伴破骨细胞样巨细胞的乳腺浸润性筛状癌一例

患者女,45岁.发现右侧乳腺肿物1 d, 于2007年9月10日入住我院乳腺外科.查体:双乳对称,无乳头内陷,未见溢血、溢液;右侧乳房外上象限距乳头2 cm处,扪及一质韧肿物,约2.5 cm×2.0 cm大小,质硬,边界不清,表面不光滑,活动度一般,无触痛,肿物表面皮肤无改变;右侧腋窝未扪及肿大淋巴结.     

胰腺间变性癌伴大量破骨细胞样巨细胞反应1例报告

患者 ,男性 ,5 2岁。因上腹部不适 1年 ,于 2 0 0 2年 5月 2 0日入院。 B超检查 :胰尾大部分及部分胰体区可见 1 2 .5 cm× 1 0 .6cm囊实性回声团块 ,边界尚规则。全身骨显像正常。临床诊断 :胰腺肿瘤 ,性质待查。 2 0 0 2年 5月 2 7日全麻下手术 ,术中所见 :肿瘤位于胰体尾部 ,呈 1 2 cm× 1 0 cm× 1 0 cm大小 ,囊实性 ,边界清楚 ,有包膜 ,切面暗红色 ,部分区域灰白色 ,质地较软 ,胰尾缩小变硬 ,脾、横结肠、横结肠系膜、后腹膜与肿瘤紧密粘连。病理诊断 :胰腺间变性癌伴大量破骨细胞样巨细胞反应。讨论　胰腺间变性癌发生率较低 ,约占胰…     

乳腺癌子宫内膜转移3例临床病理分析

目的 探讨乳腺癌子宫内膜转移的临床病理特征、治疗及预后。方法 回顾性分析3例乳腺癌子宫内膜转移患者的临床资料并结合文献复习。结果 3例乳腺癌子宫内膜转移患者中乳腺浸润性小叶癌2例,浸润性导管癌1例。子宫内膜转移灶直径为3~8 cm,中位直径4.5 cm。镜下见子宫内膜转移灶癌细胞呈圆形或椭圆形,细胞质较丰富,部分癌细胞异型性明显,排列呈管状。束状或索状分布,部分区域见小叶样结构。原发灶、子宫内膜转移灶ER、PR、Ki-67均呈阳性表达,CerbB-2、GCDFP-15、E-cadherin染色呈差异性表达,CK7、P120呈局灶阳性,CK5/6、SMA、CD10和S-100呈阴性。结论 乳腺癌伴子宫内膜转移临床少见,预后较差,生存期较短,确诊主要依靠病理和免疫组化检查,ER、PR、CK5/6、CK7、CerbB-2及GCDFP-15对子宫内膜原发癌与转移癌有一定鉴别作用。     

胰腺伴破骨样巨细胞的肿瘤

胰腺伴有破骨样巨细胞的肿瘤非常罕见，组织学形态上与骨的巨细胞肿瘤很类似；主要包括两种：伴有破骨样巨细胞的胰腺未分化癌和伴有破骨样巨细胞的胰腺粘液性囊性肿瘤。本文将就这两种肿瘤的临床及形态特征、组织学来源、诊断、鉴别诊断及预后做一综述。     

