Humans ; Lymphoma ; Tumor Microenvironment

China ; Female ; Genital Diseases, Female ; pathology ; Humans

[Objective]To evaluate the effectiveness of biopsy of bone lesions.The factors that might effect on the clinical utility were analyzed in order to find out the independent factor for clinical effectiveness.Also we evaluated the effects of these factors on the open biopsy with needle biopsy previously done.[Method]We retrospectively reviewed 206 cases performed at our institute between June 2003 and Oct 2006,including percutaneous core-needle biopsy or open biopsy.The biopsy result was classified as correct,nondiagnostic,or incorrect.The biopsy results were considered clinical useful if they were correct and not useful if they were nondiagnostic or incorrect.We identified the independent risk factor by analyzing whether the characteristics including biopsy methods,lesion position,myxoid,lesion type reduced the effect on the clinical utility and increased the probability of proceeding to subsequent open biopsy.[Result]In 206 patients,one hundred and forty-seven cases(71.4%)underwent core-needle biopsy.Forty-seven cases(22.8%)underwent open biopsy and twelve cases(5.8%)had open biopsy with needle biopsy first.One hundred and seventy-six cases(85.4%)patients had clinical useful results.Eighteen cases(8.7%)were nondiagnostic,and twelve cases(5.8%)were incorrect.Myxoid histology was identified of independent risk factor on the clinical utility by logistic regression(P=0.02).[Conclusion]Most cases of bone lesions can be diagnosed by core-needle biopsy or open biopsy.The myxoid histology is associated with decrease clinical accuracy;No single characteristic cause increase probability of open biopsy.Correct diagnose of bone lesions requires combining biopsy,radiology and clinical data.

Objective To investigate the clinical manifestation and diagnosis of osteitis deformans. Methods Three male patients with characteristic manifestations of osteitis deformans were reviewed in this study. The ages of the patients were 51, 49 and 43 respectively. Two patients with pelvic lesions on X ray films presented symptomatic pain and malaise localized in hip, one complained of tibial bowing deformity. The typical radiographic characteristics were bone enlarged size, increased bone mineral density with uneven distribution; the bone trabeculae were usually coarse and arrayed irregularly like a grid. All patients underwent the diagnostic biopsy. Under microscopic observation, the bone structures were arranged disorderly, the trabeculae were thickened and enriched with osteoclasts and osteoblasts, irregular blue cement line were also seen in thickened trabeculae, the bone marrow were replaced by the fibrovascular connective tissue. All patients were given calcitonin and diphosphonates as medical treament. Results In the follow up period of an average of 16 months(range 3-26 months), one patients had pain relief at lesioned hip but functional limitation remained, the others did not have any sign of malignant progression. The serum alkaline decreased dramatically and the involved bone did not present with deteriorated change. They were working as usual. Conclusion Osteitis deformans is a disorder of bone architecture resulting from disturbance in the rate of bone turnover; typical radiographic and pathologic feature is the important points for definite diagnosis of osteitis deformans.

ObjectiveTo investigate the clinicopathological features of the needle biopsies of prostatic lesions and to evaluate the value of 34?E12 immunostaining for the diagnosis of prostatic carcinoma.MethodsThe clinical data,levels of serum PSA and HE slides of 103 cases of the needle biopsies of prostatic lesions were reviewed.Immunohistochemical stains for 34?E12 were performed.ResultsThe morphological features revealed 36 cases of benign prostatic hyperplasia(BPH),9 cases of low grade prostastic intraepithelial neoplasia (PIN I)and 34 cases of prostatic carcinoma(PC),24 cases of high grade PIN(PINⅡ and Ⅲ) have been suspected of carcinoma.With immunohistochemical stain,all cases of BPH were strongly reactive for 34?E12 while 32 cases of prostatic carcinoma were negative;14 of 24 cases of high grade PIN were negative for 34?E12 and could be diagnosed as PC.The rest 10 of high grade PIN were interruptedly positive in the basal layer for 34?E12.In the 30 cases of prostastic carcinoma,serum PSA levels of 25 cases was over 10 ng/ml and over 50 ng/ml in 15.ConclusionsThe pathologic diagnosis should based on gland architectures and cytologic features.34?E12 negative expression and elevation of serum PSA are also the important criteria for the diagnosis of prostatic carcinoma.

