623例膀胱镜活检病理分析

目的分析因膀胱病变行膀胱镜活检患者的病理类型构成,探讨膀胱镜检查的临床价值。方法复习我院623例膀胱病变患者经膀胱镜活检组织病理资料。结果良性肿瘤76例,占12．2％,均为尿路上皮乳头状瘤。恶性肿瘤291例,占46．7％,其中尿路上皮癌254例,腺癌17例,鳞癌6例,转移癌13例,横纹肌肉瘤1例。膀胱黏膜慢性炎症140例,上皮增生50例,分别占22．5％、8．0％;而腺性膀胱炎55例,正常膀胱黏膜8例,前列腺组织3例。结论尿路上皮性肿瘤仍是最常见的膀胱疾病,其次是膀胱炎性病变。膀胱恶性肿瘤以尿路上皮癌最常见,膀胱腺癌、鳞癌或转移癌等比较少见。膀胱镜活检安全、简便,具有重要的临床应用价值。     

腺性膀胱炎诊治体会

腺性膀胱炎是膀胱慢性炎症刺激引起的一种膀胱粘膜增殖性改变。组织学上膀胱粘膜固有层有柱状上皮形成的腺样结构,其内可有产生粘液的杯状细胞,临床表现与一般慢性膀胱炎无异,近年来发病率呈增多趋势,研究表明腺性膀胱炎可与膀胱腺癌同时存在,推测腺性膀胱炎是一种癌前病变,越来越引起人们重视。我院自 1990 年~2003 年共收治 38 例该疾病患者,现就其发病原因、病理分析及诊治情况作一总结和讨论。临床资料本组38例,男23例,女15例,平均年龄43岁,发病年龄多在30~50岁,病史2个月至10年。1 临床症状:大多表现为尿急、尿频、尿痛,本组 38 例…     

腺性膀胱炎超声诊断价值

目的探讨腺性膀胱炎的超声诊断价值。方法对23例经膀胱镜或手术病理证实为腺性膀胱炎患者的临床资料、膀胱镜、超声、CT检查进行回顾性分析。结果临床表现为血尿18例,其中肉眼血尿10例;尿路刺激症状15例;排尿困难5例。膀胱镜检查23例,表现为滤泡样或绒毛样水肿型12例,乳头状癌样型6例,慢性炎症型3例,黏膜无明显改变型2例。超声检查23例,表现为膀胱局限性增厚7例,结节状增生8例,2例合并膀胱占位。23例中2例术后复发。结论超声检查发现膀胱三角区及颈部呈局限性片状增厚或明显增厚,应高度怀疑该病。腺性膀胱炎的确诊要靠病理检查。     

膀胱内翻性乳头状瘤的腔内声像图

膀胱内翻性乳头状瘤是一种较少见的膀胱肿瘤，通过对其经尿道膀胱腔内超声声像图的研究，发现有特征性改变，表现为肿块边缘呈锯齿状强回声，内部呈不均质或均质的低回声或无回声，后方回声衰减不明显，认为它与膀胱移行上皮乳头状癌声像有明显区别，可以作为诊断膀胱内翻性乳头状瘤的一种方法。     

膀胱镜活检10例病理误诊分析

目的：对在膀胱活检小标本中出现低诊断和过诊断问题进行病理形态学分析。方法：复习我院存档的膀胱活检病例共382例。结果：有10例（3．1％）为误诊病例,其中2例旺炽型腺性膀胱炎过诊断为移行细胞癌;8例移行细胞癌诊断为良性病变,其中诊断腺性膀胱炎4例（1例为原位癌,3例为早期浸润癌）,乳头状瘤2例（均为乳头状移行细胞癌Ⅰ级）,内翻性乳头状瘤1例（为伴有内翻性生长的乳头状移行细胞癌1级）,上皮增生1例（原位癌）。结论：①腺性膀胱炎与癌最易混淆;②泌尿道上皮良恶性病变的形态学鉴别诊断主要依靠细胞的异型性和有／无上皮内中层以上的核分裂象;③显示细胞增殖活性的标记物对诊断有一定的帮助。     

