炎症性肠病相关异型增生病理诊断问题与建议

炎症性肠病(IBD)相关异型增生的早期发现和处理是降低IBD相关结直肠癌发生率的关键因素。IBD相关异型增生的病理诊断对临床决策至关重要,但医师诊断异型增生的主观性常较强,不同病理医师之间诊断一致性并不理想。为提高病理医师对IBD相关异型增生诊断的准确性,中华医学会消化病学分会炎症性肠病学组病理分组组织专家进行IBD相...     

CD151及整合素α6在肠癌中的表达及其与上皮间质转化的关系

目的:研究结直肠癌组织中CD151及整合素α6的表达,探讨他们与结直肠癌临床病理因素及上皮间质转化(epithelial-mesenchymal transition,EMT)的关系.方法:132例结直肠癌制成2张组织芯片,以30例癌旁组织作对照,采用免疫组织化学检测其中CD151、整合素α6及E-钙黏蛋白(E-cadherin)、波形蛋白(Vimentin)的表达,分析比较前两种蛋白与结直肠癌临床病理因素之间的关系及其与上皮间质表达标志物之间的关系.结果:结直肠癌组织中CD151及整合素α6表达阳性率分别为65.9%和75.7%,均高于癌旁组织;CD151和整合素α6的表达均与肿瘤浸润深度及淋巴结转移密切相关;CD151在结直肠癌中表达还与E-cadherin的低表达、Vimentin的高表达密切相关.结论:CD151和整合素α6通过促进EMT促进结直肠癌浸润转移,为研究结直肠癌EMT发生机制提供新的思路,同时为CD151作为肠癌的靶向治疗指标提供理论依据.     

结直肠癌Lgr5表达对患者预后的影响

目的探讨Lgr5在人结直肠癌中的表达与临床病理特征之间的联系以及对患者预后的影响。方法采用免疫组织化学SP方法检测169例结直肠癌患者术后组织石蜡切片标本,分析Lgr5表达与临床病理特征之间的联系,并采用Kaplan-Meier法分析Lgr5表达与患者生存预后的关系。结果 Lgr5在正常大肠黏膜组织中弱表达或者阴性表达,而在结肠癌组织中高表达,并且表达与Duke C+D期、肿瘤远处结转移以及分化程度有关(P0.05;P0.001;P=0.024);与年龄、性别、肿瘤发生部位以及淋巴结转移无关。Lgr5高表达的患者术后100个月生存率明显低于低表达或者阴性表达的患者。结论 Lgr5在结直肠癌组织中高表达可以作为判定结直肠患者预后较差的一个新的指标。     

结直肠癌患者肿瘤血管形成的临床病理意义初探

目的：探讨结直肠癌血管形成与其临床病理特征的关系。方法：用免疫组化Ｓ－Ｐ法,对６２例结直肠癌石蜡切片进行染色和微血管计数。结果：伴淋巴结转移、远处转移及Ｄｕｋｅ’ｓ Ｂ、Ｃ期结直肠癌组织中,微血管计数分别高于其相应无转移及Ｄｕｋｅ’ｓＡ期病人。结论：结直肠癌肿瘤血管形成与其转移密切相关,微血管计数测定血管形成可作为预测结直肠癌转移潜能的标志。     

结直肠上皮内瘤变病理诊断分析

目的明确上皮内瘤变概念,对结直肠上皮内瘤变进行病理诊断分析,旨在指导医护人员正确诊断患者病情,避免误诊。方法选取我院收治的经内镜活检病理诊断为"上皮内瘤变"的48例作为研究对象,保留同一患者的内镜活检资料和手术标本,期间共获得同一患者手术前内镜活检切片48张,HE染色切片188张,由3名医师分别复查,最后诊断以手术标本切片为准。结果 48例患者中有23例在术前被诊断为低级别上皮内瘤变,有25例在术前被诊断为高级别上皮瘤变,术后通过病理诊断,有6例确诊为腺瘤,并伴随有低级别上皮内瘤变,有11例确诊为高级别上皮内瘤变,剩余31例均确诊为腺癌,癌症比例为64.58%,其中浸润性腺癌26例(54.17%)。根据患者的内镜活检资料和同一患者的手术标本相互比较,并通过3名医生复检,有两例在术前被误诊为腺癌。结论认真领会上皮内瘤变概念,并应用到结直肠患者病理诊断分析过程中,通过与临床医师的有效配合,降低误诊率,延长患者生命,改善患者生活质量。     

