目的探讨继发性阴茎癌的临床特点及诊治方法。方法 回顾性分析成都军区总医院全军普外中心收治的1例直肠癌术后36个月发生阴茎转移患者的临床资料，并结合国内、外46例文献报道的资料(1988~2010年)，对其发病情况、临床表现、转移途径、诊断、治疗和预后进行总结。 结果阴茎转移癌以泌尿系来源最多见（51.05%），其次为消化系统来源（36.17%）； 多发生在原发肿瘤术后5~18个月，部分表现为首发症状； 转移灶多位于阴茎体部或根部（87.23%），多表现于单发结节（48.94%），部分为多发结节（29.97%）； 25.53%伴有异常阴茎勃起； 常伴有其他部位转移（55.32%）。对单纯继发性阴茎癌不伴其他脏器转移者行部分或全部阴茎切除，术后辅以放疗、化疗和内分泌治疗能够提高治疗效果，延长生存期； 非手术治疗的患者，多因其他部位转移不能手术，绝大多数生存期在1年内。结论对阴茎出现单个或多个结节或伴有异常勃起的肿瘤患者，要考虑阴茎继发性转移的可能； 活检可明确诊断； 手术切除、辅以放化疗及内分泌治疗可延长患者的生存期。
ObjectiveTo study the clinicopathological features of mediastinum nodular sclerosis Hodgkin lymphoma (NSHL) in order to improve the recognition of it. MethodsThe clinical data of 3 cases of mediastinum NSHL between 2003 and 2012 were collected. Then we analyzed the carcinoma pathologic samples by pathomorphology, immunophenotypic phenotype, related gene rearrangement and situ hybridization with EBER. ResultsThe pathomorphologic results showed that broad fibrotic bands subdivided the lymphoid parenchyma into large nodules, the tumoral cells had distinct boundary with empty cytoplasm and small-to-medium-sized nucleoli, and the nodules contained inflammatory cell components. The immunophenotypic phenotype of the tumoral cells were CD15, CD30, PAX-5 and CD20 partly, but anaplastic lymphoma kinase, CD45, cytokeratin, CD79α and S-100 were not expressed. T cell receptor γ and IgH gene were no rearranged, and EBER in situ hybridization was not detected. ConclusionVarious lymphomas occur in the mediastinum and mediastinum NSHL is just one of them. Mastering its distinctive pathomorphology and immunophenotypic phenotype is highly significant for diagnosis, differential diagnosis and treatment of the disease.
【摘要】 目的 探讨老年人头面部脉管肉瘤的临床病理学特征。 方法 1996年-2008年对5例老年人头面部脉管肉瘤的临床资料、病理形态学、免疫组织化学染色进行观察，并对其中4例进行了随访。 结果 临床表现主要是头面部发生的瘀斑、溃疡或结节状病变。肿瘤细胞围绕皮肤附件周围排列成交通状吻合的血窦网，衬覆有异型性的内皮细胞，有的区域内皮细胞形成乳头状突起。肿瘤组织内有不同程度的弥漫性出血。肿瘤细胞表达CD34、CD31、Fli-1和FⅧ，部分表达CD117和CK8/18。经随访3例3年内死亡，1例带瘤存活1年余，1例失访。 结论 老年人头面部脉管肉瘤组织形态多样，预后较差，及时诊治十分重要。需要与其他皮肤良性血管病变和低分化癌、恶性黑色素瘤、恶性梭形细胞肿瘤、Kaposi肉瘤等鉴别。【Abstract】 Objective To explore the clinicopathological features of cutaneous angiosarcoma on the scalp and face in elder patients. Methods The clinical data of five elder patients with cutaneous angiosarcoma on the scalp and face from 1996 to 2008 were retrospectively analyzed. The patients underwent the light microscopy, pathomorphological examination, and immunohistochemistry. Four patients were followed up. Results Most clinical manifestation was dusky irregular erythematous plaques which were often ulcerated. The tumor was composed of asymmetric collection of angulated and irregular vascular spaces infiltrating between collagen bundles. Endothelial cells attaching to the vascular spaces had hyperchromatic irregular nuclei and prominent nucleoli. Hemorrhage was another histologic feature. Positive expression of CD34,CD31,Fli-1 and FⅧ were found in tumor cells, and expression of CD117 and CK8/18 was found in some of the patients. In the follow-up duration, three patients died in three years, and one failed to be followed up. Conclusion Cutaneous angiosarcoma of the scalp and face has various histomorphology and poor prognosis, which should be diagnosed and treated in time. It should be distinguished from benign cutaneous hemangioma, poorly differentiated carcinoma, malignant melanoma and malignant spindle cell tumor.