Re: [課程]病理CPC 考訊
作者: flyingaway (飄然遠走) 看板: CSMU-MED96
標題: Re: [課程]病理CPC 考訊
時間: Fri Dec 28 04:56:32 2012
整理一些小筆記，不保證會出，也不保證資料正不正確，僅供參考~
(賴)第1組: diabetes ketoacidosis
1.病人死因：兩側basal ganglion出血
2.DKA小血管出血病變(IL-1b, IL-2, IL-6)造成症狀
(賴)第2組: liver cirrhosis, post-hepatitic, active, characterized by
submassive
necrosis cholestasis, intracanalicular decompensated status, with
hepatic encephalopathy ascites and liver transplantation
clinically
1.B cell CD20
2.T cell CD3,4,8
3.肝癌(重要)
(賴)第3組: 1. Scrub typhus infection
2. Septic shock, multi-organ failure
1.恙蟲病診斷：
血清學：IgM >1:160
PCR、以及RFLP
染色後可驗出位於macrophage細胞質內的病原體(O. tsutsugamushi) (脾、肝)
。
(賴)第4組: HCC+liver abscess引起肝腦病變
1.Liver cirrhosis的可能死因：? EV bleeding
2.病人肝左側的biloma(pseudocyst) 阻塞bile duct，造成黃疸
3.正常organ 重：
腎：150g
心：300g
肝：1200~1500g
腦：1500g
(林)第5組: 小細胞肺癌 + 肺腺癌
1.Lung cancer(PPT)
Peripheral: Adenocarcinoma
Central:Squamous cell carcinoma and Small cell carcinoma
2.Paraneoplastic syndrome(PPT)
Adenocarcinoma:hypertrophic pulmonary osteoarthropathy.
SCC:Hypercalcemia,arm pain.
SCLC: SIADH , Cushing syndrome , Eeaton lambert syndrome
3.SCLC：與抽菸有關
細胞小、核濃染(有一點一點的：Salt and pepper)、細胞質少
排列：Nuclear modeling(似麻糬擠在一起)
神經內分泌腫瘤：SIADH , Cushing syndrome , Eeaton lambert syndrome
4.Adenocarcinoma：
EGFR mutation：target theraphy
Micropapillary易meta，此病人為papillary不易meta
5.病人同時有SCLC和adenocarcinoma
(林)第6組: 1. Right buccal cancer, squamous cell carcinoma, pT1N0M0, stage I
s/p wide excision and right selective neck dissection
2.Warthin's tumor
1.此病人Warthin's tumor 的PET吸收非常強，所以將此良性tumor，誤以為是meta的
2.口腔癌長到越後面預後越不好，很少做術前R/T，因為R/T後會硬梆梆的不能開刀，
多是做術後R/T
(賴)第7組: Breast cancer, Final diagnosis: Respiratory failure
本組有以下猜測:
1. pneumonia + maybe sepsis(無data 純猜測)
2. maybe lung meta(印象中最後老師也沒說有沒有...)
3. Brain meta 壓迫呼吸中梳
另外老師有提到此病患breast cancer有轉移到腦膜 很少見
1.(記)乳癌免疫染色：
(1)ER(+)、PR(+)：tamoxifen效果好
(2)Her2/new(3+)：tumor 容不容易轉移的marker，但可治療→target
therapy(Herceptin)
(3)Ki-67(+)：mitotic rate
(4)E-cadherin(+)：duct carcinoma
E-cadherin(-)：lobular carcinoma
(5)high molecular weight cytokeratin(+)：invasive lobular carcinoma
high molecular weight cytokeratin(-)：invasive ductal carcinoma
2.CXCR4、CCR7：high in breast tumor，metastasis
3.P53(+)：易轉移、預後不好
4.EGFR、MMP-2、Cathepsin D 增加：易轉移
5.ER(-)、PR(-)：預後不好
6.Invasive lobular carcinoma (8 %)：India file(細胞排成一排)
7.腦膜有tumor cell 散布很少見，腦膜轉移預後不好
(賴)第8組: Transitional cell carcinoma
1. 惡性腫瘤免疫染色(Basic Immunohistochemistry of Malignant Neoplasms)
(1)Carcinoma：cytokeratin
CK20(-) CK20(+)
CK7(-) 攝護腺、肝、腎、神經內分泌 colon
CK7(+) 肺、乳房、卵巢、
urotheliun、上消化道 urotheliun、上消化道
病人的腎臟tumor，可能由urotheliun of renal pelvis 出來，為分化差的TCC
colon ：CK20、CEA
(2)melanoma：HMB45、MelanA、S-100
(3)lymphoma：CD45
(4)Sarcoma：Desmin, CD34,vimetin
(5)Germ cell tumor：PLAP, OCT4
2.如何判斷tumor 來源
Carcinoma of Unknown Origin: Site-Specific Immunohistochemical Markers
(1)TTF-1,CK7：肺、甲狀腺
(2) thyroglobulin；甲狀腺
(3)PSA、DSMA：攝護腺
(4) GCDFP, Mammoglobin：乳房
(5)ER,PR：乳房、GYN tract
(6)RCC marker、CD10：腎
(7)thrombomodulin：膀胱
分化很差可能都會結果都會(-)
3.RCC會有Paraneoplastic symptoms：
anemia,
hepatic dysfunction,
hypercalcemia(因PTHrP,IL-6多)
cachexia,fever, erythrocytosis, AA amyloidosis, thrombocytosis, polymyalgia
rheumatica.
4.TCC：CEA會高，最常轉移到肺、肝、骨
5.血尿DD：
不痛→tumor多
會痛→結石
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※ 發信站: 批踢踢實業坊(ptt.cc)
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希望有幫到一點忙，當做離別前的小禮物，很高興和妳們同窗六年，大家珍重再見了~!!
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