CAJ | 학술논문

患者女,30岁.5年前因左乳腺癌行保乳手术并接受放射治疗,在左腋下出现放射性皮炎.2年后,在放射性皮炎部位出现3个黄豆大小的鲜红色结节,逐渐增大,行手术切除3周后复发.妊娠后肿块迅速增大、隆起,终止妊娠后,肿块增大趋势得到明显遏制.皮肤科检查:左腋下方见18 cm×14 cm类似椭圆形暗红色或鲜红色斑块,斑块表面光滑,中央为10 cm×9 cm×5 cm大的鲜红色半球形实质性隆起,表面糜烂,结痂.组织病理:真皮中下层致密、单一的梭形细胞排列成漩涡状、席纹状.部分细胞核有异形性,少见核分裂象.少数区域瘤细胞排列成“青鱼骨”状.免疫组化染色:波形蛋白(+++),肌动蛋白(+),CD34阴性.诊断:放疗后隆突性皮肤纤维肉瘤(纤维肉瘤型).
환자녀,30세.5년전인좌유선암행보유수술병접수방사치료,재좌액하출현방사성피염.2년후,재방사성피염부위출현3개황두대소적선홍색결절,축점증대,행수술절제3주후복발.임신후종괴신속증대、륭기,종지임신후,종괴증대추세득도명현알제.피부과검사:좌액하방견18 cm×14 cm유사타원형암홍색혹선홍색반괴,반괴표면광활,중앙위10 cm×9 cm×5 cm대적선홍색반구형실질성륭기,표면미란,결가.조직병리:진피중하층치밀、단일적사형세포배렬성선와상、석문상.부분세포핵유이형성,소견핵분렬상.소수구역류세포배렬성“청어골”상.면역조화염색:파형단백(+++),기동단백(+),CD34음성.진단:방료후륭돌성피부섬유육류(섬유육류형).
A 30-year-old woman presented with a 5-year history of recurrent nodular lesions in the left subaxillary region,which had rapidly grown for 7 weeks.Five years prior to the presentation,she received breast conservation surgery and radiotherapy for left breast cancer,thereafter,chronic radiation dermatitis developed in the left subaxillary region.Two years after the operation,three soybean-sized bright red nodules appeared in the lesions of radiation dermatitis,and slowly enlarged.Subsequently,the nodules were resected,but a local recurrence was observed 3 weeks after the resection.The recurrent masses underwent accelerated growth during her pregnancy,and the growth was obviously inhibited after the termination of pregnancy.Physical examination revealed a quasi-elliptic,dark or bright red plaque measuring about 18 cm × 14 cm with a smooth surface in left subaxillary region,and in the center of the plaque was a bright red,hemispheric,elevated lesion measuring 10 cm × 9 cm × 5 cm with erosions or pitchy crusts on the surface.Histopathology of the lesions showed that the tumor was located in the dermis and consisted of densely packed uniform spindle-shaped cells arranged in a characteristic storiform or whirlpool pattern.Some cell nuclei showed atypia,and few mitoses were observed.In some parts of the lesion,tumor cells were arranged in a herringbone pattern.Immunohistochemistry revealed that the tumor cells stained positive for vimentin(strongly)and actin(weakly),but negative for CD34.Based on these findings,a diagnosis of postradiation dermatofibrosarcoma protuberans(fibrosarcoma type)was made.