巨淋巴结增生症的研究进展

巨淋巴结增生症(Castleman's Disease,CD)又称血管滤泡性淋巴组织增生,是一种罕见的淋巴细胞增生性疾病.于1956年由Castleman等首次报道[1],主要临床分型为单中心型和多中心型.单中心型常局限于单个淋巴结发病,多中心型的典型表现为全身多发淋巴结增大.组织学分为透明血管型、浆细胞型、混合型.透明血管型CD约占单中心型CD病人的90%[2].而大多数多中心型CD的病人是浆细胞型,混合型则两者皆有.该病多发于胸腔内,特别是纵隔区域,以单发型为主,多发型少见.该病虽然研究在不断深入,但是人们对其发病机制、临床特点、治疗、预后等仍缺乏深入了解,诊断和治疗受到局限.     

巨淋巴结增生症的研究进展

巨淋巴结增生症(Castleman's Disease,CD)又称血管滤泡性淋巴组织增生,是一种罕见的淋巴细胞增生性疾病.于1956年由Castleman等首次报道[1],主要临床分型为单中心型和多中心型.单中心型常局限于单个淋巴结发病,多中心型的典型表现为全身多发淋巴结增大.组织学分为透明血管型、浆细胞型、混合型.透明血管型CD约占单中心型CD病人的90%[2].而大多数多中心型CD的病人是浆细胞型,混合型则两者皆有.该病多发于胸腔内,特别是纵隔区域,以单发型为主,多发型少见.该病虽然研究在不断深入,但是人们对其发病机制、临床特点、治疗、预后等仍缺乏深入了解,诊断和治疗受到局限.     

巨淋巴结增生症的研究进展

巨淋巴结增生症(Castleman's Disease,CD)又称血管滤泡性淋巴组织增生,是一种罕见的淋巴细胞增生性疾病.于1956年由Castleman等首次报道[1],主要临床分型为单中心型和多中心型.单中心型常局限于单个淋巴结发病,多中心型的典型表现为全身多发淋巴结增大.组织学分为透明血管型、浆细胞型、混合型.透明血管型CD约占单中心型CD病人的90%[2].而大多数多中心型CD的病人是浆细胞型,混合型则两者皆有.该病多发于胸腔内,特别是纵隔区域,以单发型为主,多发型少见.该病虽然研究在不断深入,但是人们对其发病机制、临床特点、治疗、预后等仍缺乏深入了解,诊断和治疗受到局限.     

CD24在乳腺浸润性导管癌中的表达及临床意义

目的:研究CD24在乳腺浸润性导管癌组织不同模式中的表达及其与临床病理因素的相关性。方法:用SP免疫组化染色法检测13例乳腺纤维腺瘤及46例乳腺浸润性导管癌组织中CD24的表达。结果: 浸润性乳腺导管癌组织中CD24在细胞膜和细胞浆都有表达，阳性率为80.43%；乳腺纤维腺瘤CD24仅在细胞膜上局灶性表达，阳性率为53.85%。CD24在浸润性导管癌中的表达浓度明显高于纤维腺瘤(P＜0.05)；并与腋窝淋巴结转移正相关(P＜0.05)；CD24细胞膜表达与雌、孕激素受体阳性表达密切相关(P＜0.001)，而与患者年龄、肿瘤大小、肿瘤分期、分级、Her 2及p53等因素无相关性（P＞0.05）。结论:CD24高表达参与乳腺癌的侵袭与转移，CD24细胞膜表达可能与乳腺癌内分泌治疗抵抗作用相关，CD24可作为乳腺不良预后的判断指标之一。     

CD105表达与乳腺癌临床病理参数的关系

为探讨CD10 5标记的微血管密度 (MVD )与乳腺肿瘤临床病理和预后的关系 ,作者应用免疫组织化学SP法及CD10 5单克隆抗体测定了 5 3例乳腺癌 ,3 0例乳腺良性肿块 ,2 0例正常乳腺组织中CD10 5标记的MVD ,并对其与临床病理因素和术后生存率进行分析。结果示正常乳腺组织、乳腺良性肿块 ,乳腺癌CD10 5的表达值依次为 3 .12± 1.18,10 .5 0± 3 .41和 5 0 .0 3± 15 .41,乳腺癌组织明显高于前两组 (P <0 .0 1)。用MVD表示的CD10 5值与TNM分期、淋巴结转移等病理因素无关。单、多因素分析结果表明 ,CD 10 5标记的MVD是乳腺癌的独立预后因素。提示CD10 5是乳腺癌血管生成的重要因素 ,它在乳腺癌中的表达较良性肿块及正常乳腺明显增高 ;CD10 5标记的MVD与临床病理因素无关 ,它可作为乳腺癌的一种重要预后指标。     

