睾丸混合性生殖细胞肿瘤临床病理分析

目的:探讨原发性睾丸混合性生殖细胞肿瘤(MGCT)的临床病理特征。方法:对我院13例原发性睾丸MGCT患者的临床病理资料进行回顾性分析,并结合相关文献进行讨论。结果:睾丸MGCT占我院同期睾丸生殖细胞肿瘤的24.1%(13/54),患者年龄2~53岁,平均28.3岁。全部病例均发生于单侧睾丸,左侧6例,右侧7例,左右侧比为0.86∶1。睾丸MGCT病理形态多样,肿瘤成分包括胚胎性癌(11例,84.6%)、精原细胞瘤(8例,61.5%)、畸胎瘤(6例,46.2%)、绒毛膜癌及卵黄囊瘤(均为4例,23.1%)。其中9例(69.2%)包含2种不同的生殖细胞肿瘤成分,3例(30.8%)包含3种不同的肿瘤成分,1例(7.7%)包含5种不同的肿瘤成分。结论:睾丸MGCT非常少见,好发于青壮年男性,不同的肿瘤成分其生物学行为、临床治疗和预后不同,因此准确的病理诊断非常必要,免疫组化标记对病理诊断与鉴别诊断具有重要作用。     

胰岛素样生长因子-2、血管内皮生长因子受体-2、血小板源生长因子受体和类肝素酶-1在肾上腺皮质癌中的表达及其意义

目的探讨胰岛素样生长因子-2（IGF-2）、血管内皮生长因子受体-2（VEGFR-2）、血小板源生长因子受体（PDGFR）和类肝素酶-1（HPA）在肾上腺皮质癌（ACC）中的表达及其临床意义。方法选取经手术治疗且具有完整的临床、病理资料的肾上腺皮质肿瘤存档石蜡标本37例,其中良性组20例,恶性组（ACC组）17例。采用免疫组化技术检测良、恶性肾上腺皮质肿瘤中IGF-2、VEGFR-2、PDGFR和HPA的表达情况。结果 IGF-2在ACC组中呈高表达（76.47%）,在良性组中表达低（5.00%）,ACC组与良性组之间IGF-2的表达有极显著性差异（P〈0.01）;VEGFR-2在ACC组中呈高表达（76.47%）,在良性组中表达较低（25.00%）,ACC组与良性组之间VEGFR-2的表达有显著性差异（P〈0.05）;PDGFR在ACC组中表达的阳性率为（17.64%）,在良性组中为（20.00%）,PDGFR在ACC组中的表达与在良性组中的表达无显著性差异（P〉0.05）。HPA在ACC组中的表达为（94.12%）,良性组中为（15.00%）,两者之间有显著性差异（P〈0.05）。结论 IGF-2、VEGFR-2和HPA在ACC中的高表达为抗肿瘤血管生成治疗在ACC中的应用,提供了相应的理论依据。     

Significance of mismatch repair protein expression in the chemotherapeutic response of sporadic invasive ductal carcinoma of the breast

The mismatch repair (MMR) gene plays a key role in the correction of DNA damage, and the loss of MMR has been implicated in resistance to a variety of chemotherapeutic drugs. The purpose of this study was to assess whether the reduced expression of hMLH1 and/or hMSH2 affects the chemotherapeutic responsiveness of sporadic invasive ductal carcinoma of the breast. Immunohistochemical studies were performed on 71 histologic specimens of breast cancer taken from the patients treated with surgery and subsequent cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) or cyclophosphamide, Adriamycin, and 5-fluorouracil (CAF) chemotherapy for stage II or III primary breast cancer. Single-strand conformational polymorphism polymerase chain reaction (PCR-SSCP) and sequencing were carried out in 16 patients. A combined immunoreactivity score (hMLH1-IS and hMSH2-IS) was calculated by multiplying the staining grade by the intensity score. Positive expression (>4) of hMLH1-IS and hMSH2-IS were 57.7% and 60.6%, respectively, and complete losses of hMLH1 and hMSH2 were observed in 4.2% of patients. Of the patients with advanced cancer with lymph node metastasis, those having a low hMLH1-IS had a significantly higher failure rate with the CMF regimen than those having a high hMLH1-IS (p = 0.03). No significant difference was noted in chemotherapeutic response according to hMLH1 and hMSH2 expression in the CAF group. Both hMLH1-IS (p = 0.03) and progesterone receptor (PR) status (p = 0.03) were well correlated with CMF chemotherapy response in breast cancers with lymph node metastasis. Our study shows that a lack of hMLH1 expression may play a role in drug resistance, especially in the CMF group, and immunohistochemical assay for MMR protein can be used as a convenient tool for evaluating chemotherapeutic response in patients with breast cancer.     

