涎腺导管内癌的病理诊断及新进展

涎腺导管内癌(intraductal carcinoma,IDC)是一种主要发生在腮腺,在导管内或囊内生长为主的罕见肿瘤,但也可伴浸润性生长,生物学行为相对惰性。具有独特的形态学、免疫表型及分子遗传学特征。主要包括4种亚型:闰管型、顶浆分泌型、闰管-顶浆分泌混合型和嗜酸型。闰管型多数存在NCOA4-RET融合,个别存在STRN-ALK融合;混合型存在TRIM27-RET融合,顶浆分泌型具有PIK3CA和HRAS突变或TP53缺失;嗜酸型具有TRIM33-RET融合或BRAF V600E突变。目前多数观点认为与涎腺导管癌不同,即使存在浸润,仍具有良好的预后,罕见复发和淋巴结转移,无远处转移。因此精准诊断对于临床治疗的选择极其重要。     

原发性肺涎腺型导管癌1例

原发于肺的支气管涎腺来源的导管癌是罕见的涎腺型恶性肿瘤, 具有高度侵袭性的生物学行为。本文报道1例65岁老年男性患者, 发生在右肺下叶结节, 根据典型的病理组织形态、免疫组织化学特征及分子基因改变, 在临床及影像排除乳腺及头颈部涎腺来源的肿瘤转移后明确诊断。     

乳腺浸润性筛状癌临床病理分析

目的探讨乳腺浸润性筛状癌（invasive cribriform carcinoma，ICC）的临床病理和免疫表型特点。方法复习8例乳腺ICC的临床病理资料，并将其组织学特征、免疫表型和预后与浸润性导管癌进行比较。结果乳腺ICC发病平均年龄42．9岁，多表现为无痛性乳房肿块，影像学微钙化常见。组织学特征是不规则癌细胞团巢呈筛状结构浸润性生长，瘤细胞核级低-中等，多数病例核分裂象少见，胞质顶浆分泌和间质成纤维细胞增生易见，常并存筛状型导管原位癌和小管癌。免疫表型显示CK34βE12高表达而CK5／6阴性，肌上皮标记阴性。8例中经典型6例、混合型2例，其发病年龄、组织学分级、腋淋巴结转移率、c-erbB-2和Ki-67阳性率均低于浸润性导管癌，近期随访结果显示预后优于浸润性导管癌。结论乳腺ICC作为WHO新确定的浸润性癌类型，预后较好，需要与筛状型导管原位癌和腺样囊性癌等鉴别，免疫组化染色有助于确诊。     

类似发生于乳腺的涎腺分泌性癌临床病理学特征

类似发生于乳腺的涎腺分泌性癌( mammary analogue secretary carcinoma of salivary glands, MASC)是一种发生于涎腺的具有乳腺分泌性癌的临床病理特征、免疫表型及遗传学改变的罕见恶性肿瘤。该肿瘤的形态和组织学结构与涎腺的腺泡细胞癌及其他一些低级别恶性肿瘤非常相似,目前认为其是一种新的独立类型肿瘤。该文现对MASC的临床病理学特征及鉴别诊断等作一综述。     

类似于乳腺分泌性癌的涎腺肿瘤:迄今尚未描述的一种涎腺肿瘤

作者报道了16例具有乳腺分泌性癌组织病理学和免疫组织化学特征的涎腺肿瘤。这是一种迄今尚未描述和明确认识的涎腺肿瘤,具有涎腺腺泡细胞癌(AciCC)和低级别囊腺癌两者相似的结构特征,极其类似于乳腺分泌性癌。     

涎腺导管癌4例临床病理分析

目的探讨涎腺导管癌(salivary duct carcinoma)的临床病理特征、免疫表型、治疗及预后。方法回顾性分析4例涎腺导管癌的临床病理资料、病理学形态及免疫表型特征,并复习相关文献。结果 4例均为男性,平均发病年龄49岁(范围36～71岁),且均发生于腮腺(4/4)。肿瘤最大径3～4 cm。镜下组织形态类似于高级别乳腺导管癌,肿瘤呈实性、管状排列,可见导管扩张及粉刺样坏死,瘤细胞较大,细胞核大,异型性明显,胞质丰富,嗜酸性。免疫表型:CK(AE1/AE3)、EMA、S-100、GCDFP-15、AR、Ki-67均阳性,SMA、CEA、p63、CD56、CGA、Calponin、PR均阴性,1例ER为1+,按乳腺癌HER-2判读标准,2例HER-2为2+,2例为0～1+。随访2例患者(2/4)于2年内发生转移。结论涎腺导管癌是一种罕见的侵袭性恶性肿瘤,预后较差,与乳腺导管癌形态相似。     

