颌下腺肌上皮癌1例并文献复习

目的:报道1例少见的颌下腺肌上皮癌（myoepithelial carcinoma,MEC）,以提高对该病的认识。方法:对1例MEC的临床病理特点、免疫组化、诊治及术后随访情况进行分析并复习文献。结果:临床特点:该例MEC患者临床病程长,两次误诊为“混合瘤”,术后复发三次。组织学:肿瘤细胞浸润性生长,呈巢团状、实性片状或梁网状排列,细胞疏密不等,以梭形、上皮样、透明为主,可见鳞状小体,细胞局灶异型性明显,核分裂象可见,未见坏死。免疫组化:上皮及肌上皮标志物CK、p63、CK5/6、SMA、Calponin等阳性,Ki-67增殖指数约20%。结论:MEC形态学表现多样,早期易延误就诊及误诊,病理学结合免疫组化检查有助于确诊,治疗以手术切除为主,具有高复发特点,术后注意密切随访。     

鼻中隔基底细胞腺瘤恶变1例报告及文献复习

目的:描述1例来源于鼻中隔的基底细胞腺瘤的病情经过,并对鼻部区域原发性基底细胞腺瘤/癌的相关文献进行复习.方法:对本例患者的临床特征,影像学以及病理学改变进行分析.总结了既往所报道的2例鼻腔原性基底细胞腺瘤以及所有文献所报道的原发于鼻部区域的基底细胞腺癌的临床与病理特征.结果:原发于鼻部区域的基底细胞腺瘤/癌(BCA/BCAC)较为罕见,两者的主要症状为鼻阻塞与鼻出血,平均病程为3.6月.13例BCAC的颈淋巴结转移率为15.4％,远低于头颈部其它区域的BCAC.术后复发率为50％,病死率为25％.电镜下BCAC与BCA在组织学上有很多相似之处,但BCAC的细胞具有异型性,核分裂象较多见,生长呈侵袭性,可能浸润周围血管或神经.BCAC需和实性腺样囊性癌、涎腺导管癌和基底样鳞状细胞癌相鉴别.结论:BCAC多数生存时间较长,生物学行为符合低度恶性肿瘤,其易复发但侵袭力不强.鼻腔的基底细胞腺瘤可能具有恶变倾向,密切随访极为必要.     

肌上皮细胞的表型分化在涎腺发育及多形性腺瘤中的意义

背景与目的探讨肌上皮细胞与涎腺发生、涎腺多形性腺瘤发生的关系以及肌上皮细胞的分化状态与肿瘤生物学行为的关系。材料与方法采用组织学、免疫组化方法对不同发育阶段(胚7~8周、胚9~10周、胚11~14周、胚15~20周)的涎腺胚胎组织及涎腺多形性腺瘤中肌上皮细胞的表型分化及功能状态进行比较分析。结果在涎腺发育过程中,导管腔面及基底层细胞表达CK19,偶可表达CK14,而不表达肌上皮细胞的标记物α-SMA,为非肌上皮来源;而原始腺泡和闰管中肌上皮细胞的标记物阳性表达,为肌上皮前体细胞分化而来。在多形性腺瘤中,非管腔的肿瘤实质中,梭形细胞、上皮样细胞表达肌上皮细胞标记物CK14、P63、α-SMA,为肌上皮来源,软骨样成分和粘液样成分偶可表达肌上皮细胞标记物CK14和α-SMA,可能亦为肌上皮来源。管腔样结构、浆细胞样细胞、透明细胞不表达肌上皮细胞标记物,可能来自管腔细胞系。结论在涎腺发育过程中,腺泡和闰管来自肌上皮细胞系;导管系统来自管腔细胞系。以肌上皮分化较好的肿瘤预后较好,其中可能的原因为肌上皮细胞分化异常,失去其自身的表型特征,从而失去抑制肿瘤生长和侵袭的作用。     

Benign mixed tumor (pleomorphic adenoma) of the breast: ultrastructural study and review of the literature

A patient is presented with a benign mixed tumor (pleomorphic adenoma) of the breast. There are 11 well-documented cases of this rare breast neoplasm. It is histologically and ultrastructurally identical to that seen in the salivary gland and follows a similar benign course. A central role of the ductal myoepithelial cell is proposed for the histogenesis of this tumor.     

