胃大细胞神经内分泌癌

目前胃肿瘤WHO分类中，仅将类癌和小细胞癌包括在神经内分泌（NE）肿瘤中，尽管它们在组织学和预后上差异较大。然而，在实际工作中，有些肿瘤是非小细胞性神经内分泌癌，而且在普通型胃腺癌中可见数量不等的NE肿瘤细胞。根据伴有异质性成分的肿瘤其组织学分类应以其主要成分和（或）去分化成分为基础的原则，这类肿瘤实为非小细胞性神经内分泌癌。为了明确这类暂名为大细胞神经内分泌癌（LCNEC）的组织学和临床特征，作者对2835例切除的胃癌进行了组织学复习和免疫组化CgA和（或）Syn染色，[第一段]     

肺原发性大细胞癌及肉瘤样癌的病理特征和鉴别诊断

2004年出版的WHO肺肿瘤组织学分类（第4版）将肺癌分为鳞状细胞癌，小细胞癌、腺癌、大细胞癌、腺鳞癌、肉瘤样癌，类癌和唾液腺型肿瘤8个主要类型，其中肺大细胞癌及肉瘤样癌同属于发生于肺的低分化或未分化癌，有多种形态学表现，根据病理形态学特征，肺大细胞癌及肉瘤样癌又分为数个亚型，可能造成诊断上的混淆。     

子宫颈癌ΔNp63蛋白表达的临床病理学意义

目的 探讨ΔNp63蛋白表达在子宫颈癌不同组织学类型中的临床病理学意义。方法 43例子宫颈上皮内瘤变（cervical intraepithelial neoplasia，CIN）（包括15例CIN1，6例CIN2和22例CIN3），21例角化型和33例大细胞非角化型宫颈鳞状细胞癌（鳞癌）、40例腺癌、4例神经内分泌癌、4例腺鳞癌、2例移行细胞癌、2例玻璃样细胞癌和1例腺瘤样基底细胞癌的标本选自韩国高丽大学安岩附属医院和延边妇幼保健医院病理科，应用免疫组化染色方法检测ΔNp63蛋白在上述病变组织中的表达情况。结果 ΔNp63蛋白在所有子宫颈鳞癌标本中呈阳性表达，而在所有腺癌则为阴性。随着CIN病变级别的增加，ΔNp63蛋白表达的分布范围也逐渐增多，而且在不同组织学类型的子宫颈癌中，合并鳞状细胞分化（associated with squamous differentiation of uterine cervix）的病变区ΔNp63表达增强，但在腺性分化和神经内分泌分化的区域ΔNp63则不表达。结论 ΔNp63蛋白检测对区分子宫颈癌组织学类型的具有重要意义，且对子宫颈腺癌的鉴别诊断是一个非常有用的指标。     

食管基底细胞样鳞状细胞癌：一种独特的临床病理类型

报道５例罕见的食管基底细胞样鳞状细胞癌。其病理特点为瘤组织以基底细胞佯癌组织为主要成分，并伴有鳞状细胞分化、粉刺状坏死和癌巢内基质玻璃样变。免疫组化显示，基底细胞样癌成分对４种上皮性抗体（高分子量角蛋白Ｋｅｒａｔｉｎ、低分子量角蛋白１０．１１、ＣＥＡ、ＥＭＡ）呈阴性或弱阳性反应，而对Ａｃｔｉｎ及Ｓ－１００部分强阳性。提示此癌分化不良并有向肌上皮等多向分化倾向。临床上此癌高度恶性，首次手术的病例已有区域淋巴结和肺转移。随访４例均死亡，术后存活期平均１２．５个月。     

食管腺癌的细胞学和组织学诊断分析

目的：探讨信用这中段腺癌细胞学诊断意义。方法：对２０例食管腺癌病例的组织切片和细胞学涂片进行形态学对照观察。结果：印戒细胞癌３例,粘液腺癌７例,管状腺癌６例,腺鳞癌２例,粘液表皮样癌２例。其细胞学的共同特征为细胞学涂片中常出现粘液背景或含粘液的癌细胞,细胞学与病理组织学诊断的符合率达９０％。结论：细胞学有助于食管腺癌的诊断食管腺癌可能起地食管固有腺。     

