黑色素性副神经节瘤临床病理分析

目的 探讨黑色素性副神经节瘤的临床病理特征及诊断、鉴别诊断要点。方法对2例黑色素性副神经节瘤进行临床病理分析、组织形态学及免疫组织化学染色观察，结合文献进行讨论。结果肿块切面见浅黑色斑纹．两例均显示一般副神经节瘤组织学表现，同时又见肿瘤细胞内含色素颗粒。免疫组织化学染色显示瘤细胞CgA（＋），NSE（＋），Syn（＋），S-100部分支持细胞（＋），CK（-），EMA（-）。例1HMB45（＋）。两例分别随访2、8年，无复发和转移。结论黑色索性副神经节瘤是副神经节瘤中一种少见亚型，瘤细胞内含多少不等的色素颗粒。需与转移性恶性黑色素瘤、类癌和腺泡状软组织肉瘤鉴别。     

腹膜后副神经节瘤6例临床病理分析

目的探讨腹膜后副神经节瘤的临床表现、病理特征及鉴别诊断。方法分析观察6例腹膜后副神经节瘤的临床症状、病理形态、免疫组化、治疗及预后,并进行文献复习。结果本组男性4例,女性2例,年龄20～65岁,平均38岁。以间歇性腹痛、腰痛及阵发性高血压为主要临床表现,有功能者2例。肿瘤体积均较大,镜下肿瘤主要由主细胞和支持细胞组成。免疫组化瘤细胞CgA和Syn弥漫强(+),支持细胞S-100(+)。4例随访12～14个月,均未见肿瘤复发及转移。结论腹膜后副神经节瘤临床经过隐匿,确诊主要靠组织学检查和免疫组化结果,治疗以手术彻底切除为主。     

支气管上皮-肌上皮瘤-附1例报道及文献复习

目的 探讨支气管上皮－肌上皮瘤的病理组织学特点、诊断及鉴别诊断。方法 应用间、免疫组化染色及电镜等方法对１例支气管上皮－肌上皮瘤的手术切除标本进行组织学观察。结果 支气管上皮－肌上皮瘤组织学特点为肿瘤细胞的多样化。免疫组化染色显示ｃｙｔｏｋｅｒａｔｉｎ、Ｓ－１００蛋白、Ｖｉｍｅｎｔｉｎ、ＭＳＡ（ｍｕｓｃｌｅ－ｓｐｅｃｉａｌ ａｃｔｉｎ）等不同程度的阳性反应。电镜下显示瘤细胞胞浆内大量的肌微丝或微丝     

睾丸原发性神经内分泌癌临床病理学观察

目的观察睾丸原发性神经内分泌癌的组织学、免疫表型及影像学特点,探讨其临床病理学特征、诊断及鉴别诊断。方法运用组织学、免疫组织化学技术对1例睾丸原发性神经内分泌癌进行光镜观察及免疫标记,并结合相关文献对其临床表现、影像学、组织形态和免疫组化特点及治疗和预后等进行综合分析。结果患者为52岁老年男性,肿瘤病理组织学表现为瘤细胞大小较一致,以梁状和岛状排列为主;瘤细胞呈多角形,胞质中度嗜酸性,核染色质细颗粒状。免疫组化染色示：瘤细胞CK （＋）、CD56（＋）、Syn （＋）、CgA（＋）,Inhibin（-）、PLAP（-）、AFP（-）。结论原发于睾丸的神经内分泌癌非常罕见,通常不伴有类癌综合征。免疫组化染色有助于该肿瘤的诊断,鉴别诊断包括转移性神经内分泌癌、睾丸畸胎瘤合并类癌、精原细胞瘤、支持细胞瘤等,多数肿瘤可以通过手术切除治愈。     

