胰腺浆液性微囊性腺瘤临床病理学观察

目的 探讨胰腺浆液性微囊性腺瘤(serous microcystic adenoma,SMA)的临床与病理学特点.方法 对12例SMA进行临床病理、特殊染色及免疫组化观察并随访.结果 ①临床:12例SMA中,男3例、女9例,35～70岁,平均51.5岁;7例因体检发现,5例因上腹不适或疼痛就诊;肿瘤直径2.0～13 cm,平均6.0 cm,切面均呈蜂窝状,囊内含清亮液体或灰红色液体.②镜下:瘤组织由多量小囊腔构成,囊壁内衬单层立方或扁平上皮,胞浆透亮,富含糖原,部分嗜酸,核小而圆,深染,大小一致,无明显异型性,核分裂像极少或无.③特殊染色:瘤细胞PAS(+),AB-PAS(-).④免疫组化:AEl/AE3及EMA(+),CEA、Vimentin、CgA、Syn、CD34、P53及S-100均(-).10例病人随访12～71个月,均未见复发.结论 SMA为胰腺罕见的肿瘤,临床上多无明显症状,依据其特有的病理组织学形态及免疫组化染色可明确诊断.其具体生物学行为有待进一步研究.     

胰腺浆液性微囊性腺瘤临床病理学观察

目的 探讨胰腺浆液性微囊性腺瘤(serous microcystic adenoma,SMA)的临床与病理学特点.方法 对12例SMA进行临床病理、特殊染色及免疫组化观察并随访.结果 ①临床:12例SMA中,男3例、女9例,35～70岁,平均51.5岁;7例因体检发现,5例因上腹不适或疼痛就诊;肿瘤直径2.0～13 cm,平均6.0 cm,切面均呈蜂窝状,囊内含清亮液体或灰红色液体.②镜下:瘤组织由多量小囊腔构成,囊壁内衬单层立方或扁平上皮,胞浆透亮,富含糖原,部分嗜酸,核小而圆,深染,大小一致,无明显异型性,核分裂像极少或无.③特殊染色:瘤细胞PAS(+),AB-PAS(-).④免疫组化:AEl/AE3及EMA(+),CEA、Vimentin、CgA、Syn、CD34、P53及S-100均(-).10例病人随访12～71个月,均未见复发.结论 SMA为胰腺罕见的肿瘤,临床上多无明显症状,依据其特有的病理组织学形态及免疫组化染色可明确诊断.其具体生物学行为有待进一步研究.     

胰腺浆液性微囊性腺瘤临床病理学观察

目的 探讨胰腺浆液性微囊性腺瘤(serous microcystic adenoma,SMA)的临床与病理学特点.方法 对12例SMA进行临床病理、特殊染色及免疫组化观察并随访.结果 ①临床:12例SMA中,男3例、女9例,35～70岁,平均51.5岁;7例因体检发现,5例因上腹不适或疼痛就诊;肿瘤直径2.0～13 cm,平均6.0 cm,切面均呈蜂窝状,囊内含清亮液体或灰红色液体.②镜下:瘤组织由多量小囊腔构成,囊壁内衬单层立方或扁平上皮,胞浆透亮,富含糖原,部分嗜酸,核小而圆,深染,大小一致,无明显异型性,核分裂像极少或无.③特殊染色:瘤细胞PAS(+),AB-PAS(-).④免疫组化:AEl/AE3及EMA(+),CEA、Vimentin、CgA、Syn、CD34、P53及S-100均(-).10例病人随访12～71个月,均未见复发.结论 SMA为胰腺罕见的肿瘤,临床上多无明显症状,依据其特有的病理组织学形态及免疫组化染色可明确诊断.其具体生物学行为有待进一步研究.     

胰腺浆液性微囊性腺瘤临床病理分析

目的 探讨胰腺浆液性微囊性腺瘤的临床病理特征及其诊断与鉴别诊断.方法 对7例胰腺浆液性微囊性腺瘤病例的临床资料、病理形态、免疫组化进行分析.结果 7例患者均为女性,平均年龄51岁,有临床症状者2例(28.6％).镜下肿瘤主要由大小不等的囊腔组成,囊壁衬覆单层立方上皮,细胞胞质透明并富含糖原.上皮细胞核小而圆,居中,无核仁,无核分裂象.部分囊腔之间可见粗大的纤维组织分隔.免疫组化上皮细胞AE1/AE3、CK7、CK8、CK19、CK/LMW、EMA(+);CEA、CD31、CD34、D2-40、Syn、CgA、Calretinin、Vim(一).结论 胰腺浆液性微囊性腺瘤是一种较为少见的良性肿瘤,老年女性好发,预后好,确诊主要靠术后病理组织学和免疫组化.     

