慢性重型肝炎临床与病理诊断不一致原因综合分析

目的分析慢性重型肝炎(CSH)临床与病理诊断不相一致的原因。方法根据血清生化指标与临床症状对患者做出临床诊断,再对慢性重型肝炎肝组织做病理诊断。结果慢性重型肝炎的临床与病理诊断符合率仅为14.58%。结论慢性重型肝炎的临床与病理诊断不一致,应建立完善的临床诊断标准。     

1023例病毒性肝炎临床与病理诊断分析

探讨病毒性肝炎临床与病理诊断的符合率。将1023例病毒性肝炎临床与病理资料输入计算机,用SPSS8.0统计软件进行相关分析。各型肝炎临宋与病理诊断总符合率76．9％,诊断符合率依次为慢性肝炎重度组(CHs)81．9％,慢性肝炎轻中度组(CHL～m)81．4％,活动性肝硬变(ALC)52％,静止性肝硬变(LC)50％,急性重型肝炎(ASH)50％,急性肝炎(AH)38．6％,慢性重症肝炎(CSH)35．7％,亚急性重症肝炎(SSH)0％。临床与病理结合,有助于提高病毒性肝炎的诊断准确率。     

皮肤肿瘤232例临床与病理分析

目的分析基层医院皮肤肿瘤患病情况,探讨该地区皮肤肿瘤的发病规律。方法收集该院2011-01~2016-12期间进行皮肤组织病理活检证实为皮肤肿瘤的病例共232例。将皮肤肿瘤患者临床和病理资料整理分类,并进行统计学分析。结果 (1)良性皮肤肿瘤和恶性/交界性皮肤肿瘤的男女间差异无统计学意义。(2)组织来源上数量最多的依次是表皮肿瘤和黑素细胞性肿瘤。(3)数量最多的皮肤肿瘤依次是脂溢性角化症、基底细胞癌、色痣、皮肤纤维瘤和鲍温病。(4)临床与病理符合率较低,仅为52.59%。(5)恶性/交界性肿瘤患者确诊时的年龄显著高于良性肿瘤患者,差异有统计学意义(P0.01)。(6)暴露部位更容易发生恶性/交界性肿瘤。结论该院皮肤肿瘤行病理检查中以表皮肿瘤和黑素细胞性肿瘤多见,病理送检率偏低,临床和病理诊断符合率低。临床医师尤其是基层医师应加倍重视组织病理活检,尤其是对年长者暴露部位的皮肤肿物。     

肿瘤病理诊断进展

［摘要］　肿瘤病理精准诊断对指导临床治疗及判断预后至关重要,形态学是病理诊断的基石,免疫组化检测帮助病理诊断,而分子检测助力病理诊断及指导临床精准治疗。人工智能技术与病理形态学诊断不断融合,基于深度学习的人工智能使计算机自动处理病理形态并辅助精确诊断成为可能,进而使病理诊断逐渐走向智能化。该文就肿瘤病理诊断新进展进行阐述。     

卵巢混合性生殖细胞肿瘤病理特征及诊断分析

目的分析卵巢混合性生殖细胞肿瘤的临床病理特征,探讨肿瘤中各成分漏诊、误诊情况及其原因。方法收集36例确诊为卵巢混合性生殖细胞肿瘤的病例资料,并进行形态学观察及免疫组化检查。结果 36例患者发病年龄为6～63岁,中位年龄22.4岁。所有肿瘤均含有两种或两种以上生殖细胞肿瘤成分。其中13例漏诊卵黄囊瘤成分,2例漏诊无性细胞瘤成分,1例漏诊绒癌成分,漏诊率达44.4%; 1例误诊为透明细胞癌。结论卵巢混合性生殖细胞肿瘤存在多种肿瘤成分,各成分比例不同,生长方式也不同,不同类型生殖细胞肿瘤在处理方式和预后存在差异。     

205例老年人涎腺肿瘤临床病理分析

２０５例老年人涎腺肿瘤临床病理分析南京医科大学口腔病理教研室（２１００２９）宋晓陵南京市口腔医院病理科陈君勤口腔颌面部肿瘤对老年人健康危害极大。在老年人口腔肿瘤中，涎腺上皮来源的良恶性肿瘤占有相当大的比例，为探索其临床病理特点，现将我们在过去１０年中...     

