香港中文大学化学病理学系的学科建设与管理

香港中文大学化学病理系与重医医学检验系是兄弟协作单位 ,同时创建于 1982年 ,过去数年紧密合作 ,协作举办了多次研讨班 ,培养研究生和检验医师 ,编著学术刊物 ,教授互访 ,相互借鉴 ,共同发展。现特邀系主任林伟基教授对该系的建设与发展作简介 。

肺原发性印戒细胞癌临床病理学观察

目的:探讨肺原发性印戒细胞癌的临床病理特点及生物学特征。方法:对8例肺原发性印戒细胞癌患者的肿瘤组织病理学进行分析,并对细胞角蛋白广谱(Ckpan)、细胞角蛋白(CK)7、CK20、血管内皮生长因子(VEGF)、甲状腺转录因子(TTF)-1等指标进行免疫组织化学染色和阿辛蓝(AB)、过碘酸雪夫(PAS)特殊染色。结果:光镜下见肿瘤细胞中等大小、圆形、胞质内含大量黏液,形成圆形黏液滴,推挤细胞核至一侧,呈印戒样外观。特殊染色AB及PAS全部阳性;免疫组化结果Ckpan及癌胚抗原(CEA)8例全部阳性,CK7、TTF-1及VEGF阳性7例,CK20阳性1例。结论:肺原发性印戒细胞癌确诊主要依靠病理及免疫组化检查,其中TTF-1、CK7及CK20有助于鉴别肺原发与转移性印戒细胞癌。

110例眼部恶性黑色素瘤的临床病理分析

背景眼部黑色素瘤是一种恶性肿瘤，预后较差。了解眼部黑色素瘤的发生发展规律对于其早期诊断和治疗有重要意义。目的了解眼部恶性黑色索瘤的发生部位、病理分型及其与预后的关系。方法收集自1980年1月至2007年12月在华西医院眼科就诊，并经常规组织病理学检查、免疫组织化学检测和组织超微结构观察证实为眼部恶性黑色素瘤的110例标本及其患者的临床资料进行回顾性分析，对眼部黑色素瘤的组织发生、病理组织成分进行分类，并分析不同类型黑色素瘤与扩散率及预后的关系。结果眼部黑色素瘤的发病部位依次为：葡萄膜66例（60．00％）、眼表组织27例（24．55％）、眼眶继发性肿瘤8例（7．27％）、眼睑皮肤7例（6．36％）、泪囊2例（1．82％）。按照肿瘤的组织病理学结果可分为梭A细胞型31例（28．18％）、梭B细胞型31例（28．18％）、混合细胞型25例（22．73％）、上皮细胞型17例（15．46％）和其他型6例（5．45％）。上述5种病理分型的110例肿瘤患者的扩散或复发率从高到低依次为其他型、上皮细胞型、混合细胞型、梭B细胞型、梭A细胞型，各型总体扩散或复发率比较差异有统计学意义（x2=14．463，P：0．006）。眼部黑色素瘤的临床表现与其发生的部位有关，但多无特异性。结论眼部恶性黑色素瘤的好发部位绝大多数为葡萄膜和眼表组织，组织病理学分类中以梭形细胞型最常见，分类为其他型的黑色素瘤扩散率较高。恶性黑色素瘤的临床表现无特异性，应引起临床医师的重视。

乳腺导管原位癌并发微小浸润的临床及免疫组织化学分析

目的探讨乳腺导管原位癌并发微小浸润(ductal carcinoma in situ with microinvasion,DCIS-Mi)的临床及病理特点。方法确诊为DCIS-Mi 28例,对标本做连续切片,HE染色后用目镜测微尺测量微小浸润灶的最大径,并计数微小浸润灶的数量;用免疫组化法检测ER、PR、HER2和p53等的表达,并结合临床特点进行分析。结果28例患者中26例(93%)有钼靶摄影片的变化,22例(78.6%)存在微小钙化。平均浸润灶数量为3个。高核分级和粉刺型原位癌分别为57.1%和46.4%。26例行淋巴结切除术,平均每例切除12枚淋巴结,常规HE染色检查未发现淋巴结转移。ER、PR的阳性表达分别为15(53.6%)和17(60.7%),ER、PR的阳性表达明显和低核分级与非粉刺样癌相关(P<0.01);p53、HER2的阳性表达分别为11(39.3%)和15(53.6%),其表达和高核分级和粉刺样癌呈正相关(P<0.01)。结论高核分级和粉刺型DCIS以及HER2和p53过表达的DCIS更具有侵袭性,更易合并微小浸润。

