肾恶性横纹肌样瘤临床病理分析及超微结构观察

目的:探讨肾恶性横纹肌样瘤(MRTK)的临床病理表现及超微结构特点。方法:用光镜、免疫组化及电镜等方法观察其病理组织学特点、免疫组化表达及超微结构。结果:光镜的典型特点是肿瘤细胞弥漫性排列,呈圆形、椭圆形及不规则形,胞质丰富,嗜酸性,部分胞质内可见透明状小体,细胞核圆形或椭圆形,核膜厚,核仁清楚,有的细胞核呈空泡状。部分核偏向一侧似浆细胞样。细胞内外见红染的包涵体。免疫组化显示肿瘤可表达多种抗原。电镜观察特异性表现是胞质内见中间丝及圆形不规则形纤维状或轮状小体。结论:肿瘤细胞弥漫排列呈浆细胞样,免疫组化多方向表达,可向神经性、上皮性、肌性等方向分化。电镜下胞质内中间丝及纤维轮状小体是特异性诊断标志。     

肝上皮样血管内皮瘤的临床病理观察

目的 探讨肝上皮样血管内皮瘤（EH）的临床病理特点、鉴别诊断及预后。方法 观察4例肝EH的组织形态学特点并行免疫组化检测,并结合相关文献进行分析。结果 EH镜下肿瘤细胞为上皮样、梭形或多角形,呈条索状、小巢状生长,或在血管内呈乳头状生长,部分瘤细胞胞质空泡化,内含红细胞;核分裂像罕见,瘤细胞胞质丰富,嗜酸性,胞界不清,间质黏液样变或玻璃样变。免疫组化染色显示肿瘤细胞CD31、CD34、Vim阳性。结论 肝EH是一种少见的低度恶性的血管源性肿瘤,影像学易误诊,需依靠病理形态学及免疫组化确诊。     

近端型上皮样肉瘤3例临床病理分析

目的:探讨近端型上皮样肉瘤的临床病理特征、诊断要点、免疫表型、鉴别诊断及生物学行为.方法:分析3例上皮样肉瘤的临床病理资料,观察其组织病理学形态及免疫表型特征,对其进行随访.结果:女2例,男1例.发病年龄24-34岁.位于头部2例,肩部1例.临床均表现为无痛性生长的单一结节状肿块.肿瘤细胞呈圆形、卵圆形及梭型,含有均质状嗜酸性胞质,细胞核空泡状,核仁明显,一个或多个,见肉芽肿样改变及出血囊性变.肿瘤细胞波形蛋白(Vimentin)、细胞角蛋白(AE1/AE3)、CD34阳性表达,上皮膜抗原(EMA)部分阳性表达.阴性表达的是 CD31、FⅧ因子、Mac387、CD68、S-100蛋白、SMA、HMB-45、desmin、CD240.1例死于发病后14个月,1例于发病6个月后出现复发,另1例随访个5月无复发和转移.结论:近端型上皮样肉瘤的组织病理学特征是:肿瘤细胞呈结节状分布,有上皮样结构,肿瘤细胞有弥漫性嗜酸性胞质,核大,空泡状,核仁明显,核分裂相多见.瘤细胞共同表达Vimentin、AE1/AE3、CD34,部分病例瘤细胞表达EMA;需与上皮样血管肉瘤、滑膜肉瘤、上皮样恶性神经鞘瘤鉴别诊断.其生物学行为高度恶性.     

嗜酸性脑膜瘤二例临床病理分析

目的探讨嗜酸性脑膜瘤（OM）的临床病理学特征。方法回顾性分析2例OM患者的临床病理学及免疫组织化学特点,并复习文献。结果2例OM患者均为男性,年龄分别为58岁和49岁。肿瘤分别位于右额叶和大脑镰部。肿瘤均与硬脑膜相连,界限清楚。肿瘤细胞排列成弥漫片状和巢状结构,肿瘤细胞呈多角形,具有丰富的嗜酸性胞质,细胞核卵圆形,居中。肿瘤细胞异型性小,核分裂象和坏死罕见。肿瘤细胞表达Vimentin、上皮膜抗原（EMA）、孕激素受体（PR）和抗线粒体抗体（antimitochondrial）。结论OM非常罕见,其诊断主要依靠组织病理学特点和免疫表型。     

大腿腺泡状软组织肉瘤临床病理分析及文献复习

目的:探讨腺泡状软组织肉瘤(alveolar soft part sarcoma,ASPS)的临床病理学特征。方法:对1例ASPS进行大体、组织病理学和免疫组化染色观察,并复习相关文献。结果:患者女性,39岁,肿瘤发生于宫颈。镜下肿瘤细胞排列成腺泡状,细胞巢之间可见窦状血管分隔,瘤细胞胞质内含丰富的嗜酸性颗粒。结论:ASPS是一罕见的高度恶性软组织肿瘤,结合临床及病理学特征,可作出正确诊断。     

