肺孤立性纤维性肿瘤肉瘤变一例报告及文献复习  

Lung solitary fibrous tumor with sarcomatous transformation: report of a case and review of literature

作　　者：吴春[1,2] 刘冲[1] 石群立[1] 周航波[1] 章如松[1] 陆珍凤[1] 

机构地区：[1]南京大学医学院临床学院南京军区南京总医院病理科,江苏南京210002 [2]扬州友好医院(江苏油田总医院)病理科,江苏扬州225261

出　　处：《诊断学理论与实践》2010年第6期572-575,共4页Journal of Diagnostics Concepts & Practice

摘　　要：目的:探讨肺孤立性纤维性肿瘤(SFT)肉瘤变的临床病理学特征、诊断与鉴别诊断以及治疗和预后。方法:对1例肺SFT伴肉瘤变的标本进行临床病理学观察,并结合国内外文献进行复习。结果:患者男,57岁。因畏寒、发热2个月余,干咳10余天入院,胸部CT示左下肺病灶,体积9.5 cm×6.3 cm×5.5 cm,境界清楚。术中见肿瘤位于左下肺脏层胸膜下,表面光滑,质地较硬。镜检:肿瘤大部分区域由梭形细胞、大片玻璃样变的胶原和分支状血管构成,瘤细胞围绕血管周围排列成血管外皮瘤样,部分区域细胞丰富、密集,异型明显,病理性核分裂象>4/10HPF,并见坏死。免疫组织化学检查示,Vimentin+++、CD34++、CD99+++、Bcl-2++、CD117-、Des-、SMA-、S-100-、CKpan-,Ki-67增殖指数细胞密集区高达50%。病理诊断为肺SFT伴局部肉瘤变。术后随访16个月,一般状况良好。结论:SFT肉瘤变确诊依靠病理组织形态学和免疫组织化学检查,并应与肺部其他恶性间叶源性肿瘤进行鉴别。Objective To study the clinicopathologic features,diagnosis and differential diagnosis,treatment and prognosis of lung solitary fibrous tumor with sarcomatous transformation.Methods A case of lung solitary fibrous tumor with sarcomatous transformation was reported and the literature was reviewed.Results The patient was a 57-year-old man presenting with fever for 2 months and dry cough for 10 days.CT scan revealed a 9.5 cm×6.3 cm×5.5 cm well-circumscribed nodular mass in left lower lung.On operation,the tumor lied on the surface of lung and below the pleura,which is solid with a smooth surface.Microscopy showed spindle cells,branching blood vessels and large patches of hyaline collagen,tumor cells surrounding the blood vessels producing an epithelioma pattern.In some area,tumor cells were abundant and dense with atypia and necrosis,mitoses4/10HPF.Immunohistochemistry： Vimentin＋＋＋,CD34＋＋,CD99＋＋＋,Bcl-2＋＋,CD117-,Des-,SMA-,S-100-,CKpan-and Ki-67 proliferating index reached 50% in cell dense area.The pathological diagnosis was lung solitary fibrous tumor with sarcomatous transformation.The patient was followed for 16 months and found to be well.Conclusions Solitary fibrous tumor with sarcomatous transformation is rare.The diagnosis is based on histopathology and immunohistochemistry.Differential diagnosis includes other malignant mesenchymal tumor of lung.

关 键 词：肺 孤立性纤维性肿瘤 免疫组织化学 

分 类 号：R734.2[医药卫生—肿瘤]