卵巢子宫内膜异位囊肿破裂26例临床分析

目的 提高对卵巢子宫内膜异位囊肿破裂发病特点的认识.方法 对10年来收治的卵巢子宫内膜异位囊肿破裂患者的临床资料进行回顾性分析.结果 卵巢子宫内膜异位囊肿破裂多发生在围绝经期,表现为剧烈腹痛,且腹膜刺激症状明显,可伴有体温升高、白细胞升高等非特异性的炎症表现.血清CA125水平多升高.B超多表现为附件区囊肿壁厚,囊液稠,无丰富血流.结论 结合患者的月经周期、症状、体征、血清CA125水平、B超检查等,可诊断卵巢子宫内膜异位囊肿破裂.为了预防粘连,改善病人预后,首选的治疗方案为手术.     

子宫内膜异位症中箈络细胞的识别及形态特征（英文）

目的:研究箈络细胞(telocytes)在人卵巢子宫内膜异位症组织中的分布和形态结构特征。方法:取卵巢囊肿患者组织标本,通过苏木精-伊红染色,诊断为卵巢子宫内膜异位症。同时,在透射电子显微镜下对该组织进行观察。结果:通过观察苏木精-伊红染色后的卵巢囊肿病灶组织,发现存在异位子宫内膜,进而确诊为卵巢子宫内膜异位症。透射电子显微术结果显示卵巢子宫内膜异位症中的确存在箈络细胞。箈络细胞胞体小,向外延伸极其细长的念珠状突起,突起部分别由膨大的粗段与细段交替组成;粗段包含许多细胞器,如内质网和线粒体;且明显可见自噬小体和脂滴。此外,箈络细胞通过突起直接接触或分泌囊泡间接联系而形成网络结构。结论:我们通过透射电子显微术证实子宫内膜异位症病灶中确实存在箈络细胞,并描述了其形态学特征。本研究为卵巢子宫内膜异位症提供了新的细胞成分,加深了对卵巢子宫内膜异位症病理方面的认识。     

子宫内膜混合性腺-神经内分泌癌1例并文献复习

目的观察子宫内膜混合性腺-神经内分泌癌的临床病理特点,探讨其诊断和起源。方法对1例子宫内膜发生的子宫内膜样腺癌伴神经内分泌癌行HE及免疫组化染色,并复习相关文献。结果患者女性,47岁。子宫腔内见一菜花样肿物,大小4 cm×3 cm×2 cm,侵达肌壁。镜检:瘤组织由子宫内膜样腺癌及小细胞神经内分泌癌成分混合构成,子宫内膜样腺癌占70%,小细胞神经内分泌癌占30%,两种肿瘤成分相互掺杂。免疫表型:腺癌成分表达CK、CA125、ER、PR,小细胞神经内分泌癌成分表达Syn、CgA,Ki-67增殖指数为60%。术后随访7个月,患者无复发、转移。病理诊断为子宫低分化子宫内膜样腺癌伴神经内分泌癌(小细胞型,Ⅲ级)。结论子宫内膜混合性腺-神经内分泌癌较罕见,其两种成分可能为多潜能细胞向两个方向分化的结果,诊断主要依靠病理形态学和免疫表型,预后差。     

肿瘤坏死因子-α在卵巢肿瘤患者腹水中的表达及意义

目的 探讨卵巢肿瘤患者腹水中肿瘤坏死因子-α(TNF-α)与卵巢癌之间的关系,探讨其对腹水性质鉴别的价值.方法 采用酶联免疫吸附法(ELISA)检测59例卵巢上皮性肿瘤、9例原发性腹膜癌、6例卵巢子宫内膜异位囊肿患者腹水TNF-α水平.结果 腹水TNF-α水平在卵巢恶性上皮性肿瘤、卵巢交界性肿瘤、原发性腹膜癌中的水平明显高于卵巢良性上皮性肿瘤、卵巢子宫内膜异位囊肿,且与肿瘤的恶性行为包括临床分期、组织分化程度、淋巴转移及腹水量等有关.结论 腹水TNF-α对诊断卵巢癌有较高的敏感性和特异性,可能成为卵巢恶性肿瘤的标志物.     

