乳腺腺肌上皮瘤的临床病理学观察

目的 探讨乳腺腺肌上皮瘤的临床病理诊断、治疗和预后.方法 应用光镜及免疫组化染色对5例乳腺腺肌上皮瘤进行临床病理诊断、分型、治疗及预后分析, 同时复习相关文献.结果 5例均发生于女性,均为良性肿瘤,年龄29～37岁,平均33.2岁.1例为实体型,1例为腺管型,3例为小叶型.镜下见肿瘤由增生的腺上皮和肌上皮两种成分构成, 前者构成管状结构的内层, 后者构成管状结构的外层以及实性区域.前者表达CK、EMA、MUC-1, 后者表达SMA、S-100、p63、Calponin.随访5例6～12年肿瘤均无复发或转移.结论 乳腺AME是一种罕见而独特的病变, 多数属于良性肿瘤, 预后通常较好, 手术仍是最好的治疗手段,其诸多方面的问题尚有待于进一步探讨.     

乳腺腺肌上皮瘤临床病理观察及文献复习

目的探讨乳腺腺肌上皮瘤（adenomyoepithelioma,AME）的形态学及免疫组化表型特征。方法对2例乳腺AME进行临床病理学分析和免疫组织化学研究。结果肿瘤由增生的腺上皮和肌上皮组成。腺上皮CK、EMA、ER、PR（＋）;肌上皮CK（-）,S-100蛋白、SMA、actin（＋）、EMA局部弱（＋）,GFAP、desmin（-）。结论乳腺AME是一种具有独特病理学特征的良性肿瘤,由腺上皮和肌上皮共同增生而成。熟悉该肿瘤的组织学和免疫表型特点对鉴别诊断有重要意义。     

乳腺腺肌上皮瘤

１临床资料患者，女性，３５岁，已婚。无意中发现左乳外上限有一核桃大小肿块，质偏硬，轻度触痛，抗炎治疗无效。同侧腋窝未触及肿大淋巴结。临床诊断：左乳肿块，乳腺癌待排除。遂行肿块切除术。２病理检查２１肉眼观察结节状组织４ｃｍ×３５ｃｍ×３ｃｍ大小，灰...     

乳腺腺肌上皮腺病及腺肌上皮瘤

腺肌上皮腺病(adenomyoepithelialadenosis,AMEA)为乳腺腺病的一种特殊类型,非常少见,其特征为病变由增生的腺上皮和肌上皮组成,以肌上皮增生为主。如果病变形成境界明显的肿块,一般称之为腺肌上皮瘤(adenomyoepitheli oma,AME)。由于AMEA肿物无包膜,并有推进性边缘,故常误诊为     

乳腺腺肌上皮瘤

乳腺腺肌上皮瘤(adenomyoepithelioma,AME)被用于诊断由上皮和肌上皮细胞增生形成的肿瘤。作者复习了35例诊断为AME或诊断中提及AME的会诊病例,目的是为了更好地界定AME的诊断标准和预后意义。该组病例中AME23例、伴有明显肌上皮增生的乳头状瘤8例、乳头腺瘤2例、化生性肿瘤2例     

宫颈恶性腺瘤的细胞形态学观察

报告7例宫颈恶性腺瘤的细胞形态学特点:细胞易脱落;核小较一致;核周染色深。油镜见有1～2个核仁;核缘失去弧形;浆内有分泌大空泡;伴有较多分泌物;PAS、Alcian蓝染色呈阳性。薄片细胞大,恶性形态易显示。厚片细胞小,易误诊。又由于细胞异形不显著,细胞病理学诊断易误诊。本瘤恶性度高。对化疗、放疗不敏感,预后差。7例中3例在术后5年内死亡,3例术后2年7个月尚存活,1例失访。     

男性乳腺腺肌上皮瘤1例

患者男性 ,4 1岁。因左乳头旁肿块多年 ,胀痛 1个月入院。体检 :左侧乳头旁触及 4cm× 3cm× 3cm包块 ,质硬 ,可活动 ,表面尚光滑。行手术切除 ,术中见境界清楚包块 ,质硬。病理检查　眼观 :灰粉不整形组织 1枚 ,3cm× 2cm× 2cm ,似有包膜 ,切面颜色灰白灰红相间 ,质硬。镜检 :圆形和椭圆形的上皮细胞腺管周围围以片状和束状排列的肌上皮细胞 ,呈圆形、多边形及梭形 ,部分肌上皮细胞胞质透亮 ,与其中间的腺上皮细胞深染的胞质形成反差。腺上皮形成大小不一的腺管 ,内有嗜伊红的分泌物。肌上皮的数量大大超过腺上皮的数量。肿瘤细胞轻度异型…     

