Case report 623

A case of OCC in a 35-year-old woman is presented. Proof was obtained by open biopsy. This rare entity is benign and its etiology is still obscure. No definite association with osteitis pubis or osteitis condensans ilii has been reported. The involvement of the clavicle is invariably unilateral. The clinical and radiographic characteristics of this benign condition have been discussed and the differential diagnosis has been considered. Consideration should be given to the concept that if the imaging features are characteristic, as in this case, biopsy may not be necessary.     

T细胞性淋巴瘤中CD21的表达及其与EB病毒感染关系的研究

目的 :研究T细胞性淋巴瘤 (T -CellLYMPHOMAS ,TCLS)中EPSTEIN -BARR病毒 (EB病毒 )和其受体CD2 1的表达及其相互关系。方法 :对 4 6例TCLS用免疫组化LSAB法检测CD2 1,原位杂交法检测EB病毒 (EBERS)。结果 :CD2 1的阳性率为 13% (6 /46 ) ,其中淋巴结内TCLS 4例阳性 ,淋巴结外 2例阳性。E BERS阳性率为 5 2 .5 % (2 4 /46 ) ,淋巴结内 3例和结外 2 1例。 2例结外TCLSCD2 1与EBERS同时阳性。CD2 1表达与EB病毒感染无明显相关性 (P >0 .0 5 )。结论 :部分T细胞性淋巴瘤中有CD2 1表达 ,EB病毒感染可能与之有关。但CD2 1表达的病毒例并非均有EB病毒感染。另外 ,CD2 1阴性的TCLS中EB病毒感染途径尚有等进一步研究。     

Electron microscopic study of signet-ring cells in diffuse carcinoma of the human stomach

Summary The signet-ring cells seen in gastric carcinoma of the diffuse type were studied by light and electron microscopy. A classification of these cells into Types A, B and C was developed, based on intracellular mucous granules, nuclei and organelles, and by reactions to PAS and Alcian-blue staining. The gradual transition of Type A cells to Type B and the subsequent change of Type B to Type C suggest successive stages in maturation. These cells, especially those of Type B, resemble the mucous neck cells of the corpus and the glands of the pylorus.     

Pharyngeal enterogenous cyst associated with canalis basilaris medianus in a newborn

We report the CT and MR characteristics of a newborn with a rare, complex malformation characterised by a large rhinopharyngeal and oropharyngeal enterogenous cyst, associated with an osseous defect of the basiocciput, called canalis basilaris medianus (CBM). A partial herniation of the bulb was demonstrated through the bony defect on the midline. The enterogenous cyst occupied the rhinopharynx and oropharynx, narrowing the pharyngeal lumen and making it difficult for the introduction of an orotracheal tube.     

后肾腺瘤临床病理特征及文献复习（附12例）

目的:探讨后肾腺瘤（metanephric adenoma,MA）的临床病理特征、诊治、预后及其鉴别诊断。方法:回顾性分析12例MA的临床病理特征、免疫组化结果及治疗预后。结果:12例后肾腺瘤均为境界清楚的肿块;肿瘤细胞形态温和,小而密集,排列成腺泡状、乳头状、分枝小管状,间质不明显;细胞丰富,核圆形、卵圆形,无核仁,染色质细腻,胞浆稀少,淡染,少见核分裂象;部分可见砂粒体样钙化。免疫组织化学染色 WT-1、CD57、PAX8、Vimentin、PAX2阳性,CK7、CD10、CD117阴性。结论:后肾腺瘤为一种罕见的肾脏上皮源性良性肿瘤,临床特征不明显,具有独特的组织病理学特征,免疫组化染色对其诊断具有重大意义,治疗以手术为主,完整切除预后良好。     

挖空细胞在病理诊断尖锐湿疣中的诊断价值

目的 评价挖空细胞在组织学上诊断尖锐湿疣的诊断价值。方法 以挖空细胞作为诊断标准,对2063份活检标本进行组织学诊断,其诊断结果与病理学上诊断尖湿疣的“金标准”进行比较分析。结果 以挖空细胞作为尖锐湿疣的组织学诊断标准,其诊断的灵敏度为77.93%,特异度95.26%,阳性预告值97.25%,阴性预告值66.70%,阳性似然比81.81,阴性似然比23.17,漏诊率22.07%,误诊率4.74%。结论 挖空细胞是细胞感染人乳头瘤病毒（HPV）或其他病毒后,在形态学上发生特异性改变,是诊断尖锐湿疣的重要组织学依据,但不是组织学上诊断的唯一标准。     

