肾黏液性小管状和梭形细胞癌临床病理特点分析

目的:分析肾脏黏液性小管状和梭形细胞癌的临床病理特点,提高对肾黏液性小管状和梭形细胞癌的认识。方法:回顾性分析8例肾黏液性小管状和梭形细胞癌患者的临床资料。女5例,男3例,平均年龄48.4(25～80)岁。肿瘤最大直径平均4.2(2.5～10.0)cm。3例行开放性肾癌根治术,3例行腹腔镜肾癌根治术,2例行腹腔镜肾脏部分切除术。结果:手术顺利,术中术后未出现明显并发症,术后病理检查均诊断为肾黏液性小管状和梭形细胞癌。平均住院7(5～10)天,术后平均随访30(7～45)个月,均未见肿瘤复发及转移。结论:肾黏液性小管状和梭形细胞癌是一种极为罕见的低度恶性的肾脏肿瘤,临床症状、影像学表现与肾癌类似,需依靠病理组织学确诊。早期手术治疗是首选治疗方法,预后良好,需长期密切随访,对最大直径<4.0cm患者,推荐行腹腔镜下保留肾单位手术。     

肾脏黏液管状和梭形细胞癌1例并文献复习

目的 探讨黏液性管状梭形细胞癌(MTSCC)的诊断、治疗、预后.方法 报告1例37岁男性左肾占位性病变之临床资料、手术及病理结果.结果 术中见左肾上极与腹膜黏连严重,游离肾门,局部解剖不清晰,伴多发淋巴结肿大.行开放性左肾根治性切除术.病理学诊断:肾脏黏液性管状和梭形细胞癌.免疫组织化学染色:LCK++、HCK++、Vimt-、F8 -、CD34 -、CK-.结论 罕见肾脏黏液性管状梭形细胞癌恶性程度低,早期手术是首选的治疗方法,病人可长期存活.     

两种不同临床类型的肾黏液性小管状和梭形细胞癌

目的:探讨两种不同临床类型肾黏液性小管状和梭形细胞癌的临床特点。方法:报告2例不同临床类型肾黏液性小管状和梭形细胞癌患者的临床资料,进行对比分析,并复习有关文献。结果:例1为体检发现,无局部及远处转移,无病理性核分裂像,异型性小。例2以持续高热就诊,有局部及远处转移,病理性核分裂像常见,异型性明显。2例均行肾癌根治术,例1术后随访未见复发。例2患者于术后3个月死亡,此为国内首例报道因肾黏液性小管状和梭形细胞癌死亡者。结论:肾黏液性小管状和梭形细胞癌有两种不同临床类型,多数为低度恶性,亦存在恶性程度较高的病例,需区别对待。     

肾黏液样小管状和梭形细胞癌临床病理学观察

目的:探讨肾黏液样小管状和梭形细胞癌(mucinous tubular and spindle cell carcinoma,MTSCC)的临床病理学特征、鉴别诊断、起源、治疗及预后。方法:观察1例MTSCC的临床病理学特征及应用Elivision法进行免疫组织化学检测,同时术后随访相关情况。结果:镜下瘤组织主要由上皮样细胞呈狭长小管状、索状排列和弥漫的梭形细胞几种结构紧密排列在黏液样基质中构成,部分迷路乳头状结构,梭形细胞区较少,似平滑肌瘤。瘤细胞形态温和,异型性小,核圆形或卵圆形,核仁不明显,核分裂象罕见。免疫组织化学检查瘤细胞CK、vimentin+,CD10、CD15-,CK34βE12、CK7、CK19在迷路样区域+,在索状、小管状区域-,迷路样区域Ki-67指数最高,达4%。患者行肿瘤及部分肾切除术,术后未行特殊治疗,随访5个月,无复发和转移。结论:MTSCC是肾原发性罕见低度恶性肿瘤,来源不定,可能起源于多种组织。肿瘤局部切除的预后不确定。     

肾梭形细胞癌的诊断和治疗(附8例报告)

目的提高肾梭形细胞癌的诊治水平和对此类型肾癌的认识。方法回顾性分析8例肾梭形细胞癌的临床资料,结合文献复习进行讨论。结果8例均行根治性肾切除术,术后病理证实为肾梭形细胞癌;随访6-17个月,7例死于术后肿瘤复发或转移,1例随访9月出现肺转移。结论肾梭形细胞癌是一种高度恶性少见的肾细胞癌,确诊有赖于影像学检查及典型病理表现,治疗以手术为主,预后不良。     

