教学课程资源库 更多>>

关键词： 中职院校   病理学   教学改革   教学方式   改革途径  

摘要： 病理学在整个医学学科中能够发挥出非常关键性的作用,处于基础医学和临床医学之间,是医学专业学习的基础,但是现阶段中职院校在病理学这门课程的教学过程中,在培养技能型以及综合型人才的教学模式上,还存在一定的缺陷。因此需要进一步强化病理学的教学成果,优化病理学的教学模式,展开病理学这门课程的教学改革,这样才能够培养出更多的综合型以及技能型医学人才,满足整个医疗行业的需求,适用中职院校在教育行业上的发展目标。基于此,文章对中职病理学改革的途径展开相应的分析和探讨,以供同行参考。

摘要： Purpose/Objective(s) In locally advanced rectal cancer (LARC) patients treated with neoadjuvant chemoradiotherapy (CRT), surgery could be omitted in patients with complete pathological response (pCR) without compromising progression-free and overall survivals. Our objective is to develop a radiomic model based on Magnetic Resonance Imaging (MRI) and contrast-enhanced computed tomography (CT) scans to predict the pathologic complete response (pCR) to neoadjuvant CRT in LARC. Materials/Methods All patients treated for a LARC with neoadjuvant CRT and subsequent surgery in 2 centers in the West of France (Insitut of Cancerologie Brittany Occidental (ICBO) and Nantes) were considered. Both pre-CRT pelvic MRIs and contrast-enhanced CT-scans were mandatory for inclusion. The tumor was manually segmented on the T2-weighted and diffusion axial sequences and on the contrast-enhanced CT-scan. Eighty-eight radiomic parameters (15 shape and geometry features, 11 first-order and 62 second-order) were extracted from each sequence using the in-house MirasÓ software, with a total of 1056 features by patient. The overall cohort was randomly split into two independent cohorts (training: 70% and testing: 30%). A strict feature set selection workflow based on the Spearman's correlation coefficient and the Area Under the Curve (AUC) was developed to reduce the number of features. Based on these selected features, three pCR prediction models (clinical, radiomics and combined: clinical + radiomics) were developed on the training set only with a random forest approach and a Bootstrap internal validation with n = 1000 replications. An optimal cut-off maximizing the model's performance was defined on the training set. Each model was then evaluated on the testing set, based on the AUC and the C-statistic calculated with the pre-defined cut-off. Finally, a posteriori harmonization using the ComBat approach was applied to account for imaging modalities heterogeneity. Results Of the 124 included

关键词： 神经内分泌肿瘤   特殊染色   组织学形态   免疫表型   细胞异型性   RAD51   无义突变   基因变异  

摘要： 目的探讨胃具有腺和神经内分泌双向分化的癌(AC)的临床病理学特征。方法收集苏州大学附属第三医院/常州市第一人民医院2019—2020年诊断的胃AC 2例患者的临床资料,观察其组织形态学特征,通过免疫组织化学染色、特殊染色及二代测序等技术分析其免疫表型及分子特征,并复习相关文献。结果 2例患者均为男性。例1,54岁,病变位于胃窦,肿瘤最大径为4 cm;例2,75岁,病变位于贲门,肿瘤最大径为2 cm。镜下观察肿瘤细胞主要呈片状或条索状分布,细胞异型性大,核仁明显,核分裂象多见,肿瘤细胞主要为印戒细胞样,例1可见神经内分泌肿瘤成分,并伴淋巴结转移,例2局灶伴有细胞外黏液,还可见瘤巨细胞。2例肿瘤细胞均弥漫强阳性表达突触素、嗜铬粒素A和CD56,广谱细胞角蛋白、MUC1和MUC4也有表达,不表达MUC2、MUC5AC及MUC6。特殊染色结果:阿辛蓝-过碘酸雪夫(AB-PAS)染色阳性。二代测序结果:例1 RAD51D ***266Cys错义突变,例2 TSC1、SMAD4、PALB2、VEGFA、FGFR3错义突变,TP53无义突变,PTEN剪接位点变异,MYC拷贝数扩增。结论胃AC是一种同时具有神经内分泌和腺上皮分化特征的罕见肿瘤,结合组织学形态、免疫表型、AB-PAS染色结果及基因变异特点有助于诊断。