腺性膀胱炎与膀胱移行细胞癌关系的形态学观察

报道４８例腺性膀胱炎，显微镜下分为４种类型：（１）移行上皮型，（２）肠上皮型，（３）前列腺上皮型，（４）移行一前列腺上皮混合型。其中２０例（４１．６７％）先、后或同时发现有膀胱移行细胞癌。作者认为，腺性膀胱炎常见于慢性炎症性病灶和肿瘤组织的周围，故慢性炎症和肿瘤的刺激可能是腺性膀胱炎产生的重要原因。文章强调，在诊断腺性膀胱炎时，要进一步排除膀胱移行细胞癌的可能性。     

女性尿道综合征患者的膀胱镜下表现及病理特点的初步研究

目的 研究女性尿道综合征患者膀胱及其颈口的改变。方法 对43例女性尿道综合征患者行膀胱镜检查并活检，结合病史等进行分析。结果 43例患者中37例膀胱镜下可见单纯或慢性增生性炎症改变。以病理分类．慢性膀胱炎占30例(其中14例合并黏膜鳞状化生，腺性膀胱炎7例)，慢性膀胱颈口炎症15例(8例为合并发生)，正常黏膜6例。结论 女性尿道综合患者大多有膀胱或及其颈口的慢性炎症，对不同的病变宜采取相应的治疗。     

膀胱内翻性乳头状瘤9例诊治分析

膀胱内翻性乳头状瘤是一种少见的尿路上皮肿瘤,是一种良性病变,肿瘤大部分由索条或巢状的尿路上皮构成,作者总结10年来9例膀胱内翻性乳头状瘤的诊治体会并结合文献复习对此类疾病进行讨论.     

经尿道等离子电切病灶加膀胱灌注吡柔比星预防腺性膀胱炎复发的临床研究

目的探讨腺性膀胱炎经尿道等离子电切膀胱病灶术后应用吡柔比星膀胱内灌注化疗预防腺性膀胱炎复发的疗效。方法 60例病理证实的腺性膀胱炎患者。A组30例经尿道等离子电切除术;B组30例经尿道电汽化切除术,两组术后均行吡柔比星膀胱内灌注,比较两组患者术后腺性膀胱炎复发率及术后3个月膀胱创面上皮完全覆盖愈合率。结果随访9个月～1年。A组6例复发,B组8例复发,两组复发率比较差异无显著性,3个月膀胱创面上皮完全覆盖率A组27例为90%,B组16例为53%。差异有显著性。结论经尿道双极等离子电切加膀胱灌注吡柔比星是治疗腺性膀胱炎的较好方法,能减少腺性膀胱炎复发,创伤小,愈合快,安全性高。     

膀胱肾源性腺瘤3例报道及文献复习

目的探讨膀胱肾源性腺瘤(NA)的临床病理学及免疫组化特征,诊断与鉴别诊断。方法回顾性分析3例膀胱NA,总结其临床、病理学和免疫组化特征,并复习相关文献。结果男性2例,女性1例,年龄20~76岁。1例有急性膀胱炎病史,1例2年前有经尿道前列腺电切病史。膀胱镜下3例病变均表现为黏膜的局部隆起。组织学上,病变主要由乳头状、小管状和小囊状结构组成,管腔中可见嗜酸性分泌物,上皮为立方状或矮柱状,部分呈“靴钉样”改变;间质水肿及慢性炎改变。免疫组化:上皮细胞PAX2、PAX8(+),CK7、P504S部分(+),而PSA和p63(-),Ki-67增殖指数<2%。结论膀胱NA是一种少见的良性增生性改变,患者常有泌尿道损伤病史。膀胱NA常需与尿路上皮癌、前列腺癌以及膀胱透明细胞腺癌等相鉴别。掌握其临床病理学和免疫组化特征,有助于提高诊断率。     

腺性膀胱炎的超声诊断与分型

目的： 研究腺性膀胱炎的声像图特点、病理基础、诊断价值及其临床意义。方法： 回顾性分析１４ 例经手术病理证实的腺性膀胱炎的声像图资料, 就其病理与超声显像的关系及超声鉴别诊断进行了分析。结果： 本组超声诊断符合率为７９％ （１１／１４ 例）。根据超声所见并结合手术后病理结果, 将其声像图表现分为四型： Ⅰ型： 乳头增生型２ 例; Ⅱ型： 结节增生型 ２ 例; Ⅲ型： 弥漫增生肥厚型４ 例; Ⅳ型： 混合增生型 ６ 例。结论： 超声对腺性膀胱炎的定位和定性具有重要的诊断价值, 结合病史和临床表现可减少误诊。     

