超声对睾丸肿瘤及肿瘤样病变的诊断及鉴别诊断

目的 探讨超声对睾丸肿瘤及肿瘤样病变的诊断及鉴别诊断价值.方法 回顾分析33例睾丸肿块患者的超声声像图表现,并与其病理结果进行对照.结果 33例睾丸肿块患者中,精原细胞瘤12例,淋巴瘤6例,表皮样囊肿6例,混合性生殖细胞瘤2例,畸胎瘤2例,胚胎性癌、内胚窦瘤各1例,其他3例.结论 超声检查对睾丸肿瘤及肿瘤样病变的诊断及鉴别诊断具有重要价值,可为进一步治疗方案的制定提供依据,是睾丸肿瘤首选的影像学检查方法.     

气管上皮-肌上皮癌的临床病理学观察

目的观察气管上皮-肌上皮癌(epithelial-myoepithelial carcinoma,EMC)的临床病理学、影像学特点,探讨其免疫组化特征及鉴别诊断。方法采用组织学、免疫组化及组织化学技术对1例气管EMC进行光镜观察及免疫标记,并结合相关文献对其临床表现、影像学、组织形态和免疫组化特点等进行综合分析。结果患者男性,25岁,肿瘤病理组织学表现为分叶状生长,管状和实性区混合存在。瘤细胞由上皮和肌上皮细胞组成,呈双层腺管样结构。免疫组化染色示:上皮细胞CK、EMA均(+),肌上皮细胞SMA、S-100、p63、HHF35、GFAP均(+),管状结构周围PAS染色(+)。结论原发于气管的EMC十分罕见,影像学具有一定特征,免疫组化染色有助于该肿瘤的诊断,应与多形性腺瘤、肌上皮瘤、嗜酸细胞瘤、腺样囊性癌等鉴别;以手术切除为主的综合治疗预后较好。     

Epithelial-myoepithelial carcinoma of the bronchus: a clinicopathological observation

目的 观察气管上皮-肌上皮癌(epithelial-myoepithelial carcinoma,EMC)的临床病理学、影像学特点,探讨其免疫组化特征及鉴别诊断.方法 采用组织学、免疫组化及组织化学技术对1例气管EMC进行光镜观察及免疫标记,并结合相关文献对其临床表现、影像学、组织形态和免疫组化特点等进行综合分析.结果 患者男性,25岁,肿瘤病理组织学表现为分叶状生长,管状和实性区混合存在.瘤细胞由上皮和肌上皮细胞组成,呈双层腺管样结构.免疫组化染色示:上皮细胞CK、EMA均(+),肌上皮细胞SMA、S-100、p63、HHF35、GFAP均(+),管状结构周围PAS染色(+).结论 原发于气管的EMC十分罕见,影像学具有一定特征,免疫组化染色有助于该肿瘤的诊断,应与多形性腺瘤、肌上皮瘤、嗜酸细胞瘤、腺样囊性癌等鉴别;以手术切除为主的综合治疗预后较好.     

婴幼儿原发腹膜后卵黄囊瘤临床病理观察

目的 探讨婴幼儿原发腹膜后卵黄囊瘤(yolk sac tumor,YST)的临床病理特征.方法 对1例幼儿原发腹膜后YST进行临床病理和免疫组化分析,并结合文献探讨该病特点.结果 患儿男性,18个月大.送检腹膜后标本为灰白色实性肿块;镜下肿瘤具有疏松网状结构,嗜酸性小球、SD小体等特点;免疫组化:肿瘤组织表达CK及AFP.结论 婴幼儿原发腹膜后YST十分少见,诊断主要依靠组织学特点、免疫组化结果、患者年龄、部位及临床检查.     

