Clinical Pathology最新文献

英文中文

Estrogen Receptor, Progesterone Receptor, and HER-2 Expression in Recurrent Pleomorphic Adenoma 雌激素受体、孕激素受体和HER-2在复发性多形性腺瘤中的表达

IF 1.3 Q3 PATHOLOGY

Clinical Pathology

Pub Date : 2019-09-01 DOI: 10.1177/2632010X19873384

A. D. de Souza, A. Altemani, N. D. de Araújo, Lucas Novaes Texeira, V. D. de Araújo, A. Soares

Pleomorphic adenoma (PA) is the most common salivary gland neoplasm and, although mostly benign, recurrences, being called recurrent pleomorphic adenoma (RPA) and malignant transformation to carcinoma ex pleomorphic adenoma (CXPA), do occur. Recently, attention has been focused on molecular targeted cancer therapy in various tumors, including salivary gland tumors. The aim of this study was to investigate the role of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER-2) in PA, RPA, and CXPA. In total, 20 cases of PA, 18 of RPA, and 7 cases of CXPA were immunohistochemically studied for ER, PR, and HER-2. For evaluation of ER and PR, only nuclear expression and greater than 10% positive cells were regarded as cutoff criteria. HER-2 was evaluated semiquantitatively and graded from 0 to 3+. HER-2 amplification was assessed by chromogenic in situ hybridization (CISH). Tumors were negative for ER, PR, and HER-2 in all cases of PA and RPA. A case of CXPA showed moderate and complete membranous staining, and 6 cases were negative. HER-2 amplification was not observed in any case. In conclusion, the lack of ER, PR, and HER-2 expression in PA, RPA, and CXPA suggests that these proteins are not involved in progression, recurrence, or malignant transformation of PA.

多形性腺瘤（PA）是最常见的唾液腺肿瘤，尽管大多是良性的，但仍会发生复发，称为复发性多形性腺瘤和恶性转化为癌性多形性瘤（CXPA）。近年来，包括唾液腺肿瘤在内的各种肿瘤的分子靶向癌症治疗受到关注。本研究的目的是研究雌激素受体（ER）、孕激素受体（PR）和人表皮生长因子受体-2（HER-2）在PA、RPA和CXPA中的作用。对20例PA、18例RPA和7例CXPA的ER、PR和HER-2进行了免疫组化研究。对于ER和PR的评估，只有细胞核表达和大于10%的阳性细胞被视为截止标准。对HER-2进行半定量评估，并从0到3+进行分级。HER-2扩增通过显色原位杂交（CISH）进行评估。在所有PA和RPA病例中，肿瘤的ER、PR和HER-2均为阴性。1例CXPA显示中度和完全膜染色，6例呈阴性。在任何情况下均未观察到HER-2扩增。总之，PA、RPA和CXPA中缺乏ER、PR和HER-2表达表明这些蛋白与PA的进展、复发或恶性转化无关。

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引用次数: 6

Diagnostic Value of TROP-2 and CK19 Expression in Papillary Thyroid Carcinoma in Both Surgical and Cytological Specimens. TROP-2和CK19在甲状腺乳头状癌手术和细胞学标本中的表达诊断价值。

