鉴别克罗恩病与溃疡性结肠炎的列线图预测模型构建

目的 探讨鉴别克罗恩病(Crohn's disease,CD)和溃疡性结肠炎(ulcerative colitis,UC)的独立危险因素并构建列线图预测模型.方法 回顾性分析429例炎症性肠病(inflammatory bowel disease,IBD)的临床病理资料,通过单因素和多因素分析鉴别CD和UC的危险因素并...     

阴道镜配合病理活检应用于宫颈疾病的诊断价值

目的 评价电子阴道镜及宫颈病理活检对宫颈疾病的诊断价值.方法 收集我院妇科门诊2003年至2006年宫颈疾病患者行阴道镜检查病行宫颈活检的病理结果进行对照分析.结果 电子阴道镜检查后行宫颈活检1060例,病理结果显示:宫颈癌16例,宫颈上皮内瘤样变342例,宫颈炎性病变702例,阴道镜诊断宫颈上皮内瘤样变及宫颈癌的符合率分别为:93.44%和93.75%.结论 阴道镜检查配合病理活检诊断宫颈疾病结果及时可靠,尤其对宫颈上皮内瘤样变的早诊断及降低宫颈癌的发生率有重要价值.     

高血糖通过AMPK/SIRT1调控CDK5通路介导阿尔兹海默症样分子病理改变

炎症性肠病 (Inflammatory Bowel Disease,IBD) 包括溃疡性结肠炎 (Ulcerative Colitis,UC) 和克罗恩病 (Crohn''s Disease,CD)。营养不良在IBD患者中很常见。与UC相比,CD中更易出现严重的营养不良。IBD患者肌肉减少症 (肌少症) 的患病率很高,肌少症对IBD患者的术后并发症和住院时间有负面影响,是IBD患者中需重视的问题。肌少症可通过多种机制发展,包括营养不良、慢性炎症、脂肪组织的炎症、维生素缺乏和肌-肠轴失衡。除了IBD患者的临床缓解和内镜下黏膜愈合外,对肌少症进行适当的治疗很重要。本综述旨在总结IBD和肌少症的相关研究成果,可能为IBD的诊治提供一种新的思路。     

食物不耐受对炎症性肠病严重程度及病变部位的预测作用

分析食物不耐受对炎症性肠病(IBD)的分期和受累部位的预测作用。研究发现, IBD患者的食物不耐受阳性率显著高于健康查体人群。活动期IBD患者显著高于缓解期IBD人群。克罗恩病(CD)患者食物不耐受种类显著高于溃疡性结肠炎(UC)患者, 高度食物不耐受对IBD的分期及CD是否累及小肠有预测作用。     

炎症性肠病患者中四种自身抗体联合检测的临床意义

为探讨联合测定血清抗中性粒细胞胞浆抗体(ANCA)、抗酿酒酵母菌抗体(ASCA)、抗小肠杯状细胞抗体(IGA)、抗胰腺腺泡抗体(PAB)对溃疡性结肠炎(UC组)和克罗恩病(CD组)的诊断和鉴别诊断价值.用间接免疫荧光法测定20例UC组和20例CD组以及10例肠道疾病组患者和5名健康对照组血清ANCA、ASCA、IGA、PAB水平.在四个组中ANCA的阳性率分别为70%、25%、10%和0%,UC组显著高于后三组(P<0.05);而ASCA的阳性率分别为15%、60%、10%和0%,CD组显著高于其他三组(P<0.05).IGA阳性率分别为30%、65%、10%和0%,CD组亦显著高于二个对照组(P<0.05),但与uc组比较,无显著性差异(P>0.05).ANCA /ASCA-诊断UC的敏感性、特异性和阳性、阴性预测值分别是55%、90%、84.6%和66.7%,而ASCA /ANCA-的诊断CD分别是35%、95%、87.5%和59.4%.IGA /ANCA-的诊断cD分别是45%、95%、90%和63.3%;AN-CA、ASCA和IGA阳性有利于炎症性肠病(IBD)的诊断却不能敏感地筛选;ANCA、ASCA和IGA联合检测可作为UC和CD鉴别诊断,是IBD非创伤性鉴别诊断方法之一.     

