伴菊形团样结构的恶性外周神经鞘膜瘤1例

患者男性,33岁,因枕部包块术后2年、复发1年入院.1年前在无明显诱因下,再次出现相同部位包块,质韧,压痛,较前增大,无恶心,呕吐.查体：枕部可触及一4.0 cm×3.0 cm包块.TOPO定位：左侧枕部皮下软组织内可见梭形软组织块影,密度尚均匀,测CT值约56 Hu,相邻颅骨外板骨质结构完整,未见明显受压及骨质破坏征象,两侧大脑半球密度均匀,灰白色,分界清,未见明显异常密度影.各脑室系统及大脑表面沟池显示正常.大脑中线结构居中.CT示：（1）左侧枕部皮下占位,（2）颅脑平扫颅内未见明显异常.临床诊断：左枕部纤维瘤[第一段]     

宫颈癌中MMP-2及TIMP-2的表达及其临床意义

目的 :通过检测基质金属蛋白酶 - 2 (MMP - 2 )及基质金属蛋白酶组织抑制物 - 2 (TIMP - 2 )在宫颈癌中的表达 ,探讨其与宫颈癌侵袭转移的关系。方法 :采用免疫组化S -P法检测 5 1例宫颈癌和 16例正常宫颈组织中MMP - 2和TIMP - 2的表达情况。结果 :MMP - 2、TIMP - 2在正常宫颈上皮组织中均无表达 ,在宫颈癌组织中的阳性表达率分别为 74 .5 % (38/ 5 1)、4 7.1% (2 4 / 5 1) ,有显著性差异 (P <0 .0 1)。MMP - 2、TIMP - 2的表达与组织学类型无关 ,但与临床分期、细胞分化程度、淋巴结转移有关。结论 :MMP - 2、TIMP - 2的表达与宫颈癌的侵袭转移有关 ,MMP - 2、TIMP - 2可作为预测宫颈癌侵袭转移潜能和临床预后的指标。     

恶性外周神经鞘瘤52例临床病理分析

目的观察恶性外周神经鞘瘤的临床病理学特征、诊断及鉴别诊断。方法回顾性分析52例恶性外周神经鞘瘤的临床病理学及免疫表型特征并复习相关文献。结果 52例患者中,男女发病率为1∶1,年龄4~71岁,头颈部18例(35%),四肢12例(23%),躯干9例(17%),深部组织8例(15%),椎管内4例(8%),生殖道1例(2%)。镜下肿瘤组织呈束状或漩涡状排列,瘤细胞短纺锤形、卵圆形、梭形,核分裂象易见。免疫表型:瘤细胞局灶表达S-100蛋白,Ki-67增殖指数10%~70%。结论恶性外周神经鞘瘤罕见,侵袭性高,预后差,其组织形态复杂多样,需与滑膜肉瘤、纤维肉瘤、血管外皮瘤、富于细胞性神经鞘瘤、纤维型脑膜瘤以及平滑肌肉瘤等鉴别。     

肺原发性恶性外周神经鞘瘤的临床病理分析

目的 探讨肺脏原发性恶性外周神经鞘瘤(MPNST)的临床病理学特征及诊断、鉴别诊断要点。方法 对2例肺MPNST进行临床病理学分析及免疫组织化学与超微结构研究。结果 2例光镜下均显示MPNST的形态特点，免疫组织化学显示S-100蛋白、MBP、Vim、NSE肿瘤细胞呈阳性表达，电镜观察1例可见特征性Luse小体。结论 肺原发性MPNST极为罕见，临床诊断较困难。根据其光镜病理形态特征，S-100蛋白、MBP免疫组织化学检测和(或)电镜检查可确诊。结合文献，该肿瘤早期无明显临床症状，一般发现时已属晚期，预后差。病理学上应与肺脏平滑肌肉瘤、纤维肉瘤、单相型滑膜肉瘤、肉瘤样癌鉴别。     

