原发卵巢Müllerian腺肉瘤1例及文献回顾

报道复旦大学附属妇产科医院于2022年收治的原发性卵巢Müllerian腺肉瘤(Müllerian adenosarcoma,MA)1例,并进行文献复习,分享卵巢腺肉瘤的诊治经验。患者,女性,29岁,未婚育,外院行腹腔镜下卵巢病损切除术,术中探查见“右侧卵巢体积增大,下极可见大小约11 cm×8 cm的菜花样肿块,无包膜,质地似鱼肉样,完全切除肿块送检”。术后经北京某(三甲)医院及我院病理科会诊提示卵巢腺肉瘤,遂行全面分期手术:腹腔镜下右侧输卵管卵巢切除术、左侧卵巢囊肿剥除术、大网膜切除术、腹膜多点活检术;宫腔镜下宫颈管占位切除术。术后予紫杉醇+异环磷酰胺化疗4周期。患者化疗结束后定期随访,目前术后近2年随访期间无复发征象。

Müllerian腺肉瘤的临床及超声特点分析

目的：探讨Müllerian腺肉瘤（MA）的临床与超声特点。方法：回顾性分析复旦大学附属妇产科医院2007年11月至2014年7月25例经手术病理检查证实为MA患者的临床病史及超声表现。结果：125例MA患者平均年龄48.2±13.8岁,10例为绝经后妇女。主要临床表现为异常阴道流血（22例）,下腹痛（1例）及体检发现异常占位（2例）。病变部位在子宫内膜20例（80%）、宫颈3例（12%）、宫腔和宫颈1例（4%）以及盆腔内1例（4%）。16例单纯MA,5例伴性索样分化,4例伴肉瘤成分过度生长。其FIGO分期为ⅠA 8例、ⅠB 14例、ⅠC 1例,ⅢA 1例。2MA位于子宫的患者超声图像显示宫腔或（及）颈管内单个大小不等（最大径12~95mm,平均40.1±24.5mm）的息肉样占位,部分脱垂到阴道内（24例）;形态不规则,边界模糊（8例）或尚清晰（16例）;实性为主者22例（88%）,囊实性者2例（8%）,而1例（4%）位于盆腔内者是囊性为主、边界不清的低回声肿块。彩色多普勒血流显像：条索状血流信号7例,星点状血流信号者12例,彩色血流信号不明显者6例。结论：MA是一种少见的低度恶性肿瘤,其临床及超声表现无特异性,需要病理检查确诊。熟悉其临床及超声表现有助于加强对MA的认识,从而正确诊断。

宫颈Müllerian腺肉瘤临床病理观察

目的探讨子宫颈Müllerian腺肉瘤(MAs)的临床病理特征、免疫表型、鉴别诊断及治疗。方法对1例宫颈MAs行光镜、免疫组化检查,复习临床资料及相关文献。结果本例瘤组织上皮成分为宫颈管腺体,腺体成裂隙状,间质细胞分布不均,在腺体周围呈袖套样分布,伴轻~中度细胞异型性,核分裂象>7个/10HPF。免疫组化间质细胞ER和PR(+),SMA、desmin和CD10部分(+),h-Caldesmon(-)。结论宫颈MAs较罕见,诊断主要依靠组织形态特征,免疫组化有助于鉴别诊断和确定异源性成分,组织中有无间质过度生长和肌层浸润影响患者预后,也是临床术式选择和是否辅助治疗的主要依据。

