恶性睾丸间质细胞瘤3例报告及文献复习

目的：探讨成人恶性睾丸间质细胞瘤的临床病理特点,明确适宜的治疗方式.方法：回顾性分析我院从1997年6月至2009年12月诊治的3例成年恶性睾丸间质细胞瘤患者,分析其临床资料包括症状体征、实验室检查、影像学检查、治疗方式、病理结果及随访情况.结果：3例患者均行睾丸根治性切除术.1例患者术后9个月出现淋巴结转移,13个月出现肺转移并于术后26个月死于肿瘤广泛转移;另2例患者术后即刻行腹膜后淋巴结清扫发现了CT未提示的腹膜后淋巴结转移,其中1例术后43个月出现肺转移.结论：部分成人睾丸间质细胞瘤呈恶性病程,需严密随诊.腹膜后淋巴结清扫术具有诊断价值,转移患者预后较差.     

Mees线一例

患者女,41岁.2007年2月初发现左侧乳腺一肿块,大小4 cm×1.5 cm×1.5 cm,2月5日在当地医院行手术切除,术后病理:左侧乳腺浸润性导管癌,乳头、腋下脂肪组织及肌肉未见癌转移,淋巴结未见癌转移(0/5).术后给予异环磷酰胺、甲氨蝶呤和氟尿嘧啶先后化疗3个周期,预行第4周期化疗时发现右侧乳腺肿块,大小2 cm×1.5 cm×3 cm.2007年6月21日到我院就诊,6月26日行改良根治术.术后病理为:右乳浸润性导管癌,淋巴结未见转移(0/2).     

腮腺低分化腺癌皮肤转移1例

患者男,65岁,左侧面部起疹1个月,临床表现为左侧面部约5 cm×8 cm边界清楚的褐色斑块。皮损组织病理示：表皮未见明显异常,真皮层可见分化较差的瘤细胞弥漫巢片状分布,细胞核大深染,染色质粗糙,核仁易见,异型性明显,可见少许核分裂象,部分区域残存腺管样结构,间质纤维组织增生,大量淋巴浆细胞浸润。免疫组织化学：CK7(+)、AE1/AE3(+)、GATA3(+)、CAM5.2(+)、Ki-67(20%+);S-100(-)、TTF-1(-)、PSA(-)、p63(-)、PAX8(-)、CD30(-)、Vim(-)。诊断：左侧腮腺低分化腺癌、左侧面部皮肤转移腺癌。治疗：术前辅助化疗(多西他赛120 mg d1+顺铂30 mg d1～4,每3周1次),保留面神经左侧腮腺及肿物切除术+邻近淋巴结切除术,术后化疗(多西他赛100 mg d1+顺铂100 mg d1,每3周1次)。     

前列腺小细胞神经内分泌癌1例报告并文献复习

目的:总结前列腺小细胞神经内分泌癌的临床表现、诊断、治疗及预后,提高对其认识。方法:报告1例42岁中年男性前列腺小细胞神经内分泌癌患者,以下尿路梗阻为表现起病,肛门指检提示前列腺体积左侧增大,前列腺特异性抗原(prostate specific antigen,PSA)正常。泌尿系彩超、CT及MR提示前列腺占位。结果:前列腺穿刺活检组织病理结果显示前列腺小细胞神经内分泌癌。患者行经腹膜外途径腹腔镜下前列腺癌根治术,术后肿瘤复发并转移,采用依托泊苷联合顺铂方案化疗6个疗程,结果使肿瘤体积缩小,效果良好。结论:前列腺小细胞神经内分泌癌为临床罕见病,起病隐匿,症状不典型,以病理检查和免疫组化确诊,早期可行根治性手术治疗,术后或晚期以化疗为主,疗效肯定,生存期短,预后不良。     

乳房外Paget’s病伴多发转移

患者男,71岁。阴囊右侧皮肤肿物1年余,阴囊水肿1个月。皮肤科检查：阴囊右侧可见5 cm×4 cm乳头瘤样增生性肿块,界限清楚,中央潮红、糜烂,伴白色分泌物,部分区域上覆秽黄色厚痂及米粒至绿豆大薄壁水疱,触之易出血,基底及周围有浸润感,质硬,阴阜可见散在米粒大浸润性暗红色丘疹,阴囊及阴茎明显水肿。皮损组织病理：表皮内Paget细胞团,真皮内可见浸润的肿瘤细胞,免疫组化示细胞角蛋白（CK）7及巨囊性病液体蛋白（GCDFP）-15阳性,CK20阴性。辅助检查：PET-CT示左颈部淋巴结、双肺门、纵膈、腹膜后、盆腔及左髂骨转移可能。诊断：乳房外Paget’s病伴多发转移。治疗：至成形科行右侧阴囊病变扩大切除、左侧腹股沟淋巴结部分清扫术,目前正在术后放疗中。     