炎症性肠病合并巨细胞病毒感染的研究进展

炎症性肠病(inflammatory bowel disease,IBD)是一类免疫介导的慢性非特异性肠道炎症,包括溃疡性结肠炎(ulcerative colitis,UC)和克罗恩病(crohndisease,CD),其发病机制与遗传、环境、感染和免疫相关.IBD病变主要累及肠道,有时可出现多种肠外表现.治疗以5-氨基水杨酸、糖皮质激素、免疫抑制剂、生物制剂为主.     

上皮样胃肠道间质瘤12例临床病理分析

目的探讨上皮样细胞型胃肠道间质瘤(gastrointestinal stromal tumors,GIST)的病理形态、免疫表型特征及鉴别诊断。方法对12例上皮样GIST进行形态观察,免疫组化标记,并结合相关文献进行讨论。结果本组上皮样GIST男女之比为2∶1,平均年龄53.5岁。发生部位包括胃3例,小肠3例,肠系膜2例,网膜3例,腹膜后GIST侵犯肾脏1例。除3例活检小标本外,其余9例肿瘤均完整切除。上皮样GIST镜下形态以圆形、卵圆形或短梭形上皮样细胞为主,瘤细胞中等大小,胞质略嗜酸,细颗粒状。核圆或卵圆形,多为单核,偶见多核细胞。多数病例还可见多少不等的空泡样细胞或核偏位呈印戒样细胞。肿瘤细胞呈器官样构型(4例)、大的片块状构型(3例)、富细胞性构型(4例)及假乳头状构型(1例)。免疫组织化学标记显示绝大多数上皮样GIST表达CD117、CD34或Dog-1,而不表达CK、Syn、Melan-A等。结论上皮样GIST因其细胞形态和组织结构具有上皮性肿瘤的特点而可能与之混淆,CD117和CK免疫标记可明确诊断。     

炎症性肠病外周血单个核细胞LncRNA表达谱研究

目的明确炎症性肠病患者外周血单个核细胞(peripheral blood mononuclear cell,PBMC)中长链非编码RNA(long non-coding RNA,LncRNA)的表达谱特征,并明确关键LncRNA与病情指标相关性。方法分离炎症性肠病患者PBMC,以正常志愿者PBMC为对照,提取RNA并进行LncRNA表达谱芯片检测,筛选关键LncRNA并分析其与炎症性肠病病情活动度的相关性。结果溃疡性结肠炎(ulcerative colitis,UC)组差异表达LncRNA 1 672个、克罗恩病(Crohn's disease,CD)组差异表达LncRNA 1 048个,2组共有差异表达177个;差异表达中ENSG00000251186.1改变最为明显,在UC组中上调9.4倍、CD组中上调8.9倍;ENSG00000251186.1与UC组患者CRP、ESR及改良Mayo评分均呈正相关关系,与CD组患者的CRP、ESR及CD活动指数也为正相关关系;ROC曲线显示ENSG00000251186.1曲线下面积UC组为0.902 4、CD组为0.903 1。结论炎症性肠病患者外周血单个核细胞LncRNA表达谱出现显著异常,其中ENSG00000251186.1明显上调且与炎症指标、病情活动度密切相关,可能有助于IBD的早期诊断。     

