腱鞘巨细胞瘤穿刺细胞学的诊断与鉴别诊断  

Diagnosis and differential diagnosis of fine needle aspiration cytology(FNAC) of giant cell tumor in tendon sheath

作　　者：李建民 李晶[2] 杜书强 侯燕 解建军[3] 

机构地区：[1]临清市人民医院病理科,山东临清252600 [2]青岛大学医学院附属肿瘤医院肿瘤科,山东青岛266003 [3]聊城市第二人民医院病理科,山东临清252603

出　　处：《诊断病理学杂志》2016年第8期613-615,619,共4页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨腱鞘巨细胞瘤的穿刺细胞学特点和鉴别诊断。方法选取27例腱鞘巨细胞瘤的穿刺细胞学涂片,光镜观察其细胞学特点,并与腱鞘囊肿、痛风结节、软骨母细胞瘤、透明细胞肉瘤和骨巨细胞瘤的细胞学特点进行比较。结果 27例中细针穿刺细胞学(FNAC)诊断25例,典型特征为均可见大小不一的多核巨细胞,间质细胞以较小的组织样细胞为主,伴多少不一的呑噬含铁血黄素的泡沫状细胞,散在淋巴细胞及纤维细胞。而腱鞘囊肿FNAC以细胞稀少的黏稠液为主,痛风结节细胞学表现为炎症反应并可见针形尿酸盐结晶,软骨母细胞瘤多表现为互不粘连的软骨母细胞增生,透明细胞肉瘤以核仁明显的圆形、卵圆形散在细胞为主,细胞质透明或裸核状,骨巨细胞瘤的FNAC单核间质细胞多表现为卵圆形、梭形并可见异型性,同时巨细胞大小不一。结论熟练掌握并应用腱鞘巨细胞瘤的FNAC特点,可有助于此类疾病的术前诊断与鉴别诊断。Objective To explore the cytological characteristics and differential diagnosis of giant cell tumor of tendon sheath. Methods Aspiration cytology smears were prepared from 27 cases of giant cell tumor of tendon sheath; and the cytological characteristics of ganglion cysts, tophns, chondroblastoma, clear cell sarcoma and giant cell tumor of bone were compared. Result The diagnosis was made in 25 of 27 cases of FNAC. Cytological features of the giant cell tumors included muhinueleated giant cells of various sizes, smaller interstitial cells, predominantly histiocytoid cells, accompanied with different proportion of foam cells with hemosiderin and scattered lymphoeytes and fibroeytes. However, thecal cyst was mainly characterized by viscous fluid with sparse cells in FNAC. Gouty tophus cytology showed inflammatory reaction with gout crystals. Chondroblastoma typically demonstrated in-adhesive chondroeytes. Clear cell sarcoma was cytologically round or oval cells with obvious nueleoli, clear cytoplasm or bare nuclei. Giant cell tumor was predominatly mononuelear cells with oval morphology and spindle cells with mild atypia and multinuclear giant cells in various sizes. Conclusion Mastering the FNAC features of giant cell tumor of tendon sheath, contributes to the preoperative diagnosis and differential diagnosis of this tumor.

关 键 词：腱鞘巨细胞瘤 细针穿刺细胞学 诊断及鉴别诊断 

分 类 号：R738[医药卫生—肿瘤]