恶性黑色素瘤组织学变异型与鉴别诊断

目的研究恶黑的临床病理特点、组织学变异型及鉴别诊断。方法应用HE染色、免疫组化标记对130例恶黑形态学进行观察、分析临床资料，并划分组织学变异型。结果根据病理形态学发现及免疫组化标记，130例恶黑组织学变异被分为上皮样型、肉瘤样型、癌肉瘤样型、促结缔组织增生型、小细胞型、血管周细胞样型、假腺样型、浆细胞样型、横纹肌样型、巨细胞样型、印戒细胞型、透明细胞型、气球样细胞型及炎性MFH样型。结论恶黑的组织病理结构和形态变异复杂，细胞类型多，少色素、无色素及核仁模糊占大多数，有不同的病理类型，有时诊断很困难，应特别注意与多种类型肿瘤相鉴别。     

肺原发性大细胞癌及肉瘤样癌的病理特征和鉴别诊断

2004年出版的WHO肺肿瘤组织学分类（第4版）将肺癌分为鳞状细胞癌，小细胞癌、腺癌、大细胞癌、腺鳞癌、肉瘤样癌，类癌和唾液腺型肿瘤8个主要类型，其中肺大细胞癌及肉瘤样癌同属于发生于肺的低分化或未分化癌，有多种形态学表现，根据病理形态学特征，肺大细胞癌及肉瘤样癌又分为数个亚型，可能造成诊断上的混淆。     

一例Lp免疫细胞瘤的细胞学免疫荧光双标记研究

以前,对一组由淋巴细胞、淋巴样细胞、浆细胞样细胞及母细胞(包括淋巴母细胞及免疫母细胞)等多种细胞构成并伴有或不伴巨球蛋白血症的恶性淋巴瘤认识不足,1975年Lennert等将这组淋巴瘤称为淋巴浆细胞/浆细胞样淋巴细胞恶性淋巴瘤(即LpImmunocytoma)。并分为三个亚型:1.淋巴浆细胞型、2.浆细胞样淋巴细胞型、3.多形性型。最近又根据产生M蛋白的类型分     

子宫颈微偏腺癌6例临床病理分析

目的探讨子宫颈微偏腺癌的形态学、组织化学及免疫表型特征。方法对6例子宫颈微偏腺癌组织学特征进行观察,并行黏液组化及免疫组化染色（S-P法）。结果6例均有子宫颈腺体显著增生,腺体腔缘面呈花边状、锯齿状或乳头状突入到腺管腔内,并有成角状外翻,腺体呈浸润性生长。黏液组织化学：AB（pH1．0、2．5）／PAS染色证实,腺体腔内为混合性黏液,主要含唾液酸黏液,硫酸黏液减少,中性黏液较多。免疫表型：CEA（5／6）阳性,CA125（6／6）阴性。vimentin、SMA浸润性腺体周围纤维母细胞／肌纤维母细胞（6／6）阳性。结论子宫颈微偏腺癌以其特殊的形态结构和细胞轻微的异型、AB／PAS阳性、CEA阳性及腺体周围反应性纤维母细胞／肌纤维母细胞增生为特征。     

丛状纤维组织细胞瘤3例临床病理观察

目的 探讨丛状纤维组织细胞瘤临床病理特点及鉴别诊断要点.方法 对3例丛状纤维组织细胞瘤进行临床资料及光镜和免疫组化标记观察.结果 组织学特点:纤维结缔组织把肿瘤细胞分隔成丛状或结节状.结节则由单核或多核组织细胞样细胞构成,结节外周围绕短梭形的纤维母/肌纤维母细胞样细胞.部分结节则主要由纤维母细胞样细胞组成,不见多核巨细胞.免疫组化染色显示:单核或多核组织细胞样细胞表达CD68、α-ACT和溶菌酶,梭形细胞表达Vim和SMA.结论 丛状纤维组织细胞瘤是一种低度恶性的软组织肿瘤,其诊断主要依靠组织病理学和免疫组化标记.     

