小汗腺螺旋腺瘤少见亚型2例及其临床病理分析  

Clinicopathological analysis of 2 rare subtypes of eccrine spiradenoma

作　　者：徐军 陈君平 骆童 王健 XU Jun;CHEN Junping;LUO Tong;WANG Jian(Department of Pathology,901 st Hospital of the Joint Logistics Support Force of People’s Liberation Army,Hefei 230031,China)

机构地区：[1]中国人民解放军联勤保障部队第九〇一医院病理科,合肥230031

出　　处：《临床与病理杂志》2024年第9期1311-1316,共6页Journal of Clinical and Pathological Research

基　　金：中国人民解放军联勤保障部队第九〇一医院院管重点课题(2024YGZD03)。

摘　　要：回顾性分析2例小汗腺螺旋腺瘤(eccrine spiradenoma,ES)少见亚型患者的临床病理特征并复习相关文献。男、女患者各1例,分别为65、38岁,分别因下腹部、右上肢皮下肿物4、5年余入院,均行包块切除术。术后病理检查示:低倍镜下2例肿瘤均为真皮内境界清楚、分叶状结节,高倍镜下可见2种类型的细胞:第1种是大细胞,具有空泡状至微嗜碱性的细胞质和泡状细胞核,核膜薄,核仁明显;第2种是围绕大细胞栅状排列的基底样细胞,细胞核深染,未见细胞异型性、核分裂和坏死,在肿瘤细胞之间常可观察到分散的淋巴细胞。例1肿瘤间质内见广泛开放、扩张的脉管腔;例2肿瘤组织内小卵圆形细胞排列形成筛状、微囊状或假腺样腔隙,其内为黏液样分泌物。免疫组织化学染色示:大导管上皮细胞广谱细胞角蛋白(cytokeratin pan,CKpan)、细胞角蛋白(cytokeratin,CK)7和上皮膜抗原(epithelial membrane antigen,EMA)呈强阳性,癌胚抗原(carcino-embryonic antigen,CEA)、白细胞抗原分化簇(cluster of differentiation,CD)117局灶弱阳性,外层的小基底样细胞呈p63、S-100阳性。例2中筛状、微囊状或假腺样区域大多数卵圆形细胞p63、S-100阳性,CD34、唾液酸糖蛋白(podoplanin,D2-40)、CD117、CD43、大囊泡病液相蛋白15(gross cystic disease fluid protein 15,GCDFP-15)阴性;未见β-连环蛋白膜表达减少和异位表达,细胞核增殖抗原Ki-67阳性率为2%~3%。ES少见亚型中可伴有显著的开放扩张血管,可出现类似腺样囊性癌的管状或筛状结构,免疫组织化学检测均能表达上皮和肌上皮标志物,这2种少见的形态变异极易导致误诊。诊断的关键是找到ES的典型病理组织特征,免疫组织化学检测可帮助提示肿瘤的来源及分化。This study retrospectively analyzed 2 cases of rare subtypes of eccrine spiradenoma(ES)and reviewed relevant literature.The cases involved a 65-year-old male and a 38-year-old female,who presented with subcutaneous masses in the lower abdomen and right upper limb,respectively,for 4 to 5 years,and underwent mass excision.Pathological examination revealed well-demarcated,lobulated dermal nodules under low magnification,with 2 distinct cell types observed under high magnification:large cells with vacuolated to slightly basophilic cytoplasm,vesicular nuclei,thin nuclear membranes,and prominent nucleoli;and basaloid cells with deeply stained nuclei arranged in a palisading pattern around the large cells,without atypia,mitosis,or necrosis,often interspersed with lymphocytes.Case 1 exhibited extensive open and dilated vascular spaces within the stroma,while Case 2 showed small oval cells forming cribriform,microcystic,or pseudo-glandular structures containing mucin-like secretions.Immunohistochemistry(IHC)showed strong positivity for cytokeratin pan(CKpan),cytokeratin(CK)7,and epithelial membrane antigen(EMA)in ductal epithelial cells,with focal weak positivity for carcino-embryonic antigen(CEA)and cluster of differentiation(CD)117.The outer basaloid cells were positive for p63 and S-100.In Case 2,the cribriform and pseudo-glandular regions showed positivity for p63 and S-100,but were negative for CD34,podoplanin(D2-40),CD117,CD43,gross cystic disease fluid protein 15(GCDFP-15),and β-catenin alterations,with a Ki-67 index of 2%-3%.Rare ES subtypes may feature prominent dilated vasculature and structures resembling adenoid cystic carcinoma,making them prone to misdiagnosis.Accurate diagnosis requires identifying typical ES histological features,with IHC aiding in determining tumor origin and differentiation.

关 键 词：小汗腺螺旋腺瘤 病理特征 免疫组织化学 鉴别诊断 上皮细胞 肌上皮细胞 

分 类 号：R73[医药卫生—肿瘤]