67例肾上腺转移瘤的临床及B超分析

我院从１９５８年至１９９２年底收治的８６０００余例恶性肿瘤患者中，临床诊断肾上腺转移瘤８０例。通过回顾性研究，对临床资料较完整的６７例，共计８３个肾上腺转移瘤分析结果显示：１．恶性肿瘤可经血行或直接转移至肾上腺，以血行转移为主；２．肾上腺转移瘤最常见的原发肿瘤是肺癌，占７０％（４７／６７），特别是小细胞未分化肺癌，占４０％（２７／６７）其次是恶性淋巴瘤占１１．９％（８／６７）；３．发现肾上腺转移瘤     

儿童扁桃体原发性恶性B细胞淋巴瘤临床病理观察

目的总结儿童扁桃体原发性恶性B细胞淋巴瘤的病理特点、组织学类型及鉴别诊断要点。方法HE染色行形态学观察,免疫组化染色进行B、T分类,相关癌基因蛋白及EB病毒蛋白(LMP-1)表达的检测。结果4例均为B细胞淋巴瘤,其中3例为弥漫型滤泡性淋巴瘤,1例为伯基特淋巴瘤;LMP-1均(-)。结论儿童扁桃体原发性恶性B细胞淋巴瘤在形态学上易误诊为炎症或低/未分化癌,诊断主要依据HE切片辅以免疫组化标记,组织学类型为弥漫型滤泡性淋巴瘤和非地方性伯基特淋巴瘤2种,与EB病毒感染的关系可能不大。     

中枢神经系统原发的恶性淋巴瘤

本文总结了８例中枢神经系统原发的恶性淋巴瘤，分析其临床病理特点。８例肿瘤均位于大脑且为弧立的或弥漫多中心的病灶。组织学类型均为弥漫型，以小细胞性及低度恶性为多。ＬＣＡ，ＣＤ（２０）及ＣＤ（４３）免疫组织化学染色证实中枢神经系统恶性淋巴瘤多为Ｂ细胞性淋巴瘤。     

鼻咽部肿瘤及瘤样病变的临床病理分析

目的加深对鼻咽部肿瘤及瘤样病变发病情况和特点的全面了解,提高临床及病理诊断水平。方法收集鼻咽部肿瘤及瘤样病变活检标本1362例,统计其构成比、发病年龄及性别分布,观察其临床病理变化特点。结果（1）本组鼻咽部肿瘤及瘤样病变总的构成比按组织来源排序如下：淋巴造血组织〉上皮组织〉软组织〉骨及软骨组织〉异位颅内组织肿瘤及瘤样病变。恶性肿瘤中排在前五位的是鼻咽癌〉淋巴瘤〉涎腺型腺癌〉脊索瘤〉恶性软组织肿瘤;良性肿瘤及瘤样病变中排在前五位的是良性淋巴组织增生症〉以血管纤维瘤为主的软组织肿瘤〉被覆上皮的乳头状瘤〉异位颅内组织肿瘤及瘤样病变〉多形性腺瘤。（2）淋巴造血组织来源者868例,良性淋巴组织增生828例,恶性淋巴瘤等恶性病例40例（4．6％,40／868）,其中以弥漫性大B细胞淋巴瘤及外周T／NK细胞淋巴瘤居多,男性多见;良性与恶性的比例为20．7：1。上皮组织来源者共373例,其中恶性多见为353例（94．6％,353／373）,以鼻咽癌为最多[327例,分别占上皮性肿瘤及恶性上皮性肿瘤的87．7％（327／373）及92．6％（327／353）],其次为腺样囊性癌[11例,分别占2．9％（11／373）及3．1％（11／353）];良性肿瘤以乳头状瘤和错构瘤（16例）及多形性腺瘤（4例）居多;恶性与良性的比例为17．3：1。软组织肿瘤为101例（7．4％,101／1362）,其中最常见的是血管纤维瘤77例（76．2％,77／101）,均为男性患者;恶性者少见,仅10例;良性与恶性的比例为9．1：1。骨及软骨组织肿瘤中以脊索瘤最多见（11例）,男2例,女9例。异位颅内肿瘤及瘤样病变也可见到,共观察到5例。除上述病变外,还收集到其他各种类型肿瘤及瘤样病变共32例,几乎涵盖了2005年版WHO鼻咽部肿瘤分类中列举的所有类型。结论鼻咽部可以发生多种组织类型的肿瘤及瘤样病变,其中以良性淋巴组织增生、鼻咽癌、鼻咽部血管纤维瘤、恶性淋巴瘤和涎腺型腺癌较常见,它们具有特征性的临床和病理改变,其他肿瘤及瘤样病变在临床和病理改变方面与全身其他部位者相同或相似,诊断及鉴别诊断主要依靠病理检查。     

