Kikuchi淋巴结炎的临床病理学观察

目的：探讨Kikuchi淋巴结炎的病因及临床特征,提高对Kikuchi淋巴结炎的认识,减少误诊。方法：对31例病理确诊为Kikuchi淋巴结炎的病例,结合临床特点和免疫组化进行分析观察。结果：31例中男性14例,女性17例,临床表现均为发热和浅表淋巴结肿大。所有的病例可见核碎片及淋巴细胞凋亡;淋巴结内出现片状或灶状形态多样的组织细胞增生。免疫组化标记CD45、CD68及CD3均为阳性表达。结论：本病病理形态以组织细胞增生为特征,主要是与组织细胞来源的淋巴瘤进行鉴别,免疫组化标记CD68及CD3阳性表达,对本病诊断有很重要的价值。该病属自限性疾病,预后多良好。     

组织细胞性坏死性淋巴结炎的临床病理学研究及其与恶性淋巴瘤的鉴别（附31例报告）

组织细胞性坏死性淋巴结炎（ＨＮＬ）为一种少见的良性疾病。好发于年轻妇女的颈部，引起淋巴结肿大，并常伴有发热及其它全身症状，形成独具一格的临床病理过程。因其组织像具有一定的谱系变化，故对其不熟悉者易造成误诊。据文献记载误诊率竟高达３０％～４０％，特别是在其早期增殖阶段尤甚。作者通过对３１例ＨＮＬ的分析，不仅系统总结了本病的临床病理特征，而且着重阐述了其与淋巴瘤的鉴别要点。尽管目前认为本病属于自限性的良性过程，但在本组病例中也确有２例为系统性红斑狼疮患者，提示两者间可能有某种内在的联系，值得今后进一步探索，包括进行长期随访及了解病人的转归。     

17例组织细胞坏死性淋巴结炎的病理学观察

本文对１７例诊断为组织细胞环死性淋巴结炎切片进行回顾性分析。认为光镜下病变区大量组织细胞增生及核碎片为其最主要的病理特点。     

17例组织细胞坏死性淋巴结炎的病理学观察

本文对17例诊断为组织细胞坏死性淋巴结炎切片进行回顾性分析。认为光镜下病变区大量组织细胞增生及核碎片为其最主要的病理特点。     

组织细胞坏死性淋巴结炎9例临床病理分析

组织细胞坏死性淋巴结炎、亚洲较多发,本病好发于青少年,80%在30岁以下．较多见于女性。本病组织学改变较具特征性,一般不易误诊,但在坏死边缘区较多转化淋巴细胞和组织细胞显增生．并伴有大量核分裂像时,易误诊为恶性淋巴瘤。我科自1993年至2003年10年间共检查诊断9例,现报告如下：     

增生性Kikuchi淋巴结炎与恶性淋巴瘤的鉴别诊断

目的：探讨增生性Ｋｉｋｕｃｈｉ淋巴结炎与恶性淋巴瘤的鉴别诊断要点。方法：收集７例诊断疑难的Ｋｉｋｕ－ｃｈｉ淋巴结炎病例进行组织学和免疫组织化学观察。结果：本病的共特点是：（１）先发热后淋巴结肿大、有自限性;（２）病变为多灶性。由以新生组织细胞和吞噬细胞为主混有少量浆细胞样单核细胞、Ｔ免疫母细胞及Ｔ小淋巴细胞多细胞组成,有核碎片散在;（３）缺乏中性白细胞浸润;（４）核分裂易见。结论：作者认为本病的特殊病史,病变多灶性,以组织细胞为主的多细胞组成并有核碎片散在等特点是与恶性淋巴瘤朱鉴别诊断要点。     

可误诊为恶性肿瘤的组织细胞坏死性淋巴结炎

可误诊为恶性肿瘤的组织细胞坏死性淋巴结炎王敏１许越香２组织细胞坏死性淋巴结炎是由日本的Ｋｉｋｕｃｈｉ等及Ｆｕｊｉｍｏｔｏ在１９７２年首先报告，故又称Ｋｉｋｕｃｈｉ病或Ｋｉｋｕｃｈｉ－Ｆｕｊｉｍｏｔｏ病，是一种良性自限性（ｓｅｌｆ－ｌｉｍｉｔｅｄ）疾病...     

