淋巴结外Rosai-Dorfman病临床病理观察

目的探讨淋巴结外窦组织细胞增生伴巨大淋巴结病（SHML,Rosai-Dorfman病）的病理诊断,免疫组化特点及鉴别诊断。方法对3例淋巴结外SHML患者进行HE、免疫组化染色观察,并复习相关文献。结果 3例患者男性1例,女性2例,年龄38～72岁。其中一例为多发病变,位于胸部及腹壁软组织。另两例为单发病变,分别位于右上肢软组织及右侧胫骨下段。组织学显示病变内大量组织细胞、淋巴细胞、浆细胞浸润,形成染色深浅不一的结节样区域。组织细胞体积大,胞浆丰富,核呈泡状,可见小核仁,在组织细胞的胞浆内,可见淋巴细胞吞噬现象。免疫组织化学染色示该组织细胞表达S-100蛋白与CD68。结论淋巴结外SHML是一种罕见的组织细胞增生性病变,在病理诊断方面,易误诊、漏诊,明确病理组织学特点在鉴别诊断中有重要意义。     

皮肤窦性组织细胞增生症2例病理诊断并文献复习

目的探讨原发皮肤窦性组织细胞增生症的临床病理学特征、诊断及鉴别诊断。方法分析2例皮肤窦性组织细胞增生症的临床特点,并行HE和免疫组化染色观察。结果 2例病变均位于皮肤真皮层及皮下组织,单发或多发性,光镜下增生的组织细胞与浸润的淋巴细胞、浆细胞形成浅、深相间的结构特点,特征性的组织细胞体积巨大、胞质丰富,内见形态完整的淋巴细胞、浆细胞及红细胞等,组织细胞表达S-100、CD68。结论皮肤窦性组织细胞增生症是一种少见的组织细胞增生性病变,有特定的病理学特征,系统累及可能性较小,预后较好。组织学上应与Langerhans细胞组织细胞增生症、慢性炎症等病变鉴别。     

原发性颅内Rosai-Dorfman病临床病理分析

目的：探讨原发性颅内Rosai—Dorfman病的临床病理特征、诊断及鉴别诊断。方法：分析1例原发性颅内Rosai—Dorfman病患者临床病理特点,包括病史、影像学资料、手术标本病理HE切片及免疫组织化学切片,并进行相关文献复习。结果：原发性颅内Rosai—Dorfman病好发于中年男性;术前影像学检查常诊断为脑膜瘤;组织学显示“明暗”相间的特征（多量淡染的组织细胞、浆细胞和淋巴细胞）伴纤维化,同时组织细胞内有多量吞噬的淋巴细胞,免疫组织化学标记显示组织细胞表达S-100蛋白和CD68。结论：原发性颅内Rosai-Dorfman病是一种极其少见组织细胞异常增生性病变,较容易误诊或漏诊。病理诊断时需与颅内非特异性炎性病变和浆细胞肉芽肿、富于淋巴浆细胞型脑膜瘤等鉴别,该病变组织学特征及组织细胞S-100蛋白和CD68阳性表达是诊断本病的可靠依据。     

组织细胞坏死性淋巴结炎临床病理特征分析

目的：探讨组织细胞坏死性淋巴结炎的临床表现、病理学特点。方法：结合文献报道,回顾性分析2009年1月～2010年1月本院10例组织细胞坏死性淋巴结炎住院患者的临床资料。结果：10例患者多伴有发热、白细胞减少、浅表淋巴结肿大、血沉及乳酸脱氢酶升高,对抗生素及抗结核治疗无效;淋巴结活检：病理学发现以凝固性坏死和组织细胞反应性增生为主,而中性粒细胞浸润少见,免疫组织化学染色示病变区域组织细胞CD68（＋）,T淋巴细胞CD45RO（＋）,B淋巴细胞CD20（＋）,均应用肾上腺皮质激素治疗,疗效显著。结论：综合分析临床表现、病理学及免疫组织化学,并加强随访,才能降低其误诊率。     