卵巢原发性非霍奇金恶性淋巴瘤的诊断与鉴别诊断

目的探讨卵巢原发性恶性淋巴瘤的诊断及卵巢原发性恶性肿瘤（颗粒细胞瘤、克鲁根伯瘤、未分化癌、无性细胞瘤及原始外胚叶肿瘤）鉴别诊断。方法应用组织病理学及免疫组织化学观察。结果免疫组织化学明确了卵巢原发性恶性淋巴瘤的诊断。结论原发性恶性淋巴瘤非常罕见，临床及病理诊断较困难，单凭形态学很难与其他小细胞肿瘤相鉴别，免疫组织化学标记有一定价值。     

鼻腔鼻窦恶性肿瘤治疗的进展

鼻腔鼻窦恶性肿瘤（SNMs）是耳鼻咽喉科较少见的肿瘤性疾病,国内外统计占全身恶性肿瘤的1％～3．66％。SNMs原发于鼻腔者较少,其病理类型以癌为主,占80％以上,肉瘤约占10—20％。原发于鼻窦者以上颌窦最为常见,占60％-80％,筛窦10％～20％,额窦及蝶窦均〈5％。其病理类型包括鳞癌（SCC）、腺癌（AC）、腺样囊性癌（ACC）、嗅母细胞瘤（ONB）、恶性黑色素瘤（MM）、神经内分泌癌（NEC）、恶性淋巴瘤等。     

甲状腺肿瘤的诊治进展

甲状腺肿瘤包括良性肿瘤和恶性肿瘤。甲状腺良性肿瘤一般指结节性甲状腺肿和甲状腺腺瘤 ,甲状腺恶性肿瘤包括甲状腺癌和肉瘤。甲状腺癌一般指甲状腺乳头状癌、甲状腺滤泡状癌、甲状腺髓样癌和未分化癌。甲状腺未分化癌一般包括分化差的乳头状腺癌和滤泡状腺癌及原发于甲状腺的鳞状细胞癌、大细胞癌、小细胞癌、巨细胞癌、腺样囊性癌和粘液腺癌 ;较罕见的还有甲状腺恶性淋巴瘤等。本文主要讨论常见的甲状腺良恶性肿瘤的诊断和治疗。1　结节性甲状腺肿及良性腺瘤结节性甲状腺肿是单纯性甲状腺肿的一种 ,在地方性甲状腺肿流行区和非地方性甲状…     

原发性心脏肿瘤45例临床病理分析

目的：分析45例原发性心脏肿瘤的病理类型,形态学变化及其临床病理特征。方法：采用HE染色,组化及免疫组化ABC技术对45例原发性心脏肿瘤进行病理学观察。结果：良性肿瘤36例（80．0％）,包括心房黏液瘤,乳头状纤维弹力瘤,心脏横纹肌黏液瘤,心包囊肿;恶性肿瘤8例（17．8％）,包括血管内皮肉瘤,恶性间皮瘤,恶性淋巴瘤及心包恶性胸腺瘤;交界性上皮样血管内皮瘤1例（2．2％）,结论：原发性心脏良性肿瘤以心房黏液瘤最多见,其他少见;原发性心脏恶性肿瘤类型较多,组织学形态较复杂,易与继发性肿瘤混淆,选择适当的影像学检查,有效的心脏外科手术,配合以病理形态学观察及免疫组化标记,对原发性心脏肿瘤的诊治很有必要。     