宫颈原发性腺泡状软组织肉瘤临床病理观察

目的:探讨腺泡状软组织肉瘤(alveolar soft part sarcoma,ASPS)的临床病理学特征。方法:对1例ASPS进行大体、组织病理学和免疫组化染色观察,并复习相关文献。结果:患者,女,33岁,ASPS发生于宫颈。镜下肿瘤细胞排列成腺泡状,细胞巢之间可见窦状血管分隔,瘤细胞胞质内含丰富的嗜酸性颗粒。PAS染色,瘤细胞胞质内可见棒状结晶体。免疫组化:Vim阳性,desmin、SMA、myoglobin、CgA、S-100、EMA、AEI/AE3、CD68、和HMB45(-)全部为阴性。结论:宫颈ASPS是一罕见的恶性软组织肿瘤,结合临床病理学特征及免疫组化,可作出正确诊断。     

腋窝汗腺癌2例临床诊断治疗及文献复习

目的:报告腋窝汗腺癌2例临床诊断治疗经过,文献复习探讨汗腺癌病理特征、诊断及治疗现状。方法:描述腋窝汗腺癌2例临床诊断治疗过程,对病理组织学及免疫组织化学进行分析,并对相关文献复习。结果:汗腺癌具有特征性的病理改变,肿瘤细胞具有汗腺分化,细胞排列呈腺腔样结构或导管腺样囊状结构,胞质含有大量嗜酸性颗粒。结论:汗腺癌是一种罕见的皮肤恶性肿瘤,诊断主要依靠病理组织学,临床治疗应予以手术为主的综合治疗。     

12例腮腺嗜酸性细胞腺瘤临床病理分析

目的探讨腮腺嗜酸性细胞腺瘤的临床病理学特征。方法对12例腮腺嗜酸性细胞腺瘤进行临床、病理组织学和免疫组织化学观察，并结合文献探讨其临床表现、病理形态及鉴别诊断。结果12例患者平均年龄57．2岁。组织学上见密集的上皮肿瘤细胞片块状分布，瘤细胞圆形或多边形、体积大、胞浆内充满嗜伊红颗粒，胞核圆或卵圆形，核小深染。Vimentin、Actin、S-100在瘤细胞中均阴性表达；EMA和CK强阳性表达。结论腮腺嗜酸性腺瘤比较少见，多发生于老年人。明确诊断依赖于病理检查，应与多种临床类似病变鉴别诊断。     

肾脏嗜酸细胞瘤的临床诊疗分析(附4例报告)

目的:探讨原发性肾脏嗜酸细胞瘤的临床特征、病理特点、治疗方法.方法:对4例嗜酸细胞瘤患者的临床资料,结合文献进行分析.结果:男2例,女2例,年龄分别为34、73、47、45岁,临床表现无特异性.CT检查2例肿瘤位于肾脏下极,表现出以中心区星状瘢痕为特征.1例行根治性肾切除术,另1例术中病理检查为良性而行肾部分切除术,余2例均误诊断为肾癌而行根治性肾切除术.镜检:肿瘤细胞圆形或类圆形,细胞均匀一致,呈巢状、片状或管状排列,具有许多嗜酸性颗粒的胞质,肿瘤中心部可见玻璃样变性无细胞区;免疫组化:CK( )、EMA( )、Vimentin(-).3例患者随访6个月至41个月,均健在,未见肿瘤复发或转移,1例患者术后失访.结论:肾嗜酸细胞瘤是一种良性实质性上皮肿瘤,临床表现无特异性,影像学检查可帮助诊断,对于怀疑此肿瘤患者应术中行病理检查,治疗以保留肾脏手术为宜,确诊需要病理行免疫组化检查,术后密切随访.     

胃巨大血管球瘤1例并文献复习

目的:探讨胃血管球瘤的临床、病理学特征以及诊断和鉴别诊断.方法:报道1例发生在胃部的血管球瘤,对其进行组织学、免疫组化检查并复习文献.结果:胃血管球瘤临床上多发于中年女性,好发于胃窦部,常见症状为上腹部疼痛;其形态学特点表现为肿瘤组织呈结节状,肿瘤细胞大小较一致,呈圆形或多边形,胞质透亮或嗜酸性,核圆形,瘤细胞排列成实性或围绕血管周围排列;免疫组化标记显示肿瘤细胞vimentin、SMA、actin、calponin均为(+),CK、CD117、Syn、S-100、EMA、desmin、CD99、CD34均(-).结论:胃血管球瘤罕见,临床上缺乏特异性症状、主要表现为上腹部疼痛,生物学行为多为良性,具有特定的形态学特征和免疫表型,需要和其他肿瘤如上皮样胃间质瘤、类癌等进行鉴别.     