上皮样型恶性周围神经鞘瘤

我们拟探讨上皮样型恶性周围神经鞘瘤形态学特征与预后的关系。１２例经光镜和免疫组化观察，其中７例作了电镜观察。组织学可分为纯上皮样型（５例）；混合型、伴有梭形细胞区（５例）和骨化型（２例）。１２例均呈Ｓ－１００蛋白阳性表达，并显示多种细胞骨架异质性，包括（１）神经细胞分化：表现为ＮＳＥ和神经微丝阳性反应，节细胞分化；（２）上皮性分化：角蛋白阳性反应，电镜见有桥粒和张力微丝束；（３）间叶性分化：波形蛋白阳性、骨化生和横纹肌样表型。该瘤的异质性与侵袭性同步，异质性明显的３例均因肺转移死于就诊后７个月至４年。     

ras p21基因蛋白产物在胃肝样腺癌细胞内表达的研究

目的：探讨胃肝样腺癌及普通型胃癌ｐ２１基因蛋白产物表达情况，进一步判断肿瘤的恶性程度。方法：应用免疫组化ＡＢＣ法，对２８例胃肝样腺癌进行检测。结果：２８例胃肝样腺癌Ｐ２１基因表达阳性率９６．４％，其中染索状１８例，团块状１０例，共阳性表达明显高于普通型胃癌。结论：检查胃肝样腺癌Ｐ２１基因蛋白产物表达，为临床治疗及判断预后提供重要依据。     

胃混合性外分泌-内分泌癌的临床病理分析

目的 探讨胃混合性外分泌-内分泌癌的病理形态学特征.方法 对100例胃癌利用Syn、CgA、CD56和NSE四种抗体进行免疫组化检测,筛出23例混合性外分泌-内分泌癌,进行病理形态学观察.结果 具有外分泌特征的区域可见分化好或分化差的管状腺癌、乳头状腺癌、黏液腺癌、印戒细胞癌、未分化癌等组织学形态,具有神经内分泌特征的区域可以看到6种不同的组织形态学表现:分化好的腺管状、分化差的低分化腺癌样、印戒细胞或黏液腺癌样、小细胞癌样、髓样癌样、淋巴上皮癌样.在同一病例内以上6种形态或以不同比例出现,或以某一种形态为主.结论 胃混合性外分泌-内分泌肿瘤并不少见,形态学上与常见的胃腺癌不易区别,需要依靠免疫组化进行检测,其生物学行为是否与腺癌存在明显差异,需要进一步研究.     

锁骨上淋巴结转移癌233例分析

目的：探讨锁骨上淋巴结（SCL）已知发部位转移癌的病理学特别。方法：对1980－1999年（近20年）233例和1961－1980年（前20年）246例已知原发部位SCL转移癌患者的性别、年龄、转移癌原发部位和组织学类型等进行比较分析。结果：近20年来，转移癌的患者趋于高龄、女性增多，转移性肺癌（尤其是左侧SCL）增多，双侧SCL转移癌的原发部位皆肺居首位，转移性腺癌、鳞癌和未分化癌也首先来自肺，左侧SCL转移性黏液腺癌（包括印戒细胞癌）主要来自胃肠道（6／10例，特别是胃），右侧者全部来自肺（8／8例）等。结论：在寻找SCL来源未明转移癌的原发部位时，任何一侧（尤其是右侧）SCL转移癌（无论是腺癌、鳞癌或未分化癌）都应首先考虑转移性肺癌的可能性。     

13例宫颈透明细胞腺癌临床病理及免疫组化分析

１３例与妊娠期宫内接触乙雌芪酚（ＤＥ８）无关的宫颈透明细胞癌１３例，占同期宫颈腺癌的３．９５％。随访有８例生存５年以上。病理组织学上微囊为主型４例，乳头－腺管为主型８例，实体片状为主型１例。通过形态学、ＡＢ／ＰＡＳ组化染色及ＥＭＡ、ＣＥＡ、ＰＲ、ＥＲ、Ｖｉｍｅｎｔｉｎ免疫酶标检测，结果证明该癌起自苗勒管上皮，为宫颈腺癌的一种特殊类型。     

