以器官系统为中心的组织学与病理学课程整合的探索

目的:探索以器官系统为中心(OSC)的组织学与病理学课程整合的方法和效果.方法:在临床医学专业设立教学改革班,并实施组织学与病理学的课程整合改革.普通班采取传统的以学科为中心的课程设置,对教学效果进行对比.结果:学生和教师对整合课程满意度较高,教改班整合课程成绩高于普通班两门课程成绩,差异均有统计学意义.结论:组织学与病理学整合课程设置优于传统的以学科为中心的课程设置,但整合课程还有待进一步完善.

独立学院《组织学与病理学》综合教学模式初探

为了初步改变以往组织胚胎学与病理学分开教学、互不联系的教学格局,帮助学生理解并融合各学科的知识,将医学影像学专业的组织胚胎学与病理学两门学科的教学内容整合。整合可提高教学效果,并提高学生的逻辑能力、综合能力和灵活运用所学知识的能力。因此,组织胚胎学与病理学进行融合教学是可行的,值得推广。

中医院校中医学专业组织学与病理学课程整合教学初探

随高等教育的改革与发展,学科交叉渗透和综合化是高等教育发展的必然趋势。课程整合是体现学科交叉渗透和综合化发展趋势的具体方式之一。我校2016年试行了临床医学专业消化系统的课程整合教学,效果良好。本文在借鉴临床医学专业整合教学基础上,探索中医学专业组织学与病理学课程的整合,为我校推进基础医学课程整合提供借鉴。

慢性胃炎的病理组织学表现与胃镜检查的关系

目的:探讨慢性胃炎的病理组织学表现及与胃镜检查的关系。方法:回顾分析了262例经病理组织学检查诊断为慢性胃炎的病理组织学表现,并与胃镜检查的结果比较,探讨两者之间的关系。结果:262例慢性胃炎患者中,慢性浅表性胃炎(CSG)有202例,占77.10%,其中以慢性活动性胃炎居多,占71.23%。慢性萎缩性胃炎(CAG)伴局部胃粘膜腺上皮轻—中度异型增生和肠上皮化生较CSG为多,分别为68.33%和33.33%。胃镜诊断与病理组织学诊断相符的病例只有46例,占17.56%。胃镜诊断为胃粘膜粗糙原因待查39例,占14.89%。而大多数病例(142例)胃镜诊断为胃溃疡,占54.20%,其中有25例为溃疡恶变待排。结论:262例慢性胃炎患者的病理组织学表现,以CSG多见。而慢性胃炎伴局部胃粘膜腺上皮轻—中度异型增生和肠上皮化生又以CAG多见。262例慢性胃炎病例中胃镜诊断为慢性胃炎只有46例,占17.56%,而多数病例为胃溃疡,提示胃溃疡发生在慢性胃炎基础上,尤其是慢性活动性胃炎。

赤芍、栀子、大黄修复大鼠CCI_4肝损伤的细胞病理学研究续报

将43只实验大鼠分成5组:肝损伤组给CCI_4皮下注射;大黄组、赤芍组、栀子组除给CCI_4皮下注射外,分别给以上述各药煎剂灌胃各共7日;对照组皮下注射生理盐水,并以自来水灌胃。结果,三个中药治疗组与肝损伤组相比,除栀子组外,大黄组及赤芍组均使肝损伤区域缩小,肝细胞中脂滴减少,细胞核增大,RNA、核仁增多,糖原恢复,琥珀酸脱氢酶和葡萄糖-6-磷酸酶活性增强,粗面内质网恢复平行排列,滑面内质同增加,线粒体形态结构恢复、数量增加,表明大黄及赤芍对CCI_4所致肝损伤均有修复作用(大黄更佳),其机制可能是通过内质同损伤的阻止,促进蛋白质合成及解毒,恢复了肝功能。