面中线部位小圆细胞恶性肿瘤病理诊断误诊原因及对策

鼻腔、鼻窦、咽部及口腔等面中线部位的一些小圆细胞性肿瘤如中线T细胞淋巴瘤、嗅神经母细胞瘤、恶性黑色素瘤及低-未分化癌等,极易混淆,造成误诊.本文报道上述恶性肿瘤50例,并就其误诊原因进行分析,探讨提高诊断正确性的对策.     

口咽部B细胞来源非霍奇金淋巴瘤的CT诊断

目的：分析口咽部B细胞来源非霍奇金淋巴瘤（NHL）的CT表现、特征,初步探讨不同病理类型B细胞来源NHL的CT表现特点,为临床诊断和治疗提供更为准确的信息。方法：对18例经病理证实的口咽部B细胞来源非霍奇金淋巴瘤的CT表现进行回顾性分析。结果：18例中,弥漫大B细胞淋巴瘤13例,占72．2％（13／18）,滤泡性淋巴瘤3例,占16．7％（3／18）,套细胞淋巴瘤1例,占5．6％（1／18）,结外边缘区淋巴瘤（MALT淋巴瘤）1例,占5．6％（1／18）。病变分布为：扁桃体NHL9例（弥漫大B细胞淋巴瘤8例、套细胞淋巴瘤1例）;舌根8例（弥漫大B细胞淋巴瘤5例、滤泡性淋巴瘤3例）;软腭1例,为结外边缘区淋巴瘤（MALT淋巴瘤）。18例病变均表现为肿块型。同时有淋巴结受累者12例（66．7％）,其中双侧受累者3例。结论：口咽B细胞来源NHL多发生于扁桃体及舌根。病理类型以弥漫大B细胞淋巴瘤为主,主要表现为肿块。CT对于B细胞来源NHL的鉴别诊断和病变范围的判断具有重要作用。     

Does texture analysis improve breast ultrasound precision?

OBJECTIVE: To evaluate the possibility of distinguishing between benign and malignant breast tumors using a computer-aided evaluation of echogenicity and echostructure of ultrasound findings at certain focal points. STUDY DESIGN: The ultrasound images from 89 cases of breast tumor were documented under standardized conditions using a linear array machine and 7.5 MHz transducer. In each sonographic image, the maximum area of the 'region of interest' of the tumor was marked and then subjected to consecutive statistical analysis and correlation with the histological findings. For evaluation of tumor status eight parameters of first and second order texture statistics (gray level histogram, Fourier analysis, co-occurrence matrix) were applied. RESULTS: Benign tumors were clearly distinguished from carcinomas in the evaluation of the co-occurrence matrix and the Fourier analysis on the basis of Wilcoxon and Student t-test (P < 0.05) but not in the gray level histogram. Using logistic regression a sensitivity of 73.8% and a specificity of 54.2% were obtained. A statistically significant difference between benign tumors and moderately differentiated together with poorly differentiated carcinomas could be demonstrated. CONCLUSION: This study concludes that texture analysis appears to distinguish between benign and most malignant tumors. A computer texture analyzing system is able to improve the subjective assessment of ultrasound images of the breast but can not replace it. Where the limits of subjective assessment of a given tumor are reached, computerized texture analysis will provide additional information in the differentiation of benign from malignant findings.     

