ABSTRACT
Objective: To investigate the clinicopathological features, diagnosis and differential diagnosis of breast myofibroblastoma. Methods: The clinicopathological data and prognostic information of 15 patients with breast myofibroblastoma diagnosed at the Department of Pathology of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China from 2014 to 2022 were collected. Their clinical characteristics, histological subtypes, immunophenotypes and molecular characteristics were analyzed. Results: There were 12 female and 3 male patients, ranging in age from 18 to 78 years, with a median and average age of 52 years. There were 6 cases in the left breast and 9 cases in the right breast, including 12 cases in outer upper quadrant, 2 cases in inner upper quadrant and 1 case in outer lower quadrant. Most of the cases showed a well-defined nodule grossly, including pushing growth under the microscope in 13 cases, being completely separated from the surrounding breast tissue in 1 case, and infiltrating growth in 1 case. Among them, 12 cases were classic subtype and composed of occasional spindle cells with varying intervals of collagen fiber bundles; eight cases had a small amount of fat; one case had focal cartilage differentiation; one case was epithelioid subtype, in which epithelioid tumor cells were scattered in single filing or small clusters; one case was schwannoma-like subtype, and the tumor cells were arranged in a significant palisade shape, resembling schwannoma, and one case was invasive leiomyoma-like subtype, in which the tumor cells had eosinophilic cytoplasm and were arranged in bundles, and infiltrating into the surrounding mammary lobules like leiomyoma. Immunohistochemical studies showed that the tumor cells expressed desmin (14/15) and CD34 (14/15), as well as ER (15/15) and PR (15/15). Three cases with histologic subtypes of epithelioid subtype, schwannoma-like subtype and infiltrating leiomyoma-like subtype showed RB1 negative immunohistochemistry. Then FISH was performed to detect RB1/13q14 gene deletion, and identified RB1 gene deletion in all three cases. Fifteen cases were followed up for 2-100 months, and no recurrence was noted. Conclusions: Myofibroblastoma is a rare benign mesenchymal tumor of the breast. In addition to the classic type, there are many histological variants, among which the epithelioid subtype is easily confused with invasive lobular carcinoma. The schwannoma-like subtype is similar to schwannoma, while the invasive subtype is easily misdiagnosed as fibromatosis-like or spindle cell metaplastic carcinoma. Therefore, it is important to recognize the various histological subtypes and clinicopathological features of the tumor for making correct pathological diagnosis and rational clinical treatment.
Subject(s)
Female , Humans , Male , Adolescent , Young Adult , Adult , Middle Aged , Aged , Antigens, CD34 , Biomarkers, Tumor/analysis , Leiomyoma/pathology , Neoplasms, Muscle Tissue/pathology , NeurilemmomaABSTRACT
Objective: To study the clinicopathological and genetic features of natural killer (NK)-cell enteropathy for better understanding of this rare disease and prevention of its misdiagnosis. Methods: Two cases of NK-cell enteropathy were diagnosed in the First Affiliated Hospital of Zhengzhou University, China from October 2017 to February 2021. The clinical characteristics, morphology, immunohistochemistry, Epstein-Barr virus-encoded RNA (EBER) in situ hybridization and T cell receptor gene rearrangement were analyzed. The patients were followed up by a telephone interview. Results: The patients were both male, aged 40 and 28 years, respectively. Both patients were admitted to the hospital for an annual checkup without obvious gastrointestinal symptoms. The endoscopy showed that the gastric body of case 1 had a mucosal bulge, small area of congestion and erosion, while the rectum of case 2 had congestion and erosion. Microscopically, the lesions of the 2 cases were relatively limited. Many lymphoid cells infiltrated within the lamina propria of the mucosa and into the muscularis mucosa in case 2. In case 1, the glands were reduced in the lesion, and the glandular cavity was slightly compressed and deformed. There was no infiltration or destruction of the glands in either case. Lymphoid cells were atypical, with medium-to-large cell sizes. Their cytoplasm was medium-to-slightly abundant and appeared eosinophilic or translucent. In case 2, characteristic eosinophilic granules were seen in the cytoplasm of a few cells. The nuclei in both cases were round, oval and irregular, with fine chromatin, inconspicuous nucleoli, and no mitotic figures were noted. Necrosis was seen in case 1 while both cases had no central growth or destruction of blood vessels. Immunophenotyping showed that CD56, granzyme B and TIA-1 were positive in both cases, part of the cells was CD3-positive, and some cells were weakly CD4-positive in case 2. The CD5, CD8, CD30, ALK and B-lineage markers (CD20, CD79α) were all negative. The Ki-67 proliferation index was about 60% and 30%, respectively. Both cases were EBER negative. TCR gene rearrangement was polyclonal. Follow-up showed that none of the 2 patients had any special treatments and stayed well. Conclusions: NK-cell enteropathy is rare, with biological behaviors similar to benign tumors, and occasional recurrence. Its histology and immunophenotype are easily confused with NK/T cell-derived lymphomas. Combination of its unique endoscopic features, EBER negativity, polyclonal TCR gene rearrangement and good prognosis can confirm the diagnosis and avoid misdiagnosis and overtreatment.