IF 1.3 Q3 PATHOLOGY

Clinical Pathology

Pub Date : 2019-07-22 eCollection Date: 2019-01-01 DOI: 10.1177/2632010X19863047

Asmaa Gaber Abdou, Mohammed Shabaan, Rania Abdallha, Nehal Nabil

Papillary thyroid carcinoma (PTC) represents the most common primary malignant thyroid tumor and its diagnosis is dependent on the presence of classic nuclear features that are sometimes seen in some non-neoplastic and benign lesions. Several immunohistochemical markers are used individually or in combination to help in differentiation of PTC from mimickers. The aim of the current study was to assess the diagnostic value of TROP-2 and cytokeratin 19 (CK19) expression in differentiating PTC from other mimickers both singly and in combination. The current study was carried out on 77 surgical specimens (56 PTC and 21 non-neoplastic cases) and 12 cytological specimens (4 THY2, 6 THY4, and 2 THY5). TROP-2 was negative in 81% of non-neoplastic surgical specimens and in 100% of THY2 cytological specimens while it was positive in 71.4% of PTC surgical specimens and 100% of THY4/THY5 cytological specimens. Sensitivity and specificity of TROP-2 positive expression for diagnosis of PTC in surgical specimens reached 71% and 81%, respectively, while it reached 100% for both in cytological specimens. Cytokeratin 19 showed positive expression in 85.7% of non-neoplastic surgical specimens and in 92.9% of PTC surgical specimens. Cytokeratin 19 showed negative expression in 75% of Thy2 cases while it was positive in all studied Thy4 and Thy5 cases. Sensitivity and specificity of CK19 total estimated score for diagnosis of PTC in surgical specimens were 78.6% and 66.7%, respectively, while it reached 100% and 75% in cytological specimens. Positive TROP-2 and CK19 expression in PTC were associated with lymph node metastasis. TROP-2 is a specific rather than sensitive marker while CK19 is a sensitive rather than specific marker in differentiating PTC from other mimickers in surgical specimens. The diagnostic validity of both markers was superior in diagnosis of classic PTC compared with follicular variant PTC. TROP-2 is superior to CK19 in diagnosis of PTC in cytological specimens. Both TROP-2 and CK19 could be used preoperatively in adjunct to hematoxylin and eosin for more confident diagnosis of thyroid cytology and along with radiology as predictors of lymph node metastasis.

乳头状甲状腺癌（PTC）是最常见的原发性甲状腺恶性肿瘤，其诊断取决于经典核特征的存在，有时在一些非肿瘤和良性病变中可见。几种免疫组织化学标记物被单独或组合使用，以帮助区分PTC和拟态物。本研究的目的是评估TROP-2和细胞角蛋白19（CK19）表达在单独或联合区分PTC与其他拟态细胞中的诊断价值。本研究对77个外科标本（56个PTC和21个非肿瘤病例）和12个细胞学标本（4个THY2、6个THY4和2个THY5）进行了研究。TROP-2在81%的非肿瘤手术标本和100%的THY2细胞学标本中呈阴性，而在71.4%的PTC手术标本和100%THY4/THY5细胞学标本中阳性。TROP-2阳性表达在外科标本中诊断PTC的敏感性和特异性分别达到71%和81%，而在细胞学标本中两者均达到100%。细胞角蛋白19在85.7%的非肿瘤手术标本和92.9%的PTC手术标本中呈阳性表达。细胞角蛋白19在75%的Thy2病例中呈阴性表达，而在所有研究的Thy4和Thy5病例中均呈阳性。CK19总分在外科标本中诊断PTC的敏感性和特异性分别为78.6%和66.7%，而在细胞学标本中分别达到100%和75%。TROP-2和CK19在PTC中的阳性表达与淋巴结转移有关。TROP-2是一种特异性而非敏感性标记，而CK19是区分外科标本中PTC与其他拟态物的敏感而非特异性标记。与卵泡变异型PTC相比，这两种标志物在诊断经典PTC方面的有效性更高。TROP-2在细胞学诊断PTC方面优于CK19。TROP-2和CK19可在术前与苏木精和伊红联合使用，以更可靠地诊断甲状腺细胞学，并与放射学一起作为淋巴结转移的预测指标。

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引用次数: 11

Monostotic Fibrous Dysplasia of the Lumbar Spine With Secondary Features of Solid Variant Aneurysmal Bone Cyst 以实体变异性动脉瘤性骨囊肿为次要特征的腰椎单一性纤维发育不良

IF 1.3 Q3 PATHOLOGY

Clinical Pathology

Pub Date : 2019-07-01 DOI: 10.1177/2632010X19861109

N. Maloney, K. Linos

Fibrous dysplasia is a benign, mass-forming disease of bone composed of abnormal fibrous and osseous elements that can be accompanied by endocrine dysfunction, skin pigmentation, and intramuscular myxomas. It is usually encountered as a solitary lesion in the tibia or femur but can develop in any bone and can be unifocal or multifocal. Difficulty arises when a solitary lesion is identified in an uncommon site or when there are prominent secondary changes, such as aneurysmal bone cyst (ABC). Molecular studies are available as an adjunct to histomorphology to aid distinction from other entities. GNAS mutations, present in greater than 70% of fibrous dysplasia cases, help in the distinction from primary ABC and low-grade osteosarcoma, which exhibit different molecular abnormalities. We report a case of monostotic fibrous dysplasia in a lumbar vertebral body with secondary change consisting of the solid variant of ABC.

