宫颈息肉样病变临床病理分析

目的 探讨宫颈息肉样病变的临床病理特点、诊断及鉴别诊断。方法 分析了4239例宫颈息肉样病变的临床病理资料,进行光镜观察,部分病例进行了特殊染色和免疫组化染色,按病理组织学形态特点进行分类。结果 宫颈息肉（瘤样病变）占97．6％,其中纤维肉芽组织型36．9％、腺瘤样性息肉24．0％、单纯型20．0％、血管瘤样型8．6％、混合型4．1％、囊肿型2．4％、淋巴组织增生型2．4％、假蜕膜型1．4％、微腺管型0．3％;肿瘤性病变占2．4％,多为恶性肿瘤。结论 宫颈息肉在病理形态上具有多态性,在诊断宫颈息肉时要注意与息肉样改变的真性肿瘤鉴别,还要考虑到部分类型宫颈息肉的潜在恶性。     

3179例宫颈息肉样病变临床病理分析

目的：了解宫颈息肉样病变的病理类型。方法：对３１７９例宫颈息肉样病变进行临床病理分析，按病理组织学形态特点进行分类。结果：９８．９９％病例为宫颈息肉，其中腺性息肉３２．７３％、单纯型３０．７９％、纤维肉芽组织型２７．２％、血管瘤样型６．５１％、淋巴组织增生型２．５１％、微腺管型０．２５％。本组另一类为肿瘤性病变，仅占１．０１％，多为恶性肿瘤。结论：在诊断宫颈息肉时要注意与息肉样改变的真性肿瘤鉴别，     

13例宫颈透明细胞腺癌临床病理及免疫组化分析

１３例与妊娠期宫内接触乙雌芪酚（ＤＥ８）无关的宫颈透明细胞癌１３例，占同期宫颈腺癌的３．９５％。随访有８例生存５年以上。病理组织学上微囊为主型４例，乳头－腺管为主型８例，实体片状为主型１例。通过形态学、ＡＢ／ＰＡＳ组化染色及ＥＭＡ、ＣＥＡ、ＰＲ、ＥＲ、Ｖｉｍｅｎｔｉｎ免疫酶标检测，结果证明该癌起自苗勒管上皮，为宫颈腺癌的一种特殊类型。     

腺样鳞状细胞癌12例临床病理分析

１２例发生于外阴、阴茎、眼睑结膜、口腔、鼻腔、头部及下肢的腺样鳞癌病人中，男女各６人，年龄２４－７３岁，平均５８．４岁。肿瘤由角化鳞癌细胞形成的腺样结构和实性癌组织组成，均有广泛或较广泛的浸润，但有区域淋巴结转移者仅１例。局部扩大切除术治疗可有良好效果，此癌发生可能与普通鳞癌组织的变态性分化有关。     

1747例宫颈阴道病变筛查结果分析

目的 探讨膜式液基薄层细胞学检测(ThinPrep cytology test，TCT)技术在宫颈病变筛查中的价值。方法 对1747例门诊及住院患者行TCT检测。细胞学检查阳性者行阴道镜检查及多点活检，并行病理组织学检查。结果 1747例中51例不满意，不满意率2．92％，剩余1696例中1455例(85．79％)在正常范围内；139例(8．20％)为良性反应性改变；101例属非典型鳞状上皮细胞(atypical squamous cells，ASC)及其以上病变，检出率5．96％，其中ASC52例(3．07％)，鳞状上皮内病变(squamous intraepithelial lesion，SIL)及鳞状细胞癌(squamous cell carcinoma，SCC)共40例(2．36％)，二者之比为1．30：1；低度鳞状上皮内病变(low grade squamous intraepithel iallesion，LSIL)33例(1．95％)；高度鳞状上皮内病变(high grade squamous intraepithel iallesion，HSIL)7例(0．41％)；宫颈鳞状细胞癌(SCC)4例(0．24％)。不典型腺细胞(atypical glandular cells，AGC)4例(0．24％)，腺癌(Adenocareinomal)4例(0．06％)。在微生物检测中，霉菌52例，检出率3．07％，滴虫4例，检出率0．24％。与病理组织学对照，细胞学检出15例中的LSIL11例；检出7例HSIL中的6例；检出了全部4例鳞状细胞癌；组织学证实的1例腺癌被检出。结论 TCT技术制作的薄片，细胞结构清晰，背景清朗，可明显提高标本的满意率；且具有较高的阳性检出率，与组织学对照的诊断符合率亦较高，是临床宫颈病变筛查的好方法。     

