乳腺导管上皮内瘤变

乳腺导管上皮内瘤变(ductal intraepithelial neoplasm)是一个新概念。该概念包含乳腺导管上皮增生(IDH)、导管上皮不典型性增生(AIDH)以及导管原位癌或导管内癌一系列导管上皮增生性病变。由IDH到导管原位癌构成了一个由良性到恶性病变的渐变谱系，进一步则演变为浸润性导管癌(IDC)。导管上皮内瘤变诊断难点主要集中于AIDH同     

胃上皮内瘤变分类及形态学探讨

胃上皮内瘤变(gastric intraepithelial neoplasia,GIN),或称胃上皮异型增生(gastric epithelial dysplasia)与胃癌关系密切,高级别异型增生与40%～100%早期胃癌相关,并见于5%～80%进展期胃癌的癌旁组织[1-2].     

外阴上皮内瘤变与人乳头状瘤病毒感染的相关性

目的 探讨人乳头状瘤病毒(HPV)在外阴上皮内瘤变(VIN)中的感染情况及与p53、Ki-67蛋白表达的关系.方法 用原位杂交法(ISH)检测HPV6/11、16/18、31/33型在55例VIN及10例外阴正常皮肤组织中的表达.同时用免疫组化SP法检测p53、Ki-67蛋白的表达.结果 HPVl6/18、31/33、6/11在VINⅢ中的阳性表达率分别为60%(6/10)、20%(2/10)和0%(0/10);在VIN Ⅱ中为53.57%(15/28)、39.28%(11/28)和10.71%(3/28);在VIN Ⅰ中为17.65%(3/17)、5.88%(1/17)和29.41%(5/17);正常对照组没有表达.p53、Ki-67蛋白在VINHI中的阳性表达率分别为70%(7/10)和90%(9/10);在VINⅡ中为78.57%(22/28)和78.57%(22/28);在VIN Ⅰ中为64.71%(11/17)和35.29%(6/17);在正常对照组没有表达.经统计学分析,VINⅢ、Ⅱ组中的HPVl6/18感染与正常组差异有显著性(P＜0.05);VINⅡ组的HPV31/33感染与正常组差异有显著性(P＜0.05);VINⅢ、Ⅱ组p53、Ki-67及VIN Ⅰ组p53阳性表达率与正常组差异有显著性(P＜0.05);VIN Ⅰ组Ki-67阳性表达率与VINⅡ组相比差异有显著性(P＜0.05).结论 VIN的发生与HPV感染有关,尤其与HPVl6/18、31/33型感染密切相关.VIN与外阴癌感染的HPV型别相同.在VIN的发生发展中,HPV感染以及p53突变可能起重要的作用.     

肝内胆管上皮内瘤变的病理学特征及诊断

肝内胆管癌（intrahepatic cholangiocarcinoma,ICC）又称胆管细胞癌或胆管癌,在世界大部分地区是肝脏第二常见恶性肿瘤,占肝脏原发肿瘤的5％～25％,平均约10％。在组织学上最近强调两种与肝内胆管癌有关的恶性前期病变,第一是胆管内乳头状肿瘤（intraductal papillary neoplasm of the biliary tract,IPNB）,类似于胰腺导管内乳头状肿瘤,常继发浸润性黏液性ICC;第二为显微镜下病变,即胆管上皮不典型增生,[第一段]     

516例宫颈上皮内瘤变的回顾性分析

目的总结宫颈上皮内瘤变（CIN）的临床表现及诊治过程,探寻防治宫颈癌前病变有效措施。方法回顾性分析2008年6月～2009年12月在四川省人民医院妇科诊治的516例CIN患者的年龄,临床表现,诊断、治疗及随访过程。结果 CIN患者的平均年龄32.4岁,其中CIN I 205例（占39.73%）,CIN Ⅱ246例（占47.67%）,CIN Ⅲ65例（占12.6%）。临床表现上38.18%有不正常阴道流血。经过18个月随访,治愈率99.61%,仅2例CIN Ⅲ未愈,再次手术。结论通过细胞学-阴道镜-组织学的三阶梯检查能更准确及时地发现CIN,而对CIN正规的治疗和随访能有效地阻断其发展为子宫颈癌。     

