Sinonasal-type hemangiopericytoma of the nasal cavity and paranasal sinus

Sinonasal-type hemangiopericytoma is a very rare disease. A 64-year-old man was admitted to our hospital because of nasal obstruction. Nasal endoscopy showed a polyp in the right nasal cavity. Imaging modalities including CT and MRI revealed polypoid tumors in the right nasal cavity and right sphenoid sinus. Excision of the tumors was performed. Macroscopically, the nasal tumor was reddish and focally cystic, and the tumor of the sphenoid sinus was reddish and solid. Microscopically, round and polygonal cells were seen to proliferate monotonously in a medullary fashion. Each tumor cell had a vesicular nucleus and amphophilic cytoplasm. The cellularity was high and mitotic figures were recognized in 6 per 10 high-power fields. Many thin-walled vessels were embedded within the tumor. No collagenization was recognized. A silver stain showed that fine argyrophilic fibers encased individual cells and a few cell nests. Mild invasion into the surrounding tissue was recognized in focal areas. The tumor showed focal cystic and hemorrhagic changes. Immunohistochemically, the tumor cells were positive for vimentin, bcl-2 and factor XIIIa, and negative for cytokeratins, epithelial membrane antigen, CD34, desmin, α-smooth muscle antigen, myoglobin, myogenin, CD31, KIT, p53 protein, CD99, and factor VIII-related antigen. Ki-67 labeling was 17%. The pathological diagnosis was low-grade malignant sinonasal-type hemangiopericytoma. The patient was followed up, but no recurrence has been seen 4 years after the operation.     

Mucinous tubular and spindle cell carcinoma of kidney: a clinicopathological study

Mucinous tubular and spindle cell carcinoma is a rare tumor described in the 2004 WHO classification as a new entity with a relatively indolent behavior. We report a case of 53-year-old woman presenting a well-circumscribed tumor confined in the right kidney. The histologic findings consisted of tightly packed, small, elongated tubules separated by pale mucinous stroma. The tumor cells were cuboidal to spindled with eosinophilic cytoplasm and lower nuclear grade. The tumor was immunoreactive for cytokeratin CK 7 and CK19, and had negative staining for CD10. The morphological and immunohistochemical features were consistent with mucinous tubular and spindle cell carcinoma of kidney. Because of the favorable prognosis with this type of tumor, mucinous tubular and spindle cell carcinoma must be differentiated from papillary renal cell carcinoma, especially the variant with sarcomatoid dedifferentiation.     

Basaloid squamous cell carcinoma of the sinonasal tract

BACKGROUND: Basaloid squamous cell carcinoma (BSCC) is a high grade, aggressive variant of squamous cell carcinoma with a predilection for the larynx, hypopharynx, tonsils, and base of the tongue. To the authors' knowledge, BSCC originating in the nasal cavity and paranasal sinuses rarely has been reported. METHODS: Fourteen cases of BSCC involving the nasal cavity and paranasal sinuses were identified in the files of the Otolaryngic-Head and Neck Pathology Tumor Registry of the Armed Forces Institute of Pathology from 1975-1997. Clinical records and follow-up were available in all cases. Paraffin blocks were available for histochemical and immunohistochemical studies in all cases. RESULTS: There were 7 females and 7 males, ages 32-86 years (median, 66.5 years; mean, 62 years). The patients presented primarily with a mass lesion and unilateral nasal obstruction. In nine patients the tumor was confined to the nasal cavity. In three patients the tumor involved the sinuses alone and in two patients the tumor involved the nasal cavity and paranasal sinuses. Histologically, the tumors were widely invasive with a variety of growth patterns, including lobular, solid, trabecular, cribriform, and fascicular. The neoplastic infiltrate included predominantly pleomorphic, basaloid-appearing cells with hyperchromatic nuclei, inconspicuous to prominent nucleoli, and a variable amount of eosinophilic to clear-appearing cytoplasm. Mitotic figures, including atypical forms, were readily apparent as was necrosis (individual cell and comedo-type). Foci of squamous differentiation were limited in extent but were found in all cases and included squamous whorls, individual cell keratinization, and intercellular bridges. Intraepithelial dysplasia, carcinoma in situ, or invasive squamous carcinoma was present in all cases. Other histologic features included intercellular stromal hyalinization and peripheral nuclear palisading. In two cases, neural-type rosettes were found. Immunoreactivity for a variety of epithelial markers including cytokeratin (AE1/AE3/LP34), CAM 5.2, 34betaE12, CK7, and epithelial membrane antigen was present in all cases. Variable reactivity was present with vimentin, actins (smooth muscle and muscle specific), neuron specific enolase, S-100 protein, glial fibrillary acidic protein, CK20, carcinoembryonic antigen, Leu7, and Ewing's marker. Chromogranin, synaptophysin, neurofibrillary protein, leukocyte common antigen, HMB-45, desmin, and Epstein-Barr virus latent membrane protein were absent. Surgical resection was the treatment of choice. Eight patients had recurrent or persistent tumor and metastatic disease occurred in five patients. At last follow-up, 7 patients (50%) had died of disease with a median survival of 12 months from the time of diagnosis and 3 patients were alive with disease over periods ranging from 8 months-5 years. Of the 4 remaining patients, 2 were alive without disease at 1 month and 5 years, respectively, 1 patient was lost to follow-up with no evidence of tumor at 3 years, and 1 patient had died of unrelated causes with no evidence of disease. CONCLUSIONS: Sinonasal BSCC is a histologically distinct variant of squamous cell carcinoma with pathologic features and aggressive biologic behavior similar to BSCC localized to more common mucosal sites of the upper aerodigestive tract.     

