BACKGROUND Micronodular thymic tumors with lymphoid stroma include micronodular thymoma with lymphoid stroma(MNT)and micronodular thymic carcinoma with lymphoid hyperplasia(MNC),whose micromorphological features are l...BACKGROUND Micronodular thymic tumors with lymphoid stroma include micronodular thymoma with lymphoid stroma(MNT)and micronodular thymic carcinoma with lymphoid hyperplasia(MNC),whose micromorphological features are lymphoid stromal hyperplasia and nodular arrangement of tumor epithelial cells.This type of tumor is rare;therefore,the corresponding clinical guidelines,histopathological diagnostic criteria,prognostic factors,and therapeutic regimens have not been established.CASE SUMMARY This study covers a novel presentation of MNC in a patient and summarizes the clinicopathological characteristics of this type of tumor by using pooled-analysis methods.Morphologically,this tumor type is a series of benign to malignant pedigrees.We establish the following criteria for the classification of micronodular thymic tumors with lymphoid stroma:(1)Tumor cells with moderate-to-severe dysplasia;(2)Tumor cell mitotic figures>2/10 high-power fields;(3)Appearance of neoplastic necrosis;(4)No terminal deoxynucleotidyl transferase-positive immature T lymphocytes within the tumor;(5)Tumor cells with a Ki-67 index≥10%;and(6)Tumor cells express CD5.Cases that fall into the borders of two categories in terms of morphology are attributed to atypical MNT.It is proposed that the diagnosis of MNT should be established on the diagnostic criteria mentioned above.CONCLUSION Our diagnostic algorithm can effectively distinguish malignant tumors from benign tumors and provides a potent basis for predicting a prognosis,which offers a practical reference for oncologists and pathologists.展开更多
BACKGROUND Adrenal incidentaloma(AI)has been frequently encountered in the clinical setting.It has been shown that primary aldosteronism(PA)or subclinical Cushing’s syndrome(SCS)are the representative causative disea...BACKGROUND Adrenal incidentaloma(AI)has been frequently encountered in the clinical setting.It has been shown that primary aldosteronism(PA)or subclinical Cushing’s syndrome(SCS)are the representative causative diseases of AI.However,the coexistence of PA and SCS has been reportedly observed.Recently,we encountered a case of AI,in which PA and SCS coexisted,confirmed by histopathological examinations after a laparoscopic adrenalectomy.We believe that there were some clinical implications in the diagnosis of the present case.CASE SUMMARY A 58-year-old man presented with lower right abdominal pain with a blood pressure of 170/100 mmHg.A subsequent computed tomography scan revealed right ureterolithiasis,which was the cause of right abdominal pain,and right AI measuring 22 mm×25 mm.After the disappearance of right abdominal pain,subsequent endocrinological examinations were performed.Aldosterone-related evaluations,including adrenal venous sampling,revealed the presence of bilateral PA.In addition,several cortisol-related evaluations