消化道小细胞癌的临床病理分析

目的 研究消化道小细胞癌临床病理和免疫表型特征。方法 对17例消化道小细胞癌作了临床病理形态学观察和免疫组织化学检测。结果光镜形态分为3型：小细胞型8例，中间细胞型4例，混合型5例。免疫表型：EMA12例、NSE10例、keratin9例、CgA6例、S-100蛋白3例呈阳性，vimentin均阴性。结论 EMA、NSE、keratin为小细胞癌的较为可靠的标记物，支持此瘤来源于内胚层全能干细胞。     

Myoepitheliomas and myoepithelial adenomas of salivary gland origin. Immunohistochemical evaluation of filament proteins, S-100 alpha and beta, glial fibrillary acidic proteins, neuron-specific enolase, and lactoferrin

Immunohistochemical identification of keratin proteins (TK, KL1 and PKK1), vimentin, myosin, S-100 protein (using polyclonal antiserum) and S-100 alpha and beta subunits, glial fibrillary acidic protein (GFAP), neuron-specific enolase (NSE), lactoferrin, and lysozyme was made in myoepitheliomas, myoepithelial adenomas, and clear cell adenomas of salivary gland origin. Myoepithelioma cells were divided into two types: plasmacytoid cells, which showed great heterogeneity in terms of keratins and S-100 alpha and beta proteins and a lack of GFAP, NSE, lactoferrin, and lysozyme in most the cells, and fibrous and dendritic tumor cells, which displayed variable staining for keratin and S-100 alpha and beta proteins. Myoepithelial adenomas were composed of small-, intermediate-, and large-sized spindle cells that showed irregular positive reactions for keratins and S-100 alpha and beta. Immunohistochemical deposition of S-100 protein was restricted strongly to the dendritic cells present in hyalinous and myxomatous areas. Clear cell adenomas revealed uniformly slight staining of keratins and S-100 proteins, and negative staining or rarely positivity for GFAP, NSE, lactoferrin, and lysozyme. When the immunohistochemical deposition of these proteins was compared between normal glands and myoepithelial tumors, heterogeneity of expression of keratins, S-100 proteins, GFAP, and NSE was notable in the tumors. Progenitor cells of several kinds of myoepithelioma were suggested to be intercalated reserve cells, which are thought to be the same cell that gives rise to pleomorphic adenoma of salivary glands.     

Esthesioneuroblastoma. Intermediate filaments, neuroendocrine, and tissue-specific antigens

Esthesioneuroblastoma (EN), a malignant neuroblastic tumor arising in the superior portion of the nasal cavity, shares histologic similarities with a number of primary malignant tumors that arise in this region, including rhabdomyosarcoma, lymphoepithelioma, and lymphoma. To establish an antigenic profile of EN as an aid in the differential diagnosis of these histologically similar nasal tumors, immunostaining was performed for the following intermediate filaments: keratin, neurofilament, glial fibrillary acidic protein, and desmin; neuron-specific enolase (NSE), S-100 protein, chromogranin, human common leukocyte antigen (HLE), epithelial membrane antigen (EMA), myoglobin, and carcinoembryonic antigen (CEA) on 21 primary nasal tumors: eight EN, five lymphoepitheliomas, two small cell carcinomas, three lymphomas, and three rhabdomyosarcomas. Keratin and CEA stained only the carcinomas (6/7+, 4/7+), respectively; desmin and myoglobin only rhabdomyosarcoma (3/3+, 1/3+); and HLE only lymphomas (3/3+). Chromogranin and neurofilament staining occurred exclusively in one case each of EN. S-100 and NSE commonly stained EN (5/8+, 6/8+), but carcinomas (1/7+, 2/7+) and rhabdomyosarcomas (1/3+, 3/3+) were also positive. Despite the apparent nonspecificity of NSE and S-100, an antigenic profile of positive NSE of S-100 staining with negative epithelial, muscle, and lymphoid antigens uniquely identified six of eight EN. Chromogranin and neurofilament positivity was further evidence for EN in two cases. This antigenic profile is a helpful adjunct in the diagnosis of EN and other primary malignant nasal tumors.     