纤维发育不良是一种由异常纤维和骨元素组成的良性骨块形成疾病，可伴有内分泌功能障碍、皮肤色素沉着和肌内粘液瘤。它通常是胫骨或股骨的孤立性病变，但可以在任何骨骼中发展，可以是单灶性或多灶性。当在不常见的部位发现孤立性病变或有明显的继发性变化时，如动脉瘤样骨囊肿（ABC），就会出现困难。分子研究可以作为组织形态学的辅助手段来帮助区分其他实体。GNAS突变存在于70%以上的纤维发育不良病例中，有助于区分原发性ABC和低度骨肉瘤，后者表现出不同的分子异常。我们报告了一例腰椎单发性纤维发育不良，继发性改变由ABC的实体变体组成。

引用次数: 2

Unexpected Gallbladder Metastasis of Clear Cell Renal Carcinoma 透明细胞肾癌的胆囊意外转移

IF 1.3 Q3 PATHOLOGY

Clinical Pathology

Pub Date : 2019-07-01 DOI: 10.1177/2632010X19861112

Ian White, Shane A. Smith, K. Rizkalla, E. Davies

Renal cell carcinoma (RCC) commonly metastasizes to areas such as the lungs, liver, bone, brain, adrenals, and lymph nodes. We present a rare case of a 59-year-old female patient with RCC metastasis to the gallbladder. The patient had undergone right nephrectomy for RCC more than 6 years prior to the metastasis. During routine follow-up, a polypoid lesion of the gallbladder was identified. Laparoscopic cholecystectomy was performed, and pathologic examination of the specimen revealed metastatic RCC. The patient was completely asymptomatic, which reinforces the importance of postoperative follow-up. Renal cell carcinoma is one of the few common malignancies for which there is good evidence of survival benefit from surgical resection of the metastatic tumours.

肾细胞癌(RCC)通常转移到肺、肝、骨、脑、肾上腺和淋巴结等部位。我们报告一个罕见的病例，一个59岁的女性患者的肾细胞癌转移到胆囊。患者在发生转移前6年以上曾因肾细胞癌行右肾切除术。在常规随访中，发现胆囊息肉样病变。行腹腔镜胆囊切除术，病理检查显示转移性肾细胞癌。患者完全无症状，这加强了术后随访的重要性。肾细胞癌是为数不多的常见恶性肿瘤之一，有很好的证据表明手术切除转移性肿瘤可使生存受益。

引用次数: 5

Pseudodematiaceous Fungi in Rhinosinusal Biopsies: Report of 2 Cases With Light and Electron Microscopy Analysis 鼻粘膜活检中的假水肿真菌——附2例光镜和电镜分析

IF 1.3 Q3 PATHOLOGY

Clinical Pathology

Pub Date : 2019-01-01 DOI: 10.1177/2632010X19874766

D. Oddó, D. Cisternas, G. Mendez

The diagnosis of a mycosis is often established through a biopsy, which allows to differentiate invasive and non-invasive lesions, and also to identify hyaline and dematiaceous fungi. However, pigmented fungal elements that do not correspond to dematiaceous fungi, which we have called pseudodematiaceous, can occasionally be present in biopsies. Herein, we present 2 cases of mycosis caused by pseudodematiaceous fungi in rhinosinusal biopsies. A new classification for fungi identified in biopsies is proposed, dividing them into 3 groups: hyaline, dematiaceous, and pseudodematiaceous.

