颗粒细胞瘤15例临床病理分析

目的探讨颗粒细胞瘤的组织起源及临床病理学特征。方法回顾分析15例颗粒细胞瘤的临床资料及组织学形态特征,并采用免疫组化(SP法)观察其免疫表型。结果良性颗粒细胞瘤13例,恶性颗粒细胞瘤2例。男性5例,女性10例,年龄19~69岁,平均年龄41·6岁,2例恶性颗粒细胞瘤年龄分别为67岁和69岁。良性颗粒细胞瘤直径0·4~5·3cm,平均2·3cm,2例恶性颗粒细胞瘤直径分别为6和14cm。均为单发病例,临床上主要表现为真皮、皮下或黏膜下孤立性无痛性结节,分别位于腰部3例、腋下、胸壁各2例,乳腺、上臂、子宫、肛周、声带、食管、结肠、舌部各1例。病理组织学上,良性颗粒细胞瘤的肿瘤细胞通常有比较丰富的嗜酸性颗粒状胞质和小而深染的胞核,而恶性颗粒细胞瘤的肿瘤细胞中可见带有明显核仁的空泡状核,细胞核明显异型及部分细胞呈梭形。免疫组化示神经标记物NSE、S-100蛋白强阳性,表达溶菌酶的标记物CD68也强阳性,而表达平滑肌和横纹肌的标记物SMA、MG均阴性。结论颗粒细胞瘤为来源于雪旺细胞的肿瘤,恶性者少见,大多发生在年龄大的患者,且肿瘤体积比较大。     

卵巢幼年型粒层细胞瘤8例临床病理分析

目的 探讨卵巢幼年型粒层细胞瘤(juvenile granulosa cell tumor, JGCT)的临床病理特点、诊断及鉴别诊断.方法 回顾本院诊治的8例JGCT的临床、病理特征及免疫表型特点,并进行随访获知其预后情况.结果 8例JGCT患者发病年龄6～21岁,平均15.1岁.临床主要表现为腹部包块、腹水及女性假性性早熟.巨检表现为囊实性肿块.光镜下肿瘤细胞呈实性巢状,片状弥漫性排列,部分可排列成多个圆形或椭圆形大小不等的滤泡,少数可形成巨滤泡结构,有的滤泡腔内还可见均质红染物质.瘤细胞呈圆形、多边形,中等大小或较大,胞质丰富,空淡或微嗜酸性,核圆形,染色质均质状,无明显核沟,有一定异型性,可见核分裂象.免疫表型:瘤细胞均表达inhibin-α、CD99、vimentin,部分病例Melan-A、calretinin、S-100阳性,瘤细胞不表达CKpan、EMA、PLAP、Syn和CgA.结论 JGCT非常少见,属于低度恶性肿瘤,预后较好.确诊依赖于临床特点、组织形态学及免疫组化标记.病理诊断时要与卵巢的成人型粒层细胞瘤、高钙血症型小细胞癌、类癌、无性细胞瘤等肿瘤相鉴别.     

后肾间质肿瘤的病理观察

目的观察后肾间质肿瘤的临床病理表现,探讨其有病理诊断价值的组织学特征。方法对2例后肾间质肿瘤进行HE染色及免疫组织化学染色（EnVision法）,并进行观察。结果后肾间质肿瘤为单侧性肾占位,肿瘤位于肾髓质,边界清,呈“扇贝形”与相邻肾组织连接。镜下主要表现为：肿瘤内可见单个的肾小球和肾小管,梭形或星形肿瘤细胞呈“葱皮样”围绕肾小管和肾血管排列,细胞分布不均匀,在低倍镜下形成“结节样”图像;大部分肿瘤中内陷的小血管壁发育不良。肿瘤细胞CD34阳性表达。结论近肾小管区细胞和血管组成的“结节样”图像和CD34阳性是具有诊断和鉴别诊断价值的组织学特征。     

