p63在脂溢性角化病中的表达及意义

目的 研究p63蛋白在脂溢性角化病中的表达,探讨其与脂溢性角化病发病的关系.方法 采用免疫组织化学S-P法检测56例脂溢性角化病和5例正常皮肤组织中p63的表达情况,并进行统计学分析.结果 脂溢性角化病中p63蛋白表达的阳性率为91.07%,与正常皮肤组织中的表达有显著性差异(P＜0.01).结论 p63蛋白参与了脂溢性角化病的发病过程,对研究脂溢性角化病的发病机制有一定意义.     

老年性脂溢性角化病143例临床及病理分析

脂溢性角化病(SK)又名老年疣(Verruca senilis)、基底细胞乳头瘤(Basal cell papilloma),是临床上较常见的一种表皮内良性肿瘤,男性多见,其临床及病理类型较多,临床易与多种良、恶性皮肤肿瘤相混淆,诊断中不时遇到困难,而导致治疗方法选择错误.为了探索老年性SK的临床与病理之间的联系,提高对本病的认识及诊断正确率,本文对我院皮肤科80年代以来病理诊断为SK的143例老年患者临床和组织病理学资料进行分析.     

脂溢性角化病的国内外研究现状

脂溢性角化病(SK),即基底细胞乳头瘤,是因角质形成细胞(KC)成熟迟缓所致的一种良性表皮内肿瘤,又称老年疣.皮损常多发,好发于头面部、躯干、上肢,一般不累及掌、跖.典型的临床表现早期为扁平丘疹或斑片,淡褐或深褐色,表面光滑;后逐渐增大隆起,表面可呈轻度乳头瘤样增生,常附有油腻性鳞屑,病程缓慢,无自愈倾向.典型的SK不难诊断,但不典型者很容易与黑素瘤、色素型基底细胞上皮瘤、日光性角化病及色素痣等相混淆[1].此时诊断主要依靠组织病理检查.目前SK的病因、发病机制等尚不清楚.     

海南地区老年脂溢性角化病的流行病学调查

目的探讨海南地区500例老年脂溢性角化病的流行病学情况。方法将2016年1月至2018年12月在海南省妇幼保健院皮肤科美容门诊接受治疗的500例脂溢性角化病患者的临床资料组成观察组,同时将同期于海南省妇幼保健院院皮肤科接受治疗的58例非脂溢性角化病患者的临床资料组成对照组,记录入选者一般资料,比较两组临床检测指标[三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白(apo)A-1与apoB]、发病部位、病理分型,同时分析影响老年脂溢性角化病发生的相关因素。结果两组HDL-C、apoA-1、apoB值对比差异无统计学意义(P0.05);观察组TG、TC、LDL-C值均明显高于对照组,差异有统计学意义(P0.05);躯干(29.40%)、四肢(15.00%)与头颈面部(37.60%)为500例脂溢性角化病患者的好发部位,角化过度性(37.80%)与棘层肥厚型(41.80%)为其常见病理分型;两组性别、婚姻状态、饮酒情况、体重指数(BMI)及高血压患病率对比,差异无统计学意义(P0.05);观察组年龄(70岁)、吸烟、受教育年限(0～6年)、冠心病、缺乏锻炼占比均明显高于对照组,差异有统计学意义(P0.05);将年龄、吸烟、受教育年限、冠心病、锻炼纳入为候选变量,通过Logistic回归分析发现,年龄70岁、吸烟、受教育年限(0～6年)、冠心病与缺乏锻炼为老年脂溢性角化病发生的危险因素(OR1,P0.05)。结论脂溢性角化病患者存在部分血脂增高现象,年龄70岁、吸烟、受教育年限(0～6年)、冠心病、缺乏锻炼为该疾病发生的危险因素,临床需给予针对性治疗措施,以控制疾病发生率。     

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。     

老年脂溢性角化与血脂的相关性分析

脂溢性角化是老年常见皮肤病，病因不清，男性的发病高峰在50—70岁，女性为40—60岁。有研究发现脂溢性角化存在血脂异常，但是本人在临床工作中发现与其有不符之处。本文旨在通过观察脂溢性角化皮损数量与血脂的相关性，探讨脂溢性角化与血脂的关系。     