Bilateral vocal fold immobility: Clinical findings of ten cases and suggested treatment options

ObjectiveTo present the clinical findings of 10 cases of bilateral vocal fold immobility (adducted type) and suggest potential treatment options.MethodsThis retrospective study included 10 patients who underwent tracheostomy for restricted airway due to bilateral vocal fold immobility of the adducted type during the period from 2007 to 2017. All 10 patients underwent unilateral laterofixation surgery with or without additional arytenoidectomy using a CO₂ laser. The effect of laterofixation surgery for decannulation was evaluated. Statistical analysis was performed to assess the effects of laterofixation based on the results of preoperative and intraoperative examinations including endoscopic examinations, electromyography, and the intraoperative traction-mobility test.ResultsInitial laterofixation surgery for decannulation was effective in 6 cases. In the 4 cases that exhibited laterofixation failure, additional endoscopic subtotal arytenoidectomy was performed. Statistical analysis of the effects of laterofixation revealed that, in cases with bilateral preserved muscle tone, unilateral simple laterofixation surgery was unable to achieve a significantly effective glottal airway. Additional subtotal arytenoidectomy was also ineffective in a case with bilateral ankylosis.ConclusionBased on the clinical findings in these 10 cases of bilateral vocal fold immobility of the adducted type, treatment options are suggested and a severity classification system of bilateral vocal fold immobility is proposed that focuses mainly on electromyography results for assessment of dynamic restenosis and traction-mobility test results for assessment of static restenosis. Validation of the classification system is needed in a larger cohort of cases of bilateral vocal fold immobility.     

Effect of BRAF V600E mutation detection of fine-needle aspiration biopsy on diagnosis and treatment guidance of papillary thyroid carcinoma

ObjectiveThe aim of this study was to evaluate the diagnostic value of detection of BRAF V600E mutation in the fine-needle aspiration cytology (FNAC) specimens of thyroid nodules and the relationship between BRAF V600E mutation and the clinicopathological characteristics of papillary thyroid carcinoma (PTC).MethodsA total of 252 patients who underwent initial thyroid surgery were retrospectively analysed. All the patients underwent a preoperative FNAC at our institution, and the thyroid puncture cell fluid was used for both the cytological diagnosis and BRAF V600E mutational analysis using quantitative polymerase chain reaction. The Cochran-Mantel-Haenszel test was used to evaluate the diagnostic value of BRAF V600E mutation in FNAC fluid in diagnosing PTC. The association between BRAF V600E mutation and the clinicopathological parameters of PTC was analysed using the χ² test.ResultsThrough FNAC, 21 (8%), 60 (24%), and 171 (68%) cases were cytologically diagnosed as benign, indeterminate, and malignant, respectively. Postoperatively, 242 cases were histopathologically diagnosed as PTCs and 10 as goitre nodules. In the FNAC samples, 12 (57 %) of the 21 benign, 48 (80 %) of the 60 indeterminate, and 152 (88.9 %) of the 171 malignant cases showed BRAF V600E mutation. The histopathological diagnosis was used as the gold standard. The sensitivity and specificity of BRAF V600E mutational analysis in the FNAC samples for the diagnosis of PTC were 91.7 % and 100 % in benign, 82.8 % and 100 % in the indeterminate, and 89.4 % and 100 % in the malignant cases, respectively.ConclusionBRAF V600E mutational analysis in FNAC samples of thyroid nodules can be used an effective supplementary diagnostic method at our institution. However, BRAF V600E mutation was not associated with aggressive characteristics in PTC.     

Occult carcinoma confirmed to be a diffuse sclerosing variant of papillary thyroid carcinoma with unusual immunohistochemical features: A pitfall of clinicopathological diagnosis

Immunocytochemistry in a 78-year-old man diagnosed as having systemic metastatic cancer of unknown primary origin revealed atypical cells positive for napsin A and TTF-1, suggesting adenocarcinoma of the lung. However, there was no evidence of a primary lesion in the lung on positron emission tomography/computed tomography or at autopsy. Meanwhile, both the left and right thyroid lobes were firm and grayish white with marked fibrosis. Histology identified a diffuse sclerosing variant of papillary thyroid carcinoma that was positive for TTF-1 and napsin A but negative for PAX8. This disease entity is often misdiagnosed clinically as chronic thyroiditis. This is the first report of napsin A-positive and PAX8-negative thyroid carcinoma and highlights the pitfalls of clinicopathological diagnosis.