皮肤纤维瘤和隆突性皮肤纤维肉瘤中XIIIα因子与CD34的不同表达

目的：探讨XIIIα因子(FXIIIα)和CD34在鉴别皮肤纤维瘤(DF)和隆突性皮肤纤维肉瘤(DFSP)中的应用价值。方法：应用免疫组化技术对11例DF和8例DFSP中FXIIIα与CD34的表达进行了观察。结果：11例DF中9例FXIIIα阳性，全部病例CD34均为阴性；8例DFSP FXIIIα均示阴性，CD34皆为阳性。结论：FXIIIα和CD34可作为鉴别DF和DFSP的重要标记物。     

早期动态增强CT扫描用于诊断卵巢良恶性肿瘤的价值

目的:探讨早期动态增强CT扫描用于诊断卵巢良恶性肿瘤的价值。方法:随机选取2015年5月至2017年5月南京市第二医院收治的卵巢肿块患者60例,均接受早期动态增强CT扫描,对60例患者动态增强CT扫描情况进行统计分析,并对其动态增强CT扫描情况与术后病理诊断符合情况进行分析。结果:恶性肿瘤患者的A期、C期、V期显著强化率均显著高于良性肿瘤、交界性肿瘤患者,差异具有统计学意义(P <0. 05),V期一般强化率显著低于良性肿瘤、交界性肿瘤患者(P <0. 05),但三者的A期、C期一般强化率之间的差异不显著,差异无统计学意义(P> 0. 05),无强化率显著低于良性肿瘤患者,差异具有统计学意义(P <0. 05),但与交界性肿瘤之间的差异不显著,差异无统计学意义(P> 0. 05),而交界性肿瘤患者的C期显著强化率、V期一般强化率又均显著高于良性肿瘤患者,差异具有统计学意义(P <0. 05),无强化率又显著低于良性肿瘤患者,差异具有统计学意义(P <0. 05),但二者的A期显著强化率、一般强化率、C期一般强化率、V期显著强化率之间的差异均不显著,差异无统计学意义(P> 0. 05)。60例患者动态增强CT扫描情况与术后病理诊断符合55例,达到了91. 7%的诊断符合率。结论:早期动态增强CT扫描用于诊断卵巢良恶性肿瘤的价值高。     

卵泡输出率、窦卵泡计数结合年龄评估卵巢反应性及预测体外受精临床结局的研究

目的:探讨卵泡输出率(Follicular Output Rate,FORT)、窦卵泡计数(antral follicle count,AFC)结合年龄评估卵巢反应性及预测体外受精临床结局的价值。方法:选择2014年6月至2016年6月连云港市妇幼保健院生殖中心行体外受精-胚胎移植的不孕症妇女,选择长方案促排卵治疗,共纳入197个治疗周期,新鲜周期获得治疗结局159个周期,分三个年龄组、三个AFC组,三个FORT组,分别比较临床资料、促排卵资料、实验室和临床结局等指标,评价年龄、AFC、FORT三个指标与卵巢反应及治疗结局的相关性以及三个指标之间的相关性分析。结果:妊娠组与非妊娠组比较,妊娠组的FORT、受精率、优质胚胎率均较非妊娠组高,差异具有统计学意义。随着年龄增加,Gn用量增加,注射人绒毛膜促性腺激素(human chorionic gonadotrophin,HCG)日当天雌二醇(estradiol,E_2)、获卵数、受精率、优质胚胎率、临床妊娠率及种植率均降低,差异具有统计学意义,但FORT在三种年龄段内无差异。三个不同AFC组相比较,随着AFC的增加,获卵数增加,实验室及临床结局指标无统计学差异。高、中、低FORT组比较,HCG日E_2在高FORT组中最高,在低FORT组中最低。获卵数、优胚率、临床妊娠率、胚胎种植率在低、中、高三组间逐步升高,差异有统计学意义。FORT、AFC、年龄三者之间无相关性。结论:联合年龄、AFC、FORT三种指标可以有效预测卵子的数量、质量、卵巢的反应性以及治疗结局。     

