Extragastrointestinal stromal tumor presenting as a scrotal mass： an unusual case

We describe an unusual case of extragastrointestinal stromal tumor （EGIST） presenting as a scrotal mass. A 71- year-old man presented with a gradually enlarging scrotal mass with a 20-year duration. Physical examination re vealed a huge （as large as volleyball）, round, nontender mass occupying the whole scrotum, which was resected completely. Clinical and radiological findings did not comply with any other primary site disease. Under histological examination, the tumor showed a spindle cell pattern with low cellularity, absence of necrotic and mitotic features. Immunohistochemical anlaysis revealed the tumor reactive for CD117 and CD34, while negative for smooth muscle actin, desmin and S-100 protein. To our knowledge, this is the first reported case of an EGIST involving the scrotum.     

Extragastrointestinal stromal tumor of lesser omentum mimicking a liver tumor

Extragastrointestinal stromal tumors are rare, so clinicopathologic features are not fully elucidated. We report a large extragastrointestinal stromal tumor of the lesser omentum mimicking a liver tumor.     

原发腹膜后的间质瘤误诊为肾癌1例报告并文献复习

目的 提高腹膜后间质瘤的认识,减少临床误诊.方法 报道1例误诊为肾肿瘤的腹膜后间质瘤,并结合文献讨论其临床特征、发病机制以及诊断治疗.结果 免疫组织化学和病理学结果展现出间质瘤的固有特征：CD117（＋）,CD34（＋）·SMA（-）,DES（-）,S-100（-）.结论 胃肠道外的问质瘤很少见,其临床影像学特点不易与临近部位的脏器的一般肿瘤区分,临床上为避免误诊应重视其免疫组织化学和病理学特征.     

胃肠道及胃肠道外间质瘤216例临床病理学特点分析

目的 探讨胃肠道间质瘤（gastrointestinal stromal tumor,GIST）和胃肠道外间质瘤（extragastrointestinal stromal tumor,EGIST）的临床病理和免疫组化特点及其诊断标准。方法 回顾性分析天津医科大学总医院及第二医院2000-2009年已确诊的216例GIST和EGIST病人的临床资料,其中,天津医科大学总医院175例,天津医科大学第二医院41例。 结果 216例病人中,男性112例,女性104例,男女比例为1.077 : 1;发病年龄15~91岁,中位年龄58岁;肿瘤原发于胃肠道者182例,以胃多见;胃肠道外者34例,以肠系膜多见。肿瘤直径0.8～30.0cm,由梭形细胞和上皮样细胞组成,细胞排列呈交叉束状、漩涡状及巢状。214例CD117呈阳性。临床多表现为消化道出血、腹部疼痛、腹部肿块及肠梗阻等症状。 结论 GIST较EGIST多见;胃肠道以中、高度危险者多见,胃肠道外以高度危险者多见。临床治疗原则首选广泛手术切除。     

前列腺胃肠外间质瘤1例报告并文献复习

目的：提高前列腺胃肠外间质瘤的诊治水平。方法：回顾性分析1例前列腺胃肠外间质瘤的临床和影像资料,并结合相关文献讨论。该患者入院诊断前列腺肉瘤,为明确诊断行经直肠超声引导前列腺穿刺术。结果：活检穿刺组织病理报告：光镜下肿瘤细胞密集,排列紊乱,以梭形细胞为主;免疫组化标记：CD117和CD34表达阳性,PSA、S-100和SMA阴性,支持前列腺胃肠外间质瘤诊断。行伊马替尼靶向治疗,随访6个月肿瘤无明显缩小,至今仍存活。结论：前列腺胃肠外问质瘤极为罕见,确诊主要依靠病理诊断和免疫组织化学,除外胃肠道来源,影像学检查可提供直接依据。外科手术治疗效果较好。靶向药物治疗前列腺胃肠外间质瘤的作用还有争论。     

Phyllodes tumor of the prostate: Recurrent obstructive symptom and stromal proliferative activity

We report the case of a 59-year-old man with a metachronous development of phyllodes tumor and adenocarcinoma of the prostate. He complained of urinary obstruction and transurethral resections of the prostate (TUR-P) had been performed six times in 10 years. Microscopic examination showed cystically dilated glands consisting of bizarre cells with pleomorphic, hyperchromatic nuclei in the stroma at the sixth TUR-P. Radical prostatectomy was performed against recurrences and adenocarcinoma was incidentally detected. Apparent up-regulation of proliferative nuclear antigens (PCNA), but not p53, was observed in the prostatectomy specimen by Western blotting. Active proliferation of stromal cells is considered to have caused the recurrent obstructive symptom.     

