成人肠道淋巴样息肉病临床病理分析及文献复习

目的:探讨成人肠道淋巴样息肉病的临床及病理学特征。方法:应用光镜及免疫组织化学方法观察4例成人肠道淋巴样息肉病的组织学特点及免疫学表型,并复习相关文献。结果:4例中3例为男性,1例为女性,年龄分别为75、75、46及70岁。4例病例均因其他疾病切除末端回肠及回盲部时,偶然发现末端回肠多发息肉样隆起,直径0.1~0.5 cm。镜下见回肠粘膜淋巴组织显著增生,淋巴滤泡增生并形成息肉样小结节,淋巴滤泡的生发中心明显增大,围绕生发中心的套区境界清楚。免疫组织化学显示大部分呈滤泡样增生的淋巴细胞CD20强阳性表达,不表达Cyclin D1,生发中心细胞不表达Bcl-2。结论:成人淋巴样息肉病是一种罕见的良性病变,具有独特的临床病理特点,临床上易于同部分恶性肿瘤相混淆,诊断依靠病理组织学及部分辅助方法。     

淋巴结生发中心进行性转化一例报告——附文献复习

目的 提高对淋巴结生发中心进行性转化(PTGC)的认识,探讨其临床特征、组织病理学和免疫组织化学特点及其与生发中心增生的相关疾病的鉴别诊断并对相关文献进行复习.方法 报告1例淋巴结生发中心进行性转化患者的临床特征和实验室检查指标及诊治经过.结果 患者主要表现为无痛性外周淋巴结肿大,病理组织学表现为滤泡增生,出现进行性转化的生发中心,生发中心和套区淋巴细胞边界不清.免疫组织化学检查示转化的生发中心细胞CD20~+、CD5~+、CDw75~+.结论 PTGC是一种临床少见的淋巴结病,组织病理学和免疫组织化学辅助检查是其诊断的重要依据.     

Castleman病7例临床病理分析

目的探讨Castleman病的临床诊断鉴别诊断及病理组织学特征。方法通过组织学、组织化学、免疫组化及基因重排克隆性分析等方法对Castleman病进行研究，并结合文献加以分析。结果7例Castleman病中5例为透明血管型，表现为增生的淋巴结内均匀的分布着大小相近的小淋巴滤泡；滤泡生发中心变小，其内可见泡状核的滤泡树突状细胞，有透明变性的小动脉穿入；外套层明显增厚，小淋巴细胞呈同心圆排列于血管周围，形成特征性的“洋葱”样同心圆结构，类似胸腺小体；滤泡间毛细血管增加，可有玻璃样变和纤维化；淋巴窦大部分消失或全部消失。2例浆细胞型特点是滤泡间大量的成熟浆细胞增生，有淋巴窦消失改变，滤泡内的毛细血管穿入，“洋葱”样改变不明显，滤泡间可见PAS染色阳性的无定型的嗜酸性物质沉积。其中1例浆细胞型部分区域淋巴细胞显著增生，弥漫成片，免疫组化显示κ链限制性表达，基因重排克隆性分析显示IG受体阳性，表明已转化为B细胞淋巴瘤。结论Castleman病是一种特殊类型的淋巴结增生性疾病，可发生于任何年龄，诊断时要与反应性滤泡性增生、淋巴瘤等进行鉴别，并注意是否发生淋巴瘤等恶性转化。     

回肠末段疾病412例内镜表现和病理特点分析

目的探讨回肠末段疾病近年来的发病情况、内镜表现和病理特点。方法回顾性分析6 a来回肠末段疾病的临床、内镜及病理资料。结果 412例回肠末段疾病中男261例,女151例,男女之比1.73∶1,内镜下表现以充血、水肿、糜烂、溃疡、结节样或息肉样隆起、淋巴滤泡样增生为主;病理以非特异性炎症为主,其次为克罗恩病、结核、淋巴瘤。结论结肠镜进镜到达回肠末段,是发现回肠末段疾病的重要手段,病理学、免疫组化是诊断回肠末段疾病的可靠、有效的方法。     

