伴有破骨细胞样巨细胞的胰腺未分化癌1例报道及文献复习

目的：探讨伴有破骨细胞样巨细胞的胰腺未分化癌的临床病理特点.方法：观察1例伴有破骨细胞样巨细胞的胰腺未分化癌的形态学特征,并进行免疫组织化学染色.结果：伴有破骨细胞样巨细胞的胰腺未分化癌肿瘤主要有两种细胞组成,一种为单核细胞,分为组织细胞样单核细胞和梭形或多形性瘤细胞两型;另一种为多核巨细胞,分为非肿瘤性的破骨细胞样巨细胞和瘤巨细胞两型.免疫组织化学研究显示,这两种细胞Vimentin均阳性,均不表达cytokeratin（AE1/AE3）,CK5/6,CEA,CgA;其中破骨细胞样巨细胞、组织细胞样单核细胞CD45,CD68阳性,而瘤巨细胞和梭形瘤细胞阴性.结论：伴有破骨细胞样巨细胞的胰腺未分化癌是一种罕见恶性肿瘤,可能为胰腺未分化癌的一个亚型.诊断需与胰腺恶性纤维组织细胞瘤、转移的骨巨细胞瘤或黑色素瘤等鉴别.     

43例食管基底样鳞状细胞癌临床病理分析

目的探讨食管基底样鳞状细胞癌（basaloid squamous cell carcinoma,BSCC）临床病理特点。方法对43例食管BSCC进行组织形态学及免疫组化观察,并对其临床病理特点及随访资料进行分析。结果BSCC由类似于鳞状上皮基底细胞样的细胞组成,细胞排列呈实性巢状、小梁状、假腺样或筛状结构,巢周边瘤细胞常呈栅栏状排列,巢中央可见粉刺样坏死。24例（55.8％）与普通鳞癌或腺鳞癌并存,11例（25.6％）出现局灶鳞化,28例（65．1％）见到脉管内癌栓。免疫组化染色CKpan、AE1、AE3均呈不同程度的阳性表达,p53、Ki-67、PCNA呈中至强阳性表达,Syn、CgA分别有1例呈弱阳性,S-100蛋白、SMA、CEA均为阴性。结论BSCC是食管一种少见的鳞状细胞癌变异型,具有独特的形态特点和明显的侵袭性行为,预后较差。免疫组化无特异性,诊断主要依靠形态学特点。     

乳腺黏液囊肿样病变临床病理特征分析

目的探讨乳腺黏液囊肿样病变的临床病理特征及其诊断和鉴别诊断。方法对9例乳腺黏液囊肿样病变进行临床病理分析。以SP法对细胞角蛋白AE1／AE3、平滑肌肌动蛋白（SMA）、p63、c-erbB-2和053进行免疫组织化学染色,组织化学为AB和PAS法染色。结果患者均为女性,年龄23-43岁（平均34岁）,乳腺均可触及肿物。肿物切面呈多囊性胶冻样。镜下可见多发性、充满黏液的囊肿,囊腔衬覆扁平-立方-柱状上皮,其中3例上皮有乳头状增生,1例有不典型增生。间质内可见黏液湖,其内无漂浮细胞。囊内及间质黏液呈AB及PAS染色阳性。囊肿衬覆上皮细胞及2例黏液湖内漂浮的上皮细胞团AE1／AE3阳性。囊肿上皮细胞外侧扁平肌上皮呈SMA、p63阳性。c-erbB-2和p53染色均阴性。结论乳腺黏液囊肿样病变是一种独立的良性病变,容易误诊,需与黏液癌等肿瘤进行鉴别。     

伴类癌样结构的皮脂腺瘤1例及文献复习

目的探讨伴类癌样结构的皮脂腺瘤的临床病理学特征及诊断和鉴别诊断。方法对1例伴类癌样结构的皮脂腺瘤进行临床、组织病理学和免疫组化观察,并复习相关文献。结果患者头皮处见一1cm×1cm×0.5cm结节状肿物,全身检查未见内脏器官病变。镜检:肿瘤位于真皮,呈境界清楚的多结节状分布。肿瘤大部分排列成片状、腺样、筛孔状,部分区域细胞形成类癌样结构,大多数肿瘤细胞呈基底样细胞改变,可见散在明确的皮脂腺细胞分化,核分裂象偶见,未见明显异型性和坏死。免疫表型:肿瘤细胞AE1/AE3、MLH1、MSH2、皮脂腺细胞EMA均阳性,CgA、Syn、NSE均阴性。结论皮脂腺瘤中的类癌样结构是最近才认识的少见组织学结构,病理诊断中应注意与转移性类癌、其他皮肤附属器肿瘤和Muir-Torre综合征相鉴别。     