左肾巨大黏液样小管状和梭形细胞癌1例报告

我院2019年11月收治1例左肾黏液样小管状和梭形细胞癌(MTSCC)患者, 女, 75岁。肿瘤位于左肾上极, 大小约23.3 cm×18.0 cm×21.8 cm, 行经腹根治性左肾切除术, 术后随访3年2个月, 未见肿瘤复发和转移。发生在肾的MTSCC是罕见的低度恶性肿瘤, 发展缓慢, 边界清楚, 很少发生浸润和转移, 确诊依靠病理检查, 手术是治疗本病的唯一有效方法。     

肾脏黏液性管状和梭形细胞癌一例报告并文献复习

目的 探讨肾脏黏液性管状和梭形细胞癌患者的临床病理特点。方法 分析1例肾脏黏液性管状和梭形细胞癌患者临床资料，结合文献复习讨论。患者，男，27岁。查体发现右肾占位性病变6d，CT及MRI示右肾上极囊实性占位，术前诊断良性病变。行右肾根治性切除术。结果 术中见肿瘤对肾组织有推挤样边界，位于右肾上极，冰冻切片诊断低度恶性黏液性上皮性肿瘤。病理检查：大体标本见右肾上极6cm×5cm×4cm类球形肿物，边界清楚，切面实性、灰白色。肿瘤细胞排列成管状、实性梁索状漂浮于黏液性基质中，Alcianblue染色（＋）。免疫组化：上皮细胞CK（＋）、CK7（＋）、EMA（＋）、Vimentin（＋）、34βE12（＋）。病理诊断：肾脏黏液性管状和梭性细胞癌。术后随访5个月未见肿瘤复发和转移。结论 肾脏黏液性管状和梭形细胞癌是一种罕见的低度恶性上皮性肿瘤，具有潜在远处转移的可能，应与其他肾脏良恶性肿瘤相鉴别。     

肾黏液小管状和梭形细胞癌的临床特点分析

目的 探讨肾黏液小管状和梭形细胞癌(MTSCCa)的临床特点、治疗和预后. 方法 MTSCCa患者4例.均为女性.年龄42～76岁,平均57岁.腰痛2例,其中伴肉眼血尿1例;体检发现肾肿瘤2例.肿瘤位于左肾3例,右肾1例.CT检查示肾内低密度影,增强后有轻度强化,且有延迟强化.肿瘤直径3.8～12.0 cm,平均6.8 cm.T1aN0M0 1例,T1bN0M0 2例,T2N0M0 1例.4例均行根治性肾切除术,其中1例行腹腔镜手术. 结果 4例手术顺利.肿瘤大体标本切面呈灰白色或灰褐色,周边有完整包膜.肿瘤内有出血区域:镜下表现为管状和梭形结构穿插于黏液样间质中,病理均诊断为肾MTSCCa.2例术后行干扰素及IL-2免疫治疗3个月.随访9～46个月,均未见复发或转移.结论 MTSCCa是一种罕见的低度恶性肾脏上皮肿瘤,多见于女性,早期手术切除是首选治疗方法,预后良好.     

肾黏液样小管状和梭形细胞癌2例病例报告并文献复习

目的:探讨肾癌的罕见类型肾黏液样小管和梭形细胞癌(MTSCC)的临床病理特点、治疗和预后。方法:回顾性分析2009年11月、2013年10月收治的2例MTSCC患者的临床资料,并结合文献进行讨论。结果:2例患者均为女性,发病年龄分别为47、57岁,均由体检时发现,无临床表现。均为单侧单发,直径均在4 cm左右,影像学资料提示乏血供肿瘤,均采用后腹腔镜肾根治术,病理报告显示免疫组化CK7、CK19均为阳性,CD10阳性、阴性各1例。1例随访6年,1例随访1年,术后均无复发转移。结论:MTSCC是一类罕见的肾细胞癌,恶性程度较低,预后较好。影像学资料显示乏血供的肾占位病变在MTSCC的诊断中占有重要地位,需要与乳头状肾细胞癌、肾梭形细胞癌、间叶型梭形细胞肉瘤鉴别。治疗方法可选择根治性切除术和保留肾单位手术,根据肿瘤大小、位置、肾功能进行选择,微创手术优于开放手术。尽管预后相对好,仍有伴或不伴肉瘤样改变的MTSCC发生远处转移的报道,因此应重视术后的随访。     