组织细胞性坏死性淋巴结炎16例临床分析

目的：探讨组织细胞性坏死性淋巴结炎的临床特点及诊治结果。方法：对16例组织细胞性坏死性淋巴结炎进行回顾性分析。结果：16例中,曾有9例误诊,误诊率56.3％,均经肾上腺皮质激素药物治疗后痊愈。结论：该病起病急,临床表现无特异性,易误诊,确诊需作局部淋巴结组织病理活检。对肾上腺皮质激素药物敏感,治疗结果呈良性自限性过程,预后好。     

临床酷似淋巴瘤的组织细胞性坏死性淋巴结炎65例临床病理分析

目的：探讨临床上酷似淋巴瘤的组织细胞性坏死性淋巴结炎 （HNL） 的临床病理特点、 鉴别诊断和EBER原位杂交特征。方法： 回顾性分析65例HNL淋巴结活检标本的HE切片、 免疫组织化学SP法检测病灶内细胞的免疫表型和EBER原位杂交检测。结果： 本组男性31例 （47.7%）、 女性34例 （52.3%）, 男女比例为1： 1.1; 年龄20岁以下18例 （27.7%）、 20岁以上26例（40.0%）、 30岁以上13例 （20.0%）, 20～30岁之间病例较多。病程为30d的病例最多, 有15例 （23.1%）、 其次为7d 7例 （10.8%）。发热20例 （30.8%）、 无发热45例 （69.2%）。淋巴结最大直径1.5～3.0 cm 48例 （73.9%）。镜检淋巴结结构完整56例 （86.2%）、 部分完整7例 （10.8%）、 结构完全破坏者2例 （3.1%）。淋巴结单个大的坏死灶1例 （1.5%）、 多灶性坏死灶62例 （95.4%）、 出现坏死灶融合呈大片坏死者33例 （50.8%）。淋巴结中组织病理学三个阶段特点： 增殖期、 坏死期和黄色瘤期, 三种不同病理特征, 可同时出现在同一淋巴结中。淋巴结免疫组织化学染色显示大量CD68阳性细胞。EBER指标, 阳性14例 （21.5%）、 阴性51例 （78.5%）。经Logistic回归分析, 性别、 发热、 EBER与各指标间的关系P>0.05, 无统计学意义。多元线性回归分析, 淋巴结结构与坏死期细胞百分比之间存在关联, 回归方程： Y=0.012+0.008X, 其中Y为结构, X为坏死期细胞百分比。说明坏死期细胞百分比越多, 结构完整性越低, 结构越不完整。用Logistic回归分析, 皮质多灶性坏死与其余各指标之间的关系, P>0.05, 无统计学意义。同样, 皮质融合性坏死与其余各指标之间的相关性不明显 （P>0.05）, 病理组织学各阶段变化经统计学处理结果： 增殖期、 坏死期细胞百分比与皮质融合坏死灶、 坏死边缘灶转化淋巴细胞之间都存在关联。黄色瘤期百分比与皮质坏死灶、 年龄之间存在关联。结论： HNL诊断性条件, 即所谓三个组织学特点, 必须与淋巴瘤、 结核相鉴别。     

A fatal case of multicentric Kikuchi's histiocytic necrotizing lymphadenitis

Kikuchi's histiocytic necrotizing lymphadenitis (Kikuchi's disease) is a histologically alarming but self-limiting lesion typically affecting the cervical lymph nodes of young adults. The authors report the first case of fatality occurring during the active phase of Kikuchi's disease. The 38-year-old patient presented with fever and generalized lymphadenopathy. During hospitalization, he developed abrupt onset of heart failure and died. Postmortem examination revealed enlarged lymph nodes all over the body showing typical histologic changes of Kikuchi's disease, but there was no encroachment on vital structures. The heart was dilated and flabby, with multiple microscopic foci of necrosis and mild fatty change. There were no other significant findings, and all cultures were negative. The authors speculate that large amounts of cytokines produced by the histiocytes or high endogenous catecholamines resulting from the stress response might be responsible for the myocardial damage. Alternatively, infection by an as yet uncharacterized microbial might be the underlying cause for both the lymphadenitis and myocardial disease.     