乳腺叶状肿瘤的临床病理学研究

目的 探讨乳腺叶状肿瘤的病理形态学特点,分类和诊断标准,与复发转移的关系及其临床意义。方法 采用回顾性分析的方法对203例有随1访（6－372个月）资料的叶状肿瘤作了详细形态学持征的分析和分类研究,统计学聚类判别分析（SPSS软件10．0版）。结果 良性133例（复发28例）,交界性42例（复发19例,死亡2例）,恶性28例（复发18例,死亡15例）。统计学分析结果显示,肿瘤生长方式,瘤细胞异型性,核分裂象计数和肿瘤性坏死所组成的变量子集分类错判率为零。以此4项为主,完善了病理组织学诊断标准。良性,交界笥和恶性组间复发率,转移和死亡率差异均有显著性意义。肿瘤复发随术式的扩大而减少,2次以上复发占53．85％（35／65）。结论 此瘤可分为良性,低度恶性（交界性）及恶性三种类别。肿瘤生长方式,瘤细胞异型性,核分裂象和肿瘤性坏死是诊断此瘤并对其进行分级（分类）的重要依据。提示首次术式的选择的重要性,良性叶状肿瘤应选择肿物扩大切除术,对于复发的交界性和恶性肿瘤应作乳房切除术。     

宫颈恶性腺瘤6例临床病理分析

目的 探讨宫颈恶性腺瘤(cervical adenoma malignum，CAM)临床病理学特征及早期诊断。方法 对6例CAM的临床资料及3例阳性涂片进行分析，选用CEA、c—erbB—2、CD44v6、Ezrin(p81)和mucin5种抗体采用二步法进行免疫组化染色。结果 CAM临床表现均有白带大量增多，但白带检验结果无异常。3例细胞学涂片显示特征性图像。CEA在6例CAM中有阳性表达，而在正常宫颈组织中仅1例表达。其余4项免疫组化指标对CAM和正常宫颈组织的表达尢差异。结论 细胞学检查在CAM早期诊断中有重要意义。CEA阳性对CAM与良性宫颈病变有一定鉴别意义。临床白带长时间大量增多且化验无异常发现时应警惕CAM的可能。     

孤立性纤维性肿瘤临床病理学观察

目的探讨孤立性纤维性肿瘤(solitary fibrous tumor,SFT)的临床、病理组织学、免疫组化特征,提高对该病的认识。方法对7例SFT病例进行大体观察、病理组织学及免疫组化En V ision二步法标记,观察V im、CD34、CD99、bc l-2 Des、SMA、HMBE-1、CK、S-100蛋白在SFT组织中的表达。结果7例SFT分别发生于胸腔、腹腔、纵隔、眼眶及胸壁软组织,临床表现为肿块压迫所致的症状,肿块1.5 cm×1.5 cm×1 cm~20 cm×20 cm×18 cm,光镜下肿瘤细胞由长梭形细胞构成束状、编织状排列,间质内有多少不一的胶原纤维,无特殊的组织构型及形态的多样性为其组织学特点。免疫表型:CD34、V im、CD99均为弥漫强阳性,bc l-2 5例阳性,Des、SMA、HMBE-1、CK、S-100蛋白阴性。结论SFT是一组形态多样、无特殊组织构型及有多少不一胶原纤维的梭形细胞肿瘤,其特殊的免疫表型,有助于对该病的诊断,但SFT的确诊必须结合组织形态和免疫组化共同完成。SFT的生物学行为取决于其组织学形态和肿块的大小及生长方式,完全切除肿块者预后较好。     

Malignant adenomyoepithelioma of the breast: a non-tubular and matrix-producing variant

Two women, aged 82 and 58 years old, cases 1 and 2, respectively, with the non-tubular and matrix-producing variant of malignant adenomyoepithelioma (MAM) of the breast are described. The tumors were 20 and 35 mm in diameter, respectively, and had cut surfaces with a tan-white-colored appearance and vague lobulation. Although both tumors showed marked central necrosis and a high level of mitoses, the tumor cells had relatively monomorphous nuclei and exhibited only mild atypia. The invasive component was predominantly trabecular and lobular, and the intraductal component demonstrated a focal-comedo pattern. The cytoplasm of the tumor cells was rather scanty, vacuolar or pale with ill-defined borders. The tumor in case 2 contained intermingled spindle-shaped cells. The stroma of both tumors resembled that of pleomorphic adenoma, containing a myxoid and chondroid matrix and, in case 2, cartilage and mature bone. Immunohistochemical and ultrastructural analyses of both tumors revealed dual cytological differentiation, predominantly of myoepithelial cells with secretory epithelial cells intermingled haphazardly. Although these tumors resembled metaplastic carcinomas, particularly matrix-producing carcinomas, they showed marked myoepithelial differentiation without overt tubular differentiation, a pattern quite different from matrix-producing carcinomas and from the adenomyoepitheliomas reported so far. MAM of the breast, non-tubular and matrix-producing variant, resembles epithelioid myoepithelial carcinoma of the salivary gland and has not been reported previously in the English literature.     

