胃腺癌和癌旁腺体形态改变的病理学观察

我们对１０７例胃腺癌和癌旁腺体的形态改变，结合粘液组织化学和免疫酶组织化学的方法进行了观察，发现不同性质的腺体扩张和组织学类型有关。单纯性腺体扩张见于各种类型的腺癌；异型性腺体扩张多见于管状腺癌。尤其早期管状腺癌出现各级、多量异型腺体扩张，并与管状腺癌的腺体交叉，有向管状腺癌由轻度到重度异型增生上皮过渡的形态。异型性腺体扩张的组织结构、细胞形态、粘液组织化学和免疫酶组织化学都与管状腺癌相一致，只是程度的差异。     

良性腺性Schwann瘤

目的：报道罕见的Schwann瘤1例及复习该瘤的病理特征。方法：应用组织化学和免疫组织染色检测肿瘤组织中梭形细胞成分和腺性结构。结果：肿瘤由典型Schwann瘤和腺性成分组成。腺性结构表达Leu-7、GFAP、MBP、CEA、AE1／AE3、34βE12。结论：良好腺性Schwann瘤中的腺性成可能是增生的汗腺上皮。     

宫颈液基细胞学中非典型腺细胞的形态结构特征与临床意义

目的:探讨宫颈液基细胞学中非典型腺细胞诊断的临床意义，评估有临床意义的细胞学形态结构特征，研究细胞学中鉴别腺上皮细胞病变与鳞状细胞病变的形态线索。方法:对我院2011年至2019年液基细胞学筛查为非典型腺细胞（atypical glandular cell,AGC）的病例复阅，通过与组织学结果对照，评估相关的细胞学特征。结果:514例AGC患者中，组织学结果阳性232例(45.1%)，包括腺细胞病变114例(22.2%)，鳞状上皮细胞病变104例(20.2%)，腺细胞病变合并鳞状上皮细胞病变11例(2.1%)，其他恶性肿瘤3例(0.6%)。评估的11个细胞学特征中，有8个特征在良性变化和癌或癌前病变之间有显著的统计学差异（P<0.05），分别为失去极性、羽毛状结构、乳头样结构、核膜不规则、出现大核仁、粗糙的染色质、中性粒细胞口袋、细胞浆内大空泡。有6个与腺上皮病变相关，前3位依次是:中性粒细胞口袋、羽毛状结构、细胞浆内大空泡；有4个与鳞状上皮病变相关，前3位分别是:核膜不规则、核深染、粗糙的染色质；羽毛状结构对于区别腺上皮病变和鳞状上皮病变最有意义。结论:AGC随访恶性率高，细胞学中应重点关注失去极性、羽毛状结构、乳头样结构等8个特征，而拥挤重叠、核浆比升高、核深染不应作为评估肿瘤性变化的标准。     

活检胃粘膜腺体扩张的电镜观察

本文以光镜所见为对照,对24例活检胃粘膜腺体扩张进行了超微结构观察。结果单纯性腺体扩张仅有腺上皮细胞表面微绒毛变短,细胞外形规则。异型性腺体扩张的超微结构所见,细胞增生活跃,重度异型性腺体扩张的细胞,间隙增宽,连接发育不良,核形不规则,核内小体增多,同胃腺癌细胞关系密切。提示胃粘膜活检标本的超微结构观察,有助于判定病变性质,对不同性质腺体扩张的癌变过程的研究有重要作用。     