腹部超声在不同时期炎症性肠病中的评估价值及特点分析

目的:研究腹部超声在不同时期炎症性肠病(IBD)中的评估价值及特点.方法:选取本院2018年3月-2020年3月收治的100例IBD患者设为研究对象.患者皆进行结肠镜以及病理学确诊,溃疡性结肠炎(UC)患者58例其中UC缓解期组22例,UC活动期组36例;克罗恩病(CD)患者42例其中CD缓解期组20例,CD活动期组22例.选取健康的体检者30例设为对照组.比较对照组、UC活动期和UC缓解期以及CD活动期和CD缓解期患者的肠壁厚度、动脉阻力指数(RI)值和血流状态的变化.结果:肠壁厚度比较对照组最低,其次为UC、CD缓解期两组,CD活动期组最高(P<0.05).RI值比较对照组最高,其次为UC、CD缓解期两组,CD活动期组最低(P<0.05).血流状态0-Ⅰ级比较,对照组最高,其次是UC、CD缓解期两组,CD活动期组最低;Ⅱ-Ⅲ级比较对照组最低,其次为UC、CD缓解期两组,UC活动期组最高(P<0.05).相比结肠镜以及病理学确诊,腹部超声UC缓解期90.91％,UC活动期88.89％,CD缓解期85.00％,CD活动期86.36％.结论:腹部超声检测UC以及CD活动期和缓解期患者肠壁厚度、RI以及血流状态具备优势,准确评估不同时期IBD活动性.     

非特殊性血管周上皮样细胞肿瘤31例的病理学观察

目的 探讨非特殊性血管周上皮样细胞肿瘤(PEComa-NOS)的临床病理学特征,评价恶性血管周上皮样细胞肿瘤(PEComa)的诊断标准.方法 回顾性复习31例PEComa-NOS的临床表现、影像学资料、光镜形态和免疫学表型,分析预后资料.2例为空芯针穿刺活检标本,2例为剖腹探查活检标本,其余27例为手术切除标本.结果 ...     

Diagnostic problems in chronic inflammatory bowel disease related specimens

A diagnosis of inflammatory bowel disease (IBD) carries serious long term implications for patient management and for cost of care. Pathologists must be aware of common mimics of IBD to prevent misdiagnosis. The distinction between ulcerative colitis and Crohn's disease is usually straightforward in resections but cannot be made easily on mucosal biopsies alone. Correlation with clinical and endoscopic findings is needed in the latter instance. The diagnosis of “indeterminate colitis” must be made only in resection specimens using strict diagnostic criteria. This review deals with common problems associated with the diagnosis of IBD and IBD-associated neoplasia.     

CD44v6 expression in inflammatory bowel disease is associated with activity detected by endoscopy and pathological features

AIMS: Overexpression of CD44v6 in colon crypt epithelial cells has been suggested to have diagnostic potential in differentiating ulcerative colitis from other forms of colon inflammation, including Crohn's disease. Our aim was to determine the value of CD44v6 expression in inflammatory bowel disease (IBD) and to look for possible associations between CD44v6 expression and activity of this disease. METHODS AND RESULTS: CD44v6 expression was studied using immunohistochemical techniques in 100 surgical and endoscopic colon samples of ulcerative colitis (n = 71) and Crohn's disease (n = 29), and in every case disease activity was studied by endoscopy and microscopic examination. Fifty-five of 71 (77.5%) samples of ulcerative colitis showed monoclonal antibody 2F10 stained colon epithelium, as did 16 of 29 (55.2%) samples of Crohn's disease. CD44v6 was detected in 88.2% (15 of 17) of cases of IBD with severe disease activity and in 100% of eight cases of severe ulcerative colitis. Our study showed a strong association between CD44v6 expression and the activity of IBD (P = 0.007). CONCLUSIONS: CD44v6 expression in IBD is significantly associated with activity detected by means of endoscopy and pathological features. Our data suggest that CD44v6 expression may have some usefulness in conjunction with other factors as a means of evaluating the disease activity. Moreover, CD44v6 expression was higher in ulcerative colitis than Crohn's disease (P = 0.02), although this does not confirm the utility of monoclonal antibody 2F10 in differential diagnosis between ulcerative colitis and Crohn's disease, as there was a notable percentage of positive samples of Crohn's disease.     

