声带息肉的组织病理学

对150例声带息肉手术摘除标本进行组织病理学检查,结果显示息肉上皮下组织可见水肿、血管扩张、玻璃样变、纤维增生、灶性出血、含铁血黄素沉着等多种改变.炎症细胞浸润十分常见.结合文献复习,对本病的病理分型进行讨论.     

Vocal cord inflammatory myofibroblastic tumor with mucoid deposits harboring TIMP3–ALK fusion: A potential diagnostic pitfall

A 35‐year‐old Japanese man who had experienced hoarseness for 10 years presented with a vocal cord lesion. A gross examination revealed a left vocal cord polyp occupying two‐thirds of the vocal space. The endoscopically resected lesion contained scattered atypical fibroblastic, stellate, or ganglion‐like cells with mucoid stroma. Vacuolated cells were also seen. Lymphoplasmacytic infiltrate was largely undetectable. A vocal cord polyp was first suspected, but well‐differentiated liposarcoma and inflammatory myofibroblastic tumor (IMT) were included in the differential diagnoses. The tumor cells were positive for anaplastic lymphoma kinase (ALK), calponin, and vimentin, and negative for other smooth muscle markers by immunohistochemistry. Structures resembling myofibroblasts were not observed by electron microscopy, which confirmed abundant rough endoplasmic reticulum in the tumor cells and accumulated lipid droplets in some tumor cells. ALK gene rearrangement was detected by fluorescence in situ hybridization, and TIMP3–ALK fusion was confirmed by 5′ rapid ampli?cation of cDNA ends. We diagnosed the lesion as an IMT, and an ALK‐rearranged stellate cell tumor may be postulated. This is the first report of a fusion partner gene of ALK in a case of laryngeal IMT.     

声带息肉中凹空样细胞和HPV的相关性

目的；通过形态学和分子生物学技术来探讨声带息肉与人类乳头状瘤病毒（ｈｕｍａｎ ｐａｐｉｌｌｏｍａ ｖｉｒｕｓ，ＨＰＶ）的关系。方法：对９９例声带息肉ＨＥ染色标本，进行形态学光镜研究；同时，随机选择其中４０例标本采用聚合酶链反应技术行ＨＰＶＤＮＡ检测。结果：９９例标本中有５５例声带息肉复层鳞状上皮棘细胞层中出现凹空样细胞，阳性率为５５．５％。     

A case of Peutz-Jeghers syndrome associated with high-grade intramucosal neoplasia

Peutz-Jeghers syndrome (PJS) is a rare, inherited autosomal dominant disease characterized by mucocutaneous pigmentation and polyps in the gastrointestinal tract. Here, we report the rare case of a 64-year-old female patient with pigmentation on her lips and extremities for over 63 years and intermittent abdominal pain and, diarrhea for 3 years. The presence of intestinal and colorectal hamartomatous polyps was confirmed. The removal and characterization of her rectal polyp showed it to be a typical hamartomatous polyp with a portion of it being an adenoma with high-grade intramucosal neoplasia. A survey of the patient’s family identified 9 people in the family with Peutz-Jeghers syndrome and three of them have already died from colorectal cancer. This case study serves as an example of how imperative it is to survey the patient about their family history in order to detect early cancerous lesions.     

声带早期癌DNA分析及p53、Ki-67和bcl-X的表达

目的　以声带原位癌和早期微小浸润癌为主要研究对象 ,探讨声带从良性到恶性病变各阶段中DNA倍体及基因表达的变化 ,并结合其临床生物学行为 ,深入了解其实质。方法　对 18例声带肿瘤性病变做激光扫描细胞DNA分析并进行随访。对 6 2例声带病变 ,以声带原位癌 (CIS)和早期微小浸润癌 (EMIC)为主 ,与声带浸润性癌、声带息肉分别分为 3组 ,检测p5 3、Ki 6 7和bcl X的基因表达并作各组间对比。 结果　DNA倍体分析表明CIS、EMIC和浸润性癌不同 ,前两者几乎都是二倍体 ,而后者 90 %为异倍体 ;随访结果示CIS、EMIC病人无 1例死于肿瘤 ;还发现DNA二倍体和有DNA凋亡峰的肿瘤患者预后好 ,而肿瘤呈异倍体的患者预后差。免疫表型 :p5 3蛋白在声带肿瘤性病变中表达异常高 ;86 %的CIS、EMIC和 91%的浸润性癌都表达p5 3蛋白 ,阳性指数分别为 2 35和 2 2 6 ,同时此两组的Ki 6 7的阳性平均指数也分别为 2 9%和 2 7% ,与声带息肉差异有显著性 (P <0 0 1)。另一方面 ,bcl X的表达从良性病变到恶性病变呈递减态势 ,以浸润性癌中下降最明显 ,与息肉病变差异有显著性 (P =0 0 0 2 )。结论　声带良性病变、CIS、EMIC及浸润性癌在基因表达和DNA倍体上表现有所不同 ,提示它们各自之间有本质的差别 ,声带原位癌的表现界于良恶     

