超声联合肿瘤标志物预测附件包块良恶性质的临床价值

目的研究术前超声联合肿瘤标志物预测附件包块良恶性质的临床价值。方法回顾性分析2009年1月至2010年10月间,于同济大学附属第一妇婴保健院收治的475例附件包块患者,术前超声评估附件包块性质(包括肿块大小,回声性质和血流信号)和肿瘤标志物(CA125、CA199、AFP、CEA和CA153)检查,与最终手术病理结果比较。结果手术石蜡病理提示卵巢恶性肿瘤100例,交界性肿瘤50例,良性肿瘤325例。术前超声提示囊性肿块183例,其中良性144例(78.7%)、恶性19例(10.4%);超声提示混合性肿块247例,其中良性160例(64.8%)、恶性58例(23.5%);超声提示实性肿块45例,其中良性21例(46.7%)、恶性23例(51.1%)。超声提示混合性或实性肿块与囊性肿块相比,卵巢恶性肿瘤病率显著增加(27.7%vs.10.4%)(P<0.001)。提出卵巢肿瘤预测模型1、2、3,模型1:CA125≥35kU/L+超声混合或实性;模型2:CA125≥100kU/L+超声混合或实性;模型3:CA125≥35kU/L+CA199≥37kU/L+超声混合或实性。结论超声提示附件混合性或实性包块同时合并CA125升高者,卵巢恶性肿瘤发生率显著增高。     

637例直径≤5cm卵巢肿块的病理组织学类型分析及处理

目的:调查分析直径≤5cm卵巢肿块的病理组织学类型。方法:回顾分析经手术剔除且经常规病理组织学检查确诊的直径≤5cm卵巢肿块的临床资料。结果:卵巢肿瘤323例(50.71%),其中,良性肿瘤297例(46.62%),恶性肿瘤23例(3.61%),交界性肿瘤3例(0.47%)。瘤样病变314例(49.29%)。结论:直径≤5cm卵巢肿块中卵巢肿瘤和卵巢瘤样病变占绝大多数,卵巢瘤样病变中黄体囊肿、黄素囊肿、滤泡囊肿、卵巢冠囊肿、卵泡囊肿和包涵囊肿等占44.27%,可不必处理,但临床上应予以重视。     

子宫腺瘤样瘤的超声诊断价值——附84例病例分析

目的:探讨超声检查对子宫腺瘤样瘤的诊断价值。方法:回顾性分析84例经手术切除物病理免疫组织化学诊断为子宫腺瘤样瘤患者的超声声像图特点,分析其彩色多普勒血流信号特点。结果:84例子宫腺瘤样瘤超声均显示实性回声,其中显示低回声78例(92.9%),中等回声3例(3.6%),高回声3例(3.6%)。病灶位于肌壁间64例(76.2%),浆膜下13例(15.5%),黏膜下2例(2.4%),5例具体位置不详(6.0%)。肿瘤直径0.5~6.0 cm,以1~3 cm多见,占65.5%(55/84)。彩色多普勒显示病灶内少许或无彩色血流信号。结论:超声检查对子宫腺瘤样瘤的诊断有重要参考价值。     