胃间质瘤的CT诊断与影像学分型

目的：分析胃间质瘤(GST)的CT诊断特点,探讨其影像学分型。方法回顾性分析经手术病理证实的16例GST临床影像学资料,结合文献进行分析。结果16例中单发型14例,其中粘膜下型6例,肌壁间型4例,浆膜下型8例。多发型2例,其中同一部位多发瘤体1例,不同部位多发瘤体1例。胃底及胃体发病14例。 CT表现为圆形或类圆形肿块,增强后实性部分明显、持续强化。结论 GST的CT诊断及影像学分型具有一定特点。     

成人与儿童髓母细胞瘤的MRI特征分析

目的 分析成人与儿童髓母细胞瘤的MRI表现,提高对髓母细胞瘤的认识。方法 回顾性分析2009年1月—2017年12月广东省农垦中心医院经手术病理证实的髓母细胞瘤36例的影像学资料。将其分为两组:儿童组(＜18岁)25例,成人组(≥18岁)11例。36例患者术前行MRI平扫及增强扫描,观察并对比分析两组患者肿瘤的发生部位、瘤体最大径线、边界、囊变、实性部分强化程度、瘤周水肿、梗阻性脑积水、室管膜种植转移等影像学特征。结果 36例髓母细胞瘤均发生于幕下,儿童常见于小脑蚓部(21/25),成人病灶多位于小脑半球(9/11),差异有统计学意义(P=0.000)。儿童肿瘤最大径为(4.50±0.58) cm,其中17例肿瘤最大径超过4 cm;成年人瘤体最大径为(5.24±1.36) cm,其中8例肿瘤最大径超过4 cm;两者比较差异无统计学意义(Z=-0.895, P＞0.05)。成人组和儿童组囊变分别有16例和11例,瘤周水肿分别有4例和7例,差异均有统计学意义(P=0.034、0.008);而边界、梗阻性脑积水及室管膜种植转移方面组间差异均无统计学意义(P值均＞0.05)。36例患者髓母细胞瘤实性部分均表现为T₂WI及T₂WI-FLAIR稍高信号,T₁WI等偏低信号。12例做了弥散加权成像检查(5例儿童、7例成人),瘤体实性部分均表现为弥散受限;增强后,两组肿瘤实性区域均表现为轻度至中度强化。结论 儿童髓母细胞瘤好发于小脑蚓部,成人以小脑半球多见;儿童肿瘤囊变及瘤周水肿相对于成年人少。儿童与成人髓母细胞瘤均常表现为边界清楚肿块,实性区域轻度至中度强化,易发生梗阻性脑积水,可发生室管膜种植转移。     

胰腺实性假乳头状瘤的 CT 表现与病理分析

目的：探讨胰腺实性假乳头状瘤（ SPTP）的CT特征及病理改变。方法：回顾性分析6例SPTP的临床资料,其中男1例、女5例,平均年龄24．5岁。所有患者均进行CT平扫及增强扫描。病灶位于胰头2例,胰体1例,胰尾3例;胰尾3例中,1例发生肝脾多发转移,1例发生肝脏多发转移。总结其CT表现及病理学表现特征。结果：CT平扫病灶大小约3 cm ×5 cm～11 cm ×10 cm,呈圆形、类圆形或分叶状囊实性肿块,均可见包膜;1例病灶周缘可见细条状及斑点状钙化,2例病灶内可见斑片状出血灶。增强扫描病灶实性部分呈渐进性持续强化,可见特征性表现“浮云”征。所有病例均未见胆管或胰管扩张。6例病变病理检查均显示肿瘤有完整或不完整的纤维包膜,瘤组织由实性区、假乳头区混合组成,瘤细胞形态较一致,部分区域有出血、坏死及退行性变。结论：SPTP好发于青年女性,其CT表现有一定特征性,多期增强扫描有助于诊断与鉴别诊断;肿瘤细胞以纤细的纤维血管为轴心形成特征性的分支状假乳头状结构是其组织病理学特征性改变。     

卵巢囊肿蒂扭转的CT和MRI诊断价值

目的 探讨CT与MRI对卵巢囊肿蒂扭转的诊断价值.方法 回顾性分析10例经手术病理证实为卵巢囊肿蒂扭转的CT或MRI影像学特征.结果 盆腔囊实性双肿块且实性肿块与一侧子宫角或输卵管相连10例(100％);增强扫描实性部分轻度强化或不强化;囊壁不均匀增厚8例(80％)、囊壁均匀增厚2例(20％);囊肿边界清楚光滑8例(80％);盆腔积血1例(10％).结论 卵巢囊肿蒂扭转的CT与MRI表现具有一定特征性,作为超声检查的一种补充检查方法,对卵巢囊肿蒂扭转的诊断和鉴别诊断具有一定的临床价值.     

