Application of the ligation clip-assisted modified " expansion and collapse method" in thoracoscopic resection of the external posterior basal segment in children with congenital pulmonary airway malformation / 中华实用儿科临床杂志

Objective:To explore the feasibility of using ligation clip-assisted modified " expansion and co-llapse method" to determine the intersegment plane in thoracoscopic resection of the external posterior basal segment (S 9+ 10) in children with congenital pulmonary airway malformation (CPAM). Methods:Retrospective study.The clinical data of 12 CPAM children who underwent thoracoscopic S 9+ 10 resection in Children′s Hospital Affiliated to Shandong University from July 2019 to May 2021 were collected and analyzed.There were 7 males and 5 females.The age at operation ranged from 3.50 to 11.50 months.The body weight of patients ranged from 6.5 to 11.5 kg.In all the patients, the ligation clip-assisted modified " expansion and collapse method" was applied during the operation to determine the intersegment plane (S 9+ 10 was in the expansion state and the remaining lungs were in the collapse state) before thoracoscopic S 9+ 10 resection.After S 9+ 10 resection, the surgical treatment and postoperative recovery were summarized and analyzed. Results:All the operations were completed under thoracoscopy, and there was no conversion to thoracotomy.In 11 patients, the intersegment plane was accurately determined by the ligation clips-assisted improved " expansion and collapse method" , and the S 9+ 10 segment was successfully resected.Of these 11 cases, 8 cases had right S 9+ 10 resection and 3 cases had left S 9+ 10 resection.In the process of using the ligation clip-assisted improved " expansion and collapse method" to determine the intersegment plane, the operator needed to clamp the ligation clip after the anesthesiologist expanded the lung completely.Because the operation was not stable enough, the ligation clip fell off and did not clamp S 9+ 10, resulting in operation failure.The operation was changed to the traditional " expansion and collapse method" . Besides, the basal segment bronchus was cut off by mistake, so the right basal segment had to be resected.The operation time ranged from 85 to 205 min, with a median of 149 min.Intraoperative bleeding ranged from 5 to 15 mL, with a median of 10 mL.The indwelling time of drainage tubes ranged from 2 to 4 days, with a median of 3 days.The postoperative hospital stay ranged from 5 to 8 days, with a median of 6 days.Postoperative pathological examination results suggested 4 cases of type 1, 6 cases of type 2 and 2 cases of type 3.There were 2 cases of simple subcutaneous emphysema without postoperative complications such as bleeding, bronchopleural fistula and atelectasis.The follow-up time ranged from 6 to 28 months, with a median of 15 months.The chest CT of all children showed no residual lesions and no residual cavities in the involved hemithorax. Conclusions:Ligation clip-assisted improved " expansion and collapse method" for determining the intersegment plane is suitable for CPAM children with a narrow thoracic space, and the operation is simple and effective.It is relatively safe and feasible to use this method in S 9+ 10 resection.

Mammary myofibroblastoma: a clinicopathologic analysis of nine cases / 中华病理学杂志

Objective@#To study the clinicopathologic characteristics and differential diagnosis of mammary myofibroblastoma.@*Methods@#Nine cases of mammary myofibroblastoma diagnosed between 2006 and 2017 were collected from the Department of Pathology, Fudan University Shanghai Cancer Center. Clinical and histopathologic features of these nine cases were examined, immunohistochemical staining was performed, FISH analysis for the detection of FOXO1 gene was performed in one case, and follow-up data were also collected.@*Results@#There were seven female and two male patients, with a mean age of 54 years, median age of 50 years (ranging from 40 to 83 years). Four lesions each were located in the left and right breast, and one was in the left subaxillary accessory breast tissue. Clinically, 8 patients presented with a breast mass, 3 of which accompanied with pain. All of the tumors were well-demarcated grossly with a mean diameter of 2.5 cm. Microscopically, there were no entrapped ductal or lobular structures within the tumor. Seven tumors were classic type, which were composed of bland-looking spindle neoplastic cells without mitoses, arranging in intersecting fascicles, and interrupted by thick hyalinized collagen bundles. One case was of epithelioid variant, demonstrating epithelioid neoplastic cells diffusely arranged or in cluster. The other one case was mixed spindle and epithelioid-cell type. Atypical tumor cells were observed in 3 cases. Immunohistochemically, tumor cells were diffusely positive for desmin (9/9) and CD34 (6/9), as well as ER (7/7), PR (6/6) and bcl-2 (3/3). SMA (4/7) and Calponin (1/2) were focally or partially positive in some cases. H-caldesmon (1/2) was weakly positive and epithelial markers were negative. Ki-67 proliferation index was low (<10%). There was no monoallelic loss of FOXO1/13q14 loci in the detected case according to FISH analysis. Follow-up data were available for all patients, and follow-up period ranged from 12 to 78 months. All patients remained well without recurrence.@*Conclusions@#Mammary myofibroblastoma is a rare benign mesenchymal tumor. In some circumstances, it may exhibit confusing morphologies, including some variants. The epithelioid variant of mammary myofibroblastoma might mimic invasive lobular carcinoma, leading to the diagnostic dilemmas and even misdiagnosis, especially in core needle biopsy specimen or frozen sections. Familiarity with the characteristics of this tumor is of great importance for accurate diagnosis and proper treatment.

