粒细胞肉瘤临床病理学观察

Clinical features and pathology of granulocytic sarcoma

目的:探讨粒细胞肉瘤(granulocytic sarcoma,GS)的临床、病理组织学、免疫组化特征及诊断和鉴别诊断。方法:对7例GS的临床资料、组织形态学及免疫组织化学特征进行回顾性分析,同时复习相关文献。结果:多数GS以淋巴结肿大或其他局部孤立性肿物为首发症状,组织学上表现为弥漫分布、形态相对一致的分化较差细胞,小至中等大小,胞质少,胞核呈圆形、卵圆形,染色质细腻。免疫组化染色显示,髓过氧化物酶(MPO)表达6例,CD43表达6例,CD68表达5例,CD99表达4例,CD34表达3例,CD15表达1例。结论:GS在常规石蜡包埋切片上的形态学特点与恶性淋巴瘤极其相似,易造成误诊。联合使用MPO、CD68、CD43、CD34、CD99等多种粒系抗体进行免疫表型的检测可使绝大多数GS得到确诊。

Objective： To study the clinical and pathologic features, diagnosis and differential diagnosis of the granulocytic sarcoma（GS）. Methods： The clinical manifestations, histopathological, immunohistochemical featrures and treatment of seven cases of granulocytic sarcoma were studied retrospectively, and related literatures were reviewed. Results： The major primary clinical manifestations of the granulocytic sarcoma were enlargement of lymphatic nodes or solitary local masses. Histologically, GS was consisted of a relatively homogeneous population of poorly differentiated cells distributed in a diffuse pattern; the size of the cells was small to medium, with scant cytoplasm; the nucleus was round and oval, and had finely dispersed chromatin. Immunohistochemistry study showed that 6 cases were positive for MPO and CD43, 5 cases for CD68, 4 cases for CD99, 3 cases for CD34 and CD43. Conclusion ： Granulocytic sarcoma resembles morphologically malignant lymphoma very much in routine paraffin - embedded tissue sections and may be ready to be misdiagnosed. Immunohistochemistry panel of granulocytic makers such as MPO, CD68 ,CD43, CD34, CD99 can successfully identify the vast majority of GS.