十二指肠部肿瘤（结果已公布）

x****g

女性，50岁，十二指肠**部肿物，直径约7cm。行肿物穿刺术

k****3

胞浆内嗜酸性颗粒非常清楚
首选潘氏细胞癌，CD68阳性

鉴别一下神经内分泌癌

初**理

细胞一致,胞浆嗜酸,向一侧拉长,细胞核深染,无明显细胞核,未见核分裂,部分区域呈**状结构,考虑1神经内分泌肿瘤,2胰腺实性假**状瘤,免疫组化CK,VIM,SYN,CgA,CD10,PR可鉴别。

w****i

胰腺实性假**状瘤,

h****k

我怎么感觉像粘液腺癌呢，没看到间质。巢团状细胞之间的好像是粘液。

p****y

这是冰冻切片or冻后切片么？

x****g

活检切片，不是冰冻

p****y

细胞一致,胞浆嗜酸,向一侧拉长,细胞核深染,无明显细胞核,未见核分裂,部分区域呈**状结构,考虑
1 神经内分泌肿瘤
2 胰腺实性假**状瘤
初学病理 发表于 2010-3-14 07:16

                               
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我也首先考虑这两个，kint123提到的潘氏细胞癌没有见过，形态上应该也需要考虑，呵呵！

j****e

感觉像胰腺实性假**状瘤，神经内分泌肿瘤应该少出现这些粘液样物吧？

k****3

师弟，我等着看答案呢

x****g

CK8-;CD56+;CD10+;CgA-;Syn+;CD117-;CD34-;SMA-;P53-;Ki-67+(<10%);actin-;β-catenin+

下图1：CD10 , 图2:β-catenin+

x****g

最后诊断：实性假**状肿瘤

w*y

经典，学习了！

p****y

回复 12# xhyong

一直不是很清楚CD10阳性该怎么解释

x****g

Some cases of Solid pseudopapillary neoplasm  exhibit endocrine differentiation, based on consistent staining for CD56 (neural cell adhesion molecule) and occasional staining for synaptophysin. However, chromogranin is always negative in these tumors. Both acinar and ductal markers are consistently negative. The absence of keratin expression in more than 50% of cases is unusual for any type of epithelial tumor or normal epithelial cell of the pancreas. Other consistently positive immunohistochemical stains in these tumors include vimentin, α1-antitrypsin (Fig. 35-62) (and α1-antichymotrypsin), and CD10, none of which is considered specific for any particular line of cellular differentiation. By electron microscopy, the most striking finding is the presence of large electron-dense granules, generally containing complex internal membranous and granular inclusions.[284], [295] Initially interpreted to represent either zymogen granules or neurosecretory granules,[293] these structures are now believed to resemble complex secondary lysosomes. They contain α1-antitrypsin immunohistochemically. Solid pseudopapillary neoplasms often express progesterone receptors, but estrogen receptor expression is not common.[284], [297] Of note, solid pseudopapillary neoplasms often harbor β-catenin mutations,[295] and thus show diffuse nuclear immunoexpression of this protein. Cyclin D1 is also expressed in this tumor

x****g

Cytokeratins (CAM 5.2, AE1/AE3) are typically either negative or only very focal in SPNs. However, the neoplastic cells express vimentin and a-1 antitrypsin diffusely and strongly. Other markers consistently expressed in SPN are CD10, CD56, progesterone receptor, and abnormal (nuclear and cytoplasmic) b-catenin.16,17 Recently, C-kit (CD117) and FLI-1 expressions have been reported in a portion of SPNs.

x****g

Cytokeratins (CAM 5.2, AE1/AE3) are typically either negative or only very focal in SPNs. However, the neoplastic cells express vimentin and a-1 antitrypsin diffusely and strongly. Other markers consistently expressed in SPN are CD10, CD56, progesterone receptor, and abnormal (nuclear and cytoplasmic) b-catenin.16,17 Recently, C-kit (CD117) and FLI-1 expressions have been reported in a portion of SPNs.