TCT联合阴道镜在宫颈疾病中的诊断价值

目的 探讨液基薄层细胞检测系统（TCT）联合阴道镜及阴道镜下宫颈活检在宫颈疾病中的诊断价值。方法 回顾性分析2006年1月至2007年12月来我院门诊主诉白带增多、性交出血及妇检宫颈糜烂的756例患者行TCT筛查，其中125例阳性患者进行阴道镜下宫颈活检情况。结果 TCT异常率为16．53％，TCT检查CINI及以上病例诊断与病理活检诊断符合率为83．10％、灵敏度为86．44％（51459）、特异性为88．10％（74／84）、阳性预测值83．61％（51／61）、阴性预测值90．24％（74／82）；阴道镜检查CINI及以上病例诊断与病理活检诊断符合率为71．43％、灵敏度为95．45％（63／66）、特异性为86．05％（74／86）、阳性预测值84．00％（63／75）、阴性预测值96．10％（74／77）；TCT检查2例宫颈癌，而阴道镜和病理活检均诊断3例宫颈癌，提示阴道镜检查宫颈癌的诊断价值高于TCT。结论 TCT细胞涂片联合阴道镜下活检病理组织学检查可明显提高CIN的阳性检出率，是发现宫颈疾病安全、方便、准确、可靠的检查方法，适合作为CIN的筛查方法。     

367例甲状腺疾病临床病理诊断分析

目的：总结甲状腺腺瘤和单结节性甲状腺肿的鉴别诊断,细针穿刺诊断在甲状腺疾病中的应用经验和价值,旨在提高甲状腺疾病的诊断和鉴别诊断水平。方法：对367例甲状腺病变进行病理形态学为主的复验和结果分析。结果：甲状腺疾病中女性患者占82．6％;各类疾病中甲状腺腺瘤占首位（50．1％）;术中冷冻切片对甲状腺良恶性疾病诊断（定性）的符合率为100％,具体类型诊断（定类）符合率为88．2％;细针穿刺诊断准确率为77．8％。结论：应重视甲状腺腺瘤与单结节性甲状腺肿的鉴别诊断;甲状腺疾病,尤其是甲状腺恶性疾病的细针穿刺诊断准确率低,无法取代传统的冷冻切片诊断。     

29例胃肠道类癌内镜分析

目的探讨胃肠道类癌的内镜诊断及临床特征。方法回顾分析我院1995年1月至2005年12月收治的胃肠道类癌29例的内镜表现、活检病理及部分临床资料。结果29例患者术前各部位胃肠道类癌内镜及活检病理确诊情况：胃底贲门癌2／3例（66．7％）；十二指肠类癌1／2例（50％）；直肠类癌4／7例（57．1％）；回盲部阑尾类癌6／8例（75．0％）；结肠类癌5／8例（占62．5％）；末段回肠类癌0／1例。误诊率37．9％。较早期类癌内镜下表现为表面光滑质地硬隆起型粘膜下层肿物，灰白色或黄色，部分病例内镜下可呈毛玻璃样外观，亚蒂或广基，大部分类癌内镜下与腺癌差别不大，难以区分，术前内镜活检病理诊断率65．5％．结论胃肠道类癌内镜表现特征不明显，活检病理取材准确性不高，结合免疫组化可能提高诊断准确率。     

江门市新会区人群甲状腺功能状况调查

目的探讨新会地区人群的甲状腺功能状况与甲状腺疾病发病情况。方法采用地方性抽样调查与实验室检测分析相结合，于2005年4月至2006年9月抽取新会区会城镇、崖门镇、罗坑镇和杜阮镇的居民以及新会区中医院的体检者和就诊病人，共12036人，进行其甲状腺功能状况调查，以甲状腺功能检测异常值结合临床诊断来判断甲状腺疾病的发病率及与性别、年龄等的关系。结果各项指标异常总检出率为：4镇居民（A组）的T3和T4均为8．5％，FT3和FT4均为7．6％、TSH为21．5％，就诊体检者（B组）的T3为19．0％，T4为18．4％，FT3为16．8％，FT4为16．0％，TSH为30．8％。4个镇的发病率依次是：崖门镇（26．5％），罗坑镇（21．6％）．会城镇（19．6％），杜阮镇（13．6％），4镇居民总发病率（21．5％）低于就诊体检者（29．8％）：4镇居民和就诊体检者均以31-40岁发病率最高；两组总发病例数男782例，女2199例，总发病率男女比为1：2．8，其中甲亢男女比约为1：4。结论新会地区人群的甲状腺功能异常者较多，甲状腺疾病发病率比较高，究其原因可能与高碘饮食等有一定关系。     