Objective To discuss the treatment and prognosis of multifocal osteosarcoma. Methods Between January 1998 and June 2005, nine patients(seven males and two females), six with synchronous multifocal osteosarcoma and three with metachronous multifocal osteosarcoma were treated in our department. The diagnosis of multifocal osteosarcoma was confirmed by clinical presentation, radiology and pathology. Eight of the nine patients received chemotherapy with adriamycin(60 mg/m2), cisplatinum(100 mg/m2), high-dose methotrexate(8-12 g/m2), vincristine(1.4 mg/m2), ifosfamide(12.5 g/m2), and G-CSF. Based on the response to primary chemotherapy, further chemotherapy plans were made, and different operations were done to control local lesions or to relieve symptoms. Arsenous acid, paclitaxel and VP-16 were used in patients who responded poorly to primary chemotherapy. Results One patient who given up remedy was died in systematic fail due to the cancer after 5 month, five patients who were diagnosed synchronous multifocal osteosarcoma died from progressive disease in 3.5 to 17 months (mean time was 9.8 months). Only two of them had a good response to chemotherapy and had finished at least four cycles of chemotherapy,and they had a better survival time of 15 and 17 months respectively. Three patients with metachronous multifocal osteosarcoma had a better prognosis. After a two-year follow-up, two lived with disease and one lived without disease. Conclusion The prognosis of patients with multifocal osteosarcoma is poor, and patients with metachronous multifocal osteosarcoma have a relatively better prognosis. To improve the prognosis of patients with multifocal osteosarcoma, aggressive chemother-apeutics are needed.

Objective To observe the satisfaction of obtaining endometrial tissue in using endometrial sampling device and explore the influence for pathology diagnostic accordance rate,and to discuss the problem needs to focus in obtaining endometrial tissue with endometrial sampling device for endometrial cancer and precancerous lesion screening.Methods Totally 204 cases using endometrial sampling device with the subsequent diagnostic curettage,hysteroscopy,or hysterectomy were collected.A comparison of pathological diagnosis between two methods was made.The relationship among specimen quantity,proficiency,pathological types and diagnostic accordance rate were analyzed.Results The diagnostic accordance rate of endometrial cancer and precancerous lesion of two methods was 67％ (20/30).92.2％ (188/204) cases successfully got the endometrial glands,77.0％ (157/204) cases got ≥5 specimens of glands and 62.3％ (127/204) cases got ≥10 specimens of glands.When obtaining ≥5 but＜ 10 endometrial glands,the diagnostic accordance rate was 76.7％ (23/30); however,obtaining ≥10 endometrial glands,the diagnostic accordance rate was 92.9％ (118/127).The degree of specimen satisfaction of the first phase was lower than the second phase.Conclusions Obtaining ≥5 endometrial glands in using endometrial sampling device could satisfy the requirement of the basic pathological diagnosis.The proficiency of sampling and the pathological types could influence the degree of specimen satisfaction,and then influence the diagnostic accordance rate.

