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 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.

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 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.

To explore the automated immunostainer screening anaplastic lymphoma kinase (ALK) gene fusion non-small cell lung cancer (NSCLC) and clinicopathological characteristics of the molecular subtype lung cancers. Methods Five hundred and sixty-six cases of NSCLC were collected over a 16 month period. The test for ALK was performed by Ventana automated immunostainer with anti-ALK D5F3. The histological features, treatment and outcome of patients were assessed. Results Thirty-eight cases (6.7%, 38/566) of NSCLC showed ALK gene fusion. The frequency of ALK gene fusion was higher in male (7.1%, 25/350) than that in female (6.0%, 13/216) patients, but not achieving statistical significance (chi2 = 0.270, P = 0.604). ALK + NSCLC was more significantly more frequent in patients < or = 60 years (9.9%, 28/282) than >60 years (3.5% , 10/284) of age. Histologically, the ALK + NSCLCs were mostly adenocarcinoma (81.6%, 31/38) , among which eighteen cases were solid predominant subtype with mucin production; nine cases were acinar predominant subtype; one case was papillary predominant subtype and three cases were invasive mucinous adenocarcinoma. The ALK + non-adenocarcinoma included three cases of squamous cell carcinoma, three cases of adenosquamous carcinoma and one case of pleomorphic carcinoma. Among the ALK + NSCLC patients, the number of non/light cigarette smokers (86. 8% , 33/38) was more than that of heavy smokers. Twenty-nine cases were stages III and IV; twenty-nine cases showed lymph node metastasis; twenty cases showed metastases mostly to brain and bone; and one case showed EGFR gene mutation coexisting with ALK gene fusion. Twelve of fifteen patients received crizotinib therapy and remained stable. Conclusions NSCLC with ALK gene rearrangement shows distinctive clinical and histological features. Ventana-IHC may he a feasible and valid technique for detection of ALK rearrangement in NSCLC.
Adenocarcinoma ; genetics ; pathology ; Carcinoma, Adenosquamous ; genetics ; pathology ; Carcinoma, Non-Small-Cell Lung ; genetics ; pathology ; Carcinoma, Squamous Cell ; genetics ; pathology ; Female ; Gene Fusion ; Gene Rearrangement ; Humans ; Lung Neoplasms ; genetics ; pathology ; Male ; Middle Aged ; Protein Kinase Inhibitors ; therapeutic use ; Pyrazoles ; therapeutic use ; Pyridines ; therapeutic use ; Receptor Protein-Tyrosine Kinases ; genetics ; Sex Factors

Purpose To investigate the clinicopathological and immunohistochemical features of primary small cell carcinoma of the cervix ( SCCC) and its prognosis. Methods 18 cases of primary cervical small cell carcinoma were evaluated by histopathology, in si-tu hybridization and immunohistochemistry and relevant literatures were reviewed. Results The age of the patients ranged from 30 to 69 years ( mean age, 40 years) . Major clinical manifestation was irregular colporrhagia. Colposcopy often revealed a cervical mass or cervical erosion. Microscopically, the tumor cells were small and round and arranged in a solid distribution. The cell had little cyto-plasm and increased karyoplasmic ratio with deeply stained granular chromatin and increased pathological mitosis. Immunohistochemi-cally, the tumor cells were often positive for CKpan, variable positive for Syn, NES, CgA, CD56 and p16. HPV 16/18 were positive in 4 cases. Conclusion SCCC is a neuroendocrine tumor of high malignancy and poor prognosis with a possible pathogenesis of HPV 16/18 infection. CKpan, Syn, CgA, NSE and CD56 are useful markers for the diagnosis of SCCC.

Purpose To investigate the expression and significance of HLA-G in ovarian serous carcinoma ( OSC) . Methods HLA-G antigen was immunohistochemically labeled on paraffin-embedded sections of 108 OSCs. The relationship between HLA-G expression and the clinicopathologic parameters was studied. Results The positive expression of HLA-G was observed in 58. 33% (63/108) of OSC tissues. Positive expression of HLA-G was significantly related with lymph node metastasis, recurrence, occurrence site, FIGO stage and MDACC grading system (P<0. 05). In survival analysis, the expression of HLA-G was significantly relevant to prognosis (P=0. 015). Multivariate Cox analysis showed the expression of HLA-G was an important prognosis factor of OSC (P=0. 01). Con-clusion The positive expression of HLA-G could predict high grade and advanced stage of OSC as well as poor prognosis. Also it could distinguish high-grade OSC from low-grade OSC.

