单中心鼻腔鼻窦乳头状瘤-嗜酸细胞型15例临床病理分析

目的 探讨鼻腔鼻窦乳头状瘤-嗜酸细胞型(sinonasal papillomas-oncocytic type, SPO)的临床病理学特征、诊断、鉴别诊断、治疗及预后。方法 收集15例SPO临床资料，采用HE及免疫组化EnVision两步法进行检测，分析其临床病理特征并复习相关文献。结果 15例SPO患者年龄43～71岁，平均62.5岁，男女比约为3∶1。SPO具有典型的组织学特点，肿瘤细胞上皮通常有2～8层，胞质丰富，嗜酸性、颗粒状。表面外层细胞可见纤毛，特征性改变是上皮层内含有微脓肿和(或)含有黏液的小囊。免疫表型：肿瘤细胞CD44、AMA、GLUT1均(+++),Ki-67增殖指数2%～5%。结论 SPO是鼻腔鼻窦乳头状瘤的少见类型，具有独特的组织学特征，有复发和恶变潜能，治疗以手术切除为主。     

氟尿嘧啶对鼻内翻性乳头状瘤患者术后辅助治疗的研究

目的探讨提高人类鼻乳头状瘤治疗水平及预防复发与癌变的途径。方法回顾性分析25例患者的临床资料,实验组采用5-FU局部定期湿敷治疗(治疗组)(I组);10例患者及家属拒绝术后使用5-FU,予鼻内镜常规换药处理(对照组)(Ⅱ组),均采用手术摘除并随访1年或1年以上。结果I组中有1例术后6个月内,2例患者手术后12个月复发需行二次手术后痊愈。Ⅱ组中有1例于术后3个月内,2例于术后6个月内,2例于术后12个月内复发。4例经再次手术治疗后痊愈。1例癌变。结论5-FU湿敷作为鼻乳头状瘤术后辅助治疗方法效果理想,可有效防止复发,值得借鉴推广使用。     

鼻内镜联合柯陆式术切除鼻内翻性乳头状瘤11例

目的：探讨鼻腔鼻窦内翻性乳头状瘤的外科治疗方法.方法：采用鼻内镜及柯-陆式联合手术,治疗鼻腔鼻窦内翻性乳头状瘤患者11例,其中Krouse临床分级Ⅱ级4例,Ⅲ级7例.结果：术后随访1～3 a.11例中,9例痊愈,局部复发1例,癌变（鳞癌）1例.结论：鼻内镜联合柯-陆术式切除鼻腔鼻窦内翻性乳头状瘤,具有手术创伤小、术野清晰、肿瘤切除彻底等优点;对于Krouse分级为Ⅱ、Ⅲ级的鼻内翻性乳头状瘤患者,建议首选该术式.     

HIF-1α、MVD及EGFR表达对鼻内翻性乳头状瘤恶变的诊断意义及紫杉醇干预效果分析

目的:分析HIF-1α、MVD及EGFR的表达对鼻内翻性乳头状瘤恶变不同阶段的诊断意义及紫杉醇的临床效果。方法:采用免疫组织化学方法检测并定量分析鼻内翻性乳头状瘤、轻度及中重度不典型增生状和恶变组织中HIF-1α、MVD及EGFR的表达情况及三者的相关性,并分析紫杉醇对恶变组织中上述分子的改善作用。结果:HIF-1α、MVD及EGFR的表达随增生及恶化程度的加剧而增强,且鼻内翻性乳头状瘤、轻度及中重度不典型增生状组织中HIF-1α、MVD及EGFR的表达具有显著的统计学差异性(P0.01),HIF-1α与MVD及EGFR表达呈正相关性。紫杉醇可显著改善恶变组织中HIF-1α、MVD及EGFR的表达,且紫杉醇治疗后与中重度不典型增生状组织表达无显著的统计学差异性(P0.05)。结论:HIF-1α、MVD及EGFR参与了鼻内翻性乳头状瘤的发生、增生及恶化过程,可以作为临床诊断鼻内翻性乳头状瘤增生及恶化的标志物。     

