molecular pathology of intraductal papillary mucinous neoplasms of the pancreas

Since the first description of intraductal papillary mucinous neoplasms(IPMNs)of the pancreas in the eighties,their identification has dramatically increased in the last decades,hand to hand with the improvements in diagnostic imaging and sampling techniques for the study of pancreatic diseases.However,the heterogeneity of IPMNs and their malignant potential make difficult the management of these lesions.The objective of this review is to identify the molecular characteristics of IPMNs in order to recognize potential markers for the discrimination of more aggressive IPMNs requiring surgical resection from benign IPMNs that could be observed.We briefly summarize recent research findings on the genetics and epigenetics of intraductal papillary mucinous neoplasms,identifying some genes,molecular mechanisms and cellular signaling pathways correlated to the pathogenesis of IPMNs and their progression to malignancy.The knowledge of molecular biology of IPMNs has impressively developed over the last few years.A great amount of genes functioning as oncogenes or tumor suppressor genes have been identified,in pancreatic juice or in blood or in the samples from the pancreatic resections,but further researches are required to use these informations for clinical intent,in order to better define the natural history of these diseases and to improve their management.

European vs 2015-World Health Organization clinical molecular and pathological classification of myeloproliferative neoplasms

The BCR/ABL fusion gene or the Ph^1-chromosome in the t(9;22)(q34;q11)exerts a high tyrokinase acticity,which is the cause of chronic myeloid leukemia(CML).The1990 Hannover Bone Marrow Classification separated CML from the myeloproliferative disorders essential thrombocythemia(ET),polycythemia vera(PV)and chronic megakaryocytic granulocytic myeloproliferation(CMGM).The 2006-2008 European Clinical Molecular and Pathological(ECMP)criteria discovered 3variants of thrombocythemia:ET with features of PV(prodromal PV),"true"ET and ET associated with CMGM.The 2008 World Health Organization(WHO)-ECMP and 2014 WHO-CMP classifications defined three phenotypes of JAK2^(V617F)mutated ET:normocellular ET(WHO-ET),hypercelluar ET due to increased erythropoiesis(prodromal PV)and ET with hypercellular megakaryocytic-granulocytic myeloproliferation.The JAK2^(V617F)mutation load in heterozygous WHO-ET is low and associated with normal life expectance.The hetero/homozygous JAK2^(V617F)mutation load in PV and myelofibrosis is related to myeloproliferative neoplasm(MPN)disease burden in terms of symptomaticsplenomegaly,constitutional symptoms,bone marrow hypercellularity and myelofibrosis.JAK2 exon 12mutated MPN presents as idiopathic eryhrocythemia and early stage PV.According to 2014 WHO-CMP criteria JAK2 wild type MPL^(515)mutated ET is the second distinct thrombocythemia featured by clustered giant megakaryocytes with hyperlobulated stag-horn-like nuclei,in a normocellular bone marrow consistent with the diagnosis of"true"ET.JAK2/MPL wild type,calreticulin mutated hypercellular ET appears to be the third distinct thrombocythemia characterized by clustered larged immature dysmorphic megakaryocytes and bulky(bulbous)hyperchromatic nuclei consistent with CMGM or primary megakaryocytic granulocytic myeloproliferation.

PVSG and WHO vs European Clinical,Molecular and Pathological Criteria for prefibrotic myeloproliferative neoplasms

The Polycythemia Vera Study Group(PVSG),World Health Organization(WHO) and European Clinical,Molecular and Pathological(ECMP) classifications agree upon the diagnostic criteria for polycythemia vera(PV) and advanced primary myelofibrosis(MF). Essential thrombocythemia(ET) according to PVSG and 2007/2008 WHO criteria comprises three variants of JAK2V617 F mutated ET when the ECMP criteria are applied. These include normocellular ET,hypercellular ET with features of early PV(prodromal PV),and hypercellular ET due to megakaryocytic,granulocytic myeloprolifera-tion(ET.MGM). Evolution of prodromal PV into overt PV is common. Development of MF is rare in normocellular ET(WHO-ET) but rather common in hypercellular ET.MGM. The JAK2V617 F mutation burden in heterozygous mutated normocellular ET and in heterozygous/homozygous or homozygous mutated PV and ET.MGM is of major prognostic significance. JAK2/MPL wild type ET associated with prefibrotic primary megakaryocytic and granulocytic myeloproliferation(PMGM) is characterized by densely clustered immature dysmorphic megakaryocytes with bulky(bulbous) hyperchromatic nuclei,which are never seen in JAK2V617 F mutated ET,and PV and also not in MPL515 mutated normocellular ET(WHO-ET). JAK2V617 mutation burden,spleen size,LDH,circulating CD34+ cells,and pre-treatment bone marrow histopathology are mandatory to stage the myeloproliferative neoplasms ET,PV,PMGM for proper prognosis assessment and therapeutic implications. MF itself is not a disease because reticulin fibrosis and reticulin/collagen fibrosis are secondary responses of activated polyclonal fibroblasts to cytokines released from the clonal myeloproliferative granulocytic and megakaryocytic progenitor cells in ET.MGM,PV and PMGM.

