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关键词： 甲状腺乳头状癌   浸润性生长   组织学形态   肿瘤复发   BRAF   柱状细胞   临床病理学   CDX2  

摘要： 目的分析柱状细胞型甲状腺乳头状癌(columnar cell variant of papillary thyroid carcinoma,CCV-PTC)的临床病理特征及预后,并着重探讨甲状腺癌常见驱动基因突变状态。方法回顾性分析7例CCV-PTC的临床资料及组织学形态,EnVision法进行免疫表型分析,突变阻滞扩增系统(ARMS)-PCR检测BRAF V600E基因突变,Sanger测序检测RAS及端粒酶逆转录酶基因(TERT)启动子基因突变。结果男性4例,女性3例,年龄29~65岁。组织学肿瘤细胞呈柱状、假复层排列,7例均表达甲状腺滤泡上皮标记,1例表达CDX2,p53均呈野生型表达。4例存在BRAF V600E突变(4/7),4例存在TERT启动子突变(4/5),5例均未见RAS突变(0/5)。术后随访8~89个月,4例出现肿瘤复发,2例死亡。结论 CCV-PTC以柱状肿瘤细胞假复层排列为特征,可表达CDX2,具有较高的BRAF V600E及TERT启动子突变率,浸润性生长者预后较差。

关键词： 病理学   线上课程   课程建设   混合式教学  

摘要： 随着各医学院网络建设的日益完善,更多多媒体和计算机技术被应用在线上课程建设当中。在此背景下,文章以病理学线上课程建设的内容、思路为出发点,对线上课程的建设策略加以探讨,期待通过线上课程建设,加快推进病理学课程教学的现代化发展。

摘要： Purpose/Objective(s) Current pathologic lymph node (LN) staging for head and neck squamous cell carcinomas (HNSCC) is based on LN size, laterality, and presence of extracapsular extension. However, some retrospective registry and single institution studies have suggested that the number of positive (+) LNs is the dominant nodal factor driving survival in HNSCC. Given the limitations of these datasets, it is unclear whether number of +LNs increases mortality through increased locoregional recurrence (LRR), distant metastases (DM), or both. In this study, we evaluate the prognostic value of number of +LNs in HNSCC using an international cohort of patients enrolled on three prospective randomized controlled trials (RCTs). Materials/Methods Secondary analysis was performed of RTOG 9501, RTOG 0234, and EORTC 22931, 3 prospective RCTs of patients undergoing surgery followed by post-operative radiation (RT) with or without systemic therapy. Univariate and multivariable models with restricted cubic splines were constructed to evaluate the association between number of +LNs and overall survival (OS), disease-free survival (DFS), LRR, and DM. Competing risks analysis was used for LRR and DM. Non-linear restricted cubic splines were used to model the relationship between +LN number and outcomes. Results Overall, 947 patients were included in this secondary analysis. OS independently decreased with increasing number of +LNs without plateau, which was most pronounced up to a change point of 5 +LNs (hazard ratio [HR], 1.19 per LN; 95% confidence interval [CI], 1.10–1.29; P < 0.001). Mortality risk continued to increase after 5 +LNs, but more slowly (HR per LN, 1.03; 95% CI, 1.01–1.05; P < 0.001). Similarly, DFS decreased sharply up to 5 LNs (HR per LN, 1.19; 95% CI, 1.1–1.29; P < 0.001), and more gradually beyond this (HR per LN, 1.03; 95% CI, 1.01–1.05; P < 0.001). DM displayed similar behavior to OS and DFS, with risk increasing sharply with each +LN up to 5 (HR per LN, 1.14; 9

摘要： Purpose/Objective(s) After radical surgery, patients with high-risk factors were recommended adjuvant concurrent chemoradiation (CCRT). Cisplatin and cisplatin-based combination chemotherapy were the most common concurrent chemotherapy in previous studies. However, there are still few randomized controlled studies comparing which is better for survival. We conduct this prospective study to compare triweekly combination chemotherapy with weekly cisplatin chemoradiation in adjuvant radiation for cervical cancer patients with high-risk factors after radical surgery. Materials/Methods Patients aged 18-70 years early-stage cervical cancer with high-risk pathological factors (adenocarcinoma/adenosquamous carcinoma, parametrial invasion, positive surgical margins, and lymph node metastasis) after radical hysterectomy were included and randomized 1:2 to the DDP group and DP group. The DDP group received chemotherapy with weekly cisplatin (40 mg/m2 ) of 5 cycles concurrent with radiation. The DP group received a triweekly regimen of cisplatin (75 mg/m2 ) plus docetaxel (75 mg/m2 ) of 4 cycles and the first cycle was initiated within 1-2weeks after surgery. Radiotherapy was started concurrently at the second cycle of chemotherapy in DP group. The primary end point was the rate of disease-free survival (DFS) at 5 years. Results A total of 268 patients were included in the analysis (91 in the DDP group, 177 in the DP group). The median follow-up period is 54 months (2-90m), and 2 cases were lost to follow-up. Baseline demographic and disease characteristics were balanced among the treatment groups. In the intention-to-treat population, 5-year DFS showed a better trend in DP group than DDP group, although there was no statistically significant difference (85.9% vs 78.0%; HR 1.64; 95% CI, 0.91-2.95, P  = 0.096). There was no difference in 5-year OS, DMFS and LRFS between the groups (87.0%, 87.6% and 97.2% for DP group; 79.1%, 82.4% and 94.5% for DDP group, P  = 0.127, 0.249 and 0