原发性皮肤CD4+小/中等大小T细胞淋巴组织增殖性疾病4例临床病理分析

目的探讨原发性皮肤CD4~+小/中等大小T细胞淋巴组织增殖性疾病的临床特点、组织学特征、诊断及鉴别诊断。方法分析4例原发性皮肤CD4~+小/中等大小T细胞淋巴组织增殖性疾病的临床资料、病理形态、免疫表型及基因重排,并复习相关文献。结果 (1)原发性皮肤CD4~+小/中等大小T细胞淋巴瘤好发于中老年人的头颈部,常为单发结节。(2)肿瘤细胞弥漫浸润真皮层。(3)肿瘤细胞小～中等大,轻～中度异形性,大细胞少于30%。(4)肿瘤细胞CD4~+/CD8~-,一般不表达CD30和细胞毒性标记。(5) T细胞受体克隆性重排。结论原发性皮肤CD4~+小/中等大小T细胞淋巴瘤属于少见的皮肤原发T细胞淋巴组织增殖性疾病,肿瘤完整切除后预后较好。     

上消化道颗粒细胞肿瘤10例临床病理学分析

目的探讨上消化道颗粒细胞瘤的临床病理学特点以及治疗和预后。方法观察10例上消化道颗粒细胞瘤的临床、组织形态学以及免疫组织化学等特征。结果患者平均年龄40.5岁,男女比例为7∶3。9例上消化道颗粒细胞肿瘤位于食管,1例位于胃。肿块多位于黏膜层至黏膜下层。组织学上,肿瘤细胞呈紧密的巢状或片状,多呈浸润性生长,但常无坏死。细胞呈圆形、多边形或梭形,细胞质丰富且含有多量呈PAS-D阳性的嗜双色性颗粒状物质,细胞核小、圆而居中,核分裂象少见。免疫谱示肿瘤细胞均呈弥漫强阳性表达nestin和S-100,多呈CD68差异性阳性表达,而CK、CD117、CD34、desmin和SMA均阴性。经随访12～54个月,10例肿瘤均未见复发和转移。结论上消化道颗粒细胞肿瘤少见,但特征性的组织学和免疫组织化学特征有助于诊断,多行内窥镜下或手术切除治疗,常具有良性的临床经过。     

丛状纤维组织细胞瘤3例临床病理观察

目的 探讨丛状纤维组织细胞瘤临床病理特点及鉴别诊断要点.方法 对3例丛状纤维组织细胞瘤进行临床资料及光镜和免疫组化标记观察.结果 组织学特点:纤维结缔组织把肿瘤细胞分隔成丛状或结节状.结节则由单核或多核组织细胞样细胞构成,结节外周围绕短梭形的纤维母/肌纤维母细胞样细胞.部分结节则主要由纤维母细胞样细胞组成,不见多核巨细胞.免疫组化染色显示:单核或多核组织细胞样细胞表达CD68、α-ACT和溶菌酶,梭形细胞表达Vim和SMA.结论 丛状纤维组织细胞瘤是一种低度恶性的软组织肿瘤,其诊断主要依靠组织病理学和免疫组化标记.     

肺原发性横纹肌肉瘤2例临床病理分析

目的探讨肺横纹肌肉瘤(rhabdomyosarcoma,RMS)的临床病理特征、免疫表型及鉴别诊断。方法分析2例肺RMS的临床特点和影像学资料,行常规病理组织学和免疫组化检查,并结合相关文献探讨其临床病理特征。结果 2例均为女性,年龄分别为24、50岁,影像学检查肿瘤位于右肺中叶及左肺下叶。肿瘤细胞组织学形态多种多样,但基本上重演骨骼肌胚胎发育过程中各个阶段的细胞,其主要由原始小圆形细胞和不同分化程度的横纹肌母细胞以不同比例组成。免疫表型:肿瘤细胞不同程度表达desmin、Myoglobin、Myogenin、Myo D1。结论肺RMS属于极其罕见的恶性肿瘤,临床表现为肺内占位性病变的相关症状或体征,该肿瘤的诊断依赖病理组织学及免疫组化检查,预后较差。     