血清PSA测定与前列腺癌病理组织学类型关系的研究

目的研究血清PSA水平与前列腺癌病理组织学类型的关系,以提高前列腺癌的早期诊断水平。方法选择经手术证实的前列腺癌(PCa)组50例和前列腺增生(BPH)组50例,术前均测定血清TPSA、FPSA和P(V)、RI水平并与病理组织学类型进行比较相关分析,采用SPSS 10．0统计学处理。结果PCa组与BPH组比较,血清中TPSA,FPSA,F/T比值,PSAD和P(V)水平两组差异有显著性意义(P<0．01)。低分化癌组与高分化癌相比较:血清TPSA、FPSA、PSAD和RI水平两组差异有显著性差异(P<0．05)。比较分析表明血清TPSA、FPSA、PSAD和RI水平与前列腺癌病理组织学类型密切相关(r≈0．4),而F/T比值和P(V)无相关性。结论PSA是前列腺早期诊断和预后判断的可靠指标。

动脉粥样硬化不稳定斑块的研究进展

动脉粥样硬化不稳定斑块的破裂是冠心病急性冠脉综合征的主要原因之一。对不稳定斑块的形态特点及病理生理特性的研究,对提高急性冠脉综合征的诊断治疗水平,预防急性冠脉综合征的发生具有重要的临床意义。可通过对动物动脉的物理、化学及生物的损伤建立起不稳定斑块的动物模型,目前对不稳定斑块的研究主要通过建立动物模型。不稳定斑块有其特点:大的脂核、薄的纤维帽、大量炎性细胞浸润及细胞因子如:基质金属蛋白酶、肿瘤坏死因子-α参与等。

TCT对宫颈癌早期筛查及诊断的意义

目的通过与病理活体组织学检查比较,评价TCT对宫颈癌早期筛查的价值。方法选取妇科门诊就诊的患者238例和妇科普查人群289名共计527名进行TCT检查,行阴道镜检查后在宫颈选择宫颈鳞-柱状上皮交接部分3、6、9、12点或上皮细胞异常处取组织标本送病检。结果 (1)就诊患者组的TCT检查阳性率为65.13%(155/238),妇科普查组为56.06%(162/289)。(2)以病理诊断为金标准,计算结果显示TCT筛查CIN及宫颈癌的灵敏度为97.70%,特异度为95.00%,阳性预测率为79.43%,阴性预测率为99.52%,漏诊率为2.30%。结论 TCT能有效筛查出CIN,结合阴道镜下的活检和组织病理学检查能明显提高诊断的准确率,结果存在一定的假阳性和假阴性率。

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.

Epidemiological and histopathological study of relevance of Guizhou Maotai liquor and liver diseases

AIM: To explore the relevance of Maotai liquor and liver diseases. METHODS: Epidemiological study was conducted on groups of subjects, each consisting of 3 subjects from the Maotai liquor group consisting of 99 individuals and one from the non-alcoholic control group consisting of 33 individuals. Liver biopsy was performed on 23 volunteers from Guizhou Maotai Distillery who had a constant and long history of drinking Maotai liquor. Experimental histopathological study was conducted as follows: sixty male Wistar rats were divided into 3 groups randomly and fed with Maotai liquor, ordinary white wine, and physiological saline respectively for a period of 8 and 12 weeks. The rats were sacrificed in batches, then serum ALT, AST, TBil, and AKP were measured. Rat livers were harvested to measure the liver indexes, GSH, and MDA. Histopathological examinations were also performed. Another eighty mice were randomly divided into 4 groups and fed with Maotai (at different dosages of 10 ml.kg(-1) and 20 ml.kg(-1)), ethanol, and physiological saline. The animals were sacrificed after 4 weeks and serum ALT was determined. Then the livers were harvested and liver indexes and MDA were measured. RESULTS: The incidence rate of hepatic symptoms, splenomegaly, liver function impairment, reversal of Albumin/Globulin and increased diameter of portal veins in the Maotai liquor group were 1.0% 1/99 , 1.0% 1/99 , 1.0% 1/99 , 1.0% 1/99 , 0 0/99 and 0 0/99 , 0 0/99 ,0 0/99 , 0 0/99 , 0 0/99 , respectively. There was no significant difference between the Maotai group and the non-alcoholic control group P】0.05 . Various degree of fatty infiltration of hepatocytes was found in the 23 volunteers receiving liver biopsy, but there was no obvious hepatic fibrosis or cirrhosis. A comparison was made between the Maotai liquor group and the ordinary white wine group. It was found that hepatic MDA in rats and mice were 0.33+/-0.10 and 0.49+/-0.23 respectively in Maotai group and 0.61+/-0.22 and 0.66+/-0.32 in the ordinary white wine group; MDA had an obvious decrease in the Maotai liquor group (P【0.05); hepatic GSH were 0.12 mg.g(-1)+/-0.06 mg.g(-1) in rats of the Maotai liquor group and (0.08+/-0.02)mg.g(-1) in white wine group, it was obviously increased in the Maotai liquor group (P【0.05). After the 20 rats had been fed with ordinary white wine for 8 weeks consecutively, disarranged hepatocyte cords, fatty infiltration of hepatocytes, and fibrous septa of varying widths due to hepatic connective tissues proliferation were observed; after 12 weeks, the fibrous tissue proliferation continued and early cirrhosis appeared. Compared with the ordinary white wine group, fatty infiltration was observed in the 8-week and 12-week groups, but no necrosis or fibrosis or cirrhosis was found in the Maotai liquor group (P【0.05). CONCLUSION: Maotai liquor may cause fatty liver but not hepatic fibrosis or cirrhosis, and it can strengthen lipid peroxidation in the liver.

