Objective To investigate the clinical and pathological features,diagnosis and differential diagnosis of isolated granulocytic sarcoma of the ovary. Methods The clinical manifestations,pathological features,immunohistochemistry,treatment and prognosis were analyzed in 1 case of isolated granulocytic sarcoma of the bilateral ovary with the review of literatures. Results Granulocytic sarcoma of the ovary was rare. Only 14 cases had been reported so far. This case presented a greenish masse arising from the right ovary measuring 10.0 cm × 8.5 cm × 6.0 cm and 4.8 cm × 3.0 cm × 2.2 cm mass in the left ovary. The neoplastic cells grew in a diffuse pattern or India file, composed of myeloid cells at various stages of maturation, being predominantly primitive myelocytes with a few immature eosinophils. Immunohistochemistry,tumor cells were strongly positive for MPO,CD117,CD43,but negative for CD79α,CD3 Conclusions In routine morpholog,granulocytic sarcoma may be misinterpreted as lymphoma,granular cell tumor,et al. Neoplastic cells at various stages of maturation,India file pattern and immature eosinophils are important diagnostic clues. Immunohistochemical stains are essential in order to obtain correct diagnosis. Despite the localized nature of tumor, intensive antileukemia chemotherapy is necessary.

Objective:To investigate the prognostic values of tumor–stroma ratio and tumor-infiltrating lymphocytes in colorec-tal cancer. Methods:A total of 218 stageⅡorⅢprimary colorectal cancer patients were analyzed for the tumor–stroma ratio (TSR) and tumor-infiltrating lymphocytes (TIL) by using HE stained histological sections. The relationship between TSR and clinicopatholog-ic variables and the difference in clinical outcomes of different groups were also analyzed. Results:Overall survival rates for the stro-ma-low group were significantly higher than the stroma-high group in stagesⅡandⅢcolorectal cancer (P＜0.05). However, the differ-ences in TSR were not correlated with clinicopathologic features such as gender and age (P>0.05). Overall survival rates of patients with high TIL were significantly higher than patients with low TIL (P＜0.05). Patients with high TIL had notable better prognosis than patients with low TIL (P＜0.05) in the stroma-low group. Conclusion:TSR and TIL are independent prognostic factors for stagesⅡandⅢcolorectal cancer. The combined estimates of TSR and TIL in routine pathology diagnoses may provide more evidence to predict the prognosis of stagesⅡandⅢcolorectal cancer.

Purpose To study the clinicopathological features of lymphangiomyomatosis (LAM) of pelvis lymph node.Methods A patient with endometrial endometrioid adenocarcinoma and LAM was analyzed including clinical data and pathological features.HE and immunohistoehemistry of EnVision stainings were used,and the literatures were reviewed.Results Well-moderately differentiated endometrioid adenocarcinoma could be observed in the endometrium.Proloferation of LAM cells were seen in the capsule and medulla of the pelvic lymph node.The LAM cell was spindle,epitheliod and polygonal cells with oxyphilic or clear cytoplasm which arranged surrounding lacunes.The LAM cells showed no atypia and mitosis could not seen.The tumor cells showed diffusely positive for SMA,Caldesmon,desmin,vimentin,ER and PR,the cells lining the lacunes were positive for CD34 and D2-40.The epitheliod cells were positive for HMB-45 and negative for Melan-A.The Ki-67 immunostaining showed a proliferation index of ＜ 1％.Conclusion LAM is an uncommon neoplastic multisystem disease that affects the lungs mostly.Endometrial endometrioid adenocarcinoma with LAM of pelvic lymph node is extremely rare.The diagnosis can be made according to the histological characteristics and immunohistochemical features.Moreover this conclusion will provide the clinicopathological materials for the future study about LAM.

