睾丸富于细胞纤维瘤临床病理观察

目的:探讨睾丸富于细胞纤维瘤的临床病理特征、鉴别诊断和预后。方法:对1例睾丸富于细胞纤维瘤的临床表现、组织形态和免疫组化进行综合分析,并结合文献讨论其病理特点及鉴别诊断。结果:30岁男性患者,右侧睾丸不适并无痛性肿大为主诉。睾丸纤维瘤实性边界清楚,包膜亦厚亦薄,切面灰白色,镜下梭型瘤细胞排列成席纹状、鱼骨状或束状,细胞丰富,细胞核无多形性,核分裂像为0～1个/10HP。免疫组化显示肿瘤细胞波形蛋白(+)、S-100局灶(+)、平滑肌蛋白局灶(+)、肌纤维蛋白(-)、α-抑制素(-)、CD34(-)、CD99(-)、Ki-67阳性率不足1%。结论:睾丸富于细胞纤维瘤是一种罕见的睾丸性索间质肿瘤,与卵巢同源性肿瘤病理特征相同;容易与睾丸的其它梭型细胞肿瘤混淆,形态学结合免疫组化可资鉴别;手术切除预后良好。     

阴茎梭形细胞血管内皮瘤(1例报告并文献复习)

目的 探讨阴茎梭形细胞血管内皮瘤的生物学行为和临床病理特征.方法 回顾分析1例阴茎梭形细胞血管内皮瘤,结合文献分析其发病情况、临床病理特征、诊断和治疗.结果 患者行阴茎多发肿物切除术,术后多次复发.免疫组化染色：CD34（＋）.结论 阴茎梭形细胞血管内皮瘤治疗主要采用手术切除,辅以免疫等综合治疗,预后良好但复发率高.     

原发性附睾肿瘤（附24例报告）

附睾肿瘤少见，易与其他疾病混淆，故作者对１９８３年至１９９５年６月２４例原发性附睾肿瘤进行报告。其中良性２３例，恶性１例。６６．７％肿瘤位于附睾尾部，１２．５％位于尾体部，双侧性１例为平滑肌瘤，多发性１例为腺样瘤。作者认为附睾肿瘤症状轻微或缺如，易与附睾其他性质肿物相混淆，良性应与附睾结核、慢性炎症或肉芽肿等鉴别。恶性肿瘤除有恶性肿块特征外，常出现精索增粗，并以输精管增粗为主。良性附睾肿瘤作附睾切除或单纯肿瘤切除，术后无复发，预后良好。恶性肿瘤应与睾丸精索恶性肿瘤同样对待，并根据病理类型加用化疗和放疗，以提高疗效。     

腹股沟富于细胞性血管纤维瘤1例报道并文献复习

目的 探讨富于细胞性血管纤维瘤（cellular angiofibroma,CAF）的影像学表现、病理特征、临床诊断、鉴别诊断以及治疗和预后。方法 报道1例腹股沟区CAF的临床表现、病理特征及治疗情况，并结合国内外相关文献报道的142例病例资料进行分析。结果 本例65岁男性患者，因发现左侧腹股沟区肿块5年且逐渐长大而入院行手术完整切除左侧腹股沟区肿物，肿物约7 cm×3 cm×5 cm大，质地较韧，边界清晰，术后病理学检查见肿物由大量短梭形细胞和小到中等大的血管组成，边界清晰，可见纤维性包膜。免疫组织化学示雌激素受体（部分+）、平滑肌肌动蛋白（血管+）、CD34（+）及CD117(+),Sox-10、S-100、Dog-1、结蛋白、P16、CDK4、mdm2、上皮膜抗原、孕激素受体、视网膜母细胞肿瘤抑制蛋白及神经营养因子络氨酸激酶均为（–）。最终诊断为CAF，术后随访3个月肿瘤无复发。复习国内外文献报道的142例CAF患者资料，肿瘤主要位于外阴（74例）和阴囊-腹股沟区（47例），21例位于其他部位，均接受手术治疗。CAF通常表现为触及无痛性肿块，肿瘤大体呈圆形、卵圆形或分叶状，镜下可...     

