24例胸内恶性间皮瘤病理诊断分析

胸内间皮瘤来源于胸膜,心包膜间皮细胞较少见。恶性多于良性。本文收集我院１９８３～１９９７年经Ｘ线检查、手术、病理活检证实的胸内恶性间皮瘤２４例（其中胸膜间皮瘤２０例,心包间皮瘤４例）作临床病理分析。１临床资料１·１病历来源本组男１７例,女７例。年龄１...     

腹膜间皮肉瘤误诊一例报告

患者，男，24岁。因腹痛伴发热1月于2002年7月入院。开始为持续性脐周部隐痛伴低热，口服抗菌药物治疗10d无好转，腹痛加重，出现高热，行B超检查：中腹部见团块状中等回声，大小6．5cm×6．6cm×4．8cm，边界欠清晰，内回声不均，有小的低回声区，提示腹部炎性肿块，在当地医院静滴抗菌药物治疗半月，无效，且肿块生长快。患者1月前有“急性阑尾炎”手术史。     

18例恶性胸膜间皮瘤的CT诊断与鉴别诊断

恶性胸膜间皮瘤（MPM）是一种少见的恶性度高、生存期短和死亡率高的胸膜原发肿瘤,大多数患者在出现症状后2年内死亡。患者的早期临床表现和影像学表现均无特异性,易误诊为胸部其他疾病。笔者收集本院18例临床和影像资料完整的MPM患者资料,对其首次就诊CT表现进行回顾性分析,以期提高对该疾病的首诊准确率。     

3例恶性腹膜间皮瘤的临床诊断和治疗

报道3例恶性腹膜间皮瘤的发病史、临床症状、确诊过程以及治疗效果。 更多还原     

子宫特殊类型平滑肌瘤病理诊断价值分析

目的:探讨子宫特殊类型平滑肌瘤患者的临床病理特点以及对其进行病理诊断的应用价值。方法:选取我院2009年12月—2011年12月子宫特殊类型平滑肌瘤患者82例作为A1组,选择我院2011年12月-2013年12月患有同种疾病患者82例作为A2组。对患者进行为期1年-5年的随访,对比A1组、A2组患者的年龄、对患者选择的手术方法、患者肌瘤在再次复发的概率以及肌瘤恶变的具体情况,对两组患者子宫特殊类型也进行详细比较。结果:对比两组患者的年龄、对患者进行手术的方法、患者肌瘤再次复发的概率没有表现出明显差异(P>0.05)。并且在A1组与A2组患者中,都没有出现肌瘤恶变的患者。结论:子宫特殊类型平滑肌瘤属于一种良性疾病,对于没有确定是否会转变为恶性的肌瘤,在对其实施病理诊断的过程中应该谨慎认真。     

谈谈对胸膜间皮瘤的诊断及临床分析

目的深入探讨对胸膜间皮瘤的诊断及临床分析。方法回顾性分析13例经临床确诊的胸膜间皮瘤病变的超声表现及X线表现。从病变的分布、形态及胸膜积液的特点进行分析。结果对本组13例胸膜间皮瘤患者都做出了正确诊断。结论临床与超声、X线结合诊断胸膜间皮瘤,具有较高的临床诊断价值和实践指导意义,具有诊断率高,误诊少,结果准确的优势。     

CD20在胸腺瘤病理诊断及分型中的作用

胸腺瘤是一种复杂的肿瘤,它位于胸腺上皮细胞的内壁,属于严重的恶性肿瘤,它的病理分型和临床分期也在临床应用上有很大的争议。本综述介绍CD20对胸腺瘤病理诊断及其分型,为今后CD20在胸腺瘤中的应用提供依据。     