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.

Immunohistochemical analysis of p53,cyclinD1,RB1,c-fos and N-ras gene expression in hepatocellular carcinoma in Iran

AIM： TO study the effect of some genes especially those involved in cell cycle regulation on hepatocellular carcinoma. METHODS： Paraffin-embedded tissue samples of 25 patients （18 males and 7 females） with hepatocellular carcinoma were collected from 22 pathology centers in Tehran during 2000-2001, and stained using immunohistochemistry method （avidin-biotin-peroxidase） for detection of p53, cyclinD1, RB1, c-los and N-ras proteins. RESULTS： Six （24%）, 5 （20%）, 12 （48%） and 2 samples （8%） were positive for p53, cyclinDl, C-los and N-ras expression, respectively. Twenty-two （88%） samples had alterations in the （31 cell-cycle checkpoint protein expression （RBI or cyclinD1）. P53 positive samples showed a higher （9 times） risk of being positive for RBI protein than p53 negative samples. Loss of expression of RBI in association with p53 over-expression was observed in 4 （66.7%） of 6 samples. Loss of expression of RBI was seen in all cyclinD1 positive, 20 （90.9%） N-ras negative, and ii （50%） C-fos positive samples, respectively. CyclinD1 positive samples showed a higher （2.85 and 4.75 times） risk of being positive for c-los and N-ras expression than cyclinD1 negative samples. CONCLUSION： The expression of p53, RB1 and c-los genes appears to have a key role in the pathogenesis of hepatocellular carcinoma in Iran. Simultaneous overexpression of these genes is significantly associated with their loss of expression during development of hepatocellular carcinoma.

Tumor budding as a potential histopathological biomarker in colorectal cancer:Hype or hope?

Colorectal cancer （CRC）, the third most commonly di- agnosed type of cancer in men and women worldwide is recognized as a complex multi-pathway disease, an observation sustained by the fact that histologically identical tumors may have different outcome, including various response to therapy. Therefore, particularly in early and intermediate stage （stages Ⅱ and Ⅲ, respec- tively） CRC, there is a compelling need for biomarkers helpful of selecting patients with aggressive disease that might benefit from adjuvant and targeted therapy. Histopathological examination shows that likely other solid tumors the development and progression of hu- man CRC is not only determined by genetically abnor- mal cells, but also by intricate interactions between malignant cells and the surrounding microenvironment. This has led to reconsider the features of tumor mi- croenvironment as potential predictive and prognostic biomarkers. Among the histopathological biomarkers, tumor budding （i.e., the presence of individual cells and small clusters of tumor cells at the tumor invasive front）has received much recent attention, particularly in the setting of CRC. Although its acceptance as a reportable factor has been held back by a lack of uniformity with respect to qualitative and quantitative aspects, tumor budding is now considered as an independent adverse prognostic factor in CRC that may allow for stratifica- tion of patients into risk categories more meaningful than those defined by tumor-node-metastasis staging alone, and also potentially guide treatment decisions, especially in T2-T3 NO （stage Ⅱ） CRCs.

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.

