右大腿低度恶性肌纤维母细胞肉瘤  

Low-grade myofibroblastic sarcoma of the right thigh:a case report

作　　者：周芬 张恋 王萍 王浦俊 王雨晴 张玉龙 刘树雷 ZHOU Fen;ZHANG Lian;WANG Ping;WANG Pujun;WANG Yuqing;ZHANG Yulong;LIU Shulei(Department of Dermatology,Chongqing Red Cross Hospital,People's Hospital of Jiangbei District,Chongqing 400020,China;Department of Dermatology,the First Afiliated Hospital of Army Medical University,Chongqing 400038,China;Department of Dermatology,958 Hospital of PLA ARMY,Chongqing 400020,China)

机构地区：[1]重庆市红十字会医院、江北区人民医院皮肤科,重庆400020 [2]陆军军医大学第一附属医院皮肤科,重庆400038 [3]陆军第九五八医院皮肤科,重庆400020

出　　处：《临床皮肤科杂志》2025年第4期224-227,共4页Journal of Clinical Dermatology

摘　　要：报告1例右大腿低度恶性肌纤维母细胞肉瘤。患者男,83岁。右大腿瘢痕处疼痛1年,溃疡2个月。皮肤科检查:右大腿一4.0 cm×3.0 cm×0.4 cm溃疡,其上可见黄色坏死组织附着,边缘见痂壳和黑褐色色素沉着,溃疡及周围触痛明显,质地中等,未扪及明显肿块。皮损组织病理检查:表皮角化过度伴角化不全,棘层增生肥厚;真皮内大量梭形细胞呈结节状或片状穿插分布,细胞质丰富淡染,其间可见少量炎性细胞浸润,部分细胞核大深染,可见核分裂象。免疫组化:平滑肌肌动蛋白(SMA)、波形蛋白(vimentin)、肌动蛋白(actin)、P16和细胞周期蛋白依赖激酶4(CDK4)均阳性,增殖核抗原(Ki-67)约30%阳性,CK、结蛋白(desmin)和上皮膜抗原(EMA)均局灶阳性,CD34血管阳性,P63、HMB45、CD117、S-100蛋白、双微体基因2(MDM2)、CD21、间变性淋巴瘤激酶(ALK)、生肌调节因子1(MyoD1)和肌细胞生成素(myogenin)均阴性。诊断:低度恶性肌纤维母细胞肉瘤。予Mohs显微手术完整切除皮损,随访9个月未复发。A case of low-grade myofibroblastic sarcoma of the right thigh is reported.An 83-year-old male patient presented with pain in the scar of his right thigh for 1 year and ulcers for 2 months.Physical examination showed an ulcer measuring 4.0 cm×3.0 cm×0.4 cm in sizes,attached with yellowish necrotic tissue,and dark brown crusts on the edge,on the right thigh.The ulcer and its surrounding area had obvious tenderness without palpable mass.Histopathological examination showed epidermal hyperplasia with hyperkeratosis and parakeratosis.There were many spindle cells in the dermis which were distribut-ed in a nodular or sheet-like pattern.A patchy inflammatory cell infiltrate was noted in the surrounding dermis.Most dermal spindle cells had abundant and pale cytoplasm,some dermal spindle cells showed enlarged hyperchromatic nuclei.Mitoses were noted.Immunohistochemical results showed that the dermal spindle cells were positive for SMA,vimentin,actin,P16 and CDK4,and were focally positive for CK,desmin,and EMA.Ki-67 labeled approximately 30%tumor cells.CD34 labeled blood vessels.The tumor cells were negative for P63,HMB45,CD117,S-100,MDM2,CD21,ALK,MyoD1 and myogenin.The pa-tient was diagnosed with a low-grade myofibroblastic sarcoma and underwent Mohs microsurgery for complete resection.After 9 months of follow-up,there was no recurrence.

关 键 词：肌纤维母细胞肉瘤 低度恶性 瘢痕 

分 类 号：R739.5[医药卫生—肿瘤]