原发性扁桃体指突状树突细胞肉瘤1例及文献复习  

Primary tonsil interdigitating dendritic cell sarcoma:report of a case and review of literature

作　　者：孙玉满 韩凤艳 张玲 吴蒙[2] 武思丞 刘宏侠 SUN Yu-man;HAN Feng-yan;ZHANG Ling;WU Meng;WU Si-cheng;LIU Hong-xia(Department of Pathology,Affiliated Hospital of Tangshan Vocational and Technical College,Tangshan 063000,China;Depprtment Pathology,Tangshan Vocational and Technical College,Tangshan 063000,China)

机构地区：[1]唐山职业技术学院附属医院病理科,河北唐山063000 [2]唐山职业技术学院病理教研室,河北唐山063000

出　　处：《诊断病理学杂志》2024年第7期644-647,共4页Chinese Journal of Diagnostic Pathology

摘　　要：目的 探讨指突状树突细胞肉瘤(IDCS)的临床病理学特点、免疫学表型、诊断和鉴别诊断要点。方法 通过常规HE染色、免疫组织化学标记及EBER原位杂交检测,对1例IDCS进行显微镜下组织学形态观察,并进行文献复习。结果 IDCS细胞呈卵圆及短梭形,镜下呈弥漫性浸润生长,表面坏死、渗出,侵犯扁桃体组织。瘤细胞胞浆丰富、嗜酸、界限不清,细胞核主要呈卵圆形、短梭形,细胞有异型,核仁明显,核分裂像易见。肿瘤内散在少数正常小淋巴细胞。免疫组化染色显示肿瘤细胞S-100、CD68、Vimentin呈阳性表达,CD1a、CD23、CD35、CD3、CD20等呈阴性表达,Ki-67增殖指数为70%~80%。原位杂交检测显示EBER阴性表达。结论 指突状树突细胞肉瘤是来源于指突状树突细胞的一种少见肉瘤。病理诊断主要依靠病理形态学和免疫组织化学标记,S-100、CD68阳性表达、CD1a、CD23、CD35、CD3、CD20阴性表达是诊断该肿瘤的重要参考依据之一。鉴别诊断主要包括滤泡树突细胞肉瘤、组织细胞肉瘤、朗格汉斯细胞肉瘤、大细胞性B细胞和T细胞淋巴瘤、恶性黑色素瘤、转移性神经内分泌癌等。Objective To explore the clinical pathological characteristic,immunological phenotype,diagnosis and differential diagnosis of interdigitating dendritic cell sarcoma(IDCS).Methods One case of IDCS was studied by routine HE staining,immunohistochemistry labeling and EBER in situ hybridization detection,as well as review of related literatures. Results Under the microscope,IDCS cells were oval and short fusiform,diffuse infiltrating growth,with surface necrosis,exudation and tonsil invasion.Tumor cells cytoplasm was abundant,eosinophilic,unclear boundaries.Nuclei were mainly oval,short spindle-shaped,and the cells were atypical,nucleoli were obvious,nuclear division image was easy to see.There were a few small normal lymphocytes scattered within the tumor.Immunohistochemical staining showed that tumor cells were positively expressed S-100,CD68 and Vimentin,CD1a,CD23,CD35,CD3 and CD20 were negatively expressed,Ki-67 proliferation index was 70%-80%.In situ hybridization test showed negative expression of EBER.Conclusion IDCS is a rare type of sarcoma originating from interdigitating dendritic cells while diagnosis mainly relies on pathological morphology and immunohistochemical markers. The positive expression of S-100 and CD68 and the negative expression of CD1a,CD23,CD35,CD3 and CD20 are important references for the tumor diagnosis.The differential diagnosis mainly includes follicular dendritic cell sarcoma,histiocytic sarcoma,Langerhans cell sarcoma,large cell B cell and T-cell lymphoma,malignant melanoma,metastatic neuroendocrine carcinoma,etc.

关 键 词：指突状树突细胞肉瘤 扁桃体 免疫组化 病理诊断 鉴别诊断 

分 类 号：R739.6[医药卫生—肿瘤]