CAJ | 학술논문

目的比较骨小细胞恶性肿瘤穿刺活检及术后标本的常规组织学及免疫组织化学方面的差异和鉴别诊断.方法回顾分析1995至2010年间诊断的77例小细胞恶性肿瘤的穿刺活检与术后病理情况,分别对他们的临床资料、常规组织学和免疫组织化学染色结果进行总结.结果77例患者中男48例,女29例,年龄6 ～ 73岁,其中尤文肉瘤/PNET 38例,淋巴瘤10例,浆细胞骨髓瘤23例,小细胞骨肉瘤2例,小细胞转移癌2例,间叶性软骨肉瘤2例.骨小细胞恶性肿瘤发生部位可以累及全身,依次好发于四肢长骨及中轴骨、扁骨.镜下常见密集分布的核蓝染小圆或短梭形细胞,形态及结构类似,穿刺标本与手术标本病理诊断结果完全符合率达到84.4％(65/77),支持率100％(77/77).结论骨小细胞恶性肿瘤较罕见,分类复杂,光镜下形态学类似,组织结构不典型,需结合临床资料、影像学改变、病理形态及免疫组织化学结果综合分析,有条件者加作分子生物学检测才能做出正确判断.穿刺活检对诊断骨小细胞恶性肿瘤效果肯定.
목적 비교골소세포악성종류천자활검급술후표본적상규조직학급면역조직화학방면적차이화감별진단.방법 회고분석1995지2010년간진단적77례소세포악성종류적천자활검여술후병리정황,분별대타문적림상자료、상규조직학화면역조직화학염색결과진행총결.결과77례환자중남48례,녀29례,년령6 ～ 73세,기중우문육류/PNET 38례,림파류10례,장세포골수류23례,소세포골육류2례,소세포전이암2례,간협성연골육류2례.골소세포악성종류발생부위가이루급전신,의차호발우사지장골급중축골、편골.경하상견밀집분포적핵람염소원혹단사형세포,형태급결구유사,천자표본여수술표본병리진단결과완전부합솔체도84.4％(65/77),지지솔100％(77/77).결론골소세포악성종류교한견,분류복잡,광경하형태학유사,조직결구불전형,수결합림상자료、영상학개변、병리형태급면역조직화학결과종합분석,유조건자가작분자생물학검측재능주출정학판단.천자활검대진단골소세포악성종류효과긍정.
Objective To compare the pathologic diagnosis and immunohistochemistry of small cell malignant tumors (SCMT) of bone using both core needle biopsy and surgical specimen.Methods Seventyseven cases of SCMT with core needle biopsies and surgical specimens available were respectively analyzed by histologic examination and immunohistochemical study,with literature review.Results The male-to-female ratio was 48∶ 29.The age of the patients ranged from 6 to 73 years.The tumors studied included Ewing sarcoma/PNET (n =38),myeloma (n =23),lymphoma (n =10),small cell osteosarcoma (n =2),small cell carcinoma (n =2) and mesenchymal chondrosarcoma (n =2).The tumors involved limbs,axial skeleton and flat bones.Microscopically,the tumors shared similar histology,with small round cells and spindly cells arranged in diffuse sheets.The pathologic diagnosis by core needle biopsies correlated with that by surgical specimens in 84.4％ (65/77) of the cases.Conclusions SCMT represents a heterogeneous group of malignancy.Correlations with clinicoradiologic findings and application of ancillary investigations including immunohistochemistry and molecular study are important for definitive diagnosis.Pathologic diagnosis using core needle biopsies shows good results and provides useful information for surgical planning.