降钙素阴性的甲状腺神经内分泌肿瘤临床病理特征分析

【摘要】 目的 探讨降钙素阴性的甲状腺神经内分泌肿瘤的临床病理特征及鉴别诊断。方法 对1例诊断为降钙素阴性的甲状腺神经内分泌肿瘤病例进行病史收集、形态学检查及免疫表型检测,并复习相关文献。结果 52岁女性患者在我院行甲状腺全切术后,甲状腺右叶剖视见一直径0.6cm的灰白结节,边界欠清,切面实性、质中,镜下肿瘤细胞排列成巢团状,细胞呈卵圆形或梭形,胞浆中等,胞核较小,染色质粗颗粒状,核仁不明显,间质纤维组织增生,免疫表型：甲状腺转录因子1（TTF-1）、嗜铬素A（CgA）、突触素（Syn）和癌胚抗原（CEA）均弥漫阳性,甲状腺球蛋白（TG）、降钙素（CT）均阴性,Ki 67增殖指数<1%。结论 降钙素阴性的神经内分泌肿瘤是一种罕见的甲状腺肿瘤,诊断需结合病理形态尤其是免疫表型。     

降钙素阴性的甲状腺神经内分泌肿瘤一例

神经内分泌肿瘤（neuroendocrine neoplasm）是一组起源于肽能神经元和神经内分泌细胞的异质性肿瘤,可发生于全身许多器官和组织[1].甲状腺髓样癌是最常见的甲状腺神经内分泌肿瘤,可分为散发性和遗传性.遗传性甲状腺髓样癌为常染色体显性遗传性疾病,并常为多发性内分泌肿瘤2型（MEN2）的一种临床表现.多数表现为降钙素升高,50％的患者可出现CEA升高[2].降钙素阴性的甲状腺神经内分泌肿瘤非常少见,可能是甲状腺癌的一种特殊类型,需要引起临床医师注意.烟台毓璜顶医院甲状腺外科近期收治一例降钙素阴性的甲状腺神经内分泌肿瘤,报道如下.     

甲状腺髓样癌临床病理学特征

目的探讨甲状腺髓样癌的临床病理特点、免疫表型及诊断。方法回顾性研究8例甲状腺髓样癌的临床资料,采用免疫组化方法研究其病理形态特点,并结合文献进行分析。结果8例甲状腺髓样癌的癌组织主要由多角形及梭形细胞组成,可呈多种组织学类型,其中巢状型3例,束状/带状型2例,其他类型3例。免疫组化降钙素、嗜铬素A均（＋）,6例神经元特异性烯醇化酶（＋）,5例癌胚抗原（＋）,6例突触素（＋）,1例HMB4（5＋）。MTC 50%颈部淋巴结转移。组织化学：刚果红染色（＋）。结论诊断时应注意与形态相似的肿瘤相鉴别,降钙素是甲状腺髓样癌特异性标记物,刚果红染色阳性及降钙素阳性是诊断的关键。     

胃肠胰神经内分泌肿瘤的临床诊断和治疗的研究进展

神经内分泌肿瘤是一类起源于神经内分泌细胞的肿瘤,临床相对较罕见,可发于全身任何部位。胃肠和胰腺是神经内分泌肿瘤最常见生长部位,其大小、位置和病理分型等各有不同,在免疫表型、组织形态学和生物学行为等方面亦各有特点,同时诊疗方法及其预后更存在明显差异。本文针对胃肠胰神经内分泌肿瘤的基本病理、检查诊断方法及不同病理分型可由于的治疗方法进行综述,为临床治疗提供参考。     

卵巢甲状腺肿类癌三例报告

目的 探讨卵巢甲状腺肿类癌的临床病理学特点和生物学行为。方法 对3例卵巢甲状腺肿类癌作临床病理分析及免疫组织化学染色，并随访结果。3例卵巢甲状腺肿类癌中2例为囊肿型，1例为混合型。组织学上2例以梁状结构为主，混合岛状结构；1例为梁状结构。免疫组织化学标记3例Syn、CgA及NES均阳性；2例降钙素阳性，生长抑素阴性，TG滤泡区阳性，而类癌区为阴性。结论 卵巢甲状腺肿类癌是一种伴有甲状腺滤泡分化的低度恶性神经内分泌癌。     