胰腺肿瘤的病理诊断和鉴别诊断

胰腺肿瘤发病率近年呈上升趋势,本文仅就胰腺外分泌的上皮性肿瘤的主要类型加以介绍。其中包括胰腺导管腺癌及其主要的变型和腺泡细胞癌、胰母细胞瘤等。文中还包括了浆液性囊性肿瘤、黏液性囊性肿瘤、导管内乳头状黏液肿瘤（IPMN）和导管内乳头状嗜酸性肿瘤以及实性一假乳头状肿瘤,对上述个性肿瘤的免疫组化特点和分子特征也进行了阐述。     

卵巢转移性肿瘤37例临床与病理分析

目的 分析和总结卵巢转移性肿瘤的临床和病理特征.方法 回顾广西壮族自治区人民医院近6年间手术治疗的卵巢转移性肿瘤共37例,分析其病理形态、免疫组织化学等病理学特征和临床资料.结果 卵巢转移性肿瘤发病年龄15~69岁,平均年龄43.6岁.临床表现为非特异性,多以附件包块伴有腹水为主要特征,占45.9%(17/37),癌细胞检出率高达64.7%(11/17).双侧卵巢发生有24例,占64.9%(24/37).临床误诊率高达59.5%(22/37).肿瘤组织形态多数以印戒细胞癌和腺癌结构为主要表现.来源部位胃肠道肿瘤占75.6%,子宫内膜样腺癌占16.2%.结论 卵巢转移性肿瘤以胃肠道肿瘤转移最为常见,确诊需病理特征与临床资料相结合.女性胃肠癌手术史者,需密切随访,警惕卵巢转移性肿瘤的发生.     

11例儿童原发性心脏肿瘤临床病理分析

目的探讨儿童原发性心脏肿瘤的临床病理特征。 方法选取2010年11月至2018年4月郑州儿童医院收治的11例原发性心脏肿瘤患儿,所有患儿均接受手术治疗,术中取肿瘤组织标本进行观察。 结果11例儿童原发性心脏肿瘤均为良性肿瘤,包括5例心脏横纹肌瘤、5例心脏纤维瘤、1例心脏黏液瘤。 结论原发性心脏肿瘤在儿童群体中发病率较低,且多为良性,其中心脏纤维瘤及心脏横纹肌瘤相对较常见,不同类型原发性心脏肿瘤均具有典型病理学特征,经免疫组化检查可准确诊断疾病。     

原发性气管支气内肿瘤：附30例临床病理分析

本文报道气管、支气管内原发性良，恶性肿瘤３０例，男１７例，女３例，年龄１０－７４岁，平均３９．２岁，恶性肿瘤１９例占６３．３％，良性１１例，占３６．７％，讨论气管、支气管内肿瘤病理类型特点，生物学行为及预后，并简要探讨了气管，支气管内肿瘤的手术及激光疗沓。     

慢性肝炎临床与病理对照分析

为提高慢性肝炎临床诊断的正确性，按2000年“病毒性肝炎防治方案”对774例慢性肝炎患者临床表现、七项血液生化学指标ALT、AST、总胆红素(TSB)、白蛋白(ALB)、白蛋白／球蛋白比值(A／G)、γ—球蛋白(γ—G)、凝血酶原活动度(PTA)及门静脉内径(MPV)、脾静脉内径(SPV)、脾厚与病理对照分析。结果临床表现如乏力、腹胀、纳差、恶心、厌油、黄疸、鼻／牙龄出血、蜘蛛痣及血液指标ALT、TSB、PTA、ALB、A／G均能较好反映肝组织炎症活动程度，PTA、ALB、γ—GT、A／G能较好反映肝纤维化进程，脾厚是反映早期肝纤维化较敏感指标。     

Pulmonary pathology in patients with AIDS: an autopsy study from Mumbai

Objective Although India has a high prevalence of HIV/AIDS, the associated pathologies responsible for morbidity have not been evaluated previously in a representative study. Hence, an autopsy study was carried out to analyse the spectrum of pulmonary lesions in patients with HIV/AIDS. Methods A retrospective and prospective autopsy study was carried out during 1988–2000 at Mumbai, India. Lungs from 143 adults, with at least 10 sections from each case, were examined using routine and special stains. Results The risk factors for 97 men (68%) and 38 women (27%) included: heterosexual sex with multiple partners (135 cases, 95%); blood transfusions (three cases; 2%); sex between men (two cases; 1%); and unknown risk factors (three cases, 2%). Pulmonary pathology was observed in 126 (88%) cases. The lesions identified were tuberculosis (85 cases, 59%), bacterial pneumonia (26 cases, 18%), cytomegalovirus (CMV) infection (10 cases, 7%), cryptococcosis (eight cases, 6%), Pneumocystis carinii pneumonia (seven cases, 5%), aspergillosis (four cases, 3%), toxoplasmosis (two cases, 1%), Kaposi's sarcoma (one case, 1%), squamous cell carcinoma (one case, 1%). Two or more infections were observed in 18 (13%) cases. Conclusions Pulmonary diseases and risk factors among patients with AIDS in India differ from those reported in industrialized countries. Tuberculosis was the most frequently observed pulmonary infection, followed by bacterial pneumonia and CMV pneumonitis. In contrast with industrialized countries, PCP remains less common in our patients. The information on opportunistic infections obtained in this study will be useful for managing HIV/AIDS cases at district level hospitals where diagnosing specific HIV‐associated diseases is not always possible.     

