Purpose To investigate the clinicopathologic features and prognostic factors of apocrine carcinoma ( AC) of breast. Meth-od Clinical data of 70 ACs and 283 invasive carcinomas, not otherwise specified were collected. Differences between the prognostic outcomes of the two groups were compared, and the relationship between clinicopathological characteristics and prognosis was also ana-lyzed. Results The mean age of the patients with AC (56. 17 ± 12. 41 years) was older than those with invasive carcinoma not other-wise specified (52. 77 ± 11. 07 years) (P=0. 039). The patients with AC had a lower frequency of axillary nodal metastasis, a lower frequency of ER and PR positivity comparing to invasive carcinoma not otherwise specified ( P<0. 05 ) . No significant differences in the overall survival (P=0. 221) and disease-free survival (P=0. 378) periods of the two groups were observed. Kaplan-Meier surviv-al analysis showed tumor size, lymph node metastasis, pathological stage, lymph node tissue infiltration were related with prognosis of patients with AC ( P<0. 05 ) . In multivariate analysis, lymph node metastasis was associated with a worse prognosis ( P<0. 05 ) . Conclusions Although AC and invasive carcinoma not otherwise specified have different clinicopathologic characteristics, the prog-noses of patients with these diseases are similar. Lymph node metastasis could be used as an independent factor for predicting the prog-nosis of patients with AC, early diagnosis and early treatment is the key to improve its prognosis.

Objective To investigate the values of CD21 and CD43 proteins in the differential diagnosis of mucosa-associated marginal zone B-cell lymphoma (MALToma) from benign lymphadenosis. Methods The expression of CD21 and CD43 proteins in the tissues of 25 MALToma (case group) and 25 benign lymphadenosis (control group) was detected by immunohistochemistry. Results Abnormal CD21+follicular dendritic cells (FDC) meshes were found in all patients of case group. Most of the FDC meshes were sparse and broken, and a few were enlarged or fused into pieces. Intact CD21+FDC meshes were all found, and abnormal FDC meshes were not found in control group. The positive rate of abnormal FDC meshes in case group was significantly increased compared with that in control group (χ2 = 46.080, P= 0.000). The expression rate of CD43+in CD20+cells was 24 % (6/25) in case group, but it was negative in control group (χ2=4.375, P=0.030). Conclusions Abnormal CD21+FDC meshes and CD43+expression in CD20+cells are useful in the differential diagnosis between MALToma and benign lymphadenosis. The abnormal FDC meshes of MALToma are enlarged or fused in the minority of cases.

Objective:To interpret the main revision about the test method for bacteriostat effect in Chinese Pharmacopoeia(2015 edition). Methods:The main difference of the bacteriostat effect test method in Chinese Pharmacopoeia(2015 edition) and (2010 edi-tion) was compared. Results:The bacteriostat effect test method in the 2015 edition was revised at a comparatively large scale in the positioning of bacteriostat effect test, product classification, assessment criteria and so on. Conclusion: The bacteriostat effect test method in Chinese Pharmacopoeia (2015 edition) gradually improves the check standards in line with the international standards.

Objective To analyze the results of the assessment of malaria elimination in 8 counties(districts)in Huai'an City,Jiangsu Province,so as to provide evidences for consolidating the achievement of malaria elimination. Methods The da-ta from the network reports of malaria epidemic situation,blood examinations of febrile patients,epidemiological questionnaires of malaria cases,investigation and disposal of epidemic focuses were collected and analyzed in Huai'an City from 2010 to 2016. The results of the assessment on the clinicians'ability of malaria diagnosis and treatment as well as the inspectors'skill of Plas-modium microscopic examinations were analyzed. In the natural village where the last local case of malaria was reported ,no less than 200 blood filter papers were made for gene detection of Plasmodium. Results From 2010 to 2016,308 malaria cases were reported in Huai'an City. Totally 323002 patients received blood detection of malaria,among which 272 ones were positive and the positive rate was 0.08％. The majority of the malaria cases were imported,except 19 and 3 local infection cases in 2010 and 2011,respectively. Except Qinghe District,a total of 1420 blood filter papers from the other 7 counties(districts)were detect-ed genetically,and the results were all negative. Six of the eight counties(districts)gained an average score of 20 points on the Plasmodium microscopic examination,and Jinhu County and Huai'an District got a minimum average score of 19.6 points. In ca-pacity assessment of malaria diagnosis and treatment,Hongze District gained the highest average score of 20 points,and Huai'an District got the lowest average score of 18.8 points. The malaria elimination assessment scores of the eight counties(districts) were all above 97 points. All the 8 counties(districts)in Huai'an City passed the malaria elimination assessment at county(dis-trict)level until 2016. Conclusions All the 8 counties(districts)in Huai'an City have passed the malaria elimination assess-ment with high scores. After the malaria elimination,the monitoring still should continue to consolidate the achievement.