妊娠合并卵巢肿瘤及瘤样病变58例临床分析

目的探讨妊娠合并卵巢肿瘤及瘤样病变患者的临床特征和处理对策。方法回顾性分析2009年1月至2010年12月福建省妇幼保健院收治的58例经手术病理诊断的妊娠合并卵巢肿瘤及瘤样病变患者的临床资料。结果 58例妊娠合并卵巢肿瘤及瘤样病变患者占同期妊娠的0.24%(58/23756),其中卵巢良性肿瘤及瘤样病变56例(96.6%),卵巢恶性肿瘤2例(3.4%)。妊娠前首次发现者5例(8.6%);孕早期发现者22例(37.9%),孕中期发现者18例(31.0%),孕晚期发现者13例(22.4%);孕早、中期均为超声检查发现,孕晚期均为剖宫产术中发现。56例卵巢良性肿瘤及瘤样病变患者中,50例(89.3%)行卵巢囊肿切除术,6例(10.7%)行附件切除术,随访8～18个月未见复发。2例妊娠合并卵巢恶性肿瘤患者中,1例卵巢浆液性囊腺癌行肿瘤细胞减灭术,术后辅助化疗8个疗程,随访12个月无瘤生存;1例卵巢肿瘤切除术后病理诊断卵巢幼年性颗粒细胞瘤,拒绝再次手术及化疗,术后2个月死亡。58例患者中,妊娠合并卵巢肿瘤蒂扭转行急诊手术8例,发生率为13.8%。58例患者的病理类型为成熟畸胎瘤24例(41.4%),浆液性囊腺瘤22例(37.9%),黄体囊肿10例(17.2%),颗粒细胞瘤1例(1.7%),浆液性乳头状囊腺癌1例(1.7%)。结论超声检查可以诊断和监测妊娠期卵巢肿瘤及瘤样病变,而剖宫产术中常规行双侧附件探查亦很重要。妊娠合并卵巢肿瘤蒂扭转患者以成熟畸胎瘤为最多见。     

慢性非哺乳期乳腺炎超声声像图、钼靶及术后病理对照分析

目的：分析慢性非哺乳期乳腺炎（nonlactation mastitis NLM）声像图特征性表现,探讨彩色多普勒超声对NLM诊断和鉴别诊断价值。方法：病理证实NLM患者43例,回顾性分析其声像图、钼钯x线表现,并与病理结果进行对照。结果：本组43例中：导管扩张症（mammary duct ectasia MDE）19例（44％）、肉芽肿性乳腺小叶炎（granulomatous lobular mastitis GM）13例（30％）、其他非特殊感染性乳腺炎11例（26％）。声像图主要表现及特征：①乳头下方、乳晕区导管扩张或合并有囊性或混合性肿物;②囊性为主的较大混合性肿物;③皮肤单个或多个瘘口;④实性低回声肿物;⑤非肿块型病变。结论：声像图的特征性表现较好地反映NLM炎症病理过程,但在不同炎性类型中特征性表现具有共性,超声有时难易以做出炎症类型的病理诊断,超声、钼钯X线联合检查对于术前明确炎性或癌性病变具有重要意义。     

310例儿童及青少年卵巢肿瘤临床分析

目的:分析儿童、青少年卵巢肿瘤的临床病理特点、诊治和预后。了解保留生育后的月经恢复及生育情况。方法:收集2000年1月~2015年8月青岛大学附属医院收治的年龄19岁的310例卵巢肿瘤患者的临床病例资料,包括发病特点、临床表现、辅助检查、治疗方法及相关预后。患者中,≤12岁81例(儿童组),13~19岁229例(青少年组)。结果:患者常见临床症状以腹痛、月经不规律为主。良性肿瘤269例(86.77%),恶性肿瘤36例(11.61%),交界性肿瘤5例(1.61%)。其中生殖细胞肿瘤最多191例(61.61%),其次是卵巢瘤样病变61例(19.68%)。儿童组中恶性及交界性肿瘤分别为14.81%(12/81)和0,青少年组中恶性及交界性肿瘤比例分别为10.48%(24/229)和2.18%(5/229)。B超及肿瘤标记物有助于卵巢良、恶性肿瘤的诊断。卵巢恶性生殖细胞肿瘤(MOGCT)大都采取保留生育功能的术式,5年总生存率、月经及后代生育情况均无明显影响。结论:儿童及青少年有腹痛、月经不规律及腹胀症状时,应充分排除卵巢肿瘤可能。儿童、青少年卵巢肿瘤有其自身特点,对恶性生殖细胞肿瘤首选保留生育功能术式。保留生育手术后生存率较高,月经及生育能力亦无不良影响。     

超声诊断盆腔良恶性肿瘤

超声诊断盆腔良恶性肿瘤２０００１１上海医科大学妇产科医院张珏华，常才女性盆腔的良恶性肿瘤除子宫外主要来源于卵巢，输卵管肿瘤极少见，此外尚有来源于肠道者及转移性肿瘤。一、超声诊断卵巢肿瘤卵巢肿瘤组织学分类繁多，但按声像图分三大类：囊性、囊实性、实质性。...     

