免疫标记和BRAF V600E突变联合检测在细胞学诊断不确定甲状腺结节中的应用

目的 评估免疫标记半乳糖凝集素-3(Gal-3)、细胞角蛋白-19(CK-19)、间皮细胞角蛋白-1(HBME-1)和BRAF V600E突变联合检测对术前甲状腺细胞学诊断不确定结节的良恶甄别作用.方法 选取四川大学华西医院2014年12月至2019年3月术前细胞学诊断不确定的甲状腺结节患者992例为研究对象,其中行3项免疫标记和/或BRAF V600E突变辅助检测的314例患者为观察组,未行上述辅助检测的678例为对照组,以术后病理学诊断评估上述检测单独或联合应用辅助技术的诊断价值.结果 观察组术后恶性率高于对照组(P<0.001).观察组中,195例患者行Gal-3、CK-19和HBME-1的免疫标记检测,301例患者行BRAF V600E突变检测,其中仅182例患者行3项免疫标记和BRAF V600E突变联合分析.对于单个检测,BRAF V600E突变和CK-19的特异性和敏感性最高,分别为100.0％和90.6％,当联合使用时诊断效能明显提高.BRAF V600E突变检测、Gal-3和CK-19组合的诊断效果最好,准确率最高达92.9％,该组合术前正确分类了168个恶性结节中的161个(95.8％)和14个良性病变中的8个(57.1％),其中159例甲状腺乳头状癌中有158例被本组合正确分类.结论 免疫标记Gal-3、CK-19和BRAF V600E突变检测对细胞学诊断不确定的甲状腺结节有较高的良恶性甄别价值.     

小剂量氨氯地平联合替米沙坦治疗高血压临床效果观察

目的对小剂量氨氯地平联合替米沙坦治疗高血压的临床疗效进行探究和分析。方法选取2012年5月~2014年5月收治的118例高血压患者作为观察对象,随机分为观察组和对照组。观察组(n=59)给予小剂量氨氯地平联合替米沙坦治疗,对照组(n=59)仅给予小剂量氨氯地平治疗,对比两组患者的治疗效果。结果观察组治疗总有效率为96.61%,明显优于对照组,差异有统计学意义(P<0.05);观察组和对照组治疗后的舒张压(DBP)和收缩压(SBP)水平与治疗前相比均有下降,观察组治疗后DBP和SBP水平下降幅度明显大于对照组,差异有统计学意义(P<0.05)。结论采用小剂量氨氯地平联合替米沙坦治疗高血压,临床效果显著,可以有效控制血压,缓解临床症状,具有临床推广意义。     

淋巴结细针穿刺标本的流式细胞术分析

Objective Comparative evaluation of flow cytometric immunophenotyping in the diagnosis and differentiation of lymphadenopathy,lymphoma and reactive lymphoid hyperplasia. Methods Ninty-nine fine-needle aspiration specimens from patients with tentative clinical lymphoprofierative disorders were consecutively analyzed by both cytology and flow cytometry with histology results as the gold standard. The three color antibodies including CD3,CD3,CD4,CD5,CD10,CD19,CD20,CD23,CD45,K,λ,FMC7 and CD34 were used for cell composition evaluation and cells with abnormal phenotype. Lymphoma cases were classified according to new WHO classification and subtypes were categorized by immunophenotypic analysis. The results from flow cytometry and cytology were compared. Results By cytological study, 40 of 99 cases were diagnosed with lymphoma, 29 cases were diagnosed with metastatic carcinoma, and 30 cases were diagnosed with reactive lymphoid hyperplasia, necrosis or tuberculosis. Among them, 2 non-Hodgkin lymphoma(NHL) cases were misdiagnosed as reactive lymphoid hyperplasia by cytology. Biopsy was performed in 18 cases of NHL including 16 B-NHL and 2 T-NHL By flow cytometry study, 35 of 99 eases were diagnosed with lymphoma, including 4 cases of lymphoblast lymphoma, 1 case of T-cell lymphoma, and 30 eases of other B-NHL For those 30 cases of B-NHL, 28 cases showed monoclonal light chain expression, and k: λ orλ: k atios exceed 3: 1, and B-cell proportion was (73. 2±27. 2)%. Twenty-six cases could be sub-classified by immunophenotyped. Among 16 histologically confirmed B-NHL cases, only 2 cases diagnosed with follicular lymphoma showed discrepancy with flow cytometry results. In all cases diagnosed with reactive lymphoid hyperplasia and metastasis carcinoma , no abnormal lymphocytes can be found, and k: λ or k: λ ratios were less than 3: 1. Conclusions Fine-needle aspiration analysis with flow eytometrie immunophenotyping can be helpful in diagnosis and differential diagnosis as well as sub-classification of NHL     