原发性胃恶性淋巴瘤的内镜诊断与临床分析

目的对原发性胃恶性淋巴瘤的临床特点、内镜下特征进行了回顾性分析,以提高对该病的认识,提高胃镜诊断率。方法选取我院2002～2005年5年间手术后病理证实的30例原发性恶性胃淋巴瘤患者分析其一般资料,临床表现,内镜特征及病理。结果原发性胃恶性淋巴瘤发病无人群特定性,但中老年人比例较高。70%以上患者表现有上腹痛。胃镜缺乏特异性表现,常呈多形性、弥漫性、范围广的特征,镜下难于同其他胃恶性肿瘤鉴别。全部病理结果均为B细胞非霍奇金淋巴瘤。结论原发性胃恶性淋巴瘤以胃肠道症状为主,是临床少见的胃恶性肿瘤,病理类型主要为B细胞非霍奇金淋巴瘤,术前误诊率高。为提高诊断率,对胃镜下隆起性病变尤其是肿块表面伴糜烂溃疡时应高度怀疑,注意病理取材方法及质量,预后一般优于胃其他肿瘤。     

对尘肺病理诊断标准的修订建议

我国卫生部和国家劳动保护总局于１９７８年５月２１日批准颁布了适用于矽肺病理诊断的《矽（尘）肺病理诊断分期标准（试行方案）》［（７８）卫护字第５７１号、（７８）劳护字第１７号］，１９８０年的修订稿增加了混合尘结节（即不典型矽结节）的计数方法。１９８８年...     

螺旋CT在弥漫性恶性腹膜间皮瘤鉴别诊断中的应用及影像特征

目的 分析螺旋CT在弥漫性恶性腹膜间皮瘤鉴别诊断中的应用价值及影像特征。方法 选取2018年1月至2022年1月于福建省泉州市第一医院就诊的45例疑似弥漫性恶性腹膜间皮瘤患者为研究对象,所有患者均接受腹部螺旋CT检查,以手术病理结果为金标准,分析螺旋CT诊断弥漫性恶性腹膜间皮瘤的效能,并总结其CT影像特征。结果 经手术病理结果证实,45例疑似弥漫性恶性腹膜间皮瘤患者中明确诊断39例;以手术病理结果为金标准,螺旋CT诊断弥漫性恶性腹膜间皮瘤的灵敏度为94.87%,特异度为83.33%,准确度为93.33%。弥漫性恶性腹膜间皮瘤的CT影像特征显示,病灶主要分布于腹膜、大网膜以及肠系膜,多表现为大结节或团块状增厚,边缘多不规则,侵犯腹腔脏器风险以及淋巴结肿大率较低,淋巴结无环形强化表现,腹腔内可见不同程度的积液征象。结论 螺旋CT诊断弥漫性恶性腹膜间皮瘤的效能较高,临床可根据病灶形态学特点、边缘表现等特征实现对弥漫性恶性腹膜间皮瘤的鉴别诊断。     

Accuracy of death certification of pleural mesothelioma in Italy

In order to provide estimates of the accuracy of death certification of malignant pleural mesothelioma in Italy, the causes of death of a series of ascertained cases were investigated. The study included 523 cases of pleural mesothelioma diagnosed in 1984–1988 by 88 hospital departments and clinics. Vital status at 7 May 1990 was ascertained for 92.7% of subjects. The overall concordance between pathological diagnosis and death certification was about 75%.     

Pathology of mesothelioma

The incidence of mesothelioma has been gradually increasing in Japan, and the underlying factor for this is considered to be the increase in the amount of asbestos imported into Japan between 1960 and 1975. Mesothelioma can be roughly divided into localized and diffuse types, but the former is extremely rare. In making a diagnosis of mesothelioma, it is important to confirm the location of tumor and the specific gross findings before histological examination. Mesothelioma can be categorized histologically as epithelioid type, sarcomatoid type, biphasic type, desmoplastic type, among others. It can take many forms; consequently, there are many diseases to be differentiated when the diagnosis of mesothelioma is based on histological analyses. Immunohistochemical stains are useful for making a diagnosis, but the correct combination of antibodies as positive or negative markers should be selected and a comprehensive assessment of the staining results is necessary. The accuracy of the pathological diagnosis is very important to the patients because they can be receive official compensation or relief when the diagnosis of mesothelioma is confirmed. Under present conditions, both clinicians and pathologists must make a concerted effort to improve the accuracy of the diagnosis of mesothelioma.     