肾脏黏液样小管状和梭形细胞癌4例临床病理分析

为了进一步探讨肾脏黏液样小管状和梭形细胞癌(mucinous tubular and spindle cell carcinoma, MTSCC)的临床病理学特征、诊断及鉴别诊断。回顾性分析4例肾脏MTSCC临床资料、病理学特征、诊断及鉴别诊断、治疗及预后,并复习相关文献。4例患者中,女3例,男1例。平均发病年龄54岁。1例发生于左肾,3例发生于右肾,肿瘤最大径2.5～7 cm。镜下组织学特点为紧密排列的、小而狭长的小管和乳头构成,小管间为淡染黏液样结构,形态似平滑肌瘤或肉瘤,黏液样间质染色为酸性黏液,乳头表面被覆形态温和的立方上皮。免疫表型:广谱CK、CK(AE1/AE3)、vimentin、LCK、CK7、CK19、CK18、EMA、P504S、Ki67均阳性。特殊染色:黏液性基质AB/PAS染色为阳性。MTSCC是一种非常少见的肾脏恶性肿瘤,为低度恶性,大多数预后较好,少部分瘤体可发生转移和复发,预后较差,治疗主要以手术切除为主。     

低度恶性潜能多房性囊性肾肿瘤的临床病理分析

目的:探讨低度恶性潜能多房性囊性肾肿瘤的临床病理特点及与其他囊性肾疾病的诊断和鉴别。方法:收集21例低度恶性潜能多房性囊性肾肿瘤患者的临床及病理资料,对其行组织形态学观察和免疫组织化学分析。结果:患者男14例,女7例;年龄22~61岁,平均43岁。13例常规体检发现,其余8例因腰部不适或血尿入院。大体检查:肿瘤直径1.5~4.2cm,界限清楚。切面呈多房囊性或蜂窝状,囊内含清亮浆液性或凝胶状液体。显微镜下囊壁衬覆单层胞浆透亮的肿瘤细胞,细胞核小,未见核仁,WHO/ISUP核分级1级17例,2级4例;衬覆细胞偶可见呈多层,或形成囊内小乳头。囊壁由薄层纤维组织构成,3例伴钙化。囊壁间可见呈簇或小巢状分布的肿瘤细胞。免疫组化显示:肿瘤细胞PAX8和CAⅨ呈强阳性,CK、CK7、上皮膜抗原(EMA)和波形蛋白(Vimentin)部分阳性,而CD10阳性仅3例。7例行根治性肾切除术,14例行肾部分切除术。19例术后获随访,随访时间7~216个月,均未见复发和转移。结论:低度恶性潜能多房性囊性肾肿瘤是2016版WHO泌尿系统和男性生殖系统肿瘤分类新更名的一个肾肿瘤,其WHO/ISUP核分级低、低TNM临床分期,预后极好,诊断时需严格把握标准。临床上需依据肿瘤部位、大小以及有无突破肾包膜等决定手术方式。     

无功能性胰腺神经内分泌肿瘤临床病理分析

目的：探讨无功能性胰腺内分泌肿瘤的临床病理学特征、免疫表型及预后。方法：对9例无功能性胰腺内分泌肿瘤的临床病理学资料进行分析。结果：肿块直径1.8～7.0cm,平均（4.5±1.1）cm。大部分肿块有厚薄不均匀的纤维包膜,部分肿瘤组织与胰腺有相互移行及穿插生长,1例包膜血管内见瘤栓。5例核分裂相达到2～6个/10HP。PAS染色、AACT、Vimentin、Ins均阴性,NSE、CK均阳性,8例Syn、CgA阳性。术后随访复发2例。结论：无功能性胰腺内分泌肿瘤患者由于没有明显的临床症状,发现较晚。治疗首选手术切除,预后判断必须综合考虑肿瘤直径、核分裂相、有无坏死、有无包膜血管神经侵犯、Ki-67阳性表达率等多个指标。     

