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睾丸肿瘤

doctorjing 离线

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楼主 发表于 2009-08-17 12:51|举报|关注(0)
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姓    名: ××× 性别:  男 年龄:  74
标本名称:  右侧睾丸
简要病史:  右侧睾丸肿胀一月,术中见右侧睾丸明显增大。
肉眼检查:  右侧睾丸大小为8*6*6cm,切面呈灰白色,鱼肉状。
睾丸肿瘤图1
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睾丸肿瘤图2
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睾丸肿瘤图3
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睾丸肿瘤图4
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睾丸肿瘤图5
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睾丸肿瘤图6
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睾丸肿瘤图7
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睾丸肿瘤图8
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睾丸肿瘤图9
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睾丸肿瘤图10
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doctorjing 离线

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1 楼    发表于2009-08-17 12:54:00举报|引用
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 请大家多多支持!
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wfbjwt 离线

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2 楼    发表于2009-08-17 14:10:00举报|引用
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 图片模糊,感觉细胞大,有核仁,混杂淋巴细胞,考虑精原细胞瘤。
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fyshan 离线

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3 楼    发表于2009-08-18 07:04:00举报|引用
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 At this age and this morphology, spermatocytic seminoma should be considered.
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mjma 离线

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4 楼    发表于2009-08-18 08:46:00举报|引用
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I think there are two important differential diagnoses for this case - seminoma (pure) and high grade diffuse large B cell lymphoma. Of the two, I favor the latter because of the diffuse infiltrative pattern, nuclear size (smaller than I would expect for seminoma), vesicular chromatin and prominent nucleoli (seminoma cells have hyperchromatic nuclei, not vesicular chromatin pattern). There are certainly many small lymphocytes that could exist in either neoplasms. A few simple immunohistochemical stains (AE1, PLAP, CD117, CD45, CD20 or CD79a, CD3 or CD43) should resolve the matter. If this is a case of testicular seminoma, it is most likely a pure form and classic. Although the age of the patient is advanced, I do not see a mixture of variably differentiated germs cells seen in spermatocytic seminoma.
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5 楼    发表于2009-08-18 14:13:00举报|引用
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以下是引用mjma在2009-8-18 8:46:00的发言:

I think there are two important differential diagnoses for this case - seminoma (pure) and high grade diffuse large B cell lymphoma. Of the two, I favor the latter because of the diffuse infiltrative pattern, nuclear size (smaller than I would expect for seminoma), vesicular chromatin and prominent nucleoli (seminoma cells have hyperchromatic nuclei, not vesicular chromatin pattern). There are certainly many small lymphocytes that could exist in either neoplasms. A few simple immunohistochemical stains (AE1, PLAP, CD117, CD45, CD20 or CD79a, CD3 or CD43) should resolve the matter. If this is a case of testicular seminoma, it is most likely a pure form and classic. Although the age of the patient is advanced, I do not see a mixture of variably differentiated germs cells seen in spermatocytic seminoma.

译:我认为本例有两个重要的鉴别诊断:单纯的精原细胞瘤和高度恶性的弥漫的大B细胞淋巴瘤.在这二者中我支持后者,因为其弥漫的浸润构型,核的大小(比我认为的精原细胞瘤小),空泡样染色质和明显的核仁(精原细胞瘤有浓染的核,并非空泡状染色质构型).当然二者肯定都有许多小淋巴细胞存在.几个简单的免疫染色(AE1, PLAP, CD117, CD45, CD20 or CD79a, CD3 or CD43)应该能解决这个问题.如果这是一例精原细胞瘤,很有可能是一种单纯型和经典型.尽管病人的年龄是提前了,我看不出在精子细胞性精原细胞不同分化的生殖细胞的混合
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6 楼    发表于2009-08-18 15:23:00举报|引用
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 读书的时候。老板曾教训过我。看看年龄都60岁了,还诊断精原细胞瘤?!

实际上虽然绝对了些,但是这是很重要的一点,临床的信息对于病理学来学也十分的重要。因为生殖细胞肿瘤在一定年龄后,其发生的几率明显减少。同意楼上老师的意见——DLBCL,图像看得出来是用数码相机在显微镜上照的,如果需要本人可以代为拍摄。

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stevenshen 离线

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7 楼    发表于2009-08-31 04:30:00举报|引用
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Diffuse, interstitial infiltrative, highly cellular, relatively uniform large cells in an older man.

I agree with Dr. Ma...favor diffuse large B cell lymphoma.

Other tumors that have interstitial infiltrative pattern are classic seminoma and metastatic high grade prostate carcinoma.

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