早期胃印戒细胞癌临床病理特征

目的 探讨早期胃癌中印戒细胞癌的临床病理特征。方法回顾性分析了2010年4月至2012年9月间经南京军区福州总医院手术病理证实的早期胃癌中41例印戒细胞癌和104非印戒细胞癌患者的临床病理资料。结果早期胃癌中,印戒细胞癌与非印戒细胞癌在年龄、性别、肿瘤部位上存在差异（P〈0．05）,而无论发病前有无腹痛,以及在血型、癌胚抗原值、肿瘤直径、浸润深度、淋巴结转移、内镜下肉眼类型无显著差异（P〉0．05）。结论早期胃癌中的印戒细胞癌好发于年轻人、女性及胃下部（胃窦）,内镜下也缺乏特异性表现。其早期无明显症状,癌胚抗原值无特异性增高。     

结直肠腺癌病理分型的临床意义及预后分析

目的 探讨结直肠黏液腺癌、印戒细胞癌与乳头状、管状腺癌临床病理的差异和预后.方法 收集1994年8月至2007年3月结直肠手术患者2089例,其中黏液腺癌144例,印戒细胞癌25例,乳头状腺癌和管状腺癌1837例,剔除其他类型肠道肿瘤83例.比较三组的临床病理特点.对影响结直肠预后的部分临床病理指标,如年龄、肿瘤部位、分期、腹膜、病理分型进行单因素和非条件Logistic回归分析.对三组进行总体生存分析.结果 黏液腺癌患者发病的中位年龄为(54.20±16.25)岁,印戒细胞癌患者为(40.43±12.88)岁,乳头状腺癌和管状腺癌患者为(58.73±13.62)岁,印戒细胞癌发病年龄最低(P<0.001).三组男女比例、肿瘤直径、肿瘤部位、TNM分期、腹膜转移、淋巴结转移和脏器侵犯差异均有统计学意义(P值均<0.05).经单因素和非条件Logistic回归分析发现,黏液癌和印戒细胞癌是预示结直肠癌预后的危险因素,而印戒细胞癌是预示结直肠癌预后的独立因素.三组总体生存时间和生存率间差异有统计学意义(P<0.001).结论 结直肠黏液腺癌和印戒细胞癌预后较乳头状、管状腺癌差.黏液癌和印戒细胞癌是预示结直肠癌预后的危险因素.     

胃印戒细胞癌并肺癌性淋巴管炎1例报道

肺癌性淋巴管炎(pulmonary lymphangitic carcinomatosis,PLC)是一种少见的肺内转移癌,诊断困难,预后较差。本文就1例胃印戒细胞癌并PLC患者的诊治过程进行分析,为临床工作者提供参考,降低该病死亡率。     

伴嗜酸粒细胞增多的髓系白血病形态学研究

目的:探讨伴有嗜酸粒细胞增多的髓系肿瘤嗜酸粒细胞的形态学特征.方法:回顾性分析13例慢性嗜酸粒细胞白血病(CEL)、17例急性髓系白血病(AML)伴有t(8}21)(q22;q22),(AML/ETO)、25例AML伴有骨髓异常嗜酸粒细胞,inv(16)(p13;q22)或t(16;16)(p13;q22),(CBFβ/MYH11)和20例慢性粒细胞白血病慢性期(CML-CP)患者骨髓及外周血涂片嗜酸粒细胞细胞形态学,每例患者计数200个骨髓嗜酸粒细胞,分析各阶段嗜酸粒细胞比例及其形态特征.结果:CEL患者骨髓嗜酸粒细胞以嗜酸杆状核和分叶核细胞为主,形态学主要表现为细胞质嗜酸性颗粒减少,空泡及碱性颗粒.AML伴骨髓异常嗜酸粒细胞,inv(16)(p13;q22)患者骨髓嗜酸粒细胞以中晚阶段嗜酸粒细胞为主,细胞明显成熟障碍,形态学改变主要表现为粗大紫红色嗜碱性颗粒增多并覆盖细胞核,少数伴有细胞质空泡.AML伴t(8;21)(q22;q22)患者骨髓嗜酸粒细胞以嗜酸晚幼粒细胞为主,成熟阶段粒细胞减少,其形态学主要表现为颗粒增多但细小,多数表现为金黄色颗粒覆盖细胞核上.CML-CP患者骨髓嗜酸粒细胞以嗜酸晚幼粒细胞和杆状核细胞为主,颗粒以细小密集增多为主,颗粒减少及空泡不明显.结论:伴嗜酸粒细胞增多的髓系肿瘤,除各自原发病的特点之外,其嗜酸粒细胞比例以及形态学改变不尽相同,通过详细细胞形态学分析能够为上述疾病的诊断与鉴别提供初步依据.     

