【摘要】 目的 总结原发性乳腺淋巴瘤（primary breast lymphoma，PBL）的临床病理学、免疫组织化学特征、综合治疗及复发情况。 方法 对2010年11月入院手术切除的PBL术后同侧乳头复发的1例患者的临床资料进行回顾分析，病理常规切片及免疫组织化学观察。 结果 光学显微镜检查低倍镜下肿瘤细胞弥漫性浸润破坏乳头组织，导致乳头结构紊乱，肿块乳管结构紊乱；高倍镜下显示瘤细胞成分多样，以中等大小细胞和大细胞为主，肿瘤细胞弥漫侵犯小血管。免疫组织化学结果显示Ki-67（gt;90%），CD20（+），bcl-6（+），MUM1（+），CD43（灶+），CD3（-），CD10（-）。符合恶性非霍奇金淋巴瘤。 结论 PBL是一种少见的结外淋巴瘤，临床表现缺乏特异性，术前很难与乳腺其他良、恶性病变区分，其诊断主要依靠术后病理。目前单纯肿块切除术+放射治疗联合全身化学疗法是治疗PBL临床共识，肿瘤复发可能与Ki-67高度表达存在相关性。【Abstract】 Objective To investigate the clinical pathology, immunohistochemical features, comprehensive treatment, recurrence and prognosis of primary breast lymphoma (PBL). Methods We retrospectively analyzed the clinical data including general information and pathological and immnohistochemical examinations of one patient with recurrent PBL in nipple of the same side after surgery who was admitted into our hospital in November 2010. Results Under low-power optical microscope lens, we found that the tumor cells diffused and infiltrated the nipple tissue which looked quite disorganized. Under high-power lens, we observed various tumor cells, especially the medium-and large-sized tumor cells which infiltrated small vessels. The results of immunohistochemical tests were as follows: Ki-67 (gt;90%), CD20 (+), bcl-6 (+), MUM1 (+), CD43 (nidus+), CD3 (-), and CD10 (-). All these indexes indicated malignant non-Hodgkin’s lymphoma. Conclusions PBL is a kind of extremely rare extra-nodal lymphoma with low-specificity clinical manifestations, and it is hard to distinguish from other mammary abnormalities. Its diagnosis mainly depends on pathological examinations. At present, lumpectomy followed by chemotherapy and radiotherapy is the best treatment method. Its recurrence may be related to the high expression of Ki-67.
ObjectiveTo explore the differences of rehabilitation clinical characteristics between youth stroke patients and middle and old age stroke patients, to provide references for secondary prevention and personalized rehabilitation treatment for youth stroke.MethodsFrom May 2016 to October 2019, stroke inpatient in the Department of Rehabilitation Medicine of Huashan Hospital of Fudan University were included. Patients were divided into youth group and middle and old age group according to their age. The clinical characteristics of the two groups during the rehabilitation period were analyzed.ResultsA total of 271 patients were included, including 70 in the youth group and 201 in the middle and old age group. The proportion of patients with hypertension (85.07% vs. 71.43%), diabetes (34.83% vs. 17.14%) and infection (20.90% vs. 8.57%) in the middle and old age group were higher than those in the youth group (P<0.05). The proportion of patients with hemorrhagic stroke (71.43% vs. 32.84%), history of stroke surgery (54.29% vs. 13.43%), epilepsy secondary to stroke (31.43% vs. 4.48%) and overweight/obesity (57.14% vs. 42.79%) in the youth group were higher than those in the middle and old age group (P<0.05). There was no significant difference in the proportion of gender, cognitive impairment, and thinness between the two groups (P>0.05). Among patients whose disease course was within 1 month at the time of admission, there was no significant difference in Brunnstrom stage of upper limbs-hands-lower limbs between the two groups (P>0.05). The scores of Berg Balance Scale (Z=−2.493, P=0.013) and Barthel Index (Z=−2.527, P=0.012) in the youth group were higher than those in the middle and old age group. Among patients whose disease course was between 1 month and 3 months at the time of admission, there was no significant difference in Brunnstrom stage of upper limbs-hands-lower limbs and Barthel Index between the two groups (P>0.05). The scores of Berg Balance Scale in the youth group were higher than those in the middle and old age group (Z=−2.004, P=0.045). Among patients whose disease course was more than 3 months at the time of admission, there was no significant difference in the scores of Berg Balance Scale, Barthel Index, and Brunnstrom stage of upper limbs-hands-lower limbs between the two groups (P>0.05).ConclusionsFor youth stroke patients, weight control is very important, and it is necessary to pay close attention to whether there are seizures. In the case of patients with stable vital signs in the early stage of the disease, more active rehabilitation treatment can be given.