1400例甲状腺疾病快速冷冻切片的病理诊断分析与探讨

目的甲状腺疾病快速冰冻切片病理诊断分析的准确性及其在术中的实用性。方法对2015年5月~2019年5月经手术治疗的1400例甲状腺疾病病人进行冷冻切片和明确病理分析。以评估快速冰冻切片病理诊断结果的准确性以及对甲状腺疾病手术的影响。结果与术中诊断符合率相比,甲状腺疾病冰冻切片诊断良性准确率高99.77%,出现漏诊1例,误诊2例;甲状腺疾病冰冻切片诊断恶性准确率占65.06%,漏诊7例,误诊有22例。结论临床上快速冰冻切片病理诊断对甲状腺疾病的诊断具有一定的价值,但也可能存在一定的漏诊率,特别是对于恶性肿瘤的评估。

50例膀胱乳头状肿瘤的病理组织学诊断分析

目的为了将膀胱乳头状肿瘤的病理组织学诊断的准确性提高。方法选择50位被诊断为膀胱乳头状肿瘤的病人的肿瘤的病理组织切片,由我院三位资深病理科医生分别独立阅片,做出诊断结果后,再通过讨论统一所有病例病理切片的诊断结果。结果内翻性乳头状瘤有3例,乳头状瘤有2例,低恶性的潜能的乳头状肿瘤有13例,乳头状癌Ⅰ级有15例,乳头状癌Ⅱ级有9例,乳头状癌Ⅲ级有8例。和原来的诊断结果的符合率是72%。乳头状癌Ⅰ级和低恶性的潜能的乳头状肿瘤是诊断分析出现的主要分歧。结论观察膀胱乳头状肿瘤的关键是其结构组织以及细胞的异型性,但各个病理医生的经验不同所下的诊断也不同,所以对于经验尚浅的病理医生来说尤须进行回顾性的总结才能下正确的病理诊断。

甲状腺结节457例的临床病理分析

目的:分析探讨甲状腺结节性病变的临床病理特点。方法:对手术切除经临床确诊的457例甲状腺结节患者的病理资料进行回顾性分析。结果:457例甲状腺结节患者中男122例,女335例,男女之比为1:2.75,中位年龄40岁。良性疾病389例,占甲状腺结节的85.12%;恶性疾病68例,占甲状腺结节的14.88%。良性与恶性之比为85.72:1,良性疾病以结节性甲状腺肿和甲状腺腺瘤为主,占良性结节的94.34%;恶性肿瘤以乳头状癌为主,占恶性肿瘤的92.65%,其中微小乳头状癌(直径<1cm)13例,占乳头状癌的20.64%,髓样癌4例,弥漫大B细胞淋巴瘤1例。结论:病理检查可以明确甲状腺结节性疾病的性质和病理类型,正确和合理的病理诊断是临床诊断的基础,对临床治疗和预后有一定的指导意义。

A clinicopathological analysis in unsuspected gallbladder carcinoma: A report of 23 cases

AIM： To study the clinicopathological characteristics of unsuspected gallbladder carcinoma （UGC）. METHODS： We retrospectively studied 23 cases of UGC in Tongji Hospital, and compared their clinicopathological characteristics with 33 cases of preoperatively diagnosed gallbladder carcinoma （PDGC）. RESULTS： The proportion of UGC coexisting with cholecystolithiasis was significantly higher than that of PDGC （x^2 = 13.53, P 〈 0.01）. The infection rate of hepatitis B virus was 21.74% （5/23） in UGC and 30.30% （10/33） in PDGC. Nine （39.13%） of 23 patients with UGC and 8/33 （24.24） PDGC had contact with schistosome pestilent water. The rate of multiple pregnancies was 56.52% （13/23） in the patients with UGC and 42.42% （14/33） in PDGC. The primary location of the UGC was mostly in the neck and body of the gallbladder, and that of the PDGC was often in the body and bottom. The incidence of Nevin stage I and 11 UGC was significantly higher than that of PDGC （x^2 = 4.44, P 〈 0.05 and 2 = 4.96, P 〈 0.05） while that of Nevin stage V UGC was significantly lower than that of PDGC （x^2 = 7.59, P 〈 0.01）. According to the grading of carcinoma, the incidence of well-differentiated UGC was significantly higher than that of PDGC （2 = 4.16, P 〈 0.05）, and that of poorlydifferentiated UGC was significantly lower than that of PDGC （x^2 = 4.48, P 〈 0.05）.CONCLUSION： There are different characteristics between UGC and PDGC, such as in primary location, malignant degree and incidence of coexistence with cholecystolithiasis. Cholecystolithiasis, hepatitis B, schistosome and multiple pregnancies were high risk factors for gallbladder carcinoma.

