胃癌卵巢转移12例报告

目的探讨Krukenberg瘤的临床特点,总结治疗经验.方法回顾性分析我院1988～1999年收治的胃癌卵巢转移12例.结果8例施一期胃癌根治及双卵巢切除,2例胃癌术后行卵巢切除,1例卵巢转移癌术后再行胃癌手术,1例仅行剖腹探查术.印戒细胞癌8例,低分化腺癌2例,未分化腺癌2例,侵犯双侧卵巢10例.18月内均死亡.结论Krukenberg瘤在年轻女性中多见,恶性度高,易漏诊,预后极差,化疗常无效,早期发现、手术可能是获得根治的唯一机会.     

表现为Krukenberg瘤的阑尾类癌卵巢转移1例

继发于胃肠道癌的卵巢转移性癌称作Krukenberg瘤，也有学者将来源于全身任何部位肿瘤转移到卵巢称为Krukenberg瘤．而表现为Krukenberg瘤的阑尾类癌卵巢转移病例罕见，1970年以来英文文献报道了约17例此类病例。     

卵巢印戒细胞间质瘤的临床病理分析

目的：探讨卵巢印戒细胞间质瘤（signet—ring stromal tumor，SRST）的临床病理特点、鉴别诊断、治疗、生物学行为及预后。方法：采用HE、组织化学和免疫组织化学SP法检测SRST肿瘤细胞PAS—D、CK、CK7、CK20、Vimentin、Actin、inhibin、calretinin的表达。结果：4例SRST患者年龄20—56岁（平均40岁），所有肿瘤均为单侧发生、组织学表现为印戒样细胞与梭形细胞混合存在，无上皮分化（如腺管、细胞巢或备索）。组织化学染色PAS—D、免疫组织化学染色CK、CK7、CK20、inhibin、calretinin均为阴性，Vimentin和Aetin阳性．患者随访11～52个月（平均27．8个月）．均生存，无肿瘤复发或转移。结论：SRST是少见的卵巢良性肿瘤，预后好，组织学上与Krukenberg瘤等肿瘤易混淆．结合临床病理特征、纽炽化学和免疫组织化学有助于SRST的诊断.     

伴印戒细胞成分乳腺癌的临床病理学观察

目的 探讨伴印戒细胞成分乳腺癌的病理特征及诊断，鉴别诊断要点。方法 经HE、AB／PAS及免疫组化对8例伴印戒细胞成分乳腺癌进行观察。并文献复习。结果 本组患者均为女性，平均年龄54．6岁。肿块平均2．6cm；组织学以浸润性乳腺癌伴多少不等的典型印戒样癌细胞为特征，6／8例为浸润性小叶癌，其中5／6例ER、PR阳性表达；2／8例浸润性导管癌,1／2例ER、PR阳性;7／8例癌细胞中印戒细胞成分超过10％；4例做AB／PAS均提示印戒细胞浆内的粘液表达；印戒细胞成分的多少与病人预后有关系。结论 伴印戒细胞成分乳腺癌是乳腺癌中的一种特殊类型，排除转移及与粘液腺癌的鉴别诊断尤为重要。     

伴印戒细胞成分乳腺癌的临床病理学观察

目的　探讨伴印戒细胞成分乳腺癌的病理特征及诊断 ,鉴别诊断要点。方法　经HE、AB/PAS及免疫组化对 8例伴印戒细胞成分乳腺癌进行观察 ,并文献复习。结果　本组患者均为女性 ,平均年龄 5 4 6岁 ,肿块平均 2 6cm ;组织学以浸润性乳腺癌伴多少不等的典型印戒样癌细胞为特征 ,6 / 8例为浸润性小叶癌 ,其中 5 / 6例ER、PR阳性表达 ;2 / 8例浸润性导管癌 ,1/ 2例ER、PR阳性 ;7/8例癌细胞中印戒细胞成分超过 10 %;4例做AB/PAS均提示印戒细胞浆内的粘液表达 ;印戒细胞成分的多少与病人预后有关系。结论　伴印戒细胞成分乳腺癌是乳腺癌中的一种特殊类型 ,排除转移及与粘液腺癌的鉴别诊断尤为重要。     