Clinicopathologic features of breast lymphoma in core needle biopsy / 中华病理学杂志

Objective@#To investigate the clinicopathologic features and differential diagnosis of breast lymphoma in core needle biopsy.@*Methods@#Seventy-two cases of breast lymphoma in core needle biopsy between 2011 and 2016 were extracted from the pathology database of Fudan University Shanghai Cancer Center. The clinicopathologic features were analyzed. The histological diagnosis of the tumors was based on the WHO classifications of tumors of hematopoietic and lymphoid tissues. Immunohistochemistry and molecular methods were performed to detect related antigens and genes.@*Results@#Seventy-one patients were female and one was male. The median age was 54 years. The tumors were located in the right breast in 32 (44.4%) patients and in the left breast in 40 (55.6%) patients. Seven patients had a previous history of lymphoma. Most of the cases presented as a single and painless breast mass. Sixty-three patients received systemic treatment, and nine patients received systemic therapy after excision. The common morphological feature was that single tumor cells infiltrated the stroma, without cohesiveness between tumor cells, and lacking glandular or nested epithelioid structures. The normal ductal and lobular structures of the mammary gland were typically preserved. The tumor cells in some cases were distributed in single rows, and should be differentiated from invasive carcinoma. All cases were positive for LCA, negative for CK. Sixty-eight cases were classified as B-cell lymphoma, including 63 cases (87.5%) of diffuse large B-cell lymphoma (DLBCL; including 3 cases of EBV-positive DLBCL and 60 cases of DLBCL, NOS), two cases of Burkitt lymphoma, one case of mantle cell lymphoma, one case of extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue and one case of precursor B lymphoblastic leukemia/lymphoma. The remaining cases included two peripheral T-cell lymphoma (NOS), one extranodal NK/T cell lymphoma, nasal type and one myeloid sarcoma. In 63 cases of DLBCL, 22 cases (34.9%) expressed germinal center B-cell-like (GCB) phenotype and 41 cases (65.1%) showed non-germinal center B-cell-like (non-GCB) phenotype.@*Conclusions@#Core needle biopsy could be the preferred method for diagnosis of breast lymphoma. Diffuse large B-cell lymphoma is the most common histologic type of breast lymphoma, and non-GCB subtype is more frequent than GCB subtype.

Clinicopathologic study of infiltrating epitheliosis of the breast / 中华病理学杂志

Objective@#To evaluate the morphological and immunohistochemical features of infiltrating epitheliosis and its differential diagnosis.@*Methods@#Nine consultation and routine cases of infiltrating epitheliosis diagnosed from January 2015 to December 2016 in Fudan University Shanghai Cancer Center were collected. All tissues were formalin-fixed paraffin-embedded and routinely HE stained. The HE slides were reviewed. Immunohistochemical staining of CKpan, CK7, CK19, CK5/6, CK14, p63, SMMHC, Calponin, ER, PR, HER2, Ki-67 and S-100 protein was performed using Ventana BenchMark automated immunostainer.@*Results@#The morphological features of infiltrating epitheliosis included: (1) Florid proliferation of epithelial cells forming solid nests or papillary, glandular and cord-like pattern. The proliferative cells possessed nuclei of varying size and shape without atypia. (2) The stroma was altered, showing varying degrees of fibrosis or sclerosis. (3) The proliferative epithelial nests might flow into the spaces within small ducts and lobules at the periphery of the lesion, resulting in pseudo-infiltration. Immunohistochemically, infiltrating epitheliosis was non-uniformly positive for ER/PR, and was positive for high molecular weight CK5/6 and CK14. Myoepithelial markers p63, SMMHC and Calponin demonstrated intact, partial or entire loss of myoepithelial cells around the epithelial nests. The loss of myoepithelial markers staining was more frequent at the periphery of the lesion. The most important differential diagnoses included invasive ductal carcinoma, ductal carcinoma in situ (DCIS), and low grade adenosquamous carcinoma, etc.@*Conclusions@#Infiltrating epitheliosis is an important pseudo-infiltrating lesion. The lack of atypia, non-uniform ER/PR expression, positivity for high molecular weight cytokeratins, and the intact to partial to entire loss of myoepithelial markers around the proliferating cell nests are the key points to differentiate it from invasive carcinomas and DCIS.

