高龄胆囊癌肉瘤患者伴发胆囊结石1例报告并文献复习

<正>胆囊癌肉瘤(gallbladder carcinosarcoma)是恶性上皮成分与恶性间叶成分交织混合生长的恶性肿瘤,由Landsteiner[1]于1907年首先报道,其恶性程度高,预后差,临床上极其罕见。本文通过总结我院肝胆外科1例胆囊癌肉瘤的诊治经验,结合相关文献资料,对该病的发生机制、临床表现、影像特征、病理特点、鉴别诊断及预后进行探讨,现报告如下。1病例资料男性患者,82岁,因"反复右上腹疼痛20年,再发1个月"     

细胞粘附分子在胆囊癌中表达的意义

研究胆囊癌组织中细胞粘附分子CEA和CD44v6蛋白表达的意义。用免疫组化法检测 44例胆囊癌组织中CEA和CD44v6蛋白的表达。 44例胆囊组织中CEA和CD44v6蛋白表达的阳性率分别为 75 %和 48% ;两者的表达与肿瘤浸润外膜和淋巴结转移均呈正相关 (P <0 0 5 ) ;胆囊癌组织中CEA和CD44v6蛋白呈协同表达 (P<0 0 5 )。CEA和CD44v6蛋白与胆囊癌的发展和淋巴结转移密切相关。     

胆囊癌组织中微血管定量及其意义

应用第Ⅷ因子相关抗原的单克隆抗体ＡＢＣ免疫组化，研究４０例胆囊癌组织中微血管。发现低分化腺癌微血管定量，明显高于分化腺癌和鳞癌，组织学分级Ⅲ级和炎性细胞浸润＋＋级病例微血管定量明显高于组织学分级Ⅰ级和炎性细胞浸润Ｏ级病例，转移胆囊癌微血管定量明显高于未转移胆囊癌。     

PTEN和P16基因蛋白在胆囊癌组织中的表达

[目的]探讨PTEN和P16基因蛋白在胆囊癌组织中表达的意义。[方法]应用免疫组织化学技术检测58例胆囊腺癌、20例胆囊腺瘤和20例慢性胆囊炎组织中PTEN和P16基因蛋白表达。[结果]胆囊癌患者PTEN和P16表达阳性率分别为43．1％（25／58）和37．9％（22／58），其表达阳性率均明显低于胆囊腺瘤和慢性胆囊炎（P〈0.05）。PTEN和P16表达与胆囊癌的分化程度、浆膜浸润和转移相关（P〈O．05）。[结论]检测PTEN和P16基因蛋白表达可作为评估胆囊癌生物学行为和预后的参考指标。     

胆囊癌组织中PTEN的表达及意义

采用免疫组化SP法检测10胆例囊炎和40例胆囊癌患者胆囊组织中PTEN的表达。结果显示PTEN蛋白主要定位于细胞质,胆囊炎组织PTEN蛋白表达强度显著高于胆囊癌组织（P〈0.01）。胆囊癌组织中PTEN蛋白表达强度与肿瘤浸润深度、肿瘤分化程度、淋巴结转移情况和病理分级有相关性（P均〈0.05）。认为PTEN基因在胆囊癌组织中表达降低。PTEN表达下调在胆囊癌的发生发展中发挥作用。     

纵隔原发性粒细胞肉瘤二例

正粒细胞肉瘤(granulocytic sarcoma,GS)也称髓系肉瘤(myeloid sarcoma,MS),是一种由未成熟髓系细胞在髓外增生和浸润而形成的实体恶性肿瘤。GS包括白血病性(白血病髓外浸润)和非白血病性(原发性或孤立性)[1]。几乎可以发生于全身的各个部位,常累及骨骼、软组织、淋巴结、皮肤、胃肠道及睾丸[2]。GS单独发生时,其骨髓无白血病表现,称为原发性粒细胞肉瘤(primary granulocytic sarcoma,PGS),原发性粒细胞肉瘤发病率极低,发生于纵隔的粒细胞肉瘤更为罕见,国内外文献仅有少量个案报道[3]。本文报道我院确诊的2例纵隔原发性粒细胞肉瘤,以提高对本病的认识,避免误诊误治。     

女性生殖道苗勒腺肉瘤9例临床病理学分析

目的分析9例女性生殖道苗勒腺肉瘤(female genital tract Müllerian adenosarcoma,FGTMA)的临床病理特征、免疫表型,提高对该病的认识。方法回顾性分析病理确诊的9例FGTMA的临床和组织学特征及免疫表型,并随访观察。结果临床主要表现为阴道不规则流血、盆腔包块和子宫颈肿物。全部行手术治疗,5例术后辅以化疗,1例放疗。肿瘤由良性腺上皮和肉瘤性间质组成。5例伴有异源性成分,其中4例同时伴肉瘤样过度生长。免疫表型:腺上皮细胞角蛋白(CK)均阳性;间质波形蛋白(vimentin)均阳性,2例P53均≥75%细胞弥漫阳性,5例P16阳性,MutS同源蛋白2(MSH2)、MutS同源蛋白6(MSH6)、Mut L同源蛋白1(MLH1)1例同时阴性。Ki-67增殖指数5%～45%。结论 FGTMA临床无特异性,确诊依赖病检。早期且完整切除病灶者预后较好,晚期且合并肉瘤样过度生长者预后差。     

