卵巢成熟性囊性畸胎瘤癌变临床病理分析

目的探讨卵巢成熟性囊性畸胎瘤癌变的临床病理特征。方法对4例成熟性囊性畸胎瘤癌变患临床资料、HE切片及免疫组化结果进行观察分析。结果 4例成熟性囊性畸胎瘤癌变成分均为鳞状细胞癌。结论卵巢成熟性囊性畸胎瘤癌变成分最常见为鳞状细胞癌,病理诊断需与卵巢原发性及继发性鳞状细胞癌、腺癌等进行鉴别。     

卵巢成熟性囊性畸胎瘤合并黏液性交界性肿瘤临床病理观察

目的 探讨卵巢成熟性囊性畸胎瘤合并黏液性交界性肿瘤的临床病理特点、诊断、鉴别诊断及肿瘤发生来源.方法 复习1例卵巢成熟性囊性畸胎瘤合并黏液性交界性肿瘤伴上皮内癌患者的临床资料,行组织学观察和免疫组化分析,并复习相关文献.结果 患者女性,20岁.CT示左侧卵巢巨大、多房、囊实性包块,界限清楚.巨检:肿瘤18.5 cm×17 cm ×7 cm大小,表面光滑,局部破溃,破口处有黏稠的黏液样物流出,切面多房囊实性,囊性部分含黏液样物质,其中一个房内充满皮脂毛发样物;实性部分灰白色,黏滑感.镜检:肠型黏液性上皮细胞呈复层,瘤细胞核大,核分裂象易见,局部腺体共壁或呈筛孔状,间质内未见浸润;其中1个囊腔内衬鳞状上皮,可见毛囊、皮脂腺、汗腺等成分,并可见胃肠型上皮.免疫组化:黏液性上皮CK 7和CK20(+).结论 卵巢成熟性囊性畸胎瘤合并黏液性交界性肿瘤少见,发生上皮内癌变者更为罕见.黏液性交界性肿瘤可能起源于成熟性囊性畸胎瘤的胃肠型上皮成分.     

卵巢囊性成熟型畸胎瘤癌变临床病理观察

目的探讨卵巢囊性成熟型畸胎瘤癌变的临床病理特征、诊断与鉴别诊断、治疗及预后。方法回顾性分析3例卵巢囊性成熟型畸胎瘤癌变患者的临床资料、组织病理形态、免疫组化染色、治疗及随访结果,并回顾相关文献。结果 3例卵巢囊性成熟型畸胎瘤癌变患者,发生在左侧卵巢2例、右侧卵巢1例,平均年龄41.3岁,其中1例为绝经后患者。光镜下肿瘤内可见不同比例的皮肤及其附属器、肠上皮、纤毛柱状上皮、软骨、骨、脂肪及成熟脑组织,例1局部上皮增生伴重度异型增生,排列紊乱,极性消失,部分细胞核明显增大、深染,部分细胞可见核仁或核沟;例2局部见低分化鳞状细胞癌;例3局部见中分化管状腺癌成分。免疫组化染色结果显示:例1,癌变细胞CK5/6、p63、p40均(+),GATA3(+),CK8/18弱(+),Cam5.2(+),CK7和CK20(-),Ki-67约60%(+);例2,癌变细胞CK5/6、p63、p40(+),CK8/18局部弱(+),CK7、CK20、GATA3均(-),Ki-67约70%～80%(+);例3,癌变细胞CK20、CDX-2和Villin均(+),CK7、CK5/6、p63、CA125、PAX-8均(-),Ki-67约40%(+)。结合免疫组化结果,例1为成熟型畸胎瘤伴局部非浸润性尿路上皮癌;例2为成熟型畸胎瘤伴局部低分化鳞状细胞癌;例3为成熟型畸胎瘤伴局部中分化管状腺癌(肠型腺癌)。3例临床分期均为Ⅰ期,其中例2、例3术后给予化疗。例2化疗后随访9年4个月,无复发或转移;例3化疗后随访6年,复发死亡;例1术后未进行其他治疗,术后4个月门诊复查,未见复发或转移,进一步随访中。结论卵巢囊性成熟型畸胎瘤癌变十分少见,掌握其临床病理特征对该病的诊断、鉴别诊断、治疗及预后都有重要意义。     

