肾脏嗜酸细胞腺瘤1例误诊分析

肾嗜酸细胞腺瘤首先是由Ziple于1942年报道的,它是一种特殊的良性肾脏肿瘤,约占肾脏肿瘤的3％～7％[1].临床上通常无症状,多由体检或其他疾病检查时偶然发现,常常误诊为肾细胞癌.本文就我院术前误诊为肾细胞癌的1例肾嗜酸细胞腺瘤,结合文献分析如下.     

同侧腮腺混合性Warthin瘤与唾腺导管癌1例

患者男性,76岁,因左耳后肿块50年、右口角歪斜1年、左颈肿块7个月入院。体检发现左肋腺内肿块,质硬,固定,直径4cm,并发现左颈肿大淋巴结1枚,直径2cm,CT示左肋腺团块影,似结节融合,密度高,中心见低密度影,茎突前间隙见囊性低密度影,边界尚清,术前穿刺诊断：左腮腺腺癌,后行左腮腺癌联合根治术。     

嗜酸细胞性胃肠炎1例及文献复习

目的 探讨嗜酸细胞性胃肠炎(eosinophilic gastroenteritis,EG)的临床病理特征、鉴别诊断及治疗和预后.方法 报道1例EG的临床病理资料并复习文献.结果 患者男性,55岁.临床表现为腹痛、腹泻,CT示胆总管下端肿瘤,腹腔积液,胃壁、部分小肠壁增厚.临床考虑为十二指肠占位性病变并小肠梗阻,行剖腹探查术.术后病理检查示胃壁、十二指肠壁可见大量嗜酸性粒细胞浸润.结论 EG是一种罕见胃肠道疾病,临床表现无特异性,容易误诊,确诊主要依据病理检查证实胃肠道黏膜组织受嗜酸细胞异常浸润,并应排除其他情况.激素治疗有效,为自限性疾病,目前无恶变报道.     

悬雍垂嗜酸性细胞腺瘤1例

悬雍垂嗜酸性细胞腺瘤１例１程忠２田家乐１万珊作者单位：１湖北省广水市第一医院病理科４３２７００２湖北省人民医院病理科，武汉４３００６０患者女，３７岁，发现咽部肿物２年余，因近１月肿块逐渐增大于１９９５年１２月６日入院。检查：见悬雍垂左侧有一黄豆大基底...     

肾透明细胞癌伴同侧肾上腺皮质腺瘤内转移1例及文献复习

目的：探讨1例肾透明细胞癌(clear-cell renal cell carcinoma,clear-cell RCC)伴同侧肾上腺皮质腺瘤内转移的临床病理特征及转移机制。方法：观察1例肾透明细胞癌转移至同侧肾上腺皮质腺瘤的临床表现、组织学特征、免疫组织化学特点,并复习相关文献。结果：患者,男性,63岁,右季肋部不适半月余入院。术后结果显示右肾透明细胞癌。单纯性孤立性肾囊肿。右肾上腺皮质腺瘤,瘤内见转移的肾透明细胞癌、直径约3 mm。结论：肾透明细胞癌转移至同侧肾上腺皮质腺瘤是非常罕见的现象。     

肾嗜酸细胞腺瘤CT及MRI特征分析

目的 探讨肾嗜酸细胞腺瘤(RO)CT及MRI的表现特点,为RO的临床诊断提供参考。方法 回顾性分析2011年2月—2017年7月解放军福州总医院经术后病理检查确诊为RO的24例患者的临床资料,其中男12例、女12例,年龄36~71(55.2±10.4)岁。患者术前行CT平扫及增强三期扫描,或行MRI平扫及增强扫描,观察病灶的部位、大小、形态、边界,坏死、囊变及星状瘢痕,平扫及多期增强扫描病灶强化情况,以及有无肾周组织侵犯及淋巴结转移。结果 24例患者中22例行CT检查,5例行MRI检查。共发现25个病灶,23例为单侧单发,1例为双侧单发;9例位于右肾,16例位于左肾;病灶最大径(3.4±1.2)cm。CT检查22例23个病灶,平扫13例病灶呈等密度,2例可见钙化,3例见囊状低密度影,12例见星状瘢痕;增强扫描均强化明显,动态增强曲线呈“速升缓降”型。MRI检查5例5个病灶,平扫5例T₁WI呈等、低信号,T₂WI呈混杂稍高信号,DWI呈混杂高信号;增强扫描1例见囊状低密度影,1例见星状瘢痕。所有病例肾周脂肪间隙清晰,肾静脉及下腔静脉内均未见瘤栓,肾门及腹主动脉旁均未见肿大淋巴结。结论 RO的CT及MRI表现具有一定的特征性,术前提高对RO的认识,可减少不必要的根治性肾切除术,具有重要的临床应用价值。     

