Objective To analyze the clinical and histopathological features of 100 cases of scrotal Paget's disease. Methods Specimens were collected from 100 outpatients with scrotai Paget's disease evaluated in the Department of Dermatology, Huashan Hospital, Fudan University during the period of 1987-2004. Clincal data as well as findings in the examination with H&E staining, special staining and immunohisto-chemical staining were retrospectively assessed for these cases. Results Three types of tumor cells were observed in these specimens, including typical Paget cells (51 cases), mutinous or signet-ring cells ( 11 cases), small cells ( 18 cases). Mixed types of tumor cells were seen in 20 cases. Paget cells spread in the epidermis in three patterns (sparsely, intensively and classically). Tumor cells could extend down along the epithelium of follicles or sweat glands, ultimately broke through dermal-epidermal junction or the basal membrane of adnexa, and migrated into the dennis. Conclusions Histopathological examination is the most important clue to the diagnosis of scrotal Paget's disease. Histologically, it should he differentiated from superficial spreading malignant melanoma, skin iymphoma, pagetoid squamous cell carcinoma in situ and secondary scrotal Paget's disease.

Objectives:To investigate the effect of glutamine on the shape of residual intestine and colon in rats with short bowel syndrome.　Methods:23 male Sprague-Dawley rats,underwent a 80% small bowel resection,were randomly divided into three groups:food group(n=8) rats,fed rat chow and water libitum after operation;TPN group(n=8),infused with Gln-supplied TPN;and normal control group.On seventh day after operation,rats were weighted and remaining jejunum、remaining ileum and colon were harvested for histological observation(light microscopy and electron microscopy).　Results:There was significant difference in rat average weight between food group and Gln group after operation.Jejunal mucosal villus height(VH) and mucosal thickness(MT) and ileal mucosal VH in food group were significantly increased than those in control group.Jejunal mucosal VH and MT in control group were significantly higher than in TPN group.Ileal mucosal crypt depth(CD) and MT in control group were also significantly higher than in TPN group.Jejunal and ileal mucosal VH、CD and MT in Gln group were significantly higher than in TPN group.Colonic MT in food group was significantly higher than in control group.Colonic MT in Gln group was significantly bigger than in TPN group.　Conclusions:After 80% intestinal resection,the remaining intestine can develop the adaptation,but the adaptation is incomplete.TPN therapy can maintain body weight,but only TPN can not result in the adaption.Gln-supplied TPN can stop the remaining itestinal mucosal atrophy,and promote the remaining intestinal adaptation and colonic mucosal hypertrophy.

Objectives:To investigate the effects of intravenous LCT or MCT/LCT fat emulsions on the lipid mediators and pancreatic histological changes in ANP rats. Methods:Forty three male SD rats were randomized to groups as follow.Group A～C were without ANP, group A:normal controls, group B:normal rats having received lipid based TPN and group C:operation control(OC) group having received the glucose fluid.Group D～F were with ANP,glucose group,Intralipid group and Lipofundin group.The amylase and prostaglandins in serum were determined in group A.Pancreatic histological examinations were also performed.In group B～F,Amylases or prostaglandins in serum were determined at 4,48 and 72 h, and pancreatic histological examination and pathological scoring were also completed. Results:Intralipid had no effects on serum prostaglandins when it was infused to normal rats.In groups of ANP,intravenous fat emulsion increased the 6 keto PGF 1? ,and PGE 2 concentration in serum at 4 h.Pancreatic hemorrhagic and fat necrosis were significantly reduced in Lipofundin group. Conclusions:Intravenous fat emulsion does not worsen the damages to pancreas in ANP.MCT/LCT fat emulsion is more suitable for patients with ANP.

Objective To detect plasma interleukins-35 (IL-35 )level in the patients with active tuberculosis complicated with bronchiectasis and to analyze its clinical significance.Methods Peripheral blood of patients with active tuberculosis from depart-ment of Dongguan 6th People′s hospital were collected,assigned to the active tuberculosis complicated with bronchiectasis group and active tuberculosis group.The healthy volunteers served as the control group.The plasma IL-35 level was measured by ELISA, and peripheral blood neutrophils and lymphocytes were detected by hematology analyzer.Results The levels of plasma IL-35 signif-icantly increased in both patients with active tuberculosis complicated with bronchiectasis and patients with active tuberculosis.The level of plasma IL-35 of patients with active tuberculosis complicated with bronchiectasis was significantly higher than that of the patients with active tuberculosis.The absolute value and percentage of peripheral blood neutrophils of patients with active tubercu-losis complicated with bronchiectasis were significantly higher than those of healthy volunteers.However,the percentage of periph-eral blood lymphocytes of patients with active tuberculosis complicated with bronchiectasis was significantly lower than that of healthy volunteers.Pearson correlation analysis showed that the absolute value of peripheral blood neutrophils of patients with ac-tive tuberculosis was positively correlated to the level of plasma IL-35.Conclusion IL-35 may play an important role in the progres-sion of active tuberculosis complicated with bronchiectasis.The determination of IL-35 may be helpful to the diagnosis of patients with active tuberculosis complicated with bronchiectasis.

