胰腺实性-假乳头状肿瘤的超微结构研究

目的探讨胰腺实性-假乳头状肿瘤(SPTP)的超微病理特征、鉴别诊断及组织起源。方法对3例SPTP进行了电镜观察。结果电镜观察见肿瘤细胞大小形态较一致,核圆形或卵圆形,异型不明显,可见核沟,核分裂象罕见.瘤细胞有丰富的线粒体及粗面内质网,可见到神经分泌颗粒,酶原样颗粒及特征性的环状板层体。结论SPTP可能起源于胰腺原始多潜能干细胞,诊断上须与胰腺其它良恶性肿瘤相鉴别.     

胰腺实性假乳头状肿瘤临床病理分析

目的 探讨胰腺实性假乳头状瘤（solid-pseudo-papillary tumor of pancreas,SPT）的临床病理学特点及其生物学行为。方法 对6例SPT临床及病理资料进行回顾性复习,光镜观察其形态学特征,并采用免疫组化S-P法检测肿瘤细胞α-AT等9种抗体的表达,并对其中1例做AB／PAS染色。结果 6例SPT中5例为女性、1例为男性,平均年龄34岁,瘤体平均直径9．3cm;光镜下瘤细胞圆形,大小较一致,无明显异型性,排列成实性片状区和假乳头状结构,假乳头轴心黏液变性,囊性区常见出血、坏死;其中1例除上述特征外还出现了大量的印戒细胞样瘤细胞,这些瘤细胞AB／PAS染色阴性,CEA阴性,S-100蛋白阴性,随访至今已4年余,无复发及转移。2例浸润包膜及周围胰腺组织;6例中3例有随访的均健在且无复发及转移。免疫组化检测：6例Vim阳性（6／6）,4例α-AT阳性（4／6）,3例Syn阳性（3／6）,1例CK弱阳性（1／6）、PR阳性（1／6）,ER阴性（o／6）,EMA阴性（0／6）,CEA阴性（0／6）,S-100蛋白阴性（0／6）。结论 SPT好发于年轻女性;组织形态学特征为瘤细胞大小一致,排列成实性片状区与独特的假乳头状结构,偶见瘤细胞呈印戒细胞样,间质可黏液变性;该肿瘤生物学行为交界性或恶性潜能未定的肿瘤,即使出现包膜及周围胰腺浸润,预后亦较好。     

胰腺实性-假乳头状瘤1例

患者女,29岁,左侧腰部间歇性胀痛不适10个月余.既往有肾囊肿病史, B超复查肾囊肿时发现胰尾部约5 cm×5 cm占位性病变.其他体检正常.考虑胰腺肿瘤,剖腹探查行胰腺肿瘤切除术,术中发现肿瘤与脾脏粘连紧密,连同脾脏一并切除.     

胰腺实性-假乳头状肿瘤透明细胞变异型

胰腺实性-假乳头状肿瘤(SPTP)是一种罕见但具有特征性的肿瘤,转移率低,仅占胰腺恶性肿瘤的1%~2%,死亡率极低约1·5%,其细胞表型尚不明确,可有灶性透明细胞,其胞质透明的机制不清。作者报道3例完全由透明细胞组成的SPPT变异型,2例为会诊病例,1例为外检病例,2例女性,均32岁,1例男     

胰腺实性—假乳头状肿瘤8例临床病理学分析

目的探讨胰腺实性-假乳头状肿瘤(solid-pseudopapillary tumor of pancreas,SPTP)的临床病理学特点、诊断和鉴别诊断、治疗及其预后。方法对8例SPTP患者的临床、病理学特点及免疫组化结果进行研究,并复习相关文献。结果 8例均为女性,年龄19～38岁,平均28岁。肿块直径3～15 cm。镜下肿瘤由乳头区和囊实区混合组成,瘤细胞围绕纤维血管轴心形成特征性假乳头结构。免疫表型:CK(3/8)、vimentin(8/8)、NSE(8/8)、CD56(8/8)、ER(0/8)、PR(5/8)、α-AT(8/8)、CgA(1/8)、Syn(8/8)、E-cadherin(0/8)、β-连环蛋白(8/8)和cyclinD1的核阳性率均大于40%。随访6例患者17～131个月,均无肿瘤复发及转移,并存活至今。结论 SPTP是一种好发于年轻女性,具有低度恶性潜能的少见胰腺肿瘤,其病理形态特征和免疫组化标记对SPTP的诊断和鉴别诊断具有重要价值。     