106例青年女性乳腺癌临床病理特点的回顾性分析

目的 回顾性分析青年女性乳腺癌的临床病理特征,探讨其发病特点,为青年女性乳腺癌临床诊治提供经验.方法 整理并分析南方医科大学附属深圳妇幼保健院2007年1月至2012年12月确诊的106例青年(≤35岁)女性乳腺癌(青年组)的临床病理资料及相关免疫组化指标,并与同期诊断的435例年龄＞35岁的中老年女性乳腺癌(中老年组)进行对比分析.计数资料间率的比较采用x2检验.结果 青年组乳腺癌占同期收治乳腺癌的19.6％(106/541),病理类型以浸润性导管癌为主,占86.8％ (92/106).与中老年组比较,其组织学分级(Ⅱ/Ⅲ级)、腋窝淋巴结转移率和HER-2表达水平更高[93.4％ (99/106)比85.3％(371/435),37.7％(40/106)比26.2％(114/435),52.8％(56/106)比40.7％ (177/435),P值均＜0.050,而ER和PR表达水平则更低[57.5％(61/106)比68.5％ (298/435),60.4％ (64/106)比70.3％ (306/435),P值均＜0.050].并且,两组间肿瘤直径、病理类型及P53表达水平的差异均无统计学意义(P＞0.050).结论 青年女性乳腺癌有特殊的临床病理特征,其组织学分级、淋巴结转移率和HER-2表达水平高,而ER、PR表达低,其恶性程度更高,临床处理需注意早期诊断和合理治疗.     

巨细胞血管纤维瘤临床病理分析

目的:探讨巨细胞血管纤维瘤(GCA)的临床病理学特征及鉴别诊断要点。方法:对1例GCA患者的临床病理特征、免疫组化和预后进行观察,并结合文献复习分析。结果:该肿瘤多发生在眼眶,也可以发生于眼眶外其他部位。常为境界清楚的无痛性包块,其形态上介于孤立性纤维性肿瘤和巨细胞纤维母细胞瘤之间。瘤组织主要由短梭形或卵圆形细胞构成,无一定排列方式。细胞无异型,并见特征性不规则分布的血窦样或裂隙样假血管性腔隙,内衬一层多核巨细胞,呈不连续分布。周围的间质内易见出血,并见多少不等的多核巨细胞散在分布。免疫组化示Vimentin、CD34、CD99、Bcl-2均(+)。结论:巨细胞血管纤维瘤系一种罕见的良性肿瘤或低度恶性潜能的肿瘤。具有独特的形态特征,其诊断和鉴别诊断主要依靠病理组织学,必要时结合免疫组化。局部完整切除后很少复发,但仍需密切随访。     

肝脏破骨巨细胞样肉瘤1例

患者,男性,21岁。主因无明显诱因出现右上腹伴右腰背部反射痛两次入院。     

上皮样肉瘤的临床病理分析

目的探讨上皮样肉瘤的临床病理特征及鉴别诊断。方法复习10例上皮样肉瘤的临床病理资料,应用免疫组化进行病理形态和免疫表型分析。结果免疫组化结果显示,10例均表达细胞角蛋白(CK)和波形蛋白(Vim)阳性,上皮膜抗原(EMA)9例阳性,6例CD34阳性,S-100、平滑肌肌动蛋白(SMA)各在1例肿瘤中见局灶阳性,不表达结蛋白(Des)、肌红蛋白(MG)、FRAg、CD31、HMB45。结论上皮样肉瘤是一种分化未定免疫表型复杂的少见的软组织肿瘤,好发于肢体远端。     

前列腺癌及良性前列腺病变临床病理与免疫组化分析

[目的]对前列腺癌和良性前列腺病变的病理形态学及免疫组化进行分析,以提高对前列腺癌的诊断准确率。[方法]回顾性分析2005年1月至2006年10月间42例前列腺癌患者的临床资料,研究其病理学及免疫组化特点,并与同期130例良性前列腺病变患者进行比较分析。[结果]前列腺癌42例,表现为正常大腺泡结构消失、基底细胞消失、组织结构异常、核间变和间质浸润等形态学改变;免疫组化显示PAP、PSA阳性率均为100%,p504s阳性率95.2%,34βE12和p63均阴性。而良性前列腺病变130例,存在基底细胞层,仅非典型性腺瘤样增生和高级别前列腺上皮内瘤中可见少数腺上皮细胞核仁增大;免疫组化显示PAP、PSA、34βE12和p63均阳性,p504s局灶弱阳性率2.5%。[结论]结合临床资料、病理形态学改变及免疫组化指标进行综合分析,能够提高前列腺癌诊断和鉴别诊断的准确率。     