A case report; systemic lupus erythematosus associated with lupus laryngitis]

Systemic lupus erythematosus (SLE) is an autoimmune collagen vascular disease which produces widespread damage to multiple organs. Few studies on laryngeal involvement in SLE have been reported. We report here a case of SLE complicated by lupus laryngitis. A 27-year-old woman was diagnosed as having SLE in October 1996 based on findings of polyarthritis, lymphocytopenia, positive anti-nuclear antibody and anti-Sm antibodies. Polyarthralgia disappeared transiently, and no other clinical symptoms were found. Therefore, she was followed with no medication. She presented hoarseness with high fever and facial erythema in September 1998. Laboratory findings on admission revealed pancytopenia and hypocomplementemia. Anti-nuclear antibody, anti-Sm antibody and anti-RNP antibody were all positive with high titers. Chest X ray examination showed pleural effusion. Laryngoscopy showed a bamboo-joint-like lesion at the middle of the bilateral vocal cords. She was treated with 60 mg of prednisolone (i.v.) which resulted in improvement of hoarseness, pancytopenia, hypocomplementemia and pleuritis. Based on these findings, we diagnosed her hoarseness as the manifestation of laryngitis associated with SLE (lupus laryngitis).     

The clinicopathologic spectrum of benign mass lesions of the vocal fold due to vocal abuse

Benign masses of the vocal fold related to phonotrauma are clinically classified into polyps, nodules, Reinke's edema, and cysts. Despite the apparent distinctiveness of the clinical nomenclature, low inter- and intraobserver diagnostic agreement has been reported. Excepting cysts, which are epithelial lined, histologic examination of the remaining lesions has shown a variety of overlapping features insufficiently specific for the clinical diagnoses. This study reviews the clinicopathologic characteristics among these benign lesions of the vocal fold. A total of 78 nonneoplastic lesions of the vocal fold were reviewed by 2 pathologists for the presence of epithelial hyperplasia, basement membrane thickening, edema, vascular proliferation, and extracellular "amyloid-like" fibrin. In 46 cases with prebiopsy stroboscopic images, 2 otolaryngologists classified each lesion as polyp, nodule, Reinke's edema, cyst, or other. They agreed in 43% (n = 20, 13 polyps, 5 nodules, 1 Reinke's edema, 1 other) and disagreed in 57% (n = 26). There was no histologic feature that reliably distinguished among the lesions. In addition, reactive stromal cell atypia was present in 14 cases. Cysts were distinctive, as all were epithelial lined. The clinicopathologic classification of benign laryngeal lesions is neither clinically reproducible nor histologically unique. Treatment will continue to be individualized based on clinical judgment.     

CT colonography: does improved z resolution help computer-aided polyp detection?

Multislice helical CT offers several retrospective choices of longitudinal (z) resolution at a given detector collimation setting. We sought to determine the effect of z resolution on the performance of a computer-aided colonic polyp detector, since a human reader and a computer-aided polyp detector may have optimal performances at different z resolutions. We ran a computer-aided polyp detection algorithm on phantom data sets as well as data obtained from a single patient. All data were reconstructed at various slice thicknesses ranging from 1.25 to 10 mm. We studied the performance of the detector at various ranges of polyp sizes using free-response receiver-operating characteristic analyses. We also studied contrast-to-noise ratios (CNR) as a function of slice thickness and polyp size. For the phantom data, reducing the slice thickness from 5 to 1.25 mm improves sensitivity from 84.5% to 98.3% (all polyps), from 61.4% to 95.5% (polyps in the range [0, 5) mm) and from 97.7% to 100% (polyps in the range [5, 10) mm) at a false positive rate of 20 per data set. For polyps larger than 10 mm, there is no significant improvement in detection sensitivity when slice thickness is reduced. CNRs showed expected behavior with slice thickness and polyp size, but in all cases remained high (> 4). The results for the patient data followed similar patterns to that of the phantom case. Thus we conclude that for this detector, the optimal slice thickness is dependent upon the size of the smallest polyps to be detected. For detection of polyps 10 mm and larger, reconstruction of 5 mm sections may be sufficient. Further study is required to generalize these results to a broader population of patients scanned on different scanners.     