胰腺透明细胞变异型实性-假乳头状肿瘤1例并文献复习

目的 探讨胰腺透明细胞变异型实性-假乳头状肿瘤(clear cell variant of solid pseudopapillary neoplasm, ccSPN)的临床病理学特征。方法 回顾性分析1例ccSPN的临床资料,采用免疫组化EnVision两步法检测CK、vimentin、CD10、β-catenin、CD56、Syn、CgA、E-cadherin、Ki-67的表达,分析蛋白表达与临床病理特征的关系,并复习相关文献。结果 患者女性,54岁,以腹部疼痛为首发症状,MRI示胰体尾部占位伴钙化。镜下见肿瘤界尚清,瘤细胞体积小,形态温和,呈巢状或小梁状排列,大部分胞质内含大小不等的空泡或胞质完全空泡化,细胞核圆形或卵圆形,核仁不明显,未见明确核分裂象。瘤组织被透明变的间质分隔,局部黏液样变。免疫表型：vimentin、CD10、β-catenin、CD56、Syn均阳性,CK、E-cadherin、CgA均阴性,Ki-67增殖指数约2%。结论 ccSPN是实性-假乳头状肿瘤的一种罕见变异型,行影像学检查,并尽早手术切除及长期随访是疾病诊治的关键。     

胰腺实性-假乳头状瘤2例临床病理分析

目的 探讨胰腺实性-假乳头状瘤(SPT)的临床病理学特征及诊断、鉴别诊断。方法 对2例SPT行临床病理学分析及免疫组化研究。结果 2例患者均有腹部包块及腹痛症状。组织学：单形性肿瘤细胞构成实性及假乳头状结构，常伴有出血、囊性变，间质不同程度硬化。免疫表型：Vim( )、NSE( )、αl-AT( )、ER( )、PR( )；α-ACT灶性( )；上皮性标志(-)、Syn(-)、CgA(-)、CD68(-)。结论 胰腺SPT是较少见的、预后较好的交界性肿瘤，其诊断与鉴别诊断主要依据临床资料、组织学形态特征及免疫组化标记。     

实性-囊性-乳头状肿瘤3例报道及文献复习

实性-囊性-乳头状肿瘤(solid-cystic-papillary tumor，SCPT)为罕见的胰腺肿瘤。原发于后腹壁和腹膜后者国内未见报道。笔者报道3例实性-囊性-乳头状肿瘤，探讨其临床组织病理学特征、诊断及鉴别诊断、组织发生和生物学行为。     

胰腺实性-囊性-乳头状上皮性肿瘤1例

胰腺实性—囊性—乳头状上皮性肿瘤(SCPEN)很少见，占胰腺非内分泌肿瘤的0．17％—2.70％。国内文献对该肿瘤报道较少，其组织学来源尚未确定。笔者结合文献报道1例SCPEN。     

胰腺实性-假乳头状肿瘤中TFE3的表达及意义

目的探讨胰腺实性-假乳头状瘤(solidpseudopapillary neoplasms,SPN)的临床病理学特征、免疫表型及TFE3表达的意义。方法回顾性分析22例胰腺SPN的临床病理特点,采用免疫组化EnVision法检测TEF3在22例胰腺SPN中的表达;选取15例原发胰腺的其他肿瘤作为对照,5例胰腺SPN行FISH检测TFE3基因状态。结果 21例胰腺SPN显示TFE3不同程度的核阳性,胰腺其他肿瘤TFE3呈阴性,FISH检测未发现TFE3基因改变。结论胰腺SPN是好发于年轻女性的低度恶性肿瘤,除β-catenin外,TFE3亦可作为诊断胰腺SPN的有用指标。     

Burkitt's lymphoma: new insights into molecular pathogenesis

The World Health Organisation classification reports three subcategories of Burkitt's lymphoma (BL)--endemic, non-endemic, and immunodeficiency associated--proposed to reflect the major clinical and genetic subtypes of this disease. These different types of BL have been reviewed and studied by immunohistochemistry and molecular methods. The results point out the heterogeneity of BL and suggest that AIDS related BL may have a different pathogenesis from that of classic BL.     

