伴破骨细胞样巨细胞的乳腺癌

目的 :探讨伴破骨细胞样巨细胞乳腺癌的临床病理特点。方法 :观察 4例伴破骨细胞样巨细胞癌的病理形态学改变。结果 :浸润性导管癌型 (Ⅱ～Ⅲ级 ) 2例 ,乳头状癌型和筛状癌型各 1例。破骨细胞样巨细胞在癌细胞周围分布。结论 :此种类型的癌需和伴反应性肉芽肿的癌、伴破骨细胞样巨细胞的化生性癌、间质反应性巨细胞、叶状肿瘤伴破骨细胞样巨细胞、癌肉瘤伴破骨细胞样巨细胞、肉瘤伴破骨细胞样巨细胞等鉴别。     

伴破骨细胞样巨细胞或反应性肉芽肿的乳腺癌

目的 探讨伴破骨细胞样巨细胞或反应性肉芽肿的乳腺癌的临床病理特点。方法 复习11例伴破骨细胞样巨细胞的乳腺癌（carcinoma with osteoclastic giant cells,COGC）和8例伴反应性肉芽肿的乳腺癌（carcinoma with responsive granuloma,CRG）的临床病理资料,部分病例行免疫组化染色和特殊染色。结果 COGC患者平均年龄40.6岁,CRG患者平均年龄53.6岁,均因发现乳腺包块就诊。COGC多呈界限清楚的结节状,切面多为灰红、灰褐色。COGC肿瘤类型包括浸润性导管癌5例、浸润性乳头状癌、浸润性微乳头状癌和浸润性筛状癌各2例。肿瘤内破骨细胞样巨细胞大小形态各有差异,分布弥散或不均匀,与肿瘤细胞关系密切。肿瘤间质内尚见不同程度的新旧出血、血管和纤维组织增生。腋窝淋巴结癌转移灶保留原发灶的形态学特点。CRG形态多不规则,切面多为灰白色。肿瘤类型均为浸润性导管癌,伴随出现的肉芽肿多密切围绕在癌巢周围,由上皮样细胞和朗汉斯型巨细胞构成。抗酸染色和六胺银染色无阳性发现。进行免疫组化染色病例的破骨细胞样巨细胞和肉芽肿均呈CD68（KP1和PGM1）阳性,S-100蛋白和Ⅷ因子呈阴性。CD34染色显示COGC的微血管密度为（21.9±4.2）/HPF,与对照组浸润性导管癌无明显差异（P〉0.05）。获得随访资料的6例COGC和2例CRG在随访期内无复发、转移或死亡。结论 乳腺COGC和CRG均属少见肿瘤,前者的大体和组织学具有一定的特异性。破骨细胞样巨细胞和肉芽肿出现的预后意义尚需积累更多的病例进行分析。     

伴破骨细胞样巨细胞肾肿瘤2例及文献复习

目的 探讨伴破骨细胞样巨细胞肾肿瘤(RT-OGC)的临床病理特点。方法 观察2例RT-OGC的病理形态学改变和免疫组织化学检测，并结合文献进行讨论。结果 肾盂移行细胞乳头状癌型1例，破骨细胞样巨细胞与移行细胞癌相连接；肾肉瘤样癌型1例，破骨细胞样巨细胞在肉瘤样成分周围分布或与肉瘤样成分混杂。免疫表型：破骨细胞样巨细胞CD68、Vim、αl-ACT均阳性，CK、EMA均阴性。结论 RT-OGC是少见的肾恶性上皮性肿瘤的一个亚型，破骨细胞样巨细胞起源于间叶组织的单核巨噬细胞系统，是机体对肿瘤的反应，其组织形态要与癌肉瘤和骨巨细胞瘤鉴别。     

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.     

伴有破骨细胞样巨细胞的乳腺癌

伴有破骨细胞样巨细胞的乳腺癌(Breast carcinoma with osteoclastl-ike giant cells)少见,其病理学改变十分特殊,以乳腺癌间质中存在多数多核巨细胞为特征,由于其形态类似于破骨细胞,所以多数文献将其描写为破骨细胞样     

含破骨巨细胞样细胞的胰腺多形性癌1例及文献复习

目的 探讨含破骨巨细胞样细胞的胰腺多形性癌的临床病理特征。方法 对1例含破骨巨细胞样细胞的胰腺多形性癌进行临床、病理组织学和免疫组织化学观察。结果 患者为58岁女性，因中上腹部持续性隐痛2个月余就诊，B超、CT检查发现胰腺占位。切除标本示实性结节状肿块，灰白、灰黄色，存灶性坏死。镜下见肿瘤由低分化腺癌伴梭形肉瘤样细胞构成，两种细胞均示CK、Vim、α-AT阳性。可见多灶性巨细胞瘤样结构，由单核瘤细胞和形态上良性的破骨巨细胞样细胞构成；前者见CK散在阳性，Vim和α-AT阳性；后者仅见CD68和Vim阳性。结论 含破骨巨细胞样细胞的胰腺多形性癌是多形性胰腺癌的一种亚型，破骨巨细胞为反应性细胞，非肿瘤成分。     