The problem of rheumatoid nephropathy

AIM: To study clinical and morphological variants and frequency of renal involvement in patients with rheumatoid arthritis (RA). MATERIAL AND METHODS: Routine laboratory tests, device (urography, dynamic scintigraphy of the kidneys) and ultrasound investigations, lifetime and postmortem examinations of renal tissue using histological, immunohistochemical and electron-microscopic techniques, biopsy of gingival and rectal mucosa for amyloid detected renal lesions in 268 (46.2%) of RA patients followed up for 25 years meeting the ARA criteria. In 98 (37%) patients renal lesions were verified morphologically. Lifetime renal biopsies were made for 60 of them. RESULTS: The diagnosis of chronic pyelonephritis was made in 117 patients, 42 patients had nephrolithlasis, nephroptosis and papillary necrosis were found in 49 and 3 patients, respectively. Arterial hypertension was present in 96 examinees, nephrotic syndrome was diagnosed in 19 and chronic renal failure--in 67 patients. Drug-related nephropathy occurred in 35 cases, in 26 cases symptoms of pyelonephritis arose prior to RA. Combination of renal diseases was found in 197 patients. Renal pathology was not verified morphologically only in 5 cases. Glomerulonephritis (GN) variants were present in 35 patients: mesangioproliferative (n = 27), membraneous (n = 5), mesangiocapillary (n = 3). 12 of them took Au preparations or D-penicillamin, therefore diagnosis of true rheumatoid GN was feasible only in 23 of them. GN was combined with renal amyloidosis (n = 28), minimal morphological changes (n = 19), interstitial/tubulointerstitial nephritis (n = 4), pyelonephritis (n = 4), arteriolosclerotic nephrosclerosis (n = 3). 41 patients with diagnosed pyelonephritis were found morphologically to have amyloidosis (n = 16), GN (n = 10), minimal morphological changes of renal tissue (n = 6), tubulointerstitial nephritis (n = 3), pyelonephritis, pyelonephritis alone (n = 4). CONCLUSION: The above morphological findings point to high occurrence of renal pathology in RA. In many cases morphological signs are more serious than clinical symptoms. If RA activity is not controlled, nephritis of any type may transform into amyloidosis. When it is impossible to formulate morphological diagnosis in RA patients, it is proposed to use the term "nephropathy". Unrelated to RA nephropathy's diagnosis is valid in cases when renal pathology manifested before RA. Renal diseases arising in the presence of RA may be associated with this disease and should be reflected in its classification.     

腺性膀胱炎的超声声像图表现与分型

目的探讨腺性膀胱炎的超声声像图特征及诊断价值。方法对52例经膀胱镜活检及手术病理证实的腺性膀胱炎患者的声像图表现进行回顾性总结分析。结果52例腺性膀胱炎声像图表现分为三种类型：Ⅰ型：乳头增生型22例,膀胱内壁呈乳头状或息肉样增生;Ⅱ型：结节增生型24例,膀胱内壁局限性增生呈团块状或结节状隆起;Ⅲ型：弥漫增生肥厚型6例,膀胱壁呈节段性或弥漫性增生肥厚,累及整个膀胱壁。超声与手术病理符合率90.38%（47/52）,误诊率9.62%（5/52）。结论超声检查对腺性膀胱炎具有重要的诊断价值。     

三维超声造影对肾肿瘤血管结构的初步研究

目的 探讨三维超声造影(three-dimensional contrast-enhanced ultrasound,3D-CEUS)在显示肾肿瘤血管结构中的应用价值.方法 121例常规超声提示肾肿瘤的患者,均经手术后病理证实.首先进行常规超声及超声造影检查,待造影剂基本廓清,再次注射造影剂进行3D-CEUS检查并存储图像.应用QLAB工作软件进行3D-CEUS图像重建,按照血供丰富程度将3D-CEUS图像分为4级.结果 肾良恶性肿瘤3D-CEUS血管结构表现不同.肾细胞癌实质早期3D-CEUS血管结构主要表现为迂曲扩张的粗网状或杂乱树枝状(83.17%,84/101),部分存在充盈缺损区(60.40%,61/101)及假包膜(14.85%,15/101).恶性肿瘤实质早期的血管结构主要是Ⅲ级或Ⅳ级.肾错构瘤实质早期3D-CEUS主要表现为云雾状,局部呈网状或树枝状(31.58%,6/19)或云雾状基础上叠加网状(63.16%,12/19).3D-CEUS对肾肿瘤血管结构的显示优于超声造影.结论 肾肿瘤超声造影三维重建是超声造影的有益补充.