Historical and new insights into pathogenesis of type 1 diabetes

In recent years, there have been exciting new insights into pathogenesis of type 1 diabetes in a number of areas of immunology. In this edition, a collection of four review articles are presented, which encompass new findings presented at the Immunology of Diabetes Society meeting in London 2018. The articles are focused particularly in 4 related areas of investigation, which include autoantibodies in type 1 diabetes, new autoantigenic targets for CD4 T cells, trafficking of immune cells to the pancreas and islet-immune interactions in the pancreas.     

Newer insights into the pathogenesis of liver cancer.

A new hypothesis leading to a new model of liver carcinogenesis is described; it is based on the acquisition by carcinogen-altered hepatocytes during initiation of a new functional handle--resistance to the cytotoxicity of a carcinogen--and on the ability of such cells to proliferate in an environment that prevents proliferation of normal hepatocytes. The creation of such a differential environment now enables a quantitative analysis for initiation, the beginning synchronization of the putative premalignant hepatocytes for about 15 cell cycles, the study of the pattern of growth of such resistant cells to form nodules that have some resemblance to the organizational pattern of fetal liver, the analysis of the appearance of distinctive positive and negative markers for these cells, and the further investigation of the development of liver cancer from such cells. The remarkable similarity in overall pattern betweeen the development of cancer in the skin and in the liver with chemicals and the possible role of both somatic mutation and neodifferentiation in carcinogenesis are briefly discussed.     

Dexamethasone-suppressible hyperaldosteronism: Pathophysiology,clinical aspects,and new insights into the pathogenesis

Summary A profile of dexamethasone-suppressible hyperaldosteronism (DSH), a variant of primary aldosteronism, is drawn by reviewing its pathophysiological and clinical aspects. Genetic studies show no HLA linkage and point to an autosomal dominant mode of inheritance, suggesting that the prevalence of this disease has been underestimated in the past. Hypertension, hypokalemia, suppressed renin, and high aldosterone values characterize DSH in the basal state, similar to the other forms of primary aldosteronism, i.e., aldosterone-producing adenoma (APA) or bilateral idiopathic adrenal hyperplasia (IAH). Biochemically DSH and APA can be differentiated from IAH since in both aldosterone does not respond to upright posture, to angiotensin II infusion, and to angiotensin-converting enzyme (ACE) captopril. In contrast, morphologically DSH is similar to IAH, since neither macroscopic nor histologic examinations of the adrenals give evidence of any unilateral abnormality. However, DSH is differentiated from APA and IAH by the hyperresponsiveness of aldosterone to acute ACTH administration as well as by the failure of aldosterone to escape from prolonged ACTH stimulation. The final diagnosis of DSH rests upon the prompt reversal of the features of mineralocorticoid excess by glucocorticoid therapy. In some cases hypertension is unresponsive to dexamethasone and needs alternative treatment. The main pathogenetic hypotheses point to a pituitary and/or an adrenal abnormality, but the intrinsic nature of the disease remains to be elucidated.Abbreviations ACE angiotensin-converting enzyme - ACTH adrenocorticotrophic hormone - APA aldosterone-producing adenoma - B corticosterone - DOC deoxycorticosterone - DSH dexamethasone-suppressible hyperaldosteronism - IAH idiopathic adrenal hyperplasia - 18-OH DOC 18-hydroxydeoxycorticosterone - 18-OH B 18-hydroxycorticosterone - PRA plasma renin activity     

New insights into asthma pathogenesis and treatment

Although national asthma guidelines help organize standards for asthma care, current asthma management is still primarily symptom based. Recent reports provide insights on how to improve asthma management through steps to better understand the natural history of asthma, individualize asthma care, reduce asthma exacerbations, manage inner city asthma, and some potential new ways to use available medications to improve asthma control. Despite many significant gains in managing asthma, we must now find improved strategies to prevent asthma exacerbations, alter the natural history of the disease, and to reduce health disparities in asthma care. Perhaps new directions in personalized medicine including a systems biology approach, along with improved health care access and communication will lead to better methods to alleviate the burden of asthma. This review will discuss the benefits and limitations of the current approach to asthma management, new studies that could impact new directions in asthma management, and new insights related to mechanisms of asthma and allergic airways inflammation that could eventually lead to improved asthma control.