P16免疫染色可以提高子宫平滑肌肿瘤的组织学分类

子宫平滑肌肿瘤根据核分裂像、细胞学异型性和凝固性肿瘤细胞坏死可分为平滑肌瘤和平滑肌肉瘤。平滑肌瘤和平滑肌肉瘤是不同的肿瘤，不属于一个生物学谱系。然而，恶性潜能未定的子宫平滑肌肿瘤（STUMP）因缺乏临床经验而不能明确归人平滑肌瘤或平滑肌肉瘤。作者研究了p16在各种子宫平滑肌肿瘤（平滑肌肉瘤15例、平滑肌瘤22例、STUMP8例和10例正常子宫肌层）中的表达，结果显示12／15例平滑肌肉瘤强烈而弥漫性表达p16，     

KI-67、P53、BCL-2在子宫平滑肌肿瘤中的表达及临床意义

目的探讨KI-67、P53、BCL-2与子宫平滑肌肿瘤的关系及其临床意义。方法采用免疫组化方法检测38例子宫平滑肌瘤、36例具恶性潜能的平滑肌瘤(STUMP)和33例子宫平滑肌肉瘤中KI-67、P53、BCL-2的表达。结果①KI-67、P53在子宫肉瘤中的表达强于子宫平滑肌瘤。②BCL-2在子宫肉瘤中的表达弱于子宫平滑肌瘤。结论LMS患者BCL-2表达越强,其生存期越长。K I-67、P53、BCL-2有可能成为区别子宫平滑肌肉瘤与子宫平滑肌瘤及判断子宫平滑肌肉瘤预后的指标。     

子宫内膜间质肉瘤中BCOR、CD10和Cyclin D1的诊断意义

目的探讨子宫内膜间质肉瘤(endometrial stromal sarcoma, ESS)中BCOR、CD10和Cyclin D1的表达及其诊断意义。方法收集38例ESS,其中低级别子宫内膜间质肉瘤(low-grade endometrial stromal sarcoma, LG-ESS)23例、高级别子宫内膜间质肉瘤(high-grade endometrial stromal sarcoma, HG-ESS)12例和未分化子宫肉瘤(undifferentiated uterine sarcoma, UUS)3例,另收集6例子宫平滑肌肉瘤(包括2例黏液性平滑肌肉瘤)和20例子宫富于细胞性平滑肌瘤作为对照组,采用免疫组化EnVision法检测BCOR、CD10和Cyclin D1在不同子宫组织中的表达,分析三者的差异表达并复习相关文献。结果 BCOR在HG-ESS、LG-ESS、UUS、平滑肌肉瘤和富于细胞性平滑肌瘤中的表达分别为7、1、0、0和0例,CD10在HG-ESS、LG-ESS、UUS、平滑肌肉瘤和富于细胞性平滑肌瘤中的表达分别为8、21、1、2和4例,Cyclin D1在HG-ESS、LG-ESS、UUS、平滑肌肉瘤和富于细胞性平滑肌瘤中的表达分别为5、4、1、1和0例。结论 BCOR在HG-ESS中具有较高的敏感性与特异性,特别是在Cyclin D1阴性和伴黏液样背景的HG-ESS中,可联合CD10和Cyclin D1用于HG-ESS的诊断及鉴别诊断。     

子宫肿瘤恶性程度与肥大细胞脱颗粒后面积呈负相关

目的探讨肥大细胞浸润对子宫平滑肌肿瘤的影响。方法收集子宫平滑肌瘤12例、恶性未定平滑肌瘤10例和平滑肌肉瘤7例。观察和计量组织特征、肥大细胞颗粒、第Ⅷ因子相关抗原及瘤细胞凋亡率,分析肥大细胞释放颗粒与其他指标间的相关性。结果子宫平滑肌瘤瘤细胞数最少(P<0.01),恶性未定平滑肌肿瘤居中,平滑肌肉瘤最多(P<0.01)。平滑肌瘤肥大细胞脱颗粒面积百分率最多,恶性未定平滑肌瘤居中,平滑肌肉瘤最低;脱颗粒面积百分率与瘤细胞数相比呈负相关。平滑肌瘤内皮细胞第Ⅷ因子相关抗原阳性染色面积最低,恶性未定平滑肌肿瘤居中(P<0.01),平滑肌肉瘤最高(P<0.01);第Ⅷ因子相关抗原阳性染色面积与肥大细胞脱颗粒面积比呈负相关。平滑肌瘤瘤细胞凋亡率最低,恶性未定平滑肌肿瘤居中(P<0.01),平滑肌肉瘤最高(P<0.01);瘤细胞凋亡率与肥大细胞脱颗粒面积比呈负相关。结论子宫平滑肌肿瘤恶性度和血管状态与肥大细胞脱颗粒面积百分比成负相关。     