年轻未孕女性子宫Müllerian腺肉瘤5例临床病理分析

目的:探讨年轻未孕子宫Müllerian腺肉瘤患者的临床病理特征,提高对该病的认识。方法:分析5例年轻未孕子宫Müllerian腺肉瘤患者的临床表现及病理组织学特点。结果:5例患者均以经量增多伴阴道不规则流血为初诊主诉,子宫均增大,4例有息肉样物脱出宫颈。肿瘤由良性腺上皮成分和肉瘤性间质成分组成。免疫表型,肉瘤成分普遍Vimentin阳性,大部分CD10阳性,部分Desmin、SMA阳性。5例中术前诊断3例;4例经术后病理检查证实。治疗主要采用次广泛全子宫+单侧附件+盆腔淋巴结切除,术后预防性化疗。结论:年轻未孕子宫Müllerian腺肉瘤的基本形态由良性腺上皮和肉瘤性间质混合组成。对年轻未孕患者出现阴道不规则流血并伴有息肉样物脱出宫颈,且伴子宫增大时要警惕子宫Müllerian腺肉瘤。治疗以手术为主,可辅以化疗。

宫颈原发性Müllerian腺肉瘤4例临床病理分析

目的探讨宫颈原发性Müllerian腺肉瘤的临床病理特征,提高对该瘤的认识。方法对4例发生于宫颈的Müllerian腺肉瘤进行光镜、免疫组化标记检查,并复习临床资料及相关文献。结果临床上患者以阴道不规则出血为主要症状。镜下肿瘤由良性腺上皮成分和肉瘤性间质成分组成;腺体常扩张,异型性较明显的间质成分突入腺腔内形成息肉状结构,腺体周围间质成分比较密集,围绕腺体形成"袖套样"结构;核分裂象分布不均(1～15个/10 HPF)。免疫表型没有特异性。结论宫颈原发性Müllerian腺肉瘤是一种罕见的肿瘤,诊断主要依靠组织形态学特征,免疫组化标记主要用于确定异源性成分及与其他肿瘤的鉴别。

Function of microglia and macrophages in secondary damage after spinal cord injury

Spinal cord injury （SCI） is a devastating type of neurological trauma with limited therapeutic op- portunities. The pathophysiology of SCI involves primary and secondary mechanisms of injury. Among all the secondary injury mechanisms, the inflammatory response is the major contrib- utor and results in expansion of the lesion and further loss of neurologic function. Meanwhile, the inflammation directly and indirectly dominates the outcomes of SCI, including not only pain and motor dysfunction, but also preventingneuronal regeneration. Microglia and macrophages play very important roles in secondary injury. Microglia reside in spinal parenchyma and survey the microenvironment through the signals of injury or infection. Macrophages are derived from monocytes recruited to injured sites from the peripheral circulation. Activated resident microglia and monocyte-derived macrophages induce and magnify immune and inflammatory responses not only by means of their secretory moleculesand phagocytosis, but also through their influence on astrocytes, oligodendrocytes and demyelination. In this review, we focus on the roles of mi- croglia and macrophages in secondary injury and how they contribute to the sequelae of SCI.

Increasing secondary bacterial infections with Enterobacteriaceae harboring bla_(CTX-M-15) and bla_(CMY-6) in patients with bronchogenic carcinoma:an emerging point of concern

Objective:To look for secondary bacterial infections in bronchogenic carcinoma（BCA） with resistant organisms harboring bla genes considering the paucity of relevant studies.Methods: A total of 137 confirmed cases of BCA and 34 healthy volunteers were studied for the occurrence and prevalence of blaCTX-M and and blaAmpC harboring-enterobacteriaceae.A subset of these patients（n=69） was previously reported for the secondary infection with the Aspergillus species. Bronchoalveolar lavages（BAL） were subjected for bacterial and fungal cultures and the bacterial isolates were screened by multiplex PCRs for the presence of blaCTX-M and blaAmpC.The isolates were also screened for the association of insertion sequence（IS26） by PCR and characterized by RAPD for any clonal relatedness.Results:A total of 143 bacterial isolates were obtained from 137 BAL specimens of BC,patients.The Enterobacteriaceae-isolates were multidrug-resistant showing concomitant resistance to fluoroquinolones and aminoglycosides.Both blaCTX-M and blaAmpC of CIT family were detected in 77.4%and 27.4%isolates,respectively.Sequencing revealed the presence of blaCTX-M-15 and blaCMY-6.Twenty one percent of the isolates were simultaneously harboring blaampC and blaCTX-M-15.IS26 PCR and RAPD typing revealed the presence of diverse bacterial population but no predominant clone was identified.The present study also suggests strong association of aspergillosis with lung cancer and further strengthens the potential use of non-validated serological tests suggested earlier.Conclusions:We emphasize that all patients of bronchogenic carcinoma should also be screened for secondary bacterial infections,along with secondary fungal infections,so as to introduce early and specific antimicrobial therapy and to prevent unwanted deaths.

