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外科病理学中的描述性术语(二)

2019-10-8 09:00| 发布者: admin| 查看: 37| 评论: 0

摘要: 【前言】《The Practice of SurgicalPathology》一书是病理诊断的入门指南,为了让大家更好理解医学术语,笔者将这些术语进行翻译如下(中英文对照):结构模式(Architectural Pattern)术语和定义(Term and defin ...

 

 

前言The Practice of Surgical Pathology一书是病理诊断入门指南为了让大家更好理解医学术语,笔者将这些术语进行翻译如下(中英文对照):

结构模式(Architectural Pattern)

术语和定义(Term and definition)

外观/外貌(Appearance)

举  例

腺泡状:类似于肺泡或小细胞、囊或巢

(Alveolar: resembling alveoli or little cells, sacs, or nests)

巢状--病变有结构,但没有腺体或导管(Nested—there is structure to the lesion but no glands or ducts)

Paraganglioma

副神经节瘤

(图2.1A)

基底细胞样:类似于基底细胞癌(Basaloid: resembling

basal cell carcinoma)

一种蓝色的巢状肿瘤

(通常为低分化鳞状细胞),

细胞核紧密排列,在巢的边缘呈栅栏状

(A blue, nested tumor (often poorly differentiated squamous) with tightly packed nuclei and palisading around the edge of the nest)

Basal cell carcinoma

基底细胞癌

(图2.1B)

双相的:具有两种细胞系成分(Biphasic: having components

of two cell lineages)

梭形细胞伴上皮样细胞岛或腺体(Spindled cells with islands of epithelial cells or glands)

Synovial sarcoma

滑膜肉瘤

筛状:穿孔的,像一个滤器

(Cribriform: perforated,

 like a colander)

腺体结构中油炸土豆片样圆孔

(Crisp round holes within a glandular structure)

Adenoid cystic carcinoma腺样囊性癌(图2.1C)

不协调:分裂成单个细胞

(Discohesive:

falling apart into single cells)

细胞间无公共边界

(No common borders among cells)

Lobular carcinoma in situ

原位小叶癌

上皮样:

由胞质丰富的圆形或卵圆形细胞组成

(Epithelioid: composed of round to oval cells with abundant cytoplasm)

细胞看起来肥胖,有清晰的细胞边界;与肉瘤相反(Cells look plump and have clear cell borders;

the opposite of sarcomatoid)

Ductal carcinoma, breast

导管癌,乳腺

(图2.1D)

成束的:由束状组成

(Fascicular:

composed of fascicles)

平行排列的细长的梭形细胞束

(Bundles of elongated, spindly cells streaming in parallel arrays)

Leiomyoma

平滑肌瘤

(图2.1E)

腺样:形成有腔的腺体结构

(Glandular: forming gland structures with lumens)

真正的腺体应该有

围绕管腔辐射的极化细胞

(True glands should have polarized cells radiating around a lumen)

Adenocarcinoma

腺癌

肾小球样:类似于肾小球

(Glomeruloid:

resembling the glomerulus)

卷曲的血管、毛细血管或腺体

(A coiled tangle of vessels, capillaries, or glands)

Vascular proliferations in

Glioblastoma

胶质母细胞瘤

中的增生血管

鱼骨样/人字形:类似花呢织物的图案(Herringbone: resembling

a pattern of tweed fabric)

束状的变异,曲折排列/锯齿状排列

(A variant of fascicular

that shows bundles alternating

in a zigzag arra)

Fibrosarcoma

纤维肉瘤

(图2.1F)

 

鞋钉样:类似于曾用于鞋中的大头钉(Hobnailed: resembling a large-headed nail

once used in shoes)

上皮或内皮细胞像小驼峰样向上弯曲并伸入管腔(Epithelial or endothelial cells that round up and protrude into the lumen as little humps)

Angiosarcoma

血管肉瘤

(图2.1G)

单行/列兵样:细胞以单行线浸润组织(“Indian file”:

cells infiltrating through the tissue in single-file lines)

可仅有三四个细胞平行于基质呈线状(Lines may be only three to four cells long and run parallel to stromal planes)

Lobular breast carcinoma

乳腺小叶癌

微囊:散在的小囊性空间,

不是导管、小管或腺体

(Microcystic: scattered small cystic spaces that are not ducts, tubules, or glands)