血管内T细胞淋巴瘤一例报道并文献复习

目的提高对血管内淋巴瘤（IVL）的认识。方法报道一例IVL的临床表现和诊治经过,并进行文献复习。结果以发热、皮疹和嗜血细胞综合征为表现的IVL少见,该例患者经过积极化疗效果不显著,最后死于肝衰竭和消化道出血。结论IVL少见,患者生前诊断困难,病情进展快,预后差。     

Carotid sinus syndrome secondary to head and neck malignancy: case report and literature review

We report two cases of carotid sinus syndrome secondary to head and neck malignancy. The underlying mechanisms unique to head and neck malignancy and treatments of the syndrome are discussed.     

颈部复发性滤泡树突细胞肉瘤1例并文献复习

目的 分析头颈部滤泡树突细胞肉瘤的临床特征、治疗方式和预后.方法 复习1例颈部复发性滤泡树突细胞肉瘤的治疗及随诊资料,结合相关文献探讨其临床特征以及治疗、预后.结果 颈部滤泡树突细胞肉瘤主要表现为无痛性肿块;肿瘤细胞呈纺锤形/卵圆形,呈束状、旋涡状排列;免疫组化CD21和CD35阳性.复发后二次手术挽救加术后放疗,1年后死于肺转移,未见局部复发.结论 颈部滤泡树突细胞肉瘤是一种少见的低到中度恶性肿瘤,需借助免疫组化的方法与其他组织学形态类似的肿瘤鉴别,治疗多数以手术为主,伴有病理不良预后因素、复发或残存时辅助放疗/化疗.     

脑多形性黄色瘤型星形细胞瘤1例及文献复习

目的：了解多形性黄色瘤型星形细胞瘤（pleomorphic xanthoaslrocytoma,PXA）的病理特点及其与预后的关系。方法：通过HE及免疫组织化学染色法对1例PXA患者进行临床病理观察与预后分析。结果：Ki-67增殖指数（PI）为3．87％,偶见病理核分裂像,本例于手术确诊后半年死于复发。结论：PXA的Ki-67增殖指数的增高（一般〈1％）及病理核分裂像对评估预后有一定的参考价值。     

鼻腔鼻窦肌上皮癌的生物学行为及诊治

目的 提高临床医生对鼻腔鼻窦肌上皮癌的认识。方法 回顾性分析我科近期收治的两例鼻腔鼻窦肌上皮癌临床资料，并复习文献。结果 1例为女性，47岁；1例为男性，54岁。临床表现为鼻塞、鼻腔暗红色肿物。鼻窦CT示鼻腔占位性病变。术前病理及免疫组化(S-100蛋白、平滑肌动蛋白、细胞角蛋白、波形蛋白等呈阳性染色)确诊“肌上皮癌”。两例均行鼻侧切开鼻腔肿瘤切除术，例1术后5月出现颈淋巴结转移，术后11月死于全身骨及肝转移。例2术后8月死于肺转移。结论 鼻腔鼻窦肌上皮癌极为罕见，迄今为止，仅8例报道。综合文献，该瘤具有生长迅速、广泛侵犯周围组织、颈部淋巴结转移率高、血行转移率高、治疗后易复发、预后差等特点。诊断依赖病理及免疫组化。治疗以根治性手术为主，对于cNO的患者,应行分区性颈淋巴结清扫术。     

