梭形细胞/多形性脂肪瘤8例临床病理观察
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摘要
目的探讨梭形细胞脂肪瘤/多形性脂肪瘤(spindle cell lipoma/plemorphic lipoma,SCL/PL)的临床病理特征、诊断及鉴别诊断。方法结合HE和免疫组化染色对8例SCL/PL进行回顾性分析,并复习相关文献。结果镜下主要由增生的梭形细胞、成熟脂肪细胞和多少不等的绳索样胶原纤维组成,间质黏液变性,PL还可见特征性的大花环状的多核巨细胞。肿瘤细胞表达vimentin和CD34,Ki-67增殖指数约2%。术后随访3～74个月,均未见复发或转移。结论 SCL/PL是一种良性脂肪瘤的特殊亚型,治疗首选手术切除,预后良好,因此其诊断及鉴别诊断尤为重要。
Purpose To investigate the clinicopathological features,the diagnosis and differential diagnosis of spindle cell lipoma/pleomorphic lipoma( SCL/PL). Methods Eight cases of SCL/PL were studied by HE staining and immunohistochemistry. The literature was reviewed. Results Microscopically,the neoplasm consisted of spindle cells,mature adipocytes and thick rope-like collagen bundles in variable proportions with mucinous degeneration. The floret-like multinucleated giant cells were easy to be seen in the pleomorphic lipoma. Immunohistochemical analysis revealed that the tumor cells were positive for CD34 and vimentin. The Ki-67 was approximately 2%. The patients were followed up for 3 ～ 74 months,and no recurrence or metastasis occurred. Conclusion The SCL/PL is a special subtype of benign lipoma,surgery is considered the first choice,and outcome is favorable. The diagnosis and differential diagnosis of SCL/PL are important.
Purpose To investigate the clinicopathological features,the diagnosis and differential diagnosis of spindle cell lipoma/pleomorphic lipoma( SCL/PL). Methods Eight cases of SCL/PL were studied by HE staining and immunohistochemistry. The literature was reviewed. Results Microscopically,the neoplasm consisted of spindle cells,mature adipocytes and thick rope-like collagen bundles in variable proportions with mucinous degeneration. The floret-like multinucleated giant cells were easy to be seen in the pleomorphic lipoma. Immunohistochemical analysis revealed that the tumor cells were positive for CD34 and vimentin. The Ki-67 was approximately 2%. The patients were followed up for 3 ～ 74 months,and no recurrence or metastasis occurred. Conclusion The SCL/PL is a special subtype of benign lipoma,surgery is considered the first choice,and outcome is favorable. The diagnosis and differential diagnosis of SCL/PL are important.
引文
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[4]Azzopardi J G,Iocco J,Salm R.Pleomorphic lipoma:a tumor simulating liposarcoma[J].Histopatholgy,1973,7(4):511-523.
[5]Han X C,Zheng L Q,Shang X L.Dendritic fibromyxolipoma on the nasal tip in an old patient[J].Int J Clin Exp Pathol,2014,7(10):7064-7067.
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[7]Lau S K,Bishop J A,Thompson L D.Spindlecell lipoma of the tongue:a clinicopathologic study of 8 cases and review of the literature[J].Head Neck Pathol,2015,9(2):253-259.
[8]Khashper A,Zheng J,Nahal A,et al.Imaging characteristics of spindle cell lipoma and its variants[J].Skeletal Radiol,2014,43(5):591-597.
[9]Seo B F,Kang I S,Oh D Y.Spindle cell lipoma:a rare,misunderstood entity[J].Arch Craniofac Surg,2014,15(2):102-104.
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[11]Chen B J,Marifio-Enfiquez A,Fletcher C D,et al.Loss of retinoblastoma protein expression in spindle cell/pleomorphic lipomas and cytogenetically related tumors:an imnmnohistochemieal study with diagnosticimplications[J].Am J Surg Pathol,2012,36(8):1119-1128.
[12]Uehara K,Ikehara F,Shibuya R,et al.Molecular signature of tumors with monoallelic 13q14 deletion:a case series of spindle cell lipoma and genetically-related tumors demonstrating a link between FOXO1 status and p38 MAPK pathway[J].Pathol Oncol Res,2018,24(4):861-869.