摘要： Purpose/Objective(s) Inguinofemoral lymphadenectomy (IFL) is a morbid procedure, and studies support the use of sentinel lymph node biopsy (SLNB) as an initial staging procedure for women with early stage operable vulvar cancer. However, in the recently presented GROINSS-V II study, for patients with SLNB metastasis > 2 mm, groin radiotherapy with a total dose of 50 Gy was not a safe alternative to IFL due to an increased number of groin recurrences. Therefore, the management of patients with SLNB-positive groin disease remains controversial. We used the National Cancer Database (NCDB) to examine national trends in the use of SLNB, IFL, and adjuvant therapies in clinically node negative, pathologic node positive (cN-/pN+) vulvar cancer. Materials/Methods The NCDB was used to identify patients with cN-/pN+ vulvar cancer between 2012 and 2017. Patients with benign histologies, Paget's disease, and melanoma were excluded. Demographic and clinical data were compared with the chi-squared and Wilcoxon rank-sum test. Overall survival (OS) was analyzed with the Kaplan-Meier method and log-rank test. Cox proportional hazards regression modeling was used to determine factors associated with OS. Results A total of 1,715 patients with cN-/pN+ vulvar cancer were identified. Of this group, sentinel lymph node data was recorded for 1,172 patients. The rate of SLNB with or without IFL increased from 10.2% in 2012 to 24.0% in 2017. The rate of patients who had SLNB alone increased from 3.4% to 15.1% and conversely, the rate of IFL +/- SLNB decreased from 96.6% to 84.9% (P < 0.05). The SLNB-alone cohort (n = 126) did not differ from the IFL +/- SLNB (n = 1046) cohort in terms of race, age, tumor size, margin status, treatment at academic vs. community center, income, insurance, and residence in a metropolitan or non-metropolitan area. Rates of adjuvant treatments were similar with radiation therapy utilized in 63.5% and 64.9% of the SLNB-alone and IFL +/- SLNB cohorts, respectively.

摘要： Purpose/Objective(s) Postmastectomy radiation therapy (PMRT) is recommended for patients with breast cancer who have positive nodal disease. Whether there is a benefit to PMRT in patients who have cN+ disease at diagnosis, but a pathologic complete response following neoadjuvant chemotherapy (NAC) in the lymph nodes (pCRn) is unknown. The purpose of the present study is to determine if there is a benefit to PMRT in patients who have a pCRn following neoadjuvant chemotherapy, and which subsets of patients may derive the benefit from PMRT following a pCRn. Materials/Methods This study was conducted using patients from the National Cancer Data Base (NCDB). Patients included in this study were women diagnosed with breast cancer with cT1-4N1-3 disease who had invasive ductal carcinoma histology and received treatment with NAC and then mastectomy. Overall survival (OS) was compared between all patients using the Kaplan- Meier analysis. To further determine if subsets of patients may derive a greater benefit from PMRT, OS was compared after stratifying patients for clinical T stage, clinical N stage, pathologic T stage, and molecular subtype. Multivariable logistic regression ascertained factors associated with PMRT use. Cox proportional hazards modeling determined variables associated with OS. Results A total of 14,960 patients met the selection criteria, of whom 10,092 (67.5%) received PMRT, and 4598 (30.7%) did not. Amongst all patients, there was no difference in OS with the use of PMRT (10-year OS 76.3% vs 78.6%, P  = 0.4147). Improvement with the use of PMRT was observed amongst patients with cN3 (10-year OS 73.1% vs 51.7%, P < 0.001), cT3 (10-year OS 77.0% vs 72.2%, P  = 0.0154) or cT4 (10-year OS 69.6% vs 59.1%, P  = 0.0001) disease, ypT2 (10-year OS 72.9% vs 65.0%, P  = 0.0053) or ypT3 disease (10-year OS 62.3% vs 45.3%, P  = 0.0466), as well as patients with ER+HER2+ disease (10-year OS 85.4% vs 56.5%, P  = 0.0225). Factors predictive of PMRT use include younger