恶性黑色素瘤的免疫组织化学鉴别诊断

以Ｓ－１００、Ｖｉｍｅｎｔｉｎ、ＨＭＢ４５、Ｋｅｒａｔｉｎ、ＥＭＡ、ＬＣＡ抗体，ＳＰ法对原病理诊断或疑诊的３５例恶性黑色素瘤（ＭＭ）进行染色。结果１０例典型的少色素性ＭＭ均呈Ｓ－１００、Ｖｉｍｅｎｔｉｎ和ＨＭＢ４５阳性，符合原ＭＭ诊断。原病理诊断１９例和疑诊６例共２５例无色素性恶性黑色素瘤（ＡＭＭ）中，２１例同时呈Ｓ－１００、ｖｉｍｅｎｔｉｎ和ＨＭＢ４５阳性，故确诊为ＡＭＭ；４例Ｓ－１００和ＨＭＢ４５阴性肿瘤中，３例为Ｋｅｒａｔｉｎ阳性、ＥＭＡ弱阳性，１例为ＬＣＡ和Ｖｉｍｅｎｔｉｎ阳性，证实不是ＭＭ而是癌和淋巴瘤。结果表明，Ｓ－１００和ＨＭＢ４５是ＭＭ诊断性标志物，后者具有特异性。     

Utility of immunohistochemistry in distinguishing ovarian sertoli-stromal cell tumors from carcinosarcomas.

Poorly differentiated Sertoli-stromal cell tumors and carcinosarcomas of the ovary both show biphasic epithelial and stromal patterns and may both show heterologous stromal elements, presenting a difficult diagnosis. We studied the immunohistochemical profile of Sertoli cell differentiation in human testes and applied these findings to the ovarian tumors. Eleven Sertoli-stromal cell tumors, six carcinosarcomas of the ovary, and 11 testes (six fetal, one infant, and four adult) were studied using antibodies to cytokeratin AE1:AE3 (AE1:3), cytokeratin CAM 5.2 (CAM), epithelial membrane antigen (EMA), vimentin, desmin, muscle-specific actin (MSA), S-100 protein (S-100), CA 19-9, CA 125, carcinoembryonic antigen monoclonal (CEA-M), carcinoembryonic antigen polyclonal (CEA-P), and placental alkaline phosphatase (PLAP). In the fetal testes, immature gonadal stroma and sex cord areas stained with vimentin (six of six cases), AE1:3 (five of six cases), and CAM (six of six cases). Sertoli cells in immature gonadal stroma areas, sex cords, and seminiferous tubules of normal fetal, infant, or adult testes never showed immunoreactivity for EMA, S-100, CA 19-9, CA 125, CEA-M, CEA-P, or PLAP. All Sertoli-stromal cell tumors stained with AE1:3 and CAM in areas of Sertoli cell differentiation (11 of 11 cases) but did not stain with EMA, PLAP, CEA-P, CEA-M, CA 19-9, CA 125, or S-100 (none of 11 cases). Carcinosarcomas expressed AE1:3 and CAM in all epithelial areas (six of six cases) and most stromal areas (five of six cases). Carcinomatous areas of carcinosarcoma also showed immunoreactivity for EMA (six of six cases), CA 125 (two of six cases), PLAP (two of six cases), CEA-P (two of six cases), and CEA-M (one of six cases), while stromal areas of carcinosarcoma expressed EMA (four of six cases) and S-100 (four of six cases). Heterologous stromal elements were present in three of 11 Sertoli-stromal cell tumors (two showed skeletal muscle and one showed both skeletal muscle and cartilage differentiation) and in four of six carcinosarcomas (one skeletal muscle, one cartilage, and two cartilage and skeletal muscle). All skeletal muscle heterologous elements expressed desmin, vimentin, and MSA. The heterologous cartilage in carcinosarcoma stained with S-100 (three of three), while the one case of heterologous cartilage in Sertoli-stromal cell tumor did not. These results suggest that ovarian Sertoli-stromal cell tumor can be distinguished from carcinosarcoma by the absence of staining for EMA, PLAP, CEA, CA 125, or CA 19-9 in epithelial areas of Sertoli-stromal cell tumor.(ABSTRACT TRUNCATED AT 400 WORDS)     

Breast carcinomas with protein S-100 immunoreactivity. An immunocytochemical and ultrastructural study