阴囊、阴茎Paget病临床病理分析

目的:探讨阴囊、阴茎Paget病的临床病理特点、诊断及鉴别诊断依据。方法:复习13例阴囊、阴茎Paget病的临床病理资料,采用HE染色、特殊染色(AB/PAS)及免疫组化技术进行观察分析。结果:阴囊、阴茎Paget病以老年男性多见,发病年龄55～84岁,中位年龄为71岁。肉眼皮损呈湿疹样改变。光镜下表皮内可见数目不等的Paget细胞呈单个散在、巢状或条索状分布。所有病例AB/PAS染色均阳性;13例均表达CK7、CEA、EMA抗原,不表达CK5/6、S-100及P63,GCDFP-15与CK20阳性表达率分别为76.92%(10/13)和53.85%(7/13)。结论:阴囊、阴茎Paget病为低度恶性的皮肤上皮性肿瘤,有特殊的临床及组织病理学特点,免疫组化标记有助于该肿瘤的诊断。     

肾黏液样小管状和梭形细胞癌临床病理观察(附3例报告)

目的:探讨肾黏液样小管状和梭形细胞癌(MTSCC)的临床病理学特点、诊断、鉴别诊断、治疗方法及预后。方法:对3例MTSCC进行HE和免疫组化、特殊染色,并复习相关文献,分析患者的临床、病理特点。结果:3例中女2例,男1例,发病年龄48~62岁,平均年龄56.3岁,均伴临床症状。肿瘤边界清楚,可见局部坏死,1例合并肾盂输尿管重复畸形。镜下肿瘤由紧密排列的小管构成,细胞异型性小,小管间为淡染黏液样间质,并见梭形细胞区。黏液样基质Alcian blue染色+。上皮样细胞EMA+,AE1/AE3+,Vimentin+,CK7+,CK19+,EMA+,AMACR+,CD10-,S-100-,SMA-,HMB45-,Ki-675%。行肾癌根治术,术后恢复良好,未行辅助治疗,随访2~7年未见肿瘤复发和转移。结论:MTSCC是一类低度恶性的肾上皮性肿瘤,组织形态温和,合并发育畸形者罕见。肿瘤边界清楚,可有假包膜,可发生坏死。预后较好,可长期存活。少数病例发生局部复发或淋巴结转移。正确诊断和避免过度诊断、过度治疗非常重要,早期手术是其首选的治疗方法。     

胰腺假乳头实体上皮瘤的诊断和治疗

目的　探讨胰腺假乳头实体上皮瘤的诊断和治疗方法。方法　回顾性分析我院自1994年6月至2 0 0 3年6月收治的2 1例胰腺假乳头实体上皮瘤患者的临床资料。结果　本组中13例以腹痛为主要表现,7例可扪及腹块。影像学检查未能明确诊断。12例肿瘤位于胰头,9例位于胰体尾部。肿瘤平均直径9 5 (3～2 0 )cm。1例合并肝转移。12例胰头肿瘤中4例行胰十二指肠切除术,8例行肿块切除术;9例胰体尾部肿瘤均行胰腺体尾部加脾切除术。14例术中冰冻病理诊断明确,另有3例免疫组化染色结果报告为胰岛素瘤或其他恶性肿瘤,最终由病理切片及免疫组化染色结果明确诊断。免疫组化染色报告15例NSE染色中14例阳性,10例Vimentin染色中8例阳性,8例PAS染色中7例阳性,细胞角蛋白、上皮膜抗原及嗜铬颗粒素A均阴性。18例获随访,中位随访时间2 4 (1～6 0 )个月,均无瘤存活。结论　对年轻女性出现的胰腺巨大肿瘤应高度怀疑胰腺假乳头实体上皮瘤。积极的手术治疗能获得良好的预后。     

Pancreatic microcystic adenoma coexistent with pancreatic ductal carcinoma. A report of two cases

We report two cases of microcystic (glycogen-rich) adenoma of the pancreas with coexistent pancreatic adenocarcinoma. Both patients presented with an epigastric mass. On laparotomy, each had two separate pancreatic tumors. The benign tumors were composed of small cysts with a flattened to cuboidal glycogen-rich epithelium. Both malignant tumors were composed of mucinous epithelium and showed positive staining for CEA and Leu-M1. Although pancreatic microcystic adenoma and ductal adenocarcinoma are believed to arise from different precursor cells, the association reported here suggests a common predisposition to both tumors. Careful examination of the pancreas is warranted in cases of microcystic adenoma to rule out a possible coexistent pancreatic carcinoma.     

