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Prostatic and urothelial metastasis in the same lymph node: a case report. 前列腺和尿路上皮在同一淋巴结转移1例报告。
IF 0.1 4区 医学 Q4 Medicine Pub Date : 2015-04-01
Elena Pacella, Francesco Ricci, Maurizio Colecchia, Francesco Boccardo, Antonio Lopez-Beltran, Bruno Spina

Background: Collision metastasis is a rare phenomenon in which metastases of carcinoma from 2 separate primary tumors occur in the same lymph node. We summarize here the clinical course and highlight the histological challenges in the diagnosis of this rare phenomenon.

Case: A biopsy performed due to gross hematuria by endoscopic resection revealed an infiltrative high-grade urothelial carcinoma in a 75-year-old man receiving androgen deprivation therapy due to biopsy-proven high-grade prostate cancer. A radical cystectomy, with regional lymphadenectomy and prostatectomy, was performed. Three nodes appeared to have metastatic foci from both primary tumors: prostatic and urothelial cancer. The presence of the 2 tumor types colliding in the same lymph nodes was confirmed by immunohistochemical stains.

Conclusion: In a patient with simultaneous tumors it is important to remember that a part of lymph node metastases with histological polymorphic appearance may result from a collision metastasis. In light of the important therapeutic consequences, a differential diagnosis is needed, suggesting appropriate immunohistochemical investigations.

背景:碰撞转移是一种罕见的现象,是两个不同原发肿瘤在同一淋巴结发生转移。我们在此总结临床过程,并强调在诊断这种罕见现象的组织学挑战。病例:一名75岁男性患者因肉眼血尿经内镜切除进行活检,发现浸润性高级别尿路上皮癌,因活检证实为高级别前列腺癌而接受雄激素剥夺治疗。行根治性膀胱切除术、局部淋巴结切除术和前列腺切除术。三个淋巴结似乎有来自原发肿瘤的转移灶:前列腺癌和尿路上皮癌。免疫组化染色证实两种肿瘤在同一淋巴结发生碰撞。结论:在同时发生肿瘤的患者中,重要的是要记住,部分淋巴结转移具有组织学多态性外观可能是由碰撞转移引起的。鉴于重要的治疗后果,需要鉴别诊断,建议适当的免疫组织化学检查。
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引用次数: 0
Involved LEEP excision margins as predictor of residual/recurrent disease in HIV-positive and HIV-negative women in a low-resource setting. 在低资源环境中,LEEP切除边缘作为hiv阳性和hiv阴性妇女残留/复发疾病的预测因子。
IF 0.1 4区 医学 Q4 Medicine Pub Date : 2015-04-01
Louis-Jacques van Bogaert

Objective: To describe the accuracy of the diagnosis of involved excision margins after loop electrosurgical excision procedure (LEEP) in a low-resource setting.

Study design: Cross-sectional study of 176 LEEPs indicated for a cytological report of high-grade squamous intraepithelial lesion (HGSIL). A total of 72 HIV-positive and 104 HIV-negative women with cervical intraepithelial neoplasia (CIN) ≥ 2 on their LEEP histology report with involved excision margins were enrolled in the study. All patients underwent either a repeat LEEP or a hysterectomy. The specimens were evaluated for residual/recurrent CIN ≥ 2 or less.

Results: Persistent/recurrent CIN ≥ 2 was diagnosed in 139 (79.4%) instances and microinvasive squamous cell carcinoma in 6 (3.4%). Thirty (17.2%) showed CIN1. The persistence/recurrence rate was 72.2% and 88.5% in HIV-positive and HIV-negative women, respectively (χ2 = 7.5, p = 0.006).

Conclusion: In > 80% the diagnosis of involved excision margins was confirmed, a positive predictive value of 82.4%. In the absence of more accurate follow-up methods such as HPV testing or co-testing with cytology, a correct diagnosis of margin status, especially when involved, is an important guide to further management and follow-up.