粒细胞肉瘤38例临床病理分析

目的 探讨粒细胞肉瘤的临床病理特征及鉴别诊断.方法 对38例粒细胞肉瘤患者的病理组织进行HE及免疫组织化学(EnVision法)染色观察,结合临床资料进行分析,并复习相关文献.结果 患者发病年龄2～77岁,平均年龄43.3岁,男23例,女15例.临床主要表现为体表淋巴结肿大、局部软组织肿块及疼痛.其中随访18例,死亡14例,平均生存时间16.9个月.组织学表现为肿瘤细胞弥漫成片,小～中等大小,形态较一致,胞质少而淡染,核呈圆形或不规则形,可见核仁,核分裂象易见.部分肿瘤具有"列兵样"组织结构,肿瘤细胞间可见散在分布的幼稚嗜酸性粒细胞.免疫组织化学染色显示瘤细胞表达抗髓过氧化物酶、CD43,部分表达CD68、溶菌酶、CD99和末端脱氧核苷酸转移酶,而CD3、CD20、CD79a、AE1/AE3和胎盘碱性磷酸酶阴性.结论 粒细胞肉瘤临床少见,形态学上易误诊为非霍奇金淋巴瘤、Ewing肉瘤/PNET、胚胎性横纹肌肉瘤等,免疫组织化学技术对于确诊本病具有重要价值.     

母细胞性浆细胞样树突细胞肿瘤5例临床病理分析

目的探讨母细胞性浆细胞样树突细胞肿瘤的临床病理学特征。方法应用光镜及免疫组化法观察5例母细胞性浆细胞样树突细胞肿瘤的组织学特点及免疫表型,并复习相关文献。结果 5例中3例为男性,2例为女性,年龄分别为53、72、40、14及15岁。5例病变均以皮肤斑块或结节为首发表现,并均累及骨髓,其中1例累及淋巴结。皮肤病变显示肿瘤细胞在真皮弥漫分布,不累及表皮。肿瘤细胞中等大小,核圆形或椭圆形,染色质细腻。5例均表达CD56、CD123、CD43,3例表达CD4;5例均不表达CD8、Td T及EBER。5例均行化疗,1例死亡,2例放弃治疗后失访,2例健在。结论母细胞性浆细胞样树突细胞肿瘤是一种罕见的肿瘤,具有独特的临床病理特点,诊断依靠病理组织学及部分辅助方法。     

牙源性鳞状细胞瘤临床病理观察

目的 探讨牙源性鳞状细胞瘤的临床病理特征、诊断及鉴别诊断.方法 光镜观察及免疫组化法对1例牙源性鳞状细胞瘤进行临床病理分析,并复习文献.结果 肿瘤位于右下颌骨,病灶为多房囊性,表面骨质菲薄,内容物为灰白色凝胶样,骨质破坏.光镜下可见肿瘤组织由形态大小不等、分化良好的鳞状上皮岛和纤维间质构成,具有局部浸润性.免疫组化:Ki-67和p53均阴性.结论 牙源性鳞状细胞瘤是一种罕见的良性上皮性肿瘤,组织学形态特点是其诊断的主要依据,需与成釉细胞瘤、高分化鳞状细胞癌、牙源性钙化上皮瘤或成釉细胞纤维瘤相鉴别.     

Metastatic pineocytoma of the spinal cord after long-term dormancy

An unusual tumor in the spinal cord of a 57 year old man is reported. At the age of 42 years, the patient had had a pineal region tumor that subsequently disappeared completely after local radiation therapy only. Eleven and 15 years later, at the ages of 53 and 57 years, respectively, solitary spinal cord tumors were found and removed. Pathological examination revealed that these tumors were of neurogenic origin and showed the characteristic features of pineal parenchymal tumors such as pineocytoma and pineoblastoma. Based on the cytology of individual tumor cells and the absence of mitotic figures and necrotic foci, this patient was diagnosed as having metastatic pineocytoma of the spinal cord. This case suggests that distant, subarachnoidal metastasis to the spinal cord can occur in pineocytomas even after long-term dormancy.     