16例涎腺肌上皮肿瘤临床病理及免疫组化分析

[目的]探讨涎腺肌上皮肿瘤的临床病理特征、免疫组化表达以及鉴别诊断.[方法]16例涎腺肌上皮肿瘤进行病理组织形态学及免疫组化观察.[结果]良性肌上皮瘤12例,恶性肌上皮瘤4例,组织形态均可分为上皮样细胞型,梭形细胞型,浆细胞样细胞型及透明细胞型.良、恶性肌上皮瘤的免疫组化染色S-100蛋白阳性率分别为91.7%(11/12),100%(4/4);SMA阳性率为66.7%(8/12),50%(2/4);Calponin阳性率91.7%(11/12),75%(3/4).[结论]涎腺肌上皮肿瘤的瘤细胞形态多样;S-100蛋白、SMA及Calponin等的免疫组化染色有助于诊断和鉴别诊断.     

头颈部滤泡树突状细胞肉瘤一例报告并文献复习

探讨头颈部滤泡树突细胞肉瘤的临床病理特征及诊断、治疗方法.报道1例复发的右侧颈部滤泡树突细胞肉瘤41岁女性患者的临床资料.应用MEDLINE,以"树突细胞,肉瘤,滤泡状树突细胞"为主题词进行检索.对1986-01-2009-08发生于头颈部的滤泡树突细胞肉瘤并且有英文全文的文章进行分析总结.结果显示,成功手术切除右侧颈部复发的滤泡树突细胞肉瘤,术后予以放疗. 通过MEDLINE检索共报道79例头颈部的FDCS患者,50.6%患者进行手术治疗,47.5%复发.21.5%患者进行了术后放疗,复发率35.3%.51.9%的患者复发后再手术和(或)放疗.CD21(+)和CD35(+)对淋巴滤泡树突细胞肉瘤的诊断有重要的意义.初步研究结果提示,淋巴滤泡树突细胞肉瘤是一种少见具有一定恶性倾向的肿瘤.外科手术加放疗是一种较好的治疗方法.     

腮腺多形性腺瘤术后复发的生物学活性研究

目的探讨Ki-67、p16与腮腺多形性腺瘤术后复发生物学行为的相关性。方法应用EnVision免疫组织化学方法,检测Ki-67、p16在腮腺多形性腺瘤术后复发者第一次(复发前)手术、第二次(复发后)手术标本未复发者手术标本中的表达。结果Ki-67在复发者第一、二次手术与未复发者标本中的表达有显著性差异(P<0.05),在复发者第一、二次手术标本中的表达无显著性差异(P>0.05);p16在复发者第一次手术与未复发者标本中的阳性强度表达构成比有显著性差异(P<0.05)。结论腮腺多形性腺瘤术后复发与其自身的生物学活性有关。     

Adrenal endothelial cyst associated with adrenocortical adenoma:a case report and literature review

We present a case of a middle-aged male Chinese patient who was asymptomatic with a large(6×7 cm)right adrenal mass was found in this patient upon routine health examination.He underwent laparoscopic right adrenalectomy after comprehensive evaluation,and the mass was finally diagnosed as right adrenal endothelial(vasculature)cyst associated with adrenocortical adenoma according to pathological and immunohistochemical studies.The puzzling image resemblance of a variation of adrenal cyst to carcinoma necessitated histological examination for confirmative diagnosis.The development of endothelial cyst is extremely rare,and its association with other adrenal neoplasms is even rarer.Herein,we report a new case of adrenal endothelial cyst associated with adrenocortical adenoma,which was almost indistinguishable from adrenocortical carcinoma,and hope that it would be helpful in the diagnosis of other similar cases.     