Objective To determine sonographic features and outcome of fetal lung abnormal lesions. Methods Blood supply of the lesion, fetus hydrops and other extra-lung anomalies should be evaluated by color Doppler flow image(CDFI) when abnormal lesion was detected in fetus lung during routine scanning. The fetus with lung abnormal lesion without hydrops at the first time scanning should be monitored by ultrasound in every four to six weeks. Results Forty cases fetus presented lung abnormal lesions, which included 21 cases with hyperechogenic solid masses,15 cases with cystic-solid mixture masses,4 cases with cystic masses. Lesions of 8 cases were demonstrated systemic arterial blood supply arising from the aorta on CDFI and the diagnosis of pulmonary sequestration (PS) were suggested. Seventeen cases lesion that had small size or decreased or disappeared or remained stable in size with gestational age developing had normal neonate. Conclusions CDFI is very useful in detecting abnormal lesion of the fetal lung and differentiating pathology and evaluating the prognosis. The outcome of isolated lung lesion without hydrops and mediastinal shift that decreased or disappeared or remained stable in size had a good prognosis.

Objective: To explore the characteristics of maternal glucose and lipid metabolism in twin pregnancies complicated by gestational diabetes mellitus (GDM). Methods: The clinical features of twin and singleton pregnancies complicated by GDM, which delivered in Peking University First Hospital from January 1st, 2012 to December 31st, 2017 were retrospectively analyzed. A total of 286 twin pregnancies with GDM (GDM-T group) were collected, and 572 singleton pregnancies complicated by GDM (GDM-S group) which were matched by delivery time in a ratio of 1∶2 among all singleton pregnancies with GDM. The characteristics of maternal glucolipid metabolism in the second trimesters of pregnancy was compared between two groups. Results: (1) Compared with GDM-S group, the maternal delivery age were lower [(32±4), (33±4) years] and prepregnancy body mass index (BMI) were higher [(24±4), (23±4) kg/m²] in GDM-T group, the differences were statistically significant (all P<0.05). The incidence of chronic hypertension was found no significant difference (P=0.581). (2) The 3 points of glucose values in 75 g oral glucose tolerance test (OGTT) and OGTT-area under curve (AUC) had no significant difference between GDM-T and GDM-S group.When compared with GDM-S group, the maternal glycosylated hemoglobin levels [(5.41±0.35)%, (5.32±0.28)%], the insulin resistance index (4.07±0.77, 2.63±1.50) and the proportion of insulin use (7.7%, 4.4%) were all significantly higher in GDM-T group (all P<0.05). The values of triglyceride [(3.4±1.4), (2.6±1.2) mmol/L], total cholesterol [(6.3±1.1), (6.0±1.0) mmol/L], low density lipoprotein cholesterol [(3.3±0.9), (3.1±0.8) mmol/L] were significantly higher and values of high density lipoprotein cholesterol [(1.7±0.4), (2.0±0.5) mmol/L] were significantly lower in GDM-T group than GDM-S group (all P<0.05). (3) There was no significant difference in the incidence of gestational hypertension between the two groups (P>0.05). When compared with GDM-S group, the incidences of preeclampsia and small for gestational age were both significantly higher (13.3% vs 2.4%; 28.7% vs 1.7%) and the incidence of large for gestational age was significantly lower in GDM-T group (4.5% vs 15.2%; all P<0.05). Conclusions The insulin resistance is aggravated in twin pregnancies and the characteristics of lipid metabolism are different between singleton and twin pregnant women complicated by GDM, and there are more complications in twin GDM pregnancies.

