盆腔、腹腔多发性滤泡树突状细胞肉瘤1例并文献复习

目的 探讨滤泡树突状细胞肉瘤的临床和病理特点,提高对其诊治水平．方法报道1例盆腔、腹腔多发性滤泡树突状细胞肉瘤病例,运用组织病理学、免疫组化方法观察滤泡树突状细胞肉瘤的特征,并复习文献加以分析。结果镜下肿瘤细胞呈梭形或上皮样,细胞界限不清,弥漫片状分布,部分排列呈漩涡状,细胞核圆或椭圆形,轻度异型,少量多核瘤细胞,部分淋巴细胞围绕血管。瘤细胞CD21和CD35阳性,Vim阳性,CKpan、EMA、Desmin、SMA、CD117、CD34、S-100、CD68、Calretinin、HMB45均阴性。结论滤泡树突细胞肉瘤是一种少见的低-中度恶性肿瘤,诊断依赖组织病理学及免疫组化标记,尚缺乏统一的治疗标准。     

滤泡性树突状细胞肉瘤研究进展

  滤泡性树突状细胞肉瘤( follicular dendritic cell sarcoma, FDCS) 是一种较罕见的树突状细胞肿瘤, 1986年首次由Monda等^［1］报道。从WHO的肿瘤分类中可知, FDCS属于组织细胞和树突细胞肿瘤类^［2］。该细胞群还包括组织细胞恶性肿瘤、朗汉斯组织细胞肿瘤、指状树突型细胞肿瘤。此肿瘤罕见, 患者年龄14～80岁, 中位年龄约45岁, 通常发生于中青年, 无性别差异。大部分发生于淋巴结, 常表现为无痛性淋巴结大, 约1/3病例发生于结外部位。1994年Chan等^［3］首次报道2例发生于口腔的结外FDCS, 以后结外FDCS的报道逐渐增多, 有发生于扁桃体、咽部、胃、胰腺、腹膜、腹膜后、腭、小肠、肠系膜、脾、纵膈、肝脏、甲状腺、肺、乳腺、结肠等^［4-19］。     

血管肉瘤的电镜及免疫组化观察

目的：总结血管肉瘤的形态学、免疫组化及超微结构特点，探讨免疫组化及超微结构在诊断与鉴别诊断中的意义。方法：10例血管肉瘤标本均经HE及免疫组化染色，光镜观察；其中5例取10％甲醛常规固定标本进行电镜观察。结果：肿瘤组织形态多样，但多数瘤实质内可见相互吻合的大小不一、形态不规则的血管网，内衬不典型的肿瘤性内皮细胞。分化差的瘤细胞呈弥漫性、实片状或巢状排列，血管腔隙不明显，诊断较为困难。免疫组化染色F8RA和CD34均为阳性；血管肉瘤超微结构的特征性改变为多量不完整基板包绕的肿瘤细胞、周细胞和细胞浆内Weibel—Palade小体，W—P小体是内皮细胞的标志性结构。结论：电镜观察及免疫组化在该瘤的诊断与鉴别诊断中有决定性意义。     

小鼠胸腺树突状细胞的分布与形态学观察

目的研究小鼠胸腺树突状细胞的分布与形态。方法运用光镜、电镜和树突状细胞标志物(CD205、CDla与MIDC-8)免疫组化标记方法观察小鼠胸腺树突状细胞的分布、含量与形态。结果小鼠胸腺树突状细胞在皮髓交界区分布最多,然后依次为皮质区和髓质区。树突状细胞约占胸腺细胞总数的2％。胸腺树突状细胞表面形成胞浆突起向,周围包绕的淋巴细胞间延伸,核不规则,多有凹陷,胞浆低电子密度,细胞器稀少且不含溶酶体。结论多种树突状细胞标志物联合标记,结合光镜、电镜形态学观察,可以有效地计数并显示胸腺树突状细胞的形态特征。     

鼻咽部滤泡树突细胞肉瘤1例

本文报道1例发生于鼻咽部的滤泡树突细胞肉瘤。患者男,58岁,鼻咽右侧壁实性分叶状肿块,向内突入鼻咽腔,向外突入咽旁间隙,边界清楚,CT呈均匀等密度,T 1WI为等信号,T 2WI呈较高信号,内见条状低信号,增强后中等强化,时间-信号强度曲线呈“速升缓降”型。病理诊断为滤泡树突细胞肉瘤。 ...     

