心包滑膜肉瘤临床病理观察

Clinicopathological features of primary synovial sarcoma in pericardium

目的探讨心包滑膜肉瘤的临床病理学特征及其鉴别诊断,提高对该病的认识和诊治水平。方法对1例心包滑膜肉瘤进行光镜观察、免疫组化染色和荧光原位杂交(FISH)检测,并结合文献分析讨论。结果肿瘤由单一的梭形细胞组成,呈交织的束状,向上皮样细胞分化。免疫组化:calponin(+),p53和vimentin(+),bcl-2和EMA散在(+)。FISH检测显示18号染色体基因位点断裂及易位。结论心包单相纤维型滑膜肉瘤诊断较为困难,容易误诊,在掌握组织学特征和临床病史的同时,必须结合免疫组化及分子生物学检测综合分析,才能作出正确诊断。

Objective To explore the clinicopathological features and differential diagnosis of primary synovial sarcoma of the pericardium and to improve diagnosis and therapy of this disease. Methods A case of primary synovial sarcoma of the pericardium was studied with the help of light microscopy, mmunohistochemistry, fluorescence in situ hybridization （FISH） with review of the relevant literature. Results The tumor was composed of monomorphic spindle cells growing in intersecting fascicles with differentiation into epithelium-like cells. Immunohistochemically, there was positive reactivity for vimentin,calponin, p53, and bel-2. EMA was partly positive. Being studied by FISH, breakage and translocation on chromosome 18 were noted. Conclusions Diagnosis of primary monophasie fibrous synovial sareomasynovial sarcoma of the pericardium is difficult. In order not to misdiagnosis, we must grasp the histological characteristics and clinical history of the tumor, and comprehensively immunohistochemical and molecular analyses are also essential.