Abstract：

Objective To evaluate the feasibility of three-dimensional contrast-enhanced ultrasound (3D-CEUS) in showing vascular patterns of renal tumors.Methods The images of 3D-CEUS examination were retrospectively analyzed in one hundred and twenty one renal tumors which were confirmed sequentially by pathology.3D-CEUS was performed after conventional ultrasound and contrast-enhanced ultrasound (CEUS).The 3D-CEUS images were reconstructed by QLAB workstation and classified into 4 grades based on the blood supply characteristics.Results All the tumors were confirmed by pathology and operations,including clear cell renal cell carcinoma (CCRCC) (n=91),papillary renal cell carcinoma (PRCC) (n=5),chromophobe renal cell carcinoma (CRCC) (n=5),renal angiomyolipoma (RAML) (n=19),and cystic nephroma (n=1).Three-dimensional reconstruction could provide clear stereoscopic views of the interested structures and morphological characteristics of lesions.The three-dimensional ultrasonography of a particular renal tumor could be a mixture of different basic grades.There were significant differences between benign and malignant renal tumors in 3D-CEUS.The image quality was the best in early parenchymal phase comparing to other phases.In early parenchymal phase,84 RCCs (83.17%) were tortuous expansive reticular or irregular messy dendritic,61 cases (60.40%) with filling defect areas and 15 cases (14.85%) with pseudocapsules.Grade Ⅲ and Grade Ⅳ were the main vascular patterns in maglinant tumors.In early parenchymal phase,6 RAMLs (31.58%) were nebulous with dendritic in part,12 cases(63.16%) were reticular on the basis of nebulous with homogeneous internal structures.The vascular pattern was shown better in 3D-CEUS than CEUS.Conclusions 3D-CEUS can provide clear stereoscopic structures and morphological characteristics of the lesions,it is a useful adjuvant of CEUS for the diagnosis of renal tumors.     

乳腺乳头状癌病理亚型病例的临床及影像学特征

  目的  研究乳腺乳头状癌病理亚型病例的超声(US)、乳房X线摄影(MG)和MRI影像图谱,对比分析乳头状癌病理亚型病例的临床和影像特征差异及其临床意义。  方法  收集2012年2月~2021年12月病理确诊的47例乳腺乳头状癌患者临床和影像学检查资料。根据世界卫生组织最新肿瘤组织学分类,将纳入的47例患者(49个病灶)分为4组:乳头状导管原位癌(pDCIS)组、包裹性乳头状癌(EPC)组、实体性乳头状癌(SPC)组和浸润性乳头状癌(IPC)组。比较不同病理组的临床特征(n=47)、US(n=47)、MG(n=45)和MRI(n=14)的影像特征差异。根据BI-RADS分类标准,将BI-RADS分类≥4A认为是阳性诊断,分析3种影像学的误诊率。  结果  临床特征:所有组中触及包块比乳头溢液更多见。pDCIS(9/16,56.3%)亚组乳头溢液占比最高,IPC亚组触诊到包块的占比最高(9/11,81.8%)。US影像特征:IPC亚组的肿块形态不规则占比高于EPC亚组(P=0.023);IPC亚组的肿块边界不清占比远高于SPC组(P=0.025);与pDCIS相比,EPC亚组的囊实性肿块占比更高(P=0.048)。MG影像特征:SPC亚组肿块形态不规则的占比最高(4/6,66.7%),EPC亚组表现为形态规则的占比最高(5/6,83.3%); 在肿块边界不清或星芒状特征方面,SPC亚组占比高于pDCIS亚组(P=0.015)。MRI影像特征:SPC组的ADC低于其他亚组(ADC=0.37×10-3 mm2/s,P=0.005),EPC亚组低于pDCIS亚组(P=0.017)。US、MG及MRI的误诊率分别为46.8%、37.8%及14.3%,US的误诊率高于MRI(P=0.029)。  结论  乳腺乳头状癌亚组之间影像特征存在重叠。虽然US和MRI均可显示肿瘤形态学特征,但US误诊率显著高于MRI。MG对肿瘤钙化类型和分布更敏感,MRI在发现肿瘤扩散及伴发的同时性肿瘤方面更有效。US显示的肿块内血流信号、US和MG显示的肿块边缘及形态、MRI表观扩散系数等影像特征在乳腺乳头状癌病理亚型病例中存在差异。      

