皮肤Merkel细胞癌超微结构观察

皮肤Merkel细胞癌,又称皮肤神经内分泌癌,因为罕见,给肿瘤患者早期诊断和治疗带来困难,为了提高对该肿瘤的认识,我们对1例皮肤Merkel细胞癌进行了免疫组织化学和超微结构观察研究.     

皮肤merkel细胞癌扁桃体转移1例并文献回顾

目的：探讨皮肤Merke!细胞癌的诊断及鉴别诊断、治疗及预后。方法：对1例皮肤Merkel细胞癌扁桃体转移患者的临床病史、肿瘤组织的病理免疫组化表达及治疗过程进行回顾性分析,并结合相关文献就其临床特征及转移方式进行讨论。结果：本例Merkel细胞癌患者表现为臀部merkel细胞癌,于术后5个月发生附近淋巴结转移,再次手术后出现远处转移。手术后2年,发现右颌下包块,咽部不适,扁桃体活检证实扁桃体小细胞神经内分泌癌;免疫组化EMA（＋）NSE（4-）CK、CgA、Vim、ICA均（-）。结论：Merkel细胞癌罕见且进展快,即使综合治疗后仍有局部复发和远处转移的倾向,预后差。诊断主要依靠病理,免疫组化染色有助于鉴别诊断。临床上需结合病史与扁桃体原发癌相鉴别。     

皮肤鳞状细胞癌的MRI表现

目的 :探讨皮肤鳞状细胞癌的MRI表现及临床意义。方法 :回顾性分析经手术及病理证实的9例皮肤鳞状细胞癌患者的临床及影像学资料,9例均行MRI平扫及增强扫描。结果:4例位于头颈部,4例位于四肢,1例位于躯干;8例位于曝光部位,1例位于非曝光部位。4例为结节隆起型,2例为皮下结节型,1例为溃疡型,2例为混合型。5例表现为椭圆形肿块,4例表现为不规则形肿块。与肌肉信号相比,T1WI:2例呈等、稍低信号,7例呈等信号;T2WI:9例呈稍高信号;DWI:5例呈弥散受限高信号表现,4例未行DWI;Gd-DTPA增强扫描:7例重度强化,2例中度强化;7例见"鼠尾征",其中5例位于皮肤,2例位于皮肤和浅筋膜。结论:较大的皮肤鳞状细胞癌MRI表现有一定的特征,MRI对病灶术前评价有重要的价值。     

人体皮肤Merkel细胞原代培养与鉴定

目的探索人体皮肤Merkel细胞体外培养方法,为进一步研究银屑病发病中Merkel细胞的神经内分泌调节作用积累基础资料。方法获取正常人皮肤组织,采用酶消化法分离细胞。设计专门的细胞体外培养系统,观察Merkel细胞在3种不同培养液中贴壁和增殖情况。采用Merkel细胞特异性标记抗体CK20标记Merkel细胞,采用免疫组化和流式细胞仪进行鉴定。结果人体皮肤Merkel细胞在3种培养液中均能顺利贴壁和增殖,并具有内分泌功能,但1号培养液[ Hamˊs-F12＋胎牛血清（10/100 ml）＋bFGF（20 ng/ml）]更有利于Merkel细胞生长。经流式细胞仪鉴定,Merkel细胞纯度可达90.11%。结论在本培养系统中,人体皮肤Merkel细胞能成功进行体外培养,并可获得较高纯度的Merkel细胞。     

肾嫌色细胞癌 MRI 表现及文献复习

目的：探讨 MRI 对肾嫌色细胞癌(CRCC)的诊断价值及局限性。方法回顾性分析临床资料齐全的5例 CRCC MRI 资料。结果T1 WI 呈等或稍低信号,T2 WI 呈等或稍高信号,信号均匀或稍不均匀,DWI 呈稍高信号,平均 ADC 值1.42×10-3 mm2/s。2例可见瘢痕,T1 WI 呈低信号,T2 WI 呈高信号。动态增强扫描皮质期轻度强化,髓质期及延时期持续轻度强化,其中1例可见轮辐状强化,1例可见粗大流空血管影,增强扫描血管强化。结论CRCC 术前诊断有一定难度,MRI 是 CRCC 的重要检查方法,能够为定性诊断提供帮助。     