Actinomycosis of the vocal cord: a case report

A 30-year-old Chinese lady was admitted for hoarseness of voice of one month's duration. Clinical examination revealed a granuloma of the left vocal cord while chest X-ray showed an opacity in the lower lobe of the right lung. The provisional clinical diagnosis was tuberculous laryngitis. A biopsy of the vocal cord lesion revealed inflamed tissue with actinomycotic colonies. Cultures and sputum smears did not reveal any tuberculous bacilli. The patient responded to a 6-week course of intravenous C-penicillin, regaining her voice on day 5 of commencement of antibiotics. A subsequent CT scan of the neck and thorax revealed multiple non-cavitating nodular lesions in both lung fields, felt to be indicative of resolving actinomycosis. She was discharged well after completion of treatment. It was felt that this is a case of primary actinomycosis of the vocal cord with probably secondary pulmonary actinomycosis.     

Lobular carcinoma metastasis to endometrial polyp unrelated to tamoxifen. Report of a case and review of the literature

Endometrial polyps are rare sites for metastatic breast carcinoma. Such cases have mostly been reported in tamoxifen-related polyps. We report a case of lobular carcinoma with metastasis to an endometrial polyp in a patient with no history of tamoxifen therapy. The histological features of the polyp in our case closely mimicked those of tamoxifen-related polyps, emphasizing the fact that although characteristic-these features are not specific for tamoxifen. This case also reiterates the need for careful evaluation of endometrial polyps, since inconspicuous deposits of lobular carcinoma can easily be missed.     

Colorectal polyps in an Australian population. A histological and immunohistochemical study

The histology and immunohistochemistry of 896 polyps and other focal epithelial abnormalities detected macroscopically in 86 surgical resections from patients with colorectal adenocarcinoma and benign bowel disorders were studied. The lesions identified included 177 adenomas, 387 hyperplastic (metaplastic) polyps, and 202 non-neoplastic polyps designated 'focal cryptal hyperplasia'. Numbers of both neoplastic and non-neoplastic polyps were significantly increased in resections for carcinoma, with 72 per cent of all polyps in right and 10 per cent in left hemicolectomy specimens being neoplastic. Thirty per cent of adenomas were less than 2 mm in diameter and 6 per cent larger than 10 mm. Observations on polyp size, number, distribution, histological appearance, and antigenic composition suggested that focal cryptal hyperplasia evolves into the hyperplastic polyp. In doing so, there is loss of expression of a tissue specific antigen. Hyperplastic polyps were significantly larger in colons with adenoma than in those without.     

A family of Gardner's syndrome with report of an autopsy case

A family with Gardner's syndrome including one autopsy case is reported. A 22 year-old man had multiple polyposis of the colon and the small intestine, epidermal cysts, soft part tumor of the abdominal skin and osteomas in the calvarium and rib, and died of a carcinoma in the transverse colon and embolism of the brain. Histologically, all polyps were diagnosed as adenomatous polyp. The greater their diameter, the higher the tendency of atypism was observed. However, the polyps around the cancer were few, small, and with low atypism, and we could not obtain evidence showing direct transformation of adenomatous polyps into carcinoma. His two elder brothers had multiple polyposis of the colon, epidermal cysts and osteomas in the calvarium or mandibular bone, but are still alive.     

边缘先验信息下的多类型肠道息肉图像分类网络

肠道息肉的分级能够为内窥镜医生提供辅助诊断,对需要及时处理的高风险息肉和可以暂缓处理的低风险息肉进行区分。现有的基于深度学习息肉分类算法不能很好地区分类间相似性高的图像,针对息肉分级任务有待改进。提出一个包含边缘检测阶段、边缘特征描述提取阶段以及息肉分类阶段的边缘先验信息下的多类型肠道息肉图像分类网络。首先,在边缘检测阶段的跳跃连接层处,设计并嵌入反向注意力边缘监督模块以更好地捕获息肉边缘细节信息;其次,在内窥镜医生先验知识的指导下分别通过统计息肉边缘像素点个数和凹凸性来表示息肉边缘周长大小和光滑性特征,以此来补充神经网络特征提取的不足;最后,在分类网络的DenseBlock4后加入通道注意力自适应地捕获判别性特征。所构建的数据集来自丽水市人民医院消化内镜中心2018年至2019年的脱敏数据,样本量含1 050幅原始图像。在构建的四分类数据集上进行五折交叉验证,达到了77.29%的总体准确率,相比于已有算法的最好结果提高了6.46%。融合边缘先验信息的分类网络能够有效地对非腺瘤性息肉与低级别腺瘤性息肉、高级别腺瘤性息肉与腺癌这两组类间高相似度的息肉图像进行区分,增加网络的鲁棒性并提高网络的分类性能,在有限的训练数据集下为医生诊断提供辅助意见。     