卵巢甲状腺肿类癌3例报道

目的探讨卵巢甲状腺肿类癌的临床病理特点和生物学行为．方法对3例卵巢甲状腺肿类癌进行临床病理分析及免疫组化染色观察．结果2例为混合型。1例为瘤壁结节型；组织学上2例以梁状结构为主，其中混有巢状结构，1例是梁状和小管状结构；免疫组化表型：3例syn和cgA均阳性；T（3甲状腺滤泡区阳性，而类癌区阴性，同时做S-100均阴性，其中1例cgA弱阳性．结论卵巢甲状腺肿类癌是一种伴有甲状腺滤泡分化的低度恶性神经内分泌癌．     

鼻咽部低级别甲状腺样乳头状腺癌的临床病理分析

目的探讨鼻咽部低级别甲状腺样乳头状腺癌（TL-LGNPPA）的临床病理特征、免疫表型及鉴别诊断。方法对2例TL-LGNPPA患者的临床表现、组织学形态及免疫表型进行回顾性分析,并复习相关文献。结果1例女性,44岁;1例男性,67岁。2例患者肿物均位于鼻咽顶部,呈外生性息肉状生长。镜下观察,肿瘤均由乳头状结构和管状腺体组成,乳头间质为纤维血管轴心。乳头和管腔被覆立方或柱状上皮,细胞核呈圆形、卵圆形,形态一致,相对温和,细胞质嗜酸性。免疫组化标记显示,2例患者肿瘤细胞均弥漫表达广谱细胞角蛋白、细胞角蛋白（CK）7、CK19、甲状腺转录因子-1和波形蛋白,灶性表达上皮膜抗原和CD117,不表达CK5/6、p63、CK20、甲状腺球蛋白、PAX8、CD15和BRAFV600E,Ki-67阳性指数为1%~2%。EB病毒编码的小RNA原位杂交法检测2例均为阴性。结论TL-LGNPPA是一种罕见的低度恶性上皮性肿瘤,具有独特的形态学特点和免疫表型,熟悉其临床病理特点有助于诊断及鉴别诊断。     

神经内分泌肿瘤诊断中NSE,Cg—A SYP标志的意义

神经内分泌肿瘤是一组以含有神经内分泌颗粒，可分泌特异性激素或多肽为共同特征的特殊肿瘤，它发生部位广泛，形态结构多样，给病理诊断带来困难。研究发现，正常及肿瘤性神经内分泌细胞中含有某些共同物质，可作为识别神经内分泌肿瘤特异性标记物。目前应用较多的标记物有神经特异性烯酸化酶（NSE），嗜铬颗粒蛋白A（Cg-A）及突触膜蛋白（Svv）。本研究应用NSE、Cg-A、SYP三种标记物的抗体，对不同部位的神经内分泌肿瘤进行标记，以探讨三种标记物在神经内分泌肿瘤中的诊断价值。材料和方法一、一般资料（一）材料收集1977～1994年…     

多层螺旋CT对甲状腺病变的诊断价值

目的评价多层螺旋CT（MSCT）在甲状腺肿瘤诊断中的价值。方法回顾性分析50例经手术病理证实的甲状腺肿瘤的MSCT扫描资料。结果50例甲状腺肿瘤病例中，甲状腺腺瘤22例，MSCT诊断符合率68.75％（22／32），假阳性10例；结节性甲状腺肿瘤18例，诊断符合率44.4％（8／18），假阴性9例，1例隐匿性，MSCT未检出；甲状腺癌10例，诊断符合率90％（9／10），假阴性1例。结论MSCT诊断可靠，在显示甲状腺内肿块以及对肿瘤定性诊断方面有重要价值。     

RET原癌基因突变致多发性内分泌腺瘤病2b型临床诊治

多发性内分泌腺瘤病（MEN）2b型是RET基因突变引起的常染色体显性遗传病,常见临床表型为甲状腺髓样癌（MTC）、嗜铬细胞瘤、多发性黏膜神经瘤和类马凡体型,各表型可同时或先后发生,易漏诊。本文分析了1例MEN2b型患者病史、诊断、治疗及随访资料。本例患者1995年无诱因出现颈部增粗,诊断为"右甲状腺腺瘤";1999年发现"左侧甲状腺占位";2000年发现舌、唇黏膜增厚并突起小肿物,肿物渐增大;2009年及2010年分别行左、右肾上腺肿物切除,术后病理示：嗜铬细胞瘤。本次入院行下唇内侧局部小突起切除和双侧甲状腺次全切除术,术后病理示：舌黏膜神经瘤、MTC。患者基因测序发现RET基因第16号外显子918密码子突变（M918T）,患者父母、兄均未出现MEN2b表型特征,基因检测无异常发现。患者MTC术后1年降钙素水平仍高于参考值,结合肺部CT检查结果,考虑MTC肺部转移可能性较大。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.