心包原发性恶性间皮瘤的临床病理分析

目的：探讨心包原发性恶性间皮瘤的临床病理特征。诊断与鉴别诊断要点。方法：对4例心包原发性恶性间皮瘤进行临床病理分析。光镜及免疫组化染色观察并复习有关文献。结果：男3例,女1例,平均年龄42岁,3例呈局限型,1例为弥漫浸润型。组织学上可表现为肉瘤样梭形细胞型,上皮样型及双相型,免疫组化染色显示肉瘤样梭形细胞表CK、vimentin;上皮样型瘤细胞表达HBME1、CK。结论：原发于心包的恶性间皮瘤罕见,预后极差。临床常被误诊,其组织形态亦复杂多样,应注意与心包的良性增生性病变,心包转移性腺癌和梭形细胞肿瘤等相鉴别。     

恶性外周神经鞘瘤52例临床病理分析

目的观察恶性外周神经鞘瘤的临床病理学特征、诊断及鉴别诊断。方法回顾性分析52例恶性外周神经鞘瘤的临床病理学及免疫表型特征并复习相关文献。结果 52例患者中,男女发病率为1∶1,年龄4~71岁,头颈部18例(35%),四肢12例(23%),躯干9例(17%),深部组织8例(15%),椎管内4例(8%),生殖道1例(2%)。镜下肿瘤组织呈束状或漩涡状排列,瘤细胞短纺锤形、卵圆形、梭形,核分裂象易见。免疫表型:瘤细胞局灶表达S-100蛋白,Ki-67增殖指数10%~70%。结论恶性外周神经鞘瘤罕见,侵袭性高,预后差,其组织形态复杂多样,需与滑膜肉瘤、纤维肉瘤、血管外皮瘤、富于细胞性神经鞘瘤、纤维型脑膜瘤以及平滑肌肉瘤等鉴别。     

上皮样恶性周围神经鞘膜肿瘤

患者男，35岁。右颈部肿块3年伴右上肢麻木、乏力半年。MRI示右颈部肿块，压迫臂丛神经。临床诊断：右颈部肿块，神经纤维瘤可能性大。手术见：肿块位于右颈部软组织内，压迫并包裹臂丛神经下干，肿块中央囊性变，肿块与臂丛神经下干无法分离，予以肿块与臂丛神经下干一并切除送病理检查。     

腹腔巨大恶性神经鞘膜瘤一例

患者男 ,5 5岁。腹痛、腹胀 10余天。于 1998年 6月 2日入院。体检 :腹部胀满、腹部左侧上至肋缘下至盆腔可触及一巨大肿物 ,表面不光滑 ,活动度差。Ｂ超检查示 :腹腔囊实性占位。患者无家族史 ,其他部位检查无异常发现。术中见 :腹腔内一巨大肿物 ,表面光滑 ,约 30ｃｍ× 30ｃｍ× 2 0ｃｍ大小 ,囊性感 ,壁较厚 ,肿物从网膜突出 ,胃推向左上方 ,横结肠推向下后方 ,肝质地正常 ,胃前壁及小肠均无异常。肿物下界达盆腔 ,与胰尾处粘连紧密 ,胰实质正常 ,与后腹膜无明显粘连。完整切除肿物送检。病理检查 :送检椭圆形肿物一个 ,有部分包膜 ,大…     

恶性孤立性纤维性肿瘤4例临床病理分析并文献复习

目的：探讨恶性孤立性纤维性肿瘤(malignant solitary fibrous tumor,MSFT)临床病理特点、诊断和鉴别诊断及治疗预后。方法：对4例MSFT回顾并分析其临床病理特点,并复习相关文献。结果：男性2例,女性2例,发病年龄43~64岁。肿瘤部位分别为胸腔内、乙状结肠系膜、右肩部、左足。镜下肿瘤呈细胞丰富区与稀疏区相间的特点,局灶形态类似血管外皮瘤。瘤细胞梭形或短梭形,异型性明显,核分裂像易见,局灶可见坏死。免疫组化：瘤细胞表达Vim、CD34、CD99、Bcl-2,不表达CK、S-100。结论：MFST少见,确诊依靠形态学和免疫组织化学,需与血管外皮瘤、纤维肉瘤、滑膜肉瘤、恶性间皮瘤及恶性外周神经鞘瘤相鉴别。MFST易复发和转移,手术完整切除是其主要治疗手段,需长期随访。     

左心房恶性纤维性间皮瘤一例

患者男 ,5 5岁。咳嗽、咳痰、气促 40余天 ,活动后尤甚 ,痰中带血丝 ,咳粉红色泡沫痰 ,伴发热 (38℃ ) ,无腹胀 ,无浮肿。于 1996年 8月 10日入院。体检 :双肺呼吸音粗 ,偶可闻及湿罗音 ,心率 84次 /分 ,律齐 ,心音响 ,心尖区有 2级隆隆样舒张期杂音 ,未闻及心包摩擦音。胸片及ＣＴ示两肺内较广泛间质性病变 ,伴双侧胸腔积液 ,心脏彩超示左房粘液瘤 ,中度肺高压。行左房肿瘤切除术。术中见心脏中度增大 ,左心房增大 ,腔内有 7.5ｃｍ× 6 .0ｃｍ× 5 .3ｃｍ肿块 ,灰红色 ,实质性 ,质偏硬 ,表面高低不平 ,广基型 ,基底部位于左房顶并侵犯左肺…     

