结直肠高级别上皮内瘤变的临床意义及外科治疗(附83例报告)

目的 :研究结直肠高级别上皮内瘤变的临床及病理特征 ,探讨外科治疗原则和策略。方法 :本院腹外科 2 0 0 2年 1月～ 2 0 0 4年 7月收治的结直肠肿瘤患者中 ,术前经内镜病理活检诊断为高级别上皮内瘤变者 83例 ,术前提示癌变者 2 8例 (33.7% )。 83例中男性 4 5例 ,女性 38例 ;年龄 33～ 88岁 ,中位年龄 6 0岁 ;肿瘤位于盲肠 1例 ,升结肠 7例 ,结肠肝曲 2例 ,横结肠 3例 ,结肠脾曲 1例 ,降结肠 5例 ,乙结肠 15例 ,直肠 4 6例 ,多原发 3例肿瘤分别位于盲肠 /直肠、升结肠 /乙结肠、降结肠 /乙结肠。 83例患者中 1例单纯探查 ,4例单纯扩肛肿瘤局切术 ,2例扩肛局切术后补充行Miles术 ,8例行姑息性肿瘤切除手术 ,余 6 8例行根治性结直肠癌手术。手术标本与术前病理作比较。结果 :术后病理 4例 (4 .8% )仍为高级别上皮内瘤变 ,肿瘤最大径 1～ 2cm ,平均 1.5cm ;余 79例 (95 .2 % )均证实为腺癌 ,肿瘤最大径 1～ 8cm ,平均 3.76cm ,两组大小有显著性差异 (P <0 .0 1)。术前后病理结果比较 ,Kappa一致值为 0 .0 4 4 ,一致性较差。多元相关分析显示肿瘤癌变与大小及浸润深度相关。证实为腺癌的 79例中已有 7例伴有肝转移 ,4例伴有盆腔转移 ;34例 (4 3.0 4 % )有局部淋巴结转移。 4 7例直肠肿瘤 (包括 1例多原发 )     

高级别宫颈上皮内瘤变临床特点与诊治分析

[目的]分析高级别宫颈上皮内瘤变（CIN）患者的临床及诊治特点,评估彩超、术中冰冻（FSE）的诊断价值。[方法]回顾性分析经手术治疗的CIN2／3患者的临床病理资料,分析术前、术中、术后病理分级转化及手术治疗情况。[结果]①CIN2／3患者的流产率（73．91％）、恶性肿瘤家族史比例（32．02％）均高于正常对照组,与CIN的发生呈正相关。②58．89％（149／253）的CIN2／3病例彩超表现为宫颈回声异常。③FSE漏诊宫颈癌77.33％,未提高高级别CIN的诊断符合率,与PSE一致性较差（Kappa=0．217,P〈0．001）。[结论]高流产率、恶性肿瘤家族史可能与CIN发生有关。彩超对高级别CIN有辅助诊断价值。FSE对术中决策有一定价值,但依据FSE指导手术存在风险。高级别CIN的治疗应避免治疗过度／不足。     

高级别宫颈鳞状上皮内瘤变患者锥切术后人乳头瘤病毒感染的临床研究

目的 探讨宫腔镜下宫颈锥切术(TCRC)治疗宫颈高级别鳞状上皮内瘤变(HSIL)合并人乳头瘤病毒感染(HPV)患者的效果及对HPV清除疗效的影响.方法 选取2019年8月至2020年10月间榆林市第二医院收治的96例HSIL合并HPV患者为研究对象.依据随机数表法将入选患者分为观察组与对照组,每组48例.对照组行宫颈冷...     

食管贲门重复癌及重复高级别上皮内瘤变患病队列分析

 目的从经典的重复癌诊断和WHO肿瘤新分类两个标准，分析食管癌高发区食管贲门重复癌和重复高级别上皮内瘤变患病情况。方法选择河北省磁县2013例40-69岁队列人群为样本。根据WHO新分类标准，将食管鳞状上皮的重度不典型增生、原位癌和贲门腺上皮重度不典型增生、粘膜内癌划为高级别上皮内瘤变（HIN）。对食管和贲门病理同时为HIN的作为重复HIN诊断；食管贲门重复癌仍采用Warren标准。结果以Warren的诊断标准统计，食管贲门重复癌患病率为0．01％（2／2013），占食管贲门原位癌、粘膜内癌和早期浸润癌总检出的2．2％（2／88）；重复HIN患病率0．2％（4／2013），占HIN总检出的3．3％（4／123）。结论磁县40-65岁人群食管贲门重复癌和重复HIN患病率相对较高。     