Protein S-100 immunoreactivity was observed in 5 of 50 breast carcinomas (3 infiltrating lobular and 2 infiltrating ductal carcinomas). A diffuse cytoplasmic staining was present in single cells and groups of cells. The majority of normal myoepithelial cells in ducts of unremarkable appearance next to tumor areas were stained in all 50 breast carcinomas. The 5 protein S-100 positive tumors all stained for prekeratin and 4 of them were vimentin-positive. No immunoreactivity for actin or NSE was observed in the 5 tumors. Electron microscopy did not distinguish the protein S-100 positive carcinomas from the 45 protein S-100 negative tumors. The significance of protein S-100 immunostaining in breast carcinomas is discussed.     

Esophageal pleomorphic giant cell carcinoma combined with small cell carcinoma

Herein is presented the case of an esophageal pleomorphic giant cell carcinoma combined with small cell carcinoma (SCC). The patient, a 77-year-old man, initially presented with dysphagia and hoarseness, and endoscopy indicated a large esophageal tumor. Despite chemoradiation therapy, the patient died from widespread local extension of the tumor and distant metastases approximately 8 months after onset of the symptoms. Histologically, the primary tumor was composed of pleomorphic tumor components, SCC components, and a tiny focus of squamous cell carcinoma. The pleomorphic tumor cells, consisting of solid sheets of poorly cohesive epithelioid cells and numerous multinucleated giant cells with abundant eosinophilic cytoplasm, were immunohistochemically positive for vimentin and desmin, with scattered positivity for epithelial membrane antigen (EMA) and neuron-specific enolase (NSE), but negative for myoglobin. These findings were histopathologically compatible with pleomorphic giant cell carcinoma occurring at other sites such as the lung. SCC cells, morphologically similar to their pulmonary counterpart, were positive for EMA and some neuroendocrine markers such as chromogranin A and NSE, and occasionally positive for vimentin and desmin. Esophageal pleomorphic giant cell carcinoma can occur in close association with SCC, and should be included in the differential diagnosis of esophageal tumors showing pleomorphism.     

Small cell neuroendocrine carcinoma of the colon and rectum: clinical, histologic, and ultrastructural study and immunohistochemical comparison with cloacogenic carcinoma

In an effort to provide immunocytochemical data that would be useful in distinguishing between small cell epithelial tumors of the anorectal region, 10 cases of neuroendocrine small cell colorectal carcinoma (NSCCC) and five cases of cloacogenic carcinoma (CC) were studied with antibodies to cytokeratin, epithelial membrane antigen (EMA), chromogranin, blood group isoantigens (BGI), carcinoembryonic antigen (CEA), Leu-M1, Leu-7, leukocyte common antigen (LCA), S-100 protein, neurofilaments (NF), neuron-specific enolase (NSE), serotonin, and 14 neuropeptides. The diagnoses for all 15 tumors were verified ultrastructurally. Among the antigenic determinants considered, reactivity for low- and medium-molecular-weight cytokeratin, EMA, NSE, and NF was seen in the majority of NSCCCs, whereas the CCs were positive for all cytokeratin classes, BGI, EMA, and CEA. In addition, Leu-M1, Leu-7, and chromogranin were each expressed in three cases of NSCCC. None of the other antisera yielded positive results in tumors of either type. All 10 patients with NSCCC died of their tumors within 11 months of clinical presentation, while four of the five CCs proved fatal, with an average survival of 28 months. One of the patients with CC was free of disease 31 months after diagnosis. These data suggest that an immunocytochemical panel, consisting of antibodies to high-molecular-weight cytokeratin, BGI, CEA, NSE, and NF (and possibly Leu-7 and chromogranin as well), is capable of distinguishing between NSCCC and CC in problematic cases. Although tumors of both types are aggressive, it is possible that the survival statistics for both may be improved through more accurate diagnostic classification.     