一例转移性黑素瘤患者经综合性治疗存活14年

患者男,1934年出生.1997年8月患者无意中发现左手大拇指桡侧甲缘一米粒大小淡黑色斑丘疹,表面无溃烂,到四川大学华西医院普外科就诊,诊断为"色素痣",予CO2激光治疗后局部皮损消失.1999年3月患者发现左腋窝淋巴结肿大,约5 cm×4 cm,穿刺细胞学检查见恶性瘤细胞(考虑为黑素细胞),予左腋窝淋巴结清扫术,术后化疗7周期,具体化疗方案及剂量不详.化疗结束予重组人干扰素γ(IFN-γ)100万U肌内注射每日1次,2个月后减为隔日1次,治疗2个月,再以每周2次维持治疗约1年.治疗期间局部淋巴结及皮下未见增生结节.     

右大腿巨大脂肪肉瘤北大核心CSCD

报告1例右大腿巨大脂肪肉瘤。患者男,72岁。发现右大腿包块18年,包块进行性增大伴右下肢活动后肿痛1年。皮肤科检查见右大腿内侧巨大皮下肿物,质稍软,边界不清。术前磁共振成像示右大腿内侧见15.3 cm×15.8 cm×28.0 cm的不规则短T1长T2信号,压脂序列信号不均。予以手术切除肿瘤,称重约5.25 kg。术后组织病理提示高分化脂肪肉瘤。出院1年后随访未见复发。     

膀胱癌皮肤转移一例

<正>临床资料患者,女,78岁。于3年前因无痛性肉眼血尿1个月诊断为浸润性尿路上皮肿瘤,行根治性膀胱切除及回肠膀胱术,术后病理提示浸润性高级别尿路上皮癌,浸透膀胱壁全层达周围脂肪组织,并累及左侧输尿管开口处,膀胱脂肪外侧浆膜未见累及,两侧输尿管断端未见癌细胞,淋巴结未见转移。术后出现下肢静脉血栓,未行放化疗。术后半年开始出现间断尿道口溢血,2次行尿道镜检查均于尿道口盲端见多发乳头状肿物,予激光切除,并于半年前行     

继发性皮肤弥漫大B细胞淋巴瘤1例

报告1例继发性皮肤弥漫大B细胞淋巴瘤。患者男,76岁,因左小腿结节1月余就诊。皮肤专科检查:左小腿可见多个2~5cm大小淡褐色结节,压痛明显,左侧腹股沟可扪及一大小约2cm×2cm大小淋巴结,质软,活动度一般,无压痛,余全身浅表淋巴结未扪及肿大。皮损组织病理示:真皮中下层弥漫较大淋巴细胞样细胞浸润,肿瘤细胞形态不规则,异形明显,核大深染,胞浆丰富,病理核分裂象易见。免疫组化:CD20弥漫阳性(+++);Bcl-6(+++);MUM-1部分阳性(++);Ki-6780%~90%(+)。FISH基因检测:BCL6基因发生断裂。诊断:弥漫大B细胞淋巴瘤ⅣB期。予R(利妥昔单抗)+miniCHOP方案(美罗华+环磷酰胺+长春地辛+表柔比星+地塞米松)化疗1次,后患者家属放弃治疗,患者2个月后死亡。     

头皮原发性大汗腺癌1例

报告1例头皮原发性大汗腺癌。患者男,66岁,因"头皮无痛性肿物1年,术后复发1个月"就诊。皮肤专科检查:右侧头顶部见一手术切口,大小约4 cm×1 cm,周围无红肿、渗液。头皮肿物病理检查:肿瘤于真皮内浸润性生长,细胞呈列兵样或巢团样排列,圆形、卵圆形,胞浆嗜酸性,核大而空泡状,核仁明显,核分裂像易见,间质纤维组织致密伴玻璃样变及炎细胞浸润。影像学检查:PET-CT:右侧顶部头皮术后局部软组织增厚;右侧耳后2枚淋巴结代谢增高,转移可疑;超声等示:双侧乳腺区及腋下未见特殊。结合临床表现、病理学及影像学检查,诊断:头皮原发性大汗腺癌并右侧耳后淋巴结转移。患者予25次头皮及耳后放疗,放疗期间同步口服卡培他滨化疗,剂量为早上1 500 mg晚上2 000mg,2次/天,疗程为14天,停7天,共6周期。患者临床症状缓解,随访10个月,复查无异常。     

