溃疡性结肠炎结肠粘膜HLA—DR抗原表达

本文检测了６０例溃疡性结肠炎的３０例正常结肠粘膜上皮细胞ＨＬＡ－ＤＲ抗原表达。结果显示，３０例正常结肠粘膜上皮及腺体不表达ＨＬＡ－ＤＲ抗原，而６０例ＵＣ中有３２例结肠粘膜上皮和腺体不同程度表达该抗原。其中，４２例活动性ＵＣ中２９例表达，１８例非活动ＵＣ仅３例表达，同时发现ＵＣ结肠粘膜上皮表达ＨＬＡ－ＤＲ抗原还与粘膜炎症程度成正比。结果提示，细胞免疫机制在ＵＣ的发病机理中起重要作用。     

溃疡性结肠炎结肠粘膜HLA－DR抗原表达

本文检测了６０例溃疡性结肠炎和３０例正常结肠粘膜上皮细胞ＨＬＡ－ＤＲ抗原表达。结果显示，３０例正常结肠粘膜上皮及腺体不表达ＨＬＡ－ＤＲ抗原；而６０例ＵＣ中有３２例结肠粘膜上皮和腺体不同程度表达该抗原。其中，４２例活动性ＵＣ中２９例表达，１８例非活动性ＵＣ仅３例表达。同时发现ＵＣ结肠粘膜上皮表达ＨＬＡ－ＤＲ抗原还与粘膜炎症程度成正比。结果提示，细胞免疫机制在ＵＣ的发病机理中起重要作用。     

17例单发和多发血管滤泡性淋巴组织增生的临床病理特点

目的 探讨非多中心血管滤泡性淋巴组织增生（ｕｎｉｃｅｎｔｒｉｃ ｃａｓｔｌｅｍａｎ’ｓ ｄｉｓｅａｓｅ，ＵＣＤ）和多中心血管滤泡性淋巴细胞增生（ｍｕｌｔｉｃｅｎｔｒｉｃ ｃａｓｔｌｅｍａｎ’ｓ ｄｅｓｅａｓｅ，ＭＣＤ）的临床病理特征。方法结合文献，对我院１９７２～１９９９年间１７例血管滤泡性淋巴组织增生（ｃａｓｔｌｅｍａｎ’ｓｄｅｓｅａｓｅ，ＣＤ）的临床、病理、随访观察结果进行分析；所有病例均经组织病理证实为ＣＤ，并按Ｆｒｉｚｚｅｒａ标准病理分型为ＨＶ型、ＰＣ型和Ｍｉｘ型、原诊断标准为单个淋巴结病变，ＭＣＤ必须有广泛淋巴结切除及我个淋巴结病变。结果 ＵＣＤ９例，７７．８％为ＨＶ型，３３．３％有轻度的系统性症状，无其他脏器受局部复发或它处再发，１１．１％恶变，ＨＶ型和ＰＣ型具有不同的组织病理形态改变。结论 ＵＣ     

萎缩性胃炎与幽门螺杆菌感染的组织病理学研究

为了探讨慢性胃炎从浅表到萎缩的演变过程中幽门螺杆菌（ＨＰ）感染的作用，本文对２８０例内镜诊断为慢性胃炎的胃窦粘膜活检标本进行了病理组织学和ＨＰ检测（培养、病理染色和快速尿素酶试验）结果的分析。结果显示，ＨＰ总检出率为６３２％（１７７例），其中正常粘膜、慢性浅表性胃炎（ＣＳＧ）、慢性萎缩性胃炎（ＣＡＧ）的阳性率分别为２６６％（４例），６０８％（１１５例）和７６３％（５８例），三组间比较差异有显著性（均Ｐ＜００１）。ＨＰ阳性率随增龄而增加，ＣＡＧ的比例及病变分级也随增龄而增大，年轻的ＣＡＧ患者伴ＨＰ感染较多。在ＨＰ感染的胃粘膜中，检出活动性胃炎１２１例（６８３％）、淋巴滤泡７８例（４４０％）、肠化生及不典型增生２９例（１６３％），三种病变与胃粘膜萎缩的关系非常密切。提示ＨＰ感染可促进ＣＡＧ的形成。     

