多次复发的腹膜后脂肪肉瘤的病理形态学和生物学行为观察

The patho morphology and biological behavior of repeatedly recurrent liposarcoms in retroperitoneum

目的观察腹膜后多次复发性脂肪肉瘤的病理形态学特点、生物学行为和鉴别诊断。方法收集了１０例腹膜后脂肪肉瘤病人的临床资料，组织切片除行ＨＥ染色外，还运用免疫组织化学ＬＳＡＢ法行Ｓ１００、肌动蛋白、波形蛋白和肌红蛋白等染色。对１０例３２个原发和复发肿瘤标本进行了大体和显微镜下观察。结果本组中６／８例原发肿瘤和１３／２４例复发肿瘤为硬化性脂肪肉瘤，其组织学特征是分化较好的梭形细胞呈束状或车轮状排列，肿瘤内含分化性脂肪肿瘤成分。本组１０例腹膜后脂肪肉瘤在２０个月～１０年间于腹膜后１～７次肿瘤复发，仅１例发生１次远处转移。本组中５例在肿瘤复发、转移过程中发生了组织学亚型的转化。结论本组中硬化性脂肪肉瘤是腹膜后脂肪肉瘤最常见的组织学亚型；腹膜后脂肪肉瘤经常局部复发，远处转移少见，反覆切除复发肿瘤可延长病人生存期。

Objective To investigate the patho morphological features and biological behavior of repeatedly recurrent liposarcomas in retroperitoneum as well as the differential diagnosis with other malignant mesenchymal tumors. Methods Totally 10 patients accompanied with detailed clinical data. Except HE staining, immunohistochemical assays for S 100 actin, vimentin and myoglobin were also used for 32 specimens. Results 6/8 cases of the primary and 13/24 cases of the recurrent tumors of this group were diagnosed as sclerosing liposarcoma with spindle cell proliferation arranged in fascicles and whorls. Ten retroperitoneal tumor recurred within 20 months～10 years, and among them, distant metastasis obtained only in one case. The histologic subtypes of recurrent and metastasized tumors became varied in 5 cases. Conclusion Sclerosing liposarcoma was the most common histological subtype, see in retroperitoneal liposarcoma, local recurrence frequent, but distant metastasis rare. Surgical removal of the recurrent tumors might prolong the survival expectation of these patients.