677例子宫平滑肌肿瘤的病理诊断

目的：探讨子宫平滑肌肿瘤的病理诊断。方法：对677例子宫平滑肌肿瘤重新观察肿瘤细胞密度,异型性,核分裂象,瘤细胞凝固性坏死和浸润性边缘,作出诊断。结果：普通平滑肌瘤654例,特殊组织类型平滑肌瘤21例（富于细胞型7例,畸异型4例,不典型性9例,核分裂活跃型1例）,恶性潜能未定型平滑肌肿瘤1例,平滑肌肉瘤1例,普通子宫平滑肌瘤核分裂与月经周期显著相关,4例特殊组织类型平滑肌瘤可见肿瘤血管内生长,随访表明特殊组织类型平滑肌瘤为良性经过。结论：特殊组织类型子宫平滑肌瘤虽因形态有异,而导致误诊,但其生物学行为均属良性。     

子宫奇异型平滑肌瘤的临床病理分析

目的探讨子宫奇异型平滑肌瘤组织形态、免疫组织化学及生物学行为特征.方法对25例子宫奇异型平滑肌瘤进行瘤体大体及镜下观察;20例行平滑肌肌动蛋白(SMA)、增殖细胞核抗原(PCNA)、雌激素受体(ER)、孕激素受体(PR)免疫组织化学SP和ABC法染色,20例子宫富于细胞性平滑肌瘤作为对照组;并行临床资料分析及跟踪随访.结果临床主要表现为阴道不规则出血、腹痛和盆腔包块,1例合并大量腹水,2例合并妊娠,无应用孕酮类药物者.镜下部分或全部胞核奇异,双核或多核易见,核内多见1至数个较大红染包涵体样物(直径7～26 μm),核分裂象0～2/10高倍视野(HPF).20例奇异型平滑肌瘤做 SMA染色,全部奇异瘤细胞胞质呈肌源性表达,与对照组相同;PCNA染色,观察组15例(75.0%)呈弱阳性,与对照组相比,差异有显著意义(P=0.027);在观察组中18例(90.0%)ER呈阴性表达,表现有ER丢失现象,对照组则全部阳性,两组相比差异有极显著性意义,P＜0.005;PR两组均呈阳性;同时发现大部分核内包涵体样物呈肌源性表达,即SMA阳性.长期随访无复发.结论子宫奇异型平滑肌瘤虽形态奇异,但属良性肿瘤.本组形态学变化与外源性孕酮药物无关,与妊娠关系应予以关注.免疫组织化学表达有一定特征,应与平滑肌肉瘤及恶性潜能待定平滑肌瘤进行鉴别.     

