前列腺恶性副神经节瘤1例报告

肾上腺外副神经节瘤是沿交感肾上腺神经内分泌系统分布的产生、代谢和分泌儿茶酚胺的神经嵴源性肿瘤,前列腺副神经节瘤较为罕见,临床表现不典型,误诊率高,现将贵州省人民医院收治的1例患者报道如下。1病例报道患者男性,49岁,因发现“肉眼血尿4年”于2020年7月13日入院,临床表现为肉眼血尿,并伴有尿频、尿急、尿痛,小便淋漓,夜尿增多(每晚3~4次)。     

膀胱副神经节瘤7例报告并文献复习

目的:探讨膀胱副神经节瘤(PUB)的疾病特点、病理特征、诊断及治疗方法.方法:收集2007年11月-2019年12月收治7例PUB患者的临床资料,对临床记录、手术记录、病理报告、随访记录等进行了回顾性分析.结果:7例患者中女6例,男1例,术前均无排尿后高血压、心悸、排尿晕厥、血尿等临床表现;治疗方案均采取手术切除肿瘤:...     

十二指肠节细胞性副神经节瘤1例并文献复习

2022年11月11日潍坊市人民医院收治1例38岁男性病人,以阵发性上腹痛为主要症状,入院后实验室检查及肿瘤标志物均未见明显异常,行上腹部增强CT提示十二指肠降段富血供结节;超声内镜检查示：十二指肠降段乳头下方肿物,中心黏膜溃疡,直径约1.7 cm,起源于肌层。内镜活检未能明确肿物性质,于2022年11月16日行外科手术局部切除,术后病理及免疫组织化学检测结果符合节细胞性副神经节瘤(gangliocytic paraganglioma, GP)。病人术后第6天顺利出院,院外随访未见异常。GP主要发生于十二指肠降段,临床发病罕见,缺乏典型的临床表现,术前诊断困难,局部切除即可获得良好的疗效,只有侵犯周围血管及淋巴组织才推荐行胰十二指肠切除术,临床医师需加强对此病的认识,避免误诊而导致过度治疗。     

原发性胆囊副神经节瘤1例报告并文献复习

背景与目的：副神经节瘤（PGL）是一种源自神经嵴外胚层的神经内分泌肿瘤,胆道系统是肾上腺外PGL的罕见部位。目前关于原发性胆囊副神经节瘤（PGP）的研究较少,多为个案报道,其临床表现和影像学特征不典型,致使术前诊断困难,易被漏诊或误诊。笔者通过回顾1例PGP患者的诊治经过,并结合国内外相关文献报道,总结该病的临床特点、诊断和治疗方法,以期提高临床工作者对罕见部位PGL的认识。方法：回顾性分析收治的1例PGP患者的临床资料,结合国内外相关文献,探讨该病的临床特点、诊断和治疗方法。结果：患者为35岁女性,因上腹部疼痛5 d入院,腹部彩超提示胆囊内有一大小约2.6 cm×2.0 cm异常强回声,呈乳头状,基底较宽,无蒂,后方无声影,改变体位不移动,考虑腺瘤。腹部CT平扫显示胆囊底部等密度软组织肿块影,增强CT显示胆囊底部类圆形、边界清楚的软组织肿块,未侵及浆膜层,动脉期明显强化,三期强化程度等同于血管强化,考虑胆囊占位性病变,性质待排。于全麻下行腹腔镜下胆囊切除,术中快速冷冻切片考虑神经内分泌肿瘤,术后病理提示为PGP。定期随访1年,未见肿瘤复发和转移,目前继续随访中。结论：PGP是一种具有...     

前列腺副神经节瘤1例报告并文献复习

目的:提高对前列腺副神经节瘤的认识和诊治水平。方法:报告确诊前列腺副神经节瘤1例,肿瘤组织行神经元特异性烯醇化酶(NSE)、嗜铬A、突触素(Syn)、S-100和前列腺特异性抗原(PSA)免疫组化染色。结合文献复习,总结其临床、病理和治疗情况。结果:这1例前列腺副神经节瘤以血精就诊。行前列腺根治切除术,病理检查符合副神经节瘤组织学特征,免疫组化染色:NSE、嗜铬A、Syn、S-100阳性,PSA阴性。随访42个月,排尿和排便通畅,疗效满意,无转移和复发。结论:前列腺是肾上腺外副神经节瘤极少见的位置,临床非常罕见。前列腺副神经节瘤的临床和病理特征具有特殊性,需病理确诊,治疗宜手术完整切除肿瘤,术后应密切随访。     

