骨髓增生异常综合征合并非霍奇金淋巴瘤一例病例报道并文献复习

目的:探讨骨髓增生异常综合征合并非霍奇金淋巴瘤的发病机制、诊断及治疗,并判断其预后情况。方法:回顾我院收治的一例骨髓增生异常综合征(MDS)患者同时诊断间变大细胞淋巴瘤(ALCL)患者的临床资料,总结其诊断及治疗经过,对其预后进行评价。结果:该患者诊断间变大细胞淋巴瘤后,经化疗对症治疗病情无显著改善,且患者ALK阳性,考虑预后较差,建议造血干细胞移植。结论:骨髓增生异常综合征合并非霍奇金淋巴瘤的病例在国内外十分罕见,治疗方法目前尚需进一步研究。     

浅谈免疫组化标记结果的解读与淋巴瘤的诊断

目的 提高对正确解读免疫组化结果的重要性的认识.方法 对3例淋巴瘤误诊病例进行复习,并增加相关抗体标记予以鉴别诊断.结果 例1,滤泡性淋巴瘤(FL)误诊为淋巴结淋巴组织反应性增生,与形态学观察忽略肿瘤性滤泡及对免疫表型Bc12表达的认识不足有关.例2,经典型富于淋巴细胞型霍奇金淋巴瘤(LRCHL).①误诊为FL,与形态学观察遗漏R-S细胞,以及误判免疫组化标记Bcl2、CD20有关,即将Bcl2、CD20阳性的非肿瘤细胞,误判为肿瘤细胞.②误诊为结节性淋巴细胞为主型霍奇金淋巴瘤(NLPHL)与免疫组化标记的错误解读有关,把围绕瘤细胞的背景小淋巴细胞CD20阳性,误判为R-S细胞CD20阳性;将CD30阳性的R-S细胞,误判为活化性B淋巴细胞.例3,AML误诊为T-LBL.主要是对瘤细胞表达非特异性抗体TDT、CD7、CD43的意义认识不足有关.结论 淋巴瘤的诊断是建立在形态学、免疫组化标记、临床资料和遗传学之上的,而且,免疫组化标记结果的正确解读对淋巴瘤的诊断至关重要.     

一例皮下脂膜炎样T细胞淋巴瘤的报告

目的分析皮下脂膜炎样T细胞淋巴瘤的临床表现及病理组织学特征,探讨其诊断和治疗方法,提高临床医生对该病的认识。方法对1例面部和下肢浮肿及全身多发硬结1月余,发热1周的患者临床表现的演变、确诊时的组织病理学特点、免疫组织化学结果等多方面进行观察。结果皮肤活检发现组织学病变主要局限于皮下脂肪间质内见核深染的异型细胞弥漫分布或环绕脂肪细胞分布。免疫组化示CD3+,CD8+,CD68+,TiA-1+,G-B+,CD20-,CD7-,TDT-,提示为T细胞来源。治疗(环磷酰胺+长春新碱+表阿霉素)1疗程患者自动出院回家。结论皮下脂膜炎样T细胞淋巴瘤是一种特殊类型的原发性皮肤淋巴瘤,对不明原因的全身皮肤多发硬结伴发热的患者应该考虑该病的可能。病损处皮肤活检是确诊该病的主要手段。治疗常用联合化疗,如CHOP方案。本病预后较差。     

CVTP联合化疗方案对初治和复治难治恶性淋巴瘤的临床疗效研究

目的:比较环磷酰胺-西艾克-吡柔比星-泼尼松(Cyclophosphamidum-Vindesine-Tetrahydropyranyl-Prednisone,CVTP)联合化疗方案对初治和复治、难治恶性淋巴瘤的临床疗效。方法:按照化疗史将102例恶性淋巴瘤患者分为初治组59例和复治难治组43例,两组患者均给予CVTP联合化疗方案治疗,比较两组化疗效果、外周血淋巴细胞亚群、毒副反应差别。结果:初治组患者部分缓解(partial remission,PR)率和总有效率(overall response rate,ORR)均显著高于对复治难治组,差异具有统计学意义(P0.05);初治组患者治疗后CD3~+、CD4~+、CD4~+/CD8~++、NK细胞含量均显著高于复治难治组,CD8~+水平显著低于复治难治组,差异具有统计学意义(P0.05);初治组患者化疗期间白细胞下降、血红蛋白下降、血小板减少、恶心呕吐发生率均显著低于复治难治组,差异具有统计学意义(P0.05)。结论:CVTP联合化疗方案治疗初治恶性淋巴瘤近期疗效优于复治难治患者。     