Subject(s)
Humans , Male , Epstein-Barr Virus Infections , Herpesvirus 4, Human/genetics , Immunophenotyping , Killer Cells, Natural , Lymphoproliferative DisordersABSTRACT
Wulingsan， a classic prescription first recorded in the Treatise on Cold Damage （Shang Han Lun） by ZHANG Zhong-jing for patients with water retention syndrome due to the disturbance of Qi transformation in bladder， has often been modified by ancient and modern doctors for the treatment of renal diseases. It produced satisfactory outcomes without inducing adverse reactions. The databases including China National Knowledge Infrastructure （CNKI）， Wanfang Data Knowledge Service Platform， and PubMed were searched for articles concerning the clinical application and pharmacological mechanism of Wulingsan in the treatment of renal diseases published by domestic and foreign scholars in recent years. The summary of the included articles revealed that Wulingsan has been widely employed for the treatment of renal edema， diabetic nephropathy， acute and chronic glomerulonephritis， nephrotic syndrome， renal insufficiency， abnormal urination， etc.， and the resulting outcomes were satisfactory. Wulingsan alone or in combination with western medicine yielded better clinical outcomes than the western medicine alone. In the exploration of its pharmacological mechanism， there existed some individual reports by Korean scholars， while Chinese scholars tended to work as a team. After years of research， each team has found that Wulingsan was superior to Wulingsan decoction in excreting water， which might be related to the absence of massive low-polarity and volatile components in the decoction that were responsible for regulating the expression of aquaporins （AQP） in kidney of saline-loaded rats. Wulingsan regulates the endocrine state of rats with kidney yang deficiency， inhibits the reabsorption of water， increases the activity of Na+-K+-ATPase， and reduces the expression of AQP 1， AQP 2， AQP 3， and AQP 4. Besides， it bi-directionally regulates the human water metabolism， which is achieved via the dual-directional regulation of purinergic P2X3 receptor expression on bladder detrusor. The efficacy of Wulingsan in treating chronic renal failure is attributed to its protection against the damaged renal tissue，structure and fanction. Hence， this paper summarized the research progress of Wulingsan in the treatment of renal diseases in recent years， aiming to provide a reference for the clinical and basic exploration of Wulingsan against renal diseases in the future.