膀胱副神经节瘤1例报告并文献复习

目的提高膀胱副神经节瘤的诊疗水平。方法回顾性分析1例膀胱副神经节瘤患者的临床资料,分析总结该病的临床特征及诊疗经过。患者,男,51岁,排尿后头晕同时血压升高,血儿茶酚胺和尿香草苦杏仁酸明显升高,MRI见膀胱前壁33 mm×27 mm 肿块,膀胱镜检未发现肿瘤。术前考虑膀胱前壁副神经节瘤,完善扩容降压3周以上,行腹腔镜下膀胱部分切除术。结果手术顺利,切除范围包括瘤体及部分膀胱壁,术中生命体征平稳。术后10 d 拔除导尿管,未见排尿时血压升高及头晕。术后病理证实为膀胱副神经节瘤。术后3个月复查,血压正常,盆腔CT未见复发。结论膀胱副神经节瘤术前应做好充分准备,术中预防血压波动导致的高血压危象,腹腔镜下膀胱部分切除术治疗效果满意,术后需定期随访。     

膀胱副神经节瘤二例报告并文献复习

目的 总结膀胱副神经节瘤的临床病理学特征及诊疗方法.方法膀胱副神经节瘤2例.例1,女,35岁.临床表现排尿后心慌、头痛,B超及CT检查示膀胱左侧壁肿块2.6 cm×1.5cm,尿3-甲氧-4-羟苦杏仁酸(VMA)35.3～43.3 μmol/24 h(正常值10～35 μmol/24 h).例2,男,22岁.临床表现无痛性全程血尿,B超及CT检查示膀胱右前壁肿块2.5 cm× 2.0 cm,尿VMA 17.9～31.3 μmol/24 h.结果行经尿道膀胱肿瘤电切术1例,行膀胱部分切除术1例.病理诊断为膀胱副神经节瘤.免疫组化CgA、Syn、S-100蛋白和NSE(+).患者术后症状消失,行膀胱镜及B超分别随访3个月、3年肿瘤无复发.结论膀胱副神经节瘤为潜在恶性肿瘤,诊断需结合临床、病理及免疫组化结果判断,膀胱部分切除为主要治疗手段.

Abstract：

Objective To study the clinical,histopathological,immunohistochemical features and the diagnosis and treatment of paraganglioma of urinary bladder. Methods Two cases of paraganglioma of urinary bladder were treated. The first case was a male with painless haematuria. The abdominal ultrasonography and CT scan showed a 2.5 cm× 2.0 cm mass in the right anterior wall of the bladder, and urine vanillylmandelic acid elevated to 17. 9- 31. 3 μmol/24 h (normal range 10- 35 μmol/24 h). The second case was a female who presented with 8 years history of headache and palpitation after voiding. Abdominal ultrasonography and CT scan showed a 2. 6 cm× 1.5 cm mass in the left wall of the bladder, and her urine vanillylmandelic acid was 35.3-43.3 μmol/24 h. Results One patient underwent transurethral resection (TURBT) and the other underwent partial cystectomy.The two cases were diagnosed as bladder paraganglioma by pathological examination. Immunohistochemically, the tumor cells were positive for CgA, Syn, NSE and S-100. No evidence of recurrence was detected during follow-up at 3 months and 3 years. Conclusions Paraganglioma of urinary bladder should be considered as a low grade malignancy. Partial cystectomy should be recommended. The diagnosis depends on clinical symptoms, pathological and immunohistochemical results.     

膀胱副神经节瘤二例报告并文献复习

目的 总结膀胱副神经节瘤的临床特点及诊疗方法。方法 报告2例膀胱副神经节瘤诊治情况,并复习国内外有关文献。结果 2例均为女性,1例为功能性副神经节瘤,予苯苄胺控制血压至正常后行膀胱部分切除术。术后血压正常,排尿无头痛等;1例为非功能性副神经节瘤,经常规术前准备,行经尿道膀胱肿瘤电切术。病理报告为副神经节瘤。术后效果均满意,分别随访2年和1年余,无复发。结论 功能性和非功能性膀胱副神经节瘤各有其特点,病理及免疫组化是确诊的唯一手段,手术治疗是主要治疗方法。     

