Objective To investigate the clinical and pathological characteristics of urocpithelial sarcomatoid carcinoma of the urinary system,and improve the diagnosis and treatment of these tumors.Methods We reviewed the pathology comfirmed urinary system caicinoma at the General Hospital of PLA from January 1999 to December 2010 and analyzed the clinical and pathological data of cases with sarcomatoid carcinoma in them retrospectively according to the literatures. Results A total of 4386 urinary system carcinoma were comfirmed,among them 18 (0.41％) cases of sarcomatoid carcinoma were identified,including 13 from bladder,4 from ureter and 1 multiple neoplasm of pelvis and ureter.The patients,11 males and 7 female,had a median age of 63.3 years (41-84 yrs).Gross hematuria (18 cases) were the main presenting symptoms,3 with flank pain,4 with pollakisuria,urgency and dysuria (urinary irritation symptoms] and 5 with urinary obstruction.The patient with multiple neoplasm of pelvis and ureter received allograft renal transplantation 7 years ago and took anti-rejection drugs all the way after operation.17 patients underwent surgical resection,9 radical cystectomy,5 radical nephroureterectomy,3 partial cystectomy and the remain was biopsy.Tumor size ranged from 2.5 to 12 cm (median,5.6 cm).Microscopically,coexisting high grade urothelial carcinoma was present in all the 18 cases,12 with sarcomatoid differentiation,3 with sarcomatoid and squamous carcinoma differentiation and 3 with sarcomatoid and glandular differentiation.Sarcomatoid component occupied 10 -90 percent.Immunohistochemical testing showed the sarcomatoid cells were positive for cytokeratin (CK) and vimentin.12 patients died of disease 20 days to 42 months (median,5.3 months) postoperatively.3 patients have been surviving with tumor free for 3,3 and 17 months respectinely,and the other 3 was failure to be followed. Conclusions Sarcomatoid carcinoma of the urinary bladder is a highly malignant disease,and the prognosis is very poor.The diagnosis depends on histopathologic and immunohistochemical studies.Early diagnosis and cystectomy or nephroureterectomy together with chemotherapy/radiotherapy may improve the curative effect.

Objective To find out the immunologic mechanism of complete Freud's adjuvant (CFA) when used for preventing from streptozotocin (STZ)-insulitis and STZ-induced diabetes mellitus. Methods 20 healthy Kunming mice were equally and randomly divided into A and B groups. The animals in group A was respectively injected once into the pad of hind foot and intraperitoneally injected with 50?L CFA, and the animals in group B was injected with 50?L sodium chloride. After 2 weeks, all mice in both groups were i.p. injected with STZ (40 mg?kg-1/d) for 5 days. All mice were killed 6 weeks after administration of CFA or sodium chloride. Diabetes was diagnosed if blood glucose level was more than 16.7mmol/L after 2 consecutive days. The incidence of diabetes was compared between the two groups before mice were killed. The expression of Fas/FasL on ? cells as well as on infiltrating T cells of islets was investigated by immunochemistry method. Results The incidences of diabetes mellitus and insulitis in group A and group B were 0 % vs 80% (P