目的:探讨低资源环境下环形电切手术(LEEP)后受累切缘诊断的准确性。研究设计:对176例leep进行横断面研究,以细胞学报告显示高级别鳞状上皮内病变(HGSIL)。共有72例hiv阳性和104例hiv阴性的LEEP组织学报告中宫颈上皮内瘤变(CIN)≥2并伴有切除边缘的妇女被纳入研究。所有患者均接受重复LEEP或子宫切除术。评估标本的残留/复发CIN≥2或更小。结果:139例(79.4%)诊断为持续/复发CIN≥2,6例(3.4%)诊断为微创鳞状细胞癌。30例(17.2%)为CIN1。hiv阳性和hiv阴性妇女的持续/复发率分别为72.2%和88.5% (χ2 = 7.5, p = 0.006)。结论:受累切除边缘的确诊率> 80%,阳性预测值为82.4%。在缺乏更准确的随访方法(如HPV检测或与细胞学联合检测)的情况下,对切缘状况的正确诊断,特别是在涉及的情况下,是进一步管理和随访的重要指导。
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引用次数: 0
Extranodal (dural) Rosai-Dorfman disease radiologically and histologically mimicking meningioma: a case report. 结外(硬膜)Rosai-Dorfman病放射学和组织学模拟脑膜瘤1例报告。
IF 0.1 4区 医学 Q4 Medicine Pub Date : 2015-04-01
Samer Nassif, Fouad Boulos

Background: Rosai-Dorfman disease (sinus histiocytosis with massive lymphadenopathy) is an idiopathic nonneoplastic lymphohistiocytic proliferation with variable clinical presentations, sometimes mimicking other disorders including neoplasm. Particularly, intracranial Rosai-Dorfman disease is rare and without well-established optimal treatment modalities.

Case: A 42-year-old man presented with gradually progressive unilateral hearing and vision loss over a two-year period. An MRI of the head showed findings consistent with meningiomatosis. He subsequently underwent a dural biopsy, and histologic examination of the lesion showed sheets of histiocytes positivefor CD68 and S-100 and negative for CD1a within a rich lymphoplasmacytic infiltrate. Some of the histiocytes showed emperipolesis of lymphocytes and plasma cells. These findings were consistent with Rosai-Dorfman disease. Interestingly, EMA-positive meningothelial whorls were seen scattered within the dominantly histiocytic-appearing process, mimicking the appearance of meningioma; these whorls were thought to be reactive in nature.

Conclusion: This case is important as it high-lights unusual clinical and histopathologic features of Rosai-Dorfman disease, thereby adding to the spectrum of manifestations of this entity. Awareness of such features is helpful in averting the misdiagnosis of intracranial Rosai-Dorfman disease with reactive meningothelial hyperplasia as meningiomas.

背景:Rosai-Dorfman病(窦性组织细胞增生伴大量淋巴结病)是一种特发性非肿瘤性淋巴组织细胞增生,临床表现多变,有时与肿瘤等其他疾病相似。特别是颅内Rosai-Dorfman病是罕见的,没有明确的最佳治疗方式。病例:一名42岁男性,两年内出现渐进性单侧听力和视力丧失。头部核磁共振显示脑膜瘤病。随后,他接受了硬脑膜活检,病变的组织学检查显示,在丰富的淋巴浆细胞浸润中,组织细胞CD68和S-100呈阳性,CD1a呈阴性。部分组织细胞淋巴细胞和浆细胞增多。这些发现与Rosai-Dorfman病一致。有趣的是,在以组织细胞为主的过程中可见分散的ema阳性的脑膜上皮轮,与脑膜瘤的外观相似;这些螺旋在本质上被认为是反应性的。结论:该病例很重要,因为它突出了Rosai-Dorfman病的不同寻常的临床和组织病理学特征,从而增加了该实体的表现谱。了解这些特征有助于避免将颅内Rosai-Dorfman病合并反应性脑膜上皮增生误诊为脑膜瘤。
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引用次数: 0
Immunocytochemistry associated with oral exfoliative cytology: methodological analysis.. 免疫细胞化学与口腔剥脱细胞学:方法学分析。
IF 0.1 4区 医学 Q4 Medicine Pub Date : 2015-04-01
Alessandra Dutra da Silva, Celina Faig Lima, Bruna Jalfim Maraschin, Natália Koerich Laureano, Natália Batista Daroit, Fernanda Brochier, Manoel Sant'Ana Filho, Fernanda Visioli, Pantelis Varvaki Rados

Objective: To evaluate different immunocytochemical protocol variations to find the most effective protocol for the analysis of involucrin, epidermal growth factor receptor (EGFR), and E-cadherin antibodies. Exfoliative cytology is a noninvasive method used to monitor and screen for early changes in the oral mucosa of patients exposed to carcinogens such as tobacco and alcohol. It has been postulated that its association with immunocytochemistry may improve the effectiveness of the screening process.

