磁共振成像动态增强扫描联合T2WI及DWI序列对前列腺病变的诊断分析

目的 探究磁共振成像动态增强扫描(DCE-MRI)联合T2加权成像(T2WI)及扩散加权成像(DWI)在前列腺病变中的诊断价值。方法 选取川北医学院附属南充市中心医院2019年10月至2021年10月收治的452例疑似前列腺癌(PCa)的前列腺病变患者,均行MRI及DWI扫描。以病理结果为金标准,分析DCE-MRI联合T2WI及DWI对前列腺病变的诊断价值。结果 病理学检出良性327例,恶性125例。DCE-MRI联合T2WI及DWI检查检出良性300例,恶性152例,对PCa的诊断灵敏度、特异度和准确度分别为92.80%(116/125)、88.99%(291/327)、90.04%(407/452)。前列腺增生主要为组织对称性均匀增大,中央带可见增生结节,病灶组织影像学轻薄,DWI表现为较均匀中等或稍高信号。PCa在T2WI序列上表现为高信号周围带中的低信号结节,病灶向外扩张时呈现不对称性增大趋势,周围脂肪间隙受侵;DWI表现为高信号,且明显高于周围正常组织。在DWI量化分析中,良性病灶和恶性病灶的平均表观扩散系数(ADC)值差异具有统计学意义(t=13.218,P<0.00...     

多种肿瘤标志物联合前列腺特异性抗原检测在前列腺癌诊断中的价值

目的：探讨多种肿瘤标志物联合前列腺特异性抗原检测在前列腺癌诊断中的临床价值。方法：选取我院2013年4月到2014年9月的400例血清标本。采用酶联免疫吸附测定法检测所有患者的血清前列腺特异性抗原水平,检测抗原家族成员1b、蛋白激酶A锚定蛋白4、α甲基酰基辅酶A消旋酶、滑膜肉瘤x断裂点基因2的水平。对各个肿瘤标志物在前列腺癌患者的血清特异性、敏感性、阳性表达率进行计算。随机选取抗原家族成员1b、蛋白激酶A锚定蛋白4、α甲基酰基辅酶A消旋酶、滑膜肉瘤x断裂点基因的阳性表达血清,采用蛋白质印迹方法验证。采用Luminex液相芯片法联合前列腺特异性抗原检测和抗原家族成员1b、蛋白激酶A锚定蛋白4、α甲基酰基辅酶A消旋酶、滑膜肉瘤x断裂点基因进行检测所有的血清标本。结果：400例测试者的血清前列腺特异性抗原检测水平：256例〈4μg/L,91例4~10μg/L,53例〉10μg/L。4种肿瘤标志物在150例前列腺癌患者血清中表达阳性,抗原家族成员1b为69例（46.0%）、滑膜肉瘤x断裂点基因2 52例（34.7%）、α甲基酰基辅酶A消旋酶41例（27.3%）、蛋白激酶A锚定蛋白4 65例（43.3%）。4种标志物联合前列腺特异性抗原检测的曲线下面积为0.878;单一前列腺特异性抗原检测的敏感性为61.0%、特异性分别为45.1%,联合检测的敏感性为81.0%、特异性分别为83.1%。结论：相对于较为单一的前列腺特异性抗原检测,抗原家族成员1b、蛋白激酶A锚定蛋白4、α甲基酰基辅酶A消旋酶、滑膜肉瘤x断裂点基因2联合前列腺特异性抗原检测,可以显著增强前列腺癌诊断的特异性和敏感性,联合检测的诊断价值非常高,具有临床价值意义,可以大力推广。     