子宫Müllerian腺肉瘤临床病理分析

目的通过对Müllerian腺肉瘤的临床表现、镜检、免疫组化及鉴别诊断的总结分析,提高对Müllerian腺肉瘤的认识水平.方法回顾性分析总结本院2009年至2018年期间收治的8例子宫Müllerian腺肉瘤的临床表现、镜下形态及免疫组化结果.结果Müllerian腺肉瘤多见于中老年女性,临床表现常为异常阴道流血、阴道排液或肿块突入阴道.大体多为息肉状肿块.形态上,显著增生的富细胞性间质构成息肉状突起,形似叶片,腺体周围更富于细胞,显得更为致密("袖套样").免疫组化,间质成分表达CD10、ER、PR.结论Müllerian腺肉瘤易漏诊或误诊,形态上富细胞性间质围绕良性腺体聚集是镜下诊断的重要依据,鉴别诊断包括:腺纤维瘤、非典型性息肉样腺肌瘤、低级别子宫内膜间质肉瘤、癌肉瘤、宫颈的腺泡状横纹肌肉瘤等病变鉴别.

基于2^(n)-1长m序列的FHT运算及FPGA实现

在地面4G/5G移动通信中辅同步信号(Secondary Synchronization Signal,SSS)都由长为31和127的小m序列组成,在求最大相关值运算中通常都采用快速哈达码变换(Fast Hadamard Transform,FHT)来减少计算量、降低运算资源的使用,但是对于任意长序列的FHT推导没有扩展描述。文章针对基于2^(n)-1任意长度的小m序列到FHT运算的行列变换过程给出了完整的矩阵推导,并利用长为3的小m序列进行仿真验证结论的正确性,最后以5G标准中长度为127的SSS序列完成FHT的FPGA实现。

女性生殖系统恶性Mllerian混合瘤临床病理分析

目的 探讨女性生殖系统恶性M櫣ｌｌｅｒｉａｎ混合瘤的发生、免疫表型和鉴别诊断?椒ā《?16例子宫、输卵管和卵巢恶性M櫣ｌｌｅｒｉａｎ混合瘤进行临床病理和免疫组织化学观察?峁?16例患者中 ,恶性M櫣ｌｌｅｒｉａｎ混合瘤发生于子宫颈 2例 ,子宫体 11例 ,输卵管 1例 ,卵巢 2例。同源性 9例 (5 6 % ) ,异源性 7例 (44 % )。癌转移 7例 (44 % ) ,其中异源性转移 5例 (71% ) ,以肉瘤成分转移为主。免疫表型 :在 14例中所有癌成分CK和所有肉瘤成分Vim呈阳性表达 ,4 3%病例的肉瘤成分呈CK和Vim双相表达 ,Des 9例阳性 (6 4 % ) ,MG 4例阳性 (2 9% ) ,CD6 85例阳性 (36 % )。结论 女性生殖系统恶性M櫣ｌｌｒｉａｎ混合瘤可能来源于中胚层 ,多发生于子宫 ,其异源性肿瘤恶性度高 ,转移快。肿瘤的全面检查和免疫表型可作为鉴别诊断的重要参考依据。

