纤维肉瘤的诊断及鉴别诊断

Diagnosis and differential diagnosis of fibrosarcoma

目的 :进一步探讨纤维肉瘤与其它梭形细胞软组织肿瘤的鉴别诊断。方法 :分别选取 1980年前 (5 2例 )与 1980年后(18例 )原病理诊断为纤维肉瘤病例 ,经 3位病理医师按标准复查原病理切片 ,结果一致者 30例 ,选出其中 2 0例和另外有争议的 2 4例 ,共 44例分别作免疫组织化学vimentin、α1 AT、S 10 0、NF、desmin、myoglobin、C keratin染色。结果 :1980年前 5 2例中维持原诊断 30例 ,修改诊断 2 2例 (42 3% ) ,分别为恶性纤维组织细胞瘤 8例、恶性神经鞘膜瘤 4例、单相性梭形细胞滑膜肉瘤 3例、平滑肌肉瘤 3例、横纹肌肉瘤 2例、韧带状纤维瘤 2例 ;1980年后纤维肉瘤 18例中 ,维持原诊断 16例 ,修改诊断 2例 (11 1% ) ,分别为恶性纤维组织细胞瘤和滑膜肉瘤各 1例。结论 :坚实的病理形态学基础、细致的观察是病理正确诊断的关键 ;合理应用免疫组化或电镜技术 。

Purpose To study farther the differential diagnostic between fibrosarcomas and other spindle cell sarcomas. Methods Seventy cases of fibrosarcoma, which were diagnosed before (52 cases) and after (18 cases) 1980, were selected. The expression of Vimentin, α 1 AT,S 100 protein, neuro filaments (NF), desmin, myoglobin and cytokeratin (CK) were detected by means of immunohistochemistry. Results Among the 52 cases, 30 cases were confirmed to fibrosarcomas, which were identical with primary dingnoses;22 cases were revised to malignant fibrous histocytoma (8 cases), malignant nerve sheath tumor (4 cases), monophasic spindle cell synovial sarcoma (3 cases), leiomyosarcoma(3 cases), rhabdomyosarcoma(2 cases) and abdominal desmmoid tumor (2 cases). Of the 18 cases, only two cases were misdiagnosed and were revised to malignant fibrous histocytoma and spindle cell synovial sarcoma, respectively. Conclusions Study knowledge in pathological morphology and careful observation may be the key point of giving a proper diagnosis. Its necessary to apply reasonable immunohistochemistry and electron microscopy in the differential diagnoses between fibrosarcomas and other spindle cell sarcomas.