组织细胞坏死性淋巴结炎30例临床病理分析

目的：探讨组织细胞坏死性淋巴结炎的临床病理特点、诊断及鉴别诊断。方法：收集30例确诊的组织细胞坏死性淋巴结炎结合文献资料进行临床病理分析。结果：病理形态分增生型、坏死型、黄色瘤型。11例出现大小不等的凝固性坏死。30例出现核碎裂及细胞凋亡，中性粒细胞几乎未见，坏死灶周边出现大量增生的不同类的组织细胞和转化的淋巴细胞，免疫母细胞，且淋巴滤泡增多，其中22例有不同程度误诊误治。结论：组织细胞坏死性淋巴结炎在不同阶段，增生、坏死及黄色瘤交错存在，临床上有发热后颈部淋巴结肿大且极易误诊，抗生素使用无效。应及时取淋巴结活检，与淋巴瘤诊断困难时，应做免疫组织化学检查。本病预后良好。     

皮肤窦组织细胞增生症的临床病理分析研究

目的探讨皮肤窦组织细胞增生症(SHML)的临床与病理特点,诊断及鉴别诊断,以提高对该病的认识。方法观察2例皮肤窦组织细胞增生症的组织病理特点和免疫组化结果,并复习相关文献。结果 2例患者镜下真皮内均可见成片的组织细胞,胞体大,多边形,胞质丰富淡染,可见伸入运动,细胞核呈空泡状,伴淋巴细胞、浆细胞浸润。免疫组化结果 S-100蛋白强阳性,CD68阳性,CD1a阴性。结论皮肤窦组织细胞增生症是一种临床较少见疾病,易漏诊、误诊,其组织病理特点及免疫组化表达是诊断与鉴别诊断的主要依据,目前治疗方法不一,在进一步探讨中。     

皮肤以浆细胞为主的淋巴组织瘤样增生临床病理学分析

目的探讨皮肤以浆细胞为主的淋巴组织瘤样增生的临床病理特征。方法对1例皮肤以浆细胞为主的淋巴组织瘤样增生的临床表现,组织学特征,免疫表型进行分析。结果患者,女,18岁,右手腕部皮肤包块十年,显微镜下皮肤鳞状上皮角向下延伸,真皮层及皮肤附属器周围由小到中等大小淋巴样细胞和浆细胞浸润,免疫标记:LCA(+++),CD3、CD38,CD138、MUM-1(++),CD20散在阳性,CD30阴性,kappa、lambda均为散在阳性,呈多克隆表达,Ki-67增值指数20%。结论皮肤以浆细胞为主的淋巴组织瘤样增生少见,良性,易误诊,应与皮肤性真淋巴瘤相鉴别,完整切除可治愈。     

膀胱浆细胞样尿路上皮癌病理特点及鉴别诊断

目的探讨膀胱浆细胞样变异型尿路上皮癌的临床病理特征、鉴别诊断。方法运用光镜、特殊染色及免疫组化染色对1例浆细胞样变异型尿路上皮癌进行观察并复习文献。结果瘤细胞呈浆细胞样特征弥漫分布,胞浆嗜酸性或透亮,核大、偏位、深染。黏膜固有层及浅肌层见瘤细胞弥漫浸润。免疫组化：瘤细胞CK20、CK7、CK5、CK18、CD138、EMA（＋）,E-cadherin、p63、CD38、LCA和vimentin,S-100.Desmin,MyoD1（-）。结论浆细胞样变异型尿路上皮癌罕见,具有浆细胞样特征,需与恶性黑色素瘤、横纹肌肉瘤、浆细胞瘤等肿瘤相鉴别。     