30岁以下卵巢肿瘤患者223例临床分析

目的:探讨年龄30岁以下卵巢肿瘤患者的临床特点、病理类型、治疗及预后.方法:回顾性分析1992年10月一2007年10月间、年龄30岁以下223例卵巢肿瘤患者的临床资料.结果:有明显临床症状就诊者占71.30%(168/223).良性肿瘤192例(86.10%),恶性肿瘤包括低度恶性潜能上皮性肿瘤(L,MP)31例(13.90%).生殖细胞肿瘤91例、上皮性肿瘤72例、性索间质肿瘤9例、卵巢瘤样病变5l例.良性肿瘤中蒂扭转者切除卵巢的比例高于非蒂扭转者.恶性肿瘤手术病理分期:I期28例、Ⅱ期l例、Ⅲ期2例,其中22例保留生育功能.11例LMP患者术后未化疗,其余20例恶性肿瘤患者中19例进行化疗.随访时间10～181个月,27例无瘤生存,4例死亡;21例月经正常,9例有生育计划的患者中.7次妊娠.4次足月分娩.总5年生存率为80.2l%,病理分期是影响生存率的主要因素.结论:30岁以下年轻患者卵巢肿瘤以良性、生殖细胞肿瘤为主.卵巢恶性肿瘤临床手术病理分期早期,手术应尽可能保留生育功能.化疗对卵巢及生育功能无明显影响.应重视年轻女性的临床表现并定期妇科检查.     

儿童及青少年卵巢恶性肿瘤

卵巢恶性肿瘤在19岁的青少年、儿童中非常罕见,不到儿童所有恶性肿瘤的1%,却是最常见的青少年妇科恶性肿瘤。与成人卵巢肿瘤主要来源于上皮组织不同,青少年儿童卵巢肿瘤以生殖细胞肿瘤为主,包括畸胎瘤、性腺母细胞瘤、内胚窦瘤(又称卵黄囊瘤)、胚胎癌、多胚癌及绒癌。非生殖细胞肿瘤包括性索-间质肿瘤和上皮性肿瘤,性索-间质肿瘤包括卵泡膜-纤维瘤、Sertoli-Leydig细胞肿瘤及幼年型颗粒细胞肿瘤。与成人卵巢癌就诊时大多为晚期不同,青少年、儿童卵巢肿瘤患者就诊时大多处于临床早期,可行保守性手术。有效地治疗肿瘤的同时保留卵巢及生育功能是青少年卵巢肿瘤治疗的目标。     

子宫腺瘤样瘤10例临床病理及超声特征分析

目的:探讨子宫腺瘤样瘤的临床病理特征及超声声像图特点,提高对该病的认识。方法:回顾性分析10例子宫腺瘤样瘤的临床、病理及声像图表现。结果:10例子宫腺瘤样瘤7例表现为月经不调、痛经或阴道流血,3例无自觉症状。术前体检或超声检查均误诊。超声检查病灶呈中等回声或低回声不均质结节,边界欠清。6例位于浆膜下,4例位于子宫肌壁间,直径1.1~10.0 cm。镜下见肿瘤由腺腔样结构组成,内衬扁平或低柱状上皮细胞,腔内可见淡染的黏液物,间质为疏松或致密纤维或纤维和平滑肌束的组合。免疫组化检查10例患者腺瘤样瘤肿瘤细胞CK(AE1/AE3)(+)、Vimetin(+)、广谱细胞角蛋白(+),癌胚抗原(-)、CD34(-)。均经术后病理检查确诊,其中4例伴发子宫肌瘤或子宫腺肌病。结论:子宫腺瘤样瘤临床缺乏特异性表现,术前超声检查声像图特征缺乏特异性,易误诊。免疫组化检查有助于诊断,需术后病理学检查确诊。     

Aptima法人乳头瘤病毒E6/E7 mRNA检测在子宫颈癌筛查中的流行病学分析及其诊断价值

目的 通过Aptima法检测人乳头瘤病毒(HPV)E6/E7 mRNA,研究其分型和定量检测结果在不同年龄和子宫颈活检中的分布情况,探讨其在子宫颈病变中的诊断价值.方法 选取2019年1月至2020年1月于郑州大学第三附属医院行HPV E6/E7 mRNA检测的患者为研究对象,收集HPVE6/E7 mRNA阳性患者的年...     