嗜酸粒细胞性气道炎症和慢性咳嗽

嗜酸粒细胞性气道炎症是以气管和支气管壁存在明显嗜酸粒细胞浸润为特征的一种病理状态。哮喘、咳嗽变异性哮喘及非哮喘性嗜酸粒细胞性支气管炎是慢性咳嗽的常见病因,嗜酸粒细胞性气道炎症是其共同病理过程,提示嗜酸粒细胞性气道炎症与慢性咳嗽的发生可能有密切联系,并呈现不同的临床表型。     

胃印戒细胞癌与胃混合印戒细胞癌患者临床病理资料及预后对比分析

目的 通过对比分析胃印戒细胞癌（SRCC）与胃混合印戒细胞癌（mixed-SRCC）的临床病理资料及预后情况，为胃癌的个体化、精准化治疗提供参考。方法 接受根治性手术切除的含印戒细胞成分的胃癌患者481例，其中胃SRCC 161例、胃mixed-SRCC 320例。比较胃SRCC、胃mixed-SRCC的临床病理资料及预后。分析胃SRCC、胃mixed-SRCC的预后影响因素。结果 胃SRCC肿瘤直径>5 cm、肿瘤位于胃下1/3、淋巴结转移阴性、浸润深度T1a者比例高于mixed-SRCC(P均<0.05)；早期胃SRCC远端胃切除术、肿瘤直径>5 cm、浸润深度T1a、病理分期ⅠA期者比例高于早期胃mixed-SRCC，进展期胃SRCC淋巴结转移阴性、脉管侵犯阴性者比例高于胃mixed-SRCC(P均<0.05)。胃SRCC患者总体3年生存率及进展期患者3年生存率高于胃mixed-SRCC患者（P均<0.05）。淋巴结转移（HR=0.407,95%CI 0.177～0.937,P=0.035）、浸润深度（HR=4.409,95%CI 1.269～15....     

嗜酸粒细胞性肺病:亟待澄清认识

嗜酸粒细胞性肺病(eosinophilic lung diseases,ELD)是指以气道和(或)肺实质嗜酸粒细胞增多为特征的一组异质性临床疾病,伴有或不伴有外周血嗜酸粒细胞增多[1].以前与ELD相关的名称较多,如嗜酸粒细胞肺浸润、肺嗜酸粒细胞增多症、嗜酸粒细胞性肺炎和肺嗜酸粒细胞综合征等,但目前多以ELD代替[2-5].     

胃印戒细胞癌的形态发生

目的观察胃印戒细胞癌癌前病变及癌变形态发生．方法全切除胃印戒细胞癌标本６８例，常规固定，包埋制片，光镜检查．结果腺管增殖带延长３５例，颈粘液细胞依次变为小立方形细胞（Ⅰ型细胞）、中等大小组织细胞样细胞（Ⅱ型细胞）及典型印戒细胞（Ⅲ型细胞）；见到球样异型增生灶１６例；癌细胞始发为Ⅱ型细胞６例；管状腺癌演变为印戒细胞２例．结论胃印戒细胞癌的形态发生可能有数种途径．印戒细胞癌与肠化关系应进一步探明     

嗜酸粒细胞性气道炎症和慢性咳嗽

嗜酸粒细胞性气道炎症是以气管和支气管壁存在明显嗜酸粒细胞浸润为特征的一种病理状态.哮喘、咳嗽变异性哮喘及非哮喘性嗜酸粒细胞性支气管炎是慢性咳嗽的常见病因,嗜酸粒细胞性气道炎症是其共同病理过程,提示嗜酸粒细胞性气道炎症与慢性咳嗽的发生可能有密切联系,并呈现不同的临床表型.     