Metastatic basosquamous carcinoma detected by sentinel lymph node biopsy

We describe a rare case of basosquamous carcinoma (BSC) in a 69‐year‐old man. He had noticed a pigmented nodule on his left thigh. Dermoscopic examination showed ulceration at the center and non‐typical leaf‐like areas at the periphery. Linear‐irregular vessels were also seen. He underwent tumor excision in addition to sentinel lymph node biopsy (SLNB). Histopathological examination revealed both features of basal cell carcinoma (BCC) and squamous cell carcinoma. The sentinel lymph node was positive for tumor cells. Immunostaining for Ber‐EP4 was focally positive for invasive tumor cells. Although complete inguinal lymphadenectomy had been performed, multiple in‐transit metastases around the primary lesion and left iliac lymph node metastasis developed after the operation. It is considered that BSC has a worse prognosis than BCC with a potential for metastasis. Based on the findings of previously reported cases and our case, SLNB may be applied for certain high‐risk cases including BSC larger than 3 cm in size and careful follow up is recommended for patients with BSC.     

皮肤鳞状细胞癌中基质金属蛋白酶2及金属蛋白酶组织抑制因子2的表达

目的：探讨皮肤鳞状细胞癌(简称鳞癌)中基质金属蛋白酶2(MMP-2)、金属蛋白酶组织抑制因子2(TIMP-2)的表达及其与肿瘤分化程度和淋巴结转移的关系。方法：用ABC免疫组化技术观察50例皮肤鳞癌(高分化鳞癌34例，低分化鳞癌16例，其中14例淋巴结转移)。结果：MMP-2与TIMP-2均表达于瘤细胞和癌旁间质细胞、血管内皮细胞质中。MMP-2表达阳性率为76％(38／50)，在低分化鳞癌组中的表达明显高于高分化组(P=0．021)和有淋巴结转移组(P=0．003)。TIMP-2表达阳性率为74％(37／50)，在高分化或无淋巴结转移的鳞癌组中的表达明显高于低分化(P=0．010)或有淋巴结转移组(P=0．018)。结论：皮肤鳞癌中MMP-2和TIMP-2表达与其分化程度及淋巴结转移有关。     

Paget's disease of the breast in a man with neurofibromatosis

A 68-year-old white man with type 1 neurofibromafosis presented with a 1 -year history of a pruritic non-healing eruption on his left breast. The persistent lesion had been gradually enlarging. This had been unsuccessfully treated with both corticosteroid and antifungal creams. Physical examination of the involved breast revealed a well-demarcated 5 × 3 cm red, slightly Jnfiltrated piaque with adherent fine white scale and erosions with serous exudate (Fig. 1). The areola was completely obscured by the lesion and the nipple could not be identified. Neither a breast mass nor axillary adenopathy was present. A punch biopsy confirmed the diagnosis of Paget's disease. The patient subsequently underwent a left modified radical mastectomy with ipsilateral lymph node dissection. The final pathology revealed intraductal carcinoma, comedo and noncomedo type, with overlying pagetoid cells in the epidermis (Figs 2–4). Special stains included a positive epithelial membrane antigen, focally positive carcinoembryonic antigen, and negative S-100. All 21 lymph nodes submitted from the axillary lymph node dissection were negative for tumor.     