幽门螺杆菌感染与胃黏膜淋巴滤泡周围上皮HLA-DR抗原的表达

目的探讨幽门螺杆菌感染与胃黏膜淋巴滤泡发生的关系,以及诱导胃黏膜上皮细胞表达人类白细胞DR抗原的可能机制。方法观察164例幽门螺杆菌阳性与96例幽门螺杆菌阴性胃黏膜淋巴滤泡的发生率;应用卵白素生物素过氧化酶法检测幽门螺杆菌阳性和幽门螺杆菌阴性胃黏膜淋巴滤泡周围上皮细胞人类白细胞DR抗原的表达并进行相关分析。结果幽门螺杆菌阳性组胃黏膜淋巴滤泡的发生率(90/164)显著高于幽门螺杆菌阴性组(16/96)(P<0.001),而幽门螺杆菌阳性组与幽门螺杆菌阴性组胃黏膜淋巴滤泡周围上皮细胞人类白细胞DR抗原的表达无显著性差异(P>0.05)。结论幽门螺杆菌促使胃黏膜上皮细胞表达人类白细胞DR抗原,可能是通过促使局部胃黏膜炎症的形成,进而诱导胃上皮细胞表达人类白细胞DR抗原。     

18 F-FDG PET显像对不同亚型淋巴瘤的诊断价值

目的：探讨^18F-脱氧葡萄糖(FDG)PET显像对霍奇金淋巴瘤(HL)和以世界卫生组织(WHO)分类标准分类的不同亚型非霍奇金淋巴瘤(NHL)的诊断价值。方法：对236例淋巴瘤(62例HL和174例NHL)患者的FDG PET全身显像结果进行回顾性分析，并与WHO病理分型的结果比较。结果：PET显像对淋巴瘤的检出阳性率为94％(221／236例)，对HL和NHL的阳性率分别为97％(60／62例)和93％(161／174例)。在不同NHL亚型中，8例套细胞淋巴瘤，99％(76，77例)的弥漫性大B细胞淋巴瘤(DLBCL)，95％(55／58例)的滤泡性淋巴瘤(FL)，73％(8／11例)的淋巴结边缘区淋巴瘤(MZL)，2／3例黏膜相关性(MALL型)结外边缘区B细胞淋巴瘤(MALT-MZL)，5／8例的无其他特征外周T细胞淋巴瘤(PTCL)，2／3例的伯基特淋巴瘤(BL)，2例间变性大细胞性淋巴瘤和覃样肉芽肿、小淋巴细胞性淋巴瘤和NK／T细胞型淋巴瘤各1例FDG摄取异常，而13例(3例MZL，3例PTCL，3例FL，MALT-MZL、DLBCL、BL和前体T淋巴母细胞淋巴瘤各1例)未见异常FDG分布。结论：^18F-FDG PET显像对常见的NHL亚型检出阳性率较高，对相对少见的NHL亚型检出阳性率较低。     

HPD的组织学效应:免疫器官

LACA小鼠腹腔注射HPD 0.4mg、2.0mg和2.0mg×3/只后,免疫器官都发生不同程度的组织学效应。主要为胸腺萎缩,脾和淋巴结(肠系膜)的胸腺依赖区萎缩及其中淋巴细胞减少;脾白髓边缘区内淋巴细胞减少或消失,淋巴滤泡萎缩,滤泡内中、小淋巴细胞对HPD的反应比生发中心细胞更明显。牌生发中心数量减少和截面积变小。文中强调,这些代表T、B淋巴细胞系统的组织结构变化,必然会影响或有损机体的细胞和体液免疫功能。     

组织蛋白酶D在霍奇金淋巴瘤组织的表达及意义

目的：探讨组织蛋白酶D(CaihepsinD，CathD)在霍奇金淋巴瘤(Hodgldn lymphoma，HL)组织中的表达及意义。方法：应用免疫组织化学方法对霍奇金淋巴瘤进行CathD、CD34、CD45RO、CD20染色。探讨组织蛋白酶D在霍奇金淋巴瘤发病中的作用。结果：CathD主要表达于阻组织中的组织细胞和树突状细胞，其表达明显多于反应性增生淋巴组织；CathD不表达于RS／Variants(RS／V)细胞；其表达与血管生成无相关性；HL中主要的反应性增生淋巴细胞为T细胞。结论：CathD的表达与HL中微血管生成无相关性，可能与局部细胞免疫增强有关。     

滤泡辅助性T细胞（TFH）在炎性肠病中的表达研究

目的观察新型CD4＋T辅助细胞亚群-滤泡辅助性T细胞（T follicular helper cells,TFH）在炎性肠病（inflammatory bowel diseases,IBD）中的表达,探究其在IBD发病中的作用及机制。方法用饮用葡聚硫酸钠（dex-tran sulfate sodium,DSS）的方法建立IBD动物模型,密度梯度离心法分离小鼠脾淋巴细胞,采用不同荧光素标记的CD4I、COS、CD40L、CXCR5抗体进行流式细胞染色,分析上述TFH的表面标记在DSS诱导IBD（DSS-IBD）模型中的变化;同时提取淋巴细胞RNA,用实时定量PCR检测TFH的特异性转录因子Bcl-6和效应分子IL-21的表达变化。结果与结论与对照组相比,DSS-IBD模型动物CD4＋ICOS＋,CD4＋CD40L＋,CD4＋CXCR5＋T细胞的比例,以及Bcl-6和IL-21在mRNA表达水平均显著下降,显示TFH亚群的功能调节失常可能是该类IBD的重要发病机制之一。     