结直肠息肉、结直肠癌的特点及与幽门螺杆菌感染相关性的研究

目的探讨结直肠息肉、结直肠癌临床与病理的特点及其与幽门螺旋杆菌(Helicobacter pylori,H.pylori)感染的相关性。方法收集安徽医科大学第二附属医院2018年7月至2020年9月同时行肠镜及幽门螺旋杆菌血清学抗体检测的患者资料共460例,并分为结直肠息肉组、结直肠癌组、正常对照组,回顾性分析结直肠息肉的部位、大小、数量、病理类型;结直肠癌的部位、大小、分期、病理类型及H.pylori感染情况。结果结直肠息肉组、结直肠癌组的H.pylori感染率分别为50.4%、58.2%,均高于正常对照组(35.3%),差异有统计学意义(P<0.05)。且结直肠息肉组复发患者H.pylori感染率高于初发者,差异有统计学意义(P<0.05)。254例结直肠息肉患者中,按照不同部位、大小、数量、病理类型分亚组,各亚组之间H.pylori感染率差异均无统计学意义(P均>0.05)。56例结直肠癌患者中,H.pylori感染在不同部位、大小、分期、病理类型间比较,差异均无统计学意义(P均>0.05)。Logistic多因素回归分析结果显示,年龄、性别、H.pylori感染均是结直肠息肉和结直肠癌的独立危险因素。结论H.pylori感染增加结直肠息肉及结直肠癌的风险,且是结直肠息肉、结直肠癌的独立危险因素。但H.pylori感染与结直肠息肉的部位、大小、数量、病理类型以及与结直肠癌的部位、大小、分期、病理类型均无关。     

Nup88在结直肠癌组织中的表达及意义

目的研究核孔蛋白复合体蛋白88（Nup88）蛋白和mRNA在结直肠癌组织中的表达及其与临床病理特征的关系。方法免疫组化方法检测181例结直肠癌标本、18例淋巴结转移癌及84例匹配的癌旁无瘤黏膜组织中Nup88蛋白表达;RT-PCR法检测Nup88 mRNA在29例结直肠癌标本及配对的癌旁2 cm组织、切缘黏膜中的表达水平。结果结直肠癌组织和淋巴结转移癌中Nup88蛋白阳性率均高于癌旁无瘤黏膜组织（P〈0.01）;Nup88蛋白的表达与结直肠癌组织分化程度有关。Nup88 mRNA在肿瘤组织中的表达水平高于癌旁无瘤黏膜和切缘黏膜（P均〈0.01）。结论 Nup88蛋白及mRNA与结直肠癌的发生发展有关,其蛋白表达可作为评估结直肠癌生物学行为的指标之一。     

CADM1与DAL-1/4.1B在结直肠癌中的表达及临床意义

目的:研究CADM1和DAL-1/4.1B两种抑癌基因在结直肠癌中的表达并分析两者之间及其与结直肠癌各临床病理参数之间的关系,探讨CADM1和DAL-1/4.1B在结直肠癌发生发展中的作用,为结直肠癌的基因治疗提出新的思路.方法:应用免疫组织化学(SABC法)检测30例结直肠癌组织,10例结直肠腺瘤组织,30例正常结直...     

结直肠癌细胞粘附分子CD15表达的预后意义

我们应用免疫组化法,检测了结直肠癌组织中ＣＤ１５的表达状况,观察与临床和病理参数之间的关系及对患者预后的影响．１材料和方法１．１材料收集１９９３０４／１９９８０４之间手术切除结直肠标本．其中原发癌９０例（结肠癌５４例,直肠癌３６例）、淋巴结转移癌...     

刍议糖尿病与结直肠癌临床病理因素及预后的关系

目的从预后方面以及病理层面研究结直肠癌的发生与糖尿病之间的关联。方法从2013年4月至2014年7月该医院接收的结直肠癌病人中分别抽选75例同时患有糖尿病的病人以及另外75例未患糖尿病病人。同时患有两种病症的病人属于研究组,其余仅患有结直肠癌症的病人则归纳到对照组。并探索糖尿病病症与人体结直肠发生癌变是否存在关联。结果通过Logistic技术实施研究,在病理方面,人体结直肠发生癌变情况和糖尿病病症未呈现关联。两组再次出现结直肠癌变的概率及生存时间接近P0.05。结论人体出现结直肠癌变在病理方面与糖尿病没有关联,同时糖尿病病症不会在预后方面对结直肠癌带来影响。     

