肾原发性大细胞神经内分泌癌1例报告并文献复习

目的提高对肾神经内分泌癌的认识。方法报告1例肾原发性大细胞神经内分泌癌的临床资料并结合文献讨论有关临床症状、诊断和治疗。结果肾神经内分泌癌临床表现和影像学与常见。肾癌相比无明显特异性,需通过病理学和免疫组织化学结果肯定诊断。结论肾原发性大细胞神经内分泌癌罕见,其临床和影响学表现难与肾癌区别,主要靠病理学和免疫组织化学确诊,该病恶性程度高、预后差,只有早期发现,早期手术治疗以提高疗效。     

原发性肺淋巴上皮样癌化疗附文献分析

淋巴上皮样癌(LELC)是于东南亚一带高发的与EB病毒感染相关的一类癌变,主要发生在鼻咽部。原发性肺LELC是一类非常少见的非小细胞肺癌,CT是其诊断的重要手段,而病理诊断为其确诊的唯一手段。手术切除是原发性肺LELC主要治疗手段,化疗亦为其重要治疗手段。本文报道了一例原发肺LELC患者的诊疗过程及结果,并对肺原发LELC的相关文献报道做一回顾与分析,以期对此类疾病治疗提供思路和参考。     

原发性输尿管淋巴上皮样癌一例报告并文献复习

目的 探讨原发性上尿路淋巴上皮样癌的临床表现、病理特点、治疗和预后. 方法 原发性输尿管淋巴上皮样癌患者1例.女,81岁.间断无痛性全程肉眼血尿1个月就诊.CT尿路造影提示左输尿管盆腔段腔内可见长约2.5 cm类圆形软组织密度影.行腹腔镜下左输尿管癌根治术. 结果大体标本:纵行打开输尿管,距输尿管远端3.5 cm处见2.5 cm×2.0 cm隆起肿物,切面灰白,质稍硬,实性.镜检:肿瘤细胞呈巢状分布,体积较大,胞质丰富,核大,圆形,空泡状,核仁明显,间质内大量小淋巴细胞浸润.病理诊断:输尿管淋巴上皮样癌,浸及深肌层,病理分期pT2N0M0.原位杂交技术EBER为阴性.随诊3个月未见肿瘤复发及转移. 结论原发性上尿路淋巴上皮样癌罕见,需经病理组织学检查确诊.根治手术为主要治疗手段,预后优于其他类型尿路上皮癌.     

原发性肾小细胞癌1例报告及文献复习

目的探讨原发性肾小细胞癌的病理诊断和临床病理特点。方法对1例肾小细胞癌进行光镜、电镜观察和免疫组化标记并行相关文献复习。结杲结节状肿瘤位于肾下部近肾门处,瘤组织由短梭形与小圆形细胞构成,呈片巢状、小梁状排列。瘤细胞胞质较少,核深染,核分裂像多见。瘤组织浸润肾皮质、肾盂和肾门周围脂肪组织。肾门处与腹主动脉旁淋巴结可见转移。电镜见瘤细胞胞质内较多神经内分泌颗粒。免疫组化示多种上皮与神经内分泌标志物表达阳性,全身其他脏器未发现肿瘤。随访21个月无复发转移。站论肾脏小细胞癌具有小细胞癌的一般病理形态学特征。依据光镜、电镜变化和免疫组化标记并除外转移,可确诊为肾原发性小细胞癌。     

Carcinoma showing thymus-like differentiation of the thyroid (CASTLE): a comparative study: evidence of thymic differentiation and solid cell nest origin

Carcinoma showing thymus-like differentiation (CASTLE) is a rare intrathyroidal neoplasm, a member of a tumor family probably arising from ectopic thymus or branchial pouch remnants. Thyroid solid cell nests (SCNs) may also be derived from branchial pouch remnants. SCNs express p63, carcinoembryonic antigen (CEA), and high molecular weight keratin (HMWK). To determine whether CASTLE and SCNs derive from similar embryologic origins/lines of differentiation, and to better differentiate CASTLE from other thyroid neoplasms, we compared p63, CD5, HMWK, and CEA staining of CASTLE and SCNs with other thyroid and thymic lesions. Seven CASTLE, 11 SCNs, 10 thymic carcinoma, 11 invasive thymoma, 12 thymoma, 28 papillary thyroid carcinoma, 4 thyroid squamous cell carcinoma, 2 childhood sclerosing carcinoma, 4 follicular adenoma, 6 follicular carcinoma, 4 poorly differentiated carcinoma, and 20 lymphocytic thyroiditis cases were analyzed. In normal thyroid, only SCNs stained for p63, HMWK, and CEA. The only CD5-positive cells in normal thyroid were T cells. Thymomas and normal thymus stained similarly to SCNs. All CASTLE and thymic carcinomas exhibited diffuse p63 and HMWK staining and all CASTLE cases and the majority of thymic carcinomas were positive for CEA and CD5. In contrast, none of the other thyroid neoplasms examined exhibited consistent staining for all 4 markers studied. These findings provide further evidence that CASTLE is distinct from other thyroid neoplasms, is probably of thymic origin, and may arise from branchial pouch remnants, the thyroid SCNs. Moreover CD5, HMWK, CEA and p63 can be used to help distinguish CASTLE from other thyroid neoplasms.     

