The apprenticeship education of Traditional Chinese medicine(TCM)is an important pathway for the cultivation of talents in TCM education.The combination of institutional education and apprenticeship education is considered to be the most suitable educational model that aligns with the inherent characteristics of TCM education.The current status of TCM education in western medical institutions and the main challenges include the difficulty in transitioning between western and Chinese medical reasoning and limited clinical internship hours for TCM.The strengths and features of TCM apprenticeship education lie in cultural heritage,classical teachings,mentorship,practice orientation and personalized education.Therefore,integration of TCM apprenticeship education and clinical internships for western medical students represents a new educational model for medical undergraduates.

Objective:To investigate the diagnostic role of NR4A3/NOR-1 immunohistochemistry in acinic cell carcinoma (AciCC) of the salivary gland.Methods:A total of 142 tumors were collected from 2004 to 2020 at Nanjing Jinling Hospital, including 24 cases of AciCCs, 12 salivary gland secretory carcinomas,14 salivary duct carcinomas,16 adenoid cystic carcinomas,3 basal cell carcinomas,13 mucoepidermoid carcinomas,7 myoepithelial carcinomas,15 pleomorphic adenomas,15 warthin tumor, 8 myoepithelioma,8 basal cell adenomas, and 7 oncocytomas; 28 normal salivary gland tissues and 2 pancreatic AciCC were also included.Results:NR4A3/NOR-1,a nuclear marker,was positive in 91.7% (22/24) of AciCC of the salivary gland,while DOG1,a membranous and cytoplasmic marker, demonstrated a sensitivity of 95.8% (23/24);there was no significant difference in the overall positive rates( P=0.551), but the stain pattern was different. NR4A3/NOR-1 was negative in normal salivary gland tissues and any other types of tumors in the salivary gland; however,DOG1 showed apical staining in the acinar cells in the salivary gland,as well as salivary gland secretory carcinomas,adenoid cystic carcinomas,basal cell carcinomas,mucoepidermoid carcinomas,myoepithelial carcinomas and basal cell adenomas( P<0.001). NR4A3/NOR-1 showed a high sensitivity(91.7%) and specificity(100%) to identify AciCC of the salivary gland,and in combination with DOG1, the sensitivity increased to 100%. Furthermore, NR4A3/NOR-1 were only positive for AciCC arising from salivary glands but not pancreas(0/2)( P=0.018). Conclusion:NR4A3/NOR-1 is a special and sensitive biomarker for AciCC of salivary glands; combined NR4A3/NOR-1 and DOG1 can be an ideal diagnostic immunohistochemical panel for AciCC.

Objective: To investigate the clinical manifestations, imaging features, clinicopathologic features, and differential diagnosis of solitary fibrous tumors/anginoblastomas (SFT/HPCs) originating in the central nervous system. Methods: Sixty cases of SFT/HPCs originating in the central nervous system were collected at Nanjing Jinling Hospital, from January 1, 2008 to December 31, 2016. The clinical data, imaging data, histomorphologic changes and immunohistochemical finding were analyzed in the sixty cases. Results: The 60 cases included 26 males and 34 females, aged 14 to 85 (median 49) years. The main clinical manifestations were headache, dizziness with nausea and vomiting. Radiologically, the tumors were large, enhancing, solid and cystic masses attached to the dura. Histopathologically, the neoplasms were composed of spindle cells with oval nuclei, inconspicuous nucleoli and moderate amount of eosinophilic cytoplasm arranged in fascicles with areas of hyalinized stroma, myxoid changes and a staghorn vascular pattern. Immunohistochemically, tumor cells of all cases were positive for vimentin (100.0%, 60/60), STAT6 (98.3%, 59/60), CD34 (61.7%, 37/60), and the tumor cells were typically positive for CD99, bcl-2, EMA and SSTR2 as well.Negative for S-100 protein, SOX10, E-cadherin, GFAP. Ki-67 index ranged from 1% to 50%. Forty cases were followed up for 6 to 82 months with average of 40 months, 30 patients were alive and 10 patients died. Conclusions Central nervous system SFT/HPCs can be aggressive and relapses may occur several years after diagnosis. STAT6 is highly sensitive and specific for the diagnosis. Complete tumor resection is optional treatment followed by radiotherapy and chemotherapy. There is a correlation between the prognosis and the location of the disease, the histological grade, Ki-67 index, and fusion gene variants.

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 At present, there are few studies about myelolipoma within adrenal cortical adenoma.Our aim was to provide more basis for correct diagnosis and treatment by investigation into its clinical and pathological features.Methods The clinical and pathological data were retrospectively reviewed in 11 patients of myelolipoma within adrenal cortical adenoma, along with relative literature reviews.Results The median age of 11 patients (7 females, 4 males) was 49±9.5 years, among whom 3 patients presented Cushing's syndrome, 1 patient with more than 10 years' recurrent dizzy with hypertension, other 7 patients were found coincidently by routine examination.Adrenal mass were found by imaging examination.Pathologically, myelolipomas were in solitary nodule distribution and/or admixed with adrenal cortical adenomas.Myelolipomas were composed of variable admixture of mature adipose tissue and hematopoietic elements.Surgical treatment was performed for all 11 patients, and no relapse was found in 2 months' to 11 years' follow-up.Conclusion Myelolipoma within adrenal cortical adenoma is extremely rare, which is common in females.The patients may present with Cushing's syndrome, hypertension or without obvious clinical syndrome.All the patients are in favorable prognosis after surgical resection.