结肠镜诊断回肠末端病变的临床意义

目的探讨结肠镜诊断回肠末端病变的临床应用价值。方法对80例回肠末端病变的结肠镜检查资料及病检结果进行分析。结果病变类型为末端回肠炎25例,淋巴滤泡增生症29例,溃疡10例,息肉2例,结核8例,小肠出血6例。结论结肠镜不仅可以直视末端回肠病变,还能进行病理活检,可明显提高疾病的确诊率。因此在对末端回肠病变的诊断中,结肠镜检查应为首选方法     

儿童小肠淋巴管扩张症消化内镜特点及临床15例分析

目的 提高对儿童小肠淋巴管扩张症(IL)临床、内镜及病理特点的认识,减少误诊.方法 回顾性分析2006年3月-2009年3月该院收治年龄3-16岁,15例小肠淋巴管扩张症临床表现、实验室检查、消化内镜特点及其病理结果.结果 消化内镜特点:8例消化内镜发现十二指肠黏膜白色点状或小斑块(胃镜6例,小肠镜2例),其中2例发现病变附近有肿块或不规则溃疡,同时结肠镜发现回肠末端局部黏膜息肉样隆起;7例小肠镜发现空回肠黏膜白色粟米样改变,6例病变附近见肿块或不规则溃疡.病理特点:8例十二指肠黏膜慢性炎症伴淋巴管扩张(其中2例回肠末端黏膜慢性炎症,伴淋巴滤泡增生,淋巴管扩张),十二指肠非霍奇金淋巴瘤、间质瘤各1例;7例空回肠黏膜慢性炎症,伴淋巴管扩张,回肠非霍奇金淋巴瘤、小肠淋巴管瘤、小肠间质瘤、回肠绒毛状腺癌、炎性病变并肌纤维母细胞瘤样增生及Cohn's病各1例.结论 有血浆蛋白与球蛋白同时下降的浮肿患儿,伴或不伴淋巴细胞减少,要重点怀疑IL,行消化内镜及病理检查明确诊断,并尽量寻找其原发病因.     

透明血管型Castleman病旁淋巴结临床病理分析

目的了解透明血管型Castleman病（HVCD）旁淋巴结的病理改变。方法通过光镜观察及免疫组化检测,对7例HVCD旁淋巴结进行形态学观察和免疫表型定位。结果7例淋巴结内淋巴窦结构均存在;皮质层有较多滤泡,多数生发中心小甚至无;套区看似明显增厚,用IgD标记套区,发现其中3例确有套区增生,其余为边缘区细胞增生;5例偶见滤泡生发中心退变;2例出现呈洋葱皮样排列的套区;1例偶见透明血管滤泡;1例存在含多个生发中心的单个滤泡;滤泡间区高内皮静脉增生不明显。结论HVCD旁淋巴结可以局灶性呈现HVCD的部分病理特征,滤泡常有看似增厚的“套区”。因此,在先行较大肿块旁淋巴结活检时,如发现上述特征,应考虑周围有无HVCD原发灶的存在。     

嗜酸性淋巴肉芽肿临床病理及发病学研究

目的 探讨嗜酸性淋巴肉芽肿(Eosinophilic Iymphogranuloma，EIG)的临床病理特点，对其发病机理进行初步分析。方法 利用光镜、免疫组织化学及特殊染色方法观察6例EIG病变组织中的CD21、CD35、IgE、IgA、IgG和肥大细胞，对所有病例的临床和实验室资料进行分析。结果 所有病例均为男性，年龄13～36岁，平均25岁，病变均位于头颈部。组织学上以血管内皮细胞增生、嗜酸性粒细胞大量浸润、淋巴细胞浸润及滤泡形成、纤维组织增生为基本病变。免疫组化显示病变组织中IgE明显增多，主要分布在淋巴滤泡生发中心内及生发中心外浆细胞内；肥大细胞大量增生。外周血IgE水平升高。术后随访，全部存活。结论 EIG是一种具有特殊临床病理表现的良性病变，手术治疗后虽常复发，但预后良好。其发病可能与Ⅰ型变态反应有关。     