细针吸取微小组织学与涂片细胞学在颈淋巴结转移性肿瘤中的诊断价值

目的　探讨微小组织学与涂片细胞学 (FNAC)在淋巴结转移性肿瘤分型中的诊断价值。方法　选取有术后病理组织学对比的 16 8例颈部淋巴结转移病例 ,其中 111例仅行FNAC检查 ,5 7例有微小切片与FNAC检查。结果　微小切片加FNAC组诊断敏感性为 96 5 % ,FNAC组为 79 3%。淋巴结转移性肿瘤分型中微小切片组加FNAC组准确率为 94 7% ,涂片组分型准确率为 82 % ,两者相比差异显著 (P <0 0 5 )。高分化癌转移淋巴结时有较明显的细胞学特征 ,与同组微小切片相比差异不显著 (P >0 0 5 ) ;淋巴结转移性低分化肿瘤中涂片组无明显细胞学特征 ,诊断准确率 73% ,微小切片与FNAC结合组诊断准确率 93 6 % ,后者与前者相比差异显著 (P <0 0 5 )。结论　针吸细胞涂片检查在高分化转移性肿瘤中诊断正确性较高 ,淋巴结转移性低分化肿瘤可利用细胞涂片与微小组织学相结合的方法提高分型的准确率     

浅表淋巴结恶性肿瘤的声像图分析

目的比较不同类型浅表淋巴结转移癌声像图的差异。方法分析经病理证实的98例浅表淋巴结恶性肿瘤的声像图特点。结果与其他腺癌相比,甲状腺癌转移淋巴结血供丰富,无回声区的淋巴结增多（P〈0．01）,并且8例乳头状甲状腺癌转移淋巴结内可见微钙化;淋马瘤与转移癌、低分化与中分化癌、鳞癌与腺癌之间比较,各项观察指标均无统计学差异（P〉0．05）。结论除部分乳头状甲状腺癌转移淋巴结的声像图能够提示原发病灶外,声像图不能提示恶性肿瘤分化程度及来源。     

原发性胃淋巴瘤临床病理特征及预后独立危险因素分析

目的分析原发性胃淋巴瘤（PGL）组织分型及围手术期相关因素对预后的影响。 方法对中国医科大学附属第一医院胃肠肿瘤外科1988年9月至2011年7月期间收治的53例PGL患者的临床病理资料进行回顾性分析,通过Kaplan-Meier生存曲线计算累积生存率,采用Log-rank检验单因素分析和Cox模型多因素分析分析其临床特征及围手术期相关因素对预后的影响,并通过单因素分析法分析不同病理分型,其影响预后相关因素是否存在差异。 结果53例PGL患者发病年龄21~78岁（平均年龄54岁,中位年龄58岁）。本组病例组织分型：黏膜相关淋巴组织淋巴瘤（MALT）占64.2%（34/53）、弥漫性大B细胞淋巴瘤（DLBCL）22.6%（12/53）。Ann Arbor临床分期：ⅠE期22例（41.5%,22/53）、ⅡE期19例（35.8%,19/53）、ⅢE期1例（1.9%,1/53）、ⅣE期10例（18.9%,10/53）。随访资料完整的53例患者中,1、3、5年生存率分别为81.1%、47.2%、32.1%,总体中位生存期为35个月。单因素分析显示：影响预后的相关因素中性别（P=0.021）、年龄（P=0.028）、肿瘤大小（P=0.004）、手术根治度（P<0.001）、侵犯脏器（P<0.001）、病理组织分型（P=0.006）、Ann Arbor分期（P=0.029）方面差异具有统计学意义;多因素分析显示：手术根治度（OR=3.611）、病变组织分型（OR=1.729）、Ann Arbor分期（OR=1.509）是影响预后的独立因素。影响MALT预后相关因素中性别（P=0.028）、手术根治度（P<0.001）、侵犯脏器（P<0.001）以及Ann Arbor分期（P=0.003）方面差异具有统计学意义。而DLBCL预后与患者胃肠道炎性病变、溃疡等良性疾病史存在相关性（P=0.003）。 结论肿瘤根治度、侵犯脏器、原发性胃淋巴瘤的组织分型是影响原发性胃淋巴瘤预后的独立因素;患者性别、手术根治度、侵犯脏器、Ann Arbor分期与MALT的预后存在相关性;患者胃肠道疾病史与DLBCL预后存在相关性。     