乳腺肿瘤中BCSG1、CD105的表达及意义

目的探讨BCSG1、CD105在乳腺癌发生、发展中的生物学意义。方法采用免疫组织化学技术SP法,检测40例乳腺纤维腺瘤、20例乳腺导管原位癌及62例乳腺浸润性导管癌组织,BC-SG1、CD105的表达情况。结果 BCSG1,CD105表达[微血管密度(MVD)计数]在三组乳腺肿瘤组织中的阳性表达比较差异均有统计学意义(P0.05)。乳腺浸润性导管癌组织中BCSG1、CD105阳性表达率明显升高,提示乳腺肿瘤的浸润和血管生成增强。结论联合检测两种指标的表达状况将有助于乳腺癌的早期诊断和预后判断。     

伴发副肿瘤天疱疮的腹膜后Castleman病2例报道及文献复习

副肿瘤天疱疮(paraneoplastic pemphigus,PNP)是一种自身免疫性大疱性皮肤病,常伴发于淋巴细胞增生性肿瘤,如非霍奇金淋巴瘤、慢性淋巴细胞性白血病、胸腺瘤及Castleman病等,也可伴发于非淋巴细胞增生性肿瘤,包括肠、前列腺、胰腺和乳腺的腺癌、炎性纤维肉瘤及恶性黑素瘤等.该病临床比较罕见,广州医学院第二附属医院最近确诊2例腹膜后Castleman病伴发PNP的患者,均及时手术切除肿瘤,治愈后顺利出院,现报道如下.     

CD117、C-erbB-2及表皮生长因子受体在原发性肝癌组织中的表达及其临床意义

目的 检测原发性肝癌组织中CD117、C-erbB-2及表皮生长因子受体(EGFR)表达,探讨其在肝癌诊断和治疗中的意义.方法 经病理确诊的127例原发性肝癌患者,采用免疫组织化学法检测肿瘤组织中CD117、C-erbB-2及EGFR表达,分析其与肿瘤数目、直径、血管侵犯、组织分化及甲胎蛋白(AFP)水平关系.结果 CD117、C-erbB-2及EGFR阳性表达率分别为32.3%(41/127)、22.8%(29/127)和27.6%(35/127),CD117表达与肿瘤数目、直径和血管侵犯明显相关;C-erbB-2表达与肿瘤直径、血管侵犯和肿瘤分化明显相关;EGFR表达与肿瘤数目、AFP水平和肿瘤分化明显相关.结论 肝癌组织表达CD117、C-erbB-2及EGFR与肿瘤形态和生物学特性有关,对肝癌预后判断和靶向治疗具有一定指导意义.     

CD24在乳腺癌组织中表达的意义及其与Ki67、Bcl-2的关系

目的 研究乳腺浸润性导管癌组织中CD24的表达及与细胞核增殖抗Ki67及凋亡抑制蛋白Bcl-2的关系,探讨CD24在乳腺癌发生发展中的作用.方法 应用免疫组化ElivisiDnTM Plus二步法检测86例乳腺浸润性导管癌组织和30例非瘤乳腺上皮组织中CD24及Ki67、Bcl-2的表达情况,分析CD24表达与Ki67、Bcl-2以及患者年龄、肿瘤大小、组织病理学分级、淋巴结转移、临床分期等临床病理学参数之间的关系.结果 在86例乳腺浸润性导管癌中CD24表达的阳性率为87.2%(75/86),与对照组比较均有统计学差异(P<0.01);CD24表达与患者年龄、肿瘤大小、组织病理学分级、临床分期未见显著相关(P0.05),与腋窝淋巴结转移呈正相关(P<0.01);乳腺癌CD24表达与Ki67表达呈正相关(P<0.01),与Bel-2表达没有相关性(P0.05).结论 CIY24蛋白的表达与乳腺癌细胞增殖及侵袭转移具有相关性,是判断肿瘤生物学行为和患者预后的重要参考指标之一.     