Objective:To investigate the clinicopathological features and misdiagnosis factors of ALK positive large B-cell lymphoma (ALK +LBCL). Methods:The clinicopathological data of 3 patients with ALK +LBCL in the Department of Pathology, the Affiliated Hospital of Xuzhou Medical University from 2010 to 2021 were collected retrospectively. Immunohistochemistry (IHC) was used for immunophenotyping, in-situ hybridization (ISH) for EBV-encoded RNA (EBER) detection, in-situ fluorescence hybridization (FISH, break-apart probes) for ALK, MYC, and CCND1 translocations. Next-generation sequencing (NGS) was used for the detection of gene fusions and mutations. And clinicopathological features and prognosis of patients were analyzed. Results:Among the 3 ALK +LBCL patients, there were 2 males and 1 female, aged 42, 59, and 39 years, respectively, none of which presented with B symptoms. Case 1 showed systemic lymphadenopathy with elevated serum EBV DNA loading, while cases 2 and 3 presented with extranodal lesions in the nasal and hard palate, respectively. Bone marrow biopsies were performed in cases 1 and 3, and neither showed involvement. Case 1 was at clinical stage Ⅲ while both cases 2 and 3 were at stage Ⅰ, and IPI score ranged 0-1 in all cases. The morphology of these cases was similar. The architecture was effaced by sheets of cohesive large cells growing in extensive infiltration and intra-sinus growth pattern. The neoplastic cells showed immunoblastic or plasmablastic morphology, and large anaplastic cells were easily found. The tumor cells expressed ALK protein cytoplasmically in almost all cells, with ALK gene translocations detected by FISH. Common B-cell and T-cell markers, including CD20, PAX5, CD19, CD2, CD3, CD5, CD7, CD43, CD56, and bcl-2, were negative, while plasmacytic differentiation markers, including CD138, CD38, and MUM1, were positive; CD22, BOB1 and OCT2 were variably expressed. CD10 was strongly expressed only in case 3. All cases were negative for bcl-6 but positive for CD4, perforin, CD30 (partial cells), pSTAT3 (diffusely), and MYC (40%-50%). The Ki-67 index was ranged 60%-70%. MYC translocation was not detected in any case by FISH. In case 1, EBER was strongly positive in>90% of tumor cells. Case 3 was diffusely positive for cyclin D1 but negative for SOX11 expression and CCND1 translocation. All cases harbored ALK fusion genes detected by NGS. In case 1, the fusion partner was TFG, which had not been reported in DLBCL, while in the other 2 cases, ALK fused with the CTCL gene, which was commonly seen in ALK +LBCL. Cases 1 and 3 were treated with ECHOP-based chemotherapy for six cycles and were followed up for 70 and 27 months, respectively, and both achieved complete remission. Conclusions:ALK +LBCL cases with diffuse EBER-positivity reported in this study show TGF as a new fusion partner of ALK in DLBCL, together with cyclin D1 expression. These rare cases are easily confused with EBV positive diffuse large B-cell lymphoma, not otherwise specified (EBV +DLBCL, NOS), cyclin D1 positive diffuse large B-cell lymphoma (cyclin D1 +DLBCL) and ALK positive anaplastic large cell lymphoma (ALK +ALCL), resulting in misdiagnosis. Being aware of these rare phenotypes is essential for pathologists to diagnose ALK+LBCL and guide appropriate treatment accurately.

Objective To explore clinical value of the expression levels of cell surface transmembrane glycoprotein molecule 44(CD44)mRNA,cell surface transmembrane glycoprotein molecule 24(CD24)mRNA,and protein in the placenta of severe preeclampsia(SPE)patients.Methods The SPE patients who were delivered by cesarean section in the Second People's Hospital of Liaocheng from June 2019 to June 2022 were further divided into 45 patients in early onset SPE group(gestational age≤34 weeks)and 55 patients in late onset SPE group(gestational age＞34 weeks)according to the different gestational age.The control group consisted of 100 normal cases in the same period.The expression of CD44 and CD24 in placenta of SPE patients was detected by fluorescent quantitative PCR and immunohistochemistry,Pearson method was used to analyze the difference of their expression levels and their correlation with the clinical characteristics of SPE disease,and multivariate logistic regression was used to analyze the influencing factors of SPE.Results Compared with the control group,the expression levels of CD44 mRNA(0.55±0.12 vs 1.02±0.33)and CD24 mRNA(0.68±0.19 vs 1.05±0.11)in SPE placental tissues decreased significantly,the differences were statistically significant(t=13.385,16.853,P＜0.05).The immunohistochemical staining results showed that CD44 and CD24 were mostly negative or weakly positive in the SPE group placental tissue,while they were mostly positive in the control group,the positive rates of CD44 and CD24 in the SPE placental tissue were lower than those in the control group,and the differences were statistically significant(χ2=9.696,14.346,P＜0.05).Compared to the early onset SPE group,the expression levels of CD44(0.65±0.17 vs 0.42±0.11)and CD24(0.77±0.23 vs 0.58±0.13)mRNA in placental tissue of late onset SPE were higher,and the differences were statistically significant(t=7.830,4.932,P＜0.05).Compared with the control group,the BMI,systolic blood pressure,diastolic blood pressure,urinary protein,Cr,LDH and BUN were significantly increased in SPE group(t=5.360～30.241,all P＜0.05).In SPE group,the gestational age was earlier,the MPV and ALB were lower,the newborn's birth length was shorter,and the body weight than control group,the differences were statistically great(t=3.232～11.109,all P＜0.05).The expression of CD44 and CD24 in SPE placenta was positively correlated(r=0.698,P＜0.05),the expression of CD44 in SPE placenta was positively correlated with CD24,gestational week of delivery,MPV and neonatal birth length(r=0.611,0.639,0.612,0.465,all P＜0.05),and was negatively correlated with systolic blood pressure,urinary protein and LDH(r=-0.604,-0.569,-0.593,all P＜0.05).The expression of CD24 was positively correlated with gestational age,MPV and newborn birth length(r=0.605,0.584,0.640,all P＜0.05),and was negatively correlated with systolic blood pressure,urinary protein and LDH(r=-0.637,-0.593,-0.561,all P＜0.05).The results of logistic regression analysis showed that MPV(95％CI:1.429～4.350),urinary protein(95％CI:1.529～2.709),and LDH(95％CI:1.425～3.932)were all independent risk factors for SPE(all P＜0.05).High levels of CD44(95％CI:0.561～0.940)and CD24(95％CI:0.495～0.814)were independent protective factors for SPE(P＜0.05).Conclusion The low expression levels of CD44 and CD24 in placenta of SPE patients are independent protective factors of SPE,which can provide direction for the follow-up treatment of SPE.

