第116例进行性眼肌麻痹-牙龈肿痛-急性肾衰竭

病历摘要 患者男,50岁,因复视3 d伴左侧牙龈疼痛入院.患者3 d前无明显诱因下出现复视,自觉右上眼睑上抬困难,无晨轻暮重,无头痛、头晕,无发热恶寒,无恶心呕吐.同时自觉左侧下牙龈部疼痛,波及左面颊部,服用布洛芬后症状有改善.     

疑难病例析评 第116例 进行性眼肌麻痹-牙龈肿痛-急性肾衰竭

患者男，50岁，因复视3d伴左侧牙龈疼痛入院。患者3d前无明显诱因下出现复视，自觉右上眼睑上抬困难，无晨轻暮重，无头痛、头晕，无发热恶寒，无恶心呕吐。同时自觉左侧下牙龈部疼痛，波及左面颊部，服用布洛芬后症状有改善。既往有糖尿病史1年。入院查体：体温37．3℃，脉搏760次／min，呼吸14次／min，血压140／90mm Hg（1mm Hg=0．133kPa）。神清，左下牙龈红肿，全身浅表淋巴结未及肿大，双肺呼吸音清，未闻及干湿啰音。     

肾混合性上皮间质肿瘤和成人囊性肾瘤的临床病理学观察

Objective To study the clinicopathologie features,immunophenotype and differential diagnosis of mixed epithelial and stromal tumor of kidney ( MEST) and adult cystic nephroma ( CN).Methods Five cases of MEST and 4 cases of CN were retrospectively analyzed.Immunohistochemical study was carried out and the literature was reviewed.Results All of the five patients with MEST were females.Their median age was 45 years.For CN,there were 3 males and 1 female and their median age was 41 years.All patients presented with loin pain and hematuria.On gross examination,MEST was well-circumscribed but non-encapsulated.There was no evidence of haemorrhage or necrosis.Three of the cases were solid in nature.One was composed of a mixture of solid and cystic elements,while the remaining case showed a multicystic cut surface bridged by thick fibrous septa.On the other hand,CN were well-circumscribed and encapsulated.They were multiloculated cystic in nature.The cystic spaces were separated by thin septa and there was no significant solid or necrotic component.Histologically,MEST consisted of proliferation of cystically dilated glands admixed with spindly stromal cells with various cellularity and growth patterns.Both the glandular and stromal elements were well-differentiated with no cytologic atypia identified.The glandular structures in 2 of the cases were partially lined by endometrial or tubal epithelium.In contrast,the thin-walled cystic spaces in CN were lined by a single layer of epithelium.Immunohistochemical　study showed that the epithelial cells were positive for pan-cytokeratin and epithelial membrane antigen.The spindle cells in MEST expressed vimentin (5/5 ) ,smooth muscle actin (3/5 ),desmin (4/5 ),CD10 (5/5),estrogen receptor (4/5) and progesterone receptor (4/5).They were negative for HMB45,CD34,CD117 and S-100 protein.On the other hand,the spindle cells in CN were variably positive for vimentin (4/4),smooth muscle actin (4/4),desmin (1/4),estrogen receptor (3/4) and progesterone receptor (1/4).They were negative for CD10,HMB45,CD34,CD117 and S-100 protein.Conclusions Both MEST and CN are uncommon renal neoplasm.Most of them run a benign clinical course.The stromal cells in MEST show smooth muscle or myofibroblastic differentiation.Areas demonstrating Miillerian features also existed in some cases.MEST and CN share overlapping histological and immunohistochemical features,and may represent spectrum of the same group of lesions.     

肾混合性上皮间质肿瘤和成人囊性肾瘤的临床病理学观察

Objective To study the clinicopathologie features,immunophenotype and differential diagnosis of mixed epithelial and stromal tumor of kidney ( MEST) and adult cystic nephroma ( CN).Methods Five cases of MEST and 4 cases of CN were retrospectively analyzed.Immunohistochemical study was carried out and the literature was reviewed.Results All of the five patients with MEST were females.Their median age was 45 years.For CN,there were 3 males and 1 female and their median age was 41 years.All patients presented with loin pain and hematuria.On gross examination,MEST was well-circumscribed but non-encapsulated.There was no evidence of haemorrhage or necrosis.Three of the cases were solid in nature.One was composed of a mixture of solid and cystic elements,while the remaining case showed a multicystic cut surface bridged by thick fibrous septa.On the other hand,CN were well-circumscribed and encapsulated.They were multiloculated cystic in nature.The cystic spaces were separated by thin septa and there was no significant solid or necrotic component.Histologically,MEST consisted of proliferation of cystically dilated glands admixed with spindly stromal cells with various cellularity and growth patterns.Both the glandular and stromal elements were well-differentiated with no cytologic atypia identified.The glandular structures in 2 of the cases were partially lined by endometrial or tubal epithelium.In contrast,the thin-walled cystic spaces in CN were lined by a single layer of epithelium.Immunohistochemical　study showed that the epithelial cells were positive for pan-cytokeratin and epithelial membrane antigen.The spindle cells in MEST expressed vimentin (5/5 ) ,smooth muscle actin (3/5 ),desmin (4/5 ),CD10 (5/5),estrogen receptor (4/5) and progesterone receptor (4/5).They were negative for HMB45,CD34,CD117 and S-100 protein.On the other hand,the spindle cells in CN were variably positive for vimentin (4/4),smooth muscle actin (4/4),desmin (1/4),estrogen receptor (3/4) and progesterone receptor (1/4).They were negative for CD10,HMB45,CD34,CD117 and S-100 protein.Conclusions Both MEST and CN are uncommon renal neoplasm.Most of them run a benign clinical course.The stromal cells in MEST show smooth muscle or myofibroblastic differentiation.Areas demonstrating Miillerian features also existed in some cases.MEST and CN share overlapping histological and immunohistochemical features,and may represent spectrum of the same group of lesions.     