结直肠原发性粒细胞肉瘤临床病理分析及鉴别诊断

目的探讨结直肠原发性粒细胞肉瘤(GS)的临床病理学特征及鉴别诊断方法。方法分析20例结直肠原发性粒细胞肉瘤患者的临床表现、组织病理学特征和免疫组化,并在复习相关文献后进行临床病理分析和鉴别诊断总结。结果患者镜下观察肠壁中等大小的瘤细胞弥漫浸润,细胞核卵圆形或不规则,可见核仁,核分裂像不明显,中等量胞浆,有的胞浆嗜酸或纤细颗粒状。免疫组化:波形蛋白(Vim)、分化簇(CD)34、CD43、髓过氧化酶(MPO)、CD117、CD99、CD68、CD163均阳性,Ki67(+)为60%~70%。治疗结束36个月后,20例患者中有13例患者病症稳定,体内肿瘤细胞未出现扩散现象,有2例患者出现了肿瘤细胞转移的情况,剩下5例患者均死亡。结论粒细胞肉瘤缺乏特异性的临床表现,并且与多种肿瘤以及病灶部位的肿瘤病症具有一定的类似性,病理检测的准确率较低。粒细胞肉瘤若在早期得到诊断并进行早期全身的系统化疗,患者的生存率会获得明显的提高,因此,应当对体检或疑似患者进行巨检+镜检+免疫组化检测的方式进行病理检测,并着重观察MPO和CD68两项指标。     

鼻腔结外Rosai-Dorfman病2例及文献复习

目的探讨鼻腔结外Rosai—Dorfman病（RDD）的临床表现、病理特征及鉴别诊断。方法对2例鼻腔结外RDD采用光镜及免疫组化、特殊染色结合临床资料及文献复习,对鼻腔结外RDD进行临床病理分析。结果鼻腔结外RDD形态学有不同程度的纤维组织增生和以浆细胞为主的混合炎细胞浸润,胞质内含有淋巴细胞和浆细胞的大多角形组织细胞数量多少不一,呈簇状或散在分布。结论鼻腔结外RDD较为少见,诊断有一定难度,形态学易与鼻硬结病、Langerhans细胞组织细胞增生症、肉芽肿性炎症、纤维组织细胞瘤等相混淆,需要免疫组化和特殊染色加以鉴别。     

皮肤扁平疣自体植入疗法疣体脱落的病理及免疫学基础

为探讨扁平疣自体植入疗法疣体脱落的病理及免疫学基础，对反应期疣体进行常规ＨＥ染色（７例）和免疫组织化学标记（６例），结果显示，病理组织学改变（Ｉ）疣体反应区淋巴细胞浸润，同时伴棘细胞水肿，溶解：（２）未见急性炎细胞浸润及坏死细胞残骸，未见单核巨噬细胞聚集及其吞噬现象，（３）真皮层血管扩张充血不明显，免疫学特征（１）反应区浸润的淋巴细胞显示ＣＤ４５ＲＯ＋，ＣＤ６＋，ＣＤ４＋，ＣＤ８＋，ＣＤ２０－Ｍａ     

Reduction of CD4 positive T cells and improvement of pathological changes of collagen-induced arthritis by FTY720

FTY720 belongs to a new class of immunosuppressants. Little is known about its influence on T cell subtypes and pathological changes in arthritis. Here we illustrated the effect of FTY720 on peripheral T cell subsets and joint damage of collagen-induced arthritis rats. Rats were administered FTY720 or prednisone daily from day 0 to day 28. Body weight, hind paw swelling and arthritis index were measured. Bone destruction was determined by micro-computed tomography and histopathology, and T cell subsets were analyzed by flow cytometry and immunohistochemistry. The results showed that FTY720 inhibited the development of arthritis. Radiological analysis revealed that FTY720 treated collagen-induced arthritic rats had much less joint damage in comparison to untreated collagen-induced arthritic rats. Histological study showed that collagen-induced arthritic rats suffered from inflammatory cell infiltration and synovial hyperplasia in their joints, and FTY720 treatment clearly reduced these pathological changes. Immunohistochemical analysis showed that FTY720 treatment significantly decreased the number of CD4(+) T cells in the synovium of collagen-induced arthritic rats. Collagen-induced arthritic rats appeared to have more CD4(+), but not CD8(+) T cells in their peripheral blood than normal control rats. Following FTY720 treatment, peripheral blood CD3(+) and CD4(+) T cells in collagen-induced arthritic rats were significantly decreased. In conclusion, FTY720 is an effective compound in the treatment of collagen-induced arthritic rats and in reducing CD4(+) T cells in collagen-induced arthritic rats.     