胃肠道上皮内瘤变

国际癌症研究机构（IARC）于2000年出版的WHO肿瘤新分类中由Hamilton和Aahonen教授主编的《消化系统肿瘤病理学和遗传学》一书,对胃肠道病变的诊断名称、定义和标准作了一些新的规定,有些规定与我国使用的名称和诊断标准存在较大的差异,其中把上皮内瘤变的概念引入胃肠道癌前病变和早期癌.现就胃肠道上皮内瘤变（intraepithelial neoplasia, IN）进行阐述.     

318例高级别宫颈上皮内瘤变及宫颈癌患者的TCT和hrHPV检测分析

  目的  探讨如何使用现有的筛查方法, 减少高级别宫颈上皮内瘤变(cervical intraepithelial neoplasia grade 2 or 3, CIN2/3)及宫颈癌的漏诊。  方法  回顾性分析2014年6月至2018年8月318例中国医科大学附属航空总医院治疗的CIN2/3及宫颈癌患者的临床资料, 其中CIN2/3为296例、宫颈癌为22例, 采用宫颈液基薄层细胞学检查(thinprep cytology test, TCT)及高危型人乳头瘤病毒(high risk human papilloma virus, hrHPV)检测方法, 分析患者的年龄、TCT和hrHPV。  结果  296例CIN2/3患者中30~39岁患者为130例(43.92%)、占第1位, 20~29岁年轻患者为69例(23.31%)、占第3位。318例患者中TCT阳性为199例(62.58%), hrHPV阳性为308例(96.86%), 两者联合筛查阳性为313例, 阳性率为98.43%(313/318)。hrHPV分型检测主要亚型依次为16、52、58、33、18、31型。  结论  CIN2/3及宫颈癌的发病年龄年轻化, 年轻患者筛查不容忽视。TCT单独筛查较hrHPV单独筛查易漏诊高级别病变, TCT联合hrHPV筛查可提高检出率。TCT阴性, hrHPV非16、18亚型的其他hrHPV阳性, 尤其是hrHPV52、58、33、31亚型阳性患者也建议行阴道镜检查。      

结直肠活检诊断高级别上皮内瘤与术后诊断差异的临床病理分析(附47例报告)

目的:探讨结直肠高级别上皮内瘤变的临床病理学特征及手术前后病理诊断的差异.方法:对47例内镜活检病理诊断结直肠高级别上皮内瘤的病例进行回顾性总结,分析其临床病理特点.并与术后病理结果进行对照分析.结果:结直肠上皮内瘤变好发部位以直肠最多,其次为乙状结肠和横结肠.最终确诊35例为结直肠癌,12例仍为高级别上皮内瘤变.结论:结直肠高级别上皮内瘤变术前与术后病理诊断存在较大的差异,尤其是在直肠部位.临床及病理医生应充分沟通,以提高诊断正确率及选择合理的治疗方式.     

食管高级别上皮内瘤变与平滑肌瘤同时共存1例并文献复习

<正>食管平滑肌瘤是最常见的食管良性肿瘤,起源于黏膜肌层或固有肌层,多发生在食管中下段。食管平滑肌瘤是具有低恶性潜能的生长缓慢的肿瘤,内镜下正常黏膜覆盖的小型且无症状的平滑肌瘤不需要手术治疗。食管高级别上皮内瘤变(high-grade intraepithelial neoplasia, HGIN)相当于重度异型增生,为食管癌的癌前病变,属于食管浅表肿瘤的范畴。食管浅表肿瘤包括早期食管癌及癌前病变。     

