Objective　To improve the recognition of the imaging appearances of inflammatory pseudotumors of the spleen (IPS), 3 cases with IPS were reported. Methods　The US (n=3), CT (n=3) and MRI (n=1) findings of IPS were reviewed and correlated with the pathologic findings. Results　On US, a well-defined solitary mass with heterogeneous echo texture was found in all 3 cases. A hyperechoic rim with associated acoustic shadowing was shown in 1 case. In all of the 3 cases in nonenhanced CT scanning, a well-defined hypoattenuated mass was found. One had a calcified egg-shell-like rim; On the venous/delayed phase of enhanced CT after contrast administration in 2 cases, slight/marked enhancement was shown. On nonenhanced MRI in 1 case, the mass was shown as heterogeneous hypointensity on T1- and T2- weighted images. Conclusion　IPS should be included in the differented diagnosis of solitary mass lesion of spleen. The imaging findings depend on the variable proportions of fibrous and granulomatous components within the lesion. IPS was characterized by well-defined solitary mass on sonogram, delayed enhancement on enhanced CT, and hypointensity on T2 weighted MR images.

Purpose To investigate the clinicopathologic changes of the lung epithelial tumor with epithelioid granuloma. Methods E-leven cases of lung malignant tumor with epithelial epithelioid granuloma reaction were studied according to the histological changes of lung epithelial tumor, immunophenotype, acid-fast staining, and tuberculosis PCR test results combined with follow-up data. Results The mean age was 62. 3 years, and male to female ratio was 10∶ 1. The main clinical manifestations displayed a cough, chest pain, fever and hemoptysis or bloody sputum. Nine cases were malignant tumors, tuberculosis or inflammatory lesions was 1 case each in pre-vious surgery. The tumor with epithelioid granuloma formation of the 11 cases displayed in the same site ( mixed) . The histopathologic changes of the lesions showed a epithelioid or typical tuberculous granulomas formation, including 4 cases of adenocarcinoma, 5 cases of squamous cell carcinoma and 2 cases of neuroendocrine tumors. The acid-fast bacilli staining was positive in 3 cases;6 cases were positive for PCR detection of mycobacterium tuberculosis. 5 patients died within 2 years due to various causes. Conclusions The lung epithelial tumors with epithelioid granuloma is more commonly found in the middle-aged, The signs and symptoms of the patients are similar to primary epithelial malignant tumors of the lung . The biological behavior was progressive with poor prognosis. The diagnosis of the lesions depends on pathological examination. It is very important to pay more attention to the pathological examination, especially in lung puncture samples, and the differential diagnosis for a definate diagnosis and treatment.

To investigate the clinicpathologic features and the main point of differential diagnosis of T-cell lymphomas in breast. MethodsTwo cases of T-cell lymphomas of the breast were analysed about clinic data, histopathology and imrnunochemistry. ResultsBoth of the patients were women whose age were 37 and 31 years old. Histopathologically, the tumor cells appeared sheet and cord-like arrangements. Some of them distributed around the blood vessel. There was an obvious phenomenon closing blood vessel. Tumor ceils were characterized by less cytoplasm, big and distorted nucleus, thin chromation. Large pieces of necrosis were observed. There were no lympho-epithelial lesions. Immunnohistochemistry showed that CD45, CD45RO, CD3 and CD43 in the tumor cells were all positive, while CD20 and CD74 were negative. Follow-up results showed that one died two and half months after operation and the other died sixteen months after operation. ConclusionsT-cell lymphoma of the hreast is the high malignant tumur which is extremely rare, and its diagnosis mainly depends on the histopathology and the marker of immunohistochemistry.

In order to better play an important role of pathology consultations in the routine work of clinical pathology,and to solve the problems presented during consultation,we comprehensively analyze the reasons that cause pathology consulation,the pathological data management,patient-physician dispute,medical liability,as well as other aspects involved in consulation.Meanwhile,measures to resolve these problems are also proposed.