苯二甲酸二异壬酯（DINP）的化学环境病理学和毒理学

DINP在玩具、家庭、消费品和工业品中用量很大，而在与食品接触的塑料中则用量较少。DINP对人的影响主要通过两个途径：1)职业性的接触；2)非职业性的接触，即一般居民的接触。

苯二甲酸二异壬酯（DINP）的化学环境病理学和毒理学

DINP在环境样品中和消费品中的抽出和清除的分析方法，通常是采用其它苯二酸酯的分析方法。个别情况下也利用其他方法来测定环境中的物质和塑料制品中的DINP(表3)。

低度恶性子宫内膜间质肉瘤临床病理分析

目的:探讨低度恶性子宫内膜间质肉瘤(LGESS)的临床病理学特征及其诊断和鉴别诊断。方法:对2例LGESS标本进行光镜检查和免疫组化观察,并复习相关文献。结果:LGESS临床表现为阴道流血,光镜示肿瘤由增生的内膜间质细胞组成,见簇状生长螺旋小动脉。免疫组化示瘤细胞共同型急性淋巴细胞白血病抗原、波形蛋白、雌激素受体、孕激素受体和结蛋白均阳性,平滑肌肌动蛋白部分阳性,抑制素和外周神经标记蛋白阴性。结论:LGESS具多样组织形态,需结合病理形态、免疫组化及临床资料进行诊断和鉴别诊断。

胸骨孤立性浆细胞瘤1例并文献复习

目的 通过临床病例及文献复习,探讨胸骨孤立性浆细胞瘤(SP)临床诊断与治疗关键问题。方法 分析武汉科技大学附属汉阳医院胸外科2020年9月至2021年10月治疗的1例胸骨SP病人的临床资料(临床表现、实验室特征、影像学特征、外科手术、病理学特征及随访资料),并复习相关文献。结果 计算机体层成像(CT)示胸骨体可见肿块影,呈膨胀性生长,并伴有骨质破坏,边缘较清,周围软组织未见异常改变。术后病理提示胸骨浆细胞瘤,结合血红蛋白、尿本周蛋白、血钙、肌酐水平、免疫球蛋白、骨髓细胞学及X线等,临床诊断为胸骨SP。结论 诊断胸骨SP需综合分析影像学、实验室、病理检查结果及临床表现,尽早明确诊断是关键;手术结合适当的放疗是其治疗的最佳手段。

Prognostic Impact of Histopathologic Response after Neoadjuvant Chemotherapy in Stage Ⅲ_A Non-small Cell Lung Cancer

Objective： To investigate prognostic impact of histopathologic response induced by neoadjuvant chemotherapy in patients with stage ⅢA non-small cell lung cancer （NSCLC）. Methods： Forty patients with stage ⅢA NSCLC underwent two cycles of neoadjuvant chemotherapy with mitomycin, vindosine, and cisplatin followed by surgery. Histopathologic response in resection of the tumor was examined after surgery. Tumor regression was classified as grade Ⅳ, grade Ⅲ, grade Ⅱ, and grade Ⅰ according to the extent of tumor necrosis and the extent of the vital tumor tissues. The tumor regression grading was correlated with the survival time of the patients. Results： After two cycles of chemotherapy, 19 （47.5%） of 40 patients had objective response （2 complete and 17 partial response）. In 40 resected tumor specimens, 2 （5%） were classified as regression grade Ⅳ, 16 （40%） as regression grade Ⅲ, 18 （45%） as regression gradeⅡ, and 4 （10%） as regression grade Ⅰ. The rate of complete surgical resection was significantly higher in patients with tumor regression grade Ⅲ-Ⅳ （〈10% vital tumor tissue）（P〈0.05）. The median survival time in patients classified as having tumor regression grade Ⅲ-Ⅳ was significantly longer than that in patients who had regression grade Ⅰ-Ⅱ （P〈0.05）. The 3-year survival rate in patients with regression grade Ⅲ-Ⅳ was markedly higher than that in patients who had regression grade Ⅰ-Ⅱ （P〈0.05）. Conclusion： The extent of tumor regression induced by neoadjuvant chemotherapy is a critical issue for successful therapeutic approach in patients with stage ⅢA NSCLC. In resected specimens of tumors after chemotherapy, the presence of marked tumor regression （regression grade Ⅲ-Ⅳ） is predictive for superior survival time.

