Clinicopathological multiplicity of dementia with Lewy bodies

‘Dementia with Lewy bodies (DLB)’ is a generic clinicopathological concept characterized by progressive dementia and Lewy bodies (LB). We examined 23 autopsied DLB cases clinicopathologically and immunohistochemically. These cases were classified into the neocortical type (10 cases), the limbic type (seven cases), the cerebral type (one case) and the brainstem type (none) according to our pathological criteria, which were based on the regional incidence of LB and the degree of neuronal loss in the substantia nigra. Each subtype of DLB was further divided into the common form and the pure form on the basis of the degree of Alzheimer pathology. The remaining five cases were not classified by our pathological criteria, and were designated ‘the senile dementia of Alzheimer type (SDAT) or Alzheimer's disease (AD) type of DLB with neocortical or limbic LB’. We examined how each subtype was correlated with various clinical features, such as the age of disease onset, the clinical duration, the degree of dementia, and the presence or absence of parkinsonism, fluctuating cognition and visual hallucination. The results of this study indicate that DLB can be clinicopathologically divided into a number of subtypes, that each subtype is preferentially correlated with some clinical feature, and that the neocortical type, common form, is the major type of DLB.     

原发性皮肤CD30+间变性大细胞淋巴瘤临床及组织病理分析

目的：探讨原发性皮肤CD30 间变性大细胞淋巴瘤(ALCL)的临床及组织病理学特征。方法：对3例患者的皮损行组织病理学及免疫组化检查,观察原发性皮肤CD30 ALCL组织病理学特征及CD45、CD3、CD20、CD30、EMA、HMB45等抗体染色结果。结果：3例患者临床上均表现为皮下结节。组织病理学特征为肿瘤细胞异形性明显,呈多形性,胞质丰富,核大,核仁明显。CD30标记阳性,不表达T细胞标记CD45RO及CD3。结论：原发性皮肤CD30 ALCL是具有独特形态特点及临床特征的肿瘤,根据组织学特征及免疫组化CD30阳性,可与其他恶性肿瘤进行鉴别。     

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。     

CUX-1在胶质瘤中的表达及其对临床病理和预后的意义

目的探究转录因子CUX-1在胶质瘤中的表达及其对临床病理和患者预后的意义。方法在TCGA数据库中对CUX-1在肿瘤和正常脑组织中的差异性表达及其对患者总体生存期的影响进行生物信息学分析。运用蛋白印迹、免疫组化实验检测CUX-1在不同级别胶质瘤中的表达,同时分析其与临床病理指标及患者预后的关系。结果生信分析结果表明CUX-1在胶质瘤中表达显著上调,且CUX-1高表达明显缩短患者生存期。蛋白印迹、免疫组化结果证明CUX-1随肿瘤WHO分级的升高而上调(P 0. 05),且CUX-1与胶质瘤WHO分级及增殖指标Ki67、P53mut显著相关(P 0. 05)。Kaplan-Meir分析示CUX-1低表达患者生存期显著长于高表达者(P 0. 01)。结论 CUX-1在胶质瘤中显著上调,且与肿瘤增殖密切相关,同时CUX-1高表达提示患者预后较差。综上,CUX-1有望作为胶质瘤预后的分子标志物和治疗的潜在靶点。     