类似甲状腺高细胞型乳头状癌的乳腺肿瘤

如果乳腺肿瘤显示乳头状结构,瘤细胞呈嗜酸性柱状并有核沟及核内假包涵体,甲状腺来源的转移癌是首先考虑的诊断。约5 %的乳腺转移癌源自甲状腺。作者描述了5例具有甲状腺高细胞型乳头状癌形态学特征的乳腺原发性肿瘤。此组患者均为女性,年龄5 6～74岁(平均6 3岁)。临床病史和随访显示4例有资料的病例均无甲状腺疾病史或乳腺肿瘤诊断后出现甲状腺结节。组织学观察原位肿瘤1例,微浸润肿瘤2例,浸润性肿瘤2例。肿瘤细胞呈实体或乳头状生长,部分区域显示类似甲状腺的滤泡样结构。部分区域乳头致密拥挤呈实体或梁索状。筛状结构则由含嗜酸性物质的…     

内镜经泪前隐窝入路治疗上颌窦前内下壁病变

目的　探讨鼻内镜下经泪前隐窝径路治疗上颌窦病变的临床效果。 方法　回顾性分析了2008年1月~2018年1月三家医院耳鼻咽喉头颈外科收治的采用内镜辅助下经泪前隐窝入路治疗的各种上颌窦病变患者67例的临床资料。 结果　上颌窦内下壁囊肿20例,上颌窦内下壁息肉6例,内翻性乳头状瘤2例,真菌球性鼻-鼻窦炎23例,变态反应性真菌性鼻-鼻窦炎13例,慢性侵袭性真菌性鼻-鼻窦炎1例。所有患者术后定期随访半年以上未见复发。 结论　鼻内镜下泪前隐窝入路能够充分显露上颌窦腔,彻底切除上颌窦内的病变,手术操作方便,能够有效治疗上颌窦各种良性病变,如有明显的泪前隐窝及齿槽隐窝存在,可作为上颌窦前内下壁病变的首选手术入路。     

内镜经泪前隐窝入路治疗上颌窦前内下壁病变

目的　探讨鼻内镜下经泪前隐窝径路治疗上颌窦病变的临床效果。 方法　回顾性分析了2008年1月~2018年1月三家医院耳鼻咽喉头颈外科收治的采用内镜辅助下经泪前隐窝入路治疗的各种上颌窦病变患者67例的临床资料。 结果　上颌窦内下壁囊肿20例,上颌窦内下壁息肉6例,内翻性乳头状瘤2例,真菌球性鼻-鼻窦炎23例,变态反应性真菌性鼻-鼻窦炎13例,慢性侵袭性真菌性鼻-鼻窦炎1例。所有患者术后定期随访半年以上未见复发。 结论　鼻内镜下泪前隐窝入路能够充分显露上颌窦腔,彻底切除上颌窦内的病变,手术操作方便,能够有效治疗上颌窦各种良性病变,如有明显的泪前隐窝及齿槽隐窝存在,可作为上颌窦前内下壁病变的首选手术入路。     

膀胱内翻性乳头状瘤22例临床分析

目的：探讨膀胱内翻性乳头状瘤的临床特点及诊治方法。方法回顾性分析我院收治的22例膀胱内翻性乳头状瘤的临床资料,并对所有患者进行随访。结果所有患者术后病理诊断为膀胱内翻性乳头状瘤,其中同时并发膀胱移行细胞癌Ⅱ级2例,细胞轻度异型1例,并发慢性膀胱炎者3例。术后随访1~5年,未见肿瘤复发。结论膀胱内翻性乳头状瘤为可发生癌变的良性肿瘤,临床诊断应以膀胱镜病理检查为主并仔细排查膀胱移行细胞癌的可能,尿道膀胱电切术联合膀胱灌注疗法是治疗该病的有效手段。     