TPO-Ab在甲状腺自身免疫性疾病中的应用

目的：探讨甲状腺过氧化物酶抗体（TPO-Ab）在甲状腺功能亢进（甲亢）、甲状腺功能减退（甲减）、单纯性甲状腺肿大患者的临床价值。方法：采用放射免疫分析检测甲状腺疾病患者血清TGA、TMA、TPO-Ab浓度及血清FL、FT4、TSH水平,分析TPO-Ab在69例甲亢、53例甲减及45例单纯性甲状腺肿的阳性率。结果：TPO-Ab的阳性率（82％-92．5％）明显高于同组的TGA（44．2％）、TMA（69．8％）,甲减组TPO-Ab的阳性值（平均57．4％）明显高于甲亢组（31．2％）和单纯甲状腺肿组（17．6％）,差异有显著意义（P〈0．01）。结诊!TPO-Ab对自身角癌件甲状腺疾病的诊断、治疗和预后评估具右一定的临床价值．     

超声引导下经皮肺自动穿刺活检的临床应用

目的通过超声引导下经皮肺自动穿刺活检对肺及胸膜肿块作出病理诊断,为早期诊断肺及胸膜肿块提供可靠依据方法对３０例经Ｘ线及ＣＴ诊断为肺部外周型肿块或怀疑结核或炎症但临床高度怀疑癌变或胸膜病变,需进一步明确诊断者,在超块引导下经皮用自动穿刺活检针进行穿刺活检及病理检查．结果全部获得病理学诊断．其中良性病变１１例（占３６７％）,恶性病变１９例（占６３．３％）结论对于胸膜病变及贴近胸壁的肺占位病变,经皮肺自动穿刺活检是一种良好方法．     

210例针刺胸膜活检分析

目的研究针刺胸膜活检在胸腔积液病因诊断中的价值和安全性。方法对2000年12月至2007年12月间诊断明确且做过1次以上胸膜活检的210例胸腔积液患者的临床资料进行回顾分析。结果210例胸腔积液中结核性胸膜炎102例，恶性胸膜炎60例，两者胸膜活检的阳性率分别为66．7％（68／102）和69．7％（60／86）。术后并发症主要为：气胸34．9％（105／301）、出血11．6％（35／301）、术后发热12-3％（37／301）、胸膜反应7．3％（22／301）、肿瘤细胞针道种植1．0％（3／301），未出现致命并发症。结论在结核性及恶性胸腔积液的诊断中，针刺胸膜活检是一种有效而又安全的手段，多次活检可提高确诊率。     

CT引导下经皮肺穿刺活检并发症的观察与护理

目的 探讨CT引导下经皮肺穿刺活检并发症的观察与护理方法。方法 收集56例肺占位性疾病患者，CT扫描确定最佳的穿刺点、进针角度和深度，局部麻醉后CT引导下组织切割针经皮刺入到病灶，切割组织行病理检查。如取材不满意可多次活检，术毕再次CT扫描。结果 56例肺占位病变行CT引导下经皮肺穿刺活检，53例得到确诊，阳性率为94．6％。并发症包括少量气胸11例（19．6％），肺出血9例（16．1％），少量咯血5例（8．9％），均不需特殊处理。结论 CT引导下经皮肺穿刺活检对肺占位病变的诊断阳性率高、并发症轻，值得临床推广。严密观察及精心护理是防治并发症的重要措施之一。     

外科病理诊断中的错误

以往有文献报道，根据对所有病例进行的前瞻性研究或对部分病例随机抽样调查结果，外科病理诊断中有明显临床意义的诊断错误率为0．26％～1．2％。然而对5000例连续活检标本进行“盲法”复习显示明显的临床诊断错误率仅为0．08％。因此，事实上外科病理诊断错误率相对较低。如果考虑到病理医生采用的诊断标准比较模糊，带有较大的循证性和经验性（基于权威和主观性），     

Bcl-2和ER在甲状腺乳头状癌中的表达及意义

目的：探讨细胞凋亡相关基因bcl-2和雌激素受体（ER）在甲状腺乳头状癌中的表达及意义。方法：用免疫组织化学sP法研究不同甲状腺组织中ER和bcl-2的表达，其中甲状腺乳头状癌50例、甲状腺良性腺瘤30例、腺瘤旁正常组织16例。结果：甲状腺乳头状癌组织中ER和bcl-2蛋白阳性率分别为54．0％（27／50）、66．0％（33／50），甲状腺良性腺瘤中ER和bcl-2蛋白阳性率分别为26．7％（8／30）、36．7％（11／30），正常甲状腺组织中ER阳性率为12．5％（2／16）、而bcl-2则不表达。甲状腺乳头状癌中ER的表达明显高于甲状腺良性腺瘤和正常甲状腺组织（P〈0．05），bcl-2的表达明显高于甲状腺良性腺瘤（P〈0．05）；且甲状腺乳头状癌中bcl-2和ER表达存在正相关关系（P〈0．05）。结论：雌激素在甲状腺乳头状癌的发生、发展中有促进细胞增殖的作用；对ER和bcl-2的联合检测在甲状腺乳头状癌的诊断及内分泌治疗有一定的临床意义。     

Molecular pathology of thyroid tumours of follicular cells: a review of genetic alterations and their clinicopathological relevance