卵巢良恶性肿瘤的CT诊断

目的：提高卵巢良恶性肿瘤CT诊断的准确性。方法：回顾性分析22例经手术病理证实的卵巢原发性良恶性肿瘤的CT表现，其中13例为成熟性囊性畸胎瘤，9例为粘液囊腺癌。结果：13例成熟性囊性畸胎瘤，单侧10例，双侧3例。10个成熟囊性畸胎瘤肿块内可见脂肪、水样密度，3例见钙化。6个成熟性囊性畸胎瘤肿块为囊实性，其内见“浮球征”。9例粘液性囊腺癌，均为单侧性，6例呈多房性分隔状肿块，4例有囊壁结节。3例呈实性肿块，其内见低密度坏死区。3例并腹膜内转移。囊性多见于卵巢良性肿瘤，实性多见于卵巢恶性肿瘤，囊实性可见于卵巢良、恶性肿瘤。结论：CT对卵巢良恶性肿瘤诊断有重要价值。     

肝成熟性囊性畸胎瘤合并腺癌1例报道并文献复习

目的　报道 1例罕见的成人肝成熟性畸胎瘤腺癌变的临床病理特点。方法　进行临床病理和免疫组化分析 ,并结合文献讨论其诊断与鉴别诊断。结果　肝肿瘤大小为 7cm× 4 5cm× 4cm ,切面部分囊性 ,部分实性。组织学上具有上皮、肌肉、软骨、脑组织等。部分腺上皮发生腺癌变。免疫组化示癌变组织CEA、p5 3、nm2 3、CK2 0、MDR、GST π等强 ( )。结论　成人肝成熟性囊性畸胎瘤非常罕见 ,腺癌变文献上还未见报道。癌细胞p5 3强阳性提示本例癌变与抗癌基因的突变有关     

椎管内脊膜瘤的MRI诊断

目的：探讨椎管内脊膜瘤的MRI诊断及鉴别诊断。材料与方法：回顾性分析16例经手术和病理证实的椎管内脊膜瘤,观察其发病部位、边缘形态、信号特点、邻近结构情况及增强表现。结果：16例患者,男6例,女10例,年龄16-68岁,平均47岁。发病部位依次为上胸段8例、颈段6例、胸腰段2例,腰段1例,15位于髓外硬膜下,1例同时累及髓外硬膜内、外。髓外硬膜下脊膜瘤9例呈半圆形,6例呈椭圆形,脊髓受压移位,15例位于硬膜外肿瘤均可见＂硬膜下＂征;1例同时累及髓外硬膜内、外的脊膜瘤呈不规则形。于T1加权像呈等信号6例,略低信号7例,等、低混杂信号3例;T2加权像呈等信号5例.略高信号10例,等、高混杂信号1例。注射Gd-DTPA后14例呈较均质性强化,2例呈不均质性强化,可见＂硬膜尾＂征。结论：MRI能够对椎管内脊膜瘤较准确定位;根据肿瘤的信号特点、肿瘤与硬脊膜的关系及强化特点,一般能够达到术前定性诊断。     

胃壁成熟性囊性畸胎瘤并腺癌临床分析

目的报道1例罕见的成人胃壁成熟性囊性畸胎瘤合并腺癌的临床病理特点。方法进行临床病理、免疫组化及基因检测分析,并结合文献讨论其诊断及鉴别诊断。结果胃肿瘤大小为14 cm×10 cm×9 cm,切面部分囊性,部分实性。组织学上具有上皮、皮脂腺、软骨等,部分腺上皮发生癌变。免疫组化在癌变组织中示:CEA、p53、CDX-2、CK7、Villin、Ki-67约(15%);基因检测示K-ras突变。结论发生于胃壁的畸胎瘤少见,发生于老年、男性且恶变者更为罕见。癌细胞p53强阳性提示本例癌变与抗癌基因的突变有关。K-ras突变。     