影像学方法在淋巴瘤疗效评估中的应用

淋巴瘤通过放化疗可获得很高的治愈率。治疗过程中,疗效评估对于评价或调整治疗方案至关重要。基于病灶形态学改变的传统影像学技术如计算机断层扫描(computed tomography,CT)与磁共振成像(magnetic resonance imaging,MRI)技术在评估淋巴瘤疗效时存在一定的局限性;磁共振加权成像(diffusion-weighted imaging,DWI)结合水分子表观弥散系数(apparent diffusion coefficient,ADC)从分子水平反映疾病的病理生理状态,是一种功能成像新技术;而正电子发射断层显像/X线计算机体层成像(Positron emission tomography/computed tomography,PET/CT)将肿瘤的代谢与形态相结合,是一种新型的功能成像技术,已广泛应用于淋巴瘤患者的分期、疗效监测和预后评估中,可较其他影像学技术更准确的评估疗效;PET/MRI技术在淋巴瘤方面的临床应用研究目前尚处于初步阶段,其临床价值尚需进一步探讨。     

抗CD20单克隆抗体治疗B 细胞淋巴瘤的效应机制

B细胞淋巴瘤是一种主要的非霍奇金淋巴瘤(non-Hodgkin’s lymphoma,NHL),95%以上的B细胞淋巴瘤均表达B细胞分化抗原CD20。尽管目前CD20在B细胞分化发育过程中的具体功能尚未阐明,但其特有的表达方式和在细胞膜上的分布特点决定了其成为B细胞淋巴瘤靶向治疗的主要靶点。近十年来,随着抗CD20单克隆抗体的不断发展和进步,联合传统的CHOP化疗方案,在NHL的治疗中显示出良好的效果。虽然,近年来抗CD20单抗逐渐被用于B细胞相关的自身免疫病的治疗,但相关作用机制尚不明确。在针对NHL的临床治疗中,抗CD20单抗的疗效被认为依赖于效应器机制,主要有ADCC、CDC和细胞凋亡。虽然抗CD20在淋巴瘤的治疗中具有显著的免疫疗效,但部分瘤荷较大的病人出现了耐药和复发,循环中大量B细胞由于单抗的结合而被机体的单核巨噬细胞吞噬或NK细胞杀伤,机体出现成熟B细胞空缺期,同时单核巨噬细胞、NK细胞和补体大量消耗,造成机体免疫效应功能饱和和效应器耗竭。本文就抗CD20单克隆抗体在治疗淋巴瘤中的具体作用机制及可能造成的机体效应器耗竭问题做一简要的概述。     

系统性种痘水疱病样皮肤T细胞淋巴瘤1例及文献复习

目的:通过分析系统性种痘水疱病样淋巴瘤病例1例,结合文献回顾,分析其临床特点、诊断治疗进展及预后,以提高临床医生对该病的认识。方法:报道1例有7年种痘水疱病史并转化为系统性T细胞淋巴瘤病例,通过皮肤活检、病理及免疫组化、TCR基因重排、实验室、MRI及影像学检查,确定诊断及治疗方案,并观察预后。后进行文献回顾。结果:本例患者的主要临床表现为多年的面部红斑、丘疱疹及水疱改变,最初诊断为"种痘水疱病",初期治疗有效,病情反复并进展,皮肤改变加重,病变逐渐累及鼻中隔及下鼻甲,出现坏死及缺损,同时伴有发热及淋巴结肿大等系统症状。皮肤病理及免疫组化提示真皮弥漫性淋巴细胞、浆细胞浸润,CD3+,CD4+,CD8散在细胞+,CD30局部细胞+,CD56局部细胞+,EBER杂交(+),Ki-67增殖指数为60%。TCR基因克隆性重排。经干扰素及激素治疗初期病情控制尚可,持续约7年时间,后病情进行性加重,表现系统性种痘水疱病样皮肤T细胞淋巴瘤症状,给予MESA方案化疗1次。化疗后病情稳定,鼻部症状明显改善。后病情进展,患者出现神经系统症状并死亡。结论:种痘水疱病样淋巴瘤早期临床表现易与种痘样水疱病相混淆,但根据其病变部位病理活检及免疫组化分析可得到确诊,早期单纯皮肤病变期可持续数年,部分对激素及干扰素治疗有效。当发展为系统性种痘水疱病样淋巴瘤期时,病情进展迅速,常可累及中枢神经系统,对于化疗反应差,预后不佳,死亡率极高。化疗对于该病的有效性有待进一步观察。     