Smear preparation of intracranial lesions: a retrospective study of 306 cases

A cytohistological correlation with determination of accuracy rate of smear preparation result was done in a retrospective study of 306 cases of intracranial tumors. Cytomorphology of few new entities of CNS tumors are described. The cytological features and WHO grading of the tumors were described on smear preparation. The cases with discrepancy in cytological and histological diagnosis were reviewed again and a final possible diagnosis on smear preparation which should have been given is discussed. The clinical details like the age, sex, and site of the tumors were analyzed. The age range of the patients was from 3 years to 63 years with male:female ratio of 1.5:1. Of the total 306 cases, a cytohistological correlation was seen in 93% cases. Twenty-two (7.3%) cases showed discrepancy between the crush preparation diagnosis and final histopathological diagnosis. Majority of the tumors were located in the cerebral hemisphere (56%) and the most frequently diagnosed tumor was astrocytoma, in particular, pilocytic astrocytoma (18.5%) followed by meningioma (11.9%), medulloblastoma (7.3%), anaplastic oligodendroglioma (5%), ependymoma (4.3%), pituitary adenoma (3.3%), schwannoma (3.3%), etc. A few rarer tumors, in central nervous system like differentiating neuroblastoma, pineocytoma, atypical choroid plexus papilloma, piloxmyxoid astrocytoma, rosette forming glioneuronal tumor, etc. are also described, Smear/crush preparation is a very effective, simple, rapid and reliable technique for the diagnosis and WHO grading of central nervous system tumors. Diagnostic accuracy of cytology with final histopathological report is established with accuracy rate of 93%.     

Cytologic features of the normal pineal gland on squash preparations

As primary pineal lesions are extremely rare, many surgical pathologists are unfamiliar with normal pineal cytologic features. We describe cytologic features of the normal pineal gland in patients of varying ages and identify common diagnostic pitfalls. We performed a retrospective review of pineal gland biopsies performed at our institution, where approximately 30,000 surgical specimens are accessioned yearly, for the last 23 years. Only two pineal gland biopsies were found. Although both cases were initially diagnosed as low‐grade gliomas on frozen section, the final diagnosis was benign pineal tissue based on light microscopy and immunohistochemistry results. Additionally, we performed squash preparations of five normal pineal gland autopsy specimens with Papanicolaou and Diff–Quik® (Dade Behring, Newark, DE) stains. Infant preparations were highly cellular smears composed of numerous, uniform, single cells with indistinct cytoplasm, small round‐to‐oval nuclei, fine chromatin, and absent nucleoli and calcifications. The vague microfollicular pattern mimicked a pineocytoma and the fine fibrillary background mimicked a glial neoplasm. Young adult smears were similar; however, microcalcifications were present with fewer background single cells. Older patients had much less cellular smears composed of small clusters of cells with fusiform‐to‐spindle nuclei, a fine chromatin pattern, and indistinct cytoplasmic borders. There were fewer background single cells and more microcalcifications. The cytologic features of the native pineal gland vary with age. Normal pineal tissue can be confused with a pineocytoma or low‐grade glioma. Familiarity with normal pineal gland cytological features will help to avoid a potential misdiagnosis. Diagn. Cytopathol. 2014;42:939–943. © 2014 Wiley Periodicals, Inc.     

