细胞角蛋白表达在肾上腺皮质肿瘤鉴别诊断中的价值

本文采用抗-细胞角蛋白单克隆及多克隆抗体(CK,Kera)对肾上腺皮质增生,腺癌、腺癌及肾癌,肝癌的免疫组织化学特征进行了研究,结果发现肾上腺皮质增生CK,Kera均阳性,且呈带状分布,肾上腺皮质腺癌均阴性,肾上腺皮质腺瘤的阳性率介于两者之间,而肾癌、肝癌除1例外均呈阳性反应,提示肾上腺皮质肿瘤在恶变过程中细胞角蛋白大量丢失,     

肾上腺皮质增生与腺瘤CT诊断及评价(附53例分析)

肾上腺皮质疾病中 ,原发性醛固酮增多症及皮质醇增多症可同时发生肾上腺皮质增生和腺瘤 ,因而在影像诊断中对它们的正确分析和诊断 ,对临床治疗将会起到一个良好的帮助指导作用。本文回顾性分析经手术病理证实 5 3例功能性肾上腺皮质疾病ＣＴ表现 ,重点探讨肾上腺皮质增生与肾上腺皮质腺瘤在原发性醛固酮增多症及皮质醇增多症中的ＣＴ改变特征。1　资料与方法本组 5 3例中 ,男 19例 ,女 34例 ,年龄 2 45 5岁。肾上腺皮质腺瘤 40例 ,其中原发性醛固酮增多症 2 6例 ,皮质醇增多症14例。肾上腺皮质增生 13例 ,其中原发性醛固酮增多症 6例 ,皮质…     

结肠上皮肿瘤P53蛋白表达及其临床意义的研究

 目的 对正常结肠粘膜上皮,结肠上皮增生样息肉,结肠上皮腺瘤和结肠腺癌组织中P53蛋白的表达进行了检测,并对其临床意义进行评估.方法 应用单克隆抗体DO-7,采用免疫组织化学LSAB方法,对7例结肠增生性息肉、59例结肠腺瘤(26例管状腺瘤、13例混合状腺瘤、20例绒毛腺瘤)和30例结肠腺癌组织中P53蛋白进行标记.结果 正常结肠上皮及增生性息肉组织中P53蛋白标记阴性.结肠腺瘤和结肠腺癌组织中P53表达阳性率明显增多差异有显著意义(P<0.01).结肠癌中P53阳性率达56.67%,并与结肠癌的分化程度及临床Dukes分期有关,分化程度越高,P53表达率越低.Dukes A期结肠癌P53表达率明显低于Dukes D期(P<0.05).结肠癌存活率随着P53阳性率和阳性标记范围的增加而降低.标记范围大于60%者存活率明显低于标记范围小于25%者(P<0.05).这也符合临床中Dukes D期患者5 a存活率明显低于Dukes A期患者的现象.在结肠腺瘤中,P53阳性率与腺瘤的大小和是否伴有异型增生有关,腺瘤直径≥20 mm者阳性率明显高于直径<10 mm者(P<0.05).P53蛋白表达随异型增生程度的增加而增加,重度异型增生和息肉癌变组织中P53阳性率明显高于轻度异型增生腺瘤(P<0.05,P<0.05).在3种类型腺瘤中,绒毛状腺瘤阳性率最高(55%).结论 结肠癌分化程度越低,P53阳性率越高,Dukes分期越差,5 a存活率越低.结肠腺瘤直径越大,异型增生程度越高,P53阳性率也越高.因此,P53表达可以做为判断结肠癌愈后的一个重要指标,也可做为预测腺瘤恶变倾象的重要指标.     