高级别宫颈上皮内瘤变行子宫切除术患者术前病理确诊方式的回顾性分析

目的:通过对比阴道镜下活检病理、宫颈锥切术中冰冻病理与术后石蜡病理（paraffin section examination,PSE）的一致性,对高级别宫颈上皮内瘤变行子宫切除术的术前病理确诊方式进行研究。方法:选取2010年1月至2015年12月阴道镜活检病理为宫颈上皮内瘤变Ⅱ级(CINⅡ)和Ⅲ级(CINⅢ、原位癌)在我院行宫颈锥切术患者共454例,其中依宫颈锥切术中冰冻病理即刻行子宫切除手术治疗患者238例,另外216例为待宫颈锥切术后石蜡病理回报后再次子宫切除手术治疗的患者,对比阴道镜下活检病理、宫颈锥切术中冰冻病理与术后石蜡病理的一致性,以及对比锥切术后石蜡病理与再次子宫切除术后病理的一致性。结果:阴道镜活检与术中冰冻病理诊断的符合率为89.11%（270/303）,CINⅡ为63.33％（38/60）,22例升级为CINⅢ;CINⅢ为95.47%（232/243）,11例升级（9例升级为宫颈癌Ⅰa1期,2例升级为Ⅰb1期）。阴道镜活检与术后石蜡病理诊断的符合率为77.53%(352/454)。CINⅡ为22.99%(20/87),67例升级（57例升级为CINⅢ,8例升级为宫颈癌Ⅰa1期,2例升级为Ⅰa2期）;CINⅢ为 90.46%（332/367）,35例升级（26例升级为宫颈癌Ⅰa1期,7例升级为Ⅰb1期,2例升级为Ⅱa期）。阴道镜活检对宫颈癌的漏诊率总体为9.91％(45／454)。宫颈锥切术中同时送冰冻病理患者303例,宫颈锥切术中冰冻病理与术后石蜡病理诊断的符合率为88.12%(267/303)。CINⅡ为60.00%(36/60),24例升级（18例升级为CINⅢ,5例升级为宫颈癌Ⅰa1期,1例升级为Ⅰa2期）;CINⅢ为95.06%(231/243),12例升级（9例升级为宫颈癌Ⅰa1期,2例升级为Ⅰb1期,1例升级为Ⅱa期）。宫颈锥切术中冰冻病理对宫颈癌的漏诊率总体为5.94%（18/303）。宫颈锥切术中同时送冰冻病理患者303例,宫颈锥切术术中冰冻病理比阴道镜活检病理诊断的符合率高,差异有统计学意义（χ2= 27.68,P﹤0.05）。待宫颈锥切术后石蜡病理回报后再次手术治疗的216例患者中,宫颈锥切术后石蜡病理对高级别宫颈上皮内瘤变及浸润癌诊断的准确率可达99.07％（214/216）。结论:阴道镜活检是初步诊断高级别宫颈上皮内瘤变的一种方法;宫颈锥切术具有诊断与治疗的作用,术中冰冻病理（frozen section examination,FSE）能够提早发现部分微小浸润癌及浸润癌,但是存在一定的误诊和漏诊率。因此,建议对所有无生育要求的高级别宫颈上皮内瘤变患者,应先行宫颈锥切术,待术后石蜡病理回报后再行子宫切除术,以达到规范治疗。     

结直肠高级别上皮内瘤变的诊治进展

WHO工作小组自应用"高级别上皮内瘤变(high grade intraepithelial neoplasia,HGIN)"这个诊断术语以来,给临床及病理科医师带来了很大困扰,目前仍没有一个经过大样本临床研究证实和循证医学检验了的统一处理方案标准,因此在临床实践中如何把握结直肠HGIN的临床诊断及采取何种处理策略值得研究。现将结直肠HGIN的研究进展综述如下。     

重复穿刺活检中高级别上皮内瘤对前列腺癌的预测价值

Objective: The significance of isolated high-grade prostatic intraepithelial neoplasia in initial biopsy as an predic-tor for prostate cancer has been extensively research, and the true relationship remnant is no clear till now. The aim of this study is to evaluate prediction value of cancer on repeat biopsy in patients with high-grade prostatic intraepithelial neoplasia, using multivariate analysis. Methods: Thirty-eight men with a diagnosis of isolated high-grade prostatic intraepithelial neo-plasia in in...     