多聚酶链反应－单链构象多态分析检测骨髓增生异常综合征N－ras癌基因突变

为探讨Ｎ－ｒａｓ基因突变在骨髓增生异常综合征（ＭＤＳ）病变过程中的意义，采用多聚酶链反应－单链构象多态（ＰＣＲ－ＳＳＣＰ）分析法检测２０例ＭＤＳ患者Ｎ－ｒａｓ癌基因，其中５例出现Ｎ－ｒａｓ基因突变，占２５％，其中３例随访半年内转变为急性髓细胞白血病（ＡＭＬ），且对化疗不敏感。提示Ｎ－ｒａｓ基因突变可促进ＭＤＳ恶性克隆过度增生。初步表明Ｎ－ｒａｓ基因突变的检测可作为一种分子生物学标志，用于监测ＭＤＳ向ＡＭＬ转化     

脑死亡的经颅多普勒超声观察

本文采用经颅多普勒超声仪检测１２例临床诊断脑死亡患者的大脑中动脉血流速度及频谱表现。发现Ｖｍｃａ介于－３ｃｍ／ｓ－１６ｃｍ／ｓ，平均５．８ｃｍ／ｓ．频谱变化表现为“震荡波”形（１１支ＭＣＡ），收缩期尖峰信号（１０支），另３支未探及。上述表现与正常及重度颅脑外伤均有明显不同。１２例患者均告死亡。我们认为：ＴＣＤ在脑死亡诊断中准确性高，是一种有用的辅助手段。     

环孢霉素A和大剂量甲基泼尼龙治疗重型再生障碍性贫血

为提高对重型再生障碍性贫血（ＳＡＡ）治疗的疗效，１９９０年以来，在雄激素常规联合方案基础上加用环孢霉素Ａ（ＣｓＡ）或大剂量甲基泼尼龙（ＨＤＭＰ）治疗成人ＳＡＡ２２例，并以单用雄激素常规联合方案的１１例为对照组，进行疗效随访观察。结果总有效率ＣｓＡ组为７１．４％（１０／１４），ＨＤＭＰ组为６２．５％（５／８），对照组为１８．２％（２／１１）。显示ＣｓＡ组和ＨＤＭＰ组的疗效均优于对照组（Ｐ＜０．０１和Ｐ＜０．０５）。ＣｓＡ组和ＨＤＭＰ组均未出现严重毒副反应。个别患者ＣｓＡ须维持疗程长达３年，提示对ＣｓＡ维持疗程与剂量的个体化应予一定的注意。认为在雄激素常规联合方案基础上加用ＣｓＡ或ＨＤＭＰ治疗ＳＡＡ，是较为有效、安全和简便的方法。     

胆囊息肉样病变超声显像与病理对照研究

本文分析我院手术治疗的胆囊息肉样病变３５例病理诊断结果，其中胆固醇性息肉２５例，乳头状腺瘤３例，单纯性腺瘤２例，上皮乳头样增生１例，上皮腺瘤样增生１例，粘膜腺瘤局限性癌变１例，慢性胆囊炎２例，超声与病理诊断符合率为９４．３％，探讨了不同类型胆囊息肉样病变的声像图特征。     

巨幼细胞贫血、骨髓增生异常综合征及白血病患者叶酸结合蛋白的研究

为研究叶酸结合蛋白特性，用放射受体结合技术及ＳＤＳ－聚丙烯酰胺凝胶电泳和同位素扫描结合的方法，分析了巨幼细胞贫血（ＭＡ）、骨髓增生异常综合征（ＭＤＳ）和白血病患者血清可溶性叶酸受体（ｓＦＲ）及骨髓单核细胞膜叶酸受体（ＦＲ）的分子量。发现白血病细胞膜上有两种叶酸结合蛋白：分子量为３．５万的ＦＲ以及分子量为４．５万的还原叶酸载体（ＲＦＣ）。ＭＤＳ组中５例ＲＡＥＢ、ＲＡＥＢ－ｔ患者骨髓单个核细胞膜上亦出现ＦＲ和ＲＦＣ；７例ＲＡＳ和ＲＡ以及ＭＡ患者骨髓单核细胞膜叶酸结合蛋白仅为ＦＲ。ＲＦＣ是一种幼稚型蛋白，在ＭＤＳ患者骨髓细胞膜上出现，可能是白血病前期表现。     

巨幼细胞贫血,骨髓增生异常综合征及白血病患者叶酸结合蛋…

为研究叶酸结合蛋白特性，用放射受体结合技术及ＳＤＳ－聚丙烯酰胺凝胶电泳和同位素扫描结合的方法，分析了巨幼细胞贫血（ＭＡ）、骨髓增生异常综合征（ＭＤＳ）和白血病患者血清可溶性叶酸受体（ｓＦＲ）及骨髓单核细胞膜叶酸受体（ＦＲ）的分子量。发现白血病细胞膜上有两种叶酸结合蛋白；分子量为３．５万的ＦＲ以及分子量为４．５万的还原叶酸载体（ＲＦＣ）。ＭＤＳ组中５例ＲＡＥＢ、ＲＡＥＢ－ｔ患者骨髓单个核膜上亦出现Ｆ     