showed the presence of SCS on the right adrenal adenoma.A laparoscopic right adrenalectomy was then performed.The histopathological examination of the resected right adrenal revealed the presence of a cortisol-producing adenoma,while CYP11B2 immunoreactivity was absent in this adenoma.However,in the adjacent nonneoplastic adrenal,multiple CYP11B2-positive adrenocortical micronodules were detected,showing the presence of aldosterone-producing adrenocortical micronodules.CONCLUSION Careful clinical and pathological examination should be performed when a patient harboring AI presents with concomitant SCS and PA.展开更多
目的探讨伴淋巴样间质的微结节型胸腺瘤(micronodular thymoma with lymphoid stroma,MNT)的临床病理学特征及鉴别诊断。方法结合文献对2例MNT的临床资料、病理学特征、免疫表型及治疗预后进行分析。结果患者男女各1例,年龄分别为56岁...目的探讨伴淋巴样间质的微结节型胸腺瘤(micronodular thymoma with lymphoid stroma,MNT)的临床病理学特征及鉴别诊断。方法结合文献对2例MNT的临床资料、病理学特征、免疫表型及治疗预后进行分析。结果患者男女各1例,年龄分别为56岁和62岁。临床上均为体检发现,无明显症状,无重症肌无力或自身免疫疾病等,影像学和大体检查均提示为前纵膈囊实性占位。镜检:实性区域表现为大量的短梭形或卵圆形上皮细胞呈小结节状分布,上皮细胞无明显异型,无明显核分裂象。其中1例结节中可见成簇的腺样结构。间质为丰富的淋巴细胞,并可见伴有生发中心的淋巴滤泡形成。免疫表型:结节内肿瘤细胞CKpan、CK19、p63、CK5/6均阳性,EMA阴性,上皮细胞巢内可见个别CD3阳性的T淋巴细胞浸润。而囊壁上皮细胞和腺样结构上皮细胞表达相反,EMA阳性,p63、CK5/6阴性。淋巴间质内,淋巴滤泡主要为CD20阳性的B细胞,CD3和CD5阳性的T细胞分布在滤泡间区,非生发中心区域尤其是套区BCL-2阳性。网状纤维染色显示网状纤维包绕多个肿瘤细胞组成的上皮巢团,而非单个上皮细胞。结论 MNT是一种非常罕见的肿瘤,肿瘤细胞p63和CK5/6弥漫阳性对其鉴别诊断有一定价值,作者推测MNT来源于胸腺髓质。展开更多
目的:探讨微结节性胸腺瘤伴淋巴样间质(micronodular thymoma with lymphoid stroma,MNT)的临床病理特征。方法:通过组织学和免疫组织化学方法观察3例MNT,研究其临床病理特征,并复习文献。结果:肿瘤有纤维性假包膜,肿块内见多发性散在...目的:探讨微结节性胸腺瘤伴淋巴样间质(micronodular thymoma with lymphoid stroma,MNT)的临床病理特征。方法:通过组织学和免疫组织化学方法观察3例MNT,研究其临床病理特征,并复习文献。结果:肿瘤有纤维性假包膜,肿块内见多发性散在或局部融合的上皮性结节,由丰富淋巴细胞间质分隔,其中可见淋巴滤泡形成。上皮性结节由温和的细长形或卵圆形细胞组成,核仁不明显,结节内淋巴细胞稀少。免疫组织化学:上皮性结节内上皮细胞CKpan,CK5/6,CK19,CK8/18均阳性,Ki67约2%阳性,CD20,EMA阴性;间隔内淋巴细胞CD20,CD3,CD5,CD99,TdT均灶区阳性,p53,CD1α均散在阳性;淋巴细胞背景内CK5/6,C8/18,EMA均阴性。结论:MNT是一种罕见的胸腺肿瘤,目前WHO归于交界性,有特殊的发病部位和形态学表现,组织学及免疫组织化学有助于该肿瘤的诊断和鉴别诊断。展开更多
2例伴有淋巴样间质的微结节型胸腺瘤(micronodular thymoma with lymphoid stroma,MNT)发病年龄52,63岁,均为女性,分别为纵隔囊实性肿物和胸骨上窝实性肿物,无重症肌无力及自身免疫疾病等。瘤组织以丰富淋巴细胞间质分隔的散在上皮性结...2例伴有淋巴样间质的微结节型胸腺瘤(micronodular thymoma with lymphoid stroma,MNT)发病年龄52,63岁,均为女性,分别为纵隔囊实性肿物和胸骨上窝实性肿物,无重症肌无力及自身免疫疾病等。瘤组织以丰富淋巴细胞间质分隔的散在上皮性结节为特征,上皮性结节的细胞呈梭形或卵圆形,形态温和,未见病理性核分裂及坏死,淋巴细胞间质可见具生发中心的滤泡。免疫组织化学上皮细胞CK,CK5/6,p63(+),CD99散在(+),EMA囊性变区域(+),CD117(-);淋巴细胞间质包含B和T细胞,以CD20(+)的B细胞为主,成熟T细胞CD3,CD5(+),而Td T,CD1α,CD99阳性的未成熟T细胞分布在上皮结节周围,少数散在分布在上皮结节内。MNT非常罕见,具有恶性潜能,恶性MNT具有低度恶性生物学行为,极少数病例可出现死亡,其上皮细胞成分和淋巴细胞间质都有恶变的可能。恶性的MNT很可能是一个连续有移行的过程。MNT的治疗中,完整切除肿物并保证肿物切缘未受肿瘤累及是至关重要的。展开更多
文摘BACKGROUND Micronodular thymic tumors with lymphoid stroma include micronodular thymoma with lymphoid stroma(MNT)and micronodular thymic carcinoma with lymphoid hyperplasia(MNC),whose micromorphological features are lymphoid stromal hyperplasia and nodular arrangement of tumor epithelial cells.This type of tumor is rare;therefore,the corresponding clinical guidelines,histopathological diagnostic criteria,prognostic factors,and therapeutic regimens have not been established.CASE SUMMARY This study covers a novel presentation of MNC in a patient and summarizes the clinicopathological