微囊缺乏极化的上皮衬覆,

而且是随意的;细胞核接触腔内

(Microcysts lack polarized epithelial linings and are haphazard; nuclei touch the lumen)

Mammary analogue secretory carcinoma

类似乳腺的

分泌性癌(图2.1H)

微乳头:无真正纤维血管轴心的

乳头状上皮形成的结构

(Micropapillary: papillary-shaped epithelial projections without

true fibrovascular cores)

可以有水母头样外观(浆液性癌)

或棒棒糖投影至导管

(Can have a medusa-head

appearance (serous carcinoma) or lollipop projections into a duct

Micropapillary serous carcinoma, ovary

浆液性微乳头状癌,卵巢(图2.1I)

Paget样扩散:单个恶性细胞散布于良性表皮(Pagetoid spread: single malignant cells scattered throughout a benign epidermis)

低倍镜下见不属于上皮的细胞

(Cells standing out at low power as not belonging in the epithelium)

Paget’s disease佩吉特病

栅栏状:

类似于用锋利的木桩做成的栅栏(Palisading: resembling a

fence made of sharp stakes)

低倍镜下平行排列的细胞核像深色镶边一样映入眼帘(Parallel arrays of nuclei catching your eye at low power as a dark border)

Basal cell carcinoma

基底细胞癌

(图2.1B)

乳头状:一种由纤维血管轴心支持增

生上皮的外生性生长模式(Papillary: an exophytic growth pattern with fibrovascular cores supporting proliferative epithelium)

菜花或珊瑚状结构,

具有分支的纤维血管轴心

(Cauliflower- or coral-shaped structures with branching fibrovascular cores)

Papilloma, breast乳头状瘤,乳腺

(图2.2A)

极化的:上皮细胞核位置一致,

位于顶部(管腔侧)或底部(基膜侧)(Polarized: epithelial cells that have a uniform nuclear position, either apical (lumen side) or basal (basement membrane side))

如果细胞核位于基底,围绕真正腔隙的极化细胞应在腔周围显示一个明显的细胞质环(Polarized cells surrounding a true lumen should show a distinct ring of cytoplasm surrounding the lumen, if the nuclei are basal)

Cribriform DCIS

筛状DCIS

(ductal carcinoma in situ导管内原位癌)

假乳头:纤维血管间隔间细胞死亡引起的乳头样改变

(Pseudopapillary: a papillary pattern caused by cell die-off in between fibrovascular septa)

看起来像乳头状,但有证据表明在

某些区域有实性或巢状生长(Looks papillary but there is evidence of solid or nested growth in some areas)

Solid pseudopapillary neoplasm, pancreas

实性假乳头状肿瘤,胰腺

网状的:类似于网或网状排列的

(Reticular: resembling a

network or netlike array)

微囊或蜂窝状外观

(Microcystic or

honeycomb appearance)

Yolk sac tumor, testes卵黄囊瘤,睾丸(图2.2B)

菊形团:

一组非上皮细胞成群围绕一个共同中心

(Rosettes: a group of non-epithelial cells that are clustered around a common center)

假菊形团是血管周围的菊形团;真菊形团是管腔或纤维核心周围的菊形团(Pseudorosettes are rosettes around a vessel; true rosettes surround a lumen or a

fibrillary core)

Ependymoma and other neuroglial and neuroendocrine lesions室管膜瘤及其他神经胶质和神经内分泌病变(图2.2C)

肉瘤样的:象肉瘤,但不是(Sarcomatoid: resembling a sarcoma, but not one)

无上皮结构或清晰细胞边界的片状或束状肿瘤细胞(Sheets or bundles of tumor cells without epithelial structures or clear cell borders)

Sarcomatoid carcinoma

肉瘤样癌

梭形:由具有梭形核的细长细胞组成(Spindled: composed of elongated cells with fusiform nuclei)

梭形细胞呈片状或束状

(Sheets or fascicles of

fusiform cells)

Leiomyoma

平滑肌瘤

鹿角样血管:裂开的分枝血管,

壁薄,散在病变处

(Staghorn vessels: gaping, branching vessels with thin walls, scattered throughout a lesion)

低倍镜下血管很明显;形状不寻常,

壁薄与直径不成比例

(Vessels should strike you as prominent at low power;

the shape is unusual,and the

walls are disproportionately

thin for the diameter)

