前臂低度恶性肌纤维母细胞肉瘤伴双肺多发转移1例
| 作者: |
1王雅清,
1袁宏伟,
1贾永峰,
1刘霞,
1云芬,
1施琳
1 内蒙古医科大学病理教研室，呼和浩特 010010 |
| 通讯: |
施琳
Email: 13684757835@163.com |
| DOI: | 10.3978/j.issn.2095-6959.2019.12.033 |
| 基金: | 内蒙古自治区高校创新研究团队计划项目(NMGIRT-A1604)；内蒙古自治区高校青年科技英才支持计划(NJYT-14-A11)。 |
摘要
探讨低度恶性肌纤维母细胞肉瘤(low-grade myofibroblastic sarcoma，LGMS)的临床病理特征及鉴别诊断要点。对1例前臂LGMS伴肺转移病例的病理组织进行HE及免疫组织化学EnVision两步法染色，并复习相关文献。前臂肿物及肺肿物穿刺病理检查均见成束的梭形细胞，排列疏密相间，核呈纺锤形，轻-中度异型，可见核分裂象，未见鱼骨刺样排列及肿瘤性坏死。间质富于薄壁分支状血管。免疫表型：梭形瘤细胞弥漫表达Vimentin，SMA，Calponin，局灶弱表达desmin，不表达caldesmon，Ki-67增殖指数30%~40%。LGMS表现为局部侵袭性生长，可复发甚至转移，术前诊断困难，确诊依靠病理和免疫组织化学检查。完整切除肿瘤和密切随访是防止LGMS复发的关键。
关键词：
低度恶性肌纤维母细胞肉瘤；肺；转移；鉴别诊断；免疫组织化学
Low-grade myofibroblastic sarcoma developed on forearm with multiple lung metastasis: A case report
CorrespondingAuthor: SHI Lin Email: 13684757835@163.com
DOI: 10.3978/j.issn.2095-6959.2019.12.033
Foundation: This work was supported by Inner Mongolia Autonomous Region University Innovation Research Team Project (NMGIRT-A1604) and Inner Mongolia Autonomous Region University Youth Science and Technology Talent Support Program (NJYT-14-A11), China.
Abstract
We report a rare clinical case of low-grade myofibroblastic sarcoma (LGMS) developed on forearm with multiple lung metastasis. To investigate the clinical and pathological features as well as the differential diagnosis of LGMS, we operated hematoxylin and eosin staining, and immunohistochemistry staining using EnVision system were perfoemed. Light microscope shoewd circumscribed to diffusely infiltrative with spindled tumor cells in the forearm masses in a loose or dense pattern. And the spindle-shaped nucleus was observed with mild to moderate atypia and mitosis, fish bone spine-like arrangement and neoplastic necrosis is not detectable. The stroma showed abundant thin-walled branched vessels. Immunohistochemistry showed that the spindle tumor cells were diffuse positive for Vimentin, SMA and Calponin, with focally weak positive for desmin and negative for caldesmon, and the Ki-67 proliferation index was 30%–40%. LGMS shows local invasive growth, recurrence and even metastasis, which made it difficult for preoperative diagnosis. And the diagnosis depends on pathological and immunohistochemical examination. Complete tumor resection and close follow-up are the key to prevent recurrence of LGMS.
Keywords：
low-grade myofibroblastic sarcoma; lung; metastasis; differential diagnosis; immunohistochemistry