多中心型Castleman病1例漏诊分析

Castleman（CD）病又称巨大淋巴结增生症，是原因未明的淋巴结增生性疾病，临床上较为少见，其临床表现多样且无特异性，诊断较困难，为了提高对CD病的认识，减少临床漏诊和误诊，本文报道1例多系统受累的多中心型CD病，并复习文献就CD病的临床和实验室检查和病理学特点以及相应的诊治措施进行讨论。CD病的临床类型分为局灶型和多中心型（全身性），病理类型有透明血管型（HV型）、浆细胞型（PC型）。早期确诊主要依靠组织病理学检查，淋巴结滤泡内和滤泡间淋巴组织增生，滤泡周围的小淋巴细胞围绕滤泡中心呈环层状排列似葱皮样结构，滤泡间血管增生明显，有血管增生样玻璃样变，是透明血管型的病理组织学特征。     

双气囊小肠镜在回肠末端疾病中的诊断价值

目的评价双气囊推进式电子小肠镜在回肠末端疾病中的诊断价值。方法对2005年4-9月该院27例有消化道症状，且结肠镜检查回肠末端病变阳性者进行双气囊小肠镜检查，并与病理及手术结果相比较。结果27例病人中发现小肠除滤泡增生外疾病23例，检出率为85．2％，其中回肠滤泡增生4例，空回肠克罗恩病6例，回肠结核5例，小肠息肉病3例，回肠毛细血管瘤3例，回肠血管扩张症3例，空肠肿瘤2例，回肠肌瘤1例。结论双气囊小肠镜能安全迅速地检查全小肠，具有直视、可控性好、能活检及进行镜下治疗等优点，有望成为小肠疾病最重要的检查手段。结肠镜常规检查回肠末段，有助于发现阳性病变，提高双气囊小肠镜诊断的阳性率。     

分裂象在淋巴结反应性增生鉴别中的意义

探索与掌ＬＲＨ组织学改变特点及规律。方法显微镜下观察９５例ＬＲＨ的组织结构,核分裂,大细胞及浆细胞等的变化。采用ＳＰＳＳ软件进行统计处理。结果滤泡增多,滤泡外淋巴组织增生是ＬＲＨ中最常见的淋巴结组织不结构紊乱,占６５．２％。ＬＲＨ中滤泡外淋巴组织内裂象比较常见,一个高倍视野核分裂象１－３个的出现率达５４．７％（５２／９５）,但均是正常核发裂,滤泡内核分裂与滤泡外核分裂有轻度相关。相关系数为ｒ＝０．     

溃疡性结肠炎合并结肠多发性锯齿状息肉的临床病理分析

目的 探讨溃疡性结肠炎(UC)合并结肠多发性锯齿状息肉的临床病理特点及免疫组化表型. 方法报告2例分别有10年和8年溃疡性结肠炎病史、合并多发性结肠锯齿状息肉病的临床、内窥镜及病理组织学改变.行AE1/AE3、CK7、CK20、CEA、CD34、SMA、p53和Ki-67免疫组化染色,并结合文献进行复习讨论. 结果 2名患者均为中年女性,间断腹泻10年和8年,分别多次行内窥镜检查发现结直肠黏膜多处糜烂、浅表溃疡.例1,降、乙状结肠可见密集分布、大小不等的息肉,最大直径3cm;例2,全结肠可见10余枚息肉.镜检:结直肠溃疡糜烂处符合溃疡性结肠炎病变;息肉处腺体大部分呈锯齿状扩张增生,部分细胞核增生呈复层,可见异型增生.免疫组化:息肉部腺体CEA(+),Ki-67阳性细胞位于锯齿状隐窝基底及中1/3;例2局部p53(+).结论 UC相关锯齿状息肉/腺瘤病具有肿瘤性病变特征,UC合并锯齿状息肉或腺瘤可能更易癌变.     