CD34与FXIIIa在隆突性皮肤纤维肉瘤和皮肤纤维瘤中的表达

目的:检测CD34和FXIIIa(Factor XIIIa)在隆突性皮肤纤维肉瘤(DFSP)和皮肤纤维瘤(DF)中的表达。方法:应用免疫组化结合阳性肿瘤细胞半定量法检测7例DFSP和13例DF中CD34与FXIIIa的表达。结果:7例DFSP CD34呈强而弥慢性阳性反应(阳性细胞率为4.6±0.03);13例DF皆为阴性。13例DF呈不同程度的FXIIIa阳性表达(阳性细胞率为3.6±0.02);而DFSP全部为FXIIIa阴性。结论:CD34和FXIIIa可分别作为鉴别DFSP和DF的重要标记物。     

慢性静脉疾病的诊断和鉴别诊断

原发性慢性静脉疾病患者常有沉重感、胀痛感、淤积性皮炎和足靴区溃疡等下肢症状.此病发病率高.国际上,原发性慢性静脉疾病的诊断水平已经从只建立临床主观印象上的笼统诊断,发展为结合了影像等相关检查的精确诊断.1994年美国静脉论坛推出了临床症状、病因、解剖学和病理生理学分类系统来规范原发性慢性静脉疾病诊断,并在2004年对该系统进行了更新.该系统使原发性慢性静脉疾病的诊断更精确,也使各种关于原发性慢性静脉疾病的研究报告具有可比性.     

促卵泡生成激素受体多态性与多囊卵巢综合征易感性的Meta分析

目的:探讨促卵泡生成激素受体(FSHR)Ser680Asn位点多态性与多囊卵巢综合征(PCOS)的相关性。方法:通过Pubmed、Embase、Medline和国内数据库等,收集国内外已经发表的有关FSHR Ser680Asn位点多态性与多囊卵巢综合征易感性的文章,筛选出符合纳入和排除标准的文献,通过对各种模型比较,应用Stata12.0对各项研究进行异质性检验,计算合并OR值及其95%CI,并进行敏感性分析和发表偏移的评估。结果:9篇文献纳入本研究,共计PCOS病例1652例,对照4434例。Meta分析显示,总体人群Ser/Ser纯合子与PCOS有显著相关性(OR=0.20,95%CI=0.17-0.24,P=0.000),但在显性模型中未发现与PCOS有明显相关性(OR=1.1,95%CI=0.96-1.26,P=0.151),与之前报道结果不一致。结论:FSHR Ser/Ser纯合子与妇女PCOS的易感性相关。     

白癜风的鉴别诊断

白癜风是一种常见的色素障碍性皮肤病。白癜风需要和多种疾病相鉴别。Gawkrodger等［１］认为白癜风需和17种疾病相鉴别。Ta?觙eb等［2］认为非节段型白癜风需和八大类疾病相鉴别。杨慧兰等［3］认为白癜风需和四大类20余种疾病相鉴别。现列举七大类20余种疾病,希望对白癜风的鉴别诊断进行较为全面、细致的介绍……     

特殊部位病变的皮肤镜诊断与鉴别诊断

皮肤镜作为一种新的数字化影像学诊断方法主要是从水平面上对皮损放大进行二维图像观察,组织病理检查则是对垂直于皮损表面一个断面的显微镜图像观察,两者密切相关、相辅相成。位于面部、掌跖、黏膜、甲等不同部位的病变,由于各部位组织结构不同而具有不同的皮肤镜表现,呈明显的部位特殊性。本文主要就上述各特殊部位病变的皮肤镜诊断与鉴别诊断进行总结和综述……     

急诊诊断不明患者的最后一项鉴别诊断：急性中毒

中毒是急诊科的一个常见疾患,也是急诊医学的一个重要组成部分,具有分布面广,对症处理多等特点。但是,如果患者未提供中毒相关的病史,诊断就会十分的困难,故误诊率高是中毒的突出特点之一。特别是长期接触低浓度毒物引起的职业中毒和地方病,往往起病隐渐,如果缺乏特异症状和指标,病因诊断并非易事。     

小儿皮肤血管瘤和血管畸形的临床病理特征和鉴别诊断

小儿血管瘤可以自然消退逐渐得到国内外诸多学者的证实和肯定。但关于小儿血管瘤和血管畸形的鉴别诊断，各家标准和意见不一［１～３］。我们详细观察分析了１９９例小儿血管病变的临床病理特征，以利于诊断和临床治疗。材料和方法对我院１９８６年～１９９６年手术切除有...     