Acute-On-Chronic Liver Failure ; blood ; pathology ; Case-Control Studies ; Cytochrome Reductases ; metabolism ; Humans ; Prospective Studies ; alpha-Fetoproteins ; metabolism

Objective When pathologists from hospitals at various levels encounters pathological sections diffcult to make clear diagosis, it is necessary to invite pathologists from higher hosiptals or special hospitals for pathologic consultation.In the study, we compared the pathological diagnosis of cases sent to other hospitals for pathological consultation with the original diagnostic result to analyze the differences by the evaluation on the impact of these differences on the treatment and prognosis of these patients, which would provide an effective evidence for the quality control of pathological diagnosis. Methods Cases initially diagnosed at the de-partment of Nanjing General Hospital and later sent to other hospitals for pathological consultation from 2010 to 2014 were collected. All the diagnostic results were examined by at least 3 senior pathologists to find exact diffrences between consultation results and origi-nal diagnostic results. Results Among 2055 cases, it was found that there were 1813 cases (88.2%) without diagnostic discrepan-cy, while 218 cases (10.6%) with minor diagnostic discrepancy and 24 cases (1.2%) with completely distinct diagnostic results. Conclusion The diagnostic results of the vast majority of consultation cases are in accordance with the original results, despite of di-agnostic discrepancies in some cases due to the complexity of disease. Expert consultation has reference for the pathological diagnosis of complicated cases, which also plays a potent supervisory role on the quality control of original pathologic results.

Objective In order to play the role of pathological network management system better in pathological examination, this study explore the present status of new pathology network management system, give an objective evaluation for the operation condition, reveal the effectiveness and the existing problems of this system, and provide reference for its development and improvement.Methods The software of pathological network management system was applied to the pathological specimen reception, patient information and examination status query, pathological diagnosis and technology process, as well as the paraffin block archive, statistical analysis, data recording, and so on.At last, we recorded all the information and made a classification and arrangement.Results Pathological network management system was running normally through the whole process of pathologic examination, including specimen receiving, all examinations, print of pathological applications and spontaneous print of pathological reports in ward, which really achieve one-stop services.But the system has unstable phenomenon occasionally.Conclusion Pathological network management system links each examination process closely, which can improve the work efficiency, and provide scientific basis for pathology quality control.

Objective　To analyse the clinical manifestations, pathoogical and immunohistochemica l features of 9 cases of primary cutaneous CD30-positive anaplastic large cell ly mphoma (ALCL) in order to improve the criteria for its early and differential diagnosis. Methods　 Histopathological method was used to study the morphological characteristics. Immunohistochemical stainings (SP or ABC method) for leukocyte common antigen (LCA), CD20, CD30, CD45RO, CD68, epithelium membran e antigen (EMA), cytokeratin (CK) and HMB45 were applied to the routine para ffin sections of all the 9 cases. Results　 The 9 cases of primary cutaneous CD30-pos itive ALCL consisting of 6 males and 3 females, aged 31 to 84 years (mean 58.2 years). All patients presented with subcutaneous masses or papular eruptions on lower trunk and extremities. Histopatholoically, the lesions were composed of nu merous large round, oval or pleomorphic cells with abundant cytoplasm, amphophil ic or basophilic, and large nucleus with distinct nucleolus. Mitosis was often o bserved. Multinucleated giant cells and Reed-Sternberg cells may be seen. The n e oplastic cells displayed positive antigen markers for CD30 in 9 cases, 6 positiv e for CD45RO and 3 cases negative for both CD45RO and CD20. Two patients died of metastasis, 2 patients experienced recurrence and 5 patients still well during follow-up. Conclusions　 Primary cutaneous CD30-positive ALCL is a morphologically distinctive neoplasm with a comparatively favorable prognosis. This tumor can be differentiated from other malignant tumors on the basis of histopathologic feat ures and positive CD30 which is of significance.