子宫Müllerian腺肉瘤5例临床病理分析

目的探讨子宫Müllerian腺肉瘤的临床病理学特征。方法收集5例子宫Müllerian腺肉瘤的临床资料,行HE、免疫组化EnVision法染色,分析其临床病理学及免疫表型特征,并复习相关文献。结果5例患者年龄41~63岁,中位年龄44岁。镜下肿瘤呈分叶状结构,富于细胞的间质呈乳头状和息肉状突入囊性扩张的腺腔内或压迫良性腺体呈成角的裂隙。轻~中度异型的间质细胞围绕腺体呈套袖样增生。免疫表型:肿瘤间质细胞ER、PR、SMA均弥漫阳性,腺体周围CD10阳性,Ki-67增殖指数3%~30%。结论子宫Müllerian腺肉瘤常表现为阴道异常出血,多为低度恶性肿瘤,手术治疗为主,不良预后与肿瘤过度生长、脉管内癌栓、FIGO分期等有关。

Müllerian Adenosarcoma of the Vaginal Stump: A Case Report and Literature Review

Müllerian adenosarcomas are rare mixed tumors with low malignant potential, and occur mainly in the uterus. Primary adenosarcomas arising in vaginal endometriosis are even more rarely reported. We report a very rare case with Müllerian adenosarcoma arising from vaginal endometriosis. A 43-year-old nulliparous woman has a history of endometriosis. Due to two parallel fistulas in cervix, severe endometriosis and adenosarcoma, she has undergone radical and multiple surgeries. After the surgery, persistent vaginal vault masses were noticed, and eight resections of the polyps at vaginal stump were performed. For the first six resections, all the pathological examinations showed endometriosis. And the last two resections demonstrated vaginal adenosarcoma. Transition between Müllerian adenosarcoma and endometriosis was gradual. Finally, adenosarcoma associated with endometriosis was diagnosed from recurrent vaginal masses. To our knowledge, this report is the sixth case that primary adenosarcomas arising in vaginal endometriosis. But chemo-therapy and radiation therapy were not taken and the patient remained in a good condition throughout the 9-year follow-up period. In addition, we present a review of the literature. The diagnosis and treatment of the tumor are also discussed.

Secondary light chain amyloidosis with Waldenstr?m’s macroglobulinemia and intermodal marginal zone lymphoma:A case report

BACKGROUND The co-existence of Waldenstr?m’s macroglobulinemia(WM) with internodal marginal zone lymphoma(INMZL) is rare and often associated with poor prognosis.CASE SUMMARY We present a Chinese female patient who developed secondary light chain amyloidosis due to WM and INMZL and provides opinions on its systemic treatment.A 65-year-old woman was diagnosed with WM 6 years ago and received Bruton tyrosine kinase inhibitor monotherapy for two years.Her INMZL was confirmed due to left cervical lymphadenopathy.The patient presented with oedema in both lower limbs one year ago,and was diagnosed with secondary light chain amyloidosis.Treatment with the BC regimen(rituximab 375 mg/m~2 monthly for 6-8 courses,and bendamustine 90 mg/m~2 per day × 2,monthly for six courses) was initiated,but not tolerated due to toxic side effects.Bortezomibbased therapy was given for two months,including bortezomib,dexamethasone,and zanubrutinb.Oedema in both lower limbs was relieved and treatment efficacy was evaluated as partial remission.CONCLUSION A detailed clinical evaluation and active identification of the aetiology are recommended to avoid missed diagnosis and misdiagnosis.

First Trimester Uterine Rupture: A Case Report on a Patient with Unsuspected Müllerian Duct Anomaly

Introduction: Mullerian malformations are a group of malformations that result from an alteration of embryonic development. Most cases are asymptomatic, however, in pregnant patients it has been associated with recurrent abortion or premature delivery. Case presentation: 12 + 2 weeks pregnant woman consulted for abdominal pain, vomiting and fever. During the study, a transvaginal ultrasound was performed, where two endometric cavities and a pregnancy in the right horn were observed. The evolution of the patient was torpid, reaching hypovolemic shock, resolved by an emergency laparotomy where the rupture of the right horn was found. Discussion: The bicornuate uterus is the consequence of a partial fusion of the paramesonephric ducts during the fetal development, resulting in two functional uterine horns. Patients with bicornuate uterus may be asymptomatic, a uterine rupture is a rare but potentially severe complication of the bicornuate uterus and is usually presented during first and second trimester. Conclusions: Pregnancy with Mullerian anomalies often has preterm delivery, IUGR and malpresentation, and even more severe complication as uterine ruptura, so, requires proper counselling and close monitoring during antenatal period.

