淋巴结传染性单核细胞增多症一例

1　病例患者男 ,2 0岁 ,以发热伴咽部不适9天入院。患者自述 9天前踢球后自觉发热 ,伴咽部不适 ,鼻塞、流涕 ,偶有干咳。体检 :体温 37.8℃ ,皮肤无黄染 ,扁桃体轻度肿大 ,咽部充血 ,双侧颈部及腹股沟可及多枚肿大淋巴结 ,双肺 (一 ) ,肝肋下未及 ,脾肋下 1cm。实验室检查 :白细胞 13× 10 9/L ,淋巴细胞 6 5 .8% ,红细胞 4 .5 2× 10 12 /L ,单核细胞 0 .7× 10 9/L。血涂片 :粒红系增生活跃 ,巨核细胞数量增多 ,成熟淋巴细胞 2 5 % ,可见异型淋巴细胞。血生化 :谷丙转氨酶 5 4 2U/L ,谷草转氨酶 5 13U/L。各项抗体检查 :患者发病第 9天…     

ERG基因及其与前列腺癌关系

因属于ETS转录因子家族,在很多肿瘤中高表达,与肿瘤的血管生成、转移、浸润、抑制凋亡有关,ERG基因在前列腺癌中主要受TMPRSS2-ERG融合基因的调节。近一半以上的前列腺癌病例表达TMPRSS2-ERG融合基因,其中ERG基因可能是前列腺癌的重要标志物,它的检测有助于前列腺癌的诊断和治疗方法的选择。TMPRSS2-ERG融合基因的存在还会影响前列腺癌病人的预后。本文就ERG基因的生物学特征、作用机制、TMPRSS2-ERG的融合机制以及ERG基因与前列腺癌的诊断、治疗和预后的关系作一综述。     

肾混合性上皮间质肿瘤和成人囊性肾瘤的临床病理学观察

Objective To study the clinicopathologie features,immunophenotype and differential diagnosis of mixed epithelial and stromal tumor of kidney ( MEST) and adult cystic nephroma ( CN).Methods Five cases of MEST and 4 cases of CN were retrospectively analyzed.Immunohistochemical study was carried out and the literature was reviewed.Results All of the five patients with MEST were females.Their median age was 45 years.For CN,there were 3 males and 1 female and their median age was 41 years.All patients presented with loin pain and hematuria.On gross examination,MEST was well-circumscribed but non-encapsulated.There was no evidence of haemorrhage or necrosis.Three of the cases were solid in nature.One was composed of a mixture of solid and cystic elements,while the remaining case showed a multicystic cut surface bridged by thick fibrous septa.On the other hand,CN were well-circumscribed and encapsulated.They were multiloculated cystic in nature.The cystic spaces were separated by thin septa and there was no significant solid or necrotic component.Histologically,MEST consisted of proliferation of cystically dilated glands admixed with spindly stromal cells with various cellularity and growth patterns.Both the glandular and stromal elements were well-differentiated with no cytologic atypia identified.The glandular structures in 2 of the cases were partially lined by endometrial or tubal epithelium.In contrast,the thin-walled cystic spaces in CN were lined by a single layer of epithelium.Immunohistochemical　study showed that the epithelial cells were positive for pan-cytokeratin and epithelial membrane antigen.The spindle cells in MEST expressed vimentin (5/5 ) ,smooth muscle actin (3/5 ),desmin (4/5 ),CD10 (5/5),estrogen receptor (4/5) and progesterone receptor (4/5).They were negative for HMB45,CD34,CD117 and S-100 protein.On the other hand,the spindle cells in CN were variably positive for vimentin (4/4),smooth muscle actin (4/4),desmin (1/4),estrogen receptor (3/4) and progesterone receptor (1/4).They were negative for CD10,HMB45,CD34,CD117 and S-100 protein.Conclusions Both MEST and CN are uncommon renal neoplasm.Most of them run a benign clinical course.The stromal cells in MEST show smooth muscle or myofibroblastic differentiation.Areas demonstrating Miillerian features also existed in some cases.MEST and CN share overlapping histological and immunohistochemical features,and may represent spectrum of the same group of lesions.     

咽部肌上皮瘤一例

咽部肌上皮瘤一例沈朋汪审清任国平患者女，４２岁。半个月来咽异物感，自已照镜时发现口咽部有一肿物。平时无咯血，无咽痛，无吞咽及呼吸困难。检查见右侧腭咽弓处有一约２．５ｃｍ×３．０ｃｍ×１．０ｃｍ的椭圆形实质性肿块，基底宽。肿块上起软腭游离缘，下接近舌根...     