食管间质瘤与平滑肌肿瘤对照性研究

目的 探讨食管间质瘤与平滑肌肿瘤临床病理、免疫组织化学及分子生物学特点。方法 24例食管间叶源性肿瘤用CD117、CD34等一组抗体重新进行分类,部分病例同时测定c-kit基因11外显子序列。结果 此组肿瘤分别为间质瘤3例（交界性1例、恶性2例）,年龄71、56、60岁,均为男性,瘤体直径4、8、14cm,源于固有肌层。瘤细胞梭形,上皮样多角形及印戒样,呈交叉束状、栅栏状及弥漫片状排列,免疫表型为CD117、CD34弥漫强阳性。平滑肌瘤20例,年龄30－60岁,平均41.6岁,男性12例,女性8例,15例源于固有肌层,直径0.8-10.5cm（平均4.5cm),5例源于黏膜肌层,直径为0.2-1.0cm(平均0.6cm)。平滑肌肉瘤1例,男性,61例,瘤体直径5cm,源于黏膜肌层。平滑肌（肉）瘤胞质丰富,嗜伊红,交叉束状排列,免疫表型为平滑肌肌动蛋白、肌特异性肌动蛋白、结蛋白弥漫强阳性。恶性间质瘤有c-kit基因11外显子的突变,平滑肌瘤无突变。结论 食管间叶源性肿瘤仍以平滑肌瘤多见,可发生与胃肠道间质瘤相同形态与免疫表型的间质瘤,典型平滑肌肉瘤极为罕见,食管间质瘤与平滑肌瘤具有不同的临床病理学及分子生物学特征。     

皮肤交界性平滑肌瘤的复发与恶性转化

目的探讨皮肤交界性平滑肌瘤的复发与恶性转化。方法复习2例皮肤交界性平滑肌瘤及其复发恶性转化的临床病理特征、免疫组化表型及相关文献。结果2例病变位于下肢和额部，肉瘤组织平滑肌标记阳性。结论少数病理诊断为皮肤平滑肌瘤的病例，虽然浅表且组织形态良性，但其生物学恶性潜能尚不能确定，部分病例复发后可转变为典型的平滑肌肉瘤。     

子宫平滑肌肿瘤诊断中的一些问题

子宫平滑肌瘤是病理医师日常工作中最常遇到的妇科标本之一 ,绝大多数病例不存在诊断的问题。当这种肿瘤出现特殊的组织形态和生长方式而类似于平滑肌肉瘤、子宫内膜间质肿瘤 ,或其他肿瘤的表现时就会造成诊断上的困难[1,2 ] ,往往出现意见分歧。现就子宫平滑肌瘤诊断的陷阱(变型 ) ,子宫平滑肌肉瘤诊断的难点 (标准 ) ,不能确定恶性潜能的子宫平滑肌肿瘤 ,以及诊断子宫平滑肌肿瘤的某些共同原则等问题讨论如下。一、诊断子宫平滑肌瘤的陷阱 (变型 )某些子宫平滑肌瘤的变型可能被误诊为平滑肌肉瘤或其他类型的子宫肿瘤 ,因此 ,正确理解子宫…     

子宫分割性平滑肌瘤1例临床病理分析

目的探讨子宫分割性平滑肌瘤临床病理学特征、诊断及鉴别诊断。方法回顾性分析1例子宫分割性平滑肌瘤的临床病理特征、免疫表型,并复习相关文献。结果患者56岁,B超示盆腔低回声包块,大小15 cm×14 cm×9 cm。MRI示子宫后壁一宫底肌层内肿块影、子宫两旁不规则块状影来源不确定,子宫后壁及双侧附件平滑肌瘤变性?或子宫腺肉瘤合并双侧附件性索来源肿瘤?镜检见肿瘤组织呈分化良好的平滑肌组织形态,沿肌壁局限型分割性生长,无坏死,未见核分裂象,呈丛状分布,平滑肌瘤结节之间明显水肿,平滑肌绕血管或血管丛呈漩涡状或不规则排列。免疫表型:子宫分割性平滑肌瘤瘤细胞表达ER、PR、vimetin、H-caldesmon、desmin、SMA均强阳性,CD34血管阳性,CD117、DOG1、CD10、CD99、HMB-45、S-100、CK和EMA均阴性,Ki-67增殖指数1%。结论子宫分割性平滑肌瘤是平滑肌瘤中极为罕见的亚型,病理诊断尤其是术中冷冻切片易误诊。     

Mitochondria as a feature of smooth muscle differentiation: a study of 70 smooth muscle tumors