65岁以上中国老年女性原发性乳腺癌临床病理特征及治疗分析：多中心10年回顾性研究

[目的]研究65岁以上老年女性原发性乳腺癌的风险暴露因素、临床病理特征以及治疗特征,为老年女性乳腺癌的诊治提供依据.[方法]回顾性分析全国7个不同地区具有代表性的7家医院收集的4211例乳腺癌患者信息,将65岁以上患者作为研究对象(老年组),50～64岁年龄组作为对照组.统计学方法为卡方检验和Fisher精确检验,P＜0.05具有统计学意义.[结果]65岁以上老年乳腺癌患者占同期乳腺癌患者的8.33％(351/4211).平均诊断年龄和平均绝经年龄分别为70.2岁(65～86岁)和49.59岁(32～58岁).与对照组相比,老年组具有以下特征:以体力工作、生育大于一胎、低学历、结婚早和初次生育年龄早者显著;临床病理特征方面,老年患者区域淋巴结转移少、分期早(即更多的0+Ⅰ+Ⅱ期患者)、激素受体阳性率高、Hey2低表达、Her-2亚型和三阴性亚型少.在侵袭性治疗方面,老年患者较少接受改良根治术、保乳术、放疗、化疗,更多的是接受乳腺单纯切除术.两组间内分泌治疗无显著差异.[结论]老年乳腺癌患者有较好的临床病理特征和生物学行为;接受侵袭性治疗少;内分泌治疗需要加强.     

恶性孤立性纤维性肿瘤2例临床病理分析

目的:探讨恶性孤立性纤维性肿瘤(malignant solitary fibrous tumor,MSFT)的临床病理特征、诊断、鉴别诊断、分子遗传学、治疗及预后.方法:对2例MSFT进行光镜、免疫组织化学研究,并复习相关文献.结果:男性2例,年龄分别为66岁及48岁.发生部位:骶前1例,临床表现为进行性二便障碍3年;后上纵隔1例,临床表现为活动后心慌半个月.肿瘤大小分别为10cm×9 cm×6 cm及12 cm×10 cm×9 cm.镜检:细胞稀少区和细胞丰富区交替分布,两者之间有粗的玻璃样变胶原纤维分隔.密集区肿瘤细胞丰富,呈束状、漩涡状排列,可见血管外皮瘤样结构;瘤细胞呈梭形、短梭形,核染色质粗,异型性明显,有肿瘤性坏死、较多量核分裂( ＞4/10 HPF),局部出血.免疫表型:肿瘤细胞CD34,Bcl-2,CD99及Vimentin弥漫阳性;P53部分阳性,上皮细胞膜抗原局灶阳性;ki-67增殖指数20％ ～ 30％;S100,Desmin,CK及胶质纤维酸性蛋白阴性.结论:MSFT是一种少见的间叶肿瘤,确诊主要依靠形态学及免疫组织化学,需与血管外皮细胞瘤、恶性纤维组织细胞瘤、纤维肉瘤、滑膜肉瘤、恶性间皮瘤、恶性外周神经鞘膜瘤和脑膜瘤等相鉴别.MSFT的预后不良,易复发和转移,根治性切除是主要治疗手段,术后应长期随访.     

Gastrointestinal stromal tumor of the digestive organs: a histopathologic study of 31 cases in a single Japanese institute

The author herein reports histopathologic features of 31 surgical cases of gastrointestinal stromal tumor (GIST) of the digestive organs. The 31 cases of GIST were diagnosed in our pathology laboratory. They consisted of 24 cases of gastric GIST, 1 case of hepatic GIST, 1 case of small intestinal GIST, 4 cases of colon GIST, and 1 case of rectal GIST. The age of the patients ranged from 56 year to 84 years with a mean of 71 years. Male to female ratio was 21:10. The presenting symptoms were gastrointestinal bleeding in 13 cases, abdominal pain and discomfort in 13 cases, and asymptomatic in 5 cases. Endoscopy and imaging modalities including US, CT and MRI were useful to detect the tumors in all cases, and biopsies confirmed the GIST diagnosis in 21 cases. The size of GIST ranged from 1 cm to 12 cm with a mean of 4.3 cm. Grossly, 23 cases were submucosal tumors, 6 serosa-side tumors, 1 solid tumor in the liver, and 1 rectal polyp. Histologically, 28 cases were of spindle cell type and 3 of epithelioid type. According to mitotic counts and tumor size, the malignant risk was very low in 4 cases, low in 14 cases, intermediate in 9 cases, and high in 4 cases. Immunohistochemically, all cases were positive for KIT and vimentin, 30 cases for CD34, and 4 cases for α-smooth muscle actin. None were positive for desmin and S100 protein. Ki-67 labeling ranged from 2% to 18%. P53 protein was negative in all cases. PDGFRA was positive in 20 cases among 24 cases examined. Genetic analysis using PCR-direct sequencing method was performed in 5 GISTs; all the 5 GISTs showed point mutations or deletions in KIT gene, but did not in PDGFRA gene. The 5 cases of GIST were positive for PDGFRA protein, suggesting that PDGFRA overexpression is not associated with PDGFRA gene mutations. Four of the 31 cases showed metastases. The chemotherapy was imatinib mesylate in 6 cases, and none in 25 cases. Four cases of high risk died of GIST, and 27 cases are alive now without tumors.     