Objective: To study the clinicopathologic characteristics and diagnostic criteria of primary mediastinal B-cell lymphoma (PMBL), and to distinguish PMBL from classic Hodgkin lymphoma(CHL) and systemic diffuse large B-cell lymphoma(DLBCL). Methods: The clinical features, histologic findings, results of immunohistochemical study and prgnosis in 27 PMBL cases were analyzed, with review of literature. Results: The age of patients ranged from 19 to 82 years (median age 34 years). All cases were located in the mediastinum and frequently accompanied by superior vein cava syndrome. Histologically, the tumor cells were pleomorphic and diffusely distributed. Clear cytoplasm and spindle tumor cells were seen in some cases. Varying amount of sclerosing stroma with collagen deposition was seen.Immunohistochemical study showed that the tumor cells were positive for CD20(100%, 27/27), CD30 (64.0%, 16/25), CD23 (77.3%, 17/22) and p63 (16/19). Clonal B cell gene rearrangement was seen. Conclusions PMBL is a subtype of diffuse large B-cell lymphoma with various histomorphology. Immunohistochemistry can help to confirm the diagnosis, and the prognosis is better than diffuse large B cell lymphoma, not otherwise specified.

OBJECTIVETo study the clinicopathologic features and differential diagnosis of alveolar soft part sarcoma (ASPS).

METHODSThe clinical data and pathologic features of 48 cases of ASPS were evaluated. Immunohistochemical study, PAS staining and fluorescence in-situ hybridization (FISH) were carried out in selected examples. Relevant literature was reviewed.

RESULTSAmongst the 48 cases studied, there were 17 males and 31 females, with male-to-female ratio of 1.0∶1.8. The age of patients ranged from 2 to 60 years (median=26 years). The tumor was most commonly located in deep soft tissue, especially that of lower extremities. Histologically, the tumor cells were arranged in alveolar or solid patterns and separated by sinusoidal vessels. They were large and contained abundant eosinophilic granules or crystals in cytoplasm. The nuclei were round to polygonal and vesicular, often with prominent nucleoli. Intravascular tumor extension was common. Some cases showed necrosis, hemorrhage and cystic changes. Immunohistochemical study showed that the tumor cells were positive for TFE3 (100%, 33/33). FISH assay was carried out in 4 cases and all of them had TFE3-ASPL gene fusion.

CONCLUSIONSASPS is a rare malignant neoplasm, often occurs in young patients. TFE3 is a useful immunohistochemical marker for diagnosis. The diagnosis is further confirmed by other markers.

Adolescent ; Adult ; Basic Helix-Loop-Helix Leucine Zipper Transcription Factors ; genetics ; Child ; Child, Preschool ; Diagnosis, Differential ; Female ; Gene Fusion ; Humans ; In Situ Hybridization, Fluorescence ; Male ; Middle Aged ; Oncogene Proteins, Fusion ; genetics ; Sarcoma, Alveolar Soft Part ; diagnosis ; pathology ; Young Adult

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 To investigate the clinicopathologic characteristics, differential diagnosis and prognosis of pulmonary epithelioid hemangioendotheliomas (PEHs).Methods The clinical symptoms and imaging findings of 6 cases of PEHs were investigated and pathologic analyses including histomorphologic and immunohistochemical studies were performed.Results Clinical symptoms of the patients were nonspecific and insidious.The typical radiological manifestation was characterized by multiple small pulmonary nodules. The pathological findings were well-demarcated hypocellular hyalinized nodules with more cellularity at the periphery of the nodule. The neoplastic cells showed mild nuclear atypia and prominent eosinophilic cytoplasm with vacuoles, attempting to form primitive vasculature.Immunohistochemically, tumor cells were positive to CD31, CD34 and ERG.Follow-up data from 8 months to 5 years showed no tumor progression, except for the development of bone metastases in one case at 6 months.Conclusions PEHs are uncommon vascular tumors with low-intermediate malignancy. Using H&E and immunohistochemistry, the final pathological diagnosis can be made and misdiagnosed as a benign fibrotic nodule or other malignant tumors can be avoided. The most effective treatment is surgical resection, if necessary, combined with chemotherapy or radiotherapy.

Objective To study the correlation between MGMT expression , clinicopathologic features and post-chemotherapy prognosis in patients with primary central nervous system lymphoma diffuse large B-cell lymphoma (PCNS-DLBCL).Methods MGMT expression was detected in 76 cases of PCNS-DLBCL by EnVision method with immunohistochemical staining .Follow-up data including treatment response and overall survival time , were analyzed.Results The rate of MGMT expression in PCNS-DLBCL was 67.1%(51/76).The MGMT expression rate in male patients was higher than that in female (P<0.05). Univariate analysis showed that these clinical pathological characteristics affected the overall survival of PCNS-DLBCL patients , including age and Hans algorithm , although no statistical significance was detected ( P value was 0.065 and 0.069 respectively ) .The overall survival of the patients with positive MGMT and aged over 60 years was shorter after chemotherapy than those without chemotherapy ( P=0.022 ) .In the patients aged over 60 years, the prognosis of MGMT-positive patients was significantly better than MGMT-negative patients ( P=0.044 ) .Conclusions The expression of MGMT is more commonly found in male patients.In the patients aged over 60 years with the same therapy , the prognosis is better in the MGMT-negative ones.Detection of MGMT protein expression can provide some guidance in choice of treatment modalities in PCNS-DLBCL patients.