Purpose To study the clinicopathologic features retrospectively and to explore the prognosis of 15 cases of young pulmonary primary salivary gland tumor. Methods The 15 cases of young pulmonary primary salivary carcinoma were analyzed respectively. Re-sults The 15 cases showed 7 cases with adenoid cystic carcinoma and 8 cases with mucoepidermoid carcinoma. Cough and bloody sputum were main symptoms, while chest pain, chest distress and fever were less seen. There were 10 cases performed with partial pul-monary lobectomy, 3 cases performed with unilateral total lobectomy, 1 case performed with artery perfusion treatment and bronchial ar-tery embolization and 1 case performed with conservative treatment for pancreatic metastasis after diagnosis. The mean follow-up time was 28 months ( from 4 to 96 months) . Conclusion The primary salivary gland-type lung tumor belonged to benign or low-grade ma-lignant tumor, mainly accompanied with hacking cough and bloody sputum, which was commonly found in trachea and bronchus. Final diagnosis could be made through bronchoscopy and biopsy. Complete surgical excision is the primary method and the prognosis is usual-ly good, especially in the young.

Purpose To investigate the expression of GATA3 in breast tumors and its clinical significance. Methods Immunohisto-chemistry EnVision method was used to detect the expression of GATA3 protein in 132 cases of breast malignant tumor tissue, 29 cases of breast benign tumor tissue, 35 cases of breast carcinoma adjacent tissue. Besides, the GATA3 expression level was compared with several clinicopathological parameters. Result (1) All the breast normal tissues expressed GATA3, while 77% of the breast cancer tissue were found to be GATA3 positive. (2) GATA3 did not expressed in diffuse large B cell lymphoma and spindle cell malignant tumor of breast. (3) In the triple negative breast cancer, the expression of GATA3 was lower than that of any other subtypes of breast carcinoma (χ2 =29. 354, P<0. 001). Conclusion The positive expression of GATA3 is correlated to classification and grade in breast tumor. Detection of the expression of this biological maker may provide a valuable marker for the differential diagnosis and prog-nostic of breast carcinoma.

Objective To explore the automated immunostainer screening anaplastic lymphoma kinase ( ALK) gene fusion non-small cell lung cancer ( NSCLC) and clinicopathological characteristics of the molecular subtype lung cancers.Methods Five hundred and sixty-six cases of NSCLC were collected over a 16 month period.The test for ALK was performed by Ventana automated immunostainer with anti-ALK D5F3.The histological features, treatment and outcome of patients were assessed.Results Thirty-eight cases (6.7%, 38/566) of NSCLC showed ALK gene fusion.The frequency of ALK gene fusion was higher in male ( 7.1%, 25/350 ) than that in female ( 6.0%, 13/216 ) patients, but not achieving statistical significance (χ2 =0.270, P=0.604).ALK+NSCLC was more significantly more frequent in patients≤60 years (9.9%, 28/282) than >60 years (3.5%, 10/284) of age.Histologically, the ALK+NSCLCs were mostly adenocarcinoma (81.6%, 31/38) , among which eighteen cases were solid predominant subtype with mucin production;nine cases were acinar predominant subtype;one case was papillary predominant subtype and three cases were invasive mucinous adenocarcinoma.The ALK +non-adenocarcinoma included three cases of squamous cell carcinoma, three cases of adenosquamous carcinoma and one case of pleomorphic carcinoma.Among the ALK+NSCLC patients, the number of non/light cigarette smokers (86.8%, 33/38) was more than that of heavy smokers.Twenty-nine cases were stages Ⅲ and Ⅳ; twenty-nine cases showed lymph node metastasis; twenty cases showed metastases mostly to brain and bone; and one case showed EGFR gene mutation coexisting with ALK gene fusion.Twelve of fifteen patients received crizotinib therapy and remained stable.Conclusions NSCLC with ALK gene rearrangement shows distinctive clinical and histological features.Ventana-IHC may be a feasible and valid technique for detection of ALK rearrangement in NSCLC.