Hemangiopericytoma

血管外皮细胞瘤

(图2.2D)

席纹状:有一个车轮状的梭形细胞,

细胞核从中心点发散(Storiform: having a cartwheel pattern—spindle cells with elongated nuclei radiating from a center point)

梭形细胞病变呈短漩涡状而不是平行束状(A cellular spindled lesion with short whorls of cells as opposed to long parallel fascicles)

Dermatofibrosarcoma protuberans

隆突性皮肤

纤维肉瘤(图2.2E)

合胞体:相邻细胞间有明显的细胞质连续性(Syncytial: having apparent cytoplasmic continuity between adjacent cells)

看起来像一堆没有可识别细胞边界的细胞核(Looks like a collection of nuclei without recognizable cell borders)

Meningioma

脑膜瘤

组织培养样模式:星形细胞松散聚集(Tissue culture pattern: a loose aggregate of stellate  cells)

细胞有纤细的细胞质触须

(Cells have delicate

Tentacles of cytoplasm)

Nodular fasciitis结节性筋膜炎

(图2.2F)

小梁:纤维间隔分隔的索状排列(Trabecular: cord-like arrays separated by fibrous septa)

细胞群呈长巢和长索状

(Long nests and cords

of cell groups)

Oncocytoma

嗜酸细胞瘤

(图2.2G)

Figure 2.1. (a) Alveolar pattern, paraganglioma; (b) basaloid pattern and palisading, basal cell carcinoma; (c) cribriform pattern, adenoid cystic carcinoma; (d) epithelioid cells, breast carcinoma; (e) fascicular pattern, leiomyoma;(f) herringbone pattern, fibrosarcoma; (g) hobnailed cells, angiosarcoma; (h) microcystic pattern, mammary analogue secretory carcinoma; (i) micropapillary architecture, serous carcinoma of the ovary.

2.1:(A)腺泡状,副神经节瘤;(B)基底细胞样和栅栏状,基底细胞癌;(C)筛孔状,腺样囊性癌;(D)上皮样细胞,乳腺癌;(E)束状,平滑肌瘤;(F)鱼骨样,纤维肉瘤;(G)鞋钉样,血管肉瘤;H)微囊型,类似乳腺的分泌性癌;(I)微乳头状结构,卵巢浆液性癌;

 

Figure 2.2. (a) Papillary architecture, papilloma of breast; (b) reticular pattern, yolk sac tumor of the testis; (c) rosette, ependymoma; (d) staghorn vessels, hemangiopericytoma; (e) storiform pattern, dermatofibrosarcoma protuberans; (f) tissue culture cells, nodular fasciitis; (g)trabecular pattern and oncocytes, oncocytoma; (h) coagulative necrosis, ischemic bowel; (i) caseating necrosis in a granuloma, tuberculosis.

2.2:(A)乳头状结构,乳腺乳头状瘤;(B)网状结构,睾丸卵黄囊瘤;(C)菊形团,室管膜瘤;(D)鹿角样血管,血管外皮细胞瘤;(E)席纹状,隆突性皮肤纤维肉瘤;(F)组织培养样细胞,结节性筋膜炎;(G) 小梁形态与嗜酸性细胞,嗜酸细胞瘤;(H)凝固性坏死,肠缺血;(I)肉芽肿,肺结核中干酪样坏死。


有无坏死(Presence or Absence of Necrosis)

术语和定义

外观/外貌(Appearance

举  例

凝固性坏死(Coagulative necrosis)

细胞看起来像木乃伊;有细胞结构轮廓,

但没有嗜碱性细胞或细胞细节

(Cells appear mummified; architecture is preserved, but there is no basophilia or cell detail)

Ischemia

缺血

(图2.2H)

干酪样坏死(Caseating necrosis)

细胞轮廓和结构完全丧失;基本上退化为粉红色颗粒状物(Total loss of cellular structure and architecture; basically degenerates into pink soup)

Tuberculosis肺结核

(图2.2I)

纤维素样坏死(Fibrinoid necrosis)

血管壁具有粉红色无结构物

(Vessels with replacement of wall

by pink amorphous material)

Vascular necrosis血管坏死(图2.3A)

脂肪坏死(Fat necrosis)

