Cytological diagnosis of metastatic glioblastoma in the pleural effusion of a lung transplant patient

The extracranial metastasis of glioblastoma is a rare event. We report the case of a patient who developed metastatic glioblastoma in pleural effusion 15 months after lung transplant, with emphasis on differential diagnosis based on cytological material. In our case, tumor cells had pleomorphic nuclei, prominent nucleoli, and fine vesicular chromatin. Some were arranged in a poorly formed pseudo‐glandular architecture, mimicking a poorly differentiated adenocarcinoma. The cytological diagnosis of metastatic glioblastoma is difficult and depends critically on clinical history and suspicion, particularly in the transplant setting. Review of the literature indicates that transmission/metastasis of intracranial malignancy occurs rarely following organ transplantation, with some debate on the suitability for transplant of organs from affected donors. Although the situation is uncommon, this report of the cytological findings of extracranial glioblastoma may extend our current knowledge and provide additional differential diagnostic information for this entity. Diagn. Cytopathol. 2014;42:619–623. © 2013 Wiley Periodicals, Inc.     

Cytomorphology of intraductal oncocytic papillary neoplasm of the liver

We describe the first cytology case report of an intraductal oncocytic papillary neoplasm (IOPN) of the liver. A 51‐year‐old male presented with recurrent cholangitis. Magnetic resonance imaging and endoscopic retrograde cholangiopancreatogram revealed a 1.1 × 0.9 cm polypoid lesion within the left intrahepatic bile duct. Fine‐needle aspiration and needle core biopsy (NCB) revealed nests, 3‐dimensional or papillary clusters of columnar or cuboidal cells with loss of polarity. The nuclei were uniform with even chromatin, and cytoplasm was granular or vacuolated. No mitosis or necrosis was seen. The cytologic and histologic diagnosis was “consistent with Intraductal Oncocytic Papillary Neoplasm (IOPN), intermediate grade (borderline).” The patient then underwent a left lateral liver segmentectomy. Microscopic examination showed histology similar to the NCB with no stromal invasion identified. Hepatic IOPN poses a diagnostic challenge due to its broad differential diagnoses. Both malignant and non‐malignant IOPNs may present with similar clinical symptoms, pathology, histology, cytomorphology, and immunohistochemistry. Hepatic IOPN should be excised as it is a precursor lesion of adenocarcinoma. Diagn. Cytopathol. 2014;42:895–898. © 2013 Wiley Periodicals, Inc.     

Intraductal tubulopapillary neoplasm of the pancreas on fine needle aspiration: Case Report with Differential Diagnosis

Intraductal tubulopapillary neoplasm (ITPN) is a rare primary pancreatic neoplasm accounting for less than 1% of all pancreatic exocrine neoplasms and 3% of intraductal neoplasms of the pancreas. Data on this entity are still limited. Here, we report a case of ITPN with cytopathologic and histopathologic findings. A 41‐year‐old woman with a 2.2 cm cyst in the head of the pancreas for five years was referred to our institution. The endoscopic ultrasound‐guided fine‐needle aspiration produced cytospins were moderately cellular with a few fragments of markedly atypical epithelium. The neoplastic cells displayed high‐grade nuclear atypia with enlarged, eccentric nuclei, anisonucleosis and prominent nucleoli, irregular nuclear membranes, high nucleus to cytoplasmic (N/C) ratios, and a moderate amount of cytoplasm with no intracytoplasmic mucin. Histologically, the lesion was found to be an ITPN with focal high‐grade dysplasia. No invasive carcinoma was identified. The neoplastic cells exhibited luminal immunolabeling for MUC‐1, but were negative for MUC‐2, trypsin, chymotrypsin, and P53. Approximately 5% of the neoplastic cells showed Ki‐67 immunoreactivity. ITPN of pancreas may be a source of markedly atypical epithelial cells in pancreatic cystic aspiration. Clinical and radiographic findings, molecular mutational analysis, in combination with cytological features are essential to differentiate it from other disease entities. Diagn. Cytopathol. 2014;42:156–160. © 2012 Wiley Periodicals, Inc.     

低度恶性潜能多房囊性肾肿瘤32例临床病理分析

目的分析低度恶性潜能多房囊性肾肿瘤(MCRNLMP)的临床病理学特征,提高对该肿瘤的认识。方法回顾性分析32例MCRNLMP的临床资料、组织学形态、免疫组化,并进行相关文献复习,探讨其临床病理特征。结果32例MCRNLMP中,男女比为23∶9,年龄29~73岁,平均49.9岁;左侧肾15例,右侧17例,多为体检发现肾占位。镜下多数囊腔内衬单层细胞,细胞核WHO/ISUP 1级或2级,部分间隔内可见小簇状透明细胞,但并非膨胀性生长。免疫组化示32例瘤细胞均CK(AE1/AE3)、vimentin、碳酸酐酶IX(CAIX)、PAX-2和PAX-8(+),28例CD10(+);CD68、TFE3(-),Ki-67增殖指数1~3%。随访3~78个月,均无复发及转移。结论MCRNLMP具有低度恶性潜能,预后极好。组织学上肿物以囊性成分为主,囊壁上皮部分为透明细胞,须与多种肾囊性病变鉴别。术前确诊困难,主要依靠术后病理明确诊断,同时也需结合临床及影像学资料。     