Objective To explore the application effect of de-escalation thinking shift mode in emergency condition of morning shift meeting. Methods Guided by the de-escalation thinking, critical ill patients transfer tables were established in the emergency department, patients admitted into the emergency resuscitation room were selected from January 2015 to December 2015, and divided into the observation group (329 cases) and the control group ( 310 cases) . Patients in the control group applied the traditional oral shift meeting mode by the bed to check the patient; patients in the observation group applied the de-escalation thinking shift mode of morning shift meeting, followed by the specification of morning shift process and content; additionally, the cooperation of nursing staff, the transfer of nursing adverse events, nurses awareness of the patient′s condition, the patient satisfaction survey were counted before and after the implementation, respectively. Results Chinese version of Nursing Assessment Shift Report (NASR) was used to evaluate the cooperation status between the two sides of nursing staffs, and the mean scores of nursing staffs were 60.50±1.80 and 78.20±2.50 in the control group and the observation group, respectively, showing statistical significance (t=14.23, P<0.01);before application, corresponding statistical results regarding the shift meeting related nursing adverse events showed that there were 5 cases of infusion prolapse/leakage, 2 cases of pressure ulcer, 3 cases of pipe extrusion, and 2 cases of delayed drug delivery;after application, there were 2 cases of infusion prolapse/leakage, 0 case of pressure ulcer, 1 case of pipe extrusion, and 1 case of delayed drug delivery;comparison results showed significantly statistical difference (χ2=1.76-6.74, P<0.05). Before application, assessment results regarding the mean scores of nurses awareness of the patient's condition showed that mean scores of patients′ state of illness, test results, current treatment, potential risk, and nursing focus were 3.83 ± 0.62, 3.16 ± 0.64, 4.17 ± 0.36, 3.47 ± 1.26, and 3.64 ± 1.10, respectively;and after application, mean scores of patients′state of illness, test results, current treatment, potential risk, and nursing focus were 4.71 ± 0.27, 4.53±0.66, 4.89 ± 0.10, 4.50 ± 0.61, and 4.72 ± 0.43, respectively;the differences were statistically significant (t=-8.86--3.35, P<0.05). Furthermore, patient satisfaction with nursing staff in emergency department was improved from 91.6%(284/310) to 96.0%(316/329)(χ2 =25.74,P<0.05). Conclusions The application of de-escalation thinking shift mode in emergency condition of morning shift meeting may contribute to the specification of the transfer process, improvement of nursing work efficiency, and finally result in the promotion of patients′safety and teamwork.

SUMMARY Pheochromocytomaisrareinpregn’ancy.Clinicalfeaturesofacaseofpheochromocytoma during pregnancy in the Peking University People’s Hospital was investigated and the literature reviewed to discuss the diagnosis and treatment of this disease.The patient manifested with hypertension and pro-teinuria,who was easily misdiagnosed with gestational hypertension disease.When she was transferred to our hospital,the symptoms such as,paroxysmal palpitation,dizziness,vomiting were noticed,and the possibility of pheochromocytoma was considered due to the accompanying abdominal mass.An emergent cesarean section was performed successfully due to preterm labor during the treatment of the disease.Af-ter the delivery the drug preparation continued.And the laparoscopic resection of pheochromocytoma pro-ceeded when the blood pressure was steady.The patient recovered fully after the surgery.The final diag-nosis of pheochromocytoma was confirmed with the pathology.Its diagnosis and treatment experiences could improve our understanding and treatment of secondary hypertension due to pheochromocytoma in pregnancy.

Objective To study the clinicopathological characteristics and immunophenotype of solid pseudopapillary neoplasm (SPN) of the pancreas.Methods Retrospective analysis was performed for the clinical materials,pathological features and immunohistochemical phenotype characteristics of the 23 SPN cases.Results Ratio of male to female was 1:10;the average age was 32 years.10(43％) patients had no clinical symptoms,12 (52％) patients had abdominal pain,abdominal distention or diarrhea;1 patient had jaundice.Tumors were in the head of pancreas in 10(43％) cases,and were in the tail or body of pancreas in 13 cases.Grossly,tumors were solid-cystic or solid;the maximum diameter were from 1.3 cm to 17 cm,with the average of 5.9 cm;12 (52％) cases appeared encapsulated.Histopathologically,21 (91％) cases appeared to exhibit a fibrous capsule surrounding the tumors,and the fibrous capsule invasion were observed in all these cases;Pancreas tissues were involved in 8(35％) cases.Tumor cells arranged in sheets,nests and pseudopapillary patterns.Hemorrhage,necrosis and cystic degeneration were often seen.Tumor cells were positive for vimentin,β-catenin,CK,CD10,PR,CD56 and Syn.Tumor were mostly negative for CgA and Ki-67.23 cases were followed up for 2 to 44 months,and all were alive.Conclusion SPN is a low degree malignant tumor often seen in young women with various histological patterns and multiple immunophenotypes.Definite diagnosis of SPN can be made by combining clinicopathological characteristics with a panel of immunohistochemicat marks.SPN grows slowly,often responds to surgical resection and rarely recur.