ABSTRACT
Objective:To discuss the clinical efficacy of comprehensive optimization of rehabilitation measures of traditional Chinese medicine(TCM) on elderly patients with COPD at stable period, in order to study its effect on immune function and inflammatory factors. Method:One hundred and forty-four patients were randomly divided into control group and observation group by random number table. Patients in control group got ipratropium bromide, 40-80 μg/time, 2-4 times/days, salmeterol roticasone powder, 1 suction/time, 2 times/days, as well as comprehensive western medical treatment measures of healthcare education, oxygen therapy and respiratory muscle exercise. In addition to the basic therapy of ipratropium bromide and salmeterol roticasone powder, patients in observation group was added with syndrome differentiation therapy of TCM, foot bath with TCM and respiratory function exercise with TCM. The course of treatment was 6 months, and 6-month follow-up were recorded. Comprehensive assessment of COPD was recorded. Before and after treatment, respiratory questionnaire (mMRC), self-assessment test for patients with chronic obstructive pulmonary disease (CAT), forced expiratory volume in the first second (FEV1), FEV1%, St George's respiratory questionnaire (SGRQ), 6-minute walking distance (6 MWD) were scored. And levels of CD3+, CD4+, CD8+, CD4+/CD8+, interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-alpha) and hypersensitive C-reactive protein (hs-CRP) were detected. Result:Comprehensive assessment of COPD in the two groups were better than those before treatment (PZ=2.066, Pα were lower than those in control group (P+ was lower than that in control group (P1 and FEV1% were higher than those in control group (P+, CD4+, CD4+/CD8+ and 6-minute walking distance were more than those in control group (PConclusion:Comprehensive optimization of rehabilitation measures in TCM can inhibit inflammatory factors, improve immune function, alleviate clinical symptoms, improve lung function, improve exercise endurance and quality of life of patients, and promote the lung rehabilitation.
ABSTRACT
Objective: To observe the clinical efficacy of addition and subtraction therapy of Xuanshen Ganju Tang combined with Sanniutang to post infection cough (PIC) with lung injury caused by dryness and heat, and investigate its effects on allergic inflammation and neurogenic inflammatory mediators.Method: One hundred and eighty eligible patients with PIC were randomly divided into control group (58 cases) and observation group (122 cases) according to the visiting sequence. Patients in control group got compound methoxyphenamine capsules, 2 capsules/time and tid. Patients in observation group got addition and subtraction therapy of Xuanshen Ganju Tang,combined with Sanniutang, 1 dose/day. The treatment course was 7 days in both groups. Symptom scores for cough (day and night), visual analogue scale of coughing (VAS) and scores for lung injury caused by dryness and heat injury were graded. Time to relieve a cough, time to relieve symptoms, time to vanish cough, and cough recurrence were recorded. Life quality was evaluated by cough-specific quality of life questionnaire (CQLQ), and the levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), IL-6, IL-8 and substance P in sputum neurogenic inflammatory mediators (SP), neuropeptide A (NKA) and calcitonin gene related peptide (CGRP) were detected.Result: Ridit analysis showed that the clinical efficacy in observation group was better than that in control group (PPPPα, IL-1β, IL-6, IL-8, SP, NKA and CGRP in observation group were all lower than those in control group (PConclusion: Addition and subtraction therapy of Xuanshen Ganju Tang combined with Sanniutang can control systems of cough, shorten coughing course, reduce recurrence rate, improve patients' life of quality, and can inhibit allergic inflammation and neurogenic inflammatory mediators in the treatment of PIC with symptom of lung injury caused by dryness and heat, with a better clinical efficacy than pure compound methoxyphenamine capsules.
ABSTRACT
<p><b>OBJECTIVE</b>To investigate the effects of anluohuaqianwan on experimental hepatic fibrosis induced by dimethyl nitrosamine (DMN) in rats.</p><p><b>METHODS</b>36 male SD rats were randomly dividied into three groups: model group, normal group, anluohuaqianwan group. The rats in the three groups were treated with DMN daily for 4 weeks. The liver function was detected using auto biochemistry analyzer, the serum HA, LN, IV-C, PIIIP were detected by immunoradiometry, the histopathology was observed in the left liver lobe after HE staining, the expression of matrix metalloproteinase-2 (MMP-2) in liver tissue were detected by immunohistochemistry.</p><p><b>RESULTS</b>The serum levels of ALT, AST, ALP, TP, ALB and the contents of HA, LN, IV-C in model group were significantly increased compared to these in the normal group (P less than 0.01). The serum levels of ALT, AST and the contents of HA in anluohuaqianwan group were significantly lower than those in the model group (P less than 0.01). The liver MMP-2 in the model group was significantly increased compared to that in the normal group (P less than 0.05). The expression of MMP-2 in liver tissue of model group was lower than that in the anluohuaqianwan group (P less than 0.05).</p><p><b>CONCLUSION</b>Anluohuaqianwan can inhibit liver fibrosis in rats induced by DMN.</p>