Study design: Four graduate students from Porto Alegre in southern Brazil had oral smears collected from the border of the tongue using a cytobrush. The following variables were analyzed: cell membrane permeability, antigen retrieval method (microwave oven or water bath), antibody incubation time (overnight or 1 hour), detection system used (Envision or LSAB), and chromogen incubation time (10 seconds or 5 minutes).

Results: Best results were obtained with the following combinations: (1) for involucrin: water bath, 1-hour incubation for primary antibody, Envision, and chromogen incubation for 10 seconds; (2)for EGFR: microwave, overnight incubation, LSAB, and chromogen incubation for 5 minutes; and (3) for E-cadherin: water bath, over-night incubation, Envision, and chromogen incubation for 5 minutes.

Conclusion: Our findings suggest that each antibody requires a specific immunocytochemical protocol to guarantee optimal results with oral smears.

目的:评价不同免疫细胞化学方案的差异,以寻找最有效的方案来分析天花素、表皮生长因子受体(EGFR)和E-cadherin抗体。剥脱细胞学是一种非侵入性方法,用于监测和筛查暴露于烟草和酒精等致癌物的患者口腔黏膜的早期变化。据推测,它与免疫细胞化学的关联可能会提高筛选过程的有效性。研究设计:四名来自巴西南部阿雷格里港的研究生使用细胞刷从舌缘收集口腔涂片。分析以下变量:细胞膜通透性、抗原提取方法(微波炉或水浴)、抗体孵育时间(过夜或1小时)、检测系统(Envision或LSAB)、显色原孵育时间(10秒或5分钟)。结果:(1)天花苷:水浴,一抗、Envision孵育1小时,显色剂孵育10秒;(2) EGFR:微波、过夜孵育、LSAB、显色剂孵育5分钟;(3) e -钙粘蛋白:水浴、过夜孵育、Envision、显色原孵育5分钟。结论:我们的研究结果表明,每种抗体都需要特定的免疫细胞化学方案来保证口腔涂片的最佳结果。
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引用次数: 0
Expression of 52-kDa FK506-binding protein (FKBP52) in human placenta complicated by preeclampsia and intrauterine growth restriction. 52-kDa fk506结合蛋白(FKBP52)在人胎盘合并子痫前期和宫内生长受限患者中的表达
IF 0.1 4区 医学 Q4 Medicine Pub Date : 2015-04-01
Nuray Acar, Ismail Ustunel

Objective: To investigate the expression of 52-kDa FK506-binding protein (FKBP52) in human placentas complicated by preeclampsia (PE) and intrauterine growth restriction (IUGR).

Study design: Case-control study including placentas from 6 PE pregnancies, 6 IUGR pregnancies, and 6 controls. FKBP52 expression was determined by immunohistochemistry and Western blot techniques.

Results: FKBP52 expression was downregulated in PE group placentas compared to control and IUGR group placentas. In IUGR group placentas FKBP52 expression was upregulated compared to control and PE group placentas. FKBP52 expression differences between PE and IUGR group placentas (p = 0.008) and control and IUGR group placentas (p = 0.042) were statistically significant. There was FKBP52 immunoreactivity in decidua, syncytiotrophoblast, villous stromal cells, and vascular endothelium in all groups. Unlike control and PE group placentas, FKBP52 expression was continuous in syncytiotrophoblast of IUGR group placentas.

Conclusion: FKBP52 seems to be disrupted in PE and IUGR pregnancies. Decrease of FKBP52 protein levels in PE and increase in IUGR group placentas might have an importance and be involved in the pathogenesis of PE and IUGR.