卵巢复合性神经内分泌癌二例临床病理学分析

目的探讨卵巢复合性神经内分泌癌的临床病理特征。方法对2018年9月至2019年1月武汉大学人民医院2例卵巢复合性神经内分泌癌行组织病理学、免疫组织化学表型分析。结果镜下见2例肿瘤均可见2种成分。其中一种成分为神经内分泌癌,另一种成分为卵巢恶性上皮性肿瘤,免疫组织化学结果显示:2例肿瘤中的神经内分泌癌成分均表达嗜铬素粒A、突触素和CD56,例1中子宫内膜样癌细胞角蛋白(CK)7、ER、PR、波形蛋白阳性。例2中黏液性癌CK7阳性。最终诊断为1例卵巢复合性小细胞癌(肺型)伴子宫内膜样癌,1例为卵巢复合性大细胞神经内分泌癌伴黏液性癌。结论卵巢复合性神经内分泌癌是一种罕见的高度恶性混合性肿瘤,预后较差,术前及术中诊断困难,免疫组织化学检测可辅助诊断。     

卵巢巧克力囊肿破裂16例分析

目的 探讨卵巢巧克力囊肿破裂的诊断与治疗,分析误诊的相关因素.方法 回顾性分析16例手术病理证实卵巢巧克力囊肿破裂的病例资料.结果 行单侧附件切除术4例,单侧卵巢巧克力囊肿剔除术10例,行全子宫加单侧附件切除1例.对例子宫内膜异位囊肿剔除术1例.术前确诊10例,确诊率62.50%,6例分别误诊为卵巢囊肿蒂扭转、黄体破裂、异位妊娠和急性阑尾炎,误诊率为37.50%.结论 了解本病临床特征并与其他相关急腹症相鉴别,综合分析,做出诊断,以减少误诊,提高确诊率.一旦确诊多需手术治疗.     

卵巢囊肿的临床特点及诊治体会

目的 探讨卵巢囊肿的临床及病理特点.方法 回顾性分析我院151例卵巢囊肿患者的临床压痛理资料.结果 151例卵巢囊肿临床表现主要为无症状性包块,或腹痛,痛经,不孕等;卵巢囊肿中非肿瘤性囊肿占87例,肿瘤性囊肿占64例,非肿瘤性囊肿以子宫内膜异位症最为常见,占40.23%(35/87);肿瘤性囊肿以成熟性囊性畸胎瘤最为常见,占57.14%(36/63);77.48%患者发病年龄介于20-50岁之间(117/151),占绝大多数.结论 卵巢囊肿为生育期女性常见的疾病,但由于缺乏特异的临床表现,就诊时大多数囊肿体积已经较大、卵巢破裂导致急腹症或到恶性肿瘤晚期,使手术风险增加和治愈率降低.     

子宫颈鳞状细胞癌伴子宫内膜及双侧输卵管扩散1例并文献复习

目的探讨子宫颈鳞状细胞癌伴子宫内膜及输卵管黏膜扩散的临床病理学特征。方法回顾性分析1例子宫颈鳞状细胞癌伴子宫内膜及双侧输卵管扩散的临床病理学及免疫表型特征、HPV检测结果,并复习相关文献。结果眼观:子宫颈外口见一隆起型肿块,肿块大小3.0 cm×2.5 cm×1.7 cm,向上累及宫颈管内口;子宫宫腔内未见明显肿块,子宫内膜菲薄且较光滑;双侧输卵管及卵巢未见明显肿块。镜检:子宫颈中分化浸润性鳞状细胞癌,浸润性病灶周围可见原位癌区域,癌组织浸润至子宫颈管壁周围纤维脂肪组织,并见脉管内癌栓形成及神经侵犯现象,肿瘤向下侵犯阴道壁上1/3;子宫内膜经全部取材制片,镜下见宫角处局灶子宫内膜表面黏膜上皮呈原位鳞状细胞癌改变,周围子宫内膜呈萎缩性改变,且与子宫颈鳞状细胞癌不相连续;双侧输卵管伞部黏膜上皮均见局灶原位鳞状细胞癌成分,周围输卵管黏膜上皮及间质均未见癌组织,未见脉管内癌栓。双侧卵巢未见明显异常。免疫表型:子宫颈、子宫内膜、输卵管肿瘤p16均阳性,输卵管肿瘤WT-1阴性,肿瘤CK5/6阳性,Ki-67增殖指数为60%;HPV-DNA检测子宫颈、子宫内膜及输卵管均显示HPV16型感染阳性。结论子宫颈鳞状细胞癌伴子宫内膜及双侧输卵管扩散的相关病例较为罕见,其发生机制可能与HPV感染有关。     