颅内透明细胞脑膜瘤椎管转移1例并文献复习

目的 探讨透明细胞型脑膜瘤（CCM）的MRI特征,以提高对该肿瘤的认识。方法 回顾性分析1例经病理证实的CCM病人的MRI表现,并复习相关文献。结果 MRI平扫显示颅内及腰椎管内CCM均呈囊实性,病灶呈“石榴”状,边界清楚,T1WI呈等信号,T2WI呈低或稍高信号;DWI呈等信号;增强扫描病变实性部分明显强化。结论 CCM的MRI影像表现具有特征性,认识这些特征有利于诊断。     

肾脏黏液性小管和梭形细胞癌1例并文献复习

目的 探讨肾脏黏液性小管和梭形细胞癌(MTSCC)的影像特征,以提高对该肿瘤的认识。方法 回顾性分析1例经病理证实的MTSCC的影像表现及病理资料,并复习相关文献。结果 超声示MTSCC为低回声包块,有明显“球体感”,向外突出;彩色多普勒血流成像（CDFI）可见包块周边有血流信号。肾动脉CT血管成像示肾动脉从肿块边缘弧形绕行。MRI平扫显示病灶T₁WI呈低信号、T₂WI呈稍高信号;DWI呈高信号,边界清楚,呈浅分叶;增强扫描病变皮质期轻度强化,髓质期强化程度有所增高,延迟期强化达到峰值,但各期强化程度均低于正常肾组织。结论 MTSCC的影像表现具有特征性,充分认识这些特征有利于对其早期诊断。     

胃印戒细胞癌皮肤转移1例

胃印戒细胞癌皮肤转移少见 ,现报告 1例如下。患者 ,男性 ,37岁 ,1998年 11月因反复上腹部胀痛 4月 ,加重伴呕吐两周入院。连续 3次胃镜及病理检查确诊为胃印戒细胞癌 ,遂行胃癌根治术。术后 2次行全身正规静脉化疗 ,翌年 6月病情缓解。 8月患者无意间发现腹部切口处有3～ 5个皮下结节 ,色红 ,固定 ,微痒。 1周后皮下结节相继消退。但 2周后皮下结节复现 ,且数量增至十余个。数日后达30多个 ,并逐渐发展至头部、面颈部、胸部及腰背部。四肢近端也见散在分布。 1个月后全身皮下硬结已增至数百个。结节大小 0 .5～ 1.5ｃｍ ,质硬 ,固定 ,无压…     

《请您诊断》病例148答案:Merkel细胞癌

病例资料患者,男,20岁,因右侧胸部疼痛5月余入院.患者5个月前无明显诱因出现右侧胸背部疼痛不适,呈间断性胀痛,无咳嗽、咳痰,无呼吸困难,5个月来胸部胀痛无缓解.实验室检查:乙肝表面抗原及乙肝e抗原阳性,HIV阴性,血清碱性磷酸酶128 U/L(正常范围40～500 U/L),男性不明原因肿瘤标记物阴性.查体:右侧胸壁...     

Impact of sentinel lymph node biopsy in patients with Merkel cell carcinoma: results of a prospective study and review of the literature

Purpose Merkel cell carcinoma (MCC) is the most aggressive of the cutaneous malignancies, showing a propensity to spread to regional lymph nodes (LNs). The aim of this prospective study was to examine the feasibility and clinical impact of sentinel lymph node biopsy (SLNB) in this cutaneous malignancy. Methods The study population comprised 23 patients with stage I MCC (median age 70 years, range 50–85 years). Lymphoscintigraphic mapping with ^{99 m}Tc-nanocolloid was performed in all patients. Sentinel lymph nodes (SLNs) were identified, excised and analysed in serial sections by conventional histopathology and cytokeratin-20 immunohistochemistry. Results Metastatic disease was determined in the SLNs of 11 patients (47.8%). Elective lymph node dissection (ELND) was performed in eight of these 11 patients, four of whom had additional positive LNs. During follow-up (median 36.1 months, range 3–79 months), seven of the 23 patients (30%) relapsed: four had a local recurrence and three, in-transit metastases. Recurrence developed in two SLN-negative patients with local LN metastases and in one SLN-positive patient with distant metastases. This patient died, representing the only tumour-related death in our sample. Median survival was 49.1 and 35.5 months for SLN-negative and SLN-positive patients, respectively. This difference was not statistically significant (p=0.3452). Conclusion SLNB allows for exact nodal staging in patients with MCC. Whether additional ELND is of further benefit remains unclear.     