上皮样血管内皮瘤9例临床病理分析

摘 要：［目的］ 分析上皮样血管内皮瘤的临床病理学特点,以提高诊断能力。［方法］ 回顾性总结9例手术切除或粗针穿刺活检诊断为上皮样血管内皮瘤的临床病理学特征及免疫组化表型。 ［结果］ 患者男性5例,女性4例;年龄16~63岁,平均年龄42岁。肿瘤分别位于肺4例、肝脏2例、软组织2例、输尿管1例。镜下观察肿瘤细胞形成上皮样形态,胞浆丰富嗜酸性,条索状或不规则散在排列,内含红细胞。间质为丰富的透明变性、黏液或黏液软骨样基质,有时可见钙化、骨化及坏死。免疫组织化学染色显示肿瘤细胞不同程度表达Vimtenin、CD31、CD34、D2-40、Fli-1、第八因子相关抗原,均未表达TFE3。8例获随访,随访时间为1~24个月均健在。［结论］ 上皮样血管内皮瘤,可见于多种实质性器官。由于其临床表现及影像学特征不典型,故不易早期发现;更因其组织形态类似于上皮样细胞,而易误诊为癌;应结合组织学特征和血管源性免疫组化表型及分子检测避免误诊。     

Lung carcinoma with spindle and/or giant cell： a clinicopathological analysis of 17 cases

Objective: Lung carcinoma with spindle and (or) giant cell (LCSG) is a rare epithelial malignant tumor. The aim of our study is to investigate the clinicopathological and prognostic characteristics of 17 cases of LCSGs. Methods: Among 421 patients underwent resection of lung carcinomas, 17 cases of LCSG were studied for clinical, gross and histological parameters. Follow-up information was obtained and analyzed to clarify prognostically significant parameters. Results: The LCSG patients consisted of 15 males and 2 females, with the age ranging from 45 to 78 years (median, 58 years); 5 cases of stage Ⅰ, 3 of stage Ⅱ, 9 of stage Ⅲ by pathological TNM staging; 2 cases of exclusively spindle cell carcinoma, 5 cases of lung carcinoma with spindle cell, 10 cases of lung carcinoma with giant-cell carcinoma. Cough, chest distress, or chest pain were the most common presenting symptoms, occurring in 15 patients (88.2%). Of 5 patients in stage Ⅰ, 4 were alive and free of relapse for more than 5 years. The difference in survival was statistically significant between LCSG and squamous cell carcinoma patients (median survival, 36 vs. 61 months; P = 0.027). Lymph node metastasis and carcinoma with giant cell were the hazardous factors impacting postoperative prognosis of LCSG patients. Conclusion: LCSG patients in early stage may have an optimistic outcome. Lung carcinomas with giant cell displayed multiple cell components in histopathology, and poor outcome due to more lymph node involved.     

Breast carcinoma with osteoclast-like giant cells: a case report and review of the Japanese literature

A 41-year-old premenopausal woman with a 3.5 cm freely mobile mass in the upper outer quadrant of the right breast was admitted to our hospital. Fine needle aspiration showed malignant epithelial cells and many multinucleated osteoclast-like giant cells (OGCs). Excisional biopsy revealed an invasive ductal carcinoma. A right modified radical mastectomy was subsequently performed. Macroscopically the tumor was well circumscribed with a dark brown cut surface. Microscopically, the tumor was a grade 2 invasive ductal carcinoma with many multinucleated OGCs adjacent the tumor cells and hemorrhage and infiltration of inflammatory cells in the stroma. The intra-mammary metastasis also contained OGCs and stromal reactions. By enzyme immunoassay, the tumor cells were negative for estrogen receptor but positive for progesterone receptor. The tumor cells were negative for both c-erbB-2 and p53. The OGCs showed positive immunostaining with the monoclonal antibody CD68, demonstrating a histiocytic origin. Lymph nodes were free of metastasis. We also review the Japanese literature concerning breast carcinoma with OGCs.     