多囊性肾细胞癌1例报道及文献复习

目的：阐明多囊性肾细胞癌的病理形态学特征及鉴别诊断要点。方法：报道1例多囊性肾细胞癌,结合文献对本病的临床病理特征进行探讨。结果：肿瘤由厚的假纤维被膜环绕,瘤体全部由大小不等的囊腔及无膨胀性实性结节的薄的间隔构成,囊腔被覆透明细胞,异形性小,间隔内含聚集的透明细胞上皮巢,结论：多囊性肾细胞癌是一种罕见的有低度恶性倾向的肿瘤,术前影像学,细胞学检查及术后的肉眼特征均与囊性肾瘤,囊性部分分化性肾母细胞瘤相似,最重要的是本瘤缺乏肉眼所见的膨胀性实性结节,显微镜下的关键特征是间隔内可见聚集的透明细胞巢。     

巨大纵隔肿瘤影像学与手术病理

目的探讨巨大纵隔肿瘤影像学与手术难点及病理诊断. 方法分析了12例巨大纵隔肿瘤的术前临床影像诊断和手术治疗要点. 结果 12例中胸腺瘤4例,神经纤维瘤3例,畸胎瘤2例,神经鞘瘤1例,食管平滑肌瘤1例,脂肪肉瘤1例.12例均成功行肿瘤全切除术.术后出现复张性肺水肿7例.无手术死亡. 结论手术治疗是巨大纵隔肿瘤的主要治疗手段.术中行肿瘤分块切除或先行瘤内减张的方法,可提高手术的安全性和切除率.切除肿瘤后缓慢胀肺,并在术后24小时内行人工辅助通气对防治复张性肺水肿有重要意义.     

Serum alpha-foetoprotein as a marker for endodermal sinus tumour (yolk sac tumour) or a vitelline component of "teratocarcinoma".

The correlation between serum alpha-foetoprotein (AFP) and the clinical pathological finding of 24 germ cell tumours arising from the testes (14 cases), the ovaries (3 cases), the mediastinum (3 cases), the retroperitoneal region (2 cases), and the sacrococcygeal region (2 cases) are presented. Irrespective of marked differences in age and sex of the patients, primary site of the tumours and clinical outcome, the 24 cases constituted a homogeneous group in fundamental histological patterns and in AFP synthesis. In all cases of endodermal sinus tumour or teratocarcinomas with a distinct vitelline component an increased serum AFP concentrations was found in the pre-operative serum samples. AFP was also demonstrated in the tumour tissue by quantitative determination of AFP in tumour homogenate (5 cases) and, by immunofluorescence technique, positive staining of the cells lining the endodermal sinuses and of the hyaline globules was found (3 cases). In 12 germ cell tumours without vitelline components in the tumour tissue sections, a normal AFP concentration below 20 mug/1 was found in preoperative serum samples.     

Histological Patterns in Germ-cell Tumours associated with Raised Serum Alpha-fetoprotein (AFP)

Serum alpha-fetoprotein (AFP) was studied in 237 patients with germ cell neoplasms of the gonads and extra-gonadal sites. Whenever possible serial determinations were performed. All patients in remission had normal serum AFP. Raised serum AFP was seen in patients with active disease whose tumours contained endodermal sinus tumour (EST). This included 29 patients with testicular tumours, 11 with ovarian, 3 with mediastinal, and one with a retroperitoneal tumour. In all these patients serum AFP levels were high and correlated well with the amount of EST within the tumour. Serum AFP became normal when the disease was eradicated. There was a gradual rise with recurrence of the disease. Slightly raised serum AFP (below 60 ng/ml) was present in two patients with embryonal carcinoma examined preoperatively. In four similar cases serum AFP was normal. All patients with pure teratoma had normal serum AFP. Seventeen patients with pure seminoma whose serum was examined preoperatively had normal serum AFP at all times. These findings indicate that raised serum AFP is associated with the presence of EST within the tumour, and AFP is a good and reliable tumour marker in patients with germ cell neoplasms containing EST.     

