MTS_1基因产物P16在膀胱移行细胞癌中的表达

目的：研究Ｐ１６蛋白在膀胱移行细胞癌中的表达及与肿瘤恶性程度的关系。方法：采用免疫组织化学方法对３１例膀胱移行细胞癌Ｐ１６蛋白的表达进行分析。结果：Ｐ１６阳性表达率为４８３８％,其表达随肿瘤恶性程度的增高而降低。结论：Ｐ１６在膀胱肿瘤发生机制和生物学行为中起有重要作用,临床应用具有广阔的前景。     

Primary retroperitoneal mucinous cystoadenocarcinomas: an immunohistochemical and molecular study

Special immunohistochemical stains for the identification of gastroenteropancreatic antigens in two cases of primary retroperitoneal mucinous cystoadenocarcinomas (PRMC) show that these tumours have patterns similar to ovarian mucinous tumours. Markers of pyloric type gastric mucosa differentiation (M1, cathepsin E, concavavalin A, pepsinogen II) are mostly positive in benign and borderline areas with endocervical type differentiation, while immunoreactivity for intestinal cell markers (M3SI and CAR-5) and for DU-PAN-2 is present mainly in frankly malignant areas, regardless of differentiation type. DNA analysis shows a point mutation of K-ras oncogene at codon 12 (GGT to CGT) in one case. The immunohistochemical and genotypic similarity of PRMC and ovarian mucinous tumours may indicate similar mechanisms in their histogenesis.     

38例脂肪肉瘤病理分析

本文报告资料完整的脂肪肉瘤38例,男性23倒(60%),女性15例(40%),男女之比为1.5:1。年龄1～73岁,就诊时的平均年龄为43.6岁,较文献报告偏低;41～60岁者多见。下肢和腹膜后占60%。根据Enzinger的标准进行组织学分型,其中分化良好型14例(36.8%)、粘液样型13例(34.2%),圆形细胞型4例(10.4%),多形细胞型7例(18.6%)。讨论了分型、部位、年龄与预后之间的关系以及鉴别诊断问题。     

Pleomorphic lipoma: a tumour simulating liposarcoma

Pleomorphic lipoma or giant-cell lipoma is a recently recognized entity affecting predominantly elderly and middle-aged men. The neck, shoulder region and back are the sites of predilection. The clinical setting is similar to that seen with spindlecell lipoma. The lesion is characterized by an intricate mixture of mature fibrous tissue, adipose tissue and myxoid tissue interspersed with cellular foci. Most characteristic of the latter are a variety of giant cells and especially the 'floret' giant-cells, so named because of the arrangement of their nuclei which is reminiscent of the petals of a flower. The pleomorphism of the lesion frequently leads to misdiagnosis as liposarcoma. Criteria for the differentiation from the various types of liposarcoma are discussed. The possible relationship of pleomorphic lipoma to some of the 'atypical lipomas' described in the recent literature is analysed. The pleomorphic lipoma is a benign lesion of subcutaneous tissue which must be sharply differentiated from sarcomas. Some of the liposarcomas alleged in the literature to have originated within a pre-existing lipoma possibly represented pleomorphic lipomas. Pleomorphic lipoma is an entity which must be added to the growing number of pseudosarcomatous lesions of soft tissue.     

Dedifferentiated liposarcoma with extensive lymphoid component

An unusual variant of dedifferentiated liposarcoma with extensive lymphocytic component is described. A 71-year-old patient suffered from a relapse of an atypical lipomatous tumor/well-differentiated liposarcoma with early micronodular (low-grade) dedifferentiation, which had been resected 4 years before. The relapse revealed features of a dedifferentiated liposarcoma with spindle-cell, partly pleomorphic dedifferentiation and osseous metaplasia. Clearly separated from the spindle-cell areas, an extensive homogeneously dense lymphoid (lymphocytic) tumor-component was evident, with relative abrupt transition to the well-differentiated liposarcoma component. Using immunohistochemistry and PCR, the lymphoid ("lymphoma-like") infiltrate proved to be a polyclonal lymphocytic proliferation. Fluorescence in situ hybridization (FISII) analysis revealed no signs of MDM2- and CDK4-gene amplification in the lymphoid areas, although within this mononuclear lymphoid population, large polymorphic nuclei displayed an amplified number of MDM2/CDK4 gene copies, indicating the presence of truly dedifferentiated tumor cells within the lymphoid component. The results favor a reactive lymphocytic infiltration versus a neoplastic one, which might be caused for example by chemoattractive agents. An extensive lymphoid "overgrowth" must be considered within the spectrum of unusual variants and in the differential diagnosis of dedifferentiated liposarcoma.     

