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【Objective】 To investigate the predictive value of high preoperative neutrophile-lymphocyte ratio (NLR) for the prognosis of nonurothelial carcinoma of the bladder (NUBC) after radical cystectomy (RC). 【Methods】 Clinical and follow-up data of NUBC patients undergoing RC during Jan.2005 and Dec.2020 were collected. The optimal cut-off value of NLR was determined with the receiver operating characteristic (ROC) curve. The survival curve was drawn with Kaplan-Meier method to compare the differences in cancer specific survival (CSS) and overall survival (OS) between the high-NLR and low-NLR groups. The independent risk factors of CSS and OS were screened with Cox proportional hazard regression model. 【Results】 Of the 62 eligible cases,34 (54.8%) were diagnosed with adenocarcinoma,17 (27.4%) with squamous cell carcinoma, 6 (9.7%) with small cell carcinoma and 5 (8.1%) with sarcoma. Kaplan-Meier analysis results showed high NLR was associated with poor CSS (P=0.001) and OS (P<0.001). Cox regression results indicated that high NLR (HR=2.42, 95%CI: 1.12-5.23, P=0.025) and advanced pathologic tumor stage (HR=3.21, 95%CI:1.53-6.74,P=0.002) were independent risk factors of unfavorable CSS. Similarly, high NLR (HR=2.75, 95%CI: 1.35-5.56, P=0.005) and advanced pathologic tumor stage (HR=2.81, 95%CI:1.43-5.57, P=0.003) were independent risk factors of unfavorable OS. 【Conclusion】 As an independent risk factor of unfavorable CSS and OS in NUBC patients undergoing RC, high preoperative NLR is of great value in the prediction of long-term prognosis and may help to optimize individualized treatment.
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Pathological specimen sampling is not only the prerequisite of a good pathological diagnosis, but also the primary clinical skill that must be mastered by the standardized residency training trainees (resident trainees) in clinical pathology department. In view of the problems and difficulties encountered in the teaching of specimen sampling, through five years of exploration and attempt, this paper has gradually established a new model with five basic elements, including theory teaching, practice teaching, promoting teaching effect by examination, learning from senior students, and review teaching. The results of evaluation analysis and questionnaire survey show that the teaching mode can make the trainees master the methods of specimen sampling quickly and efficiently, learn and improve clinical skills in practice, and lay a solid foundation for the subsequent standardized training of histopathological diagnosis.
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Objective@#To investigate the clinicopathological features, special morphologic variants and potential diagnostic traps of classical follicular dendritic cell sarcoma (FDCS).@*Methods@#A total of 25 cases of classical FDCS diagnosed in the First Hospital Affiliated to Army Medical University from 2006 to 2018 were examined by hematoxylin-eosin staining, immunohistochemistry and in situ hybridization for Epstein-Barr virus-encoded mRNA (EBER). Meanwhile, the types and characteristics of the special variants of FDCS were summarized along with those reported in the literature.@*Results@#The age of patients ranged from 23 to 77 years (mean 52 years), the male to female ratio was 1.5, and the maximum diameter of tumor was 1.5 to 20 cm (mean 7.4 cm). Twelve cases (48%) were misdiagnosed at the initial evaluation. Follow-up information was available for 17 patients, and the follow-up time was 5 to 96 months. The propotion of patients having recurrence, metastasis and mortality was 3/17, 5/17 and 2/17, respectively. Microscopically, besides the typical morphology, 10 cases of FDCS showed special histomorphologies and/or structures, including those mimicking lymphoepithelioma-like carcinoma, desmoplastic infiltrating carcinoma, classical Hodgkin′s lymphoma (CHL), anaplastic large cell lymphoma (ALCL) and hemangiopericytoma. These morphologic variants were potential diagnostic pitfalls and warranted attention. Immunohistochemistry showed that more than two markers of follicular dendritic cells (such as CD21, CD23, CD35, etc.) were expressed in cases showing typical morphology and the special variants. All 25 cases were all negative for EBER by in situ hybridization.@*Conclusions@#Classical FDCS is rare, besides the typical morphologic features, there are many special variants. In particular, these may be confused with lymphoepithelioma-like carcinoma in the nasopharynx, CHL or ALCL in the mediastinum/lymph node. Awareness of these variants is essential for accurate diagnosis.
