胸腺巨大类癌一例

患者男 ,6 1岁。因无明显诱因出现咳嗽、咳白粘痰 1个月而就诊 ,于 2 0 0 0年 2月 2 0日入院。ＣＴ检查示左上纵膈有一 2 5ｃｍ× 2 0ｃｍ巨大肿块 ,突向左侧胸腔。术中所见 :肿块大小约 2 5ｃｍ× 2 0ｃｍ× 2 0ｃｍ ,位于左上前纵膈 ,源于胸腺左下极 ,肿块包膜完整 ,血运丰富。病理检查 :椭圆形肿物约 2 5ｃｍ× 2 0ｃｍ× 10ｃｍ ,包膜完整 ,切面灰白暗红相间 ,质嫩 ,鱼肉状 ,部分呈囊性 ,重 1ｋｇ。镜下检查 :肿瘤由较单一的小圆细胞组成 ,瘤细胞核小而规则 ,圆或卵圆形 ,胞质少到中量 ,淡嗜碱性。瘤细胞排列成不规则巢状 ,梁索状 ,癌细…     

双侧卵巢原发性类癌1例

患者女，４５岁。左侧卵巢肿瘤切除术后８年，月经量增多２年。临床检查：子宫增大至１０ｃｍ×９ｃｍ×７ｃｍ，质地较硬，活动受限，盆腔可触及一个直径约４ｃｍ肿物，质地中等，表面光滑。手术所见：子宫４ｃｍ×１６ｃｍ×１０ｃｍ，可触及２个肿物；左侧卵巢缺如，右...     

原发性睾丸类癌一例

患者男 ,4 5岁。因睾丸肿大就诊。患者自 2 0年前即发现右侧睾丸较左侧稍大 ,以后逐渐长大 ,平卧与站立无变化 ,无下坠感或疼痛 ,未加注意。于 2 0 0 2年 3月 7日入院治疗。外科体检 :右侧睾丸肿大 ,约 8cm× 6cm× 5cm。质硬 ,有沉重感 ,无触痛 ,透光试验阴性。手术所见 :鞘膜内有少许淡黄色澄清液体。右睾丸肿大 ,质硬 ,将右侧睾丸完整切除。病理检查 :切除的睾丸及其周围的组织 ,总体积 7 0cm× 5 2cm× 4 5cm ,睾丸体积 6cm× 5cm× 4cm。正常睾丸组织结构完全被肿瘤替代包在鞘膜内 ,副睾亦消失 ,质稍韧。切面 ,肿瘤呈灰白夹淡黄色 ,…     

马蹄肾合并肾类癌一例

患者男 ,4 3岁。无明显诱因出现右腰部疼痛 2个月余 ,为持续性 ,无放射 ,亦无尿频、尿急、尿痛、血尿或排尿困难。1个月后出现右下肢运动障碍。当地医院行头颅ＣＴ检查示“左额脑膜瘤” ,并行“左额叶肿瘤切除术” ,术后病理诊断为“转移性腺癌”。行全身检查发现“马蹄肾并右肾内占位”。为进一步治疗于 2 0 0 0年 7月 2 5日入我院。体检 :ＢＰ 12 8/ 83ｍｍＨｇ,心肺正常。ＣＴ检查示双肾皮质相连 ,肾盂指向前腹壁 ,右肾增大约为 9ｃｍ× 8ｃｍ ,呈囊性 ,其内见钙化及附壁结节。腹膜后淋巴结肿大。同位素扫描示左肾无功能 ,右肾占位 ,功能…     

异位胸腺类癌1例

异位胸腺类癌１例沈世明１临床资料患儿男性，４岁。因左颈前发现无痛性肿块５ｄ入院。患儿５ｄ前无意中被其父母发现左侧颈部肿块，触之轻度疼痛，经Ｂ超提示为左侧甲状腺腺瘤。体检：颈软，气管居中，左颈动脉内侧可触及２ｃｍ×２ｃｍ肿块，表面光滑，活动可，不随吞咽...     

