Cystic tumors of the liver: on the problems of diagnostic criteria

We report on three cases of cystic neoplasms of the liver with mucinous epithelium. Case 1 showed a low-grade cystic neoplasm with ovarian-like stroma (OS). Case 2 showed a low-grade cystic neoplasm without OS, and case 3 showed a high-grade cystic neoplasm without OS. In all three cases, bile duct communication (BDC) was absent. Currently, pancreatic mucinous cystic neoplasm (MCN) and intraductal papillary mucinous neoplasm of the pancreas (IPMN) are clearly distinguishable. However, MCN of the liver and intraductal papillary neoplasm of the bile duct (IPN-B) are not as easily distinguished. According to the latest WHO classification (2010), these conditions are classed as typical MCN of the liver, MCNs of the liver without OS, or IPN-Bs without BDC. The clinicopathological differences between MCN without OS and IPN-B without BDC are controversial. We present three cases describing these presentations and discuss the difficulties related to the diagnostic criteria used to distinguish between MCN of the liver and IPN-B.     

乳腺粘液囊肿样病变组织病理学及针吸细胞学改变

目的 分析乳腺粘液囊肿样病变的组织病理学及细针吸取（针吸）细胞学特点,寻求在手术前根据针吸细胞学鉴别ＭＬＬ与乳腺粘液腺癌的依据。方法 重新评估７例ＭＬＬ（良性５例,恶性２例）的组织病理学及针吸细胞学材料,并以同期１４例粘液腺癌作对照,比较两种病变在组织学及针吸细胞学上的差异。     

Overview Article: Ultrastructural Features of the Common Epithelial Tumors of the Ovary: Part II

The ultrastructural features of benign and malignant serous, mucinous, and endometrial variants of ovarian carcinoma are presented. Clear cell tumors and Brenner tumors are also discussed.

Where possible, specific electron microscopic features are stressed.     

肾黏液样小管状和梭形细胞癌临床病理分析

目的：探讨肾黏液样小管状和梭形细胞癌(mucinous tubular and spindle cell carcinoma,MTSCC)的临床病理学特征、诊断和鉴别诊断,提高对MTSCC的认识和诊断水平。方法：对2例MTSCC标本进行临床病理分析,并复习相关文献。结果：肿瘤与周围肾组织分界清楚,肿瘤由紧密排列的、小而狭长的小管构成,小管间为淡染的黏液样间质。肿瘤细胞呈立方形和梭形,肿瘤细胞胞质嗜酸性,细胞核圆形或卵圆形,异型性小,核仁不明显,核分裂像少见,在黏液性间质中可见散在淋巴细胞、浆细胞。免疫组织化学显示2例均表达细胞角蛋白(cytokeratin,CK)7,CK18, CK8/18和波形蛋白,Ki-67增殖指数<5%。结论：MTSCC是一种较罕见的低度恶性肿瘤,具有独特的组织学和免疫组织化学特征,明确该肿瘤的形态学特征、诊断和鉴别诊断有重要意义。     

RNF43 is a tumour suppressor gene mutated in mucinous tumours of the ovary

Mucinous carcinomas represent a distinct morphological subtype which can arise from several organ sites, including the ovary, and their genetic characteristics are largely under‐described. Exome sequencing of 12 primary mucinous ovarian tumours identified RNF43 as the most frequently somatically mutated novel gene, secondary to KRAS and mutated at a frequency equal to that of TP53 and BRAF. Further screening of RNF43 in a larger cohort of ovarian tumours identified additional mutations, with a total frequency of 2/22 (9%) in mucinous ovarian borderline tumours and 6/29 (21%) in mucinous ovarian carcinomas. Seven mutations were predicted to truncate the protein and one missense mutation was predicted to be deleterious by in silico analysis. Six tumours had allelic imbalance at the RNF43 locus, with loss of the wild‐type allele. The mutation spectrum strongly suggests that RNF43 is an important tumour suppressor gene in mucinous ovarian tumours, similar to its reported role in mucinous pancreatic precancerous cysts. Copyright © 2012 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.     

卵巢黏液性腺癌的免疫组化研究

目的探讨卵巢原发性黏液性腺癌与转移性黏液性腺癌的组织学和免疫组织化学特点。方法选择已确诊的卵巢原发性黏液性腺癌24例,转移性黏液性腺癌16例(其中胃5例,阑尾5例,结直肠6例)。复习所有病理切片,并进行CK7和CK20免疫组化染色。结果24例卵巢原发性黏液性腺癌CK7均呈弥漫强阳性表达,而CK20仅3例有局灶阳性表达。16例转移性黏液性腺癌中,6例结直肠转移性腺癌和5例阑尾转移性腺癌的CK20均呈弥漫强阳性表达,而CK7则只有1例呈局灶阳性表达;5例胃转移性黏液性腺癌CK7均呈阳性,4例CK20阳性。结论卵巢原发性黏液性腺癌与转移性胃肠道黏液性腺癌具有明显不同的免疫组化特征,CK7和CK20在二者的鉴别诊断中具有重要价值。     

腹膜后苗勒管源性交界黏液囊性肿瘤1例报告

腹膜后苗勒管源性囊性肿瘤临床罕见,好发于盆腔,该病的诊断与治疗尚无统一标准.宁波市第一医院胃肠外科2019年3月收治1例女性腹膜后苗勒管源囊性肿瘤病人,经手术探查和病理学检查确诊,并行手术切除治疗.现报告如下.     

