中华病理学杂志
中華病理學雜誌
중화병이학잡지
Chinese Journal of Pathology
2010年
8期
522-527
,共6页
尹为华%余光银%马雅%饶慧兰%林素暇%邵春奎%梁琼%郭娜%陈国勤%周伟%赵彤%朱梅刚
尹為華%餘光銀%馬雅%饒慧蘭%林素暇%邵春奎%樑瓊%郭娜%陳國勤%週偉%趙彤%硃梅剛
윤위화%여광은%마아%요혜란%림소가%소춘규%량경%곽나%진국근%주위%조동%주매강
树突细胞,滤泡%肉瘤%天疱疮%诊断,鉴别%预后
樹突細胞,濾泡%肉瘤%天皰瘡%診斷,鑒彆%預後
수돌세포,려포%육류%천포창%진단,감별%예후
Dendritic cells,follicular%Sarcoma%Pemphiggus%Diagnosis,differential%Prognosis
目的 探讨滤泡树突细胞肉瘤(FDC肉瘤)的临床病理特征及其鉴别诊断.方法 对10例FDC肉瘤行HE染色、免疫组织化学EnVision法染色,对其中5例进行原位杂交,并对7例进行了随访.结果 10例患者中男5例,女5例,平均年龄42岁.发生于结内的6例,主要位于颈部和腹膜后淋巴结;发生于结外的4例,分别位于扁桃体、盆腔、胰尾部和脾脏.镜下观察瘤细胞呈旋涡状、席纹状或片块状排列.肿瘤细胞呈合体状、胖梭形或上皮样,胞质红染,边界不清,细胞核圆形或卵圆形,空泡状,核仁清楚,核分裂象多少不等.偶见核内假包涵体及多核瘤巨细胞.小淋巴细胞或中性粒细胞夹杂于瘤细胞间或围绕血管周围.瘤细胞CD21、CD23、CD35及D2-40呈弥漫或灶状阳性,少数病例瘤细胞上皮细胞膜抗原、CD68、S-100蛋白阳性,白细胞共同抗原、CD20、CD3、CD1a、HMB45、细胞角蛋白均阴性.EBER原位杂交,1例炎性假瘤样FDC肉瘤阳性,另外4例经典型FDC肉瘤为阴性.随访7例,随访2～39个月(平均14个月).2例伴有副肿瘤性天疱疮的患者分别于确诊半年和7个月后死于肺部感染,其余5例经手术切除或辅以放疗和化疗后,无复发和转移.结论 FDC肉瘤是一种少见类型的低至中度恶性肿瘤.CD21、CD35及D2-40的应用有助于其正确的诊断和鉴别诊断.多数病例局部手术切除或辅以放疗和化疗,预后较好,伴有副肿瘤性天疱疮的患者预后差.
目的 探討濾泡樹突細胞肉瘤(FDC肉瘤)的臨床病理特徵及其鑒彆診斷.方法 對10例FDC肉瘤行HE染色、免疫組織化學EnVision法染色,對其中5例進行原位雜交,併對7例進行瞭隨訪.結果 10例患者中男5例,女5例,平均年齡42歲.髮生于結內的6例,主要位于頸部和腹膜後淋巴結;髮生于結外的4例,分彆位于扁桃體、盆腔、胰尾部和脾髒.鏡下觀察瘤細胞呈鏇渦狀、席紋狀或片塊狀排列.腫瘤細胞呈閤體狀、胖梭形或上皮樣,胞質紅染,邊界不清,細胞覈圓形或卵圓形,空泡狀,覈仁清楚,覈分裂象多少不等.偶見覈內假包涵體及多覈瘤巨細胞.小淋巴細胞或中性粒細胞夾雜于瘤細胞間或圍繞血管週圍.瘤細胞CD21、CD23、CD35及D2-40呈瀰漫或竈狀暘性,少數病例瘤細胞上皮細胞膜抗原、CD68、S-100蛋白暘性,白細胞共同抗原、CD20、CD3、CD1a、HMB45、細胞角蛋白均陰性.EBER原位雜交,1例炎性假瘤樣FDC肉瘤暘性,另外4例經典型FDC肉瘤為陰性.隨訪7例,隨訪2～39箇月(平均14箇月).2例伴有副腫瘤性天皰瘡的患者分彆于確診半年和7箇月後死于肺部感染,其餘5例經手術切除或輔以放療和化療後,無複髮和轉移.結論 FDC肉瘤是一種少見類型的低至中度噁性腫瘤.CD21、CD35及D2-40的應用有助于其正確的診斷和鑒彆診斷.多數病例跼部手術切除或輔以放療和化療,預後較好,伴有副腫瘤性天皰瘡的患者預後差.