上海市某社区老年人皮肤肿瘤流行病学研究

目的获取上海市社区老年人群皮肤肿瘤的患病情况及危险因素资料,为皮肤恶性肿瘤的早期发现、早期诊断、早期治疗提供参考数据。方法2011年5月1日-11月30只期间采用整群抽样法对上海市长宁区北新泾街道60岁以上常住居民进行问卷调查及皮肤科检查,并对可疑皮损行病理检查明确诊断。分类统计皮肤肿瘤患病情况并分析危险因素。结果1、在2043例资料完整的居民中,良性肿瘤中脂溢性角化患病率为100％。其他良性皮肤肿瘤（包括角化棘皮瘤、皮角、日光胶原病）16例（0．78％）。经病理明确诊断的皮肤恶性肿瘤共计76例,其中日光性角化病患病率最高,总计63例（3．07％）,此外鳞状细胞癌3例（0．15％）,基底细胞癌9例（0．44％）,鲍恩病1例（0．05％）;上述病种的患病率随年龄增长而增加,高峰年龄为75岁以上;2、所有皮肤恶性肿瘤发生部位频率最高为头面颈部,总计有62例（占总病例数67．39％）,其中R光性角化病及基底细胞癌发生于头面颈的比率最高;3、所有95例可疑皮损中,临床与病理诊断符合病例数为76例（80％）;4、人群中以Ⅳ型皮肤为主,约占68．4％（1398例）,其中Ⅲ型皮肤人群中皮肤肿瘤的患病率最高（P〈0．05）;5、长期紫外线曝露者发生皮肤恶性肿瘤的概率较高（P〈0．05）。结论上海市社区老年人群中皮肤肿瘤的发生率随年龄增长,主要为非黑素瘤性皮肤癌,好发于头面颈部,这可能与人口老龄化、强紫外线、浅肤色等因素有一定关系。加强宣教,避免日晒和光防护是重要的干预措施。     

日光性角化病的发病机制及进展

日光性角化病(actinic keratosis,AK)常见于65岁以上的老年群体中,其发病与年龄密切相关,因此又被称为老年性角化,是老年群体中的最常见的皮肤病之一。在50岁以上的高加索人种中,AK的发病率可以高达45%,由于地区之间存在差异,目前的流行病学研究中,发病率为1.4%~59.2%均有报道[1]。该病是一种常见的表皮内癌前病变,紫外线长期暴露是其主要的致病因素,其病理特征为皮损处存在多样异型性的角质形成细胞[2]。皮损的特征性表现为:长期日光暴露区域的弥漫性潮红,同时伴有角化过度或覆盖鳞屑的斑块,表面粗糙如砂纸状,多分布在面、耳、手臂和手背侧、头皮等日光暴露较多部位。其中手背和前臂处的皮损可表现为过度角化型或者疣状[3]。     

老年耳廓脂溢性角化病21例分析

目的 探讨老年耳廓脂溢性角化病的诊断及治疗。方法 对21例老年耳廓脂溢性角化病的临床资料进行回顾性分析。结果 ①21例中误诊8例。②全部病例经手术切除加植皮治疗，随访0．5～7年，均无复发及癌变。结论 认清本病皮损的特征是减少误诊的关键，应警惕Leser-Trelat综合征存在的可能性；手术是行之有效的治疗方法。     

127例老年疣患者皮损中人类乳头瘤病毒DNA的检测

老年疣又称脂溢性角化病或基底细胞乳头瘤, 是老年人最常见的良性表皮增生性肿瘤,多见于躯干和面部.由于病理检查中容易将几种老年疣与寻常疣等人类乳头瘤病毒（human papillomavirus,HPV）感染疾病混淆,我们采用PCR技术对老年疣皮损进行了病理检查和HPV的检测,以探讨老年疣与HPV感染的关系.     

Treatment of external genital warts in men with imiquimod 2% in cream. A placebo-controlled, double-blind study

OBJECTIVE: The purpose of this double-blind, placebo-controlled study was to evaluate the safety, clinical efficacy and tolerability of imiquimod (2%) in cream to cure external genital warts in males. METHODS: Preselected male patients (n=60) ranging between 18 and 50 years of age (mean 24.2) harbouring 558 lesions (mean 9.3) with clinical, histopathological and polymerase chain reaction (PCR) confirmed diagnosis of human papilloma virus (HPV) infection were randomized to two parallel groups. Each patient was allocated a precoded 25g tube, and instructions on how to apply the trial medication to their lesions at home once daily for three consecutive days per week (max. 12 application in 4 weeks). To evaluate the safety, clinical efficacy and tolerance, patients were exa-mined on a weekly basis. Cure was defined as the total elimination of treated warts with PCR, and Southern blot hybridization confirmed negative HPV DNA. RESULTS: By the end of the treatment, 40% (24/60) patients and 49.8% (278/558) warts were cured. Breaking the code revealed that imiquimod cream had cured 70% (21/30) patients and 86.8% of warts, while placebo healed three subjects and 28 warts (P=0.0001). Eleven patients (18.3%), predominantly in the imiquimod cream group, experienced mild to moderate, non-objective, drug-related side effects with no dropouts. The study was followed up for 18 months from the first day of the treatment, and among the 26 cured patients, one in the imiquimod cream group and two in the placebo had a relapse after 14 months. CONCLUSION: The study demonstrated that 2% imiquimod in cream with mild non-objective side effects is safe, tolerable and significantly more effective than placebo in curing external genital warts in males.     

