妊娠合并卵巢肿瘤临床病理分析

目的探讨妊娠合并卵巢肿瘤的临床病理特征及诊断处理方案。方法对手术、病理诊断明确的78例妊娠合并卵巢肿瘤孕妇的临床病理资料进行回顾性分析。结果经手术、病理诊断明确的妊娠合并卵巢肿瘤78例,占同期妊娠者的0.09%(78/84253),良性肿瘤占96.15%(75例),以良性畸胎瘤、上皮性囊肿多见。卵巢交界性肿瘤占2.56%(2例),卵巢恶性肿瘤占1.28%(1例),并发症以卵巢肿瘤蒂扭转多见。大多行一侧附件切除术或卵巢肿瘤剔出术。结论妊娠合并卵巢肿瘤多为良性,无明显症状,应注意早期诊断,处理应根据孕周和肿瘤的性质区别对待。     

金属硫蛋白基因在上皮性卵巢肿瘤中的表达及临床意义

目的 研究金属硫蛋白（MT）基因在上皮性卵巢肿瘤中的表达及临床意义。方法 采用SABC免疫组化法，对72例上皮性卵巢肿瘤中金属硫蛋白的表达进行检测。恶性肿瘤、交界性肿瘤和良性肿瘤MT的表达分别为64．4％，30．0％和11．8％，恶性肿瘤，交界性肿瘤MT的表达明显高于良性肿瘤（分别为P＜0．01和P＜0．05）。随肿瘤组织病理分级及临床分期的增高，MT的表达也增加（P＜0．05）。MT高表达者的生存期明显缩短。结论 MT参与了上皮性卵巢恶性肿瘤的发生与发展，并有可能成为一个判定预后的有效指标。     

血管内皮生长因子及其受体在卵巢癌中表达的免疫组化 …

目的;检测血管内皮生长因子（ＶＥＧＦ）及其受体（ＫＤＲ０在卵巢癌中的表达,并探讨其与卵巢癌发生的关系。方法：采用ＳＡＢＣ免疫组化染色法,对６６例卵巢肿瘤中,ＶＥＧＦ和ＫＤＲ的表达进行检测。结果：恶性,交界性及良性卵巢肿瘤中,ＶＥＧＦ和ＫＤＲ的表达率分别为７２．９％,７５．００Ａ％,３８．４６及５４．０５％,４３．７５％〈７．６９％;恶性肿瘤及交界性肿瘤ＶＥＧＦ和ＫＤＲ的表达,明显高于良性肿瘤。     

急性心肌梗死患者务清肌钙蛋白T和C反应蛋白变化及其意义

目的：评价血汪肌钙蛋白T（TnT）和C反应蛋白（CRP）在急性心肌梗死（AMI）和不稳定型心绞痛（UAP）的早期诊断及预后评价。方法：分析了AMI48例，UAP45例及健康对照36人血清CRP、TnT、肌酸激酶（CK）和同工酶（CK－MB）水平，并对结果行配对χ^2检验。结果：AMI组入院时血清CRP和TnT阳性率分别为81．3％和97．9％，均明显高于同时间CK和CK－MB的阳性率（p均＜0．01）；UAP组血清CRP、TnT、CK及CK－MB阳性率分别为42．2％、13．3％、11．1％及6．7％。健康对照组36例四项指标均无1例阳性。结论：TnT和CRP在早期辅助诊断AMI和评估UAP患者预后中有应用价值，CK、CK－MB和CRP、TnT联合测定可以提高对AMI诊断的准确性。     

卵巢肿瘤细胞DNA及RNA含量的定量分析及其临床意义

本资料对９３例不同性质的卵巢肿瘤细胞ＤＮＡ及ＲＮＡ含量进行了定量研究，其中５０例良性、４３例恶性。并对患者进行１～５年的随访。结果是卵巢良性肿瘤的异倍率（假阳性）为４４％，恶性肿瘤异倍率为８６．０％。以“标准ＤＩ”及“标准ＲＩ”为指标判断卵巢肿瘤性质的准确率较以“异倍性”为高，且双指标同时应用高于任一单指标：对卵巢良恶性肿瘤的诊断准确率分别为９０％和９５．３％。提出“标准ＤＩ”和“标准ＲＩ”是判断卵巢肿瘤性质的理想指标。且ＤＮＡ及ＲＮＡ含量与卵巢癌预后有密切关系。     