Primary clear cell adenocarcinoma of the lung

Primary clear cell adenocarcinoma of the lung is extremely rare. A 63-year-old Japanese man consulted to our hospital because of cough and sputum. Imaging modalities including XP, CT and MRI revealed a tumor of the right middle lobe. They did not identify other tumors in the body. Because clinical cytology and biopsy showed malignant cells, segmentectomy of the lobe was performed. Grossly, the tumor was whitish tan tumor measuring 5 × 6 × 5 cm. Histologically, the tumor was composed entirely of clear cells arranged in papillary and tubular patterns. The tumor cells had hyperchromatic nuclei, and mitotic figure and nuclear stratification were scattered. Histochemically, glycogen and mucins were absent in tumor cell cytoplasm. Immunohistochemically, the tumor cells were positive for pancytokeratin (AE1/3, CAM5.2), cytokeratin (CK) 7, CK 8, CK18, CK19, EMA, CEA, CA19-9, CA125, p53, Ki-67 (labeling = 80%), TTF-1 and surfactant apoprotein A. In contrast, the tumor cells were negative for CK5/6, CK 34βE12, CK 14, CK 20, vimentin, desmin, S100 protein, α-smooth muscle actin, AFP, HMB45, CD10, CD34, HER2/neu, CD56, p63, and synaptophysin. The tumor recurred 6 months after the operation, and right middle lobectomy was performed. Postoperative imaging modalities showed no tumors. The patient is alive free from tumor 9 years after the first manifestation.     

Clear cell adenocarcinoma of the uterine cervix in a young pregnant woman: a case report with immunohistochemical study

The patient was a 30-year-old-pregnant woman (para 1, gradiva 1) without in utero exposure to diethylstilbestrol. A papillary and flat lesion was found by colposcopy in the uterine cervix in the routine examination at 10 pregnancy weeks. Biopsies showed papillary and tubular proliferation of malignant cells with clear glycogen-rich cytoplasm and malignant hobnail cells and were diagnosed as clear cell adenocarcinoma. The patient was treated by radical hysterectomy. The lesion of the cervix (10 × 15 × 5 mm) was clear cell adenocarcinoma with mild invasion into shallow myometrium (pTIb). An immunohistochemical study showed that the tumor cells were positive for pancytokeratins (AE1/3, CAM5.2, KL-1, and polyclonal wide), cytokeratin (CK) 7, CK8, CK18, CK19, epithelial membrane antigen, CA 125, p53 protein, and Ki-67 antigen (labeling = 95%). The tumor cells were negative for high-molecular weight CK (34βE12), CK5/6, CK14, CK20, vimentin, AFP, CEA, desmin, S100 protein, α-smooth muscle antigen, CD34, estrogen receptor, progesterone receptor, chromogranin, synaptophysin, neuron-specific enolase, and CD56. The patient is now of free of tumor. In the English literature, the present case is the second case of cervical clear cell adenocarcinoma during pregnancy, and the first case of cervical clear cell carcinoma investigating a wide range of immunoreactive antigens.     

