甲状腺乳头状微小癌合并桥本甲状腺炎的临床病理分析

目的研究甲状腺乳头状微小癌（PTMC）合并桥本甲状腺炎（HT）的临床病理特点,为临床诊治提供参考。方法：收集我院2010年10月-2013年9月收治并经手术病理证实为PTMC患者的临床病理资料,以是否合并HT分组比较,并进行回顾性分析。结果 119例PTMC中,男女比例1：2.6,年龄（44.4±12.4）岁,术前甲状腺功能正常者97例（81.5%）,肿瘤平均最大径（6.8±2.3）mm,有颈部淋巴结转移36例（30.3%）,合并HT 41例（34.5%）。与未合并HT组相比,合并HT组中女性更多,发病年龄较小,术前促甲状腺激素（TSH）较高,肿瘤最大径较小,相互比较存在统计学差异（P〈0.05）。合并HT组的颈部淋巴结转移率（36.6%）稍高于未合并HT组（26.9%）,且与年龄、肿瘤最大径显著相关。结论 PTMC合并HT在较年轻的女性、术前血TSH水平偏高者中较常见。起病年龄较小、癌灶最大径≥7.0 mm时更易发生颈淋巴结转移。     

早期胃癌前哨淋巴结微转移临床分析

目的探讨亚甲蓝示踪法前哨淋巴结(SLN)活检术在早期胃癌外科诊疗中的临床意义。方法 39例早期胃癌患者,术中用亚甲蓝示踪SLN,对SLN及所有术后胃周淋巴结进行HE染色,对SLN进一步行细胞角蛋白20(CK20)的免疫组化染色(IHC)及逆转录聚合酶链反应(RT-PCR)检测。比较3种检测方法对SLN转移灶检出的差异。结果 39例患者中,亚甲蓝示踪成功检出37例,检出成功率达94.5%。IHC与RT-PCR微转移检出率均为18.9%。由SLN状态预测胃周淋巴结转移情况:HE切片病检组前哨淋巴结检测准确率97.3%(36/37),假阴性率为16.7%(1/6);CK-20行IHC及RT-PCR组检测准确率97.3%(36/37),假阴性率为14.3%(1/7)。结论亚甲蓝示踪法能有效检出早期胃癌SLN。HE染色结合IHC及RT-PCR检测能提高SLN中微转移的检出率。     

摩洛哥塔扎地区颈部淋巴结肿大42例

颈部软组织结核在我国,特别是大中城市日渐减少。回顾性分析笔者援助摩洛哥期间,颈部结核性淋巴结炎等淋巴结肿大病例42例,报道如下。     

颈部巨淋巴结增生临床分析

目的 提高对颈部巨淋巴结增生(Castleman病)的诊断水平.方法 回顾性分析曾经误诊的10例巨淋巴结增生的临床资料,分析临床诊断和鉴别诊断的经验和教训.结果 10例颈部巨淋巴结增生患者,男3例,女7例;按Frizzera分类标准分为局灶性8例(其中透明血管型6例,混合型2例),多中心性2例(其中浆细胞型1例,混合型1例).临床以无痛性颈淋巴结肿大为特征,多中心性2例伴有全身症状和(或)多脏器受累等特征.10例患者均为误诊后接受淋巴结切除术后病理检查确诊.随访4～17年10例患者均健康生存,其中1例多中心性浆细胞型患者术后2年复发,再次接受淋巴结手术切除术和化疗后4年未再复发.结论 颈部巨淋巴结增生临床少见,易于误诊,应采用淋巴结切除活检术病理检查确定诊断,注意与颈淋巴结结核、颈淋巴结炎、结节病、肉芽肿等鉴别.如无系统功能严重受累,首选手术切除.     

Prognostic factors of neck node metastasis

A retrospective clinico-pathological study has been carried out in a series of 405 patients with squamous cell carcinoma of the head and neck who underwent a total of 484 radical neck dissections. The recurrence rate in the neck in 327 patients who had histological positive nodes was 21.1%, Recurrence in the neck after a standard radical neck dissection almost invariably proved fatal. A statistical analysis has been carried out to evaluate the clinical and pathological factors which are of importance in regards to recurrence in the neck. Histological factors such as extra-nodal spread and the number of histological positive nodes have been shown to be of much more prognostic importance than clinical parameters. When corrections are made for interdependencies between variables, histological extra-nodal spread proved to be the most important single prognostic factor (P < 10^?7).     

