结肠透明细胞肌黑色素瘤病理学诊断

透明细胞肌黑色素细胞瘤(clear cell myomelanocytictumor,CCMMT)是一种少见肿瘤,最常累及子宫、肝镰状韧带和肠道[1]。近年Folpe等[2]报道7例、邢晓皖等[3]报道1例CCMMT,均发生于肝圆/镰状韧带。我们遇到2例原发于结肠的CCMMT,现就其病理诊断和鉴别诊断探讨如下。1材料与方法2例CCMMT标本均经10%福尔马林液固定,常规脱水、石蜡包埋,4μm厚切片,HE染色。免疫组化采用SP法,抗体为HMB45、SMA、S-100蛋白、desmin、CK、CD117、Syn、CD34,均购自上海长嘉公司。组化染色为PAS、嗜银网状纤维染色。2结果2.1临床资料例1,女性,28岁…     

肝圆韧带体表投影研究

研究了成人３０具尸体的肝圆韧带的体表投影（男２６具，女４具）。其体表投影大致位于：以腹白线与脐之交点为顶点，过顶点在腹白线的右侧，作与腹白线成３０．９°夹角的边线上。亦可在距腹白线３．４ｃｍ距右肋弓下缘３．２ｃｍ之二线相交的肝圆韧带切迹的体表投影点与脐的连线上。若行腹壁切开，寻找肝圆韧带腹膜内位段的游离缘，应在剑突与脐连线中点的右侧２．７ｃｍ处附近做切口为佳。     

肝圆韧带力学再通的形态学研究及其临床意义

在肝圆韧带形态研究基础上，利用探针扩张和流体静压灌注再种方式对２１例新鲜成人标本进行离体再通，探讨该两种地肝圆韧带的形态影响及再通过程中的力学特性。结果表明：探针扩张可使肝圆韧带及脐－门静脉连接处再通，进入让静脉左干囊部。肝圆韧带量大可护张内径为３．５－５．５ｍｍ。扩张再通常致肝圆韧带内膜脱落或穿破内膜层形成人工假道。流体静灌注可避免人工假道产生且使肝圆韧带再通，对脐－静脉连接处常需加用探针辅助，     

脐—门静脉连接的形态及其对肝圆韧带再通的影响

肝圆韧带起自脐，汇入门静脉左干囊部，称为脐－门静脉连接，内有连续性残腔，可用力学方法行人工再通，以建立一条可供临床诊治疾病的通。在成人Ｕ－ＰＪ处残腔多数开放，亦见有膈膜或瓣膜样结构，可分为三型：狭窄型（４４．１％）、瓣膜样型（２８．８％）及膈膜型（２７．１％）。狭窄型Ｕ－ＰＪ，在门静脉左干囊部管壁上存在一瓣膜样结构。探针扩张可使肝圆韧带及Ｕ－ＰＪ再通，进入门静脉左干囊部管腔内。流体静压灌压可使肝圆     

肝卵圆细胞的研究进展

肝卵圆细胞（OCs）是肝脏的干细胞,能够分化为肝细胞、胆管上皮细胞及其他细胞,亦与肝再生和肝脏疾病密切相关。本文简要地总结了近几年有关肝卵圆细胞的来源、定位、增殖、分化、凋亡、移植及在肝再生和肝脏疾病中作用等研究进展。     

细胞病理学诊断脉络膜黑色素细胞瘤1例

患者女性,73岁.4年余前无明显诱因突然出现左眼前有少量黑影飘动,视力无明显下降,无眼红眼痛、无视物变形、无恶心呕吐、无畏光流泪等症状.患者曾于外院就诊,诊断为"左眼玻璃体积血,右眼黄斑变性",予药物治疗后好转.约1年半前,黑影飘动感明显增加,伴视力下降至仅看清眼前1～2 m处的物体,就诊时查B超以及眼底ICGA+FFA造影后诊断"双眼老年性黄斑变性,左眼脉络膜占位病变"(影像资料不详),予药物治疗及视网膜激光光凝治疗3次后,视物模糊略好转.     