小叶间隔增厚伴胸腔积液

本例表现为咳嗽、咳痰和气短症状的青年女性患者, 胸部CT提示小叶间隔增厚伴胸腔积液, 胸腔积液肿瘤标志物明显升高, PET-CT未见确切原发病灶, 最后经右锁骨上淋巴结穿刺明确为转移性腺癌(胃印戒细胞癌来源可能)和临床诊断为肺淋巴管癌病伴恶性胸腔积液。这提示即使对于年轻患者, 也应将肺淋巴管癌病纳入小叶间隔增厚伴胸腔积液的鉴别诊断范畴, 同时要警惕隐匿的胃印戒细胞癌。     

Metastatic signet ring gastric adenocarcinoma presenting with microangiopathic hemolytic anemia.

Metastatic adenocarcinoma presenting as microangiopathic hemolytic anemia (MAHA) and leukoerythroblastic blood picture is rare. We report three patients who presented with MAHA as the initial symptom of metastatic signet ring cell gastric adenocarcinoma. One patient had past history of gastric ulcer. In all these patients the initial diagnosis was based on peripheral blood smear followed by bone marrow biopsy; upper GI endoscopy showed presence of gastric ulcers with focally scattered neo-plastic signet ring cells on histopathology. All patients died within a week of diagnosis.     

Multiorganic dissemination of a colorectal signet ring cell carcinoma with fulminant clinical course

Mucinous colorectal cancer with signet ring cell aspects is a rare form of adenocarcinoma representing about 2–5% of large bowel neoplasms. The tumor frequently presents with late-stage or peritoneal spreading. It can often affect young patients and diffusely infiltrate through all layers of the intestinal wall. Local recurrence and distant metastases are common in spite of surgical operation and adjuvant treatment, conditioning a poor prognosis. At the present, early diagnosis and complete resection are the most important approaches to improve the outcome. In our report we describe a case of a 41-yr-old patient with very aggressive untreated metastatic colorectal signet ring cell carcinoma. The fulminant tumor progression was really unexpected and misled every possible medical interpretation, leading to rapid worsening of the patient's clinical conditions and no chance for chemotherapy treatment. The tumor mimicked the picture observed in the acute leukemia, developing diffuse infiltration in all serosal membranes, liver, lung, kidneys, multiple lymph nodes, and meninges, as revealed by the post-mortem medical report.     

肺癌合并血嗜酸性粒细胞增多临床特点

目的 探讨肺癌合并血嗜酸性粒细胞增多的临床特点及意义.方法 结合我院收治的1例肺癌合并嗜酸性粒细胞增多的临床资料及国外文献报道的实体肿瘤合并嗜酸性粒细胞增多的病例报道进行综合分析.结果 患者男,80岁,表现为右侧胸痛,呈持续性钝痛,胸部CT示右肺上叶后段厚壁空洞,伴邻近骨质破坏,右肺动脉及右主支气管受侵,右侧少量胸腔积液.血嗜酸性粒细胞增多,比例为0.169,绝对值2.15×109/L,痰及支气管灌洗液中嗜酸性粒细胞比例也明显增高.CT引导下穿刺活检显示为鳞癌.患者发现合并嗜酸性粒细胞时,肺癌已有转移,预后差,与文献报道一致.结论 肺癌等恶性肿瘤通过分泌嗜酸性粒细胞克隆刺激因子引发血嗜酸性粒细胞增多,为较少见的副癌综合征,提示肿瘤已有转移,预后差.     