大肠癌及其转移灶中MMP-2和TIMP-2的表达和意义

目的研究基质金属蛋白酶-2（MMP-2）及其抑制物组织基质金属蛋白酶抑制剂-2（TIMP-2）在大肠癌进展中的作用及其临床意义。方法通过免疫组化的方法检测104例大肠癌组织及其转移灶中MMP-2和TIMP-2的表达。结果MMP-2在转移灶中的阳性率（72．1％）显著高于原发灶中的阳性率（53．8％）（P〈0．05）,而TIMP-2在转移灶中的阳性率（35．6％）显著低于原发灶中的阳性率（66．3％）（P〈0．05）;MMP-2和TIMP-2在大肠癌原发及转移灶中表达均具有相关性,且呈负相关。结论MMP-2和TIMP-2的表达与大肠癌转移密切相关,而且转移灶癌细胞MMP-2的表达明显增强,TIMP-2的表达明显下降,可作为临床判断大肠癌恶性程度、转移及预后的重要参考指标。     

直肠伴有骨形成的恶性外周神经鞘瘤一例

患者男 ,6 1岁。数月前解大便时有里急后重感并有少许黏液血便 ,大便每天 2～ 3次 ,成型 ,于 2 0 0 1年 11月 2 2日入院。体检 :全身皮肤无色素沉着 ,躯干及四肢无瘤结 ,浅表淋巴结未扪及。胸部X光片、腹部B超及全身骨扫描未见异常。肛门指检 :距肛门 3～ 4cm处扪及 3cm× 3cm肿物 ,质软 ,前列腺不大 ,无结节 ,指套上染有血迹。直肠镜检 :直肠下段距齿状缘 3cm处有一结节状肿物突向肠腔 ,取少许组织送检 ,病理诊断为“直肠恶性肿瘤 ,具体组织学类型待手术切除后定”。临床疑“直肠癌”行根治切除手术。病理检查 :带有肛门组织的肠一段 ,长 …     

恶性外周神经鞘瘤临床与病理特征

目的　探讨恶性外周神经鞘瘤（MPNST）的临床与病理形态特征。 方法　收集本院收治的22例MPNST临床资料，应用光学显微镜观察病理形态特点，免疫组化分析其表型，并进行相关文献复习。 结果　22例MPNST中，男10例，女12例，年龄15~82岁，中位年龄43岁。头颈部3例，躯干及四肢近端13例，四肢远端5例，全身多发1例。临床表现主要是局部逐渐增大的无痛性肿块，症状与体征与肿块的部位及进展速度有关。19例患者行肿瘤切除手术，术后其中6例患者被嘱须行后续放疗，13例患者行化疗（以多柔比星和异环磷酰胺为主）。免疫组化检测，Vimentin（15/15）、CD99（8/8）、IMP3（10/11）、S-100蛋白（16/19）阳性，Ki-67增殖指数5%~80%。1年病死率45%，中位生存时间25个月。局部复发率55%（12例），远处转移率32%（7例）。末次随访3例无瘤生存。 结论　MPNST的临床及病理有其特点，但某些医生对其认识不足。本文总结辨析要点，以期提高该病确诊率，指导治疗和康复。     

恶性外周神经鞘瘤临床与病理特征

目的　探讨恶性外周神经鞘瘤（MPNST）的临床与病理形态特征。 方法　收集本院收治的22例MPNST临床资料,应用光学显微镜观察病理形态特点,免疫组化分析其表型,并进行相关文献复习。 结果　22例MPNST中,男10例,女12例,年龄15~82岁,中位年龄43岁。头颈部3例,躯干及四肢近端13例,四肢远端5例,全身多发1例。临床表现主要是局部逐渐增大的无痛性肿块,症状与体征与肿块的部位及进展速度有关。19例患者行肿瘤切除手术,术后其中6例患者被嘱须行后续放疗,13例患者行化疗（以多柔比星和异环磷酰胺为主）。免疫组化检测,Vimentin（15/15）、CD99（8/8）、IMP3（10/11）、S-100蛋白（16/19）阳性,Ki-67增殖指数5%~80%。1年病死率45%,中位生存时间25个月。局部复发率55%（12例）,远处转移率32%（7例）。末次随访3例无瘤生存。 结论　MPNST的临床及病理有其特点,但某些医生对其认识不足。本文总结辨析要点,以期提高该病确诊率,指导治疗和康复。     