Morphological study of 391 cases of exocrine pancreatic tumours with special reference to the classification of exocrine pancreatic carcinoma

Three hundred and ninety-one cases of primary pancreatic tumours, excluding endocrine tumours, were studied histologically. Carcinoma of the exocrine pancreas formed the largest group (98.5 per cent), benign tumours (1.25 per cent) and other malignant tumours (0.25 per cent) formed the remainder. Ductal adenocarcinoma was the commonest type and was divided into four sub-types, papillary, well, moderately and poorly differentiated duct adenocarcinoma. The moderately and poorly differentiated tumours were the commonest types. Papillary carcinoma was separated from the well differentiated tumours by its different morphological appearances and was found to exhibit different behaviour. Other special morphological types of pancreatic carcinoma, pleomorphic, mucinous, adenosquamous, acinar, microadenocarcinoma, cystadenocarcinoma and oncocytic carcinoma were also represented. Benign microcystadenomata (four cases) were considered because of their interesting morphological features and their significance in the differential diagnosis of carcinoma. Based on the morphology and behaviour of these 391 tumours, the classification of pancreatic carcinoma is discussed and some rare types are compared with previously reported cases and discussed.     

Mucosubstance histochemistry of the normal mucosa and epithelial neoplasms of the lung

Histochemical properties of mucosubstances in normal lung tissue and carcinoma of 30 operated cases were investigated using various histochemical methods. Epithelial cells lining the respiratory tract were characterized by their specific mucosubstances. Namely, the ciliated cells had a thick surface coat consisting of sulfomucins. Basal cells showed intense reactivity to Ulex europeus agglutinin-I (UEA-I) and Arachis hypogaea agglutinin (PNA). The goblet cells differed from the glandular mucous cells in their PNA and UEA-I reactivities. The Clara cells and type II pneumocytes resembled each other in having a surface coat consisting of PNA- and Maclura pomifera agglutinin (MPA)-reactive sialomucins. Carcinoma cells also had mucosubstances varying with cases and with cells of the same case, but surface coat-type mucin of Clara cell-type adenocarcinoma resembled that of the Clara cell and type II pneumocyte. Squamous cell carcinoma had only a small amount of mucosubstance which was histochemically similar to that of the basal cell.     

MUCOSUBSTANCE HISTOCHEMISTRY OF THE NORMAL MUCOSA AND EPITHELIAL NEOPLASMS OF THE LUNG

Histochemical properties of mucosubstances in normal lung tissue and carcinoma of 30 operated cases were investigated using various histochemical methods. Epithelial cells lining the respiratory tract were characterized by their specific mucosubstances. Namely, the ciliated cells had a thick surface coat consisting of sulfomucins. Basal cells showed intense reactivity to Ulex europeus agglutinin-I (UEA-I) and Arachis hypogaea agglutinin (PNA). The goblet cells differed from the glandular mucous cells in their PNA and UEA-I reactivities. The Clara cells and type II pneumocytes resembled each other in having a surface coat consisting of PNA- and Maclura pomifera agglutinin (MPA)-reactive sialomucins. Carcinoma cells also had mucosubstances varying with cases and with cells of the same case, but surface coat-type much of Clara cell-type adenocarcinoma resembled that of the Clara cell and type II pneumocyte. Squamous cell carcinoma had only a small amount of mucosubstance which was histochemically similar to that of the basal cell.     

Collision metastasis of prostatic and colonic adenocarcinoma: report of 2 cases

Collision metastases of carcinomas in lymph nodes are rare. Carcinoma metastasizing to lymph nodes containing malignant lymphoma has also been reported. The literature contains 3 cases of collision metastasis of prostatic and urothelial carcinoma. To our knowledge, we report the first 2 cases of collision metastasis of prostatic and colonic adenocarcinoma, one involving a mesenteric lymph node and the other involving a perirectal lymph node, both from resections for colonic adenocarcinoma in patients with known metastatic prostatic carcinoma.     

