肝脏炎性假瘤6例临床病理观察

目的:探讨肝脏炎性假瘤的临床病理特征、诊断及鉴别诊断。方法:复习6例肝脏炎性假瘤患者的临床资料,并对其进行组织学观察和免疫组化标记。结果:6例标本中,男性5例,女性1例,年龄31~52岁,平均45岁。临床表现为右上腹胀痛。镜下病变组织为增生的胶原纤维,部分坏死组织周围绕以增生的纤维组织,见大量的浆细胞、淋巴细胞、单核细胞等炎细胞。免疫组化染色病变组织内淋巴细胞部分为CD20、CD45RA阳性;部分为CD3、CD45RO阳性;部分淋巴细胞轻链κ、轻链λ标记双项阳性。结论:肝脏炎性假瘤术前无法确诊,多以肝癌而手术,确诊只能依靠病理学,免疫组化标记可以起到辅助诊断的作用。治疗采用手术治疗、激素治疗,以及观察随访,预后良好。     

涎腺腺泡细胞癌36例临床病理分析

目的 探讨涎腺腺泡细胞癌的临床病理学特征、诊断和鉴别诊断、治疗和预后.方法 复习36例涎腺腺泡细胞癌手术切除标本的病理切片并做相应的免疫组织化学染色,结合临床资料进行分析.结果 涎腺腺泡细胞癌男女发病均等,各年龄组均可发病,好发于腮腺浅叶,生长缓慢,病程长,预后相对较好.肉眼观：肿瘤直径3～10cm,呈浸润性生长,部分病例周围组织中可见小的瘤结.切面灰白色或浅粉红色,质地较软,易碎.镜检：五种类型的细胞组成四种组织类型.免疫表型：CK18呈细胞膜型阳性、CK7阴性具有特异性.结论 涎腺腺泡细胞癌癌细胞类型和组织类型的多样性是该肿瘤的特征,不同的组织学类型应与其组织学形态相似的肿瘤鉴别,免疫表型起关键作用.腺泡细胞癌发病少,属低度恶性肿瘤,治疗首选以根治性手术切除,病变范围广或复发病例可行术后放疗以减少局部复发和转移.     

睾丸鞘膜孤立性纤维性肿瘤1例及文献复习

目的：探讨睾丸鞘膜孤立性纤维性肿瘤的临床病理学特点、免疫组化特征及鉴别诊断。方法：对I例睾丸鞘膜孤立性纤维性肿瘤进行组织学观察,行MaxVision法免疫组化CD34、CD99、SMA、Desmin、actin、S-100、bcl-2、AE1/AE3染色及随访。结果：眼观：肿瘤呈结节状,结节直径为0.4~1.2 cm,切面灰白、实性、质韧。镜检：肿瘤由密集的胶原带构成,形成瘢痕疙瘩样的密集胶原束。梭形细胞位于胶原纤维之间呈束状排列,部分呈血管外皮瘤样结构。肿瘤细胞呈CD34及CD99弥漫性细胞质阳性,SMA、Desmin、actin、S-100、bcl-2、AE1/AE3均阴性。结论：睾丸鞘膜孤立性纤维性肿瘤罕见,应与该部位相似形态的病变和血管外皮瘤样的肿瘤相鉴别。     

外科治疗恶性结直肠间质瘤17例报告

目的 探讨恶性结直肠问质瘤的组织学和免疫组化特点及外科治疗效果。方法 回顾性分析1990年1月-2005年3月经手术治疗的17例恶性结直肠问质瘤的临床资料和病理检查结果,分析手术切除的效果以及影响手术疗效的因素。结果 17例患者均行手术治疗,且经病理证实为恶性,其中行左半结肠切除6例,右半结肠切除3例,直肠局部切除2例,腹会阴联合切除、腹壁造口术6例．中位生存时间52．0个月,术后1、3、5年生存率分别为100％、70．6％和47．1％。结论 恶性GIST的最后诊断需依靠病理切片,CD117和CD34是确诊最有价值的依据。恶性结直肠问质瘤仍应以外科手术为主,原则上需行局部根治性切除。     

