SALL4在原发性卵黄囊瘤诊断中的应用

目的评价SALL4在原发性卵黄囊瘤病理诊断中的应用价值。方法采用免疫组化EnV ision法检测SALL4蛋白在32例性腺及性腺外原发性卵黄囊瘤中的表达情况,其中睾丸14例,卵巢12例,骶尾部5例,脑1例。另外,选取10例卵巢粒层细胞瘤,5例卵巢透明细胞癌,正常睾丸及卵巢组织各10例作为对照。同时检测AFP和glypican-3在上述肿瘤中的表达情况。结果所有卵黄囊瘤均SALL4(+)(100%),均中度至强(+);28例glypican-3(+)(87.5%),其中24例(75%)中度至强(+),4例(12.5%)弱(+);25例(78.1%)AFP(+),其中22例(68.8%)弱至中度(+),3例(9.4%)强(+)。SALL4表达率和表达强度均高于AFP和glypican-3,差异显著(P0.05)。对照组中,卵巢粒层细胞瘤1例AFP和glypican-3灶性弱(+),SALL4(-)。卵巢透明细胞癌1例AFP灶性弱(+),SALL4和glypican-3(-)。正常睾丸及卵巢组织SALL4、AFP和glypican-3均(-)。结论SALL4是诊断卵黄囊瘤特异性较好的免疫标记物,其阳性率和阳性强度均优于AFP和glypican-3,特别有助于与卵巢粒层细胞瘤和透明细胞癌的鉴别。     

SALL4、CD30、D2-40和glypican-3在卵巢生殖细胞肿瘤中的表达及应用

目的探讨SALL4、CD30、D2-40和glypican-3在卵巢生殖细胞肿瘤(OGCTs)中的表达及其在诊断及鉴别诊断中的价值。方法应用免疫组化方法(En Vision法)检测SALL4、CD30、D2-40和glypican-3蛋白在55例原发性卵巢生殖细胞肿瘤中的表达,包括16例无性细胞瘤、10例胚胎性癌、12例卵黄囊瘤、1例绒毛膜癌、16例畸胎瘤(其中6例为未成熟性,10例为成熟性)。另选取10例正常卵巢组织及5例卵巢透明细胞癌作为对照。结果SALL4在无性细胞瘤(16/16)、胚胎性癌(10/10)和卵黄囊瘤(12/12)中均呈弥漫强(+),在绒毛膜癌(1/1)、未成熟畸胎瘤(3/6)和成熟性畸胎瘤中(2/10)局灶(+)。CD30在胚胎性癌(8/10)中(+),在无性细胞瘤、绒毛膜癌、卵黄囊瘤和畸胎瘤中均(-)。D2-40在无性细胞瘤(16/16)呈弥漫强(+),在胚胎性癌(3/10)中局灶(+),在卵黄囊瘤、绒毛膜癌和畸胎瘤中均(-)。glypican-3在卵黄囊瘤(11/12)中弥漫(+),在绒毛膜癌(1/1)和胚胎性癌(2/10)局灶(+),在无性细胞瘤和畸胎瘤中均(-)。10例正常卵巢组织和5例卵巢透明细胞癌均未见SALL4、CD30、D2-40和glypican-3的表达。结论 SALL4是诊断OGCTs较好的抗体,CD30、D2-40和glypican-3分别是诊断胚胎性癌、无性细胞瘤及卵黄囊瘤较好的抗体,特别有助于与透明细胞癌的鉴别。     

鼻咽部滤泡树突状细胞肉瘤的临床病理观察

目的探讨鼻咽部滤泡树突状细胞肉瘤的临床病理特点、诊断及鉴别诊断要点。方法回顾分析2例鼻咽部滤泡树突状细胞肉瘤的临床表现、影像学、组织病理学特点及免疫组化表型。结果 2例均为女性,年龄分别为53岁和56岁。肿物最大径分别为4.4 cm和4 cm。2例肿瘤均由梭形细胞组成,细胞片状排列,局部略呈车辐状、束状、旋涡状,细胞异型性不明显。免疫组化:vimentin、CD21和CD23均(+),CK(-);例1 EMA(+),CD35(-),EB病毒(+);例2 CD35(+),EMA(-),EBV(-)。例1放弃治疗,随访2个月,目前带瘤生存;例2接受了肿物扩大切除,术后25个月复发,拒绝再次手术,目前带瘤生存32个月。结论鼻咽部滤泡树突状细胞肉瘤非常罕见,明确诊断需结合组织病理学形态、免疫组化表型及EB病毒检测。     