卵巢成熟性囊性畸胎瘤合并类癌2例临床病理观察

目的探讨卵巢成熟性囊性畸胎瘤合并类癌的临床病理特征。方法观察和分析2例卵巢成熟性囊性畸胎瘤合并类癌病例的病理组织学及免疫表型的特点,并结合相关文献进行讨论。结果 2例卵巢类癌均伴有成熟性囊性畸胎瘤成分,例1为妊娠合并卵巢畸胎瘤,类癌成分呈岛状、巢团状生长;例2畸胎瘤合并卵巢甲状腺肿类癌,镜下甲状腺组织与类癌相互交织,类癌呈梁索状、岛状生长;2例瘤细胞核呈典型"胡椒盐样",染色质细腻,核分裂不明显。免疫组化:Cg A、Syn、CD56和CK均(+);例2类癌区CK19(+),TTF-1(-)。结论病理形态学观察和免疫组化染色有助于明确诊断。卵巢类癌预后较好。     

卵巢囊性成熟型畸胎瘤癌变临床病理观察

目的探讨卵巢囊性成熟型畸胎瘤癌变的临床病理特征。方法回顾性分析3668例卵巢成熟型畸胎瘤,对其中18例卵巢囊性成熟型畸胎瘤癌变患者的临床病理资料进行分析。结果 18例囊性成熟型畸胎瘤癌变占同期3668例卵巢畸胎瘤的0.49%。患者年龄27～86岁,平均51.4岁。临床主要表现为盆腔包块,畸胎瘤最大径3～20 cm,平均10.76 cm。肿瘤位于左侧卵巢6例,右侧卵巢12例。恶变成分为鳞状细胞癌8例、腺癌7例、类癌2例、甲状腺乳头状癌1例。临床分期:ⅠA期14例,ⅡA期1例,IIIC期2例,IV期1例。15例获得随访,随访期间1例复发,4例死亡,其余均存活。结论卵巢囊性成熟型畸胎瘤癌变发生率低,发病年龄以绝经后妇女为主,组织学类型以鳞状细胞癌最为多见,Ⅰ期患者预后较好。     

甲状腺内鳃裂囊肿3例临床病理学观察

目的探讨甲状腺内鳃裂囊肿的临床病理特征、诊断与鉴别诊断。方法对3例甲状腺内鳃裂囊肿的临床表现、组织形态等进行观察,并复习相关文献。结果 3例患者年龄分别为64、62及39岁,均无不适主诉,为体检发现。病变最大径分别为1、0.8和0.7 cm。肉眼均为质地偏软的灰粉色结节,其中1例可见囊性区。镜下可见病变为一囊性区,囊壁内衬复层鳞状上皮或假复层柱状上皮,纤维囊壁内有大量淋巴样组织并形成淋巴滤泡。结论甲状腺内鳃裂囊肿非常罕见,临床很容易误诊或漏诊,明确诊断需要借助组织病理学检查,手术彻底切除是唯一有效的根治方法。     

卵巢成熟囊性畸胎瘤并蒂扭转的CT表现

目的:探讨CT对卵巢成熟囊性畸胎瘤并蒂扭转的诊断价值.方法:回顾性分析9例经手术病理证实的卵巢成熟囊性畸胎瘤并蒂扭转的CT表现.结果:9例共10个卵巢成熟囊性畸胎瘤,其中9个出现蒂扭转,平均最大径8.9 cm,6例出现扭转的蒂部与肿瘤形成的囊实性双肿块,7例囊壁增厚,肿瘤内不规则片状出血2例,输卵管增粗5例.结论:CT可在术前诊断卵巢成熟囊性畸胎瘤或并蒂扭转.     