E-cadherin nuclear staining is useful for the diagnosis of ovarian adult granulosa cell tumor

We recently have demonstrated nuclear localization of E-cadherin in ovarian adult granulosa cell tumors (Histopathology 2011;58:423). The purpose of the present study is to investigate the diagnostic utility of E-cadherin nuclear staining for the differential diagnosis between ovarian adult granulosa cell tumor and its morphological mimics. Tissue samples taken from 81 ovarian tumors and 20 extraovarian tumors were immunohistochemically stained using monoclonal anti-E-cadherin antibody recognizing cytoplasmic domain (clone 36 supplied by BD Biosciences, San Jose, CA). The ovarian tumors consisted of 30 adult granulosa cell tumors, 3 Sertoli-stromal cell tumors, 14 fibrothecomas, 5 carcinoid tumors, 1 large cell neuroendocrine carcinoma, 18 endometrioid adenocarcinomas, and 10 poorly differentiated serous adenocarcinomas. Extraovarian tumors consisted of 16 uterine endometrial stromal neoplasms and 4 pulmonary small cell carcinomas. Only tumor cells with nuclear staining were considered positive in this study. Ninety percent of adult granulosa cell tumors, 67% of Sertoli-stromal cell tumors, 64% of fibrothecomas, 75% of endometrial stromal neoplasms, 75% of small cell carcinomas, and the one large cell neuroendocrine carcinoma showed E-cadherin nuclear expression, whereas all the ovarian carcinoid tumors, endometrioid adenocarcinomas, and poorly differentiated serous adenocarcinomas were negative. E-cadherin nuclear staining is useful in distinguishing between adult granulosa cell tumors and ovarian adenocarcinomas or carcinoid tumors. However, it is of limited use for distinguishing between adult granulosa cell tumors and endometrial stromal neoplasms or small cell carcinomas. E-cadherin should be included in the immunohistochemical panel for an accurate diagnosis of ovarian adult granulosa cell tumors.     

Adenoid cystic carcinoma of the breast: a histologic, cytologic, and immunohistochemical study

Six cases of adenoid cystic carcinoma (ACC) of the breast were reviewed. Immunohistochemical studies were carried out for actin, S-100 protein, EMA, keratin, CEA, vimentin, NSE, alpha-lactalbumin, and lysozyme. Fine needle aspiration biopsy smears of five patients were also reexamined. Patients were treated by tumorectomy, quadrantectomy, or modified radical mastectomy. Axillary dissection was carried out in five cases, with negative lymph nodes in all. Five patients are alive without evidence of disease from 1 year 10 months to 13 years 4 months following surgery. One patient died 7 1/4 years after mastectomy, without evidence of disease. Histologically, a diagnostic biphasic cellular pattern was seen in all cases. In addition, several unusual features were encountered in some cases: squamous metaplasia, stromal myxoid pseudocartilaginous foci, and well-formed neoplastic ducts. Actin and/or S-100 protein were variably positive in all cases. The reaction was usually present in occasional basaloid cells predominantly at the periphery of neoplastic structures. Keratin, EMA, and CEA immunostaining disclosed ductal type cells in all cases. Vimentin was positive in four cases, usually in many basaloid cells. Aspiration cytology was suspicious in two cases and yielded a definitive diagnosis of ACC in three cases. Cytologic diagnosis was based on cellular morphology and on the presence of characteristic globoid structures. Immunohistochemical results show that in ACC dual myoepithelial-ductal differentiation occurs but is relatively limited. Most of the tumor cells are not differentiated ("indifferent" cells) and often express strong vimentin positivity. Such cells are regarded as precursor cells for either differentiated element. Unusual metaplastic changes in breast ACC suggest a possible relation with pleomorphic adenoma-type tumors, and this might be of prognostic significance.     

Granular cells in odontogenic and non-odontogenic tumours

Summary Granular cells can occur in various odontogenic and non-odontogenic tumours. 5 granular cell lesions, one granular cell ameloblastoma, one so-called granular cell ameloblastic fibroma and three granular cell tumours were examined immunohistochemically for the intermediate filaments cytokeratin, vimentin, desmin, neurofilaments and the neural markers NSE and S-100 protein. The granular cell tumors (granular cell myoblastoma) showed positive staining for vimentin and S-100 protein. Only vimentin could be demonstrated in the granular cells of the so-called granular cell ameloblastic fibroma, whereas the granular cell ameloblastoma showed positive staining only for cytokeratin. A positive reaction with S-100 protein was not found in any of the odontogenic tumours. In our opinion the mesenchymal odontogenic granular cell is a fibroblast, whereas the epithelial granular cell is derived from enamel epithelium. The term granular cell ameloblastic fibroma is a misnomer, as a number of these tumours are probably central odontogenic fibromas exhibiting granular cell transformation.     

