子宫腺肌病恶变3例临床病理分析

目的:探讨子宫腺肌病恶变病例的临床病理特点。方法:回顾性分析我院2001年1月至2010年12月收治的3例子宫腺肌病恶变患者的临床病理资料。结果:3例患者就诊年龄为45、56及58岁,临床表现主要为经量增多、经期延长、绝经后阴道流血及盆腔痛,3者血清CA125浓度分别为34.98U/ml、196.6U/ml、22.4U/ml,超声检查无特异性,均依靠术后石蜡病理确诊,3例患者均行手术治疗,术后酌情辅以放化疗。结论:子宫腺肌病恶变罕见,术后病理为唯一确诊依据,术前诊断困难,易误诊、漏诊,为治疗方式的选择及实施造成一定局限性,应提高对该病的认识,重视早期诊断,正确治疗,改善预后。     

19例围绝经期子宫腺肌病误诊原因分析

子宫腺肌病术前易误诊为子宫肌瘤、子宫内膜异位症或功能性子宫出血。本文分析19例病理证实为腺肌病患者的临床症状、体征及辅助检查、以探讨误诊的原因，提高术前诊断的准确性。     

苗勒氏管腺肉瘤3例临床病理观察

苗勒氏管腺肉瘤３例临床病理观察陈善义，陆献瑜中山医科大学肿瘤医院（广州·５１００６０）苗勒氏管腺肉瘤是苗勒氏干细胞起源的混合间质肿瘤，首先由Ｃｌｅｍｅｎｔ和Ｓｃｕｌｌｙ［１］报道。国内报道１０例［２］。我院最近见３例，现综合文献复习报告如下。例１，住...     

子宫腺肌病与子宫肌瘤的临床及血清CA125值的比较分析

本文回顾性分析了1999年1月至2001年1月间收治的75例子宫腺肌病患者和93例子宫肌瘤患者的临床特点及CA125检测的价值。认为结合痛经、B超、CA125值测定对提高子宫腺肌病的诊断率有一定价值，得得临床推广应用。     

老年大肠腺瘤恶变的临床病理分析

 目的 探讨老年大肠腺瘤恶变及其病理特点。方法 对185例老年大肠脉瘤患者进行分析,观察大肠腺瘤与恶变的关系。结果 老年大肠腺瘤恶变与腺瘤大小、部位、形态、数目、组织学类型及年龄等因素有关,与性别无关。结论 老年大肠腺瘤易恶变,对可疑恶变腺瘤做全瘤切除,术后密切而有规律随访。     

乳腺腺纤维瘤10316例临床病理分析

 自1954～1990年36例间共收治乳腺腺纤维瘤10316例，均接受手术治疗并经病理证实，其中管型腺纤维瘤3436例占33．3％，围管型腺癌2795例占27．1％，混合型腺纤维瘤3156例占30．6％，分叶型腺纤维瘤526例占5．1％，囊性增生型腺纤维瘤403例占3．9％。患病年龄从9岁～68岁，中位年龄28岁。2／3在发病后2年内就诊。肿瘤最小0．3cm，最大24cm（仅1例，为分叶型腺纤维瘤），大多数≤3cm，占66．5％。病变绝大多数为单发，9228例，占89．5％，多发或双发的1088例，占10．5％。绝大多数经局部切除后治愈，少数病例433例（4．2％）切除后又复发，经再次切除治愈。在收治10316例乳腺腺纤维瘤的同期内有4例腺纤维瘤癌变为管内癌，经手术切除后，预后良好。     

16例涎腺肌上皮肿瘤临床病理及免疫组化分析

[目的]探讨涎腺肌上皮肿瘤的临床病理特征、免疫组化表达以及鉴别诊断.[方法]16例涎腺肌上皮肿瘤进行病理组织形态学及免疫组化观察.[结果]良性肌上皮瘤12例,恶性肌上皮瘤4例,组织形态均可分为上皮样细胞型,梭形细胞型,浆细胞样细胞型及透明细胞型.良、恶性肌上皮瘤的免疫组化染色S-100蛋白阳性率分别为91.7%(11/12),100%(4/4);SMA阳性率为66.7%(8/12),50%(2/4);Calponin阳性率91.7%(11/12),75%(3/4).[结论]涎腺肌上皮肿瘤的瘤细胞形态多样;S-100蛋白、SMA及Calponin等的免疫组化染色有助于诊断和鉴别诊断.     