产前超声对胎儿骶尾部畸胎瘤的诊断价值

目的探讨胎儿骶尾部畸胎瘤产前超声表现及超声诊断价值。 方法对2000年2月至2015年11月在解放军总医院产前超声检查及剖宫产娩出后手术病理检查证实骶尾部畸胎瘤的15例胎儿的超声病理资料进行回顾性分析。 结果15例胎儿产前超声表现：（1）8例胎儿骶尾部肿瘤大小（4.3±2.7）cm,其内以囊性为主回声5例、囊实混合性回声2例、实性为主回声1例,其内见钙化样强回声7例,未见钙化样强回声1例;肿瘤内均未见明显血流信号;超声诊断畸胎瘤Ⅰ型1例、Ⅱ型1例、Ⅲ型3例、Ⅳ型3例;手术病理均诊断为成熟性畸胎瘤。（2）7例胎儿骶尾部肿瘤大小（11.6±5.1）cm,其内均以实性回声为主;多血供5例,少血供2例;7例均可见钙化样强回声分散于低回声内;合并羊水过多5例;超声诊断畸胎瘤Ⅰ型2例、Ⅱ型3例、Ⅲ型1例、Ⅳ型1例;手术病理均诊断为未成熟性畸胎瘤。 结论产前超声可显示胎儿骶尾部畸胎瘤的部位、大小、内部回声、血流信号及其与周围脏器的关系,产前超声正确诊断对胎儿预后判断及分娩方式的选择有重要参考价值。     

小儿骶尾部畸胎瘤的MR诊断

目的探讨小儿骶尾部畸胎瘤的MR表现,评价MR的诊断价值。方法对15例经MR检查的患儿,进行回顾性分析。结果其中2例患儿肿瘤位于臀部生长．以囊性为主,呈圆形或椭圆形,内可见分隔,并可见脂肪信号,增强扫描可见囊壁及间隔强化;1例肿瘤全部位于盆腔内生长,呈囊实性混杂信号,增强可见实性部分、囊壁及间隔明显不均匀强化;12例可见肿瘤瘤体大部分位于盆腔内,小部分位于臀部生长,瘤内以囊性为主的囊实性混杂信号,增强扫描性实性部分囊壁及间隔有强化。结论MR检查能准确的显示小儿骶尾部畸胎瘤的位置和形态,有助于骶尾部畸胎瘤的诊断和良恶性的鉴别,并可以帮助临床选择合适的手术方式,对该病的诊断和治疗有重要意义。     

脊柱软骨肉瘤的影像表现及少见表现探讨

目的:探讨脊柱软骨肉瘤的CT和MRI影像表现,以提高对该肿瘤的认识。方法:对33例经病理证实的脊柱软骨肉瘤的影像表现与病理结果进行对照分析,探讨分析其影像表现。结果:脊柱软骨肉瘤患者共33例,其中男17例,女16例,平均年龄(41.4±11.6)岁。颈胸椎、腰椎及骶椎分别为25例、5例和3例,分别占75.8%、15.2%和3%。病变位于脊柱、脊柱旁和椎管内的分别为22例、9例和2例,分别占66.7%、27.3%和6%。19例可见骨破坏,14例骨破坏不明显,分别占57.6%和42.4%。骨破坏位于椎体、附件、椎体和附件均累及的分别占15.1%、27.3%、42.4%。15例肿瘤呈外生性生长,占45.5%,29例合并椎旁软组织肿块。15例骨破坏程度与软组织肿块不成比例。24例肿瘤伴钙化,钙化形态多样,呈点状(9例,37.5%)、环状(2例,8%)或不规则形(13例,54.1%)。病理检查结果显示普通型26例、间叶型5例、透明型1例、去分化型1例。结论:脊柱软骨肉瘤主要位于颈胸椎,腰骶椎少见;伴或不伴骨破坏;肿瘤以椎体和附件均累及多见,位于椎体及椎管内的少见,肿瘤可呈外生性生长,椎旁软组织肿块及钙化的多见。     

Significance of the solid component in predicting malignancy in ovarian cystic teratomas: diagnostic considerations.