肾上腺手术282例分析

为探讨肾上腺肿瘤的病种分布特点及诊断方法 ,对 1993年 3月～ 2 0 0 1年 12月住院行肾上腺手术的 2 82例病案资料行回顾性分析。其中男 135例 ,女 14 7例 ,年龄 4 3 6± 13 0岁 ;病变位于左侧 136例 ,右侧 131例 ,双侧 15例 ;肾上腺皮质肿瘤 16 1例 ,髓质肿瘤 75例 ,间叶病变 33例 ,转移恶性肿瘤 13例。有内分泌功能的肿瘤中以醛固酮增多症最多 ,为 83例 ,库欣综合征 2 7例 ,嗜铬细胞瘤 5 9例 (19例为意外发现 )。意外瘤共 10 5例(37 2 % ) ,恶性肿瘤共 36例 (12 8% )。肾上腺肿瘤的最大直径为 4 8± 3 4cm(0 3～ 2 2 5cm) ,醛固酮腺瘤最小 ,恶性肿瘤最大。2 82例术前诊断与术后病理诊断的符合率为 6 5 2 % ,其中有内分泌功能的皮质腺瘤符合率最高     

肾上腺皮质结节性增生与皮质腺瘤的CT鉴别诊断

目的:探讨肾上腺皮质结节性增生与肾上腺皮质腺瘤的CT鉴别诊断.方法:回顾性统计分析31例肾上腺皮质结节性增生与35例肾上腺皮质腺瘤的CT表现,所有病例均经手术及病理证实.结果:结节性增生组与腺瘤组在患者性别、病变位置、病变的边界及同侧肾上腺形态方面存在显著统计学差异(P＜0.05).Logistic回归分析表明,病变边界清楚与否在两者鉴别中具有重要意义.结论:在肾上腺结节性增生与肾上腺腺瘤的鉴别诊断方面CT检查可提供重要参考.结合临床及实验室检查,将会对两者的鉴别提供更大的帮助.     

切除大鼠卵巢对肾上腺皮质束状带和网状带的影响

目的　了解切除双侧卵巢对肾上腺皮质的影响。方法　Wistar大鼠 2 0只 ,分成对照组 1 0只 ,模型组 1 0只。模型组切除卵巢后 1 2 0d处死两组大鼠 ,分别取左肾上腺常规切片、染色 ,目镜测微尺测量肾上腺皮质束状带、网状带厚度和计数核固缩细胞数。结果　经t检验 ,两组肾上腺皮质束状带厚度 (t=2 .1 0 ,P <0 .0 5 )、网状带厚度 (t=2 .0 9,P <0 .0 5 )和两种核固缩细胞数 (t=3.77,P <0 .0 2 5 )均有显著性差异。结论　切除双侧卵巢可致肾上腺皮质束状带萎缩     

民航飞行员肾上腺腺瘤的航空医学鉴定——附病例报告三例

肾上腺腺瘤在民航飞行员中时有发生,由于诊断技术的不断提高,肾上腺肿瘤的定位诊断率也有所提高.肾上腺在内分泌系统中起着重要的作用,功能性肾上腺腺瘤对飞行员的内分泌系统造成严重影响,导致内分泌水平变化、血压升高.而无功能性肾上腺腺瘤,由于仍有部分分泌激素存在,虽量少或活性很低,也可能因血压升高影响飞行安全.因此,对肾上腺腺瘤的航空医学鉴定显得十分重要.笔者通过对南航1997-2011年临床诊断为肾上腺腺瘤的3例飞行员(其中1例经手术切除后病理确诊为肾上腺皮质囊肿伴局部皮质增生)的航空医学鉴定进行分析探讨,以期强化航空医师对此类疾病的认识,提高航空医学鉴定水平,保障飞行安全.     