Mammographic features of tuberculous axillary lymphadenitis

The clinical and mammographic findings of 10 patients with pathologically proven tuberculous axillary lymphadenitis were reviewed. The cases were identified from 10 173 mammograms performed over 6 years at Maharaj Nakorn Chiang Mai University Hospital. The 10 patients were aged 31–65 years. All cases were initially diagnosed to have breast carcinoma with axillary nodal metastases. Eight patients presented with axillary swelling, while two presented with breast enlargement. None of these cases had a palpable breast mass. Associated supraclavicular, cervical or groin nodes were found in seven cases, and two patients had evidence of pulmonary tuberculosis. All lesions were unilateral, affecting the right side in eight cases and left side in two cases. On mammogram, the axillary nodes were enlarged and homogeneously dense. The nodes were sized 2.5–5 cm. Nodal margins were variable. Some nodes were matted. Macrocalcifications were noted in three cases. Ipsilateral breast oedema without mass or microcalcifications was present in two cases. Patients with tuberculous axillary lymphadenitis have large homogeneously dense nodes with either well‐ or ill‐defined margins. It is impossible to differentiate tuberculous from malignant nodes. The presence of macrocalcifications might suggest tuberculous axillary lynphadenitis. Biopsy of enlarged axillary nodes is necessary to determine its aetiology.     

Clinicopathological features of breast angiosarcoma

Background

Breast angiosarcomas are rare neoplasm. Due to its rarity, our therapeutic strategy is extremely limited. Therefore, we investigated the clinicopathologic features and examined the treatment for angiosarcoma compared with some literatures.

Methods

We conducted a retrospective chart and slide review of all patients in our division seen from 1997 to 2012 with a diagnosis of primary or secondary breast angiosarcoma at the National Cancer Center Hospital (Tokyo, Japan).

Results

Nine patients were diagnosed with breast angiosarcoma (six primary and three secondary cases). The median age of patients with primary angiosarcoma was 39 years (range 27–65 years). The median tumor size was 6.78 cm (range 3.0–8.8 cm). In the primary tumor, 4 patients had total mastectomy and 2 had a breast conserving surgery. 3- and 5-year disease-free survival (DFS) of the patients with primary angiosarcoma was 20 and 0 %. 5-year surviving rate of primary angiosarcoma was 50 %. In all patients with secondary angiosarcoma, recurrence was observed in all cases. But one case obtained long-term survival in local control therapy.

Conclusions

Our study demonstrates breast angiosarcoma exhibits high recurrence rates. Tumor size and surgical margin may be important factor to obtain long-term survival. In this point of view, total mastectomy with adequate tumor margin with early detection is desired. In case of recurrence, if it is local, surgery may be potentially curative.

     

肛管直肠恶性黑色素瘤的临床病理特征分析

目的探讨肛管直肠恶性黑色素瘤（anorectal malignant melanoma,AMM）的临床病理学特征。方法收集南京中医药大学附属南京中医院2008年7月至2019年8月收治的15例AMM患者的临床病理资料,分析其临床及病理组织学特征、免疫表型及BRAF基因突变情况,并复习相关文献进行分析。结果15例AMM患者年龄45～88岁（中位年龄66岁）,男5例,女10例。临床主要表现为便血、肛管直肠肿物、肛门坠胀疼痛。15例中仅有2例临床诊断为恶性黑色素瘤。镜下肿瘤细胞形态多样,异型性明显,核大,核仁明显,胞浆内可见黑色素颗粒。免疫组化结果显示肿瘤细胞表达S 100、Vimentin、HMB 45及Melan A,不表达CK、EMA、LCA,Ki 67表达10%～60%阳性不等,1例可见BRAF基因突变。结论AMM是一种临床少见、预后较差的恶性肿瘤,临床表现无特异性,临床误诊率高,明确诊断需结合免疫组化标记物检查。治疗上以手术为主,辅以放疗、化疗及免疫治疗等。     

Clinicopathological features of gastric stromal tumors

Stromal tumors in the gastrointestinal (GI) tract consist of myogenic tumors, neurogenic tumors and gastrointestinal stromal tumors (GISTs). Mutations in the c-kit gene have been found in GISTs, and GISTs with c-kit mutations showed aggressive clinical behavior and histological features. In the present study, we classified stromal tumors into four groups according to histological differentiation and c-kit mutation: myogenic tumors, neurogenic tumors, c-kit mutation (-) GISTs and c-kit mutation (+) GISTs, and examined their clinicopathological importance and validity using data obtained from 125 patients with gastric stromal tumors. There was no difference in preoperative symptoms and signs among the four groups. GISTs with c-kit mutations were large and showed invasion into neighboring structures compared with the other tumors, indicating the clinically aggressive features of mutation (+) GISTs. In histological examinations, c-kit mutation (+) GISTs were higher in cellularity (P < 0.0001) and mitotic cell count (P = 0.0086), and showed frequent histological necrosis (P = 0.0058) and hemorrhage (P = 0.0170), and consequently, were higher in histological grade (P = 0.0001). In prognostic analyses, overall, cause-specific and disease-free survival of patients in the mutation (+) GIST group was the poorest among the four groups. No significant differences were found among the other three groups of myogenic tumors, neurogenic tumors and c-kit mutation (-) GISTs, indicating a similar aggressiveness in clinical presentation and histological features. Thus, this classification is considered to be clinically and pathologically important in the diagnosis of gastric stromal tumors.     