Large retroperitoneal atypical spindle cell lipomatous tumor,an extremely rare neoplasm:A case report

BACKGROUND Atypical spindle cell lipomatous tumor(ASLT)is a rare soft tissue neoplasm with a low potential for malignancy.ASLT frequently occurs in the limb and limb girdles.However,large retroperitoneal ASLTs are extremely rare.There was no concrete case report of retroperitoneal ASLTs.CASE SUMMARY An 18-year-old woman presented with abdominal pain and a palpable mass.Abdominal computed tomography revealed a large fatty mass that was approximately 30 cm in size and filled the entire abdominal cavity.Surgical excision was indicated.The tumor did not invade the adjacent organs.The pelvic cavity was then too narrow to dissect smoothly.The mass was successfully excised without tumor rupture or adjacent organ injury.Microscopically,the neoplasm was a well-differentiated adipocytic neoplasm.Immunohistochemical staining showed that the spindle cells were positive for CD34 and desmin,in addition to multifocal positivity for S100 protein.These histological features were consistent with an ASLT.The patient’s postoperative course was uneventful.At the 12-mo followup,no evidence of recurrence or metastasis was observed.CONCLUSION To the best of our knowledge,our study is the first concrete report of a large retroperitoneal ASLT in the English literature.In the large retroperitoneal ASLT located in the pelvic cavity,which made it too narrow and tight to dissect,complete excision is difficult but very important because of recurrence risk.Although large retroperitoneal ASLTs are considered extremely rare,their detection is important for accurate evaluation and management.Owing to their significant rarity,retrospective multicenter case studies are required to determine the clinicopathologic characteristics.

Retroperitoneal laparoscopic partial nephrectomy for unilateral synchronous multifocal renal carcinoma with different pathological types:A case report

BACKGROUND The majority of renal cell carcinomas are single lesions;unilateral synchronous multifocal renal carcinoma(USMRC)is rarely reported and poses a treatment challenge for urological oncologists.CASE SUMMARY A 56-year-old man was hospitalized for pain and discomfort in the right kidney area for 6 d.Contrast-enhanced computed tomography demonstrated cT1a renal tumors at the lower pole of the right kidney and a cT1b renal tumor at the middle dorsal portion of the right kidney.The patient underwent retroperitoneal laparoscopic partial nephrectomy(RLPN).There were no complications peri-operatively.Histopathology revealed a low-grade,pathologic stage T1a(pT1a),clear cell renal cell carcinoma at the lower pole of the right kidney and a pT1b,chromophobe renal cell carcinoma at the middle dorsal portion of the right kidney.No tumor bed recurrence or metastasis was observed on imaging and his renal function remained stable during the 12-mo follow-up period.CONCLUSION RLPN is a safe,effective,and feasible for the management of USMRC,which can obtain equivalent oncological results with optimal renal function preservation.