小脑发育不良性神经节细胞瘤1例及文献复习

目的：探讨小脑发育不良性神经节细胞瘤的临床病理特点，诊断和预后，方法：对1例小脑发育不良性神经节细胞瘤进行光镜，组化和免疫组化观察并结合文献分析。结果：肿瘤由异常的神经节细胞和许多平行排列的有髓纤维构成。网染显示瘤细胞间无网状纤维，免疫组化标记CgA,NF,NSE,Syn和S－100（＋），GFAP（－）。结论：此类肿瘤具有错构瘤和真性肿瘤两者的特征，为良性病变，诊断依赖于MRI，病理组织学和免疫组化。     

心脏副神经节瘤1例并文献复习

目的探讨心脏副神经节瘤的临床病理特征及鉴别诊断。方法对1例心脏副神经节瘤进行组织学观察、免疫组化染色和临床随访,并复习相关文献。结果肿瘤组织呈器官样结构,肿瘤细胞由主细胞及支持细胞构成。免疫组化:肿瘤细胞vimentin、S-100、CD56、CgA、Syn(+),而CK、CD68、GFAP(-),Ki-67阳性指数约5%。术后2年零3个月,无复发。结论心脏的副神经节瘤是罕见的副神经节肿瘤,组织病理学特点结合免疫组化标记有助于该肿瘤的诊断。     

甲状腺玻璃样小梁状腺瘤1例报告并文献复习

目的：探讨甲状腺玻璃样小梁状腺瘤的组织发生、临床病理特征、诊断、鉴别诊断及预后。方法：报道1例罕见的甲状腺玻璃样小梁状腺瘤，并结合文献进行复习。结果：肿瘤由卵圆形或多角形细胞排列成花簇状、束状或小梁状等结构；胞质细颗粒状，嗜酸性或嗜双色性，核卵圆形或长形．染色质细腻，常见核沟及核内包涵体，核分裂罕见；纤维血管间质明显玻璃样变性。免疫组化示甲状腺结合球蛋白（＋），降钙素（-）。结论：该肿瘤具有典型的形态学特征及免疫表型，需与甲状腺乳头状癌、髓样癌、副神经节瘤鉴别。生物学行为良性，手术完整切除预后好，无复发及转移。     

膀胱副神经节瘤2例报告并文献复习

目的 探讨膀胱副神经节瘤的临床病理及免疫组化特征.方法 对2例膀胱副神经节瘤进行组织病理学观察及免疫组化分析并复习文献.结果 2例大体肿物均有完整包膜.镜下肿瘤细胞排列呈巢状及条索状,其中1例伴有鳞状细胞或腺样分化的器官样结构.细胞大小不等,细胞核圆形、椭圆形、梭形,核分裂罕见.瘤细胞巢间有丰富的大、小血窦.免疫组化瘤细胞CgA、Syn、S-100阳性,CK、CK7、HMB45、CEA阴性.结论 膀胱副神经节瘤是较罕见的肿瘤,诊断依赖于组织病理形态及免疫组化.     

鼻咽部髓外浆细胞瘤2例临床病理分析及文献复习

目的：报道2例起源于鼻咽部黏膜下软组织的骨外浆细胞瘤，同时分析其病理形态学特征。方法：对2例鼻咽部髓外浆细胞瘤进行组织形态学和免疫组织化学研究，结论文献对其临床表现，病理形态特点及鉴别诊断进行探讨。结果：2例鼻咽部髓外浆细胞瘤均表现为鼻咽部隆起的肿块，表面不，无破溃，出血，组织学表现为位于鼻咽部位黏膜下软组织中的孤立性病变，组织分布较均匀，局部瘤组织呈器官样，条索状或腺样分布；瘤细胞主要由分化程度不一的浆细胞组成，Russel小体可见，Dutchs小体偶见；免疫组化显示瘤细胞呈免疫球蛋白k链（－）、λ链（＋），EMA（＋）。结论：起源于鼻咽部黏膜下软组织的髓外浆细胞瘤较罕见，易误诊为其他肿瘤，肿瘤常原位复发并演化为多发性骨髓瘤，依据临床和组织学特点，结合免疫组化染色可以作出明确诊断。     