肺泡蛋白沉着症合并肺结核1例报道并文献复习

目的探讨肺泡蛋白沉着症合并肺结核的发病机制,诊断及治疗方法。方法回顾性分析1例肺泡蛋白沉着症合并肺结核患者临床资料并复习相关文献。结果患者表现为咳嗽、咳痰、活动后气促、潮热、盗汗,在经纤支镜肺活检等检查后诊断为肺泡蛋白沉着症合并肺结核,给予抗结核治疗及经纤支镜肺泡灌洗后病情明显改善。结论肺泡蛋白沉着症合并肺结核的情况应引起重视,诊断可依据临床表现、影像学、肺功能、纤支镜活检结果等综合判断。主要治疗方法为抗结核治疗及肺泡灌洗。     

淋巴结细针穿刺标本的流式细胞术分析

Objective Comparative evaluation of flow cytometric immunophenotyping in the diagnosis and differentiation of lymphadenopathy,lymphoma and reactive lymphoid hyperplasia. Methods Ninty-nine fine-needle aspiration specimens from patients with tentative clinical lymphoprofierative disorders were consecutively analyzed by both cytology and flow cytometry with histology results as the gold standard. The three color antibodies including CD3,CD3,CD4,CD5,CD10,CD19,CD20,CD23,CD45,K,λ,FMC7 and CD34 were used for cell composition evaluation and cells with abnormal phenotype. Lymphoma cases were classified according to new WHO classification and subtypes were categorized by immunophenotypic analysis. The results from flow cytometry and cytology were compared. Results By cytological study, 40 of 99 cases were diagnosed with lymphoma, 29 cases were diagnosed with metastatic carcinoma, and 30 cases were diagnosed with reactive lymphoid hyperplasia, necrosis or tuberculosis. Among them, 2 non-Hodgkin lymphoma(NHL) cases were misdiagnosed as reactive lymphoid hyperplasia by cytology. Biopsy was performed in 18 cases of NHL including 16 B-NHL and 2 T-NHL By flow cytometry study, 35 of 99 eases were diagnosed with lymphoma, including 4 cases of lymphoblast lymphoma, 1 case of T-cell lymphoma, and 30 eases of other B-NHL For those 30 cases of B-NHL, 28 cases showed monoclonal light chain expression, and k: λ orλ: k atios exceed 3: 1, and B-cell proportion was (73. 2±27. 2)%. Twenty-six cases could be sub-classified by immunophenotyped. Among 16 histologically confirmed B-NHL cases, only 2 cases diagnosed with follicular lymphoma showed discrepancy with flow cytometry results. In all cases diagnosed with reactive lymphoid hyperplasia and metastasis carcinoma , no abnormal lymphocytes can be found, and k: λ or k: λ ratios were less than 3: 1. Conclusions Fine-needle aspiration analysis with flow eytometrie immunophenotyping can be helpful in diagnosis and differential diagnosis as well as sub-classification of NHL     

联合检测E-cadherin、CEA及Calretinin在浆膜腔积液细胞学鉴别诊断中的意义

背景与目的：浆膜腔积液中转移性腺癌细胞、恶性上皮型间皮瘤细胞和反应性间皮细胞的形态有不少相似之处，有时仅凭形态学特征不能做出准确诊断。近年来免疫细胞化学在这方面得到较多应用，但国内报道仅局限于用CK、EMA、CEA、Vim和HBME-1几种抗体，而且不能较好地进行细胞学的鉴别诊断。本研究旨在探讨联合检测E-cadherin、CEA及calretinin在浆膜腔积液鉴别诊断中的应用价值。方法：选用浆膜腔积液标本共93例，其中胸水66例、腹水24例、心包积液3例。经组织学检查或结合临床资料证实的转移性腺癌55例、恶性上皮型间皮瘤6例、间皮细胞反应性增生32例。每例均制备HE染色的涂片和细胞块，并用细胞块切片作免疫细胞化学染色。结果：E-cadherin、CEA对诊断转移性腺癌的敏感性分别为85．5％(47／55)、78．2％(43／55)，特异性分别为100％(38／38)、97．4％(37／38)。E-cadherin和CEA联合应用诊断浆膜腔积液转移性腺癌的阳性率为96．4％(53／55)。Calretinin对诊断间皮瘤和间皮细胞增生的敏感性和特异性分别为81.6％(31／38)和87．2％(48／55)。结论：E-cadherin、CEA和calretinin是鉴别浆膜腔积液转移性腺癌细胞和间皮源性细胞有价值的一组抗体。     

侵袭性细胞毒性自然杀伤/T细胞淋巴瘤

患者男 ,19岁。因反复发热头痛 1个多月 ,腹泻 5ｄ于1999年 5月 18日急诊入院。患者呈急性病容 ,皮肤巩膜未见黄染 ,体温 40℃ ,双侧腹股沟及左侧腋下可扪及数个直径0 .5～ 1.0ｃｍ淋巴结 ,质中轻触痛。双侧肺呼吸音变粗 ,肝肋下 6ｃｍ ,脾肋下 5ｃｍ ,肝脾区有触痛。实验室检查 :白细胞1.4× 10 9/Ｌ ,红细胞 3.8× 10 12 /Ｌ ,血红蛋白 83ｇ/Ｌ ,血小板2 2× 10 9/Ｌ。行抗感染及对症治疗 ,体温一直未降 ,波动在40℃左右 ,入院后第 2天再查血常规示白细胞 1.35× 10 9/Ｌ ,红细胞 2 .5 7× 10 12 /Ｌ ,血红蛋白 74.8ｇ/Ｌ ,血小板 13× 10…     