肺透明细胞类癌一例

患者男 ,45岁。于入院前 1个月体检时发现右肺上叶有一圆形肿物 ,伴乏力、咳嗽 ,于 1999年 12月 12日入白求恩医科大学第二临床医院。胸部Ｘ线及ＣＴ检查示右肺上叶后段可见一约 3 .0ｃｍ× 2 .5ｃｍ大小类圆形肿物 ,其内密度不均。5年前有肺结核病史。临床诊断 :右肺上叶后段结核瘤。术中见肿物约 5 .0ｃｍ× 5 .0ｃｍ× 4.0ｃｍ ,位于右肺上叶 ,靠近中心 ,行右肺上叶切除术。病理检查 :右肺上叶体积 15ｃｍ× 6ｃｍ× 5ｃｍ ,距支气管断端切缘 1.0ｃｍ处见一圆形肿物 ,直径 5 .0ｃｍ ,位于肺叶边缘 ,肿物与周围肺组织界限清晰 ,无包膜 ,切…     

食管不典型类癌二例

例 1,男 ,76岁。因进行性吞咽困难 2个月 ,加重 2周于1998年 2月 10日入院。体检 :一般情况尚可 ,全身浅表淋巴结未及肿大 ,心肺无异常 ,腹软 ,未及包块。血生化检查(- )。胃镜检查 :食管下段溃疡型肿块 ,约 3 0ｃｍ× 2 5ｃｍ大小 ,行剖胸食管肿瘤切除术。病理检查 :食管一段 ,长 7ｃｍ ,最大周径 9 5ｃｍ ,距上切缘 1 5ｃｍ、下切缘 2 5ｃｍ处见一肿块 ,大小 3ｃｍ× 2ｃｍ ,表面见溃疡形成 ,深 0 5ｃｍ ,肿块切面灰白色 ,质中 ,未突破外膜层。食管旁 3枚灰黑色豌豆大小淋巴结。镜下观察 :细胞形态较一致 ,细胞中等稍小 ,呈中度异型 ,…     

6例胃类癌临床病理回顾性分析

６例胃类癌临床病理回顾性分析１＊汪露祥２＊袁松３陈向红＊安徽医科大学附院病理科进修医师作者单位１黄山市人民医院病理科，屯溪２４５０００２西藏林芝地区医院病理科８６００００３安徽医科大学病理学教研室，合肥２３００３２胃类癌较少见，约占胃肿瘤的０．３％，...     

肺类癌伴眼球转移一例

患者女，16岁，因间歇性咳嗽、痰中带血3年，加重1个月于1999年1月22日入院。胸片及CT示右肺中间支气管占位伴远端阻塞性肺不张，纤维支气管镜插检病理诊断：提示类癌．行右中下肺叶切除术。     

阑尾类癌并粘液囊肿1例

阑尾类癌并粘液囊肿１例张德良曹荣至患者女，１７岁。右下腹疼痛反复发作１年，近来加重。拟诊为慢性阑尾炎急性发作收入院。剖腹探查见回盲部有一约６．５ｃｍ×３．５ｃｍ×２．５ｃｍ大的长条状肿物，表面灰黄色，与大网膜粘连，已看不到阑尾的完整形态，切除肿块，送...     

Lectin expression in carcinoid tumours of the gastrointestinal tract

The binding of peroxidase-conjugated Dolichos biflorus (DBA), Triticum vulgaris (WGA), Canavalia ensiformis (Con A), Arachis hypogaea (PNA), Lotus tetragonolobus, and Bandeiraea simplicifolia I (BSAI) to gastrointestinal carcinoid tumours was studied. The results indicate that carcinoid tumour cells express certain carbohydrates similar to those present in the adjacent surface epithelium. The differences in the lectin-binding properties of carcinoid tumours of different sites of the gastrointestinal tract are closely related to the regional differences in the lectin binding of adjacent surface epithelium. These observations therefore form a useful basis for further studies in the application of lectin histochemistry to elucidate the histogenesis of carcinoid tumours.     

