膀胱恶性纤维组织细胞瘤临床病理分析  

Clinicopathologic analysis of malignant fibrous histiocytoma of bladder

作　　者：张雨涛[1] 李家泉[2] 唐云[1] 朱建华[1] 黄俊[2] 

机构地区：[1]四川省自贡市第一人民医院病理科,四川自贡643000 [2]四川省自贡市第一人民医院泌尿外科,四川自贡643000

出　　处：《实用医院临床杂志》2011年第5期75-77,共3页Practical Journal of Clinical Medicine

摘　　要：目的探讨膀胱恶性纤维组织细胞瘤(malignant fibrous histiocytoma,MFH)的临床病理表现、诊断和鉴别诊断要点。方法对3例MFH的临床资料、病理学表现、免疫组化表型和术后随访情况进行分析并复习文献。结果 3例MFH患者均无特异性临床表现,全程无痛性肉眼血尿及下腹部疼痛为主要症状;病理学检查示病灶呈灰白色结节,边界不清;镜下见成纤维细胞排列成席纹状结构,组织细胞散在分布,并伴有黏液变性及急慢性炎细胞浸润;免疫组化检测示肿瘤细胞Lyso-zyme、CD68、AACT及Vimentin呈阳性表达,CK、SMA、Myosin及S-100均呈阴性表达。术后随访,1例患者于术后4个月因肿瘤复发及双肺转移死亡,1例患者术后63个月仍无瘤健在,另1例患者失访。结论 MFH是少见的膀胱高恶性肿瘤,术前明确诊断困难,术后病理诊断需与肉瘤样尿路上皮癌(sarcomatoid urothelial carcinoma,SUC)、反应性梭形细胞增生(reactive spin-dle cell proliferation,RPCP)及平滑肌肉瘤等鉴别,免疫组化标记有助于明确诊断。早期诊断并采取膀胱全切及系统性化疗和局部放疗可改善患者预后。Objective To investigate the clinicopathologic features,diagnosis,differential diagnosis and treatment of malignant fibrous histiocytoma（MFH） of bladder.Methods The clinical data,pathologic characteristics,immunophenotype and postoperative follow-up of 3 cases of MFH were analyzed,and available literatures were reviewed.Results There were no specific findings in clinical manifestation of the 3 cases of MFH.Two patients presented with whole range painless gross hematuria and the other patient suffered from pain of bythus.Gray-white nodule with obscure boundary was observed.Microscopically,it was characterized by storiform-arranged fibroblast with scattered histocyte,mucinous degeneration,and acute and chronic inflammatory-cell infiltration.Immunohistochemistry revealed tumor cells were positive for Lysozyme,CD68,AACT and Vimentin,but negative for CK,SMA,Myosin and S-100.One patient had been dead of tumor recurrence and metastasis after 4 months,the second patient remained well for 63 months till now,and the third one couldn＇t be contacted.Conclusions MFH is a rare malignant tumor of bladder.It is difficult to make a precise preoperative diagnosis.It＇s necessary to distinguish this tumor from sarcomatoid urothelial carcinoma,reactive spindle cell proliferations and leiomyosarcoma of bladder.Immunohistochemistry is helpful for making the differential diagnosis.It is essential to make early diagnosis,cystectomy,and adjuvant therapy including systemic chemotherapy and local radiotherapy to improve prognosis.

关 键 词：膀胱 恶性纤维组织细胞瘤 病理诊断 免疫组化 

分 类 号：R730.262[医药卫生—肿瘤] R737.14[医药卫生—临床医学]