颅内原发性内胚窦瘤6例临床病理观察

目的 研究颅内原发性内胚窦瘤（EST）的临床病理特点，探讨其组织发生。方法 临床资料分析及运用组织学、组化、免疫组化（ABC或S－P法）和电镜观察6例颅内原发性EST及伴有EST的生殖细胞肿瘤。结果 6例EST及伴有EST的生殖细胞肿瘤中，男性5例，女性1例，年龄5－16岁，平均10岁，临床以颅内高压为主要症状。EST组织学特点：疏松网状结构、嗜酸性透明小球及基膜样物形成、腺泡状和腺管状结构，部分伴有“血管套”结构、多囊性卵黄囊结构。免疫组化：瘤细胞AFP、CEA和α－1－抗胰蛋白酶（＋）。电镜观察最有特征性的是瘤细胞内外有大量高电子密度圆形物质，瘤细胞外可见无定形基底膜样物质。随访的4例患者3－10个月内死亡，1例术后7年复发。结论 颅内原发性EST及伴有EST的生殖细胞肿瘤多见于男性，好发于青少年，多位于松果体区、鞍区和第三脑室。颅内原发性EST及伴有EST的生殖细胞肿瘤少见，高度恶性，起源于多能性原始生殖细胞。     

骨髓间充质干细胞向软骨细胞的分化

背景：以骨髓间充质干细胞构建组织工程气管尚缺乏理想的特异性表面标志物,对其鉴定主要依赖细胞形态学、细胞表型及诱导分化的功能进行分析。目的：体外分离培养、鉴定兔骨髓间充质干细胞,观察在特定条件下向气管软骨细胞分化的潜能。方法：无菌环境取兔骨髓,经全骨髓贴壁筛选法分离培养细胞至第2代,流式细胞术鉴定第1、第2代细胞表面抗原CD44、CD45的表达。无菌环境取气管,经酶消化法分离培养气管软骨细胞,甲苯胺蓝染色鉴定软骨细胞蛋白聚糖的合成。在使用转化生长因子B1的基础上,将骨髓间充质干细胞与气管软骨细胞通过Transwell小室非接触式共培养,倒置显微镜观察细胞形态,甲苯胺蓝染色鉴定蛋白聚糖的合成,荧光实时定量PCR鉴定Ⅱ型胶原和蛋白聚糖mRNA的表达。结果与结论：分离、培养的细胞呈长梭形、不规则形聚集生长,传代后细胞生长速度明显增快,呈鱼群状聚集生长。第1代有96．97％的细胞表达CD44、13.72％的细胞表达CD45,第2代有99．11％的细胞表达CD44、8．54％的细胞表达CD45。气管软骨细胞甲苯胺蓝染色阳性。在诱导后,骨髓间充质干细胞形态逐渐由长梭形变为三角形或不规则形,表达软骨细胞特异性Ⅱ型胶原和蛋白聚糖mRNA基因,甲苯胺蓝染色示阳性。结果表明全骨髓贴壁筛选法可成功分离培养骨髓间充质干细胞,第2代纯度较高,且在特定诱导条件下具有分化为气管软骨细胞的潜能。     

心包原始神经外胚层肿瘤1例报道并文献复习

目的探讨心包外周原始神经外胚层肿瘤(pPNET)的临床及病理组织学特征。方法通过光镜及免疫组化染色分析1例心包原发的外周原始神经外胚层肿瘤,同时复习相关文献。结果肿瘤位于心包腔内,肿瘤细胞呈片状弥漫分布,为单一的小圆形细胞,胞质少,核圆。免疫组化示CD99、NSE和Vim( )。结论pPNET是一种少见的起源于原始神经外胚层的恶性肿瘤,好发于深部软组织,极罕见于心包及心脏肌层,具有高度侵袭性,预后差;免疫组化有助于PNET的诊断;目前治疗主要是手术切除加化、放疗。     

Optical imaging of subacute airway remodeling and adipose stem cell engraftment after airway injury