Clinical and pathological observations of retroperitoneal paraganglioma in 32 cases

Objective The aim of the study was to investigate the clinical manifestations,pathologic features,differentiation,and diagnosis of retroperitoneal paraganglioma.Methods The clinical manifestations,histopathologic morphology,immunohistologic features,treatment,and prognosis were analyzed in 32 cases of retroperitoneal paraganglioma,and the literature was reviewed. Results Low back pain was the main symptom of retroperitoneal paraganglioma,and patients often presented with increased blood pressure. Blood vessels were abundant in the neoplasm of retroperitoneal paraganglioma,and pathologic diagnosis showed that the cells of tumors were rich in cytoplasm,and some were basophilic. Immunohistochemical study showed that Cg A,Syn,S-100,and Ki-67(2%–30%) were expressed,while Melan-A and CK were not. The patients were treated with surgical resection. Thirteen cases were followed up,and no recurrence or metastases have been observed.Conclusion The diagnosis of retroperitoneal paraganglioma should be confirmed by morphologic features and immunophenotype. Patients should be followed-up due to the potential for malignancy.Key words: retroperitoneal paraganglioma; immunohistochemistry;

Pathological features and diagnosis of intraductal papillary mucinous neoplasm of the pancreas

Intraductal papillary mucinous neoplasm(IPMN) of the pancreas is a noninvasive epithelial neoplasm of mucinproducing cells arising in the main duct(MD) and/or branch ducts(BD) of the pancreas.Involved ducts are dilated and filled with neoplastic papillae and mucus in variable intensity.IPMN lacks ovarian-type stroma,unlike mucinous cystic neoplasm,and is defined as a grossly visible entity(≥ 5 mm),unlike pancreatic intraepithelial neoplasm.With the use of high-resolution imaging techniques,very small IPMNs are increasingly being identified.Most IPMNs are solitary and located in the pancreatic head,although 20%-40% are multifocal.Macroscopic classification in MD type,BD type and mixed or combined type reflects biological differences with important prognostic and preoperative clinical management implications.Based on cytoarchitectural atypia,IPMN is classified into low-grade,intermediategrade and high-grade dysplasia.Based on histological features and mucin(MUC) immunophenotype,IPMNs are classified into gastric,intestinal,pancreatobiliary and oncocytic types.These different phenotypes can be observed together,with the IPMN classified according to the predominant type.Two pathways have been suggested:gastric phenotype corresponds to less aggressive uncommitted cells(MUC1-,MUC2-,MUC5 AC +,MUC6 +) with the capacity to evolve to intestinal phenotype(intestinal pathway)(MUC1-,MUC2 +,MUC5 AC +,MUC6- or weak +) or pancreatobiliary /oncocytic phenotypes(pyloropancreatic pathway)(MUC1 +,MUC 2-,MUC5 AC +,MUC 6 +) becoming more aggressive.Prognosis of IPMN is excellent but critically worsens when invasive carcinoma arises(about 40% of IPMNs),except in some cases of minimal invasion.The clinical challenge is to establish which IPMNs should be removed because of their higher risk of developing invasive cancer.Once resected,they must be extensively sampled or,much better,submitted in its entirety for microscopic study to completely rule out associated invasive carcinoma.

Intraductal papillary-mucinous neoplasia of the pancreas:Histopathology and molecular biology

Intraductal papillary-mucinous neoplasm(IPMN) of the pancreas is a clinically and morphologically distinctive precursor lesion of pancreatic cancer,characterized by gradual progression through a sequence of neoplastic changes.Based on the nature of the constituting neoplastic epithelium,degree of dysplasia and location within the pancreatic duct system,IPMNs are divided in several types which differ in their biological properties and clinical outcome.Molecular analysis and recent animal studies suggest that IPMNs develop in the context of a field-defect and reveal their possible relationship with other neoplastic precursor lesions of pancreatic cancer.

Surgical management of 143 patients with adult primary retroperitoneal tumor

AIM: To analyze the surgical management of adult primary retroperitoneal tumors (APRT) and the factors influencing the outcome after operation. METHODS: Data of 143 cases of APRT from 1990 to 2003 in the First Affiliated Hospital of China Medical University were evaluated retrospectively. RESULTS: A total of 143 cases of APRT were treated surgically. Among them, 122 (85.3%) underwent complete resection, 16 (11.2%) incomplete resection, and 3 (3%) surgical biopsies. Twenty-nine (20.2%) underwent tumor resection plus multiple organ resections. Ninety-five malignant cases were followed up for 1 mo to 5 years. The 1-year, 3-year, and 5-year survival rates of the patients subject to complete resection was 94.9%, 76.6% and 34.3% and that of patients with incomplete resection was 80.4%, 6.7%, and 0%, respectively (P < 0.001). The Cox multi-various regression analysis showed the completeness of tumor, sex and histological type were associated closely with local recurrence. CONCLUSION: Sufficient preoperative preparation and complete tumor resection play important roles in reducing recurrence and improving survival.