肾嗜酸细胞腺瘤侵袭性的病理特征分析

目的探讨肾嗜酸细胞腺瘤侵袭性的临床病理学特征。方法回顾性分析4例肾嗜酸细胞腺瘤侵袭性的临床病理学及免疫表型特征,并复习相关文献。结果 4例嗜酸细胞腺瘤中1例侵及肾被膜纤维囊,1例侵透肾被膜纤维囊,2例侵及肾周脂肪;侵透肾被膜纤维囊者局部区域肿瘤细胞核异型明显。患者均行肾部分切除术,随访3个月~6年,无复发或转移。结论肾嗜酸细胞腺瘤虽然是一种良性肿瘤,但部分具有侵袭性的组织学特征,属于一种具有恶性潜能的肿瘤。由于部分病例具有局部异型性及侵袭性组织学特征,容易误诊为肾细胞癌而被过度治疗。因此正确评估肾嗜酸细胞腺瘤的预后,有助于对组织学特征的全面分析。     

涎腺嗜酸细胞性脂肪腺瘤二例

报道2例罕见的发生于腮腺的涎腺嗜酸细胞性脂肪腺瘤。大体观察:2例均包膜完整,1例呈多结节状,1例呈哑铃状。镜下观察:2例肿瘤均被覆薄的纤维性包膜,由不同比例的脂肪组织和大小不等的嗜酸性细胞巢混合构成。免疫组织化学染色:2例嗜酸性细胞均表达人低分子量细胞角蛋白,部分表达细胞角蛋白(CK)7、CK5/6、CK19、p63、上皮细胞膜抗原(EMA),不表达S-100蛋白、Calponin、DOG1,Ki-67阳性指数约1%~2%。2例分别随访4和5个月,均未见复发。     

Mucoepidermoid carcinoma arising in Warthin's tumor of the parotid gland

Malignant transformation of Warthin's tumor is extremely rare, although it is the second most common benign tumor of the parotid gland. We describe our experience of mucoepidermoid carcinoma arising in Warthin's tumor of the parotid gland in a 64-year-old man. He had a swelling in the left parotid-masseteric region. The removed tumor was well encapsulated and histopathologically comprised Warthin's tumor and low-grade mucoepidermoid carcinoma. The mucoepidermoid carcinoma infiltrated lymphoid stroma of the Warthin's tumor, but capsular invasion is not found. Considering the clinical course and physical examination, the lesion was diagnosed as mucoepidermoid carcinoma arising in Warthin's tumor because its features filled the criteria of malignant transformation of Warthin's tumor. There has been no recurrence or distant metastasis for 19 months. Histological change from Warthin's tumor to mucoepidermoid carcinoma may be implicated in squamous or goblet cell metaplasia of epithelial cells. It is considered that the neoplastic cells of Warthin's tumor acquire malignant genotypes simultaneously with this dual differentiation.     