We report that the presence of numerous mitochondria is an ultrastructural feature of smooth muscle neoplasms which is diagnostically useful as a marker for smooth muscle differentiation. The number of mitochondria, as well as the usual features of smooth muscle differentiation, were studied in 70 smooth muscle neoplasms from a variety of body sites. The tumors were sub-classified according to the number of mitochondria (in the majority of the tumor cells) as sparse, moderate, abundant or packed. Thirty-one percent of the leiomyomas had sparse mitochondria and 69% had a moderate number of mitochondria. Seven percent of the leiomyoblastomas contained a moderate number of mitochondria, 33% contained abundant mitochondria and 60% were packed with mitochondria. Twelve percent of the leiomyosarcomas showed sparse mitochondria, 67% showed a moderate number of mitochondria, and 21% had abundant mitochondria. For the above tumor types, the cells with abundant and packed mitochondria contained few or no visible filaments, and these cells were often round or polygonal. By contrast, adjacent spindle cells often contained numerous filaments including dense bodies. The recognition of mitochondria as a feature of smooth muscle differentiation is diagnostically useful in tumor samples showing numerous mitochondria and a paucity of filaments and dense bodies.     

Subclassification of Gastrointestinal Stromal Tumors Based on Evaluation by Electron Microscopy and Immunohistochemistry

Fifty-six gastrointestinal stromal tumors (GIST) were subclassified by ultrastructural examination and by immunophenotypic analysis using a panel of 13 antibodies. Eighty percent of the tumors originated in the stomach and small intestines. The neoplasms were classified as follows: 42.9% smooth muscle tumors (4 leiomyomas, 9 spindle cell and 8 epithelioid leiomyosarcomas, and 3 mixed spindle cell and epithelioid leiomyosarcomas); 37.5% gastrointestinal autonomic nerve tumors (GANT), 47.6% of which arose in the small intestines; 8.9% mixed leiomyosarcoma/neurogenic tumors; and 10.7% undifferentiated GIST, not otherwise specified. The muscle common actin antibody HHF-35, variably reactive with tumor cells composing 23 of 24 smooth muscle tumors, was found to be the most sensitive marker of leiomyocyte differentiation. One immunophenotypically questionable spindle cell leiomyosarcoma was diagnosed by electron microscopy. Since neuron specific enolase positive cells were found in 1/3 of the leiomyosarcoma cases, the ultrastructural demonstration of synapse-like structures and neurosecretory granules was required for diagnosing GANTs. The immunophenotype of the ultra-structurally undifferentiated GIST was vimentin and CD34 +. Variable numbers of ultrastructurally undifferentiated cells also were found in all of the tumors except 2 leiomyomas. CD34 was also expressed in smooth muscle (54%) and GAN (62%) tumors. Despite their similar light microscopic appearance, GIST are phenotypically heterogeneous, requiring both ultrastructural and immunohistochemical studies for accurate characterization.     

Two autopsy cases of primary leiomyosarcoma of the liver. Superiority of muscle-specific actin immunoreactivity in diagnosis

Two autopsy cases of leiomyosarcoma of the liver in a 49-year-old female and 63-year-old male are reported. Both of the liver tumors showed electron microscopically dense patches in the cytoplasm and intermediate junctions between the tumor cells, suggesting a smooth muscle cell origin, irrespective of their different histological features. The nature of both tumors was confirmed by positive immunoreactivity for muscle-specific actin in the tumor cells, whereas desmin immunoreactivity was labile in both cases, showing a higher diagnostic value of the former compared with the latter in these leiomyosarcomas. Both cases, showed extensive distant metastases in spite of an evident difference in their mitotic indices, indicating that this index is not reliable for judging the metastatic potential of these tumors.     

Myxoid leiomyosarcoma of the liver

This is the first report of a myxoid leiomyosarcoma arising in a cirrhotic liver. The tumor was resected from a 64-year-old man. On gross examination, it was soft and hemorrhagic. The tumor was composed of deceptively benign-looking smooth muscle cells with clear cytoplasm suspended in a myxoid stroma with foci of hemorrhage. Immunohistochemistry and electron microscopy confirmed that this was a smooth muscle cell neoplasm. The abundance of glycogen and ultrastructural signs of smooth muscle differentiation were considered consistent with an immature smooth muscle cell phenotype consistent with the diagnosis of myxoid leiomyosarcoma. Since myxoid leiomyosarcomas are aggressive tumors, it is important to recognize them histologically and also bear in mind that these tumors can occur even in unusual extrauterine locations such as a cirrhotic liver.     