Malignant Adenomyoepithelioma of the Breast: A Review

Malignant adenomyoepithelioma (MAME) of the breast is a rare lesion characterized by dual population of epithelial and myoepithelial cells which one or both components show malignant features. We report a case of MAME of the breast in a 46‐year‐old woman diagnosed by fine‐needle aspiration with extensive review of the literature. Classification, clinical presentation, cyto‐pathologic, and immunohistochemical features are described. This lesion showed both malignant components of epithelial and myoepithelial cells in cytology and histology. The malignancy was convincingly supported by high mitotic figures, pleomorphism, and invasion in tissue sections. This review of MAMEs showed that cyto‐histologic diagnosis is difficult and should be supported by immunohistochemical study.     

Detection and Significance of Occult Axillary Metastatic Disease in Breast Cancer Patients

▪ Abstract: After clinical staging, the single most important prognostic factor for patients with newly diagnosed primary breast cancer is the presence or absence of detectable metastases to axillary lymph nodes when examined by conventional light microscopy. More sensitive methods of determination of lymph node status, such as evaluation of serial sections, immunohistochemical staining, and use of molecular biological assays increase the rate of detection of micrometastases. Although the feasibility of enhanced detection of occult axillary metastatic disease is well established, the prognostic significance of such detection is only recently starting to emerge. Furthermore, the enormous recent interest in the application of sentinel lymph node biopsy as an alternative to the evaluation of the entire axilla in patients with breast cancer makes the first-time detailed evaluation for micrometastases practically feasible. In this review the different methods of detecting micrometastatic disease in the axilla and the significance of such findings are discussed. ▪     

阴囊、阴茎Paget病临床病理分析

目的:探讨阴囊、阴茎Paget病的临床病理特点、诊断及鉴别诊断依据。方法:复习13例阴囊、阴茎Paget病的临床病理资料,采用HE染色、特殊染色(AB/PAS)及免疫组化技术进行观察分析。结果:阴囊、阴茎Paget病以老年男性多见,发病年龄55～84岁,中位年龄为71岁。肉眼皮损呈湿疹样改变。光镜下表皮内可见数目不等的Paget细胞呈单个散在、巢状或条索状分布。所有病例AB/PAS染色均阳性;13例均表达CK7、CEA、EMA抗原,不表达CK5/6、S-100及P63,GCDFP-15与CK20阳性表达率分别为76.92%(10/13)和53.85%(7/13)。结论:阴囊、阴茎Paget病为低度恶性的皮肤上皮性肿瘤,有特殊的临床及组织病理学特点,免疫组化标记有助于该肿瘤的诊断。     

并发静脉癌栓的肾细胞癌中VEGF的表达及临床意义

目的：探讨血管内皮生长因子（VEGF）的表达与肾细胞癌（RCC）并发静脉癌栓（VTT）的关系。方法：采用免疫组织化学MaxVision^TM快捷法检测57例并发或未并发VTT的RCC组织和10例远离肿瘤的正常肾组织中VEGF的表达状况。实验分为三组,A组：并发VTT的RCC组织27例;B组：未并发VTT的RCC组织30例;C组：远离肿瘤的正常肾组织10例。结果：VEGF在三组中的阳性表达率分别为81．5％、63．3％和20．0％,其中A组和C组差异有统计学意义（P〈0．01）,A组和B组差异无统计学意义（P〉0．05）,B组和C组差异有统计学意义（P〈0．05）。结论：VEGF的异常表达可能在RCC并发VTT的形成中发挥重要作用,以抑制VEGF蛋白及其受体作用的靶向治疗药物在RCC并发VTT的治疗中应有良好效果。     

肝血管平滑肌脂肪瘤5例临床病理观察

目的:研究肝血管平滑肌脂肪瘤(hepatic angiomyolipoma,HAML)的形态学特点,探讨其诊断和鉴别诊断要点. 方法采用HE切片、光镜观察和免疫组织化学SP法染色对5例HAML进行分析. 结果5例HAML镜下见由厚壁的畸形血管、肌样细胞和脂肪组织混合组成,免疫组化瘤细胞表达HMB 45 、S-100和Desmin. 结论HAML 3种成分分布、比例及病理形态变化多样,HMB45阳性是诊断HAML 的重要指标之一.