子宫腺肌病临床表现及其分型

痛经与月经过多以及不孕是子宫腺肌病的主要临床表现。虽然目前对于子宫腺肌病的分型仍然存在争论,但几种子宫腺肌病分型相关临床与病理对于临床诊治还是有价值的。因此,文章仅介绍几种临床相对有指导意义的子宫腺肌病分型供参考。     

Transvaginal ultrasonography in the diagnosis of endometrial and uterine cavity changes in perimenopausal women

DESIGN: The purpose of the study was to estimate the diagnostic value of ultrasonic endometrium thickness measurement and estimation of ultrasonic endometrium qualitative features in detecting pathological changes in women in perimenopausal period. MATERIALS AND METHODS: The group of the patients consist of 242 patients in age 45-86 years, with abnormal uterine bleeding or incorrect ultrasonographic image of endometrium. In all cases transvaginal ultrasonography (TVS) and hysteroscopy were performed. RESULTS: The average thickness of endometrium in carcinoma (CA), hyperplasia (H) and polyps (P) group (properly 8.96 and 6.09 and 5.02 mm) showed essential differences in comparison with a group without changes in endometrium (3.38 mm). In group CA and H the greatest cumulation of abnormal features of ultrasonic image was ascertained. CONCLUSIONS: Ultrasonic measurement of endometrial thickness is a sensitive index in detecting cancer and pathological endometrial hyperplasia. The combination measurement of endometrial thickness and estimation of qualitative features of endometrial and uterine cavity TVS image improves results of detecting all of types of intrauterine pathology.     

EGFR及MMP-9在上皮性卵巢癌组织中的表达及其与预后的关系

目的:研究表皮生长因子受体(EGFR)及基质金属蛋白酶-9(MMP-9)在上皮性卵巢癌中的表达,分析其与卵巢癌临床病理特征及预后的关系。方法:采用RT-PCR方法检测EGFR及MMP-9 mRNA在上皮性卵巢癌、卵巢良性肿瘤和正常卵巢组织的表达。结果:卵巢癌组织中EGFR和MMP-9 mRNA的阳性表达率分别为64.44%(29/45)、73.33%(33/45),相对表达水平为0.81±0.23、0.89±0.25,均明显高于卵巢良性肿瘤和正常卵巢组织,差异均有显著统计学意义(P均<0.05)。两者在有淋巴结转移的癌组织中的相对表达量均明显高于无淋巴结转移组,Ⅲ～Ⅳ期癌组织中的表达高于Ⅰ～Ⅱ期,差异均有统计学意义(P<0.01)。卵巢癌组织EGFR和MMP-9的表达呈显著正相关。Long-rank分析显示,EGFR和MMP-9共同表达患者的累积生存率明显低于阴性者,差异有显著统计学意义(P<0.05)。结论:上皮性卵巢癌组织中EGFR和MMP-9均呈现高表达,并且与卵巢癌的临床分期、淋巴结转移及患者的生存期密切相关,可作为判断上皮性卵巢癌恶性生物学行为和预后的重要参考指标。     