胃肠道钙化性纤维性肿瘤临床病理分析

目的探讨胃肠道钙化性纤维性肿瘤(calcifying fibrous tumor,CFT)的临床病理学特征、免疫表型、诊断及鉴别诊断。方法回顾性分析7例胃肠道CFT的临床病理学及免疫表型特征,并复习相关文献。结果 7例患者中,男性2例,女性5例。发病部位:胃4例、小肠2例、直肠1例。临床表现:发生于胃的患者主要为上腹痛,发生于小肠的1例患者出现肠套叠,其余为体检或手术偶然发现,大体为黏膜下直径0.7~4 cm包块。镜下见肿瘤边界清晰,主要由丰富的透明变性的胶原纤维构成,呈漩涡状、束状及席纹状排列,肿瘤细胞呈梭形,无细胞异型性及核分裂象;7例均可见散在分布的砂砾体及多少不一的炎细胞浸润,2例可见营养不良性钙化。免疫表型:瘤细胞vimentin阳性,1例CD34局部阳性,1例可见CD117散在阳性细胞,desmin、DOG1、S-100、SMA、H-caldesmon和ALK均阴性,β-catenin胞核阴性,Ki-67增殖指数1%~3%。7例患者6例无复发,1例失访。结论 CFT是一种少见的间叶源性良性肿瘤,发生于胃肠道者临床罕见,临床表现及检查无特异性,特征性的组织学形态较易诊断,但需与其他间叶源性疾病鉴别。     

Endocrine tumours of the gastrointestinal tract-selected topics

This review provides an update on the pathogenesis and histopathological diagnosis of endocrine tumours of the gastrointestinal tract, concentrating on three different varieties whose careful assessment by pathologists is of particular clinical significance. These are the four types of enterochromaffin-like cell tumour of the gastric corpus, the periampullary somatostatin-containing D-cell tumour of the duodenum, and the frequently chromogranin A-negative L-cell tumour of the appendix and large intestine. In addition, the value of pathological factors in predicting the behaviour of gastrointestinal endocrine tumours and selecting therapy is discussed, and the crucial role of the pathologist in the multidisciplinary team management of these neoplasms is emphasized.     

Malignant lymphoma with eosinophilia of the gastrointestinal tract

Lesions of the gastrointestinal tract with massive tissue eosinophilia may present a difficult diagnostic problem. In a series of 250 gastrointestinal lymphomas drawn from the files of St Bartholomew's and St Mark's Hospitals there were 28 cases of a lymphoma with distinctive histological features, characterized by a massive tissue eosinophilia. Two of these tumours were present in the stomach and 26 in the small intestine. Eight of the latter were associated with coeliac disease. On low power examination a zoning phenomenon was regularly seen and fissuring ulceration, with perforation and fistula formation, was a common finding. The tumour cells were large and pleomorphic with irregular nuclear morphology and prominent nucleoli. Eosinophils were the predominant inflammatory cell associated with the lymphoma but plasma cells, epithelioid histiocytes and small lymphocytes were also present. Vascular changes were prominent. Involved lymph nodes showed gross expansion of the paracortex by tumour. Immunohistochemical studies showed that this lymphoma was probably of T-cell origin.     

Multicentric angiosarcoma of the gastrointestinal tract

A case of multlcentrlc gastrolntestinal angiosarcoma suffering from severe melena Is presented. Endoscopical examination revealed two polyps In the stomach and duodenum. Hlstologlcal examlnatlon showed anglosarcoma. Although a gastroduodenectomy was performed, severe melena continued, and the patient developed respiratory failure and died. At autopsy, multlple hemor-rhagic tumors were present from the duodenum to the cecum. Histologically the tumors demonstrated vasofor-matlve structure and were lmrnunohistochemically positive for von Wlllebrand factor (factor Vlll related antigen), CD34, and CD31. Numerous metastases were found In various organs, including the lungs, bones, liver, gall-bladder, and lymph nodes. The patlent had recelved hemodlalysis for 21 years due to chronic renal failure. Long-term dialysis had been associated with various malignancies. Multicentric development of anglosarcoma in the presentcase may also be related to long-term dialysis.     