卵巢子宫内膜异位囊肿的CT诊断

目的分析卵巢子宫内膜异位囊肿的CT表现，提高CT的诊断及鉴别诊断能力。方法回顾性分析经手术和病理证实的64例81个卵巢子宫内膜异位囊肿。结果囊肿直径2～12cm，平均5．8cm，囊肿边缘光滑14个，与周边粘连67个；囊液密度19～50HU，平均32HU。增强后囊肿壁呈轻中度强化14个，明显强化3个。结论CT能较大程度地显示卵巢子宫内膜异位囊肿的形态学特征，熟悉和掌握这些形态学特征是提高诊断正确率、避免误诊的关键。     

乳腺浸润性小叶癌女性生殖道转移3例报道并文献复习

目的 乳腺浸润性小叶癌转移到女性生殖道罕见,探讨其临床病理特点及鉴别诊断要点.方法 结合文献分析报道3例乳腺小叶癌女性生殖道转移,并进行临床资料、组织学和免疫组化标记观察.结果 3例患者在乳腺癌切除后,出现腹部不适及包块、不规则阴道出血,行姑且性子宫切除和(或)输卵管卵巢切除术.组织学见卵巢、输卵管、子宫内膜及肌层和平滑肌瘤内单线状癌细胞浸润生长,破坏卵巢白体,浸润输卵管黏膜和子宫内膜间质,输卵管腺上皮和宫内膜腺体完好.免疫组化标记:瘤细胞ER、PR(+),E-cad-herin(-),GCDFP-15、CK(+).结合乳腺癌切片与转移癌形态基本一致.结论 乳腺浸润性小叶癌女性生殖道转移具有组织学显著特征,根据病史及免疫组化标记可明确诊断.     

Perinuclear dot-like cytokeratin 20 staining in small cell neuroendocrine carcinoma of the ovary (pulmonary-type).

Primary ovarian small cell carcinomas are rare tumors that are subclassified into the hypercalcemic (HT) and the pulmonary type (PT), and each tumor type has different clinicopathologic characteristics. However, overlapping morphologic features can make the distinction between these lesions difficult. The PT small cell carcinoma is very rare, with only one series and a few case reports published. The authors report two additional cases of this entity and also report for the first time the immunohistochemical finding of perinuclear dot-like staining with cytokeratin 20. This staining pattern has been reported only for Merkel cell carcinoma and salivary gland small cell carcinoma. The authors suggest that the punctate CK20 staining is a useful tool in the diagnostic distinction of PT small cell carcinoma from HT small cell carcinoma, from other primary ovarian tumors such as granulosa cell tumors, and from metastatic neuroendocrine tumors originating at primary sites such as the lung. Since the authors' conclusions are based on two cases of this rare entity, additional cases will need to be studied in the future.     

