易被误诊为肿瘤的良性病变:结节性组织细胞/间皮增生  

Nodular histiocytic/mesothelial hyperplasia:a lesion potentially mistaken for a neoplasm

作　　者：马捷[1] 石群立[1] 印洪林[1] 金行藻[1] 方新颜[1] 周航波[1] 周晓军[1] 

机构地区：[1]南京军区南京总医院病理科,南京210002

出　　处：《诊断病理学杂志》2008年第3期188-190,193,共4页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨结节性组织细胞/间皮增生的临床病理特点、诊断和鉴别诊断。方法对1例发生于肺的结节性组织细胞/间皮增生进行组织病理学和免疫表型观察,结合临床资料进行分析并复习相关文献。结果患者男性,43岁。因自发性气胸复发急诊入院。术中见右侧胸膜腔严重粘连,右上、中、下肺叶均见大小不等的肺大泡。组织学,局部上皮样细胞呈结节状分布,细胞为多边形或类圆形,多镶嵌式排列;核类圆形为主,核染色质较细腻,核仁不明显,见曲核及核沟;胞质空淡或淡红颗粒状,部分细胞有轻度异型,偶见核分裂象,见少许散在的嗜酸性粒细胞浸润。免疫表型:结节区细胞CD68广泛强(+);结节状区的囊壁侧calretinin、CK5/6、Ckpan、CK7和EMA(+);呈连续带状分布,结节内见少许散在的阳性细胞,S-100蛋白偶见(+);CD1a、CgA、Syn、HMB45和TTF1均(-);Ki-67呈少量散在(+)。结论结节性组织细胞/间皮增生是一种罕见的良性病变,形态学需与肺的透明细胞瘤(糖瘤)、神经内分泌癌、透明细胞癌、朗格汉斯细胞组织细胞增生症、异位脑膜瘤和间皮增生性病变相鉴别,免疫组化示CD68广泛强(+),并混杂少许散在的间皮细胞而明确诊断。Purpose To investigate the clinicopathologic features, diagnosis of nodular histiocytic/mesothelial hyperplasia and its differential diagnosis. Methods One case of nodular histiocytic/mesothelial hyperplasia of lung was observed by HE and immunohistochemical staining, and analyzed with clinical features. Results One case of nodular histiocytic/mesothelia hyperplasia occurring in a 43-year-old man presented with abrupt pneumothorax. Serious adhesion of the fight pleural cavity and several bullas in the superior, middle and inferior lobes of the right lung were observed during operation. Histologically, the specimen showed nodular collection of cohesive polygonal or round cells usually with ovoid or deeply grooved nuclei and a moderate amount of finely granular cytoplasm. The nuclei had evenly distributed chromatin and inconspicuous nucleoli. Nuclear pleomorphism was mild. Mitosis was incidentally found. Scattered eosinophils were found in the nodular area. Immunohistochemical studies showed most cells were decorated by the histiocytic marker CD68 （PGM1）, whereas few cells were positive for the mesothelial marker calretinin and CK5/6 and usual epithelial marker Ckpan, CK7 and EMA located in the ribbon of cystic wall near the nodular lesion and rare polygonal cells within the cellular tumor-like lesion. Only rare cells stained for S100. The cells were negative for CDla, CgA, Syn, HMB45 and TTF1. Ki67 positive cells were scattered in the cellular area. Conclusions Nodular histiocytic/mesothelial hyperplasia is a rare benign tumor-like lesion, which should be distinguished from clear cell tumor （sugar tumor）, careinoid, clear cell carcinoma, Langerhans cell histiocytosis, ectopic mengioma and mesothelial proliferation. The diffuse positivity for CD68 of most cells admixed with few mesothelial cells is helpful for diagnosis of this lesion.

关 键 词：胸膜 肺 结节性组织细胞/间皮增生 免疫组化 

分 类 号：R730.262[医药卫生—肿瘤]