Laparoscopic resection of primary retroperitoneal schwannoma:A case report

BACKGROUND Schwannomas are rare,often benign,tumors deriving from Schwann cells that have low incidence in the retroperitoneal region(0.5%to 5%).Their diagnosis is hardly confirmed at early stage due to lack of specific features in signs,symptoms and imaging tests.Thus,it is necessary performing guided punch biopsy in order to identify it.Tumor removal is the treatment of choice due to its low sensitivity to radiation and chemotherapy.CASE SUMMARY Forty-seven years old female patient who was hospitalized for elective orthopedic procedure,without complications,evolved with severe pain in the lower limbs,thigh and gluteal region associated with neurogenic claudication.Persistent pain required magnetic resonance imaging(MRI)of the lumbar spine,which showed epidural collection with dural compression and massive heterogeneous perihepatic nodular lesion.The surgical team opted for draining the collection,as well as requested an MRI of the abdomen and pelvis,whose analysis showed expansive lesion in the retroperitoneum,in close contact with the inferior vena cava and with the right renal vein.A guided puncture was performed for diagnostic clarification,which showed immunohistochemical profile compatible with schwannoma.The selected treatment comprised retroperitoneum tumor resection in association with laparoscopic cholecystectomy.The patient was discharged and remained stable after 4-mo follow-up;she remains under followup to check the need of cancer investigations.CONCLUSION Schwannoma features requires surgical treatment based on laparoscopic resection,which often presents low relapse rates and optimistic prognosis.

Retroperitoneal tumor finally diagnosed as a bronchogenic cyst:A case report and review of literature

BACKGROUND Retroperitoneal bronchogenic cyst(RBC)is an extremely rare developmental abnormality.Most are benign tumors but malignant transformation is possible.Because of their anatomical position,RBCs are easily misdiagnosed as adrenal or pancreatic solid tumors on radiological evaluation.Here,we report a case of RBC,review the literature,and summarize some important features.CASE SUMMARY A 49-year-old woman was incidentally found to have a retroperitoneal tumor during a physical examination.Enhanced computed tomography and laboratory evaluations,including routine blood examination,blood biochemistry,24-h urine 17 ketones,17 hydroxyls,adrenocortical hormone,serum potassium concentration,serum amylase,lipase,and epithelial tumor markers,revealed a moderate density,54 mm×40 mm mass with a clear boundary near the left adrenal gland.The were no abnormalities in the blood and urine values.Because the patient had a history of hypertension and the location of the mass was adjacent to the adrenal gland,it was initially diagnosed as a left adrenal tumor and was resected by retroperitoneal laparoscopy.However,the pathological examination after surgery confirmed it to be a bronchogenic cyst.CONCLUSION Retroperitoneal laparoscopic surgery can be prioritized for symptomatic RBC patients.Conservative treatment is feasible for selected patients.

Intra and extra pelvic multidisciplinary surgical approach of retroperitoneal sarcoma:Case series report

BACKGROUND Retroperitoneal sarcoma(RPS) is a rare malignancy arising from mesenchymal cells that most commonly presents as an abdominal mass and is associated with poor prognosis.Although several studies have assessed the survival benefits of wide excision,few have reported detailed methods for achieving wide excision in patients with RPS.AIM To describe our experience with multidisciplinary surgical resection of RPS using intra-and extra-pelvic approaches.METHODS Multidisciplinary surgery is an anatomical approach that combines intra-and extra-peritoneal access within the same surgery to achieve complete RPS removal.This retrospective review of the records of patients who underwent multidisciplinary surgery for RPS analyzed surgical and survival outcomes.RESULTS Eight patients underwent 10 intra-and extra-pelvic surgical resections,and their median mass size was 12.75 cm(range,6-45.5 cm).Using an intrapelvic approach,laparoscopy-assisted surgery was performed in four cases and laparotomy surgery in six.Using an extrapelvic approach,ilioinguinal and posterior approaches were used in four cases each,and the prone position and midline skin incision were shared in one.All patients’ RPS masses were removed completely,and four achieved R0 resection through intra-and extra-pelvic surgery.The median estimated blood loss was 2000 m L(range,300-20000 m L) and the median hospitalization was 12.6 d(range,9-69 d).Reoperation was needed in two patients(one for wound necrosis and the other for bowel perforation and wound necrosis).The median overall survival rate and median progression-free survival were 64.6 and 13.7 mo,respectively.CONCLUSION RPS is therapeutically challenging because of its location and high risk of recurrence.Therefore,intra-and extra-pelvic surgical approaches can improve the macroscopic security of the surgical margin.