血清AFP、CEA、CA50、CAl9．9、CAl25联合检测对卵巢恶性肿瘤的诊断及复发的价值

目的 探讨血液中AFP、CEA、CA50、CA19.9、CA125含量的联合检测对恶性卵巢肿瘤的诊断及预后的临床价值.方法 采用放免法(RIA)测定138例患者治疗前后的血清5项指标含量(恶性卵巢肿瘤48例、卵巢良性肿瘤55例及良性包块35例).结果 联合检测恶性卵巢肿瘤性率95.8％(46/48),明显高于卵巢良性肿瘤、良性包块及CA125单项检测阳性率(p<0.05).卵巢良性肿瘤及良性包块的联合检测阳性率分别为12.7％(7/55)和77.1％(27/35),与CA125单项检测率无差异(P>0.05).非上皮性肿瘤联合检测阳性率明显高于CA125阳性率(p<0.05).恶性卵巢肿瘤I期-Ⅱ期联合检测阳性率明显高于CA125阳性率无差异(p<0.05).Ⅲ期-Ⅳ期CA125阳性率与联合检测阳性率无差异(p>0.05).48例恶性卵巢肿瘤经化疗或手术治疗后,证实复发有10例.联合检测阳性9例,CA125阳性5例(p(0.05).结论 上述五项指标联合检测对恶性卵巢肿瘤的诊断及预后有较高的临床价值.     

伴有浸润性微乳头状癌结构乳腺癌的诊断和预后研究

目的探讨伴有浸润性微乳头状癌（IMPC）结构乳腺癌的临床病理特征和诊断标准及其与预后相关因素的关系。方法复习1989—2001年间乳腺癌存档切片,按2003年WHO乳腺病理学标准诊断含有IMPC结构的乳腺癌100例,98例获得随访结果。结果100例具有IMPC结构乳腺癌中,淋巴管侵犯率69％（69／100）,淋巴结转移率84．8％（84／99）;98例平均随访60．1个月。结果显示,11．2％（11／98）局部复发（术后平均存活26．4个月）,38．8％（38／98）远位转移（术后平均存活36．0个月）,36．7％（36／98）死于肿瘤,术后5年生存率59％,10年生存率48％;单因素及多因素生存分析均显示有肿瘤家族史及淋巴管侵犯的患者预后差,内分泌治疗可降低患者死亡的风险,单因素生存分析显示术后化疗可提高患者生存率。结论伴有IMPC结构的乳腺癌是一种预后极差的恶性肿瘤,无论肿瘤中IMPC结构比例占多少都应引起重视,预后与肿瘤家族史、淋巴管侵犯有关,内分泌治疗及个体性化疗可能是提高生存率的有效方法。     

联合心脏瓣膜病101例外科治疗及疗效分析

目的：总结二尖瓣主动脉瓣双瓣置换术（DVR）治疗联合心脏瓣膜病的外科治疗经验。方法：2008年1月-2011年12月,我科室应用DVR术治疗联合心脏瓣膜疾病101例,其中男46例、女55例,年龄32～63岁,体重45．2～68k。风湿性心脏瓣膜病81例,退行性变瓣膜病变14例,感染性心内膜炎6例。NYHA心功能Ⅱ级16例,Ⅲ级74例,Ⅳ级11例。结果：全组体外循环时间（107．8±34．4）min,主动脉阻断（78．5±27．2）rain,术后呼吸机辅助（10．5±4．8）h,术后监护（61．2-．I-15．5）h,术后住院（10．4±4．3）d。手术死亡6例（5．94％）,各类手术并发症22例（21．78％）。术后84例随访时间4—48月,11人失访。随访患者心功能都有不同程度好转,活动能力显著改善;术后2年出现左房血栓1例,脑栓塞致左侧肢体瘫痪1例,二尖瓣轻度瓣周漏1例,尚未发现死亡病例。结论：充分的术前准备,术中良好的心肌保护,主动脉瓣间断缝合、二尖瓣连续缝合、保留二尖瓣后瓣及三尖瓣环缩等外科技术的改进和加强术后处理可降低双瓣膜置换术的风险,提高疗效。     

老年妇科手术患者216例分析及护理对策

目的探讨60岁以上妇科疾病手术患者的临床特点,病种类型及围手术期相关问题及护理对策。方法对216例60岁以上妇科住院患者进行回顾分析。结果资料显示老年妇科疾病中以生殖器恶性肿瘤（40．28％）和子宫脱垂伴阴道壁膨出（25．46％）最常见,以阴道流血、白带异常为最常见临床症状。125例手术治疗患者安全渡过围手术期。结论根据老年妇科疾病的临床特征进行早期诊断,早期治疗、手术方式选择恰当,术前准备充分,加强术中、术后护理,绝大多数老年妇科患者能顺利渡过围手术期,健康生活。     