宫颈胃型黏液腺癌的MRI表现

目的 分析宫颈胃型黏液腺癌（GAS）的MRI表现,提高诊断准确率。 方法 回顾性收集12例GAS病人的MRI影像资料,观察肿瘤信号特点、生长部位、生长方式及浸润肌层深度,并绘制动态增强扫描的时间-信号强度曲线（TIC）。 结果 宫颈GAS在MRI上表现为宫颈内生型肿块,其中实性4例,囊实性8例。肿块囊性部分在T₂WI及脂肪抑制（FS）T₂WI上表现为弥漫或簇状分布,大小不一,多位于深肌层。肿块实性成分及囊壁在扩散加权成像上呈高信号,动态增强扫描呈明显持续性强化,11例强化程度高于正常子宫肌层。TIC表现为Ⅱ型11例,Ⅰ型1例。 结论 GAS的MRI影像表现具有特征性,可提供诊断线索。     

组织病理学分型在胰腺导管内乳头状黏液性肿瘤中的临床意义

胰腺导管内乳头状黏液性肿瘤(IPMN)是一类少见的胰腺囊性肿瘤,以胰腺导管上皮细胞乳头状异常增生合并大量黏液产生为特点。IPMN根据累及胰管不同,可以分为主胰管型、分支胰管型及混合型,病理学上表现为腺瘤至浸润癌多种类型。根据细胞形态及表达黏蛋白不同,可以分为胃型、肠型、胰胆管型及嗜酸细胞型。笔者结合既往文献及团队实践经验,分析组织病理学分型在胰腺IPMN中的临床意义,旨在提高外科医师对胰腺IPMN不同组织病理学类型的认识。     

Differentiating autoimmune pancreatitis from pancreatic ductal adenocarcinoma with CT radiomics features

PurposeThe purpose of this study was to determine whether computed tomography (CT)-based machine learning of radiomics features could help distinguish autoimmune pancreatitis (AIP) from pancreatic ductal adenocarcinoma (PDAC).Materials and MethodsEighty-nine patients with AIP (65 men, 24 women; mean age, 59.7 ± 13.9 [SD] years; range: 21–83 years) and 93 patients with PDAC (68 men, 25 women; mean age, 60.1 ± 12.3 [SD] years; range: 36–86 years) were retrospectively included. All patients had dedicated dual-phase pancreatic protocol CT between 2004 and 2018. Thin-slice images (0.75/0.5 mm thickness/increment) were compared with thick-slices images (3 or 5 mm thickness/increment). Pancreatic regions involved by PDAC or AIP (areas of enlargement, altered enhancement, effacement of pancreatic duct) as well as uninvolved parenchyma were segmented as three-dimensional volumes. Four hundred and thirty-one radiomics features were extracted and a random forest was used to distinguish AIP from PDAC. CT data of 60 AIP and 60 PDAC patients were used for training and those of 29 AIP and 33 PDAC independent patients were used for testing.ResultsThe pancreas was diffusely involved in 37 (37/89; 41.6%) patients with AIP and not diffusely in 52 (52/89; 58.4%) patients. Using machine learning, 95.2% (59/62; 95% confidence interval [CI]: 89.8–100%), 83.9% (52:67; 95% CI: 74.7–93.0%) and 77.4% (48/62; 95% CI: 67.0–87.8%) of the 62 test patients were correctly classified as either having PDAC or AIP with thin-slice venous phase, thin-slice arterial phase, and thick-slice venous phase CT, respectively. Three of the 29 patients with AIP (3/29; 10.3%) were incorrectly classified as having PDAC but all 33 patients with PDAC (33/33; 100%) were correctly classified with thin-slice venous phase with 89.7% sensitivity (26/29; 95% CI: 78.6–100%) and 100% specificity (33/33; 95% CI: 93–100%) for the diagnosis of AIP, 95.2% accuracy (59/62; 95% CI: 89.8–100%) and area under the curve of 0.975 (95% CI: 0.936–1.0).ConclusionsRadiomic features help differentiate AIP from PDAC with an overall accuracy of 95.2%.