皮肤原发性上皮样肉瘤临床病理观察

1、皮肤原发性上皮样肉瘤临床病理观察         07-11-29 11:37:00     编辑：studa20                        作者：许俊龙，李玉红，张杰，刘桂英，任玉波【关键词】  皮肤肿瘤摘 

2、 要 目的：探讨皮肤上皮样肉瘤的临床病理特点，免疫组化表型及生物学行为。方法：收集2例皮肤ES患者的资料，运用显微镜观察、免疫组化等方法观察和分析其临床、细胞学涂片和病理学组织学特征。结果：本组肿瘤全部原发于皮肤，肿瘤呈结节状浸润性生长，瘤细胞又由两种细胞组成，大部分为多角形或卵圆形，胞浆丰富，嗜酸性，少部分为呈胖的梭形，象纤维母细胞样，常围绕在结节周围，结节中央常有坏死。免疫组化示：上皮膜抗原(EMA),细胞角蛋白(CK),波形蛋白(Vimentin)均强阳性，S100,CD34 弱阳性，CD20、CD3核可疑阳性，其余多项免疫组化结果均呈阴性。结论：ES少见且形态复杂多变，只凭光镜容易误诊

3、，肿瘤细胞学对其诊断无特异性，需结合免疫组化结果才能做出正确的诊断。ES预后差，患者常需行肿物扩大甚至根治术。关键词 皮肤肿瘤；上皮样肉瘤；免疫组化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    上皮样肉瘤(epithelioid sarcome，ES)是一种非常少见的起源未定的肿瘤，而且病理形态变化多端，临床和病理医师都很容易误诊，该肿瘤预后较差，多需广泛切除，因而非常有必要加强

9、对此病的认识，本文根据我院收治的2例确诊病人的临床症状和体征，结合病理形态特点、穿刺细胞学和免疫组化技术以及生物学行为对此病进行探讨。1  资料和方法1.1  临床资料  病例，女，31岁，已婚，汉族，诉右胫前皮下结节5 a，皮肤溃疡6个月入院。患者5 a前无诱因发现右胫前皮下结节，直径1 cm，略高于皮面，皮肤表面无改变，轻触痛，不活动，未给予治疗，约1个月后自行消失。2个月后在同一位置再次出现枣大小皮下结节，未诊治自行消失。1 a前同一位置又出现同样大小的皮下结节，渐向皮肤表面生长，6个月前突出皮面并破溃，少量渗出，伴疼痛，予药物治疗(具体不详)无好转，溃疡面

10、积渐增大。3个月前就诊于我院皮肤科，行结核菌素试验()，病理活检考虑慢性肉芽肿性炎，给予异烟肼0.2 g，每日2次，治疗2个月，溃疡仍无明显好转。1个月前无意中扪及腹股沟区枣样大小结节，无疼痛，给予中药局部敷疗及口服治疗，病情无明显好转。查体见：一般情况良好，右胫前皮肤可见7 cm×7 cm大小的溃疡创面，溃疡面发黑，周围皮肤红肿，轻压痛。皮肤、黏膜无黄染、皮疹及出血点。右腹股沟区触及直径2 cm的皮下结节，质韧，轻压痛，余未触及肿大淋巴结。体格检查均未见异常。实验室检查：心肌酶谱中肌酸激酶247 U/L，羟丁酸脱氢酶204 IU/L,乳酸脱氢酶261 IU/L,肌红蛋白26 g/L

11、,超敏C反应蛋白0.05 mg/L；胫前结节穿刺细胞学检查均示找到淋巴瘤细胞；皮肤病理活检示：皮肤弥漫型非霍奇金氏淋巴瘤，外周T细胞型。病例，女，92岁，诉外阴部皮下结节溃疡3个月，伴轻度疼痛感，查体见外阴部皮肤3.5 cm×2.5 cm的溃疡，溃疡表面附脓性分泌物，周围皮肤红肿，触痛明显，活检示慢性肉芽肿性炎，其余辅助检查未见明显异常，后即做肿物切除送检。1.2  方法  2例HE染色并行ElivisionTMPLUS法免疫组化检查，所用EMA、Vimetin、CK、S100、CD34、CD20、CD3、Desmin、HMB 45等试剂均购自美国Santacru

12、ze公司产品，ElivisionTMPlus试剂购自福州迈新生物技术开发有限公司，均设阳性对照，并用PBS代替一抗作为阴性对照。2  结果2.1  大体观察  2例均为皮肤组织一块，均呈结节状，皮肤中间可见溃疡，溃疡表面见脓性分泌物，切面结节呈灰白及灰红色，见灶性灰黄色坏死区，未见明显包膜，界限不清，结节可见纤维间隔。2.2  细胞学穿刺镜检  穿刺物呈聚集的多角形细胞，细胞核大，含粗颗粒状的染色质、由淡到浓的胞浆，还可见核偏位的梭形或蝌蚪形的细胞。2.3  组织学镜检  肿瘤组织均位于真皮深部，呈结节状排列，结节界限不甚清晰，中心可见