良、恶性颗粒细胞瘤15例临床病理分析
摘要
目的探讨良、恶性颗粒细胞瘤的临床病理学特征及其诊断标准。方法回顾性分析15例颗粒细胞瘤(含1例恶性颗粒细胞瘤)的临床资料、病理学特征及免疫表型,并复习相关文献。结果 15例中女性14例,男性1例,年龄18～66岁,平均42岁。14例为皮下或软组织内无痛性生长的孤立性肿块,1例(组织学诊断为恶性颗粒细胞瘤)表现疼痛及关节活动受限,伴复发、转移。肿瘤位置:四肢4例,乳腺2例,舌部2例,眼眶2例,咽喉部2例,颈枕部、升结肠和外阴各1例。肿瘤直径0. 3～4. 5 cm,平均2. 4 cm。1例镜下见凝固性坏死、核增大呈空泡状并可见明显的核仁、多形性、高核质比、瘤细胞梭形变和核分裂。形态学上,15例采用Fangburg-Smith等提出的6项诊断标准判断,结果显示:良性颗粒细胞瘤11例、不典型颗粒细胞瘤3例、恶性颗粒细胞瘤1例。14例有完整随访资料,13例无复发,1例复发3次并转移。结论颗粒细胞瘤少见,恶性颗粒细胞瘤尤其罕见,在日常工作中应高度警惕是否为恶性,以避免漏诊。Fangburg-Smith等提出的诊断标准在实际工作中有较好的可操作性。且与该肿瘤的生物学行为之间有较好的相关性,有利于临床医师对患者进行合理处置。
引文
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[8] Jungo I,Yasuo Y,Tsuyoshi S,et al. Atypical and malignant granular cell tumors in Japan:a Japanese musculoskeletal oncology group study[J]. Int J Clin Oncol,2016,21(4):808-816.
[9] Vikek A S,Jayaletchumi G,Jayalakshmi P. Granular cell tumour:malignant or benign[J]. Singapore Med,2015,56(9):513-517.
[10]郭云泉,赵峰,房新志,等.乳腺颗粒细胞瘤9例临床病理分析[J].临床与实验病理学杂志,2011,27(5):495-498.
[11]王坚,盛伟琪,朱雄增,等.恶性颗粒细胞瘤的临床病理、免疫组化和电镜观察[J].临床与实验病理学杂志,1998,14(2):120-123.
[12] Kapur P,Rakheja D,Balani J P,et al. Phosphorylated histone H3,Ki-67,p21,fatty acid synthase,and cleaved caspase-3 expression in benign and atypical granular cell tumors[J]. Arch Pathol Lab Med,2007,131:57-64.
[2] Fanburg-Smith J C,Meis-Kindblom J M,Fante R,et al. Malignant granular cell tumor of soft tissue:diagnostic criteria and clinicopathologic correlation[J]. Am J Surg Pathol,1998,22:779-794.
[3]王坚,朱雄增,张仁元.恶性颗粒细胞瘤10例临床病理学观察及文献复习[J].中华病理学杂志,2004,33(6):497-502.
[4]方铣华,张谷,程晔.颗粒细胞瘤15例临床病理分析[J].临床与实验病理学杂志,2006,22(4):417-420.
[5] Nasser H,Ahmed Y,Szpunar S M,et al. Malignant granular cell tumor:a look into the diagnostic criteria[J]. Pathol Res Pract,2011,207:164-168.
[6] Rose B,Tamvakopoulos G S,Yeung E,et al. Granular cell tumours:a rare entity in the musculoskeletal system[OL]. Sarcoma,2009:765927. doi:10. 1155/2009/765927.
[7] Tsukushi S,Nishida Y,Urakawa H,et al. Prognostic significance of histological invasion in high grade soft tissue sarcomas[J]. Springerplus,2014,3:544.
[8] Jungo I,Yasuo Y,Tsuyoshi S,et al. Atypical and malignant granular cell tumors in Japan:a Japanese musculoskeletal oncology group study[J]. Int J Clin Oncol,2016,21(4):808-816.
[9] Vikek A S,Jayaletchumi G,Jayalakshmi P. Granular cell tumour:malignant or benign[J]. Singapore Med,2015,56(9):513-517.
[10]郭云泉,赵峰,房新志,等.乳腺颗粒细胞瘤9例临床病理分析[J].临床与实验病理学杂志,2011,27(5):495-498.
[11]王坚,盛伟琪,朱雄增,等.恶性颗粒细胞瘤的临床病理、免疫组化和电镜观察[J].临床与实验病理学杂志,1998,14(2):120-123.
[12] Kapur P,Rakheja D,Balani J P,et al. Phosphorylated histone H3,Ki-67,p21,fatty acid synthase,and cleaved caspase-3 expression in benign and atypical granular cell tumors[J]. Arch Pathol Lab Med,2007,131:57-64.