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Objective:To investigate the clinicopathological features and prognosis of pleomorphic giant cell adenocarcinoma (PGCA) of the prostate, and to strengthen the understanding of this rare variant.Methods:From January 2009 to December 2019, 383 pathological samples of prostate adenocarcinoma with Gleason scores of 8-10 were selected from the First Affiliated Hospital, Army Medical University. PGCA was screened by reviewing the histomorphology of hematoxylin and eosin stained sections. Then the expression of prostate specific markers and mismatch repair (MMR) proteins of PGCA were detected by immunohistochemistry (IHC), and microsatellite instability (MSI) status was detected through polymerase chain reaction (PCR)-capillary electrophoresis. Meanwhile, the clinicopathological characteristics, diagnosis, treatment and prognosis of PGCA were summarized and analyzed along with those reported in the literature.Results:Three patients with PGCA of the prostate were 68, 63 and 71 years old respectively, and case 1 had a history of transurethral resection of the prostate and oral bicalutamide 3 months before surgery. All 3 patients underwent radical prostatectomy and received endocrine therapy, radiotherapy and/or chemotherapy, and died at 18, 23, and 10 months after surgery, respectively. Histologically, both the usual prostate adenocarcinoma with Gleason score of 9-10 and the pleomorphic giant cell component with anaplastic characteristics were observed in 3 tumors, and the latter accounted for 90%, 10%, and 20%, respectively. Immunohistochemical staining showed that both components expressed epithelial markers (CK, CK8/18) and prostate-specific markers (NKX3.1, PSA, P504S) to varying degrees, and the expression of MMR proteins (MSH2, MSH6, MLH1 and PMS2) were not defective. MSI was not detected in the usual prostate adenocarcinoma and pleomorphic giant cell components obtained by microdissection in 3 cases. Combined with 10 cases reported in the literature, there were totally 13 cases of PGCA for reviewing. The patients were 45-81 years old, the average age was 66 years old, and the median age was 66 years old. During the follow-up period of 3-36 months, 7 cases relapsed/metastasized, 6 cases died within 23 months after diagnosis, and 4 of which died within 1 year.Conclusions:PGCA is a newly recognized rare variant of prostate adenocarcinoma. At present, all cases are accompanied with high-grade usual prostate adenocarcinoma with Gleason score of 9-10, but it is different from the latter in pathological morphology and clinical manifestations, by presenting high invasiveness and poor prognosis. PGCA is not sensitive to conventional endocrine therapy, radiotherapy or chemotherapy. Accurate diagnosis of PGCA is helpful to judge the prognosis of patients and guide the treatment.
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Objective@#To investigate the clinicopathological features and prognostic parameters of the inflammatory pseudotumor-like follicular dendritic cell sarcoma (IPT-like FDCS) of liver and spleen.@*Methods@#Ninteen cases of inflammatory pseudotumor (IPT) and 5 cases of IPT-like FDCS of the liver and spleen were collected at the First Affiliated Hospital, Army Medical University from 2006 to 2016. HE sections, immunohistochemical staining, and Epstein-Barr virus encoded nuclear RNA (EBER) in situ hybridization were reviewed along with a summary of the literature.@*Results@#Among the previously diagnosed 19 cases of IPT of the liver and spleen, 2 cases were misdiagnosed (the ratio of 2/19). Among 7 new cases including 3 males and 4 females, 3 cases involved the liver and 4 cases involved the spleen. The age range was 37-64 years (mean 53 years). The maximum tumor diameter ranged from 3.0 to 11.0 cm (mean 6.5 cm). Surgical resections were performed in all patients with follow-up time ranging from 3 to 84 months.All patients were disease-free.7 new cases were all positive for EBER, and showed the expression of at least one of the FDC markers, including CD21, CD23, and CD35. The rest of 17 cases of IPT were all negative for EBER and essentially negative for FDC markers, but were all positive for SMA.@*Conclusions@#IPT-like FDCS of the liver and spleen is a rare low-grade malignant tumor morphologically mimicking inflammatory pseudotumor, and is easy to be misdiagnosis due to under-recognition. EBER in situ hybridization and FDC markers are indispensable for confirming the diagnosis.
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Objective To explore contrast-enchancement ultrasound (CEUS) parameters of hepatocellular carcinoma (HCC) with different cytokeratin-19 (CK19) expression in the background of cirrhosis.Methods CEUS data of pathologically proven HCC in patients with cirrhosis in Southwest Hospital from June 2005 to October 2013 were collected in this retrospective study. Two groups were classified on the basis of different CK19 expression in HCC patients: CK19 positive group (seventy-nine patients) and CK19 negative group (eighty-ifve patients). DFY-II Ultrasound Imaging Analysis Software was utilized to measure and calculate CEUS paramrters, including the enhancement heterogeneity of the tumor and peak intensity in arterial phase, the enhancement intensity of tumor and the enhancement ratio of tumor/adjacent liver parenchyma in portal phase. The difference between the two groups was compared by statistics test. Results TThe arterial phase enhancement heterogeneity of tumor in CK19 positive group was higher than that of the negative group (2.64±0.64 vs 2.29±0.31). The arterial phase peak intensity of tumor in CK19 positive group was lower than that of the negative group [(102.83±29.78)dB vs (120.65±25.49)dB]. The portal phase enhancement intensity of tumor in CK19 positive group was lower than that of the negative group [(66.83±20.13) dB vs (79.99±27.15) dB ].The enhancement ratio of tumor/adjacent liver parenchyma in portal phase was lower in CK19 positive group than that in the negative group (0.74±0.03 vs 0.92±0.22). All above comparisons had significant differences between two group. Conclusions The CEUS enhancement parameters had signiifcant difference between the CK19 positive HCC and negative HCC in patient with background cirrhosis.
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Objective To investigate the correlation of ? catenin expression with the carcinogenesis and progression of human colorectal cancer Methods The colorectal adenoma carcinoma tissue chips including 400 cores were constructed and the expression of ? catenin in 220 cases of colorectal adenoma and carcinoma was detected by immunohistochemical staining Results The effective rates of information by tissue chips stained by hematoxylin eosin and immunohistochemistry were 98 8% and 98 0%, respectively The nuclear expression rate of ? catenin was 35 9% in malignant changes in adenoma, which was significantly higher than that in adenoma (16 7%) and carcinoma (19 7%) ( P