前列腺特异性间质肿瘤三例临床病理分析  

Tumors of specialized prostatic strama：a clinicopathologic of three cases

作　　者：王超[1] 杨召阳 张晶[1] 李珊珊[1] 

机构地区：[1]郑州大学第一附属医院病理科,450052

出　　处：《中国实用医刊》2017年第7期1-4,F0004,共5页Chinese Journal of Practical Medicine

摘　　要：目的 探讨前列腺特异性间质肿瘤的临床病理学特征及诊断和鉴别诊断的方法.方法 分析3例原发于前列腺的特异性间质肿瘤患者的临床资料、组织学形态、免疫组织化学检测结果及随访情况,并结合相关文献进行讨论.结果 患者临床表现主要为尿频、尿急、排尿困难,腰痛,无尿痛、血尿、发热,个别患者出现会阴部不适,大便较以前变细.光学显微镜下示：恶性潜能未定的前列腺间质肿瘤（STUMP）间质细胞过度增生,呈空泡状的梭形细胞,排列疏松,其间有血管分布,核偏位且染色质均匀,异型性不明显;前列腺间质肉瘤（PSS）间质细胞增生,细胞增生活跃,呈叶状瘤样生长,前列腺腺体受到挤压呈条索状或裂隙状,瘤组织内可见较多扩张的厚壁血管.瘤细胞多形性明显,主要呈卵圆形、短梭形,胞质丰富,嗜酸性,细胞核深染,呈圆形、卵圆形或不规则形,甚至可见多角核,大小不一,具有轻到中度异型性,核仁不明显,核分裂像4-6个/50 HPF.免疫组织化学检查显示：3例患者瘤组织细胞CD34,Vimentin均为阳性,PR为弱阳性;3例SMA,S-100,ER,细胞角蛋白（CK）,Desmin均为阴性;2例Myogenin为阴性,2例MyoD1为阴性;Ki-67阳性指数为5%-50%（平均为22%）.结论 前列腺特异性间质肿瘤间质细胞增生,瘤细胞呈梭形,其间有厚壁血管分布,免疫组织化学检测Vimentin、CD34阳性,PR弱阳性.临床应结合患者的相关临床表现和病史,并依据病理学特征及相关免疫组化综合判断以确诊.Objective To investigate the clinicopathological features, diagnosis and differential diagnosis of prostate-specific stromal tumors.Methods The clinical data, histological findings, immunohistochemical results and follow-up of 3 cases of primary prostate-specific stromal tumors were analyzed, while reviewing publications regarding the clinicopathological features.Results The patients mainly presented frequency urgency, dysuria, lumbago, but no urodynia, hematuria, fever, individualperineal discomfort, stool than before thinning.Under the light microscope, the interstitial cells of stromal tumor of uncertain malignant potential（STUMP） were overgrowth and vacuolated fusiform cells were arranged with loose blood vessels, nuclear deviation and chromatin uniform, devoid of mitotic figures;The stromal cells of prostate stromal sarcoma（PSS）were active proliferation, which like the phyllodes tumor, the prostate gland was squeezed cord-like or crack-like, and the organization can be seen more expansion of the thick-walled blood vessels.Tumor cells showed some degree of hypercellular stromal, which were mainly oval, short spindle, cytoplasm rich, eosinophilic, deep staining of the nucleus.The nucleus was round, oval or irregular shape, or even polygonal with a lightly moderate atypia, while nucleolus was not obvious, the mitosis were 4-6/ 50 HPF.Immunohistochemical staining showed that CD34 and Vimentin were positive in the tumor tissues, PR was weakly positive in three cases, and SMA, S-100, ER, cytokeratin（CK） and Desmin were negative in three cases, two cases of Myogenin were negative and two cases of MyoD1 were negative;Ki-67 positive index of 5%-50%（average 22%）.Conclusions Prostate-specific stromal tumors is characterized by proliferation of stromal cell presenting shuttle, with thick-walled vessels during the distribution, and immunohistochemistry staining showed Vimentin, CD34 positive and PR weakly positive.So, the concise diagnosis can be made according to the clinical and histopathologic manifest

关 键 词：前列腺特异性间质肿瘤 恶性潜能未定的前列腺间质肿瘤 前列腺间质肉瘤 免疫组织化学 诊断 鉴别诊断 

分 类 号：R737.25[医药卫生—肿瘤]