Narrative review of prostate cancer grading systems: will the Gleason scores be replaced by the Grade Groups?

The Gleason grading system, proposed by Dr. Donald F. Gleason in 1966, is one of the most important prognostic factors in men with prostate cancer (PCa). At consensus conferences held in 2005 and 2014, organized by the International Society of Urological Pathology (ISUP), the system was modified to reflect the current diagnostic and therapeutic approaches. In particular, in the 2014 Conference, it was recognized that there were weaknesses with the original and the 2005 ISUP modified Gleason systems. Based on the results of a research conducted by Prof. JI Epstein and his group, a new grading system was proposed by the ISUP in order to address some of such deficiencies: i.e., the five distinct Grade Groups (GGs). Since 2014, results of studies have been published by different groups and societies, including the Genitourinary Pathology Society (GUPS), giving additional support to the prognostic role of the architectural Gleason patterns and, in particular, of the GGs. A revised GG system, taking into account the percentage of Gleason pattern (GP) 4, cribriform and intraductal carcinoma, tertiary GP 5, and reactive stroma grade, has shown to have some advantages, however not ready for adoption in the current practice. The aim of this contribution was to review the major updates and recommendations regarding the GPs and GSs, as well as the GGs, trying to give an answer to the following questions: “How has the grade group system been used in the routine?” and “will the Gleason scoring system be replace by the grade groups?” We also discussed the potential implementation in the future of molecular pathology and artificial intelligence in grading to further define risk groups in patients with PCa.     

雷公藤多苷治疗儿童肾病综合征的机制探讨

目的 :探讨雷公藤多苷在治疗儿童肾病综合征中的作用及其机制。　方法 :对 16年来在我科住院明确病理类型的 5 5 0例中 10 5例肾病综合征患儿 ,在激素逐渐减量的同时用雷公藤多苷 ( 1m g/ kg· d- 1 )治疗。　结果 :81例肾病综合征获得缓解 ,总缓解率达 77.1% ,其中 MCNS( 2 4例 )、Ms PGN ( 46例 )、MPGN ( 17例 )、MN ( 13例 )和FSGS( 5例 )的缓解率分别为 91.7%、89.1%、76 .5 %、38.5 %和 0 % ,FSGS效果最差 ;14例改善 ,10例无效。　结论 :由于病理类型不同疗效相差较大 ,临床上对激素治疗无效或耐药的肾病综合征患儿 ,应及时行肾活检以明确病理诊断 ,对病理类型为 MCNS和 Ms PGN者可单用雷公藤多苷治疗 ,以避免长期应用激素的不良反应 ,这是治疗儿童肾病综合征的有效方法之一     

女性输卵管结扎术后腰痛病机及医疗体育疗法

对女性输卵管结扎术后腰痛进行调查和病理分析 ,以中药配合医疗体育康复治疗术后腰痛 ,取得较好疗效 ,并提出预防措施。     

青年人胃癌临床病理34例分析

目的　探讨青年人胃癌的临床病理特点。方法　回顾性分析 34例青年胃癌病人的临床表现、病理特点、治疗及预后 ,并与 4 0例中老年胃癌病人进行对比。结果　青年人胃癌与中老年人胃癌的临床表现相似 (P >0 .1) ,诊断常被延误 (P <0 .0 5)。其病理类型以未分化癌及低分化腺癌多见 ( 79.4 % ) ,手术切除率低( 4 1.2 % ) ,预后差 ( 5年生存率 8.8% ) ,与中老年组比较P均 <0 .0 1。结论　青年人胃癌病情进展快 ,转移早 ,改善预后的关键是早诊断 ,早治疗。     

绝经后阴道出血242例临床及病理分析

目的 探讨绝经后阴道出血的病因。方法 分析２４２例绝经后阴道出血并行诊断性乔宫的临床和病理资料。结果 绝经后阴道出血的主要病理诊断分另是功能性子宫内膜（６０．７３％）、炎症（２８．９２％）和恶性肿瘤（１０．３５％）。结论 内分泌紊乱性疾病是绝经后出血的常见病因,年老妇女恶性肿瘤发生率高。     