目的:探讨52-kDa fk506结合蛋白(FKBP52)在人胎盘合并子痫前期(PE)和宫内生长受限(IUGR)中的表达。研究设计:病例对照研究,包括6例PE妊娠、6例IUGR妊娠和6例对照组的胎盘。采用免疫组织化学和Western blot技术检测FKBP52的表达。结果:与对照组和IUGR组相比,PE组胎盘中FKBP52表达下调。与对照组和PE组相比,IUGR组胎盘FKBP52表达上调。FKBP52在PE组和IUGR组胎盘(p = 0.008)与对照组和IUGR组胎盘(p = 0.042)的表达差异均有统计学意义。各组蜕膜、合胞滋养细胞、绒毛间质细胞和血管内皮均有FKBP52免疫反应。与对照组和PE组胎盘不同,IUGR组胎盘合体滋养细胞中FKBP52的表达是连续的。结论:在PE和IUGR妊娠中,FKBP52可能被破坏。PE组胎盘FKBP52蛋白水平的降低和IUGR组胎盘FKBP52蛋白水平的升高可能在PE和IUGR的发病机制中起重要作用。
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引用次数: 0
Staging of prostate cancer: a review with reference for further refinement. 前列腺癌的分期综述,为进一步细化提供参考。
IF 0.1 4区 医学 Q4 Medicine Pub Date : 2015-02-01
Boris Pospihalj

Staging of prostate carcinoma provides a standardized method for tumor classification which is based on involvement of the prostate gland, adjacent local structures, regional lymph nodes, and distant sites. Staging information is therefore crucial for clinicians to be able to assess risk of disease progression, to offer therapeutic choices in the individual patient, and to provide population-based prognostic information. Clinical staging, which is based on data obtained prior to first definitive treatment, relies on tumor determination by digital rectal examination, transrectal ultrasonography, other imaging techniques, and serum PSA level, while pathological staging requires histological identification of tumor extent in prostate gland and surrounding tissues. T1 tumors, denoted to clinically unapparent, not palpable or visible by imaging, are diagnosed by transurethral resection of the prostate procedure or needle biopsy. T2 tumors are confined to the organ, are subdivided by involvement in one or both lobes, and are determined by radical prostatectomy procedure. Stage T3 denotes locally advanced tumors that spread beyond the organ's boundaries, and T4 denotes invasion or fixation to the pelvic organs. Despite wide acceptance of the system as a whole, the current 2010 revision of the American Joint Committee on Cancer/Union for International Cancer Control tumor, node and metastasis (TNM 7) appears to contain some controversies, particularly T2 three-tiered subclassification. This review will cover suggested changes to further TNM editions; these changes have been accumulated in the literature in recent years and include items such as lymph node involvement quantification, "vanishing" carcinoma, Gleason score, resection margin status, pretreatment serum PSA level, as well as difficulties the pathologist may encounter in microscopic examination which may hamper accurate stage assessment.

前列腺癌分期为肿瘤分类提供了一种标准化的方法,该方法基于前列腺、邻近局部结构、区域淋巴结和远处部位的受累情况。因此,分期信息对于临床医生能够评估疾病进展的风险,为个体患者提供治疗选择以及提供基于人群的预后信息至关重要。临床分期基于首次明确治疗前获得的资料,主要依靠直肠指检、经直肠超声等影像学技术及血清PSA水平确定肿瘤,病理分期则需要对前列腺及周围组织的肿瘤范围进行组织学鉴定。经尿道前列腺切除术或穿刺活检诊断为临床不明显,未触及或成像可见的T1肿瘤。T2肿瘤局限于器官,可根据累及一侧或两侧肺叶而细分,并可通过根治性前列腺切除术确定。T3期为局部进展期肿瘤扩散超出器官边界,T4期为侵犯或固定盆腔器官。尽管该系统作为一个整体被广泛接受,但目前2010年修订的美国癌症联合委员会/国际癌症控制联盟肿瘤、淋巴结和转移(TNM 7)似乎存在一些争议,特别是T2三级亚分类。这项审查将涵盖对未来TNM版本的建议更改;这些变化是近年来文献中积累的,包括淋巴结累及量化、“消失”癌、Gleason评分、切除边缘状态、预处理血清PSA水平,以及病理学家在显微镜检查中可能遇到的困难,这些困难可能会妨碍准确的分期评估。
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引用次数: 0
Update on the pathology of testicular tumors. 睾丸肿瘤病理进展。
IF 0.1 4区 医学 Q4 Medicine Pub Date : 2015-02-01
Gregor Mikuz