Correlation between androgen receptor expression and surrogate molecular subtypes in invasive breast carcinoma / 中华病理学杂志

Objective@#To investigate androgen receptor(AR)expression in invasive breast carcinoma and the correlation with surrogate molecular breast carcinoma subtypes.@*Methods@#Immunohistochemical staining of AR and other biomarkers was performed in a cohort of 870 cases of primary invasive breast carcinomas collected from August to December, 2016. The association of AR expression with different histological and surrogate molecular subtypes was analyzed.@*Results@#The positive expression rate of AR in the immunohistochemistry-based surrogate subtypes was 96.3%(207/215) for Luminal A, 89.8%(378/421) for Luminal B, 82.4%(75/91) for HER2 overexpression and 37.1%(53/143) for triple negative breast carcinoma, with significant differences among the four groups (P<0.01). AR correlated positively with the expression of ER(P<0.01), PR(P<0.01), HER2(P=0.007), GATA3(P<0.01), GCDFP15(P<0.01)and mammaglobin(P<0.01), while negatively with the expression of Ki-67(P<0.01), CK5/6(P<0.01)and CK14(P<0.01).@*Conclusions@#AR exhibits a high expression in invasive breast carcinoma, which is mainly correlated with ER-positive breast carcinoma. Regardless of the relatively low expression rate, AR is a potential therapeutic target in triple negative breast carcinoma.

Metastases to the breast from non-mammary malignancies: a clinicopathologic study of 28 cases / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate the clinicopathologic characteristics and differential diagnosis of the metastases to the breast from non-mammary malignancies.</p><p><b>METHODS</b>Twenty-eight cases were collected from 2004 to 2012;microscopic pathologic examinations and immunohistochemistry (EnVision method) were performed.</p><p><b>RESULTS</b>(1) All except one patients were female, ranging from 16 to 77 years old (average 45.8 years). Twenty-six (92.9%) patients initially presented with the primary site lesions; while the other two (7.1%) patients initially presented with breast lesions. The mean interval from primary diagnosis to detection of metastatic breast lesions was 32 months (0-228 months). Fifteen patients (53.6%) had other metastases detected simultaneously or preceded the breast lesions. (2) Macroscopically, all the tumors were relatively circumscribed, with a mean diameter of 4.0 cm (0.6-12.0 cm). The histological types of the corresponding primary tumors were as follows: eight (28.6%) cases from lung adenocarcinoma, five (17.8%) from high-grade ovarian serous carcinoma, three (10.7%) from gastric adenocarcinoma, two (7.1%) from rectal adenocarcinoma, one (3.6%) from pancreatic neuroendocrine carcinoma, one (3.6%) from prostatic carcinoma, four (14.3%) from melanoma, and four (14.3%) from mesenchymal malignant tumors (three rhabdomyosarcomas and one epithelioid malignant peripheral nerve sheath tumor, MPNST). (3) Histologically, the metastatic tumors showed the morphologic characteristics of the primary tumors. Lymph-vascular invasion was observed in 19 cases. Immunohistochemical features of metastatic tumors were consistent with the primary tumors. Molecular markers for breast such as GCDFP15 and mammaglobin were negative. Metastatic tumors from lung adenocarcinoma expressed TTF-1 (8/8). Ovarian serous carcinoma metastases were positive for PAX8 (5/5) and WT1 (4/5). Gastric adenocarcinoma metastases were positive for CDX2 (3/3) and villin (1/3). Rectal adenocarcinoma metastases were positive for CDX2 (2/2). Pancreatic neuroendocrine tumor metastasis was positive for Syn and CgA (both 1/1). Prostate carcinoma metastasis was positive for AR, PSA and P504S (all 1/1). Melanoma metastases were positive for HMB45 (2/3) and S-100 protein (3/3). Rhabdomyosarcoma metastases were positive for vimentin, desmin and myoD1 (all 3/3). MPNST metastasis was positive for S-100 protein (1/1). (4) Follow-up data was available in 17 patients, with median follow-up time 54 months. The median survival from diagnosis to breast metastasis was 24 months.Seven of 17 patients died.</p><p><b>CONCLUSIONS</b>Metastases to the breast from non-mammary malignancies are rare and show pathologic features of primary tumors. It is usually presumed to be a primary breast carcinoma. Histopathologic features and clinical history in conjunction with the immunohistochemical results should be considered in differentiating a secondary mass from a primary breast carcinoma.</p>