腹膜后间质瘤的MSCT表现及临床病理分析

目的:分析腹膜后间质瘤的临床、病理组织学特征及MSCT表现,提高对本病的认识和诊断水平。方法:回顾性分析经手术和病理证实的12例腹膜后间质瘤的临床及MSCT表现。结果:12例患者主要临床表现为腹部肿块和疼痛。12例均表现为腹膜后腔软组织肿块,肿瘤最大直径3.0～21.0cm,平均11.0cm。肿瘤呈类圆形7例,不规则形5例。CT平扫密度均匀2例,其中1例增强扫描呈均匀强化,1例呈不均匀分隔状强化。平扫密度不均匀10例,均见囊变坏死区,其中钙化2例,出血2例,增强扫描实质部分呈中度以上强化,囊变坏死部分不强化,呈分隔状。病理诊断为良性1例,低度恶性潜能3例,恶性8例,远处转移3例。免疫组化表现为CD117阳性12例,CD34阳性7例。结论:腹膜后间质瘤多见于中老年患者,临床症状少,MSCT表现具有一定特征,能较好地反映病变的病理组织学特点,对本病的诊断及鉴别诊断具有重要价值。     

An analysis in MSCT manifestations and dinico-pathological findings of retroperitoneal stromal tumors

目的:分析腹膜后间质瘤的临床、病理组织学特征及MSCT表现,提高对本病的认识和诊断水平.方法:回顾性分析经手术和病理证实的12例腹膜后间质瘤的临床及MSCT表现.结果:12例患者主要临床表现为腹部肿块和疼痛.12例均表现为腹膜后腔软组织肿块,肿瘤最大直径3.0～21.0cm,平均11.0 cm.肿瘤呈类圆形7例,不规则形5例.CT平扫密度均匀2例,其中1例增强扫描呈均匀强化,1例呈不均匀分隔状强化.平扫密度不均匀10例,均见囊变坏死区,其中钙化2例,出血2例,增强扫描实质部分呈中度以上强化,囊变坏死部分不强化,呈分隔状.病理诊断为良性1例,低度恶性潜能3例,恶性8例,远处转移3例.免疫组化表现为CD117阳性12例,CD34阳性7例.结论:腹膜后间质瘤多见于中老年患者,临床症状少,MSCT表现具有一定特征,能较好地反映病变的病理组织学特点,对本病的诊断及鉴别诊断具有重要价值.     

ALA-PDT治疗继发于阴茎鳞癌的乳房外Paget病1例

乳房外Paget病是一种临床上少见的,好发于乳房外其他部位、尤其是顶泌汗腺分布区域(会阴、肛周)的一种特殊类型的皮肤恶性肿瘤,好发于老年人,临床极易误诊。该病根据肿瘤起源部位分为原发性和继发性乳房外Paget病。准确地将两者鉴别主要依靠详细的病史、系统全面的查体及病理和相关辅助检查。寻找特异性的免疫组化标志物对于区分原发性及继发性乳房外Paget病有重要价值。临床上治疗继发性乳房外Paget病的手段主要为手术切除,但传统手术损伤大,切除后复发率高,对于基础疾病较多的老年患者并不适用。本文报道了用ALA-PDT治疗继发于阴茎鳞癌的乳房外Paget病1例。患者男,78岁,阴茎癌术后13年,会阴菜花状肿物伴破溃渗液、恶臭4年就诊。皮损组织病理检查:表皮全层可见Paget细胞散在或成巢分布。免疫组化示:CK7+,CK20+,PSA+,GCDFP15±。结合临床病史及病理、免疫组化结果,诊断为继发性乳房外Paget病。予3次ALAPDT治疗后,症状较前缓解,生活质量明显提高。     

骨朗格汉斯细胞组织细胞增生症的影像学特征与病理学分析

目的 :探讨骨朗格汉斯细胞组织细胞增生症(Langerhans cell histiocytosis,LCH)的影像学特征及其与病理的关系。方法:回顾性分析15例经手术病理证实的骨LCH患者的临床及影像资料,并对其影像学特征和病理表现加以对照。患者均行CT平扫和MRI平扫加增强扫描,病理组织学检查采用HE染色,免疫组化染色检测CD1a。结果:15例中,4例位于腰椎,2例颈椎,3例胸椎,3例胫骨,2例股骨,1例肋骨。病变CT表现呈不规则形骨质破坏,骨质破坏区呈低密度,部分见线样硬化边,部分见死骨和骨膜反应;3例病变周围见软组织肿块。病变在T1WI呈等或低信号,在T2WI呈均匀高信号;6例行增强扫描,4例呈明显不均匀强化,1例轻度不均匀强化,1例未见异常强化。病理显示病变主要为Langerhans细胞,还可见普通的组织细胞、泡沫细胞和多核巨细胞;免疫组化检测CD1a呈阳性。结论:发生于不同部位的骨LCH有一定的特点,影像学特点与病理组织学基础有一定的相关性,两者相结合能提高对本病的诊断正确率。     