Bromelain treatment decreases secretion of pro-inflammatory cytokines and chemokines by colon biopsies in vitro

Oral bromelain has been anecdotally reported to decrease inflammation in ulcerative colitis (UC). Proteolytically active bromelain is known to decrease expression of mRNAs encoding pro-inflammatory cytokines by human leukocytes in vitro. To assess the effect of bromelain on mucosal secretion of cytokines in inflammatory bowel disease (IBD), endoscopic colon biopsies from patients with UC, Crohn's disease (CD), and non-IBD controls were treated in vitro with bromelain or media, then cultured. Secretion of pro-inflammatory cytokines and chemokines was measured. Significant increases in granulocyte colony-stimulating factor (G-CSF), interferon (IFN)-gamma, interleukin (IL)-1beta, IL-6, and tumor necrosis factor (TNF) were detected in the media from actively inflamed areas in UC and CD as compared with non-inflamed IBD tissue and non-IBD controls. In vitro bromelain treatment decreased secretion of G-CSF, granulocyte-macrophage colony-stimulating factor (GM-CSF), IFN-gamma, CCL4/macrophage inhibitory protein (MIP)-1beta, and TNF by inflamed tissue in IBD. Bromelain may be a novel therapy for IBD.     

Diagnostic difficulties in inflammatory bowel disease pathology

This review summarizes some of the common diagnostic problems encountered by pathologists when evaluating patients with chronic colitis and in whom inflammatory bowel disease (IBD) is either suspected or within the differential diagnosis. Both ulcerative colitis (UC) and Crohn's disease (CD) show characteristic, but non-specific, pathological features that may overlap and result in a diagnosis of 'indeterminate colitis' (IC). However, other reasons why pathologists may entertain a diagnosis of IC include failure to recognize or accept certain 'hardcore' histological features as indicative of CD, an attempt to classify cases of chronic colitis based on mucosal biopsy material or in the absence of adequate clinical and radiographic information, and the presence of other disease processes that mask, or mimic, IBD. In addition, some cases of UC may show unusual CD-like features, such as discontinuous or patchy disease, ileal inflammation, extracolonic inflammation, granulomatous inflammation in response to ruptured crypts, aphthous ulcers, or transmural inflammation. Furthermore, other forms of colitis, such as microscopic colitis, diverticulitis and diversion colitis may, on occasion, also show IBD-like changes. The clinical and pathological features that aid in the distinction between these entities, and others, are covered in detail in this review.     

Indeterminate colitis in the spectrum of inflammatory bowel disease

During a ten-year period, a double-blind retrospective study of 32 colectomy specimens from patients with inflammatory bowel disease (IBD) showed that the majority of cases could be clearly separated into ulcerative colitis (UC, 65%) and Crohn's disease (CD, 19%). However, in five (16%) colectomy specimens, the pathologic changes did not fulfill the criteria generally accepted for UC and CD. Criteria were laid down to differentiate the indeterminate form of colitis from the two more familiar types of IBD. We discuss the value of the category "indeterminate colitis" and emphasize that the term "transmural inflammation" is loosely used and that accurate definition of this criterion removes much of the difficulty from the differential diagnosis of IBD.     

Amoebic colitis

Amoebic colitis is caused by the parasite Entamoeba histolytica (E. histolytica). The condition is prevalent in countries with poor sanitation but is increasing within developed countries secondary to global travel and immigration. We report a case of amoebic colitis diagnosed in a patient with a clinical diagnosis of Crohn's disease and with no travel history. Colonic biopsies showed focal active colitis with ulcer slough; deeper levels looking for granulomas fortuitously revealed the amoebae. The diagnosis was confirmed by positive serology and symptomatic improvement after a course of eradication treatment. Pathologists should look for amoebae in biopsies for inflammatory bowel disease (IBD), as endoscopic and histological appearances of IBD and amoebic colitis can be similar but importantly immunosuppressive therapy is contraindicated in amoebic colitis.     