Endodermal sinus (yolk sac) tumour of the liver. A case report and review of the literature

A primary endodermal sinus tumour of the liver which developed in a 27-year-old woman is reported. The dimensions of the tumour were 11 x 11 x 9.5 cm. Most parts were friable, haemorrhagic, and necrotic. No metastasis was found, but one part of the tumour was invading the diaphragm directly. Histologically, the tumour had mainly a reticular pattern, and partly a solid pattern, and was characterized by the presence of Schiller-Duval bodies and intra- and extracellular hyaline globules. A small part of the tumour showed a polyvesicular vitelline pattern and glandular structures with enteric differentiation. Serum alpha-fetoprotein was very high (28,500 ng/ml), but carcinoembryonic antigen was within the normal range. Immunohistochemically, most of the tumour cells contained alpha-fetoprotein and alpha-1-antitrypsin. Carcinoembryonic antigen and glutathione S-transferase, which was recently proved to be a useful marker for colonic carcinoma, were detected only in the glandular part Four previously reported cases of primary endodermal sinus tumour of the liver are reviewed.     

Alpha-fetoprotein production by a hepatoid adenocarcinoma of the uterus.

A case of a 62 year old Japanese woman with an endometrial adenocarcinoma producing alpha-fetoprotein (AFP) is described. Microscopically, the tumour was composed of a major medullary portion and a minor tubular adenocarcinoma which had invaded the myometrium, the myometrial lymphatics and blood vessels. Neoplastic cells in the medullary portion were polygonal with glycogen-rich cytoplasm. Vascular permeation by neoplastic cells was prominent. Extensive hepatoma-like features were observed. The tumour cells lacked features suggestive of a diagnosis of embryonal carcinoma or endodermal sinus tumour. The production of AFP by the tumour cells was demonstrated immunohistochemically using the PAP technique. Only two cases of AFP producing endometrial adenocarcinomas have been reported previously.     

Hepatoid adenocarcinoma: A distinctive histological subtype of alpha-fetoprotein-producing lung carcinoma

Summary Seven cases of alpha-fetoprotein (AFP)-producing lung carcinoma were studied histologically to determine whether they fell into any previously described category. The patients were all males from 40 to 73 years of age and their serum AFP levels ranged from 1039 to 320000 ng/ml. Five cases of hepatoid adenocarcinoma, one case of endodermal sinus tumour, and one case of papillary adenocarcinoma were found. The possible origins of the tumours and their differential diagnosis are discussed. Hepatoid adenocarcinoma is a major histological category among AFP-producing lung carcinoma; other types are less frequent. The occurrence of hepatoid adenocarcinoma in both the stomach and the lung suggests that this neoplasm may also be seen in other organs of endodermal origin. It may be a major histological subtype of AFP-producing endodermal neoplasms of non-germ cell origin.     

Endodermal sinus tumour of stomach--a case report

This is a case report of an endodermal sinus tumour arising in the stomach of a 1 1/2 years male child. The tumour occupied full thickness of fundus and part of the body of the stomach. H&E sections of the tumour tissue showed endodermal sinus tumour with predominantly reticular and endodermal sinus patterns. Elevated level of alpha-fetoprotien was detected in the serum of the patient and within the tumour tissue by immunohistochemical technique.     

A Case of Ovarian Endodermal Sinus Tumour with Recurrence of a Large Benign Teratoma

A 14 year old girl was operated for a left side ovarian tumour (weight: 1900 g). Histological examination: endodermal sinus tumour, combined with embryonal carcinoma and dysgerminoma. Serum-alpha-fetoprotein (AFP) was highly elevated (2630 μg/l), and serum human chorionic gonadotropin (hCG) was slightly elevated (100 IU/l), but 2 1/2 months after operation the AFP concentration was less than 20 μg/l, and hCG less than 15 IU/l. After 2 years of intermittent treatment with combination chemotherapy (VAMBLE) the patient developed a left side abdominal tumour (weight: 4600 g). Histological examination: Benign teratoma. There was no sign of recurrence of the malignant disease, and serum AFP and hCG are still normal.     