胆囊癌组织CD15抗原表达意义

目的 探讨CD15抗原的表达及含量与胆囊癌的临床病理意义。 方法 应用微波-LSAB免疫组织化学法和图象分析技术,检测45例胆囊癌,17例胆囊腺瘤和10例慢性胆囊炎组织中CD15抗原表达及含量。 结果 CD15抗原表达阳性率及阳性细胞积分A值,在胆囊癌中(71％,4.0±3.2)显著高于胆囊腺瘤(35％,0.9±0.3)和慢性胆囊炎(20％,0.4±0.1)(P<0.05,P<0.01);胆囊癌Ⅱ,Ⅲ级(90％,5.4±1.7)显著高于Ⅰ级(58％,2.2±3.1)(P<0.05,P<0.01);有转移的肿瘤(88％,6.5±3.5)(P<0.05,P<0.01);显著高于无转移的肿瘤(52％,3.3±2.1)(P<0.01)。 结论 CD15抗原表达与胆囊癌的发生、细胞增殖、分化和转移相关,对判断胆囊癌的恶性程度、预测生物学行为和预后具有一定临床意义。     

髓系肉瘤2例

髓系肉瘤（myeloid sarcoma，MS）作为白血病初发症状较少见，其临床表现及细胞形态不典型，极易误诊为恶性淋巴瘤。病理、免疫组织化学染色在髓系肉瘤诊断中意义是十分重要的。2007年我科诊断2例，现报道如下。     

Clinicopathologic features of the flat adenoma

One hundred twenty-eight small flat adenomas (SFAs) were collected from 101 patients, and the clinicopathologic features were investigated. There were 91 adenomas with mild atypia, 20 with moderate atypia, and 17 with severe atypia. SFAs were found more often in males than in females, with a ratio of 3.4:1, and the malignancy rate in females (31.8 percent) was higher than in males (9.3 percent). About 38 percent of the patients had a history of colorectal carcinoma, and 65 percent had a history of colorectal neoplasms. Of 37 patients whose family history was traced, 21 had cancer families. SFAs were prone to be found in patients with a history of colorectal neoplasms and a cancer family. Malignancy rate increased with increasing size. The overall malignancy rate was 13.3 percent, which was considerably higher than that of ordinary small polypoid adenomas (2.8 percent). SFAs were situated more proximally (30.9 percent) than ordinary adenomas; however, there was no relationship between site and malignancy. All the lesions showed tubular adenomas, and there was no villous feature. A central depression was noted in 20 lesions, more frequently in adenomas with higher atypia. All but one adenoma with severe atypia showed a component of lower atypia, supporting the adenoma-carcinoma sequence.     

大肠癌临床病理特征分析

[目的]分析大肠癌患者的临床病理特征,探讨其发病特点及临床诊断线索。[方法]回顾性分析经手术病理诊断的75例大肠癌患者的临床资料。[结果]75例中以65岁以上患者所占比例最高,腹痛、排便习惯改变及粪便性状改变是其主要的临床表现。右半结肠癌女性发病例数高于男性,左半结肠癌中男性发病例数高于女性,右半结肠癌组大便潜血阳性率及贫血发生率高于左半结肠癌组。血清CEA阳性率高于CA19-9、CA125,病理类型以中分化腺癌最多见,TNM分期以T4期最多。[结论]大肠癌老年女性发病率有增多倾向,不明原因的贫血、便潜血阳性是大肠癌报警症状,血清CEA在大肠癌的诊断中有一定的价值。     

Clinicopathologic features of hepatic diabetic microangiopathy

Objective To study the clinicopathological features of diabetic microangiopathy in liver and diabetic hepatosclerosis(DHS) of elderly male with type 2 diabetes mellitus(T2DM).Methods One hundred and twenty autopsy cases with T2DM (diabetic group) and contemporary 48 cases,non-diabetic     

Clinicopathologic features of ampullary carcinoma without jaundice

GOALS: To evaluate clinicopathological features of ampullary carcinoma without jaundice. BACKGROUND:: Obstructive jaundice is the most common symptom of patients with ampullary carcinoma. However, some patients with ampullary carcinoma do not have jaundice at the time of diagnosis. STUDY: Clinicopathologic findings of 23 patients with ampullary carcinoma showing no visible jaundice (serum total bilirubin <3.0 mg/dL) and 38 patients with ampullary carcinoma showing jaundice at the time of diagnosis were retrospectively compared. RESULTS: Fifteen of 23 patients with nonjaundiced ampullary carcinoma complained of fever and/or abdominal pain. Five asymptomatic patients were found to have a dilated bile duct on screening ultrasound or to have a tumor-like swelling of the papilla of Vater during routine upper gastrointestinal endoscopy. There was no significant difference in age, sex, size, macroscopic type, histologic type, rates of duodenal invasion, pancreatic invasion, and lymph node metastasis, and prognosis between the two groups. The cumulative 5-year and 10-year survival rates of nonjaundiced patients were 70.2% and 49.0%, compared with 33.6% and 29.4% of jaundiced patients. Ten of the 23 nonjaundiced ampullary carcinomas (43%) were in Stage I, whereas 4 of the 38 jaundiced ampullary carcinomas (11%) were in Stage I (P < 0.01). Mechanisms of nonjaundice in ampullary carcinoma were suspected to be determinant by the infiltrating pattern of the carcinoma to the lower portion of the bile duct. CONCLUSIONS: Mechanisms of nonjaundice in ampullary carcinoma might be determined by the infiltrating pattern of the carcinoma to the lower portion of the bile. As a greater number of nonjaundiced ampullary carcinomas were in an early stage, detection of them may provide an improved clinical outcome.