Clinicopathologic features of cystic hypersecretory lesion of the breast / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the clinicopathologic features, immunophenotype and differential diagnosis of cystic hypersecretory lesion (CHL) of the breast.</p><p><b>METHODS</b>Clinicopathologic and follow-up data of six cases of breast CHL in 2010-2013 were collected and reviewed.Immunohistochemical and mucinous staining was performed.</p><p><b>RESULTS</b>All six patients were female, age ranged from 37 to 71 years (average 49.3 years). Three cases were cystic hypersecretory hyperplasia (CHH), the other three cases were cystic hypersecretory carcinoma (CHC). Clinically the lesions presented as either breast mass or mammographic calcification.Grossly, the cystic hypersecretory lesions were poorly circumscribed, with multiple colloid containing cysts on the cut surface. Microscopically, the remarkable feature was numerous enlarged cysts which contained densely eosinophilic homogeneous secretion similar to the colloid seen in thyroid follicles, and calcification was seen in the cyst in one case. The secretion was D-PAS and mucicarmine positive. The lining epithelium of the cysts was uniformly flat, cuboid or columnar, and arranged in a monolayer. The cells may be arranged in turfs, solid or micropapillary patterns in CHH.In cases with dysplasia, the epithelium showed cytological and structural atypia, but the usual morphology of atypical dutal hyperplasia such as arcades, rigid bridges or cribriform pattern was less common. The three CHC included two invasive ductal carcinomas (IDC) and one ductal carcinoma in situ (DCIS).In CHL, there was immunoreactivity to S-100 protein, CK5/6 and CK14.Of the three CHCs, ER and PR were expressed in only one IDC.No HER2 expression was identified in the two invasive CHCs.One patient was lost to follow-up, and the rest were uneventful at 18 months.</p><p><b>CONCLUSIONS</b>CHL of the breast is a rare pathological entity. Multiple colloid-filled cysts is a unique histological feature. The epithelium of CHL may show usual hyperplasia, dysplasia or carcinoma.</p>

High-risk human papillomavirus infection among rural women of Jing'an County in Jiangxi Province:a cross-sectional study / 中国肿瘤临床

Objective:To investigate the prevalence of cervical infection with high-risk human papillomavirus (hr-HPV) among the rural women of Jing-an County in Jiangxi Province. Methods:A population-based cross-sectional study was conducted among rural women of ages 35 years to 59 years in Jing-an County between May 2012 and November 2012. A total of 4 673 women were enrolled. Hybrid capture2 (hc2) was detected in 2 491 women, whereas HybriMax was detected in 2 182 women to understand the different hr-HPV types. Results:The overall hr-HPV prevalence was 11.9%. Multiple-type infections accounted for 41.5%. The most commonly seen hr-HPV type was HPV52 (2.8%), followed by HPV58, HPV16, and HPV39. No significant difference was observed in the preva-lence of hr-HPV infection between women in the mountainous and the plain areas in Jing-an County. However, the age distribution of HPV infection significantly differed (P<0.001). Conclusion:Hr-HPV infection rate in Jing-an County was close to that of other areas in China. HPV52 and HPV58 appeared to be the most prevalent HPV types and should be employed as a basis for HPV prevention in this area.

Effects of FOLFOX regimen chemotherapy on immunity of patients with colorectal cancer / 中国癌症杂志