宫颈腺上皮肿瘤性病变

随着宫颈细胞学筛查的广泛开展,宫颈鳞状上皮病变得易早期发现并得到早期治疗,因而在过去几十年,宫颈浸润性鳞状细胞癌的发病率明显下降。而与之不同的是,宫颈腺癌的相对及绝对发病率在过去30年中却呈现上升趋势。本文将重点讨论宫颈腺癌和癌前病变的病理学特征及相关的研究进展。     

新生儿咽部毛息肉7例临床病理分析

目的 探讨咽部毛息肉的临床病理学特点.方法回顾性分析7例咽部毛息肉临床病理学资料并复习相关文献.结果 7例均为女婴,入院年龄1～45天,平均14.86天.临床特点:肿块堵塞口咽部与鼻咽部,导致进食困难或呼吸困难.部位:位于咽后壁3例,鼻咽部2例,咽腭弓1例,扁桃体窝1例.病理学特点:毛息肉为带蒂的圆形肿块,实性,表面被覆皮肤,中央是脂肪、平滑肌、横纹肌和软骨等中胚层成分构成的核心区.结论 咽部毛息肉是一种先天性发育异常,可将其归入迷芽瘤.毛息肉异常罕见,应将其作为一种独立的疾病.毛息肉堵塞口咽部与鼻咽部可导致新生儿窒息,应尽早手术.     

Clinicopathologic Features of Polypoid Lesions of the Gallbladder and Risk Factors of Gallbladder Cancer

It is difficult to differentiate benign and malignancy in polypoid lesions of the gallbladder (PLG) by solely depending on imaging studies. Therefore clinicopathologic features of benign and malignant polyps are compared in an attempt to identify the risk factors of malignant polypoid lesions. The medical records of 291 patients who were confirmed to have PLG through cholecystectomy were reviewed and analyzed for age, sex, symptom, associated gallstone, morphology of PLG, size of PLG, number of PLG, and preoperative tumor markers. Benign PLG was found in 256 patients (88.0%) and malignant PLG in 35 patients (12.0%). Compared with benign group, the malignant group were older (61.1 yr vs. 47.1 yr, P<0.001), more often accompanied with symptoms (62.9% vs. 28.9%, P<0.001). Malignant PLG tended to be sessile (60.0% vs. 10.5%, P<0.001), larger (28.0 mm vs. 8.6 mm, P<0.001) and single lesion (65.7% vs. 44.1%, P<0.016). Age over 60 yr (P=0.021, odds ratio [OR], 8.16), sessile morphology (P<0.001, OR, 7.70), and size over 10 mm (P=0.009, OR, 8.87) were identified as risk factors for malignant PLG. Careful decision making on therapeutic plans should be made with consideration of malignancy for patients over 60 yr, with sessile morphology of PLG, and with PLG size of over 10 mm.     

A Clinicopathologic Study of 62 Cases

This clinicopathologic study concerns 62 patients with one of the Dupuytren type fibromatoses. Of the 62 patients, 42 had the lesion in the palm (palmar fibromatosis), 12 in the sole (plantar fibromatosis), 2 in the penis (penile fibromatosis), and 6 in the ectopic locations, the dorsal aspect of the hand in 3 patients, the dorsum of the fingers in 2, and the forearm in 1. The clinically palpable nodules were histologically classified into those of the following three phases, according to Luck's classification:¹² proliferative phase (27), involutional phase (23), and residual phase (12). In addition to fibroblastic proliferation, the lesion of the proliferative phase exhibited vascular features consisting of one or more layers of cells with oval nuclei around the vessels within the nodule. In the lesions of the late proliferative and involutional phase, the intracytoplasmic fine filaments were visible in cells compatible with myofibroblasts by Masson's trichrome stain. The nuclei of the elemental fibroblasts in the same phases were often crossed transversely by one or more fine basophilic lines.     

A Clinicopathologic Study of Tumors and Tumor-like Lesions of the Penis

A total of 147 specimens from 93 patients with penile lesions were examined at Nagasaki University Hospital during a 27-year period from 1961 to 1987. The most frequent malignant tumor was squamous cell carcinoma (SCC, 33 cases, 35.5%), followed by extramammary Paget's disease, transitional cell carcinoma, and Bowen's disease. The benign tumors and tumor-like lesions included condylorna acuminatum, cyst of the genitoperineal raphe, and lymphangioma. SCC of the penis accounted for less than 0.1% of all specimens and less than 0.62% of malignant tumors in men filed at our hospital. True phimosis accompanied 81.5% of the SCC cases. The 5-and 10-year survival rates for SCC were 77.2% and 71.3% respectively. Two patients died of penile SCC. It was considered that an absence of both keratohyaline granules in the granular layer and melanin pigment in the basal layer can serve as a useful histologic indicator for diagnosis of well differentiated SCCs that are otherwise difficult to identify.     