characteristics of this type of tumor by using pooled-analysis methods.Morphologically,this tumor type is a series of benign to malignant pedigrees.We establish the following criteria for the classification of micronodular thymic tumors with lymphoid stroma:(1)Tumor cells with moderate-to-severe dysplasia;(2)Tumor cell mitotic figures>2/10 high-power fields;(3)Appearance of neoplastic necrosis;(4)No terminal deoxynucleotidyl transferase-positive immature T lymphocytes within the tumor;(5)Tumor cells with a Ki-67 index≥10%;and(6)Tumor cells express CD5.Cases that fall into the borders of two categories in terms of morphology are attributed to atypical MNT.It is proposed that the diagnosis of MNT should be established on the diagnostic criteria mentioned above.CONCLUSION Our diagnostic algorithm can effectively distinguish malignant tumors from benign tumors and provides a potent basis for predicting a prognosis,which offers a practical reference for oncologists and pathologists.
文摘BACKGROUND Adrenal incidentaloma(AI)has been frequently encountered in the clinical setting.It has been shown that primary aldosteronism(PA)or subclinical Cushing’s syndrome(SCS)are the representative causative diseases of AI.However,the coexistence of PA and SCS has been reportedly observed.Recently,we encountered a case of AI,in which PA and SCS coexisted,confirmed by histopathological examinations after a laparoscopic adrenalectomy.We believe that there were some clinical implications in the diagnosis of the present case.CASE SUMMARY A 58-year-old man presented with lower right abdominal pain with a blood pressure of 170/100 mmHg.A subsequent computed tomography scan revealed right ureterolithiasis,which was the cause of right abdominal pain,and right AI measuring 22 mm×25 mm.After the disappearance of right abdominal pain,subsequent endocrinological examinations were performed.Aldosterone-related evaluations,including adrenal venous sampling,revealed the presence of bilateral PA.In addition,several cortisol-related evaluations showed the presence of SCS on the right adrenal adenoma.A laparoscopic right adrenalectomy was then performed.The histopathological examination of the resected right adrenal revealed the presence of a cortisol-producing adenoma,while CYP11B2 immunoreactivity was absent in this adenoma.However,in the adjacent nonneoplastic adrenal,multiple CYP11B2-positive adrenocortical micronodules were detected,showing the presence of aldosterone-producing adrenocortical micronodules.CONCLUSION Careful clinical and pathological examination should be performed when a patient harboring AI presents with concomitant SCS and PA.
文摘目的:探讨微结节性胸腺瘤伴淋巴样间质(micronodular thymoma with lymphoid stroma,MNT)的临床病理特征。方法:通过组织学和免疫组织化学方法观察3例MNT,研究其临床病理特征,并复习文献。结果:肿瘤有纤维性假包膜,肿块内见多发性散在或局部融合的上皮性结节,由丰富淋巴细胞间质分隔,其中可见淋巴滤泡形成。上皮性结节由温和的细长形或卵圆形细胞组成,核仁不明显,结节内淋巴细胞稀少。免疫组织化学:上皮性结节内上皮细胞CKpan,CK5/6,CK19,CK8/18均阳性,Ki67约2%阳性,CD20,EMA阴性;间隔内淋巴细胞CD20,CD3,CD5,CD99,TdT均灶区阳性,p53,CD1α均散在阳性;淋巴细胞背景内CK5/6,C8/18,EMA均阴性。结论:MNT是一种罕见的胸腺肿瘤,目前WHO归于交界性,有特殊的发病部位和形态学表现,组织学及免疫组织化学有助于该肿瘤的诊断和鉴别诊断。