Pathologist agreement in the interpretation of colorectal polyps

Practicing physicians commonly perform flexible sigmoidoscopy in their offices. Polyploid lesions are frequently biopsied and sent to community hospitals for pathological interpretation. The pathologist's opinion often determines the course of medical follow-up for the patient, especially in cases in which early malignancy is suspected. This paper addresses the agreement of community-based pathologists regarding the interpretation of colorectal polyp pathology. Ten pathological slide sections were sent to 22 different community-based pathologists in southeast Michigan. These pathologists were asked to record their diagnosis of the specific histologies represented in each of the slides. The results indicated a high level of agreement of histologies in the dichotomous categories of hyperplasia versus adenoma. However, there was considerable disagreement on the presence of moderate or severe atypia. The results of this study indicate that clinicians performing biopsies on patients at risk for colorectal cancer should be aware of the potential for diagnostic variability among pathologists, and should plan follow-up strategies which may include seeking second pathological opinions when a significant patient management decision must be made.     

Concordance,intra- and inter-observer agreements between light microscopy and whole slide imaging for samples acquired by EUS in pancreatic solid lesions

BackgroundNo study has compared the performance of light microscopy (LM) and whole slide imaging (WSI) for endoscopic ultrasound (EUS) histological acquired tissue samples from pancreatic solid lesions (PSLs). We evaluated the concordance between LM and WSI and the inter- and intra-observer agreements among pathologists on PSLs EUS acquired samples.MethodsLM and WSI from 60 patients with PSLs were evaluated by five expert pathologists to define: diagnostic classification, presence of a core, number and percentage of lesional cells. Washout period between evaluations was 3 months. Time of the procedures was also assessed.ResultsForty-eight cell-block and 12 biopsy samples were evaluated. A high concordance between LM and WSI was found. Inter- and intra-observer agreements for diagnostic classification were substantial and complete, respectively. For all the other parameters, the inter-observer agreement was usually higher for LM. For the intra-observer, a substantial agreement was reached regarding the presence of tissue core and the number and the percentage of malignant cells. Median time for performing LM was significantly shorter than for WSI (p < 0.0001).ConclusionsLM and WSI of cell-block and biopsy samples acquired by EUS in PSLs were highly concordant, with a substantial inter-observer and a complete intra-observer agreements regarding diagnostic classification.     

结直肠黏液腺癌病理学异质性及与预后的关系

探讨结直肠黏液腺癌临床病理及分子病理异质性。结合临床病理诊断积累的经验,并复习国内外相关文献,总结结直肠黏液腺癌的临床病理特征、微卫星不稳定性及对预后的影响。结直肠黏液腺癌病理形态特征及微卫星不稳定性状态方面的差异,导致不同的临床生物学行为,对治疗的反应及预后均不相同。结直肠黏液腺癌是一类异质性肿瘤,临床病理和分子病理相结合的精准病理诊断,有利于临床治疗方案的选择和预后分层。     

Validation of whole-slide imaging in the primary diagnosis of liver biopsies in a University Hospital

BackgroundExperience in the use of whole slide imaging (WSI) for primary diagnosis is limited and there are no comprehensive reports evaluating this technology in liver biopsy specimens.AimsTo determine the accuracy of interpretation of WSI compared with conventional light microscopy (CLM) in the diagnosis of needle liver biopsies.MethodsTwo experienced liver pathologists blindly analyzed 176 consecutive biopsies from the Pathology Department at the Hospital Clinic of Barcelona. One of the observers performed the initial evaluation with CLM, and the second evaluation with WSI, whereas the second observer performed the first evaluation with WSI and the second with CLM. All slides were digitized in a Ventana iScan HT at 400× and evaluated with the Virtuoso viewer (Roche diagnostics). We used kappa statistics (κ) for two observations.ResultsIntra-observer agreement between WSI and CLM evaluations was almost perfect (96.6%, κ = 0.9; 95% confidence interval [95% CI]: 0.9–1 for observer 1, and 90.3%, κ = 0.9; 95%CI: 0.8-0.9 for observer 2). Both native and transplantation biopsies showed an almost perfect concordance in the diagnosis.ConclusionDiagnosis of needle liver biopsy specimens using WSI is accurate. This technology can reliably be introduced in routine diagnosis.     

