【摘要】 目的 探讨老年人头面部脉管肉瘤的临床病理学特征。 方法 1996年-2008年对5例老年人头面部脉管肉瘤的临床资料、病理形态学、免疫组织化学染色进行观察，并对其中4例进行了随访。 结果 临床表现主要是头面部发生的瘀斑、溃疡或结节状病变。肿瘤细胞围绕皮肤附件周围排列成交通状吻合的血窦网，衬覆有异型性的内皮细胞，有的区域内皮细胞形成乳头状突起。肿瘤组织内有不同程度的弥漫性出血。肿瘤细胞表达CD34、CD31、Fli-1和FⅧ，部分表达CD117和CK8/18。经随访3例3年内死亡，1例带瘤存活1年余，1例失访。 结论 老年人头面部脉管肉瘤组织形态多样，预后较差，及时诊治十分重要。需要与其他皮肤良性血管病变和低分化癌、恶性黑色素瘤、恶性梭形细胞肿瘤、Kaposi肉瘤等鉴别。【Abstract】 Objective To explore the clinicopathological features of cutaneous angiosarcoma on the scalp and face in elder patients. Methods The clinical data of five elder patients with cutaneous angiosarcoma on the scalp and face from 1996 to 2008 were retrospectively analyzed. The patients underwent the light microscopy, pathomorphological examination, and immunohistochemistry. Four patients were followed up. Results Most clinical manifestation was dusky irregular erythematous plaques which were often ulcerated. The tumor was composed of asymmetric collection of angulated and irregular vascular spaces infiltrating between collagen bundles. Endothelial cells attaching to the vascular spaces had hyperchromatic irregular nuclei and prominent nucleoli. Hemorrhage was another histologic feature. Positive expression of CD34,CD31,Fli-1 and FⅧ were found in tumor cells, and expression of CD117 and CK8/18 was found in some of the patients. In the follow-up duration, three patients died in three years, and one failed to be followed up. Conclusion Cutaneous angiosarcoma of the scalp and face has various histomorphology and poor prognosis, which should be diagnosed and treated in time. It should be distinguished from benign cutaneous hemangioma, poorly differentiated carcinoma, malignant melanoma and malignant spindle cell tumor.
【摘要】 目的 探讨女性类风湿关节炎（rheumatoid arthritis，RA）患者性激素的变化及其与炎症指标的关系。 方法 2008年1月-2009年12月检测RA组45例女性患者（绝经期组16例、黄体期组14例和滤泡期组15例）和正常对照组40例女性（绝经期组14例、黄体期组、滤泡期组各13例）血清性激素水平，同时检测RA组血沉（SR）、C反应蛋白（CRP）、类风湿因子（RF）、抗环瓜氨酸肽（抗CCP） 抗体的水平。 结果 RA患者绝经期雌二醇（E2）浓度明显高于正常对照组（Plt;0.05）；RA组黄体期泌乳素（PRL）的浓度明显高于正常对照组（Plt;0.05）；RA组孕酮（PROG）浓度明显低于正常对照组（Plt;0.05）；RA组滤泡期PRL明显高于正常对照组（Plt;0.05）。RA组黄体期PRL与其孕酮（PROG）呈正相关（r=0.754，P=0.031），绝经期E2，黄体期PRL和PROG以及滤泡期PRL与SR、CRP、RF、抗CCP无相关性（Pgt;0.05）。 结论 女性RA患者月经周期的不同阶段，性激素水平的改变不同，绝经期以雌激素升高明显，黄体期和滤泡期则以孕激素改变明显。黄体期PRL与其PROG呈正相关；女性RA患者性激素的变化与其炎症指标无相关性。【Abstract】 Objective To explore the change of sex hormone levels in female patients with rheumatoid arthritis (RA) and its relationship with inflammatory markers. Methods The serum sex hormones of 45 female patients with RA (RA group, including menopausal group of 16 patients, luteal phase group of 14 patients and follicular phase group of 15 patients) and 40 females (control group: including menopausal group of 14 females, luteal phase group of 13 females and follicular phase group of 13 females) in the control group between January 2008 and December 2009 were detected. The inflammatory makers of erythrocyte sedimentation rate (SR), C-reactive protein (CRP), rheumatoid factor (RF), and anti-cyclic citrullinated peptide antibodies (anti-CCP) of patients in the RA group were also detected. Results The menopausal estradiol (E2) level and the concentration of prolactin (PRL) of patients with RA were significantly higher than that of patients in the normal control group (Plt;0.05), while the progesterone (PROG) level was significantly lower than that of patients in the control group (Plt;0.05). The PRL level of follicular phase group was significantly higher than that of the normal control group (Plt;0.05). PRL level in the luteal phase was positively correlated with its PROG level (r=0.754, P=0.031). The menopausal E2, the luteal PRL and PROG as well as the follicular phase PRL had no correlation with SR, C-reactive protein, RF, or anti-CCP antibodies (Pgt;0.05). Conclusions At different stages of the menstrual cycle in women with RA, the changes of sex hormone levels were different. The concentration of estrogen has increased significantly in menopause, while the progesterone has changed markedly in luteal and follicular phases. PRL in luteal phase is positively correlated with PROG. The changes of sex hormones in female patients with RA show no correlation with inflammatory markers.