皮肤富于细胞型纤维组织细胞瘤临床病理观察  

Clinicopathological features of celluar fibrous histiocytoma

作　　者：鲍天辉 吴慰霖 詹丽影 程晓琳 

机构地区：[1]歙县人民医院病理科,安徽歙县245200

出　　处：《诊断病理学杂志》2013年第4期218-222,共5页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨富于细胞型纤维组织细胞瘤(cFH)的临床病理特点及鉴别要点。方法对1例细胞形态多变的cFH进行临床、病理形态及免疫组化研究,同时复习相关文献。结果肿瘤位于左侧腋前,呈灰白色,质地偏韧。与多数文献报道的cFH典型组织学形态(高度富于梭形细胞和束状生长方式)有所不同;本例表现为圆形、卵圆形上皮样细胞密集排列,短梭形、梭形细胞相对较少,梭形细胞束状排列区不太明显。瘤细胞胞质嗜酸性,核卵圆形空泡状,有嗜酸性小核仁,可见多处透明变。核分裂象>4个/10 HPF,累及真皮网状层。免疫组化示肿瘤细胞CD163和vimentin(+),Ki-67增殖指数<5%,CD68和CD34(-)。结论该瘤可发生于全身任何部位,切除不完整,临床复发率高,可达26%,典型组织学特征为高度富于梭形细胞、束状结构和有较多的核分裂象,需要与平滑肌肉瘤及皮肤隆突性纤维肉瘤鉴别。Objective To study the clinical pathologic characteristics and differential diagnosis of cellular fibrous histiocytoma（cFH）.Methods One case of cellular variant of fibrous histiocytoma was studied by clinical data analysis,light microscopy and immunohistochemistry.Results The tumor located in armpit.The lesions were gray-white and partial toughening.Typical histological features of cFH were high cellularity,and short fasciculae as well as focal storiform growth pattern.Round,oval and epithelioid cells with densely arrangement predominately presented in this type,with rich hyaline region and without quite apparent fascicular growth pattern of spindle cells.The tumor cells had tapering nuclei with small eosinophilic nucleoli and relatively abundant,ill-defined and pale eosinophilic cytoplasm,with a moderate mitotic rate（4/10 HPF）.The tumor involved the deep reticular dermis.Immunohistochemical studies found that the tumor cells were positive for CD163 and vimentin,and negative for CD68,CD34,SMA and S-100,with Ki-67 proliferation index 5%.Conclusions Anatomic distribution of this tumor is wide with about one fourth（26%） cases that recur locally from 3 months to 3 years after excision.The cFH should be distinguished from dermatofibrosarcoma protuberans and leiomyosarcoma with rich cells,fascicular growth and more mitotic figures.This cases needs to be distinguished from malignant melanoma,epithelioid fibrous histiocytoma and clear cell hidradenoma.

关 键 词：皮肤肿瘤 纤维组织细胞瘤 诊断与鉴别诊断 免疫组化 

分 类 号：R739.5[医药卫生—肿瘤]