颅内硬膜外软组织巨细胞瘤1例并文献复习

目的探讨软组织巨细胞瘤(GCT-ST)的影像特点及鉴别诊断。方法回顾性分析1例经手术病理证实的颅内硬膜外GCT-ST的平扫CT、平扫和增强MRI表现并行文献复习。结果颅底CT平扫显示左侧颞部多囊性低密度影,呈分叶状,内部见高密度分隔,邻近左侧颞骨局部骨质变薄、毛糙。MRI显示左侧颞部囊性肿物,T1WI呈低信号,T2WI呈高信号,T2 FLAIR呈等信号,其内见低信号分隔;增强检查可见病变边缘及分隔强化。结论颅内硬膜外GCT-ST罕见,其临床和影像表现无特异性,确诊需病理组织学检查。     

Rare spindle cell hemangioma of bone: Case report and literature review

Spindle cell hemangioma is a rare benign hemangioma. It is mainly found as small soft tissue nodules in the distal extremities, especially in the hands. The manifestation in bone is extremely rare. We present a case of spindle cell hemangioma of bone in the frontal bone. We also reviewed the literature to find the common imaging findings of intraosseous hamangiomas. The main manifestations of X-ray and CT were osteolytic lesions with soap bubble-like changes, and soft tissue mass formation. Magnetic resonance imaging mainly showed a lobulated mass with clear boundary, uneven hyperintense on T2WI, and obvious enhancement on contrast-enhanced scan. Surgical excision is curative. While this lesion is rare, it can be considered in the differential diagnosis if the characteristic imaging features are present.     

心脏血管瘤1例并文献复习

目的 探讨心脏血管瘤的临床表现、影像特征和病理特点,以提高对心脏血管瘤的认识和鉴别诊断能力。 方法 回顾性分析1例经手术病理证实的心脏血管瘤病人的影像及病理资料并行文献复习。 结果 超声心动图上可见胸腔内主动脉根部右后方、腹主动脉膈肌水平左前方一实性为主的中等回声团,内部可见低、无回声区,周边可见强回声的钙化,血流未见异常。CT显示心脏肿物位于左室下壁,密度欠均匀,内部及边缘可见明显钙化;增强后病变轻度强化。MRI显示左室下壁基底段肿物明显向腔外突出,信号不均匀,增强后呈不均匀轻度强化。选择性冠状动脉造影可见肿瘤供血动脉来源于右冠状动脉。PET/CT显示病灶呈糖代谢缺失。正电子发射计算机断层扫描（PET/CT）显示病灶呈糖代谢缺失。 结论 心脏血管瘤可发生于心脏肌层,如发现心脏肌层肿物存在冠状动脉供血及明显蛋壳样钙化时,即使不具有典型强化表现,也需考虑血管瘤的诊断。     

Radiological appearances of metastatic Marjolin ulcer in a chronic pressure sore: a case report and literature review

Marjolin ulcer is a type of aggressive ulcerating squamous cell skin tumor that typically develops in areas of previously traumatized, burned, chronically inflamed, or scarred skin. It typically occurs following a period of dormancy. We present a rare case of Marjolin ulceration with an unusual combination of continued non-compliance after diagnosis and 40 years of unusually long latency.     

Intracranial extension of basal cell carcinoma of the scalp

A case of recurrent basal cell carcinoma of the right occipital scalp is reported. Plain film, CT, and MRI examinations of the head demonstrated direct neoplastic invasion through the occipital bone and meninges into the right cerebellar hemisphere.     

Ovarian clear cell carcinoma arising in a large endometrioma — A case report with pathological correlation and literature review

Endometriosis-associated ovarian cancer represents the most common form of malignancy associated with this benign disease. It has a better prognosis than most types of ovarian cancer, with endometrioid adenocarcinoma and clear cell carcinoma as the main histological types. Clinical presentation is usually nonspecific and tumor biomarkers can be misleading, since they can also be elevated in the presence of benign ovarian endometriosis. We report a case of a 52-year-old woman with known ovarian and deep pelvic endometriosis, who developed ovarian clear cell carcinoma within a large endometrioma. The imaging findings highlight the key role of magnetic resonance imaging in detecting suspicious features such as loss of the “T2 shading” sign, loss of high T1 signal of an endometrioma, or the presence of mural nodules. Early detection of these malignancies is fundamental for adequate surgical treatment and overall outcome.     

Merkel cell carcinoma and iodine-131 metaiodobenzylguanidine scan

Two cases of Merkel cell carcinoma, a neuroendocrine neoplasia of the skin, investigated with iodine-131 metaiodobenzylguanidine (¹³¹i-mIBG) scintigraphy, are reported. Uptake in the tumor was evident only in 1 case. The possible diagnostic and therapeutic role of ¹³¹I-mIBG in patients with this rare neoplasm is discussed. Offprint requests to: A. Castagnoli