胸部局限型Castleman病的CT诊断

目的:探讨胸部局限型Castleman病的临床、病理及CT表现.方法:回顾性分析10例经手术病理证实的胸部局限型Castleman病的病例资料.结果:10例患者中,病变位于前纵隔1例,后纵隔3例,中纵隔5例,左侧斜裂1例.CT表现:左侧斜裂病变平扫示中央区不规则钙化,增强呈不均匀中度强化;余9例病变平扫均呈均匀等密度影...     

Two cases of chronic tonsillitis studied by FDG-PET

We report two cases of chronic tonsillitis studied by FDG-PET. Symmetrical high FDG uptake by the tonsils was observed in both cases. On histopathologic examination of the resected tonsils, follicular hyperplasia was observed with proliferation of lymphocytes in the germinal centers. Increased glucose metabolism in active inflammation involving lymphocyte proliferation was thought to be a cause of high FDG uptake by tonsils in chronic tonsillitis.     

Follicular lymphoma with hepatic accumulation on FDG-PET/CT masquerading IgG4-related disease

Follicular lymphoma is clinically classified as a common type of indolent non-Hodgkin''s lymphoma, and its clinical diagnosis is difficult because B symptoms and elevated soluble interleukin-2 receptor (sIL-2R) levels are less frequent in follicular lymphoma than in other lymphomas. We report a case of follicular lymphoma masquerading immunoglobulin G4-related disease (IgG4-RD) with elevated IgG4 levels. A 67-year-old man presented to our hospital with a 1-year history of deep right supraclavicular and para-aortic lymph node lymphadenopathy on plain computed tomography (CT) findings along with elevated IgG4 levels, and the ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scan showed heterogeneous diffuse FDG uptake in the liver, and FDG uptake was noted at multiple sites in the enlarged right supraclavicular and para-aortic lymph nodes. Excisional biopsy of the right supraclavicular lymph node, performed under general anesthesia, showed a tumor-like structure mimicking a normal germinal center in the lymphoid follicle; immunostaining was positive for B-cell lymphoma 2 and CD10 proteins with some plasma cells stained with IgG, only 30% of them were positive for IgG4, and no marked fibrosis characteristic of IgG4-RD was observed; therefore, follicular lymphoma was diagnosed, and all symptoms, including FDG uptake, improved with rituximab monotherapy. Differential diagnoses of slowly progressive generalized lymphadenopathy over the years with elevated serum IgG4 levels include IgG4-RD, Castleman''s disease, and indolent lymphoma. Multiple accumulation in the liver on FDG-PET/CT, if found, may suggest indolent lymphoma among them.     

18F-FDG uptake in reactive neck lymph nodes of oral cancer: relationship to lymphoid follicles

PET using (18)F-FDG is acceptable as a preoperative diagnostic tool for head and neck cancer. PET combined with CT provides precise localization of neck lymph nodes. Reactive lymphadenopathy is well known as a principal cause of false-positive findings on PET/CT for nodal staging. We investigated the reactive lymph nodes of oral cancer to elucidate the (18)F-FDG-avid area in these nodes. METHODS: Surgically dissected neck lymph nodes of oral cancer were retrospectively reviewed. Of the patients without pathologic nodal metastasis who underwent preoperative PET/CT, 11 patients with 31 enlarged lymph nodes at 20 levels were enrolled. The maximum standardized uptake value (SUVmax) of each lymph node was recorded. The diameters of the long and short axes were measured by pathologic sectioning, and the sectional surface area was calculated in square millimeters. Besides being stained with hematoxylin and eosin, the sections were immunohistochemically stained by CD79a for B cells, CD3 for T cells, CD68 for macrophages, CD21 for follicular dendritic cells (FDCs), and ubiquitous glucose transporter type 1 (GLUT1). The expression of GLUT1 was compared with staining of lymphoid cells. The numbers of total lymphoid follicles and hyperplastic secondary follicles were counted on CD21 and hematoxylin and eosin sections, respectively. The follicular reactivity index was determined as the ratio of secondary follicles relative to total follicles on the corresponding section. These parameters of reactive lymph nodes were analyzed on a level basis. RESULTS: GLUT1 was expressed exclusively in lymphoid follicles, whose staining pattern was identical to that of FDCs. The calculated sectional area correlated significantly with the number of total follicles (r = 0.560; P = 0.0101). SUVmax did not correlate with the number of total follicles (P = 0.8947) but correlated significantly with the number of secondary follicles (r = 0.535; P = 0.0152). In addition, a strong positive correlation between SUVmax and the follicular reactivity index was demonstrated (r = 0.829; P < 0.0001). CONCLUSION: GLUT1 was expressed on cytoplasmic protrusions of FDCs in lymphoid follicles. The (18)F-FDG accumulation in reactive lymphadenopathy depended on secondary follicles. FDCs in germinal centers of secondary follicles are suggested to be avid for (18)F-FDG and the principal cause of false-positive findings for nodal staging.     