极其坚硬,呈灰白色;显微镜下脂肪细胞

结构破坏,有泡沫样巨噬细胞和巨细胞

(Grossly hard and chalky white; microscopically

the fat cells are disrupted and collapsed, with

foamy macrophages and giant cells)

Biopsy site changes in breast乳腺活检部位的改变

(图2.3B)

地图样坏死(Geographic necrosis)

描述大的汇合“大陆状”片状坏死

(Describes large confluent

“continent-shaped” patches of necrosis)

Kikuchi’s disease

组织细胞性坏死性淋巴结炎

坏疽性坏死(gangrenous necrosis)

外观蓝色、颗粒样,大量纤维蛋白沉积;

无细胞和结构细节(Has a granular and blue look, with lots of fibrin deposition;

loss of cellular and architectural detail)

Gangrene

坏疽

(图2.3C)

 

细胞形态、大小及细胞质(Cell Shape and Size and Cytoplasm)

术语和定义

外观/外貌(Appearance

举  例

嗜双色:对酸性和

碱性染料都有亲和力(Amphophilic: having an affinity for both acid and basic dyes)

有一个独特的颜色特征,

几乎是一个彩虹紫色,很难在电影中捕捉到

(Has a unique color character,

almost an iridescent purple

that is hard to capture on film)

Pheochromocytoma嗜铬细胞瘤

(图2.3D)

泡沫样巨噬细胞:

充满脂质的巨噬细胞(Foamy macrophages: macrophages stuffed with lipid)

巨噬细胞有一个黑色的小偏心核;

脂质空泡呈现闪光的颗粒状外观

(Macrophages have a small dark

eccentric nucleus; the lipid vacuoles

give a glittery granular appearance)

Papillary renal cell carcinoma

乳头状肾细胞癌(图2.3E)

颗粒状:含有颗粒

或小空泡(Granular: containing granules

or tiny vacuoles)

颜色可能会有所不同,但颗粒纹理是可见的,

特别是在冷凝器降低的情况下

(Color may vary, but granular texture is visible especially with lowered condenser)

Granular

cell tumor

颗粒细胞瘤

Hof: 与高尔基体相对应的核周透明区(Hof: a perinuclear clear zone corresponding to the Golgi apparatus)

看起来像一个灰白色小点拥抱着细胞核

(Looks like a pale spot

hugging the nucleus)

Plasma cells

浆细胞

角化:角蛋白产生(Keratinized: keratin-producing)

角质蛋白在HE染色上呈粉红色且致密

(Keratin has a very pink and dense appearance on H&E stain)

Squamous cell carcinoma鳞状细胞癌(图2.3F)

黏液样:黏液的或产生

黏液;也称为胶体(Mucous: mucinous or producing mucus (n.); also called colloid)

黏蛋白(黏液)在处理后看起来清晰,

但可以被黏蛋白或PAS-AB染色

(Mucin (mucus) appears clear after processing but can be stained with mucicarmine or PAS-AB)

Adenocarcinoma

腺癌

嗜酸性细胞的:由于线粒体丰富而具有颗粒状和嗜酸性细胞质的大细胞(Oncocytic: large cells with cytoplasm that is granular and eosinophilic due to the presence of abundant mitochondria)

癌细胞在形态学上通常是温和的

(均匀的小而致密的细胞核),

HE染色呈粉红色,大体检查呈红褐色

(Oncocytes are usually cytologically bland (uniform small dense nuclei) and look pink on H&E, mahogany on gross examination)

Oncocytoma

嗜酸细胞瘤

 

浆细胞样:像浆细胞(Plasmacytoid: like plasma cells)

胞质丰富、细胞核偏位的圆形细胞

(Round cells with abundant cytoplasm

and an eccentric round nucleus)

Plasmacytoma

浆细胞瘤

(图2.3G)

横纹肌样:

指一种类似横纹肌肉瘤

的特殊恶性肿瘤,或用于

描述组织学相似的肿瘤

(Rhabdoid: refers to

a specific malignant tumor that resembles rhabdomyosarcoma or used to describe a tumor with similar histology)

细胞核偏位、核仁明显、

胞质呈粉红色的大的肿瘤细胞

(Large tumor cells with

eccentric nuclei,

prominent nucleoli,

and globules of pink cytoplasm)