Castleman病45例临床病理学分析

目的 研究Castleman病的临床特点、组织病理、治疗及预后.方法 回顾性分析安徽省立医院病理科2003年1月-2016年6月诊断的Castleman病45例.结果 45例Castleman病中,透明血管型 39例,浆细胞型6例.39例透明血管型滤泡生发中心可见嗜伊红无结构基质,小淋巴细胞围绕成层状"洋葱皮"样结构;滤泡间毛细血管增生可见血管植入生发中心,形成"棒棒糖"结构,6例浆细胞型的生发中心萎缩及套区增宽不明显,无典型的洋葱皮样结构及血管植入现象,滤泡间大量浆细胞浸润,可见毛细血管增生,无明显玻璃样变性.29例获得完整随访资料,随访时间为4~127个月.结论 Castleman病是一种少见的慢性淋巴组织增生性病变,病因尚不明确,预后较佳;该组研究中,未获得死亡病例的记录.     

播散型环状肉芽肿四例临床病理特点与治疗研究及文献回顾

目的探讨播散型环状肉芽肿（GGA）的临床表现、组织病理特征、治疗方法及预后。方法对4例GGA的临床表现、组织病理改变、治疗方法及预后进行回顾性研究,并对近年GGA的国内外文献进行了回顾。结果4例患者,男女各2例,年龄42～72岁,以全身丘疹为主诉就诊。病程3个月至1年不等。3例曾误诊。4例GGA表现为躯干、四肢及颈部泛发肤色或红色丘疹、斑丘疹,部分损害中央可见脐凹,边缘呈环状。3例组织病理检查均示真皮浅中层胶原黏液变性,周围淋巴细胞、组织细胞呈栅状排列。1例示真皮浅中层胶原排列紊乱,胶原轻度变性,胶原束间可见散在分布的淋巴细胞、组织细胞及少量多核巨细胞。4例患者均接受了糖皮质激素制剂局部治疗,系统治疗分别为抗组胺药物、糖皮质激素、羟氯喹、异维A酸及补骨脂素紫外线疗法治疗。患者治疗后根据用药及患者治疗反应情况,不定期随诊。根据皮损数量和瘙痒程度变化判断疗效。随访6～35个月,平均随访（26±14）个月。2例患者治愈,随访2年无复发,1例有效,1例无效。结论GGA相对少见,容易误诊,临床需要注意寻找脐凹样或环状损害改变的特征性表现。组织病理特征为栅状肉芽肿或弥漫性淋巴组织细胞浸润伴胶原变性。 糖皮质激素、羟氯喹治疗及光化学疗法治疗有一定疗效。     

In melanoma changes of immature and mature dendritic cell expression correlate with tumor thickness:an immunohistochemical study

Cells with a dendritic morphology and/or expression of dendritic cell (DC) markers have been repeatedly described in several human tumors, but the distribution and density of melanoma-associated DCs have not yet been reported. The aim of the present study is to analyze the density and topographical distribution of melanoma-associated DCs and their relation with CD3(+), CD4(+) and CD8(+) T lymphocytes in forty cases of cutaneous human melanoma. In melanocytic tumours different pools of DCs were recognised in the epidermis and in the dermis, particularly in intimate relation with lymphocyte clusters inside the melanocytic proliferation, and more often at the edges of tumours. The number of Langerin-positive DCs showed an inverse correlation with tumour depth (correlation coefficient r= -0.59, P=0.0001) and was significantly lower in thick melanomas compared to thin and intermediate ones (P<0.0005). The density of CD83(+) DCs was significantly lower in thick melanomas compared to thin and intermediate ones (P<0.009). A significant correlation was found between the density of the two DCs subsets (r=0.57, p<0.0001). The number of CD3(+) lymphocytes was inversely correlated to the depth of infiltration (r=-0.596, P<0.0001): melanoma cases with II-III Clark level showed a higher T lymphocyte mean density compared to cases with IV-V Clark level (P<0.0001). T lymphocyte density was significantly lower in thick melanomas compared to thin and intermediate melanomas (P<0.0005). In conclusion, our study indicates a progressive loss of DCs and T lymphocytes in the neoplastic progression of melanomas; further identification of the molecular pathways involved in the functional impairment of these immunitary cells may lead to new immunotherapeutic approaches for melanoma patients that would improve the clinical outcome of the patients.     