原发性附睾肿瘤的诊断与治疗(附35例报告)

目的:探讨原发性附睾肿瘤的诊断及治疗方法。方法:回顾性分析本院35例原发性附睾肿瘤患者的临床资料。行肿瘤切除术10例,患侧附睾切除23例,患侧睾丸附睾切除加腹股沟淋巴结清扫1例,患侧根治性睾丸切除加二期腹膜后淋巴结清扫术1例。附睾恶性纤维组织细胞瘤1例术后辅以放疗及化疗。结果:术后病理诊断良性肿瘤33例,其中腺瘤样瘤21例,平滑肌瘤7例,纤维瘤4例,乳头状囊腺瘤1例;恶性肿瘤2例,附睾恶性纤维组织细胞瘤1例,附睾腺癌1例。35例术后随访10个月至6年,未见复发、转移及死亡病例。结论:原发性附睾肿瘤术前明确诊断困难,对于高度怀疑附睾肿瘤的患者应首选手术探查,良性者可行肿瘤或附睾切除,恶性者行根治性睾丸切除加腹膜后淋巴结清扫术。     

精囊纤维瘤1例

分析精囊纤维瘤的病理及临床特征,提升对本病的认识和治疗水平。1例45岁男性患者,主诉发现精囊肿物2个月。肿物经手术完整切除,显微镜下可见肿块由梭形细胞交织排列组成,细胞界限不清,核圆形、卵圆形或长梭形,胞浆丰富,间质淋巴细胞、浆细胞浸润,淋巴滤泡形成,免疫组织化学检查：Vimentin(+)、CK(-)。诊断为左侧精囊纤维瘤。患者术后恢复良好。随访6个月,未见复发。     

泌尿系炎性肌纤维母细胞瘤二例报告并文献复习

目的 提高对泌尿系炎性肌纤维母细胞瘤的认识.方法 分析2例泌尿系炎性肌纤维母细胞瘤患者资料并复习文献.例1,女,50岁.主诉尿痛、排尿困难2个月,B超、膀胱镜检示右侧输尿管口肿物直径约3 cm.例2,男,63岁.主诉无痛性肉眼血尿2 d,B超、膀胱镜检见膀胱三角区实性占位,直径约7 cm.结果 2例肿瘤均完整切除.例1标本光镜下见肿瘤细胞多呈长梭形,平行排列,核分裂象少见,未见病理性核分裂象,有散在炎细胞浸润,免疫组化染色示MyoD1(-),SMA(+),Vimentin(+),诊断为输尿管炎性肌纤维母细胞瘤.例2标本光镜下见肿瘤细胞呈长梭形,核仁嗜碱性,未见病理性核分裂象,间质中有散在的炎细胞浸润,少量梭形细胞明显侵蚀平滑肌束,免疫组化染色示CD34(+),MyoD1(+),符合膀胱炎性肌纤维母细胞瘤诊断.术后每3个月复查膀胱镜,例1随诊6个月,例2随诊2年,均未见复发.结论泌尿系炎性肌纤维母细胞瘤是一种特殊类型的炎性假瘤,本质上是一种良性肿瘤,临床诊断困难,治疗以手术切除为主,术后应加强随访.     

膀胱非上皮性肿瘤的诊治

目的 总结膀胱非上皮性肿瘤的诊治经验。方法 对1953～2002年收治的28例膀胱非上皮性肿瘤患者的诊治情况进行总结、分析。结果 膀胱非上皮性肿瘤的主要临床表现为血尿、盆腔肿块、尿频、排尿困难等症状。主要辅助检查为B超、CT、膀胱镜检查及镜下活检。本组28例中,经术后病理检查,恶性肿瘤17例(占61．7％),有7种病理类型,分别为膀胱横纹肌肉瘤、膀胱小细胞癌、膀胱平滑肌肉瘤、膀胱恶性淋巴瘤、膀胱恶性纤维组织细胞瘤、膀胱脂肪肉瘤、膀胱黑色素瘤;良性11例(占39．3％),有4种病理类型,分别为膀胱海绵状血管瘤、膀胱壁纤维瘤、膀胱平滑肌瘤、膀胱嗜铬细胞瘤。11例良性肿瘤均完整切除或电灼、电切。17例恶性肿瘤中,膀胱部分切除术7例、膀胱全切除术9例、无法切除1例,有7例恶性肿瘤因复发多次行手术切除。17例恶性肿瘤患者均获随访,3年存活率47．0％(8／17)。结论 膀胱非上皮性肿瘤临床少见,病理类型复杂,恶性居多且预后较差,良性肿瘤预后较好。术前诊断率低,膀胱镜下深部活检可提高诊断率。手术是该病的主要治疗方法。良性肿瘤应完整切除,恶性肿瘤应争取广泛切除,结合其病理特点辅助放化疗可能提高疗效。     