Giant Brunner's gland adenoma as an unusual cause of anaemia: report of a case

BACKGROUND: Brunner's gland adenoma (BGA) is a rare benign duodenal tumour proliferating from Brunner's glands. Here, we present a giant BGA leading to anaemia, with its clinical, endoscopic, radiological, surgical and pathological findings. CASE REPORT.: A 48-year-old Turkish man complained of a six months history of vague epigastric discomfort, loss of appetite and nausea after meals without vomiting. The physical examination had no unremarkable finding. Laboratory findings, including liver function tests, were within normal limits except a hypochromic, microcytic anaemia. The upper gastrointestinal endoscopic examination revealed a lobulated, red, polypoid tumour with a smooth surface covered with normal mucosa. The tumour was located on the anterior surface of duodenal bulb and had a wide base measuring 3.5 × 4 cm in size. Endoscopic ultrasonography revealed a submucosal polypoid mass located at the anterior surface of duodenal bulb. The endoscopic excision was tried but was not successful. The patient was operated and transduodenal polypectomy was done. The postoperative period was uneventful and the pathologic diagnosis was assessed as Brunner's gland adenoma. During the follow-up period, the endoscopic examination was normal at 12th month postoperatively. CONCLUSIONS: BGA is a rare benign cause of anaemia that can be treated with excellent results.     

Incidental uptake of 18F-fluorocholine (FCH) in the head or in the neck of patients with prostate cancer

Background

Positron emission tomography-computed tomography (PET/CT) with ¹⁸F-fluorocholine (FCH) is routinely performed in patients with prostate cancer. In this clinical context, foci of FCH uptake in the head or in the neck were considered as incidentalomas, except for those suggestive of multiple bone metastases.

Results

In 8 patients the incidental focus corresponded to a benign tumour. The standard of truth was histology in two cases, correlative imaging with MRI in four cases, ^99mTc-SestaMIBI scintigraphy, ultrasonography and biochemistry in one case and biochemistry including PTH assay in one case. The final diagnosis of benign tumours consisted in 3 pituitary adenomas, 2 meningiomas, 2 hyperfunctioning parathyroid glands and 1 thyroid adenoma.Malignancy was proven histologically in 2 other patients: 1 papillary carcinoma of the thyroid and 1 cerebellar metastasis.

Conclusions

To the best of our knowledge, FCH uptake by pituitary adenomas or hyperfunctioning parathyroid glands has never been described previously. We thus discuss whether there might be a future indication for FCH PET/CT when one such tumour is already known or suspected: to detect a residual or recurrent pituitary adenoma after surgery, to guide surgery or radiotherapy of a meningioma or to localise a hyperfunctioning parathyroid gland. In these potential indications, comparative studies with reference PET tracers or with ^99mTc-sestaMIBI in case of hyperparathyroidism could be undertaken.     

睾丸的原发性NK/T细胞淋巴瘤一例报告及文献复习

Objective： To study the clinical and pathological features of primary NK/T cell lymphoma of testis and to investigate the effective diagnosis and treatment of this disease. Methods： The surgical specimens of a patient with primary NK/T cell lymphoma of the testis were observed by light microscopy, immunohistochemistry and examined by the polymerase chain reaction （PCR） for Epstein-Barr virus （EBV） DNA and T-cell receptor （TCR） gene rearrangement, and the literature were reviewed. Results： The patient presented with left-sided painless testicular enlargement and the lymphoma had a propensity to spread to the contralateral testis, spleen, central nervous system, and so on. The neoplastic cells were positive for CD56, CD45R0 and CD3ε, while the expressions of CD20, CD79α, CD5, Bcl-2 and PLAP were negative. In addition, the EBV DNA was detected in the lymphoma by PCR. And the results of gene rearrangement studies for the y chain of the T-cell receptor were negative. The pathological diagnosis was NK/T cell lymphoma of the left testis. Conclusion： Primary NK/T cell lymphoma of the testis is a rare entity and progressed rapidly. The histopathological, immunohistochemical, EBV examination and TCR gene rearrangement studies should be carried out as soon as possible in order to get the defined diagnosis. Currently, the therapeutic efficacy is poor and the new measures should be investigated to improve the survival rate.