24例库肯勃瘤的诊治分析

目的探讨Krukenberg瘤的临床特点、诊断及治疗方法.方法回顾性分析我院1980～2004年收治的24例Krukenberg瘤的临床资料.结果 Krukenberg瘤好发于中年女性,多为双侧（18/24）,原发灶病理类型多为低分化腺癌或粘液腺癌.临床分期多为中晚期（Ⅲ期、Ⅳ期胃癌15例,Dukes C、D期大肠癌7例,Dukes B期大肠癌1例,阑尾粘液类癌1例）.恶性度高,易漏诊,预后极差,平均生存期不超过2年.结论确诊为卵巢恶性肿瘤时应首先排除转移癌的可能,发现卵巢转移肿瘤者,应常规行胃肠道检查以寻找原发灶.女性胃肠癌患者应考虑有无卵巢转移.有卵巢转移者,手术为首选治疗方式,需同时切除胃肠原发病灶、子宫及双侧附件.无卵巢转移者是否行预防性卵巢切除术应遵循个体化原则.     

胃粘液癌的肿瘤增殖与DH7识别抗原的表达

应用免疫组化ＡＢＣ法，分析单克隆抗体ＤＨ７识别抗原在１９例胃粘液癌中的表达。结果显示有腺样结构的粘液腺癌阳性率为１００％（９／９），无腺样结构的粘液细胞癌（即印戒细胞癌）阳性率仅为２０％（２／１０），其中２例阳性均属粘液细胞癌的前期——单核细胞样癌细胞形式，而另８例所见的后期印戒样癌细胞均为阴性。提示，粘液癌的肿瘤增殖发生于腺样结构的癌组织和单核细胞样癌组织中，而非发生于散在的印戒样癌细胞中，后者乃是肿瘤增殖后期的终末期癌细胞形式，从而验证了粘液细胞癌从前期单核样癌细胞到后期印戒样癌细胞的这一形态演化过程。     

卵巢克根堡氏瘤——组织化学及免疫组织化学的研究

 本文报告25例卵巢克根堡氏瘤,经观察含有硫酸化粘液及唾液酸粘液,混合存在者转移较高,而且粘液性质与胃肠道癌细胞产生的粘液无差别,有助于克根堡氏瘤的诊断。 25例中,23例CEA标记为阳性反应,其中强阳性2例,系胃粘液细胞癌转移至卵巢,乳腺癌2例转移至卵巢者为阴性(原发癌也属阴性),说明CEA是一种人类消化道较强的标记物,其转移性癌也显示阳性,可作为克根堡氏瘤诊断的辅助指标,有助于探讨原发瘤的部位。     

卵巢克根堡氏瘤——组织化学及免疫组织化学的研究

本文报告25例卵巢克根堡氏瘤,经观察含有硫酸化粘液及唾液酸粘液,混合存在者转移较高,而且粘液性质与胃肠道癌细胞产生的粘液无差别,有助于克根堡氏瘤的诊断。 25例中,23例CEA标记为阳性反应,其中强阳性2例,系胃粘液细胞癌转移至卵巢,乳腺癌2例转移至卵巢者为阴性(原发癌也属阴性),说明CEA是一种人类消化道较强的标记物,其转移性癌也显示阳性,可作为克根堡氏瘤诊断的辅助指标,有助于探讨原发瘤的部位。     

消化道癌卵巢转移7例

近3年内笔者共收治消化道癌卵巢转移患者7例,现报告如下:1 临床资料本组7例,年龄41岁～58岁,其中原发胃癌1例、直肠癌5例、乙状结肠癌1例.行B超及CT检查均发现盆腔包块.1例直肠癌侵及腹膜并与周围组织粘连,两侧卵巢肿大(右侧6.5cm×7.5cm,左侧5cm×6cm),并与直肠癌周围粘连,行乙状结肠造口、双侧卵巢切除,直肠癌活检病理报告均为粘液细胞癌(来源于直肠).1例50岁乙状结肠癌Ducke’s B期,行根治术,左侧卵巢约4cm×4cm大,同时予以切除,病理报告为卵巢肿瘤与原发癌细胞类型相同.其余原发癌为1例胃癌及4例直肠癌,行根治术后发生盆腔包块再手术,术中发现双侧卵巢肿大,并经病理检查,均为粘液腺癌,含1例印戒细胞癌.1例盆腔肿块达18cm×16cm大,并出现下肢水肿,术中证实巨大包块系右侧卵巢,已侵及子宫及骶前,其左侧卵巢约4cm×5cm大,行双侧卵巢及子宫切除.1例乙状结肠癌再手术后存活2年.1例胃癌首次术后2年发现卵巢转移,再次行双侧卵巢切除,术后1年死亡.     