影响淋巴瘤病理诊断的临床因素分析

目的 基于临床角度研究影响淋巴瘤病理诊断与临床诊断不一致的因素及其对治疗的影响。方法 收集我科2012年1月1日~2014年12月31日232例临床或病理诊断淋巴瘤患者的临床资料,研究淋巴瘤病理诊断与临床诊断不一致的原因及对治疗的影响。结果 结内淋巴瘤和弥漫大B细胞淋巴瘤病理诊断的可靠性分别高于结外淋巴瘤和非弥漫大B细胞淋巴瘤。不同取材方式对病理诊断可靠性也有影响,切除活检的肯定性病理报告率最高为73.7%。病理诊断与临床诊断不一致14例（6.0%）,3例对治疗产生中度影响,剩余11例产生轻微影响。诊断差异主要与病变部位、取材方式及淋巴瘤病理类型有关。结论 淋巴瘤病理诊断与临床诊断不一致主要是淋巴瘤本身病理诊断即十分困难,此外病灶位置与取材方式也会影响病理诊断的可靠性,临床医生应与病理专家充分沟通,争取更准确的诊断。     

经支气管肺活检在尘肺病诊断中的应用

目的 探讨经支气管肺活检在尘肺诊断中的价值.方法 以2003年1月至2010年6月在上海市肺科医院就诊、X线胸片有尘肺样改变、提供的接尘性质或累计剂量与X线胸片表现不相符或缺乏系列X线胸片、要求明确诊断并接受支气管肺活检(TBLB),取得满意标本的尘肺诊断病例379例为研究对象.进行TBLB检查和肺组织病理观察.2005年5月起对TBLB标本增加普鲁士蓝铁反应检查.根据GBZ 70-2002及GBZ 70-2009《尘肺病诊断标准》,参考病例自述和TBLB病理检查进行集体诊断.结果 在379例病例中,376例(99.2％)表现肺间质纤维化改变,228例(60.2％)粉尘沉着;111例(29.3％)的偏光镜检双折光晶粒阳性.接触矽尘、陶土尘、水泥尘、煤矽尘和铸造尘病例的偏光晶粒阳性率为37.8％(62/164),高于接触其他粉尘(电焊烟尘、石棉尘、铝尘等)者的22.7％(49/215),差异有统计学意义(P＜0.05).接触电焊烟尘或打磨尘者普鲁士蓝铁反应阳性率为53.1％(94/177),明显高于接触其他粉尘(水泥尘、铸造尘、矽尘等)者的23.2％(13/56),差异有统计学意义(P＜0.01).接触电焊烟尘尘肺组病例纤维组织增生率高于无尘肺组,差异有统计学意义(P＜0.05).接触矽尘、铸造尘、打磨尘、石棉尘的尘肺组和无尘肺组(观察对象)的肺纤维组织增生率、粉尘沉积率和偏光晶粒阳性率的差异均无统计学意义(P＞0.05).结论 经支气管肺活检能获得接触粉尘的依据和相关肺部病变,对协助尘肺病诊断具有积极意义.     

Immunological alterations found in mesothelioma patients and supporting experimental evidence

It is common knowledge that exposure to asbestos causes asbestos-related diseases, such as asbestosis, lung cancer and malignant mesothelioma, not only in people who have had long-term contact with asbestos in their work environment but also in residents living near factories that handle asbestos. Since the summer of 2005, these revelations turned into a large medical problem and caused and social unrest. We have focused on the immunological effects of both asbestos and silica on the human immune system. In this brief review, we introduce immunological alterations found in patients with malignant mesothelioma and describe the experimental background in which these were found. Analyzing the immunological effects of asbestos may improve our understanding of the biological effects of asbestos.     

Variations in mesothelioma mortality rates among migrants to Australia and Australian-born

Background: Australia’s use and consumption of asbestos occurred at the same time as its immigration boom. Our objective was to investigate mesothelioma death rates among migrants and Australian-born between 1981 and 2012.