原发性食管恶性黑色素瘤临床病理特征及组织发生

目的　讨论原发性食管恶性黑色素瘤的诊断、鉴别诊断、组织发生和生物学行为。方法　报道 2例原发性食管恶性黑色素瘤并进行临床表现、组织形态学和免疫组织化学的观察研究 ,结合文献对其诊断、鉴别诊断和组织来源进行探讨。结果　原发性食管恶性黑色素瘤好发于中老年 ,临床症状多为进行性吞咽困难 ,肿瘤多位于食管中下段 ,大体形态多呈息肉状 ,Fontana组织化学染色瘤细胞显示出嗜银性黑色素颗粒 ;免疫组化染色瘤细胞S 10 0和HMB45均为阳性。结论　食管中下段息肉样肿物在中老年患者应想到原发性食管恶性黑色素瘤的可能 ,最后确诊特别是无色素性恶黑需要靠免疫组织化学标记或电镜的支持。该肿瘤的组织发生可能来自食管粘膜基底层的黑色素细胞。     

合并桥本甲状腺炎的甲状腺乳头状癌临床病理特征分析

目的:探讨合并桥本甲状腺炎(hashimoto's thyroiditis,HT)是否影响甲状腺乳头状癌(papillary thyroid carcinoma,PTC)的临床病理特征。方法:回顾性分析514例于2015年06月至2016年12月在本院行甲状腺结节切除术、术后病理证实为PTC患者的临床资料,对比分析合并或不合并HT的PTC患者的年龄、性别、肿瘤直径、血清促甲状腺素（TSH）、有无包膜侵犯、中央淋巴结转移等临床病理特征差异。结果:514例PTC病例中合并HT者74例（14.40%）,不合并HT者440例（85.60%）,与不合并HT组相比,合并HT组女性比例更高（91.89% vs 74.09%,P<0.05）,年龄较小［（41.37±11.89）岁 vs （4４．３５±11.７９）岁,P<0.05］,肿瘤直径更小［（1.20±0.91)cm vs (1.53±1.18)cm,P<0.05］,发生包膜侵犯（18.92% vs 31.14%,P<0.05）、中央淋巴结转移（17.57% vs 30.45%,P<0.05）的比例较低,但肿瘤的多灶和多中心性方面未见显著性差异。结论:合并HT的PTC多集中于女性群体,病灶组织偏小,且PTC合并HT不会使疾病侵袭性加强。然而,合并HT患者TSH高,则可能会使PTC发生风险增加。     

Clinicopathologic characteristics of follicular lymphoma in hepatitis C virus-infected patients

Follicular lymphoma (FL) is the most common subtype of indolent non-Hodgkin lymphoma. It has been hypothesized that chronic hepatitis C virus (HCV) infection stimulates IGH-BCL2 clone proliferation, leading to development of FL. Furthermore, regression of FL after antiviral treatment without chemotherapy has been reported in HCV-infected patients. To clarify the relationship between HCV and FL, we compared the prevalence of IGH-BCL2 translocation and other clinicopathologic characteristics between HCV-infected and HCV-uninfected FL patients and determined the impact of HCV eradication on the oncologic outcomes of HCV-infected FL patients. The study included HCV-infected patients (cases) with FL seen at our institution during 2004-2018. Cases were matched with HCV-uninfected FL patients (controls) according to year of lymphoma diagnosis, sex, and hepatitis B serology. We studied 19 cases and 57 controls. More cases than controls had splenic involvement of FL (26% vs 5%, P = 0.02), higher histologic grade (grade 3 in 56% vs 24%, P = 0.01), absent or weak CD10 expression (42% vs 11%, P = 0.005), and absent BCL2 expression (33% vs 4%, P = 0.004). Compared to controls, cases had a lower rate of detection of IGH-BCL2 translocation (31% vs 68%, P = 0.02). Finally, cases with a sustained virologic response (virologic cure of HCV) had a better 10-year overall survival rate than did cases not treated with antivirals or controls (P = 0.001). In conclusion, HCV-infected patients with FL have unique clinicopathologic characteristics including improved overall survival with HCV eradication. The pathogenesis of FL in HCV-infected patients seems unrelated to antiapoptotic effect of IGH-BCL2 rearrangement.     

Clinicopathologic Characteristics of Breast Cancer in Jamaica

Breast cancer is the most common cancer in Jamaican women. This study assessed the clinicopathologicfeatures of cases in a hospital-based specialist clinic in Kingston, Jamaica. A retrospective chart review wasperformed for the 2-year study period and relevant clinical and surgico-pathologic data were recorded andanalyzed. Median age of the 121 breast cancer patients was 52 years (range 22-84, IQR 20) and there was 1 caseof male breast cancer. Most patients (65%) were referred from the surgical service after definitive breast cancersurgery, 20% were referred for pre-operative systemic therapy, and 15% had a diagnosis of metastatic disease.The surgico-pathologic group comprised 78 women who were referred for adjuvant therapy. The majorityhad presented with a palpable breast lump (91%), with median tumour size 3.5cm (range 0.4-13, IQR 4). Mosttumours were node positive (56%). Approximately one-third of patients had stage III disease (33%). Most womenpresented with large palpable tumours and had lymph node involvement confirmed on surgicopathologicalevaluation, indicative of limited early breast cancer detection. A national screening mammography programmeis recommended for detection of earlier lesions. Pre-operative systemic therapy should be considered as an optionfor eligible patients.     