足踝部骨与关节肿瘤及瘤样病变103例分析

目的研究足踝部骨与关节肿瘤及瘤样病变的发病规律。方法总结20年来齐鲁医院经病理确诊的足踩郜骨肿瘤及瘤样病变103例，结合文献分析。结果最高发病年龄集中于10～39岁组之间，男性多于女性，其比例为1．45：1。病变多何于跗骨，跖骨，趾骨。良性肿瘤及瘤样病变明显多十恶性肿瘤，其比例为6．38：1。良性肿爝67例，其中骨软骨瘤、软骨瘤最多见（占良件肿瘤的55．22％）；瘤样病变16例中，骨囊肿9例，最多见（占56125％）：恶性肿瘤13例，以滑膜肉瘤和软骨肉瘤最多见（分别有5例及3例）。结论足踩部骨肿瘤与瘤样病变良性多于恶性，病变多位于跗骨与跖骨。对足部恶性肿瘤的诊断应重视。     

鼻内镜辅助下面中揭翻术治疗翼腭窝及其毗邻区域肿瘤的临床研究

目的：探讨鼻内镜辅助下面中揭翻术切除翼腭窝及其毗邻区域肿瘤的优缺点,以提高疗效,减少并发症和后遗症。方法：采用鼻内镜辅助下面中揭翻进路手术治疗翼腭窝及其毗邻区域肿瘤患者28例,其中良性肿瘤21例、恶性肿瘤7例。结果：本组28例手术均顺利,肿瘤切除彻底。术后随访0．5～5a,21例良性肿瘤患者无一例复发;7例恶性肿瘤患者术后均行放化疗,其中2例分别于术后8个月和10个月死于局部侵犯及远处转移,生存期0．5～4a3例,5a及以上2例。结论：鼻内镜辅助下面中揭翻术适用于鼻腔、鼻窦、鼻咽、翼腭窝的良性肿瘤及生长缓慢侵犯翼腭窝及其毗邻区域的恶性肿瘤,具有微创、恢复快、面部无疤痕等优点。     

Mural nodules of anaplastic carcinoma in bilateral ovarian borderline mucinous cystadenoma: a case report

The occurrence of mural nodules in serous or mucinous ovarian tumors is not frequent but is currently well established. Mural nodules can developed in benign, borderline or malignant tumors. They can be reactive, benign or malignant. In these situations, the nodule may be carcinomatous, sarcomatous or mixed. Thus, the prognosis of the ovarian tumor can be dramatically modified by the presence of this nodule. About twenty cases of mural nodules of anaplastic carcinoma have been described. We report an additional case of two mural nodules of anaplastic carcinoma associated with bilateral ovarian borderline mucinous tumor. This tumor was synchronous with a renal cell carcinoma. We give details about the classification, the differential diagnoses and prognosis of these nodules.     

腹腔镜手术在老年女性卵巢良性疾病治疗中的应用

目的：探讨腹腔镜手术在老年女性卵巢良性疾病治疗中的应用价值和安全性。方法：收集我院2007年7月至2011年7月因卵巢良性疾病行腹腔镜手术的60岁以上患者30例为腹腔镜（A组）,随机选取同期60岁以上卵巢良性疾病经腹手术患者26例作为对照组（B组）,比较两组术中、术后情况。结果：与经腹手术组比较,腹腔镜组术中循环功能更稳定,术后镇痛方式简单、胃肠及膀胱功能恢复更快、并发症发生率低、抗生素用量少、住院时间短。结论：对老年女性卵巢良性疾病患者,腹腔镜手术对患者的心、肺及内环境影响小,术后恢复快,在老年女性中是安全可行的。     

Fascin and EMMPRIN expression in primary mucinous tumors of ovary: A tissue microarray study