PIGMENTED VILLONODULAR SYNOVITIS A Clinicopathologic Study of 52 Cases

Clinicopathologic, enzyme histochemical and electron microscopic findings in 52 patients with pigmented villonodular synovitis (PVS) are reported. The lesion was by far the most common in the knee joint (48%), followed by the ankle joint (25%). As to sex incidence, there seemed to be no predilection (46% in men, 54% in women). Microscopically, the PVS showed thin or thick villous projections of the involved synovial membrane, associated with or without nodular formation. The nodule of PVS consisted essentially of a proliferation of histiocyte-like cells with phagocytic activities. Another characteristic feature was large clefts and pseudoglandular or alveolar spaces lined by synovial cells. Enzyme histochemical studies revealed that the lesional cells had functional properties of macrophages. Electron microscopically, the lesion consisted essentially of histiocyte-like and flbroblast-like cells, together with intermediate cells and myofibroblasts.     

Dyshormonogenetic Goiter: A Clinicopathologic Study of 56 Cases

Dyshormonogenetic goiters (DG) are genetically determined thyroid hyperplasias due to enzyme defects in thyroid-hormone synthesis. We report 56 cases of DG occurring in 34 females and 22 males. The patients age ranged from newborn to 52 yr (median 16), 75% of the cases occurring before the age of 24. All patients presented with clinically evidence of goiter except for two patients that were diagnosed at autopsy. Hypothyroidism was documented before the histological diagnosis was made in 36 patients (64%). The thyroid gland was enlarged and multinodular in all cases, weighing up to 600g. Microscopically, the most common alteration consisted of markedly cellular nodules exhibiting a variety of architectural appearances, the solid and/or microfollicular patterns predominating. Papillary proliferations and an insular growth pattern were also present. Fibrosis was a common finding; in some instances it was very conspicuous, resulting in irregularities at the edge of the nodules simulating capsular invasion. Other constant features included marked nuclear atypia and minimal amount of colloid. In 18% of the cases, the degree of hyperplasia and atypia were such as to result in a mistaken diagnosis of follicular, papillary, medullary, or undifferentiated carcinoma. Three of the glands contained, incidental small neoplasms fulfilling the criteria of papillary microcarcinoma; one of them was multicentric. The presence in a thyroid gland of the combination of these morphologic features should suggest the diagnosis of dyshormonogenetic goiter. The only other condition we are aware of that can result in a similar microscopic picture is iatrogenic goiter resulting from the administration of antithyroidal agents. The opinions or assertions contained herein are the expressed views of the authors, and are not to be considered as official or as reflecting the views of the Department of the Army or Department of Defense.     

15例新生儿深部霉菌感染临床病理分析

分析新生儿深部真菌感染15例尸检的临床病理特点。其中白色念珠菌感染11例,毛霉菌感染6例,曲霉菌病2例(6例为双重感染)。全部病例胸腺均呈重度萎缩。重点分析4例毛霉菌引起的原发性真菌病,证实毛霉菌可以通过脐部创口引起肝坏死,进而向它处播散。并讨论了其它常见致病因素及真菌病诊断中应注意的事项。     

Prevalence and Risk Factors of Gallbladder Polypoid Lesions in a Healthy Population

PurposeTo determine the prevalence of and investigate the risk factors for gallbladder (GB) polypoid lesions in a healthy population.ResultsThe prevalence of GB polypoid lesions was identified as 9.96%. On multivariate analysis, chronic hepatitis B infection (CHB) and the presence of metabolic syndrome (MS) were risk factors for GB polypoid lesions. CHB and MS were also significant independent risk factors for multiple GB polypoid lesions when compared with solitary GB polypoid lesions. In addition, gastric Helicobacter pylori infection and MS were significant risk factors for GB polypoid lesions with stones when compared with GB polypoid lesions without stones.ConclusionThe prevalence of GB polypoid lesions in a healthy Korean population was 9.96%. Patients with CHB and MS need to be carefully examined for such lesions.