医疗不良事件中第二受害者复苏路径的研究现状

本文针对国外第二受害者复苏路径的5种理论模型进行了详细的分析与总结,以期为我国在患者安全文化背景下发展与构建第二受害者复苏理论模型提供参考,提高相关学者对第二受害者复苏一般规律的整体认识,为后续开展有针对性的干预研究和实践提供理论框架。     

同时性结直肠癌肝转移瘤消融治疗后辅助化疗起始时间对患者预后的影响

目的本研究以探究微波消融（MWA）治疗后辅助化疗（AC）起始时间对同时性结直肠癌肝转移瘤（CRLM）患者肝内无复发生存（RFS）及肝损害的影响。 方法回顾性分析2013年10月至2019年1月在中山大学附属第六医院确诊为同时性CRLM且行超声引导下经皮MWA治疗联合AC治疗的患者。本研究共纳入患者144例,其中G1组98例,G2组46例。中位肝内RFS为22.2个月。根据MWA术后AC开始时间,将患者分为≤4周（G1）和4~8周（G2）2组。比较G1组和G2组消融后及第1次AC前后血清丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）水平的变化。采用Kaplan-Meier法和Log-rank检验计算并比较两组患者的肝内RFS。采用Cox比例风险模型对肝内RFS的危险因素进行单因素和多因素回归分析。 结果G1组肝内RFS较G2组显著延长（中位肝内RFS,40.6个月 vs 12.6个月,Log-rank P=0.007）。采用Cox比例风险模型分析结果发现,辅助化疗开始时间间隔为4~8周（HR=1.917,95%CI：1.104~3.327,P=0.021）和肝转移瘤个数（HR=1.292,95%CI：1.096~1.524,P=0.002）是肝内RFS时间短的独立影响因素。G1组和G2组第1次AC前、后ALT、AST水平,差异均无统计学意义（P均>0.05）。 结论对于同时性CRLM患者,在MWA治疗后早期开始AC（≤4周）有助于延长术后肝内RFS时间。     

乳腺癌术后康复期患者对医护联合康复门诊需求的研究

目的深入了解乳腺癌术后康复期患者对医护联合康复门诊的需求状况,完善医护联合康复门诊的服务内容。 方法采用质性研究的现象学方法,选取13例乳腺癌术后患者进行半结构式深入访谈,并运用Colaizzi现象学7步分析法对资料进行分析。 结果提炼出3个主题和5个亚主题：延续性的患肢康复需求（患肢功能障碍的康复需求、淋巴水肿管理的需求）;多样化的信息需求（对健康生活方式的关注、对性健康及生育相关知识的需求、对辅助治疗相关知识的需求）;专业和持续的情感支持需求。 结论乳腺癌术后康复期患者对医护联合康复门诊存在较多方面的需求,应根据患者需求设置并细化门诊服务内容,为患者提供延续护理服务,改善乳腺癌术后患者的长期生活质量。     

“互联网+”模式护理管理在食管癌化疗患者中的应用

目的探讨“互联网+”模式护理管理在食管癌化疗患者中的应用价值。方法采用便利抽样法,选取郑州大学第一附属医院2017年1月—2019年1月收治的食管癌患者90例,均接受化疗。根据随机数字表法将其分成观察组(n=45)和对照组(n=45)。对照组采用常规护理管理,观察组采用以“互联网+”为平台的管理模式。分别于护理干预前和干预6个月后采血检测两组营养指标,包括血清前白蛋白(PA)、白蛋白(ALB)、转铁蛋白(TRF)水平。采用Connor-Davidson心理弹性量表评价两组患者心理弹性水平。结果两组患者干预后血清PA、ALB、TRF水平高于干预前,且观察组高于对照组,差异有统计学意义(P<0.05)。两组患者干预后精神影响、接受变化、忍受消极情感、能力、控制评分及心理弹性总分均高于干预前,且观察组高于对照组,差异有统计学意义(P<0.05)。结论与传统护理管理相比,采用以“互联网+”为平台的管理模式能进一步改善食管癌化疗患者的营养水平与心境状态,总体应用效果良好。     

欣母沛、缩宫素联合马来酸麦角新碱预防二次剖宫产术后出血的效果

目的探讨欣母沛、缩宫素联合马来酸麦角新碱预防二次剖宫产术后出血的效果。方法将72例二次剖宫产产妇按照随机数表法分为观察组(欣母沛、缩宫素联合马来酸麦角新碱治疗)与对照组(缩宫素治疗),各36例。比较两组的预防效果。结果观察组的术后2、24 h出血量、产后出血发生率及子宫复旧情况均优于对照组(P<0.05)。治疗后24 h,两组的Hb、HCT、Ca2+、FIB、D-D水平均有所改善,且观察组优于对照组(P<0.05)。结论欣母沛、缩宫素联合马来酸麦角新碱可有效预防二次剖宫产术后出血,且不增加不良反应。