The accuracy of magnetic resonance imaging and ultrasound in evaluating the size of early-stage breast neoplasms

Objective Breast cancer is the most frequently diagnosed cancer in women. Accurate evaluation of the size and extent of the tumor is crucial in selecting a suitable surgical method for patients with breast cancer. Both overestimation and underestimation have important adverse effects on patient care. This study aimed to evaluate the accuracy of breast magnetic resonance imaging(MRI) and ultrasound(US) examination for measuring the size and extent of early-stage breast neoplasms.Methods The longest diameter of breast tumors in patients with T_(1–2)N_(0–1)M_0 invasive breast cancer preparing for breast-conserving surgery(BCS) was measured preoperatively by using both MRI and US and their accuracy was compared with that of postoperative pathologic examination. If the diameter difference was within 2 mm, it was considered to be consistent with pathologic examination.Results A total of 36 patients were imaged using both MRI and US. The mean longest diameter of the tumors on MRI, US, and postoperative pathologic examination was 20.86 mm ± 4.09 mm(range: 11–27 mm), 16.14 mm ± 4.91 mm(range: 6–26 mm), and 18.36 mm ± 3.88 mm(range: 9–24 mm). US examination underestimated the size of the tumor compared to that determined using pathologic examination(t = 3.49, P < 0.01), while MRI overestimated it(t =-6.35, P < 0.01). The linear correlation coefficients between the image measurements and pathologic tumor size were r = 0.826(P < 0.01) for MRI and r = 0.645(P < 0.01) for US. The rate of consistency of MRI and US compared to that with pathologic examination was 88.89% and 80.65%, respectively, and there was no statistically significant difference between them(χ~2 = 0.80, P > 0.05).Conclusion MRI and US are both effective methods to assess the size of breast tumors, and they maintain good consistency with pathologic examination. MRI has a better correlation with pathology. However, we should be careful about the risk of inaccurate size estimation.

Intraductal papillary mucinous neoplasm originating from a jejunal heterotopic pancreas:A case report

BACKGROUND Intraductal papillary mucinous neoplasm(IPMN)is a rare pancreatic tumor and has the potential to become malignant.Surgery is the most effective treatment at present,but there is no consensus on the site of resection.Heterotopic pancreas occurs in the gastrointestinal tract,especially the stomach and duodenum but is asymptomatic and rare.We report a case of ectopic pancreas with IPMN located in the jejunum.CASE SUMMARY A 56-year-old male patient suffered from severe pain,nausea and vomiting due to a traffic accident and sought emergency treatment at our hospital.Contrast-enhanced computed tomography of the whole abdomen suggested splenic congestion,which was considered to be splenic rupture.Emergency laparotomy was performed,and the ruptured spleen was removed during the operation.Unexpectedly,a cauliflower-like mass of about 2.5 cm×2.5 cm in size was incidentally found about 80 cm from the ligament of Treitz during the operation.A partial small bowel resection was performed,and postoperative pathology confirmed the small bowel mass as heterotopic pancreas with low-grade IPMN.CONCLUSION Ectopic pancreas occurs in the jejunum and is pathologically confirmed as IPMN after surgical resection.