Rhabdoid tumor

of the kidney

肾横纹肌样瘤

印戒样:有宝石戒指形状,细胞核被充满黏液的细胞质压缩呈扁平状(Signet ring: having the shape of a jeweled ring, with a flattened nucleus compressed by a cytoplasm stuffed with mucin)

低倍镜下很难看到;高倍镜下,细胞是一滴黏蛋白,细胞壁模糊,细胞核被推到一边

(Can be very hard to see on low power; on high power, the cell is a droplet

of mucin with a faint cell wall and

a nucleus pushed to one side)

Signet-ring

cell carcinoma

印戒细胞癌

(图2.3H)

Figure 2.3. (a) Fibrinoid necrosis, pulmonary vessel; (b) fat necrosis, breast; (c) gangrenous necrosis, toe wound; (d) amphophilic cytoplasm, pheochromocytoma; (e) foamy macrophages, papillary renal cell carcinoma; (f) keratin, squamous cell carcinoma; (g) plasmacytoid morphology, plasmacytoma; (h) signet-ring cells, breast carcinoma; (i) nuclear molding, small cell carcinoma.

2.3.A纤维样坏死,肺血管;B脂肪坏死,乳腺C坏疽坏死,足趾伤口;D嗜双色胞质,嗜铬细胞瘤;E)泡沫巨噬细胞,乳头状肾细胞癌;(F,鳞状细胞癌;G浆细胞样形态,浆细胞瘤;H印戒细胞,乳腺癌;I)核成型,小细胞癌。

 

细胞核(Nucleus

Let’s take a moment to talk about the nucleus. If you are beginning your pathology residency, you will spend the next 4 years learning to read nuclei.

让我们花点时间谈谈细胞核。如果你开始病理学实习,你将在接下来的4年里学习看细胞核。

The H in H&E stands for hematoxylin, which stains nucleic acids, and therefore nuclei, purple; the eosin highlights everything else.

HE中的H代表苏木素,它能染色核酸,因此细胞核呈紫色;曙红(伊红)能显示出其他一切。

A large chunk of pathology can be boiled down to recognizing nuclear changes that suggest malignancy.

很大一部分病理学可以归结为认识到暗示恶性肿瘤的核变化。

 The nucleus is the genetic center of the cell, and surprisingly, molecular changes that disconnect the cell from normal feedback mechanisms (i.e., cancer) can often be detected by actual physical changes in the nucleus. For example, changes in the nuclear membrane, changes or irregularities in the nuclear size and shape, alterations in the chromatin pattern and density, or abnormally prominent nucleoli all prompt the pathologist to look more closely.

细胞核是细胞的遗传中心,令人惊讶的是,使细胞与正常反馈机制(如癌症)脱节的分子变化往往可以通过细胞核的实际物理变化来检测。例如,核膜的变化,核的大小和形状的变化或不规则,染色质模式和密度的变化,或异常突出的核仁都促使病理学家更加仔细地观察细胞核。

Part of what makes pathology so challenging is that different organs play by different rules, so that what is a “normal” nucleus in one organ represents dysplasia in another.

使病理如此具有挑战性的部分原因是不同的器官有不同的标准,因此一个器官中的“正常”细胞核代表另一个器官中的不典型增生。

As you learn pathology, above all you must get a feel for which nuclei should make you worry, and the way to do this is to ask your mentors to describe exactly what they are seeing when they use the single most overused and least specific word in our field: atypical.

当你学习病理学的时候,首先你必须感觉到哪些细胞核会让你担心,而这样做的方法是让你的导师准确地描述他们在使用我们领域中最常用、最不具体的一个词(非典型)的时候看到了什么。

Atypical: literally, not typical or outside the norm of a certain class of cells When a pathologist uses the term, however, it means “nuclear changes which concern me.” The exact nuclear alterations which warrant the atypical label vary by tissue type. On the clinical side, atypical is read to mean “the differential diagnosis includes benign and malignant,” and it often ends up punting the question the biopsy was intended to answer. Although it is sometimes unavoidable, try to minimize the use of “atypical” in your diagnoses.

非典型:字面上,不典型或超出某一类细胞的标准,当病理学家使用这个术语时,然而,它的意思是“与我有关的核变化”。保证非典型标记的确切核变化因组织类型而异。在临床方面,非典型性被理解为“鉴别诊断包括良性和恶性”,而且它往往最终会使活检想要回答的问题变得模糊。尽管有时不可避免,尽量在诊断中减少“非典型”的使用。

 

Variants:

变异型

Reactive atypia: nuclear changes which might concern me if it weren’t for this blazing inflammation.