Is it possible to differentiate gastric GISTs from gastric leiomyomas by EUS?

AIM: To evaluate the ultrasonog raphy (EUS) features of gastric gastrointestinal stromal tumors (GISTs) as compared with gastric leiomyomas and then to determine the EUS features that could predict malignant GISTs.METHODS: We evaluated the endoscopic EUS features in 53 patients with gastric mesenchymal tumors conf irmed by histopathologic diagnosis. The GISTs were classif ied into benign and malignant groups according to the histological risk classif ication.RESULTS: Immunohistochemical analyses demon-strated 7 leiomyomas and 46 GISTs. Inhomogenicity, hyperechogenic spots, a marginal halo and higher echogenicity as compared with the surrounding muscle layer appeared more frequently in the GISTs than in the leiomyomas (P < 0.05). The presence of at least two of these four features had a sensitivity of 89.1% and a specifi city of 85.7% for predicting GISTs. Except for tumor size and irregularity of the border, most of the EUS features were not helpful for predicting the malignant potential of GISTs. On multivariate analysis, only the maximal diameter of the GISTs was an independent predictor. The optimal size for predicting malignant GISTs was 35 mm. The sensitivity and specificity using this value were 92.3% and 78.8%, respectively.CONCLUSION: EUS may help to differentiate gastric GISTs from gastric leiomyomas. Once GISTs are suspected, surgery should be considered if the size is greater than 3.5 cm.

Magnetic resonance imaging:A new tool for diagnosis of acute ischemic colitis?

AIM： To define the evolution of ischemic lesions with 7T magnetic resonance imaging （7T-MRI） in an animal model of acute colonic ischemia. METHODS： Adult Sprague-Dawley rats were divided into two groups. Group I underwent inferior mesenteric artery （IMA） ligation followed by macroscopic observa- tions and histological analysis. In group H, 7T-MRI was performed before and after IMA ligation and followed by histological analysis. RESULTS： Morphological alterations started to develop 1 h after IMA ligation, when pale areas became evident in the splenic flexure mesentery and progressively wors-ened up to 8 h thereafter, when the mesentery was less pale, and the splenic flexure loop appeared very dark. The 7T-MRI results reflected these alterations, showing a hyperintense signal in both the intraperitoneal space and the colonic loop wall 1 h after IMA ligation; the lat- ter progressively increased to demonstrate a reduction in the colonic loop lumen at 6 h. Eight hours after IMA ligation, MRI showed a persistent colonic mural hyper- intensity associated with a reduction in peritoneal free fluid. The 7T-MRI findings were correlated with histolog- ical alterations, varying from an attenuated epithelium with glandular apex lesions at 1 h to coagulative necro- sis and loss of the surface epithelium detected 8 h after IMA ligation. CONCLUSION： MRI may be used as a substitute for invasive procedures in diagnosing and grading acute ischemic colitis, allowing for the early identification of pathological findings.

A CLINICOPATHOLOGICAL ANALYSIS OF 22 CASES OF MULTIPLE MALIGNANT TUMORS

To get a better understanding of the location,pathophysiology,etiology and prognosis of multiple malignant tumors (MPMT),we evaluated the medical records of 22 patients with MPMT.Our results suggested that radiotherapy and chemotherapy might play an important role in the pathogenesis of MPMT and follow up is important in detecting a secondary primary malignant tumor (PMT) at an early stage.Surgical removal of tumors is the first choice therapy for MPMT.