ObjectiveTo investigate the differentially expressed proteins in the plasma exosome of acute-on-chronic liver failure (ACLF) patients with different prognoses, to analyze their functions and biological processes, and to provide a basis for clinical diagnosis. MethodsA prospective study was performed for 10 ACLF patients who were hospitalized and diagnosed in Beijing YouAn Hospital, Capital Medical University, from July 2019 to October 2019, and the patients were followed up for 90 days. The patients who died or received liver transplantation were enrolled as liver transplantation/death group (5 patients), and the patients who survived were enrolled as survival group (5 patients). The Mann-Whitney U test was used for comparison of general data between the two groups. The label-free quantitative proteomic method was used for identification and quantitative analysis of plasma exosome proteins to screen out differentially expressed proteins, and a functional enrichment analysis was performed. R-3.5.1 software was used to perform a hierarchical cluster analysis of differentially expressed proteins to analyze the biological processes involving these proteins. ResultsA total of 860 proteins were identified by the exosome proteomic analysis, and according to the criteria of upregulation ＞1.2 folds or downregulation ＞1.2 folds (P＜0.05), there were 116 differentially expressed proteins. Compared with the liver transplantation/death group, the survival group had 62 upregulated proteins and 54 downregulated proteins. The bioinformatics analysis showed that these differentially expressed proteins mainly participated in immune reaction, signal transduction, vesicle-mediated transport, cell death, and cell proliferation and were closely associated with the signaling pathways including inflammatory response, carbohydrate and amino acid metabolism, hepatocyte injury, and hepatocyte regeneration. ConclusionDifferentially expressed proteins screened out by the label-free quantitative proteomic method can be used as serological markers for the early diagnosis and prognostic evaluation of ACLF.

Objective: To investigate the role of the glycogen synthase kinase 3β (GSK3β) and the peroxisome proliferator-activated receptor alpha (PPARα) signaling pathway in acute liver failure and related mechanisms in a mouse model of acute liver failure induced by D-galactosamine/lipopolysaccharide (D-GalN/LPS). Methods: C57BL/6 mice were given intraperitoneal injection of D-GalN/LPS to establish a mouse model of acute liver failure. SB216763 was used to inhibit the activity of GSK3β and PPARα siRNA was used to inhibit the expression of PPARα. Western blotting was used to measure the expression of PPARα protein. The changes in liver pathology were observed to evaluate liver injury, and the serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured to assess liver function. Quantitative real-time PCR was used to measure the mRNA expression of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), interleukin-12p40 (IL-12p40), and PPARα. A one-way analysis of variance was used for comparison of means between multiple groups; the least significant difference test was used for data with homogeneity of variance, and the Games-Howell method was used for data with heterogeneity of variance. Results: In the mice with liver failure induced by D-GalN/LPS, GSK3β inhibition promoted the mRNA and protein expression of PPARα (F = 13.18 and 301.36, P = 0.00 and 0.00). In the mice with acute liver failure induced by D-GalN/LPS, GSK3β inhibition alleviated liver bleeding, inflammation, and necrosis and reduced the serum levels of ALT (F = 25.16, P = 0.000) and AST (F = 12.96, P = 0.001), as well as the mRNA expression of TNF-α (F = 32.17, P = 0.00), IL-1β (F = 11.57, P = 0.005), and IL-12p40 (F = 14.17, P = 0.015) in liver tissue. The inhibition of PPARα expression reversed the liver-protecting effect of GSK3β inhibition, which manifested as aggravation in liver bleeding, inflammation, and necrosis, increases in the serum levels of ALT (F = 25.16, P = 0.001) and AST (F = 12.96, P = 0.000), and an increase in the mRNA expression of TNF-α (F = 32.17, P = 0.00), IL-1β (F = 11.57, P = 0.024), and IL-12p40 (F = 14.17, P = 0.001) in liver tissue. Conclusion In mice with acute liver failure induced by D-GalN/LPS, the GSK3β-PPARα-inflammatory factor signaling pathway may play an important role. GSK3β inhibition has a protective effect in mice with acute liver failure possibly by activating the inhibitory inflammatory factor of PPARα.