Gastric cancer with metastasis to the gingiva

The present case report describes a gastric cancer which showed unusual metastasis in the oral region. A 56-year-old male patient underwent total gastrectomy and splenectomy due to advanced gastric cancer in the upper third of the stomach. Fifteen months later, he presented with anorexia and gingival swelling of durations of approximately 3 and 1 month, respectively. The gastric tumor was histologically a signet ring cell and a poorly differentiated cancer with a moderate degree of vascular invasion. Biopsy specimens from the gingival tumor revealed a signet ring cell cancer. Other metastatic sites were the brain, limb bones and abdominal lymph nodes. A bone scintigram revealed an abnormal uptake in the limb bones, while it did not exhibit any abnormality in the oral region. Correlation between the histology of the gingival tumor with that of the gastric cancer, as well as the absence of a gingival tumor at the time of prior gastrectomy, led to a diagnosis that the gingival tumor was a metastasis from gastric cancer. Gastric cancer metastasizing to the oral region, either the osseus or the oral soft tissue, is very rare. Although it cannot be proved without an autopsy, negative findings in the mandible by bone scanning in the present case suggest that direct gingival metastasis can be considered, rather than mandibular metastasis involving the gingiva. Hematogenous spread could be a mechanism of metastasis for this unusual tumor.     

Chronic eosinophilic pneumonia associated with rheumatoid arthritis]

We encountered a 45-year-old woman with chronic eosinophilic pneumonia associated with rheumatoid arthritis. In May 1997, she was given a diagnosis of rheumatoid arthritis and prescribed non-steroidal anti-inflammatory drugs. After a month, she visited our hospital because of fever and cough. A chest roentgenogram and computed tomographic scan on first admission revealed peripheral infiltrative shadows in the upper fields of both lungs. Approximately 30% of peripheral blood cells were eosinophils. Furthermore eosinophils were elevated in bronchoalveolar lavage fluid and transbronchial lung biopsy specimens. A conclusive diagnosis of chronic eosinophilic pneumonia was made on these grounds. The patient responded well to steroid treatment, but was readmitted a week later because of worsening joint pain and skin eruptions in the lower extremities of both legs. A skin biopsy showed perivascular and interstitial eosinophil infiltration. The combination of steroids, a disease modifying anti-rheumatic drug, and a non-steroidal anti-inflammatory drug proved to be effective.     

Primary hepatic signet ring cell neuroendocrine tumor: a case report with literature review

Primary hepatic signet ring cell neuroendocrine tumor is extremely rare and is characterized by distinct intracytoplasmic hyaline vacuoles that are mucin negative and cytokeratin positive. The unique histological features may cause difficulty in diagnosis and delay patient care. Here the authors report a 49-year-old man with an incidental finding of a 2.7 cm liver mass in the absence of chronic liver disease. The resected tumor was grossly unencapsulated but well demarcated with friable tissue texture. Microscopically, the entire tumor consisted of sheets of monotonous cells separated by delicate microvasculature. The tumor cells had granular chromatin, inconspicuous nucleoli, and eosinophilic cytoplasm. Many of the tumor cells had eccentric, pale intracytoplasmic vacuoles resembling signet ring cells in adenocarcinoma. Immunohistochemical studies showed that the tumor cells were positive for neuroendocrine markers and that the intracytoplasmic vacuoles were negative for mucin but strongly positive for cytokeratins. Careful systemic search including OctreoScan scintigraphy (Mallinckrodt Medical, Inc., St. Louis, MO) and capsule endoscopy failed to reveal any other tumors. A diagnosis of primary hepatic signet ring cell neuroendocrine tumor was established. Ten months after surgery, the patient is well without any other detectable tumor on radiology. Serological neuroendocrine markers are also within normal limits.     