Proliferation of the synovial lining cell layer in suggested metal hypersensitivity

Synovial tissues in joints with prostheses display characteristic morphological changes in cases with aseptic failure, particularly macrophage infiltration. Since proliferation of the synovial lining cell layer represents a feature characteristic of autoimmune joint diseases, the possibility of morphological changes of the synovial lining cell layer in periprosthetic tissues was investigated. Synovial biopsies from five groups of morphologically well-defined lesions (osteoarthritis, rheumatoid arthritis, aseptic loosened metal-on-polyethylene and metal-on-metal arthroplasty and suggested metal hypersensitivity) were compared using a conventional staining method and immunohistochemistry. The synovial lining cell layer was substantially enlarged in both rheumatoid arthritis and cases suggestive of metal hypersensitivity. Macrophage infiltrates were apparent in rheumatoid arthritis and all specimens from retrieved hip arthroplasties. Although both synovial and subsynovial macrophages were positive for CD163 (indicating synovial M2 macrophages), the remaining fibroblast-like synoviocytes and scattered stromal fibroblasts showed a positive reaction with the D2-40 antibody (indicating fibroblast-like synoviocytes). Furthermore, in contrast to CD163-positive macrophages, the enlarged D2-40-positive fibroblast-like synoviocytes displayed cytoplasmatic tubular projections. Proliferation of the periprosthetic synovial lining cell layer occurred in cases with unexplained groin pain following metal-on-metal hip resurfacing arthroplasty, suggestive of hypersensitivity. Despite some important study limitations, the present observation adds to the evidence that metal hypersensitivity shares characteristic morphological features with autoimmune diseases of the joints.     

Cardiovascular prosthetic surgery: an analysis of cellular and molecular patterns underlying valve implantation failure

Cardiac valves have a very complex microscopic architecture, this is due to the presence of many cell types and to the variegated stroma. From a morphological point of view, both physiological and pathological processes clearly show there to be an anatomic continuity between valve leaflets and perivalvular tissues; indeed, both component should be taken into consideration during thrombotic processes and in fibrous tissue formation. At present, morphological features are well known and classified, while little is known about histogenetic features: fibrous tissue formation and the role of the various types of adhesion molecules and cells which participate in this process still have to be fully elucidated. In the current study, we focused on the histological analysis of the pannus. In particular, we demonstrated that the true connective nature of the exuberant fibrous tissue was entirely composed of collagen/fibronectin fibre bundles and fibroblasts. Moreover we observed that the phlogistic infiltrates were composed of immune cells, mainly represented by CD4(+) and CD8(+) T lymphocytes. Finally we also tried to assess not only the degree of endothelial layer loss, but also the extent of revascularization in the exuberant fibrous tissue.     

乳腺浸润性微乳头状癌26例临床病理特征

目的研究乳腺浸润性微乳头状癌（IMPC）临床病理特征。方法对26例IMPC组织标本行组织病理和免疫组化检测,观察其病理改变、淋巴转移情况。结果单纯IMPC仅3例;IMPC伴浸润性导管癌19例;其他类型共4例。免疫组化示癌细胞ER阳性率73·1%,PR阳性率46·2%,Her-2阳性率76·9%,CD31阳性率50%,EMA,CK7阳性率100%）。IMPC淋巴管浸润率为76·9%,淋巴结转移率为73·1%。结论 IMPC具有高度的淋巴结转,组织学形态及免疫组化相结合可诊断此病。