Microcystic adenoma (serous cystadenoma) of the pancreas. A study of 14 cases with immunohistochemical and electron-microscopic correlation

Microcystic adenoma (serous cystadenoma) of the pancreas (MA) is an unusual benign tumor of uncertain histogenesis. We have studied 14 cases of MA from 11 women and three men. The average age at diagnosis was 64 years. Six tumors were discovered incidentally. Tumors varied from 2.5 to 12 cm in greatest dimension and all were multicystic; eight tumors were located in the pancreatic head, two in the body, and three in the tail. Each tumor was composed of variably sized cysts lined by simple cuboidal or flattened, focally glycogen-rich epithelium. The stroma was variably collagenized and showed highly vascularized, delicate to broad fibrous septae, which focally contained dystrophic calcification, cholesterol clefts, and hemosiderin. Immunohistochemical studies were performed on eight cases to determine the cell of origin. Epithelial membrane antigen and a low-molecular-weight keratin, detected by monoclonal antibodies PKK1 or AE1/AE3, were diffusely seen in tumor cells of all cases. Tumor cells were uniformly negative for carcinoembryonic antigen, chromogranin, insulin, glucagon, somatostatin, vasoactive intestinal peptide, pancreatic polypeptide, and a low-molecular-weight keratin detected by monoclonal antibody PKK2. Tumor cell antigen reactivity most resembled that seen in normal centroacinar and ductal cells. Electron microscopy of seven cases showed primitive tumor cells with irregularly spaced, short, blunt microvilli, luminal occluding junctions and belt desmosomes, bundles of filaments including dense bodies in both apical and basal cell cytoplasm, sparse organelles, and variable but often pronounced amounts of glycogen. These ultrastructural features most closely resembled the normal pancreatic centroacinar cell. Based on both immunohistochemical and ultrastructural features described above, we conclude that the centroacinar cell is the cell of origin of MA.     

后肾腺瘤临床及病理特点分析（附1例报告并文献复习）

目的：探讨后肾腺瘤的临床及病理特点。方法：报告1例后肾腺瘤患者的临床及病理资料．并复习相关文献予以讨论。结果：患者行根治性右肾切除术。镜下见肿瘤细胞大小一致．呈腺样及小管状排列．胞质少．细胞无明显异型性,核分裂像少见;免疫组织化学染色：WT1Vimentin、CK、EMA均阳性．Syn、RCC、SMA、HMB15、CD10、CD34、CgA、Chr均阴性;病理学诊断符合后肾腺瘤特点。术后随访18个月．未她肿瘤复发和远处转移。结论：后肾腺瘤是一种罕见的来源于肾脏上皮组织的肿瘤．了解该肿瘤临床及病理特点有助于临床诊断及鉴别诊断。     

多种蛋白在肾上腺肿瘤组织中的表达及临床意义

目的 探讨多种蛋白:增殖细胞相关的核抗原(Ki67)、肿瘤抑制基因p53、细胞角蛋白(CKL)、上皮膜抗原(EMA)、酸性钙结合蛋白S-100、神经元特异性烯醇酶(NSE)、嗜铬素A(CgA)、突触素(syn)、癌胚抗原(CEA)和肿瘤转移抑制基因nm23在肾上腺肿瘤组织中的表达及临床意义.方法 应用单克隆抗体免疫组化技术链霉菌抗生物素蛋白-过氧化酶连接法(S-P法)检测163例肾上腺肿瘤组织中多种蛋白的表达,并收集患者的一般资料,包括患者年龄、临床症状、检验结果、病理类型等,进行统计学处理.所有资料应用SAS 6.12软件分析处理,以P＜0.05作为检验标准. 结果 CKL、S-100,NSE、CgA、Syn、nm23在肿瘤组织中表达明显升高(P＜0.05).S-100、CgA、Syn表达与病理类型显著相关(P＜0.05),3种蛋白表达两两互呈正相关性(P＜0.01).CKL,S-100、NSE、CgA、Syu、nm23在肾上腺良恶性肿瘤中的表达无差异(P＜0.05),但明显高于正常肾上腺组织(P＜0.05).Syn在肾上腺皮质腺瘤中的表达明显高于皮质腺癌(P＜0.05),Ki67在肾上腺皮质腺瘤中的表达明显低于皮质腺癌(P＜0.05).EMA、CKL在肾上腺皮质肿瘤中的表达明显高于髓质肿瘤(P＜0.05),S-100、Syn、NSE、CgA在肾上腺皮质肿瘤中的表达明显低于髓质肿瘤(P＜0.05). 结论 CKL、S-100、NSE、CgA、Syn、nm23这6种蛋白为肾上腺肿瘤的良好标志物,可用于肾上腺肿瘤的定性诊断.联合检测Syn和Ki-67对肾上腺皮质肿瘤的鉴别诊断有重要的参考价值.联合检测EMA、CKL、S-100、Syn、NSE及CgA并紧密结合临床则有助于皮髓质肿瘤的鉴别.     