头部血管肉瘤一例报道

血管肉瘤是一种少见的恶性血管肿瘤,该病发病原因及发病机制至今不明,临床表现多样化,容易误诊,且病情发展较快,可转移到附近的淋巴结或血行转移到肺、肝及骨骼,预后差.病理学检查及免疫组化CD31呈阳性对其诊断具有敏感性和特异性.手术切除和适当的放射治疗是治愈本病的关键.     

Aggressive malignant phyllodes tumor

IntroductionOriginally described in 1838 by Muller, phyllodes tumor is a rare fibroepithelial neoplasm which represents roughly 0.3–0.9% of all breast cancers. Phyllodes tumor are divided into benign, borderline and malignant histologic categories. Malignant phyllodes tumor represent anywhere from 10–30% of all phyllodes tumors. This group has both the potential to recur locally and metastasize, however not all malignant phyllodes behave this way. The challenge lays in predicting which tumor will recur locally or metastasize. Distinguishing this subset of malignant phyllodes tumor is paramount.Presentation of caseWe present a case of malignant phyllodes which presented with metastatic disease. What is fascinating about this case is not only the initial presentation but also the aggressiveness of this variation of phyllodes tumor. The patient initially presented with a large mass which encompassed her whole right breast. On surgical pathology the mass measured roughly 31 cm in diameter and weighed over 10 kg. Within 5 weeks from surgery the patient had suffered brain metastases and also 6 local recurrent tumors. The patient passed roughly 11 weeks after her first visit to our office.ConclusionDespite biopsy proven malignant phyllodes tumor, it was near impossible to predict such a rapid course of disease progression in our patient. Our case illustrates the unpredictable nature of this disease in general and it possibly sheds light on a variant of the disease which had undergone an aggressive transformation.     

调节性T 细胞和乳腺癌治疗研究近展

乳腺癌是妇女常见恶性肿瘤，发病率高居我国妇女恶性肿瘤第1位，越来越受到关注。调节性T细胞（Treg）控制T细胞乳腺癌的免疫应答中发挥重要作用，以Treg为靶点的乳腺癌治疗策略具有潜在可行性，笔者就此进行综述。     

Malignant fat-forming solitary fibrous tumor (so-called "lipomatous hemangiopericytoma"): clinicopathologic analysis of 14 cases

Fat-forming solitary fibrous tumor is a rare variant of solitary fibrous tumor (SFT). Generally regarded as benign, very few fat-forming SFTs with malignant histologic features have been reported. Here, we report 14 histologically malignant fat-forming SFTs to better characterize this subset. Seven patients were female and 7 were male, with ages ranging 20 to 93 years (median, 57 y). Five tumors were located in the lower limb, 3 in the trunk, 3 in abdominopelvic locations, 2 in the head and neck region, and 1 in the upper limb. The tumor size ranged from 3.4 to 20 cm (median, 8.6 cm). Histologically, all exhibited at least focal hypercellularity; 12 tumors had mitoses >4/10 high-power fields (range, 2 to 37; median, 8), 12 showed at least moderate atypia, and 8 showed necrosis. It should be noted that 7 tumors contained only mature adipose tissue, whereas 5 contained multivacuolated lipoblasts and 2 had areas resembling atypical lipomatous tumor (ALT). Immunohistochemically, CD34 and CD99 were positive in most cases (11 of 14 and 8 of 10, respectively); MDM2 and CDK4 were both negative in all 4 cases tested (including both tumors with ALT-like areas). Follow-up data from 10 cases (median duration, 47.5 mo; range, 5 to 76) showed 2 patients with multiple metastases (both to lung and bones, and 1 each to breast and to soft tissue), both of whom died of disease. In conclusion, fat-forming SFTs exhibiting malignant histologic features have potential for aggressive behavior. The presence of lipoblasts and/or ALT-like areas, although described in some "benign" examples of fat-forming SFT, seems much more common in the malignant subset and may prompt a careful search for morphologic evidence of malignancy in any case of fat-forming SFT.     