Pineal parenchymal tumors: a correlation of histological features with prognosis in 66 cases

The WHO classification of CNS tumors divides pineal parenchymal tumors (PPT) into pineocytoma (PC), pineoblastoma (PB) and mixed pineocytoma-pineoblastoma or PPT with intermediate differentiation. The reported incidence of mixed/intermediate PPT varies and this may reflect the difficulty in classifying tumors of this type. In an attempt to overcome the problem of the classification of PPT with intermediate differentiation, we describe the relationship between histological features and patient survival in a large cooperative series of 66 PPT from 12 neurosurgical centres. All tumors were studied with both light microscopy and immunohistochemically using antibodies against glial markers or neural/neuroendocrine markers. Our series included 11 PC, 39 mixed/intermediate PPT and 16 PB. A number of mitoses greater than 6 and the presence of necrosis were associated with a poorer outcome, while positive immunostaining for neurofilaments was associated with a better survival. We propose a new prognostic grading of 4 grades, grade I for PC, grade II for PPT with fewer than 6 mitoses and positive immunolabelling for neurofilaments, grade III for PPT with either 6 or more than 6 mitoses or fewer than 6 mitoses but without immunostaining for neurofilaments and grade IV for PB.     

子宫颈鳞状移行细胞癌临床病理分析及组织分化观察

目的：探讨子宫颈鳞状一移行细胞癌的临床病理、免疫表型、诊断和鉴别诊断。方法：按2003年WHO宫颈肿瘤分类标准观察5例宫颈鳞状移行细胞癌患者的临床病理特点,应用免疫组织化学方法对宫颈活组织和手术标本进行组织形态和免疫表型的检测。结果：患者年龄中位数为45岁,临床主要表现为阴道异常出血,肉眼子宫颈肥大、呈颗粒状、息肉样或菜花样新生物（4／5）。显微镜下未见明显挖空细胞,呈移行或鳞状细胞样分化,部分似有腺细胞样分化。组织形态学：肿瘤由纤维血管轴心的乳头状结构构成,乳头由多层异型鳞状及移行细胞样上皮覆盖。2例非浸润性,2例乳头间质浸润,1例子宫颈壁浸润;免疫组化显示P16和细胞角蛋（cytokeratin,CK）19和CK5／6均强阳性,CK7阳性强弱不等,1例CK20上皮表层灶状阳性,余为阴性;4例高危型HPV检测阳性。结论：鳞状移行细胞癌是兼有鳞状-移行细胞形态和一定腺样分化的非腺性乳头状鳞状细胞癌,它与高危型HPV感染相关,具有向乳头间质和宫颈壁浸润、复发及转移的特点。鳞状移行细胞癌需与宫颈其他乳头状肿瘤鉴别。     

The histopathological spectrum of human meningiomas

Histopathological examination and grading of meningiomas gives valuable prognostic information, although the method is subject for interobserver variability. The aim of this study was to review a large series of human meningiomas in order to examine the frequency of benign (grade I), atypical (grade II), and anaplastic (grade III) forms depending on various WHO classification schemes. In addition, we wanted to describe the frequency of various histopathological features and their mutual correlations. Sections from 196 consecutively treated primary human meningioma patients were revised retrospectively. The established criteria to grade meningiomas, which are also known to be associated with tumorigenesis, were shown to correlate significantly. The number of grade II meningiomas increased when using the WHO 2007 classification (30%) compared with previous editions, mainly due to the definition of brain infiltrating meningiomas as atypical (grade II). bimodal frequency distribution among age groups of females was observed. Continuous revision of histopathological classification systems is required to improve the diagnostic accuracy.     

Pineocytoma in a lowland anoa (Bubalus depressicornis)

This report describes the first case of a pineocytoma in an 18-year-old female lowland anoa (Bubalus depressicornis). The tumour grossly appeared as a focal, non-infiltrative, yellow-tan, encapsulated mass occupying the normal anatomical location of the pineal gland. Microscopical, immunohistochemical and electron microscopical findings were consistent with a diagnosis of pineocytoma an entity not previously described in this member of the buffalo subgenus species.     