Indeterminate colitis: definition, diagnosis, implications and a plea for nosological sanity

In 1978, Price introduced the concept of indeterminate colitis to describe cases in which colonic resections had been undertaken for chronic inflammatory bowel disease (CIBD), but a definitive diagnosis of either of the classical types of CIBD, ulcerative colitis and Crohn's disease, was not possible. This was especially apposite in cases of acute fulminant disease of the colorectum. More recently, the term indeterminate colitis has been applied to biopsy material, when it has not been possible to differentiate between ulcerative colitis and Crohn's disease. In our opinion, and in those of other workers in this field, the term should be restricted to that originally suggested by Price. This then provides a relatively well-defined group of patients in whom the implications and management of the disease are becoming much clearer. Cases where there are only biopsies with CIBD, but equivocal features for ulcerative colitis and Crohn's disease, should be termed 'CIBD, unclassified', 'equivocal/non-specific CIBD' or IBD unclassified (IBDU), in line with recent recommendations. When the diagnosis is correctly restricted to colectomy specimens, there is now good evidence that the majority of cases will behave like ulcerative colitis. Furthermore, the diagnosis should not be a contraindication to subsequent pouch surgery. When the latter is undertaken, surgeons and patients can expect an increased complication rate, compared with classical ulcerative colitis, especially of pelvic sepsis, but most patients fare well. Only very occasional patients, around 10%, will eventually be shown to have Crohn's disease. This review describes the pathology of cases appropriately classified as indeterminate colitis and the implications of that diagnosis. It also highlights recent advances in its pathological features, clinical management and its immunological and genetic associations.     

A method for the detection of eosinophilic granulocytes in colonoscopic biopsies from IBD patients

Eosinophilic granulocytes were found to be autofluorescent when Giemsa-stained sections were stimulated with indirect light fluorescence (ILF). The frequency of autofluorescent eosinophils was assessed in areas with diffuse and focal inflammation in 76 consecutive colonoscopic biopsies from patients with inflammatory bowel disease (IBD), Crohn's disease (CD = 32), ulcerative colitis (UC = 30), and collagenous colitis (CC = 7). All IBD cases had moderate to severe pancolitis. In areas with diffuse inflammation, severe eosinophilia was recorded in 39.6% or in 38 of 96 high power fields investigated in patients affected by CD, and in 3.3% or in 3 of 90 high power fields examined in patients with UC. In areas with focal inflammation, the mean percentage of eosinophils in CD was 57% (range 44-70%), and 9% in UC (range 6-26%). No focal inflammation was present in CC. In the submucosa of some CD patients, a large number of autofluorescent eosinophils and many autofluorescent cell-free granules were seen. It was inferred that these autofluorescent granules had been released from eosinophils, and that the eosinophilic granulocytes from which these granules had originated were no longer discernible. Focal eosinophilic mucosal infiltration in CD is more common than epithelioid cell granulomas, and emerges as an important parameter in the histologic differential diagnosis between colonic CD and UC.     

Ulcerative colitis or Crohn's disease? Pitfalls and problems

The interpretation of colorectal biopsies taken for the initial diagnosis of chronic idiopathic inflammatory bowel disease (IBD) is challenging. Subclassification of IBD as ulcerative colitis (UC) or Crohn's disease, which may be particularly difficult, is the subject of this review. Biopsies taken at first presentation are emphasised, partly because their features have not been modified by time or treatment. Aspects of longstanding disease and of resections are also mentioned. The first part of the review comprises background considerations and a summary of histological features that are discriminant, according to published evidence, between UC and Crohn's disease in initial biopsies. Pitfalls and problems associated with making the distinction between UC and Crohn's disease are then discussed. These include: mimics of IBD; inadequate clinical details; unreliable microscopic features; absence of histological changes in early IBD; discontinuity in UC; cryptolytic granulomas; differences between paediatric and adult UC; reliance on ileal and oesophagogastroduodenal histology; and atypical features in IBD resections. Avoidance by pathologists of known pitfalls should increase the likelihood of accurate and confident subclassification of IBD, which is important for optimum medical and surgical management.