Methods: Australian national mesothelioma deaths from 1981 to 2002 and 2006 to 2012 together with national censuses from 1981 to 2011 were extracted and combined. Directly standardised rates and negative binomial regression were applied examining differences in mesothelioma death rates with regard to country of birth.

Results: Migrants from the UK and Ireland, Italy and Germany had significantly higher mesothelioma death rates than Australian-born; lower rates were observed among migrants from other countries.

Conclusions: Our findings suggest there may have been differences in occupational health and safety between foreign and Australian-born. Because of changes in the demographics of migrants to Australia since the 1970s and changes in occupational circumstances over time, further comparisons of occupational-related health outcomes between foreign and Australian-born could identify potential occupational inequalities that may still exist today.     

肝纤维化诊断研究进展

目前,肝组织活检是肝纤维化诊断的“金标准”,但其临床应用尚难以广泛开展。此文对肝组织学活检、血清学指标、影像学指标及多参数模型诊断肝纤维化的相关研究进展进行综述。     

Prediction of mesothelioma and lung cancer in a cohort of asbestos exposed workers

BACKGROUND: Several papers have reported state-wide projections of mesothelioma deaths, but few have computed these predictions in selected exposed groups. OBJECTIVE: To predict the future deaths attributable to asbestos in a cohort of railway rolling stock workers. METHODS: The future mortality of the 1,146 living workers has been computed in term of individual probability of dying for three different risks: baseline mortality, lung cancer excess, mesothelioma mortality. Lung cancer mortality attributable to asbestos was calculated assuming the excess risk as stable or with a decrease after a period of time since first exposure. Mesothelioma mortality was based on cumulative exposure and time since first exposure, with the inclusion of a term for clearance of asbestos fibres from the lung. RESULTS: The most likely range of the number of deaths attributable to asbestos in the period 2005-2050 was 15-30 for excess of lung cancer, and 23-35 for mesothelioma. CONCLUSION: This study provides predictions of asbestos-related mortality even in a selected cohort of exposed subjects, using previous knowledge about exposure-response relationship. The inclusion of individual information in the projection model helps reduce misclassification and improves the results. The method could be extended in other selected cohorts.     

Diagnostic tumor marker of asbestos-related mesothelioma

Mesothelioma is an aggressive tumor arising from the mesothelium, and is usually associated with previous exposure to asbestos. The incubation period of the tumor may be described as 30–40 years, and the prognosis is dismal. We previously discovered the Erc (Expressed in renal carcinoma) gene in the Eker rat model (Tsc2 gene mutant) and it was a homolog of the human mesothelin/MPF gene. We developed a novel ELISA system (N-ERC/mesothelin). Recently, we found that N-ERC/mesothelin was a potentially useful diagnostic marker for asbestos-related mesothelioma.     

Predictors of filing claims and receiving compensation in malignant mesothelioma patients

Although the predominant occupation origin of mesothelioma is well known, determinant factors involved in filing compensation are scarcely investigated. A linkage between incident mesothelioma cases collected by Italian mesothelioma register (ReNaM) and compensation claims and assignment by Italian national insurance Institute (INAIL) has been conducted for cases diagnosed in the period 2010–2015 and occupational exposure to asbestos. Logistic regression models and decision tree models have been used to identify demographic, diagnostic and anamnestic factors significant for filing and receiving compensation. We have included in the analyses 5019 mesothelioma cases, and among them, 3321 (66.2 %) were found in INAIL archives as mesothelioma cases who fil claims for compensation. The modalities of asbestos exposure, sector of working activities and job type are crucial factors. Furthermore, gender, age at diagnosis, area of residence have been found to be significant predictors of probability to fil claims. Relative risks to fil claims were obtained for the above determinants and conditions to maximize the probability to obtain compensation identified. Our findings demonstrate that there is a need to enforce policies for improving awareness of the occupational origin for mesothelioma cases. Stakeholders, occupational health and safety institutions can play an important role for improving the sensitization regarding the rights of compensation benefits, ensuring the equity and the effectiveness of insurance, welfare and public health systems.