前列腺孤立性纤维肿瘤临床病理观察

目的探讨前列腺孤立性纤维肿瘤的临床表现、病理形态学、免疫组化及鉴别诊断。方法收集前列腺孤立性纤维肿瘤10例,观察其临床病理特点及免疫组化表型。结果年龄46～85岁。光学显微镜下形态多样,边界清晰,由交替性分布的细胞丰富区和细胞稀疏区组成,分枝状的血管外皮瘤样结构;可见黏液变、脂肪细胞形成。免疫表型:几乎所有肿瘤细胞质呈Viment(10/10)、CD34(10/10)强阳性、弥漫表达,CD99(9/10)、Bcl-2(10/10)呈阳性表达。结论孤立性纤维肿瘤可发生在躯体所有解剖部位,发生在前列腺的孤立性纤维肿瘤需与该处其他梭形细胞肿瘤鉴别,依据其组织学特点及免疫组化表型可作出诊断。     

隆突性皮肤纤维肉瘤的临床病理及免疫组织化学研究

目的探讨隆突性皮肤纤维肉瘤的诊断、鉴别诊断及其组织起源。方法对36例隆突性皮肤纤维肉瘤的临床和病理资料进行分析,全部标本进行HE染色,并采用免疫组织化学ABC法对Vimentin、S-100、FXIIIa、CD34、CD68、SMA、CK和Desmin 8种抗体标记结果进行观察。结果该肿瘤属低度恶性,生长缓慢,很少转移,但易复发;在组织学上具有特异性肿:瘤细胞环绕胶原纤维或毛细血管形成特征性辐射状排列。肿瘤细胞呈梭形、异型性不明显、核分裂少见。36例免疫组化标记,全部病例Vimentin和CD34呈弥散性强阳性;3例对S-100呈阳性反应;5例对SMA呈局灶性阳性反应;36例全部对FXIIIa、CD68、CK和Desmin呈阴性反应。结论隆突性皮肤纤维肉瘤在诊断上很容易误诊,主要根据HE染色观察,形态上典型,结合其临床和病理特征即可确诊,该肿瘤可能起源于真皮内的具有多种分化潜能的间叶细胞。     

鼻腔鼻窦淋巴瘤的CT和MRI诊断

目的 探讨鼻腔鼻窦淋巴瘤的CT和MRI表现,旨在提高其诊断准确性。资料与方法 回顾性分析46例经手术或活检证实的鼻腔鼻窦淋巴瘤患者的影像资料。结果 原发于鼻腔30例,鼻窦7例,鼻腔、鼻窦同时发病或累及邻近结构9例。CT表现：淋巴瘤位于鼻腔前部28例,后部2例,向前浸润鼻前庭、鼻翼、鼻背及邻近面部皮肤22例;病灶密度均匀8例,不均匀22例,增强后轻度强化7例,中度强化6例,鼻中隔、中下鼻甲浸润性破坏7例。鼻窦淋巴瘤表现为窦腔内充以软组织影,窦壁骨质浸润性改变5例,明显破坏2例,4例上颌窦周软组织浸润,增强后中度强化3例。弥漫型淋巴瘤表现为鼻腔中线区不同程度的骨质破坏,鼻腔及邻近鼻窦伴软组织肿块,6例并累及邻近面部软组织、眼眶、鼻咽部、口咽、颞下窝、翼腭窝,4例浸润颅底骨髓,2例破坏硬腭。MRI表现：T1WI低信号12例（与肌肉比较。以下同）。等信号8例;T2WI高信号11例,等信号9例;病变轻度强化6例,中度强化10例。4例沿翼腭窝神经周扩散。结论 多数鼻腔淋巴瘤及弥漫型鼻腔鼻窦淋巴瘤有特异影像学征象,可提示诊断;鼻窦淋巴瘤则缺乏特异影像学征象。CT是本病诊断的主要影像检查方法,MRI能更清楚显示病变的范围。帮助临床准确地分期。     

鼻腔T/NK细胞型淋巴瘤的影像学诊断

目的探讨鼻腔T/NK细胞型淋巴瘤的CT和MRI特点。方法回顾性分析35例经组织学证实鼻腔T/NK细胞型淋巴瘤的影像学资料。结果根据病变的范围分为局限型和弥漫型2种类型。CT表现:局限型25例,位于鼻腔前部23例,后部2例,向前浸润鼻前庭、鼻翼、鼻背及邻近面颊部皮肤23例;病灶密度均匀8例,不均匀17例,增强后低度强化6例,中度强化3例;中下鼻甲、鼻中隔轻微浸润性破坏2例。弥漫型10例,表现为鼻腔中线区骨质破坏伴软组织肿块,9例侵犯邻近鼻窦及面颊部软组织,6例蔓延到眼眶、颞下窝、翼腭窝,4例浸润颅底骨髓,3例破坏硬腭。MRI表现:T1WI低信号5例(与肌肉比较,以下同),等信号3例;T2WI高信号6例,等信号2例;病变低度强化2例,中度强化4例。3例沿翼腭窝神经周围蔓延。结论大多数鼻腔T/NK细胞型淋巴瘤有特征影像学征象,可提示诊断。     