A case of gastric metastasis of breast carcinoma resembling early gastric cancer]

Many patients suffering from breast carcinoma have metastases at initial diagnosis. The common metastatic sites are skeleton, liver and lung. Metastases to stomach are rare and only three cases have been reported in Korea. The endoscopic features of gastric metastases from breast carcinoma can be divided into three main categories: diffuse infiltration, external compression, and localized tumor deposition with ulceration or with a polypoid mass. However, metastatic gastric lesions which resemble early gastric carcinoma are rare. Typically, gastric metastases are confined to submucosa and muscularis, so that mucosal biopsy specimens might be false-negative. We report a case of gastric metastasis from infiltrative lobular carcinoma of the breast in a 66-year-old woman who had undergone left mastectomy with postoperative radiotherapy 17 years earlier. Initial diagnosis was early gastric carcinoma, signet ring cell type on gastric biopsy findings. However, definitive diagnosis of metastatic breast cancer was confirmed after endoscopic mucosal resection of a presumed primary early gastric carcinoma.     

Carcinocythemia (carcinoma cell leukemia). An acute leukemia-like picture due to metastatic carcinoma cells.

Observation of a unique population of cells on a Wright-stained blood smear of a patient with metastatic breast carcinoma prompted a study to determine their origin. The primary carcinoma contained a marker, the presence of "signet cells." These were demonstrated in direct peripheral smears and buffy coat preparation of peripheral blood and confirmed histochemically by showing positive periodic acid-Schiff, alpha-napthol and beta-glucuronidase reactions. "Carcinocythemia" is suggested as a name for this unusual process observed over a six month period. Studies of the patient's immunocompetence, of circulating cell surface immunoglobulins and karyotype analysis were made. Postmortem examination revealed retroperitoneal fibrosis, splenic atrophy and extensive metastatic carcinoma but no evidence of leukemia. The cells will be contrasted to those seen in a second patient who appeared to have acute myelocytic leukemia complicating extensive cancer involving the bone marrow. The observations suggest that a leukemia-like blood picture due to circulating cancer cells may occur during the course of metastatic breast carcinoma.     

Breast cancer metastasizing to the stomach mimicking primary gastric cancer: A case report

Breast cancer with stomach metastasis rare with an incidence of 1% or less among metastatic breast cancer patients. We experienced a case of breast cancer metastasizing to the stomach in 65-year-old female patient. She experienced dyspepsia and poor oral intake before visiting the clinic. Diffuse infiltration with nodular mucosal thickening of the stomach wall was observed, suggesting advanced gastric cancer based on gross endoscopic finding. Spread of poorly cohesive tumor cells in the gastric mucosa observed upon hematoxylin and eosin stain resembled signet ring cell carcinoma, but diffuse positive staining for GATA3 in immunohistochemical stain allowed for a conclusive diagnosis of breast cancer metastasizing to the stomach. Based on the final diagnosis, systemic chemotherapy was administered instead of primary surgical resection. After 2 cycles of docetaxel administration, she showed a partial response based on abdominal computed tomography scan. This case is an unusual presentation of breast cancer metastasizing to the gastrointestinal tract.     

卵巢转移性肿瘤37例临床与病理分析

目的 分析和总结卵巢转移性肿瘤的临床和病理特征.方法 回顾广西壮族自治区人民医院近6年间手术治疗的卵巢转移性肿瘤共37例,分析其病理形态、免疫组织化学等病理学特征和临床资料.结果 卵巢转移性肿瘤发病年龄15~69岁,平均年龄43.6岁.临床表现为非特异性,多以附件包块伴有腹水为主要特征,占45.9%(17/37),癌细胞检出率高达64.7%(11/17).双侧卵巢发生有24例,占64.9%(24/37).临床误诊率高达59.5%(22/37).肿瘤组织形态多数以印戒细胞癌和腺癌结构为主要表现.来源部位胃肠道肿瘤占75.6%,子宫内膜样腺癌占16.2%.结论 卵巢转移性肿瘤以胃肠道肿瘤转移最为常见,确诊需病理特征与临床资料相结合.女性胃肠癌手术史者,需密切随访,警惕卵巢转移性肿瘤的发生.