Antigens, CD ; metabolism ; Diagnosis, Differential ; Female ; Humans ; Killer Cells, Natural ; pathology ; Leg ; Lymphoma, T-Cell, Cutaneous ; immunology ; pathology ; Middle Aged ; Skin Neoplasms ; immunology ; pathology

Adult ; Antigens, CD ; metabolism ; Antigens, Differentiation, Myelomonocytic ; metabolism ; Diagnosis, Differential ; Histiocytosis, Langerhans-Cell ; pathology ; Humans ; Immunohistochemistry ; Male ; Meningeal Neoplasms ; metabolism ; pathology ; surgery ; Meninges ; pathology ; Peroxidase ; metabolism ; Sarcoma, Myeloid ; metabolism ; pathology ; surgery

Diagnosis, Differential ; Gastric Mucosa ; pathology ; Gastritis, Hypertrophic ; pathology ; surgery ; Humans ; Male ; Middle Aged

OBJECTIVETo describe the morphologic features and immunohistochemistry of spindle cell carcinoma of breast with neuroendocrine differentiation.

METHODSRetrospective review of 2500 cases of breast carcinoma showed 5 cases (0.2%) with a predominance (> 80%) of spindle cell component. Amongst the 5 cases studied, 2 represented intraductal spindle cell carcinoma and 3 represented invasive spindle cell carcinoma. The paraffin sections were stained with hematoxylin and eosin, alcian blue, periodic acid-Schiff and reticulin stain. Immunohistochemical studies for AE1/AE3, CEA, EMA, CK7, 34betaE12, NSE, synaptophysin, chromogranin A, Leu-7, vimentin, S-100, SMA, calponin, estrogen receptor, progesterone receptor, c-erbB2, E-cadherin, Ki-67 and p53 were also carried out. Follow-up information was available in 4 of the 5 cases.

RESULTSThe mean age of the patients was 68 years. Histologically, all tumors were predominantly composed of elongated spindle cells. Three of these cases also contained tumor cells with vacuolated cytoplasm, alcian blue-positive tumor cells were observed in 4 cases. Immunohistochemically, the spindle tumor cells in all cases expressed AE1/AE3, CEA, EMA, E-cadherin and synaptophysin. CK7 was positive in 4 cases, NSE in 3 cases, chromogranin A and Leu-7 in 2 cases. Estrogen receptor was expressed in 4 cases and progesterone receptor in 2 cases. Overexpression of c-erbB2 oncoprotein was detected in only 1 case. Vimentin was focally positive in 1 case. Two cases of intraductal spindle cell carcinoma and 1 of the 3 cases of invasive spindle cell carcinoma were classified as neuroendocrine carcinoma of spindle cell type, while the remaining 2 cases of invasive spindle cell carcinoma were considered as metaplastic carcinoma with neuroendocrine differentiation. Amongst the 4 patients with follow-up information available, 3 were still alive 24 to 58 months after the initial diagnosis. One patient died within 27 months of diagnosis.

CONCLUSIONSThe presence of spindle tumor cells and sometimes intracytoplasmic mucin are useful morphologic clues in diagnosing spindle cell carcinoma of the breast with neuroendocrine differentiation. Intraductal neuroendocrine spindle cell carcinoma needs to be distinguished from usual ductal hyperplasia and intraductal papilloma. On the other hand, invasive spindle cell carcinoma with neuroendocrine differentiation needs to be distinguished from spindle cell myoepithelioma, malignant melanoma and sometimes soft tissue neoplasm.