反应性非典型:如果不是因为这种强烈的炎症,我可能会担心这个核的改变。

Degenerative atypia: nuclear changes which would concern me if I wasn’t 100% sure this was a benign tumor.

退行性非典型:如果我不能百分之百确定这是一个良性肿瘤,我会担心的核改变。

Marked atypia: nuclear changes which are so pronounced I’m almost certain this is cancer, but if it turns out to be reactive atypia instead, you can’t sue me.

显著的异型性:核改变如此明显,我几乎可以肯定这是癌症,但如果结果是反应性异型性,你不能起诉我。

Mild atypia: nuclear changes which are so trivial I’m almost certain this is benign, but if it turns out to be dysplasia instead, you can’t sue me.

轻度非典型:核改变是如此微不足道,我几乎可以肯定这是良性的,但如果结果是不典型增生,你不能起诉我。

We see this: not atypical.

我们看到这一点:不是非典型的。

Making the interpretation of nuclei more complicated is the fact that changes in fixation, staining intensity, crush artifact, cautery, desiccation, and other variables can make the same tumor look very different. Part of the learning process is determining which nuclear features are truly part of the tumor and which are due to artifact. One way is to calibrate using the non-tumor nuclei in the tissue, such as normal epithelial or endothelial nuclei. This is similar to the process by which your brain learns to identify “blue” in all different lighting conditions, by comparing the actual color signal (which may not be blue at all) to the color signals of other known objects, like skin tone or white paper.

使细胞核的解释更加复杂的是,固定、染色强度、挤压、烧灼、干燥和其他变化可以使同一肿瘤看起来非常不同。学习过程的一部分是确定哪些核特征是肿瘤真正的一部分,哪些是由于人为造成的。一种方法是使用组织中的非肿瘤细胞核,如用正常上皮细胞核或内皮细胞核进行校准。这类似于大脑在所有不同的光照条件下,通过比较实际的颜色信号(可能根本不是蓝色)和其他已知物体的颜色信号(如肤色或白纸)来识别“蓝色”的过程。

 Some nuclear artifacts become signatures of the tumor type, like the cleared-out chromatin of papillary thyroid carcinoma. Vesicular nuclei, however, while associated with malignancy, can also be a consequence of delayed fixation.

一些人为因素造成的细胞核成为肿瘤类型的特征,如甲状腺乳头状癌染色质的清除。然而,泡状核虽然与恶性肿瘤有关,但也可能是延迟固定的结果。

There are some general categories of nuclear changes that you should be able to recognize, which are listed below.

下面列出了一些你应该能够认识到的核变化的一般类别。

Large and hyperchromatic nuclei often indicate an instability of karyotype (literally too much chromatin) that is seen in certain malignancies, whereas large but euchromatic nuclei are commonly seen in benign reactive cells. Irregular nuclear membranes (folds, crenations, corners, asymmetry) are usually not found in benign cells.

在某些恶性肿瘤中,大的和染色深的细胞核通常表明核型不稳定(字面上是染色质过多),而在良性反应细胞中,大的但含常染色质的细胞核通常可见。良性细胞通常难以见到不规则核膜(折叠、皱褶、成角、不对称)。

A prominent nucleolus indicates an active nucleus, but does not equal malignancy. Normal myeloid blasts, for example, have prominent nucleoli, and reactive epithelial cells often have multiple small nucleoli. However, the presence of a large and reddish (protein-rich) nucleolus in a tumor is characteristic of certain tumor types, including carcinoma, melanoma, angiosarcoma, and some lymphomas (e.g., Hodgkin lymphoma). Very finely speckled chromatin is typical of neuroendocrine tumors, which generally do not show a nucleolus. Finally, primitive cells, such as small round blue cell tumors and fetal cells, have a characteristic homogeneous dispersed evenly blue chromatin, as though the undifferentiated cell has yet to sort out what genes are relevant and has all of them spread out in anticipation of starting the filing system. (As a pathologist, you will begin to anthropomorphize individual cells. This is not atypical.)