ObjectivesThe aim of this study was to compare the expressions of fascin and EMMPRIN in primary malignant, borderline and benign mucinous ovarian tumors, and to investigate the relationship of these markers with tumor progression and their applicability to differential diagnosis.Materials and methodsAn immunohistochemical study was performed for fascin and EMMPRIN using the tissue microarray technique. Eighty-one cases were included in the study; there were 37 benign, 25 borderline and 19 malignant primary mucinous ovarian tumors. For each case, a total staining score was determined, consisting of scores for extent of staining and intensity of staining. The cases were allocated to negative, weakly positive and strongly positive staining categories, according to the total staining score.ResultsBoth of the markers were significantly negative in benign tumors as compared with borderline and malignant tumors. There was no significant difference between borderline and malignant groups for both markers. Sixty-eight percent of malignant tumors were stained positive by fascin, while this rate was 40% for borderline mucinous tumors. All malignant tumors were strongly stained positive for EMMPRIN, while this rate was 92% for borderline mucinous tumors. The rest of the cases stained weakly positive. No significant difference in staining score was found between fascin and EMMPRIN expression.ConclusionsIn ovarian primary mucinous tumors, fascin and EMMPRIN may play an important role in tumor progression from benign tumor to carcinoma. In that context, EMMPRIN and fascin expression may have potential application in the differential diagnosis of some diagnostically problematic mucinous ovarian tumors. However, the differential diagnostic applicability of EMMPRIN appears to be more limited than that of fascin due to its wide spectrum of staining in mucinous ovarian tumors.     

Ovarian epithelial tumors of borderline malignancy]

Ovarian tumor is known to show histological variation. Each tumor shows various clinical behavior. Ovarian epithelial tumors consist of several types of histological findings. Epithelial tumors can be classified into benign, borderline malignancy and malignant for their biological behavior. Recently the therapeutic effectiveness against ovarian cancer is increasing in order to establish the operation technique and development of chemotherapeutic method with cisplatin. Therefore it is important that borderline malignant tumors which are said to have a good prognosis be defined from obviously malignant tumors to evaluate accurately the effectiveness of the therapy against the ovarian cancer. On the other hand, borderline malignant tumors with characters of a malignant tumor, must be distinguished from benign adenoma because long-term follow up is required. However, it is difficult to make an exact histological diagnosis of benign adenoma, borderline malignancy and malignancy because the histological criteria of borderline malignancy is lacking in concreteness. The histological criteria should be defined more clearly and concretely. For example, mitotic counts per 10 HPF of borderline malignancy and DNA ploidy. Next, because of good prognosis, we need a quick therapeutic guide line for borderline malignancy, especially for stage I and young women.     

Diagnosis of ovarian tumor by measuring tumor markers]

Values of CA125, CA19-9, TPA, CA72-4, BFP and LDH in sera were detected in 148 malignant ovarian tumors, 41 borderline malignant ovarian tumors, 71 benign ovarian tumors and 64 benign uterine diseases. A new cut-off value was determined by ROC graph for distinguishing malignant and borderline ovarian tumors from benign ovarian tumors. CA125 (cut off: 30 U/ml) was a highly sensitive marker for malignant and borderline malignant ovarian tumors, the value being 88.1% (52/59) and 81.8% (9/11), respectively. On the other hand, in 37 benign ovarian tumors, the positive rate was 21.6% and in 21 benign uterine diseases it was 52.4%. CA19-9 (cut off: 150 U/ml) was inferior to CA125, but it was an effective marker for mucinous ovarian tumors. TPA (cut off: 40 U/ml) was also a sensitive (84.7%, 50/59) marker of malignant ovarian tumors. CA72-4 (cut off: 4 U/ml) was a highly specific (87.0%, 60/69) marker of malignant ovarian tumors. Combination assays of CA125/CA19-9, CA125/TPA and CA125/CA72-4 were not effective. Usefulness of BFP for early malignant ovarian tumors was suggested. Seven cases of dysgerminoma showed extremely elevated LDH levels (1,248 +/- 886 IU/1/37 degrees C). Malignancy and histological type of ovarian tumors could be decided by combination assay of these tumor markers, before surgical operation.     

血清中人附睾上皮分泌蛋白4的测定与卵巢上皮性肿瘤患者临床病理特征的关系

为探讨卵巢上皮性肿瘤患者血清人附睾上皮分泌蛋白4（HE4）水平的变化,以及与临床病理特征的关系,采用酶联免疫吸附试验（ELISA）检测21例良性卵巢上皮肿瘤患者、12例交界性卵巢上皮肿瘤患者和49例卵巢癌患者血清HE4水平,并分析其水平与临床病理特征的关系。卵巢癌组血清HE4水平（中位数123.00pmol/L）明显高于交界性卵巢上皮肿瘤组（中位数41.20pmol/L）和良性卵巢上皮肿瘤组（中位数32.80pmol/L）;血清HE4水平与卵巢上皮性癌患者是否绝经、年龄及有无淋巴结转移无关（P〉0.05）,而与患者的临床FIGO分期（Ⅰ＋Ⅱ、Ⅲ＋Ⅳ）、病理组织学类型及有无腹水有关（P〈0.05）,浆液性癌（中位数198.50pmol/L）和子宫内膜样癌患者的血清HE4水平（中位数139.25pmol/L）明显高于黏液性癌患者（中位数30.95pmol/L）（U值分别为17.00和2.00,P〈0.01）。血清HE4水平与卵巢上皮性癌临床病理特征密切相关,并有望成为卵巢上皮性肿瘤恶变的标志物。     