脾原发性恶性淋巴瘤11例临床病理及免疫组化分析

目的　对 11例脾原发性恶性淋巴瘤 (PLS)进行临床病理及免疫组化研究。方法　对瘤组织进行常规HE染色及SP法免疫组化染色 ,光镜观察。结果　 11例患者以左上腹疼痛和巨脾为主要症状。 11例瘤细胞CD45均( ) ;10例B细胞性淋巴瘤CD2 0 ( ) ,其中B小淋巴细胞性淋巴瘤 3例 ,CD43、CD79α和bcl 2 ( ) ;脾边缘区B细胞性淋巴瘤 3例 ,CD79α、IgM、ALK( ) ,IgD(± ) ;淋巴浆细胞样淋巴瘤 2例 ,CD43、CD79α、bcl 2 ( ) ,IgD(-) ;弥漫性大B细胞性淋巴瘤 2例 ,ALK( ) ,CD3 0、CD3 (± )。 1例周围T细胞性淋巴瘤 ,无其他特征型CD45RO和CD3 ( ) ,CD3 0 (± )。结论　PLS较罕见 ,应与脾内其他原发性或继发性小细胞性恶性肿瘤鉴别 ,免疫组化染色对诊断、鉴别诊断及分型具有重要意义     

Malignant lymphoma arising from heterotopic Warthin's tumor in the neck: case report and review of the literature

Warthin's tumor (WT), so-called adenolymphoma, is a benign salivary gland tumor with both epithelial and lymphoid histological characteristics, so the histogenesis remains unclear. Treatment consists primarily of tumor removal or conservative follow up. Here we present a rare case of malignant lymphoma arising from heterotopic (ectopic) WT. A 102-year-old man presented with a mass in the left side of the neck which was painless but gradually enlarged over 1 month. The mass was 2-3 cm in diameter, and freely moveable below the angle of the mandible. The mass was totally removed. The histological diagnosis was malignant lymphoma, diffuse large B-cell type, arising from heterotopic WT. Postoperative staging examination including chest radiography, bone scan, and computed tomography of the abdomen and pelvis revealed no evidence of dissemination of malignant lymphoma. Malignant transformation within WT is rarer in the lymphoid component than in the epithelial component. Only 16 cases of malignant transformation arising from WT have been reported, including only three cases of non-Hodgkin lymphoma apparently arising from heterotopic WT. Tumor removal or careful follow up is recommended in patients with WT because of the potential risk posed by such malignant transformation.     

Gene p53 mutations are restricted to poorly differentiated and undifferentiated carcinomas of the thyroid gland.

The p53 gene was analyzed in tumor specimens obtained from 52 patients with various types of carcinoma of the thyroid gland by a combined molecular and immunocytochemical approach. The histologic types included 37 well-differentiated papillary and follicular carcinomas, 8 poorly differentiated, and 7 undifferentiated carcinomas. The p53 gene was shown to be unaffected in all differentiated tumors by single-strand conformation polymorphism analysis. However, in two out of eight (25%) of poorly differentiated carcinomas and five out of seven (71%) undifferentiated carcinomas, p53 mutations were identified and subsequently characterized by DNA sequencing. One undifferentiated carcinoma displayed two areas with varying degrees of differentiation. The comparative analysis of the p53 gene, in both the more and the less differentiated area of this tumor, clearly showed that the p53 mutation was confined to the latter component of the tumor specimen. These results indicate that mutations of the p53 gene are associated with the most aggressive histologic types of thyroid tumors, such as the undifferentiated carcinoma and, to a certain extent, the poorly differentiated carcinoma, and that the alterations of this gene represent a late genetic event in human thyroid carcinogenesis.     