Lymphoepithelial cyst of the pancreas: radiological and pathological findings

We report a case of a rare lymphoepithelial cyst of the body of the pancreas that developed in a woman complaining of constipation for 15 years. Ultrasonography revealed a homogeneous isoechoic lesion, while CT demonstrated a polycystic homogeneous mass with central scar and calcification. Cytological investigation of a CT-guided biopsy permitted diagnosis of lymphoepithelial cyst. The patient was operated on and had an uneventful recovery. The histological finding was of a cyst wall lined with keratinised squamous epithelium surrounded by lymphoid tissue with reactive follicular hyperplasia. The radiological findings and differential diagnosis are discussed. Correspondence to: D. Regge     

Follicular lymphoid hyperplasia simulating intussusception in a 6-year-old boy: clinical, radiological and histopathological findings

We report the case of a 6-year-old boy who initially presented with recurrent abdominal pain. Diagnostic imaging, including ultrasound and CT, showed findings typical of an ileocecal intussusception with abdominal lymphadenopathy. Sonographically, the morphological appearance of the intussusception did not change during a 4-week follow-up period. Surgery was performed on the tentative diagnosis of a tumour versus lymphoma. Upon laparatomy, intussusception was ruled out and a large, broad-based tumour of the caecum was palpable. The histopathology after ileocecal resection revealed follicular lymphoid hyperplasia. Where there is radiological suspicion of an intussusception in children with no or insignificant symptoms, follicular lymphoid hyperplasia should be included in the differential diagnosis.     

Cathepsin D as a vitality marker in human skin wounds

Summary This paper shows the results obtained by studying the lysosomal enzyme Cathepsin D as a potential marker for the vitality of wounds in human specimens. We have analyzed 53 samples using enzymological and histological techniques. Our results show the ability of Cathepsin D to establish the vital origin of wounds inflicted 5 minutes or less before death, where the specific activity of cathepsin D reached 0.055 units at the wound edge and 0.01 units in their respective controls (P < 0.001). As previously demonstrated in an experimental series, Cathepsin D seems to be a very useful marker of high forensic interest in especially difficult cases. Further studies are in progress to check the influence of different factors such as drugs intake and clinical conditions on Cathepsin D activity.This work was supported by grants from the Ministry of Education and Science of Spain (Acciones Integradas 1990) and from the Deutscher Akademischer Austauschdienst, FRG.     

Overexpression of Glut1 in lymphoid follicles correlates with false-positive (18)F-FDG PET results in lung cancer staging.

The evaluation of mediastinal lymph node involvement in non-small cell lung carcinoma (NSCLC) is very important for the selection of surgical candidates. PET using (18)F-FDG has remarkably improved mediastinal staging in NSCLC. However, false (18)F-FDG PET results remain a problem. This study was undertaken to identify histologic and immunohistochemical differences between cases showing false and true results of mediastinal lymph node involvement assessed by (18)F-FDG PET. METHODS: Preoperative (18)F-FDG PET examinations were performed on 62 patients with NSCLC, and mediastinal lymph node sampling was done at thoracotomy or mediastinoscopy. In 111 lymph nodes, the size, glucose transporter 1 (Glut1) expression, grade of follicular hyperplasia, and involved proportion of tumor were examined and compared with the (18)F-FDG PET findings. RESULTS: Lymphoid follicular cells were strongly positive for the expression of Glut1. The grade of follicular hyperplasia in false-positive lymph nodes was higher than that in true-negative nodes (P < 0.001). The Glut1 expression of metastatic tumors was higher in true-positive nodes than that in false-negative nodes (P < 0.001). Metastatic squamous cell carcinomas showed stronger Glut1 expression than adenocarcinomas and no false-negative results on (18)F-FDG PET. On the other hand, metastatic adenocarcinomas exhibited focal and weak Glut1 expression with frequent false-negative results. CONCLUSION: The results of this study indicate that (a). lymphoid follicular hyperplasia with Glut1 overexpression may have a causal relationship with high (18)F-FDG uptake of false-positive nodes and (b). the lower expression of Glut1 in metastatic tumors, such as adenocarcinomas, might be responsible for false-negative lymph nodes.