PCNA和CEA在胃粘膜上皮异型增生和胃癌中的表达

增殖细胞核抗原（ＰＣＮＡ）的表达，能有效反映细胞增殖功能。本文通过对胃炎、胃粘膜上皮异型增生、早期胃癌和中晚期胃癌各１０例，共４０例用ＡＢＣ法作ＰＣＮＡ和ＣＥＡ两种免疫标记。发现ＰＣＮＡ的阳性表达，在胃炎、上皮异型增生、早期胃癌和中晚胃癌中呈明显递增趋势，并与ＣＥＡ的表达成正相关。可作为上述胃粘膜上皮病变诊断和分类的综合性指标之一，并有助于指导临床治疗和估计肿瘤的恶性潜能，以判断预后。     

Morphologic features of ulcerative colitis

Ulcerative colitis(UC) is an ulcero inflammatory disorder of unknown etiology affecting only the mucosa and submucosa of colon and, with Crohn's disease, is included in the term idiopathic inflammatory bowel disease. The macroscopic and microscopic features vary according to the stage of the disease process, and an acute phase and a chronic or resolving phase can be recognized. The main differential diagnosis of UC is with colorectal Crohn's disease. The most feared long-term complication of UC is cancer. The progression of UC to carcinoma is closely associated with dysplasia arising in multiple sites. The dysplastic changes should be distinguished from the epithelial changes resulting from regenerative atypia, and the evaluation of these changes is difficult. P53 immunohistochemical staining is helpful in confirming the presence of dysplasia. Molecular events in colorectal carcinogenesis of UC may be somewhat different from those of so-called adenoma-carcinoma sequence.     

Crohn's disease and colorectal malignancy

There has been much debate over the past 50 years concerning the association between colorectal carcinoma and inflammatory bowel disease. Until recently, it was widely accepted there was a higher risk in those with widespread ulcerative colitis. However, evidence now suggests an almost equal incidence in those with Crohn's disease of similar extent and duration. We present a case that underlines the important clinical and pathological features of Crohn's disease associated colorectal carcinoma (CDAC). We present a literature review and debate the role of regular colonic surveillance in patients with Crohn's disease affecting the colon.     

儿童肾上腺皮质癌21例临床病理分析

目的 探讨儿童肾上腺皮质癌（ACC）的临床病理学特点及鉴别诊断。方法 对21例儿童肾上腺皮质癌回顾病史，并进行HE染色及免疫组化标记。结果 21例儿童发病年龄1～12岁，平均4．9岁，男女之比为1：3．2，85．7％的患儿合并有皮质醇激素增高的体征。肿瘤体积普遍较大，52．4％的病例肾上腺肿瘤重量〉300g，〉80％的肿瘤镜下可见透明细胞稀少，病理性核分裂，静脉及被膜的浸润。免疫组化：21例vimentin、Syn和PCNA（＋），7例CK（AE1／AE3）（＋），11例Ki-67（＋），CEA、EMA（-），其中PCNA阳性率为28.8％～98．2％，Ki-67为1．1％～23．1％。结论 儿童肾上腺皮质癌恶性度高，预后差，多见于女童，患者大多合并有皮质醇激素增高的体征。在儿童ACC的诊断中，肿瘤的重量多数〉300g，瘤组织透明细胞稀少、病理性核分裂、静脉和被膜的浸润是相对重要的指标。PCNA阳性率〉30％、Ki-67阳性率〉10％对儿童ACC的诊断有辅助作用。     

Tissue concentrations of CEA and CA 19-9 in the carcinogenesis of colorectal carcinoma exemplified by the adenoma-carcinoma sequence

To study the behavior of the tumor-associated antigens CEA and CA 19-9 in colorectal carcinogenesis, exemplified by the adenoma-carcinoma sequence, their tissue concentrations were measured in adenomas of different size and histology and compared with those found in normal colonic mucosa and carcinoma. Both in the case of monoclonal and polyclonal CEA assay, significantly higher concentrations were found in the adenoma tissue as compared with normal mucosa. Carcinomas revealed, on average, an even higher tissue CEA level, but the concentrations measured showed considerable scatter. In the adenoma group, the villous lesions and those with severe cellular atypia were characterized by markedly higher CEA concentrations, reflecting their special position in the adenoma-carcinoma sequence. In the case of CA 19-9, too, an increase in tissue concentrations from normal mucosa through adenoma to carcinoma was observed. In contrast, among the adenomas of different histologies and dysplasia no differences were observed. These findings fit with the concept of the adenoma-carcinoma sequence which, in our opinion, represents a suitable model for studying the significance of tumor-associated antigens in the carcinogenesis of colorectal cancer and its precursors.     