Comparative morphology of endodermal sinus tumor (Teilum) to human yolk sac and a proposal of endodermal cell tumor

Histological criteria of 8 pure and typical endodermal sinus tumor (EST) were compared with the morphological features of 8 human yolk sacs from 5 to 13 weeks of pregnancy. No common features were found with regard to endodermal sinus structure (ESS) and clear-cell entoblastic pattern (CCEP), but magma reticulare (MR) and eosinophilic hyaline globules (EHG) were detected as common findings. As to the morphology and synthesis of alpha-fetoprotein (AFP), some tumor cells with eosinophilic-granular cytoplasm lining ESS had similarity to the endodermal cell of human yolk sac. Histological features of EST mimicked the morphological structure of endodermal sinus in rodent yolk sac. Pathological study on an ovarian and a gastric adenocarcinoma with high level of AFP concentration demonstrated two cell patterns with eosinophilic-granular and clear cytoplasm showing analogousness to the endodermal cell of human yolk sac. It was suggested that these tumors showed a selective differentiation to the endodermal cell of human yolk sac and might be called ECT. Further study clarified that ovarian embryonal carcinoma or teratocarcinoma with higher AFP concentration had vitelline component of EST or ECT or both.     

Clinico-pathological Aspects of Endodermal Sinus Tumor in Childhood with Reference to PAS-positive Hyaline Globules observed in Tissue Culture

During the years 1952 through June, 1977, 64 children with tumor of germ cell origin were seen at the Department of Pediatric Surgery, the University of Tokyo Hospital. There were 39 mature, 7 immature and 18 frankly malignant teratomas. Sixteen cases had histological features of endodermal sinus tumor in pure or mixed form, and all of the last eight patients showed elevated serum AFP concentrations ranging from 92,000 ng/ml to 952 ng/ml. Serum AFP concentration declined almost to zero ng/ml with a half life of about 4 days when surgical removal was complete, whereas AFP decreased only to 100–200 ng/ml with radiation therapy and chemotherapy alone. Serum concentrations of prealbumin, albumin, alpha-1-antitrypsin and transferrin were almost within normal ranges.
Two endodermal sinus tumors were studied by tissue culture, which demonstrated secretion of diastaseresistant PAS-positive hyaline globules. PAS-positive granule is one of the characteristic histologic features of endodermal sinus tumor with demonstrable AFP specific immunofluorescence.     

COMPARATIVE MORPHOLOGY OF ENDODERMAL SINUS TUMOR (TEILUM) TO HUMAN YOLK SAC and A PROPOSAL OF ENDODERMAL CELL TUMOR

Histological criteria of 8 pure and typical endodermal sinus tumor (EST) were compared with the morphological features of 8 human yolk sacs from 5 to 13 weeks of pregnancy. No common features were found with regard to endodermal sinus structure (ESS) and clear-cell entoblastic pattern (CCEP), but magma reticulare (MR) and eosinophilic hyaline globules (EHG) were detected as common findings. As to the morphology and synthesis of a-feto-protein (AFP), some tumor cells with eosinophilic-granular cytoplasm lining ESS had similarity to the endodermal cell of human yolk sac. Histological features of EST mimicked the morphological structure of endodermal sinus in rodent yolk sac. Pathological study on an ovarian and a gastric adenocarcinoma with high level of AFP concentration demonstrated two cell patterns with eosinophilic-granular and clear cytoplasm showing analogousness to the endodermal cell of human yolk sac. It was suggested that these tumors showed a selective differentiation to the endodermal cell of human yolk sac and might be called ECT. Further study clarified that ovarian embryonal carcinoma or teratocarcinoma with higher AFP concentration had vitelline component of EST or ECT or both.