Stages of B cell differentiation in human lymphoid tissue

Monoclonal antibodies reactive with B cell-specific differentiation and other antigens were used to investigate stages of B cell maturation in human lymphoid tissue, using an immunoperoxidase technique on frozen tissue sections. Lymphoid follicles, which represent the major anatomic compartment of B cells, demonstrated cellular antigenic expressions that appear to reflect differentiation of B cells. The majority of cells in the primary follicles and the mantle zones of secondary follicles expressed surface antigens similar to those of circulating B cells, namely IgM, IgD, Ia, B1, and B2. In contrast, the germinal center cells of secondary follicles stained for IgM, IgG, B1, B2, and Ia antigens, but not for IgD, and furthermore, acquired the T10 antigen. The germinal centers stained much more intensely than mantle zones with anti-B2, whereas no such striking difference in the staining intensity was observed with anti B1. Plasma cells, which represent the end stage of B cell differentiation, showed intense cytoplasmic staining with the anti-T10 antibody. The results indicate that the generation of germinal center cells in primary lymphoid follicles involves phenotype changes that correspond largely to those previously observed after both antigenic and mitogenic activation of B lymphocytes.     

胶囊内镜对86例患者小肠疾病的诊断分析

目的：分析评价胶囊内镜对小肠疾病的诊断价值。方法：对86例怀疑有小肠疾病的患者行胶囊内镜检查,并分析检查结果。结果：共检出小肠病变48例（55.8%）。其中小肠血管发育异常17例,小肠绒毛萎缩10例,小肠息肉5例,小肠溃疡3例,小肠炎症8例,小肠隆起性病变2例,小肠钩虫病1例,疑似炎症性肠病1例,末端回肠炎症伴回盲部占位1例。不明原因消化道出血23例中,检查出小肠病变19例,阳性率82.6%,其中小肠血管发育异常或伴活动性出血11例,小肠溃疡3例,钩虫病1例,小肠息肉3例,小肠多发隆起灶1例。胶囊内镜正常电池范围内对小肠检查情况：86例中有14例未能完成抵达回盲部,占16.3%。但其中10例已经发现小肠病变。结论：胶囊内镜对小肠疾病诊断率高,尤其适用于不明原因的消化道出血患者。     

15例结直肠帽状息肉病的临床病理分析及文献回顾

目的 分析结直肠帽状息肉病的临床病理特征、诊断思路及预后.方法 收集北京市肛肠医院病理科2018-2020年间病理诊断为结直肠帽状息肉病的全部病例,进行临床病理分析及文献回顾.结果 本组共有结直肠帽状息肉病病例15例,男女比例2∶1,平均年龄40岁,最小年龄17岁,最大年龄68岁.病例全部出现便血,5例出现直肠炎,10...     

Unusual complication in patient with Gardner’s syndrome: Coexistence of triple gastrointestinal perforation and lower gastrointestinal bleeding: A case report and review of literature

Gardner’s syndrome (GS) is a rare syndrome with autosomal dominant inheritance, which is characterized by multiple intestinal polyps, dental anomalies, desmoid tumors, and soft tissue tumors. All gastrointestinal symptoms seen in GS are associated with the underlying familial adenomatosis polyposis and abdominal desmoid tumors, with the most common symptoms being anemia, lower gastrointestinal bleeding, abdominal pain, diarrhea, obstruction, and mucous defecation. To our best knowledge, no case of GS that has presented with gastrointestinal perforation and bleeding has ever been reported in the English language medical literature. A 37-year-old male who had been diagnosed with GS five years earlier was referred to our clinic for lower gastrointestinal bleeding. Despite the absence of a bleeding focus on conventional angiography, the patient was operated on with laparotomy, due to the persistence of both signs and symptoms of mild peritonitis. On the laparotomy, the patient was noted to have areas of perforation in the duodenum, splenic flexura, and mid-rectum. The third and fourth part of the duodenum, the proximal 15 cm segment of the jejunum, a 10 cm segment of the terminal ileum, the whole colon, and the upper and middle rectum were resected, and duodeno-jejunal side-to-side anastomosis and terminal ileostomy were performed. The histopathological analysis of the large mass measuring 30 cm × 20 cm was reported as a desmoid tumor. The pathological examination of the tumor foci detected in the colonic specimen revealed poorly differentiated adenosquamous carcinoma.     