84例小儿恶性淋巴瘤临床特点

 本文总结84例小儿恶性淋巴瘤临床特点。 男女性别比为5.5:1。发病年龄高峰:HD5～9岁; NHL6～10岁。 NHL比HD病程短。 浅表淋巴结肿大为首发者占72.6%, 结外首发只见NHL, 占48.8%。 NHL中高度恶性占77.1%, 诊断时即为广泛播散期者占53.5%, 其中白血病化占18.6%, 脑膜侵犯占11.6%。 提示用强烈化疗方案可提高小儿NHL的疗效和生存率。     

腹膜恶性间皮瘤临床病理观察

目的:探讨腹膜恶性间皮瘤(peritoneal malignant mesothelioma,PMM)临床病理特点、免疫表型、诊断及鉴别诊断、治疗及预后.方法:对5例PMM的临床资料、病理形态、免疫组化特点进行回顾性分析,并复习相关文献.结果:PMM发病多为中老年人,年轻人偶见.患者可以有或无腹胀、腹痛,个别表现为脐部溢液.B超及CT显示单发或多发盆腹腔肿物,伴或不伴腹腔积液.生长方式为局限性或弥漫性,局限性者可以局限于肠壁向肠腔内生长形成内生性肿物.镜下组织形态复杂多样,有上皮样型及肉瘤样型双相分化特点.免疫组化示所有病例均表达Calretinin、AEl/AE3、vimentin,部分病例不同程度表达CK5/6(3/5)、D2-40(1/5)、WT-1(3/5)、HBME-1(2/5),没有病例表达CD34、Ber-EP4、DOG1、CEA、CD117、desmin、SMA、p53、NSE、ER、PR、PAX8.随访4～20个月,2例死亡,3例存活.结论:PMM少见,临床表现多样,影像学检查无特异性,组织形态及免疫组化复杂多样.少见部位如脐、肠腔内生性的PMM,临床及病理容易误诊.确诊主要依靠病理形态及免疫表型,且需与腹腔原发或转移性的其他肿瘤相鉴别,必要时用分子病理手段来帮助诊断.     

肾恶性血管周上皮样细胞肿瘤的临床病理特征

目的:探讨肾恶性血管周上皮样细胞肿瘤（PEComa）的临床病理特征、免疫表型及分子遗传学特点、诊断与鉴别诊断以及治疗方式。方法:通过深入学习2例肾恶性血管周上皮样细胞肿瘤的组织形态特点并复习相关文献,归纳该肿瘤的诊断和鉴别诊断要点、探讨其免疫表型和分子遗传学特征,总结现有的治疗策略。结果:2例分别发生在48岁女性及62岁男性患者,肿瘤直径均大于5 cm,均以上皮样细胞为主,体积大,胞浆丰富,嗜酸性,单核或多核,细胞异型性明显,可见大片坏死,核分裂象约(2~3)个/50 HPF。在例1中,可见丰富纤薄的间质血管将肿瘤分隔成巢状,腺泡样结构;在例2中,肿瘤囊性变,呈多囊性结构,囊壁由肿瘤细胞构成,上皮样细胞间可见梭形细胞区域。2例肿瘤HMB45均局灶阳性,MelanA弥漫强阳性,TFE3蛋白表达均阴性。在例1中,肿瘤细胞不表达肌源性标记（SMA、Desmin均阴性）;而在例2中,肿瘤的梭形细胞区域SMA和Desmin局灶阳性。结论:肾恶性血管周上皮样细胞肿瘤属罕见疾病,需对该肿瘤加强学习认识,避免漏诊和误诊,治疗主要以手术切除为主,术后多予随访,但预后较差,分子靶向的个性化治疗将成为趋势。     

Clinicopathologic characteristics and outcomes of transformed diffuse large B‐cell lymphoma in hepatitis C virus‐infected patients

Hepatitis C virus (HCV) causes a chronic but curable infection associated with the development of marginal zone lymphoma (MZL) and diffuse large B‐cell lymphoma (DLBCL). Preliminary data have shown frequent transformation of indolent lymphoma to DLBCL in HCV‐infected patients. To compare their clinicopathologic characteristics and oncologic outcomes, we reviewed the medical records and pathology reports of HCV‐infected and uninfected patients with DLBCL that transformed from indolent lymphoma seen at The University of Texas MD Anderson Cancer Center (June 2004 to May 2015). To identify predictors of DLBCL relapse, patients with relapse after first‐line chemotherapy were compared with those without it using univariate and logistic regression analyses. Compared with the uninfected patients (n = 63), HCV‐infected patients (n = 21) were younger (median age =54 years [interquartile range= 49–62 years] vs. 62 years [53–66 years]; p = 0.01) and more often had advanced DLBCL (Ann Arbor stage 3–4; 95% vs. 76%; p = 0.05). Immunophenotypically, more HCV‐infected than uninfected patients had CD10‐negative B cells (76% vs. 43%; p = 0.008), CD5‐positive B cells (39% vs. 7%; p = 0.004) and activated B‐cell phenotypes (57% vs. 31%; p = 0.07). Comparison of the patients who had relapse after first‐line chemotherapy (n = 42) and those who did not (n = 40) revealed that having CD5‐positive B cells was the only factor associated with DLBCL relapse in multivariate analysis (odds ratio= 10.7; p = 0.02). HCV‐infected patients with transformed DLBCL have unique clinicopathologic characteristics that make their lymphoma difficult to treat, potentially leading to unfavorable outcome. The impact of HCV eradication should be explored in such patients.