卫生医务人员

0015576 英国的病理学毕业前教育/Lev-ison D A∥日病理会志.-1998,87(1).-WS1～3 冀医情 0015577 英国的病理组织学毕业后教育/Underwood J C E∥日病理会志.-1998,87(1).-WS1～4

赵慧君:催生基因诊断创新革命

一袭黑白交间长裙、留着齐肩短发,佩戴着精致项链……她就是香港中文大学医学院化学病理学系教授赵慧君。在她那看似娇小的身体内,蕴藏着对科学研究无尽的能量。曾荣获"中国青年女科学家奖"的赵慧君,经过多年的努力,成功研发出利用基因测序技术,分析孕妇血液样本检测胎儿是否患有唐氏综合征,开创无创产前检验的先河。

Adrenal myelolipoma within myxoid cortical adenoma associated with Conn's syndrome

The coexistence of myelolipoma within adrenal cortical adenoma is extremely rare,for both tumors present usually as separate entities.There are only 16 such cases reported worldwide.To the best of our knowledge,the case we reported here is the first one of myxoid adrenal cortical adenoma associated with myelolipoma reported.A 32-year-old Chinese woman with 4-year history of hypertension was presented in our study.Computed tomography(CT)of the abdomen showed a large heterogene- ously-enhancing mass(4.5 cm in diameter)in the left suprarenal region.Clinical history and laboratory results suggest a metabolic disorder as Conn's syndrome.The patient underwent a left adrenalectomy,and a histopathological study confirmed the mass to be a myxoid adrenal cortical adenoma containing myelolipoma.The patient was postoperatively well and discharged uneventfully.In the present case report,we also discuss the etiology of simultaneous myelolipoma and adrenal adenoma associated with Conn's syndrome,and the methods of the diagnosis and differential diagnosis.

Bile acids:Chemistry,physiology,and pathophysiology

The family of bile acids includes a group of molecular species of acidic steroids with very peculiar physical-chemical and biological characteristics.They are synthesized by the liver from cholesterol through several complementary pathways that are controlled by mechanisms involving finetuning by the levels of certain bile acid species.Although their best-known role is their participation in the digestion and absorption of fat,they also play an important role in several other physiological processes.Thus,genetic abnormalities accounting for alterations in their synthesis,biotransformation and/or transport may result in severe alterations,even leading to lethal situations for which the sole therapeutic option may be liver transplantation.Moreover,the increased levels of bile acids reached during cholestatic liver diseases are known to induce oxidative stress and apoptosis,resulting in damage to the liver parenchyma and,eventually,extrahepatic tissues.When this occurs during pregnancy,the outcome of gestation may be challenged.In contrast,the physical-chemical and biological properties of these compounds have been used as the bases for the development of drugs and as pharmaceutical tools for the delivery of active agents.

Carcinosarcoma of the stomach:A case report and review of the literature

Carcinosarcomas are rare,malignant,biphasic tumors. We report the case of a 62-year-old man with gastric carcinosarcoma,along with its clinical,macroscopic and histopathological features. Macroscopically,a specimen of deformed stomach was obtained that measured 200 mm×150 mm×100 mm. A 150 mm×100 mm× 50 mm exophytic tumoral mass (Borrmann typeⅠ) was found,which involved the posterior wall from the cardia to the antrum. Histopathologically,a mixed type of malignancy was revealed: an adenocarcinoma with intestinal metaplasia,with interposed fascicles of fusiform atypical cells and numerous large,rounded and oval cells. The tumor showed positive histochemistry for cytokeratin 18,epithelial membrane antigen,carcinoembryonic antigen,chromogranin A and vimentin. Liver metastases were diagnosed 8 mo postoperatively,and the patient died 4 mo later. A review of the available literature is also presented.

Expression and significance of Tie-1 and Tie-2 receptors, and angiopoietins-1,2 and 4 in colorectal adenocarcinoma:Immunohistochemical analysis and correlation with clinicopathological factors