大肠癌中多药耐药相关蛋白表达的研究

目的:研究多药耐药相关蛋白在大肠癌的表达及其意义。方法:应用单克隆抗体 QCR-1行 LSAB免疫组化法研究42例大肠癌组织中多药耐药相关蛋白的表达水平。结果:大肠癌组织中多药耐药相关蛋白表达的总阳性率为69.1%,其中乳头状腺癌66.7%,管状腺癌70.0%,粘液腺癌69.2%,大肠癌不同病理类型与 MRP表达间无显著性差异(p>0.05);癌旁正常肠组织呈阴性表达;在大肠癌不同病理分期中,MRP 表达率癌阳性率分别为 Dukes'A 期87.5%,Dukes'B 期91.7%,Dkes'C 期60.0%,Dukes'D 期28.6%,大肠癌 Dukes'A 期与 Dukes'B 期MRP 表达率和 Dukes'D 期比较有显著性差异(p<0.01);大肠癌不同部位的 MRP 表达阳性率比较中,左半结肠62.5%,右半结肠63.7%,直肠73.9%,两者无显著性差异。结论:表明多药耐药相关蛋白是参与大肠癌多药耐药的重要因素,其表达与大肠癌病理分期相关。     

Pathological response measured using virtual microscopic slides for gastric cancer patients who underwent neoadjuvant chemotherapy

BACKGROUND Although pathological response is a common endpoint used to assess the efficacy of neoadjuvant chemotherapy(NAC) for gastric cancer, the problem of a low rate of concordance from evaluations among pathologists remains unresolved.Moreover, there is no globally accepted consensus regarding the optimal evaluation. A previous study based on a clinical trial suggested that pathological response measured using digitally captured virtual microscopic slides predicted patients' survival well. However, the pathological concordance rate of this approach and its usefulness in clinical practice were unknown.AIM To investigate the prognostic utility of pathological response measured using digital microscopic slides in clinical practice.METHODS We retrospectively evaluated pathological specimens of gastric cancer patients who underwent NAC followed by surgery and achieved R0 resection between March 2009 and May 2015. Residual tumor area and primary tumor beds weremeasured in one captured image slide, which contained the largest diameter of the resected specimens. We classified patients with 10% residual tumor relative to the primary tumorous area as responders, and the rest as non-responders; we then compared overall survival(OS) and relapse-free survival(RFS) between these two groups. Next, we compared the prognostic utility of this method using conventional Japanese criteria.RESULTS Fifty-four patients were evaluated. The concordance rate between two evaluators was 96.2%. Median RFS of 25 responders and 29 non-responders was not reached(NR) vs 18.2 mo [hazard ratio(HR) = 0.35, P = 0.023], and median OS was NR vs40.7 mo(HR = 0.3, P = 0.016), respectively. This prognostic value was statistically significant even after adjustment for age, eastern cooperative oncology group performance status, macroscopic type, reason for NAC, and T-and Nclassification(HR = 0.23, P = 0.018). This result was also observed even in subgroup analyses for different macroscopic types(Borrmann type 4/non-type 4)and histological types(differentiated/undifferentiated). Moreover, the adjusted HR for OS between responders and non-responders was lower in this method than that in the conventional histological evaluation of Japanese Classification of Gastric Carcinoma criteria(0.23 vs 0.39, respectively).CONCLUSION The measurement of pathological response using digitally captured virtual microscopic slides may be useful in clinical practice.     

Accuracy of pathologic interpretation of colorectal polyps by general pathologists in community practice.

BACKGROUND: The histologic features of colorectal polyps often guide colonoscopic surveillance and the need for surgical intervention. Our objective was to evaluate the pathologic interpretation of colorectal polyps by general pathologists in community practice. METHODS: Twenty histologic slides of colorectal polyps were reviewed by 20 randomly selected general pathologists in community practice. There were 5 malignant polyps, 9 adenomas, and 6 miscellaneous polyps. RESULTS: Cancer was correctly identified in 91% of readings and adenoma in 94%. The grade of differentiation of cancer was provided in 55% of readings, and comment regarding whether the resection margin was free of cancer was made by 50% of pathologists. Tubular adenoma was called tubulovillous or villous in 35% of readings, but tubulovillous or villous adenoma was seldom (2%) called tubular. High-grade dysplasia was correctly identified in 47% of 60 readings, was called invasive cancer in 22%, and was missed in 31%. Among miscellaneous polyps, hyperplastic polyp was correctly recognized in 75% of cases, and inflammatory polyp and juvenile polyp each were recognized by 16 of 20 pathologists (80%). Peutz-Jeghers hamartoma was identified by 4 of 20 pathologists (20%), and the polypoid phase of solitary rectal ulcer syndrome was recognized by 2 pathologists (10%). CONCLUSION: Areas of strength with regard to interpretation of colon polyps by general pathologists in community practice included identification of cancer, adenoma, and certain non-neoplastic polyps (e.g., inflammatory and juvenile polyps). Areas of weakness included lack of comment on cancer differentiation and proximity to the resection line, erroneous identification of high-grade dysplasia, and identification of rare lesions. The results of this study suggest areas on which to focus continuing education and continuous quality improvement efforts with regard to polyp interpretation.     

