颗粒细胞瘤15例临床病理分析

Granular cell tumor:a clinicopathologic analysis of 15 cases

目的 探讨颗粒细胞瘤的组织起源及临床病理学特征。方法 回顾分析15例颗粒细胞瘤的临床资料及组织学形态特征，并采用免疫组化（SP法）观察其免疫表型。结果 良性颗粒细胞瘤13例，恶性颗粒细胞瘤2例。男性5例，女性10例，年龄19～69岁，平均年龄41．6岁，2例恶性颗粒细胞瘤年龄分别为67岁和69岁。良性颗粒细胞瘤直径0．4～5．3cm，平均2．3cm，2例恶性颗粒细胞瘤直径分别为6和14cm。均为单发病例，临床上主要表现为真皮、皮下或黏膜下孤立性无痛性结节，分别位于腰部3例、腋下、胸壁各2例，乳腺、上臂、子宫、肛周、声带、食管、结肠、舌部各1例。病理组织学上，良性颗粒细胞瘤的肿瘤细胞通常有比较丰富的嗜酸性颗粒状胞质和小而深染的胞核，而恶性颗粒细胞瘤的肿瘤细胞中可见带有明显核仁的空泡状核，细胞核明显异型及部分细胞呈梭形。免疫组化示神经标记物NSE、S-100蛋白强阳性，表达溶菌酶的标记物CD68也强阳性，而表达平滑肌和横纹肌的标记物SMA、MG均阴性。结论 颗粒细胞瘤为来源于雪旺细胞的肿瘤，恶性者少见，大多发生在年龄大的患者，且肿瘤体积比较大。

Purpose To investigate the histogenesis and clinicopathologic features of granular cell tumor（GCT）. Methods The clinical and pathologic profiles of 15 GCT cases were evaluated. Immunohistochemical study was performed on all cases. Results Our study included 13 cases of benign granular cell tumor（BGCT） and 2 malignant granular cell tumors（MGCT）. There were 5 male patients and 10 female. Ages ranged from 19 to 69 years （mean, 41.6 years） , and two patients with MGCT were 67 and 69 years old in this group. The tumor size of BGCT ranged from 0. 4 to 5.3 cm （ mean 2. 3 cm） , and the tumor sizes of 2 MGCTs were 6 cm and 14 cm respectively. All cases were mainly manifested as a solitary painless nodule located in the dermal, subcutaneous and submucosal tissues. Three cases of tumors occurred in the waist, two in the subaxillary region, two in the chest wall, one each in the breast, upper arm, uterus, perianal region, vocal cords, esophagus, colon and tongue. Microscopically, the tumor cells of BGCT usually possessed abundant eosinophilic granular cytoplasm, small and dark nuclei. The tumor cells of MGCT＇usually exhibited the following features： vesicular nuclei with prominent nucleoli, nuclear pleomorphism and spindling of some tumor cells. Immunohistochemical study showed strongly positive staining for NSE, S-100 protein and CD68 in all cases, but negative for SMA and MG. Conclusions GCT is a rare tumor showing an origin from Schwann cell. The majority of MGCT occur in the elderly, and volume of the tumor usually is relatively large.