血清学检测联合前列腺超声造影对老年患者前列腺癌的诊断价值分析

目的分析血清前列腺特异性抗原(PSA)检查联合超声造影诊断老年前列腺癌的价值。方法选取2016年4月至2018年12月湖北钟祥市中医院诊治的50例前列腺癌患者作为研究对象。将这50例患者设为前列腺癌组,另将50例非前列腺癌患者设为非前列腺癌组。所有患者均行超声造影检查和血清PSA检查。对比前列腺癌组与非前列腺癌组年龄、前列腺体积、超声造影参数(强度减半时间、绝对增强强度、峰值强度、基础强度、加速时间、达峰时间、显影时间);对比两组血清游离PSA(f-PSA)、血清总PSA(T-PSA)、游离前列腺特异抗原/前列腺特异抗原比值(f/T-PSA)、PSA密度(PSAD);分析不同病理类型患者血清PSA水平分布情况;经ROC曲线评估血清PSA、超声造影在该病中的诊断价值。结果①与非前列腺癌组相比,前列腺癌组强度减半时间、加速时间、达峰时间、显影时间均更短,且差异具有统计学意义(P<0.05)。②前列腺癌组患者T-PSA、PSAD组水平均较非前列腺癌组高,差异具有统计学意义(P<0.05)。③结节型和隐匿性血清PSA<4ng/mL率最高,弥散浸润伴结节型>100ng/mL最高,不同病理分型的前列腺癌患者血清PSA水平分布差异具有统计学意义(P<0.05)。④超声造影参数中仅达峰值时间、显影时间的ROC曲线下面积超过0.5。血清PSAD、T-PSA联合达峰值时间、显影时间诊断该病的ROC曲线下面积为0.924。结论血清PSAD、T-PSA联合超声造影能提高老年前列腺癌诊断价值,其中血清PSA能辅助疾病类型鉴别。     

常规磁共振成像与三维磁共振波谱对前列腺特异性抗原灰区患者鉴别诊断价值研究

目的:探讨常规磁共振成像(magnetic resonance imaging,MRI)联合三维磁共振波谱(magnetic resonance spectroscopy,MRS)成像对PSA灰区患者在前列腺癌与BPH的鉴别价值。方法:回顾性分析25例经病理证实的前列腺癌、20例前列腺增生PSA灰区患者进行MRI及MRS检查。MRS成像计算(cho+cre)/Cit的比值,比值大于0.99为前列腺癌的可疑波谱,将病灶的多体素取平均值,并与病理及其他磁共振方法进行对照。结果:MRI确诊率77.8%,MRS确诊率86.7%,MRI联合MRS确诊率95.6%。结论:MRI联合MRS用于临床诊断PSA范围在4~10ng/mL的患者,可以提高前列腺疾病的诊断率,但还需要前列腺活检以确定诊断。     

多参数磁共振对不同分型乳腺癌的诊断分析

目的 分析多参数磁共振成像(MRI)技术在不同分型乳腺癌中的诊断价值.方法 选取2016年12月至2018年12月新疆维吾尔自治区中医医院(新疆医科大学附属中医医院)收治的120例乳腺癌患者作为研究对象.所有患者均行多参数MRI检查,并通过病理分型分析,记录多参数MRI特征.结果 120例患者中,非浸润性肿瘤20例,导...     

尿流动力学检查参数及前列腺特异性抗原水平与老年良性前列腺增生患者发生急性尿潴留的相关性研究

目的 分析尿流动力学检查参数及前列腺特异性抗原(PSA)水平与老年良性前列腺增生(BPH)患者发生急性尿潴留(AUR)的相关性。方法 选取2021年1月至2023年1月北京市平谷区医院收治的100例BPH患者作为研究对象。根据患者是否出现AUR分为AUR组和非AUR组,每组50例。检测两组的膀胱顺应性、尿流率、膀胱初始尿意容量、最大逼尿肌压力、膀胱残余尿量、最大膀胱容量;检测两组血清总PSA(tPSA)和游离PSA(fPSA)水平。结果 AUR组尿流率、最大逼尿肌压力均显著低于非AUR组,差异具有统计学意义(P<0.05);AUR组膀胱初始尿意容量、最大膀胱容量、膀胱顺应性、膀胱残余尿量均显著高于非AUR组,差异具有统计学意义(P<0.05);AUR组血清tPSA及fPSA水平均显著高于非AUR组,差异具有统计学意义(P<0.05)。尿流率、最大逼尿肌压力与BPH患者发生AUR呈显著负相关关系(P<0.05);膀胱初始尿意容量、最大膀胱容量、膀胱顺应性、膀胱残余尿量、tPSA及fPSA与BPH患者发生AUR呈显著正相关关系(P<0.05);低尿流率、低最大...     