[13]潘丹玲,陈小岩,陈灵锋,等.非典型性脂肪瘤性肿瘤/高分化脂肪肉瘤MDM2蛋白表达和基因扩增检测及临床意义[J].临床与实验病理学杂志,2017,33(7):959-762.
[14]Ruiz Molina I,Solís García E,Cívico Amat V.Dendritic infraclavicular fibromyxolipoma:at the boundary between spindle cell lipoma and solitary fibrous tumour[J].Rev Esp Patol,2018,51(1):44-48.
[15]Deyrup A T,Chibon F,Guillou L,et al.Fibrosarcoma-like lipomatous neoplasm:a reappraisal of so-called spindle cell liposarcoma defining a unique lipomatous tumor unrelated to other liposarcomas[J].Am J Surg Pathol,2013,37(9):1373-1378.
[16]乔海国,张昶,庄林,等.树突状纤维黏液脂肪瘤10例临床病理分析[J].临床与实验病理学杂志,2012,28(12):1332-1335.
[2]Fletcher C D,Bridge J A,Hogendoom P C.World Health Organization classification of tumours of soft tissue and bone[M].Lyon:IARC Press,2013:255-256.
[3]Enzinger F M,Harvey D A.Spindle cell lipoma[J].Cancer,1975,36(5):1852-1859.
[4]Azzopardi J G,Iocco J,Salm R.Pleomorphic lipoma:a tumor simulating liposarcoma[J].Histopatholgy,1973,7(4):511-523.
[5]Han X C,Zheng L Q,Shang X L.Dendritic fibromyxolipoma on the nasal tip in an old patient[J].Int J Clin Exp Pathol,2014,7(10):7064-7067.
[6]王坚,朱雄增.软组织肿瘤病理学[M].北京:人民卫生出版社,2017:486-490.
[7]Lau S K,Bishop J A,Thompson L D.Spindlecell lipoma of the tongue:a clinicopathologic study of 8 cases and review of the literature[J].Head Neck Pathol,2015,9(2):253-259.
[8]Khashper A,Zheng J,Nahal A,et al.Imaging characteristics of spindle cell lipoma and its variants[J].Skeletal Radiol,2014,43(5):591-597.
[9]Seo B F,Kang I S,Oh D Y.Spindle cell lipoma:a rare,misunderstood entity[J].Arch Craniofac Surg,2014,15(2):102-104.
[10]Billings S D,Folpe A L.Diagnostically challenging spindle cell lipomas:a report of 34‘low-fat’and‘fat-free’variants[J].Am JDermatopathol,2007,29(5):437-442.
[11]Chen B J,Marifio-Enfiquez A,Fletcher C D,et al.Loss of retinoblastoma protein expression in spindle cell/pleomorphic lipomas and cytogenetically related tumors:an imnmnohistochemieal study with diagnosticimplications[J].Am J Surg Pathol,2012,36(8):1119-1128.
[12]Uehara K,Ikehara F,Shibuya R,et al.Molecular signature of tumors with monoallelic 13q14 deletion:a case series of spindle cell lipoma and genetically-related tumors demonstrating a link between FOXO1 status and p38 MAPK pathway[J].Pathol Oncol Res,2018,24(4):861-869.
[13]潘丹玲,陈小岩,陈灵锋,等.非典型性脂肪瘤性肿瘤/高分化脂肪肉瘤MDM2蛋白表达和基因扩增检测及临床意义[J].临床与实验病理学杂志,2017,33(7):959-762.
[14]Ruiz Molina I,Solís García E,Cívico Amat V.Dendritic infraclavicular fibromyxolipoma:at the boundary between spindle cell lipoma and solitary fibrous tumour[J].Rev Esp Patol,2018,51(1):44-48.
[15]Deyrup A T,Chibon F,Guillou L,et al.Fibrosarcoma-like lipomatous neoplasm:a reappraisal of so-called spindle cell liposarcoma defining a unique lipomatous tumor unrelated to other liposarcomas[J].Am J Surg Pathol,2013,37(9):1373-1378.
[16]乔海国,张昶,庄林,等.树突状纤维黏液脂肪瘤10例临床病理分析[J].临床与实验病理学杂志,2012,28(12):1332-1335.