8例孤立性纤维性肿瘤临床病理、免疫组化特点

Clinicopathologic and immunohistochemical characteristics of 8 cases of solitary fibrous tumor

目的分析孤立性纤维性肿瘤的临床表现、病理形态学及免疫组织化学特点。方法收集孤立性纤维性肿瘤8例,对其临床、病理及免疫组织化学资料进行分析及文献复习。结果本组病例女性5例,男性3例,年龄31～62岁,平均45.3岁。发生部位包括纵隔、鼻腔、腮腺、口腔、眼眶等。临床主要表现为局部肿块及其引起的压迫症状。主要病理学改变:肿瘤直径1.5～25.0cm,大部分边界清楚,表面包膜完整;镜下瘤细胞呈梭形、短梭形,细胞质红染,核圆形、卵圆形,无异型性,核分裂象少见,细胞排列呈束状、编制状、漩涡状、席纹状或不规则状,可见大量胶原纤维,瘤细胞可分布于其间,间质部分玻璃样及黏液变性,散在炎细胞浸润。免疫组织化学结果:vimentin阳性8例,CD34阳性7例,bcl-2阳性6例,CD99阳性7例,SMA阳性4例,S-100阳性1例。结论孤立性纤维性肿瘤可发生在全身各部位。大多数是良性梭形细胞肿瘤,结合临床特点和病理镜下表现以及免疫组化能做出准确诊断,少数有低度恶性可能,表现为局部复发或远处转移,其组织学构像并不能完全精确的预测其预后,患者术后的定期随访是必要的。

Objective To study the clinicopathologic and immunohistochemical features of solitary fibrous tumor （SFT） and its biologic behavior. Methods Clinicopathologic data of 8 cases of SFT were collected and analyzed. Immunohistochemical staining （Envision method） for CD34, vimentin, CD99, bcl-2, S-100 and SMA was performed in the specimens collected from January 2003 to June 2006 in our hospital. Results Eight patients, 5 male and 3 female, aged from 31 and 62 years （ mean 45.3 ）. SFTs located in mediastinum, nasal cavity, parotid, oral cavity and orbital cavity. The main clinical manifestations were local mass and pressure symptom. The diameter of SFTs was between 1.5 cm and 25.0 cm and clear edge in most SFTs. The characteristic features under microscope included patternless growth pattern, alternating hypercellular and hypocellular areas, blunt spindle cells within keloidlike hyalinization, and hemangiopericytoma-like regions. Positive immunohistochemical staining was vimentin 8, CD34 7, bcl-2 6, CD99 7, SMA 4, S-100 1. Conclusion SFT is a rare mesenchymal spindle cell tumor, occurring in various parts of human body. It needs to be distinguished from other spindle cell tumors, and the immunophenotype can be of help in differential diagnosis. Minority of SFTs has malignant behavior, manifesting as local recurrence or metastasis. The behavior of SFT is unpredictable, requiring a careful, long-term follow-up.