临床病理在颈淋巴结转移性癌原发病灶诊断中的价值——附36例报告

目的探讨临床病理在原发灶不明淋巴结转移癌原发部位诊断中的价值。方法分析本院36例初诊为颈淋巴结“原发灶不明”转移癌诊断过程中，病理形态学结合免疫酶标对指示可能原发部位的作用和准确性。结果36例中，病理明确指出原发部位或高度可能部位者7例，其中，甲状腺髓样癌4例，前列腺癌2例，卵巢癌1例；病理指示可能原发部位，而最终确诊的原发灶与之相符者26例，其中病理提示第一部位者17例；另有3例，病理未能正确指示原发部位。结论病理形态学结合免疫酶标能较准确地指示肿瘤可能的原发部位，从而为临床对转移癌原发病灶的寻找提供帮助。结合临床、放射、病理及其它影像学诊断，建立颈淋巴结转移癌原发部位临床诊断模式是可行的。

The value of clinical pathology in diagnosis of metastatic carcinoma of an unknown primary site in cervical lymph node: 36 cases report

Objective To study the value of clinical pathology in the diagnosis of metastatic carcinoma of unknown primary site in cervical lymph node. Methods Thirty-six cases diagnosed as metastatic carcinoma of unknown primary site in cervical lymph node at first were studied in this series. In the process searching for the primary tumors, morphology and the immunostaining were used to predict the likely primary lesion. Results There were 7 cased whose primary sites were predicted clearly or probably in high level by clinical pathology, including 4 cases of thyroid medullary carcinoma, 2 cases of prostate adenocacinoma and 1 case of ovarian adenocarcinoma . There were 26 cases whose final diagnoses of primary foci were consistent with the siteS indicated by the pathological diagnoses; of them, 17 cases were at the first sites where the pathological diagnoses .predicted . In other 3 cases,the primary sites could not be predicted comedy. Conclusions Pathologic morphology combined with the immunoenzyme technique can help to predict the primary site of cervical metastatic carcinoma of unknown primary site. It is feasible to create a clinicalmodel by combination of clinical manifestations, pathology, radiology and other medical images for the diagnosis of the primary site of metastatic carcinoma in cervical lymph node.