快速冷冻剂R-134a于石蜡切片制作中的应用

石蜡切片技术广泛应用于组织学与病理学教学、科研与临床诊断[1,2],其制作需经固定、脱水透明、浸蜡、包埋、切片、展片、捞片、烤片、脱蜡、染色等一系列复杂的步骤[3],耗时较长。石蜡切片质量的好坏与诸多因素相关,其中切片尤为关键。具有一定硬度的组织蜡块是保障切片能顺利进行的条件,而蜡块硬度与环境温度呈负相关。研究者常使用冰块冷却蜡块切面,利用热传导降低蜡块温度以提高蜡块硬度[4]。但该方法存在效率低、易产生水珠干扰操作等缺点。

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.

Reinterpretation of histology of proximal colon polyps called hyperplastic in 2001

AIM： To evaluate how proximal colon polyps interpreted as hyperplastic polyps in 2001 would be interpreted by expert pathologists in 2007.METHODS： ≥ 5 mm in interpreted pathologists 2007 by 3 GI Forty consecutive proximal colon polyps size, removed in 2001, and originally as hyperplastic polyps by general at Indiana University, were reviewed in pathologists.CONCLUSION： Many polyps interpreted as hyperplastic in 2001 were considered sessile serrated lesions by GI pathologists in 2007, but there is substantial inter-observer variation amongst GI pathologists.

Simple and reproducible hepatectomy in the mouse using the clip technique

AIM: To investigate the reliability of massive hepatectomy models by using clip techniques. METHODS: We analyzed anatomical findings in 100 mice following massive hepatectomy induced by liver reduction > 70%. The impact of various factors in the different models was also analyzed, including learning curves, operative time, survival curves, and histopathological findings.RESULTS: According to anatomical results, models with 75%, 80%, and 90% hepatectomy produced massive hepatectomy. Learning curves and operative times were most optimal with the clip technique. Each hepatectomy performed using the clip technique produced a reasonable survival curve, and there were no differences in histopathological findings between the suture and clip techniques. CONCLUSION: Massive hepatectomy by the clip technique is simple and can provide reliable and relevant data.

Extremely well-differentiated adenocarcinoma of the stomach: Clinicopathological and immunohistochemical features

AIM： Minimal deviation carcinoma of the uterine cervix, otherwise known as extremely well-differentiated adenocarcinoma （EWDA）, is characterized by its benign microscopic appearance in contrast to its aggressive behavior. In order to elucidate the clinicopathological features and biological behavior of the gastric counterpart of EWDA, we, using immunohistochemistry, analyzed nine lesions for the phenotypic expression, proliferative activity, and the expression of oncogene-associated products. METHODS： Clinicopathological features, including preoperative biopsy diagnosis, were reviewed. Using immunohitstochemistry, Ki-67 labeling index and expression of p53 and c-erbB-2 protein in the gastric lesions were detected.RESULT： Locations in the middle or upper third of the stomach and polypoid macroscopic features are characteristic of EWDA of the stomach. Although 4 of the 9 lesions showed only focal lymphatic or venous invasion, lymph node metastasis was not present and none of the patients died of the lesions （mean follow-up period, 56 too）. All 9 cases of EWDA could be classified into gastric phenotype （5 lesions） and intestinal phenotype （4 lesions）. The former resembled gastric foveolar epithelium, mucous neck cells or pyloric glands, but their papillary structures were frequently elongated and the tumor cellsand their nuclei were slightly larger and more hyperchromatic compared to normal epithelium. The latter resembled intestinal metaplasia with minimal nulcear atypia and irregular glands; two of these lesions demonstrated complete intestinal phenotype, while two demonstrated incomplete intestinal phenotype. Ki-67 labeling index was low and none of the cases revealed over-expression of p53 and c-erbB-2 protein. CONCLUSION： Unlike minimal deviation carcinoma of the cervix, these findings suggest that EWDA of the stomach is a lesion of low-grade malignancy. This favorable biological behavior is supported by the data of a low Ki-67 labeling index and a lack of p53 or c-erbB-2 protein over-expression. Because of its resemblance to normal gastric mucosa or mucosa with intestinal metaplasia, EWDA is often misdiagnosed. To prevent the misdiagnosis of such lesions, the clinical and pathologic characteristics should be taken into consideration.

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.