伴有肌样/肌纤维母细胞性分化的隆突性皮纤维肉瘤的临床病理分析

目的 探讨隆突性皮纤维肉瘤（ＤＦＳＰ）中肌样／肌纤维母细胞性分化的本质及其临床病理学意义。方法 采用常规ＨＥ切片对１２４例ＤＦＳＰ进行筛选,对6例伴有肌样／肌纤维母细胞性分化的ＤＦＳＰ病例进行免疫组织化学标记,其中２例加做电镜检测。结果 肌样／肌纤维母细胞性分化多出现在纤维肉瘤型ＤＦＳＰ（ＦＳ－ＤＦＳＰ）中,表现为肿瘤周边部或肿瘤内散在性分布的深嗜伊红色小结节或短要束,由梭形细胞组成,细胞多无异型性,核分裂象也罕见,形态上似平滑肌细胞或肌纤维母细胞。免疫组织化学标记显示肌样区域细胞表达α－平滑肌肌动蛋白和肌物质特异性肌动抗原,不表达ＣＤ３４;电镜观察证实细胞含有质膜下微丝束、局灶性致密体及微胸饮囊泡样结构,与肌纤维母细胞相一致,结论 ＤＦＳＰ中的肌样／肌纤维母细胞性分化可能是间质中肌纤维母细胞增生的结果,并非代表了瘤细胞的真性肌纤维母细胞性分化。     

原发淋巴结边缘区淋巴瘤临床病理分析

目的：研究淋巴结MZL形态特征、诊断要点和鉴别诊断，为临床治疗和预后提供依据，方法：采用常规制片、免疫组化ABC法标记，光镜观察。结果：10例淋巴结MZL男性6例，女性4例，以淋巴结缓慢增大为特征，而无肝脾肿大，外周血未见异常。病理形态分为：边缘区增生型2例，结节型4例，弥漫型2例和母细胞样型2型。细胞类型：CCL细胞型5例，MBC型6例，淋巴浆细胞型2例，母细胞样型2例，10例均经免疫组化证实。结论：淋巴结MZL与MALT型淋巴瘤形态、免疫表型和起源相似。由于淋巴结组织结构特点，MZL有特殊性。     

肌样型隆突性皮肤纤维肉瘤中肌样区域的组织发生和性质

目的探讨肌样型隆突性皮肤纤维肉瘤(DFSP)中肌样区域的组织发生和性质。方法对95例DFSP中筛选出的15例肌样型DFSP进行光镜和免疫组织化学研究。结果临床资料显示女性比男性稍多见(1．5：1)。18～40岁为发病高峰年龄段(73％)。肿瘤部位常见于躯干和肢体(11／15)。镜检：在15例肌样型DFSP中(9例为纤维肉瘤型，最为常见；4例为经典型；2例为色素型，后者伴有肌样区域未见文献报道)均观察到散在分布的肌样结节和肌样束，即肌样区域，且与瘤内血管壁平滑肌细胞增生有密切的关系，并发现血管壁改变具有不同程期的特点。早期：瘤内小血管和少许较大血管壁平滑肌细胞显著增生，细胞无异型性，可见核分裂象；中期：增生的平滑肌细胞形成特征性的嗜伊红性肌样结节和肌样束，可伴轻度玻璃样变，在大多数肌样结节和肌样束中常可见偏位、不规则、变小变窄的血管腔；后期：肌样结节和肌样束可相互融合，血管腔萎陷或消失，伴有广泛玻璃样变甚至钙化。免疫表型：肌样结节和肌样束呈SMA、MSA、Vim弥漫强阳性，但对Des、smooth muscle myosin、caldesmon和CD34均呈阴性。需特别指出的是肌样结节和肌样束中偏位的血管腔衬覆的内皮细胞呈CD34阳性，证实了肌样区域与血管壁的密切关系。结论肌样型DFSP是DFSP的一种少见的组织学亚型。组织发生是来源于瘤内血管壁增生的平滑肌细胞，性质属非肿瘤性成分，而不是来源于瘤内肿瘤细胞向肌纤维母细胞分化或反应性肌纤维母细胞增生，但在特殊的条件下血管壁增生的平滑肌细胞可以转化为肌纤维母细胞。     