肝脏假性淋巴瘤的临床病理学研究及分析

目的:探讨肝脏假性淋巴瘤的临床病理特征、免疫表型及鉴别诊断。方法:在光学显微镜下对肝脏假性淋巴瘤进行组织学形态观察,并借助免疫组化进一步对其形态进行分析。由于原发于肝脏的假性淋巴瘤极为罕见,故本文将报道一例发生于肝脏的假性淋巴瘤,结合文献探讨其临床病理特点,以提高诊断及鉴别诊断水平。结果:大体上为切面可见灰白结节,结节切面灰白色,质地中等,与周围分界清,周围肝组织灰红质软。显微镜下组织学表现为肝周边淋巴结淋巴组织增生,细胞大小较一致,核圆形,细胞无异型,未见明显核分裂,其中见嗜酸性白细胞浸润及少数异型细胞。免疫组化显示肿瘤细胞表达CD3、CD20及CD30。结论:肝脏假性淋巴瘤为罕见的、良性淋巴组织增生性病变,形态学特征、免疫组化染色在肝假性淋巴瘤诊断中具有重要价值。在临床病理实践中,必须首先与常见的发生于该部位恶性肿瘤如霍奇金淋巴瘤肿瘤等鉴别。     

细胞芯片诊断胸腔液中淋巴瘤细胞的初步评价

目的探讨细胞芯片诊断胸腔液中淋巴瘤细胞的应用价值。方法应用一种目前国内外尚未见报道的细胞芯片,对33例胸腔液中淋巴瘤细胞和对照组-4例胸腔液中小细胞型癌细胞进行了免疫杂交。结果阳性杂交点细胞呈圆形分布,界限清楚,细胞形态显示良好;B-NHLC占72．7％(24／33),T-NHLC占18．2％(6／33)。CD79a对B-NHLC捕获阳性率达100％,CD3对T-NHLC捕获阳性率为75％,两均未见交叉反应。结论细胞芯片对胸腔液中淋巴瘤细胞的诊断和鉴别诊断具有重要的临床应用价值。     

Notch 1 在外周T 细胞淋巴瘤中的表达及基因突变 及其与临床生存期的相关性研究

目的:检测活化型notch1(NICD)蛋白在外周T细胞淋巴瘤组织中的表达情况,探讨活化型notch1对外周T细胞淋巴瘤患者生存时间的影响,分析其与NOTCH1基因突变之间的关系。方法:免疫组织化学法检测20例外周T细胞淋巴瘤(13例PTCLNOS、7例ALCL)及5例反应性增生患者病变组织活化型notch 1(NICD)抗体的表达,PCR-SSCP及基因测序法分析NOTCH1基因HD-N、HD-C、TAD、PEST片段的突变情况。结果:20例外周T细胞淋巴瘤NICD蛋白均为阳性,5例慢性淋巴结炎均为阴性,其中PTCL NOS组织较ALCL高表达NICD蛋白。淋巴瘤患者HD-N、HD-C、PEST片段存在基因点突变。结论:NOTCH1基因点突变可能为异常表达NICD的原因之一,异常表达的NICD影响外周T细胞淋巴瘤的生存时间。     

A Unique Protease Cleavage Site Predicted in the Spike Protein of the Novel Pneumonia Coronavirus (2019-nCoV) Potentially Related to Viral Transmissibility

正Dear Editor,In December 2019, a novel human coronavirus caused an epidemic of severe pneumonia(Coronavirus Disease 2019,COVID-19) in Wuhan, Hubei, China(Wu et al. 2020; Zhu et al. 2020). So far, this virus has spread to all areas of China and even to other countries. The epidemic has caused 67,102 confirmed infections with 1526 fatal cases     

Curcuminoids as inhibitors of thioredoxin reductase: A receptor based pharmacophore study with distance mapping of the active site

Curcumin is the yellow pigment of turmeric that interacts irreversibly forming an adduct with thioredoxin reductase (TrxR), an enzyme responsible for redox control of cell and defence against oxidative stress. Docking at both the active sites of TrxR was performed to compare the potency of three naturally occurring curcuminoids, namely curcumin, demethoxy curcumin and bis-demethoxy curcumin. Results show that active sites of TrxR occur at the junction of E and F chains. Volume and area of both cavities is predicted. It has been concluded by distance mapping of the most active conformations that Se atom of catalytic residue SeCYS498, is at a distance of 3.56 from C13 of demethoxy curcumin at the E chain active site, whereas C13 carbon atom forms adduct with Se atom of SeCys 498. We report that at least one methoxy group in curcuminoids is necessary for interation with catalytic residues of thioredoxin. Pharmacophore of both active sites of the TrxR receptor for curcumin and demethoxy curcumin molecules has been drawn and proposed for design and synthesis of most probable potent antiproliferative synthetic drugs.     