子宫内膜癌的分子病理分型及其研究进展

子宫内膜癌是一种在分子水平及组织学上存在显著异质性的恶性肿瘤,不同的病理类型具有不同的生物学行为及组织学特征。与其他组织学亚型的晚期癌症相类似,早期子宫内膜样癌通常采用辅助放射治疗,浆液性子宫内膜癌通常采用化疗。因此,正确的亚型分类是选择合适的辅助治疗方案的关键。目前,临床上子宫内膜癌的分型依旧引用Bokhman分型及世界卫生组织（World Health Organization,WHO）病理类型分型。随着精准医疗及分子诊疗技术的全面推广,传统子宫内膜癌分型方法在子宫内膜癌的个体化治疗、预后评估及相关遗传病筛查上的局限性逐渐凸显。临床上亟需一种优化的分型方法提供确切的理论及实践依据。2013年美国癌症基因组图谱（The Cancer Genome Atlas,TCGA）研究中心通过整合基因组特征的方法确定了子宫内膜癌的分子分型,该分型与Bokhman分型及WHO分型相比,取得了与子宫内膜癌患者预后更强的关联性,为子宫内膜癌的分子诊疗拉开了序幕。     

胎儿肾积水的诊断和预后影响因素研究

目的:探讨胎儿肾积水的诊断及与预后有关的因素。方法:选择孕24至28周,29至33周,34至37周,38至40周的正常胎儿(经超声检查筛查确定)各60例,80例,94例,90例进行测量,记录肾脏长径、前后径、肾盂腔宽度及肾皮质厚度。以33周前肾盂宽度≥4mm,33周后肾盂宽度≥7mm为调查对象,填写《胎儿肾积水调查随访表》并随访其肾脏的恢复情况和治疗情况。以正常胎儿为对照组,以生后确诊为阻塞性肾脏疾病者为研究组,采用Logistic回归分析的方法调查发生肾积水的危险因素。结果:正常胎儿肾脏各径线随孕龄的增加而增大。在调查的51例患者的79个肾有胎儿肾积水,其中有11例患者的17个肾生后随访确诊为阻塞性肾脏疾病,占肾积水胎儿的21.57%;随肾盂扩张程度的增加,发生产后肾积水的比例上升。发现肾积水的孕龄早晚与预后没有关系。肾皮质厚度与预后有关。皮质厚度、妊娠合并症并发症为发生肾积水的有统计学意义的相关因素。结论:发现肾积水的胎儿后,应重视肾皮质厚度、羊水的监测,对于肾盂扩张在10mm以上者,特别是15mm以上者应重点监护。     

Carcinoembryonic antigen in patients with residual ovarian cancer: Clinical and pathological correlations

The level of Carcinoembryonic antigen (CEA) in serum was estimated before the commencement of chemotherapy and/or radiotherapy in 130 patients with residual ovarian cancer. CEA was detected in 64% of the patients. The associated clinical and pathological features were examined. No differences were found in the distribution of patients who were CEA positive and CEA negative in relation to the features studied. However, a correlation between serum CEA levels on one hand and site of tumor, organ involved, and estimated tumor volume on the other was found among the CEA-positive patients. No direct correlation was observed between CEA levels and subsequent behavior of the disease, except for patients who showed CEA levels exceeding 20 ng/ml. In these patients, the risk of progressive disease increased from 40 to 63% after 12 months of follow-up.     

婴幼儿肾脏疾病肾组织病理类型的分布与临床

目的分析婴幼儿肾脏疾病病理类型的分布及其对诊断治疗的指导意义。 方法中南大学湘雅二院于1996 01—2005 09采用快速经皮肾活检术，对73例临床诊断为10种肾脏疾病的婴幼儿进行肾组织病理检查。将穿刺取得的每份组织标本分成3部分，按常规方法对所有标本均分别进行光镜、电镜及免疫荧光检查，标本均做HE、PAS、PASM、Masson染色，均应用免疫荧光检测肾组织中IgG、IgM、IgA、C3、C4、C1q、Fb，部分病例根据血化验乙肝抗原阳性者加做免疫荧光，检测肾组织中的HBsAg、HBcAg。 结果肾活检成功率为100%；最常见的病理类型为系膜增生性肾炎(51/73例，占69.9%)；临床表现类似的疾病病理类型不同，同一病理类型的疾病，临床表现可以多样。 结论肾活检病理诊断对婴幼儿肾脏疾病的诊断、治疗、估计预后均有重要价值。电镜在婴幼儿肾病理检查中起到不可忽视的作用。     