胃原发性内分泌肿瘤临床病理特点观察

目的 分析并总结胃内分泌肿瘤的临床病理特点。方法胃癌标本共计4620例,其中内分泌肿瘤20例,采用手术后肿瘤组织经石蜡包埋、切片,应用SP法做免疫组织化学染色。结果20例中有类癌1例,恶性类癌3例,小细胞癌6例,混合性外分泌-内分泌癌10例。免疫组织化学阳性表达结果：S-10080％,神经元特异性烯醇化酶85％,嗜铬粒素A50％,突触素80％,胃泌素30％,5-羟色胺65％,细胞角蛋白AE1／AE350％,癌胚抗原80％。结论尽管根据WHO肿瘤国际组织学2000年新分类,胃的内分泌肿瘤在组织形态上有类癌、恶性类癌、小细胞癌、混合性外分泌-内分泌癌及瘤样病变5种类型。但在本组报道的病例中,仍有少数病例形态特殊,很难归类。胃的内分泌肿瘤在组织学分型、治疗和预后等方面均与肠道类癌有明显不同。     

Expression of cytokeratin by malignant meningiomas: diagnostic pitfall of cytokeratin to separate malignant meningiomas from metastatic carcinoma.

Based on clinical and histologic features, differentiating metastatic carcinomas from benign or malignant meningiomas usually is not difficult. Occasionally, however, in some patients without a clinical history of carcinoma, malignant meningiomas can morphologically simulate metastatic carcinoma, necessitating an immunohistochemical study for cytokeratin to make a correct diagnosis. However, the utility of immunohistochemical markers to separate malignant meningioma from metastatic carcinoma has not been investigated. The immunoperoxidase method with antigen retrieval was used to characterize the expression of three cytokeratins (AE1/AE3, CAM 5.2, and Pan cytokeratin), EMA, CEA, Ber-EP4, CD 15, and B72.3 in 12 previously diagnosed malignant meningiomas, 20 benign meningiomas, and 20 metastatic carcinomas. Cytokeratin expression was detected in 75% of malignant meningiomas, 0% of benign meningiomas, and 100% of metastatic carcinomas. While epithelial markers of Ber-EP4, CEA, B72.3 and CD-15 were positive in 90, 80, 70 and 65% of the metastatic carcinoma, respectively, they were negative in all 12 malignant meningioma examined. Vimentin immunoreactivity was seen in all benign and malignant meningiomas, and in 20% of metastatic carcinomas. Our results indicated that cytokeratin is not a reliable immunohistochemical marker to separate a malignant meningioma from metastatic carcinoma. A panel of epithelial markers including Ber-EP4, CEA, B72.3 and CD-15, and vimentin may be needed to separate malignant meningioma from metastatic carcinoma. Cytokeratin expression can be a potential pitfall for confusing a malignant meningioma with a metastatic carcinoma.     

Immunoreactivity for epithelial and neuroendocrine antibodies are useful in the differential diagnosis of lung carcinomas

The histologic classification of pulmonary neoplasms can have important implications regarding appropriate management of patients. Although the histologic classification of lung tumors is predominantly based on morphology, ancillary studies such as immunohistochemistry can be used in difficult cases, and the diagnosis of large cell neuroendocrine carcinoma requires confirmation of neuroendocrine differentiation by immunohistochemistry or electron microscopy. We immunostained 142 lung tumors for B72.3, keratin 34betaE12, keratin 7, keratin 14, keratin 17, synaptophysin, and chromogranin to determine the utility of neuroendocrine markers and epithelial markers in the differential diagnosis. Among neuroendocrine carcinomas (small cell carcinoma and large cell neuroendocrine carcinoma), 84% (37 of 44) were chromogranin positive, 64% (21 of 36 small cell, 6 of 6 large cell neuroendocrine) were synaptophysin positive, 5% (2 of 43) were keratin 34betaE12 positive, 9% (4 of 44) were keratin 7 positive, and 5% (2 of 37) of small cell carcinomas and 50% (3 of 6) of large cell neuroendocrine carcinomas were B72.3 positive. Among non-neuroendocrine carcinomas, 5% (5 of 98) were chromogranin positive, 3% (3 of 96) were synaptophysin positive, and 97% (95 of 98) were positive for either keratin 34betaE12 or keratin 7 and 99% (97 of 98) were positive for either keratin 34betaE12, keratin 7 or B72.3. An antibody panel consisting of keratin 7, keratin 34betaE12, chromogranin, and synaptophysin separated 132 of 141 tumors (94%) into distinct groups. We conclude that immunostaining with both neuroendocrine markers and epithelial markers can be useful in the differential diagnosis of lung neoplasms.     

