骨原发性组织细胞肉瘤3例临床病理观察  

Primary histocytic sarcoma of the bone:a clinicopathological analysis of three cases

作　　者：葛畅[1,2] 许春伟[1,2] 刘光[1] 朱兵[3] 廖玉珍[4] 

机构地区：[1]北京军区总医院病理科,北京100700 [2]安徽医科大学 [3]北京军区总医院骨科,北京100700 [4]北京军区总医院放射科,北京100700

出　　处：《诊断病理学杂志》2013年第9期535-539,共5页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨组织细胞肉瘤的临床病理特征、诊断与鉴别诊断及预后。方法对3例组织细胞肉瘤进行光镜观察及免疫组化检测,并复习相关文献进行讨论。结果 3例患者均为男性,年龄18～41岁;病变分别位于胸椎、上颌骨及股骨远端和胫骨近端。影像学表现均为溶骨性改变伴周围软组织肿块。镜下肿瘤细胞弥漫分布,瘤细胞体积大、圆形或隋圆形,局灶可见梭形细胞,大部分区域瘤细胞黏附性差;瘤细胞胞质丰富、嗜伊红,部分呈泡沫状或充满微空泡,部分瘤巨细胞内可见吞噬的红细胞;核大、圆形或卵圆形,空泡状,可见偏位,部分可见增大的核仁,核分裂易见;亦可见多核瘤巨细胞;背景中常见小淋巴细胞、浆细胞、嗜中性及嗜酸性粒细胞等反应性细胞。免疫组化示肿瘤细胞CD68(KP-1及PGM1)、lysozyme和CD163(+),CK、HMB45、CD3、CD20、CD1a及MPO(-)。结论组织细胞肉瘤是一种罕见的淋巴组织恶性肿瘤,单从组织形态学上难与癌、恶性黑色素瘤、淋巴瘤、恶性纤维组织细胞瘤等相鉴别,诊断与鉴别诊断还依赖于组织形态与免疫组化结果。目前最佳治疗方案不统一,预后多数不佳。Objective To investigate the clinical and pathological features, diagnosis, differential diagnosis and prognosis of histoeytic sarcoma. Methods Methods Histological analyses and immunohistoehemical staining were conducted in 3 eases of histocytie sarcoma, with review of the literature. Results Three patients were male, aged 18 - 41 years old. The tumor occurred in the bone （ thoracic, upper jaw and the distal femur and proximal tibia）, and imaging findings were osteolytie changes associated with soft tissue mass; By light microscopy, tumor cells diffusely distributed and tumor cells were round or oval, focally spindle cells ; most areas of tumor cell adhesion was not strong; the large size of the tumor cells, with abundant and eosinophilic cytoplasm, were noted; there were foam like cells or full of micro-vacuoles in the cytoplasm. Phagocytosis of red blood cells was seen in the part of the giant cell tumor; large nuclei, round or oval, with vacuoles, visible deviation were present with partially visible red nucleoli; nuclear mitosis was easily found; there were muhinucleated giant cells under the background of small lymphocytes, plasma cells, neutrophils and eosinophils. Immunohistochemieal staining showed that tumor cells were positive for CD68 （KP-1 and PGM）, lysozyme, CD163, and negative for Langerin, CK, HMB45, CD3, CD20, CDla and MPO. Conclusion The histocytic sarcoma is a rare malignant tumor of lymphoid tissue. It is difficult to differentiate from carcinomas, malignant melanoma, lymphoma, malignant fibrous histioeytoma and other similar lesions based solely on tissue morphology. Diagnosis and differential diagnosis mainly relies on histology and immunohistochemistry. The best method of treatment is not uniform, and most of patients have poor prognosis.

关 键 词：组织细胞肉瘤 骨 病理学 免疫组化 

分 类 号：R738.1[医药卫生—肿瘤]