Viral infections of the gastrointestinal tract

Infectious agents are one of the potential etiologies for the pathologic findings of the gastrointestinal (GI) specimens. Various clinical settings such as general debilitation, infancy or advanced age, immunocompromised state, hematologic malignancies, chemotherapy or diabetes predispose patients to viral infections of the GI tract. Endoscopic evaluation with biopsies are often performed as part of the diagnostic workup of such patients. Considering the site and the pattern of injury along with microscopic recognition of the viral inclusions are essential in identifying the possible cause of injury. The aim of this article is to review the most commonly encountered viral infections of the GI tract in order to provide some guidance in differentiating between the various responsible viral agents and to highlight some of the challenges faced by pathologists in approaching such cases in daily practice.     

Human cytomegalovirus infection of the gastrointestinal tract in apparently immunocompetent patients

Human cytomegalovirus (HCMV) infection is usually reported in immunocompromised patients. This study reports 11 cases of HCMV infection of the gastrointestinal (GI) tract diagnosed in apparently immunocompetent hosts. The median age of the patients studied was 76 years, and the major presenting symptoms were diarrhea, epigastric pain, and abdominal discomfort. The large intestine was involved in 6 cases, the stomach in 4 cases, and the lower esophagus in 1 case. Endoscopy revealed ulcers or hypertrophic folds in the GI tract and single ulcers or erosions in the colon and rectum. Light microscopy showed chronic inflammatory infiltrate in the lamina propria in all cases. The diagnosis of HCMV infection was based on the histological and immunohistochemical identification of HCMV inclusion bodies in different cell types, including epithelial, endothelial, stromal, and smooth muscle cells. Both "classical" inclusions, characterized by an "owl's eye" appearance, and atypical inclusions were found. For all patients, no apparent causes of immunodeficiency were detected at the time of diagnosis of HCMV infection. At follow-up, however, 4 patients were found to harbor a malignant tumor (ie, pancreas, lung, Vater's papilla, and extrahepatic bile duct) at an interval of 2 to 5 months after the diagnosis of HCMV infection. Especially in elderly patients, HCMV infection of the GI tract might be an early clue to the presence of immunologic defects induced by an underlying neoplasia.     

Infections in the gastrointestinal tract that can mimic malignancy

Infections in the gastrointestinal tract can present with the clinical impression of malignancy. These infectious mimics can take on a variety of forms from endoscopically concerning ulcers to large infiltrative masses and may be associated with lymphadenopathy and distant disease that is concerning for metastasis. In such cases, histopathology plays a key role in rendering a diagnosis of infection. In this review, we summarize the common and rare gastrointestinal infectious mimics of malignancy reported in the English medical literature. Microorganisms of all types have been implicated including bacteria, viruses, fungi, and parasites. Common bacterial causes include tuberculosis, actinomycosis, syphilis, and lymphogranuloma venereum. A small number of cases are due to other bacteria such as Helicobacter, Yersinia, α-hemolytic Streptococcus and Rhodococcus. The most common viral mimic of malignancy is cytomegalovirus; however, herpes simplex virus and Epstein-Barr virus have also been reported. Frequent fungal causes include histoplasmosis, mucormycosis and basidiobolomycosis; with a small number of cases due to candidiasis, aspergillosis and paracoccidiomycosis. Parasitic mimics of malignancy are less common. They include mostly protozoal infection such as amebiasis; however, a handful of various helminth infections (anisakiasis, strongyloidiasis, enterobiasis, trichuriasis, schistosomiasis, fascioliasis, echinococcosis) have also been reported. In summary, infectious etiology should be considered in the differential diagnosis of lesions in the gastrointestinal tract that are suspicious for malignancy.