一例Neurothekeoma的病理探讨  

Pathological study of a case of Neurothekeoma

作　　者：李向利 张康 杨漪 翁艳 LI Xiangli;ZHANG Kang;YANG Yi;WENG Yan(Department of Pathology,the First Hospital of Tsinghua University,Beijing 100016,China;Department of Obstetrics and Gynecology,the First Hospital of Tsinghua University,Beijing 100016,China)

机构地区：[1]清华大学第一附属医院病理科,北京100016 [2]清华大学第一附属医院妇产科,北京100016

出　　处：《中国研究型医院》2023年第4期67-69,共3页Chinese Research Hospitals

摘　　要：患者男,因发现右侧胸部肿物1年余,于2018年10月29日就诊。超声检查:提示右侧乳腺发育伴实性结节。MRI:提示右乳头外上象限胸壁内见富血供结节,考虑肿瘤。2019年4月18日,手术切除肿物,送检病理,分别采用苏木精-伊红染色法(HE)、免疫组织化学、荧光原位杂交(FISH)检测尤文肉瘤断裂区域1(EWSR1)基因双色分离及间变性淋巴瘤激酶(ALK)基因断裂情况。综合诊断为右胸Neurothekeoma(NTK),富于细胞型。光镜下见肿瘤细胞呈结节状、分叶状分布,结节间可见纤维组织分割;肿瘤细胞排列成漩涡状、束状,部分区域细胞呈栅栏状,肿瘤细胞呈胖梭形、上皮样;细胞核呈梭形、卵圆形、“马蹄形”,可见核仁,核分裂象罕见;局灶间质黏液变性、毛细血管网,少量慢性炎细胞浸润。免疫组织化学:CD34(血管+)、CD10(细胞质+)、CD63(部分细胞质+)、CD99(细胞质与细胞膜+)、S-100(-)、SATA-6(-)。FISH结果:计数100个肿瘤细胞,以易位细胞比例≥10%为阳性;未见ALK突变及EWSR1基因分离。NTK是一种较为少见的良性纤维组织细胞瘤,病理检查辅助对其诊断、鉴别诊断及治疗具有重要价值。Patient is a male who presented with a right-sided chest mass discovered over a year ago.The patient sought medical attention on October 29,2018.Ultrasonography revealed solid nodules associated with right breast development.MRI showed a well-vascularized nodule within the chest wall in the upper outer quadrant of the right nipple,suggestive of a neoplasm.On April 18,2019,the mass was surgically excised and sent for pathological examination.Histopathological analysis was performed using Hematoxylin and Eosin(HE)staining,immunohistochemistry,and fluorescence in situ hybridization(FISH)to assess the presence of EWSR1 gene rearrangement and anaplastic lymphoma kinase(ALK)gene breakpoints.The comprehensive diagnosis was established as a Neurothekeoma(NTK)of the right chest,characterized by a cellular variant.Microscopically,the tumor cells exhibited nodular and lobulated growth patterns with fibrous tissue septa separating the nodules.The tumor cells demonstrated swirling and fascicular arrangements.Some regions showed palisading of tumor cells,which appeared plump and epithelioid.The cell nuclei were spindle-shaped,oval,or"horseshoe-shaped,"with visible nucleoli,while mitotic figures were rare.Focal interstitial mucoid degeneration,a capillary network,and mild chronic inflammatory cell infiltration were observed in the cellular stroma.Immunohistochemical analysis revealed positive staining for CD34(vascular),CD10(cytoplasm),partial staining for CD63(cytoplasm),and positive staining for CD99(cytoplasm and cell membrane).Negative staining was observed for S-100(-)and SATA-6(-).FISH analysis of 100 tumor cells did not reveal any ALK mutations or EWSR1 gene rearrangements.NTK is a rare benign fibrous tissue neoplasm,and histopathological examination plays a crucial role in its diagnosis,differential diagnosis,and treatment.

关 键 词：NEUROTHEKEOMA 病理状态 体征和症状 诊断 鉴别 

分 类 号：R737.9[医药卫生—肿瘤]