隆突性皮肤纤维肉瘤的临床病理分析:附28例报告

目的探讨隆突性皮肤纤维肉瘤的临床病理特征。 方法对28例隆突性皮肤纤维肉瘤从临床表现、病理形态及免疫组化等方面进行观察分析。 结果28例隆突性皮肤纤维肉瘤好发于中青年男性,临床多表现为皮肤固定的结节状肿物,手术切除不完全易局部复发。病理组织学表现为梭形细胞排列成典型的车辐状或席纹状。免疫组化所有病例Vimentin及CD34均阳性,S-100均阴性。其中2例局部伴高级别肉瘤转化,转化区域CD34表达减弱或不均匀。 结论CD34有助于DFSP与其他皮肤梭形细胞肿瘤的鉴别,当CD34表达减弱时需注意观察是否局部伴高级别肉瘤转化。       

伴间质特殊分化的子宫腺肉瘤

目的 了解伴间质特殊分化的子宫Ｍｕｅｌｌｅｒｉａｎ腺肉瘤的临床病理特征及其鉴别诊断。方法 收集７例单质形态特殊的子宫腺肉瘤、观察其临床病理特点,并进行组织化学及免疫组化染色分析。结果 所有肿瘤具有腺肉瘤的临床及组织学特征,２例间质出现组织学形态和免疫组化特点均与恶性横纹肌样瘤相似的区域,１例伴性索样成分,３例伴横纹肌肉瘤及１例伴灶性软骨成分。结论 腺肉瘤间质可向横纹肌样分化,可能与间质细胞的多分化     

骨外黏液样软骨肉瘤3例临床病理观察

目的探讨骨外黏液样软骨肉瘤的临床病理特征及鉴别诊断。方法应用HE、免疫组化染色观察3例骨外黏液样软骨肉瘤的组织学形态及免疫组化特征,并复习文献。结果3例中女性2例,男性1例,年龄30～52岁;2例发生于大腿,1例发生于手部,肿块均位于深部软组织。光镜下肿瘤呈多结节状,结节由纤维、疏松纤维血管组织分隔形成大小不等的小叶,结节内为丰富的黏液样基质,小叶周边区细胞丰富,中央区细胞稀疏;瘤细胞为圆形、卵圆形及短梭形,排列呈索状或吻合条索状;病灶内可见灶性出血,无坏死,未见明确软骨分化。免疫组化：肿瘤细胞vimentin均（＋）,2例NSE和Syn（＋）,1例S-100和CgA（＋）,1例EMA灶性（＋）;CK、HHF35、desmin、actin和GFAP均（-）。结论骨外黏液样软骨肉瘤是一种罕见的恶性软组织肿瘤,具有特征性的组织病理学特点,可伴有神经内分泌分化;虽然生长缓慢,但易转移和局部复发,需长期随访。     

黏液性脂肪肉瘤的MRI表现与病理学分析

目的探讨下肢黏液性脂肪肉瘤的MRI表现与病理学的相关性。方法回顾性分析5例经病理证实的下肢黏液性脂肪肉瘤患者的MRI资料,并与病理对照。结果黏液性脂肪肉瘤多数位于下肢深部肌肉间隙内,形态多不规整,边界清晰,其内主要为囊性信号,其内部可见排列紊乱的纤维间隔,T1WI肿块为均匀或不均匀低信号,T2WI为高信号,脂肪抑制序列肿块呈高信号,信号无减低,增强扫描可见不均匀强化;组织学上以黏液成分为主,脂肪含量极少。结论下肢黏液性脂肪肉瘤具有典型的MRI表现,MRI可以推测肿瘤的组织学分化程度,为临床提供准确、可靠的信息。     

原发性精索去分化脂肪肉瘤1例

正去分化脂肪肉瘤(DDLPS)在WHO骨和软组织肿瘤分类标准中的定义是不典型性脂肪瘤性肿瘤/高分化脂肪肉瘤(ALT/WDL)去分化为不同分化程度的肉瘤,其去分化成分多为高级别肉瘤,如多形性未分化肉瘤、纤维肉瘤和粘液性原纤维肉瘤等,也有伴低级别肉瘤成分[1]。其中血管肉瘤成分极其少见,国内外文献中精索DDPLS中存在血管肉瘤成分的病例仅1例报道[2]。此外,原发性精索肿瘤     