Uterine cervical carcinomas associated with lobular endocervical glandular hyperplasia

Tsuji T, Togami S, Nomoto M, Higashi M, Fukukura Y, Kamio M, Yonezawa S & Douchi T
(2011) Histopathology 59 , 55–62 Uterine cervical carcinomas associated with lobular endocervical glandular hyperplasia Aims: To investigate the clinicopathological features of cervical uterine carcinoma associated with lobular endocervical glandular hyperplasia (LEGH). Methods and results: Subjects comprised 12 patients with cervical carcinoma associated with LEGH. Carcinoma included nine invasive adenocarcinomas, two adenocarcinoma in‐situ (AIS) and one microinvasive squamous cell carcinoma (SCC). Baseline characteristics, cervical cytology, human papilloma virus (HPV) status, immunohistochemistry, surgical procedures and clinical outcomes were investigated. There was a pair of adenocarcinoma cases in a mother and daughter unrelated to Peutz–Jeghers syndrome. In all patients, atypical cells were seen on cervical cytology (adenocarcinoma cells in 11 cases and SCC cells in one). All the 12 patients were positive for mucin antigen 6 (MUC6) in the LEGH component, while seven patients were positive for gastric mucin (HIK1083). HPV was detected only in the SCC component. One patient with adenocarcinoma stage Ib died of disease 4 years after radical hysterectomy. The others are currently alive 2–16 years postoperatively. Conclusions: The diagnosis of adenocarcinoma with LEGH is not always difficult. The prognosis of adenocarcinoma associated with LEGH may be better than previously expected. Adenocarcinoma with a LEGH component does not always develop into a highly aggressive minimal deviation adenocarcinoma.     

Basal cell adenocarcinoma in minor salivary glands

Basal cell adenocarcinoma is a rare and relatively recently characterized malignant salivary gland tumour, the malignant counterpart of basal cell adenoma. Diagnosis depends on finding features similar to adenoma but with an infiltrative growth pattern and exclusion of adenoid cystic carcinoma, sialoblastoma and basaloid squamous carcinoma. Basal cell adenocarcinoma is very rarely reported in minor salivary glands. We report three cases of basal cell adenocarcinoma affecting the labial, buccal and palatal minor salivary glands. One recurred following complete removal but with lesional disruption and further local wide excision appeared curative. A further lesion failed to recur in 5 years' follow-up despite marginal excision and a third after 3 years' follow-up. Basal cell adenocarcinoma is considered a low-grade malignancy, and in the minor glands wide excision and radiotherapy are recommended. However, the reported lesions appear to have a more indolent behaviour than previously reported lesions in minor glands.     

Basal cell hyperplasia of the prostate

Basal cell hyperplasia of the prostate is a rare, benign lesion that often has been misdiagnosed as adenocarcinoma. Thirteen cases of basal cell hyperplasia were reviewed. All of the patients were over 60 years of age (range 63-83) and all had benign prostatic hypertrophy in addition to basal cell hyperplasia. Histologic features consisted of nests of uniform small cells with scant cytoplasm forming solid nests and acinar structures. Some foci had nodular configurations and most were located within larger nodules of "typical" glandular hyperplasia. In some instances there was a merging of the two types of hyperplasia. There was neither nuclear atypia nor pleomorphism, and the adjacent stroma was hyperplastic. Small elongated cells with desmosomes and nonspecific, dense bodies were seen on electron microscopic studies of formalin-fixed material. The architectural and cytologic features of the basal cell proliferations were not those of carcinoma. However, synchronously, two patients demonstrated foci of prostate carcinoma unrelated to the basal cell hyperplasia.     

Morphologic and molecular-genetic characterization of lung cancer developing in people who have worked at nuclear facilities and who have lived in Russian territories polluted after the accident at the Chernobyl power plant