8号和20号染色体拷贝数改变辅助食管癌外周血循环肿瘤细胞鉴定

[目的]建立基于细胞学鉴定食管鳞癌（ESCC）外周血循环肿瘤细胞（CTCs）的技术。[方法]通过偶联CD45抗体的免疫磁珠去除白细胞，富集食管癌外周血稀有细胞的“负性富集”策略，结合抗CK8／18／19免疫荧光染色（IF）和8／20号染色体荧光原位杂交（FISH）鉴定CTCs。[结果]食管癌外周血CK8／18／19^＋／CD45^-的CTCs检出率为43馏％（7／16），其中80％伴有8／20号染色体非整倍体的改变（AC）。食管癌细胞WHCO1、EC0156和KYSE250的8号AC分别为77．3％、78，6％和75％；KYSE150的20号AC为77．9％。外周血一些胞浆胞膜小完整、具有异型性的细胞核伴有8／20号AC改变。[结论]食管癌8／20号AC可以作为判断食管癌外周血CTCs恶性表型的标准，结合CK8／18／19^＋／CD45标准，不但可以鉴定具有完整细胞结构的CTCs,还可以鉴定胞浆、胞膜不完整或裸核样的CTCs的恶性表型。     

Diffuse large B-cell lymphoma of non-germinal center B-cell type of the heart in an immunocompetent woman: an autopsy case

The patient was a 30-year-old-pregnant woman (para 1, gradiva 1) without in utero exposure to diethylstilbestrol. A papillary and flat lesion was found by colposcopy in the uterine cervix in the routine examination at 10 pregnancy weeks. Biopsies showed papillary and tubular proliferation of malignant cells with clear glycogen-rich cytoplasm and malignant hobnail cells and were diagnosed as clear cell adenocarcinoma. The patient was treated by radical hysterectomy. The lesion of the cervix (10 × 15 × 5 mm) was clear cell adenocarcinoma with mild invasion into shallow myometrium (pTIb). An immunohistochemical study showed that the tumor cells were positive for pancytokeratins (AE1/3, CAM5.2, KL-1, and polyclonal wide), cytokeratin (CK) 7, CK8, CK18, CK19, epithelial membrane antigen, CA 125, p53 protein, and Ki-67 antigen (labeling = 95%). The tumor cells were negative for high-molecular weight CK (34βE12), CK5/6, CK14, CK20, vimentin, AFP, CEA, desmin, S100 protein, α-smooth muscle antigen, CD34, estrogen receptor, progesterone receptor, chromogranin, synaptophysin, neuron-specific enolase, and CD56. The patient is now of free of tumor. In the English literature, the present case is the second case of cervical clear cell adenocarcinoma during pregnancy, and the first case of cervical clear cell carcinoma investigating a wide range of immunoreactive antigens.     

Sarcomatoid carcinoma of the urinary bladder: a case report with immunohistochemical and molecular genetic analysis

The author reports a rare case of sarcomatoid carcinoma with an emphasis on immunohistochemical features. A 79-year-old man was admitted to our hospital because of hematuria. An endoscopy revealed a large polypoid tumor in the bladder, and urine cytology demonstrated malignant cells. A cystectomy was performed. The patient is now alive without metastasis 4 months after the operation. Grossly, a large polypoid tumor (5 × 6 × 5 cm) was present in the bladder. Microscopically, the tumor consisted of high-grade transitional cell carcinoma element (10% in area) and sarcomatoid element (90% in area). There was a gradual transition between the two. The tumor cells were invaded into peribladder tissue (pT3b). Immunohistochemically, the sarcomatoid element was positive for four types of pancytokeratins, high-molecular weight cytokeratin (CK), CK5/6, CK7, CK18, CK19, epithelial membrane antigen (EMA), vimentin, p53 protein, p63, Ki-67 (labeling = 92%), neuron-specific enolase (NSE), and platelet-derived growth factor receptor-α (PDGFRA). It was negative for CK14, CK20, melanosome, carcinoembryonic antigen (CEA), desmin, S100 protein, myoglobin, α-smooth muscle antigen (ASMA), CD34, chromogranin, synaptophysin, CD56, CD68, and KIT. The transitional cell carcinoma element showed similar immunoreactivity except for negative CK5/6, positive CK20, and negative vimentin. A molecular genetic analysis of KIT gene (exons 9, 11, 13, and 17) and PDGFRA (exons 12 and 18) gene with the use of PCR-direct sequencing showed no mutations. The present case is the first report of sarcomatoid carcinoma of the urinary bladder demonstrating extensive immunohistochemistry and mutational status of KIT and PDGFRA genes. The sarcomatoid carcinoma in the present case may be derived from sarcomatous differentiation of high-grade transitional cell carcinoma.     