鼻腔鼻窦炎性肌纤维母细胞瘤的临床病理学分析

目的 探讨鼻腔鼻窦炎性肌纤维母细胞瘤(IMT)的临床病理学特征、免疫表型及超微结构特点.方法 分析5例鼻腔鼻窦IM'I'的临床和病理形态学特点,用波形蛋白、肌特异性肌动蛋白(MSA)、平滑肌肌动蛋白(SMA)、钙调节蛋白(calponin)、h-钙结合蛋白(h-caldesmon)、结蛋白、间变性淋巴瘤激酶(ALK)、纤连蛋白(FN)、CK、S-100蛋白、Ki-67等抗体进行免疫组织化学(SP法)标记,取2例做透射电镜观察.结果 患者发病年龄28～62岁(平均年龄43岁),男性2例,女性3例,临床表现有鼻堵、流涕,面部疼痛、肿胀,牙疼、溢泪等,1例表现为鼻出血.5例均有复发,4例复发5次以上,1例淋巴结转移,3例死亡.组织学改变:肿瘤细胞排列呈编织状、束状、部分杂乱无序,细胞呈长梭形,有嗜酸性胞质,异型性不明显,核分裂象较少,间质内有较多淋巴细胞、浆细胞浸润,部分间质黏液变性,富于血管,部分区可见透明样变的胶原束.3例多次复发后肿瘤细胞异型性明显,核分裂象增多(平均5～6个/10 HPF),可见小灶状坏死,问质内炎性细胞减少,呈肉瘤改变.免疫组织化学标记显示:5例瘤细胞均弥漫表达波形蛋白,不同程度表达SMA、MSA、calponin和FN,结蛋白仅1例弱阳性,h-caldesmon、ALK、S-100蛋白、CK均为阴性,反复复发后Ki-67示瘤细胞增殖指数增高.电镜显示:瘤细胞胞质内可见较多的粗面内质网,部分瘤细胞的胞质内可见密体和密斑的肌丝束,细胞外基质中见多量的胶原纤维.结论 鼻腔鼻窦IMT易复发,有局部侵袭性,反复复发后可恶变及转移,病死率高,预后差.完整切除肿瘤是治疗的关键.     

鼻腔及鼻窦内翻性乳头状瘤预后与临床病理免疫组织化学参数的相关性

目的:探讨鼻腔及鼻窦内翻性乳头状瘤临床及病理免疫组织化学参数及其与预后的关系。方法:将52例可随访鼻腔及鼻窦内翻性乳头状瘤病例分成良性组、复发组和恶变组。利用免疫组织化学染色技术检测HPV、MMP-9、PCNA在各组中的表达情况。采用组织学观察、多参数统计学分析方法对52例鼻腔及鼻窦内翻性乳头状瘤的临床特点、病理形态及预后的相关性进行研究。结果:①性别、年龄、病程及肿瘤发生范围比较,三组之间差异无统计学意义;②对临近骨质的侵犯、瘤细胞不典型增生程度及核分裂像多少,恶变组与良性组之间存在统计学差异(P0.01),但复发组与良性组之间差异无统计学意义;③MMP-9、PCNA在良性组、复发组及恶变组中的高表达率逐渐增强;④HPV感染比较,三组之间存在高度显著差异。结论:综合考虑病理组织学参数可预测鼻腔及鼻窦内翻性乳头状瘤的复发;HPV感染、PCNA和MMP-9的表达可作为判断鼻腔及鼻窦内翻性乳头状瘤发展及预后的参考指标。     

Schneiderian papillomas: a clinicopathologic study of 67 cases

The clinical and pathologic features of schneiderian papillomas were studied in 67 patients. There were 40 male and 27 female patients, and the mean age at diagnosis was 49 +/- 17.9 (SD) years. Nasal obstruction or perception of a nasal mass was the most common presenting symptom; mean duration of symptoms was 10.8 +/- 15.8 (SD) months. Almost equal numbers of papillomas had predominantly endophytic (inverted) (n = 32) and predominantly exophytic (fungiform) (n = 30) patterns, and five had mixed patterns. Multiple morphologic variables were evaluated in the initial specimens, including cytologic atypia and number of mitotic figures; there were no statistically significant correlations between these variables and biologic behavior. Of the 39 patients for whom follow-up information was available (mean follow-up period, 38.6 months), six patients (all with predominantly endophytic patterns) had copresented with schneiderian papillomas and carcinomas. The remaining 33 patients initially had only benign schneiderian papillomas. In these 33 patients, recurrences developed in 11 (33 per cent), local invasion in two (6 per cent) (both with inverted papillomas), and epidermoid carcinoma in one (3 per cent) (with an inverted papilloma). Three patients had evidence of disease when last examined, and two patients had died of disease (both after copresentation with schneiderian papillomas and carcinomas). The continued use of the term inverted papilloma (endophytic pattern) as a specific subset of schneiderian papillomas is recommended, as all serious complications, including progression to local invasion, copresentation with carcinoma, and development of carcinoma, were associated with these lesions.     