Clinical validation of methylation biomarkers for optimal detection of high-grade vulvar intraepithelial neoplasia

The precursor lesions of vulvar squamous cell carcinoma (VSCC) include human papillomavirus (HPV)-associated and HPV-independent squamous neoplasia with a varying cancer risk. Our study aimed to validate the accuracy of previously identified DNA methylation markers for detection of such high-grade vulvar intraepithelial neoplasia (VIN). A large clinical series of 751 vulvar lesions, originally diagnosed as high-grade VIN, were reassessed and categorized into HPV-associated or HPV-independent vulvar disease categories. Together with 113 healthy vulvar controls, all samples were tested for 12 methylation markers with quantitative multiplex methylation-specific PCR (qMSP). Performance of individual markers and selection of an optimal marker panel for detection of high-grade VIN was determined by logistic regression analysis. SST was the best-performing individual marker (AUC 0.90), detecting 80% of high-grade VIN cases, with excellent detection of HPV-independent VIN (95%), known to have the highest cancer risk. Merely 2% of controls tested methylation positive for SST. Selection of a marker panel, including ZNF582, SST and miR124-2, resulted in a comparably high accuracy for detection of high-grade VIN (AUC 0.89). In conclusion, we clinically validated the accuracy of 12 DNA methylation markers for detection of high-grade VIN. SST, as a sole marker or in a panel, provides an optimal diagnostic tool to distinguish high-grade VIN in need of treatment, particularly HPV-independent VIN, from low-grade or reactive vulvar lesions. These findings warrant further prognostic validation of methylation biomarkers for cancer risk stratification of patients with VIN.     

Endoscopic features of esophageal high-grade intraepithelial neoplasia dominated by cytological atypia

Little is known about esophageal high-grade intraepithelial neoplasia dominated by cytological atypia (HGINc). We aimed to elucidate the endoscopic features of HGINc compared with esophageal high-grade intraepithelial neoplasia dominated by architectural atypia (HGINa). All patients pathologically diagnosed as esophageal high-grade intraepithelial neoplasia after endoscopic submucosal dissection at our center between January 2018 and December 2019 were included in this study. According to the pathological diagnosis, the patients were divided into two groups: HGINa group and HGINc group. Basic characteristics and endoscopic information were collected in detail. Data were analyzed statistically. Binary logistic regression was performed and a predictive model for HGINc was established. Then we evaluated its predictive value and built a nomogram for clinical application. A total of 175 patients were included in this study (126 with HGINa and 49 with HGINc). Among 228 lesions found in all patients, there were 148 HGINa and 80 HGINc. The independent relevant factors for HGINc were tobacco and alcohol usage, color, and gross type. To predict risk of HGINc, a three-factor model (TFM) was established with a highest area under curve (AUC) as 0.869 (95% CI, 0.852, 0.939). When the cut-off value was set as 0.3569184, the diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for HGINc was 81.14%, 88.75%, 77.03%, 67.62%, and 92.68%, respectively. HGINc differs greatly in endoscopic features from HGINa in our study. It’s important to reduce misdiagnosis that our model was established with good predictive value for clinical application.     

高级别上皮内瘤变及早期胃癌内镜与外科治疗在随访及经济指标中评估研究

目的探讨内镜与外科手术治疗高级别上皮内瘤变及早期胃癌术后残胃及吻合口黏膜改变、费用及治疗时间、随访复发情况。方法收集25例内镜治疗及100例外科手术治疗患者,分别从术后黏膜改变状态(充血、糜烂、溃疡、伴随胆汁反流)、治疗费用与时间、术后随访复发情况3方面评估,利用SPSS 16.0统计软件进行统计。结果外科手术术后黏膜明显充血者87.0%,糜烂36.0%,溃疡9.0%,伴随胆汁反流高达48.0%,内镜组除手术瘢痕外无明显术后黏膜炎性改变(P<0.001);外科手术组平均花费为(3.56±1.12)万元,平均住院时间(20±9)天,内镜治疗组平均费用(0.57±0.42)万元,平均治疗时间(5±2)天(P<0.001);外科组随访中见1例复发,内镜治疗组无复发(P>0.05)。结论内镜切除治疗高级别上皮内瘤变不仅能显著改善术后黏膜状态、降低治疗费用、缩短恢复时间,而且具有与外科手术类似良好预后。     

Prostate volume modifies the association between obesity and prostate cancer or high-grade prostatic intraepithelial neoplasia

