细针吸取活检在睾丸肿块诊断中的应用

Application of fine needle aspiration biopsy in diagnosis of testicular masses

目的 探讨细针吸取活检在睾丸肿块中的的诊断价值及分型。方法 采用持笔式细针穿刺技术获取足够的标本,部分标本制作细胞涂片进行细胞学诊断;剩余标本采用蛋白乙醇凝固-甲醛固定法制作细胞块(cell block, CB)及石蜡切片,进行HE及免疫组化(immunohistochemistry, IHC)染色。最后,综合分析常规FNA细胞涂片、细胞块切片的形态学和免疫组化染色,完成病理诊断。结果 28例睾丸肿块患者中,12例(42.9%)为非肿瘤性病变,包括囊性病变和炎症性病变。恶性肿瘤16例(57.1%)。FNA细胞涂片在区分肿瘤及非肿瘤性病变中具有特异性。细胞涂片中,精原细胞瘤通常显示肿瘤细胞细胞核大,核质比高;背景是粉染的“虎斑样”(tigroid)物质。淋巴造血系统肿瘤表现为形态比较一致、体积较大的淋巴细胞。用CB和IHC对肿瘤进行分类,精原细胞瘤10例,胚胎癌1例,弥漫性大B细胞淋巴瘤3例,间变性大细胞淋巴瘤1例,急性髓系白血病1例。结论 细针吸取活检是一种快速、可靠、相对廉价的诊断睾丸肿块的工具。CB和IHC是诊断睾丸肿瘤分型的重要辅助手段,为早期诊断及治疗提供可靠信息,值得临床推广和应用。

Objective To explore the diagnostic value of fine needle aspiration technique in the diagnosis of testicular lumps. Methods Sufficient specimens were obtained by pen-holding aspiration sampling technique. Some specimens were made into cell smears for cytological diagnosis;the remaining specimens were used to make cell blocks(CB) according to protein-alcohol-coagulation method. HE and immunohistochemical staining were performed to help making the pathologic diagnosis. Result Of the 28 patients, 12(42.9%) were non-neoplastic, including cystic lesions and inflammation lesions. There were 16 cases of malignant tumor(57.1%). FNA smears had specificity in distinguishing tumor from non-tumor lesions. The seminoma aspirates consisted of a homogeneous population of large cells with large nuclei and high nucleocytoplasmic ratio;the background of the aspirates was made up of a characteristic pinkish material, called “tigroid substance”. The cytological manifestations of lymphohematopoietic system tumors were a monotonous large lymphocyte cell pattern. CB and IHC were used to classify the tumors. There were 10 cases of seminoma, 1 case of embryonic carcinoma, 3 cases of diffuse large B-cell lymphoma(DLBCL), 1 case of anaplastic large cell lymphoma(ALCL) and 1 case of acute myeloid leukemia(AML). Conclusion FNA biopsy is a fast, reliable, and relatively cheap diagnosis tool for palpable testicular masses. CB and IHC are important auxiliary methods in the diagnosis of testicular tumors, which provide reliable information for early diagnosis and treatment, and are worthy of clinical promotion and application.