滑膜肉瘤32例临床病理分析

目的 探讨滑膜肉瘤的形态特点和鉴别诊断。方法 收集原诊断为滑膜肉瘤的病例66例、恶性周围神经鞘膜瘤10例、纤维肉瘤6例、平滑肌肉瘤13例，进行形态学观察，并采用10种抗体做免疫组化染色。结果 66例原诊滑膜肉瘤的病例中，最终确诊为滑膜肉瘤者27例，诊断准确率40．9％。最易误诊为滑膜肉瘤的肿瘤是恶性周围神经鞘膜瘤，占31．8％。5例滑膜肉瘤最初误诊为其他梭形细胞肉瘤。组织学双向分化是其主要特点，分单相纤维型，双相型和低分化型，未见单相上皮型病例。免疫组化瘤细胞表达CK和／或EMA，同时vimentin阳性，S－100和PGP9.5也有一定阳性率。bcl-2蛋白阳性率高，多为弥漫性。其他几种梭形细胞肉瘤不表达CK和EMA，bcl-2蛋白阳性率低或局灶阳性。结论 滑膜肉瘤是一种容易误诊的软组织肉瘤，免疫组化同时表达上皮性和间叶性标记。最易误诊的肿瘤是恶性周围神经鞘膜瘤。bcl-2蛋白检测对滑膜肉瘤鉴别诊断有一定帮助。     

子宫体原发性弥漫性大B细胞淋巴瘤临床病理观察

目的探讨子宫体原发性弥漫性B细胞淋巴瘤的病理诊断与鉴别诊断要点。方法对2例子宫体原发性弥漫性B细胞淋巴瘤进行临床病理特点观察,使用LCA、CD30、CD79a、CD68、CD45RO、CD3、CD20和CEA等免疫组化染色辅助诊断,并文献复习。结果子宫体原发性弥漫性B细胞淋巴瘤临床诊断困难,镜下病理形态多样,可见子宫内膜和/或肌层内淋巴样细胞增生,免疫组化B细胞标记（＋）。结论子宫原发性弥漫性B细胞淋巴瘤少见,临床易漏诊且侵袭性较高,因此准确、完整的病理诊断对预后治疗十分重要,免疫组化有辅助诊断作用。     

Diffuse large B-cell lymphoma arising in a patient with neurofibromatosis type I and in a patient with neurofibromatosis type II

We experienced two unusual cases of diffuse large B-cell lymphoma (DLBCL), which occurred in a patient with neurofibromatosis type I and a patient with neurofibromatosis type II. B-cell lymphoma is one of the most common phenotypic subgroups of malignant lymphoma. Neurofibromatosis I is characterized by café-au-lait spots and neurofibromas. Neurofibromatosis II typically consists of bilateral schwannomas of the acoustic nerve. Malignant lymphomas rarely coexist with neurofibromatosis I, and no coexistence with neurofibromatosis II has been reported. The patient with neurofibromatosis I was a 50-year-old Japanese woman, clinically manifesting von Recklinghausen's disease since infancy, who noticed an egg-sized tumor in her shoulder. The patient with neurofibromatosis II was a 39-year-old Japanese man who noticed multiple soft tissue tumors in his neck, buttock, and elbow. Biopsied materials from both cases were examined by multiparameter methods, including flow cytometry. Flow cytometry revealed large-scale cells to be tumor cells, and they were positive for CD19, CD20, and CD22. Both patients received chemotherapy, and the tumors disappeared. The patient with neurofibromatosis I was alive without recurrence at 4 years after treatment, while the patient with neurofibromatosis II died of recurrence. To the best of our knowledge, this is the first case of malignant lymphoma arising in a neurofibromatosis II patient. As for neurofibromatosis I, there were some reports about occurrence of malignant lymphoma. It is important to be aware of possibility of association of malignant tumors not only of the nervous system but also of unrelated to the nervous system when tumors appear in neurofibromatosis patients.