脾脏转移癌的临床病理特点

目的探讨脾脏转移癌的临床病理特点及其转移规律。方法总结16例脾脏转移癌病例,复习临床、外检、尸检记录资料,对其性别、年龄、临床症状、原发部位、组织学类型、脾脏的大体特点、脾脏内肿瘤的生长方式进行了分析。结果16例脾脏转移癌中,男性12例,女性4例;男性显著多于女性;年龄范围从48岁到90岁,其中位年龄为66．5岁;临床症状主要表现为左上腹不适,疼痛,消瘦乏力,食欲不振等,有些病例可扪及脾肿大,CT可发现脾内占位。肺是脾脏转移癌的最主要的原发部位,占总例数的43．8％（7／16）;男性最常见的原发部位是肺,占50．0％（6／12）,而女性最多见的是卵巢（2／4）。组织学类型中,肺未分化癌是最多见的类型,占25．0％（4／16）,其中小细胞未分化癌3例,大细胞未分化癌1例;其他依次为：肺细支气管肺泡癌2例;结肠腺癌2例;卵巢浆液性乳头状囊腺癌2例;前列腺腺癌2例。男性最多见的类型是肺未分化癌,而女性为卵巢浆液性乳头状囊腺癌。脾脏转移癌的生长方式分为单结节性、弥漫性和多结节性3种类型,多数肿瘤表现为单结节性的生长方式,少数高转移潜能的肿瘤（5／16）表现为弥漫性和多结节的生长方式,包括肺小细胞未分化癌（3／3）,肺腺癌（1／1）和前列腺腺癌（1／2）。结论脾脏转移癌少见,掌握其临床病理形态特点对于病理诊断和临床处理有指导意义。     

Squamous cell carcinoma and osteosarcoma arising from a dermoid cyst-a case report and review of literature

A rare case of multiple malignant tumors (poorly differentiated squamous cell carcinoma and high grade osteosarcoma) arising in an ovarian dermoid cyst of a 55 year old female is reported. To the best of our knowledge, this is the first well documented example of such an unusual combination of tumors arising in a dermoid cyst. The osteosarcoma and squamous cell carcinoma appear to arise in the background of benign teratomatous environment of a dermoid cyst rather than from “pure” mixed mesodermal tumors of the ovary. The tumors did not appear to have well demarcated boundaries with a junction or close intermingling of both cell types, features less favorable for collision tumor or carcinosarcoma. Despite extensive surgery with negative surgical margins and combination chemotherapy, the patient had recurrence of the tumor within four months and she died secondary to septicemia to chemotherapy and bilateral pulmonary emboli shortly after.     

Malignant ovarian struma

A rare observation of an unilateral ovarian tumour in a 62-year-old patient is presented. According to the clinical data and the results of the ultrasound examination the tumour was considered as a carcinoma. Hysterectomy with appendages and large omentum resection were performed. A tumour of the right ovary, 13 x 10 x 10 cm was found: cyst with a grey-brown soft node was observed in the cut surface. Histologically, the struma remnants were observed in the cyst wall and structures corresponding to the follicular carcinoma of the thyroid, the central parts of which had a structure of the C-cell thyroid carcinoma. Ultrastructural examination confirmed a light microscopic diagnosis of the malignant monodermal ovarian teratoma developing from the struma with areas of follicular solid C-cell carcinoma.     

Small cell carcinoma of the ovary: A case report of large cell variant

An extremely rare case of large cell variant of ovarian small cell carcinoma is described. A 34-year-old woman (gravid 1. para 1) had a unilateral ovarian mass measuring 17 cm in great at diameter and a metastasis lesion in the omentum. Microscopically, the tumor showed a diffuse arrangement of large, closely packed epithelial cells with abundant eosino-philic cytoplasm and large nuclei with prominent nucleoli. The tumor cells also were arranged in follicle-like and trabe-cular structures and cords. Immunohlstochemically, many tumor cells were diffusely positive for epithelial membrane antigen and some cells contained cytokeratin CAM5.2, valentine, neurofiiament, neuron-specific enoiase, or alpha-1 antitrypsn. However, no specific IIneage was detected. The tumor was aneuploid by flow cytometry. The patient received chemotherapy postoperatively. However, the patient showed metastases in the Inguinal and retruperitoneal lymph nodes. The aerum calcium level, which was not measured preoperatively, was mildly elevated postoperatively. The patient was well with no evidence of disease 17 months after diagnosis. This tumor must be distinguished from other primary or metelltatic 'undifferentiated' neoplasms, especially ovarian small cell carcinoma of pulmonary type and granulosa cell tumor.     

Insulin-like growth factor-binding protein 2 and 5 are differentially regulated in ovarian cancer of different histologic types.