子宫内膜间质肿瘤临床病理分析

目的 探讨子宫内膜问质肿瘤的临床、病理及其多成分分化特点、鉴别诊断和预后。方法 分析37例子宫内膜间质肿瘤(其中子宫内膜间质结节6例，低度恶性子宫内膜间质肉瘤22例，高度恶性子宫内膜间质肉瘤7例，子宫内膜间质平滑肌混合瘤2例)的临床、病理、合并症、鉴别诊断及预后。结果 不同类型肿瘤均有部分病例伴多成分分化(16例伴平滑肌分化，14例伴性索样分化，1例伴纤维分化)，其中8例同时伴2种分化成分；37例中有9例伴发子宫平滑肌瘤(其中1例同时伴发腺瘤样瘤，1例伴发高分化子宫内膜腺癌)。结论 不同类型子宫内膜间质肿瘤均可伴发多成分分化及其他类型肿瘤，具备多样性病理形态特征，其中以平滑肌分化及性索样分化最为常见；并发肿瘤以平滑肌瘤最为常见。组织化学及免疫组化染色对诊断及鉴别诊断有帮助；肿瘤预后与多成分分化的数量及类型关系不大；肿瘤有无浸润及瘤细胞异型程度、核分裂象数量是确定本瘤性质的必备条件。     

累及同侧臀部的腹膜后高分化脂肪肉瘤1例

<正>脂肪肉瘤是一种常见的软组织肉瘤,分为四种亚型:非典型性脂肪瘤性肿瘤/高分化脂肪肉瘤(ALT/WDL),去分化脂肪肉瘤(DDLPS),多形性脂肪肉瘤和黏液样脂肪肉瘤[1]。脂肪肉瘤通常发生于四肢、腹膜后、精索、睾丸、胸腔、乳房、纵隔、网膜、肠系膜等[2]。其中腹膜后脂肪肉瘤早期并无明显临床症状,通常在体检时偶然发现,由于其发生在腹膜后,故女性患者容易误诊为妇科肿瘤,且较为罕见。本文结合相关文献阐述1例巨大右侧腹膜后并累及同侧臀部的ALT/WDL,虽位置不同,但具有同源性。     

去分化脂肪肉瘤15例临床病理分析

目的探讨去分化脂肪肉瘤(DL)的临床病理特征、诊断及预后。方法对15例DL进行临床病理资料分析、免疫组化及FISH检测,同时对患者进行随访获取预后信息。结果患者年龄29～79岁,中位64岁,男性11例,女性4例;手术标本13例,穿刺标本2例。在13例DL切除标本中,均可见肿瘤由非典型脂肪瘤样肿瘤/高分化脂肪肉瘤(ALT/WDL)和非脂肪性梭形细胞肉瘤组成,11例原发病例(除外2例穿刺标本)中有3例初次取材阅片时未见ALT/WDL成分,经补取材后才发现;2例复发病例未见到高分化脂肪肉瘤成分,均为非脂肪梭形细胞成分。免疫组化:15例DL去分化成分中有10例p16(+),7例MDM2(+),5例SMA (+),4例CD34(+),4例p53(+), 3例CD68(+);脂肪肉瘤区域脂母细胞S-100(+);余CD117、DES、STAT6、CK、β-catenin等均为(-)。所有病例均行MDM2检测,FISH结果显示所有病例MDM2基因扩增。去分化区域可以单独或混合呈现以下形态:①纤维肉瘤样(9/15);②炎性肌纤维母细胞瘤样(6/15);③纤维瘤病样(4/15);④多形性未分化肉瘤样(3/15);⑤低度恶性黏液纤维肉瘤样(3/15);⑥血管外皮瘤样(1/15);⑦脑膜瘤样漩涡结构及神经样结构(1/15);⑧乳腺型肌纤维细胞瘤样(1/15);另外还可见软骨及骨分化等。随访期内2例死亡(1例3个月后复发死亡,1例12个月后脑转移死亡),余均存活。结论去分化脂肪肉瘤形态千变万化,分子遗传学MDM2基因检测至关重要;肿瘤发生部位及复发次数是肿瘤预后的关键因素,手术切除是DL主要治疗方法,放、化疗的作用仍有争议,新型靶向治疗是一个潜在治疗方向。     

