卵巢甲状腺肿类癌临床病理观察

目的 探讨卵巢甲状腺肿类癌的病理学特点和生物学行为。方法 对4例卵巢甲状腺肿类癌作临床病理分析,免疫组化染色和电镜观察,并随访。结果 3例为瘤壁结节型，1例为混合型。组织学上2例以梁状结构为主，2例梁状结构中混有巢状结构。免疫表型4例Syn和CgA均阳性，2例NSE、降钙素阳性，1例生长抑素阳性，TG滤泡区阳性，而类癌区阴性。结论 卵巢甲状腺肿类癌是一种伴有甲状腺滤泡分化的低度恶性神经内分泌癌。     

Ultrastructural observations of the so-called strumal carcinoid of the ovary

A strumal carcinoid arose in a benign cystic teratoma of the ovary. Ultrastructural studies demonstrated that both the solid acinotubular areas as well as the "follicular" components were comprised of light and dark cells that contained numerous secretory granules. These findings indicate that this neoplasm is a pure carcinoid tumor with a follicular pattern. The present study raises the question of whether all strumal carcinoids are indeed pure carcinoid neoplasms.     

Ovarian strumal carcinoid in association with multiple endocrine neoplasia, type IIA.

Strumal carcinoid is an unusual form of monodermal ovarian teratoma with thyroid-like follicles admixed with typical carcinoid tumor patterns. We encountered a case of this neoplasm in a patient with multiple endocrine neoplasia, type IIA (Sipple's syndrome), including a medullary thyroid carcinoma diagnosed 24 years previously. During evaluation of bilateral adrenal pheochromocytomas, a unilateral left ovarian strumal carcinoid was discovered. Subsequently, the patient had a parathyroid adenoma excised. The ovarian tumor was immunohistochemically reactive for neuron-specific enolase, chromogranin, synaptophysin, and serotonin, but did not stain for calcitonin. The follicular structures stained for thyroglobulin. This unusual case shows that ovarian strumal carcinoid, like carcinoid tumors at other sites, may arise in association with multiple endocrine neoplasia.     

Imprint cytology of strumal carcinoid of the ovary: A case report with immunocytochemical analysis

Strumal carcinoid is a rare ovarian tumor defined as carcinoid associated with struma ovarii. We report here the second cytological case of strumal carcinoid and performed immunocytochemical analysis for the first time. A 68‐year‐old Japanese female was found to have a solid tumor with small cystic components in the left ovary, and bilateral salpingo‐oophorectomy was performed. The Papanicolaou smear of the imprint cytological specimen of the left ovarian tumor revealed presence of two distinct components. The first component included thyroid follicles, which was composed of flat sheets of polygonal epithelial cells without nuclear groove and intranuclear inclusion. The other component was composed of trabecular clusters of columnar cells containing round to slender nuclei with “salt and pepper” chromatin. Immunocytochemical analysis revealed that synaptophysin was expressed in the latter component. Therefore, a cytodiagnosis of strumal carcinoid was made. Histopathological analyses confirmed the diagnosis of strumal carcinoid. Albeit rare, carcinoid tumor occurs in the ovary, and the recognition of characteristic nuclear features and cellular arrangement leads to correct cytodiagnosis. Presence of struma ovarii component suggests an ovarian origin. Moreover, immunocytochemical analysis for neuroendocrine markers aids its differential diagnosis from granulosa cell tumor and carcinoma arising from struma ovarii.     

Strumal carcinoid of the ovary: ultrastructural observations and long-term follow-up study

Herein is reported an ovarian strumal carcinoid in a mature tetratoma from a 54-year-old women. Ultrastructural examination revealed numerous electron-dense intracellular granules, which were intrepreted as neurosecretory granules. They corresponded to argyrophil granules observed by light microscopy and were identified within neoplastic cells arranged in both follicular and trabecular patterns. These findings corroborate the contention that the strumal carcinoid itself is a pure neuroendocrine tumor devoid of thyroid follicular epithelium, but do not disprove its possible origin from parafollicular cells of adjacent teratomatous thyroid tissue. There was no recurrence of tumor during the 20 1/2 years the patient was followed.     

Struma ovarii and strumal carcinoid

Seven ovarian tumours (3 mature teratomas, 2 strumas with malignancy 2 strumal carcinoids) have been examined histologically, hystochemically and electron-microscopically. It is shown that the cell composition of the strumal teratoma tissue is very similar to that of the ectopic thyroid. The follicular cells may proliferate either into the benign tumour (apudoma) or typical thyroid carcinoma. Parafollicular cells may give rise to C-cell hyperplasia with the amyloid deposits in the stroma. The so-called strumal carcinoid of the ovary represents probably the C-cell tumour. Its "strumal" component may be considered as preexisting follicles invaded by tumour apudocytes or as the site of tumour origin displaying the pattern of a non-medullary thyroid apudoma.     