恶性外周神经鞘瘤52例临床病理分析

目的观察恶性外周神经鞘瘤的临床病理学特征、诊断及鉴别诊断。方法回顾性分析52例恶性外周神经鞘瘤的临床病理学及免疫表型特征并复习相关文献。结果 52例患者中,男女发病率为1∶1,年龄4~71岁,头颈部18例(35%),四肢12例(23%),躯干9例(17%),深部组织8例(15%),椎管内4例(8%),生殖道1例(2%)。镜下肿瘤组织呈束状或漩涡状排列,瘤细胞短纺锤形、卵圆形、梭形,核分裂象易见。免疫表型:瘤细胞局灶表达S-100蛋白,Ki-67增殖指数10%~70%。结论恶性外周神经鞘瘤罕见,侵袭性高,预后差,其组织形态复杂多样,需与滑膜肉瘤、纤维肉瘤、血管外皮瘤、富于细胞性神经鞘瘤、纤维型脑膜瘤以及平滑肌肉瘤等鉴别。     

Malignant lymphoma of the urinary bladder: a clinicopathological study of 11 cases

AIM: To report the clinical and histological features and outcome of primary and secondary malignant lymphomas of the urinary bladder. METHODS: Eleven cases of malignant lymphoma of the urinary bladder were obtained from the registry of cases at St Bartholomews and the Royal London Hospitals. The lymphomas were classified on the basis of their morphology and immunophenotype, and the clinical records were reviewed. RESULTS: There were six primary lymphomas: three extranodal marginal zone lymphomas of mucosa associated lymphoid tissue (MALT) type and three diffuse large B cell lymphomas. Of the five secondary cases, four were diffuse large B cell lymphomas, one secondary to a systemic follicular follicle centre lymphoma, and one nodular sclerosis Hodgkins disease. Four patients with secondary lymphoma for whom follow up was available had died of disease within 13 months of diagnosis. Primary lymphomas followed a more indolent course. In one case, there was evidence of transformation from low grade MALT-type to diffuse large B cell lymphoma. The most common presenting symptom was haematuria. Cystoscopic appearances were of solid, sometimes necrotic tumours resembling transitional cell carcinoma, and in one case the tumours were multiple. These cases represented 0.2% of all bladder neoplasms. CONCLUSIONS: Diffuse large B cell lymphoma and MALT-type lymphoma are the most common primary malignant lymphomas of the bladder. Lymphoepithelial lesions in MALT-type lymphoma involve transitional epithelium, and their presence in high grade lymphoma suggests a primary origin owing to transformation of low grade MALT-type lymphoma. Primary and secondary diffuse large B cell lymphomas of the bladder are histologically similar, but the prognosis of the former is favourable.     

Malignant transformation of adenomyoepithelioma of the breast by a monophasic population: a report of two cases and review of literature

Two cases of adenomyoepithelioma of the breast with malignant transformation by monophasic population of cells are presented. The underlying benign adenomyoepithelioma with typical biphasic architectural pattern was identified and represented at least 30% of the tumor in each case. In both cases, malignant portion of tumor was composed of relatively uniform monophasic population of highly atypical cells. The malignant component in case 1 was positive for pan cytokeratin, myoepithelial markers, and basal‐type cytokeratins and also focally positive for luminal‐type of cytokeratins, but negative for hormone receptors (estrogen and progesterone) and HER‐2/neu protein overexpression. The malignant component in case 2 was positive for spectrum of myoepithelial markers but negative for luminal cytokeratins, hormone receptors and HER‐2/neu protein overexpression. The bilinear immunophenotype in the case 1 suggests that the malignant tumor may have developed from precursor multipotent cells that can differentiate into both luminal epithelial and myoepithelial cells, although malignant component in case 2 appears to be the of pure myoepithelial phenotype.     

Cystosarcoma phyllodes of the breast: a clinicopathological study of 11 cases

Eleven cases of phyllodes tumour were managed at a single institute over 12 years period. All patients were females, the mean age was 48 years, painless breast lump was the commonest presentation, the left breast was affected in (55%), the upper outer quadrant was the most commonly involved site (60%). Four cases were malignant and the remaining 7 were benign. The diagnostic accuracy rate of fine needle aspiration cytology and intraoperative frozen section was 17% and 37.5% respectively. Adequate treatment was wide local excision in benign cases and simple mastectomy in malignant tumour. At a mean follow-up of 37 months the local recurrence and distant metastasis rate was 27% and 9% respectively.     

Malignant adenomyoepithelioma of the breast combined with invasive lobular carcinoma

Presented herein is the first case of malignant adenomyoepithelioma (malignant AME) of the breast combined with invasive lobular carcinoma (ILC) in a 53-year-old woman. Histologically, the tumor was composed of nodular proliferation of biphasic epithelial and myoepithelial carcinoma, partially surrounded by ILC. Interestingly, ILC metastasized to the axillary lymph nodes, while biphasic epithelial and myoepithelial carcinoma hematogenously metastasized to the lung and the kidney. On immunohistochemistry the biphasic carcinoma consisted of cytokeratin (CK) 8/18-positive/CK5/6-positive/smooth muscle actin (SMA)-negative inner carcinoma cells and CK8/18-positive/CK5/6-positive/SMA-positive outer carcinoma cells. The monophasic ILC cells had a CK8/18-positive/CK5/6-negative/SMA-negative staining pattern. Although it is unclear whether both ILC and biphasic epithelial and myoepithelial carcinoma originated from AME or whether ILC occurred independently of malignant AME, this is an exceptionally rare case, which might give rise to a special consideration of the histogenesis of breast cancer.