57例卵巢癌的预后影响因素分析

目的：探讨卵巢癌的预后影响因素。方法：对1998年1月至2010年12月在我院诊断治疗的57例卵巢癌患者的临床资料进行回顾性分析，比较不同年龄、肿瘤病理类型、临床分期、组织分化程度、残余瘤大小及化疗疗程数问患者的五年生存率。结果：57例中，年龄〉40岁组40例、≤40岁组17例，5年生存率分别为42．5％和47．05％，组间比较差异无统计学意义（P〉0．05）；卵巢上皮性癌45例，非上皮性癌12例，5年生存率分别为44．44％和41．6％，组间比较差异无统计学意义（P〉0．05）。不同组织分化程度（高和中-低）、手术病理分期（Ⅰ-Ⅱ和Ⅲ-Ⅳ期）、残余肿瘤直径（≤2cm和〉2cm）、化疗疗程数（t〉6和〈6个）患者的5年生存率分别为73．33％和33．33％、72．41％和14．29％、53．19％和0、53．85％和22．22％，组间比较差异均有统计学意义（P〈0．05）。结论：年龄、病理类型与卵巢癌预后无关，手术病理分期、组织分化程度、残余肿瘤直径、化疗疗程数是卵巢癌的独立预后影响因素。努力提高卵巢癌的早期诊断、做到早期治疗，术后及时辅以正规、足疗程化疗是提高卵巢癌患者生存率的关键。     

卵巢Brenner肿瘤24例临床病理分析

目的 探讨卵巢Brenner肿瘤(Brenner tumor,BT)的临床病理学特征、治疗及预后.方法 回顾性分析2013年3月 ～2020年3月南京医科大学附属无锡妇幼保健院收治的24例卵巢BT患者的临床资料、病理学特征及免疫表型,并复习相关文献.结果 24例BT中16例(66.7％)为良性BT,7例(29.2％)为...     

Ovarian tumors of borderline malignancy (tumors of low malignant potential): a critical appraisal.

Before the designations borderline malignancy and low malignant potential were used, the surface epithelial-stromal tumors of the ovary were simply classified into benign and malignant categories. The introduction of the borderline category of tumors has been a great advancement in classification, because it has set apart from the general group of surface epithelial cancers a subgroup with a much better prognosis, stage-for-stage, than that of conventional ovarian carcinomas. Over the last 20 years, pathologists have learned to recognize the distinctive clinicopathologic features of serous borderline tumors as well as the adverse prognostic significance of the associated invasive peritoneal lesions, whether they may represent true implants or independent primary tumors. We have urged our surgical colleagues to search for the peritoneal lesions, and sample them meticulously, and advised our fellow oncologists not to administer adjuvant therapy to patients with noninvasive implants lacking malignant epithelial cells. There is now convincing evidence in the literature that the only fatal cases of serous borderline tumors are those associated with invasive implants, and chemotherapy is indicated only for these rare tumors. It has also been demonstrated that Stage I intestinal mucinous borderline tumors and noninvasive well-differentiated mucinous carcinomas both have an almost equally good prognosis. The current treatment for pseudomyxoma peritonei is still unsatisfactory, but we have recently learned that most of the mucinous ovarian tumors associated with pseudomyxoma peritonei are secondary to similar tumors of the appendix. In the remaining cases, however, the ovarian tumor appears to be responsible for the pseudomyxoma peritonei. Borderline tumors also exist in the endometrioid, clear cell, and Brenner surface epithelial categories, but these tumors have been too rare for clear delineation of their clinical and pathologic features. Recently, some investigators have proposed to abandon the borderline category and to return to the old benign-malignant classification system by dividing unevenly the borderline tumors into a larger group of atypical proliferative epithelial cystadenomas and a smaller category of recently described but still not well-characterized noninvasive carcinomas. In the author's opinion, such a recommendation is misleading because it ignores the possibility of rare but significant behavioral exceptions on each of these two groups of tumors. Furthermore, careful tumor staging is mandatory in both instances regardless of the type of terminology used. It is hoped that by keeping the borderline designation, knowledge on this group of ovarian tumors will continue to expand as it has been until now.