Cutaneous metastasis as the presenting sign of papillary thyroid carcinoma

Cutaneous metastasis of visceral tumors accounts for 2% of skin tumors. We report the case of a 71‐year‐old male with a smoking history who presented to dermatology department with a violaceous nodule of the right sideburn skin. The lesion was interpreted as an adenocarcinoma that was completely excised and was suspicious for a metastasis. There was a recommendation for additional work‐up. At a different institution, a positron emission tomography scan showed a left hilar mass and uptake in the right thyroid. He was then referred to our hospital for tissue diagnosis. Mediastinoscopy with biopsy of the left hilar mass showed metastatic follicular thyroid carcinoma. Subsequently, a thyroid fine needle aspirate showed suspicion for malignancy with similar morphology. Thyroidectomy and central neck dissection showed right thyroid papillary carcinoma extending to one margin and involving the lymph nodes. The left hilar metastasis mass resection showed similar lymph node findings. A re‐review of the sideburn excision revealed similar histopathology to the thyroid and mediastinal resection. This case illustrates the opportunity of considering metastatic thyroid carcinoma to skin even in cases which lack the classic cytologic and architectural features of papillary thyroid carcinoma follicular variant.     

纳米炭混悬注射液作为SLN示踪剂对早期宫颈癌盆腔淋巴结转移状态预测价值分析

目的:分析纳米炭混悬注射液作为SLN示踪剂对早期宫颈癌盆腔淋巴结转移状态预测价值。方法:选取我院2015年2月至2015年12月妇科门诊及住院部确诊为浸润性宫颈癌的患者42例。注射纳米炭混悬注射液作为SLN示踪剂,切除黑染淋巴结。然后所有患者均进行广泛子宫切除术和腹腔镜盆腔淋巴结清扫术,标本送往实验室进行病理检验。结果:42例患者中40例检出SLN出现黑染,其中30例双侧均出现黑染。共清除出1004枚盆腔淋巴结,平均每例患者共切除23.9个淋巴结,每例患者平均SLN检验出的淋巴结为3.9。病理结果表明SLN准确率为100%,而假阴性为0%。结论:SLN被检测出来的淋巴引流区最多的是闭孔,其与盆腔淋巴结的转移具有一致性,且初步证明了纳米炭混悬液作为SLN示踪剂检测宫颈癌的安全性和可靠性。     

Sentinel-Node-Biopsie

Sentinel node biopsy (SNB) is increasingly being used as a minimally invasive staging procedure in patients with malignant melanoma. For decades elective lymph node dissection (ELND) was performed in many centers on patients at risk for lymph node metastasis but without clinically detectable lymph node involvement. Today, selective lymph node dissection (SLND) is offered only to patients with histologically proven metastasis in a SN (10-29%). A positive SN is one of the most important prognostic parameters. Ten years after the introduction of the technique, the role of SNB in the treatment of cutaneous melanoma still remains controversial. Issues include the usefulness of highly sensitive evaluation of SN using molecular biology or cytology techniques, as well as the therapeutic impact of the SNB per se and the associated combined surgical or medical adjuvant therapies.     

A case of cutaneous clear cell sarcoma determined by clinicopathological and cytogenetic analysis

Cutaneous clear cell sarcoma (CCS) is a rare soft tissue malignancy that typically manifests in the distal extremities of young adults. Although it shows melanocytic differentiation, CCS is clearly pathologically and genetically distinct from malignant melanoma. Here, we report the case of a 43-year-old male who had an asymptomatic, deep-seated, slowly enlarging, firm mass over the right heel for 30 years that recently and rapidly progressed with tenderness. We arranged for the total excision of the tumor. Pathological and cytogenetic analysis of the biopsied specimen showed that it was a clear cell sarcoma. Computed tomography and positron emission tomography scans showed no signs of metastasis, and no other abnormal hypermetabolic lesions were detected. Wide excision with split-thickness skin graft and a sentinel lymph node biopsy were performed. Because of positive findings in the sentinel lymph nodes, the patient was transferred to the plastic surgery department for further radical popliteal and inguinal lymph node dissection. The patient has received regular outpatient follow-up care in our hospital for the past 8 months with no evidence of recurrence.     

Eccrine porocarcinoma: clinical and pathological studies of 12 cases

Twelve cases of eccrine porocarcinoma have been reported at our facility in the past 10 years. All of them were Japanese; half had lymph node metastases; and one-third died of this disease. Lymph node metastasis was correlated with pathological lymphovascular invasion. Death was correlated with a pathological growth pattern and clinical lymph node metastasis. Sentinel lymph node biopsy was performed usefully in two patients.     

甲下无色素性黑素瘤远端淋巴结转移

报告1例甲下无色素性黑素瘤远端淋巴结转移.患者女,28岁.左拇指甲下淡红色肿物1年半.结合病史、皮损特点、实验室检查、皮损及肿大淋巴结组织病理改变、免疫组化检查结果,确诊为该病.