喉梭形细胞鳞状细胞癌临床病理分析  

Clinicopathological analysis of spindle cell squamous cell carcinoma of larynx

作　　者：毛美玲[1] 刑莉 杨冬梅[1] 尹鸿雁[1] 万鸿飞[1] 刘红刚[1] MAO Mei-ling;XING Li;YANG Dong-mei;YIN Hong-yan;WAN Hong-fei;LIU Hong-gang(Department of Pathology,Beijing Tongren Hospital/Beijing Key Laboratory of Head and Neck Molecular Diagnostic Pathology,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院病理科/头颈部分子病理诊断北京市重点实验室,北京100730

出　　处：《临床与实验病理学杂志》2018年第7期752-756,共5页Chinese Journal of Clinical and Experimental Pathology

基　　金：首都卫生发展科研专项(2014-2-2053)

摘　　要：目的探讨喉梭形细胞鳞状细胞癌(spindle cell squamous cell carcinoma,SCSCC)的临床病理学特征及其与EBV、HPV的相关性,以提高对该病的认识和诊断水平。方法回顾性分析14例喉SCSCC的临床病理资料,观察其组织学形态、免疫表型等,采用原位杂交法检测EBER,以导流杂交法检测HPV,并选择3例进行透射电镜观察。结果 14例喉SCSCC中12例有明确的鳞状细胞癌和肉瘤样成分(双相形态),2例仅有肉瘤样成分(单相形态)。9例可见肉瘤样成分与鳞状细胞癌的过渡移形区。鳞状细胞癌区与肉瘤样区免疫组化染色结果不同。EBER原位杂交及HPV导流检测结果均阴性。透射电镜下,3例肉瘤样区瘤细胞可见上皮分化特征。14例患者术后随访6~99个月,10例存活,4例死亡。结论喉SCSCC多发于中老年男性,组织学以双相结构为特征,亦可表现为仅有肉瘤样成分的单相型形态。喉SCSCC与EBV、HPV感染无关,确诊需联合组织学形态及免疫表型,必要时可应用透射电镜检测。Purpose To study the clinical and pathologic features of spindle cell squamous cell carcinoma of larynx and relationship with Epstein-Barr virus （EBV） and the human papilloma virus （HPV） , and to improve understanding and diagnosis of the disease. Methods The clinical and pathological data of 14 cases of spindle cell squamous cell carcinoma of larynx were retrospectively analysed, its histomorphology, immunophenotypc and other characteristicsete were observed. Moreover, the mRNA of EBV was identified with the method of in situ hybrid- ization, and the HPV was investigated by flow-through hybridization. In addition, 3 cases were chosen to study with transmission electron microscope. Results On the histomorphology, 12 cases were composed of squamous cell carcinoma and sarcomatous appearance （bi-directional） , 2 cases were only composed of the sarcomatous appearance （unidirectional）. The transition of sarcomatous components and squamous cell carcinoma appeared in 9 cases. The results of immunohistochemical staining in squamous cell carcinoma and sarcomatoid regions were different. The results of in situ hybridization for EBV and flow-through hybridization for HPV were all negative in 14 cases. Transmission electron microscopy revealed epithelial differentiation in 3 sarcomatoid tumor cells. 14 patients were followed up for 6 months to 99 months, l0 cases survived and 4 cases died. Conclusion Spindle cell sqnamous cell carcinoma of larynx is a rare malignant tumor which is characterized by bi-directional morphology and can also be shown as a unidirectional form only with sarcomatoid components, mostly the disease occurs in older men. The disease has no relation with EBV and HPV. The diagnosis of the disease should be examined by histomorphology and immunohistochemistry, and transmission electron microscopy can be used if necessary.

关 键 词：喉部肿瘤 梭形细胞鳞状细胞癌 癌肉瘤 双相型 

分 类 号：R739.65[医药卫生—肿瘤]