Cystic adenomatoid tumor of the mediastinum

A case of adenomatoid tumor presenting as a mass in the anterior mediastinum is described. The patient was a 56-year-old woman with left side chest wall pain who showed a mediastinal mass on chest x-ray and CT scans. Thorough clinical and radiographic examination did not reveal any evidence of tumor elsewhere. At surgery, the tumor was found adjacent to the anterior pericardial reflection. Grossly, the tumor measured 5.5 x 5.5 x 3 cm and showed a homogeneous cut surface with numerous cystic structures that varied from 0.5 to 1.5 cm in greatest diameter. Histologic examination showed numerous cystic spaces lined by flattened or cuboidal epithelial cells. The walls of the cysts showed a proliferation of small canalicular structures lined by round to polygonal epithelioid cells with vacuolated eosinophilic cytoplasm. Immunohistochemical studies showed strong positivity of the epithelioid cells for AE1/AE3 cytokeratin, CK5/CK6, and calretinin. Stains for CK7, CK20, alpha-fetoprotein, CD31, carcinoembryonic antigen, MOC 31, and chromogranin were negative. Electron microscopic examination showed numerous long microvilli on the cell surface and abundant tonofilaments/desmosomal plaques in the tumor cells, characteristic of mesothelial cells. The patient is alive and well and free of recurrence 1 year following surgery. Adenomatoid tumor is a rare neoplasm that should be added in the differential diagnosis of anterior mediastinal masses. Immunohistochemical and ultrastructural studies may be of aid in identifying the characteristic features of mesothelial cells and to avoid mistaking this lesion for more ominous conditions.     

Macrocystic serous cystadenoma of the pancreas

We report a 47-year-old woman with macrocystic serous cystadenoma of the pancreas. She had no past history of abdominal surgery, instrumentation, or trauma. Ultrasonography and computed tomography revealed a unilocular cyst in the body of the pancreas. On magnetic resonance imaging, the cyst showed heterogeneous signal intensity on T1-weighted images, and was homogeneously hyperintense and oligolocular is on T2-weighted images. A preoperative diagnosis of mucinous cystic neoplasm of the pancreas was made, and distal pancreatectomy was performed. The resected oligolocular cyst was 5.0 × 4.5 × 3.0 cm and was lined with a single layer of cuboidal epithelium similar to that seen in microcystic serous cystadenomas. Abundant glycogen was demonstrated within the epithelial cells, as assessed by periodic acid-Schiff (PAS) staining with and without diastase digestion. The cyst exhibited a gross appearance distinct from that of typical microcystic adenomas, resulting in diagnostic difficulties for the radiologists and surgeon involved in the patient's care. Received for publication on May 20, 1999; accepted on Sept. 1, 1999     

双侧后肾腺瘤报告并文献复习

目的:探讨后肾腺瘤(MA)的临床病例特征,提高对MA的认识。方法:观察1例MA的病理组织学表现,结合临床资料及相关文献进行分析。结果:肿瘤细胞丰富,排列密集,形态一致的单层立方上皮的小管结构。免疫组化:WT1(+),CD57散在(+),Vim散在少许(+),PCK、EMA、CK7、CD10、CD117均(-),Ki67LI:1%左右。结论:MA多为单侧,双侧少见,缺乏临床特异性及影像学诊断,术前诊断较困难,难以和恶性病变相鉴别,需术前穿刺活检或术中快速冷冻病理诊断,避免肾脏全部切除。术后需注意长期随访。