Krukenberg tumors of the ovary: a clinicopathologic analysis of 27 cases

A series of 27 typical Krukenberg tumors of the ovary were analyzed. By definition, all examples were characterized by the presence of mucinous signet-ring carcinoma cells within a cellular, nonneoplastic ovarian stroma. The patients' ages ranged from 20-70 years; almost one-half were 40 years of age or younger. A primary carcinoma of the stomach (16 cases) or colon (four cases) was found in 20 (90.9%) of 22 patients with available follow-up data. The primary gastrointestinal carcinomas had been diagnosed before emergence of the ovarian tumors in only five cases. The ovarian and gastrointestinal tumors were synchronously diagnosed in ten cases, while in five instances the primary carcinomas were not discovered until after the ovarian tumors had been treated. An acceptable primary extraovarian cancer was not detected in two women. Both had bilateral Krukenberg tumors and died with widespread carcinomatosis less than two years postoperatively. Typically, the ovarian tumors were bilateral, asymmetrically large and solid. Important histologic features included a greater abundance of intracellular neutral glycoproteins than acidic mucins, a storiform pattern of hyperplastic cortical stromal cells (44.4%) and carcinomatous emboli (51.6%). While the entity of "primary" Krukenberg tumor cannot be unequivocally denied, all women with typical Krukenberg tumors should be considered as having metastatic carcinoma, usually from the stomach, until proven otherwise.     

卵巢转移癌64例临床病理分析

我院自1973年11月～1986年12月收治卵巢转移癌64例,占同期卵巢恶性肿瘤14.7％(64/436),其中库肯勃氏瘤(称KT)46例,占转移癌的71.9％。本组病例手术后加化疗者56例,尚在继续巩固化疗者9例,其中2年、5年以上者各1例。本组64例存活2年以上者仅4 例(6.3％)。本文分析了卵巢转移癌的病理组织类型,并就诊断标准及提高诊断率方面进行讨论。     

Signet-ring stromal tumor of ovary. Histochemical, light, and electron microscopic study.

A peculiar primary ovarian neoplasm occurring in a 28-year-old woman is presented. The tumor cells showed extensive cytoplasmic vacuolation, resulting in a "signet-ring" appearance similar to what was described in Krukenberg tumors. The tumor was studied histochemically, as well as by light and electron microscopy. The cells appeared to be uniform. A moderately electron-dense flocculent material was present in the cytoplasmic vacuoles. similar material was seen in the intercellular matrix with some fibrillary structures suggesting a protein structure. This, coupled with the lack of any basement membrane material around the tumor cells, indicates a mesenchymal tumor that is probably derived from the multipotent ovarian stromal cell. The features that help to differentiate this tumor from other ovarian tumors with clear or vacuolated cells are discussed. Because of its gross and microscopic appearance, the tumor is expected to behave in a benign fashion.     

Signet-ring cell carcinoma of the breast. The mucinous variant of infiltrating lobular carcinoma?

Five cases of the type of mammary carcinoma that has been designated "signet-ring cell carcinoma" are presented. This tumor is characterized by the presence of numerous cells containing intracellular mucin, without large amounts of extracellular mucin as is seen in colloid (gelatinous, mucinous) carcinoma of the breast. Although such cells may be seen in many mammary carcinomas, they are never as frequent as in the variant described. Ultrastructurally, the most characteristic finding is the presence of numerous intracellular lumina containing material which appears to represent the mucin identified with the light microscope. This finding differs from that in colloid carcinoma, in which the scantier intracellular mucin occurs in the form of intracytoplasmic membrane-bound vesicles. The five tumors in the present series were all associated with either in situ lobular carcinoma or a "sinus catarrh"-like pattern of nodal metastases, or both. On the basis of these light and electron microscopic data, the signet-ring cell carcinoma is suggested as a variant of infiltrating lobular carcinoma, clinically and pathologically distinct from colloid carcinoma.     