AT方案与NP方案治疗晚期乳腺癌临床疗效观察

目的比较AT方案与NP方案治疗晚期乳腺癌的临床疗效、毒副反应及临床受益反应(clinicalbenefitresponse,CBR)。方法Ⅲ～Ⅳ期乳腺癌患者64例,分为AT组(ADM+TAX)38例,NP组(NVB+DDP)26例。结果AT组有效率68.4%(26/38),CBR率55.3%(21/38);NP组有效率65.4%(17/26),CBR率53.8%(14/26)。组间疗效及CBR无显著性差异(P>0.05)。主要毒副作用为骨髓抑制、消化道反应和静脉炎,均为可逆性。结论AT方案和NP方案对于复发或有远处转移的晚期乳腺癌疗效确切,毒副作用可以耐受,均可作为一线治疗方案应用。     

15例十二指肠Brunner腺瘤的诊治

目的研究十二指肠Brunner腺瘤的临床特征和诊治进展。方法总结分析15例十二指肠Brunner腺瘤患者的临床表现、血清学检测、X线钡餐造影、普通内镜、超声内镜检查和治疗结果。将部分接受超声内镜检查者的诊断结果与术后组织病理检查结果进行对比。结果15例患者中有症状和体征者8例，其中伴发溃疡4例（溃疡并发穿孔2例），并发上消化道出血4例。所有患者血清学检查无异常；接受X线钡餐造影6例，内镜检查13例。诊断十二指肠Brunner腺瘤仅2例；超声内镜检查8例，均诊断为十二指肠Brunner腺瘤。15例患者中采用外科手术治疗7例，内镜摘除治疗8例，术前超声内镜检查结果与术后组织病理学诊断一致。结论十二指肠Brunner腺瘤是一种良性肿瘤，临床表现缺乏特异性。超声内镜检查对该病的诊治有一定价值，外科于术或内镜下摘除是主要的治疗方法。     

B-Lynch子宫缝扎术治疗剖宫产术中大出血疗效观察

对33例剖宫产术中发生子宫收缩乏力性出血的产妇，行B-Lynch子宫缝扎术止血，结果所有产妇子宫均迅速缩小变硬，阴道流血量明显减少。认为B-Lynch子宫缝扎术是治疗剖宫产术中子宫收缩乏力性出血的有效措施之一，可避免子宫切除，保留生育功能。     

茶多酚治疗慢性酒精性肝损伤的实验研究

目的 建立酒精性肝病大鼠模型,观察茶多酚对酒精性肝病大鼠血清氨基转移酶活性和肝脏病理变化的影响,探讨茶多酚对酒精性肝损伤的防治作用。 方法 SD大鼠分成3组:酒精组(酒精7g·kg-1·d-1灌胃)、茶多酚组(酒精7g·kg-1·d-1 茶多酚0.25g·kg-1·d-1灌胃)和对照组(等渗盐水灌胃)。各组分别于4周末、12周末和24周末处死大鼠留取肝脏标本,用于HE染色和Masson染色。 结果 酒精组大鼠血清氧基转移酶水平较对照组升高,茶多酚组大鼠与酒精组相比,其值有明显降低,差异有统计学意义(P<0.05)。HE染色显示酒精组大鼠肝细胞浆出现不同程度的脂肪变性,小叶各带可见不同程度的点、灶状或片状坏死,24周大鼠可见桥接坏死。Masson三色染色可见24周大鼠汇管区边缘有绿染胶原纤维包绕增生,肝窦中可见绿染胶原纤维分布。茶多酚组肝脂肪变和炎症程度轻于酒精组,未发现桥接坏死。 结论 茶多酚对酒精性肝损伤具有一定的保护作用。     

细胞周期素D1和p27kip1在肾癌中的表达及其意义

目的:探讨cyclin D1、p27kip1在普通型肾细胞癌(conventional renal cell carcinoma,CRCC)发生、发展中的作用。方法:用定量RT-PCR和Western-blot方法检测25例CRCC组织和10例肿瘤远端的正常肾皮质中cyclin D1和p27kip1的mRNA和蛋白的含量;用免疫组化方法检测76例CRCC中cyclin D1、p27kip1的表达;分析cyclin D1、p27kip1的表达与肿瘤分期、分级及术后生存率的相关性。结果:CRCC中cyclin D1的mRNA和蛋白含量分别为0.488±0.399和1.069±0.371,高于正常对照组0.089±0.066和0.281±0.253(P均<0.01);cyclin D1的表达与肿瘤体积大小有关,体积大者cyclin D1高表达(P<0.05);CRCC中p27kip1mRNA和蛋白含量分别为0.191±0.111和0.146±0.051,低于正常对照组0.374±0.216和1.004±0.318(P均<0.01),随着p27kip1表达的降低,肿瘤的细胞核Fuhrman分级、TNM分期增高;p27kip1阳性组患者的5年生存率为84.26%,高于p27kip1阴性组25.25%(P<0.01)。结论:cyclin D1高表达和p27kip1的低表达与CRCC的发生有关;p27kip1的低表达可能促进肿瘤的演进,检测p27kip1可作为评价CRCC预后的参考指标。     

12例原发甲状腺恶性淋巴瘤的临床病理研究

１２例原发甲状腺恶性淋巴瘤，其中８全炙老年妇女。８例观察到淋巴上皮病损，有７例看到残太腺组织呈淋巴细胞甲状腺炎样变。本组有２例为甲状腺边缘带Ｂ细胞淋巴瘤。免疫组化示１０例为Ｂ细胞性，２例为Ｔ细胞性，分析表明；ＴＬ可能与ＬＴ时的淋巴组织有关，部分ＴＬ可从滤泡旁Ｂ细胞起源。