透明细胞汗腺瘤1例

患者女性,36岁,右手掌皮下无痛性包块1年。病理检查：带皮肤组织1．5cm×1．0cm大小,切面见真皮层1．0cm×0．5cm灰白色结节,无包膜,切面质韧,未见明显囊腔。镜下：可见类圆形、梭形肿瘤细胞呈小叶状及带状分布,并可见空泡样透明细胞区域及腺管状结构。腺管状结构可见由双层细胞组成。瘤细胞之间可见淡嗜伊红物质,未见角化物。间质中可见数量不等的纤维结缔组织穿插于肿瘤细胞间。PAS（＋＋）．Foot瘤细胞无嗜银纤维。免疫织化,keratin（＋＋）,EMA（＋＋）,vimentin（＋＋）。病理诊断：右手掌皮肤透明细胞汗腺瘤。讨论透明…     

Clear cell odontogenic tumor in the mandible: Report of a case with an immunohistochemical study of epithelial cell markers

A ram case of clear cell dontogenic tumor Is presented with an immunohistochemical study using epithelial cell markem. A 35-year-old Japanese man was admitted with a complaint of painless swelling In the anterior region of his mandible. Radiological examination showed a relatively well-defined multilocular radloiucency with root resorption of the adjacent teeth. Despite a subtotal mandlbulectomy, the tumor recurred thm times. Histologically, the tumor was composed of proiiferating clear cells and Infiltrated through the cancellous bone. Histochemical and ultrastruc-tural analyses detected cytoplasmic glycogen granules in the clear cells. They showed immunoreaetivities for cytokeratin 8,13 and 19, fllaggrin and anti-ameloblastoma antibodb, suggesting an odontogenic epithelial origin.     

Clear cell dermatofibroma

This series presents six cases of a rare variant of dermatofibroma, characterized by marked clear cell change. All lesions occurred on the lower extremities of middle-aged adults (four women, two men), mostly with the clinical diagnosis of fibrohistiocytic lesion. Histological examination revealed well circumscribed, faintly stained dermal to subcutaneous lesions which were due to the overwhelming presence of clear cells (<90%), some with prominent PAS-positive cytoplasmic granulation. Overlying epidermal hyperplasia as well as storiform arrangement of spindle cells, sclerotic collagen and some interspersed lympho-histiocytic infiltrate at the periphery of the lesion indicated the fibrohistiocytic origin. Individual histopathological peculiarities included : bizarre giant cells in two cases, prominent perivascular lympho-histiocytic response, perifollicular arrangement and haemangiopericytoma-like features with iron deposition in one case each. Immunohistochemically three of four lesions showed moderate reactivity for factor XIIIa and two of four with an anti-metallothionen marker E9, but were otherwise negative with a broad panel of markers. Electronmicroscopy in two cases revealed large pools of glycogen beside focal, prominent endoplasmic reticulum and lysosomes in some granular cells, but only optically translucent cells in cases of clear cells. Recognition of clear cell dermatofibroma is important as the differential diagnosis includes some entities with more serious outcome/considerations such as metastases of renal cell carcinoma, xanthogranulomatous reactions, balloon cell naevus/melanoma and clear cell sarcoma.     

Clear cell dermatofibroma

This series presents six cases of a rare variant of dermatofibroma, characterized by marked clear cell change. All lesions occurred on the lower extremities of middle-aged adults (four women, two men), mostly with the clinical diagnosis of fibrohistiocytic lesion. Histological examination revealed well circumscribed, faintly stained dermal to subcutaneous lesions which were due to the overwhelming presence of clear cells (<90%), some with prominent PAS-positive cytoplasmic granulation. Overlying epidermal hyperplasia as well as storiform arrangement of spindle cells, sclerotic collagen and some interspersed lympho-histiocytic infiltrate at the periphery of the lesion indicated the fibrohistiocytic origin. Individual histopathological peculiarities included : bizarre giant cells in two cases, prominent perivascular lympho-histiocytic response, perifollicular arrangement and haemangiopericytoma-like features with iron deposition in one case each. Immunohistochemically three of four lesions showed moderate reactivity for factor XIIIa and two of four with an anti-metallothionen marker E9, but were otherwise negative with a broad panel of markers. Electronmicroscopy in two cases revealed large pools of glycogen beside focal, prominent endoplasmic reticulum and lysosomes in some granular cells, but only optically translucent cells in cases of clear cells. Recognition of clear cell dermatofibroma is important as the differential diagnosis includes some entities with more serious outcome/considerations such as metastases of renal cell carcinoma, xanthogranulomatous reactions, balloon cell naevus/melanoma and clear cell sarcoma.     