尾肠囊肿2例临床病理观察

目的探讨骶尾部先天性尾肠囊肿的临床病理特征、诊断与鉴别诊断。方法对2例尾肠囊肿进行组织形态学观察和相关文献复习。对恶变病例进行免疫组化检测。结果 2例临床表现均为多房囊性结节,由不同类型的上皮组织(腺上皮、移行上皮、鳞状上皮及纤毛柱状上皮)构成囊腔。其中1例中年女性患者由尾肠囊肿演变为腺癌。免疫组化:瘤细胞AE1/AE3、CEA均呈弥漫强(+),CDX-2(+),p53灶(+),Ki-67阳性率为20%;S-100(-)。结论尾肠囊肿罕见。确诊需结合组织学形态、免疫组化,需与骶尾部原发或转移的其他肿瘤相鉴别。     

消化道神经鞘瘤17例临床病理特征分析

目的 探讨消化道神经鞘瘤临床病理、免疫组化特征及与其他间叶源性肿瘤鉴别要点.方法 对17例消化道神经鞘瘤进行临床病理分析,并行S-100、vimentin、CD34、CD117、SMA和desmin检测,对10例作PAS与Masson染色.结果 患者女性11例,男性6例,年龄38～73岁(中位年龄57岁),16例发生于胃,1例位于食管.巨检:肿瘤直径2-8 cm(平均4 cm),无包膜.8例界限较清,9例与周围组织界限欠清,均缺乏锐利边界,切面呈实性.镜检:瘤细胞梭形,呈小束状,多排列成编织状结构,均可见小束的两端及瘤细胞之间有粗细不等的胶原纤维形成.1例有小灶状上皮样结构,3例极少数肿瘤细胞胞质内可有黑色素颗粒.间质内均见有少数至弥漫淋巴细胞、浆细胞浸润,肿瘤周边均出现淋巴细胞反应带.免疫组化:vimentin和S-100强(+),3例有少数瘤细胞CD34灶状(+);10例PAS和Masson染色晶状体(-).结论 消化道神经鞘瘤有不同于软组织发生者的临床、大体及形态学特点,诊断依赖组织学及免疫组化检测.     

阴道良性混合瘤临床病理观察

目的 探讨阴道良性混合瘤的临床病理学特点及诊断要点.方法 对1例阴道良性混合瘤进行临床资料、病理学形态及免疫组化观察,并结合文献探讨其诊断及鉴别诊断.结果 患者女性,40岁.因子宫多发性平滑肌瘤、子宫腺肌症行经腹全子宫切除术,术中发现阴道壁接近处女膜缘处有一直径2 cm肿物,遂行剥除.镜下可见肿瘤组织呈腺样及小团巢状分布,局部呈黏液乳头状,部分区域细胞呈梭形,核大小较一致,偶见核分裂;肿瘤无明显包膜,与周围组织有界限.免疫组化:瘤细胞CD34、bcl-2、CD99、ER、PR、CD10、CK7和AE1/AE3(+),CK8/18弥漫(+);鳞状上皮34βE12和CK5/6(+),SMA灶状(+);Ki-67增殖指数为3％,p63、GFAP、CK20、CgA、Her-2、S-100和CA125均(-).病理诊断为阴道良性混合瘤.术后随访半年无复发.结论 阴道良性混合瘤是由间叶性成分和鳞状上皮或腺上皮构成的混合性良性肿瘤,罕见,易与其他肿瘤混淆导致误诊.     

胎儿骶尾部先天性未成熟畸胎瘤尸检1例报道并文献复习

目的探讨胎儿骶尾部先天性未成熟畸胎瘤的临床病理特征、诊断及鉴别诊断。方法分析1例胎儿骶尾部先天性未成熟畸胎瘤的临床资料、尸检病理结果,并结合文献复习。结果 B超示胎儿脊柱骶尾部囊、实性混合回声。尸检发现胎儿骶尾部可见5.5 cm×5 cm×4 cm大小肿物,切面呈囊实性,囊内含淡黄色液体。光镜下肿瘤由多个胚层组成,可见角化的鳞状上皮、纤毛上皮、软骨、平滑肌、肠管、内胚窦样结构、神经胶质细胞和原始神经管。免疫组化:小管样结构细胞nestin、vimentin和CD99(+),GFAP、NF和Neu N(-);周围神经胶质细胞GFAP和NF(+),Neu N(-);上皮细胞CK(+),内胚窦样结构S-100(+);Ki-67阳性率为20%,p53(-)。结论胎儿骶尾部先天性未成熟畸胎瘤罕见,确诊依赖于B超、组织学形态和免疫组化结果,需要与成熟性畸胎瘤和原始神经外胚层肿瘤鉴别。     