小脑发育不良性节细胞瘤2例临床病理分析

目的:阐明小脑发育不良性节细胞瘤(Lhermitte-Duclos disease,LDD)的临床病理特征.方法:回顾性分析2例小脑发育不良性节细胞瘤的临床表现、组织学和免疫组织化学特点.结果:LDD患者临床主要表现为颅内压增高、共济失调;MRI呈特征性条纹状改变;组织学表现为小脑叶片增大,板层结构异常,分子层增宽,蒲肯野细胞层及颗粒细胞层内散在分布形态异常、发育不良的神经元.免疫组织化学染色显示肿瘤细胞NSE、Syn、NeuN、CgA阳性,GFAP阴性,Ki-67增殖指数＜1%.结论:小脑发育不良性节细胞瘤是一种罕见的良性肿瘤,正确诊断必须依赖于MRI、组织病理学及免疫组织化学标记,首选治疗是肿瘤全切手术,部分病例可伴有Cowden综合征.     

血管内大B细胞淋巴瘤临床病理观察

目的:探讨血管内大B细胞淋巴瘤的临床病理学特点、诊断及其预后。方法:报道2例血管内大B细胞淋巴瘤,对其临床资料、组织学形态及免疫标记结果进行分析,并复习相关文献。结果:2例患者年龄分别为73岁、54岁,临床表现为反复发热。组织学所见,受累组织小血管扩张,管腔内充满异型肿瘤细胞。免疫组化标记,肿瘤细胞CD20(+),CD3(-)。随访1例于发病后2个月死亡,1例于发病后7个月死亡。结论:血管内大B细胞淋巴瘤是一种罕见的非霍奇金淋巴瘤,临床表现缺乏特异性,诊断依靠病理学检查。该肿瘤恶性度极高,患者预后极差。     

耳鼻喉粘液表皮样癌15例临床病理分析

目的:探讨耳鼻喉粘液表皮样癌的临床病理特征,并探讨其诊断和鉴别诊断。方法:收集15例粘液表皮样癌,观察其临床病理特点并进行免疫组化分析。结果:15例均为男性,平均年龄55岁。其中高分化者14例,低分化者1例。肿瘤细胞CK、CEA、EMA、CK8均呈阳性表达。结论:粘液表皮样癌是一种较少见的耳鼻喉肿瘤,根据其组织学改变和免疫组化染色结果,可与其他肿瘤鉴别,掌握组织学分类有助于临床的正确治疗和预后判断。     

含梭形／巨细胞肺癌28例临床病理特征及预后分析

目的：探讨含梭形／巨细胞肺癌（lung carcinoma with spindle ／giant cells,LCSG）的临床病理特征和预后。方法：回顾性总结分析1985年9月至2009年7月就诊的28例 LCSG 的临床和组织病理学资料。利用生存曲线进行生存分析,Cox 风险比例模型分析影响预后的因素。结果：LCSG 患者男女比例为11∶3,年龄33～73岁,中位年龄60岁;pTNM分期：Ⅰ期8例,Ⅱ期7例,Ⅲ期11例,Ⅳ期2例;病理类型：含梭形细胞癌11例,其中单纯梭形细胞癌2例,梭形细胞癌伴鳞癌5例、伴腺癌3例和伴腺鳞癌及大细胞癌1例;含巨细胞癌17例,其中单纯巨细胞癌13例,巨细胞癌伴鳞癌1例、伴腺癌3例。单纯肉瘤样细胞型患者的中位生存期较混合有上皮样细胞型者长（22．8个月 vs 8．0个月,P ＝0．022）。单因素分析显示,年龄（P ＝0．002）、肿瘤大小（P＝0．005）、组织学类型（P ＝0．001）、pTNM分期（P ＝0．015）、T 分期（P ＝0．008）、淋巴结转移（P ＝0．013）和 M分期（P ＝0．000）是影响 LCSG 患者预后的因素。结论：混合有上皮样细胞型的 LCSG 预后较单纯肉瘤样细胞型差;年龄、肿瘤大小和组织学类型是影响 LCSG 患者预后的因素。     