Manifestations of anogenital HPV infection in the male partners of women with anogenital warts and/or abnormal cervical smears.

The prevalence and manifestations of anogenital human papillomavirus (HPV) infection in 154 men, all of whom were the sexual partners of women with either overt anogenital warts or cervical HPV-related abnormalities, were assessed using clinical, histopathological and molecular criteria. Detailed examination of the anogenital region using a colposcope was supplemented by the use of 5% acetic acid to detect possible foci of subclinical HPV infection. Biopsies of warts and aceto-white lesions were examined histopathologically and by HPV DNA hybridization using radiolabelled HPV 6/11 and 16/18 DNA probes. More than two-thirds of the men had clinical indications of genital HPV infection: 37% had apparent macroscopic warts, almost invariably in combination with aceto-white lesions; while 34% had aceto-white lesions only. The overwhelming majority of these lesions (92%) were located on the penis only. However, only 49% of the macroscopic and 29% of the aceto-white lesions showed histological features consistent with a conclusive diagnosis of HPV infection; while the corresponding figures for HPV DNA positivity were 72% and 56% respectively. Current HPV infection was strongly associated with a past history of anogenital warts, but there was little or no correlation between the manifestations of HPV infection in the male and female sexual partners.     

慢性乙型肝炎病理与临床诊断的一致性

目的　在诊断慢性乙型肝炎的病情活动度时 ,肝组织病理学检查是决定性的依据 ,但由于难以普遍实施 ,故往往以病史、症状、体征、化验检查资料进行临床诊断。本研究旨在评价慢性乙型病毒性肝炎临床与病理诊断的符合性。方法　采用肝穿活检的方法 ,对肝组织进行镜下形态观察和免疫组织化学检查 ,作出相应的病理学诊断。临床与病理诊断作统计学Kappa检验与列联表关联分析。结果　Kappa值 =0 .3 2 1(P =0 .0 0 1) ,SpearmanCorrelation =0 42 5 (P =0 .0 0 1)。临床诊断与病理诊断的总符合率为64 .81%,慢性乙肝轻度、中度、重度的符合率分别为 90 .0 0 %、2 7.78.0 0 %、5 0 .0 0 %。结论　慢性乙肝病情活动度的临床诊断与病理诊断的一致性不强 ,故对于没有禁忌症的患者应进行肝活检 ,特别是对于中、重度的患者 ,更应该行肝穿活检 ,以明确诊断 ,估计预后。     

Histopathological findings in cholecystectomies specimens: A single institution study of 20 584 cases

Background: The histopathological examination of cholecystectomy specimens has not been standardized with a debate concerning the routine and the selective approach. The aim of this study was to assess the information obtained from routine histopathological examination of cholecystectomy specimens.Methods: All histopathological reports of cholecystectomy specimens between January 2003 and December 2016 were analyzed, including a clinical diagnosis of benign gallstone disease or cholecystitis.Results: A total of 20,584 reports were examined. The mean age of patients was 54.2 years. Patients aged more than 60 years represent 37.6% of the study population. Of all patients, 15,973(77.6%) were females.Incidental gallbladder cancers(GBC) were present in 155 cholecystectomies specimens(0.8%). 67.1% of GBC are at T2 and T3 stage. Granulomatous cholecystitis was diagnosed in only 19 cases(0.1%). GBC were more prevalent in older patients(P 10~(-6)) and cholesterolosis was more prevalent in young patients(P 10~(-6)). There was no gender predilection for GBC(P = 0.739).Conclusions: The rate of incidental gallbladder carcinoma in our study is low, yet, we found a higher proportion of T2 and T3 carcinomas stage. Granulomatous cholecystitis may need further investigations and treatments. When a selective approch of histopathological examination of cholecystectomy specimens is used, it is important to take into account that clinical parameters are significantly associated with gallbladder cancer.     

Meatoscopy: a simple technique to examine the distal anterior urethra in men.

A common problem is to determine the site of the base of meatal warts in men and if the lesions will be suitable for the treatments available in genitourinary medicine (GUM) or sexually transmitted diseases (STD) clinics. Formal endoscopy requires sterile conditions and is therefore an expensive procedure. A simple safe cheap alternative is meatoscopy using an auroscope with inflation. This allows inspection of the anterior urethra to a depth of 5 or 6 cm. With this technique 175 examinations were performed on 153 patients. Warts were confined to the lips in 27 (56%) of 48 patients with meatal warts; in an additional 5 patients with meatal warts the warts arose from deep in the fossa navicularis and in 16 patients with meatal warts there were additional warts in the fossa navicularis invisible on clinical examination. No urethral warts were seen in 103 patients without meatal warts, comprising 47 patients with external genital warts and 56 without any warts. It is concluded that meatoscopy should be undertaken in all patients with meatal warts to determine the site of their base and to assess if there are any more proximal warts. This should be done as soon as the meatal warts are seen, and urethritis has been excluded, so that appropriate treatment can be planned.     