上皮内瘤变在消化道病理诊断中的应用

上皮内瘤变（intraepithelial neoplasia,IEN）是一种以形态学改变为特征的上皮性病变,包括组织结构和细胞形态学改变,伴随细胞增殖动力学和细胞分化的异常。这种病变有基因的克隆性性改变,并有进展为浸润性病变的倾向。目前大多数学者将上皮内瘤变视为异型增生的同义词,但两者在所及的范围和传统定义上略有差异。可以根据程度的不同将上皮内瘤变分为低级别和高级别上皮内瘤变。     

516例宫颈上皮内瘤变的回顾性分析

目的 总结宫颈上皮内瘤变(CIN)的临床表现及诊治过程,探寻防治宫颈癌前病变有效措施.方法 回顾性分析2008年6月～2009年12月在四川省人民医院妇科诊治的516例CIN患者的年龄,临床表现,诊断、治疗及随访过程.结果 CIN患者的平均年龄32.4岁,其中CIN Ⅰ205例(占39.73%),CIN Ⅱ246例(占47.67%),CIN Ⅲ 65例(占12.6%).临床表现上38.18%有不正常阴道流血.经过18个月随访,治愈率99.61%,仅2例CINⅢ未愈,再次手术.结论 通过细胞学-阴道镜-组织学的三阶梯检查能更准确及时地发现CIN,而对CIN正规的治疗和随访能有效地阻断其发展为子宫颈癌.     

LEEP术治疗宫颈上皮内瘤变的疗效分析

目的探讨高频电波刀环形电切除术（LEEP）治疗宫颈上皮内瘤变（CIN）的临床疗效。方法回顾性分析127例患者的临床资料,观察手术前后病理结果、手术时间、出血量和并发症等情况。每3-6个月及3个月后,每TCT或阴道镜复查的结果。结果手术平均时间3.5 min,术中平均出血10 mL;手术成功率91.3%,并发症发生率8.6%;术前与术后病理诊断结果一致占81.1%,所有手术标本切缘均阴性。结论 LEEP手术时间短,术中出血少,是治疗宫颈上皮内瘤变的首选方法。     

子宫颈上皮内瘤变的临床诊断治疗相关进展

子宫颈癌是妇女生殖系统最常见的恶性肿瘤,起源于子宫颈上皮内瘤变,筛查发现子宫颈上皮内瘤变并积极治疗是预防子宫颈癌有效的措施。本文从子宫颈上皮内瘤变的高危因素及病理分型诊断入手,探讨子宫颈上皮内瘤变的诊断与治疗的相关进展。     

Crohn''s disease of the gall bladder

A 64 year old man with known enteric Crohn's disease developed a granulomatous cholecystitis in which the histological features were identical to those seen in sites conventionally affected by this disease. Extraintestinal granulomatous lesions are rare in Crohn's disease and the present case is reported because of its apparent uniqueness.     

Congenital absence of the gall bladder

Summary Congenital absence of the gall bladder is an extremely rare embryological aberration with a reported incidence ranging between 0.013 and 0.075%. This report, the first from South Africa, discusses 2 cases of gall bladder agenesis, bringing to 413 the number of cases reported in the literature. In confirming the diagnosis of an agenesis of the gall bladder, it is necessary to exclude the abnormal locations which are intrahepatic, retrohepatic, on the left side, or within the lesser omentum or falciform ligament and retroperitoneal. Patients with gall bladder agenesis are classified into 3 categories: i) Multiple foetal anomaly (12.9%), ii) Asymptomatic (31.6%) and iii) Symptomatic (55.6%). Notwithstanding current diagnostic modalities, this rare condition may still present a dilemma to the abdominal surgeon. Agenesis of the gall bladder is a well-recognised but uncommon congenital abnormality. With the advent of minimal access surgery laparotomy may be avoided as the condition, when suspected, may be confirmed by ERCP and CT scan.