子宫内膜间质肿瘤及其多成分分化

近年来对子宫内膜间质肿瘤多成分分化的报道日渐增多,迄今已有腺性、性索样、平滑机样、横纹肌样、纤维样、黏液样、骨化等多种分化，常常使人陷入困境，时有误诊出现。本文结合子宫内膜间质瘤的典型改变，主要对其伴多种成分分化的组织形态学进行阐述，鉴别诊断包括：子宫内膜间质结节，腺肉瘤、癌肉瘤、混合性子宫内膜间质瘤及平滑肌瘤、黏液性平滑肌肉瘤和黏液样葡萄状肉瘤等。     

胸腺神经内分泌癌4例及文献复习

目的 探讨胸腺神经内分泌癌（TNC）的临床病理特征及鉴别诊断。方法 报道4例胸腺神经内分泌癌，结合文献从临床病理，免疫表型等方面进行探讨。结果 4例3例完全无症状，巨检肿瘤呈结节状，切面灰白，可有出血坏死。镜检2例肿瘤组织呈梁索状，器官样排列，1例排列类似于梁索状，1例呈燕麦细胞样弥漫分布。免疫组化CAM5.2、CK、NSE、Syn、CgA呈阳性表达。结论 胸腺神经内分泌癌具有复杂的组织学特点，根据肿瘤组织和细胞的异型性分为高、中、低分化，免疫组化有助于与纵隔其他原发肿瘤相鉴别。     

Sonographic Appearances of Liposarcoma: Correlations with Pathologic Subtypes

Liposarcoma is the second most common malignant soft-tissue tumor. This entity is pathologically categorized into 4 subtypes: well-differentiated, myxoid, dedifferentiated and pleomorphic. Although features on magnetic resonance imaging and computed tomography for these 4 subtypes have been reported quite precisely, those on sonography have not been fully investigated. The present study was therefore aimed at clarifying the sonographic appearances of each liposarcoma subtype and assessing correlations with histopathology. The study population was made up of 35 cases, including 21 cases of well-differentiated liposarcoma, 6 cases of myxoid liposarcoma, 6 cases of dedifferentiated liposarcoma and 2 cases of pleomorphic liposarcoma. Compared with the other subtypes, well-differentiated liposarcoma was characterized by the high frequency of the following findings: isoechogenicity, tiny hyperechoic lines and hypovascularity (p < 0.01, in each). Myxoid liposarcomas were characterized by low echogenicity, intermingled with anechoic areas and moderate vascularity (p < 0.01, in each). Dedifferentiated liposarcomas showed a specific biphasic pattern of hyperechoic and hypoechoic areas and hypervascularity (p < 0.01, in each). Pleomorphic liposarcomas showed a specific gyrus-like mixture of hyperechoic and hypoechoic areas (p < 0.01). In conclusion, the present study revealed different characteristics of sonographic appearance among the 4 histopathologic subtypes of liposarcoma.     

Multiple well-differentiated retroperitoneal liposarcomas with different patterns of appearance on computed tomography: A case report

BACKGROUNDPrimary retroperitoneal liposarcoma (PRPLS) is a rare soft tissue tumor with nonspecific clinical symptoms; it has different computed tomography (CT) image features according to pathological types. Some patients with a single tumor have been previously reported in the literature. We present an exceptional case of a PRPLS patient with multiple large tumors exhibiting different patterns of appearance on CT and confirmed as atypical lipomatous tumor/well-differentiated liposarcoma by postoperative pathology. CASE SUMMARYA 64-year-old man presented with abdominal distension for 1 year. The patient was diagnosed with PRPLS based on physical examination, laparotomy, ultrasonography, CT scan, and surgery. Both of the tumors were completely resected through surgery and confirmed as atypical lipomatous tumor/well-differentiated liposarcoma by postoperative pathology. The postoperative course was uneventful without recurrence or metastasis, as demonstrated by abdominal-pelvic CT during an 18 mo follow-up. CONCLUSIONMultiple large Well-differentiated liposarcomas with different patterns of appearance on CT image can occur simultaneously in the same patient, to which more attention should be paid to make an effective differential diagnosis.     