伴恶性软组织巨细胞肿瘤成分的甲状腺乳头状癌1例并文献复习

目的观察伴恶性软组织巨细胞肿瘤(giant cell tumor of soft tissue,GCT-ST)成分的甲状腺乳头状癌的临床病理学特征、诊断及鉴别诊断。方法采用HE染色、免疫组化染色及透射电镜检查GCT-ST的临床病理学特征,并复习相关文献。结果肿瘤由分界清楚的两种成分组成,分别为甲状腺滤泡型乳头状癌(约占10%)及GCT-ST(约占90%)。GCT-ST由大量轻度异型的肿瘤性单核细胞和均匀散在分布的破骨细胞样巨细胞混合组成,其中破骨细胞样巨细胞表达vimentin、CD13、CD68及PGM1,肿瘤性单核细胞表达vimentin、CD13、CD10、Ki-67及p53;两种细胞均不表达甲状腺标志物、各种上皮标志物、肌源性标志物、神经或神经内分泌标志物。乳头状癌细胞表达TG及CK。电镜下未见上皮源性、肌源性或神经源性肿瘤分化的超微结构特点。术后11周见肿瘤复发及肺转移。结论伴恶性GCT-ST成分的甲状腺乳头状癌罕见,诊断主要依靠病理形态学及免疫表型,应注意与甲状腺破骨细胞样巨细胞亚型未分化癌鉴别。     

伴破骨细胞样巨细胞的上皮性肿瘤

伴有破骨细胞样巨细胞肿瘤的共同特征是间质中存在破骨细胞样巨细胞(osteoclast-like giant cells,OGC).可见于身体的各个部位,最常见于骨、肌腱(腱鞘)和软组织,其次是泌尿道、乳腺及胰腺(表1),通常称之为"伴OGC的肿瘤"或"巨细胞肿瘤"[1-10].本文将就伴有OGC的上皮性肿瘤进行介绍.     

伴破骨细胞样巨细胞的乳腺化生癌一例

伴破骨细胞样巨细胞的乳腺化生癌一例江昌新林建韶谭郁彬患者女，６２岁。右侧乳房肿物１０余年，按乳腺增生，服中药治疗。明显增大伴疼痛１周，于１９９４年１２月２４日入院。行右侧乳房单纯切除。病理大体检查：右乳外下象限４ｃｍ×３．５ｃｍ×３ｃｍ肿物，与周围组...     

骨原发性巨细胞血管母细胞瘤临床病理学观察

目的探讨骨原发性巨细胞血管母细胞瘤(giant cell angioblastoma,GCAB)的临床特点、影像学表现、病理学形态、免疫表型及其鉴别诊断。方法对3例骨原发性GCAB的临床资料、影像学表现、病理学形态和免疫表型进行回顾性分析。结果2例为成年女性,1例为男童。病变分别位于第2腰椎、左股骨远端和左手第3~5掌骨。患者均以局部骨疼痛就诊,其中2例伴活动受限,2例伴周围软组织肿胀。影像学显示为骨质破坏,2例累及邻近软组织。低倍镜下见组织由丛状增生的不规则形血管瘤样结节组成,结节之间为纤维结缔组织。高倍镜下,血管瘤样结节由增生的小血管和周围的胖梭形周皮细胞组成,后者可呈同心圆状围绕小血管,结节内可见散在的破骨样巨细胞。免疫表型:结节内小血管内皮细胞表达CD31和CD34,其周围的周皮细胞表达α-SMA和vimentin,破骨样巨细胞表达KP-1。结论 GCAB属于局部侵袭性的中间型血管内皮瘤。除周围软组织外,少数病例可原发于骨内,并可发生于成人。GCAB需与慢性肉芽肿性炎症、丛状纤维组织细胞瘤、簇状血管瘤和卡波西型血管内皮瘤等鉴别。     

Invasive carcinoma of the breast with granulomatous response

Three patients are described who had invasive ductal carcinoma associated with noncaseating epithelioid granulomas. Multinucleated giant cells, predominantly of Langhans' type, were present in the granulomas. The granulomas were restricted to the carcinoma, and no granulomatous response was evident in regional lymph nodes. None of the patients had clinical evidence of systemic granulomatous disease, although one patient subsequently was found to have hepatic portal granulomas. This uncommon tissue response to neoplasm is distinct from carcinomas with osteoclast-like multinucleated giant cells. Similarly, the process differs from the granulomas presenting in axillary lymph nodes that drain a carcinoma.     