Feasibility of sentinel lymph node biopsy omission after integration of 18F-FDG dedicated lymph node PET in early breast cancer:a prospective phase Ⅱ trial

Objective:Sentinel lymph node biopsy(SLNB) is currently the standard of care in clinically node negative(cN0) breast cancer.The present study aimed to evaluate the negative predictive value(NPV) of ¹⁸F-FDG dedicated lymph node positron emission tomography(LymphPET) in cN0 patients.Methods:This was a prospective phase II trial divided into 2 stages(NCT04072653).In the first stage,cN0 patients underwent axillary LymphPET followed by SLNB.In the second stage,SLNB was omitted in patients ...     

超声、PET/CT及两者联合检测对恶性黑色素瘤淋巴结转移的临床价值分析

目的：探讨超声、正电子发射断层成像/计算机断层成像（positron emission tomography/computed tomography,PET/CT）及两者联合检测对恶性黑色素瘤（malignant melanoma,MM）淋巴结转移评估的准确性,指导临床MM患者淋巴结活检及清扫的术前评估。方法：收集41例MM住院患者临床资料,分析术前淋巴结相关影像资料、术后淋巴结病理结果及病理结果跟影像结果的相关性。结果：超声、PET/CT以及两者联合检测的敏感度分别是47.36%、73.68%、78.95%,特异度分别是59.09%,86.36%、50.00%,准确度分别是53.66%、80.49%、63.41%,阳性预测值分别是50.00%、82.35%、57.69%,阴性预测值分别是56.52%,79.17%、73.33%,正确指数分别是6.45%、60.04%、28.95%。结论：PET/CT在评估MM术前淋巴结是否转移方面具有重要价值,其准确度、特异度、阳性预测值、阴性预测值均高于超声及两者联合检测,当PET/CT检查淋巴结转移为阴性时,应结合超声两者联合综合判断,避免淋巴结...     

Paraaortic sentinel lymph node detection in intermediate and high-risk endometrial cancer by transvaginal ultrasound-guided myometrial injection of radiotracer (TUMIR)

ObjectiveWe aimed to evaluate the accuracy of sentinel lymph node (SLN) mapping with transvaginal ultrasound-guided myometrial injection of radiotracer (TUMIR) to detect lymph node (LN) metastases, in patients with intermediate and high-risk endometrial cancer (EC), focusing on its performance to detect paraaortic involvement.MethodsProspective study including women with preoperative intermediate or high-risk EC, according to ESMO-ESGO-ESTRO consensus, who underwent SLN mapping using the TUMIR approach. SLNs were preoperatively localized by planar and single photon emission computed tomography/computed tomography images, and intraoperatively by gamma-probe. Immediately after SLN excision, all women underwent systematic pelvic and paraaortic lymphadenectomy by laparoscopy.ResultsThe study included 102 patients. The intraoperative SLN detection rate was 79.4% (81/102). Pelvic and paraaortic drainage was observed in 92.6% (75/81) and 45.7% (37/81) women, respectively, being exclusively paraaortic in 7.4% (6/81). After systematic lymphadenectomy, LN metastases were identified in 19.6% (20/102) patients, with 45.0% (9/20) showing paraaortic involvement, which was exclusive in 15.0% (3/20). The overall sensitivity and negative predictive value (NPV) of SLNs by the TUMIR approach to detect lymphatic involvement were 87.5% and 97.0%, respectively; and 83.3% and 96.9%, for paraaortic metastases. After applying the MSKCC SLN mapping algorithm, the sensitivity and NPV were 93.8% and 98.5%, respectively.ConclusionThe TUMIR method provides valuable information of endometrial drainage in patients at higher risk of paraaortic LN involvement. The TUMIR approach showed a detection rate of paraaortic SLNs greater than 45% and a high sensitivity and NPV for paraaortic metastases in women with intermediate and high-risk EC.     

The morphology of the atrioventricular node in scleroderma -- a three-dimensional reconstruction

A new technique for looking at the atrioventricular node andbundle is described and applied to the conducting system insix patients with scleroderma. The conducting system blockswere removed, sectioned, appropriately stained and photographed.Outlines of the atrioventricular node and bundle were generatedand digitized. From the digital information three-dimensionalimages were generated and the atrioventricular node and bundlewere rotated so that the shape could be studied from any view.In striking contrast to normal atrioventricular nodal reconstructions,those from the patients who had scleroderma showed a narrowand flattened proximal atrioventricular node. The nodal microscopy,on the other hand, did not differ significantly in architecture.It is postulated that the alterations by fibrous replacementof the proximal node could account for the relatively high frequencyof atrioventricular conduction Scleroderma, problems in patientswith scleroderma and could paradoxically account for the relativelyfrequent occurrence of supraventricular tachycardias that arealso found in this disease.