At least 90% of testicular tumors belong to the group of germ cell tumors (GCTs), which are classified according to the 2004 World Health Organization (WHO) classification. Race is one of the most important etiologic factors in the development of GCTs. White men living in Western industrialized countries show the highest rates of incidence. Known risk factors are cryptorchidism, contralateral GCT, familial association, infertility, testicular atrophy, trauma, surgery, socioeconomic status, environmental factors, and occupational exposure to noxious conditions. For the most part, the morphology of GCTs is well known to pathologists. There are, however, some little-known rare entities like anaplastic type of spermatocytic seminoma. In the group of nonseminomatous GCTs are emerging the somatic-type malignancies (carcinomas, sarcomas) arising in teratomas. Tumors of sex cord/gonadal stroma account for 1.6-6% of adult testicular tumors and are somewhat more frequent in children. Absolutely nothing is known about the epidemiology, histogenesis, and possible etiology of these tumors, which derive from Leydig, Sertoli, granulosa, and theca cells. In the group of "miscellaneous tumors," lymphomas are the most frequent testicular tumors in men older than age 50.

根据2004年世界卫生组织(WHO)的分类,至少90%的睾丸肿瘤属于生殖细胞肿瘤(gct)组。种族是gct发生的最重要的病因之一。生活在西方工业化国家的白人男性发病率最高。已知的危险因素有隐睾、对侧GCT、家族关联、不育、睾丸萎缩、创伤、手术、社会经济地位、环境因素和职业暴露于有害条件。在大多数情况下,病理学家都知道gct的形态。然而,也有一些鲜为人知的罕见实体,如未分化型精原细胞瘤。在非半细胞瘤的gct组中,出现了由畸胎瘤引起的躯体型恶性肿瘤(癌、肉瘤)。性索/性腺间质肿瘤占成人睾丸肿瘤的1.6-6%,在儿童中更为常见。关于这些肿瘤的流行病学、组织发生和可能的病因学完全一无所知,这些肿瘤起源于间质细胞、支持细胞、颗粒细胞和卵泡细胞。在“杂项肿瘤”组中,淋巴瘤是50岁以上男性最常见的睾丸肿瘤。
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引用次数: 0
Dysplasia and carcinoma in situ of the urinary bladder. 膀胱发育不良和原位癌。
IF 0.1 4区 医学 Q4 Medicine Pub Date : 2015-02-01
Antonio Lopez-Beltran, Rita C Marques, Rodolfo Montironi, Carlos Reymundo, Jorge Fonseca, Liang Cheng

Urothelial dysplasia (low-grade intraurothelial neoplasia) is recognized as a premalignant urothelial lesion in the 2004 World Health Organization (WHO) classification system. Although clarification of the diagnostic criteria of urothelial dysplasia has improved in recent years, there is still a lack of interobserver reproducibility. Active clinical follow-up is mandatory in patients with a diagnosis of urothelial dysplasia since it constitutes a marker of urothelial instability, and disease progression, in up to 19% of cases. The differential diagnosis of urothelial dysplasia is with other flat urothelial lesions with atypia, including flat urothelial hyperplasia, reactive urothelial atypia, urothelial atypia of unknown significance, and urothelial carcinoma in situ (high-grade intraurothelial neoplasia). In most cases, especially when small amounts of tissue are available, morphologic features alone may not be sufficient for diagnosis. Immunohistochemistry can be of help in selected cases, and a panel of cytokeratin 20, p53, and CD44 may help in the diagnosis. The use of HER2, p16, and Racemase remains as an option pending validation. Herein, we present the pathologic features and clinical significance of urothelial dysplasia and carcinoma in situ with emphasis on differential diagnosis from common flat lesions with atypia.

在2004年世界卫生组织(WHO)分类系统中,尿路上皮异常增生(低级别尿路上皮内瘤变)被认为是一种癌前尿路上皮病变。尽管近年来对尿路上皮异常增生的诊断标准的澄清有所改善,但仍然缺乏观察者之间的可重复性。在诊断为尿路上皮发育不良的患者中,积极的临床随访是强制性的,因为在高达19%的病例中,这是尿路上皮不稳定和疾病进展的标志。尿路上皮异常增生的鉴别诊断是与其他非典型性扁平尿路上皮病变,包括扁平尿路上皮增生、反应性尿路上皮非典型性、意义不明的尿路上皮非典型性和尿路上皮原位癌(高级别尿路上皮内瘤变)。在大多数情况下,特别是当少量组织可用时,仅凭形态学特征可能不足以进行诊断。免疫组织化学可以帮助选定的情况下,和一组细胞角蛋白20,p53和CD44可能有助于诊断。HER2、p16和消旋酶的使用仍然是有待验证的选项。在此,我们介绍尿路上皮异常增生和原位癌的病理特征和临床意义,重点是与常见的非典型扁平病变的鉴别诊断。
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引用次数: 0
Role of the pathologist in active surveillance for prostate cancer. 病理学家在前列腺癌主动监测中的作用。
IF 0.1 4区 医学 Q4 Medicine Pub Date : 2015-02-01
Roberta Mazzucchelli, Andrea B Galosi, Matteo Santoni, Antonio Lopez-Beltran, Marina Scarpelli, Liang Cheng, Rodolfo Montironi