Acquired airway injury is frequently caused by endotracheal intubations, long-term tracheostomies, trauma, airway burns, and some systemic diseases. An effective and less invasive technique for both the early assessment and the early interventional treatment of acquired airway stenosis is therefore needed. Optical coherence tomography (OCT) has been proposed to have unique potential for early monitoring from the proliferative epithelium to the cartilage in acute airway injury. Additionally, stem cell therapy using adipose stem cells is being investigated as an option for early interventional treatment in airway and lung injury. Over the past decade, it has become possible to monitor the level of injury using OCT and to track the engraftment of stem cells using stem cell imaging in regenerative tissue. The purpose of this study was to assess the engraftment of exogenous adipose stem cells in injured tracheal epithelium with fluorescent microscopy and to detect and monitor the degree of airway injury in the same tracheal epithelium with OCT. OCT detected thickening of both the epithelium and basement membrane after tracheal scraping. The engraftment of adipose stem cells was successfully detected by fluorescent staining in the regenerative epithelium of injured tracheas. OCT has the potential to be a high-resolution imaging modality capable of detecting airway injury in combination with stem cell imaging in the same tracheal mucosa.OCIS codes: (170.6935) Tissue characterization, (170.3880) Medical and biological imaging, (170.1610) Clinical applications, (170.4500) Optical coherence tomography     

混合性嗜铬细胞瘤病例报道并文献复习

目的探讨肾上腺混合性嗜铬细胞瘤的临床和病理学特征,了解病理特点、鉴别诊断及预后情况,以提高认识。方法分析1例肾上腺混合性嗜铬细胞瘤的临床资料,电话随诊患者;HE染色、光镜下观察其组织学表现,并进行免疫组化染色。结果光镜观察,肿瘤中可见两种不同类型的细胞区域:一种为瘤细胞排列成不规则巢团状,以小巢团为主,核圆形或卵圆形,胞浆细颗粒状、嗜碱性或者双嗜性,分裂象罕见;一种为束状及编织状排列的施万细胞背景下,散在及聚集分布怪异、多核性神经节细胞,免疫组化显示前一区域瘤细胞CgA、Syn强阳性,后一区域S-100弥漫强阳性,其间神经节细胞NF强阳性。结论肾上腺混合性嗜铬细胞瘤临床罕见,临床表现不一,病理是目前唯一准确诊断手段,手术切除是治疗的最佳选择,术后随访是必要的。     

三种方法制备组织工程气管支架的比较

背景：气管支架制备是组织工程学方法修复长段气管缺损的关键步骤。目的：通过比较分析3种制备异体脱细胞气管支架的方法,为组织工程气管支架制备寻找更适宜的途径。方法：手术获得兔新鲜气管,分为对照组、玻璃化液冷冻法组、酶洗法组、改良玻璃化液冷冻法组。处理后对各组标本行苏木精-伊红染色,电镜扫描观察,并测量气管最大拉伸力、破裂力和组织拉伸率等生物力学性能。结果与结论：组织学观察显示对照组、玻璃化液冷冻法组可见部分完整黏膜上皮细胞,酶洗法组、改良玻璃化液冷冻法组未见黏膜上皮细胞。电镜观察示对照组、玻璃化液冷冻法组、改良玻璃化液冷冻法组有丰富的细胞外基质和胶原纤维,而酶洗法组无细胞外基质,只有胶原纤维。组间两两比较,气管支架的最大拉伸力、最大破裂力和组织拉伸率比较,差异均无显著性意义。说明应用改良玻璃化液冷冻法制备气管支架能够有效地去除抗原性、保留细胞外基质,并维持生物力学性能,是一种较为理想的组织工程气管支架制备方法。     

Distribution of vascular permeability factor (vascular endothelial growth factor) in tumors: concentration in tumor blood vessels