Aged ; Biomarkers, Tumor ; analysis ; Breast Neoplasms ; chemistry ; pathology ; Carcinoma ; chemistry ; pathology ; Carcinoma, Intraductal, Noninfiltrating ; chemistry ; pathology ; Chromogranin A ; Chromogranins ; analysis ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Middle Aged ; Neuroendocrine Tumors ; chemistry ; pathology ; Phosphopyruvate Hydratase ; analysis ; Retrospective Studies ; Synaptophysin ; analysis

Antigens, CD ; metabolism ; Antigens, CD20 ; metabolism ; Antigens, Differentiation, Myelomonocytic ; metabolism ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Axilla ; Histiocytic Sarcoma ; drug therapy ; metabolism ; pathology ; Humans ; Immunohistochemistry ; Leukemia, Lymphocytic, Chronic, B-Cell ; drug therapy ; metabolism ; pathology ; Male ; Middle Aged ; Receptors, IgE ; metabolism

ADP-ribosyl Cyclase 1 ; metabolism ; Adult ; Brain Neoplasms ; metabolism ; pathology ; surgery ; CD79 Antigens ; metabolism ; Castleman Disease ; metabolism ; pathology ; Diagnosis, Differential ; Humans ; Leukocyte Common Antigens ; metabolism ; Lymphoma, Large B-Cell, Diffuse ; metabolism ; pathology ; surgery ; Lymphoma, Large-Cell, Anaplastic ; metabolism ; pathology ; Male ; Melanoma ; metabolism ; pathology ; Parietal Lobe ; Plasma Cells ; metabolism ; pathology

Diagnosis, Differential ; Histiocytoma, Benign Fibrous ; metabolism ; pathology ; Histiocytosis, Langerhans-Cell ; metabolism ; pathology ; Histiocytosis, Sinus ; metabolism ; pathology ; surgery ; Humans ; Infant ; Male ; S100 Proteins ; metabolism ; Xanthogranuloma, Juvenile ; metabolism ; pathology

Objective To analyze current situation and problems of health manager training in the pilot training areas. Method With the recommendations of health administration deputies in the plot areas of Shanghai, Chongqing and Urumqi, 2 centers for community health services (CHSs) were selected in each area, 9 relative persons were interviewed, 3 focus group discussions (FGDs) involved 18 persons were held totally. The FGDs focused on such questions as“the general information of the training students”“the objectives and purposes of the training in each area”, and so on. Field investigation and qualitative analysis were used to investigate the status quo and main problems of the training of health manager in the pilot areas. Result The problems of the training of health manager existing in the pilot areas mainly are:part of teachers were not fully competent to the training of health manager, training of operant skill was insufficient, training course was not unified, the assessment mechanism was not perfect. Conclusion Optimizing the construction of teachers team, standardizing the training content, increasing the time of operating skills training, establishing a unified and standardized assessment mechanism are essential.

Female ; Humans ; Lymphoma ; classification ; pathology ; Lymphoma, B-Cell, Marginal Zone ; pathology ; Mediastinal Neoplasms ; pathology ; physiopathology ; Young Adult

Objective To compare adductor canal block(ACB)with topical anesthesia for postoperative analgesia in the patients undergoing arthroscopic knee surgery.Methods Sixty patients of both sexes,aged 18-64 yr,with body mass index of 18-30 kg/m2,of American Society of Anesthesiologists physical status ⅠorⅡ,scheduled for elective arthroscopic meniscectomy,were divided into 2 groups (n=30 each) using a random number table:ACB group and topical anesthesia group(TA group).In group ACB,0.2% ropivacaine 20 ml was injected into the adductor canal under the guidance of ultrasound at 30 min before operation to perform ACB.In group TA,0.25% ropivacaine 20 ml was injected into the articular cavity at 5 min before the end of operation.The development of effective analgesia (VAS scores ≤4)and weakened quadriceps femoris muscle strength(muscle strength 0-2 grade,post-operative muscle strength was assessed by using manual muscle testing),related complications(local anesthetic intoxication,bleeding at the puncture site and hematoma) and occurrence of postoperative nausea,vomiting and delayed emergence were recorded.Results Compared with group TA,the rate of effective analgesia within 12 h after surgery was significantly increased (P<0.01),and no significant change was found in the incidence of weakened quadriceps femoris muscle strength,nausea and vomiting in group ACB(P>0.05).Local anesthetic intoxication,bleeding at the puncture site,hematoma or delayed emergence was not observed in the two groups.Conclusion ACB produces better efficacy for postoperative analgesia than topical anesthesia in the patients undergoing arthroscopic knee surgery.