前列腺孤立性纤维瘤二例报告

目的探讨前列腺孤立性纤维瘤的诊断和治疗.方法总结2例前列腺孤立性纤维瘤患者资料.例1 40岁,表现为进行性排尿困难,会阴部胀痛不适,B超示前列腺增大,周边整齐.血清PSA 1.92 ng/ml,尿流率呈下尿路梗阻尿流曲线.例2 56岁,主要症状为进行性尿频、尿急、夜尿增多,B超、CT提示前列腺不均匀增大,前列腺穿刺活检确诊后,患者拒绝手术转放射治疗后失访.结合文献复习讨论.结果例1行经尿道前列腺电切（TURP）,切除前列腺组织83 g,随访8个月,未见肿瘤复发,排尿通畅.例2失访.病理检查,2例肿瘤均由梭形细胞和胶原束构成,镜下见特征性黏液样变和血管外皮瘤样变.例1有丝分裂相为1个/10 HP,免疫组化：CD34（＋）,CD99（＋）,bcl-2（＋）,S-100（-）,SM-A（-）.病理诊断：前列腺孤立性纤维瘤.例2有丝分裂相为4个/10 HP.免疫组化：CD34（＋）,CD99（＋）,bcl2（＋）,CK（-）,S-100（-）,SM-A（灶性＋）,desmin（-）.病理诊断：前列腺孤立性纤维瘤（恶性）.结论前列腺孤立性纤维瘤是一种罕见肿瘤,确诊依赖病理学及免疫组织化学检查.主要治疗方式是TURP和前列腺根治术,良性病变预后好.     

精索炎症性肌纤维母细胞瘤一例报告

患者,50岁.因左阴囊内无痛性包块5年,逐渐增大,于2010年1月21日入院.查体:左阴囊上方精索增粗如拇指,质硬,无触痛,附睾头体部增大,与睾丸分界不清.超声检查左阴囊内无回声,深2.6 cm.左附睾头体交界处旁见一低回声,约1.7 cm×1.7 cm,边界模糊,其内回声不均,与精索及附睾结构界限不清.左精索走行区结构紊乱.CT检查示左阴囊肿胀,其内见不规则软组织密度影,增强后明显强化.对侧阴囊内无异常.诊断:左精索肿瘤.行左精索、睾丸及附睾切除术.术中见左睾丸上方精索内质硬肿物,界限清,肿瘤近端精索正常.病理检查:左精索内不规则肿物,4.0 cm×3.0 cm×2.0 cm大小,质硬,局部见肿物侵及睾丸及附睾,切面呈鱼肉样.附睾炎性充血,睾丸正常.镜下肿瘤组织呈束状或编织状排列,细胞呈梭形,核多形性,染色深,偶见核分裂象,胞质红染.肿瘤细胞Bcl(一),Actin(sm)、β-cat、CD34、CD68、Desmin(+).诊断:左精索炎症性肌纤维母细胞瘤.术后未行其他辅助治疗,随访3个月未见复发.     

肾上腺钙化性纤维性肿瘤1例报告及文献复习

探讨肾上腺钙化性纤维性肿瘤（CFT）的临床表现、病理学变化及鉴别诊断方法,并讨论其生物学行为。方法：回顾性分析1例肾上腺CFT患者的临床资料,并结合国内外文献对本病的临床表现、病理学特点、鉴别诊断及治疗方法和预后进行讨论。结果：患者出现腰痛及反复肉眼血尿;病理形态学的主要特点为肿瘤境界清楚,细胞成分稀少,肿瘤主要由胶原化纤维构成,可见散在钙化或砂粒体及小团淋巴细胞、浆细胞浸润。免疫组织化学显示梭形细胞vimentin阳性,desmin、ALK、CD34、MSA、S-100均阴性。结论：肾上腺CFT需与其它肾上腺梭形细胞肿瘤相鉴别。本瘤生物学行为良性,局部肿瘤切除即可治愈。     

Cellular Angiofibroma of Oral Mucosa: Report of Two Cases

Cellular angiofibroma is a benign vascular neoplasm that typically arises in the vulva, perineal, and paratesticular region. Microscopically the lesions exhibit multiple small, non-dilated capillary channels, many of which contain erythrocytes. The endothelial lining cells are prominent, with monomorphic oval nuclei. Interposed among the vessels are both delicate and mature collagen fibers with fibroblastic hypercellularity that is variable in older lesions where sclerosis is prominent. The lesions usually do not recur following simple excision. Recent evidence indicates that cellular angiofibromas may be cytogenetically related to spindle cell lipoma. This represents the first reported instances of cellular angiofibroma in the oral cavity.     

