皮膚原發(fā)性上皮樣肉瘤臨床病理觀察

1、皮膚原發(fā)性上皮樣肉瘤臨床病理觀察         07-11-29 11:37:00     編輯：studa20                        作者：許俊龍，李玉紅，張杰，劉桂英，任玉波【關鍵詞】  皮膚腫瘤摘 

2、 要 目的：探討皮膚上皮樣肉瘤的臨床病理特點，免疫組化表型及生物學行為。方法：收集2例皮膚ES患者的資料，運用顯微鏡觀察、免疫組化等方法觀察和分析其臨床、細胞學涂片和病理學組織學特征。結果：本組腫瘤全部原發(fā)于皮膚，腫瘤呈結節(jié)狀浸潤性生長，瘤細胞又由兩種細胞組成，大部分為多角形或卵圓形，胞漿豐富，嗜酸性，少部分為呈胖的梭形，象纖維母細胞樣，常圍繞在結節(jié)周圍，結節(jié)中央常有壞死。免疫組化示：上皮膜抗原(EMA),細胞角蛋白(CK),波形蛋白(Vimentin)均強陽性，S100,CD34 弱陽性，CD20、CD3核可疑陽性，其余多項免疫組化結果均呈陰性。結論：ES少見且形態(tài)復雜多變，只憑光鏡容易誤診

3、，腫瘤細胞學對其診斷無特異性，需結合免疫組化結果才能做出正確的診斷。ES預后差，患者常需行腫物擴大甚至根治術。關鍵詞 皮膚腫瘤；上皮樣肉瘤；免疫組化A Clinicopathologic Study of Primary Epithelioid Sarcoma of SkinaAbstract:Objective To explore the pathoclinical characteristics immunophonetype and its biological behaviour of primary epithelial sarcoma.Methods Two cases of p

4、rimary epithelial sarcoma of skin were studied by using microscope observation and immunohistochemistry and analyse their characterstics of clinic、cytological smear and pathohistology.Results The group of tumors were all located in skin.Microscopically,tumor showed an invasive growth and nodulous ar

5、rangement and was made up of two kinds of cells,relativepart of cells were characterized by multangular or oval and round cell with richful eosinophilic cytoplasm,other cells were fatty and spindle just like fibroblast.The tumor nodule's central zone that was always degenerative and necrosive th

6、at surrounded by the two kinds cells.Immunohistochemically,tumor cells showedintense positive staining for EMA、Cytokeratin and Vimentin,only showed weak positive staining for S100、CD34,while also showed dubious positive karyon staining for CD20 and CD3,other results of immnuohistochemistry were all

7、negative.Conclusion The tumor is quite difficult to diagnose only by microscope for its infrequency and various morphological features.No diagnostic particularity only bycelluar smear.Only based on histopathological characteristics with the results of immunohistochemistry,a definite pathological dia

8、gnosis of the tumor can be got.Its prognosis is very poor and a patient needs to have a marginal or even a radical resection.Key words:Skin cancer;Epithelioid sarcoma;Immunohistochemistry    上皮樣肉瘤(epithelioid sarcome，ES)是一種非常少見的起源未定的腫瘤，而且病理形態(tài)變化多端，臨床和病理醫(yī)師都很容易誤診，該腫瘤預后較差，多需廣泛切除，因而非常有必要加強

9、對此病的認識，本文根據我院收治的2例確診病人的臨床癥狀和體征，結合病理形態(tài)特點、穿刺細胞學和免疫組化技術以及生物學行為對此病進行探討。1  資料和方法1.1  臨床資料  病例，女，31歲，已婚，漢族，訴右脛前皮下結節(jié)5 a，皮膚潰瘍6個月入院?；颊? a前無誘因發(fā)現右脛前皮下結節(jié)，直徑1 cm，略高于皮面，皮膚表面無改變，輕觸痛，不活動，未給予治療，約1個月后自行消失。2個月后在同一位置再次出現棗大小皮下結節(jié)，未診治自行消失。1 a前同一位置又出現同樣大小的皮下結節(jié)，漸向皮膚表面生長，6個月前突出皮面并破潰，少量滲出，伴疼痛，予藥物治療(具體不詳)無好轉，潰瘍面

10、積漸增大。3個月前就診于我院皮膚科，行結核菌素試驗()，病理活檢考慮慢性肉芽腫性炎，給予異煙肼0.2 g，每日2次，治療2個月，潰瘍仍無明顯好轉。1個月前無意中捫及腹股溝區(qū)棗樣大小結節(jié)，無疼痛，給予中藥局部敷療及口服治療，病情無明顯好轉。查體見：一般情況良好，右脛前皮膚可見7 cm×7 cm大小的潰瘍創(chuàng)面，潰瘍面發(fā)黑，周圍皮膚紅腫，輕壓痛。皮膚、黏膜無黃染、皮疹及出血點。右腹股溝區(qū)觸及直徑2 cm的皮下結節(jié)，質韌，輕壓痛，余未觸及腫大淋巴結。體格檢查均未見異常。實驗室檢查：心肌酶譜中肌酸激酶247 U/L，羥丁酸脫氫酶204 IU/L,乳酸脫氫酶261 IU/L,肌紅蛋白26 g/L

11、,超敏C反應蛋白0.05 mg/L；脛前結節(jié)穿刺細胞學檢查均示找到淋巴瘤細胞；皮膚病理活檢示：皮膚彌漫型非霍奇金氏淋巴瘤，外周T細胞型。病例，女，92歲，訴外陰部皮下結節(jié)潰瘍3個月，伴輕度疼痛感，查體見外陰部皮膚3.5 cm×2.5 cm的潰瘍，潰瘍表面附膿性分泌物，周圍皮膚紅腫，觸痛明顯，活檢示慢性肉芽腫性炎，其余輔助檢查未見明顯異常，后即做腫物切除送檢。1.2  方法  2例HE染色并行ElivisionTMPLUS法免疫組化檢查，所用EMA、Vimetin、CK、S100、CD34、CD20、CD3、Desmin、HMB 45等試劑均購自美國Santacru

12、ze公司產品，ElivisionTMPlus試劑購自福州邁新生物技術開發(fā)有限公司，均設陽性對照，并用PBS代替一抗作為陰性對照。2  結果2.1  大體觀察  2例均為皮膚組織一塊，均呈結節(jié)狀，皮膚中間可見潰瘍，潰瘍表面見膿性分泌物，切面結節(jié)呈灰白及灰紅色，見灶性灰黃色壞死區(qū)，未見明顯包膜，界限不清，結節(jié)可見纖維間隔。2.2  細胞學穿刺鏡檢  穿刺物呈聚集的多角形細胞，細胞核大，含粗顆粒狀的染色質、由淡到濃的胞漿，還可見核偏位的梭形或蝌蚪形的細胞。2.3  組織學鏡檢  腫瘤組織均位于真皮深部，呈結節(jié)狀排列，結節(jié)界限不甚清晰，中心可見