中老年肠道炎性肌纤维母细胞瘤临床病理及预后特点

目的探讨中老年肠道炎性肌纤维母细胞瘤(inflammatory myofibroblastic tumours,IMT)的临床病理及预后特点。方法回顾性分析5例中老年肠道IMT的临床、病理形态、免疫表型及随访结果。结果4例IMT发生在右半结肠,1例在回肠。3/5患者有肠道损伤史,首发消化道症状且白细胞增高。瘤组织由梭形肌纤维母细胞和纤维母细胞构成,席纹状排列,浸润性生长,伴较多淋巴细胞、浆细胞浸润,可见胶原化及黏液水肿。其中一例异型性明显,核大且畸形。免疫表型:瘤细胞vimentin(5例)、SMA(5例)、desmin(3例)、ALK(3例)、CK(2例)阳性,Caldesmon、CD34、β-catenin、MC、CD117、DOG1、S-100、BCL-2、CD99、CD68均阴性,Ki-67增殖指数1.28%~10.01%。5例均完整切除肿瘤,随访53~137.5个月,其中1例83岁患者,于术后27个月影像学考虑肿瘤复发;另一例术后无瘤生存122个月,因其他原因去世;其余均无瘤生存,基本状况良好。结论(1)本组中老年肠道IMT多见于右半结肠,多有肠道损伤史,多首发消化道症状,白细胞多升高;(2)Vimentin和SMA同时阳性,多伴ALK阳性;(3)4/5的患者手术切除治疗效果好,1/5的患者术后2~3年可复发;高龄且ALK阳性、Ki67达10%、异型性明显很有可能是中老年肠道IMT复发的重要危险因素,其中ALK阳性者复发的风险或许为1/3。

术前Sonazoid超声造影评估肝细胞癌病理分化程度的价值

目的分析肝细胞癌(HCC)Sonazoid超声造影(CEUS)的特点与病理分化程度的相关性。方法纳入行CEUS检查并经病理确诊为HCC的患者64例,共64个病灶,根据病理分化程度将其分为高、中、低分化组,分别为6、48和10例。比较不同病理分化程度HCC的CEUS动脉期增强形态、增强水平和增强模式。结果动脉期增强形态分为均匀增强和不均匀增强2种,低分化组所有病灶及58.3%中分化组病灶呈不均匀高增强;高分化组病灶可呈均匀高增强、均匀等增强和不均匀高增强3种表现。动脉期,所有中、低分组病灶和66.7%高分化组病灶呈高增强,不同分化程度HCC的增强水平差异有统计学意义(P<0.01);门脉期,高、中、低分化组分别有16.7%、25.0%和70.0%的病灶消退成低增强,不同分化程度HCC的增强水平差异有统计学意义(P<0.05);延迟期,75%中分化组病灶和所有低分化组病灶呈低增强,66.7%高分化组病灶呈等增强,不同分化程度HCC的增强水平差异有统计学意义(P<0.01);Kupffer期,所有低分化组和95.8%中分化组病灶呈低增强,高分化组中仍有50%的病灶呈等增强,不同分化程度HCC的增强水平差异有统计学意义(P<0.01)。高分化组病灶表现为多种CEUS模式,中分化组病灶以“快进快退”、“快进慢退”为主,90.0%低分化组病灶呈“快进快退”模式,不同分化程度HCC的CEUS模式差异有统计学意义(P<0.01)。结论Sonazoid-CEUS在评估HCC病理分化程度方面具有一定价值。

外阴良性肿瘤的病理特征及临床分析

目的 探讨外阴良性肿瘤的临床特点、病理特征及治疗预后,总结相关的临床诊治经验。方法 收集2018年1月至2022年12月因外阴肿物收入首都医科大学附属北京妇产医院妇科微创中心住院治疗的24例经病理检查证实为外阴良性肿瘤患者的临床及病理资料进行回顾性分析。探讨发病年龄、临床症状体征、肿物性状特点、病理类型、治疗及转归情况。结果 24例患者中仅2例(8.3%)为多发病灶,其余患者均为单发。发病年龄为14~78岁,中位发病年龄为38岁,围绝经期患者2例(8.3%)。所有患者表现为自触和/或在妇科检查时发现外阴肿物,有2例伴异味及破溃;病程为2周~70年;3例表现为外阴囊性肿物,21例表现为外阴实性肿物(包括8例外阴皮赘),包块大小为0.5~8 cm。术后病理诊断为外阴软纤维瘤者8例,平滑肌瘤4例,外阴皮内痣、纤维瘤、乳头状汗腺腺瘤、血管肌纤维母细胞瘤各2例,多发鳞状细胞乳头状瘤、脂肪瘤、细胞性血管纤维瘤、孤立性纤维性肿瘤各1例。除1例外阴多发鳞状细胞乳头状瘤患者行单纯外阴切除术,其余患者均采用局部病灶切除术。术后随访3个月~5年,均未见复发。结论 外阴良性肿瘤多为单发,实性肿物多见,常无明显自觉症状,病理类型呈多样性,预后较好,建议尽早手术切除,术后加强随访。