Objective: To study the clinicopathologic features, differential diagnosis and prognosis of lentigo maligna (LM) and lentigo maligna melanoma (LMM). Methods: Histopathologic evaluation and immunohistochemical study by HRP multimer method were carried out in 24 cases of LM and LMM from 2012 to 2017 at Fudan University Shanghai Cancer Center. The clinical information and follow-up data were analyzed. Results: Of total 24 cases, there were 7 cases of LM and 17 cases of LMM; 10 males and 14 females. The age of patients ranged from 32 to 88 years (mean 67 years). The male-to-female ratio was 1.0∶1.4. Tumors were all located on head and face. Clinically, all patients presented with mottled light brown or sepia macule located on head and face for a long time, and some of them followed by nodules or ulceration within the lesion. The diameter of lesions ranged from 0.5 to 3.0 cm. Microscopically, LM and in-situ component of LMM were all characterized by a predominantly junctional proliferation of atypical melanocytes with marked pleomorphism, frequently extending down the walls of hair follicles and sweat ducts. Multinucleate cells were frequently present. The invasive components of LMM mainly consisted of atypical melanocytic spindle cells (13 cases, 76.5%), and the mean Breslow thickness was 1.2 mm (0.1-2.7 mm). The lesions of LM/LMM were generally associated with severe actinic damage, scattered infiltration of lymphocytes and melanophages. Statistically, the number of cases whose diameter of lesion ≥0.6 cm, mitotic rates ≥4/mm² and nests of melanocytes within epidermis in group of LMM were significantly more than those in group of LM. Immunohistochemically, atypical melanocytes in LM and LMM were generally positive for S-100, HMB45, PNL2, Melan A and SOX-10. Follow-up was available in all cases, ranging from 1 to 64 months. Only one out of 23 patients with wide surgical excision had local recurrence, and the remaining 22 patients were all alive with no evidence of disease. One LM patient who was merely treated with biopsy was alive with disease progression after 20 months follow-up. Conclusions LM/LMM is a special subtype of melanoma predominantly located on the sun-exposed skin of elderly people. Recognition of its specific histologic features can help distinguish with sun-damaged diseases and other subtypes of melanoma. The prognosis of LM/LMM patients treated with surgical excision is considered relatively favorable. However, long term follow-up should be recommended in patients with LM/LMM because of high recurrence rates indicated by previous studies.

OBJECTIVETo study the clinicopathologic features, differential diagnosis and prognosis of proliferative nodules(PNs) in congenital melanocytic nevi(CMN).

METHODSHistopathologic evaluation and immunohistochemical study by EnVision method were carried out in 8 cases of PNs in CMN. The clinical information and follow-up data were analyzed.

RESULTSThe age of patients ranged from 1 to 54 years (mean 27.6 years). Tumors were located on face (3 cases), on back (2 cases), upper extremities (2 cases) and lower extremities(1 case). Microscopically, PNs with expansile growth were observed in 8 cases of CMN. Melanocytes in PNs show variable pleomorphism with a mitotic activity of 0 to 4 per 10 high power fields. Blending of cells with adjacent CMN was noted in 6 cases. According to the morphology of melanocytes in PNs, it was classified into different types including large oval melanocytes (4 cases), small melanocytes (2 cases) and Spitz-nevus-like forms (2 cases). Immunohistochemically, melanocytes in PNs were consistent with those in adjacent CMN. They were diffusely positive for S-100 protein, but were either negative or focally positive for HMB45. Less than 5% of melanocytes were positive for Ki-67 in 8 cases of PN. Follow-up was available in all cases, ranging from 9 to 82 months. Seven patients with excision of single PN in CMN were alive with no evidence of disease, while 1 patient with multiple PNs in CMN was stable with disease after 62 months follow-up.

CONCLUSIONSPN is a rare melanocytic lesion arising in CMN. Recognition of its specific histologic features can help to avoid being misdiagnosed as melanoma. Long term follow-up should be recommended in patients with PNs, especially in those with atypical histologic features. Further investigation is needed to elucidate its clinical behavior.

Adolescent ; Adult ; Back ; Child ; Child, Preschool ; Diagnosis, Differential ; Extremities ; Facial Neoplasms ; pathology ; Female ; Humans ; Infant ; Male ; Melanocytes ; pathology ; Middle Aged ; Nevus, Pigmented ; pathology ; Prognosis ; Skin Neoplasms ; pathology

Objective: To investigate the clinicopathologic features and prognosis of ALK-positive Spitz tumors. Methods: Thirteen patients with ALK-positive Spitz tumors diagnosed at Shanghai Cancer Center, Fudan University from October 2016 to December 2017 were collected. All cases were routinely evaluated histopathological features in HE staining and detected ALK protein expression by immunohistochemistry. The ALK fusions of 7 cases were confirmed by fluorescence in situ hybridization (FISH).Follow-up data was collected. Results: The age of patients including 2 males and 11 females ranged from 4 to 47 years (mean 25 years). 12 patients were diagnosed with atypical Spitz tumors and 1 patient was diagnosed with Spitz nevus. Clinically, most lesions presented as papules or nodules, while a few lesions presented as plaques. Histologically, most tumors were exophytic (9/13). More than half of the tumors were amelanotic and the junctional component was mainly composed of melanocytic nests. Kamino bodies were not found. The bases of the tumors were mainly wedge-shaped (5/13) and flat (7/13). Eight tumors displayed mixed cell types, while 5 tumors were composed of only spindle cells. All the tumors showed a plexiform and/or intersecting fascicular growth pattern, and perineural extension was observed in 3 tumors. ALK immunohistochemistry showed diffuse and intense cytoplasmic staining in 13 cases, and 7 of them were detected by FISH to confirm the presence of ALK fusions. All patients were followed up for 7 to 21 months (median=12), with no recurrence or lymph node dissemination. Conclusions Spitz tumors with ALK fusions have their special histopathologic features.ALK fusions mainly occur in Spitz nevi and atypical Spitz tumors. The follow-up data of the existing literatures and our research indicates that the prognosis of ALK-positive Spitz tumors may be good.