CAJ | 학술논문

目的探讨组织细胞肉瘤(HS)的临床病理学特征、免疫学表型、鉴别诊断及预后.方法分析4例Hs患者临床病理资料,活检或切除的肿瘤组织标本采用常规石蜡切片,HE染色,EnVision法免疫组化染色,电镜观察,并对患者进行随访.结果 4例HS患者中男女各2例,年龄范围22~65岁(平均43.25岁);发生部位为淋巴结2例、皮肤1例、结肠1例.光学显微镜下观察,肿瘤组织的形态学特点为肿瘤细胞弥漫浸润、散在分布、互不黏附,瘤细胞体积中等到大,呈圆形、卵圆形、多角形、上皮样.胞质较丰富,略嗜酸性,部分细胞胞质呈泡沫状,核圆形、卵圆形,偏位,核染色质空泡状,核仁嗜碱性,核分裂象多见,可见病理性核分裂象.3例见舣核瘤细胞,多形性明显,可见多核瘤巨细胞,2例可见灶状泡沫状胞质的瘤细胞,1例可见灶状肉瘤样梭形细胞区,2例可见噬血细胞现象.4例均见到多少不一的炎细胞背景.4例患者均弥漫表达a-1-ACT、CD68、CD163、溶菌酶,3例表达CD45、CD45RO.电镜检杳4例患者均显示肿瘤细胞胞质丰富,内含溶酶体,不见Birbeck小体、细胞间连接及指状突起.4例均进行了随访,3例确诊后6~13个月死亡,1例局限于皮肤及皮下者现存活.结论 HS为一种罕见的显示成熟组织细胞形态和免疫表型特征的恶性肿瘤,其诊断是在形态学的基础上依靠免疫组织化学染色及电镜观察进行排除性诊断.
목적 탐토조직세포육류(HS)적림상병이학특정、면역학표형、감별진단급예후.방법 분석4례Hs환자림상병리자료,활검혹절제적종류조직표본채용상규석사절편,HE염색,EnVision법면역조화염색,전경관찰,병대환자진행수방.결과 4례HS환자중남녀각2례,년령범위22~65세(평균43.25세);발생부위위림파결2례、피부1례、결장1례.광학현미경하관찰,종류조직적형태학특점위종류세포미만침윤、산재분포、호불점부,류세포체적중등도대,정원형、란원형、다각형、상피양.포질교봉부,략기산성,부분세포포질정포말상,핵원형、란원형,편위,핵염색질공포상,핵인기감성,핵분렬상다견,가견병이성핵분렬상.3례견의핵류세포,다형성명현,가견다핵류거세포,2례가견조상포말상포질적류세포,1례가견조상육류양사형세포구,2례가견서혈세포현상.4례균견도다소불일적염세포배경.4례환자균미만표체a-1-ACT、CD68、CD163、용균매,3례표체CD45、CD45RO.전경검묘4례환자균현시종류세포포질봉부,내함용매체,불견Birbeck소체、세포간련접급지상돌기.4례균진행료수방,3례학진후6~13개월사망,1례국한우피부급피하자현존활.결론 HS위일충한견적현시성숙조직세포형태화면역표형특정적악성종류,기진단시재형태학적기출상의고면역조직화학염색급전경관찰진행배제성진단.
Objective To investigate the clinicopathologic features,immunophenotyping,differential diagnoses and Drognosis of histiocytic sarcoma(HS).Methods The clinical and pathologic findings of 4 cases 0f HS were reviewed.The samples were used for paraffin section,HE stain,immunohistochemistry stain bv EnVision method.electron microscope observation. Follow-up information was available in all patients.Results The age of Datients.2 males and 2 females,ranged from 22 to 65 years old(median,43.25 vears).The sites of involvement included lymph node(2 cases),skin or soft tissue(1 case)and colon(1 case).The tumor cells Were widespread infiltration,diffused distribution,no adhesion to each other.Tumor cells were middling and large,round,orbicular-ovate,polygon,epithelium appearance,plentiful cytoplasm and acidophilia.cystose.Nucelus was round,orbicular-ovate,dissymmetry.Nuclear chromatin Was vacuole appearance,basophilia nucleolus,caryocinesia and pathological mitotic figure.Three of the cases showed coniugate nuclei,increased pleomorphism with muhinucleated tumor giant cell formation. Focal cytoplasmic with foamv appearance was identified in 2 cases.One case demonstrated foci of spindly sarcomatoid appearance.Hemophagocytosis was identified in 2 cases.The tumor cells of 4 cases were often accompanied by various numbers of inflammatory cells.Immunohistochemical study showed that all cases were diffusely positive for a-1-ACT,CD68,CD163 and lysozyme.Three of 4 cases also expressed CD45,CD45 RO.The electron microscope results of 4 cases showed that the tumor cells were plentiful cytoplasm and a few cytolysosome in the cytoplasm,and no birbeck cytorrhyctes,cell-cell junction and digitationes.Amongst the 4 patients with follow-up information available,three died of the disease 6-13 months after diagnosis.One patient,whose lesion was localized at the skin and soft tissue,survived at the present time.Conclusion HS Was a scarce malignant tumor with mature histiocpe morphology and immunophenotype character.The diagnosis should be based on tissue morphology,immunohistochemistry and electron microscope observation to exclude other disorders.