突出的核仁表示细胞核活跃,但不等于恶性肿瘤。例如,正常的髓样细胞有突出的核仁,反应性上皮细胞常有多个小核仁。然而,肿瘤中有一个大而微红(富含蛋白质)的核仁是某些肿瘤类型的特征,包括癌、黑色素瘤、血管肉瘤和一些淋巴瘤(如霍奇金淋巴瘤)。非常细腻而散在的染色质是典型的神经内分泌肿瘤,核仁通常不明显。最后,原始/间叶细胞,如小圆蓝细胞肿瘤和胎儿期细胞,有一个特征性的均匀分散的蓝色染色质,就好像未分化的细胞还不清楚与哪些基因有关,并且所有这些细胞都在等待开始向预期的系统分化(作为病理医生,你将开始把单个细胞拟人化。这不是非典型的。)


形容细胞其他词语(Other Nuclear Adjectives)

术语和定义

外观/外貌(Appearance

举  例

钟面:均匀分布的染色质团(Clock face: evenly distributed clumped chromatin)

看起来像个足球

(Looks like a soccer ball)

Plasma cells

浆细胞

偏心:向一侧移(Eccentric: displaced to one side)

一边是细胞核,另一边是细胞质(Nucleus on one side, cytoplasm on the other)

浆细胞,

横纹肌样细胞

模塑:由于几乎没有细胞质而相互挤压和缩进的细胞核(Molding: nuclei that press together and indent each other due to the near absence of cytoplasm)

有马赛克样的外观,

通常与小而致密的蓝色核一起出现

(Has a mosaic appearance and

usually seen in conjunction

with small dense blue nuclei)

Small cell carcinoma

小细胞癌

(图2.3I)

神经内分泌:染色质细腻

斑点状或胡椒盐样(Neuroendocrine:

having finely speckled or salt-and-pepper chromatin)

细胞核应为圆形、淡染、光滑,

没有核仁,但偶尔有染色质“块”或斑点(Nuclei should be round, pale, and smooth, without nucleoli, but with occasional chromatin “chunks” or speckles)

Carcinoid

类癌

(图2.4A)

多形性:大小和形状不一(Pleomorphic: multiple sizes and shapes)

通常指的是细胞核大小和形状不一

(Usually refers to nuclei and implies a very irregular mix of sizes and shapes)

Embryonal carcinoma

胚胎癌

泡状:细胞核处于开放期,染色质在其中膨胀(与致密和浓缩相反)(Vesicular: a nucleus in open phase, in which the chromatin is expanded (as opposed to compact and condensed))

由于染色质中明显的气泡

而使细胞核肿胀和变形

(A nucleus that is swollen

and distorted by apparent

bubbles in the chromatin)

Various malignant neoplasms

各种恶性肿瘤

Figure 2.4. (a) Neuroendocrine nuclei, carcinoid tumor; (b) cherry-red nucleolus, melanoma; (c) myxoid stroma, myxofibrosarcoma; (d) desmoplastic stroma, colon cancer; (e) hyaline deposits, vessels in schwannoma; (f) hemosiderin, nasal polyp.

2.4:(A)神经内分泌细胞核,类癌;(B)樱红色细胞核,黑色素瘤;(C)黏液样间质,

黏液纤维肉瘤;(D)促结缔组织基质,结肠癌;(E)玻璃样沉积物,神经鞘瘤血管;(F)含铁血黄素,鼻息肉;


核仁Nucleolus)

术语和定义

外观/外貌(Appearance

举  例

樱桃红:意味着一个恶性核仁(Cherry red: implies a malignant-looking nucleolus)

一种大的实性核仁,

由于蛋白质含量增加而折射出的红色

(An enlarged, solid nucleolus with a refractile red tinge due to increased protein content)

Melanoma

黑色素瘤

(图2.4B)


细胞膜Cell Membrane)

术语和定义

外观/外貌(Appearance

举  例

纤毛的:有纤毛的

(Ciliated: having cilia)

如果纤毛不可见,有时末端突起就足够了

(If the cilia are not visible, sometimes the terminal bar is enough)

Respiratory mucosa

呼吸道粘膜

细胞间桥:桥粒(Intercellular bridges: desmosomes)

鳞状细胞间的刺

(The prickles or spines

between squamous cells)

Normal skin, especially visible if edematous

正常皮肤,尤其

是水肿时可见


病变间质(Stroma of Lesion)