正常前列腺间质细胞对前列腺癌细胞糖代谢水平的影响

目的:探讨正常前列腺组织不同区带来源的前列腺间质细胞对前列腺癌细胞生长的影响及其作用机制。方法:以激素非依懒性前列腺癌细胞系DU145细胞为研究对象,取新鲜的正常前列腺外周带(PZ)和移行带(TZ)组织,提取间质细胞并体外培养。收集不同区带来源的间质细胞培养上清作为条件培养液培养DU145细胞,CCK8法测定肿瘤细胞的生长曲线,台盼蓝染色测定细胞数量及活力,细胞划痕实验测定细胞侵袭性,Western印迹法测定间质细胞对肿瘤细胞糖代谢关键酶的影响。结果:1PZ间质细胞的条件培养液能促进肿瘤细胞的生长,而TZ间质细胞的条件培养液抑制肿瘤细胞的生长;2PZ间质细胞的条件培养液明显增加肿瘤细胞糖代谢关键酶己糖激酶2(HK-2)、丙酮酸激酶2(PKM-2)、乳酸脱氢酶(LDHA)、丙酮酸脱氢酶(PDH)的表达,而TZ则抑制上述酶的表达。结论:前列腺不同来源的间质细胞对肿瘤细胞的生长影响不同,其机制可能与不同来源的间质细胞对糖酵解代谢的影响不同有关。     

Characteristics of separated epithelial and stromal subfractions of prostate: II. Human prostate

Surgical samples of human benign prostatic hyperplasia tissue (BPH) were fractionated into epithelial clumps and stromal fractions, using the "optimal" tissue dissociation procedure developed for rat prostate described in the preceding report. The separated cellular fractions were compared to control unfractionated tissue (wherein extracellular secretory products had been removed) with respect to the concentrations of androgen receptor and enzyme markers on a DNA basis; cell damage was also evaluated by light and electron microscopy (EM). EM revealed extensive cell damage in epithelial clumps and stromal fractions, which had appeared normal when examined by light microscopy. Damage to the ultrastructure of individual epithelial cells present in clump fractions was very variable, involving vacuolization of the cytoplasm and condensation of nuclear chromatin in some cells, vacuolization of just the cytoplasm in other cells; only a small fraction of the cells in clumps had normal ultrastructure. Ultrastructural damage to stromal cells was much greater in fibroblasts than in muscle fibers. The cell damage observed in both subfractions of human prostate was associated with a marked degree of receptor loss. The mean decreases in the number of androgen receptors per unit DNA relative to control unfractionated tissue was 68.5 and 62.5% recovered in epithelial and stromal fractions, respectively. Measurement of various enzymes as "markers" revealed that acid phosphatase activity (per unit DNA) was associated exclusively with the epithelial clump fraction. Prolyl hydroxylase and myosin ATPase activities (per unit DNA) were restricted to the stromal fraction. The limitations of using mechanically separated subfractions of human prostate tissue for evaluation of the cellular distribution or the initial concentration of steroid receptors in human prostate tissue are discussed.     

Malignant phyllodes tumor of the prostate

We report a case of malignant phyllodes tumor of the prostate which is the eleventh reported case in the world. Phyllodes tumor of the prostate is extremely rare and histologically resembles mammary phyllodes tumor. Phyllodes tumor of the prostate is classified into benign, borderline and malignant, but health professionals should carefully follow up the borderline cases in case they take a malignant clinical course. This case was the first to be treated by pre- and postoperative radiation therapy. Although the patient had a slight response to radiation therapy, he eventually developed metastasis. Because malignant phyllodes tumor of the prostate is a very aggressive tumor, people with the condition should undergo systemic chemotherapy as adjuvant therapy.     

Malignant phyllodes tumor of the prostate

We report the case of a 47-year-old male patient who suffered from a malignant phyllodes tumor of the prostate with invasion to the rectum and urinary bladder. The local recurrence at the left scrotum was identified 6 years after radical cystoprostatectomy. Another 2 years after radical orchiectomy showed no evidence of secondary local recurrence or distant metastasis. Histopathologically, both primary and recurrent tumors showed an admixture of stromal and glandular components. However, while extensive squamous metaplasia was identified in the primary tumor, the recurrent tumor had only focal and mild squamous metaplasia. No dependable prognostic factor has been found to date. Here, we describe the morphological features and immunohistochemical presentations of malignant phyllodes tumor of the prostate and review the literature.     

Epithelial stromal tumor of the seminal vesicle

Primary tumors of the seminal vesicles are rare neoplasms; there have been only 69 accepted cases. The histologic features are usually adenocarcinoma; however, there are rarely reported epithelial stromal tumors of the seminal vesicles. We report a case of a 70-year-old man with an epithelial stromal tumor of the seminal vesicle who presented without symptoms of bladder outlet obstruction. The patient underwent radical cystoprostatectomy. No signs of tumor recurrence were noted within 14 months of surgery. To our knowledge, 13 cases of epithelial stromal tumors of the seminal vesicle have been previously reported.     