肾脏混合性上皮间质肿瘤一例报告并文献复习

目的报告1例肾脏混合性上皮间质肿瘤患者的临床及病理特点。方法患者女性,50岁。有20年口服避孕药史。主诉腰部不适和血尿半年,CT及MRI示左肾上极囊实性8cm×6cm肿物,术前诊断囊性肾癌,2004年7月行左肾根治性切除术。结果术中发现左肾上极与周围组织严重粘连。术后见左肾上极7.9cm×8.9cm×9.0cm多房囊性肿瘤,边界清楚,内充满咖啡色粘稠液体,囊腔直径0.5~2.0cm,部分囊壁较厚呈实性。病理检查:肿瘤均由上皮和间质成分共同构成,上皮细胞呈立方状、柱状和靴钉样,可见明确的胃肠道上皮分化细胞。间质成分主要由梭形细胞构成,可见特征性呈束状分布的平滑肌组织。免疫组化:上皮细胞AE1/AE3(+),间质细胞ER(+)、PR(+)、SMA(+)。术后随访8个月未见复发。结论肾脏混合性上皮间质肿瘤为良性肿瘤,罕有胃肠道上皮分化特征,需与肾脏其他良恶性肿瘤鉴别。     

Gastric choristoma of the midline neck in a newborn: a case report and review of the literature

The current report describes a 3-week-old boy presenting with a gastric choristoma of the anterior compartment of the neck. Initial examination at birth found 3 masses in the anterior region of the neck. The only remarkable symptom consisted of episodes of cyanosis induced by neck flexion. The neck mass was removed after computed tomography scan assessment. Pathology finding showed the diagnosis of gastric choristoma. Cervical location of a gastric choristoma in children is rare. Its presentation as a clinically palpable anterior compartment cervical mass at birth even more rare.     

Chromophobe renal cell carcinoma showing oncocytoma-like hyalinized and edematous stroma: A case report and review of the literature

A case of chromophobe renal cell carcinoma (CRCC) with abundant hyalinized and edematous stroma mimicking oncocytoma is presented. This stromal architecture in the current case has not been reported on CRCC to our knowledge. A further interesting finding is entrapped non-neoplastic tubules in the hyalinized and edematous stroma composing the tumor. These histological features, such as abundant hyalinized and edematous stroma containing non-neoplastic tubules, may be analogous to oncocytoma. We reported a unique case of CRCC and studied with light microscopy and immunohistochemistry.     

Urothelial carcinoma of the bladder with trophoblastic differentiation: A case report

We report a case of a urothelial carcinoma with trophoblastic differentiation of the bladder that occured in a 23-year-old man. The patient presented with hematuria. Multiple papillary masses were resected transurethrally. Histopathologically, grade III urothelial cell carcinoma contained giant cells that were positive for human chorionic gonadotrophin (HCG), placental alkalen phosphatase, and human placental lactogen. HCG secreting tumors are reported to be highly aggressive. The patient is alive and well without evidence of recurrent disease or metastasis at 10 months from transurethral resection. To our knowledge, this case is the youngest patient in the literature so far.     

前列腺肉瘤样癌二例报告并文献复习

目的 探讨前列腺肉瘤样癌的临床表现、病理特点和诊治方法. 方法 前列腺肉瘤样癌患者2例.例1,51岁.因排尿困难、会阴部不适2个月,急性尿潴留入院.实验室检查PSA值2.31 ng/ml,CT检查示前列腺密度不均,左叶弥漫性增大、浸润膀胱.经直肠穿刺活检诊断为前列腺肉瘤样癌.行全膀胱、前列腺切除加尿流改道(Bricker手术),术后行局部放射治疗和内分泌治疗.例2,54岁,因排尿困难伴间歇性肉眼血尿1个月入院.实验室检查PSA 2.61 ng/ml.B超检查示低回声块.CT检查示前列腺密度不均.经直肠穿刺活检诊断为前列腺肉瘤.行全膀胱、前列腺切除加尿流改道(Bricker手术). 结果 2例术后病理均诊断为前列腺肉瘤样癌.镜下肿瘤组织由上皮癌细胞和肉瘤样间质2种成分组成,之间可见移行区过渡.免疫组化:2种成分中细胞角蛋白、上皮膜抗原均呈阳性表达.癌细胞波形蛋白阴性,肉瘤样细胞阳性.例1术后41个月出现广泛转移,2个月后死亡.实验室检查PSA正常.例2术后16个月出现骨转移并有局部复发,手术去势联合比卡鲁胺最大限度雄激素阻断治疗3个月无效,术后19个月死亡.实验室检查PSA<4.0 ng/ml.结论前列腺肉瘤样癌是一种罕见、高度恶性的肿瘤,预后不良,确诊需依赖病理表现及免疫组织化学检查.根治性切除辅以局部放射治疗和内分泌治疗可行.     