Metastatic breast lobular carcinoma to tamoxifen-associated endometrial polyp: case report and literature review

Tamoxifen is a widely used adjuvant treatment of breast carcinoma with partial estrogenic agonist effect. This activity may result in a spectrum of proliferative endometrial abnormalities including uterine polyps. We report a 53-year-old woman receiving tamoxifen for previously excised breast lobular carcinoma who presented with vaginal bleeding. Histologic examination of the endometrium revealed typical morphology of tamoxifen-associated polyp with foci of metastatic lobular carcinoma. Metastatic breast carcinoma to tamoxifen-associated polyp has rarely been described in the literature. Pathologists and gynecologists should be aware of this possibility in women who have a history of breast carcinoma and who are receiving tamoxifen. Careful histologic evaluation of the endometrium is crucial.     

The miRNA landscape of colorectal polyps

The genomic landscape of adenomas and polyps may help define disease pathways. Expression of miRNAs in adenomas and polyps may importantly contribute to these pathways. We evaluated miRNA expression in 293 polyp‐normal colorectal mucosa pairs. Polyps were classified as either adenomatous polyp (AD), hyperplastic polyp (HP), or sessile serrated polyp (SSP). We compared these miRNA expression profiles in polyps to miRNA expression in microsatellite unstable (MSI) and stable (MSS) tumors. A False Discovery Rate of 0.05 based on Benjamini and Hochberg was used to adjust for multiple comparisons. There were 70 miRNAs with differential expression by polyp type with a fold change <0.75 or >1.34 after adjusting for multiple comparisons. The major differences in miRNA expression were observed between AD and SSP and AD and HP, with few differences in expression noted for SSP and HP. AD polyps were more likely to be upregulated from normal colonic mucosa, while SSP and HP were more likely to be downregulated from normal colonic mucosa. MiRNA expression in the SSP and HP tumors almost uniformly go in opposite directions from the MSS tumor miRNA expression and was mixed with MSI tumors. We conclude that different types of polyps have unique miRNA expression profiles. © 2017 Wiley Periodicals, Inc.     

Comparative molecular pathology of sporadic hyperplastic polyps and neoplastic lesions from the same individual

AIM: The biology of colorectal hyperplastic polyps is of considerable relevance, because recent evidence suggests that under certain circumstances hyperplastic polyps may be precursors of neoplasms. The aim of this study was to assess and compare the clinical and molecular characteristics of hyperplastic polyps and neoplastic lesions removed from patients without the hyperplastic polyposis syndrome. METHODS: One hundred and twenty six patients were identified through a series of genetic epidemiological studies. Each patient had at least one neoplastic lesion and one hyperplastic polyp; there was a total of 147 hyperplastic polyps. All lesions were evaluated for K-ras mutations, loss of heterozygosity (LOH) of the adenomatous polyposis coli (APC) gene, and microsatellite instability. RESULTS: K-ras mutation was detected in 15 (10%) hyperplastic polyps, all from the rectosigmoid colon. No hyperplastic polyp had APC LOH or microsatellite instability. Patients with adenomas or carcinomas showing K-ras mutations were not more likely to have hyperplastic polyps with K-ras mutations. The average number of adenomas did not differ between those patients with hyperplastic polyps with K-ras mutations and those without K-ras mutations. There was no association between the hyperplastic polyp and the adenoma regarding the colon segments from which the two lesions were removed. CONCLUSIONS: The sporadic hyperplastic polyp is a lesion with limited molecular change and no relation to patients' neoplastic lesions.     

Intrathoracic aneurysm of the right subclavian artery presenting with hoarseness: a case report

Intrathoracic segment of the subclavian artery is an unusual location for peripheral arterial aneurysms. They are normally caused by atherosclerosis, medial degeneration, trauma, and infection. We report a case of a patient with right subclavian artery aneurysm presenting with hoarseness. Chest radiograph demonstrated a superior mediastinal mass. Laryngoscopy showed a fixed right vocal cord. By chest computed tomography, magnetic resonance imaging, and angiography, preoperative diagnosis was established as a saccular aneurysm with afferent loop and efferent loop. Patient underwent complete resection of the aneurysm followed by endto-end anastomosis via median sternotomy. Postoperative pathology was consistent with an atherosclerotic aneurysm filled with thrombus. After surgical operation, hoarseness is still continued.     