Fine-needle aspiration cytology of suture granulomas of the breast: A potential pitfall in the cytologic diagnosis of recurrent breast cancer

The fine-needle aspirates of three cases of suture granulomas of the breast area following mastectomy, lumpectomy, or axillary node dissection were reviewed. The original histologic diagnoses were mucinous (colloid) carcinoma, intraductal carcinoma, and low-grade phyllodes tumor. In two patients a new nodule developed in the surgical scar, and in the third a nodule developed in the axilla 2 cm away from the scar. The cellularity of the aspirates ranged from low to moderate, and all three cases contained variable numbers of spindled cells and fragments of cellular stroma. Multinucleated giant cells characteristic of suture granulomas were absent in all cases. Abundant metachromatic amorphous background material was present in one case, which was interpreted as recurrent mucinous carcinoma. The remaining cases were interpreted as suspicious for recurrent neoplasm. Upon excision, all were suture granulomas with fibroblastic proliferation. Suture granulomas can both clinically and cytologically mimic recurrent malignancy. The predominance of spindled cells and dissimilarity to the original tumor appear to be the most helpful features to cytologically distinguish suture granuloma from recurrent carcinoma in the absence of the characteristic multinucleated giant cells. © 1994 Wiley-Liss, Inc.     

Granuloma formation in patients after injection of methanol extraction residue (MER-GCG).

Nine patients with advanced cancer who were receiving the methanol extraction residue of BCG (MER-BCG) intradermally or intratumorally underwent biopsies from the injected sites or from locally enlarged lymph nodes. Most preparations showed a chronic granulomatous reaction consisting of lymphocytes, histiocytes, and epithelioid cells as well as either Langhans's or foreignbody type giant cells, or both. The degree of granuloma formation and giant cell infiltration varied. In only one case did the reactions consist merely of chronic lymphocytic and histiocytic inflammation with no granuloma formation. Examination of melanoma nodules injected with MER showed, in addition to granulomas, large numbers of giant cells penetrating the tumour.     

Invasive breast carcinoma with granulomatous response and deposition of unusual amyloid.

AIMS: To report an unusual case of invasive breast ductal carcinoma associated with non-caseating epithelioid granuloma and unusual deposition of amyloid. METHODS: Formalin fixed, paraffin wax embedded tissue from breast and lymph nodes were stained with a variety of methods. Representative tissue fragments were sampled and fixed in 2.5% buffered glutaraldehyde, postfixed in 1% osmium tetroxide, dehydrated and embedded in Araldite. Thin sections were viewed under a Phillips 400T transmission electron microscope. RESULTS: Multinucleated giant Langhans' cells were found in the granulomatas tissue in both breast carcinoma and metastatic axillary lymph node carcinoma. Electron microscopic examination showed "tubular" amyloid deposition intermingled with invasive carcinoma and granuloma. "Tubular amyloid" was characterised by a mesh of non-branching curving fibrils with hollow profiles. These tended to be located in the cell membranes. CONCLUSION: The presence of an epithelioid granulomatous reaction and deposition of "tubular" amyloid in an invasive breast carcinoma could be related to an abnormal immunological response.     

Systemic Macrophage Mobilization and Granulomatous Response to BCG in the Protein-Deficient Rabbit

In view of increased susceptibility to tuberculosis in protein malnutrition, the phenomenon of accelerated granulomatous response by the macrophage was studied in rabbits immunized and subsequently challenged with BCG. Dietary protein depletion resulted in marked retardation of macrophage mobilization and granuloma formation in various organs. The granulomatous index was low in most organs. The granulomas were few, small, abortive and ill-formed by loosely knit epithelioid cells and giant cells. This deficiency of macrophage function might limit the effectiveness of BCG vaccination in the malnourished host.     

Correlation among immune response, morphogenesis of the granulomatous reaction and spleen lymphoid structure in murine experimental paracoccidioidomycosis.

We studied the correlation among cellular immune response, the pattern of lung granulomatous lesions and alterations in spleen lymphoid structure in Swiss mice inoculated intravenously with Paracoccidioides brasiliensis strain 18. The animals were evaluated at 24, 48 and 96 h after infection and further studied weekly for 18 weeks by: (i) the macrophage migration inhibition test with phytohemagglutinin (PHA) and P. brasiliensis antigen (PbAg); and (ii) histopathology of the lung and spleen lesions. One group of animals was gamma-irradiated (8 Gy), infected under the same conditions and evaluated for the pattern of lung granulomatous lesions and spleen lymphoid structure at 24, 48 and 96 h after infection. During the first week of infection, the non-irradiated animals presented a positive response to PHA and PbAg, compact granulomas in the lungs and a typical hyperplasia of the spleen white pulp. However, from weeks 2 to 5, a depression of the cell-mediated immunity (CMI) response to PHA and PbAg was observed in association with granulomas presenting only large mononuclear cells and lacking both giant cells and a peripheral halo of small mononuclear cells. This pattern of granuloma formation was similar to that seen in gamma-irradiated animals, whose cells involved in CMI were absent. After week 7, the non-irradiated animals showed granulomas characterized by the presence of giant cells and a peripheral halo of small mononuclear cells. This type of granuloma was formed concomitantly with recovery of the CMI and of the lymphoid structure of the spleen. The results showed a correlation among granulomas composed of large mononuclear cells, hypoplasia of the splenic tissue and impaired CMI. This correlation indicated that although granuloma morphogenesis per se does not depend on the activation of CMI, this response is important at later stages during modulation of the cellular composition of the granulomas.     