The family of insulin-like growth factor-binding proteins (IGFBPs) comprises six members, which bind and regulate the functions of insulin-like growth factors. Overexpression of IGFBP2 and IGFBP5 contributes to the invasiveness and progression of several human cancers, but their role and clinical significance in ovarian cancer has not been investigated in detail. We examined IGFBP2 and IGFBP5 expression levels using two tissue microarrays, one containing six normal surface epithelium, six benign serous cysts, 10 serous borderline tumors, eight low-grade, and 20 high-grade serous carcinomas. The other comprising 441 ovarian cancers of different histologic types linked to a clinicopathologic database. Each tumor was sampled in duplicate with a 1.0-mm punch core needle. Immunohistochemical staining was performed using antibodies against IGFBP2 or IGFBP5. The staining intensity was scored semiquantitatively as negative (0), weak (1-10%), moderate (10-50%), or strong (50-100%) using computerized image analysis. Statistical analyses used Fisher's exact test and Kaplan-Meier method. IGFBP2 and IGFBP5 were overexpressed in high-grade serous carcinomas compared to normal surface epithelium, benign serous cysts, serous borderline tumors, or low-grade serous carcinoma. They were differentially expressed in different types of ovarian carcinomas, being more often expressed at high levels in high-grade serous carcinoma, malignant mixed mullerian tumors and undifferentiated carcinoma, and more often expressed at low levels or not at all in clear cell and mucinous carcinomas. We concluded that IGFBP2 and IGFBP5 might play a role in the development of high-grade ovarian serous carcinoma, but not in mucinous or clear cell ovarian carcinomas.     

Neuroendocrine carcinoma of the oral cavity

We report the clinical and pathologic features of a small cell neuroendocrine carcinoma arising in the oral cavity of a 63-year-old man. The tumor stained positively with neuron-specific enolase and had dense core granules ultrastructurally. Chemotherapy ordinarily given for pulmonary small cell carcinoma induced a clinical remission. When the tumor recurred 8 mo later, focal squamous differentiation was present within the neuroendocrine carcinoma. The patient died 2.5 yr after presentation.     

卵巢非特异性类固醇细胞瘤临床病理分析

目的探讨卵巢非特异性类固醇细胞瘤的临床、病理学特征以及诊断、治疗。方法对8例卵巢非特异性类固醇细胞瘤进行HE和免疫组织化学（EliVision法）染色及特殊染色,结合临床资料和文献进行分析。结果7例良性非特异性类固醇肿瘤,肿瘤主要由两种细胞构成：一种为多角形细胞,胞质含小颗粒或嗜酸性;一种为胞质含空泡的较大细胞。细胞排列成巢或条索状,似肾上腺球状带和束状带。1例恶性非特异性类固醇肿瘤,细胞呈明显异型性,核分裂象7／10 HPF,伴出血、坏死。免疫组织化学显示：肿瘤细胞胞质内钙结合蛋白和α-抑制素普遍阳性表达。诊断非特异性类固醇细胞瘤需与广泛黄素化的颗粒细胞瘤、卵泡膜细胞瘤、富于脂质的支持细胞瘤和嗜酸型透明细胞癌等相鉴别。良性肿瘤治疗一般为肿瘤切除或加患侧附件切除术;恶性肿瘤行肿瘤加附件切除,辅以化疗或促性腺激素激动剂治疗。结论非特异性类固醇细胞瘤是类固醇细胞肿瘤中最常见的类型,良性多见;免疫组织化学可辅助肿瘤诊断;治疗方法主要取决于肿瘤的良恶性。     

Papillary thyroid carcinoma of the thyroglossal duct cyst: comparative cytohistologic and immunochemical study of 2 new cases and review of the literature

We report a cytohistologic and immunohistochemical study of 2 cases of papillary thyroid carcinoma occurring in a thyroglossal duct cyst. The patients were a 21-year-old woman and a 48-year-old man. Needle aspiration cytology smears were consistent with papillary thyroid carcinoma. The Sistrunk procedure was done. Papillary carcinoma was found within a thyroglossal duct cyst. In 1 case, the tumor spread outside the cyst. Follow-up was uneventful in both patients (2 and 9 years, respectively). Our results would indicate that papillary carcinoma of thyroglossal duct cyst, though indistinguishable from its thyroid homologue, has a more indolent course and could therefore be singled out as a clinicopathologic entity. Needle aspiration cytology reliably assists in planning patient management.