E-cadherin蛋白在前列腺癌组织中的表达及临床意义

目的　探讨上皮细胞钙粘素 (E cadherin ,E Cad)在前列腺癌组织中的表达及其临床意义。方法　应用免疫组织化学 (SP)方法测定 42例前列腺癌及 3例正常和 7例良性前列腺增生组织中E Cad蛋白的表达。结果　 42例前列腺癌组织中 2 1例E Cad蛋白表达阳性 ( 5 0 %)。随肿瘤细胞病理分级、临床分期程度的增高 ,癌细胞表达E Cad蛋白阳性率降低 ,高、中分化组 2 2例前列腺癌中 19例E Cad蛋白表达阳性( 86%) ,与低分化组 2 0例中 2例 ( 10 %)阳性表达 ;A +B期和C +D期前列腺癌组织中的阳性表达率分别为 65 5 %( 19/ 2 9)和 15 3 %( 2 / 13 ) ,各组间比较有显著性差异 ( χ2 =2 4 43 ,P <0 0 0 5 ;χ2 =9 0 3 ,P <0 0 0 5 )。而正常和良性前列腺增生组E Cad蛋白均呈阳性免疫反应。结论　E Cad蛋白异常表达在前列腺癌的恶性进展中起重要作用 ,检测E Cad蛋白的表达有利于判断病期及预后。     

乏脂质肾上腺皮质腺瘤的MR影像表现

目的 分析肾上腺皮质腺瘤中不含脂质类型的MR表现.资料与方法 回顾性分析2008～2010年经手术病理证实的6例不含脂质的肾上腺皮质腺瘤的MR影像表现,总结肾上腺皮质腺瘤的不典型MR影像特征.结果 6例皮质腺瘤在MR影像上表现为化学位移成像反相位图像信号未见降低(不含脂质),5例出现囊变坏死,5例动脉期轻度强化,1例中度强化,扩散加权成像(DWI)图像均呈混杂高信号,平均表观扩散系数(ADC)值为0.718×10-3mm2/s.结论 肾上腺皮质腺瘤的不典型MR表现主要为体积较大、信号混杂、少血供,有利于与肾上腺其他肿瘤鉴别.ADC值有望进一步增强诊断的准确性.     

免疫组化技术在肺神经内分泌肿瘤病理诊断中的应用

目的 探讨肺神经内分泌癌临床特点和免疫病理分型.方法 总结我院肺神经内分泌癌14例的病理资料与临床资料进行分析.结果 肺神经内分泌癌占同期检出肺癌的12%（14/117）,其中男性10例,占71.4%（10/14）.神经内分泌癌免疫标记NSE Syn CgA阳性率分别为92.9%,71.4%,64.3%.结论 肺神经内分泌癌具有恶性程度高,发展迅猛,早期就伴有局部或远处转移.存在上皮及神经内分泌等多项分化,联合多项免疫标记可极大提高肺神经内分泌肿瘤检出率.     

肾上腺性征异常病变的CT和MRI诊断

目的:报告5例肾上腺性征异常病变的CT和/或MRI影像学表现,并结合文献讨论这两种影像检查方法对肾上腺性征异常病变的诊断价值和限度。方法:5例肾上腺性征异常病变中,先天性肾上腺皮质增生1例,皮质腺瘤和皮质癌各2例,除1例先天性肾上腺皮质增生外,余4例均经手术和病理证实。5例均进行了CT检查,其中1例皮质腺瘤还进行了MRI检查。结果:CT检查1例先天性肾上腺皮质增生表现为双侧肾上腺明显增大并边缘多发小结节;2例皮质腺瘤表现为肾上腺卵圆形肿块,密度较均一;2例皮质癌表现为肾上腺较大肿块,密度不均,1例有散在钙化,1例下腔静脉内有瘤栓。MRI检查1例皮质腺瘤,T1WI和T2WI信号强度类似肝实质,且在反相位上信号强度明显下降。结论:CT和/或MRI检查有助于肾上腺性征异常的诊断和鉴别诊断,对评估病人的预后和采取合理的治疗方案具有重要意义。     