关键词： 兽医病理学   思政元素   教学实习  

摘要： 教学实习是动物医学专业教学内容的重要组成部分。为指导学生解决实习期间面临的专业问题,做好学生的思想教育,采用线下线上结合的混合模式,把兽医病理学蕴涵的思政元素融入到对学生日常实习指导中。贯彻落实兽医病理学专业教育和思政教育同向同行的教育方针,探索专业课思政教育改革的途径。

关键词： 神经胶质瘤   病理学   疾病特征   预后   组蛋白3变体(H3.3)  

摘要： 目的探讨H3 G34突变型弥漫性半球胶质瘤(DHG-G34)的临床和病理学特征。方法回顾性分析2016年1月至2020年1月首都医科大学附属北京天坛医院神经外科收治的6例DHG-G34患者的临床资料。6例患者术前均行头颅MRI增强扫描,其中4例行肿瘤切除术,另2例行立体定向活组织检查术。行肿瘤切除术的4例患者术后复查头颅MRI,判断肿瘤的切除程度。对所有患者行电话随访,询问患者术后治疗情况和生存状态。对肿瘤组织标本行HE染色、免疫组织化学染色及基因检测。结果6例患者中位年龄为18岁(14〜34岁),男性占优势(5/6);病变均位于大脑半球,呈单灶性(3/6)或多灶性(3/6);增强扫描显示无明显强化(2/6)或轻度不均匀强化(4/6)。行肿瘤切除术的4例患者术后复查头颅MRI,均为次全切除。5例(5/6)患者获得随访,中位随访时间为21个月(16~30个月);术后均同步行放、化疗。至末次随访,3例死亡,2例存活。HE染色的组织学诊断结果为,间变性星形细胞瘤3例(3/6),胶质母细胞瘤3例(3/6);其中表现单一高级别胶质瘤形态的4例(4/6),混有原始神经元成分的2例(2/6)。免疫组织化学染色结果显示,6例患者的肿瘤细胞均弥漫表达突变型H3 G34R、胶质纤维酸性蛋白(GFAP)、H3K27me3,过表达P53,均不表达少突胶质细胞转录因子2(Olig2)和α地中海贫血伴智力低下综合征X连锁(ATRX),而突触素(Syn)局灶性中等强度表达(2/6)。4例行肿瘤切除术的患者基因检查结果显示,均无异梓檬酸脱氢酶(IDH)1/2、端粒酶反转录酶启动子(IERT)C228T/C250T及BRAF-V600E基因突变,其中2例(2/4)存在O^(6)-甲基鸟嘌呤-DNA-甲基转移酶启动子(MGMT)甲基化。结论DHG-G34多见于大脑半球,可呈多灶性生长,MRI强化不明显;组织病理学具有异质性,但分子病理学改变一致;患者预后差。

关键词： 结直肠息肉   结直肠癌   肠镜   病理学  

摘要： 目的分析永煤集团总医院近20年接诊的结直肠病患者肠镜下结直肠病变检出状况。方法分析2001-2020年永煤集团总医院收治的35687例结直肠癌和结直肠息肉患者的临床资料。以5年为一个阶段将研究对象分为A组(2001-2005年,n=5132)、B组(2006-2010年,n=6473)、C组(2011-2015年,n=9921)和D组(2016-2020年,n=14161);比较各组患者年龄分布、临床表现、病变部位和病理分型情况。结果A组患者年龄18~90岁,平均(64.55±5.19)岁;B组18~96岁,平均(58.17±5.44)岁;C组18~91岁,平均(54.56±6.19)岁;D组18~88岁,平均(50.09±5.58)岁。患者的发病年龄呈现年轻化趋势,但总体以40~69岁人群为主。近20年结直肠病患者就诊时临床表现主要为腹痛、便血、腹部包块、大便习惯改变和肠梗阻等,其中腹痛一直为主要症状,而近年来便血、腹部包块、肠梗阻的患者减少。近20年结直肠部病变部位有左移趋势,升结肠发病率减少,降结肠和乙状结肠发病率增加,且多部位发病率减少,乙状结肠为主要发病部位。近20年结肠息肉仍以炎性息肉和管状腺瘤为主,其中炎性息肉发病率升高,管状腺瘤发病率降低;结直肠癌仍以中分化腺癌为主,且中分化腺癌发病率升高,高分化和低分化腺癌发病率降低。结论近20年永煤集团总医院结直肠病变患者逐年增加,主要发病人群为40~69岁人群,乙状结肠为主要发病部位,结直肠息肉和管状腺瘤以炎性息肉为主,结直肠癌以中分化腺癌为主,肠镜检查时应重点观察。