梭形细胞变异型弥漫性大B细胞淋巴瘤1例报道及文献复习

目的：探讨梭形细胞变异型弥漫性大B细胞淋巴瘤的临床病理特征、病变性质及鉴别诊断要点。方法：对1例梭形细胞变异型弥漫性大B细胞淋巴瘤的组织形态特征、免疫组化表型，结合临床预后进行分析。结果：1例23岁女性患者在半年内先后发生结肠肿瘤和乳腺肿瘤。HE切片显示肿瘤细胞弥漫性浸润肠壁和乳腺组织，瘤细胞有异型性和核分裂，并伴有显著的梭形细胞特征。免疫表型显示瘤细胞CD45 ，CD20 ，CD45RO-，CD30-，Vim ，Des-，SMA-，S-100-，CK-，EMA-。患者1年内死于肿瘤。结论：本例梭形细胞变异型大B细胞淋巴瘤是一种罕见的高度恶性肿瘤，在缺乏免疫组化标记的情况下易误诊为肉瘤或低分化癌。     

Rare tumors of sinonasal track

Objective

To characterize the clinical behavior of rare sinonasal malignancies.

Methods

Clinical data from the cases of rare sinonasal malignancies at Gujarat Cancer and Research Institute during 2001–2007 were extracted. Data for histologic type of tumor, tumor stage and survival were analyzed.

Results

Eighty-nine cases of the non-squamous cell malignancy were identified. The mean patient age was 54 years. In this study, we found minor salivary gland tumor in 31 patients, sarcoma in 19 patients, spindle cell carcinoma (SpCC) in 19 patients, undifferentiated carcinoma in 9 patients, lymphoma in 6 patients and melanoma in 3 patients. Adenoid cystic carcinoma exhibited the best survival rate (3 years survival rate was 77%), whereas melanoma and undifferentiated carcinoma exhibited poor survivals (1 year survival was 25% and 33%, respectively and 3 years survival rate is 0%).

Conclusions

Adenoid cystic carcinoma is the most common squamous cell carcinoma (SCC) of the sinonasal track. Survival for the patients with undifferentiated carcinoma and melanoma involving the sinonasal track is poor.     

肾黏液样小管状和梭形细胞癌临床病理观察

 目的 探讨肾黏液样小管状和梭形细胞癌的临床病理特点及鉴别诊断。 方法 观察2例肾黏液样管状和梭形细胞癌的临床资料、组织病理学及免疫组织化学特点,并复习相关文献。 结果 患者男、女各1例,年龄分别为66岁和54岁。1例因体检被发现,另1例因贫血就诊。病理检查：肉眼瘤组织切面呈实性、灰白色,边界多清楚,未见囊性变。镜下瘤组织由多少不一的小管状和梭形细胞区构成,间质富含黏液。瘤细胞部分呈立方状,胞浆透明或弱嗜酸颗粒状,核圆形或不规则形,核分裂相少见。部分细胞梭形,束状或编织样排列,似平滑肌瘤。1例以立方状细胞成分为主,另1例以梭形细胞成分为主。免疫组织化学：2例瘤细胞均呈CK(AE1/AE3)、EMA、Vimentin阳性,其中1例并呈Syn局灶阳性;而desmin、CgA、S－100、SMA、CD117、CD34、CD10、 HMB45、p53、ER及PR均阴性,Ki67指数均小于1％;术后分别随访7月和11月,均未见复发和转移。 结论 肾黏液性管状和梭形细胞癌为罕见的肾脏低度恶性肿瘤,病理诊断时需与其他肾肿瘤鉴别。     

Serum squamous cell carcinoma antigen is a useful biologic marker in patients with inverted papillomas of the sinonasal tract