伴有生发中心增生的血管免疫母细胞性T细胞淋巴瘤的临床病理研究

目的探讨伴有生发中心增生的血管免疫母细胞性T细胞淋巴瘤的临床、病理形态学及免疫表型特点。方法对4例伴有生发中心增生的血管免疫母细胞性T细胞淋巴瘤标本进行形态学、免疫组化及EB病毒原位杂交观察,并进行临床随访。结果 4例病例均显示生发中心增生伴血管免疫母细胞性增生,但是套区变薄,境界不清。3例表达CD10,2例表达CXCL13,4例表达PD-1。4例均见EBV(+)的母细胞。4例在就诊时均处于临床进展期,3例得到随访,其中2例死亡。结论诊断伴有生发中心增生的血管免疫母细胞性T细胞淋巴瘤,必须将形态学、免疫表型特征和临床表现密切结合。     

结肠镜检查1055例临床分析

目的 评价全结肠镜检查的临床价值。方法对经结肠镜检查的1055例患者,尤其是全结肠镜检查进入回肠末段的患者进行回顾性分析。结果1055例结肠镜检查患者中,结肠病变共655例（62．09％）,以大肠癌、结肠息肉为高发病率,其中肠癌合并结直肠息肉的53例（35．33％）。进入回肠末段的有582病例,回肠末段病变共178例（30．58％）,结肠疾病合并回肠末段病变的42例（23．60％）,其中有回肠末段炎、淋巴滤泡增生症、溃疡性回肠炎、回肠结核、回肠克罗恩病、回肠末段出血、回肠息肉、回肠末段恶性淋巴瘤。结论回肠末段病变具有较高的发病率,且病变具有多样性,另外结肠疾病合并回肠末段病变及大肠癌并结直肠息肉的发病率也较高,结肠镜检查时不应仅满足于一处病灶的发现,除肠腔狭窄或禁忌外,均应在肠道清洁良好的基础上进入回肠末段进行全肠镜检查。     

ANTIGENS IN IMMUNITY : XV. ULTRASTRUCTURAL FEATURES OF ANTIGEN CAPTURE IN PRIMARY AND SECONDARY LYMPHOID FOLLICLES

This paper describes the trapping of antigen in lymphoid follicles of rat popliteal lymph nodes as revealed by electron microscopic radioautographs following injection of ¹²⁵I-labeled Salmonella adelaide flagella and other materials. The antigen was taken up vigorously, and to an approximately equal extent, by both primary and secondary follicles. The rate of uptake was faster in preimmunized than in virgin adult rats. The bulk of the antigen in follicles was extracellular, and persisted in this location for at least 3 wk. Label was most frequently found at or near the surface of fine cell processes. Many of these were branches of dendritic follicular reticular cells. Such processes interdigitated with equally fine processes of lymphocytes, creating an elaborate meshwork. In some cases, antigen was found between lymphocytes which appeared to be in close apposition. Occasionally, a few grains appeared over lymphocyte nuclei and study of serial sections suggested that this probably represented true entry of small amounts of antigen into lymphocytes. The characteristic "tingible body" macrophages (TBM) of germinal centers appeared to play only a secondary role in follicular antigen retention. They showed degrees of labeling over their phagocytic inclusions varying from negligible to moderately heavy. Moreover, follicles lacking or poor in TBM retained antigen just as effectively as those containing numerous TBM. The hypothesis is advanced that TBM may be derived from monocytes that migrate down from the circular sinus. Follicular localization of three other materials was also studied, though not in such detail. These were ¹²⁵I-HSA complexed to anti-HSA: ¹²⁵I-labeled autologous IgG; and ¹²⁵I-monomeric flagellin. All of these showed the basic features of intercellular, membrane-associated deposition noted with ¹²⁵I-flagella. The role of follicular antigen depots in immune induction is discussed. The tentative conclusion is reached that follicular antigen in a primary follicle encounters natural antibody on the surface of certain antigen-reactive lymphocytes. The resultant reaction causes blast cell transformation and eventually the genesis of a germinal center.