目的 探讨不典型胎盘早剥的临床特点。 方法 对2008年5月－2009年5月收治的55例胎盘早剥患者的临床资料进行回顾性分析。其中产前漏诊30例，疑诊15例，确诊10例。胎盘早剥的产前确诊率为18.2%，漏诊率为54.5%。所有患者均经产后证实。 结果 重度子痫前期（25.5%）、胎膜早破（12.7%）是胎盘早剥的主要发病诱因；阴道流血（52.7%）、腰腹痛（47.3%）及胎心异常（36.4%）是其常见的临床表现。胎盘早剥者，剖宫产率、胎儿窘迫及早产率均增加。 结论 不典型胎盘早剥病情隐匿。后壁胎盘、早剥面积小及B型超声检查阴性是漏诊的主要原因。对此患者应提高认识，动态监测，及时处理，以改善母婴结局。
ObjectiveTo systematically review the overall diagnostic efficacy of Gd-EOB-DTPA-enhanced MRI in differentiating dysplastic nodules (DNs) and hepatocellular carcinoma (HCC), exploring whether the hepatobiliary phase can effectively improve diagnostic accuracy. MethodsThe PubMed, Embase, Web of Science, Cochrane Library, CNKI, WanFang Data, and CBM databases were searched from January 1998 to March 2023 to identify original studies on Gd-EOB-DTPA-enhanced MRI for the differential diagnosis of DNs and HCC. Two investigators independently performed literature screening, extraction of data features and quality assessment. Meta-analysis was performed using Stata 17.0 and Meta-disc1.4 software. ResultsA total of 14 papers were included in this meta-analysis, including 375 DNs and 653 HCC. The results of meta-analysis showed that, in the multiparametric diagnostic sequence, the pooled Sen, Spe, PLR, NLR and AUC were 0.95 (95%CI 0.87 to 0.98), 0.95 (95%CI 0.91 to 0.97), 18.57 (95%CI 9.64 to 35.78), 0.06 (95%CI 0.02 to 0.14) and 0.98 (95%CI 0.97 to 0.99), respectively. ConclusionGd-EOB-DTPA-enhanced MRI has a good differential diagnostic value for DNs and HCC. Hepatobiliary phase imaging also greatly compensates for the diagnostic deficiency of dynamic enhancement with low sensitivity for early HCC.
【Abstract】Objective To investigate the changes of myoepithelial cells in mammary atypical hyperplasia and breast cancer. MethodsSP immunohistochemistry was used to detect actin expression in normal breast tissue, grade Ⅰ, Ⅱ and Ⅲ atypical hyperplasia and breast cancer. Electromicroscopy was used to observe the changes of ultrastructure of myoepithelial cells. Results Actin was only detected in myoepithelial cells of normal breast tissue and grade Ⅰand Ⅱ atypical hyperplasia. The positive expression rates of actin in grade Ⅲ atypical hyperplasia（70%） and breast cancer（90%） were significantly higher than that in grade Ⅱ atypical hyperplasia（10%），P＜0.01. In mammary atypical hyperplasia, the number of myoepithelial cells increased with disturbed alignment and abnormal ultrastructure. The changes included that the protrusions on the cell surface diminished, myofilaments and pinosomes in the myoepithelial cells of grade Ⅱ, Ⅲ atypical hyperplasia decreased, and the irregularity of the nuclear morphosis and the increase of nuclear heterochromosome were found. ConclusionThe changes of actin expression in atypical hyperplasia are possibly correlated with carcinogenesis of breast cancer, and myoepithelial cells may play a role in carcinogenesis of breast cancer.
Objective To discuss the surgical indication of mammotome （MMT） operation and its auxiliary diagnosis value on breast cysts. Methods Seventy-eight patients with breast cysts from May 2010 to November 2011 in this hospital were enrolled. Excision and biopsy were performed according to the following guidelines：Single cyst with inhomogeneous interna echoes and diameter at least 1 cm；Multiple cysts associated with irregular megalgia， localized thickening of breast or ineffective drug treatment after three months；High risk of breast cancer；Hypoechoic nodules and laticifers exaggerated cysts；Ultrasonography showed disorderly echo and abundant blood supply in glandular tissues around the lesions. The result of preoperative ultrasound was compared with that of postoperative pathology diagnosis. Results In these 78 breast cysts patients with preoperative ultrasound diagnosis， 40 cases were breast multiple cysts， 38 cases were multiple cysts plus untouchable hypoecho nodules；42 cases were high risk lesions， and the other 36 cases were low risk lesions. Postoperative pathology diagnosis revealed 27 cases of cystic hyperplasia， 2 cases of atypical hyperplasia， and 1 case of breast cancer in the ultrasonic high risk lesions， and 19 cases of cystic hyperplasia in the ultrasonic low risk lesions. Ultrasound diagnostic accuracy rate was 60.26%（47/78）， sensitivity was 61.22%（30/49）， and specificity was 58.62%（17/29）. The number of resection lesions was 13.00±8.16， the time of operation was （74.25±22.68） min. The average hospital stay was 1 d after surgery. The local hematoma occurred in 2 cases and no other complications occurred during one month of follow-up. Conclusions The guidelines of MMT protocoled according to clinical manifestation of breast cyst patients and imaging of high-frequency ultrasound in author’s department are simple and utility. Minimal excision and biopsy via MMT can confirm the histological type and help for early diagnosis of breast cancer and precancerous lesion. It is important and necessary to standardize the surgical indications of MMT in the clinical work.
To investigate the changes of tenascin (TN) expression during the course of canceration through atypical hyperplasia of breast epithelia. The SP immunohistochemical method was used to study TN expresson in 50 different breast tissues. Results: There was no TN expression in normal breast and grade Ⅰ hyperplasia; immunostaining of TN was detected in 2 cases with grade Ⅱ atypical hyperplasia; the expression of TN in grade Ⅲ atypical hyperplasia (80%) and infiltrating ductal breast cancer (90%) was significantly higher than that in grade Ⅱ atypical hyperplasia (20%); and immunostaining of TN was detected in part of the cancer cells. Conclusion: These results suggest that TN expression in the stroma of serious atypical hyperplasia may play a role in limiting the outgrowth of hyperplastic epithelia.
Objective To observe the changes of basement membrane (BM) during carcinogenic change of the atypical hyperplasia of the mammary. MethodsSP immunohistochemical method and two special stain method (Foot and PAS stain method) and the electron microscope were used to observe the changes of the BM. Results BM already changed in atypical hyperplasia grade Ⅱ, and more significantly changed in atypical hyperplasia grade Ⅲ. BM was thinner or thicker somewhere distinctively under the microscope, and some little deletions were observed under the electron microscope in atypical hyperplasia grade Ⅲ, and there was no BM in breast cancer.Conclusion The change procedure of BM was correlated with the changes of the epithelial, atypical hyperplasia. The changes of BM in the atypical hyperplasia are a part of the carcinogenic procedure from the epithelial atypical hyperplasia of the mammary.
Barrett’s esophagus is considered an important risk factor for the pathogenesis of esophageal adenocarcinoma. Treatment strategies for diseases from high-grade dysplasia （HGD） to adenocarcinoma are different. The recurrence rates of endoscopic treatment and anti-reflux surgery are comparatively higher. Abnormal lesions of the esophagus can be completely resected by esophagectomy for the treatment of HGD to adenocarcinoma, and treatment outcomes are confirmed.But appropriate surgical strategies and lymph node dissection scopes should be chosen according to different cancer staging.Lymph node metastasis is a major factor in determining prognosis.