BACKGROUND: Inverted papilloma (IP) is a frequent benign sinonasal tumor that is characterized histologically by squamous metaplasia, epithelial acanthosis, and hyperplasia of the nasal epithelium. Because of its high recurrence rate and malignant transformation potential, careful long-term follow up is necessary. METHODS: The purpose of the current report was to study the expression of squamous cell carcinoma (SCC) antigen in sinonasal IPs and to evaluate the usefulness of SCC antigen as a biologic marker for the follow-up of patients with sinonasal IP. The expression of SCCA1 in three sinonasal IP cases, three sinonasal SCC cases, and cases of normal nasal epithelium were examined by Western blot analysis, and the SCCA1 expression pattern in 31 IP specimens and 4 carcinoma in IP specimens were evaluated immunohistochemically. The serum levels of SCC antigen in 11 patients with sinonasal IP also were analyzed. RESULTS: SCCA1 was overexpressed in all three sinonasal IP tissues compared with sinonasal SCC tissues or normal nasal epithelium. SCCA1 cytoplasmic immunoreactivity was detected in the suprabasal epidermal keratinocytes of all 31 sinonasal IP cases. In the four carcinoma in IP specimens, SCCA1 expression in the papillomatous lesion was more intense than in the cancerous lesion. The serum SCC antigen level was high in 10 of 11 patients with IP (91%) and significantly decreased after surgical resection of the tumors. CONCLUSIONS: The results of the current study indicate that SCCA1 frequently is overexpressed and may play a biologic role in the development of sinonasal IPs. Serum SCC antigen may be a useful biologic marker in patients with sinonasal IP.     

Synovial sarcoma in cerebellum: a case report and literature review

Synovial sarcoma is a tumor of unknown origin and is extremely rare in the central nervous system. We present a case involving an unusual cerebellar synovial sarcoma in a male infant. Neuroimaging revealed a large, solid, gadolinium-enhancing mass located in the parenchyma of the right cerebellar hemisphere and associated with multiple cyst formation. Histologically, the tumor was composed of uniform spindle cells with indistinct borders and numerous mitotic figures. The tumor cells were observed to form dense cellular sheets, but in some areas the tumor showed a hemangiopericytomatous vascular pattern consisting of tumor cells arranged around dilated, thin-walled blood vessels. Immunohistochemistry showed that vimentin, CD99 and Bcl-2 were diffusely positive in most cells, and focal reactivity for cytokeratin (AE1/AE3) and S-100 protein was also observed. The tumor cells were, however, negative for CK19, EMA, CD34, synaptophysin, GFAP, desmin, myogenin, and smooth muscle actin. Cytogenetic analysis using fluorescence in situ hybridization demonstrated the translocation t(X;18)(p11;q11). A diagnosis of primary cerebellar monophasic synovial sarcoma was made. To our knowledge, this is the first report of a synovial sarcoma in brain parenchyma. The present case indicates that it is essential to select the appropriate immunohistochemical panel and—especially—perform molecular analysis to accurately diagnose intracranial spindle cell tumors.     

颅底鼻腔上皮样血管内皮细胞瘤误诊分析

为了探讨颅底、鼻腔上皮样血管内皮细胞瘤(EH)的临床、影像及病理学特点,结合文献回顾性分析2例颅底鼻腔EH患者的诊断和治疗.该病病因不清,临床症状少且轻微,无特征性.影像学主要表现为不规则占位影,侵袭性生长,血供丰富.病理学上肿瘤呈结节状分布,细胞形态以上皮样或梭形细胞为主,瘤细胞胞质丰富,呈巢团状不规则排列,结节周边细胞较丰富,间质黏液变.瘤细胞一般缺乏多形性,核分裂及坏死少见.免疫组化显示,CD31、CD34阳性,广谱CK偶见灶性阳性,其他抗体阴性.初步研究结果提示,颅底鼻腔EH为一种上皮样血管内皮细胞分化的低度恶性肿瘤,具有独特病理学特征,临床及影像学特征不明显,容易误诊,需要引起重视,组织病理学是确诊关键.     