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Absence congénitale de la vésicule biliaire

Résumé L'absence congénitale de la vésicule biliaire est une malformation dont l'incidence est évaluée de 0,013 à 0,075 %. Nous rapportons deux observations d'agénésie de la vésicule biliaire, représentant les premiers cas de l'Afrique du Sud, nous les confronterons au 413 cas de la littérature. Pour confirmer le diagnostic d'agénésie de la vésicule biliaire, il est nécessaire d'exclure les localisations vésiculaires anormales, soit intra-hépatiques, soit rétro-hépatiques, soit dans le foie gauche, soit à l'intérieur de l'omentum ou du ligament falciforme, voire même rétro-péritonéales. Les patients porteurs d'agénésie de la vésicule biliaire sont classés en trois catégories : 1) Sujets porteurs de multiples anomalies foetales (12,9 %) 2) Sujets asymptômatiques (33,6 %) 3) Sujets avec manifestations cliniques (55,6 %). Néanmoins, les modalités diagnostiques habituelles peuvent, dans de rares conditions, se présenter dans le cadre d'une urgence chirurgicale abdominale. L'agénésie de la vésicule biliaire est une malformation bien connue, mais reste une anomalie rare. Avec l'avènement des abords chirurgicaux à minima, la laparotomie peut être évitée à condition que dans les cas suspectés, on réalise une exploration par endoscopie rétrograde des voies biliaires et pancréatiques (ERCP) et un scanner abdominal.

     

Carcinoid tumor of the gall bladder

Carcinoid of the gall bladder and bile duct is a rare tumor. Primary gall bladder and biliary duct system carcinoids constitute less than 1% of all carcinoid tumors arising from different parts of the body. We describe a case of carcinoid tumor of the gall bladder in a 53-year-old woman. The rarity of this entity prompted us to present our patient as a case report. There have been only 33 cases described in the literature.     

Intraepithelial neoplasia/dysplasia - histopathology in ulcerative colitis

About 1-2% of all colorectal carcinomas (CRCs) arise from a background of chronic inflammatory bowel diseases (IBDs) such as ulcerative colitis (UC) or Crohn's disease, and around 15% of patients with IBD die from colorectal cancer. Intraepithelial neoplasia/dysplasia in the setting of IBD is considered a precancerous lesion by definition. Intraepithelial neoplasia may present itself either as a flat or polypoid mucosal lesion and is referred to as a dysplasia-associated lesion or mass (DALM) in the latter case. The therapeutic consequence of high-grade intraepithelial neoplasia/dysplasia and/or DALM is proctocolectomy in most centers because of the high risk of synchronous or metachronous CRC. The diagnosis of ulcerative colitis-related intraepithelial neoplasia and its distinction from regenerative changes and sporadic adenomas (ALMs) occurring in UC is still one of the greatest challenges in gastrointestinal pathology. Intra- and interobserver variability for the distinction between low-grade intraepithelial neoplasia and regenerative lesions tends to be quite high. This is partly due to the difficult histomorphology and partly due to the relative rareness of this diagnosis (approximately 10% of patients with IBD).     

Gall stones and carcinoma gall bladder

One hundred and fifty surgically resected gall bladder specimens were included in the study to evaluate the relationship between the prevalence of gall stones and histochemical alteration in sequential changes of metaplasia, dysplasia and neoplasia in gall bladder epithelium. Multiple sections were processed and stained with haematoxylin and eosin, Periodic acid Schiff's stain, Alcian blue (pH 2.5)/Periodic acid, Orcein/Alcian blue (pH 2.5) and Alcian Blue/Periodic acid/Potassium borohydride saponifications stains. Details of gall stones present were also noted. Prevalence of gall stones in gall bladders with metaplastic, dysplastic and neoplastic mucosal changes was significantly higher (P < 0.001) than those gall bladders which had no epithelial changes. Increase in sialomucin with a corresponding decrease in sulphomucin was observed from metaplasia to malignancy. Neutral mucin increased in metaplastic cells but was significantly reduced in neoplastic cells. Loss of O-acylation in sialmucin was also present in neoplastic cells. The histochemical changes suggest that chronic injury due to cholelithiasis induces appearance of neutral mucin positive metaplastic cells, which may further dedifferentiate to sialomucin containing dysplastic or neoplastic cells if the stimulation persists.