特殊类型肾盂尿路上皮癌8例临床病理分析

目的探讨特殊类型的肾盂尿路上皮癌的临床病理特点。方法对2000年～2006年间收集的8例具有特殊临床病理特征的肾盂癌作光镜和免疫组化染色观察,并行随访。结果肾盂尿路上皮癌特殊的组织学表现为：肉瘤样癌（3例）,鳞癌和伴鳞癌（2例）,微乳头癌（1例）,透明细胞癌（1例）,伴有横纹肌样及印戒样细胞特征（1例）。其中2例肉瘤样癌肉眼观呈弥漫浸润型,组织形态最具多样性,瘤细胞呈短梭形束状或假血管肉瘤样或弥漫多角形排列,间质伴假肉瘤样反应或黏液变性等。病理分期：1例高分化鳞癌为PT2,余7例均为PT2-PT4。8例均见尿路上皮乳头状癌或原位癌。免疫组化：微乳头癌、透明细胞癌表达CK7、CK20、CD15、CEA,肉瘤样细胞表达AE1／AE3、CK7、vimentin。横纹肌样及印戒样细胞表达AE1／AE3、CK7、3413E12、vimentin。随访3—6I）个月（平均29．3个月）,1例高分化鳞癌至今存活,1例伴有鳞癌的低分化尿路上皮癌术后至今8个月存活,但伴广泛转移,余6例于术后2—28个月死于肿瘤转移。结论肾盂尿路上皮癌多为低分化、高分期,类似于膀胱尿路上皮癌,具有多种细胞形态特征,易发生广泛浸润及转移,预后较差。其特殊的形态学变异和免疫组化特点,为其鉴别诊断提供了依据。     

乳腺分泌脂质性癌临床病理分析

目的 探讨乳腺分泌脂质性癌(breast lipid-secreting carcinoma)临床病理特征.方法 对3例进行病理组织学观察、特殊染色PAS、AB染色和免疫组化标记ER、PR、Ki-67、c-erbB-2、p53等.结果 3例均为女性,年龄分别为44、54、50岁,均可触及乳腺肿块,肿瘤境界欠清楚,镜下肿瘤边缘呈浸润性生长,肿瘤主要由空泡状细胞即组织细胞样细胞和其它少量皮脂腺样细胞、大汗腺样细胞组成.AB、PAS染色阴性.免疫组化(SP法)瘤细胞示:ER、PR阴性、c-erbB-2、Ki-67、p53不同程度阳性.3例均术中快速切片诊断癌后,行乳腺改良根治手术.结论 乳腺分泌脂质性癌是一种相对少见,恶性度较高,预后较差的肿瘤,诊断主要依靠病理组织检查及特殊染色.免疫标记可帮鉴别诊断及判断预后.     

乳腺纤维瘤病样梭形细胞癌临床病理分析

目的 探讨乳腺纤维瘤病样梭形细胞癌（fibromatosis-like spindle cell carcinoma,FLSCC）临床病理特征。方法 对3例FLSCC病例进行光镜观察和免疫组化染色[CK、CK（34βE12）、vimentin、SMA、ER、PR、Ki-67、c-erbB-2]。结果 3例均为女性,年龄分别为47、53、56岁,均可触及乳腺肿块。肿瘤境界清楚,但镜下边缘呈浸润性。肿瘤主要是梭形细胞、多边形细胞、少量的管状腺体及鳞上皮巢混合,间质纤维明显增生伴胶原化,细胞成束状排列或散在分布,似纤维瘤病样改变。梭形细胞分化良好,异型性不明显,部分区域细胞较丰富,其间聚集的上皮簇或片状多边形细胞核有轻度异型,可见少数核分裂象。多边形细胞与梭形细胞有移行。病变中亦可见淋巴细胞、浆细胞聚集浸润。上皮细胞、多边形细胞及部分梭形细胞CK（34βE12）、CK（AE1／AE3）阳性,CK阴性的梭形细胞表达vimentin、SMA。3例均行肿块切除,其中1例,术后4个月复发,再行乳腺根治术。结论 乳腺（纤维瘤病样）梭形细胞癌是一种少见的、低度恶性肿瘤,诊断需依赖免疫组化标记并与乳腺其它梭形细胞肿瘤相鉴别。     