Skeletal muscle metastases of carcinoma: a clinicopathological study of 12 cases

OBJECTIVE: To clarify the clinical and magnetic resonance (MR) imaging features of a rare condition of metastasis of carcinoma to skeletal muscle. METHOD: Clinicopathological findings for 12 patients (10 male, two female, age range 48-89 years, mean age 68 years) with skeletal muscle metastases of carcinomas were reviewed retrospectively. RESULTS: In nine of the 12 patients the skeletal muscle metastasis was presented as "painful mass". The lung was found to be the most common primary source, accounting for 33% of the cases, and the lower extremity was the most common metastatic site, accounting for 67% of the current series. Diagnosis was made by biopsy in all cases. Overall, MR images were not specific, but on the gadolinium-DTPA enhanced MR images, extensive peritumoral enhancement associated with central necrosis was found in 11 of the 12 patients (92%). Seven patients died within 2-19 months (average: 9 months) after the detection of the skeletal muscle metastasis, among whom only one patient was continuously disease free for 92 months after wide excision of the metastatic lesion. CONCLUSION: Skeletal muscle metastasis is often presented as a painful mass in patients with known primary carcinoma. For diagnosis, needle biopsy is mandatory. However, a painful mass with an extensive peritumoral enhancement should be highly suspected to represent carcinoma metastasis to skeletal muscles. In selected patients, wide excision with combined chemotherapy could yield unexpectedly good results.     

小脑血管母细胞瘤2例临床病理分析

目的:探讨小脑血管母细胞瘤（HB)临床影像学表现、病理学特征及免疫组化特点,为鉴别诊断的准确率提供依据。方法:回顾性分析2015年10月至2017年4月诊治的2例HB患者临床资料、影像学表现、病理学特征及免疫组化特点并复习相关文献。结果:2例HB患者均以头痛为首发症状,影像学检查提示小脑半球囊实性和实质性占位,镜下肿瘤主要以大间质细胞和丰富的毛细血管网构成,并根据间质细胞的丰富程度分为细胞亚型,其肿瘤组织内含大量的间质细胞,细胞呈圆形或多角形,胞浆丰满呈空泡状;网状亚型,肿瘤组织内含大量的毛细血管,网织染色示有丰富的网状纤维。HB间质细胞中Vimentin、S-100蛋白、Inhibin-a、CD56表达均阳性且NSE、VEGF高表达,EMA、CD34、CD31、GFAP、EGFR均呈阴性。血管内皮细胞均表达内皮细胞标记物CD34、CD31及FⅧAg。Ki-67增殖指数标记阳性率＜5％。结论:HB是临床较为少见的中枢神经系统良性肿瘤（WHO Ⅰ级),影像学表现具有一定的特异性,结合病理学特征及免疫组化特点,有助于提高诊断的准确率。     

Hepatocellular carcinoma in the Philippines: a clinicopathological study of 150 cases

Clinicopathological features were examined in 150 hepatocellular carcinoma cases autopsied from 1977 to 1983 in the Philippines and were compared to those of cases reported in Japan. The characteristics of hepatocellular carcinoma in the Philippines were as follows. 1. The age of autopsied patients with hepatocellular carcinoma in the Philippines was approximately 10 years younger than in Japan. The Philippines cases included even 10- to 11-year-old patients. 2. The macroscopic type of hepatocellular carcinoma in the Philippines consisted predominantly of the massive type of Eggel's classification. On the other hand, an encapsulated tumor was found in only one case. 3. The histological characteristics of hepatocellular carcinoma in the Philippines were not especially well defined. Hyaline globules and fatty metamorphosis were found in 1 and 12, respectively, of 90 Philippine hepatocellular carcinoma cases. 4. The frequency of HBs antigen in hepatocellular carcinoma in the Philippines was 37%. This is almost equal to that in Japan.