CT of perineural tumor extension: pterygopalatine fossa

Tumors of the oral cavity and paranasal sinuses can spread along nerves to areas apparently removed from the primary tumor. In tumors of the palate, sinuses, and face, this "perineural" spread usually involves the maxillary division of the trigeminal nerve. The pterygopalatine fossa is a pathway of the maxillary nerve and becomes a key landmark in the detection of neural metastasis by computed tomography (CT). Obliteration of the fat in the fossa suggests pathology. Case material illustrating neural extension is presented and the CT findings are described.     

CT of the inferomedial orbit and the lacrimal drainage apparatus: normal and pathologic anatomy

The normal and pathologic CT anatomy of the lacrimal drainage apparatus was examined during study of the orbits, nasal cavity, and paranasal sinuses in 100 patients with a variety of clinical complaints related to the inferomedial orbit. The bony lacrimal fossa, the nasolacrimal canal, and the fluid- or air-filled lacrimal sac and nasolacrimal duct were readily recognized in all cases. The lacrimal fossa and sac are found at the inferomedial orbit and are preseptal structures. Cystic expansion of the lacrimal sac (dacryocystitis) may mimic orbital abscess clinically; however, the radiographic recognition of a cystic, peripherally enhancing mass centered at the lacrimal fossa should exclude postseptal abscess and permit more conservative therapy. Obstruction or invasion of the drainage apparatus by tumor, infection, or posttraumatic scarring is readily depicted by CT. Sagittal/coronal images reformatted from thin transverse axial sections are often useful in defining the origin of an inferomedial orbital mass and its relation to the lacrimal sac when clinical studies and axial CT findings are equivocal.     

Rhino-orbital zygomycosis]

Zygomycosis is rare but highly invasive fungal infection, with high mortality rate. A 67 years old diabetic man was presented with rhino-ocular form of the disease. Fungal elements invaded the skin and subutaneous facial tissue, with involvement of the nose, paranasal sinuses and orbit. The portal of entry of fungus was through paranasal sinuses, after the tooth extraction. Various clinical manifestations were presented: headache, facial swelling, tenderness over the involved sinuses, unilateral orbital cellulitis with proptosis, facial and orbital pain, black nasal discharge, decreased visual acuity, blindness. Patient was treated surgically and by liposomal amphotericin B. He underwent maxillectomy, ethmoidectomy and sphenoidectomy and orbital exenteration because of the dissemination of the disease into the orbit. The specific diagnosis of the infection was established upon the microscopic demonstration of casual agent in the debridement tissue. Early diagnosis was important in this highly fatal disease. Aggressive surgical debridement, therapy with amphotericin B and correction of underlying metabolic acidosis must be performed. The successful medical therapy in this patient suggests that lipid formulation of amphotericin B should be given, because this antifungal agent performed the best control of the infection with the minimal adverse effects.     

Isolated intracranial Rosai-Dorfman disease mimicking meningioma in a child: a case report and review of the literature

We report the first case of extensive involvement of isolated intracranial Rosai-Dorfman's disease (RDD) in a child. Our case is unique because it presents with involvement of the middle cranial fossa, cavernous sinus, pituitary gland, orbit, ethmoid and sphenoid sinuses. Previous cases of intracranial RDD in children have reported separate involvement of cavernous sinus, suprasellar region, and frontal and petroclival regions. Involvement of the pituitary gland has so far not been reported. A 14-year-old male presented with a medical history of loss of vision, raised erythrocyte sedimentation rate (ESR), and abnormal prolactin and cortisol levels. Radiologically the diagnosis was meningioma. The histopathological diagnosis was RDD with emperipolesis and S-100 positivity. RDD is a histiocytic proliferation of unknown aetiology, which commonly affects lymph nodes. Uncommonly it involves the extranodal sites and rarely the central nervous system (CNS). 80 cases of RDD involving CNS have been reported in the literature, and only 5 were in children. Although the definitive diagnosis of RDD disease is based on the histopathology report, it should be included in the differentials of a lesion mimicking meningioma especially in children.     