Epithelial tumors of the lacrimal glands: a clinicopathologic study.

We report the clinicopathologic features of epithelial tumors of the lacrimal gland apparatus, which are rare and therefore represent a major challenge for diagnosis and treatment. Histologic material from 22 lesions was studied by light microscopy, histochemistry, and immunohistochemistry. A comparison with major and minor salivary gland tumors was performed to analyze the relative distribution of these tumors and to establish whether salivary glands and lacrimal gland tumors are similar or different in their pathologic appearance and clinical behavior. There were three benign pleomorphic adenomas and 19 malignant tumors. The gender distribution was equal. The ages of the patients ranged from 10 to 73 years (mean age, 46 years). Among the malignant tumors, adenoid cystic carcinoma was the most common (nine cases), followed by mucoepidermoid carcinoma (three cases). There were two cases each of malignant mixed tumor and adenocarcinoma. All mucoepidermoid carcinomas and the adenocarcinomas were histologically high grade. There also was one case each of salivary duct carcinoma, spindle cell carcinoma, and oncocytic adenocarcinoma. Of 14 patients in whom clinical follow-up was available, seven had distant metastases and four died of their disease. The only case occurring in a child was an adenoid cystic carcinoma that recurred locally after 14 years. The clinical and pathologic features of lacrimal gland tumors resemble those lesions that arise in the intraoral minor salivary glands. The greater relative proportion of malignant cases in this series probably reflects a selection bias.     

An unusual cause of multiple hepatic cysts

A metastatic hepatic process, generally arising from a primary tumor of the gastrointestinal tract, is a common cause of multinodular and/or multicystic liver. If the primary tumor remains unknown in spite of complete and exhaustive explorations, it might be useful to re-evaluate the benign nature of previously resected tumors. We report the case of a 37 year-old woman who presented a multicystic metastatic liver related to a nasal cylindrical cell carcinoma resected 4 years earlier and diagnosed initially "inverted papilloma". Cylindrical cell carcinoma also called "transitional carcinoma" or "schneiderian carcinoma" is rare with only a few cases reported in the literature. Metastases occur generally in the lungs and no previous reported cases mention secondary hepatic location.     

Oncocytic breast papilloma

Summary A rare case of an intracystic oncocytic papilloma of the breast in a 34 year old woman is described. The light and electron microscopic differences between oncocytic and apocrine epithelial cells and the problem of oncocytic meta- or neoplasia are discussed.     

Sclerosing polycystic adenosis of the parotid gland: Report of one case diagnosed by fine‐needle cytology with in situ malignant transformation

