小腿小细胞型骨外骨肉瘤临床病理观察  

Extraskeletal small cell osteosarcoma in leg: a clinicopathological analysis

作　　者：翁阳[1] 牛海艳[1] 邓仲端[2] 

机构地区：[1]海南医学院病理学教研室,海口571101 [2]华中科技大学同济医学院病理学系,武汉430030

出　　处：《诊断病理学杂志》2006年第4期278-280,i0010,共4页Chinese Journal of Diagnostic Pathology

摘　　要：目的 研究骨外骨肉瘤的临床病理特征、诊断和鉴别诊断。方法 运用HE染色、免疫组化和电镜检查，对1例罕见的小腿骨外骨肉瘤进行临床病理形态学研究，并复习文献。结果 巨检：为灰白色牛角样肿物。镜检：肿瘤由大小一致的小细胞构成。瘤细胞的胞质甚少，核呈圆形、卵圆形或不规则形，染色质细，不见核仁，或有2—3个小核仁，核分裂多见。肿瘤被纤维结缔组织分隔成小结节状，伴有结节周围骨化及钙化，并可见到瘤细胞产生的骨基质，及大量互相吻合的编织骨小梁形成。免疫组化：vimentin、CD99、CgA和S-100（-），Syn散在（＋），NSE（±）。电镜：瘤细胞胞质内见微丝，有丰富的线粒体和内质网，但未见神经分泌颗粒；细胞外有胶原。结论 小细胞型骨外骨肉瘤临床和影像学表现易与骨化性肌炎相混淆。Objective To study the clinicopathological features, diagnosis and differential diagnosis of extraskeletal osteosarcoma （ KSOS）, with review of the literature. Methods The clinical and pathological features of a case of rare ESOS were investigated by routine H - E staining, immunohistochemistry and electron microscopy. Results Grossly, the tumor was a gray ox born-hke mass. Microscopically, the tumor was composed of small cells of uniform size with scanty cytoplasm, round, oval, or irregular nuclei containing fine chromatin, no nucleoli or 2 - 3 small nucleoli, and many mitoses. The tumor was divided by fibrous component into nodules with peripheral ossification and calcification. In addition, the production of the osteoid matrix by the ceils and numerous anastomosing woven bone trabeculae could be seen. Immunohistochemistry showed that the tumor cells were negative for vimentin, CD99, CgA and S-100 protein, except that it was sporadic positive for Syn, and NSE expression varied. Electron microscopically, microfilaments, abundant mitochnodria and endoplasmic reticula, but no neurocrine granules, were observed in the cytoplasm, and there was a plenty of extracellular collagen. Conclusions This case here reported is EXOS of small cell type. The clinical and radiological features of this tumor may be confused with that of myositis ossificans. Close contact of pathologists with clinicians is a key to make correct diagnosis of this tumor.

关 键 词：骨外骨肉瘤 临床病理 免疫组 电镜 

分 类 号：R738.6[医药卫生—肿瘤]