垂体腺瘤中FRα的表达与临床意义

目的检测垂体腺瘤中叶酸受体α（FRα）的表达情况,探讨FRα与垂体腺瘤相关临床指标的关系。方法运用冰冻切片免疫组化方法,检测124例垂体腺瘤中FRα的表达情况,分析其与患者性别、年龄、肿瘤径线、肿瘤侵袭性的关系。结果 FRα在NF腺瘤中的阳性率为73.8%（31/42）,在PRL腺瘤中的阳性率为9.7%（3/31）,在GH腺瘤中的阳性率为6.7%（2/30）,在ACTH腺瘤中的阳性率为9.5%（2/21）,FRα在NF腺瘤中的表达水平明显高于在其他病理类型垂体腺瘤中的表达（P〈0.05）。在垂体NF腺瘤中,FRα的表达与肿瘤的侵袭性有关（P〈0.05）,与性别、年龄、肿瘤大小无明显关系（P＞0.05）。在其他三种垂体腺瘤中,FRα与上述指标无明显关系。结论 FRα在垂体NF腺瘤中高表达,在其他病理类型的垂体腺瘤中低表达;FRα与垂体NF腺瘤的侵袭性相关。     

Adrenal masses falsely diagnosed as adenomas on unenhanced and delayed contrast-enhanced computed tomography: Pathological correlation

Objectives To assess the accuracy of CT for the diagnosis of histologically confirmed adrenal adenoma and nonadenoma using CT numbers. Materials and methods Our study included 91 adrenal masses in 83 patients; histopathological diagnoses were 45 adenomas, 31 pheochromocytomas, 6 hyperplasias, 4 metastasis, and 5 miscellaneous lesions. Unenhanced CT in 46 patients and unenhanced and delayed contrast-enhanced (DCE) CT in 37 patients were retrospectively reviewed to examine the correlation between CT findings and those on pathological examination and to obtain diagnostic accuracy. Results Sensitivity, specificity, and accuracy for adenoma were 40% (18/45), 91% (42/46), and 66% (60/91) with unenhanced CT, and 96% (24/25), 61% (11/18), and 81% (35/43) with DCE CT. Adrenal masses falsely diagnosed as adenoma on unenhanced CT included three hyperplasias and one endothelial cyst, and those falsely diagnosed as adenoma on DCE CT were five pheochromocytomas, one oncocytic coritical tumor, and one primary pigmented nodular adrenocortical dysplasia. Twenty-five lipid-poor adenomas were falsely diagnosed as nonadenomas on unenhanced CT and one degenerated adenoma both on unenhanced CT and on DCE CT. Conclusion Diagnosing adenoma merely on CT numbers can lead to misdiagnosis. The lower specificity than expected is due to pheochromocytomas presenting as false positives. An erratum to this article can be found at     

Multidetector CT in diagnostic work-up of patients with primary hyperparathyroidism

PURPOSE: This study was performed to evaluate the accuracy of multidetector computed tomography (MDCT) in detecting parathyroid lesions in patients with primary hyperparathyroidism. MATERIALS AND METHODS: We included 60 patients with primary hyperparathyroidism. Preoperative first-line examinations revealed negative and doubtful ultrasound (US) findings in 34 and 26 cases, respectively, and negative, doubtful and positive scintigraphic findings in 19, 20 and 21 cases, respectively. CT findings were compared with the surgical results. RESULTS: CT examination was positive in 35 cases, negative in 15 cases and doubtful in ten cases. Forty out of 60 patients underwent surgery, and 39 lesions (37 adenomas, two primary hyperplasias) were identified. Surgery was negative in two cases. In eight cases, lesions had ectopic location. Surgery confirmed the CT findings in 23 positive cases. In 8/10 doubtful cases, surgery confirmed the location of the lesion in five cases, identified the ectopic location of lesions in two cases, and was negative in one case. In 9/15 cases with negative CT findings, surgery identified the lesion in eight cases. Sensitivity, specificity and diagnostic accuracy values were 78%, 25% and 73%, respectively. CONCLUSIONS: MDCT is an accurate second-line diagnostic technique in the detection of parathyroid lesions, allowing exploration of the entire cervical and mediastinal regions.     