不同原发部位胃转移癌12例

目的:探讨不同原发部位胃转移癌的临床特点及诊治.方法:对我院1990-01/2010-01诊断胃癌的病例资料进行检索,其中符合胃转移癌诊断者12例,计算其在胃癌中的构成比,结合国内外相关文献,分析不同原发部位胃转移癌的临床特点、诊治手段及其效果与预后.结果:胃转移癌原发部位以食管癌居多,占胃转移癌的50%(6/12).患者多有原发肿瘤病史,临床表现与原发性胃癌相似,诊断主要依赖于原发癌病史及病理组织学检查,预后较差(生存期9.5 mo),尽早诊断并手术可改善预后.结论:胃转移癌发病率极低,不易与原发性胃癌鉴别,诊断依据是原发癌病史及病理组织学检查,预后差,手术是主要的治疗手段.     

原发性肺隐球菌病临床与病理对照观察

目的探讨原发性隐球菌病（PC）的临床表现与病理变化特点。方法对23例肺原发性肺隐球菌病临床及病理资料进行对比分析,组织化学染色及光镜观察。结果23例中8例术前经肺穿刺活检明确诊断,15例开胸探查,病理证实为此真菌病,病理诊断5例为粘液胶样病变,炎性肉芽肿病变12例,结节状纤维肉芽肿病变6例,所有病例均检出新型隐球菌并行手术病灶切除,粘液卡红（Mc）,过碘酸雪夫染色（PAS）及六胺银（GMS）组织化学染色隐球菌呈阳性。术后3例并发隐球菌性脑膜炎,占本组病例13％（3／23）,本组病例术后经6周～3个月不同疗程的抗真菌治疗,术后随诊3个月～1年,均无隐脑及肺部复发。结论PC的临床与影像学表现均无特异性,肺穿刺活检病理检查有助于此病的诊断,术后应常规抗真菌治疗,以防发生隐脑与肺部复发。     

结核性阑尾炎的诊断与治疗

目的探讨结核性阑尾炎的诊断和治疗方法。方法对１９６８～１９９７年收治的４６５２例阑尾炎中，经病理确诊的１２例（占０２６％）结核性阑尾炎作回顾性分析。结果本组病例的平均发病年龄为３５岁，女性多见，男女比为１∶２，多为继发（７例）。１２例中增殖型７例，溃疡型３例，混合型２例。术前均误诊，术中确诊２例。１２例均手术治疗，单纯阑尾切除７例，盲肠部分切除２例，右半结肠切除１例，合并回盲部淋巴结切除２例，术后抗结核治疗９例。１２例均顺利痊愈，无并发症。结论结核性阑尾炎发病率低，临床表现无特异性，术前确诊困难，要注意术中观察并重视病理检查。应早期手术和术后抗结核治疗，防止并发症产生。     

2例长期未确诊的足部疣状皮肤结核分析

目的:总结2例长期未确诊的足部疣状皮肤结核患者未确诊的可能原因与诊断线索。方法:分析2例疣状皮肤结核患者的临床表现、组织病理特点及治疗经过,结合国内外相关文献进行总结。结果:2例患者病程分别长达30余年及10余年未确诊,根据临床表现中原发皮肤损害表现及组织病理发现肉芽肿性炎,结合病原学检查均诊断为疣状皮肤结核。经三联抗结核治疗1年后基本痊愈。结论:疣状皮肤结核的临床表现在发生、发展的过程中会有较大变化,但是重视病程中的基本皮肤损害及肉芽肿性炎的组织病理的相对稳定性的特点,再结合特异的病原学检查结果及诊断性治疗结果可以确诊。     

PET-CT显像在直肠癌术后局部复发诊断中的价值

目的评价^18F-脱氧葡萄糖（FDG）PET—CT定性及半定量显像技术在直肠癌术后局部复发诊断中的临床价值。方法对20例临床可疑直肠癌术后局部复发的患者行全身^18F—FDGPET—CT显像，将显像结果与病理组织学及临床随访结果对比。结果病理组织学及临床随访证实，局部复发15例。采用定性方法诊断直肠癌术后局部复发的灵敏性和特异性分别为100％、60％。采用半定量法显示恶性肿瘤的标准摄取值（SUV，范围为2．7～17．2，平均9．9）明显高于良性病变者（SUV为1．3～4．0，平均2．6），诊断直肠癌术后局部复发的灵敏性和特异性分别为100％、80％。结论全身^18F—FDGPET-CT显像有利于直肠癌术后局部复发的定性及定位诊断；半定量方法较定性法更具有特异性。