背部巨大恶性外周神经鞘瘤1例

患者女性,57岁,因"背部巨大肿物"入院.患者3年前无意中发现背部"枣子"大小肿物,不伴疼痛,无发热.曾在外院行3次手术切除,具体情况不详,但均术后复发.体检:患者背部可见1约45 cm×30 cm×30 cm大小肿物,质较硬,界限清,活动度可,表面部分破溃,有淡黄色液体溢出.另于全身皮肤散在多个"疣状"突起,手术切除巨大肿块.临床诊断:神经纤维瘤伴感染(背部).     

Fine-needle aspiration cytology of malignant peripheral nerve sheath tumors

The histopathologic features of malignant peripheral nerve sheath tumors (MPNSTs) have been well described. There have been limited studies on the cytologic features of MPNST. In this present study, we have retrospectively reviewed eight histopathology confirmed cases of MPNST over a 5-year period. Detailed cytomorphological analysis of these cases was carried out individually by two observers. On cytology, these cases were diagnosed as benign spindle-cell tumor (two), spindle-cell tumor possibly benign (one), spindle-cell tumor possibly malignant (one), malignant spindle-cell tumor (two), spindle-cell tumor, and neural origin (two). The cardinal cytomorphologic features were loosely cohesive clusters and fascicular arrangement of spindle cells with rounded ends. The kinking of nuclei was not a conspicuous finding. Fibrillary background was noted in two of the cases. Nuclear pleomorphism was ranged from mild to moderate degree. One case exhibited extensive intranuclear pseudoinclusions. Mitotic figures (including atypical forms) were present in almost all the cases. Possibly a constellation of cytologic features such as clusters of short and long fascicles of cells admixed with dissociated spindle cells of round-ended nuclei and prominent nucleoli on myxoid or fibrillary background and frequent mitosis may be helpful in diagnosis of MPNSTs. The cytomorphologic features along with clinical correlation are necessary to increase the diagnostic accuracy of MPNST on aspiration cytology.     

上皮样恶性周围性神经鞘瘤临床病理分析

目的 探讨上皮样恶性周围性神经鞘瘤(epithelioid malignant peripheral nerye sheath tumor,EMPNST)的临床病理特征及鉴别诊断.方法 收集9例EMPNST的临床病理资料,行光镜和EnVision法免疫组化观察,并复习文献.结果 9例EMPNST,女性4例;年龄20～67岁,中位年龄37.5岁;病变主要位于四肢,上肢3例,下肢4例,右季肋部和咽隐窝各1例;>5 cm 7例,其中1例>10 cm;<5 cm 2例,平均6.2 cm,无包膜.深在型8例,浅在型1例,组织学,纯上皮样型5例,其中2例见节细胞样或横纹肌样瘤样区域,4例混合型伴有梭形细胞区.免疫表型S-100蛋白及NSE 9例均呈阳性反应,纯上皮样型5例S-100蛋白呈强阳性,4例混合型呈灶性阳性,8例PGP 9.5阳性,7例MBP阳性,5例EMA灶性或弱阳性,4例vimentin阳性,3例CD57灶性阳性,而HMB-45、desmin、CD34、CK阴性.结论 EMPNST是恶性周围性神经鞘瘤的一种少见亚型,形态学上缺乏特征性,易与其他软组织上皮样肿瘤混淆.S-100蛋白及PGP9.5阳性是诊断EMPNST有价值的指标,但缺乏特异性,因此诊断时必须结合临床、组织形态和免疫表型的结果,综合判断以免引起误诊.     