关键词： 化学性与药物性肝损伤   病理状态,体征和症状   诊断  

摘要： 药物性肝损伤(DILI)肝组织学表现分为炎症坏死型、胆汁淤积型、脂肪变性和脂肪肝炎型、血管损伤型、轻微病变型等多种病理类型。对于疑诊为DILI但又不肯定、不能用DILI一元论解释的肝损伤、多药物接触史而不能确定具体致损药物的DILI、治疗效果不符合预期DILI、慢性DILI等,需要组织病理学进一步鉴别诊断;组织病理学还可用于评估DILI病情轻重和预后。因DILI肝组织病变分布不均一,要有充足的组织样本量才能减少取样误差。由于肝损伤性疾病组织病理学表现“一因多果、多因一果”,病理密切结合临床才能最大可能得出最终诊断,在DILI的组织学诊断过程中临床病理讨论尤为重要。

摘要： Purpose/Objective(s) Several recent studies have suggested that total neoadjuvant therapy (TNT) provides improved pathologic response and disease-free survival over neoadjuvant chemoradiation. However, the timing of the radiation as a part of the total neoadjuvant paradigm is unclear. In some studies radiation has been used first and others it has been used after chemotherapy. This study compares pathologic complete response (pCR) and survival patterns with TNT using upfront chemotherapy followed by chemoradiation (C-CRT) versus upfront chemoradiation followed by chemotherapy (CRT-C) in patients with locally advanced rectal cancer using the National Cancer Database. Materials/Methods Patients with cT3/4 or node positive rectal cancer, diagnosed between 2004–2017 were included. TNT with chemotherapy first was defined as chemotherapy given at least two months before concurrent chemoradiotherapy followed by definitive surgery. CRT-C was defined as chemotherapy and radiation starting within 14 days of each other, followed by chemotherapy, followed by definitive surgery four to six months later. Minimum follow up was 6 months, in order to account for immortal time bias. Multivariable logistic regression was performed to assess whether upfront chemotherapy followed by chemoradiation versus upfront chemoradiation followed by chemotherapy was significantly associated with pCR, defined as ypT0N0. Overall survival (OS) was analyzed via Kaplan-Meier method with the log-rank test. Multivariable Cox regression analysis was used to assess the impact of covariates on OS. Results There were 9,393 TNT cases identified. Of these, 1522(16.2%) received C-CRT and 7871(83.8%) received CRT-C. The pCR was 12.2% in both groups. On multivariable logistic regression analyses, there was no difference in pCR based on the timing of the radiation (OR 0.987, 95% CI 0.824-1.183, P  = .89). Kaplan-Meier analysis revealed that the 5-year OS rates for TNT was superior for C-CRT over CRT-C, with 5-year

关键词： 痣和黑素瘤   皮肤表现   病理过程   复发   肿瘤转移   痣样黑素瘤  

摘要： 目的探讨痣样黑素瘤的临床和组织病理学特征。方法回顾性分析2000—2020年西京皮肤医院诊断的3例痣样黑素瘤患者的临床和组织病理资料。结果3例痣样黑素瘤患者中,女2例,男1例,皮损初始表现为黑斑、丘疹。2例在手术切除后皮疹复发增大成斑块或新发结节样皮损。组织病理学检查:表皮及真皮内上皮样黑素细胞增生,细胞有异型性,部分细胞核深染。免疫组化结果显示,皮损内瘤细胞Melan-A、S100表达阳性;HMB45在真皮瘤细胞内弥漫阳性,局部阴性;Ki67增殖指数升高,细胞周期蛋白D1表达活跃。结论痣样黑素瘤易误诊为色素痣或脂溢性角化病;对于组织学诊断为色素痣,但临床出现复发或者转移的患者,需高度警惕痣样黑素瘤的可能。