鼻腔原发性移行细胞癌一例并文献复习

鼻腔移行细胞癌临床表现为鼻塞进行性加重及间断性出现脓血性分泌物、头痛和听力下降。巨检示质灰红色碎组织,质地中等。镜下见细胞呈巢状、乳头状排列,细胞核呈圆形或卵圆形,浸润性生长,嗜碱或透亮。免疫组织化学示P63、CK5/6、CK18、UroplakinIII、CerbB-2、p53和CEA均阳性,Ki-67阳性指数约30%,而S-100,Cga,Syn,Calponin均阴性。鼻腔原发移行细胞癌较为罕见,临床易误诊,其诊断和鉴别诊断主要依靠病理组织学结构和免疫组织化学检查。     

A different pattern of cytotoxic T lymphocyte recognition against primary and metastatic tumor cells in a patient with nonsmall cell lung carcinoma

BACKGROUND: Lung carcinoma represents the most frequent cause of cancer death worldwide because of tumor metastases. The objective of the current study was to analyze the immunologic response during the progress of lung carcinoma metastasis. METHODS: The authors established two tumor cell lines that were derived from primary and metastatic lesions in a patient with lung carcinoma (Patient G603). One cell line (G603L) was established from the primary lesion, and the other cell line (G603AD) was established from a metastatic lesion in the right adrenal gland 7 months after the patient underwent surgery for the primary lesion. Autologous regional lymph node lymphocytes were stimulated with CD80-transfected G603L cells, then cytotoxic T lymphocytes (CTLs) were induced against both lung carcinoma cell lines. RESULTS: Both G603L cells and G603AD cells expressed Class I human leukocyte antigen, intracellular cell adhesion molecule 1, and lymphocyte-associated antigen type 3 (LFA-3), but not Fas or Fas ligand on their surfaces. By stimulation with CD80-transfected G603L cells, 2 CTL clones (H2/17 and H2/36) were established from the bulk CTLs. CTL clone H2/17 lysed G603L cells but not G603AD cells, suggesting that the antigen recognized by CTL clone H2/17 was abrogated during the process of metastasis. In contrast, CTL clone H2/36 lysed both G603L cells and G603AD cells, indicating that the antigen recognized by CTL clone H2/36 was maintained in the tumor cells throughout tumor progression. CONCLUSIONS: The results demonstrated the possibility that some tumor-associated antigens may be abrogated during the process of metastasis, although others are maintained. The identification of these antigens will lead to a better understanding of their immunologic role during disease progression in patients with lung carcinoma.     

Heat-Shock Protein 70 as a Tumor Antigen for in vitro Dendritic Cell Pulsing in Renal Cell Carcinoma Cases

Immunological functions of heat shock proteins (HSPs) have long been recognized. In this study we aimed toefficiently purify HSP70 from renal cell carcinoma and test it as a tumor antigen for pulsing dendritic cells in vitro.HSP70 was purified from renal cell carcinoma specimens by serial column chromatography on Con A-sepharose,PD-10, ADP-agarose and DEAE-cellulose, and finally subjected to fast protein liquid chromatography (FPLC).Dendritic cells derived from the adherent fraction of peripheral blood mononuclear cells were cultured in thepresence of IL-4 and GM-CSF and exposed to tumor HSP70. After 24 hours, dendritic cells were phenotypicallycharacterized by flow cytometry. T cells obtained from the non-adherent fraction of peripheral blood mononuclearcells were then co-cultured with HSP70-pulsed dendritic cells and after 3 days T cell cytotoxicity towards primarycultured renal cell carcinoma cells was examined by Cell Counting Kit-8 assay. Dendritic cells pulsed in vitrowith tumor-derived HSP70 expressed higher levels of CD83, CD80, CD86 and HLA-DR maturation markersthan those pulsed with tumor cell lysate and comparable to that of dendritic cells pulsed with tumor cell lysateplus TNF-α. Concomitantly, cytotoxic T-lymphocytes induced by HSP70-pulsed dendritic cells presented thehighest cytotoxic activity. There were no significant differences when using homologous or autologous HSP70as the tumor antigen. HSP70 can be efficiently purified by chromatography and induces in vitro dendritic cellmaturation in the absence of TNF-α. Conspecific HSP70 may effectively be used as a tumor antigen to pulsedendritic cells in vitro.     