Two Autopsy Cases of Primary Leiomyosarcoma of the Liver Superiority of Muscle-specific Actin Immunoreactivity in Diagnosis

Two autopsy cases of leiomyosarcoma of the liver in a 49-year old female and 63-year-old male are reported. Both of the liver tumors showed electron microscopically dense patches in the cytoplasm and intermediate junctions between the tumor cells, suggesting a smooth muscle cell origin, irrespective of their different histological features. The nature of both tumors was confirmed by positive immunoreactivity for muscle-specific actin in the tumor cells, whereas desmin immunoreactivity was labile in both cases, showing a higher diagnostic value of the former compared with the latter in these leiomyosarcomas. Both cases, showed extensive distant metastases in spite of an evident difference in their mitotic indices, indicating that this index is not reliable for judging the metastatic potential of these tumors. Acta Pathol Jpn 41: 461–465, 1991.     

Intermediate and fine cytofilaments in cutaneous and subcutaneous leiomyosarcomas.

The expression of fine and intermediate cytofilaments in 10 cutaneous and seven subcutaneous leiomyosarcomas was studied immunohistochemically. All the tumors contained tumor cells which showed a positive immunoreactivity for desmin in formaldehyde-fixed and paraffin-embedded sections, but none of the seven anti-desmin antibodies used alone produced a distinct positive staining in all the tumors. A lack of correspondence in terms of immunoreactivity between tumor cells and the supposed muscle of origin was observed, especially in the subcutaneous leiomyosarcomas. In all cases, antibodies to muscle-specific and smooth muscle-specific actin were found to produce a positive staining in both the tumors and the supposed muscle of origin. Vimentin was detected in 8/10 cutaneous and 4/7 subcutaneous leiomyosarcomas, while the supposed muscle of origin was positive in 3/10 and 7/7 cases, respectively. Four of the cutaneous and three of the subcutaneous leiomyosarcomas contained tumor cells which stained positively for cytokeratins, while the supposed muscle of origin showed no positivity. It thus appears that a phenotypic shift in terms of vimentin and cytokeratin expression occurs in the tumor cells of cutaneous and subcutaneous leiomyosarcomas compared with the supposed muscle of origin. It is recommended that more than one monoclonal anti-desmin antibody is used to characterize these tumor entities. It is also concluded that the immunoreactivity for muscle-specific actins in superficial leiomyosarcomas is more constant, although less specific, than that of desmin and that the demonstration of the simultaneous expression of muscle-specific actins and desmin is helpful.     

Is anti-h-caldesmon useful for distinguishing smooth muscle and myofibroblastic tumors? An immunohistochemical study

Misinterpretation of positive staining of antibodies to desmin, smooth muscle actin, and muscle actin as representing smooth muscle differentiation in the context of a spindle cell tumor is not uncommon. Anti-h-caldesmon is a promising novel immunohistochemical reagent for more specific smooth muscle differentiation. We studied 72 tumors (11 leiomyosarcomas, 26 malignant fibrous histiocytomas [MFHs], 11 fibromatoses, 11 cellular cutaneous fibrous histiocytomas [CCFHs], 5 malignant peripheral nerve sheath tumors, 4 synovial sarcomas, and 4 cases of nodular fasciitis), the reactive myofibroblastic response in 5 cases of acute cholecystitis, and the desmoplastic response surrounding 5 invasive breast carcinomas. Tissues were examined for expression of h-caldesmon, desmin, smooth muscle actin, and muscle actin. Diffuse staining for h-caldesmon was present only within the leiomyosarcomas. Focal staining for h-caldesmon involving less than 1% of lesional cells was present in 3 of 26 MFHs and 1 of 11 CCFHs. There was overlap in staining for the other "myoid" markers in all of the lesions that contained myofibroblasts. Anti-h-caldesmon seems to be a reliable marker of smooth muscle differentiation, and its inclusion in a panel of myoid immunohistochemical reagents should allow distinction of smooth muscle and myofibroblastic tumors.     