术语和定义

外观/外貌(Appearance

举  例

软骨样的:类似软骨的,

或由软骨组成的

(Chondroid: resembling, or made of, cartilage)

蓝灰色基质,小细胞悬浮于腔隙

(Bluish-gray stroma with small cells suspended in lacunae)

Normal cartilage正常软骨

结缔组织增生:引起肿瘤旁基质水肿和纤维化(Desmoplastic: causing edema and fibrosis in the stroma next to a neoplasm)

恶性腺体周围有粉红色纤维化和明显

水肿的交替层;低倍镜下整体呈淡白色(Alternating layers of pink

fibrosis and clear edema

surrounding malignant glands;

overall appears pale at low power)

Adenocarcinoma, pancreas or colon

胰腺或结肠腺癌(图2.4D)

水肿:积水

(Edematous: waterlogged)

HE上呈透明的,所以看起来像是许多被清理的空间(Water is clear on H&E so appears as lots of cleared-out space)

Granulation tissue

肉芽组织

纤维化/硬化:被胶原替代(纤维化)(Fibrotic/ sclerotic: replaced by collagen (fibrosis))

胶原蛋白在HE上呈粉红色,不透明,通常呈平行纤维状(Collagen is pink and opaque on H&E and usually streams in parallel fibers)

Sclerosed intraductal papilloma硬化性导管内乳头状瘤

玻璃样变:透明、清澈、

均匀(Hyaline: clear, transparent,homogeneous)

玻璃粉色外观

(Glassy-pink appearance)

Characteristic vessel walls in schwannoma神经鞘瘤的特征性血管壁(图2.4E)

黏液样的:类似黏液,但通常与软组织损伤和透明质酸有关(Myxoid: resembling mucus, but usually associated with a soft tissue lesion and hyaluronic acid)

呈淡粉色至蓝灰色背景,粘液状

(Appears as a faint pink to bluish-gray background,

with a  stringy mucous look)

Myxofibrosarcoma黏液纤维肉瘤

(图2.4C)


其他非细胞的物质Other Noncellular Entities)

术语和定义

外观/外貌(Appearance

举  例

淀粉样蛋白:以β-折叠片状分子结构沉积的蛋白质(Amyloid: protein deposited in a β-pleated sheet molecular structure)

呈玻璃状粉红色,用刚果红和苹果绿的荧光染色呈三文鱼样粉红

(Appears glassy pink, stains salmon-pink with Congo red, and fluoresces apple green)

Medullary carcinoma, thyroid

甲状腺髓样癌

炭色色素

(Anthracotic pigment)

非常黑和非常致密的细颗粒(Very black, very dense fine granules)

Pulmonary lymph nodes肺淋巴结

钙化和砂粒体(Calcium and psammoma bodies)

紫色,颗粒状,边缘坚硬;砂粒体呈同心圆状(Purple and granular, with hard edges; psammoma bodies are concentrically laminated)

Papillary

thyroid carcinoma

甲状腺乳头状癌

胶质:指甲状腺滤泡内产生黏液的肿瘤或粉红色物质(Colloid: refers to a mucin-producing neoplasm or the pink substance in thyroid follicles)

甲状腺胶体是一种薄而

均匀的粉红色样物

(Thyroidal colloid is a thin homogeneous pink)

Thyroid tissue


甲状腺组织

含铁血黄素

(Hemosiderin)

(Has a glittery golden-brown refractile appearance with the poor man’s polarizer (waving your finger above the light source))

Old blood in

any lesion

任何损伤处的

陈旧性出血

(图2.4F)

脂褐素

(Lipofuscin)

黄褐色和球状外观(Appears

yellowish brown and globular)

Seminal vesicle

精囊

黑色素

(Melanin)

不像含铁血黄素,不可折射;可能是棕色到灰色(Unlike hemosiderin, is not refractile; may be brown to gray)

Melanoma

黑色素瘤

纹身色素

(Tattoo pigment)

类似于炭色色素,可能是多色的

(Similar to anthracotic pigment, may be multicolored)

Skin with tattoos有纹身的皮肤


···全文完···


作者简介

慧海拾穗,主治医师。

从事儿童病理诊断,对淋巴造血、软组织和泌尿生殖系统肿瘤有着浓厚的兴趣。

座右铭:《为病寻理》就要爱病理!

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