목적 탐토려포수돌세포육류(FDC육류)적림상병리특정급기감별진단.방법 대10례FDC육류행HE염색、면역조직화학EnVision법염색,대기중5례진행원위잡교,병대7례진행료수방.결과 10례환자중남5례,녀5례,평균년령42세.발생우결내적6례,주요위우경부화복막후림파결;발생우결외적4례,분별위우편도체、분강、이미부화비장.경하관찰류세포정선와상、석문상혹편괴상배렬.종류세포정합체상、반사형혹상피양,포질홍염,변계불청,세포핵원형혹란원형,공포상,핵인청초,핵분렬상다소불등.우견핵내가포함체급다핵류거세포.소림파세포혹중성립세포협잡우류세포간혹위요혈관주위.류세포CD21、CD23、CD35급D2-40정미만혹조상양성,소수병례류세포상피세포막항원、CD68、S-100단백양성,백세포공동항원、CD20、CD3、CD1a、HMB45、세포각단백균음성.EBER원위잡교,1례염성가류양FDC육류양성,령외4례경전형FDC육류위음성.수방7례,수방2～39개월(평균14개월).2례반유부종류성천포창적환자분별우학진반년화7개월후사우폐부감염,기여5례경수술절제혹보이방료화화료후,무복발화전이.결론 FDC육류시일충소견류형적저지중도악성종류.CD21、CD35급D2-40적응용유조우기정학적진단화감별진단.다수병례국부수술절제혹보이방료화화료,예후교호,반유부종류성천포창적환자예후차.
Objective To study the clinicopathologic features of follicular dendritic cell sarcoma(FDCS) and its differential diagnosis. Methods Ten cases of FDCS were studied by light microscopy,immunohistochemistry and in-situ hybridization. The clinical features and follow-up information were of the patients was 42 years. Six of them were located in cervical and peritoneal lymph nodes and four in extranodal sites (including tonsil, pelvic cavity, tail of pancreas and spleen). Histologically, the tumor cells had whorled, storiform or diffuse growth patterns. They were spindle in shape and contained syncytial eosinophilic cytoplasm, with round or oval nuclei, vesicular chromatin, distinct nucleoli and a variable number of mitotic figures. Multinucleated tumor giant cells and intranuclear pseudoinclusions were occasionally seen. There was a sprinkling of small lymphocytes and neutrophils within the tumor as well as in the perivascular region. Immunohistochemical study showed that the tumor cells were diffusely or focally positive for CD21, CD23, CD35 and D2-40, but negative for LCA, CD20, CD3, CD1a, HMB45 and CK.Some of them showed EMA, CD68 and S-100 reactivity. In-situ hybridization for Epstein-Barr virus-encoded RNA (EBER) showed positive signals in only one case (which was diagnosed as inflammatory pseudotumor-like FDCS). Of the 7 patients with follow-up information available (duration: 2 months to 39 months; mean: 14 months), 2 cases with paraneoplastic pemphigus died of pulmonary infection at 5 and 7 months respectively. The remaining 5 patients were alive and disease-free after surgical excision ( +/-chemotherapy and radiotherapy). Conclusions FDCS is a rare low to intermediate-grade malignant tumor. Appropriate application of FDC markers, such as CD21, CD35 and D2-40, would be helpful for arriving at a correct diagnosis. Most cases are associated with good prognosis after surgical treatment, with or without chemotherapy and radiotherapy. Patients with paraneoplastic pemphigus carry a less favorable prognosis.