真菌病的诊断通常是通过活检来确定的，活检可以区分侵入性和非侵入性病变，也可以识别透明真菌和脂质真菌。然而，在活组织检查中偶尔会发现与骨脂真菌不对应的色素真菌成分，我们称之为假骨脂真菌。在此，我们报告了2例由鼻鼻活检中假真菌引起的真菌病。提出了一种新的真菌分类方法，将其分为3组:透明菌、木脂菌和假木脂菌。

引用次数: 2

Combined Tumors in Hematolymphoid Neoplasms: Case Series of Histiocytic and Langerhans Cell Sarcomas Arising From Low-Grade B-Cell Lymphoma 血液淋巴肿瘤的合并肿瘤：低级别B细胞淋巴瘤引起的组织细胞和郎格罕细胞肉瘤病例系列

IF 1.3 Q3 PATHOLOGY

Clinical Pathology

Pub Date : 2019-01-01 DOI: 10.1177/2632010X19878410

S. Skala, J. Ye, J. Stumph, W. Macon, Frances R Quinones, Vadim Khachaturov, R. Ketterling, R. Dewar

We report an index case of histiocytic sarcoma arising in a 70-year-old patient with long-standing chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). The patient presented in 2017 with painful, enlarging swelling of the left neck. He had remote history of cutaneous squamous cell carcinoma with no sign of recurrence, and his CLL/SLL was thought to be in remission. Computed tomography showed mild splenomegaly and multifocal lymphadenopathy including a 3-cm left neck mass. Biopsy of the left neck mass showed CLL/SLL with associated histiocytic sarcoma. Flow cytometry demonstrated a B cell neoplasm with CLL/SLL phenotype. Despite radiation therapy, he expired 3 months after presentation. Two similar cases (CLL/SLL and histiocytic sarcoma, follicular lymphoma and Langerhans cell sarcoma) from another institution are also illustrated. The pathological features of combined tumors in lymphoid neoplasms, a general framework to the work-up to determine interrelatedness of tumor components, and the clinical relevance are discussed.

我们报告了一例70岁长期慢性淋巴细胞白血病/小淋巴细胞淋巴瘤（CLL/SLL）患者的组织细胞肉瘤指数病例。患者于2017年出现左颈部疼痛、肿胀加剧。他有皮肤鳞状细胞癌的病史，没有复发的迹象，他的CLL/SLL被认为处于缓解期。计算机断层扫描显示轻度脾肿大和多灶性淋巴结病，包括一个3厘米的左颈部肿块。左颈部肿块的活检显示CLL/SLL伴有相关的组织细胞肉瘤。流式细胞术显示B细胞肿瘤具有CLL/SLL表型。尽管接受了放射治疗，他还是去世了演示后数月。还说明了来自另一个机构的两个类似病例（CLL/SLL和组织细胞肉瘤、滤泡性淋巴瘤和郎格汉斯细胞肉瘤）。讨论了淋巴肿瘤中合并肿瘤的病理特征、确定肿瘤成分相关性的一般框架以及临床相关性。

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引用次数: 5

Regional Lymph Node Enlargement in Clinically Severe Cherubism 临床重度小天使病的局部淋巴结肿大

IF 1.3 Q3 PATHOLOGY

Clinical Pathology

Pub Date : 2019-01-01 DOI: 10.1177/2632010X19861107

Y. Chen Wongworawat, D. Jack, J. Inman, F. Abdelhalim, C. Cobb, C. Zuppan, A. Raza

Cherubism is a rare benign autosomal dominant disorder characterized by progressive, painless, bilateral enlargement of the mandible and/or maxilla because of bone replacement by fibrotic stromal cells and osteoclast-like cells forming multilocular cysts. The lesions typically stabilize and regress after puberty. We present a 14-year-old male with severe familial cherubism. Bilateral mandibular enlargement began around age 4 and progressed until puberty, affecting his speech and mastication without subsequent involution. Composite mandibulectomy and mandible reconstruction with fibula free flap technique improved functionality and cosmesis. Histology was consistent with the diagnosis of cherubism, showing large areas of bland spindle-cell fibrous tissue and moderately abundant collagen and multiple nodules of giant cell-rich tissue resembling central giant cell granuloma. Regional lymph nodes were sampled due to enlargement, demonstrating hemosiderin-laden macrophages and basophilic laminated concretions localized to the cortical interfollicular space and along the peripheral follicular marginal zone, findings which have not been previously reported.