The structure, reproduction and taxonomy of Vidalia and Osmundaria (Rhodophyta, Rhodomelaceae)

Comprises species occurring mostly in subtidal habitats in tropical, subtropical and warm-temperate areas of the world. An analysis of the type species, V. spiralis (Sonder) Lamouroux ex J. Agardh, a species from Australia, establishes basic characters for distinguishing species in the genus. These characters are (1) branching patterns of thalli, (2) flat blades that may be spiralled on their axis, (3) width of the blade, (4) primary or secondary derivation of sterile and fertile branchlets and (5) position of sterile and fertile branchlets on the thalli. Application of the latter two characters provides an important basic method for separation of species into three major groups. Osmundaria , a genus known only in southern Australia, was studied in relation to Vidalia , and its separation from the Vidalia assemblage is not accepted. Species of Vidalia therefore are transferred to the older genus name, Osmundaria. Two new species, Osmundaria papenfussii and Osmundaria oliveae are described from Natal. Confusion in the usage of the epithet, Vidalia fimbriala Brown ex Turner has been clarified, and Vidalia gregaria Falkenberg, described as an epiphyte on Osmundaria pro/ifera Lamouroux, is revealed to be young branches of the host, Osmundaria prolifera.     

New or rare chromosome counts in Artemisia L. (Asteraceae, Anthemideae) and related genera from Kazakhstan

Fifteen chromosome counts of six Artemisia taxa and one species of each of the genera Brachanthemum, Hippolytia, Kaschgaria, Lepidolopsis and Turaniphytum are reported from Kazakhstan. Three of them are new reports, two are not consistent with previous counts and the remainder are confirmations of very scarce (one to four) earlier records. All the populations studied have the same basic chromosome number, x = 9, with ploidy levels ranging from 2x to 6x. Some correlations between ploidy level, morphological characters and distribution are noted.     

肝癌中HBV和HCV基因和抗原的分布及意义

采用原位分子杂交方法检测HCV RNA及HBV X基因;采用免疫组织化学方法研究HCV核心抗原,非结构区C33c抗原及HBxAg在肝细胞肝癌中的定位及分布.结果表明(1)HCV RNA、HBV X基因在肝细胞肝癌组织检出率分别为40%(55/136)和82%(112/136).HCV RNA定位于癌细胞的胞浆内,阳性细胞呈散在、灶状及弥漫分布三种形式;HBV X基因在肝癌细胞中的分布呈胞浆型、核型及核浆型,阳性细胞也呈上述三种分布形式;(2)HCV C33c抗原、核心抗原在肝细胞肝癌中的阳性率为81%(133/164)及86%(141/164).C33c抗原定位于癌细胞及肝细胞的胞浆内;核心抗原既定位于癌细胞核中,又可定位于胞浆中.C33c抗原阳性细胞以灶状分布为主;而核心抗原阳性细     

Comparative morphology of the carpel in the Liliaceae: Hewardieae, Petrosavieae, and Tricyrteae

The young pistils in the melanthioid tribes, Hewardieae, Petrosavieae and Tricyrteae, are uniformly tricarpellate and syncarpous. They lack raphide idioblasts. All are multiovulate, with bitegmic ovules. The Petrosavieae are marked by the presence of septal glands and incomplete syncarpy. Tepals and stamens adhere to the ovary in the Hewardieae and the Petrosavieae but not in the Tricyrteae. Two vascular bundles occur in the stamens of the Hewartlieae and Tricyrtis latifolia. Ventral bundles in the upper part of the ovary of the Hewardieae are continuous with compound septal bundles and placental bundles in the lower part. Putative ventral bundles occur in the alternate position in the Tricyrteae and putative placental bundles in the opposite. position in the Petrosavieae. The dichtomously branched stigma in each carpel of the Tricyrteae is supplied by a bifurcated dorsal bundle.