Histopathology of tumour associated sarcoid-like stromal reaction in breast cancer

Summary In 5 cases of invasive ductal and lobular carcinoma of the breast multiple epithelioid and giant cell containing granulomas were detected, localized mainly in circumferential regions, but also in the center of the carcinomas. These granulomas were interpreted as sarcoid-like stromal reactions, occurring as sarcoid-like lesions in uni- and bilateral primaries, in a recurrent tumour, and also in axillary lymph nodes. Histopathologically, these granulomas were not quite uniform, some of them corresponding to typical sarcoidosis, others showing marked proliferations of epithelioid or giant cells or containing fibrinoid exudate or necroses. The granulomas were surrounded by dense infiltrates of mononuclear cells. Tuberculosis and mycosis was excluded. There were no hints of generalized sarcoidosis. Pathogenetically, these are reactions in the tumour stroma of varying intensity, and are not caused by necroses of the tumour tissue nor by microbial infections. Such tumour-associated sarcoid-like stroma reactions are interpreted as a T-cell mediated immune response to an antigen expression of the carcinoma acting as the local trigger; in 2 cases they were connected with sarcoid-like lesions of the axillary lymph nodes. Their occurrence in bilateral carcinoma of the breast points to an immunological disposition for this special kind of host-versus-tumour response. The intensity of these changes in a recurrent tumour reflects an immunological hypersensitivity reaction.The pathogenetic and differential diagnostic aspects of epithelioid granulomas of the female breast in chronic granulomatous mastitis, panniculitis, foreign body reaction, rare infections, and in therapeutically induced sarcoidosis are described and discussed.Dedicated to Prof. Dr. K. Lennert, Kiel, in Honour of his 65th Birthday     

Granulomatous gastritis associated with Campylobacter pylori

Three cases of granulomatous inflammation in gastric biopsies showing Campylobacter pylori infestation are described. This type of reaction to Campylobacter pylori has not previously been described, and occurred in 1.1% of gastric biopsies containing Campylobacter-like organisms (CLO), in this series of all gastric biopsies submitted for histological examination during one year. Two other cases each showed a mucosal granuloma: one was a patient with Crohn's disease and the other had foreign body giant cells in a biopsy of the edge of a healing gastric ulcer. Each of our three CLO-positive cases with granulomas showed scanty CLO's only. Thus, although granulomatous inflammation associated with CLO's is uncommon as a proportion of all CLO-positive gastric biopsies, these currently represent the commonest condition associated with granulomas in gastric biopsies, in our experience.     

Immunohistochemical observation of lysozyme in macrophages and giant cells in human granulomas.

Lysozyme activity of macrophages and giant cells in various human granulomas were examined with immunoperoxidase bridge method in tissue sections. Various numbers of epithelioid cells and giant cells of epithelioid cell granulomas of tuberculosis, sarcoidosis and Crohn's disease exhibited intense granular cytoplasmic lysozyme activity. Foreign body granulomas induced with various substances showed negative or faintly positive lysozyme stain. Macrophages and giant cells of aspergillus granuloma associated with thymus hypoplasia and T-cell depression contained no lysozyme. The results suggest that cell-mediated immunology plays an important role for the lysozyme synthesis of macrophages in granuloma.     

IMMUNOHISTOCHEMICAL OBSERVATION OF LYSOZYME IN MACROPHAGES AND GIANT CELLS IN HUMAN GRANULOMAS

Lysozyme activity of macrophages and giant cells in various human granulomas were examined with immunoperoxidase bridge method in tissue sections. Various numbers of epithelioid cells and giant cells of epithelioid cell granulomas of tuberculosis, sarcoidosis and Crohn's disease exhibited intense granular cytoplasmic lysozyme activity. Foreign body granulomas induced with various substances showed negative or faintly positive lysozyme stain. Macrophages and giant cells of aspergillus granuloma associated with thymus hypoplasia and T-cell depression contained no lysozyme. The results suggest that cell-mediated immunology plays an important role for the lysozyme synthesis of macrophages in granuloma.