上皮样血管平滑肌脂肪瘤6例临床病理分析

目的 探讨上皮样血管平滑肌脂肪瘤(epithelioid angiomyolipoma,EAML)的临床病理特点、免疫表型,诊断及鉴别诊断.方法 对5例肾脏和1例肝脏上皮样血管平滑肌脂肪瘤进行病理形态观察及免疫组织化学检测.结果 6例上皮样血管平滑肌脂肪瘤形态相似,肿瘤细胞多呈巢状和片状排列,围绕血管呈袖套状,瘤细胞体积大,形态单一,多边形或梭形,胞质丰富,嗜酸性颗粒状,细胞核较大,核仁明显呈空泡状.免疫组化显示肿瘤细胞HMB45、vimentin 和平滑肌特异性抗原(SMA,MSA)弥漫阳性;而EMA、CK(AE1/AE3)呈阴性.结论 上皮样血管平滑肌脂肪瘤是一种具有恶性潜能的间叶源性肿瘤,形态学上常容易误诊,免疫组化对鉴别诊断有重要意义.     

子宫上皮样滋养细胞肿瘤的临床病理特征

目的探讨子宫上皮样滋养细胞肿瘤(ETT)的临床病理特征。方法分析1例合并局灶绒毛膜细胞癌的临床和病理资料，结合文献进行讨论。观察病变的大体及镜下特点，采用HE染色及免疫组化S-P法测定cK(AEl／AE3)、HPL、HCG、α-inhibin。结果肿瘤由绒毛膜型中间滋养细胞组成，瘤细胞巢呈地图样分布，瘤巢间充满嗜酸性透明变性物质。肿瘤的免疫表型：CK(AE1／AE3)、HPL、PLAP和α-inhibin均呈阳性表达。结论ETT为滋养细胞肿瘤的新类型，系由绒毛膜型中间滋养细胞组成，属于低度恶性肿瘤。ETT应与胎盘部位滋养细胞肿瘤、胎盘部位结节、绒毛膜细胞癌和宫颈鳞癌鉴别。     

骨上皮样血管内皮瘤临床病理学观察

目的 探讨骨上皮样血管内皮瘤的临床病理特征和诊断。方法 对3例骨上皮样血管内皮瘤进行临床资料分析、光镜观察和免疫组织化学检测，并结合文献进行讨论。结果 3例病变部位均为下肢。最常见的临床症状是局部疼痛。X线表现为溶骨性骨破坏，1例伴有病理性骨折。组织形态学特征是上皮样瘤细胞形成较原始的小血管腔，呈巢状、索状、不规则形分布于有黏液样变或透明变性的间质中，肿瘤组织内或边缘散布成熟的骨小梁组织。3例肿瘤均表达vimentin、FⅧRAg和CD34。随访结果2例未见肿瘤复发，1例失访。结论 原发于骨的上皮样血管内皮瘤是较少见中间型血管源性肿瘤，其组织形态学要与骨上皮样血管瘤、上皮样血管肉瘤和转移性癌等鉴别。     

Sebaceous carcinoma of the breast

Sebaceous carcinoma (SC) of the breast is a rare malignant tumor and only nine cases, including the present one, have been reported in the English-language literature. The present report describes a case of mammary SC in a 50-year-old Japanese woman. The tumor was gray–white on cut surface and separate from the skin and the nipple. Microscopically, lobules encircled by a fibrous envelope and cords or small cell nests in the stroma were noted. These two types of structures were composed of dark cells and clear foamy cells. The dark cells had large nuclei and amphophilic cytoplasm. The clear foamy cells had numerous lipid vacuoles, confirmed on immunostaining with anti-adipophilin antibody and electron microscopy. In the lobules the gradual transitions from basal dark cells to central clear foamy cells and comedo-like necrosis were observed. The tumor cells were positive on immunohistochemistry for cytokeratins (CAM5.2, AE1/AE3), Her2/neu and androgen receptor but negative for estrogen and progesterone receptors. This is the first case of an androgen receptor-positive mammary SC to be reported, and therefore contributes to the understanding of the clinicopathological features of SC of the breast.     