AIM: There is strong evidence that tyrosine kinases are involved in the regulation of tumor progression, cellular growth and differentiation. Recently, many kinds of tyrosine kinase receptors have been reported, among them Tie-1 and Tie-2 receptors constitute a major class.Angiopoietin (Ang)-1 is known as a ligand ofTie-2 tyrosine kinase receptor. The objective of this study was to establish a comprehensive Tie-1 and Tie-2 and Ang-1, 2 and 4expression profile in human colorectal adenocarcinomas.METHODS: We examined 96 cases of surgically resected human colorectal adenocarcinoma by immunohistochemistry and investigated the statistical correlation between the expressions of Ties and Angs and clinicopathological factors.RESULTS: Among the 96 cases of adenocarcinoma, 87(90.6%), 92 (95.8%), 83 (86.5%), 89 (92.7%), and 76cases (79.2%) showed positive staining in the cytoplasm of carcinoma cells for the Tie-1 and Tie-2 and Ang-1, 2and 4 proteins, respectively. Histologically, the expressions of Ties and Angs were variable. The expressions of Ties and Angs were correlated with several clinicopathological factors, but did not correlate with the presence of lymph node metastasis. Ties and Angs were highly expressed in human colorectal adenocarcinoma cells.CONCLUSION: These findings suggest that the Tie-Ang receptor-ligand complex is one of the factors involved in the cellular differentiation and progression of human colorectal adenocarcinoma.

DEC1 nuclear expression:A marker of differentiation grade in hepatocellular carcinoma

AIM: To investigate the expression patterns of human differentiated embryo chondrocyte 1 (DEC1) in hepatocellular carcinoma (HCC) and corresponding adjacent non-tumor and the normal liver tissues, the association between DEC1 expression and histopathological variables and the role of DEC1 in hepatocarcinogenesis. METHODS: The expression of DEC1 was detected immunohistochemically in 176 paraffin-embedded sections from 63 patients with HCC and 50 subjects with normal liver tissues. RESULTS: DEC1 protein was persistently expressed in the cytoplasm of hepatocytes in normal liver and HCC tissues. Compared with adjacent non-tumor liver tissues, HCC tissues showed high nuclear expression of DEC1 protein. However, high DEC1 nuclear expression was more frequently detected in well-differentiated (83.3%) than in moderately (27.3%) and poorly differentiated HCC (16.7%). Low DEC1 expression was associated with poor histological differentiation and malignancy progression. A correlation was found between the nuclear expression of DEC1 protein and histological differentiation (r = 0.376, P = 0.024). CONCLUSION: DEC1 is expressed in the cytoplasm of hepatocytes and because nuclear DEC1 expression is decreased with decreasing differentiation status of HCC, nuclear DEC1 might be a marker of HCC differentiation.

甲状腺胸腺样分化癌两例

甲状腺胸腺样分化癌(CASTLE)是一种罕见的甲状腺恶性肿瘤,与甲状腺其他恶性肿瘤不同,表现为胸腺样分化的特征,需通过病理学检查及免疫组织化学检查确诊。CASTLE的治疗以手术为主,辅以放射治疗,预后较好。该文报道了2例CASTLE患者,均为体检发现甲状腺肿块,1例发现甲状腺病变时已有淋巴结和喉返神经的转移,另1例发现甲状腺病变时肿瘤已累及甲状旁腺和喉返神经,2例均接受了手术切除肿瘤,经术后病理学检查及免疫组织化学检查确诊,术后辅以放射治疗,口服左甲状腺素片,目前随访情况均良好。

Expressions of claudin-4 and claudin-1 in endometrial cancer and their significance

Objective:To observe the expressions of claudin-4 and claudin-1 in endometrial cancer and explore their correlations with clinicopathological parameters of endometrial cancer.Methods:Immunohistochemical methods(SP) were used to detect the expressions of claudin-4 and claudin-1 in 52 tissue samples of endometrial cancer,24 of atypical hyperplasia,20 of pericancerous endometrium,and 19 of endometrium at proliferative phase.And then the expressions were analyzed statistically to find out the correlations with clinicopathological parameters of endometrial cancer.Results:Positive rate of claudin-4 was 36.8%,70.8% and 90.4% in endometrium at proliferative phase,atypical hyperplasia and endometrial cancer,respectively,with significantly differences between them(P<0.05),and it was statistically different between pericancer endometrium and endometrial cancer(P<0.05).Positive rate of claudin-1 was 89.5%,66.7% and 63.5%,respectively showing a descending tendency and significantly differences between endometrium at proliferative phase and endometrial caner(P<0.05),and it was also statistically significantly different between pericancer endometrium and endometrial cancer(P<0.05).The high expression rate of claudin-4 was related to invasion depth,but not to histological grading,pathological staging or lymph node metastasis of endometrial cancer,and the low expression of claudin-1 in endometrial cancer was not associated with histological grading,pathological staging,invasion depth or lymph node metastasis.Conclusion:The expression levels of claudin-4 and claudin-1 are correlated with onset and development of endometrial cancer.