关键词： 自身免疫性肝炎   药物性肝损伤   血清抗体   病理学特点  

摘要： 目的:分析自身免疫性肝炎与药物性肝损伤患者血清抗体和肝组织病理学特点。方法:选取2018年11月—2019年11月我院接受治疗的40例自身免疫性肝炎患者和50例药物性肝损伤的患者,对两组患者的血清抗体、肝组织病理学情况等特点进行比较分析。结果:肝功能指标的对比中,药物性肝损伤患者的丙氨酸转氨酶(ALT)、草氨酸转氨酶(AST)、白蛋白(ALB)和总胆红素(TBIL)的指标均高于自身免疫性肝炎的患者,差异均有统计学意义(P<0.05),两组患者CHE1、ALP和GGT比较,差异均无统计学意义(P>0.05);药物性损伤患者的血清抗体阳性率除ANA外,其他指标均低于自身免疫性肝炎患者,差异有统计学意义(P<0.05);药物性损伤患者在汇管区中性粒细胞浸润和肝内胆汁淤积的发生情况呈现出更高的趋势,浸润淋巴细胞、浸润浆细胞和肝细胞玫瑰花样结构的发生情况则自身免疫性肝炎的发生率更高,差异有统计学意义(P<0.05)。结论:自身免疫性肝炎与药物性肝损伤患者在血清抗体、肝组织病理学和免疫学上有着显著差异,通过此种检测,可对患者的病情进一步鉴别和诊断起到重要作用,为患者提供更准确的治疗。

关键词： 涎腺肿瘤   分泌性癌   NTRK   腺泡细胞癌   分子病理  

摘要： 目的探讨涎腺分泌性癌(salivary secretory carcinoma,SSC)的临床病理学特征、免疫表型、治疗及预后。方法收集12例SSC的临床病理学资料,行免疫组化EnVision两步法染色和FISH法检测,并复习相关文献。结果12例SSC均发生于涎腺,包括腮腺9例、颌下腺2例和气管小涎腺1例。患者年龄15~78岁,中位年龄48岁;肿瘤平均最大径2.4 cm(0.5~5 cm)。SSC镜下形态结构多样,包括巢状、微囊、乳头状、实性和小管状结构。微囊和小管的腔内常充满黏液及嗜酸性胶样分泌物。瘤细胞核多为卵圆形,小核仁、核分裂象罕见,胞质丰富嗜酸性。免疫表型:9例CK7呈弥漫胞膜阳性,9例S-100呈弥漫阳性,2例S-100呈部分阳性,8例Mammaglobin呈弥漫胞质阳性,1例Mammaglobin呈部分阳性,2例Mammaglobin呈局灶阳性,5例GATA3呈弥漫胞核阳性。9例行DOG1检测,其中4例呈局灶阳性,1例呈部分阳性,4例呈阴性。6例行pan-TRK检测,其中3例呈弥漫核阳性,1例约10%肿瘤细胞核阳性及核仁阳性,另2例为单纯核仁阳性。5例采用融合探针FISH检测显示有特征性ETV6-NTRK3基因融合。12例患者临床均表现为相应部位的无痛性肿块,8例获得随访,中位随访时间24.5个月(8~28.5个月),均无复发或转移。结论SSC属于罕见的头颈部肿瘤,临床生物学行为多为惰性,pan-TRK免疫组化检测可用于初筛,确诊需经FISH或二代测序检测。