胃的肝样腺癌的临床病理分析

目的 研究胃的肝样腺癌（ｈｅｐａｔｏｉｄ ａｄｅｎｏｃａｒｃｉｎｏｍａ ｏｆ ｔｈｅ ｓｔｏｍａｃｈ，ＨＡＳ）和病理形态和临床特点。方法 采用常规ＨＥ染色和免疫组织化学方法对３例胃的肝样腺癌进行研究。结果 ３例ＨＡＳ细胞胞质内均有甲胎蛋白（ＡＦＰ），α－抗胰糜蛋白酶（ＡＣＴ）和α－抗胰蛋白酶（ＡＡＴ）表达。肿瘤的发病部位以胃窦部多见，３例均有局部胃壁脉管浸润和局部淋巴结转移，其中２例有肝转移，分别     

胃肝样腺癌11例分析

目的探讨胃肝样腺癌(HAS)的临床和病理特点及其诊断和治疗。方法回顾我院11例胃肝样腺癌的临床病理特点及其诊断和治疗。结果 11例肝样腺癌平均59.27岁,其中男性9例;治疗前血清AFP均升高(5/5);病变均为溃疡或溃疡型肿物、低分化或中低分化腺癌伴部分肝样腺癌,位于胃窦部2例,胃体部3例,贲门部6例;同时有肝转移者5例(5/11);手术切除者7例,其中3例行根治性手术;7例患者均有淋巴结转移;临床病理分期Ⅲ期2例、Ⅳ期9例;5例手术患者、3例未手术患者行不同疗程的全身化疗±介入化疗;患者总体预后差,死亡4例,其生存期为1～10个月。结论胃肝样腺癌是一类特殊的胃癌,容易发生淋巴结、肝脏转移,临床疗效差,应予以重视。     

宫颈胃型腺癌10例临床分析

目的:探讨宫颈胃型腺癌的临床病理特征、诊治情况及预后.方法:回顾性分析我医院妇科自2018年5月至2020年11月收治的10例宫颈胃型腺癌患者的临床病例资料.结果:10例患者中初次就诊时Ⅰ期5例,Ⅱ期2例,Ⅲ期3例,但术后因淋巴转移或远处转移而致分期升级至Ⅲ-Ⅳ期者可高达90％;单纯胃型腺癌者7例,单纯微偏腺癌者1例,...     

１１例胃肝样腺癌患者的病理与临床特征分析

目的：探讨胃肝样腺癌（hepatoid adenocarcinoma of stomach ,HAS）特殊的临床病理特点和预后的关系,以指导临床治疗。方法：回顾性分析我院１１例曾行外科手术切除,术后经病理证实为胃肝样腺癌的患者的多个临床及病理参数。结果：１１例患者中男性７例,女性４例,平均年龄６１.５岁,５例术前已有肝转移,４例术后发生肝转移。发病部位以胃窦部小弯侧多见（５４.５％）,病理类型多为溃疡型（７２.７％）。结论：胃肝样腺癌是原发于胃黏膜腺体的肿瘤,形态上具有肝细胞样分化和腺癌样分化两种结构,因常伴有淋巴转移及肝转移,故预后较普通型胃癌差。     

Chemotherapy of human alpha-fetoprotein-producing gastric carcinomas grown in nude mice

We have examined the effects of chemotherapeutic drugs on tumor growth and metastasis of human alpha-fetoprotein-producing gastric carcinoma (AFPGC) xenografts growing in nude mice. These xenografts consisted of 3 hepatoid adenocarcinomas and 2 non-hepatoid, poorly differentiated adenocarcinomas. Mitomycin C and cisplatin inhibited the tumor growth and liver metastasis of hepatoid adenocarcinomas in nude mice. 5-fluorouracil also inhibited the growth of hepatoid adenocarcinomas but did not exhibit a significant antimetastatic action. Doxorubicin was effective only against non-hepatoid adenocarcinomas. These results indicate that chemotherapeutic drugs for AFPGC should be used according to the subtype of the tumor.     