慢性肾病继发性甲状旁腺功能亢进症术后骨饥饿综合征^(99)Tc^(m)-MIBI骨摄取

目的分析慢性肾病继发性甲状旁腺功能亢进症行甲状旁腺切除术后骨饥饿综合征(HBS)患者^(99)Tc^(m)-甲氧基异丁基异腈(MIBI)骨摄取情况,为临床诊疗提供参考。资料与方法回顾性分析2014年6月—2021年12月于南通大学附属江阴医院行甲状旁腺切除术的106例继发性甲状旁腺功能亢进症的影像及临床资料,采用视觉评估分析甲状旁腺平面显像骨骼显像剂摄取情况,根据术后有无发生HBS分为HBS组和非HBS组。比较两组患者临床特征、实验室指标及^(99)Tc^(m)-MIBI骨摄取的差异。结果106例中,42例(39.62%)^(99)Tc^(m)-MIBI骨摄取阳性,多表现为弥漫性骨骼显像剂摄取,以胸骨、锁骨及肋骨多见。与非HBS组相比,HBS组的年龄较小(t=-3.058),碱性磷酸酶和甲状旁腺激素水平较高(Z=-5.148、-2.218),血清校正钙较低(Z=-2.102),^(99)Tc^(m)-MIBI骨摄取的阳性率及部位数较高[50%比28%,2(1,3)比1(1,1);χ^(2)=5.344,Z=-2.970],差异均有统计学意义(P均<0.05)。结论慢性肾病继发性甲状旁腺功能亢进症行甲状旁腺切除术后发生HBS患者的碱性磷酸酶和甲状旁腺激素水平更高,更易发生^(99)Tc^(m)-MIBI骨摄取。

Vaginal clear cell adenocarcinoma in Herlyn-Werner-Wunderlich syndrome:A case report

BACKGROUND Herlyn-Werner-Wunderlich(HWW)syndrome is a rare Müllerian duct anomaly,characterized by a combination of urogenital abnormalities.The occurrence of primary cervico-vaginal carcinomas in patients with HWW syndrome is excep-tionally rare,posing significant challenges for screening,early diagnosis,and effective management.CASE SUMMARY We report a rare case of primary clear cell carcinoma of the vagina complicated in a 40-year-old woman with HWW syndrome.The patient presented with irregular vaginal bleeding for 4 years.On gynecological examination,an oblique vaginal septum was suspected.Surgical resection of the vaginal septum revealed a com-municating fistula and a tumor on the left vagina and the left side of the septum,which was confirmed as clear cell carcinoma.One month later,she underwent a radical hysterectomy,vaginectomy,bilateral salpingo-oophorectomy,and pelvic lymph node dissection.Due to significant side effects,she completed only one course of chemotherapy.A year later,lung metastasis was detected and continued to grow.A thoracoscopic wedge resection of the right upper lobe was performed 4 years after the initial surgery.We also conducted a systemic review of the lite-rature on primary cervical or vaginal carcinoma in HWW syndrome to explore this rare entity.CONCLUSION Cervico-vaginal adenocarcinomas in patients with HWW syndrome are occult,and require early surgical intervention and regular imaging surveillance.