胃镜活检和术中冰冻病理检查对胃间质瘤的诊断价值

目的　分析胃间质瘤患者胃镜活检和术中冰冻病理检查的价值。方法　回顾性分析1 998年至 2 0 0 1年收治的 42例胃间质瘤患者的临床和病理资料 ,并进行随访。结果　 42例中良性 2 0例 ,交界性 1 5例 ,恶性 7例。 40例行胃镜检查的患者中 1 4例取得活检 ,但仅 5例确诊 (3 5 7% ) ,另有1例疑及本病 ;2 0例患者行术中快速冰冻病理检查 ,确诊率为 40 % (8 2 0 ) ,另有 7例 (3 5 % )提示为本病。随访发现良性和交界性胃间质瘤在手术后均无复发 ,恶性胃间质瘤预后极差。结论　临床上对胃间质瘤的认识不足 ,应提高胃间质瘤术前和术中冰冻病理检查的诊断率和病变性质判断的准确性 ,以指导临床治疗     

Solitary fibrous tumor of the prostate

An extremely rare case of solitary fibrous tumor of the prostate is presented. The patient underwent a radical retropubic prostatectomy and has remained well with no evidence of recurrence during the last 18 months. This is the fifth reported case of such a lesion arising in the prostate.     

Pancreas-sparing duodenectomy for gastrointestinal stromal tumor

Background

Pancreas-sparing duodenectomy (PSD) is a promising alternative procedure to pancreaticoduodenectomy for the treatment of duodenal tumors with low-grade malignant behavior.

Methods

Between March 2003 and September 2012, PSD was performed in 7 patients with a gastrointestinal stromal tumor (GIST) in the second (n = 5) or third (n = 2) portions of the duodenum. The short- and long-term outcomes of treatment were analyzed in all patients.

Results

The median blood loss was 160 mL, and the median operative time was 315 minutes. No pancreatic leakage or perioperative mortality occurred. Surgical margins were negative in all cases. All patients were alive at the median follow-up time of 42 months after PSD. The recurrence-free 5-year survival rate was 53% in all patients. Hepatic metastases developed in 2 of the 5 patients with high- or intermediate-grade risks at the time of diagnosis. Hepatic resection was performed, and imatinib mesylate was administered in the 2 cases.

Conclusions

Good short- and long-term outcomes and surgical curability were observed in patients treated with PSD for duodenal GIST.     

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目的　探讨胃肠道间质瘤的临床表现、诊断及治疗。方法　回顾性分析上海建工医院及复旦大学华山医院外科 2000年 9月至 2003年 12月间收治 35例胃肠道间质瘤病人的临床及病理资料。结果　35例均行手术治疗。肿瘤根治 4例,近端或远端胃大部切除、病变肠段切除、肿块切除或扩大切除 26例;因肿瘤广泛粘连,无法完整切除 5例。病理:CD117阳性 29例(82 .9% ),CD34阳性 31例 (88 .6% )。结论　胃肠道间质瘤在中老年人中好发,以便血、腹痛和腹部不适、腹部肿块表现为主。肿瘤的大小是胃肠道间质瘤良、恶性的重要临床指标。病理形态学检查是确诊间质瘤的唯一方法。完整的局部手术切除是最有效的治疗手段。对无法切除或有肿瘤残余及术后复发的病人可应用甲磺酸伊马替尼(格列卫)进行治疗。     

胃肠道间质瘤46例临床诊治分析

目的探讨胃肠道间质瘤(G IST)的临床特点。方法对1998~2004年收治的46例G IST病人的临床表现、手术处理及病理结果进行回顾性分析。结果46例均行手术治疗。病理诊断良性13例(28.3%),潜在恶性10例(21.7%),恶性23例(50%)。随访时间6个月至6年,7例出现远处转移或局部复发,10例死亡(其中9例为恶性G IST)。结论G IST缺乏特征性临床表现,术前确诊率较低,其确诊依赖病理结果。目前G IST的治疗仍以手术切除为主,对复发或远处转移者积极再次手术可延长生存期。     

Gastrointestinal stromal tumor of the lesser omentum: report of a case

We describe herein an extremely unusual case of a gastrointestinal stromal tumor (GIST) of the lesser omentum. A 45-year-old man was admitted to our hospital with an intra-abdominal mass that was subsequently misdiagnosed as a submucosal tumor of the stomach. The tumor arose from the lesser omentum and was removed without difficulty. Histologically, the tumor was composed of spindle–shaped cells with an interlacing bundle pattern, and immunohistochemical examination showed that it was positive for myeloid stem cell antigen (CD34), but negative for HHF35 and S-100 protein. These findings were consistent with a GIST lacking myogenic features and neural attributes. The patient had an uneventful postoperative course, and was free of recurrence when last seen 11 months after his operation. Received: April 3, 2000 / Accepted: March 6, 2001     

胃肠道间质瘤的CT检查表现

Gastrointestinal stromal tumors (GISTs) are common mesenchymal neoplasms in the gastrointestinal tract.The results of computed tomography play important roles in the diagnosis,treatment planning and fo...