经直肠前列腺超声造影联合血清PSA诊断前列腺癌的价值研究

目的研究经直肠前列腺超声造影联合血清前列腺特异性抗原(PSA)诊断前列腺癌的价值,为临床诊治提供参考。方法回顾性分析大连大学附属中山医院2016年1月至2018年1月诊治的126例前列腺疾病患者的临床资料,所有患者治疗前均行直肠前列腺超声造影、血清PSA检查。将术后病理结果作为金标准,对比经直肠前列腺超声造影、PSA、超声联合PSA诊断的特异性、敏感性和准确性,经直肠前列腺超声造影、PSA、超声联合PSA病理诊断结果的Kappa一致性系数。结果经直肠前列腺超声造影、PSA、超声联合PSA与手术病理诊断的Kappa一致性系数分别为0.73、0.71和0.87,超声联合PSA诊断前列腺癌一致性最高。超声联合PSA诊断前列腺癌的特异度为88.2,准确度为84.9,灵敏度为78.1,均高于单独的经直肠前列腺超声造影和PSA。结论经直肠前列腺超声造影联合血清PSA诊断前列腺癌,其特异性、灵敏度和准确性均较高,且与病理学诊断一致性最好,值得临床借鉴。     

皮肤良恶性病变DNA原位定量AgNORs的图象分析

应用彩色病理图象分析仪对６１例皮肤良性恶性病变进行ＤＮＡ原位定量及ＡｇＮＯＲｓ的图象分析，结果表明，皮肤癌的ＤＮＡ倍体多呈出Ｃ５，〉Ｃ５，ＡｇＮＯＲｓ的图象分析示３种变量即ＧＮ（颗粒数目），ＧＡ（颗粒面积）ＧＶ（颗粒的变异系数）意义较大，在良恶性皮肤病中差异非常显著（Ｐ〈０．０１）。研究表明，ＤＮＡ原位定量与ＡｇＮＯＲｓ的图象分析对判断皮肤良恶性病变，皮肤癌的鉴别诊断及癌前病变的预测有重要意义。     

Mutations of the BRAF gene in benign and malignant melanocytic lesions

A single-point mutation in exon 15 of the BRAF gene has recently been reported in a high percentage in cultured melanoma cells and in 6 of 9 primary melanomas examined. To evaluate the impact of the T1796A BRAF mutation, we screened primary melanomas, various types of nevi and lesions where a melanoma developed in an underlying nevus. We could detect the mutation in 28 of 97 (29%) melanomas and in 39 of 187 (21%) nevi, including blue nevi (0/20) and Spitz nevi (0/69), which did not carry the mutation. In melanomas with an underlying nevus, either the mutation was present in both the laser-microdissected nevus cells and the laser-microdissected melanoma cells (3/14) or both lesions were negative for the BRAF mutation except one case. In conclusion, mutations in exon 15 of the BRAF gene are nonspecific for progression of a nevus to a melanoma. Other so far unknown cofactors seem to be of importance.     

HPV-DNA联合TCT对宫颈病变的诊断价值及效能分析

目的探讨人乳头状瘤病毒(HPV-DNA)、液基薄层细胞学检测(TCT)在宫颈病变患者中的诊断价值。方法选择2016年1月至2018年1月入院治疗的200例宫颈病变患者作为研究对象,所有患者均经过病理学活检最终得到确诊,病理学活检前对所有患者进行HPV-DNA、TCT检测,将HPV-DNA、TCT检测结果与病理学活检结果进行比较,分析HPV-DNA联合TCT检测敏感性、特异性及准确度;记录并统计宫颈病变患者HPV-DNA、TCT检测所需费用,分析HPV-DNA联合TCT检测对宫颈病变患者中的诊断价值。结果 200例患者均顺利完成TCT检查与HPV-DNA检查,TCT检查下SCC组织及正常组织占据比例最大,分别为75.50%和10.0%;而HPV-DNA检测阳性患者为40例,占26.49%;与TCT检查结果比较HPV检查具有较高的符合率,差异无统计学意义(P0.05);HPV-DNA检查与TCT检查结果与病理学检查CINII、SCC比较差异无统计学意义(P0.05);HPV-DNA联合TCT检查CINI、CINII与CINIII检查与病理组织学诊断符合率,均高于单一HPV-DNA检查和TCT检查,差异具有统计学意义(P0.05);HPV-DNA和TCT检查在宫颈疾病中的诊断敏感性、特异性比较差异无统计学意义(P0.05);HPV-DNA联合TCT检查在宫颈疾病中诊断敏感性、特异性,均高于单一HPV-DNA检查和TCT检查,差异具有统计学意义(P0.05)。结论将HPV-DNA联合TCT检测用于宫颈病变中具有较高的诊断价值,能获得良好的诊断效能,值得推广应用。     

