皮肤原发性上皮样肉瘤病理及临床误诊探讨.docVIP

皮肤原发性上皮样肉瘤病理及临床误诊探讨 　　【摘要】目的:探讨皮肤上皮样肉瘤的临床病理特点，免疫组化表型及生物学行为。方法:收集5例皮肤ES患者的资料，运用显微镜观察、免疫组化等方法观察和分析其临床、细胞学涂片和病理学组织学特征。结果:本组肿瘤全部原发于皮肤，肿瘤呈结节状浸润性生长，瘤细胞又由两种细胞组成，大部分为多角形或卵圆形，胞浆丰富，嗜酸性，少部分呈胖梭形，象纤维母细胞样，常围绕在结节周围，结节中央常有坏死。免疫组化示：上皮膜抗原（EMA），细胞角蛋白（CK），波形蛋白（Vimentin）均强阳性，CD34 及CD68弱阳性，其余多项免疫组化结果均呈阴性。结论:ES少见且形态复杂多变，只凭光镜容易误诊，肿瘤细胞学对其诊断无特异性，需结合免疫组化结果才能做出正确的诊断。ES预后差，患者常需行肿物扩大甚至根治术。 　　【关键词】皮肤肿瘤；上皮样肉瘤；免疫组化 　　A Clinicopathologic misdiagnosis Study of Primary Epithelioid Sarcoma of Skina 　　Zhao Jun Sun Qian Wang xue li 　　【Abstract】Objective To explore the pathoclinical characteristics immunophonetype and its biological behaviour of primary epithelial sarcoma.Methods Five cases of primary epithelial sarcoma of skin were studied by using microscope observation and immunohistochemistry and analyse their characterstics of clinic、cytological smear and pathohistology.Results The group of tumors were all located in skin.Microscopically，tumor showed an invasive growth and nodulous arrangement and was made up of two kinds of cells，relativepart of cells were characterized by multangular or oval and round cell with richful eosinophilic cytoplasm，other cells were fatty and spindle just like fibroblast.The tumor nodules central zone that was always degenerative and necrosive that surrounded by the two kinds cells.Immunohistochemically，tumor cells showedintense positive staining for EMA、Cytokeratin and Vimentin，only showed weak positive staining for CD34and CD68，other results of immnuohistochemistry were all negative.ConclusionThe tumor is quite difficult to diagnose only by microscope for its infrequency and various morphological features.No diagnostic particularity only bycelluar smear.Only based on histopathological characteristics with the results of immunohistochemistry，a definite pathological diagnosis of the tumor can be got.Its prognosis is very poor and a patient needs to have a marginal or even a radical resection. 　　【Key words】Skin cancer；Epithelioid sarcoma；Immunohistochemistry 　　【中图分类