肾脏黏液性管状及梭形细胞癌的临床病理观察

目的探讨肾脏黏液性管状及梭形细胞癌（mucinous tubular and spindle cell carcinoma,MTSCCa）的临床病理特点、免疫表型及鉴别诊断要点,并复习相关文献对其组织起源作一探讨。方法对1例肾脏黏液性小管状和梭形细胞癌进行临床病理学特征及免疫组化的分析。结果患者女性,56岁,无特异临床症状,体检发现右肾占位。巨检发现肾上极实质内一灰白界清结节,直径7cm,切面均匀。镜下见瘤细胞主要呈两种结构：由单层立方细胞排列成的细管状结构及类似于平滑肌瘤的梭形细胞结构,局部可见透明细胞及乳头样结构,立方状细胞及梭形细胞均形态温和。背景中见大量黏液,并可见淋巴细胞、浆细胞及泡沫细胞浸润。免疫组化：CK7、CK18、Vim阳性表达;SMA、HMB45、SYN均阴性。结论MTSCCa是一种少见的低级别肿瘤,预后较好,可能来源于远端肾单位。     

Hazards and complications of endoscopic transurethral ureterolithotripsy and lithoextraction and means of prevention

Complications related to ureterolithotomy and ultrasonic ureterolithotripsy performed under the control of visual endoscope were analyzed in 86 ureterolithiasis patients, methods of their prevention discussed. All the aforementioned complications were distributed into three groups: inapplicability of surgery due to anatomic and functional defects of lower and upper urinary tracts, intraoperative, and postoperative complications. The commonest ones were ureteral abruption and perforation, acute pyelonephritis, temporary vesicoureteral reflux. Their control measures were considered as relative methods of treatment: immediate surgical intervention in case of ureteral abruption, renal catheterization in patients with insignificant ureteral perforation or acute pyelonephritis. Adequate ureteroscopy, careful consideration of pro- and contraindications, catheterization of renal pelvis and urinary bladder performed within 2-3 days after the surgery and adequate antibacterial therapy are the most decisive steps in the control of aforementioned complications.     

牙体牙弓颌骨阻力中心及其临床意义

牙体、牙弓及颌骨的阻力中心在正畸矫治力系统中具有重要的意义,也是正畸学领域争论较多的一个问题。Dermaut等研究表明,当力作用于物体阻力中心时,物体将发生平动,否则将发生平动和转动的复合运动。目前,国内外多数学者认为牙体、牙弓及颌骨存在阻力中心,但其位置存在争议。本文就牙体、牙弓及颌骨的阻力中心及其临床意义作一综述。     

Characterisation and differentiation of chondroblastomas and chondromyxoidfibromas - presence and expression of collagen types I and II

AIM: Chondroblastomas and chondromyxoidfiibromas are rare benign skeletal neoplasms with reported overlapping histology. Aim of this study was to analyse the biochemical composition of the matrix of these tumour entities in order to further characterise the cellular phenotypes of these neoplasms using typical cell biological marker genes. METHODS: The matrix compositions of chondroblastomas and chondromyxoidfibromas were analyzed by HE-histology, histochemistry, and immunolocalization techniques. Cellular gene expression patterns were detected by mRNA in situ hybridization. RESULTS: Chondroblastomas are rich in collagen type I and show foci of an osteoid-like matrix, whereas collagen type II as a typical marker of chondrocytic differentiation was not detected in any of the specimens. Chondromyxoidfiibromas had foci of chondroid appearance with chondroblastic cellular differentiation characterised by collagen type II expression. CONCLUSION: These results characterise chondroblastomas and chondromyxoidfiibromas as skeletal neoplasms that have a different biology and which can be distinguished by matrix protein expression products: collagen type II, the typical marker of chondroblast differentiation, could only be detected in chondromyxoidfibromas, but not in chondroblastomas. Thus, both neoplasms are clearly different on the cell biological level.     