透明细胞肉瘤临床病理分析

目的探讨透明细胞肉瘤（clear cell sarcoma,CCS）的临床病理特点及诊断与鉴别诊断。方法对9例CCS进行临床病理分析,并行组织学、免疫组化染色和电镜观察。结果9例CCS患者年龄19～62岁,平均38．6岁;肿瘤多数位于肢体末端（6／9）。组织学观察：肿瘤由被纤维组织分隔成巢或束状的胞质透亮或淡伊红染的上皮样细胞和梭形细胞构成,核圆形或卵圆形,较空淡,可见明显核仁。1例见少数多核巨细胞,1例胞质内含色素颗粒,2例间质黏液样变性,1例局部侵及表皮。术后随访6—24个月,6例中2例局部复发伴转移。免疫组化观察：9例CCS均表达vimentin和HMB-45,7／9例S-100蛋白阳性,5／9例NSE阳性,4／9例melan-A阳性,1／9例Syn阳性。电镜观察：胞质内可见不同时期的黑色素小体。结论CCS是好发年轻人肢体末端的软组织肉瘤,预后不良,属高度恶性。诊断应结合临床与病理形态,免疫组化在诊断和鉴别诊断中起重要作用。     

Primary hepatic clear cell myomelanocytic tumor. Case report and review of the literature

A case of hepatic clear cell myomelanocytic tumor in a 31-year-old woman presenting clinically with abdominal pain is reported. Histopathologic examination showed a lesion characterized by a population of large epithelioid cells with clear or eosinophilic granular cytoplasm, rich in glycogen. Immunohistochemically, the tumor cells were positive for HMB-45, Melan-A and muscle-specific actin, but negative for epithelial markers, desmin, S-100 protein, and neuroendocrine markers. Ultrastructurally, the tumor cells had abundant glycogen, well-developed rough endoplasmic reticulum, microtubules and aberrant melanosomes. Clinical and pathologic features with a brief review of the relevant literature for hepatic CCMMT as a variant of perivascular epithelioid cell tumor (PEComa) are discussed.     

Clear cell basal cell carcinoma

We describe a case of clear cell basal cell carcinoma of the superficial type, presenting as a crusted eruption on the abdomen. Histological examination showed a solid proliferation of clear cells attached to the under-surface of an atrophied epidermis. In addition, distinct pagetoid infiltration was seen within the overlying epidermis. A focal connection between the clear cell portion and a deeper lying nodular basal cell carcinoma was demonstrated, elucidating the true nature of the lesion. Immunohistochemical studies and electronmicroscopy confirmed the epithelial derivation of the tumour. The clear cell appearance was due to multiple cytoplasmic electronlucent vacuoles which were not surrounded by membranes.     

Ultrastructural Study of a Clear Cell Chondrosarcoma

A lesion in the left humeral head of a 15-year-old Japanese boy was light-microscopically diagnosed as clear cell chondrosarcoma. Fresh tissues from the lesion were studied ultrastructurally. In most tumor cells, that is, clear cells, paucity of organelles, sparse free ribosomes, and low protein content in cytosol were most striking. Tumor cells had many microvilli characteristic of cartilage cells. Among scanty organelles, vesicles or cisternae of dilated rough endoplasmic reticulum were rather conspicuous, and well-developed Golgi complexes were sparse. Intercellular matrix was scanty. These results suggest that intercellular matrix substance may be synthesized substantially by rough endoplasmic reticulum, whereas the synthesized substance perhaps cannot be transported smoothly into extracellular spaces because of scanty well-developed Golgi complexes.     

带血管蒂肝圆韧带瓣转位修复胆管缺损的应用解剖

观察30例成人肝圆韧带标本,肝圆韧带呈纤维条索样,内含少许不规则残腔。肝圆韧带的血液供养主要来自肝右动脉的分支及伴行的附脐静脉。由于肝圆韧带近端紧邻胆管,远端易于游离,提出了带血管蒂的肝圆韧带瓣作为自体生物材料来修复肝外胆管的缺损,并讨论了该术式有关的应用解剖要点。     

Clear cell carcinoma of minor salivary glands

Two cases of carcinoma of the minor salivary glands are presented in which most cells had clear cytoplasm. Both patients had clinical histories in excess of 10 years and, in the one case with adequate follow-up, no recurrence had occurred after a further 11 years. Both tumours were locally invasive. The clear cells contained small amounts of glycogen, but no intracytoplasmic mucin. Immunohistochemical and ultrastructural studies showed epithelial features, with no evidence of myoepithelial differentiation. These tumours were very similar to the small number of previously reported cases, which were all considered to be low-grade carcinomas. Amongst the differential diagnoses, the most important is metastatic clear cell carcinoma of the kidney and this can only be confidently excluded clinically or by the use of imaging techniques. In summary, we consider intraoral clear cell carcinoma to be a distinct tumour of low malignant potential.