A black adrenocortical adenoma causing Cushing's syndrome not imaged by radiocholesterol scintigraphy

In a 33-year-old female patient with left adrenal tumour and Cushing's syndrome, adrenocortical scintigraphy with radiocholesterol did not image the tumour nor the suppressed contralateral gland. Histology showed a black adrenocortical adenoma composed only of compact cells; there was no evidence of malignancy. This demonstrates that non-visualization of the adrenal glands in a patient with Cushing's syndrome is not invariably due to adrenal carcinoma. The literature on black adrenal adenomas causing Cushing's syndrome is reviewed.     

Percutaneous laser ablation of unresectable primary and metastatic adrenocortical carcinoma

PURPOSE: To evaluate the feasibility, safety, and clinical benefits of percutaneous laser ablation (PLA) in patients with unresectable primary and metastatic adrenocortical carcinoma (ACC). PATIENTS AND METHODS: Four patients with hepatic metastases from ACC and a Cushing's syndrome underwent ultrasound-guided PLA. In one case the procedure was performed also on the primary tumor. RESULTS: After three sessions of PLA, the primary tumor of 15 cm was ablated by 75%. After 1-4 (median 1) sessions of PLA, five liver metastases ranging from 2 to 5 cm were completely ablated, while the sixth tumor of 12 cm was ablated by 75%. There were no major complications. Treatment resulted in an improvement of performance status and a reduction of the daily dosage of mitotane in all patients. The three patients with liver metastases presented a marked decrease of 24-h urine cortisol levels, an improved control of hypertension and a mean weight loss of 2.8 kg. After a median follow-up after PLA of 27.0 months (range, 9-48 months), two patients have died of tumor progression, while two other patients remain alive and free of disease. CONCLUSIONS: Percutaneous laser ablation is a feasible, safe and well tolerated procedure for the palliative treatment of unresectable primary and metastatic ACC. Further study is required to evaluate the impact of PLA on survival.     

侵袭性垂体腺瘤的MRI表现与MMP-9表达的相关性

目的研究侵袭性垂体腺瘤侵袭鞍底、鞍旁的不同MRI表现与MMP-9表达水平的相关性。资料与方法经手术、病理证实的垂体腺瘤90例,免疫组织化学染色,评价MMP-9的表达水平与肿瘤对鞍底及鞍旁的不同侵犯程度的MRI表现之间的关系。结果手术证实侵袭性垂体腺瘤59例。蝶窦腔内见肿瘤者30例（58.8%）,对诊断肿瘤侵袭性的敏感性为59%,特异性为100%,阳性预测值为100%,阴性预测值为65%。受侵犯的海绵窦中有95%（57/60）超过该侧颈内动脉外侧壁连线,对诊断肿瘤侵袭性的敏感性为95%,特异性为100%,阳性预测值为100%,阴性预测值为98%。垂体腺瘤包绕范围〉2/3者37侧,对诊断相应侧别海绵窦受侵袭的敏感性为62%,特异性为100%,阳性预测值100%,阴性预测值84%。侵犯海绵窦或鞍底的垂体腺瘤的MMP-9表达水平均高于未侵犯海绵窦或鞍底的垂体腺瘤。结论将鞍底破坏,窦腔内直接可见肿瘤组织作为鞍底受侵袭的MRI标准,将肿瘤向两侧超过颈内动脉海绵窦段和床突段外侧壁连线,或肿瘤包绕颈内动脉范围〉2/3至完全包绕作为海绵窦受侵袭的MRI标准。     

喉鳞状细胞癌中C-erbB-2和E-钙粘附素蛋白表达及其意义

目的：探讨癌基因c—erbB-2蛋白和黏附分子E-钙黏蛋白（E—cad）表达与喉鳞状细胞癌（LSCC）的发生、发展和生物学意义。方法：应用免疫组织化学方法，检测45例LSCC组织和15例声带息肉（VCP）组织中c—erbB-2和E—cad蚤白表达水平。结果：在LSCC组织中c—erbB-2和E—cad表达阳性率分别为75．6%（34／45）和62．2％（28／45）。LSCC中，c—erbB-2表达阳性率高于VCP（0／15，0．0%,40，X^2=22．12，P＜0．01），而E—cad表达阳性率低于VCP（15／15，100％，X^2=4．73，P〈0．05）。c—erbB-2高表达和E—cad低表达与LSCC分级和淋巴结转移相关（P〈0．05）。LSCC中c—erbB-2表达与E—cad表达呈负相关（r=-0．30）。结论：c—erbB-2和E—cad表达水平可作为判断LSCC分级和淋巴结转移和预后的重要参考指标。     