Objective To investigate the relationship between the expression of p53 protein and Ki-67 antigen in order to detect its clinical characters and the significance of them in them occurrence and development of appendiceal mucinous neoplasms.Methods 42 tissues of appendiceal mucinous neoplasms were selected by pathological diagnosis in the department of pathology of the PLA general hospital from May 1993 to October 2007.The 10 samples of control group were obtained from simple appendicitis after surgery.Applied PV6000 immunohistochemical method,the expressions of p53 protein and Ki-67 antigen were detected.Results The expression of p53 protein in appendiceal mucinous neoplasms was higher than that in appendicitis tissue [31.0 ％ (13/42) vs 0 (0/10),x2 =4.127,P =0.042).The positive rate of p53 protein in appendiceal mucinous adenocarcinoma was higher than that in low-grade appendiceal mucinous neoplasm tissue (40.0 ％ vs 8.3 ％,x2 =4.0218,P =0.044).The positive rate of p53 protein in appendiceal mucinous neoplasms tissue with pseudomyxoma peritonei was higher than that in tissue without PMP (45.5 ％ vs 15.0 ％,x2 =4.5464,P =0.033).The expression of Ki-67 antigen in appendiceal mucinous neoplasms was higher than that in appendicitis tissue (45.2 ％ vs 10.0 ％,x2 =4.2374,P =0.039).Considering the different factors (such as gender,age,pathological type and PMP),Ki-67 antigen expressions were still not significantly different (P ＞ 0.05).In appendiceal mucinous neoplasms,the difference of positive rates of Ki-67 between the p53 positive expression group and the p53 negative group was statistically significant (x2 =7.6299,P =0.0057).Conclusion The expression of p53 protein was correlated with the expression of Ki-67 antigen.It's valuable that both p53 protein and Ki-67 antigen are used to evaluate the biological behavior of appendiceal mucinous neoplasms and predict the malignant degree.

Objective To investigate the clinic-pathological characteristics and prognosis of 48 female cases with peritoneal pseudomyxoma(PMP).Methods The clinicopathologic features and follow-up data of 48 female patients with PMP diagnosed in the General Hospital of People's Liberation Army from Jan.1982 to Dec.2011 were retrospectively reviewed.The relationship between clinic-pathological characteristics and prognosis were analyzed using log-rank test and Cox proportional hazards model.Results (1) Clinicopathologic features:the mean age of the 48 cases was 58.8 years (range from 24 to 79 years).Symptoms:abdominal distention and abdominal discomfort were the main symptoms.Imaging examinations showed nonspecific abdominal and pelvic lesions in most cases.Treatment:all the 48 patients underwentlaparotomy and cytoreductive surgery (CRS),in which 15 (31％) patients with completeness of the cancer resection (CCR)-1,24(50％) cases with CCR-2,and CCR-3 in 9(19％) cases.Six (12％) cases were treated by intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin,20 (42％) patients were treated with different options postoperative adjuvant chemotherapy.Pathological types:the cases were histologically classified into 3 subcategories:disseminated peritoneal adenomucinosis (DPAM),peritoneal mucinous carcinomatosis (PMCA),and PMCA with intermediate or discordant features (PMCA-I/D),which were 22 (46％) cases,9 (19％) cases and 17 (35％) cases,respectively.Appendiceal tumors:44(92％) cases underwent appendectomy,in which 38 cases presented appendiceal tumors (including 20 cases of low-grade appendiceal mucinous adenoma and 18 cases of appendiceal mucinous adenocarcinoma),2 cases were diagnosed as appendicitis,4 cases with unknown pathologic diagnosis.And the other 4(8％) cases,who didn't undergo appendectomy at the first operation,presented peritoneal tumor recurrence and appendiceal mucinous tumors 1,11,32 and 85 months after surgery,respectively.Parenchymal organs involved:ovarian involving was happened in 34 (71％)patients including 15 cases with the right ovary involving,13 cases in both sides,and 6 cases involving the left side.The other parenchymal organs in 10(21％) cases.(2) Prognostic factors:11 patients died,31 survived and 6 cases were lost to follow-up.The mean survival time was 99 months(ranged from 1 to 312 months).The 3-year,5-year and 10-year survival rates were 73.3％,68.0％ and 46.6％,respectively.Univariate statistical analysis showed that age,pathological type and parenchymal involvement were significantly relationship with the survival time (all P ＜ 0.05).But the operation times,appendiceal tumor type,ovarian involvement,CCR,intraperitoneal HIPEC and post-operative adjuvant chemotherapy were not significantly correlate with survival time (all P ＞ 0.05).Multivariate analysis showed that age and pathologic type were independent prognostic factors (P ＜ 0.05).Conclusions No specific clinical features presented in PMP.CRS with HIPEC should the recommended treatment.Both ovaries exploration and appendectomy should be carried out routinely in CRS.The 10-year overall survival of PMP is low.Age,pathological type and parenchymal organs involvement other than ovarian are correlated with the prognosis.And the pathological type and age are independent prognostic factors of PMP.