Xanthogranulomatous mastitis: Clinicopathology and pathological implications

Xanthogranulomatous inflammation is an uncommon finding in the breast. Sixteen cases of xanthogranulomatous mastitis were reviewed to determine the characteristic clinicopathological features. Xanthogranulomatous mastitis involved foamy histiocyte clusters interspersed with inflammatory cells. Foamy histiocytes were bland with small pyknotic nuclei. Xanthogranulomatous mastitis was associated with fat necrosis in five cases (31%), multinucleated giant-cell reactions in six cases (38%), and cholesterol crystals in five cases (31%). In three cases (19%), xanthogranulomatous mastitis coincided with ductal carcinoma in situ or invasive ductal carcinoma. Duct ectasia with foamy histiocyte aggregates were noted in five cases (31%). It is suggested that the etiology of xanthogranulomatous mastitis is obstruction and rupture of the ectatic duct with foamy histiocyte aggregates. In breast core biopsy, granular cell tumor and invasive carcinoma such as histiocytoid carcinoma and lipid-rich carcinoma could demonstrate similar pathological features to xanthogranulomatous mastitis. In conclusion, xanthogranulomatous mastitis could be encountered in breast core biopsy and surgical excision tissue. Diagnosis of xanthogranulomatous mastitis can be made by excluding other diseases that elicit xanthogranulomatous inflammation in the breast. In breast core biopsy, xanthogranulomatous mastitis could be distinguished from granular cell tumor, histiocytoid carcinoma and lipid-rich carcinoma by using cytokeratin and histiocytic marker such as α1-anti-trypsin and CD68 stain.     

乳腺癌肉瘤1例报道及文献复习

目的探讨乳腺癌肉瘤的临床病理学特征及其鉴别诊断。方法对1例乳腺癌肉瘤进行组织病理学和免疫表型观察并复习文献,了解该肿瘤的特征。结果镜检显示病变边界清楚,以软骨肉瘤为主,其边缘有少量分化较差的浸润性导管癌成分。免疫表型：软骨肉瘤细胞vimentin强阳性,S-100蛋白阳性,ER、PR,c-erbB-2和CK（AE1／AE3）均阴性;癌细胞CK（AE1／AE3）、ER、PR及c—erbB—2均阳性,vimenfin、S—100蛋白阴性。结论原发于乳腺的癌肉瘤较罕见,诊断需与乳腺恶性分叶状肿瘤以及软组织肉瘤鉴别。     

Histiocytoid carcinoma of the male breast

Histiocytoid carcinoma of the breast is a rare tumor with approximately 30 cases reported, all occurring in female patients. We report the first case of histiocytoid breast carcinoma in a male patient. A 68-year-old man presented with a 2.5-cm breast mass. Microscopic examination of the needle core biopsy revealed a diffuse (lobular type) infiltration of tumor cells as angulated clusters, linear arrangements, small nests, and individual cells; there was no duct formation. The nuclei were round-oval and hyperchromatic with inconspicuous nucleoli and finely dispersed chromatin. The cytoplasm was abundant, was amphophilic, and ranged from granular to vacuolated. A subset of tumor cells contained periodic acid Schiff-positive cytoplasmic material, which was largely but incompletely removed by diastase treatment. There was minimal nuclear pleomorphism, and mitotic figures were inconspicuous. The intervening stroma was densely fibrotic, and the tumor infiltrated among tightly packed collagen bundles. Immunohistochemistry was positive for estrogen receptor, progesterone receptor, androgen receptor, vimentin, epithelial membrane antigen, and pan-cytokeratin. The tumor was negative for CK7, CAM5.2, 34BE12, AE1/AE3, GCDFP-15 (BRST-2), E-cadherin, and CD68. The mastectomy resection demonstrated similar histologic findings. Sentinel lymph node biopsy was negative. The morphology of this tumor is similar to that described for histiocytoid carcinoma of the female breast, a rare entity. Such tumors are felt to be variants of lobular carcinomas, which is supported by diffuse infiltrative growth, loss of E-cadherin expression, and strong ER positivity. We believe our case to be the first reported example of histiocytoid carcinoma in a male breast.     

Spontaneous regression of breast cancer with axillary lymph node metastasis: a case report and review of literature

Spontaneous regression (SR) of cancer is a rare but well-documented biological phenomenon. However, the mechanism remains to be elucidated. We herein report a case of the SR of breast cancer at both the primary site and metastatic axillary lymph node with spontaneously-induced T cell-mediated immunological responses. A 52-year-old female with a lump in the left axilla was diagnosed to have a small breast carcinoma with a distinct axillary lymph node metastasis. During the preoperative systemic examination, she was diagnosed to have severe type 2 diabetes mellitus, was treated with insulin, and the hyperglycemia was normalized after one month. Surgery for left breast cancer was then performed. The postoperative histopathological examination revealed the SR of breast cancer at both the primary site and metastatic axillary lymph node. Immunohistochemical studies revealed that estrogen receptor positive, AE1/AE3-positive ductal carcinoma completely underwent necrosis associated with extensive infiltration of CD3-positive T cells in the tumor nodule in the lymph node. In addition, primary ductal carcinoma cells also underwent single cell necrosis with infiltration of T cells with lymph follicle-like organization of B cells in the mammary gland. The features were suggestive that the tumor eradication in the metastatic lymph node and regression of the primary ductal carcinoma could be due to host T cell response to the ductal carcinoma. As far as we know it is the first report that shows the spontaneous regression of breast cancer, probably due to the spontaneously-induced T cell response.     