Expression of calretinin and the alpha-subunit of inhibin in granular cell tumors

Granular cell tumors (GCTs) typically express S-100 protein, which has been used as a marker in differential diagnosis. Calretinin, a calcium-binding protein related structurally to S-100, and inhibin, a polypeptide hormone secreted primarily by ovarian granulosa cells and testicular Sertoli cells and functioning as an inhibitor for pituitary follicle-stimulating hormone secretion, are potentially useful but not well-evaluated markers for GCTs. We studied 43 cases of GCT with antibodies to calretinin, the inhibin alpha-subunit, and S-100 protein. All tumors were positive for inhibin alpha-subunit and S-100 protein, with 50% or more cells showing moderate to strong staining. Forty tumors (93%) were positive for calretinin, ranging from focal weak to diffuse strong staining. Enhanced staining for calretinin in the tumor cells adjacent to hyperplastic squamous epithelium was observed in 9 of 13 cases showing pseudoepitheliomatous hyperplasia. Calretinin and the inhibin alpha-subunit are useful markers for GCTs. The expression of calretinin, a primarily neuronal protein, in GCTs further supports its neural differentiation or derivation. The elevated calretinin expression in the tumor cells adjacent to the hyperplastic squamous epithelium suggests a role for calretinin in the tumor cells-squamous epithelium interaction.     

Immunohistochemical characterization of atypical fibroxanthoma and dermatofibrosarcoma protuberans.

Atypical fibroxanthoma (AFX) and dermatofibrosarcoma protuberans (DFSP) have generated undue interest regarding their histogenesis, biological behavior, and differentiation from other forms of spindle cell tumors of the skin, including spindle cell squamous carcinomas and desmoplastic melanomas. To identify characteristic immunophenotypes, 12 AFXs and 15 DFSPs were examined with a panel of antibodies against cytokeratin; vimentin; desmin; proteolytic enzymes (alpha-1-antitrypsin and alpha-1-antichymotrypsin); melanoma-associated antigens defined by HMB-45, HMB-50, and NKI/C3; muscle-specific actin (HHF-35); and S-100 protein. The staining patterns of these two tumors were nearly identical. All cases tested negative for cytokeratin, desmin, and S-100 protein and strongly positive for vimentin. Six (50%) AFXs and 12 (80%) DFSPs tested focally positive for muscle-specific actin. None of the cases were reactive with melanoma antibodies HMB-45 and HMB-50; NKI/C3 strongly stained 26 of 27 tumors. Compared to HMB-45 and HMB-50, NKI/C3 cross-reacted with nonmelanocytic neoplasms. Two AFXs stained for alpha-1-antitrypsin and alpha-1-antichymotrypsin. This study confirms (1) the immunophenotypic similarity of AFX and DFSP, (2) the presence of myofibroblastic differentiation in both tumors, as reflected by HHF-35 staining, and (3) that AFX and DFSP are easily distinguished from spindle cell squamous carcinoma and desmoplastic melanoma by the absence of cytokeratin, HMB-45, and HMB-50 staining.     

Adenoma of the non-pigmented ciliary epithelium: A rare intraocular tumor with unusual immunohistochemical findings

A case of adenoma of the non-pigmented ciliary epithelium with smooth muscle differentiation is reported. This uncommon ocular tumor affected a 36-year-old woman, and had caused decreased visual acuity and a total cataract. Ultrasound biomicroscopy disclosed an associated persistent hyperplasic primary vitreous (PHPV). Sectoral cyclectomy with removal of the mass and intracapsular cataract extraction were performed. The tumor was diffusely positive for vimentin, smooth muscle actin, NSE, and S-100, focally for CD68 and Melan-A, and was negative for desmin, EMA, HMB-45, and CD99. Occasional cells reacted for cytokeratin. The proliferation index, as assessed by Ki-67, was below 10%. The overlying non-neoplastic ciliary epithelium was positive for vimentin, NSE, and S-100.     