Comparison between different reconstruction routes in esophageal squamous cell carcinoma

AIM:To compare postoperative complications and prognosis of esophageal squamous cell carcinoma patients treated with different routes of reconstruction. METHODS:After obtaining approval from the Medical Ethics Committee of the Sun Yat-Sen University Cancer Center, we retrospectively reviewed data from 306 consecutive patients with histologically diagnosed esophageal squamous cell carcinoma who were treated between 2001 and 2011. All patients underwent radical McKeown-type esophagectomy with at least two-field lymphadenectomy. Regular follow-up was performed in our outpatient department. Postoperative complica-tions and long-term survival were analyzed by treatment modality, baseline patient characteristics, and operative procedure. Data from patients treated via the retrosternal and posterior mediastinal routes were compared. RESULTS:The posterior mediastinal and retrosternal reconstruction routes were employed in 120 and 186 patients, respectively. Pulmonary complications were the most common complications experienced during the postoperative period (46.1% of all patients; 141/306). Compared to the retrosternal route, the posterior mediastinal reconstruction route was associated with a lower incidence of anastomotic stricture (15.8% vs 27.4%, P = 0.018) and less surgical bleeding (242.8 ± 114.2 mL vs 308.2 ± 168.4 mL, P < 0.001). The median survival time was 26.8 mo (range:1.6-116.1 mo). Upon uni/multivariate analysis, a lower preoperative albumin level (P = 0.009) and a more advanced pathological stage (pT; P = 0.006; pN; P < 0.001) were identified as independent factors predicting poor prognosis. The reconstruction route did not influence prognosis (P = 0.477). CONCLUSION:The posterior mediastinal route of reconstruction reduces incidence of postoperative complications but does not affect survival. This route is recommended for resectable esophageal squamous cell carcinoma.

The radiological image of pulmonary inflammatory pseudotumor:an analysis of 36 cases

Objective:The aim of the study was to discuss the X-ray and CT manifestations and characteristics of pulmonary inflammatory pseudotumors.Methods:The 36 patients with pathological diagnosis of pulmonary inflammatory pseudotumor were tested by thoracic X-ray and CT scan,and their imaging characteristics were analyzed.Results:Most of masses had intact capsule and smooth border.It was very important to diagnose pulmonary inflammatory pseudotumor when the mass was closed to or adhered to the pleura with irregular shadow or being sharply circumscribed.Conclusion:X-ray and CT scan are very important ways to diagnose the pulmonary inflammatory pseudotumor,and to accurately diagnose it,the clinical data,complete analysis are also necessary.

Clinicopathological analysis of solitary fibrous tumor

Objective:The aim of this study was to investigate the clinicopathologic characteristics,diagnosis and differential diagnosis,molecular genetics,treatment and prognosis of solitary fibrous tumor(SFT).Methods:The clinicopathological manifestations were analyzed retrospectively in 22 patients with surgically confirmed SFT.Results:There were 12 male patients and 10 female patients,with the age range 33-67(mean 48.62) years.The SFTs originated from different from parts of the body,including 13 in the chest,2 in the lungs,3 in the abdomen,1 in the lumbosacral area,2 in the pelvis,and 1 in the left shoulder.There were 19 benign and 3 malignant tumors.Major clinical presentations were local masses and compression symptoms.Microscopy:the tumor was composed of areas of alternating hypercellularity and hypocellularity.The tumor cells were spindle to short-spindle shaped and arranged in fascicular or storiform pattern and hemangiopericytoma-like structure was presented.Immunohistochemically,Vimentin positive rate was 100%(22/22),Bcl-2 positive rate was 95.5%(21/22),CD99 positive rate was 86.4%(19/22),CD34 positive rate was 81.8(18/22),focally positive for P53,as well as negative CK,S100 and Desmin.Ki67 labelling index was 2%-30%.Conclusion:SFT is a rare tumor which may be found in various parts of human body.SFT mostly is a benign tumor,but a few could be malignant.Its diagnosis mainly rely on its morphologic features and immunohistochemical profiles.The major treatment is to completely resect it by operation and long-term clinical follow-up is necessary.