OBJECTIVE: To determine whether gray scale characteristics of the solid components of cystic ovarian teratomas exist that could differentiate more common benign forms from malignant variants. METHODS: We retrospectively reviewed the sonographic images of 188 ovarian teratomas that contain at least a 25% cystic component and correlated the images with the final diagnosis. Features of the solid component assessed included its echo texture, overall appearance, shape, size, and internal homogeneity. RESULTS: One-hundred seventy-seven teratomas were benign, and 11 were malignant; among the malignant masses, 7 were high grade. Of the benign forms, 155 solid components (88%) were hyperechoic, 168 (95%) were focal in appearance, 105 (59%) were nodular in shape, and 123 (69%) were uniformly solid. Of the malignant types, 9 solid components (82%) were isoechoic, 6 (55%) had branching, 6 (55%) were irregular in shape, and 8 (73%) were uniformly solid. Five malignant teratomas (45% overall and 71% of high-grade subtypes) had branching isoechoic components. Only 2 benign teratomas (1%) had isoechoic components that branched. CONCLUSIONS: The presence of a branching isoechoic component in a cystic ovarian teratoma may suggest malignancy.     

Extratesticular gliomatosis peritonei after mesenteric teratoma: a case report and literature review

Mesenteric teratoma is a rare extragonadal teratoma. Gliomatosis peritonei (GP) is mature glial tissue implanted into the peritoneum''s surface and is mainly accompanied by ovarian teratoma. Only a few cases of gliomatosis have occurred in the extraperitoneum. We present a rare case of a 3-year-old boy who presented with extratesticular GP after excision of an immature mesenteric teratoma at 2 months old. After the extratesticular mass was excised, we found ductile tissue on the surface of the terminal spermatic cord and epididymis. Some ductile tissue of the epididymis was removed and sent to a laboratory for a pathological examination. The mass and the ductile tissue of the epididymis had a hard consistency. The pathological diagnosis was extratesticular gliomatosis. Complete surgical resection of the teratoma and GP is helpful for identifying the presence of malignant lesions and for preventing malignant transformation. However, characteristics of GP lesions are extensive and they are difficult to completely remove. Moreover, GP is usually benign. Therefore, the residual GP tissue was not completely removed in our case. The child is still in good health, but requires lifelong follow-up. In conclusion, we report our experience of a rare case of extraperitoneal GP from an extragonadal teratoma.     

A case of thyroid-type papillary carcinoma derived from ovarian mature cystic teratoma, resected by laparoscopic surgery

Follicular variant thyroid-type papillary carcinoma (FVTPC) arising from thyroid tissue in mature cystic teratoma of the left ovary is extremely rare, and it is not easy to diagnose preoperatively. However, with reports of an early postoperative death, we must prudently select the strategy for this lesion. A 50-year-old woman had a uterine fibroid with hypermenorrhea and a left ovarian tumor measuring approximately 8 cm diameter. Serum thyroid-stimulating hormone level was within the normal limit. A laparoscopic hysterectomy and left salpingo-oophorectomy were performed. During surgery, there were no signs of invasion or metastasis, and there was no spillage in the abdomen. On histopathological examination of the left ovary, we diagnosed FVTPC arising from thyroid tissue in mature cystic teratoma of the left ovary. FVTPC in ovarian struma is a rare malignant transformation. We must be aware of the possibility of such a rare malignant disease when treating teratoma laparoscopically.     

Cystic ovarian teratoma with intracystic floating globules

Ovarian cystic teratomas are cystic fatty tumors that are often found in patients of reproductive age, and the diagnosis can be easily made radiologically. We present a case of postmenopausal ovarian cystic teratoma with an unusual radiologic appearance of intracystic floating globules.