Sclerosing polycystic adenosis (SPA) is a rare pathological condition affecting the salivary glands, first described by Smith etal. in 1996. Even though this lesion is being increasingly diagnosed, less than 50 cases have been published in the world literature to date. In line with numerous other pathological analogies between breast and salivary gland lesions, SPA shares with fibrocystic disease of the breast many histopathological features, i.e., fibrosis, oncocytic (apocrine) changes, hyperplasia of ductal and acinar epithelium, cystic dilation of ducts, and, often, atypical epithelial changes. Most of the described cases have followed a benign clinical course, despite the frequent possibility of atypical hyperplasia in more than 50% of the cases and of the more than occasional in situ malignant transformation. In this article, we introduce a new case occurring in the parotid gland of a 57‐year‐old male showing atypical epithelial hyperplasia and low‐grade in situ mucoepidermoid carcinoma. Fine‐needle cytology (FNC) was performed on the lesion and, when a diagnosis of SPA was prospected, the variegated cytological features of the obtained sample posed several differential diagnostic problems. The spectrum of pathological lesions entering differential diagnosis comprised sebaceous adenoma, Warthin's tumors with presence of sebaceous remnants, and low‐grade mucoepidermoid carcinoma. Histopathological examination disclosed SCA with intraductal neoplastic transformation resembling noninvasive low‐grade mucoepidermoid carcinoma. The cytological diagnosis of SPA should be entertained whenever a polymorphous picture is found on FNC samples comprising oncocytic/apocrine changes, sebaceous cells, cystic background, and epithelial hyperplasia with low‐grade cytological atypias. Diagn. Cytopathol. 2010. © 2009 Wiley‐Liss, Inc.     

Respiratory epithelial adenomatoid hamartoma: diagnostic pitfalls with emphasis on differential diagnosis

In the upper aerodigestive tract, respiratory epithelial adenomatoid hamartoma (REAH) is described as a polypoid proliferation of glands lined by ciliated respiratory epithelium that seem to invaginate downward into the submucosa while maintaining direct continuity with the surface mucosa. The lesion can be confused with a variety of benign and malignant entities, including inflammatory polyp, inverted schneiderian papilloma, and low-grade sinonasal adenocarcinoma. In reviewing the historical, clinical, gross, and histopathologic features of REAH and its subtypes, we elucidate how the distinction of REAH with florid mucinous metaplasia from low-grade adenocarcinoma can be challenging particularly in the setting of small biopsy samples. Diagnostic criteria are reviewed with emphasis on key distinguishing characteristics. The significance of this distinction is paramount in preventing unwarranted surgery and untoward consequences for the patient.     

Oxyphilic proliferations of the respiratory tract and paranasal sinuses.

Neoplasms of the upper respiratory comprised primarily of eosinophilic cells are, in general, rare, and they include a diverse group of lesions. Low-grade oncocytic neuroendocrine neoplasms (so-called oncocytic carcinoids) can be encountered in several locations throughout the respiratory tract. The oncocytoma and related entities, lesions that presumably arise from minor gland tissue, can likewise be seen from the nasal cavity to the lung; differences in clinical significance may relate to the location of such lesions, and are discussed herein. Granular cell tumor is another entity that can involve both the upper respiratory tract and lungs, and specific features of this lesion in different anatomic sites are highlighted. The oncocytic variant of Schneiderian papilloma is an important nasal lesion to recognize, because of important therapeutic and prognostic implications of that diagnosis. Finally, unique oncocytic variants of glomus tumor and pulmonary alveolar adenoma are discussed, as well as eosinophilic varieties of pulmonary carcinomas and mesotheliomas.     

乳腺上皮-肌上皮性肿瘤4例临床病理学分析

目的：探讨乳腺上皮-肌上皮性肿瘤(epithelial-myoepithelial tumor of breast)的临床病理学特点、免疫表型、诊断及鉴别诊断。方法：对4例乳腺上皮-肌上皮性肿瘤的临床特点、组织形态学及免疫组织化学结果进行分析,并复习相关文献。结果：患者：男性1例,女性3例,平均年龄51岁(27~63岁)。4例肿瘤直径1.5~3.0 cm(平均2.0 cm),无包膜,切面灰白色。显微镜下可见肿瘤由双相增生的肌上皮细胞和腺上皮细胞构成,肌上皮细胞环绕腺上皮细胞构成特征的套管结构。免疫组织化学染色,腺上皮细胞表达CK8/18、CK7,肌上皮细胞表达p63、Calponin、CK5/6。1例诊断为腺肌上皮瘤(adenomyoepithelioma,AME),3例诊断为伴有癌的腺肌上皮瘤(恶性腺肌上皮瘤, malignant adenomyoepithelioma,MAME)。结论：乳腺上皮–肌上皮性肿瘤是少见的肿瘤类型,需与导管内乳头状瘤、化生性癌等鉴别。