误诊为肉瘤的结节性筋膜炎之临床病理研究

目的：探讨结节性筋膜炎被误诊为肉瘤的原因,方法观察７４例被误诊为肉瘤的结节性筋膜炎临床病理及免疫组化特点,其中对６２例采用ＡＢＣ、ＬＳＡＢ法行免疫组化染色。结果７４例病人临床表现均为良性经过,但镜下组织学极似肉瘤形态,６８例获随访,结果均存活,复发率不足１％,６２例做了免疫组织化学染色,梭形细胞Ｖｉｍｅｎｔｉｎ阳性,ＭＳＡ,ＳＭＡ和ＫＰ１部分病例阳性,Ｋｅｒａｔｉｎ、Ｓ－１００、Ｄｅｓｉｍｉｎ均为     

风疹病毒JR_(23)株感染BALB/c小鼠脑组织的病理学特征

为研究风疹病毒（ＲＶ）ＪＲ２３株感染中枢神经系统（ＣＮＳ）的特性及病理学特征,ＢＡＬＢ／ｃ 小鼠经腹腔感染ＲＶ ＪＲ２３株,并于感染后的第２１ｄ 取小鼠大脑及小脑组织,ＨＥ及免疫组织化学染色,观察小鼠脑组织ＲＶ 感染状况及病变特征。结果显示,受感染的小鼠无明显的ＣＮＳ症状,病理学特征以大脑灰质小灶性神经元变性坏死为主,病变神经元周围见增生的少突胶质细胞形成卫星现象。在神经元坏死灶中可见小胶质细胞增生,形成噬神经元现象及由小胶质细胞和少突胶质细胞构成的胶质细胞结节。神经元及神经胶质细胞内未见病毒包涵体。免疫组织化学染色显示,ＲＶ 主要分布于大脑灰质,神经元细胞、星形胶质细胞和少突胶质细胞均可受到ＪＲ２３株的感染。提示卫星现象、噬神经元现象和胶质细胞结节形成可作为ＲＶ－ＪＲ２３感染ＣＮＳ的病理学参考指标。免疫组织化学染色对确诊ＣＮＳＲＶ 的感染具有特异性     

5-氟尿嘧啶在胰十二指肠切除术患者血液和胰液中的动态分布

探讨５－氟尿嘧啶能否通过胰十二指肠切除术后的残留胰腺组织进入胰液中,并达有效的治疗浓度,为胰腺为临床合理化疗提供理论依据。方法通过观察胰十二指肠切除术患者胰快速推注５－氟尿嘧啶后血液和胰液中药物动态分布及相关性,术后静脉一次性快速推注５－氟尿嘧啶１．０ｇ／ｍ＾２,在给药前后按设计时间点分别采集静脉血和胰液,采用高效液相色谱法测定血浆和胰液５－氟尿嘧啶药物浓度,应用ＰＣＮＯＮＬＩＮ程序程序计算共动态     

春季结膜炎穹窿结膜的临床病理

证明春季结膜炎在穹窿结膜的临床病理。方法：详细记载球（角膜缘）、睑及穹窿结膜的临床表现;对３８眼（２１例）的穹窿结膜（上穹窿３４眼、下穹窿４眼）进行活检,组织切片ＨＥ染色,光学显微镜下观察病理改变。结果：结膜上皮不同程度增生,上皮下淋巴细胞、浆细胞浸润或胶元纤维增生,３８眼标本中３２眼有嗜酸性白细胞、１眼有嗜碱性白细胞浸润。一极轻病例双眼下穹窿结膜只有很少几个淋巴细胞,其中却散在个别嗜酸性白细胞。结论：春季结膜炎的临床病理改变包括穹窿结膜。     

Focal segmental membranous glomerulonephropathy associated with other glomerular diseases

In four patients with the nephrotic syndrome, renal biopsy revealed focal segmental membranous glomerulonephropathy (FSMGN) associated with the histologic patterns of "nil" disease (two cases), hereditary nephritis and diffuse diabetic glomerulosclerosis. The occurrence of FSMGN in association with other glomerular diseases, presumably unrelated to immune complex deposition, is infrequent in our experience. Rather than necessarily representing an early stage or milder form of membranous glomerulonephropathy, it may be an epiphenomenon. This interpretation has prognostic and therapeutic implications and raises important pathogenetic questions. In particular, this study suggests that in some instances, preexisting functional and structural abnormalities may play a role either in the deposition of preformed circulating immune complexes or in the local formation of immune complexes.