Objective To compare the efficacy and safety of different Chinese patent medicines in the treatment of benign prostatic hyperplasia(BPH)by Bayesian network Meta-analysis.Methods PubMed,EMbase,Cochrane Library,CNKI,SinoMed,WanFang Data and VIP databases were electronically searched to collect randomized controlled trials(RCTs)of Chinese patent medicine in the treatment of BPH from inception to January 1,2023.Two researchers independently screened the literature,extracted data,and assessed the risk of bias of the included studies.Bayesian network Meta-analysis was performed using Stata 15.0 and GeMTC 14.3 software.Results A total of 51 RCTs involving 12 kinds of Chinese patent medicines and 4 927 patients were included.The results of direct Meta-analysis showed that Chinese patent medicine combined with conventional western medicine was superior to conventional western medicine alone in reducing international prostate symptom score(MD=-4.44,95％CI-5.09 to-3.79,P＜0.001),improving maximum urinary flow rate(MD=3.16,95％CI 2.71 to 3.61,P＜0.001),reducing residual urine volume(MD=-8.27,95％CI-9.62 to-6.92,P＜0.001)and prostate volume(MD=-3.89,95％CI-4.60 to-3.18,P＜0.001).The results of the network Meta-analysis showed that the Longbishu capsules combined with conventional western medicine had the best effect in reducing the international prostate symptom score.In terms of improving maximum urinary flow rate,Xialiqi capsules combined with conventional western medicine had the best effect.Zegui Longshuang capsules combined with conventional western medicine had the best effect in reducing residual urine volume.In terms of reducing prostate volume,Relinqing granules combined with conventional western medicine had the best effect.The incidence of adverse reactions in the Chinese patent medicine combined with conventional western medicine group(8.27％)was lower than that in the conventional western medicine group(11.98％).Conclusion The existing evidence shows that compared with conventional western medicine alone,Chinese patent medicine combined with conventional western medicine is better than conventional western medicine alone in improving various clinical symptoms of BPH,and has better safety.Various proprietary Chinese patent medicines have different therapeutic focuses,and individualized medication can be used according to the specific symptoms of BPH patients in clinical treatment.Limited by the quantity and quality of the included studies,the above conclusions need to be verified by more high-quality studies.

Objective:To analyze the clinicopathological features and differential diagnosis of large B-cell lymphoma with IRF4 rearrangement, aiming enhance its recognition and prevent misdiagnosis.Methods:The clinicopathological features, immunophenotype, and fluorescence in situ hybridization (FISH) results of six cases diagnosed with IRF4 rearrangement-positive B-cell lymphoma at the Affiliated Hospital of Xuzhou Medical University from 2015 to 2023 were retrospectively analyzed. Additionally, a comprehensive review of the literature was conducted.Results:Six patients with IRF4 rearrangement-positive large B-cell lymphoma were included. Patients 1 to 5 included three males and two females with a median age of 19 years ranging from 11 to 34 years. Four patients presented with head and neck lesions, while the other one had a breast nodule; all were in clinical Ann Arbor stages I to Ⅱ. Morphologically, entirely diffuse pattern was present in two cases, purely follicular pattern in one case, and diffuse and follicular patterns in other two cases. The tumor cells, predominantly centroblasts mixed with some irregular centrocytes, were of medium to large size, with a starry sky appearance observed in two cases. Immunophenotyping revealed all cases were positive for bcl-6 and MUM1, with a Ki-67 index ranging from 70% to 90%, and CD10 was positive in two cases. IRF4 rearrangement was confirmed in all cases by FISH analysis, with dual IRF4/bcl-6 rearrangements identified in two cases, leading to a diagnosis of LBCL-IRF4. Case 6, a 39-year-old female with a tonsillar mass and classified as clinical Ann Arbor stage Ⅳ, displayed predominantly diffuse large B-cell lymphoma (DLBCL) morphology with 20% high-grade follicular lymphoma characteristics. Immunohistochemistry showed negative CD10 and positive bcl-6/MUM1, with a Ki-67 index of approximately 80%. Triple rearrangements of IRF4/bcl-2/bcl-6 were identified by FISH, leading to a diagnosis of DLBCL with 20% follicular lymphoma (FL). All six patients achieved complete remission after treatment, with no progression or relapse during a follow-up period of 31-100 months.Conclusions:Large B-cell lymphoma with IRF4 rearrangement is a rare entity with pathological features that overlap with those of FL and DLBCL. While IRF4 rearrangement is necessary for diagnosing LBCL-IRF4, it is not specific and requires differentiation from other aggressive B-cell lymphomas with IRF4 rearrangement.