前列腺癌多参数MRI诊断及误诊原因分析

目的 探讨前列腺癌临床特点、多参数MRI表现,总结其误诊原因及防范措施。方法 对2020年4月—2022年2月收治的多参数MRI检查后误诊为膀胱癌、前列腺增生的前列腺癌10例的临床资料进行回顾性分析。结果 10例年龄54~73岁。6例因尿急、尿频、尿潴留、排尿困难就诊,直肠指诊示前列腺肥大,查血清前列腺特异性抗原升高,多参数MRI及前列腺穿刺活组织病理检查未发现前列腺肿瘤证据,误诊为前列腺增生,后经术后病理检查确诊T1期前列腺癌。4例以尿痛、血尿、排尿困难就诊,经多参数MRI检查误诊为膀胱癌,查血清前列腺特异性抗原升高,直肠指诊发现前列腺肥大,再次行多参数MRI和前列腺组织穿刺活组织病理检查证实为前列腺癌累及膀胱。误诊时间4~10 d。误诊为前列腺增生6例接受根治性手术,误诊为膀胱癌4例予内分泌和放射治疗,随访至今病情控制尚可。结论 临床接诊以尿急、尿频、尿潴留、排尿困难等症状就诊的中老年男性患者时应考虑到前列腺癌可能。加强对前列腺癌影像学特征认识,行多参数MRI检查时重点观察前列腺结构、包膜完整与否、膀胱壁连续性等重要特征,必要时可行前列腺穿刺活组织病理检查,以提高该病术前诊断正确率。

结直肠癌组织中错配修复蛋白的表达及其与临床病理特征的关系

目的分析结直肠癌组织中错配修复蛋白(MMR)的表达情况及与临床病理特征的关系,并探讨MMR检测在临床工作中的价值。方法收集2021年12月至2023年7月山东省济宁市第一人民医院胃肠外科经外科手术治疗的212例结肠癌及直肠癌患者的相关临床病历资料,分析MMR蛋白Mut L蛋白同系物1(MLH1)、Mut S蛋白同系物2(MSH2)、Mut S蛋白同系物6(MSH6)、减数分裂后分离蛋白2(PMS2)的表达情况并将错配蛋白缺失(dMMR)与其他临床病理数据进行分析。结果212例患者中存在MLH1缺失5例(2.4%),PMS2缺失10例(4.7%),MSH2与MSH6分别缺失2例(0.9%),MLH1、PMS2共同缺失5例(2.4%),MSH2、MSH6共同缺失2例(0.9%)。212例结直肠癌组织中dMMR 12例占5.7%;dMMR与结直肠癌患者的性别、年龄、分化程度、TNM分期、T分期、N分期、有无脉管癌栓及有无神经侵犯均无关;与肿瘤部位、组织学类型相关(P<0.05)。结论MMR表达缺失与肿瘤部位及组织学类型相关,通过对MMR的检测可对术后治疗方案提供指导并对判断癌症患者的预后有重要意义。

骨髓增殖性肿瘤临床病理学特征分析

目的探讨骨髓增殖性肿瘤的骨髓病理组织形态学特点,探讨其临床诊断价值。方法选取2020年1月至2023年3月本院收治的MPN患者138例,对骨髓活检组织作组织学观察及免疫组化行表型分析,同时进行基因学检测。结果138例确诊MPN患者中,BCR ABL阳性CML 39例,BCR ABL阴性MPNs中PV 13例、ET 72例和PMF 11例。经典型MPN骨髓活检组织各具有诊断性形态学特点。CML粒红系比例明显增大伴粒系核右移,巨核细胞均为胞体小、分叶少的巨核细胞,PV粒红系比例明显减小,巨核细胞形态多样,混杂分布;ET粒红系比例大致正常,巨核细胞则为胞体大、分叶多的巨核细胞;PMF巨核细胞形态怪异,核染色质深染浓集,多伴网状纤维显著性增生。结论骨髓活检组织形态在MPN精准诊断和分型中具有重要临床意义。