内皮抑素和血管抑素表达与大肠肿瘤侵袭转移的关系

目的探讨内皮抑素和血管抑素在大肠肿瘤组织中的表达,与大肠癌不同阶段的关系及临床意义。方法应用免疫组织法检测20例正常大肠组织、20例大肠腺瘤和60例大肠癌及其组织中内皮抑素和血管抑素的表达情况。应用χ2检验对内皮抑素和血管抑素两者在大肠肿瘤不同阶段的表达关系进行统计分析,两者表达间的相关性探讨采用spearman相关分析。结果内皮抑素和血管抑素阳性表达与大肠肿瘤不同阶段的关系spearman相关系数分别为-0.438、-0.362,两者的表达与大肠癌的Dukes分期、淋巴结转移显著相关(P<0.05),均与腺瘤的类型无相关性。结论内皮抑素和血管抑素可以抑制大肠癌的侵袭转移。内皮抑素和血管抑素在大肠癌组织中呈低表达,且两者的阳性表达率随着临床分期的进展而降低,提示其与大肠癌的发生、发展、浸润及转移有明显关系。两者在大肠癌组织中的表达呈明显的一致性,对两者进行联合检测,有助于大肠癌的早期诊断、治疗及预后的评估。     

癌组织及外周血中CD44、PLCEl、甲基化Sept9基因及DNA错配修复蛋白表达水平与结直肠癌病理分期及预后的相关性分析

目的探讨癌组织及外周血中白细胞分化抗原分化簇第44号(CD44)、磷酯酶Cεl(PLCEl)、甲基化Sept9基因及DNA错配修复蛋白表达水平与结直肠癌病理分期及预后的相关性。方法将2013年3月至2015年5月在西宁市第二人民医院确诊为结直肠癌的56例患者设为观察组,将同期于我院体检的55名健康成年人设为对照组。比较两组甲基化Sept9基因、CD44、PLCEl及DNA错配修复蛋白表达情况,分析以上指标在结直肠癌患者中的临床分布特点并进行相关性检验,比较不同甲基化Sept9基因、CD44、PLCEl及DNA错配修复蛋白表达情况并分析其与结直肠癌患者的预后相关性。结果观察组甲基化Sept9基因及CD44表达阳性率、PLCEl表达阴性率、DNA错配修复蛋白表达缺失率高于对照组(P<0.05)。甲基化Sept9基因、PLCEl及DNA错配修复蛋白在不同肿瘤浸润深度、肿瘤大小、病理分期及有无淋巴结转移结直肠癌患者中的表达差异有统计学意义(P<0.05)。CD44在不同肿瘤浸润深度、病理分期及有无淋巴结转移结直肠癌患者中的表达差异有统计学意义(P<0.05)。PLCEl与结直肠癌的浸润深度、病理分期呈负相关(r=-0.367,P=0.045;r=-0.522,P=0.008);甲基化Sept9基因与浸润深度、病理分期、淋巴结转移呈正相关(r=0.715,P=0.026;r=0.471,P=0.032;r=0.453,P=0.010),CD44与浸润深度、病理分期、淋巴结转移呈正相关(r=0.349,P=0.007;r=0.591,P=0.022;r=0.452,P=0.027),DNA错配修复蛋白与病理分期﹑淋巴结转移呈负相关(r=-0.487,P=0.041;r=-0.551,P=0.030)。不同CD44、甲基化Sept9基因、PLCEl及DNA错配修复蛋白表达情况的结直肠癌患者3年生存率差异有统计学意义(P<0.05)。PLCEl、DNA错配修复蛋白与结直肠癌患者3年生存率呈正相关(r=0.574,P=0.041;r=0.478,P=0.037),甲基化Sept9基因与结直肠癌患者3年生存率呈负相关(r=-0.515,P=0.034)。结论CD44、PLCEl、甲基化Sept9基因及DNA错配修复蛋白均与结直肠癌的病理分期相关,其检测有助于了解疾病的恶性程度,评估患者预后。