Bronchial carcinoid tumor in a 12-year-old child

Symptoms (hemoptysis, recurrent pulmonary infections), diagnostic work-up (roentgenology, bronchoscopy with biopsy), and treatment (surgical resection of a bronchial carcinoid tumor in a 12 year old girl) are discussed. Special attention was paid to the tumor histochemistry, showing serotonin containing granules. Levels of circulating hormones and vasoactive agents, including serotonin, were within normal limits.     

Reproducibility and prognostic significance of area of residual tumor (ART) in post-neoadjuvant resections of pancreatic ductal adenocarcinoma

BackgroundThe pathologic assessments of tumor response after neoadjuvant chemoradiotherapy (NACRT) are critical to improving the prognostic stratification for patients with pancreatic ductal adenocarcinoma (PDAC). Here we clarified the utility of our new grading system based on the area of residual tumor (ART) as compared to existing systems, such as the College of American Pathologists (CAP) and MD Anderson (MDA) score. Methods: Eight reviewers individually evaluated the tumor regression grade of 30 patients with PDAC based on three types of grading systems. The interobserver concordance and clinicopathological characteristics were compared between the three systems. Results: The interobserver concordance (kappa value) of the ART, CAP, and MDA score were 0.61, 0.48, and 0.53, respectively. Discrepant cases, which were 27% of the cases, exhibited smaller tumor and tumor bed sizes than concordant cases. The reduction in tumor size evaluated by microscopy showed a correlation with the rate of change in carcinoembryonic antigen (CEA) level, CA19-9 level, and tumor size on computed tomography (CT). The ART score was correlated with the tumor size on CT before and after NACRT and disease-free survival. The CAP and MDA scores were not associated with prognosis. Conclusion: The ART grading system may be the most practical system to assess the tumor response in post-NACRT resections of PDAC.     

非酒精性脂肪性肝炎临床检验指标与病理特点的关系

目的探讨非酒精性脂肪性肝炎（NASH）患者的临床检验指标与病理特点之间的关系,以期能为该病的临床诊断与预后提供信息。方法回顾性分析2008年5月至2011年12月本院收治的206例经肝组织学检查确诊的NASH患者的临床资料,并对ALT、AST等检验指标以及肝穿刺病理结果等相关资料进行统计学分析。不同程度的脂肪变性、炎症和肝纤维化间的检测采用独立样本的t检验或者单因素方差分析,相关性分析采用Spearman分析。结果ALT、AST、乳酸脱氢酶（LDH）对于判断肝脂肪变性、炎症及纤维化3种病理改变程度均具有统计学意义（P均〈0．05）;白细胞（WBC）、碱性磷酸酶（ALP）对于判断肝脂肪变性及纤维化程度具有统计学意义（均为P〈0．05）;平均红细胞体积（MCV）、血小板（PLT）、白蛋白（Alb）、胆碱酯酶（CHE）、γ-球蛋白电泳（γ—EP）、葡萄糖（Glu）对于判断肝脂肪变性程度具有统计学意义（P均〈0．05）;不同的肝脂肪变性程度与炎症程度、纤维化程度,不同的炎症程度与纤维化程度之间均有相关性（相关系数分别为0．261、0．561、0．353,P均〈0．05）。结论 ALT、AST、LDH对于判断肝脂肪变性、炎症及纤维化程度,WBC、ALP对于判断肝脂肪变性及纤维化程度,MCV、PLT、Alb、CHE、叫一EP、Glu对于判断肝脂肪变性程度具有统计学意义。     

Worldwide trends in lung cancer pathology

Molecular profiling studies serve to remind us that lung cancer is a complex disease, with different phenotypes that are characterized by variation in morphology as well as molecular composition. Over recent decades, there appear to be worldwide shifts in the relative frequencies of various phenotypic patterns of lung cancer, which are even more striking than changes in the overall incidence of lung cancer. This review summarizes major worldwide trends in lung cancer pathology, which can be explained in part, but not entirely, by changes in cigarette design. Characterizing these trends will be important for recognizing contributions of carcinogens other than tobacco smoke to the worldwide problem of lung cancer.     