组织芯片检测p16蛋白在不同胃组织中的表达意义

[目的]分析胃癌相关差异表达蛋白p16在不同胃组织中的表达意义,为临床早期发现胃癌及评估胃癌患者预后提供有价值的资料.[方法]采用免疫组织化学染色,检测胃组织芯片(包括正常胃黏膜、癌旁、非典型增生、胃癌及淋巴结转移癌组织)中p16蛋白的表达,分析其在胃癌组织中表达与临床病理特征的关系.[结果] p16蛋白在正常胃黏膜、癌旁、非典型增生和胃癌组织中的表达率分别为76.47％ (26/34)、79.59％( 39/49)、34.62％ (9/26)和8.64％(7/81);p16蛋白在胃癌组织中阳性表达率较正常胃黏膜、癌旁组织和非典型增生组织降低(P＜0.01),而非典型增生组织中阳性表达率较正常胃黏膜和癌旁组织降低(P＜0.05);p16蛋白表达与胃癌患者年龄、肿块大小和淋巴结转移有关(P＜0.05).[结论] p16蛋白表达与胃癌的发生发展、患者年龄、肿块大小及淋巴结转移有关.     

Kimura病8例报告

[目的]了解Kimura病的临床病理特征.[方法]回顾分析8例Kimura病患者的临床资料.[结果]1例患者以腹胀、腹泻、双下肢浮肿起病,伴下腹部散在红色丘疹及双侧耳后淋巴结、肠系膜淋巴结肿大.7例患者以颈部肿块就诊.8例均行肿块切除、皮质激素或细胞毒药物治疗.[结论]外周血嗜酸性粒细胞和血清IgE升高对该病的诊断具有重要意义.皮质激素应作为Kimura病的首选治疗方法.     

Clinical importance of correlations between p53 immunoreactivity and clinicopathological parameters in lung carcinoma

Many studies have revealed the frequency of p53 abnormalities in lung cancer. However, clinico-pathological studies of p53 abnormalities have yielded conflicting results. We examined the p53 immunoreactivity and studied the correlations of p53 status and clinicopathological parameters in 76 primary lung cancers. By using DO-7 antibody, different degrees of p53 immunoreactivity was detected in 8 of 30 small cell lung cancer (SCLC, 26.6%) and 22 of 46 non-small cell lung cancer (NSCLC, 47.8%), 6 of 19 adenocarcinoma, 16 of 27 epidermoid carcinoma cases. In the whole group, no correlation was detected between the p53 status and the histological types of tumor, local tumor invasion, nodal status, and distant metastasis and patient characteristics, such as age, gender or smoking habit. P53 status was also found to have no effect on survival. However, in the NSCLC group, there was a significantly higher p53 immunoreactivity in well- and moderately-differentiated tumors (p<0.05). Patients with p53 immunoreactivity had a poor therapeutic response in the whole group. We concluded that, although p53 immunreactivity may be found in NSCLC, this does not correlate with clinicopathological parameters except therapeutic response. In SCLC p53 immunreactivity can be negligible.