Active surveillance (AS) is an alternative strategy that aims to minimize overtreatment by selecting only patients with significant prostate cancer (PCa) tumors for immediate treatment. Patients with favorable tumor characteristics are closely monitored using serum prostate-specific antigen (PSA) levels and serial biopsies of the prostate. In addition, other predictors of tumor progression, such as PSA doubling time, can be used during AS management. AS represents an excellent opportunity to identify molecular biomarkers of PCa behavior and to develop novel therapeutic strategies.

主动监测(AS)是一种替代策略,旨在通过仅选择具有显著前列腺癌(PCa)肿瘤的患者进行立即治疗来减少过度治疗。对具有良好肿瘤特征的患者,应密切监测血清前列腺特异性抗原(PSA)水平和连续前列腺活检。此外,肿瘤进展的其他预测因素,如PSA倍增时间,可以在as治疗期间使用。AS是鉴定前列腺癌行为的分子生物标志物和开发新的治疗策略的绝佳机会。
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引用次数: 0
Value of frozen sections in uropathology. 冷冻切片在泌尿病理学中的价值。
IF 0.1 4区 医学 Q4 Medicine Pub Date : 2015-02-01
Ferran Algaba

The indications of frozen section diagnosis in uropathology are quite specific, and this explains the fact that they amount to a mere 7.3% of the frozen sections performed in general hospitals. Generally speaking, frozen sections are not warranted to identify the nature of a tumoral mass, with the following exceptions: (1) renal masses of a doubtful parenchymal origin or located in the urinary tract, (2) testicular neoplasias, when the possibility of a conservative treatment arises, and (3) determination of the presence of a prostate adenocarcinoma in an organ donor with high serum prostate-specific antigen (but even in these circumstances the need is widely controversial). Intraoperative determination of surgical margins is particularly useful in (1) partial nephrectomies (it may be limited to inspection after dyeing the margin with India ink; bed freezing is very seldom needed) and (2) partial penectomies (always studying the urethral margin and the cavernosal and spongiosal corpora margins). The study of the nodes is a widely debated issue, and except for those cases in which unexpectedly increased node size is found, systematic frozen sections are indicated neither of the bladder nor of the prostate. The situation regarding penis carcinoma is different, as in the groups with intermediate and high risk of node metastasis; frozen section is recommended, particularly of radioisotope-marked sentinel nodes.

泌尿病理学冷冻切片诊断的适应症非常特殊,这也解释了为什么在综合医院进行的冷冻切片中,它们仅占7.3%。一般来说,冷冻切片不能确定肿瘤肿块的性质,以下情况除外:(1)肾实质来源可疑或位于泌尿道的肿块;(2)睾丸肿瘤,当可能出现保守治疗时;(3)在血清前列腺特异性抗原高的器官供体中确定前列腺腺癌的存在(但即使在这些情况下,是否需要进行冷冻切片也存在广泛争议)。术中对手术边缘的测定在以下手术中特别有用:(1)部分肾切除术(可能仅限于用墨汁染色边缘后的检查;很少需要冷冻床)和(2)部分阴茎切除术(经常研究尿道边缘和海绵体和海绵体边缘)。对淋巴结的研究是一个广泛争论的问题,除了那些发现出乎意料的淋巴结增大的病例外,系统的冷冻切片既不表明膀胱也不表明前列腺。阴茎癌的情况有所不同,如淋巴结转移的中高危组和高危组;建议冷冻切片,特别是放射性同位素标记的前哨淋巴结。
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引用次数: 0
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Analytical and Quantitative Cytopathology and Histopathology
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