Clinicopathological features of primary gastric lymphoma

BACKGROUND AND OBJECTIVES: Surgery has been the mainstay of the treatment of primary gastric lymphoma, but the value of surgical treatment needs reevaluation. METHODS: Thirty-two patients with primary non-Hodgkin B-cell lymphoma of the stomach were examined retrospectively to evaluate prognostic factors and their impact on survival. All patients had undergone abdominal exploration for radical surgery between 1979 and 1992. The prognostic factors in view of survival after treatment were determined with both univariate and multivariate analyses. RESULTS: The resectability rate was 66% (21/32) and radical resections had been performed on 53% (17/32). The overall median survival was 65 months and the overall 5-year survival was 56%. The 5-year survival rates related to a modified Ann Arbor classification as follows: I 1E, 86%; I 2E, 100%; II 1E, 44%; II 2E, 37%; IIIE, 20%; and IVE, 0%. Univariate analysis using Kaplan-Meier estimates showed that radical surgery, Ann Arbor stage, patient's age, and lymph node involvement were significant prognostic factors. According to Cox proportional regression analysis, only Ann Arbor stage, radical surgery, and age were significant independent variables. CONCLUSIONS: According to our experience, surgery is still needed for the treatment of primary gastric lymphomas, but the benefits of primary chemotherapy or adjuvant chemotherapy using cytotoxic drugs must be determined in large prospective controlled trials.     

Clinicopathological features of human brainstem gliomas

We describe the clinicopathological features of 25 brainstem gliomas (BSGs). Twenty BSGs located in the pons and were all in children. Four BSGs located in the medulla oblongata were in 2 children and 2 adults. One (in a child) was located in the midbrain. Radiological findings on MR images were low-intensity on T1 weighted images and high-intensity on T2 weighted images. Mean survival when pontine glioma was treated by radiotherapy and/or use of temozolomide was 14 months, although 4 patients (3 cervicomedullary types and one focal type arising from midbrain) are alive. Follow up was from 5 months to 6 years. Histopathological features of 10 cases of the diffuse type were: 4 grade II astrocytomas, 4 grade III astrocytomas, and 2 glioblastomas. MIB-1 index was from 0.8 to 38 %. P53 was positive for 80 % of 15 tumors and there were no negative results. MGMT was positive in 60 % of 15 tumors and negative in 12.4 %. IDH1 was negative in 61.6 %. There was no positive result for IDH1 in this study. Thus, our histopathological results were indicative of high p53 immunoreactivity and no IDH1 immunoreactivity related to secondary malignant change.     

高风险垂体腺瘤的临床病理特征

  目的  探讨高风险垂体腺瘤的临床病理特征及诊断要点。  方法  选取2017年6月至2020年9月北京大学国际医院收治的24例高风险垂体腺瘤患者,进行形态学观察、免疫组织化学染色及基因检测,同时收集患者的临床资料并进行随访,综合分析病理特点与临床特征的相互关系。  结果  24例高风险垂体腺瘤中男性14例,女性10例,发病年龄28～68岁,平均年龄45.4岁,临床表现为鞍区占位或激素分泌异常的症状。肿瘤最大径0.7～4.8 cm,影像学提示侵袭性腺瘤12例。根据固有激素、转录因子和低分子量角蛋白的免疫组织化学染色特点,结合临床症状及血清激素水平进行诊断,其中稀疏颗粒型生长激素细胞腺瘤4例,沉默性促肾上腺皮质激素细胞腺瘤12例,男性泌乳激素细胞大腺瘤6例,多激素PIT-1阳性腺瘤2例。基因检测1例存在GNAS基因突变。14例获得随访资料,2例复发（其中1例因肿瘤复发死亡）。  结论  高风险垂体腺瘤的诊断应该结合免疫组织化学、血清激素水平及临床症状综合分析,并且需要提示临床复发和进展的风险。