涎腺腺泡细胞癌7例细胞学特点

目的分析涎腺腺泡细胞癌(acinic cell carcinoma,AciC C)细针穿刺的细胞学特点,探讨细针穿刺对涎腺AciC C的诊断价值。方法回顾性分析7例细针穿刺涎腺AciC C的细胞形态学特点及临床资料。结果 7例涎腺AciC C涂片中均可见腺泡样细胞及透明细胞,其中3例癌细胞呈小梁状伴吻合,2例间质富于淋巴细胞浸润,1例间质有囊性变,1例间质伴胶原纤维的玻璃样变;细胞块切片实体型2例,微囊型5例。结论涎腺AciC C是腮腺的常见低度恶性肿瘤,联合检测细针穿刺涂片联合细胞块切片可作出准确诊断。     

15例涎腺肌上皮瘤临床病理学分析

目的探讨涎腺肌上皮瘤的临床病理学特点、诊断及鉴别诊断。方法对15例涎腺肌上皮瘤的临床特点、组织学形态、免疫表型进行观察,并结合文献复习。结果涎腺肌上皮瘤主要发生在腮腺、上腭处,瘤细胞呈梭形、浆细胞样、上皮样、透明细胞样,细胞无明显异型,呈岛、片、网状结构分布,瘤细胞间可见均质红染的玻璃样物或大量黏液成分,免疫表型:CK5/6、S-100、p63、SMA、calponin。结论涎腺肌上皮瘤是少见肿瘤,细胞类型多,排列方式以片状为主,很少见到管腔样结构,确诊主要依靠其细胞形态以及排列方式,需与肌上皮癌、多形性腺瘤等鉴别。     

Spindle cell tumors of the pleura: differential diagnosis

Spindle cell tumors that arise in or metastasize to the pleura must be thoroughly evaluated to arrive at a definitive diagnosis. Malignant mesothelioma is the most common tumor arising in the pleura, but metastatic tumors to the pleura occur more frequently. Additionally, many tumors arising in the lung and surrounding tissues involve the pleura. It is crucial to arrive at a correct diagnosis since many of these neoplasms show different prognoses and require varying treatment modalities. Sarcomatoid malignant mesothelioma is a rare tumor that arises in the pleura, and can be confused with numerous tumors arising in or metastasizing to the pleura, including synovial sarcoma, metastatic sarcomatoid carcinoma, metastatic melanoma, thymoma, renal cell carcinoma, localized fibrous tumor, leiomyosarcoma, and other types of sarcoma. Desmoplastic malignant mesothelioma is a fibrous sarcomatoid variant of malignant mesothelioma, and is occasionally mistaken for chronic fibrous pleurisy. Here, we review morphological, clinical, histological, immunohistochemical, ultrastructural, and molecular methods that aid in the diagnosis of spindle cell tumors of the pleura, and we provide specific examples of patients in which this multi-modal approach proved to be helpful.     

Mesotheliome mit leukozytärem Infiltrat

Malignant mesotheliomas are rare tumors which can affect pleura, peritoneum, pericardium, or tunica vaginalis testis. Histomorphologically, predominant epitheloid, sarcomatoid and biphasic types can be distinguished. In some cases, leucocytic infiltrations can be observed adjacent to the tumor. Here, mesotheliomas presenting inflammatory reactions to tumor growth have to be differentiated from occasional cases with parasynchronic development of neoplastic lymphatic diseases. Moreover, so called lymphohistiocytoid mesotheliomas, a sporadically observed variant of malignant mesotheliomas, have been reported to imitate inflammatory patterns. These different forms of malignant mesotheliomas are difficult to distinguish and may lead to diagnostic misinterpretations and consequently therapeutic mismanagement. The purpose of this study was to differentiate morphological and immunohistochemical characteristics of the above mentioned diagnoses. We therefore studied two rare cases, a mesothelioma with parallel lymphoma and a lymphohistiocytoid mesothelioma, and compared them to a third more common case of mesothelioma with inflammatory tissue-reaction.     