PIVKA-II-producing advanced gastric cancer

We describe the case of a 68-year-old man with primary advanced adenocarcinoma of the stomach, who displayed extremely high plasma levels of protein induced by vitamin K antagonist (PIVKA)-II (15600mAU/ml) and normal levels of alphafetoprotein (AFP) (4ng/ml). Ultrasonography and dynamic computed tomography ruled out hepatocellular carcinoma (HCC) or liver metastasis. After preoperative chemotherapy, pancreatico-spleno total gastrectomy with D2 lymphadenectomy was performed. Postoperatively, plasma levels of PIVKA-II returned to within the normal range (29mAU/ml). Microscopic examination revealed stomach adenocarcinoma showing various histological types, such as moderately to poorly differentiated mucinous adenocarcinoma, but hepatoid differentiation of gastric adenocarcinoma was not detected. Localization of PIVKA-II and AFP within tumor cells was demonstrated by immunohistochemical staining using monoclonal antibodies. These results indicate that tumor cells from gastric cancer may produce PIVKA-II. Some cases of PIVKA-II- and AFP-producing advanced gastric cancer with liver metastasis have been reported, but this is the first report of gastric cancer without liver metastasis producing PIVKA-II alone.     

含有透明细胞胃癌的临床病理研究

目的：探讨含有透明细胞胃癌的临床病理意义。方法：２６例含有透明细胞胃癌手术标本分别进行光镜、电镜观察及组织化学、ＡＢＣ法免疫组化染色。２例妊娠３月胎儿胃肠标本作对照。结果：含有透明细胞胃癌均为进展期癌，组织学主要有２种类型：不同分化程度的乳头状管状腺癌及肝样腺癌，１８例（７６．９２％）见淋巴管癌栓，５例（１９．２３％）见静脉癌栓；淋巴结及肝转移率高（８８．４６％，４４．５４％），５年生存率为９．１     

An autopsy case of AFP-producing gastric carcinoma resembling hepatocellular carcinoma on light microscopy

We experienced an autopsy case of alpha-fetoprotein(AFP)-producing advanced gastric carcinoma with liver metastasis. Microscopically, the tumor was compose by medullary nests of poorly differentiated adenocarcinoma cells. The cells had an exclusively hepatoid pattern characterized by discrete masses, nests, and broad bands, consisting of large eosinophilic epithelial cells and separated by fibrous stroma. Immunohistochemical studies of hepatoid cells yielded a positive reaction for AFP, but negative for CEA. Electron microscopically, tumor cells possess a ductal lumina with abundant microvilli having a central core filaments, and secretory granules in cytoplasma. These findings suggest that the tumor cells differentiated into intestinal direction, irrespective of the appearance of their hepatoid features characterized by light microscopy.     

AFP阳性胰腺癌和壶腹乳头部癌的临床病理研究

目的:研究AFP阳性胰腺癌(4例)和壶腹乳头部(1例)癌的临床病理特征.方法:收集并分析5例此癌患者的临床资料,对其病理标本应用光镜、免疫组织化学进行研究.结果;此类癌多见于中老年人,血清AFP明显增高;5例均发生肝转移,于1年内死亡,平均生存期5个月;病理组织形态:均为浸润性癌,脉管内常见癌栓;2例为分化差腺癌,2例为肝样腺癌(1例为壶腹乳头部,1例为胰腺),后者癌组织由两种不同而又密切相关的腺癌区和肝样分化区组成,肝样区癌细胞具有与肝细胞癌相类似的形态特征,其癌细胞AFP染色呈阳性表达.结论:此类癌由于AFP具有免疫抑制作用,癌细胞侵袭性强易发生肝转移,病人预后不良,属高度恶性肿瘤.     

Histogenesis of hepatoid adenocarcinoma of the stomach: molecular evidence of identical origin with coexistent tubular adenocarcinoma

Hepatoid adenocarcinoma of the stomach is a highly malignant neoplasm. Most gastric hepatoid adenocarcinomas coexist with tubular adenocarcinoma. However, the relationship between hepatoid adenocarcinoma and tubular adenocarcinoma is still unclear. In the present study, the characteristics of the coexistent tubular adenocarcinomas were determined by examining their profiles of mucin production. Subsequently, molecular pathological techniques were applied to determine the clonality of 15 mixed hepatoid and tubular adenocarcinomas of the stomach. Mucin analysis suggested that the coexistent tubular adenocarcinomas with hepatoid adenocarcinoma were of the intestinal type. The patterns of chromosome X inactivation were identical between the hepatoid adenocarcinoma component and tubular adenocarcinoma component in all of 3 informative female cases. Mutations in the p53 gene were found in 5 cases. The sequences were identical within both tumor components in all 5 cases. Microsatellite analysis indicated more than 3 common patterns of loss of heterozygosity in 8 cases. These observations strongly suggested that hepatoid adenocarcinomas were of identical origin to coexistent tubular adenocarcinomas.