HPV status in sentinel nodes might be a prognostic factor in cervical cancer

OBJECTIVE: Although there have been studies that focused on the correlation between the HPV presence of pelvic lymph nodes and pathological metastasis in patients with cervical cancer, the biologic role of HPV DNA in lymph nodes still remains uncertain. We performed this study to investigate the correlation between the sentinel-node HPV status and pelvic lymph node metastasis in patients with cervical cancer. The patients were followed up for 3 years to evaluate the clinical role of HPV in sentinel nodes as a prognostic factor. METHODS: From August 2001 to July 2003, 57 patients affected by stages IB-IIA cervical cancer had sentinel-node biopsies performed during radical hysterectomy and pelvic and paraaortic lymphadenectomy. Each detected sentinel node was divided into two parts. One part of them was submitted for frozen section examination and the other was submitted for HPV typing by oligonucleotide microarray. After follow-up, we analyzed the outcome of the patients with respect to the influence of sentinel-node HPV. RESULTS: Sentinel nodes were identified in all patients. A total of 79 nodes from 57 patients were detected as sentinel nodes. Metastasis in the sentinel nodes were found in 10 patients (17.6%) by frozen section and 11 patients by pathologic examination. The results of sentinel lymph node frozen biopsy were statistically significant for predicting the metastasis of the pelvic lymph nodes (P<0.05), but showed one false-negative case. HPV DNA was detected in the cervical cancer lesions of 55 patients (96.5%) and 80.0% (44/55) of them were found to have HPV DNA in the sentinel nodes as well. HPV DNA was detected in sentinel nodes of 10 patients among 11 patients with lymph node metastasis. Disease recurred in five patients and one of them did not show pelvic lymph node metastasis at surgery. But, all of these patients had HPV in sentinel nodes. The combination of sentinel-node frozen biopsy and HPV typing showed a negative predictive value of 100% in predicting non-metastasis of lymph node and no recurrence of disease. CONCLUSION: Our results suggested the possibility that sentinel-node HPV typing could play a supportive role to reduce the false-negative rate of the sentinel-node biopsy. All of five patients with recurrence had HPV infection in the sentinel nodes. Absence of HPV in sentinel nodes showed reliable negative predictive value for lymph node metastasis and recurrence. Additional study will be needed to confirm the clinical application of the sentinel-node procedure and to determine whether there is a correlation of HPV status of sentinel nodes to lymph node metastasis and recurrence in cervical cancer patients.     

The coronary hemodynamics and left ventricular function in patients with compensated hypertension

In this study, we tried to characterize the changes in left ventricular (LV) function and coronary hemodynamics in patients with compensated hypertension (HT) who were free from coronary artery disease. The study group consisted of 10 men with compensated essential HT at ages 48-65 years (mean = 58). The durations of HT history for the various patients ranged from 5 to 14 years. Mean arterial pressure (MAP) was 122 +/- 2 mmHg at the time of study. The control group was composed of 8 men with mild mitral valve prolapse. They were studied because of chest pain with no demonstratable pathological conditions. Their ages ranged from 39 to 65 years (mean = 57). The MAP for controls was 86 +/- 3 mmHg. All patients in both groups underwent routine cardiac catheterization, coronary arteriography, and measurements of the coronary sinus (CS) and great cardiac vein (GCV) blood flows. Left ventricular muscle mass (LVMM), coronary resistance and coronary reserve were also derived from the hemodynamic study. There was a significant difference in the LVMM index between the study patients (114.9 g/m2) and the control subjects (96.8 g/m2, p less than 0.001). The LV function of the patients in the study group was essentially normal, but the following parameters were significantly different from those of the control subjects: cardiac index, stroke volume index, and dp/dtmax. There was a good correlation between repeated measurements of both the CS and GCV blood flows (r = 0.97 for both).(ABSTRACT TRUNCATED AT 250 WORDS)