Background and purpose: Anti-tumor chemotherapy compromises normal immune function of the patients. There were many reports that chemotherapy for advanced colorectal cancer often inhibit the cellular immune function. The effect of FOLFOX regimen chemotherapy on immunity of the patients with colorectal cancer before and after therapy was studied, and healthy people were used as a control. Methods: Eighty colorectal cancer patients were treated by FOLFOX regimen, which consisted of 2-hour infusion of oxaliplatin(85 mg/m~2) and 2-hour infusion of leucovorin (CF)(200 mg/m~2) on Day 1, followed by 5-fluorouracil(5-FU) bolus (400 mg/m~2) on Day 1 and 46-hour infusion (2 400 mg/m~2). FOLFOX regimen was repeated at 2-week intervals. Two treatments of the above regimen were defined as one cycle. Flow cytometry was used to detect T lymphocyte subsets and NK cells in blood samples from patients with colorectal cancer before and after therapy. Data obtained fi'om healthy people was used as control. Results: CD3~+, CD4~+ T cells, NK cells and CD4~+/CD8~+ ratio in blood samples were not significant before and after chemotherapy in first day, second week and fourth week(P0.05). Lower CD3~+, CD4~+ T cells, NK cells and CD4~+/CD8~+ ratio were detected in blood samples from cancer group than that from the healthy control(P<0.05). CD8~+ T lymphocyte were reverse. This change was related to the TNM pathological stage. Conclusion: FOLFOX regimen was effective for patients with coloreetal cancer, which can improve patients' life quality and did not impact on the immune function of the patients. The immune function of lymphocytes in peripheral blood of the patients with colorectal cancer was low, and even worse in the patients with late TNM stage. It is valuable for estimating the function of cell immune of the patients, patients prognosis and the role of immune therapy in the treatment of the patients by detecting T lymphocyte subset and NK cell.

Optical coherence tomography for evaluating the relation between vision and neuroepithelial layer in retinal lesion and its prognosis / 中国组织工程研究

BACKGROUND: Optical coherence tomography(OCT) is a new type of noncontactable, noninjurious retinal tomographic technique. Minor serous detachment in retinal neuroepithelial layer can be resoluted and shown by it. The range of inferior fluid of retinal neuroepithelail layer or pigment epithelial layer can also be quantitatively measured to evaluate the recovery of vision.OBJECTIVE: To study the applicative value of OPT in evaluating the relation of vision and neuroepithelial layer in idiopathic central serous chorioretinopathy(ICSC) and its prognosis.DESIGN: Single sample study.SETTING: Ophthalmologic center in a university hospital.PARTICIPANTS: Patients with ICSC who were primarily diagnosed from January 1999 to June 2003 in the Ophthalmologic Center of the Medical College of Jinan University were included. There were 32 males and 8 females, with an average of(36.2 ± 5.6) years old.INTERVENTIONS: Zeiss-Humphrey OCT imaging meter was used for the examination. The maximal range and height of detachment in the serous detachment region of ICSC were measured respectively, and average value and standard deviation were then calculated.MAIN OUTCOME MEASURES: Vision and the maximal range and height of serous detachment.RESULTS: Local detachment of retinal neuroepithelial layer in the center of macula retina was shown in the OCT images of the 40 eases(41 eyes) with ICSC. Detachment ranged from 705 to 5 720 μm[an average of (3 051 ± 1 338) μm], with the height from 55 to 491 μm[an average of (270 ± 114) μm] . Four eyes were complicated with serous detachment of pigment epithelial layer. And it was suggested by statistical analysis that the range and height of detachment were related with vision.CONCLUSION: OCT, as an objective noninjurious retinal tomography, its high resolution has important value and special predominee in the diagnosis, quantitative analysis and the detection and follow-up of optical functional assessment during the course of the ICSC.

Analysis of clinicopathological featurs in patients with Chinese hereditary nonpolyposis colorectal kindreds / 中华消化杂志

Objective To explore clinical features and prognosis of patients with hereditary nonpolypnsis colorectal cancer(HNPCC).Methods Twenty-four kindreds of Chinese HNPCC according to Amsterdam standard were enrolled and their pedigree trees were drawn.Clinicopathological and follow- up data were collected,clinical features and prognosis of 24 kindreds of Chinese HNPCC were analyzed as well.Results Among 24 H NPCCkindreds,there were 116 cases of cancer including 16 cases of multiple cancers in probands and 9 cases of multiple cancers in the members of kindreds.The age of patients ranged from 19 to 74.Of all the patients,there were 120 loci of colorectal cancers and 32 foci of HNPCC related extracolonic cancers.Among probands of 24 HNPCC kindreds,the average incidence age of onset- ring first colorectal cancer was 42.5,the male and right-side colon cancer patiens were more than female and left-side colon cancer patiens,respectively.The most pathologic type was tubular adenocarcinomas with moderately differentiation,which accounted for 45.8%(11/24).Up to the deadline of follow-up, 14 cases had survived for more than 5 years accounting for 58.3%(14/24) Of them,9 cases survived for more than 10 years and 1 case survived for 27 years.Conclusions Chinese patients with HNPCC have special characteristics such as moderately differentiated tubular adenocarcinomas,early onset of coloreetal cancer,right-side colon involvement.