Diagnostic accuracy of biopsy after neoadjuvant treatment for well-differentiated and dedifferentiated retroperitoneal liposarcoma

PurposeAccurate histopathological grading of percutaneous biopsies is essential to guide adequate management of patients with suspected retroperitoneal liposarcoma. In this regard, however, limited reliability has been described. Therefore, we conducted a retrospective study to assess the diagnostic accuracy in retroperitoneal soft tissue sarcomas and simultaneously investigate its impact on patients' survival.Materials and methodsReports of an interdisciplinary sarcoma tumor board between 2012 and 2022 were systematically screened for patients with well-differentiated (WDLPS) and dedifferentiated retroperitoneal liposarcoma (DDLPS). Histopathological grading on pre-operative biopsy was correlated with corresponding postoperative histology. Additionally, patients' survival outcomes were examined. All analyses were performed in two subgroups: patients with primary surgery and patients with neoadjuvant treatment.ResultsA total of 82 patients met our inclusion criteria. Diagnostic accuracy of patients who underwent upfront resection (n = 32) was significantly inferior to patients with neoadjuvant treatment (n = 50) (66% versus 97% for WDLPS, p < 0.001; 59% versus 97% for DDLPS, p < 0.001). For patients with primary surgery, histopathological grading on biopsy and surgery was concordant in only 47% of cases. Sensitivity for detecting WDLPS was higher than for DDLPS (70% versus 41%). Higher histopathological grading in surgical specimens correlated with worse survival outcomes (p = 0.01).ConclusionHistopathological grading of RPS may no longer be reliable after neoadjuvant treatment. The true accuracy of the percutaneous biopsy may need to be studied in patients who do not receive neoadjuvant treatment. Future biopsy strategies should aim to improve identification of DDLPS to inform patient management.     

腹膜后滑膜肉瘤6例临床病理及分子病理学分析

目的:探讨腹膜后滑膜肉瘤的临床病理特征、免疫表型及分子遗传学改变。方法:收集北京大学国际医院病理科2014年12月至2021年07月期间手术切除腹膜后标本病理诊断为滑膜肉瘤6例,进行光镜观察、免疫表型及分子病理学分析,并复习相关文献。结果:男性2例,女性4例,年龄12~56岁（平均年龄29岁,中位年龄26岁）;肿瘤大小8~20 cm,平均15.2 cm,界限较清,梭形细胞型5例,双相型1例;CKpan、EMA、Bcl-2、CD99、TLE1、Vimentin、CD34、Calponin阳性比例分别为5/6、6/6、6/6、3/6、6/6、5/6、0/6、4/6,INI1呈特殊模式表达6/6,Ki-67高表达;FISH结果显示6例均有SS18-SSX基因融合;3例为SS18-SSX2基因融合,并有伴随基因突变。结论:腹膜后滑膜肉瘤是少见的发病部位,明确诊断常需结合组织病理学形态、免疫组织化学表达及分子遗传学特征进行综合分析。     

原发性腹膜后恶性肿瘤的诊断和治疗(附23例报告)

目的提高腹膜后恶性肿瘤的诊疗水平。方法对23例原发性腹膜后恶性肿瘤进行回顾性分析。23例腹膜后恶性肿瘤的临床表现各异,其中例无周围脏器侵犯,14例有周围脏器侵犯。手术根治性切除14例(其中包括9例无周围脏器侵犯和5例联合脏器切除)。姑息性切除6例,仅做术中活检3例。结果手术后并发症仅有1例,是由于术中大出血引起。本组无发生围手术期死亡的病例。手术后复发是5例。复发时间是从术后3个月至1年。5例术后复发均行再手术切除。结论腹膜后恶性肿瘤临床表现缺乏特异性,易侵犯周围腹腔脏器。其首选治疗方法为根治性切除术,如果病人的全身及局部情况许可,应考虑行姑息性切除术．对术后局部复发病例亦应争取再手术切除。     

后腹腔镜微创取石术治疗输尿管上段结石合并轻度肾积水的临床效果

目的探讨后腹腔镜微创取石术治疗输尿管上段结石合并轻度肾积水的临床效果。方法选取本院收治的100例输尿管上段结石合并轻度肾积水患者,依据手术方法将其分为后腹腔镜微创取石术组(n=50)和输尿管镜碎石取石术组(n=50)。比较两组的治疗效果。结果后腹腔镜微创取石术组的术中出血量少于输尿管镜碎石取石术组,手术时间长于输尿管镜碎石取石术组,结石清除率高于输尿管镜碎石取石术组,术后并发症总发生率低于输尿管镜碎石取石术组(P<0.05)。手术后,两组的血清TNF-α、IL-6、KIM-1、Cys-C水平均升高,IL-2水平均降低,但后腹腔镜微创取石术组均优于输尿管镜碎石取石术组(P<0.05)。结论后腹腔镜微创取石术治疗输尿管上段结石合并轻度肾积水,可减少术中出血量和并发症,减轻机体炎症反应,提高结石清除率。