WHO(2017)涎腺肿瘤分类解读

正1新增加的肿瘤及其亚型1.1分泌性癌乳腺样分泌性癌(mammary analogue secretory carcinoma,MASC)于2010年首次报道,属于涎腺的恶性肿瘤,被WHO(2017)涎腺肿瘤分类收录。由于该肿瘤存在t(12;15)(p13;q25)染色体易位及ETV6-NTRK3基因融合~([1]),故被命名为MASC。MASC常发生于成人,发病年龄广,流行病学上MASC性别差异不显著,男性略多于女性~([2])。肿瘤生长一般较为缓     

涎腺腺泡细胞癌临床病理分析并文献复习

目的：探讨涎腺腺泡细胞癌的临床病理学特点及诊断要点。方法：对1例涎腺腺泡细胞癌进行临床资料、病理形态学及免疫组织化学观察,并结合文献对其诊断及鉴别诊断进行探讨。结果：镜下瘤细胞胞体宽大,胞浆嗜碱性呈细颗粒状,核圆形瘤细胞生长呈腺泡状或实性片状生长,部分区域呈乳头状改变,免疫组化显示AE1/AE3(+)、CK8/18(+)、CK7(+)、AAT(+)、S-100(+)。结论：涎腺腺泡细胞癌发病率低,但根据其常见的发病部位及特征性的组织形态,结合免疫组织化学方法,有助于其诊断及鉴别诊断。     

与甲状腺滤泡相似的涎腺滤泡型腺泡细胞癌1例并文献复习

目的探讨涎腺滤泡型腺泡细胞癌的临床病理学特点。方法回顾性分析1例涎腺滤泡型腺泡细胞癌的临床病理学、影像学及免疫表型特征,并复习相关文献。结果患者男性,40岁,CT检查及肉眼观均显示左侧腮腺区可见一囊实性结节,与周围界限清楚,肿物最大径约3 cm。低倍镜下见肿瘤境界清楚,包膜较完整;肿瘤细胞大都形成微囊和大囊腔隙,内含嗜酸性蛋白性物质,由肿瘤细胞围绕,相似于甲状腺滤泡,此为滤泡型腺泡细胞癌的特征。高倍镜下见囊壁细胞已被压扁呈梭形,胞质略嗜碱性,核扁梭形,未见明显异型。肿瘤细胞PAS阳性。免疫表型:腺泡样区域和滤泡状区域的肿瘤细胞均表达抗胰蛋白酶α-AAT、抗糜蛋白酶α-ACT、DOG1,Ki-67增殖指数2%～3%,均不表达甲状腺标志物TG和TTF-1,也不表达S-100、Mammaglobin和vimentin。结论滤泡型腺泡细胞癌原发于涎腺,非常罕见,目前其临床生物学行为难以确定,需对患者进行长期随访。     

涎腺分泌性癌细针穿刺细胞病理学特征

目的探讨涎腺分泌性癌的细针穿刺细胞病理学特征。方法收集福建省肿瘤医院2017年12月至2018年5月2例腮腺分泌性癌患者的临床资料,对其进行细胞学、组织学观察、免疫组织化学及分子遗传学方法检测,并结合文献进行讨论。结果2例细胞学涂片均显示富于细胞,主要呈乳头结构或单个散在分布。肿瘤细胞核偏位,胞质丰富,嗜酸性或空泡状。免疫组织化学示肿瘤细胞弥漫表达细胞角蛋白7(CK7)、波形蛋白和S-100蛋白。例1 DOG1和Mammaglobin灶性阳性,例2 Mammaglobin弥漫强阳性,DOG1阴性。例2免疫细胞化学示肿瘤细胞弥漫表达Mammaglobin,而S-100蛋白仅局部表达,不表达DOG1。间期荧光原位杂交(FISH)检测到ETV6基因易位。结论涎腺分泌性癌细胞学形态与其他涎腺肿瘤重叠,仅仅根据细胞学形态诊断存在困难。制备细胞蜡块并借助免疫细胞化学和FISH检查可准确诊断。     

Level of functioning of siblings and parents of probands of varying degrees of retardation

A further analysis of already published data supports the position that retardates of low ability level less frequently have retarded siblings, retarded parents, and parents low in occupational level than do retardates higher in ability level. The analysis supports the position that there are two types of retarded individuals, persons retarded as a result of gene or chromosomal anomalies, brain injury, etc., who more frequently occur in the lower-level retardate group, and persons whose retardation represents polygenic segregation, who more frequently occur in the higher-level group.     