Cellular angiofibroma: clinicopathologic and immunohistochemical analysis of 51 cases

Cellular angiofibroma is a recently described histologically distinctive benign mesenchymal neoplasm composed of 2 principal components, the cellular spindle cell component and prominent stromal blood vessels. Cases in males have sometimes been called "angiomyofibroblastoma-like tumor." We describe a series of 51 cases of cellular angiofibroma to further characterize its clinicopathologic and immunohistochemical features. There were 26 women and 25 men, ranging in age from 22 to 78 years (mean 53.5, median 52 years). Men tended to be older than women. Tumor size ranged from 0.6 to 25.0 cm (overall median size 3.9 cm, median in women 2.7 cm, median in men 6.7 cm). Most common sites were the vulvovaginal region (22 cases) and the inguinoscrotal region (19 cases). Preoperative duration (known for 25 patients) ranged from 1 week to 5 years, with presentation as a painless mass, except for 1 case each with intermittent genital bleeding and a painful mass. Most lesions were located primarily in subcutaneous tissue. Most cases were grossly well marginated. Two cases showed foci of hemorrhage and 1 case showed foci of necrosis. Microscopically, 41 tumors were well circumscribed, and 2 tumors infiltrated into the surrounding tissue. All tumors consisted of bland, spindle-shaped cells, short bundles of wispy collagen and numerous small- to medium-sized thick-walled vessels. Intralesional fat was present in 12 cases (6 female and 6 male cases). Mild cytologic atypia (5 cases) and frequent mitoses (3 cases) were infrequent; significant nuclear atypia and abnormal mitoses were absent. By immunohistochemistry, 29 of 48 tumors (60%) expressed CD34, 10 of 48 (21%) SMA, 4 of 48 (8%) desmin, but none expressed S-100 protein. Follow-up information was available for 40 patients (range 4-168 months; mean 31.2 months) and no patient has developed recurrence or metastasis to date.     

Inflammatory Myofibroblastic Tumor of the Abdominal Wall Simulating Rhabdomyosarcoma: Report of a Case

We report the case of a 6-year-old boy with a progressively enlarging mass in the anterior abdominal wall. Computed tomography showed an intensely enhancing heterogeneous lesion arising from the anterior abdominal wall muscles with intraperitoneal extension. Based on the location of the tumor and the radiological findings we made a provisional diagnosis of rhabdomyosarcoma. However, the findings of fine-needle aspiration and Trucut biopsy were inconclusive for malignancy. We performed complete excision of the mass, including the involved left costal segment. Microscopically, the tumor was composed mainly of spindle-shaped cells without malignant features, and immunohistochemical analysis revealed positive staining for actin. These findings confirmed a diagnosis of an inflammatory myofibroblastic tumor (IMT). To our knowledge, this is the first case report of an extrapulmonary IMT arising from the anterior abdominal wall.     

Laminin and type IV collagen in different histological stages of Kaposi's sarcoma and other vascular lesions of blood vessel or lymphatic vessel origin

Immunohistochemical staining was used to demonstrate basement membrane (BM) laminin and type IV collagen in eight cases of Kaposi's sarcoma (KS). These KS were not associated with AIDS and represented different histological stages of the disease: patch (three cases), plaque (one case), and nodule (four cases). Nine cases of benign angiogenic lesions, five of blood vessel origin, and four of lymphatic vessel origin were also studied. An early event in vascular proliferation at the patch stage of KS was an intersection of dermal collagen bundles and the appearance of granular BM material around this space. With the increase of amount and linear arrangement of BM material, well-defined capillaries were formed. Two types of capillary were found in KS lesions. One showed morphological features of blood capillaries, with a round lumen; thick, continuous BM, and occasional pericytes in the wall. The other included irregularly shaped vessels with thin, often disrupted BMs; thus these capillaries morphologically resembled lymphatic capillaries. BM staining also clearly revealed the vascular nature of the nodular lesions of KS, which were composed of a network of slit-like spaces surrounded by BMs. The solid tumor cell areas were sparse; they were composed of spindle-shaped cells surrounded by thin, interrupted basal laminae. By using antibodies against human laminin and human type IV collagen, it was also possible to demonstrate thin, widely disrupted BMs subendothelially in normal dermal lymphatic capillaries. Typically, the BMs in lymphangiomas and lymphangiectasias were continuous and more clearly defined.     