OBJECTIVETo analyze the influence of prelaboratory and intralaboratory factors on the turnaround time of the reports in order to develop a reference database for continuous quality improvement, a retrospective study of the timeliness was reported.

METHODSUsing cluster sampling of a total of 5,979 pathology reports selected by sampling a single month's reports from each quarter of the year 2000, of which there were 5,250 cases from routine biopsy and 729 cases from operative specimen. The timeliness and the factors that influence the turnaround time of the two types of surgical pathology reports were analyzed.

RESULTS4,872 pathology reports of 5,250 routine biopsy cases were completed in 3 working days, and 613 of 729 cases of the operative specimens were completed in 4 working days. The percentage was 92.8% and 84.1% respectively. Factors that significantly contributed to the increase in turnover time of biopsy reports included request of immunohistochemical staining, delayed arrival of the operative specimen at the laboratory after frozen section, additional recutting, intradepartment consultation and decalcification etc. As for the operative cases, several factors were associated with delayed report: second day arrival of the operative specimen at the laboratory after frozen section, lack of the adequate clinical history, request for immunohistochemical staining etc.

CONCLUSIONSThe majority of surgical pathology reports in the department can be completed timely and the timeliness meets the general standard. Only about 10 percent of the reports were delayed because of some prelaboratory and intralaboratory factors, for which there were 33.5% and 66.5% respectively for routine biopsy, and 50.9% and 49.1% respectively for operative specimen.

Objective: To study the different clinicopathological characteristics between classic and epithelioid renal angiomyolipoma, and the relationships between clinicopathological characteristics and biological behaviors as basis for clinical treatment. Methods: The clinicopathological and follow-up data for the patients diagnosed with renal angiomyolipoma between 2004 and 2011 were retrospectively reviewed and analyzed. Results: There were 414 cases of renal angiomyolipoma diagnosed over 8 years ago, accounting for 8.1% (414/5 287) of all renal parenchymal tumors. The patients included 122 male and 292 female (male-to-female ratio of 1.0∶2.4), mean age 44.0 years (range 15-74 years). Of these, 195(47.1%) tumors occurred in the left kidney, 212(51.2%) in the right kidney and seven (1.7%) were bilateral. Clinically, some cases presented with hypochondrial pain, hematuria or palpable masses. Histologically, 394(95.2%) were classic angiomyolipoma, 20(4.8%) were epithelioid angiomyolipoma; 54, 23 and 7 cases had hemorrhage, necrosis and cystic degeneration, respectively; and 5, 30 and 14 cases had perirenal fat invasion, atypical cells and polymorphic/giant tumor cell. There was a positive correlation between atypical cells and epithelioid tumor type, respectively. The other clinicopathological parameters did not correlate with histological type. Follow-up data was available in 360 patients, with follow-up period of 3 to 99 months. One case died from other causes. The remaining patients were free of disease. Conclusions Angiomyolipoma is a common renal parenchyma tumor. Clinically, it is usually biologically benign. Histologically, it can be either classic or epithelioid types. The epithelioid type should be differentiated from the classic renal cell carcinoma, Mit family translocation renal tumor and renal hemangioblastoma. Atypical cells, more commonly found in the epithelioid angiomyolipoma, do not affect the clinical prognosis of patients.