前列腺恶性叶状肿瘤(附一例报告并文献复习)

目的　探讨前列腺恶性叶状肿瘤的临床、病理特征及治疗方法。　方法　分析 2 0 0 3年1月收治的 1例前列腺恶性叶状肿瘤患者的临床资料 ,并进行文献复习。患者 6 0岁 ,因排尿困难伴间歇性肉眼血尿 1年 ,TURP术后症状复发 2个月入院。直肠指诊示前列腺 5cm× 6cm ,质软 ,表面光滑。血清PSA 1.2 5ng/ml,CT检查示前列腺密度不均。复阅病理切片后诊断为前列腺肉瘤 ,全麻下行根治性前列腺切除术。　结果　术后病理检查肿瘤类似乳腺叶状囊肉瘤 ,由上皮和间质成分构成 ,其中间质细胞明显增多 ,细胞有异型性 ,可见核分裂相。上皮细胞增生 ,但无明显异型性。由上皮细胞形成的囊腔被增多的间质成分挤压、拉长形成类似叶状的裂隙。精囊及膀胱颈部均有肿瘤细胞浸润 ,诊断前列腺恶性叶状肿瘤 ,标本切缘阴性。免疫组化染色检查 :间质细胞Vimentin( ) ,Actin( - ) ,上皮细胞CK( ) ,PSA( ) ,AE1/AE3( ) ,基底细胞CK34BE12 ( )。患者于术后 6个月肿瘤复发 ,拒绝进一步治疗 ,目前仍在随访中。　结论　前列腺恶性叶状肿瘤罕见 ,确诊依靠其特异性临床及病理表现 ,根治性前列腺切除术是目前最可靠的治疗方法     

原发性前列腺鳞癌1例报告并文献复习

目的:提高对原发性前列腺鳞癌的病因及诊治的认识。方法:回顾性分析1例64岁男性原发性前列腺鳞癌患者临床资料:经病理检查诊断为原发性前列腺鳞癌,行手术治疗后辅以放疗,并复习相关文献,探讨本病的病因、诊治及预后。结果:患者术后随访11个月,仍存活。结论:原发性前列腺鳞癌临床罕见,恶性程度高,肿瘤进展快,预后差;对内分泌治疗无效,早期手术治疗并辅以放化疗效果明显。     

前列腺交界性叶状肿瘤一例报告并文献复习

目的 探讨前列腺叶状肿瘤的分型、临床表现、病理特征、治疗方法及预后情况.方法 2006年10月收治前列腺交界性叶状肿瘤患者1例.患者32岁,因渐进性排尿困难2周、尿潴留1 d入院.直肠指诊示前列腺明显增大,质软、囊性感,表面光滑.血清PSA 20.62 ng/ml.B超及MRI显示前列腺右侧叶多囊性肿大结节,前列腺穿刺活检考虑为良性间叶源性肿瘤,分化欠成熟.结果硬膜外麻醉下行前列腺肿瘤剜除术,切除标本约40 g.病理报告为前列腺交界性叶状肿瘤,肿瘤由上皮和间质成分构成,间质细胞明显增生,细胞有异型性,可见核分裂象;上皮细胞增多,无明显异型性;免疫组化染色Vimentin强阳性,PSA和PAP阳性,SMA阴性.术后40 d患者肿瘤复发,遂行前列腺根治切除术.病理报告为前列腺低度恶性叶状肿瘤,未侵及被膜外,前列腺尿道切端可见肿瘤组织;细胞增生活跃.术后1个月行体外盆腔放射治疗.随访6个月患者生存良好,仍在随访中.结论前列腺叶状肿瘤由增生的上皮和间质成分组成,穿刺活检很难穿到增生的上皮成分而不能确诊;复发恶性度增高,前列腺根治性切除术是目前最可靠的治疗方法.