节细胞性副神经节瘤的影像表现及临床病理分析(附3例报告并文献复习)

目的探讨节细胞性副神经节瘤的影像表现及其临床病理学特点。资料与方法结合临床病理特征及文献,回顾性分析3例经手术病理证实的节细胞性副神经节瘤的影像表现。3例均行全消化道钡剂造影及CT平扫与增强。结果 CT检查示肿块分别位于十二指肠降段、上段空肠及中段空肠,3例均表现为肠腔内软组织密度肿块,肿块最大直径1.6～4.9 cm。3例病灶均未见钙化、出血及包膜。增强后上段空肠病灶呈明显周边强化,中央见无强化区,周围见肿大淋巴结;余2例表现为明显均匀强化。上段空肠病灶钡剂造影表现为局部肠管扩张,肠管内见一较大充盈缺损影,局部黏膜变平,肠管柔软,蠕动正常;余2例钡剂造影未见异常。3例均位于黏膜下,肿块实性质软,切面见丰富血管网,未见包膜。镜下全部肿块均由上皮样细胞、神经节样细胞及梭形细胞三种细胞构成。免疫组织化学标记上皮样细胞均表达嗜铬粒素A(CgA)、突触素(Syn)及神经元特异性醇化酶(NSE),1例亦表达细胞角蛋白(CK);梭形细胞均表达神经丝蛋白(NF)及S-100蛋白;神经节样细胞表达NF、NSE。结论节细胞性副神经节瘤的影像表现有一定特点,但缺乏特异性,确诊需结合组织病理学及免疫组织化学检查。     

Hepatocellular adenoma: multiphasic CT and histopathologic findings in 25 patients

PURPOSE: To evaluate multiphasic computed tomographic (CT) findings of hepatic adenomas and to correlate these findings with those of histopathologic analysis. MATERIALS AND METHODS: Multiphasic helical CT was performed in 25 patients with 44 hepatic adenomas. Nonenhanced scans were obtained in all cases, along with hepatic arterial-dominant phase (HAP) and portal venous-dominant phase (PVP) images at 25-28 and 60-70 seconds after intravenous contrast material injection at 3-5 mL/sec. Twelve patients with 24 adenomas also underwent delayed-phase (5-10-minute) CT. Two independent readers retrospectively reviewed each case for the number of detectable lesions in each CT phase, morphologic features of tumors, and degrees of enhancement. RESULTS: Thirteen patients had solitary adenomas; 12 patients had two or three adenomas. Both observers agreed on the numbers of lesions detected in all cases and in all phases of enhancement. The detection rate for all 44 adenomas per type of examination was as follows: nonenhanced, 86% (38 of 44); HAP, 100% (44 of 44); PVP, 82% (36 of 44), and delayed, 88% (21 of 24). Tumor margins were well defined in 38 adenomas (86%), and the surface was smooth in 42 adenomas (95%). The right hepatic lobe was the only site of adenoma or was a site along with the left lobe in 29 cases (66%). Tumor fat and calcifications were uncommon (three cases [7%] and two cases [5%], respectively). Other than areas of fat, hemorrhage, or necrosis, the adenomas enhanced nearly homogeneously, especially on PVP and delayed-phase scans. Five patients had coexistent hepatic masses, which were focal nodular hyperplasia (n = 3) or hepatocellular carcinoma (n = 2). CONCLUSION: Hepatic adenomas often have characteristic features at multiphasic CT that may allow their distinction from other hepatic masses.