Cherubism是一种罕见的良性常染色体显性遗传疾病，其特征是由于纤维基质细胞和破骨细胞样细胞替代骨形成多房囊肿，导致下颌骨和/或上颌骨进行性、无痛、双侧增大。病变通常在青春期后稳定并消退。我们报告一位患有严重家族性小天使症的14岁男性。双侧下颌增大始于4岁左右，一直发展到青春期，影响了他的言语和咀嚼，随后没有退化。复合下颌骨切除术和腓骨游离皮瓣重建下颌骨改善了功能和美观。组织学检查与小天使症的诊断一致，显示大面积扁平的梭形细胞纤维组织和适度丰富的胶原，以及多个结节状的富含巨细胞的组织，类似于中央巨细胞肉芽肿。由于淋巴结肿大，对区域淋巴结进行了采样，显示富含含铁血黄素的巨噬细胞和嗜碱性层状结核局限于皮质滤泡间间隙和外周滤泡边缘区，这些发现以前没有报道过。

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引用次数: 1

Biliary Intraepithelial Neoplasia in Non-biliary Cirrhosis—Report From 100 Explanted Livers: A Single Center Experience 非胆汁性肝硬化的胆管上皮内增生——来自100例肝移植的报告：单中心经验

IF 1.3 Q3 PATHOLOGY

Clinical Pathology

Pub Date : 2019-01-01 DOI: 10.1177/2632010X19876934

Maryam Zarei, Alireza Shasaeefar, K. Kazemi, M. Dehghani, S. Malekhosseini, B. Geramizadeh

Background: Intrahepatic cholangiocarcinoma is a highly malignant tumor with a very short 5-year survival. Multistep carcinogenesis has been suggested as the main pathway for the development of this tumor. Main suggested precursors have been (1) biliary intraepithelial neoplasia (BilIN) and (2) intraductal papillary neoplasm of bile duct (IPNB). The former is flat and does not produce grossly and radiologically detectable mass lesion, but the latter produces grossly identifiable lesion. Objectives: The development of bile duct dysplasia (BilIN) in chronic biliary diseases has been investigated and proved, but the incidence of BilIN in non-biliary causes of cirrhosis such as hepatitis B and non-alcoholic steatohepatitis has very rarely been investigated. In this study, we have tried to find out the prevalence of BilIN in non-biliary cirrhosis. Patients and Methods: During the study period (2017-2018) in 100 explanted livers with the diagnosis of non-biliary cirrhosis, thorough sampling (at least 20 sections) was performed, and pathologic sections were studied for the presence of BilIN. Results: In the 100 studied livers with different diagnoses of non-biliary causes of cirrhosis, 31% of cases showed BilIN-1 and 2% of cases showed BiliIN-2. No case of BilIN-3 has been identified. Discussion and Conclusions: Non-biliary causes of cirrhosis should be considered as precursors of cholangiocarcinoma (BilIN); however, the incidence of this occurrence is low.

背景：肝内胆管癌是一种高度恶性的肿瘤，5年生存期很短。多步致癌作用已被认为是该肿瘤发展的主要途径。主要提示的前体是（1）胆管上皮内瘤变（BilIN）和（2）胆管导管内乳头状瘤（IPNB）。前者是扁平的，不会产生大体上和放射学上可检测的肿块病变，但后者产生大体上可识别的病变。目的：对慢性胆道疾病中胆管发育不良（BilIN）的发展进行了研究和证实，但对非胆汁性肝硬化（如乙型肝炎和非酒精性脂肪性肝炎）中BilIN的发病率却很少进行研究。在这项研究中，我们试图找出BilIN在非胆汁性肝硬化中的患病率。患者和方法：在研究期间（2017-2018），对100个诊断为非胆汁性肝硬化的移植肝脏进行了彻底取样（至少20个切片），并研究了病理切片中是否存在胆汁酸。结果：在100个不同诊断为肝硬化非胆汁性原因的研究肝脏中，31%的病例显示为BilIN-1，2%的病例显示BilIN-2。尚未发现BilIN-3病例。讨论和结论：肝硬化的非胆道原因应被视为胆管癌（BilIN）的前兆；然而，这种情况的发生率很低。

