罕见的手掌软组织混合瘤1例并文献分析  

A Rare Mixed Tumor of Palmar Soft Tissue:Case Report and Literature Analysis

作　　者：黄萱[1] 李艳[1] 陈琼霞[1] 陈莹[1] 镇鸿燕[1] HUANG Xuan;LI Yan;CHEN Qiongxia;CHEN Ying;ZHEN Hongyan(Department of Pathology and Pathophysiology,School of Medicine,Jianghan University,Wuhan 430056,Hubei,China)

机构地区：[1]江汉大学医学院病理学与病理生理学教研室,湖北武汉430056

出　　处：《江汉大学学报（自然科学版）》2023年第1期72-78,共7页Journal of Jianghan University：Natural Science Edition

摘　　要：目的 探讨软组织混合瘤的临床病理特点及鉴别诊断。方法 对罕见的手掌软组织混合瘤病例行常规HE和免疫组织化学染色检查,并随访;同时结合相关文献复习对其临床病理特点进行分析。结果 该类病变形态学表现复杂,密集增生的上皮样、肌上皮样细胞,呈巢状、片状分布,可见纤维结缔组织分隔;瘤细胞增生明显,呈团块状排列且推挤纤维性包膜;另可见散在少许的异型性瘤细胞,间质玻璃样变及软骨黏液样变。肿瘤细胞在AE1/AE3、Vim、S-100、CD10和p63均表达阳性;GFAP呈灶状阳性;Ki-67增殖指数3%;p53在病变中呈广泛阳性表达。该病例术后建立随访,结果 为患者无复发,无转移。结论 软组织混合瘤是一种少见的具有病理异质性特点的间质性肿瘤,发生在手掌非常罕见。病理形态学表现是重要的诊断依据,免疫指标S-100和p63联合检测可辅助其诊断及鉴别诊断。在良性肿瘤和交界性及恶性肿瘤的判断上,增殖指数Ki-67及肿瘤抑制基因p53的检测非常重要,肿瘤细胞推挤包膜的趋势或侵犯包膜的生物学行为都应作为风险评估的标准。Objective To investigate the clinicopathological characteristics and differential diagnosis of the mixed tumor of soft tissue. Methods The rare case of a palm-soft tissue mixed tumor was examined by routine HE and immunohistochemical staining and followed up. At the same time,the clinicopathological characteristics were analyzed based on the relevant literature review. Results The morphological manifestations of the lesions were complex,with the dense proliferation of epithelioid and myoepithelial cells distributed in nests and sheets and separated by fibrous connective tissue. The proliferation of tumor cells was obvious,arranged in clumps,and the fibrous capsule was pushed. There were scattered heteromorphic tumor cells,hyaline change,and chondromyxoid change. Tumor cells were positive for AE1/AE3,Vim,S-100,CD10,and p63,GFAP was focally positive,Ki-67 value-added index was 3%,and p53 was widely positive in the lesions. The patient was followed up after surgery,and no recurrence or metastasis was found. Conclusion The mixed tumor of soft tissue is a rare interstitial tumor with pathological heterogeneity,which occurs in the palm very rarely. The pathological manifestations are an essential diagnostic basis, and the combined detection of immune indexes S-100 and p63 can assist the diagnosis and differential diagnosis. In the judgment of benign tumors, borderline and malignant tumors,detection of the Ki-67 proliferation index and p53 tumor suppressor gene is critical,and the tendency of tumor cells to push the envelope or biological behavior of invading envelope should be used as risk assessment criteria.

关 键 词：软组织混合瘤 手掌 免疫组织化学 鉴别诊断 

分 类 号：R738[医药卫生—肿瘤] R445[医药卫生—临床医学]