女性腺性膀胱炎疗效分析(附65例报告)

目的 探讨女性不同程度腺性膀胱炎的治疗方法。方法 回顾性分析65例女性腺性膀胱炎患者的临床资料。结果 65例获得6～24个月随访。46例治愈，10例好转，6例排尿症状缓解，血尿消失，经常下腹及尿道口隐痛不适，3例术后6曲个月复发。无1例癌变。结论 膀胱镜检查结合组织活检是诊断女性腺性膀胱炎的重要方法，经尿道电汽化术或电切术治疗女性腺性膀胱炎疗效满意。     

表现为男性间质性膀胱炎的膀胱癌4例诊治分析并文献回顾

目的探讨表现为男性间质性膀胱炎/膀胱疼痛综合征（IC/BPS）的膀胱癌4例患者的特点及诊治经过,以期提高对男性表现为IC/BPS的膀胱癌的诊治效率。 方法收集2015年1月至2018年1月就诊于北京大学第一医院泌尿外科行膀胱水扩张随机活检的男性间质性膀胱炎患者,对住院期间相关临床资料及门诊随访资料进行分析。 结果4例术后病理确认为膀胱癌患者纳入本研究,年龄分别为53、46、71、67岁。其中1例患者曾接受前列腺钬激光剜除术。4例患者病理分别为乳头状移行细胞癌、高级别尿路上皮癌、高级别尿路上皮癌、乳头状移行细胞癌。术前自由排尿最大尿量分别为155 ml、18 ml、75 ml、93 ml,水扩张后膀胱容量为400 ml、95 ml、140 ml、250 ml。膀胱水扩张均具有黏膜苍白、广泛点状出血及局部纤维素样渗出表现,其中2例具有局部黏膜发红增厚、滤泡样改变。4例患者最终均接受了膀胱全切尿流改道术,术后疼痛症状均缓解,随访均无复发。 结论男性IC/BPS需要警惕膀胱癌的存在,推荐多位点、重复的随机活检,可能提高膀胱癌的确诊率。     

乳头状肾细胞癌伴砂粒体形成─附3例报告

本文报告了３例乳头状肾细胞癌伴砂粒体形成的病理变化和砂粒体的形态特征，探讨了砂粒体的形成机制，提出了在肾细胞癌中出现砂粒体，预示此类肿瘤生长缓慢，可能与预后有关。     

Healing process of vascular cutting edge using an Nd:YAG laser bipolar dissector

The wound healing process was histopathologically investigated in a rabbit femoral artery (n = 48) after transection using a laser bipolar dissector (LBD, 1064nm the Nd:YAG bipolar contact laser) with laser power of 13W in 0.5-sec pulses. The cutting edges were harvested immediately (n = 6) and at 1 (n = 6), 4 (n = 6), and 7 (n = 6) days, 2 (n = 6), 3 (n = 6), and 4 (n = 6) weeks, and 6 months (n = 6), and evaluated by light microscopy. During the postoperative period, no perforation was seen in the 48 transected sites with the LBD. The healing process after LBD transection was accomplished within 2 weeks by organization of the intraluminal thrombus and by the formation of granulation tissue outside the adventitia of vessels. Characteristic morphological changes after LBD transection were recognized in the tapering area, i.e., cartilage and bone formation. Cartilaginous foci (n = 6) were observed in the media at 4 weeks after transection, and osseous foci (n = 3) in subendothelial space at 6 months. These observations may suggest that the heterotopic cartilaginous and osseous metaplasia of a vessel wall may be a result of the biostimulative effects of the Nd:YAG laser.