Synchronous multiple primary carcinomas refers to 2 or more than 2 kinds of different primary malignant tumors develop synchronously or in 6 months.The incidence of synchronous multiple primary carcinoma is low.A patient with esophageal basaloid squamous cell carcinoma (BSCC) and gastric adenocarcinoma was admitted to the First People's Hospital of Lianyungang in October 2011.The main symptom of this patient was dysphagia,and multiple lesions were found in esophagus,cardia and stomach fundus by gastroscopy respectively.On computed tomography image,eminence lesion in esophageal midpiece and wall thickening from esophagus-cardia to stomach fundus were displayed and were both enhanced slightly by enhancement scanning.The esophageal and cardia tumors were resected via left thoracic approach,and postoperative pathological examination revealed esophageal BSCC and moderately differentiated adenocarcinoma of cardia respectively.Comedo necrosis and red basal membrane material were seen under light microscope.The expressions of cytokeratin 5/6 and P63 were positive,the expression of cytokeratin L was weak positive and the expressions of synaptophysin,chromogranin A and CD117 were negative.The patient suffered from pleural effusion and multiple liver metastases after 4 months follow-up and died of liver metastases in May 2012.Multiple primary carcinomas including esophageal BSCC and gastric adenocarcinoma are rarely seen in clinical practice.Their diagnosis and differential diagnosis mainly depend on histological morphology and immunohistochemical method.Surgical resection combined with postoperative radiotherapy and chemotherapy is selectable,but the prognosis is poor.

Objective To evaluate the clinical value of ultrasound breast imaging reporting and data system (BI‐RADS) in small solid breast masses with diameter ≤1 cm. Methods The ultrasound features of 230 solid breast masses with diameter ≤ 1 cm were described by ultrasound BI‐RADS, the relationship between ultrasound features, BI‐RADS final assesment and pathology were analyzed. Results Of these 230 masses, 72 (31 3.% ) were pathologically confirmed to be malignant and 158 (68 7.% ) to be benign. The ultrasound BI‐RADS features of mass shape, margin, orientation, posterior acoustic features, and microcalcificaition were significantly different between malignant and benign masses( P < 0.05). Irregular shape, noncircumscribed, nonparallel orientation, postrior shadowing, microcalcifications were regarded as malignant ultrasound features, their positive predictive values(PPV), sensitivity, specificity and accuracy for malignancy were 53 3.% -100%, 2 8.% -75 0.%, 82 3.% -100%, 69 6.% -80 9.%, respectively. One hundred and fifty‐two(66.1% ), 62(27 0.% ), 16(7 0.% ) masses were classified into grade 3, 4, and 5, respectively. The PPV for grade 3, 4 and 5 were 10 5.%, 64 5.%, 100% respectively. Among BI‐RADS grade 3 cases, 87 5.%malignant masses were intraductal carcinoma in situ and special type of invasive cancer, among pathological benign BI‐RADS grade 4 masses, 90 9.% were hyperplasia and intraductal papilloma. Conclusions In small breast masses with diameter ≤ 1 cm, due to the sensitivity of malignant signs are not high, the overlap between signs of benign and malignant lesions, pathological type and other factors, the positive predictive value of BI‐RADS grade 3 is higher than criteria of American College of Radiology, so BI‐RADS classification requires further detailed study.

Purpose To investigate the diagnostic utility of the immunohistochemical markers SALL4, D2-40 and Glypican-3 in prima-ry testicular germ cell tumors (TGCTs). Methods The expression of SALL4, D2-40 and Glypican-3 protein was detected by EnVi-sion immunohistochemical method in 56 cases of primary testicular germ cell tumors, including 5 intratubular germ cell neoplasms ( IT-GCNs) , 10 seminomas, 14 embryonal carcinomas ( ECs) , 14 yolk sac tumors ( YSTs) , 1 choriocarcinoma, 5 immature teratomas and 12 mature teratomas. 10 normal testicular tissues and 5 lymphomas were selected as control. Results All of ITGCNs, seminomas, YSTs and ECs were diffusely strongly positive for SALL4. Focal SALL4 staining was seen in choriocarcinoma, 3 of 5 immature terato-mas and 3 of 12 mature teratomas. All of ITGCNs, seminomas showed diffusely strong D2-40 staining. ECs (4/14) were focally posi-tive for D2-40, while choriocarcinoma, YSTs and teratomas were negative for D2-40. Glypican-3 was diffusely positive in YSTs (13/14), and focally weakly positive in ECs (2/14), respectively. ITGCNs, seminomas, choriocarcinoma and teratoma were negative for Glypican-3. In contrast, 10 normal testicular tissues and 5 lymphomas showed no SALL4, D2-40 and Glypican-3 staining. Conclu-sions SALL4 is a useful diagnostic marker with high sensitivity and specificity for TGCTs. Combination of SALL4, D2-40 and Glypi-can-3 is helpful to the diagnosis and differential diagnosis for TGCTs.