Molecular characterization of tumour heterogeneity and malignant mesothelioma cell differentiation by gene profiling

Malignant mesothelioma is an aggressive tumour, characterized by a variable differentiation pattern and poor prognosis. At present, the clinical outcome in patients with malignant mesothelioma is mainly predicted by the morphological phenotype of the tumour. However, this conventional clinicopathological parameter is of limited value, partly because of the biological heterogeneity of this tumour and poor understanding of the regulatory mechanisms underlying the various patterns of growth. To elucidate the intrinsic molecular programmes that determine tumour differentiation, oligonucleotide arrays were used in an in vitro model of mesothelioma differentiation. The analysis of 2059 genes detected 102 genes that were significantly deregulated. Clustering of these genes into functional categories showed distinctive patterns for the two phenotypes, namely epithelioid and sarcomatoid. The molecular fingerprint of the sarcomatoid tumour component indicates overrepresentation of growth factor receptors and growth factor binding proteins, whereas epithelioid mesothelioma cells express other tumour-promoting factors involved in differentiation, metabolism, and regulation of apoptosis. These differences in the molecular phenotype may give a better basis for diagnosis and for designing novel therapies.     

Use of p16 FISH for differential diagnosis of mesothelioma in smear preparations

Because most of malignant pleural mesothelioma (MPM) patients first present with pleural effusion, detection of mesothelioma cells on effusion smears is critical for early diagnosis. Recently, accumulating evidence indicating that the cytological diagnosis of MPM supported by ancillary techniques is as reliable as that based on histopathology has led to new guidelines for the cytopathologic diagnosis of MPM. Based on the guidelines, a combination of cytomorphological criteria and verification by ancillary techniques is required for the cytologic diagnosis of MPM. Detection of p16 homozygous deletion by fluorescence in situ hybridization (FISH) is the most reliable ancillary technique for differentiating MPM from reactive mesothelial cells (RMC) because of its relatively high sensitivity and extremely high specificity. We showed that the p16 deletion status of MPM cells in pleural effusions reflected that of the underlying invasive MPM tissues, indicating the usefulness of p16 FISH in effusion smear cytology for MPM diagnosis. Thus, for differentiating MPM from RMC, we propose to perform p16 FISH as often as possible. A positive p16 homozygous deletion supports the diagnosis of MPM. However, a negative result does not rule out the possibility of MPM. In such cases, a morphological assessment is critical. Therefore, we analyzed the morphological characteristics of p16 deletion‐positive mesothelioma cells using a combination of virtual microscopy and p16 FISH, and identified three morphological characteristics useful for the differentiation, including cell‐in‐cell engulfment with or without hump formation, multinucleate cells, and larger berry‐like cell aggregates. Diagn. Cytopathol. 2016;44:774–780. © 2016 Wiley Periodicals, Inc.     

Are oestrogens and genetic predisposition etiologic factors in the development of clear cell carcinoma of the peritoneum?

A literature search was carried out for clinical observations that could explain the possible aetiology of primary peritoneal clear cell carcinoma (CCC) including diagnostic dilemmas, various theories of origin, oestrogen dependence and genetic association. It was found to be an extremely rare tumour (CCC) arising in the peritoneum and is often misdiagnosed as mesothelioma or serous carcinoma or metastatic adenocarcinoma due to overlapping morphological features. The awareness of such dilemmas is important even before making a diagnosis. Clinicopathological features and immunohistochemical studies like WT1, CK20 and calretinin are usually helpful in differentiating CCC from serous carcinoma, metastatic carcinoma from bowel and mesothelioma. (CK7 is common to all epithelial tumours, CEA can be expressed in clear cell carcinoma, WT1 is normally expressed in serous carcinoma, calretinin is expressed in mesothelioma and CK20 in colon carcinoma). The distinction between the above tumours is important as correct diagnosis is required in initiating appropriate treatment.     