Osteoclast-rich undifferentiated carcinomas of the urinary tract.

Osteoclast-like giant-cell neoplasms of the urinary tract are rare. They are composed of ovoid or spindle-shaped mononuclear cells with evenly spaced osteoclast-like giant cells. Terminology, histogenesis, and biologic behavior of these tumors remain controversial. Six cases of osteoclast-like giant-cell neoplasms of the urinary tract were identified from the consultation files of two of the authors. Patients were all male and elderly (range 65-82), with the exception of one 39-year-old male. In all, 3/6 tumors developed in the bladder and 3/6 in the renal pelvis. Size ranged from 5 to 11 cm. One bladder and three renal pelvis tumors were high stage (pT3) at time of presentation. Adjacent to the osteoclast-like giant-cell neoplasm in the same specimen, all patients had urothelial carcinoma in situ and/or high-grade papillary urothelial carcinoma. Multinucleated cells had identical morphological and immunohistochemical properties of osteoclasts; positive for CD-68, LCA, CD51 and CD54, and negative for cytokeratins and EMA. Varying percentages of mononuclear cells expressed alpha-smooth muscle actin (4/6), desmin (1/6), S-100 (4/6), LCA (2/6) and CD68 (6/6). However, mononuclear cells were also positive for epithelial markers in 4/6 tumors (cytokeratins AE-1/AE-3, Cam 5.2, CK7 and/or EMA). p53 stained mononuclear tumor cells in three cases, paralleling the staining on the accompanying urothelial carcinoma. Ki-67 stained mononuclear tumor cells, but not osteoclast-like giant cells. Follow-up data were available in five cases. One patient developed recurrence of noninvasive urothelial carcinoma and is still alive. Four patients were dead due to disease within 15 months, three with distant metastases. The intimate association of these tumors with urothelial carcinoma along with their immunohistochemical profile supports an epithelial origin for the mononuclear cells and non-neoplastic reactive histiocytic lineage for the osteoclast-like giant cells.     

卵巢幼年型粒层细胞瘤8例临床病理分析

目的 探讨卵巢幼年型粒层细胞瘤(juvenile granulosa cell tumor, JGCT)的临床病理特点、诊断及鉴别诊断.方法 回顾本院诊治的8例JGCT的临床、病理特征及免疫表型特点,并进行随访获知其预后情况.结果 8例JGCT患者发病年龄6～21岁,平均15.1岁.临床主要表现为腹部包块、腹水及女性假性性早熟.巨检表现为囊实性肿块.光镜下肿瘤细胞呈实性巢状,片状弥漫性排列,部分可排列成多个圆形或椭圆形大小不等的滤泡,少数可形成巨滤泡结构,有的滤泡腔内还可见均质红染物质.瘤细胞呈圆形、多边形,中等大小或较大,胞质丰富,空淡或微嗜酸性,核圆形,染色质均质状,无明显核沟,有一定异型性,可见核分裂象.免疫表型:瘤细胞均表达inhibin-α、CD99、vimentin,部分病例Melan-A、calretinin、S-100阳性,瘤细胞不表达CKpan、EMA、PLAP、Syn和CgA.结论 JGCT非常少见,属于低度恶性肿瘤,预后较好.确诊依赖于临床特点、组织形态学及免疫组化标记.病理诊断时要与卵巢的成人型粒层细胞瘤、高钙血症型小细胞癌、类癌、无性细胞瘤等肿瘤相鉴别.     

Malignant Sertoli cell tumour of the testis. An immunohistochemical study and a review of the literature

The fifteenth case of malignant Sertoli cell tumour is reported and the literature is reviewed. The reported case was unilateral with lung metastases. Immunohistochemical examination showed positive staining reaction within the tumour cells for vimentin and cytokeratin, while AFP, HCG, PLAP, EMA and CEA were not found, which is in accordance with the staining pattern found in normal Sertoli cells.