肿瘤标志物在卵巢肿瘤的诊断及良、恶性鉴别中的作用分析

目的：分析肿瘤标志物在卵巢肿瘤（Ovarian Tumors,OT）的诊断及良、恶性鉴别中的作用,为卵巢肿瘤的诊断提供理论依据.方法：选取我院2007年9月至2010年3月收治的171例OT患者,按照其肿瘤良、恶性分为良性组（n=94）和恶性组（n=77）,并选取同期门诊健康体检妇女80名纳入对照组,对比三组受检者肿瘤标志物水平的差异.结果：OT患者CA125、CA153、CA199、CA242、CEA、铁蛋白等肿瘤标志物水平均显著高于对照组人群,恶性组患者上述肿瘤标志物水平亦高于良性组患者（P＜0.05）,三组人群NSE、β-HCG、AFP、PSA、f-PSA及HCG水平无明显统计学差异（P＞0.05）;恶性组CA125、CA153、CA199、CA242、CEA、铁蛋白、β-HCG、AFP、HGH阳性率均显著高于良性组及对照组,三组人群CA125、CA199、CA242、CEA、铁蛋白、β-HCG、AFP及HGH阳性率存在显著统计学差异（P＜0.05）.结论：CA125、CA199、CA242、CEA、铁蛋白、β-HCG、AFP及HGH等肿瘤标志物在OT的诊断及良、恶性鉴别中具有较好的效果,随着肿瘤标志物水平和阳性率的上升,提示患者OT进展程度更高、肿瘤恶性风险增加,选择CA125、CA199和CEA进行联合检测,可在降低成本的同时得到良好的鉴别诊断效果,值得临床广泛应用.     

血清肿瘤标志物在卵巢癌早期诊断中的临床价值

目的:探讨血清肿瘤标记物中癌胚抗原(CEA)、甲胎蛋白(AFP)、糖类抗原125(CA125)、糖类抗原153(CA153)及糖类抗原199(CA199)在卵巢癌早期诊断中的应用价值。方法:以210例疑似卵巢癌患者作为研究对象,以病理学检查结果作为卵巢癌确诊标准,分别对CEA、AFP、CA125、CA153及CA199检查指标对卵巢癌诊断的灵敏性、特异性及诊断价值进行分析。结果:本研究中共有150例确诊为卵巢癌。而CEA、AFP、CA125、CA153及CA199检查在卵巢癌诊断中,以CA125的灵敏性及特异性最高。同时,在所观察的血清肿瘤标记物中,以CA125检查对卵巢癌的诊断价值最高。结论:血清CA125可作为早期卵巢癌的诊断标记物,对提高早期卵巢癌的诊断效果具有重要的应用价值。     

化疗对卵巢恶性生殖细胞肿瘤术后患者卵巢功能的影响

目的:观察卵巢恶性生殖细胞肿瘤(MOGCT)患者行保留生育功能术后并进行化疗对卵巢功能的影响。方法:选取我院肿瘤科收治的45例MOGCT并行术后辅助化疗患者作为研究对象,选取同时期收治的年龄相近且具有生育需求并给予手术切除但术后未行化疗的45例卵巢良性肿瘤患者作为对照组,观察组给予BEP方案进行化疗,比较两组术前、术后6个月以及术后12个月的血清黄体生成素(LH)、促卵泡生成素(FSH)、雌二醇(E2)水平,观察化疗组患者化疗期间月经异常的发生情况。结果:术后6个月,对照组患者的LH、FSH、E2水平接近于正常水平,化疗组中的LH、FSH水平明显高于对照组,而E2水平则低于对照组,组间比较差异有显著性意义,术后12个月化疗组LH、FSH水平与6个月时相比明显下降,而E2水平显著升高,术后12个月,两组LH、FSH、E2水平组间比较无明显差异(P0.05)。在化疗期间,共有34例(75.6%)患者出现月经异常,其中有19例(42.2%)为停经,15例(33.3%)为月经量减少,随着化疗周期的延长,停经以及月经减少患者数量升高。结论:MOGCT患者在术后化疗期将出现性激素水平改变以及月经异常,主要表现为血清促性腺水平升高、雌激素水平下降、月经异常,但具有可逆性。     