The relationship between obesity and prostate cancer remains unclear. We investigated the effect of prostate volume on the obesity and prostate cancer association. With a multi-centered, rapid-recruitment protocol, weight and body size measurements were collected prior to diagnosis, and medical charts were reviewed for pathology results (n = 420 controls, 119 high-grade prostatic intraepithelial neoplasia (PIN) cases, and 286 cancer cases (41% Gleason > 6). In multivariable logistic regression models adjusting for age, PSA levels and history, DRE results, and number of cores at biopsy, the association between BMI and cancer was restricted to men with a smaller prostate volume (volume < 40 cm³: OR_{BMI ≥ 30} = 2.17 (1.09, 4.32), p _trend = 0.02; volume ≥ 40 cm³: OR_{BMI ≥ 30} = 0.77 (0.34, 1.77), p _trend = 0.17; p _interaction = 0.03). Similarly, the WHR and PIN association was significantly modified by prostate volume (volume < 40 cm³: OR_{(WHR: Tertile 3 vs. T1)} = 3.76 (1.54, 9.21) (p _trend < 0.01); volume ≥ 40 m³: OR_{(WHR: T3 vs. T1)} = 0.63 (0.32, 1.23) (p _trend = 0.17); p _interaction < 0.01). In conclusion, prostate volume acts as a modifier, and BMI and WHR are significantly associated with prostate cancer or PIN, respectively, in the absence of biopsy sampling error derived from obesity-related prostate enlargement.     

Chromosomal profiles of high-grade cervical intraepithelial neoplasia relate to duration of preceding high-risk human papillomavirus infection

High-grade cervical intraepithelial neoplasia (CIN2/3) represents a heterogeneous disease both with respect to clinical behavior and chromosomal aberrations detected. We hypothesized that the extent of chromosomal aberrations reflects the duration of their existence. Chromosomal profiles were determined of CIN3 of women with a known 5-year history of high-risk human papillomavirus virus (hrHPV) infection, in which duration of prior hrHPV infection was considered a proxy for duration of CIN3 existence. Eleven women had a <5 year preceding hrHPV infection (CIN3<5yrPHI) and 24 had a PHI lasting ≥5 years (CIN3≥5yrPHI). For comparison, six CIN3 adjacent to squamous cell carcinomas (CIN3-SCC), the corresponding SCCs, and six CIN1 were included. Unsupervised hierarchical clustering analysis of the chromosomal profiles revealed two clusters. One was characterized by a low number of chromosomal aberrations and included all CIN1, 81.8% of CIN3<5yrPHI and 33.3% of CIN3≥5yrPHI. Samples in the second cluster, displaying multiple aberrations, included 18.2% of CIN3<5yrPHI, 66.7% CIN3≥5yrPHI, all except one CIN3-SCC and all SCCs. The number of genomic aberrations increased according to lesion grade and also with longer duration of PHI. The increase in aberrations in CIN3≥5yrPHI compared to <5yrPHI was highly significant (p = 0.001), suggesting that CIN3≥5yrPHI represent more severe lesions. In conclusion, longer duration of preceding hrHPV infection is associated with an increased number of chromosomal aberrations. Hence, CIN3 with a longer duration of existence are likely more prone to have an increased short-term risk of cervical cancer.     

Clinical efficacy and prognostic risk factors of endoscopic radiofrequency ablation for gastric low-grade intraepithelial neoplasia

BACKGROUNDThe use of radiofrequency ablation (RFA) has been reported in the treatment of gastric low-grade intraepithelial neoplasia (LGIN). However, its efficacy and prognostic risk factors have not been well analyzed.AIMTo explore the efficacy and prognostic risk factors of RFA for gastric LGIN in a large, long-term follow-up clinical study.METHODSThe clinical data of 271 consecutive cases from 198 patients who received RFA for treatment of gastric LGIN at the Chinese PLA General Hospital from October 2014 to October 2020 were reviewed in this retrospective study. Data on operative parameters, complications, and follow-up outcomes including curative rates were recorded and analyzed.RESULTSThe curative rates of endoscopic RFA for gastric LGIN at 3 mo, 6 mo, and 1-5 years after the operation were 93.3%, 92.8%, 91.5%, 90.3%, 88.5%, 85.7%, and 83.3%, respectively. Multivariate analyses revealed that Helicobacter pylori (H. pylori) infection and disease duration > 1 year had a significant effect on the curative rate (P < 0.001 and P = 0.013, respectively). None of patients had bleeding, perforation, infection, or other serious complications after RFA, and the main discomfort was postoperative abdominal pain.CONCLUSIONRFA was safe and effective for gastric LGIN during long-term follow-up. H. pylori infection and disease course > 1 year may be the main risk factors for relapse of LGIN after RFA.