摘要： Purpose/Objective(s) Spatially fractionated radiotherapy, or GRID radiotherapy, is a technique utilizing multiple beamlets of high dose radiotherapy in a heterogeneous grid pattern to treat tumor non-uniformly with megavoltage X-rays while maintaining normal tissue tolerance. We sought to characterize associations between GRID dosimetric parameters and pathologic response in patients undergoing preoperative GRID radiotherapy for high grade soft tissue sarcoma. Materials/Methods We analyzed 26 patients with high grade soft tissue sarcomas undergoing GRID radiotherapy. Dosimetric parameters included mean dose to GTV, maximum dose to 0.01 cc, maximum dose to 0.03 cc, D5, D10, D20, D50, D90, D100, V5, V10, V20, V50, V90, V100, total area under the curve, maximum tumor length, maximum tumor width, tumor volume, equivalent uniform dose to GTV, minimum surface to tumor distance, maximum surface to tumor distance, maximum tumor depth, maximum dose outside GTV, maximum dose to skin, number of beamlets, peak to valley ratio, and peak to peak distance. Results The dosimetric parameters most closely associated with pathologic response were maximum dose to 0.01 cc and maximum dose to 0.03 cc (Spearman coefficient of 0.685, P -value of 0.01). Mean dose to GTV, V90, and V100 showed weak associations that weaker associations that were not significant (Spearman coefficient of 0.442, 0.510, and 0.504 with P -values of 0.08, 0.09, 0.09). Conclusion This study showed an association between the dosimetric parameters maximum dose to 0.01 cc and maximum dose to 0.03 cc and pathologic response in patients undergoing preoperative GRID radiotherapy for high grade soft tissue sarcoma.

关键词： 多层螺旋CT   磁共振成像   颅咽管瘤   病理学  

摘要： 目的观察其MSCT、MRI影像学特征及与病理特征进行对照分析。方法回顾性分析本院2017年6月至2019年4月收治的60例颅咽管瘤患者的临床资料,观察MSCT检查及MRI检查平扫和增强扫描的影像特点,与病理特征进行对照;分析颅咽管瘤的MSCT和MRI表现,记录肿瘤平扫和增强后的相关数据。结果60例患者中T1WI上呈低信号34例,混杂信号19例,高信号7例。T2WI以高信号为主,31例内有低信号区;有49例钙化,囊肿壁钙化呈弧线状、蛋壳状,实质肿块钙化呈点状、斑点状。结论MSCT检查及MRI检查可清楚显示颅咽管瘤的影像学特点,为临床上诊断和鉴别颅咽管瘤提供了可靠的信息,并与临床病理具有良好的相关性,结合患者临床资料可有效提高诊断准确率。

关键词： 胸腺类癌   Cushing综合征   甲状腺转录因子1   MEN1基因   满月脸   阳性指数   肿瘤压迫   梭形细胞  

摘要： 目的探讨胸腺类癌的临床病理特征,并对其预后及影响因素进行分析。方法收集郑州大学第一附属医院2011年8月至2020年10月诊断的25例胸腺类癌,分析其临床病理特征及预后,并对1例多发性内分泌腺瘤病1型(MEN1)患者及其子的外周血进行基因遗传学分析。结果 25例胸腺类癌中,男性18例,女性7例,男女比例2.6∶1.0,年龄23~67岁,平均年龄50岁,15例(60%)患者有吸烟史;典型类癌1例(4%),不典型类癌24例(96%);15例患者(60%)伴有肿瘤压迫症状,1例(4%)有内分泌相关症状(满月脸、皮肤紫纹),3例(12%)有转移引起的相关症状,6例(24%)无症状。8例(32%)患者血清神经元特异性烯醇化酶(NSE)水平升高,2例为MEN1患者,1例合并Cushing综合征。Ⅰ期20例(80%),Ⅱ期1例(4%),Ⅲ期3例(12%),Ⅳ期1例(4%)。手术治疗18例(72%)、手术联合放疗2例(8%)、手术联合化疗5例(20%)。镜下观察:肿瘤细胞排列呈梁状、腺样、实性,瘤细胞巢间血窦丰富。其中5例可见梭形细胞形态,1例为嗜酸细胞亚型。广谱细胞角蛋白、CD56、突触素、嗜铬粒素A、甲状腺转录因子1、p53及PAX8的阳性率分别100%(25/25)、92%(23/25)、96%(24/25)、72%(18/25)、4%(1/25)、0/15、0/16,Ki-67阳性指数为5%~30%。1例MEN1患者及其子均有MEN1基因突变。Cox多因素分析未发现影响胸腺类癌的预后因素(P>0.05)。结论胸腺类癌以不典型类癌常见,临床症状不典型,明确是否为胸腺原发需结合临床及影像学资料;伴MEN1的胸腺类癌患者,要对其直系亲属进行基因检测和随访;影响胸腺类癌的预后因素需更多病例及更长时间的随访。