CT、超声、CA125联合检测在卵巢癌诊断中的应用分析

目的:探讨 CT、超声、CA125联合检测对卵巢癌的诊断价值.方法:回顾分析经 CT、超声、CA125检测的卵巢肿瘤患者196例临床资料,以术后病理诊断标准判断三者的诊断价值.结果:在卵巢癌诊断中 CT、超声、CA125三者联合检查比单一检查准确性高(P<0.05),但 CT检查的术前分期与术后病理分期比较无显著性差异(P>0.05).结论:卵巢癌术前 CT、超声、CA125联合检测可以提高患者术前诊断准确性,且 CT在卵巢癌分期诊断中准确性较高.     

Cutaneous dermal non‐neural granular cell tumor is a granular cell dermal root sheath fibroma

Dermal non‐neural granular cell tumor (NNGCT) was first described in 1991 as an S100‐negative polypoid non‐melanocytic tumor. Although originally introduced in the literature as a primary cutaneous tumor, it was later emphasized that such qualification could not be held until the line of differentiation was clarified. It was also demonstrated that not all cases were polypoid. In the current study we try to further characterize this entity by presenting 5 cases of NNGCT. As expected, not all of them were polypoid. The ages of the patients varied from 10 to 43 (mean age 22). They all were composed of S100‐negative granular cells with variable atypia and mitotic figures. None of them recurred in follow‐up of up to 12 years (mean 8.2 years). We found evidence of folliculocentricity in 4 cases (in 1 case, this feature could not be investigated because the biopsy was a small shave specimen), that is, tumors were always surrounding, embedding, or following a hair follicle. In some occasions, such features were better demonstrated by immunohistochemistry against the arrector pili muscle. Our cases showed intense immunoexpression of CD10 and CD68. We conclude that NNGCT is morphologically related to the hair follicle and we believe that it is a granular cell dermal root sheath fibroma.     

睾丸精原细胞瘤的MRI诊断与鉴别诊断研究

目的:探讨睾丸精原细胞瘤MRI诊断与鉴别诊断,以期提高对此病认识度。方法:回顾性分析2010年3月至2013年3月14例经病理组织学证实为睾丸精原细胞瘤患者,均MRI检查,观察其影像学表现,并和病理形态学进行比较。结果:所有睾丸精原细胞瘤均位于睾丸实质内,未突破白膜,其中8例结节形,4例为不规则和分叶状且边界清楚,11例表现为均匀一致低信号,2例不均匀混合信号。增强扫描中,9例病灶边缘可见有纤维分隔样早期明显强化,TIC为平台型;5例肿瘤伴出血坏死,为不均匀强化,TIC为速升缓降型。病理表现为肿瘤细胞形态一致圆形或三角形,有胞膜,浆核丰富,核分裂常见。结论:睾丸精原细胞瘤的MRI特征性表现为T2WI病灶均匀低信号影并纤维血管间隔早期强化。     

Pleomorphic fibroma and dermal atypical lipomatous tumor: are they related?

Pleomorphic fibromas represent dome‐shaped or polypoid cutaneous lesions characterized by a paucicellular and densely fibrotic background punctuated by scattered atypical to pleomorphic spindle and multinucleated giant cells. Some of these tumors will have incorporated adipose tissue, although these adipocytic areas lack distinct cytologic atypia and may represent entrapped normal periadnexal or subcutaneous adipose tissue. Nonetheless, owing to the similarity of some of the morphologic features of pleomorphic fibroma with cutaneous atypical lipomatous tumor, diagnostic confusion can ensue. The potential diagnostic challenges are further highlighted by a recent report of a lesion with histopathologic features of both. In response, we studied the presence of 12q15/ MDM2 amplification by fluorescence in situ hybridization and MDM2 expression by immunohistochemistry in a series of 15 pleomorphic fibromas to investigate whether these two entities share a common pathogenic origin. One case of cutaneous atypical lipomatous tumor was used as positive control for 12q15 amplification. All 15 cases were negative for MDM2 by immunohistochemistry with no demonstrable 12q15/MDM2 amplification by fluorescence in situ hybridization. Therefore, these two entities are best regarded as pathogenetically distinct. MDM2 immunohistochemistry or fluorescence in situ hybridization studies can be used to differentiate between the two if needed.     