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引用次数: 3

Malignant Solitary Fibrous Tumour of the Breast Mimicking a Benign Tumor 模仿良性肿瘤的乳腺恶性孤立性纤维瘤

IF 1.3 Q3 PATHOLOGY

Clinical Pathology

Pub Date : 2019-01-01 DOI: 10.1177/2632010X19868462

I. Barco, Clarisa González, E. Vallejo, A. Pessarrodona, N. Giménez, A. García-Fernández

Solitary fibrous tumour (SFT) of the breast is exceedingly uncommon. Radiological assessment usually shows benign features. We report on a case of malignant SFT of the breast, while emphasizing the need for additional immunostains to reach a definitive diagnosis. Standard treatment consists of lesion removal with adequate margins.

乳腺孤立性纤维瘤（SFT）极为罕见。放射学评估通常显示良性特征。我们报告了一例乳腺恶性SFT，同时强调需要额外的免疫染色才能得到明确的诊断。标准治疗包括切除有足够边缘的病变。

引用次数: 6

A Case of Gastric Amphicrine Signet-Ring Cell Carcinoma 胃腺印戒细胞癌1例

IF 1.3 Q3 PATHOLOGY

Clinical Pathology

Pub Date : 2019-01-01 DOI: 10.1177/2632010X19880535

Y. Hanamatsu, Chiemi Saigo, Nami Asano, Yusuke Kito, K. Nakada, Y. Takeda, T. Takeuchi

“Amphicrine” (in Greek, amphi- means “both” or “double”) refers to cells that synchronously exhibit the endocrine and exocrine phenotypes. Gastric amphicrine carcinoma is very rare, and only a few case reports are found in the English literature; thus, its pathobiological features remain unclear. Here, we report a case of amphicrine gastric carcinoma. A woman in her sixth decade of life presented with anemia and underwent upper endoscopy, followed by histopathological examination of biopsy specimens. She appeared to have gastric cancer with a tumor measuring 5.0 cm × 4.0 cm in size. Subsequently, the patient underwent total gastrectomy with lymph node dissection. Histopathological examination revealed a poorly cohesive carcinoma that sparsely coexisted with signet-ring cell carcinoma cells with regional lymph node metastasis. Interestingly, synaptophysin immunoreactivity with the coexistence of Alcian blue was found in individual signet-ring cell carcinoma cells. Furthermore, the present amphicrine carcinoma cells immunohistochemically expressed CD44 variant 9, a functional cancer stem cell marker. We believe that the present case findings may support the idea of multipotent stem cells being an origin of amphicrine gastric cancers.

“Amphicrine”(在希腊语中，amphi-意思是“两个”或“双重”)指的是同时表现出内分泌和外分泌表型的细胞。胃腺癌非常罕见，在英文文献中仅有少数病例报道;因此，其病理生物学特征尚不清楚。在此，我们报告一例两性胃癌。一位妇女在她的60岁的生活提出了贫血，并进行了上内窥镜检查，随后组织病理检查活检标本。她似乎患有胃癌，肿瘤大小为5.0厘米× 4.0厘米。随后，患者行全胃切除术并淋巴结清扫。组织病理学检查显示为黏结性差的癌，与印戒细胞癌稀疏共存，并伴有局部淋巴结转移。有趣的是，在单个印戒细胞癌细胞中发现突触素免疫反应性与阿利新蓝共存。此外，目前的两癌细胞免疫组织化学表达CD44变体9，这是一种功能性癌症干细胞标志物。我们认为，本病例的发现可能支持多能干细胞是两性胃癌起源的观点。

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引用次数: 1

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