淋巴结细针穿刺标本的流式细胞术分析

Objective Comparative evaluation of flow cytometric immunophenotyping in the diagnosis and differentiation of lymphadenopathy,lymphoma and reactive lymphoid hyperplasia. Methods Ninty-nine fine-needle aspiration specimens from patients with tentative clinical lymphoprofierative disorders were consecutively analyzed by both cytology and flow cytometry with histology results as the gold standard. The three color antibodies including CD3,CD3,CD4,CD5,CD10,CD19,CD20,CD23,CD45,K,λ,FMC7 and CD34 were used for cell composition evaluation and cells with abnormal phenotype. Lymphoma cases were classified according to new WHO classification and subtypes were categorized by immunophenotypic analysis. The results from flow cytometry and cytology were compared. Results By cytological study, 40 of 99 cases were diagnosed with lymphoma, 29 cases were diagnosed with metastatic carcinoma, and 30 cases were diagnosed with reactive lymphoid hyperplasia, necrosis or tuberculosis. Among them, 2 non-Hodgkin lymphoma(NHL) cases were misdiagnosed as reactive lymphoid hyperplasia by cytology. Biopsy was performed in 18 cases of NHL including 16 B-NHL and 2 T-NHL By flow cytometry study, 35 of 99 eases were diagnosed with lymphoma, including 4 cases of lymphoblast lymphoma, 1 case of T-cell lymphoma, and 30 eases of other B-NHL For those 30 cases of B-NHL, 28 cases showed monoclonal light chain expression, and k: λ orλ: k atios exceed 3: 1, and B-cell proportion was (73. 2±27. 2)%. Twenty-six cases could be sub-classified by immunophenotyped. Among 16 histologically confirmed B-NHL cases, only 2 cases diagnosed with follicular lymphoma showed discrepancy with flow cytometry results. In all cases diagnosed with reactive lymphoid hyperplasia and metastasis carcinoma , no abnormal lymphocytes can be found, and k: λ or k: λ ratios were less than 3: 1. Conclusions Fine-needle aspiration analysis with flow eytometrie immunophenotyping can be helpful in diagnosis and differential diagnosis as well as sub-classification of NHL     

血栓素、神经特异性钙结合蛋白和HBME-1在鉴别浆膜腔积液间皮源性细胞和转移性腺癌中的作用

所有标本均来自四川大学华西医院病理科2001年10月至2003年6月的浆膜腔积液标本共93例，包括胸水66例、腹水24例、心包积液3例。间皮细胞增生32例，恶性上皮型问皮瘤6例、转移性腺瘤55例。20例增生间皮、48例转移性腺癌和6例间皮瘤由组织学证实，其中3例间皮瘤由尸检确诊，其余病例则结合患者的病史，影像学或血清学等临床资料证实。每例均制备HE染色的涂片和细胞块。     

伴印戒细胞样细胞分化的中枢神经系统胶质母细胞瘤:病例报告及文献复习

目的 探讨中枢神经系统胶质母细胞瘤的临床表现及病理学特征.方法 回顾分析1例伴印戒细胞样细胞和神经节细胞分化的中枢神经系统胶质母细胞瘤患者的临床表现、组织病理学和免疫表型特点,采用免疫组织化学染色方法诊断与鉴别诊断,并复习相关文献.结果 男性患者,29岁.临床主要表现为头晕、头痛、记忆力减退并渐进性加重,伴双眼视力下降.MRI检查右侧额叶近中线灰白质区占位性病变伴出血.手术中可见肿瘤瘤体主要位于右侧额叶,小部分沿胼胝体浸润至左侧额叶,大小约为4.50 cm×5.00 cm×5.00 cm,与正常脑组织边界不清;肿瘤呈实性、灰红色、质地柔软、血液供应丰富.光学显微镜观察肿瘤主要由胶质分化的细胞组成;肿瘤细胞排列呈实性片状,散在单核或多核瘤巨细胞,可见周围有肿瘤细胞呈假"栅栏"样排列的小灶性坏死及呈肾小球样的间质血管增生;肿瘤细胞具有明显的异型性、细胞核深染以及核分裂象;部分肿瘤细胞呈印戒细胞样细胞和神经节细胞分化特征.免疫组织化学染色肿瘤细胞胞质胶质纤维酸性蛋白、神经微丝蛋白、巢蛋白和蛋白基因产物9.5表达阳性,部分肿瘤细胞胞质嗜铬素A和突触素表达阳性,肿瘤细胞胞核P53蛋白表达阳性,Ki-67抗原标记指数(MIB-1)为20%～30%.结论 中枢神经系统胶质母细胞瘤是恶性程度最高的星形细胞肿瘤,也是中枢神经系统好发的肿瘤,但伴印戒细胞样细胞和神经节细胞分化的胶质母细胞瘤临床少见,好发于成年人,预后不良.