after SBRT were 21.3 months, 9.7 months, 10.0 months, and 22.0 months, respectively. KRAS mutations were observed in 96% (43/45) of patients. On UVA and MVA, tumors with KRAS G12V mutation demonstrated a higher local response rate to neoadjuvant therapy when compared to tumors with other KRAS mutations

关键词： 组织病理学   彩色图片   电子显微镜   免疫组织化学   免疫荧光染色   标尺   电子版   组织标本  

摘要： 如果作者稿件中包含有组织病理图、免疫荧光染色图、免疫组织化学图、电子显微镜图片,为了反映组织标本大小的最精确尺度,请在电子版图片的左下方附注标尺。

摘要： Purpose/Objective(s) Currently, neoadjuvant chemoradiation (CRT) followed by total mesorectal excision is a standard treatment for patients with stage II and III rectal cancer. However, non-operative management of rectal cancer is an emerging approach to allow patients to preserve their anal sphincter. Factors that may help identify patients most likely to have a pathological complete response (pCR) would be helpful for physicians and patients considering a non-operative approach. Materials/Methods A total of 377 patients from our institution who had clinical stage II or III rectal cancer treated with neoadjuvant chemoradiation were included in the analysis. Patients were grouped based on their pCR status. Clinical parameters including overall stage, gross tumor volume (GTV), and radiation dose were analyzed by univariate and multivariate analysis, with pCR being the dependent variable. A Receiver Operator Characteristic (ROC) curve was generated in order to identify a tumor volume cutoff with the highest sensitivity for predicting pCR. Results The cohort had a median age at diagnosis of 61 years, 68% were male, and 85% presented with stage III disease. 68 of the 377 patients (18%) included in our analysis achieved pCR. A tumor volume of < 18.7 cc is highly sensitive (90%) for predicting pCR. Additionally, on multivariate analysis, a GTV of < 18.7 cc (odds ratio (OR) = 3.1, 95% confidence interval (CI) = 1.613-6.356, P  = 0.001) was significantly associated with an increased rate of pCR. Overall stage (P  = 0.026) was also significantly associated with pCR, while prescribed dose (P  = 0.45) did not appear to impact pCR rates. Conclusion Our analysis identified a GTV volume of < 18.7 cc as a strong predictor for pCR in stage II and III rectal cancer patients receiving neoadjuvant chemoradiation, which will be helpful in identifying potential candidates for non-operative management.

关键词： 病理学   实验教学   虚拟仿真  

摘要： 病理学是一门重要的医学基础学科。针对其实验教学中存在的问题,初步探索出包含病理学虚拟图库、虚拟仿真实验和虚拟综合性实验3个模块的病理学虚拟仿真实验教学平台的建设方案以及该虚拟教学平台的应用效果,为响应教育部一流本科课程的双万计划,推进现代信息技术与实验教学项目相融合,提升实验教学质量和水平奠定基础。

摘要： Purpose/Objective(s) According to society guidelines, stereotactic body radiotherapy (SBRT) can be delivered in patients who have a lung lesion that is clinically and radiographically consistent with non-small cell lung cancer (NSCLC) and refuse biopsy, have undergone a nondiagnostic biopsy, or are at prohibitive risk of biopsy. The purpose of this study is to report outcomes of patients with stage I-II NSCLC, with or without pathologic diagnosis, treated with SBRT at our institution. Materials/Methods We performed a single-institution retrospective review of patients with early-stage node-negative NSCLC who received curative-intent SBRT between 2005 and 2018. We included patients with biopsy-proven NSCLC or presumed NSCLC based on radiographic findings. We calculated outcomes using the Kaplan-Meier method and used a log-rank test to assess prognostic impact. Results The study population consisted of 175 patients and 186 individual lung nodules with a median follow-up time of 2.6 (range, 0.1 – 12) years for all patients, and 3.5 (range, 0.2 – 8.4) years for living patients. The median age was 70.2 (range, 43 – 90) years and the median maximum tumor diameter was 1.9 (range, 0.7 – 5.6) cm. Twenty-three (13.1%) patients had a history of previously treated NSCLC, and more than a third (n = 66, 37.7%) of patients were oxygen-dependent at the time of SBRT. One hundred and seven (61.1%) patients were treated empirically with SBRT without a pathologic diagnosis. Most tumors were peripheral with only 9.7% (n = 18) centrally located, and most were located in the upper lobes (n = 123, 70.3%). The median prescription dose was 50 (range, 48 – 62.5) Gy in 5 (range, 4-10) fractions. Among the entire cohort, the 3-year rates (95% confidence interval) of local control, regional control, cause-specific survival, and overall survival were 81.0% (73.8% – 86.5%), 89.5% (82.7% – 93.8%), 72.4% (64.5% – 79.1%), and 48.3% (40.7% – 55.9%), respectively. There was no difference in local-regio