Extraneural Sclerosing Perineurioma of the Buccal Mucosa: A Case Report and Clinicopathologic Review

The perineurioma is an infrequently encountered benign peripheral nerve sheath tumor composed of a clonal proliferation of perineurial cells. Rare cases of perineurioma have been reported in the oral cavity. An extraneural sclerosing perineurioma arising in the buccal mucosa of a 17-year-old male is presented. Histopathologically, the tumor is composed of a well circumscribed nodular proliferation of spindle cells arranged in a storiform growth pattern, in some areas subtly arranged around vascular channels. The tumor cells reveal positive immunostaining for epithelial membrane antigen (EMA), collagen type IV and vimentin, and negative immunostaining for S-100 protein, consistent with a perineurial origin. To the best of our knowledge, this case represents the first report of an extraneural sclerosing perineurioma involving the oral cavity.     

膀胱炎性肌纤维母细胞瘤2例报告并文献复习

目的：探讨膀胱炎性肌纤维母细胞瘤的临床、病理、组织生化特性和诊治方法及预后。方法：报告2例肉眼血尿伴重度贫血的膀胱炎性肌纤维母细胞瘤患者的诊治资料,并结合文献进行探讨。结果：膀胱炎性肌纤维母细胞瘤以肉眼血尿和尿痛为最常见症状,肿瘤好发于膀胱底部、顶壁、侧壁;组织学由具有平滑肌细胞和纤维母细胞特征的梭形细胞、大量慢性炎性细胞及血管样黏液构成。1例随访3年,1例随访6个月,均无瘤存活。结论：膀胱炎性肌纤维母细胞瘤为低度恶性肿瘤,罕见。确诊依据病理学检查,应与平滑肌肉瘤、横纹肌肉瘤、梭形细胞癌等鉴别;治疗原则以切除肿瘤、保留膀胱功能为主,TUPKBT、TURBT或膀胱部分切除术,术后辅以化疗药物膀胱灌注,效果佳。     

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目的 提高腹膜后肿瘤的手术效果。方法 回顾分析1980－2001年腹膜后肿瘤28例的治疗情况。结果 完整切除21例，部分切除或探查活检7例，无手术死亡。5年生存率分别为：未切除组14．3％，恶性切除组37．5％，良性切除组69．2％。结论 提高手术切除率是改善预后的关键，术前核磁共振（MRI），数字减影（DSA）检查有助于了解肿瘤内及周围血管的走行，用不同方法处理侵及重要血管的腹膜后肿瘤并争取彻底切除，是减少术后复发，提高生存率的重要方法。     

Vascular tumors of the abdominal wall

BACKGROUND: Vascular tumors of the abdominal wall are rare, benign congenital malformations that may cause pain or cosmetic disfigurement and are of significance for their ability to mimic more clinically aggressive tumors. There have been no previous reports of vascular tumors of the abdominal wall. This investigation reports the clinical presentation, diagnosis, and treatment of three patients with vascular tumors of the abdominal wall. METHODS: Magnetic resonance angiography (MRA) was used to identify feeding and draining vessels and to aid in operative planning for two patients; in a third patient, standard magnetic resonance imaging revealed the feeding vessels. RESULTS: MRA accurately identified the feeding and draining vessels and aided in operative planning, thus facilitating complete tumor resection. To date, patients have not experienced tumor recurrence. CONCLUSIONS: These cases suggest that MRA can be employed as a noninvasive imaging technique and should be the standard preoperative modality to plan the operative approach to vascular tumors of the abdominal wall.     

Hepatic angiomyolipoma developing during the follow-up of ulcerative colitis: Report of a case and review of the literature

Hepatic angiomyolipoma is a rare tumor composed of spindle-shaped and epithelioid smooth muscle cells, adipose tissue, and proliferating blood vessels. We report the first documented case of this tumor developing in a patient with ulcerative colitis. A solitary tumor (7.5×7.5×7cm) was detected in the left lateral segment of the liver and a left hepatic lobectomy was performed. The diagnosis of angiomyolipoma was confirmed by a pathological examination. We also review the literature on previously reported cases of hepatic angiomyolipoma.