经尿道膀胱黏膜与膀胱颈联合电切配合术后吡柔比星灌注治疗女性腺性膀胱炎临床研究

目的:探讨经尿道膀胱黏膜与膀胱颈联合电切配合术后吡柔比星灌注治疗女性腺性膀胱炎的临床效果。方法:选取2009年-2013年在我院接受治疗的腺性膀胱炎女性患者120例。随机分为观察组与对照组,每组60例。两组患者均给予经尿道膀胱黏膜与膀胱颈联合电切术。在次基础上,观察组给予术后吡柔比星进行治疗。观察两组治疗效果、尿动力学指标、不良反应,并随访复发结果。结果:观察组治疗显效29例,有效26例,无效5例,治疗有效率为91.67%;对照组治疗显效21例,有效25例,无效14例,治疗有效率为76.67%。观察组治疗有效率明显高于对照组（P＜0.05）。观察组最大尿流率为（24.32±6.31）ml/s,平均尿流率为（12.67±5.98）ml/s,最大尿道压为（7.21±1.72）kPa;对照组最大尿流率为（17.87±8.75）ml/s,平均尿流率为（7.99±5.43）ml/s,最大尿道压为（10.98±3.01）kPa。观察组膀胱刺激征7例,骨髓抑制0例,肾功能损害1例,皮疹1例,尿道狭窄1例,不良反应发生率为16.67%（10/60）;对照组膀胱刺激征12例,骨髓抑制3例,肾功能损害2例,皮疹3例,尿道狭窄2例,不良反应发生率为36.67%（22/60）。对两组患者随访,随访率100%。观察组随访时间为（14.34±3.43）个月,对照组随访时间为（14.04±3.41）个月,两组随访时间无显著差异（P＞0.05）。观察组复发率为15.00%,对照组复发率为31.67%。结论:经尿道膀胱黏膜与膀胱颈联合电切配合术后吡柔比星灌注治疗女性腺性膀胱炎治疗效果显著,且复发率低,临床上值得推广。     

Management of borderline change in endocervical cells: a more dependable approach

Background:

There are limited data and guidance from the UK on borderline nuclear change in endocervical cells (BNCs). The objective of this study is to determine the clinical outcome of women with BNCs, to determine the accuracy of colposcopy and propose a more robust management algorithm.

Methods:

This is a retrospective review of all BNC referrals between January 2006 and December 2011 at the Northumbria Healthcare Trust. Histological diagnosis was based on high-grade histology (CIN 2 or worse). Any high-grade histology in the first year of follow-up was included in the final diagnosis.

Results:

Of the 9001 new referrals, 167 women had BNCs. Thirty-seven (22%) were diagnosed with high-grade histology on initial assessment. Sixty women had satisfactory and negative colposcopy, out of which 7 (12%) were detected with high-grade histology/cytology in the first year of follow-up. Overall, 50 high-grade histology (30%), including two invasive carcinomas were detected.

Conclusions:

Current follow-up of BNCs relies heavily on colposcopic assessment. A significant proportion of women with negative colposcopy was found to have high-grade histology in the first year of follow-up. We propose a more robust management algorithm to lower the probability of missed high-grade histology in this subgroup of women.     

EGFR和PCNA在腺体扩张的胃粘膜中的表达及意义

对纤维胃镜活检的胃粘膜腺体扩张标本进行了形态观察，并采用ＳＰ免疫组化方法，观察ＥＧＦＲ和ＰＣＮＡ的表达。结果ＥＧＦＲ在胃粘膜单纯性腺体扩张中，仅有１９％的弱阳性表达，在异型性腺体扩张中，阳性表达为５３．８％，有显著性差异（Ｐ＜０．０１）。胃腺癌阳性表达７６．３％，与异型性腺体扩张比较无显著性差异（Ｐ＞０．０５）。ＰＣＮＡ在单纯性腺体扩张中阳性细胞数平均值为１９．２个，在异型性腺体扩张中，平均值为４５个，二者有非常显著性差异（Ｐ＜０．０１）。胃管状腺癌阳性细胞平均值为５８．１个，与异型性腺体扩张比较无显著性差异（Ｐ＞０．０５）。提示ＥＧＦＲ和ＰＣＮＡ表达均随细胞的异型性程度增加而递增，二者有显著的相关性。对胃粘膜良、恶性病变的诊断和鉴别有实用价值，联合检测可提高诊断的准确率。异型性腺体扩张是重要的癌前病变。     

Doses in mammography: From the phantom to the patient

While the use of a reference phantom is essential for dosimetry in acceptance testing and in regular quality control checks of a mammographic X-ray unit, it is also of importance to be able to estimate the patient dose in each individual investigation. Radiographic and physical data were analysed for a total of 212 women who between them were screened at three locations participating in a breast screening programme. The radiologists made estimates of the individual breast composition (% glandular/adipose ratio) at the film reporting sessions, and then the glandular doses were calculated by the auditor according to the NCRP 85 methodology. Arising from the data analysis of this dosimetry survey, a method is proposed to determine objectively patient breast composition from the photo-timed mAs for a given film optical density setting. This permits the NCRP calculations to be extended from breasts of ‘average’(50/50) composition to breasts of individually determined composition. The diversity of the results between the three locations emphasises the need for regular audits of a mammographic X-ray unit's performance by an experienced radiological physicist, at least annually or after any major interventional service on the unit.