本帖最后由 pathology 于 2014-5-28 18:05 编辑
本周病例（2014.5.12—2014.5.18）
1、你考虑什么诊断？
HPV相关性癌伴腺样囊性样结构（HPV-related carcinoma with adenoid cystic-like features）
Microscopically, the carcinoma is seen as highly cellular proliferations of basaloid cells compacted into expanding lobules. Rounded nests of varying sizes and shapes are separated by thin fibrous bands of collagenized stroma. The pattern of growth is predominantly solid, but cribriforming growth is also present. In these cribriform areas, basaloid cells align around cylindromatous microcystic spaces filled with a basophilic material.
The predominant cell type is the basaloid cell. These basaloid cells are characterized by hyperchromatic and slightly angulated nuclei, scant cytoplasm, and a high nuclear to cytoplasmic ratio. Although the invasive component of the tumor does not exhibit overt keratinization, the overlying surface epithelium demonstrates dysplastic changes characterized by full thickness dyspolarity and cellular atypia. A second cell type, the true ductal cell, is highlighted by cKIT immunohistochemical staining.
Diagnostic Clues:
Despite significant morphologic overlap with ACC, it is distinct in several respects including
origin in the sinonasal tract
morphologic resemblance to adenoid cystic carcinoma (ACC)
associated with surface squamous dysplasia
associated with high risk HPV infection, particularly type 33
presence of a myoepithelial phenotype as evidenced by the IHC expression of myoepithelial markers (p63, c-KIT, calponin, MSA)
absence of the MYB gene rearrangement (MYB-NFIB gene fusion)
p16
p63
cKIT
high risk HPV-ISH
2、需要做什么鉴别诊断？
基底样鳞状细胞癌、涎腺型肿瘤（实性型腺样囊性癌、上皮-肌上皮癌、基底细胞腺癌……）
3、本病预后如何？
目前文献报道的8例病例中，有2例出现了局部复发，但没有淋巴结合远处转移（中位随访15月）。尚需更多病例以了解这一特殊类型的HPV相关的鼻腔鼻窦癌的临床特征和预后。
Ref：
尊重著作权人合法权益，该附件版权审核中
HPV-related carcinoma with adenoid cystic-like features.pdf
(1.15 MB, 下载次数: 11)
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本期病例是2013年AJSP上新近报道的一类比较特殊的肿瘤，形态学非常具有迷惑性，但一旦了解了这种肿瘤的存在，选择恰当的免疫组化则不难诊断。综合回答思路，akeman、派瑞松加一分，fusuyong、xjjrk累积半分，rattlebox鲜花鼓励！
希望大家一如既往的支持病理每周一题， | 
发表于 2014-5-13 18:20
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发表于 2014-5-13 19:26
pathology