Langerhans cells in various benign and malignant pigment-cell lesions of the skin

Summary We used immunohistochemistry to study Langerhans cells (LCs) and the composition of the dermal inflammatory infiltrate both in normal skin and in biopsies from various benign and malignant pigment-cell lesions. In normal skin and most benign pigment-cell lesions, epidermal LCs are regularly distributed. OKT₆-Positive cells outnumber the OKIa-positive cells. The inconspicuous dermal infiltrate studied in these biopsies was composed of helper and suppressor/cytotoxic T cells and some dermal LCs. More epidermal LCs with an abnormal cytologic presentation were found in a halo naevus and in the radial growth part of primary malignant melanomas. This finding was associated with a dermal infiltrate composed of suppressor/cytotoxic T cells, suggesting a defense mechanism of the host towards abnormal melanocytes. Epidermal LCs were rare in the central part of the biopsies which showed a primary malignant melanoma in its vertical growth. A dermal inflammatory infiltrate was absent in that area. These findings are interpreted as the morphologic expression of a damaged immune system.F. Facchetti is on leave from Istituto di Anatomia Patologica, Spedali Civili di Brescia, Brescia, Italy     

p53在2例良性皮肤病恶变过程中的表达及临床意义探讨

以ＤＯ－１鼠单克隆抗体进行免疫组化染色，检测２例患者从良性病变发展为恶性肿瘤过程中不同皮损的ｐ５３表达。结果良性损害为ｐ５３阴性，继发癌前期损害和恶性肿瘤则ｐ５３表达阳性，提示ｐ５３突变可能参与了表皮恶性肿瘤的发生和演变。     

Confocal scanning laser microscopy of benign and malignant melanocytic skin lesions in vivo

BACKGROUND: The ability of physicians for early diagnosis of cutaneous melanomas is less than perfect, prompting research into noninvasive methods for diagnosis. OBJECTIVE: Our purpose was to evaluate confocal scanning laser microscopy (CSLM) for noninvasive imaging of benign and malignant melanocytic lesions in vivo. METHODS: Forty pigmented skin lesions (including adjacent normal skin as control) in vivo were imaged with near-infrared CSLM. The confocal images were correlated to histopathology. RESULTS: Nuclear, cellular, and architectural detail in the epidermis and superficial dermis is imaged with high resolution and contrast. Melanin causes the cytoplasm of pigmented cells to appear bright. Melanocytic nevi had cohesive nests of uniformly circular cells and increased microvascular blood flow. Melanomas had a polymorphous cytologic structure, containing atypical, pleomorphic cells in disarray and irregular dendritic cells. CONCLUSION: CSLM is capable of identifying distinct patterns and cytologic features of benign and malignant pigmented skin lesions in vivo. CSLM may be useful to noninvasively discriminate benign and malignant lesions in vivo.     

Stereological estimation of nuclear volume in benign melanocytic lesions and cutaneous malignant melanomas

Recent developments in stereology have made it possible to obtain unbiased, objective estimates of the volume weighted mean nuclear volume (vV) from ordinary histological sections, without any assumptions concerning nuclear shape. The aim of this study was to gather baseline data of nuclear vV in melanocytic cutaneous tumors and to compare these with estimates of nuclear volume fraction and with traditional two-dimensional morphometric estimates of nuclear profile area, nuclear density, and mitotic index. Routinely processed, paraffin embedded tissue specimens from 47 malignant melanomas and 76 noninvasive melanocytic cutaneous tumors were investigated retrospectively. vV clearly distinguished between noninvasive (average vV = 122 microns 3) and invasive lesions (average vV = 246 microns 3). Most of the patients with malignant melanomas showing an overlap of nuclear vV with benign lesions had a favorable prognosis. No significant differences in vV could be demonstrated among different noninvasive tumor types. Two-dimensional estimates only distinguished benign from malignant tumors with considerable overlap and with significantly varying influence from other factors among different benign lesional types. The variance associated with estimates of vV disclosed a linear relationship to vV, whereas the relative variation seemed to be constant. Tumor heterogeneity was without significant influence on estimates of nuclear vV. It is concluded that nuclear vV is a superior, efficient, and sensitive estimator for distinguishing between melanocytic cutaneous tumors showing different biological behavior, well-suited for objective malignancy grading.