Fibrosarcoma mimicking plasmacytoma or carcinoma: an ultrastructural study of 4 cases

Because the fibroblast has a remarkable capability of phenotypic modulations, reflected in both morphologic and immunohistochemical (IHC) changes, ultrastructural studiesare mandatory to identify the variants of fibroblasts. Myofibroblasts or histiofibroblasts are such examples, demonstrating chimeric ultrastructural features of fibroblastic cells in common with smooth muscle cells or with histiocytes, respectively. The presence of epithelioid fibroblastic cells sharing morphologic features with epithelial or plasma cells has not been yet characterized. The authors identified 4 cases of fibrosarcomas (FS) characterized by an unusual phenotype and associated with peculiar ultrastructural findings. The electron microscopic (EM) findings were correlated with the histologic appearance and immunoprofile. All tumors were located in the extremities, 3 in soft tissues and 1 in the bone. By light microscopy 2 cases were composed predominantly by round uniform cells with a striking plasmacytoid appearance. One case mimicked carcinoma, composed predominantly by epithelioid cells and scattered giant tumor cells. The fourth case showed a mixture of plasmacytoid-like and epithelioid cells. By IHC, tumor cells were positive for vimentin and in 2 cases also for epithelial membrane antigen. Kappa/lambda light chain and cytokeratins markers were negative. By EM all 4 tumors showed in addition to classic features of fibroblasts, unusual epithelial-type features, such as secretory granules of "neurosecretory-type" (3 cases), rudimentary cell junctions (3 cases), microvilli (2 cases), and lumen-like structures (1 case). One plasmacytoid-type tumor showed finely granular extracellular deposits. The study describe 4 examples of fibrosarcomas with unusual features at the ultrastructural level, which are associated microscopically with a peculiar phenotype, mimicking plasmacytoma or carcinoma. These findings broaden the spectrum of fibroblastic cell variants in neoplasia.     

Fibrosarcoma Mimicking Plasmacytoma or Carcinoma: An Ultrastructural Study of 4 Cases

Because the fibroblast has a remarkable capability of phenotypic modulations, reflected in both morphologic and immunohistochemical (IHC) changes, ultrastructural studiesare mandatory to identify the variants of fibroblasts. Myofibroblasts or histiofibroblasts are such examples, demonstrating chimeric ultrastructural features of fibroblastic cells in common with smooth muscle cells or with histiocytes, respectively. The presence of epithelioid fibroblastic cells sharing morphologic features with epithelial or plasma cells has not been yet characterized. The authors identified 4 cases of fibrosarcomas (FS) characterized by an unusual phenotype and associated with peculiar ultrastructural findings. The electron microscopic (EM) findings were correlated with the histologic appearance and immunoprofile. All tumors were located in the extremities, 3 in soft tissues and 1 in the bone. By light microscopy 2 cases were composed predominantly by round uniform cells with a striking plasmacytoid appearance. One case mimicked carcinoma, composed predominantly by epithelioid cells and scattered giant tumor cells. The fourth case showed a mixture of plasmacytoid-like and epithelioid cells. By IHC, tumor cells were positive for vimentin and in 2 cases also for epithelial membrane antigen. Kappa/lambda light chain and cytokeratins markers were negative. By EM all 4 tumors showed in addition to classic features of fibroblasts, unusual epithelial-type features, such as secretory granules of "neurosecretory-type" (3 cases), rudimentary cell junctions (3 cases), microvilli (2 cases), and lumen-like structures (1 case). One plasmacytoid-type tumor showed finely granular extracellular deposits. The study describe 4 examples of fibrosarcomas with unusual features at the ultrastructural level, which are associated microscopically with a peculiar phenotype, mimicking plasmacytoma or carcinoma. These findings broaden the spectrum of fibroblastic cell variants in neoplasia.     

Leiomyoma of the thyroid gland

Primary smooth muscle tumors of the thyroid gland are very rare neoplasms, leiomyosarcomas comprising the majority of these. Only three cases of primary leiomyoma have been reported to date, all of which have occurred in females of varying ages. We present the morphological, immunohistochemical and ultrastructural features of a fourth case of leiomyoma of the thyroid gland, occurring in a post-menopausal woman with a history of uterine leiomyomas.