Vascular permeability factor (VPF) is a highly conserved 34-42-kD protein secreted by many tumor cells. Among the most potent vascular permeability-enhancing factors known, VPF is also a selective vascular endothelial cell mitogen, and therefore has been called vascular endothelial cell growth factor (VEGF). Our goal was to define the cellular sites of VPF (VEGF) synthesis and accumulation in tumors in vivo. Immunohistochemical studies were performed on solid and ascites guinea pig line 1 and line 10 bile duct carcinomas using antibodies directed against peptides synthesized to represent the NH2-terminal and internal sequences of VPF. These antibodies stained tumor cells and, uniformly and most intensely, the endothelium of immediately adjacent blood vessels, both preexisting and those newly induced by tumor angiogenesis. A similar pattern of VPF staining was observed in autochthonous human lymphoma. In situ hybridization demonstrated VPF mRNA in nearly all line 10 tumor cells but not in tumor blood vessels, indicating that immunohistochemical labeling of tumor vessels with antibodies to VPF peptides reflects uptake of VPF, not endogenous synthesis. VPF protein staining was evident in adjacent preexisting venules and small veins as early as 5 h after tumor transplant and plateaued at maximally intense levels in newly induced tumor vessels by approximately 5 d. VPF-stained vessels were also hyperpermeable to macromolecules as judged by their capacity to accumulate circulating colloidal carbon. In contrast, vessels more than approximately 0.5 mm distant from tumors were not hyperpermeable and did not exhibit immunohistochemical staining for VPF. Vessel staining disappeared within 24-48 h of tumor rejection. These studies indicate that VPF is synthesized by tumor cells in vivo and accumulates in nearby blood vessels, its target of action. Because leaky tumor vessels initiate a cascade of events, which include plasma extravasation and which lead ultimately to angiogenesis and tumor stroma formation, VPF may have a pivotal role in promoting tumor growth. Also, VPF immunostaining provides a new marker for tumor blood vessels that may be exploitable for tumor imaging or therapy.     

喉炎性肌纤维母细胞肿瘤1例报告并文献复习

目的：探讨喉炎性肌纤维母细胞肿瘤的临床病理特点、诊断、治疗、预后。方法：对1例喉IMT进行回顾性分析、免疫组化染色和光镜观察，并进行文献复习。结果：该病临床主要表现为声音嘶哑、发音困难等，确诊主要依靠病理学诊断。肿瘤主要由具有纤维母细胞特征的梭形细胞、慢性炎性细胞组成，Vimentin是最常见的表达。结论：喉IMT是一种罕见的良性肿瘤，有局部浸润和复发的潜能，治疗上以兼顾功能的根治性切除为主，预后良好。     

The present status of bronchoscopic Nd:YAG laser

In Japan, the first bronchoscopic Nd:YAG laser applied clinically was performed in our institute 10 years ago, and based on this decade of experience, the indications, effectiveness, and limitations were studied. Between 1980 and 1989, a total of 202 cases were treated by Nd:YAG laser in our institute. Among them, 94 (46.5%) cases were primary lung cancers, 10 (5.0%) cases were primary tracheal malignancies, 56 (27.7%) cases were metastatic tracheal tumors, 6 (3.0%) cases were benign tracheal tumors, and 36 (17.8%) cases were nontumorous tracheal lesions. The indications for Nd:YAG laser therapy were defined as emergency widening of airway, curative treatment, reduction of tumor size, nontumorous benign lesions, and hemostasis. The desired therapeutic effects were obtained in 55/58 (94.8%) for emergency airway widening, 22/27 (81.5%) for curative treatment, 69/88 (78.4%) for reduction of tumor size, and 48/68 (70.6%) for nontumorous benign lesions. While performing Nd:YAG laser treatment, some limitations, such as poor residual pulmonary function, tumor size, tumor depth, cartilage structure, granulation, and stricture length, were encountered. Since bronchoscopic Nd:YAG laser treatment has become a well-established therapeutic modality for tracheobroncheal lesions, areas to be addressed in the future are the training of bronchoscopic laser therapists and research on the extension of applications. To increase the range of clinical applications, it is hoped that makers of laser systems will provide tunable wavelength machines at reduced cost.