原发性胆汁性肝硬化患者临床与病理学特点

目的:探讨不同程度的原发性胆汁性肝硬化(PBC)患者临床与病理特点.方法:根据PBC患者是否已进展至肝硬化将患者分为慢性胆管炎组(CC)和肝硬化组(LC),比较两组患者生化指标、肝脏组织学变化及临床并发症的差异,所有患者均给予熊去氧胆酸(UDCA)治疗,观察患者1年转归情况.结果:CC组患者病理损伤轻,对治疗敏感,LC组患者病理损伤重,治疗效果差,易出现进行性升高性黄疸、慢性肝功能衰竭.结论:PBC患者早期使用UDCA治疗有助于控制病情进展,当本病进展至肝硬化期则预后不良.     

慢性乙肝患者血清铁蛋白与肝组织病理学的关系

探讨慢性乙型肝炎(CHB)血清铁蛋白(serum ferritin,SF)含量与肝功能、肝纤维化指标及肝脏病理的关系。对140例行肝组织活检患者的血清标本进行SF、肝功能、肝纤维化指标检测。结果显示:CHB临床各型SF水平随着病程的进展逐渐升高,与对照组比较有显著差异(P<0.01)。SF与肝组织病理分级、分期、肝纤维化指标及肝功能存在相关性。认为SF可作为肝脏组织病理损害的判断指标之一,检测SF有助于了解肝细胞受损程度。     

Concordance among hematopathologists in classifying blasts plus promonocytes: A bone marrow pathology group study

Enumeration of blasts and promonocytes is essential for World Health Organization (WHO) classification of myelomonocytic neoplasms. The accuracy of distinguishing blasts, promonocytes and monocytes, including normal vs abnormal monocytes, remains controversial. The objective of this analysis is to assess concordances between experienced hematopathologists in classifying cells as blasts, promonocytes, and monocytes according to WHO criteria. Each of 11 hematopathologists assessed glass slides from 20 patients [12 with chronic myelomonocytic leukemia (CMML) and 8 with acute myeloid leukemia (AML)] including blood and BM aspirate smears, and limited nonspecific esterase (NSE) stains. All cases were blindly reviewed. Fleiss’ extension of Cohen's kappa for multiple raters was used on these variables, separately for peripheral blood (PB) and bone marrow (BM). Spearman's rank correlation was used to assess correlations between each pair of hematopathologists for each measurement. For the classification based on the sum of blasts and promonocytes in the BM, Fleiss’ kappa was estimated as 0.744. For PB, categorizing patients according to the sum of blasts and promonocytes, Fleiss’ kappa was estimated as 0.949. Distinction of abnormal monocytes from normal monocytes in PB did not achieve a good concordance and showed strong evidence of differences between hematopathologists (P < .0001). The hematopathologists achieved a good concordance rate of 74% in CMML vs AML classification and a high k rate, confirming that criteria for defining the blasts equivalents (blasts plus promonocytes) could be applied consistently. Identification of monocyte subtypes (abnormal vs normal) was not concordant. Our results support the practice of combining blasts/promonocytes into a single category.     

Elevated (> or = 10%) MIB-1 proliferative index correlates with poor outcome in gastric stromal tumor patients: a study of 35 cases

Mitotic activity and tumor size are currently regarded as the most powerful prognostic indicators for patients with gastrointestinal stromal tumor (GIST). This retrospective study evaluated the prognostic accuracy of MIB-1 proliferative index (PI) in combination with these two indicators in 35 GIST patients. Within a high-risk group, determined initially by tumor size and mitotic count, overall survival was significantly shorter for patients whose tumors had PI 10% MIB-1 positive cells. When tumor location (gastric versus small intestine) was taken into account, a combination of tumor size, mitotic count, and PI 10% identified a subgroup of patients with significantly shorter survival for gastric (but not small intestinal) GIST. Based on our results, MIB-1 immunostaining, when used in combination with tumor size and mitotic count, appears to be a powerful tool for identifying patients, especially those with gastric tumors, at high risk of recurrence and early tumor-related death.