Strumal carcinoids of the ovary. An immunohistologic and ultrastructural study

A series of six ovarian strumal carcinoids was examined. The presence of thyroid follicular epithelium was conclusively proved by the presence of follicular cells immunohistochemically positive for thyroglobulin, and by the ultrastructural identification of non-neuroendocrine cells with features of thyroid epithelium lining the follicles. Progressive replacement of thyroid epithelial cells by carcinoid cells accounts for the predominance of neuroendocrine granule-containing cells and the scarcity of thyroid epithelial cells lining many of the follicles. A variety of neuroendocrine hormones and other immunoreactive substances was demonstrated within carcinoid cells, including somatostatin (five cases), chromogranin (five cases), serotonin (five cases), glucagon (four cases), insulin (two cases), and gastrin (one case). Only one case contained calcitonin-positive cells. None were carcinoembryonic antigen-positive or had amyloid deposits. The carcinoid element in five cases stained positively for prostatic acid phosphatase. While strumal carcinoid shares some features with medullary carcinoma of the thyroid gland, it has sufficient differences to warrant a separate designation.     

Strumal carcinoid of the ovary. A case report

The case of a 58-year-old Japanese female with strumal carcinoid of the ovary is described. Ultrastructural examinations revealed numerous neurosecretory-type granules in the cytoplasm of both thyroid and carcinoid components. Immunohistochemical studies showed immunoreactivities for thyroxin and thyroglobulin in the thyroid component. Several mucous glands were also observed in the tumor tissue. These morphological findings suggested that the follicles in the thyroid component were lined with thyroid follicular, carcinoid and mucous cells, and also supported the theory that this tumor may be derived from multidirectional differentiations of endodermal origin.     

Strumal carcinoid of the ovary associated with hyperinsulinaemic hypoglycaemia and cutaneous melanosis

Using immunohistochemical techniques ovarian carcinoid tumours can be shown to contain a wide variety of neuro-hormonal peptides but clinical effects, apart from the carcinoid syndrome, are very rare. Non-islet cell tumours with documented hyperinsulinaemic hypoglycaemia are also rare. This is the first recorded case of an ovarian strumal carcinoid associated with hyperinsulinaemic hypoglycaemia. Concurrent skin hyperpigmentation is believed to have resulted from the effects of tumour derived α-melanocyte stimulating hormone or an antigenically similar, biologically active peptide.     

A Case Report

The case of a 58-year-old Japanese female with strumal carcinoid of the ovary is described. Ultrastructural examinations revealed numerous neurose-cretory-type granules in the cytoplasm of both thyroid and carcinoid components. Immunohistochemical studies showed immunoreactivities for thyroxin and thyroglobulin in the thyroid component. Several mucous glands were also observed in the tumor tissue. These morphological findings suggested that the follicles in the thyroid component were lined with thyroid follicular, carcinoid and mucous cells, and also supported the theory that this tumor may be derived from multidirectional differentiations of endodermal origin.     

Simultaneous strumal ovarii and lymphoma with emphasis on the diagnostic usefulness of immunohistochemical stains.

Strumal ovarii has been rarely associated with other tumors, such as carcinoid tumor, carcinoma, and primary ovarian malignant lymphoma. We report the coexistence of a strumal ovarii and ovarian involvement by malignant lymphoma in a 70-year-old woman. The tumors were detected 10 years following exposure to ionizing radiation during the Chernobyl nuclear tragedy.     

Calcitonin secreting struma-carcinoid tumor of the ovary.

The ultrastructure of strumal carcinoid tumors at times may reveal a far more complex structure than can be ascertained from light microscopy. It may at times be indistinguishable from medullary carcinoma of the thyroid gland. Both tumors appear to be capable of producing 5-hydroxyindolacetic acid and calcitonin. The common shared biologic and ultrastructural features suggest a common origin, from neuroectodermal cells.     

Cytopathologic characteristics of the primary strumal carcinoid tumor of the ovary: A case report with emphasis on differential diagnostic considerations

Primary strumal carcinoid tumor of the ovary (SCTO) is an extremely rare entity, though the survival rate is excellent if the disease is confined to one ovary. A case is presented here in which intraoperative squash smears in a 45‐year‐old woman with a left adnexal mass revealed dispersed or small clusters of neoplastic cells forming loosely cohesive gland‐like structures with abundant cytoplasm. The nuclear chromatin was finely granular with a “salt and pepper” appearance and occasional tiny nucleoli. The position of the nucleus presented a vaguely plasmacytoid appearance. Small fragments of thyroidal colloid‐like structures were also identified. A cytopathologic diagnosis of a SCTO was suggested. Further evaluation and immunohistochemical studies were conducted on formalin‐fixed, paraffin‐embedded material. Cords or nests of uniform cells with abundant cytoplasm, and eccentric nuclei with coarse chromatin and occasional colloidal tissue were identified on H&E sections. The tumor cells showed diffuse and strong cytoplasmic staining for chromogranin A, synaptophysin, CD56, and vimentin but were negative for calretinin, α‐inhibin or CDX2. The proliferative index with MIB‐1 was around 3%. Thyroidal colloid‐like structures were immunoreactive for thyroglobulin and TTF‐1 stains. The diagnosis of primary SCTO was confirmed based on cytopathologic, histopathological, and immunohistochemical results, and the location of the tumor. Awareness of the cytopathological findings of SCTO can assist in diagnosing this rare entity correctly. Diagn. Cytopathol. 2013;41:812–816. © 2011 Wiley Periodicals, Inc.     