M型磷脂酶A2受体在原发性膜性肾病中的诊断价值及其血清抗体水平与预后的关系

目的探讨M型磷脂酶A2受体(PLA2R)对原发性膜性肾病(PMN)的诊断价值,及其血清抗体水平与疗效的相关性。方法选取上饶市人民医院2021年9月至2022年12月收治的80例PMN患者作为PMN组,另选取同时期收治的37例继发性膜性肾病(SMN)患者作为SMN组,检测两组患者肾组织中PLA2R的表达,比较组间差异。检测PMN患者的血清PLA2R抗体表达情况,分析阳性患者的血清PLA2R抗体水平随着治疗进行与24 h尿蛋白、血清白蛋白(Alb)、血肌酐(SCr)水平的相关性。结果PMN组的肾组织PLA2R阳性率高于SMN组,差异有统计学意义(P<0.05)。受试者特征曲线(ROC)分析显示,肾组织PLA2R表达诊断PMN的敏感度为81.25%、特异度为91.89%,ROC曲线下面积为0.866,具有较高的诊断效能。血清PLA2R抗体阳性的PMN患者的抗体水平与疗效的相关性分析显示,血清PLA2R抗体水平与24 h尿蛋白水平呈正相关(r=0.452),差异有统计学意义(P<0.05),与Alb水平呈负相关(r=-0.426),差异有统计学意义(P<0.05)。结论肾组织PLA2R的表达有助于PMN与SMN的鉴别诊断,血清PLA2R抗体水平的降低可提示治疗有效。

SARS病毒M蛋白的二级结构和B细胞表位预测

以SARS病毒基因组序列为基础 ,采用Garnier Robson方法、Chou Fasman方法和Karplus Schulz方法预测蛋白质的二级结构 ;按Kyte Doolittle方案、Emini方案和Jameson Wolf方案预测SARS病毒M蛋白的B细胞表位。预测结果表明 ,在SARS病毒M蛋白N 端第 1 1～ 2 0、2 7～ 36区段和第 1 33～ 1 41区段可能是α 螺旋中心 ;M蛋白分子N 端第 2 0～ 2 7、34～ 37,44～ 5 6,61～ 64,70～ 76,79～ 97,1 1 7～ 1 32 ,1 42～ 1 47,1 65～ 1 76区段和第 2 1 6～ 2 2 1区段可能是β 折叠中心。在M蛋白N 端第 5～ 6、40～ 44、1 0 5～ 1 0 7、1 1 2～ 1 1 6、1 89～ 1 90、2 0 2～ 2 0 3区段和第 2 1 0～ 2 1 5区段具有较柔软的结构 ,有可能进行一定幅度的摆动或折叠而形成较复杂的三级结构。SARS病毒M蛋白N 端第 1～ 1 5、37～ 47、99～ 1 2 0、1 81～ 1 92区段和第 1 96～ 2 1 5区段内或附近很可能是B细胞表位优势区域。以蛋白质的二级结构预测作为辅助手段 ,用抗原指数 ,亲水性参数和可及性参数预测SARS冠状病毒M蛋白的B细胞表位 。

上湾煤矿8.5 m采高综采面液压支架关键参数分析

为保障8.5 m超大采高综采面的安全生产,采用工程类比、理论分析、数值模拟的方法,综合确定液压支架关键参数。根据来压前支架受静载荷的特点建立力学模型,并通过现场实测验证其可靠性;运用FLAC2D二次开发,采用YY-YY结构作为等效支架来分析支架的支护强度,以提高结果的科学性与准确性。结果表明：8.5 m采高综采面顶板厚度约20 m,初次来压步距约56 m,周期来压步距约21m;垮落带高度60 m,裂隙带高度120 m,发育至地表;液压支架支护强度为1.8 MPa,高度为4.0~8.8 m,工作阻力26 000 k N。

一类新的周期为2p^m的q阶二元广义分圆序列的线性复杂度

该文基于Ding-广义分圆理论,将周期为2p^m(p为奇素数,m为正整数)广义分圆序列的研究推广到任意素数阶情形,构造了一类新序列。通过数论方法分析多项式广义分圆类,确定并计算线性复杂度与序列的2次剩余类和2次非剩余类的划分紧密相关。结果表明该类序列的线性复杂度远远大于周期的一半,能抗击应用Berlekamp-Massey(B-M)算法的安全攻击,是密码学意义上性质良好的伪随机序列。