Anemia and jejunal intussusception: An unusual presentation for a metastatic phyllodes breast tumor

INTRODUCTIONPhyllodes tumor of the breast is a rare cause of breast cancer, accounting for less than 0.5% of breast cancers. These tumors are classified as benign, borderline, or malignant, with malignant tumors compromising nearly 25% of cases. Metastases occur in 20% of malignant tumors, lungs, bones, liver and brain being the frequent sites of metastases.PRESENTATION OF CASEWe present a case of a metastatic phyllodes tumor to the small bowel causing jejunal intussusception, symptomatic anemia, and small bowel obstruction.DISCUSSIONPatients with phyllodes tumor of the breast can develop disease recurrence even years after initial treatment. Phyllodes tumor metastasizing to the small bowel is extremely rare, with only three known previously described case reports in the literature.CONCLUSIONHigh risk patients, with a past medical history of phyllodes breast cancer, should be monitored closely. Even years after breast cancer treatment, these patients may present with gastrointestinal complaints such as obstruction or bleeding, and therefore metastatic disease to the small bowel should be considered on the differential with subsequent abdominal imaging obtained.     

Granular cell tumor of the breast

Granular cell tumors (GCT) are uncommon, usually benign, neoplasms that are thought to derive from Schwann cells of the peripheral nerves. They can originate anywhere in the body but are most frequently found in the head and neck, particularly in the oral cavity. When they are located in the breast, as may occur in 5-8 per cent of cases, the clinical and pathologic appearance is similar to that of a malignant tumor. Immunohistochemical analysis, including reactivity for periodic acid-Schiff, CD68, and S100 and negative reactivity for cytokeratin, is required for definitive diagnosis. Awareness of this tumor's unique characteristics might aid in differentiating it from the more common malignant tumors of the breast.     

Adrenal metastasis of a phyllodes tumor of the breast: Case report and review of the literature

INTRODUCTIONA phyllodes tumor is a neoplasm of mixed mesenchymal and epithelial origin affecting the breast. It may pursue a benign or malignant evolution with distant metastases in the latter case. Sites most commonly affected by metastases are the lungs and bones. Simple mastectomy is the mainstay of treatment. This article presents the first described case of metastasis to the adrenal gland after sarcomatous transformation of a phyllodes tumor. A review of the literature is presented afterwards.PRESENTATION OF CASEA 57-year old female patient presented with a voluminous breast mass which was completely resected. Unfortunately she presented with malignant recurrence in the breast which was also resected. A later recurrence within the lung presented and was completely resected but showed aspects of sarcomatous changes. Finally a recurrence was pathologically documented within the adrenal gland. Unfortunately, disease later progressed and the patient refused further treatment at that point.DISCUSSIONWhile malignant transformation of breast phyllodes tumors and metastasis is relatively common, the prognosis for initially benign lesion that are completely excised is usually good. This case represents the first documented metastasis to the adrenal gland of a breast phyllodes tumor.CONCLUSIONWe presented the first case of adrenal metastasis of a phyllodes tumor after sarcomatous degeneration. This is an unusual presentation of a relatively uncommon but well-recognized disease of variable malignant potential.     

副乳腺肿瘤11例报告

目的:探讨副乳腺肿瘤的临床特点、诊断及治疗方法。方法:对11例患者的临床及病理资料进行回顾性分析。结果:恶性肿瘤发病年龄多见45岁以上,良性肿瘤多在45岁以下。肿瘤最常见部位是腋下。主要临床症状是局部肿块,11例术前均误诊。结论:副乳腺肿瘤较少见,手术治疗是其首选治疗方法。良性肿瘤以局部切除为主,恶性肿瘤的治疗以根治性切除为主,术后辅以化疗或放疗,可提高患者生存率。     

Expression of Vascular Endothelial Growth Factor and Presence of Angiovascular Cells in Tissues from Different Thyroid Disorders

Background

Vascular endothelial growth factor (VEGF) is involved in tumor angiogenesis and other pathophysiological processes.