Nestin expression as a new marker in malignant peripheral nerve sheath tumors

Malignant peripheral nerve sheath tumor (MPNST) can be difficult to diagnose because it lacks specific immunohistochemical markers. S-100, which is a useful marker of MPNST, has limited diagnostic utility. Recent studies suggest that nestin, which is an intermediate filament protein, is expressed in neuroectodermal stem cells. The diagnostic utility of immunostains for nestin and three other neural markers (S-100, CD56 and protein gene product 9.5 (PGP 9.5)) were evaluated in 35 cases of MPNST and in other spindle cell tumors. All MPNST cases were strongly positive for nestin and had cytoplasmic staining. Stains for S-100, CD56, and PGP 9.5 were positive in fewer cases (17/35, 11/35, and 29/35 cases, respectively), and had less extensive staining. Nestin was negative in 10/10 leiomyomas, and weak nestin expression was seen in 10/10 schwannomas, 3/10 neurofibromas, 2/8 synovial sarcomas, 2/10 liposarcomas, 4/7 carcinosarcomas and 3/7 malignant fibrous histiocytomas. In contrast, strong nestin positivity was seen in 10/10 rhabdomyosarcomas, 15/19 leiomyosarcomas, and 9/9 desmoplastic melanomas. Nestin is more sensitive for MPNST than other neural markers and immunostains for nestin in combination with other markers could be useful in the diagnosis of MPNST.     

Peripheral nerve sheath tumors: an update and review of diagnostic challenges

Peripheral nerve sheath tumors (PNSTs) are one of the more common soft tissue neoplasms encountered in the daily surgical pathology practice, most of which have classic histologic features. There are, however, some common diagnostic challenges encountered by surgical pathologists and neuropathologists, as well as controversies regarding classification and grading of PNSTs. As molecular studies advance and novel targeted therapies are developed, it has become imperative that we become familiar with the diagnostic criteria for these common neoplasms and their potential mimics.     

基质金属蛋白酶MMP-2、MMP-9及其抑制因子TIMP-1、TIMP-2在子宫内膜异位症血清中的表达及临床意义

目的探讨基质金属蛋白酶MMP-2、MMP-9及其抑制因子TIMP-1、TIMP-2在子宫内膜异位症（EMs）血清中的表达及临床意义。方法采用双抗体夹心酶联免疫吸附法（ELISA）检测55例EMs患者和30例对照组血清中删P-2,MMP-9、TIMP-1和TIMP-2水平。结果BMs组血清中MMP-2和MMP-9水平显著高于对照组,TIMP-1和TIMP-2水平显著低于时照组（P〈0．05）。Ⅲ-Ⅳ期血清MMP-2和MMP-9水平显著高于Ⅰ-Ⅱ期和对照组,TIMP-1和TIMP-2水平显著低于Ⅰ-Ⅱ期和对照组（P〈0．05）。结论MMP-2、MMP-9与Elds发生和发展相关,TIMP-1、TIMP-2对MMP-2、MMP-9水平调节有重要作用。     

Malignant peripheral nerve sheath tumor with perineurial cell differentiation (malignant perineurioma)

A unique case of malignant peripheral nerve sheath tumor (MPNST) with perineurial cell differentiation occurring in a 63-year-old woman in a subcutis of the forearm is described. The tumor contained cellular and myxoid areas. The neoplastic cells were fusiform with distinct cell borders. They were arranged in storiform pattern and in wavy parallel cell cords in the cellular areas. Focally, a pleomorphism and mitotic activity (including atypical mitoses) similar to those of malignant fibrous histiocytoma were seen. The myxoid parts contained haphazardly oriented cells and scarce lipoblast-like multivacuolated cells mimicking a liposarcoma. In the differential diagnosis, myxoid liposarcoma, dermatofibrosarcoma protuberans, malignant fibrous histiocytoma and low-grade fibromyxoid sarcoma were considered. Immunohistochemically, perineurial differentiation was indicated by the diffuse expression of epithelial membrane antigen and focal reactivity for CD34. The tumor was negative with antibodies to S-100 protein, Leu-7, CD68 (KP1), vimentin and cytokeratin AE1/AE3. Ultrastructure of tumor cells revealed features of MPNST. No recurrence occurred in the patient during 2 years follow up.