初始表现为T淋巴母细胞性淋巴瘤并伴PDGFRA重排的髓系/淋系肿瘤1例

伴PDGFRA、PDGFRB或FGFR1重排或PCM1-JAK2及嗜酸性粒细胞增多的髓系/淋系肿瘤,是2016版WHO淋巴造血系统肿瘤分类中的独立疾病类型。在这一类别中,共同的特征是融合基因的形成导致异常酪氨酸激酶的表达。其中,伴有PDGFRA重排的髓系/淋系肿瘤是最常见的肿瘤类型。现报道1例罕见的以T淋巴母细胞性淋巴...     

肾混合性上皮间质肿瘤和成人囊性肾瘤的临床病理学观察

Objective To study the clinicopathologie features,immunophenotype and differential diagnosis of mixed epithelial and stromal tumor of kidney ( MEST) and adult cystic nephroma ( CN).Methods Five cases of MEST and 4 cases of CN were retrospectively analyzed.Immunohistochemical study was carried out and the literature was reviewed.Results All of the five patients with MEST were females.Their median age was 45 years.For CN,there were 3 males and 1 female and their median age was 41 years.All patients presented with loin pain and hematuria.On gross examination,MEST was well-circumscribed but non-encapsulated.There was no evidence of haemorrhage or necrosis.Three of the cases were solid in nature.One was composed of a mixture of solid and cystic elements,while the remaining case showed a multicystic cut surface bridged by thick fibrous septa.On the other hand,CN were well-circumscribed and encapsulated.They were multiloculated cystic in nature.The cystic spaces were separated by thin septa and there was no significant solid or necrotic component.Histologically,MEST consisted of proliferation of cystically dilated glands admixed with spindly stromal cells with various cellularity and growth patterns.Both the glandular and stromal elements were well-differentiated with no cytologic atypia identified.The glandular structures in 2 of the cases were partially lined by endometrial or tubal epithelium.In contrast,the thin-walled cystic spaces in CN were lined by a single layer of epithelium.Immunohistochemical　study showed that the epithelial cells were positive for pan-cytokeratin and epithelial membrane antigen.The spindle cells in MEST expressed vimentin (5/5 ) ,smooth muscle actin (3/5 ),desmin (4/5 ),CD10 (5/5),estrogen receptor (4/5) and progesterone receptor (4/5).They were negative for HMB45,CD34,CD117 and S-100 protein.On the other hand,the spindle cells in CN were variably positive for vimentin (4/4),smooth muscle actin (4/4),desmin (1/4),estrogen receptor (3/4) and progesterone receptor (1/4).They were negative for CD10,HMB45,CD34,CD117 and S-100 protein.Conclusions Both MEST and CN are uncommon renal neoplasm.Most of them run a benign clinical course.The stromal cells in MEST show smooth muscle or myofibroblastic differentiation.Areas demonstrating Miillerian features also existed in some cases.MEST and CN share overlapping histological and immunohistochemical features,and may represent spectrum of the same group of lesions.     

血管内NK/T细胞淋巴瘤二例

血管内NK/T细胞淋巴瘤（intravascular NK/T?cell lymphoma,IVNKTL）是一种具有NK/T细胞免疫表型的血管内淋巴瘤,临床罕见。IVNKTL与EB病毒感染相关,临床呈高度侵袭性,与另一种EB病毒相关的结外NK/T细胞淋巴瘤,鼻型（extranodal NK/T?cell lymphoma,nasal type,ENKTCL）相似……     

精囊囊腺瘤1例报告并文献复习

目的:探讨精囊囊腺瘤的临床表现、病理特点和诊治方法。方法:对1例精囊囊腺瘤进行临床分析并结合文献复习,从临床表现、病理特点、诊治方法及疗效方面总结。结果:患者行连同肿瘤的精囊切除,病理报告符合精囊囊腺瘤,术后3个月超声、CT检查,未见肿瘤复发。结论:精囊囊腺瘤临床少见,易漏诊。常规直肠指检很必要,超声、CT有利于明确诊断。一般连同肿瘤的精囊切除即可,预后良好。     

肾脏平滑肌肉瘤的影像学诊断（附二例报告）

肾脏平滑肌肉瘤的影像学诊断（附二例报告）蔡锡类高广如陈峰王照明柳靖肾脏平滑肌肉瘤非常少见，约占恶性肾肿瘤的２％～３％，但在肾肉瘤中是最多见的一种［１］。国内外文献多为个案报道，有关Ｂ超、ＣＴ或ＭＲＩ检查者则更少［２］。最近我们遇见２例，经手术和病理证...     

TGF-β_1及细胞外基质在主动型Heymann肾炎病变中的定量研究

目的　探讨TGF- β1 及细胞外基质在不同病变阶段主动型Heymann 肾炎肾小球内的表达情况。方法　建立AHN 模型, 用免疫组化SP法检测TGF- β1 及纤维连接蛋白、IV 型胶原在不同病变阶段Heymann 肾炎大鼠肾小球内的表达并用计算机图像分析系统进行定量分析。结果　自AHN 诱发后第4 周开始, 随TGF- β1 表达的上调, AHN 大鼠肾小球内细胞外基质成分纤维连接蛋白、IV 型胶原的含量也增加, 并随病变进展而明显增多。结论　TGF- β1 可能通过刺激AHN 大鼠肾小球上皮细胞产生过量细胞外基质而介导了AHN 病变的发生及发展