Carcinoembryonic antigen (CEA) levels and their clinical significance in Crohn's disease

25 patients with Crohn's disease were followed up with serial serum carcinoembryonic antigen (CEA) determinations during hospitalization and at a control investigation eight weeks following discharge. The CEA level was compared with extent, duration and clinical activity of disease, as well as with Crohn's Disease Activity Index (CDAI) and several acute phase reactants. The distribution of positive CEA levels (greater than 5 ng/ml) was similar in phases of acute inflamation and in remission. CEA levels did not show any significant correlation with CDAI, acute phase reactants, extent of involvement, duration of disease or histological findings. In this study CEA levels did not prove to be helpful indicators of disease activity or of cancer risk in Crohn's disease.     

子宫颈微偏腺癌与微腺体增生临床病理分析

目的 探讨子宫颈微偏腺癌及子宫颈微腺体增生的临床和病理特点.方法 对2例子宫颈微偏腺癌及1例子宫颈微腺体增生患者临床资料和免疫组化染色结果进行分析.结果微偏腺癌临床表现为大量水样白带,肉眼观察子宫颈增粗,切面见大小不一、含有黏液的囊腔;而微腺体增生宫颈无明显异常.结论 微偏腺癌是宫颈的恶性病变,分化好,预后差;微腺体增生是一种完全良性病变.     

Considerations of surveillance, dysplasia, and carcinoma of the colon in the management of ulcerative colitis and Crohn's disease

Patients with ulcerative colitis are at greater risk of developing carcinoma of the colon than the general population even if the exact risk cannot be determined. Thus, an effort must be made to find the carcinoma at its inception or better still before it occurs. Dysplasia serves as a premalignant marker in some cases, and a surveillance program serves to find either dysplasia or the carcinoma. Until more specific premalignant changes are identified, endoscopic surveillance with multiple biopsies offers the best protection for the patient with longstanding ulcerative colitis against carcinoma. There is now sufficient evidence that this also pertains to Crohn's disease of the colon.     

胎盘部位中间型滋养细胞疾病的临床病理分析

目的探讨子宫胎盘部位中间型滋养细胞疾病的临床病理特点,归纳鉴别诊断要点。方法收集15例胎盘部位过度反应（EPS）和1例胎盘部位滋养细胞肿瘤（PS＇IT）,分析临床资料、病理学形态及免疫组化标记：胎盘碱性磷酸酶（PLAP）、人胎盘催乳素（HPL）、人绒毛膜促性腺激素（HCG）、细胞角蛋白（CK）、癌胚抗原（CEA）和细胞增殖指数（Ki-67）,并结合文献。结果15例EPS与1例PSTF均以中间型滋养细胞为主,向蜕膜、子宫平滑肌和血管浸润,EPS浸润肌层〈1／3,坏死较轻,细胞异型性不明显,极少核分裂;PSTF浸润肌层〉1／3,可见出血、坏死,细胞异型性明显,核分裂易见。两者在PLAP、HPL、HCG、CK18和CEA的表达相似,而Ki67有明显差异。结论EPS和PSTF诊断及与其他滋养细胞疾病的鉴别主要依据临床病史、病理学形态和免疫组化。     

Cancer of the large bowel in children

We present the morphologic and clinical features of large bowel carcinoma in 22 patients seen over 18 years at St. Jude Children's Research Hospital. We saw 18 cases of mucinous adenocarcinoma, three of well differentiated adenocarcinoma, and one case of poorly differentiated adenocarcinoma. The patients ranged in age from 9 to 19 years with a median age of 15. There were 12 female and ten male patients; 12 were black and ten were white. Eighteen patients had Dukes' stage C disease, with median survival of seven months and one patient alive 12 months after diagnosis. Three patients had Dukes's stage B disease, with two patients surviving 16 months each and one presently alive seven months after diagnosis. Only one patient had Dukes' stage A disease and is alive 121 months after diagnosis. Large bowel carcinoma in children is predominantly mucinous adenocarcinoma and occurs in the adolescent age group. Tumor distribution is fairly even throughout the large bowel, and all subtypes of the tumor are positive for carcinoembryonic antigen (CEA) on immunohistologic study. Active tumor and tumor regrowth are always accompanied by high serum levels of CEA. The tumor has no predilection for sex, but is significantly more frequent in blacks (P less than .05). Discovery of the tumor in an early stage improves the prognosis.