Usefulness of immunohistochemistry for recognizing metastatic colorectal adenocarcinoma in infarcted lymph nodes

Lymph node infarction is a spontaneous coagulative necrosis of the affected lymph node and is frequently associated with concurrent and subsequent malignant lymphoma. However, this phenomenon appears to be rarely associated with metastatic carcinomas. Here, we report on the histopathologic and immunohistologic findings of three cases showing lymph node infarction in the regional lymph node associated with metastatic colorectal adenocarcinoma. Histologically, coagulative necrosis of metastatic carcinoma was surrounded by a thick rim of granuloma consisting of histiocytes with or without epithelioid features, foamy cells, and a small number of lymphocytes. The immunohistochemical study of the coagulative necrosis demonstrated that cytokeratins (AEI/AE3 and CAM5.2) and carcinoembryonic antigen (CEA) were well preserved in all three cases. However, compared with viable tumor tissues, only a few tumor cells were positive for epithelial membrane antigen. Using formalin-fixed and paraffin-embedded tissues, immunostaining for cytokeratins and CEA of the lymph node containing necrotic carcinoma may provide clinically valuable information.     

Metaplastic spindle-cell (fibromatosis-like) carcinoma of the breast--report of 4 cases

The authors report about clinico-morphological features in four cases of spindle-cell metaplastic carcinoma of the breast, closely mimicking benign soft tissue fibromatosis or nodular fasciitis. All patients were females aged 54-72 years with a palpable nodule within the breast, 20-35 mm in size. Histologically, the tumor infiltrated surrounding tissue; it consisted of spindle cells with relatively bland morphology, arranged in a fascicular, storiform or random fashion. Mitotic activity was low, focally the tumors revealed regressive changes (hyalinization, myxoid degeneration). Cytokeratin expression was proven in all four cases. In two patients the tumor metastasized and the patients died of it; this fact confirms recently published data that despite its deceptively benign appearance, fibromatosis--like carcinoma of the breast is undoubtedly a malignant process with potentially aggressive behaviour. Differential diagnosis of this unusual variant of metaplastic breast carcinoma is discussed together with related therapeutic issues.     

Fine‐needle aspiration of soft tissue myoepithelioma

Soft tissue myoepithelioma is a rare neoplasm composed of myoepithelial cells. We describe the cytologic features of a soft tissue myoepithelioma arising in the right lower chest wall in a 65‐year‐old woman. The fine‐needle aspiration (FNA) smears showed round to oval, spindle, epithelioid, and plasmacytoid cells in the myxoid background. The nuclei were uniform, round to ovoid, with finely distributed chromatin and eosinophilic or pale cytoplasm, and resembled lobular carcinoma of breast. Ultrasound guided core biopsy showed the tumor cells had bland cytologic features, arranged in small cords, nests, and dissociated single cells, with no glandular differentiation or breast tissue seen. The tumor cells demonstrated immunoreactivity for cytokeratin (AE1/AE3) and glial fibrillary acidic protein, but were negative for estrogen receptor. Fluorescence in situ hybridization demonstrated the EWSR1 rearrangement, confirming the diagnosis of myoepithelioma. Diagn. Cytopathol. 2016;44:152–155. © 2015 Wiley Periodicals, Inc.     

Aspiration biopsy cytology of papillary carcinoma of the breast.

The fine-needle aspirates of two cases of noninfiltrating papillary carcinoma (PC) and three examples of early invasive PC of the breast were examined. In three cases in which the tumors displayed cuboidal or polygonal cells the aspirates showed papilla-like clusters of tumor cells with relatively "strong" cellular cohesiveness. Single and small aggregates of tumor cells as well as hemosiderin-laden or foamy macrophages were also present. Aspirates from the two PCs predominantly consisting of tall columnar epithelial cells revealed only monolayered and multilayered epithelial fragments with folding in one case. In the other case large epithelial fragments and small tight clusters of polygonal tumor cells were present. No bipolar nuclei of myoepithelial cells were identified in all cases. No specific cellular features permitting the differentiation between noninfiltrating and early invasive breast PCs were identified in this small series. Staining for carcinoembryonic antigen using the peroxidase-antiperoxidase technique was performed on aspiration smears of three cases. It revealed a positive cytoplasmic reaction in two cases.