Synchronous ipsilateral Warthin tumor encased by a separate mucoepidermoid carcinoma of the parotid gland: A case report and review of the literature

Fine‐needle aspiration (FNA) is a cost effective and low morbidity procedure in the initial assessment of salivary gland tumors. However, cytological assessment of ipsilateral synchronous tumors (which make up less than 0.3% of all salivary gland neoplasms) may pose diagnostic challenges. Therefore, a wholesome approach, including FNA with clinical and radiological correlation, is of utmost importance. Here, we report a unique case of Warthin tumor encased by a separate high‐grade mucoepidermoid carcinoma that was first diagnosed on FNA. Another striking feature seen was the presence of chronic sialadenitis in the surrounding nonneoplastic salivary gland. The presence of two different neoplasms in the background of chronic sialadenitis raises the question of a possible causal relationship. Traditionally, there has been diagnostic difficulty when dealing with synchronous tumors of the salivary gland and the background of chronic sialadenitis may further complicate the diagnosis. FNA is very helpful and can give important cues to the diagnosis. Diagn. Cytopathol. 2010. © 2009 Wiley‐Liss, Inc.     

颈静脉球瘤1例及副神经节瘤文献复习

目的探讨颈静脉球瘤的临床病理特征和副神经节瘤的生物学行为。方法对1例颈静脉球瘤进行组织学观察和免疫组化标记,同时复习相关文献。结果颈静脉球瘤的组织学改变类似于其他部位的副神经节瘤,免疫组化标记:瘤细胞Syn、CgA和NSE均阳性,EMA、CK、HMB45、CD34和CD99均阴性。结论颈静脉球瘤是一种起源于副神经节的少见肿瘤,呈侵袭性生长,有低度恶性的生物学行为。根据肿瘤的组织学特征,结合CT或MR I影像学资料和免疫组化标记可以作出诊断。     

Pulmonary gangliocytic paraganglioma: a case report and review of the literature

Gangliocytic paraganglioma (GP) is a rare histologic type of neuroendocrine tumors. We report a case of pulmonary GP in a 29-year-old male presenting with an asymptomatic endobronchial nodule. Grossly, the tumor showed a 4.0x3.8x3.5 cm well-defined nodule with yellowish cut surface. Microscopically, the tumor was composed of three distinct cellular types: epithelioid cells, ganglion-like cells and spindle cells. Meanwhile, transitional cells, having morphologic features between ganglion-like and epithelioid cells, were also presented. The epithelioid cells arranged in various morphologic architectures, including Zellballen, papillary, cystic and microcystic pattern. The epithelioid cells were positive for AE1/AE3, CAM 5.2, chromogranin A and synaptophysin. Ganglion-like cells showed immunoreactivity for chromogranin A and synaptophysin. A few ganglion-like cells were also positive for AE1/AE3 and/or CAM 5.2. The spindle cells were positive for S-100 protein and neurofilament. The transitional cells showed a similar immunohistochemical profile to the epithelioid cells. The authors believe stem cell theory is a reasonable explanation for the origin of GP. GP probably originate from some kind of mucosa associated stem cell which can differentiate into diverse cellular lineages.     

Histopathologic changes in parotid gland parenchyma after fine needle aspiration biopsy of a Warthin's tumour. A case report

Fine needle aspiration biopsy of a non-tender tumour in the right parotid gland was performed in a 63-year-old man. A cytological diagnosis of Warthin's tumour was made. Six weeks later, the tumor was removed by a formal parotidectomy. During dissection of the marginal mandibular branch of the facial nerve, significant fibrosis in the surrounding soft tissues was noted, requiring resection of the nerve. We also found a metaplastic (infarcted) Warthin's tumour with focal necrosis surrounded by metaplastic squamous epithelium. There was extensive fibrosis within the adjacent atrophic parotid parenchyma, striated muscle and around peripheral nerves. Small arteries at the periphery of the tumour were occluded by thrombi. The authors believe that the fibrosis of the tissue adjacent to the tumour was more likely due to the ischemia than to a direct puncture trauma caused by the fine needle aspiration.     

