Mr. Zhang, in his 50s, went to the Zhejiang Spa 13_span 16 hospital because of an unexplained mass in his left lung during physical examination. The results of puncture show that this is a somewhat "uncommon" lung cancer, which may be poorly differentiated lung cancer .
but Chief physician Peng Fang, director of the Department of Pathology, Zhejiang Hospital Hospital , but thought of another possibility: SMARCA_span 16span defective undifferentiated tumor. After three analyses and tests on the same specimen, her speculation was confirmed: Mr. Zhang was diagnosed with SMARCA4-deficient undifferentiated tumor, a type of lung malignant tumor that has not been reported clinically until nearly five years.
The pathology department is a behind-the-scenes department. Pathologists often do not directly face the patient. However, the diagnosis of the patient's condition is made by the pathologist and indicates the direction of treatment for the clinician.
urinary bleeding more than two years
always finding out the reason
about two or three years Start,The 60-year-old Lao Yang repeatedly had hematuria , and all the necessary examinations were done, and the examination results showed no abnormalities. "There are no stones or abnormal tumor indicators, but blood in the urine appears after a period of time, and the cause cannot be found, and the root can not be broken." It was found that there was a congenital malformation in his renal blood vessels, which may be the reason for his repeated hematuria. For renal vascular malformations, the doctor recommended that he be followed up for long-term observation.
In June of this year, he was admitted to Zhejiang Hospital again, but this time, the problem was not blood in the urine, but a "small thing" on his chest wall. The thoracic puncture result suggested a poorly differentiated malignant tumor. What made him even more heartbreaking was that the attending doctor couldn't tell what malignant tumor he had.
"Most of the malignant tumors that occur in the human body are derived from epithelial tissues, which is cancer. According to common sense, the chest wall generally does not grow cancer, so the malignant tumors on the chest wall are often malignant mesothelioma. sarcoma or lymphoma leukemia. So, is this “malignant tumor” cancer of epithelial origin, other sarcomas, or lymphoma leukemia? If it is cancer, is it a primary growth from the chest wall or something else The local cancer metastasized, if it is metastasis, where did it metastasize, etc., all these require our pathologists to judge and help clinicians to formulate treatment plans." Peng Fang took over the case and began to "tracing the root cause" ".
repeated testing to trace
finally fell swoop "captured murderers"
biopsy for Mr. Yang ,The pathology department performed immunohistochemistry three times. The first time it was clear that this malignant tumor of the chest wall was a cancer, where did it come from? In the second time, the target was basically locked: the kidneys. For this reason, Peng Fang suggested that Lao Yang take a PET-CT examination.
"The PET-CT examination showed that the tumor on the chest wall of the patient was indeed a metastasis of a malignant tumor, and there were multiple metastases throughout the body." Peng Fang said, in order to further clarify, decided to do the third immunohistochemistry and genetic testing At the same time, I invited the hospital's radiology department and urology surgeons to have a consultation and discussion.
The hard work has paid off. Under the perseverance of the doctors, the truth has become clear: Lao Yang's kidney is inherently different, and there is a small tumor at the junction of 's renal pelvis and renal parenchyma. Although inconspicuous, it is extremely malignant and easily overlooked. In the previous examinations, it was never found.
After finding the "culprit", the Department of Urology quickly formulated a series of corresponding treatment plans for Lao Yang based on the pathological report and the results of genetic testing.
"The first stone in my heart finally fell. At least I know what disease I have and how I can cure it." Upon learning this result, Lao Yang was a little depressed, but he actively cooperated with the follow-up treatment.
disease "verify Mami"
treatment indicated direction
compared to other clinical departments,The pathology department is a bit strange to many people. The patients who did not come in and out, only all kinds of experimental equipment, and various numbered human tissue slices.
Peng Fang and her colleagues use microscopes and other auxiliary equipment in this laboratory every day to observe the tissue sections sent from the clinic, observe the structure and morphology, and use their knowledge and experience to check The specimen tissue makes a clear pathological diagnosis, clarifies the nature of the disease, especially to determine the nature of the tumor and benign and malignant, and finally helps the clinician to give the most appropriate treatment plan.
"Only when the tumor type is clarified can we avoid detours in treatment and avoid unnecessary medical waste." Peng Fang said that medicine is constantly evolving and the human body has too many mysteries, and the development of diseases is unpredictable. This requires pathologists to continue to learn and improve, enrich experience, so as to make accurate analysis and judgments, so that patients can avoid detours.
In fact, in addition to judging the nature of the tumor, the pathology department is also closely related to other clinical departments. For example, when clinically encounters some infectious diseases that are not cured by ordinary anti-inflammatory treatment, they will also take a little lesion and send it to the pathology department. Microscope and subsequent immunohistochemical special staining are used to help determine whether it is some special infection.
Because, pathological examination is the final diagnosis of the disease, and all treatments are carried out around the pathological diagnosis results.
Editor: Jing Audit: Long
Source: Daily Business
herein expert guidance
Peng Fang
Chief physician,Director of the Department of Pathology, Zhejiang Hospital. Duke University , visiting scholar in the Department of Pathology. He is also the vice chairman of the Youth Committee of the Pathology Branch of Zhejiang Medical Association, the vice chairman of the Youth Committee of the Oncology Pathology Professional Committee of Zhejiang Anticancer Association, and the member of the Ultramicro and Molecular Pathology Professional Committee of the Chinese Research Hospital Association. Engaged in pathological diagnosis for more than 20 years, good at surgical pathological diagnosis, especially lung cancer, esophageal cancer, gastric cancer, intestinal cancer, thyroid cancer and other tumor pathological diagnosis, and tumor targeted therapy related molecules Pathological testing.
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