右精索脂肪肉瘤伴右睾丸鞘膜积液1例

患者男 ,6 0岁。右腹股沟包块 3年余。体检右腹股沟区内侧及右阴囊触及约 6ｃｍ× 10ｃｍ× 4ｃｍ光滑包块 ,活动度尚可 ,透光试验 ( ) ,无压痛。辅检无特殊。诊断为右精索睾丸鞘膜积液。术中见右精索旁脂肪组织堆积 ,其中有两处 2ｃｍ× 3ｃｍ的质韧光滑肿块 ;另见右睾丸鞘膜积液 ,切开流出黄色液约 6 0ｍｌ。取右精索处脂肪组织送病检。病理检查　巨检 :6ｃｍ× 3 5ｃｍ× 1 8ｃｍ组织 1件 ,切面见有 2个肿块 ,分别为 5ｃｍ× 2ｃｍ× 1 8ｃｍ与 4ｃｍ×1 5ｃｍ× 1 8ｃｍ。质中偏软韧 ,灰黄白色 ,分叶结节状。大肿块旁有一绿豆大淋巴结…     

恶性腹膜间皮瘤临床病理进展

恶性腹膜间皮瘤(malignant peritoneal mesothelioma,MPM)是一种非常罕见的腹膜恶性肿瘤,预后差.MPM在诊断病理学上面临一些挑战,诊断MPM时需搜集详细的临床信息,MPM的一些形态变异亚型,在实际工作中常联合采用一组抗体进行诊断.MPM每个组织学分类均有其独特的鉴别诊断.MPM常见的遗...     

增殖性外毛根鞘囊肿的临床病理分析

目的探讨增殖性外毛根鞘囊肿（proliferating trichilemmal cyst,PTC）的临床病理学特征、鉴别诊断及组织发生。方法对9例良性、1例恶性和1例发生间变的PTC病例进行临床资料分析、光镜观察并复习相关文献。结果9例良性PTC,女性8例,男性1例,年龄38—78岁,平均病程7．8年;2例恶性PTC年龄分别为82岁和47岁,平均病程为5年。良、恶性PTC共同特征为增生的鳞状上皮组成的瘤团中央突然角化,恶性PTC皮损迅速扩大,病理特征包括较多核分裂象、细胞异型性以及瘤组织侵犯周围正常组织。结论良、恶性PTC的区分应该依靠临床和病理学特征,鉴别诊断包括皮肤鳞状细胞癌和外毛根鞘癌等。     

Malignant mesothelioma of the tunica vaginalis

A case of a malignant mesothelioma of the tunica vaginalis is presented. The patient with an intrascrotal mass was a 32-year-old Japanese male who had no history of asbestos exposure. The tumor was located on the surface of the right testis and was composed of columnar to polygonal cells with glandular and papillary structures. It showed many mitoses and focal invasion of the tunica albuginea. The tumor cells contained alcian blue- and Hale's colloidal iron-positive, hyaluronidase-digestible materials. Immunohistochemical stains for cytokeratin and vimentin were positive, while those for carcinoembryonic antigen, epithelial membrane antigen, Leu-M1, and factor VIII-related antigen were negative. The systemic examinations revealed no other tumors. Based on these findings the tumor was diagnosed as malignant mesothelioma of the tunica vaginalis. The differential diagnosis is discussed under the histologic, histochemical, and immunohistochemical points of view and the previous literature is reviewed.     

Malignant mesothelioma of the tunica vaginalis testis: diagnostic studies and differential diagnosis

Malignant mesothelioma of the tunica vaginalis testis is an extremely rare tumor representing 0.3% to 5% of all malignant mesotheliomas. Gross examination of testicular mesotheliomas typically reveals tumor nodules studding the thickened tunica vaginalis and, in some cases, infiltrating the testicular parenchyma, leading to diagnostic challenges. Microscopically, the tumor is characterized by epithelioid cells arising from the tunica vaginalis with papillary, tubulopapillary, or solid architectural patterns. The papillae are usually lined by a single layer of cells with relatively bland cytologic features. An epithelial cell phenotype admixed with a sarcomatoid pattern has also been described in a few cases. Immunohistochemically, the tumor is usually positive for calretinin, Wilms tumor-1, epithelial membrane antigen, D2-40, thrombomodulin, cytokeratin 7, and cytokeratin 5/6. Electron microscopic studies reveal epithelial cells joined by tight junctions, forming lumina, and displaying long microvilli with length to width ratios often greater than 10. The most important differential diagnostic considerations include florid mesothelial hyperplasia, adenomatoid tumor, carcinoma of the rete testis, and serous papillary tumors. In addition, the various types of testicular germ cell tumors should be considered, including seminomas, embryonal carcinomas, and intratubular germ cell tumors, particularly in tumors with testicular parenchymal involvement. Pleomorphic sarcomas should also be considered, particularly when dealing with the biphasic variant. The prognosis for this entity is grave, with a median survival of 23 months. Aggressive therapy with radical orchiectomy remains the mainstay of treatment.     