肾素瘤1例临床病理及文献复习

目的：阐述肾素瘤的病因，病理特征及鉴别诊断要点。方法：对１例肾素瘤进行大体、光交易、免疫组化镜观察，并复习有关文献。结果：肾素瘤包膜完整光下酪似血管外皮瘤；免疫线化，部分细胞Ｖｉｍｅｎｔｉｎ呈阳性反应，瘤组织的腺样及乳头样结构区瘤细胞ｃｙｔｏｋｅｒａｔｉｎ呈阳性反应。电下瘤细胞胞浆内可见多量圆形分泌颗粒及棱莆和梯形结晶样物。结论：肾素瘤是发生于变更的肾小球入球小动脉血管平滑肌细胞的罕见衣性肿瘤，明     

Warthin-like tumor variant of papillary thyroid carcinoma: Case report and literature review

A tumor approximately 4.0 x 3.0 cm in size with a cystic change was observed in the left lobe of the thyroid gland of a 52-year-old woman. The removed tumor had lymph follicle formation with a germinal center. This lymphatic tissue showed papillary and island-like growth; the growths were surrounded by atypical epithelium showing nuclear features of papillary carcinoma. The atypical epithelium had ground-glass nuclei with nuclear grooves, clearly indicating intranuclear cytoplasmic inclusion bodies. No chronic thyroiditis was observed in the background of the patient. Parts of the metastatic lymph nodes had cells with an eosinophilic cytoplasm, clearly showing an intratumor lymph follicle formation, as in the primary lesion. This is a rare case of thyroid papillary carcinoma similar to Warthin's tumor of the salivary gland. Here we present this case, with a review of previously published reports.     

Tubulocystic oncocytoma of the kidney: a case study and review of literature with focus on implications for differential diagnosis

Renal oncocytoma (RO) can rarely present with a multilocular or tubulocystic growth pattern that may cause significant diagnostic difficulties with a variety of cystic renal cell carcinomas (RCC). Distinguishing these RO variants from their many RCC mimickers is critical because of its typical benign clinical course. Herein, we report a case of RO with extensive tubulocystic architectures on a 42-year-old female patient and discuss the clinicopathologic characterizations of this unusual RO variant with an emphasis on the wide spectrum of differential diagnoses of a variety of primary or secondary renal tumors that are featuring of both oncocytic cell changes and tubulocystic growth patterns.     

Inverted ductal papilloma of minor salivary gland: case report with immunohistochemical study and literature review

Inverted ductal papilloma (IDP) is a type of ductal papilloma arising in ducts of minor salivary glands. Very few cases, and no cases in Japan, have been reported. Reported herein is a case of IDP with a review of the literature. The patient was a 49-year-old man presenting with a lump in the right buccal mucosa of the premolar area of the mandible. The tumor was excised en bloc after a biopsy diagnosis of IDP. On the surface of the covering epithelium, an opening was seen to be filled with mucinous material. On cut surface the opening led to the tumor cavity. The major portion of the tumor parenchyma was made up of papillary proliferation of basaloid squamous cells. Some crypts, microcysts, and mucous cells were seen. There were no findings suggestive of a malignant tumor. The patient's postoperative course was uneventful and there has been no recurrence after 1 year's follow up. Immunohistochemical analysis of the present case supports the hypothesis that IDP originates from squamous metaplasia and proliferation of minor salivary gland duct cells.     

Mycobacterium tuberculosis infection within Warthin's tumor: report of two cases

We report two patients with Warthin's tumor who were also infected with Mycobacterium tuberculosis. Case 1 was a 75-year-old woman with Warthin's tumor and multiple small epithelioid granulomas with caseous necrosis involving the submandibular gland. This patient died of tuberculous meningitis 4 months after biopsy. Case 2 was a 78-year-old man with a 10-year history of a parotid mass which had enlarged rapidly over 2 months. Surgical excision revealed Warthin's tumor and epithelioid granulomas involving the left parotid gland. DNA extracted from paraffin sections was amplified by nested polymerase chain reaction (PCR) with primer sets for the mycobacterial 65-KDa antigen gene. Restriction enzyme digestion of the PCR products could differentiate Mycobacterium tuberculosis from other mycobacteria in both cases. Although the histogenesis of lymphoid components of Warthin's tumor is controversial, the frequent prevalence of inflammation or necrosis and our present findings suggest these components have a similar behavior to regional lymph nodes.