Primary Pleural Epithelioid Mesothelioma of Clear Cell Type: A Case Report and Review of Current Literature

Primary pleural epithelioid mesothelioma with clear cell morphology is a particularly rare neoplasm, with only a few documented cases. Here, the authors report a case of a 76-year-old man, with a history of asbestos exposure, admitted for mild dyspnea. Radiologic examination revealed right pleural effusion and pleural thickening. Cytological examination of aspirated pleural samples was consistent with non-small cell carcinoma. Histological examination of the resected, via VATS, plural specimens was consistent with the diagnosis of clear cell epithelioid mesothelioma. The authors further analyze the main morphological and immunohistochemical features of clear cell epithelioid mesothelioma, emphasizing the algorithm for excluding other clear cell tumors metastatic to the pleura.     

心包原发性恶性间皮瘤的临床病理分析

目的：探讨心包原发性恶性间皮瘤的临床病理特征。诊断与鉴别诊断要点。方法：对4例心包原发性恶性间皮瘤进行临床病理分析。光镜及免疫组化染色观察并复习有关文献。结果：男3例,女1例,平均年龄42岁,3例呈局限型,1例为弥漫浸润型。组织学上可表现为肉瘤样梭形细胞型,上皮样型及双相型,免疫组化染色显示肉瘤样梭形细胞表CK、vimentin;上皮样型瘤细胞表达HBME1、CK。结论：原发于心包的恶性间皮瘤罕见,预后极差。临床常被误诊,其组织形态亦复杂多样,应注意与心包的良性增生性病变,心包转移性腺癌和梭形细胞肿瘤等相鉴别。     

Primary pleural epithelioid mesothelioma of clear cell type: a case report and review of current literature

Primary pleural epithelioid mesothelioma with clear cell morphology is a particularly rare neoplasm, with only a few documented cases. Here, the authors report a case of a 76-year-old man, with a history of asbestos exposure, admitted for mild dyspnea. Radiologic examination revealed right pleural effusion and pleural thickening. Cytological examination of aspirated pleural samples was consistent with non-small cell carcinoma. Histological examination of the resected, via VATS, plural specimens was consistent with the diagnosis of clear cell epithelioid mesothelioma. The authors further analyze the main morphological and immunohistochemical features of clear cell epithelioid mesothelioma, emphasizing the algorithm for excluding other clear cell tumors metastatic to the pleura.     

Sarcomatous Type of Malignant Mesothelioma

Thirteen malignant mesotheliomas of a sarcomatous type were studied by light microscopy and ten were studied by electron microscopy. The histologic patterns varied from tumor to tumor, often resembling other soft tissue sarcomas. Electron microscopic observation showed most of the tumors to be composed of primitive cells. Despite their mesenchymal character, many tumors contained foci of rudimentary epithelial differentiation. It is concluded that both histologic types of malignant mesothelioma, the epithelial as well as the sarcomatous, originate from the same precursor cell at various points of its differentiation and reflect the range of maturation from the mesenchymal reserve cell to the epithelial mesothelial cell.     

Sarcomatous Type of Malignant Mesothelioma

Thirteen malignant mesotheliomas of a sarcomatous type were studied by light microscopy and ten were studied by electron microscopy. The histologic patterns varied from tumor to tumor, often resembling other soft tissue sarcomas. Electron microscopic observation showed most of the tumors to be composed of primitive cells. Despite their mesenchymal character, many tumors contained foci of rudimentary epithelial differentiation. It is concluded that both histologic types of malignant mesothelioma, the epithelial as well as the sarcomatous, originate from the same precursor cell at various points of its differentiation and reflect the range of maturation from the mesenchymal reserve cell to the epithelial mesothelial cell.