Hepatoid carcinoma of the ovary. A newly described tumor

Five cases of ovarian carcinoma with hepatoid features, three of them primary and two probably primary, are described. The tumor cells were arranged predominantly in sheets and contained moderate to abundant amounts of eosinophilic cytoplasm; varying numbers of tumor cells stained immunohistochemically for alpha fetoprotein. In contrast to the much younger age range of patients with ovarian hepatoid yolk sac tumors, the ages of the five patients with hepatoid carcinomas ranged from 42 to 78 (average, 63 years), and none of them had gonadal dysgenesis or recognizable germ cell components within their tumors. All the tumors presented as adnexal masses; in four cases they were Stage III and in one case, Stage IIB; this last tumor spread to the upper abdomen within 4 years. In three cases the clinical course and pathology findings indicated that the tumor had originated in the ovary; in the remaining two cases the tumors were interpreted as only probably primary in the ovary. Hepatoid carcinomas must be distinguished from other ovarian neoplasms, especially from hepatoid yolk sac tumors.     

Lymph node involvement by direct extension in adenoid cystic carcinoma. Absence of classic embolic lymph node metastasis.

Thirty-four cases of adenoid cyctic carcinoma seen at the University of Virginia Hospital from 1946 to 1974 were reviewed, with special emphasis on lymph node involvement by tumor. Lymph node involvement was found in three cases of primary tumors of the submaxillary gland, and all of the affected lymph nodes were in the immediate vicinity of the primary tumor. Two lymph nodes were involved in two of the cases, and one node was involved in the third case. In all of these lymph nodes, adenoid cystic carcinoma was present in the soft tissue surrounding the node, and the tumor extended into the node. No metastatic tumors were observed in 46 lymph nodes removed incidentally at the time of local excision of the primary tumors in 10 additional cases or in 212 lymph nodes examined after unilateral radical neck dissections in six other cases. Five autopsies in this series showed no lymph node metastases. In this series of cases adenoid cystic carcinoma only invades lymph nodes in the immediate vicinity of the primary tumor. When lymph node involvement does occur, it does not result from embolic lymph node metastasis; rather, a direct invasion of the lymph node from tumor in the perinodal soft tissue occurs. Obviously, this small study does not completely exclude the possibility of embolic metastasis; however, if it does occur, it must be extremely rare.     

Bilateral ovarian carcinoma: cytogenetic evidence of unicentric origin

Cytogenetic analyses were performed on the tumors from both ovaries in 15 patients with bilateral ovarian carcinoma. In 4 of them, omental implants were also examined. Abnormal karyotypes were detected in 11 cases. The baseline karyotypes in the 2 tumorous ovaries were identical in each patient, indicating that bilateral ovarian cancer develops by metastatic spreading. There was no clear-cut evidence of differences in the clonal evolution between the tumors of the 2 ovaries, and hence the side harboring the primary tumor could never be determined. The metastatic nature of the omental implants was proved by the fact that their karyotypes were indistinguishable from those of the ovarian tumor tissue.     

Signet-Ring Stromal Tumor of the Ovary: Report of a Case and Review of the Literature

Signet-ring stromal tumor of the ovary is extremely rare, with only ten cases reported in the literature. We report on a case of signet-ring stromal tumor of the left ovary in a 54-year-old woman who presented with abdominal discomfort. Histologically, the tumor was composed of an admixture of spindle and round cells which contained a large cytoplasmic vacuole which displaced the nucleus, creating a signet-ring appearance. Numerous cells showed intracytoplasmic hyaline globules. Immunohistochemically, the tumor cells showed positivity for vimentin, actin, inhibin, and calretinin, thus confirming the ovarian stromal origin of the neoplasm. The patient remains free of disease one year and 9 months after surgery. Signet-ring tumor of the ovary is a rare variant of benign ovarian stromal neoplasm and should be distinguished from metastatic mucin-secreting signet-ring adenocarcinoma.     

Esophageal mucoepidermoid carcinoma containing signet-ring cells: three case reports and a literature review.

We report 3 cases of esophageal signet-ring cell carcinoma which were found in a set of 505 resected esophageal tumors. The incidence of esophageal signet-ring cell carcinoma was 0.6%. All of the signet-ring cell carcinomas were histologically mixed with squamous cell carcinoma (mucoepidermoid carcinoma). The signet-ring cells had intracellular mucin, which was positive for both periodic acid-Schiff (PAS) and alcian blue at pH 2.5. At the time of presentation, extensive extraesophageal tumor spread and local extension were found in all cases. All of the patients died within 2 years after the esophagectomy irrespective of whether they received chemotherapy or radiotherapy. Our results, and those previously reported, suggest that most esophageal carcinomas containing signet-ring cell carcinoma are aggressive neoplasms associated with a poor prognosis after esophagectomy.