皮肤毛母细胞瘤与基底细胞癌的临床病理鉴别诊断

目的探讨皮肤毛母细胞瘤与基底细胞癌的临床病理及免疫组化、鉴别诊断要点。方法对已确诊的6例毛母细胞瘤和20例基底细胞癌的石蜡标本行HE染色及CK7、bcl-2、AR、CD10、Ki-67免疫组化染色,观察形态学和免疫组化表达特点。结果毛母细胞瘤来源于基底样生发细胞,肿瘤位于真皮及皮下组织内,不与表皮相连,境界清楚,由分布均匀的伴有毛囊分化的毛母细胞团构成;免疫组化:5例CK7(-),1例弱(+);3例bcl-2(-),3例弱(+);6例AR(-),6例CD10(-),而瘤周间质(+);Ki-67阳性指数10%~20%。基底细胞癌来源于基底样生发细胞,癌细胞与表皮基底部相连,呈浸润性生长,周边癌细胞呈栅栏状排列,周围间质疏松,癌巢和间质之间形成收缩裂隙;免疫组化14例CK7(+),6例弱(+);17例bcl-2(+),3例弱(+);16例AR(+),4例弱(+);20例为癌细胞CD10(+),癌周间质(-);Ki-67阳性指数20%~30%。结论结合镜下组织学特点及免疫表型,有助于两种肿瘤的鉴别诊断。     

淋巴管内乳头状血管内皮瘤临床病理观察

目的探讨淋巴管内乳头状血管内皮瘤(PILA)的临床病理学特点、诊断与鉴别诊断、起源及预后。方法对1例PILA的临床表现、组织形态、组织化学及免疫组化特点进行分析,并复习相关文献。结果患儿女性,1岁11个月。出生时即发现右前臂红色肿物。镜下见肿瘤组织位于真皮,由不规则的扩张的薄壁管腔构成,类似海绵状淋巴管瘤,部分管腔内见玻璃样轴心的乳头状皱褶,管壁与乳头衬覆鞋钉状内皮细胞。免疫组化:管壁与乳头衬覆鞋钉状内皮细胞CD34、VEGFR-3、CD31、FⅧ因子均呈(+),海绵状管腔内皮细胞及乳头衬覆鞋钉状内皮细胞D2-40(-);组织化学:VG染色显示乳头玻璃样轴心呈红色,Masson染色显示乳头玻璃样轴心呈绿色。结论淋巴管内乳头状血管内皮细胞瘤罕见,成人与儿童均可发生,确诊主要依靠组织病理学,组织化学及免疫组化染色对诊断有帮助。其可能来源于淋巴管,预后大多良好。     

Xpl1.2易位性肾细胞癌3例临床病理特征分析

目的探讨Xp11.2易位性肾细胞癌的临床病理学特点及其鉴别诊断、治疗和预后。方法收集3例Xp11.2易位性肾细胞癌,复习患者的临床资料,进行组织学及免疫组化观察,并结合文献复习分析。结果 3例患者中男性2例,女性1例,年龄10～40岁,平均年龄26.7岁。肿块大小分别为2.5 cm×2.5 cm×2.8 cm、4.5 cm×3.5 cm×3.2 cm和8 cm×6.7 cm×9 cm。光镜下肿瘤组织呈巢状、乳头状或假乳头状排列,肿瘤细胞有大量透明至嗜酸性胞质,细胞界限清楚;1例细胞核核仁清晰,3例肿瘤组织中均可见砂砾体。免疫组化:3例肿瘤TFE3均强(+),RCC和CD10弱(+)至强(+);1例vimentin强(+),2例CK7强(+),3例EMA(-)。本组1例失访;1例发现时已全身多处骨转移;1例随访3个月病情稳定,无复发。结论 Xp11.2易位性肾细胞癌是一种少见肿瘤,诊断主要依据病理学形态和免疫组化TFE3(+)。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.