Materials and methods

We studied the localization of VEGF in human thyroid tissues to clarify its involvement in proliferative processes in a variety of thyroid disorders. Immunohistochemical analysis using purified rabbit polyclonal anti-human VEGF or anti-human CD34 antibody and a streptavidin–biotin peroxidase complex detection system was performed on 58 tissue specimens from 53 patients with different thyroid disorders and 5 normal thyroid glands.

Results

Vascular endothelial growth factor was not detected in normal thyroid follicular cells. However, some thyroid tumor cells expressed VEGF in the cytoplasm (papillary carcinoma, 10/18; follicular carcinoma, 1/3; medullary carcinoma, 2/2; follicular adenoma, 3/11; adenomatous goiter, 2/4). In benign follicular adenoma and adenomatous goiter, weak expression of VEGF was found in small areas of the tumor, whereas in malignant thyroid tumors, it was strongly expressed in many cells. However, VEGF was not expressed in anaplastic carcinoma, malignant lymphoma, or Graves’ disease. Angiovascular cells stained with CD34 antibody in tissues from different thyroid disorders reflected statistically significant differences in papillary carcinoma, follicular adenoma, and Graves’ disease compared with normal thyroids, and such cells showed a trend toward increases in medullary carcinoma and adenomatous goiter. In contrast, low vascularity was observed in anaplastic carcinoma, malignant lymphoma, and follicular carcinoma.

Conclusions

Because VEGF probably functions as a hypoxia-inducible angiogenic factor, overexpression of this mediator, concomitant with hypervascularity, may be induced more strongly in malignant thyroid tumors, which need more oxygen to proliferate, than in benign follicular tumors. However, neither VEGF nor CD34 was expressed in anaplastic thyroid carcinoma, which is an extremely poorly differentiated malignant tumor. CD34 but not VEGF was expressed in the hyperplastic thyroid tissues of Graves’ disease composed of nontransformed cells. Thus, the expression of VEGF concomitant with CD34 is suggested to reflect both the transformation and differentiation state of malignant tumors.     

A primary immunoblastic T malignant lymphoma of the small bowel, with azurophilic intracytoplasmic granules. A histologic, immunologic, and electron microscopy study

We report an aggressive primary T-immunoblastic lymphoma of the small intestine without blood involvement or associated celiac disease. Grossly, the tumor was composed of multiple disseminated ulcerated, infiltrating, or protuberant nodular lesions. Immunologic investigation showed that lymphoma cells were of peripheral (post-thymic) T-cell origin and expressed the phenotype associated with cytotoxic-suppressor subset (Leu4/CD3+, Leu9/CD7+, Leu2/CD8+, Leu11/CD16+, Leu 7/NKcells+, FcIgG+, HLA-DR+, anti-Tac/CD25+, Ki-1/CD30-, Leu1/CD5-, Leu5/CD2-, Leu3/CD4-). A particular morphologic feature of this case is the presence of numerous azurophilic granules within the lymphoma cells, identified as lysosomes by cytochemical and ultrastructural studies. In view of recent immunologic evidence that normal cytotoxic/suppressor T-cells selectively reside within the epithelium of the normal bowel and some of them contain azurophilic granules, it could be suggested that our patient's lymphoma represents a malignant counterpart of these lymphocytes. Furthermore, the aggressive character of this T malignant lymphoma (T-ML) could be related to the expression of T-cell activation markers HLA-DR and Tac/CD25 and the proliferation-associated antigen Ki-67 on a high proportion of tumor cells.     

Pleomorphic adenoma of the breast: Report of a case

We present herein the case of a 74-year-old woman found to have a pleomorphic adenoma, or so-called mixed tumor, of the breast. The patient presented with a hard mass, 3 cm in diameter, located just beneath the left areola. Physical examination suggested a diagnosis of breast carcinoma; however, the findings of both ultrasonography and mammography indicated a benign neoplasm. Aspiration biopsy cytology was evaluated as class III and the diagnosis of pleomorphic adenoma was finally confirmed by examination of an excisional biopsy specimen. As it is a rare benign tumor, pleomorphic adenoma of the breast has been mistaken for a malignant tumor clinically, mammographically, cytologically, and even by frozen section. Thus, an awareness of this disease in the breast will help to prevent misdiagnosis and overaggressive surgery.