扁桃体原发性恶性肿的临床病理分析

目的：对25例扁桃体原发性肿瘤的临床病理特征,进行分析研究。方法：收集25例经临床病理证实的扁桃体原发性恶性肿瘤患者的临床资料,复习有关病理组织常规切片,部分病例标本进行免疫组织化学染色、显微镜观察分析。结果：鳞状细胞癌7例,恶性弥漫性非霍奇金淋巴瘤17例,血管肉瘤1例;淋巴瘤白细胞共同抗原（CD45）均为阳性表达,大多为B细胞来源,而细胞角蛋白（CK）均为阴性;鳞癌CK均为阳性表达,而CD45和波形蛋白（Vimntin)均为阴性;血管肉瘤表达F8和Vimentin。结论：扁桃体原发性恶性肿瘤以弥漫性非霍奇金淋巴瘤最为常见,其次是鳞癌,最后确诊要依靠病理形态学及免疫组织化学来证实,并采取综合治疗。     

CD45RA-Foxp3high but not CD45RA+Foxp3low suppressive T regulatory cells increased in the peripheral circulation of patients with head and neck squamous cell carcinoma and correlated with tumor progression

Background

T regulatory cells (Tregs) contribute to the progression of head and neck squamous cell carcinoma (HNSCC) by suppressing antitumor immunity. However, little is known regarding the functional heterogeneity of Tregs in HNSCC patients.

Methods

Using multicolor flow cytometry, the frequency of three Treg subsets, separated on the basis of CD45RA and Foxp3, from the peripheral circulation of newly-presenting HNSCC patients (19 oral cavity squamous cell carcinoma, 20 hypopharyngeal squamous cell carcinoma, 18 nasopharyngeal squamous cell carcinoma, 19 oropharyngeal squamous cell carcinoma, and 36 laryngeal squamous cell carcinoma) were assessed with regard to 31 healthy donors and clinicopathological features. Moreover, the functional capacity of each Treg subsets was evaluated based on CD45RA and CD25 expression.

Results

The frequency of Tregs in the peripheral circulation of HNSCC patients as a whole cohort was higher than in healthy donors (P < 0.0001). However, the frequency of Tregs was similar between patients with oral cavity squamous cell carcinoma and healthy donors (P = 0.269). Further dividing Tregs into three subsets based on Foxp3 and CD45RA expression revealed that the frequency of CD45RA^-Foxp3^high Tregs and CD45RA^-Foxp3^lowCD4⁺ T cells in patients with HNSCC developing from different subsites was higher than in healthy donors (P < 0.0001, P < 0.0001), whereas the frequency of CD45RA⁺Foxp3^low Tregs was lower than in healthy donors (P < 0.0001). Functionally study revealed that CD45RA^-CD25⁺⁺⁺ Tregs significantly inhibit the proliferation of CD4⁺CD25^- T cells (P < 0.001) and secrete lower levels of cytokines (P < 0.01) compared with CD45RA^-CD25⁺⁺CD4⁺ T cells. Importantly, the frequency of CD45RA^-Foxp3^high Tregs positively correlate with tumor stage (P < 0.0001) and nodal status (P < 0.0001).

Conclusions

CD45RA^-Foxp3^high Tregs increase in the peripheral circulation of HNSCC patients, and correlate with tumor stage and nodal status; suggesting a role in tumor progression which may be manipulated by future immunotherapy.     

鼻型NK/T细胞淋巴瘤26例临床病理分析

目的:研究鼻型NK/T细胞淋巴瘤(ENKL)的免疫表型、病理特点、临床特点。方法:回顾性分析26例ENKL的临床表现、病理组织学特点,采用免疫组化SP法检测LCA、CD3、UCHL1、CD20、CD79a、CD56、TIA-1、Granzyme B、perforin,原位杂交方法检测EBER在ENKL中的表达情况。结果:NK/T细胞淋巴瘤发生在鼻腔占80.77%(21/26),伴坏死、溃疡、鼻出血者100%(26/26),肿瘤细胞嗜血管现象占46.15%(12/26),伴"鳞状细胞癌样反应"占20.08%(6/26)。CD3、CD56、TIA-1、Granzyme B、perforin及EBER阳性表达率达100%。结论:临床及病理形态复杂多样性是NK/T细胞淋巴瘤的特点。病理诊断中须注意与炎症或高分化鳞状细胞癌鉴别。ENKL根据典型的临床表现、病理形态学改变、免疫表型特点及EBER原位杂交阳性能准确诊断。