脂肪肉瘤彩色多普勒超声特征分析

目的 探讨脂肪肉瘤的超声声像图特征。方法 回顾性分析我院经手术切除病理证实为脂肪肉瘤的31例患者资料、超声声像图特征。结果 31例患者中,去分化脂肪肉瘤13例,高分化脂肪肉瘤10例,多形性脂肪肉瘤4例,粘液样脂肪肉瘤4例,肿瘤平均最大长径约(16.97±9.70)cm,病灶以等-高回声为主61.3%(19/31),回声分布不均匀90.3%(28/31),多表现为乏血供,以Adler血流分级为0级51.6%(16/31)和I级41.2%(14/31)为主。主要的病理亚型高分化脂肪肉瘤超声特征以高回声为主70.0%(7/10),去分化脂肪肉瘤则表现为低回声46.2%(6/13)和高回声30.8%(4/13)的双相模式。结论 脂肪肉瘤超声声像图表现具有一定的特征性,对于超声准确诊断该病能够提供一定的帮助。     

Evaluation of intratumoral hemodynamics with color Doppler imaging in patients with colorectal carcinoma: comparison between waveform analysis and histopathologic characteristics

Purpose We studied the relation between intratumoral hemodynamics and histopathologic characteristics in patients with colorectal carcinoma.Methods A series of 82 patients with 28 well-differentiated adenocarcinomas, 40 moderately differentiated adenocarcinomas, 10 poorly differentiated adenocarcinomas, and 4 mucinous adenocarcinomas underwent color Doppler examination and surgical treatment. The waveform of blood flow in the thickened wall of the colon was analyzed by determining the maximum velocity (Vmax) and resistance index (RI). These parameters were compared with histopathologic findings of the resected specimens: gross form, tumor size, depth of invasion, histologic stage, and histopathologic classification.Results Both Vmax and RI were higher in the invasive tumors rather than the expansive ones. Vmax and tumor size were not correlated; however, the RI increased proportionately with tumor size in tumors larger than 4cm in diameter. Both parameters increased with depth of invasion and histologic stage through stage IIIb. Both were markedly higher in mucinous adenocarcinomas than in the other histopathologic types. Furthermore, Vmax in well, moderately, and poorly differentiated adenocarcinomas did not differ significantly, although RI was negatively associated with the degree of differentiation.Conclusions We concluded that blood-flow analysis is closely associated with histopathologic findings of colorectal carcinomas and that it provides information useful in the clinical management of these patients.     

Retroperitoneal liposarcoma: sonographic findings

This study, based on sonographic (US) results of 10 cases with histologically proven retroperitoneal liposarcoma (eight well-differentiated and two pleomorphic types), shows that the presence of fine echogenic lines within the tumor is a useful sign for diagnosing a well-differentiated liposarcoma. Presence of numerous fine fibrous septa in the lipomatous tumor tissue is thought to be responsible for this interesting phenomenon. Of interest is the fact that the direction of these lines changed according to the probe format used: parallel horizontal lines when using a linear probe and concentric lines converging toward the probe when using a sector or curved linear probe. In contrast, pleomorphic liposarcoma does not show this US sign. Knowledge of these US findings is useful for the diagnosis of retroperitoneal liposarcoma. Received: 10 January 2000/Accepted: 9 February 2000     

多形性横纹肌肉瘤的鉴别诊断

本文对２１例原病理诊断为ＰＲＭＳ的标本，应用特殊染色Ｍａｓｓｏｎ，ＰＡＳ，ＰＴＡＨ及免疫组织化学Ｖｉｍｅｎｔｉｎ、Ｄｅｓｍｉｎ，ＨＨＦ－３５、Ｍｙｏｇｌｏｂｉｎ，Ｍａｃ３８７，ａ－ＡＴ，Ｓ－１００蛋白，ＮＳＥ，Ｃ－ｋｅｒａｔｉｎ等标记，结合病理组织形态观察，结果维持原理诊断的９例，修改诊断为ＭＨＦ的８例，ＰＬＭＳ２例，ＰＬＰＳ１例，恶性蝾螈瘤１例。９例ＰＲＭＳ均为男性，年龄２７￣７２岁，中位年龄数     