Objective To study the clinicopathologic features of thyroid-like follicular renal cell carcinoma.Methods Clinical data were collected in 5 cases of thyroid-like follicular renal cell carcinoma.HE staining and immunohistochemistry were carried out in surgically-removed specimen to analyze the clinical and pathological features with review of the literatures.Results The patients aged 20-55 years, with one male and four females;the tumor occurred in the left kidney in three cases and right kidney in two cases.One case had a history of thyroid papillary carcinoma 3 years ago, and the patient had left flank pain, macroscopic haematuria for 2 weeks.The rest four cases had no consciousness of clinical symptoms and signs, without history of thyroid gland surgery; the physical examination found a mass in the kidney and normal thyroid glands.Three patients underwent radical nephrectomy, and the other two patients underwent tumor partial nephrectomy.The tumors were 2-4 cm in size.They showed a solitary nodular mass of well circumscribed with taupe and gray on cut surface.Microscopically,most of tumor cells arranged in thyroid follicular pattern in different sizes, with papillary configuration in a small portion,in four cases;the follicular structure was intermixed with the papillary each half in one case.A large amount of thyroid colloid was deposited within follicule-like structure or papillary axis, lined by simple columnar cells or cubic cells, with obvious atypia, ground-glass nuclei, nuclear groove and rare mitosis.Immunohistochemical staining showed tumor cells were positive for PAX8,and negative for thyroid transcription factor 1 (TTF1) and thyroglobulin ( Tg).One of five patients presented with lymph node metastases (4/4) of renal hilum the same time in the diagnosis.Five cases were followed up for 5 -84 months after operation, and no tumor progression was found.Conclusions Thyroid-like follicular renal cell carcinoma is primary renal epithelial malignant tumor.The diagnosis mainly depends on its characteristics of histological appearance,namely similar to the histological morphology of well-differentiated thyroid follicular carcinoma and papillary carcinoma, and the metastasis from the thyroid papillary or follicular carcinoma must be excluded.On the premise of clinical history, immunohistochemical markers TTF1 and Tg have certain value in the differential diagnosis.

Objective To investigate the MRI features of renal oncocytoma(RO). Methods We retrospectively analyzed the data of 26 patients by histologically confirmed with RO in Chinese PLA General Hospital from September 2006 to May 2017 and performed pre-operative MRI and dynamic contrast-enhanced MRI.Lesions were divided into two groups based on the diameter:large group with large than 3 cm(16 cases,16 lesions)and small group with less than 3 cm(10 cases,11 lesions).Features of each lesion were analyzed, including location, pseudocapsules, lipids and other 11 indicators. Tumor imaging features were compared between two groups by univariate and multivariate logistic regression analysis. Results Of 27 RO lesions, 12 were located in the left kidney and 15 in the right kidney. Twenty five lesions appeared exophytic(92.6%,25/27),10 lesions showed exophytic angular interface(37.0%,10/27), 25 lesions showed pseudocapsule(92.6%,25/27),4 lesions appeared lipid(14.8%,4/27),2 lesions showed cystic degeneration or necrosis(7.4%,2/27),1 lesion showed hemorrhage(3.7%,1/27),13 lesions appeared fibrous scar(48.1%,13/27),19 lesions with moderate or intense enhancement in the corticomedullary phase (70.4%, 19/27), 9 lesions with wheel-spoke-like enhancement (33.3%, 9/27), and 2 lesions showed segmental enhancement inversion (7.4%, 2/27). Univariate logistic regression exhibited statistically significant correlation between exophytic angular interface with renal parenchyma,fibrous scar,moderate or intense enhancement in the corticomedullary phase,and wheel-spoke-like enhancement of the tumors both in small and large RO groups with OR value of 0.054, 9.898, 8.400 and 10.000, respectively. In the multivariate logistic regression analysis, exophytic angular interface with renal parenchyma and intense enhancement in the corticomedullary phase were found to be high risk factors with OR value of 0.033 and 15.381,respectively.Conclusions The main manifestation of RO on MRI is that both kidneys can occur, with many exogenesis, pseudocapsules, but less lipids, cystic degeneration, necrosis, hemorrhage and segmental enhanced reversal;smaller lesions(diameter<3 cm)tend to conical interface,while larger lesions (diameter≥3 cm)may have fibrous scars,spoke-shaped enhancement,moderate and significantly enhanced cortical phase characteristics.