Malignant mesothelioma of the tunica vaginalis testis: a case with a predominant sarcomatous component

We present a case of malignant mesothelioma (MM) of the tunica vaginalis testis. A 64-year-old man was referred for an operation on a right hydrocele that later proved to be a tumor during surgery. The tumor was malignant with a biphasic pattern of epithelial and sarcomatous components. The latter component was predominant. Cuboidal or columnar cells formed irregular tubular structures in the epithelial component. In contrast, spindle-shaped or polygonal cells formed intricate structures with stromal connective tissues in the sarcomatous component. Immunohistochemical staining revealed that the tumor was mesothelial in origin and positive for cytokeratin, vimentin, HBME-1 antigen and calretinin. In general, MM occur in the pleura or peritoneum; those originating in the tunica vaginalis testis are very rare and represent less than 5% of all MM. In addition, MM in the tissues usually consist primarily of an epithelial component. According to previous reports tumors with a predominant sarcomatous component are extremely rare. In general, a sarcomatous component predicts poor prognosis and our case does, in fact, deteriorate over time. Our case suggests that despite its low incidence, MM must be considered when a case is diagnosed as hydrocele testicle.     

Malignant mesothelioma of the tunica vaginalis testis. Report of a case and review of the literature.

An autopsy case of malignant mesothelioma of the tunica vaginalis testis in a 60-year-old man is described. The tumor showed widespread metastasis via the lymphatics, leading to the patient's death five years after diagnosis. A review of 38 previously described cases is also presented. The most frequent presenting symptom was hydrocele. When a hydrocele in association with a paratesticular tumor is present, aspiration cytology should be performed first. In most of the cases with a fatal outcome, the tumors metastasized to the retroperitoneal lymph nodes. Once the diagnosis has been made, lymphangiography or CT scan should be done immediately.     

Papillary mesothelioma of the tunica vaginalis propria testis

Summary Ultrastructural features of a papillary mesothelioma arising in a hydrocele-sack are reported. The tumour cells presented numerous microvilli, desmosomes, basement membranes and abundant bundles of microfilaments, which all are hallmarks of mesotheliomas. The predominant cell type was the clear epithelial cell, but transitional cells and degenerative forms (foamy cells) were also found. The morphology and differential diagnosis of mesothelial tumours arising in the tunica vaginalis propria testis are discussed.     

Malignant mesothelioma of the tunica vaginalis and epididymis

Malignant mesothelioma of the para-testis is a rare cancer which may be clinically undiagnosed for several years and found incidentally at cut up for presumed benign disease. It has a number of histological presentations to be aware of and pitfalls to avoid. It is important to be able to reliably distinguish para-testicular MM from various other less aggressive entities which have significantly different management strategies. We present a case of epididymis and tunica vaginalis MM that was incidentally diagnosed on histological examination following a hydrocelectomy.     

Malignant mesothelioma of the tunica vaginalis in a dog

A 12-year-old Scottish terrier had a scrotal mass which was diagnosed as a malignant mesothelioma of the tunica vaginalis. The tumour resulted in a rapidly fatal clinical course with direct extension into the peritoneal cavity via the inguinal canal; there were no haematogenous or lymphatic metastases. This is the first case report of such a tumour in the dog. The histology and differential diagnoses of these tumours and a review of similar tumours in other species and possible causative agents are given.     

Benign papillary mesothelioma of the tunica vaginalis testis

We report a case of benign mesothelioma of the tunica vaginalis testis in a 69-year-old man who presented with a 4-month history of scrotal swelling. A polypoid pedunculated nodule, 1.5 cm in diameter, was found near the head of the right epididymis. Histologically, the tumor exhibited features characteristic of a well-differentiated papillary mesothelioma. The mesothelial origin of this tumor was further supported by immunohistochemical analysis. The tumor cells exhibited nuclear p53 protein accumulation, despite the benign histologic findings and a 3-year uneventful follow-up after resection. A polymerase chain reaction analysis for simian virus 40 DNA was negative. The papillary configuration seen in this tumor is uncommon for this site, inasmuch as benign mesotheliomas of the tunica vaginalis testis usually exhibit an adenomatous pattern. One should be aware of this pattern, and benignity should be mentioned in the pathologic report to prevent overtreatment. In addition, positive p53 immunohistochemical staining should not be taken automatically as evidence for malignancy in this type of lesion.