Usefulness of Texture Analysis for Computerized Classification of Breast Lesions on Mammograms

This work presents the usefulness of texture features in the classification of breast lesions in 5,518 images of regions of interest, which were obtained from the Digital Database for Screening Mammography that included microcalcifications, masses, and normal cases. Sixteen texture features were used, i.e., 13 were based on the spatial gray-level dependence matrix and 3 on the wavelet transform. The nonparametric K-NN classifier was used in the classification stage. The results obtained from receiver operating characteristic analysis indicated that the texture features can be used for separating normal regions and lesions with masses and microcalcifications, yielding the area under the curve (AUC) values of 0.957 and 0.859, respectively. However, the texture features were not very effective for distinguishing between malignant and benign lesions because the AUC was 0.617 for masses and 0.607 for microcalcifications. The study showed that the texture features can be used for the detection of suspicious regions in mammograms.     

The new WHO classification of tumors of the nervous system 2000. Pathology and genetics

New developments in neuro-oncology have prompted an update of the World Health Organization (WHO) classification of tumors of the nervous system. Major changes include the addition of new entities and the refinement of criteria for the diagnosis and grading of various neoplasms, in particular the meningiomas. As novel clinico-pathological entities, the chordoid glioma of the third ventricle, the atypical teratoid/rhabdoid tumor (AT/RT), the solitary fibrous tumor, and the perineurioma have been listed. The former lipomatous medulloblastoma of the cerebellum, previously incorporated in the family of embryonal tumors, is now classified as cerebellar liponeurocytoma. The term mixed pineocytoma/pineoblastoma has been replaced by pineal parenchymal tumor of intermediate differentiation. Furthermore, the large cell medulloblastoma and the tanycytic ependymoma were established as novel tumor variants. A separate chapter on the peripheral neuroblastic tumors has now been included in the classification. Substantial revisions were introduced in the meningioma chapter. For both atypical meningioma WHO grade II and anaplastic meningioma WHO grade III, histopathological criteria are now precisely defined. An important new addition to the WHO 2000 classification of nervous system tumors is the inclusion of molecular pathology findings. With this combination of pathology and genetics it has set the stage for a new format of the WHO tumor classification series.     

子宫颈鳞状移行细胞癌临床病理分析

目的 分析子宫颈鳞状移行细胞癌（squamotransitional cell carcinoma,STCC）的临床、病理及免疫组化表达特征,探讨STCC的诊断和鉴别诊断及细胞分化。方法 参照2003年WHO子宫颈肿瘤组织学分类,对8例STCC进行临床病理形态学观察和免疫组化检测。结果 患者平均年龄37．1岁（28～54岁）,临床表现为接触性阴道出血,部分病例白带有异味,病程1个月～5年。子宫颈肥大呈粗颗粒状或微绒状,部分病例（2／8）见息肉或菜花样新生物。所有病例均见乳头状结构,乳头由多层异型鳞状细胞样或移行细胞样上皮覆盖,细胞无挖空特征,乳头内为纤维血管中心柱;大部分乳头为非浸润性,2例为浸润性,2例子宫颈壁有深部浸润的表面乳头中见厚壁血管。所有病例均见程度不等的子宫颈间质浸润（0．1cm至全层）,HE切片下判断4例有脉管内浸润,1例盆腔淋巴结有转移。免疫组化染色显示p16均呈强阳性表达,CK7、CK14、CK19呈不同程度阳性表达,CK20仅在2例见局灶阳性,在D2-40标记下发现6例有淋巴管浸润。结论 STCC是一种具有独立形态学特征的子宫颈恶性肿瘤,有别于子宫颈普通鳞癌及其他呈乳头状生长的恶性肿瘤如疣性癌、疣状癌等;尽管大部分乳头为非浸润性,STCC易向子宫颈壁浸润的特点提示深部活检明确诊断的必要性,乳头内厚壁血管可能与深部浸润有关;免疫组化结果提示STCC属鳞状细胞癌,不支持有真正的移行细胞分化。STCC与高危型HPV感染有关,易经淋巴道转移。