Calcifying aponeurotic fibroma of the knee: A case report with radiological findings

Calcifying aponeurotic fibroma is a rare type of benign tumor that occurs most commonly in the distal extremities of young children. Due to its infiltrative growth, it has a high tendency of recurrence. Although the clinicopathological features of over 100 cases of this rare disease have been reported, its clinical and radiological features have yet to be described in detail. We present a case of calcifying aponeurotic fibroma of the knee from birth with radiological images, that demonstrate the peculiar features of this uncommon benign tumor and discuss its clinicopathological features based on computed tomography and magnetic resonance images.     

经阴道超声鉴别诊断子宫内膜癌及子宫内膜增生症的价值分析

目的探讨经阴道超声技术鉴别诊断子宫内膜癌及子宫内膜增生症的价值分析。方法选取2015年7月至2018年10月深圳市龙华区人民医院妇科和肿瘤科诊治的180例已确诊子宫内膜病变患者作为研究对象。根据病理类型将子宫内膜癌患者为观察组85例,子宫内膜增生为对照组95例,两组通过临床资料回顾性分析检测结果与病理诊断的一致性,均进行阴道彩色多普勒超声检测,分析比较两组患者显像指标,如子宫内膜厚度、子宫血流显示率、血流阻力指数等,观察子宫形状、内膜回声,并记录检测结果。结果观察组中有81例诊断为子宫内膜癌,3例误诊,1例漏诊,准确率为95.29%(81/85);对照组中有90例诊断为子宫内膜增生症,3例误诊,2例漏诊,准确率为94.74%(90/95)。子宫内膜厚度观察组为(22.43±3.29)mm,对照组为(15.93±3.45)mm;子宫血流显示率观察组为82.37%,对照组为9.29%;血流阻力指数观察组为0.43±0.03,对照组为0.67±0.03;观察组子宫体增大,回声不均匀,子宫内膜不均匀轻度增厚,对照组子宫大小形态无异常,回声均匀,子宫内膜增厚。结论经阴道彩色多普勒超声技术能够鉴别诊断子宫内膜癌及子宫内膜增生症,在子宫内膜病变中能作为首选检测方法,具有一定临床应用推广价值。     

Cytokeratin expression in trichoblastic fibroma (small nodular type trichoblastoma), trichoepithelioma and basal cell carcinoma

Classical trichoblastic fibroma or small nodular type trichoblastoma (Ackerman) is a rare tumour. This tumour, trichoepithelioma and basal cell carcinoma (BCC) have some overlapping histopathological features. There are only a few reports on immunohistochemical studies in large series of these three neoplasms. We investigated immunostaining patterns of 10 different anticytokeratin (CK) antibodies and several other markers in these neoplasms, comparing them with the patterns in normal adult and fetal skin. In trichoblastic fibroma (three cases), CK1/5/10/14, CK7, CK8/18, CK10/11, CK14, CK17 and CK19 were expressed in the basaloid nests, and CK6 and involucrin were detected in the inner layers of keratinous cysts. Trichoepithelioma (seven cases) expressed CK1/5/10/14, CK8/18, CK14, CK17 and CK19 in the basaloid nests, and CK6, CK10, CK10/11 and involucrin were positive in the keratinous cysts. However, no CK7 expression was observed. Solid and keratotic types of BCC (29 cases) expressed CK1/5/10/14, CK7, CK8/18, CK14, CK17 and CK19 in the basaloid nests. The keratinous cysts in BCC were stained with anti-CK6, CK10, CK10/11 and involucrin antibodies. Coupled with the expression of CK8/18, CK17 and CK19 in the outer root sheath of the adult hair follicle, these three neoplasms shared a keratin phenotype characteristic of the outer root sheath. Judging from our immunohistochemical results, trichoblastic fibroma and BCC cannot be differentiated by their patterns of CK expression. The expression of CK7, which is noted in fetal hair follicles, trichoblastic fibroma and BCC, suggests the presence of subpopulations that retain fetal phenotypic characteristics in these two neoplasms. Although the current concept regards trichoepithelioma and trichoblastic fibroma as a single tumour group, the lack of CK7 expression in trichoepithelioma supports the notion that the two are different.