Histochemical and contractile properties of striated muscles of urethra and levator ani of dogs and sheep

AIMS: To understand their possible importance in long- and short-term control of continence, some properties of the striated muscles of the urethra and pelvic floor (levator ani) of dogs and sheep were investigated, especially fiber types and contractile characteristics. MATERIALS AND METHODS: Striated muscles of urethra and levator ani of 29 male and 6 female dogs and 11 male and 6 female sheep were removed and cut into strips. Some strips were frozen and stained for ATPase at pH 9.4 and 4.3 for fiber typing; others were set up in an organ bath to study contractile responses to nerve stimulation. RESULTS: All muscles contained both type I (slow) and type II fibers, ranging from 97% type II in female greyhound urethra to 60% in female sheep levator ani. For each muscle, there were fewer type II muscles in sheep than in dog. The diameters of the urethral fibers were about 60% of the levator ani in dogs and 34% in sheep. Contraction of the urethral muscle was faster than for levator ani and declined to about 80% of the peak, 500 msec after the beginning of stimulation at 20 Hz. The levator ani contraction rose to a steady level as long as stimulation continued. CONCLUSIONS: Both the levator ani and urethral striated muscles contain slow and fast fiber types. The levator ani muscles are capable of sustained contraction with rapid onset which will produce long-term closure of the urethra. The circular urethral muscle contraction was faster but less well maintained.     

Incorporation and release of85Sr and14C-proline-hydroxyproline in mineral and collagen of bone and incisor teeth of growing rats

The extent to which exchange and reutilization processes of mineral tracers affect skeletal mineral accretion and resorption measurements was evaluated by comparing the rates of appearance and disappearance of⁸⁵Sr and¹⁴C-proline-hydroxyproline in bones and teeth in growing rats for 12 days following simultaneous parenteral injection of these tracers. Expressions for the relative rates of collagen synthesis and breakdown, which unlike mineral metabolism are considered not to be complicated by exchange phenomena, were based on¹⁴C-proline conversion to¹⁴C-hydroxyproline; the specific activity of the latter was determined. Both the mineral and the collagen specific activities reflected the rates and patterns of growth of the samples assayed; rapid growth and a short interval of time between formation and resorption of tissue in themetaphyseal bone which contains the cartilagineous growth plate, slow growth and an interval of time between formation and resorption of tissue indiaphyseal bone and incisor teeth which is longer than the 12 days of the experiment. However, in metaphyseal bone the specific activity collagen/mineral ratio dropped by one half during the 4–12 day interval in contrast to diaphyseal bone and incisor teeth in which no change in this ratio was observed during this period of time. The data indicate that collagen in the metaphyseal growth zone is removed by resorption before it has become fully mineralized, and that exchange is a relatively unimportant factor in the long term kinetics of bone mineral.

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Zusammenfassung Das Ausmaß, bis zu welchem Austausch- und Wiederverwendungsprozesse der mineralen Tracer die Messungen des mineralen Skelett-Auf- und Abbaues beeinflussen können, wurde ausgewertet; zu diesem Zweck wurde die Geschwindigkeit des Auftretens und Verschwindens von⁸⁵Sr und von¹⁴C-Prolin-Hydroxyprolin in Knochen und Zähnen von wachsenden Ratten während der 12 auf die simultane parenterale Injektion dieser Tracer folgenden Tage verglichen.Der Ausdruck für die relative Geschwindigkeit des Kollagen-Auf- und Abbaues, bei welchem im Gegensatz zum Mineralmetabolismus kein Mitwirken des Austauschphänomens vermutet wird, basiert auf der Umwandlung von¹⁴C-Prolin zu¹⁴C-Hydroxyprolin; die spezifische Aktivität des letzteren wurde bestimmt.Aus der spezifischen Aktivität des Minerals sowie jener des Kollagens konnten die Geschwindigkeit und die Art des Wachstums der untersuchten Proben ersehen werden, d.h.schnelles Wachstum und ein kurzes Zeitintervall zwischen Bildung und Resorption des Gewebes imKnochen der Metaphyse, die auch die knorpelige Wachstumsplatte enthält, und andererseitslangsames Wachstum und längeres Zeitintervall (länger als die 12 Tage des Experimentes) zwischen Bildung und Resorption des Gewebes imKnochen der Diaphyse und in den Schneidezähnen. Immerhin fiel die spezifische Aktivität des Kollagen/Mineral-Anteils im Knochen der Metaphyse während dem 4–12tägigen Zeitintervall auf die Hälfte, im Gegensatz zum Knochen der Diaphyse und der Schneidezähne, bei welchen während dieser Zeitspanne kein Unterschied in diesem Verhältnis beobachtet wurde.Diese Ergebnisse zeigen, daß Kollagen in der Wachstumszone der Metaphyse durch Resorption verschwindet, bevor es ganz mineralisiert ist, und daß der Austausch ein relativ unwichtiger Faktor in der Kinetik auf lange Sicht des Knochenminerals ist.