原发性腹膜后副神经节瘤5例报告并文献复习

目的：探讨腹膜后副神经节瘤的临床和病理特点、诊治方法及预后.方法回顾性分析2013年3月至2015年7月收治的5例腹膜后副神经节瘤患者的临床资料.其中男3例,女2例,年龄32~68岁,平均46岁;有高血压症状者3例,无症状体检发现者2例.5例均接受手术治疗,术后随访6个月~3年.结果5例患者均在腹腔镜下手术完整切除肿瘤,术中见肿瘤位于肾上极区3例,肾门区1例,肾下极区1例.术后病理证实为副神经节瘤.4例患者随访期间均未见复发与转移.2例高血压患者术后血压下降但未降至正常值范围,患者口服降压药辅助降压.1例术后1．5年肿瘤复发再次行手术切除瘤体.结论腹膜后副神经节瘤临床罕见,尽早手术切除是其最有效的治疗方法,术中应尽可能的完整切除肿瘤组织,避免肿瘤组织的残留,预后主要取决于肿瘤是否复发与转移.     

原发性腹膜后副神经节瘤14例报告并文献复习

目的：探讨原发性腹膜后副神经节瘤的临床和病理特点、诊治方法及预后。方法：回顾性分析14例病理检查证实为腹膜后副神经节瘤患者的临床资料：男8例,女6例,年龄14～66岁。有高血压症状9例,其中尿香草扁桃酸（VMA）升高8例,尿儿茶酚胺升高9例。14例均接受手术治疗。术后随访13个月～5年。结果：术中见肿瘤位于肾门区4例,肾上极区5例,肾下极区2例,肾上腺前外上方3例。13例手术完全切除肿瘤,1例伴肝转移者行肿瘤大部切除及肝尾叶切除。病理检查诊断为良性肿瘤13例,恶性肿瘤1例。术后随访12例,9例术前高血压者有7例血压恢复正常;9例无瘤生存,1例复发,2例死亡。结论：手术完全切除肿瘤是腹膜后副神经节瘤最有效的治疗方法,充分的术前准备和围手术期处理是手术成功的关键。术后生存时间取决于肿瘤是否发生淋巴结或远处转移,复发病例可再次手术切除。     

Paraganglioma (pheochromocytoma) of the posterior mediastinum: a case report and review of the literature

Pheochromocytoma is an uncommon tumor in the pediatric population. Paraganglioma, or extra-adrenal pheochromocytoma, accounts for only a small fraction of pediatric pheochromocytomas, with most of these tumors presenting within the abdominal cavity. Herein the authors report the extremely rare case of a biochemically active paraganglioma presenting as a posterior mediastinal mass in an 8-year-old boy.     

前列腺导管腺癌20例报告并文献复习

目的:探讨前列腺导管腺癌的临床表现、病理特征、治疗方法等。方法:报告1995～2010年天津各大医院收治的20例前列腺导管腺癌疾病的情况:患者年龄64～82岁,平均74.5岁,其中13例主因不同程度的排尿困难入院,9例PSA高于正常,17例B超和MRI提示异常,20例均经过穿刺或病理活检确诊。根据病情需要行不同的手术和药物治疗。结果:免疫组化检查提示有前列腺导管腺癌较特异性表现。术后随访12～60个月,14例患者死亡。结论:前列腺导管腺癌在前列腺癌中较罕见,难于早期诊断;确诊主要依靠病理和免疫组化检查;治疗方法可采用根治性前列腺切除术。     

前列腺囊腺瘤1例报告及文献复习

目的:探讨前列腺囊腺瘤的临床病理特征。方法:应用常规病理、免疫组化方法观察1例前列腺囊腺瘤手术切除标本,结合相关临床资料及其病理特点进行分析,并复习文献。结果:患者男性,55岁,于1年前因排尿费力在外院行TUVP术。肿瘤大体为灰白色肿块,切面可见大小不等的囊腔,内充透明及浅白色液体。组织学特点:肿瘤呈筛状、微囊状或腺样排列,内衬覆立方上皮到柱状上皮细胞,细胞核位于基底部,无细胞异型性,无核分裂象。免疫表型:腺上皮表达PSA、PAP、CK7,而基底细胞34βE12阳性,CK20、P504S、CEA和绒毛蛋白均阴性,Ki67(+)<2%。结论:前列腺囊腺瘤是一种少见的前列腺来源的良性肿瘤,前列腺囊腺瘤在形态学上具有独特的组织结构,多表达PSA和PAP。     

Bone dissemination of prostate cancer after holmium laser enucleation of the prostate: A case report and a review of the literature

We report a case of dissemination of prostate cancer after holmium laser enucleation of the prostate in an 80‐year‐old patient. The patient presented at hospital because of nocturia. Transrectal ultrasound‐guided biopsy was carried out because of high serum prostate‐specific antigen (3.55 ng/mL), but it showed no malignancies. Benign prostate hyperplasia was diagnosed, and he was started on an α1‐blocker. Although the urinary symptom improved with silodosin, acute urinary retention occurred 3 years after therapy began. Holmium laser enucleation of the prostate for relief of bladder outlet obstruction enabled discharge of urine. Pathological examination of the resected tissue found adenocarcinoma with a high Gleason score, 4 + 5. Serum alkaline phosphatase increased rapidly after holmium laser enucleation, and bone scintigraphy confirmed multiple bone metastases. Prostate cancer, T1bN0M1b, was diagnosed.     