Clinicomorphological analysis of 15 lung carcinomas of patients who had been exposed for a long time to the radiation after the Chernobyl accident was performed. The material consisted of 10 surgical and 5 autopsy cases and was studied at the light, electron microscopic and immunohistochemical level. There were 6 peripheral, 8 central carcinomas and one massive tumor. Fibrous areas with many dust particles were found in peripheral carcinomas. In central tumors chronic obstructive bronchitis with epithelial dysplasia and metaplasia was observed. Carcinoma was represented by various histologic types: small cell (4 cases), combined small cell with squamous differentiation (5 cases), adenocarcinoma (5 cases), adenosquamous type (1 case). Peculiar calcium deposits in both stroma and parenchyma were found in tumors with glandular differentiation. Morphogenesis of calcium microdeposits may be connected with dust radioactive particles elimination. Central carcinoma had, in the majority of cases, a neuroendocrine differentiation and can be related to some types of small cell carcinoma. Peripheral cancer was mostly of a glandular differentiation and was, as a rule, carcinoma in the scar. Lung carcinomas studied had peculiar molecular-genetic features: lack or low bcl-2 expression, low Ki-67 expression and a high degree of c-myc expression. Tumors were characterized by a low apoptosis index independently of a histologic type. Apoptosis was not complete: lack of apoptotic bodies phagocytosis this resulting in postapoptotic detritus formation.     

Molecular characterization of Italian nevoid basal cell carcinoma syndrome patients

Mutations in the PTCH gene, the human homolog of the Drosophila patched gene, have been found to lead to the autosomal dominant disorder termed Nevoid Basal Cell Carcinoma Syndrome (NBCCS, also called Gorlin Syndrome). Patients display an array of developmental anomalies and are prone to develop a variety of tumors, with multiple Basal Cell Carcinomas occurring frequently. We provide here the results of molecular testing of a set of Italian Nevoid Basal Cell Carcinoma Syndrome patients. Twelve familial patients belonging to 7 kindreds and 5 unaffected family members, 6 non-familial patients and an additional set of 7 patients with multiple Basal Cell Carcinoma but no other criteria for the disease were examined for mutations in the PTCH gene. All of the Nevoid Basal Cell Carcinoma Syndrome patients were found to carry variants of the PTCH gene. We detected nine novel mutations (1 of which occurring twice): 1 missense mutation (c.1436T>G [p.L479R]), 1 nonsense mutation (c.1138G>T [p.E380X]), 6 frameshift mutations (c.323_324ins2, c.2011_2012dup, c.2535_2536dup, c.2577_2583del, c.3000_3005del, c.3050_3051del), 1 novel splicing variant (c.6552A>T) and 3 mutations that have been previously reported (c.3168+5G>A, c.1526G>T [p.G509V], and c.3499G>A [p.G1167R]). None of the patients with multiple Basal Cell Carcinoma but no other criteria for the syndrome, carried germline coding region mutations.     

脾脏转移癌的临床病理特点

目的探讨脾脏转移癌的临床病理特点及其转移规律。方法总结16例脾脏转移癌病例,复习临床、外检、尸检记录资料,对其性别、年龄、临床症状、原发部位、组织学类型、脾脏的大体特点、脾脏内肿瘤的生长方式进行了分析。结果16例脾脏转移癌中,男性12例,女性4例;男性显著多于女性;年龄范围从48岁到90岁,其中位年龄为66．5岁;临床症状主要表现为左上腹不适,疼痛,消瘦乏力,食欲不振等,有些病例可扪及脾肿大,CT可发现脾内占位。肺是脾脏转移癌的最主要的原发部位,占总例数的43．8％（7／16）;男性最常见的原发部位是肺,占50．0％（6／12）,而女性最多见的是卵巢（2／4）。组织学类型中,肺未分化癌是最多见的类型,占25．0％（4／16）,其中小细胞未分化癌3例,大细胞未分化癌1例;其他依次为：肺细支气管肺泡癌2例;结肠腺癌2例;卵巢浆液性乳头状囊腺癌2例;前列腺腺癌2例。男性最多见的类型是肺未分化癌,而女性为卵巢浆液性乳头状囊腺癌。脾脏转移癌的生长方式分为单结节性、弥漫性和多结节性3种类型,多数肿瘤表现为单结节性的生长方式,少数高转移潜能的肿瘤（5／16）表现为弥漫性和多结节的生长方式,包括肺小细胞未分化癌（3／3）,肺腺癌（1／1）和前列腺腺癌（1／2）。结论脾脏转移癌少见,掌握其临床病理形态特点对于病理诊断和临床处理有指导意义。