Thyroid cancer is the most common endocrine malignancy. Knowledge of the molecular pathology of thyroid tumours originating from follicular cells has greatly advanced in the past several years. Common molecular alterations, such as BRAF p.V600E, RAS point mutations, and fusion oncogenes (RET–PTC being the prototypical example), have been, respectively, associated with conventional papillary carcinoma, follicular‐patterned tumours (follicular adenoma, follicular carcinoma, and the follicular variant of papillary carcinoma/non‐invasive follicular thyroid neoplasm with papillary‐like nuclear features), and with papillary carcinomas from young patients and arising after exposure to ionising radiation, respectively. The remarkable correlation between genotype and phenotype shows how specific, mutually exclusive molecular changes can promote tumour development and initiate a multistep tumorigenic process that is characterised by aberrant activation of mitogen‐activated protein kinase and phosphoinositide 3‐kinase–PTEN–AKT signalling. Molecular alterations are becoming useful biomarkers for diagnosis and risk stratification, and as potential treatment targets for aggressive forms of thyroid carcinoma. What follows is a review of the principal genetic alterations of thyroid tumours originating from follicular cells and of their clinicopathological relevance.     

Occult thyroid carcinoma: a rare case report and review of literature

Occult thyroid carcinoma is very common in the clinic and is generally divided into four groups. Here, we proposed two types of occult thyroid carcinoma as the fifth group. The first type was locoregional lymph node metastases from thyroid carcinoma, and the second type was distant organ metastases from thyroid carcinoma. The unique aspect of the fifth group was that the primary carcinoma of the fifth group was not finally found by pathological examination. To better understand the fifth group, we reported a typical case. Furthermore, we discussed the diagnostic criteria and procedures and the management of the fifth group of occult thyroid carcinoma.     

Thyroid neoplasms of follicular cell derivation: A simplified approach

Thyroid tumors of follicular cell derivation are increasing in incidence. These lesions exhibit a spectrum of morphologic and behavioral features that provide the opportunity to understand malignant transformation and progression. Molecular data suggest that the thyroid undergoes a series of genetic alterations that account for the development of the various types of thyroid carcinoma. Our understanding of these tumors has progressed dramatically over the past 50 years and the classification has become complex and cumbersome. We provide a practical approach to clinical diagnosis and propose a simplified classification of these common neoplasms.     

Follicular variant of papillary carcinoma: cytologic findings on FNAB samples-experience with 16 cases

Between January 1, 1992 and December 31, 1997, a cytopathological diagnosis of follicular variant of papillary thyroid carcinoma (FVPC) was made on a series of 16 out of 18 patients with palpable nodules who underwent fine-needle aspiration biopsy (FNAB) in our Department. The results of aspiration biopsy were followed by histopathological examination of the surgically excised tissues. There were three false-negative aspirations (16.6%), of which two were probably bound to fine-needle sampling and one due to a mixture of benign and malignant cells which had originally gone unrecognized. The accuracy of the cytopathologic diagnosis in this variant was 88.8%. An analysis of the diagnostic cytopathological criteria was performed, which demonstrated the importance of both architectural features (monolayered and branching sheets, microacinar structures, and their combinations) and nuclear features (presence of nuclear grooves). Background -bound features were mainly represented by dense, nonfilamentous colloid. The cytopathologic findings in FVPC were compared to those found in a series of 10 usual papillary carcinomas (UPC) and 10 follicular neoplasms (FN). These latter had originally been diagnosed by FNAB and were subsequently classified histologically as follicular adenoma (n = 6), follicular carcinoma (n = 3), or adenomatoid colloid nodule (n = 1). Statistical evaluation was performed on the cytopathological findings in the three classes of lesions (FVPC, UPC, and FN) as to their presence and relative frequency or absence by using a nonparametric one-way ANOVA (Kruskall-Wallis) and, where necessary, a Mann-Whitney U test. Papillary cellular fragments and multinucleated giant cells (P < 0.005), nonfilamentous dense colloid, squamoid cells, and syncytia were significantly more represented in UPC than in FVPC (P < 0.05), while histiocytes were significantly more frequent in FVPC (P < 0.005). Other nuclear and/or background features were significant only in the distinction between papillary carcinomas as a group and FN. The cytological differential diagnosis of the FVPC is briefly discussed with relevance to the possible pitfalls caused by its peculiar cyto- and histomorphology.     

Subisthmic accessory thyroid gland in man: A case report and a review of thyroid anomalies

Morphological variations of the thyroid gland are common and generally occur superior to the gland, reflecting its developmental origin. In this report we describe an accessory lobe located inferior to both lateral lobes and the isthmus. The accessory lobe was supplied by a branch of the right inferior thyroid artery and its vein drained via the plexus thyroideus impar. A discussion of thyroid anomalies is presented and a system for classifying variations of thyroid anatomy is proposed. Clin. Anat. 10:341–344, 1997. © 1997 Wiley-Liss, Inc.     

Pitfalls in thyroid tumour pathology

This review provides an itemized listing of major diagnostic pitfalls in the field of thyroid tumour pathology, emphasizing the features that the authors have found most useful in their recognition and avoidance.