超声引导下细针穿刺细胞学检查在妇科盆腔肿瘤诊治中的应用

目的:探讨超声引导下细针穿刺细胞学(fine needle aspiration,FNA)检查对妇科盆腔肿瘤的临床诊断与治疗价值。方法:32例妇科盆腔肿瘤患者在B超引导下进行FNA检查,同时送组织病理学检查。结果:32例盆腔肿瘤患者中,FNA检查诊断为卵巢恶性肿瘤28例,盆腔良性病变4例。FNA诊断为恶性肿瘤的28例患者中,除3例因针吸样本量较少未能作出组织病理学诊断外,余25例组织病理学诊断为浆液性、黏液性、乳头状癌或子宫内膜样腺癌等。FNA诊断为良性肿瘤的4例患者中,术后组织病理学证实为卵巢畸胎瘤、卵巢浆液性囊腺瘤、子宫肌瘤、附件炎性反应。FNA检查对盆腔肿物诊断的敏感性和特异性均为100.0%。32例患者均未发现针道种植及感染。结论:FNA诊断妇科肿瘤的敏感性及特异性高,具有重要的临床价值。     

下肢高分化及黏液型脂肪肉瘤的影像表现与病理分析

目的探讨下肢高分化及黏液型脂肪肉瘤影像学表现与病理学的关系,提高影像诊断准确率。方法回顾分析12例下肢脂肪肉瘤的影像学表现,与术后病理类型进行对照分析。结果8例高分化型脂肪肉瘤边界清楚,T,WI及T2WI呈高或稍高信号,内部分隔厚度〉2mm;CT为均匀低密度,分隔轻中度强化。病理见较多分化好的脂肪细胞。4例黏液型边界大部分清楚,T,WI等低信号,3例夹杂少许高信号脂肪影,T2WI以高信号为主,内见多房分隔：CT上呈等、低混杂密度,不均匀团片样、云絮状强化,实性成分及粗大间隔强化明显。病理上疏散黏液中见短梭形细胞或单泡状脂母细胞。结论高分化型脂肪肉瘤影像学表现典型,多数黏液型脂肪肉瘤伴有少量脂肪,MRI及CT在一定程度上能反映肿瘤的分化程度。     

Correlation between microbubble contrast-enhanced color doppler sonography and immunostaining for Kupffer cells in assessing the histopathologic grade of hepatocellular carcinoma: preliminary results

PURPOSE: The aim of this study was to determine the histopathologic grades of hepatocellular carcinomas (HCCs) on the basis of the presence of Kupffer cells, using color Doppler sonography with the liver-specific microbubble contrast agent Levovist. METHODS: Color Doppler sonograms generated by stimulated acoustic emission were obtained 7 minutes after intravenous injection of 5 ml of Levovist (300 mg/dl) in patients with histopathologically confirmed HCCs. CT scans were also obtained and evaluated, and hematoxylin and eosin staining for morphologic examination and immunostaining (anti-CD68) for detecting Kupffer cells were performed for confirmation of the sonographic findings. RESULTS: Eighteen tumors had a defect in the color Doppler signal (color void) that corresponded with the baseline gray-scale image of the tumor. On histopathologic examination, these 18 tumors were all found to be either poorly or moderately differentiated HCCs with either a marked reduction in the number of or the absence of Kupffer cells. The remaining 2 tumors showed color signals. Histopathologic examination of these 2 tumors disclosed well-differentiated components within the tumors, with Kupffer cells in the tumor tissue. CONCLUSIONS: Color Doppler sonography using a liver-specific microbubble ultrasound contrast agent appears to reflect the histopathologic features of HCCs and may thus be useful for differentiating liver tumors and determining a treatment strategy.     

外周原始神经外胚叶瘤8例临床病理分析

目的 探讨外周原始神经外胚叶瘤的临床病理特征。方法 收集8例外周原始神经外胚叶瘤观察其临床病理特点并进行免疫组织化学分析。结果 所有病例在活检前均未能明确诊断，组织学检查该肿瘤具有一定的形态学特点如由大小一致的小圆形细胞组成，核圆形，点彩状，肿瘤细胞免疫组化表达Vimentin及CD90，结论 外周原始神经外胚叶瘤是一种极少见的肿瘤，临床表现缺乏特异性，早期诊断十分困难。根据其组织学改变和免疫组化染色结果，可与其他肿瘤鉴别。