Paradoxical low nasal nitric oxide in nasal polyposis

BACKGROUND: Nitric oxide (NO) is synthesized in the respiratory tract. Three isoforms of NO synthase have been described in man, with the inducible form related to inflammatory disease. In the paranasal sinuses constitutive production of nitric oxide has been demonstrated, with levels of 20-25 p.p.m. being found in sinus puncture. Nasal polyposis is a chronic inflammatory condition in which inducible nitric oxide synthase (iNOS) expression is elevated in nasal polyp epithelium. OBJECTIVES: 1. Measurement of upper airway nitric oxide in nasal polyposis patients compared with those with allergic rhinitis, and with normal controls. 2. To assess the effect of polyp treatment on nasal NO levels. METHODS: NO levels (parts per billion) were measured in nasal and pulmonary exhaled air using a LR 2000 Logan Sinclair nitric oxide gas analyser. This utilizes the chemiluminescence principle. Eighty-two patients were studied: 44 with rhinitis, but without polyps, and 38 with nasal polyps. NO levels were compared with those of 20 normal controls. In 23 further polyp patients, levels were measured pre- and post-treatment and the changes were compared with alterations in polyp size, as assessed by rigid nasendoscopy. RESULTS: Nasal NO levels were significantly lower (Kruskal-Wallis, P = 0.000, chi2 = 27.5, d.f. = 3) in patients with polyps than those found in uncomplicated allergic rhinitis. NO levels were correlated directly with extent of polyposis as graded by the Lund-McKay index. Successful treatment, with reduction in polyp volume, was associated with a rise in NO levels (P = 0.042). CONCLUSION: NO levels are low in nasal polyposis, despite high levels of iNOS, possibly related to blockage of the ostiomeatal complex and failure of NO generated constitutively in the sinuses to reach the nasal airway. A rise in the NO levels is seen with successful polyp treatment, and is proportional to the reduction in endoscopically assessed polyp size, suggesting that with both medical and surgical therapy, the ostiomeatal complex obstruction is decreasing. We propose the following scenario. Nasal NO levels are the result of two processes: inducible NO production by inflamed nasal mucosa plus constitutive sinus mucosal production, detectable in normals. In uncomplicated allergic rhinitis with patent sinus ostia NO levels tend to be elevated, but when inflammation is sufficient to obstruct sinus ostia (as in nasal polyps), NO levels fall because sinus NO makes the major contribution.     

The morphogenesis of polyps of the large intestine]

The proportion of so-called hyperplastic polyps among other colon epithelial tumours remains unclear. Colon polyps are studied in 400 patients: hyperplastic polyps are found in 107, a combination of hyperplastic polyp with tubular adenoma in 143, tubular adenoma in 72, villous adenoma in 41 and tubulovillous adenoma in 37 cases. Hyperplastic structures and formation of adenomatous structures were, as a rule, observed in a polyp tip, this corresponding to the increase of nuclei volume and DNA amount in the tip colonocytes. The determination of karyometric coefficient (the ratio of the colonocyte nuclei volume in the polyp tip to colonocytes in the intact mucosa) is proposed as a quantitative criterion of proliferative and dysplastic processes.     

A straightforward approach to computer-aided polyp detection using a polyp-specific volumetric feature in CT colonography

This study presents a straightforward approach to computer-aided polyp detection and explores its advantages and future potential. A straightforward computer-aided polyp detection (CAD) scheme was developed that consisted of colon wall segmentation, a polyp-specific volumetric filter, and the counting and thresholding of cluster volume sizes. 65 patients had undergone the bowel cleaning scheme without fecal tagging and the optical colonoscopy (OC) and CT colonography (CTC) were performed. The polyp sizes determined by OC were used as reference measurements. The CTC dataset with 103 polyps were divided into training and test datasets. After tuning for the optimal parameter settings, the per-polyp sensitivities of the developed CAD scheme for clinically relevant polyps (≥6 mm) were 100% at 8.5 false positives (FPs)/patient using the training dataset, and 93.3% at 7.7 FPs/patient using the test dataset. The developed CAD scheme was found to have a relatively high detection performance, easily optimized parameter settings, and an easily understood internal operation.