Objective:To investigate the relationship between spinal Mas-related gene receptor C (MrgC) and pathophysiological mechanism of bone cancer pain in mice.Methods:Forty male C3H/HeNCrlVr mice, aged 5-7 weeks, weighing 20-25 g, were selected and divided into 4 groups ( n=10 each) using a random number table method: sham operation group (group S), bone cancer pain group (group P), bone cancer pain + MrgC agonist group (group P-agonist) and bone cancer pain + Mrg C antagonist group (group P-Ab). Preparation of the bone cancer pain model: mouse fibrosarcoma cells (NCTC2472) were injected into the upper tibia of mice in P, P-agonist and P-Ab groups, and the equal volume of D-Hanks balanced salt solution was given instead in S group. Fourteen days later cerebrospinal fluid was intrathecally injected in S and P groups, and MrgC agonist and MrgC antibody were intrathecally injected in P-agonist and P-Ab groups. The mechanical paw withdrawal threshold (MWT) to von Frey stimuli was measured before developing the model (T 0), at 7 days after developing the model (T 1), at 14 days after developing the model (before intrathecal injection, T 2), and at 4, 8 and 12 h after intrathecal injection (T 3-5). Results:Compared with group S, no significant change was found in the MWT at T 0 ( P>0.05), and the MWT was significantly decreased at T 1-T 5 in the other groups ( P<0.05). Compared with group P, the MWT was significantly increased at T 3-T 5 in group P-agonist, and the MWT was significantly decreased at T 3-T 5 in group P-Ab ( P<0.05). Conclusions:Spinal MrgC plays an endogenous protective role in the pathophysiological mechanism of bone cancer pain to a certain extent in mice.

Objective:To evaluate the test-retest reliability of MRI criteria in the 2019 Bosniak classification of cystic renal masses (CRMs) and to analyze the impact of lesions′ property, size and readers′ experience on the test-retest reliability.Methods:From January 2009 to June 2019, 207 patients with 207 CRMs were included in this retrospective study. All of them underwent renal MRI and surgical-pathologic examination. According to Bosniak classification, version 2019, all CRMs were independently classified twice by eight radiologists with different levels of experience. All radiologists were blinded to the pathology of the lesions. By using intraclass correlation coefficient (ICC), test-retest reliability was evaluated for all CRMs and for subgroups with different pathological properties (benign and malignant) and different sizes (≤40 mm and>40 mm). The test-retest reliability of 4 senior readers (≥10 years of experience) and 4 junior readers (<10 years of experience) were evaluated respectively. The comparison of ICC was performed using Z test. Results:The 207 CRMs included 111 benign lesions (83 benign cysts, 28 benign tumors) and 96 malignant tumors. There were 87 lesions with maximum diameter ≤40 mm and 120 with maximum diameter>40 mm. The test-retest reliability (ICC) of each reader for all lesions was 0.776-0.888, the overall ICC was 0.848 (95%CI 0.821-0.872). The ICCs of senior and junior readers were 0.853 (95%CI 0.824-0.880) and 0.843 (95%CI 0.811-0.871) respectively, without significant difference between the two groups ( Z=0.85, P=0.374). The ICC of all readers was 0.827 for benign lesions and 0.654 for malignant lesions, showing significant difference ( Z=2.80, P=0.005). The ICC was 0.770 for lesions ≤40 mm and 0.876 for lesions>40 mm, which was significantly different ( Z=-2.36, P=0.018). For CRM subgroups with different pathological properties and different sizes, there was no significant difference in test-retest reliability between senior and junior readers (all P>0.05). Conclusion:The test-retest reliability of MRI criteria in the 2019 Bosniak classification of CRMs is excellent and unaffected by readers′ experience. The reliabilities are not consistent among CRMs of different pathological properties and different sizes, but all reached the level of good and above.