Radiation-induced esophageal cancer: A case report and a review of the literature

A 63 year old woman who had been irradiated for thyroid carcinoma at 36 years of age developed a cervico-esophageal stricture, the biopsy specimens from which revealed squamous cell carcinoma. Total esophagectomy was performed and a small linear ulcer was found in the resected specimen. Histological examination revealed moderately differentiated squamous cell carcinoma with severe fibrosis around the tumor, indicating radiation-induced cervical esophageal cancer. The characteristics of radiation-induced esophageal cancers described in the literature are reviewed in context of the present case.     

Androgen receptor expression in clinically localized prostate cancer： immunohistochemistry study and literature review

Aim： To evaluate androgen receptor （AR） expression in clinically localized prostate cancer （PCa）. Methods： Specimens were studied from 232 patients who underwent radical prostatectomy for clinically localized prostatic adenocarcinoma without neoadjuvant hormonal therapy or chemotherapy at our institution between November 2001 and June 2005. Immunohistochemical study was performed using an anti-human AR monoclonal antibody AR441. The mean AR density in the hot spots of different histological areas within the same sections were compared and the correlation of malignant epithelial AR density with clinicopathological parameters such as Gleason score, tumor, nodes and metastases （TNM） stage and pre-treatment prostate-specific antigen （PSA） value was assessed. Results： AR immunoreactivity was almost exclusively nuclear and was observed in tumor cells, non-neoplastic glandular epithelial cells and a proportion of peritumoral and interglandular stromal cells. Mean percentage of AR-positive epithelial cells was significantly higher in cancer tissues than that in normal prostate tissues （mean e SD, 90.0% ± 9.3% vs. 85.3% ±9.7%, P 〈 0.001）. The histological score yielded similar results. The percentage ofAR immunoreactive prostatic cancer nuclei and histological score were not correlated with existing parameters such as Gleason score, tumor, nodes and metastases stage and pre-treatment PSA value in this surgically treated cohort. Conclusion： The results of the present study suggest that there may be limited clinical use for determining AR expression （if evaluated in hot spots） in men with localized PCa.     

前列腺炎症性肌纤维母细胞瘤1例报告并文献复习

目的:提高前列腺炎症性肌纤维母细胞瘤(IMT)的诊治水平. 方法:回顾性分析l例前列腺IMT患者的临床资料并复习相关文献.患者,男性,62岁,因反复排尿困难曾在当地医院诊断为“前列腺增生症”,前后行两次前列腺电切术(TURP).术后症状仍反复发作,故患者第1次来我院就诊,行TURP加经尿道膀胱肿瘤电切术(TUR-BT)...     

精索副神经节瘤一例报告并文献复习

目的 提高对精索副神经节瘤诊断和治疗的认识.方法 报道1例精索副神经节瘤患者,并复习文献.患者38岁,因发现左侧阴囊内肿物20余年,阴囊坠胀不适数年入院.查体发现左侧精索静脉重度曲张及左精索上部占位性病变.B超提示左精索静脉曲张,左精索上方实质性结节,境界清楚,大小约2.0 cm×2.5 cm,周围血供丰富.结果 行左精索静脉高位结扎术及左精索肿物切除术.术中见精索肿物呈圆形结节,边界清楚,质中,将左精索肿物及其包膜完整切除.病理组织学表现为瘤细胞弥漫,呈不典型的车辐状或编织状排列,细胞大小形态较一致,胞质丰富,弱嗜酸性,核大淡染,核分裂象易见,并可见病理性核分裂象;间质为丰富的血管和淋巴细胞和单核细胞等炎细胞浸润;瘤细胞局部浸润边缘平滑肌.免疫组织化学检查示波形纤维蛋白、嗜铬粒蛋白A、突触运载蛋白均阳性.病理诊断为精索副神经节瘤.术后随访18个月,无复发及转移.结论 精索副神经节瘤确诊需依赖病理组织学检查,良恶性判别尚无统一标准,须完整切除肿瘤,尤其是年轻未育者,术后长期密切随访.