Modes of Inheritance of Errors of Refraction

Eighteen families in which both parents had refractions within the range of +4·0 D to −4·0 D and axial lengths seen in emmetropia (22·3-26·0 mm) showed coefficients of correlation of the order 0·5 indicative of polygenic inheritance. Such coefficients were seen for axial length (0·407) and for the cornea (0·487), but not for the lens (which is known to be yoked to the axial length). No such coefficients were seen in 19 families in which one of the parents had axial length outside the emmetropic range (nine families with long axes and 10 with short axes).

The pattern of polygenic inheritance for emmetropia (completely correlated optical components) and errors of refraction up to 4·0 D (inadequately correlated components: correlation ametropia) follows that seen in stature and other measurable characters. In contrast the high refractive errors with their abnormal axial lengths (component ametropia) are—like the extremes in stature—pathological anomalies with monofactorial inheritance.

     

Recovery of responsiveness of cells of lateral geniculate nucleus of rat

1. Recovery of responsiveness of single cells in lateral geniculate nucleus of rat has been determined in both P and I cells. There are three types of recovery curve among P cells; (a) early recovery, (b) early partial recovery followed by depression and then complete recovery, (c) prolonged depression followed by cyclic recovery. Type (c) is by far the commonest recovery curve. In contrast to the spike in a P cell, the synaptic potential recovers to its full amplitude in about 20 msec. All I cells exhibit similar rapid recovery curves after a prolonged depression.2. Conditioning stimuli applied to visual cortex also produce a prolonged depression in most P cells but I cells can be re-excited at short intervals from cortex. Decortication does not prevent the prolonged depression of the multineuronal response produced by optic nerve stimulation.3. A neuronal model is proposed to explain these observations. It is supposed that I cells (interneurones) are innervated by axon collaterals of the P cells (principal cells, projecting to visual cortex) and that the I cells exert an inhibitory influence on the P cells.     

Analysis of two types of dopaminergic responses of neurons of the spinal ganglia of rats

It was established, in experiments on isolated spinal ganglia of adult rats in concluons of intracellular recording, that dopamine (1 M/liter) elicits depolarized responses in 61% of neurons, hyperpolarized in 20% of neurons, and depolarized-hyperpolarized in 19% of neurons. The depolarized responses are associated with the activation of D₁ dopamine receptors, and are governed by the shift of cAMP-dependent cation (sodium) channels to the conducting state. The hyperpolarized responses are triggered by the activation of D₂ dopamine receptors, which by means of HTP-binding protein convert the potassium channels to the conducting state. The change in the polarization of neurons with the action of dopamine influences their electrical excitability variously.Translated from Fiziologicheskii Zhurnal SSSR imeni I. M. Sechenova, Vol. 76, No. 6, pp. 739–745, June, 1990.     

局部注射辛伐他汀对骨质疏松大鼠股骨髁骨小梁的改建效应

背景：局部注射具有成骨作用的辛伐他汀,可显著增加骨质疏松大鼠股骨颈及股骨髁部的骨密度及力学强度,分析局部注射辛伐他汀对股骨髁骨小梁的影响。 目的：进一步研究骨质疏松大鼠股骨内局部注射辛伐他汀对股骨髁骨小梁的影响。为将辛伐他汀应用于临床骨质疏松局部治疗提供实验基础。 方法：18只雌性SD大鼠双侧卵巢切除后3个月,制备大鼠骨质疏松模型。实验大鼠随机数字表法均分为3组,分别在实验大鼠的右侧股骨髓腔内单次注射辛伐他汀溶液5 mg、10 mg,对照组单纯注射空白载体。分别在注射后1个月处死大鼠并取材。Micro-CT扫描并定量分析骨组织形态变化。 结果与结论：给药后1个月,Micro-CT扫描结果显示,辛伐他汀治疗组的骨微结构参数如骨皮质厚度、骨小梁密度及连接率明显优于对照组。说明疏松骨骼单次注射小剂量辛伐他汀可显著促进股骨髁部骨小梁改建,改善骨骼微结构,可为强化局部、防治骨质疏松骨折的新选择进一步提供实验基础。