鼻腔鼻窦原发上皮样血管内皮瘤1例

目的探讨鼻腔鼻窦原发上皮样血管内皮瘤的临床病理特征、诊断、鉴别诊断及治疗措施。方法患者于2000年7月因右侧鼻阻及反复右侧鼻出血就诊,行鼻窦CT、MRI检查示:右侧鼻腔鼻窦软组织影,周围骨质无破坏。取活检病理报告为上皮样血管内皮瘤。当时建议其手术治疗,患者拒绝,遂带瘤生存。2007年9月患者因全身多处严重骨质疏松再次住院,查体发现右侧鼻腔肿物。再次取病理活检,证实为上皮样血管内皮瘤。结果光镜下肿瘤细胞呈多角形或类圆形上皮样,无明显核分裂象;其组织结构多样,呈单个细胞条索、实性巢状及管腔样结构排列。鼻腔鼻窦原发上皮样血管内皮瘤的特征性病理表现包括:细胞原始管腔结构;玻璃样间质;网状纤维染色显示血管腔隙结构;瘤细胞表达Vim、CD31、FVⅢRAg,少数细胞表达CD34。结论鼻腔鼻窦原发的上皮样血管内皮瘤是极少见的低度恶性血管性肿瘤,诊断主要依据病理,应注意与转移性癌、黑色素瘤、上皮样血管肉瘤、上皮样血管瘤等鉴别,可行鼻侧切开鼻腔鼻窦肿物切除术或鼻内窥镜下肿物切除术治疗。     

鼻腔鼻窦原发恶性黑色素瘤的影像学表现

目的：分析鼻腔鼻窦原发恶性黑色素瘤CT及 MR 表现,探讨其诊断要点。方法回顾性分析经活检或手术病理及免疫组化证实的16例鼻腔鼻窦恶性黑色素瘤的CT、MR特征及临床资料,均行 CT 平扫及增强,其中9例行 MR 平扫及增强。结果16例CT表现均为单侧发病;肿瘤位于鼻腔8例,鼻窦4例,同时累及鼻腔、鼻窦4例;形态欠规整,呈软组织密度,其内未见钙化和囊变;周围组织均受侵;增强后不均匀中-重度强化。9例 MR表现均为单侧发病;肿瘤位于鼻腔4例,鼻窦3例,同时受累鼻腔、鼻窦2例;形态欠规则,1例呈T1 WI高信号,T2 WI低信号,3例呈T1 WI等信号,T2 WI等/稍高信号,5例呈混杂信号。增强后不均匀轻-中度强化;周围组织均有侵犯。结论鼻腔鼻窦原发恶性黑色素瘤 CT表现缺乏特异性;典型恶性黑色素瘤有 MR 特征性表现,但罕见,以非色素及混合型常见。CT联合 MRI能准确显示肿瘤部位及与周围组织、邻近骨质的关系。     

Diagnosis of tumor in the nasal cavity and paranasal sinuses with [<Superscript>11</Superscript>C]choline PET: Comparative study with 2-[<Superscript>18</Superscript>F]fluoro-2-deoxy-<Emphasis Type="SmallCaps">d</Emphasis>-glucose (FDG) PET

[11C]choline (11C-choline) positron emission tomography (PET) was performed to evaluate its clinical utility in the diagnosis of tumors in the nasal cavity and paranasal sinuses. We studied 22 patients with suspicion of malignant tumors in the nasal cavity and paranasal sinuses. Tumor uptake of 11C-choline was measured with standardized uptake value (SUV) and correlated with the pathological diagnosis. 2-[18F]fluoro-2-deoxy-D-glucose (FDG) PET was performed in all patients for comparison. Both 11C-choline and FDG PET depicted squamous cell carcinoma showing an increased activity significantly higher than that of normal tissue, and these SUVs were significantly higher than those of benign lesions. FDG uptake in malignant tumors as a whole was variable. Although 11C-choline uptake in squamous cell carcinoma was lower than FDG uptake, 11C-choline uptake in malignant tumors was relatively uniform and statistical significance was found. PET with 11C-choline may be useful to diagnosis tumors in the nasal cavity and paranasal sinuses.     

Atypical aesthesioneuroblastoma: CT and MRI findings

Aesthesioneuroblastoma is an uncommon tumour of the superior nasal cavity, originating from the olfactory mucosa. Usually no specific radiological features indicate the diagnosis; normally these tumours are seen on CT as homogeneous, enhacing, soft tissue masses causing bone remodelling. Typical but quite nonspecific MRI findings include high signal on T2-weighted images and strong enhancement after gadolinium. The extent of tumour in the paranasal sinuses and anterior cranial fossa is best assessed with MRI after intravenous gadolinium, and this is considered as the most accurate method for assessing preoperative resectability. We report an aesthesioneuroblastoma in an atypical location, with extensive calcification.