摘要： 《临床与实验病理学杂志》(ISSN 1001-7399 CN 34-1073/R),月刊,连续入选《中国科学引文数据库》(CSCD)来源期刊、北京大学图书馆《中文核心期刊要目总览》“临床医学类核心期刊”及科技部中国信息研究所中国科技核心期刊(统计源期刊)。精准医疗被认为是继经验医学、循证医学之后的第三次医学革命,作为当今肿瘤临床研究最活跃的领域之一,精准医疗在肿瘤治疗中正发挥越来越重要的作用;而肿瘤诊断的“金标准”,病理诊断不仅能判定肿瘤的良恶性质、分类和分级,也是临床医师进行预后评估和药物选择的重要依据。

关键词： 肿瘤,眼眶   横纹肌肉瘤   研究,回顾性   分析,病理学  

摘要： 目的分析眼眶横纹肌肉瘤的临床表现、影像学特征、治疗方法及病理特点。方法回顾性分析天津医科大学第二医院眼科1980年至2018年眼眶横纹肌肉瘤36例(36眼)的临床资料。结果患者年龄5个月~14岁,平均(6.54±3.79)岁。眶上象限为其好发部位。就诊的主要症状为眼球突出。B超检查,肿瘤显示为低或无回声区;彩色多普勒探查,肿瘤内可见动脉频谱,血流丰富。28例行CT扫描呈软组织密度影,其中骨质破坏6例。10例行MRI检查,8例T1WI显示为中等或中等偏低信号,T2WI为高信号。36例中眶内容摘除4例,前路开眶切除肿物32例。病理学检查显示:亚型中胚胎型20例(55.6%),腺泡型9例(25.0%),多形型7例(19.4%)。结论眼眶横纹肌肉瘤属高度恶性肿瘤,传统的B超、CT、MRI结合PET-CT等影像学检查可以指导诊断、治疗,监测复发与转移。

关键词： 淋巴瘤,T细胞,外周   淋巴瘤   肌,骨骼   预后  

摘要： 目的探讨骨骼肌细胞毒性T细胞淋巴瘤(cytotoxic T-cell lymphoma,CTL)临床病理学特点及预后。方法回顾性收集2008—2019年首都医科大学附属北京友谊医院和解放军联勤保障部队第九八九医院(原第一五二中心医院)14例骨骼肌CTL和47例非骨骼肌结外CTL患者的临床资料,镜下观察肿瘤形态,检测肿瘤细胞的免疫表型、EB病毒(EBV)感染状态和T细胞受体(TCR)克隆性,比较分析两组患者的临床病理特征和预后。结果骨骼肌CTL占本组结外CTL的23.0%(14/61)。患者中位年龄45.5岁(11~76岁),男性6例,女性8例。临床上主要表现为局部生长的无痛性肿块。有B症状者占比为2/14。肿瘤分别发生于颊部(7例)、舌部(4例)、下唇(3例)及左上臂(2例),其中有2例均累及两个部位。临床分期ⅠE期10例,ⅡE期4例。与非骨骼肌结外CTL比较,骨骼肌CTL多无B症状、临床分期低、主要累及面颊及口腔(舌部和唇部,P<0.05)。形态学上表现为骨骼肌组织内异型淋巴细胞弥漫性浸润。免疫组织化学检测,肿瘤阳性表达T细胞抗原(CD2、CD3、CD5、CD7),其中一个或多个抗原表达减弱或表达缺失者占比为11/14。所有病例均表达T细胞胞质内抗原-1、颗粒酶B和CD8(CD8^(+)>CD4^(+)模式),CD56阴性。Ki-67阳性指数中位数为35.0%(5%~60%)。所有病例EBER原位杂交检测阴性。除6例未检测外,其余病例TCR基因重排克隆性分析检测结果为阳性。10例获得随访,中位随访时间为40个月(10~67个月)。10例患者完全缓解,5年生存率为100%,与非骨骼肌结外CTL(5年总生存率35.9%)比较,差异有统计学意义(χ^(2)=8.277,P=0.004)。结论骨骼肌CTL多发生于面颊和口腔,肿瘤细胞具有侵嗜骨骼肌或肌炎样的形态学特征,具有CD8^(+)>CD4^(+)和细胞毒性分子模式的免疫表型,临床分期低,预后较好。