原发性睾丸类癌病理特征及文献回顾

目的:探讨原发性睾丸类癌的临床特点、组织病理学及免疫组织化学的特征.方法:收集1例原发性睾丸类癌进行镜下观察并相关文献分析.结果:原发性睾丸类癌的癌细胞呈巢团状或条索状或弥漫实性片块状排列,部分区域可见腺样结构,腺腔不规则,胞核位于中央,圆形,染色质细颗粒状,核分裂罕见.结论:原发性睾丸类癌为低度恶性肿瘤,睾丸原发性类癌预后较好,伴发类癌综合征及转移者预后相对偏差.     

CARCINOID TUMORS -REVIEW OF LITERATURE WITH SPECIAL REFERENCES TO SITES OF ORIGIN and HUMORAL SUBSTANCES PRODUCED-

Carcinoid tumors arising in mucosa of respiratory and alimentary tracts were found to form a distinct group with characteristic endocrine function in relationship to their site of origin. These include ACTH-secretlng bronchial carcinoid, histamine-producing gastric carcinoid, and serotonin-producing ileal and appendiceal carcinoid. It is also conceivable that the carcinoid-islet cell tumor of duodenum and the rectal carcinoid may constitute other groups of the carcinoid tumor, though the humoral substances produced by these tumor groups have not yet been identified. On the basis of morphologic and metabolic features of the carcinoid tumors occurring in different sites, it is proposed that the carcinoid tumor is derived from the neuroendocrine cells which embryo-logically migrate into the primitive alimentary tract mucosa and mature Into the endocrine cells with unique metabolic function in the final resting site of the respective organs. ACTA PATH. JAP. 22:533–540. 1972.     

Multiple carcinoid tumors of the rectum: Report of two cases suggesting the origin of carcinoid tumors

Two cases of multiple carcinoid tumors of the rectum with numerous micronests of carcinoid tumors are reported. The patients were 51‐ and 58‐year‐old males. Many carcinoid tumors and numerous carcinoid micronests were found in the resected rectum; the total number of carcinoid tumors, groups of micronests, and solitary micronests was 69 in the first case and 62 in the second case. The micronests, consisting of a few to many endocrine cells, were observed in the lamina propria, muscularis mucosa, and/or submucosa. Micronests increased in number, gathered and formed carcinoid tumors, which were up to 8 mm in diameter. It was found that a nest of the carcinoid tumors in the lamina propria showed continuity with the endocrine cells of a crypt in the different carcinoid tumors in both cases. The carcinoid tumor and micronest infiltrated the nerves and ganglions in the muscularis mucosa and submucosa. Nests of the carcinoid tumors and micronests were surrounded by S‐100‐positive cells. Lymph node metastases of the carcinoid tumor were found in both cases. Rectal carcinoid tumors may originate from endocrine cells of the crypts, and multiple carcinoid tumors may occur heterogeneously.     

Carcinoid tumour metastatic to the orbit with infiltration to the extraocular orbital muscle

Ninety-three percent of symptomatic patients with small intestinal carcinoid tumours have metastases. The most common sites of metastases are lymph nodes and liver. Orbital metastases have rarely been described and the majority of them involve the choroid rather than extraocular orbital structures. We report a patient who developed proptosis, impairment of vision and reduced ocular motility on the left side, eighteen months after operation for primary intestinal carcinoid tumour with hepatic metastases. CT and MR studies revealed the tumour mass infiltrating the inferior rectus muscle. Biopsy examined by imprint and frozen section showed tumour consistent with metastatic carcinoid. The tumour was removed. HE and staining for cytokeratin, chromogranin, NSE, serotonin, somatostatin and gastrin showed that the tumour tissue corresponded to that of the primary intestinal carcinoid tumour. Intramuscular orbital metastasis from a carcinoid tumour is a rare occurrence. Diagnosis may be difficult, especially where no evidence of primary carcinoid tumour is present. Metastatic orbital carcinoid should be suspected in patients with a clinical history of carcinoid tumour and who develop ocular complaints and mass lesion in the orbit. Complete surgical removal of the tumour is important for optimal restitution of vision and eye movements.     

Peripheral spindled carcinoid tumor: a review of its ultrastructure, differential diagnosis, and biologic behavior

The ultrastructure, differential diagnosis, and biologic behavior of the peripheral pulmonary spindled carcinoid tumor are reviewed. Electron microscopy is useful in distinguishing the spindled carcinoid from a variety of neoplasms with similar histologic features. The spindled morphology is a rare expression of the carcinoid tumor that is almost exclusively confined to the lung periphery. It appears that the spindled carcinoid without atypical features is fully capable of regional lymph node metastases in approximately 20 per cent of the cases.