睾丸富于细胞纤维瘤临床病理观察

Testicular cellular fibroma:A clinicopathological observation

目的:探讨睾丸富于细胞纤维瘤的临床病理特征、鉴别诊断和预后。方法:对1例睾丸富于细胞纤维瘤的临床表现、组织形态和免疫组化进行综合分析,并结合文献讨论其病理特点及鉴别诊断。结果:30岁男性患者,右侧睾丸不适并无痛性肿大为主诉。睾丸纤维瘤实性边界清楚,包膜亦厚亦薄,切面灰白色,镜下梭型瘤细胞排列成席纹状、鱼骨状或束状,细胞丰富,细胞核无多形性,核分裂像为0～1个/10HP。免疫组化显示肿瘤细胞波形蛋白(+)、S-100局灶(+)、平滑肌蛋白局灶(+)、肌纤维蛋白(-)、α-抑制素(-)、CD34(-)、CD99(-)、Ki-67阳性率不足1%。结论:睾丸富于细胞纤维瘤是一种罕见的睾丸性索间质肿瘤,与卵巢同源性肿瘤病理特征相同;容易与睾丸的其它梭型细胞肿瘤混淆,形态学结合免疫组化可资鉴别;手术切除预后良好。

Objective： To investigate the clinicopathological characteristics, differential diagnosis and prognosis of testicular cellular fibroma. Methods： We comprehensively analyzed the clinical presentation, histomorphology and immunohistochemistry of a case of testicular cellular fibroma, reviewed the relevant literature, and discussed its pathological features and differential diagnosis. Results ： A 30-year-old man presented with complaint of discomfort and painless enlargement in the right testis. The tumor was found to be a testicular fibroma characterized by a solid, thickly or thinly encapsulated, circumscribed and gray-white mass. Microscopically, fusiform cells were arranged into a storiform and herringbone pattern or fascicles. The tumor exhibited a great deal of cellularity and no nuclear polymorphisms, with a mitotic rate of 0 - 1/10 HP. Immunohistochemistry showed that the tumor cells were positive for Vimen- tin, patchily positive for S-100 and SMA, but negative for Desmin, α-inhibin, CD34 and CD99. The positive rate of Ki-67 was less than 1%. Conclusion： Testicular cellular fibroma is a rare testicular sex cord stromal tumor, pathologically resembling its ovarian counterpart. It can be distinguished from other testicnlar spindle cell tumors by morphology and immunohistochemical staining. For the treatment of testicular cellular fibroma, surgical resection often has a good prognosis.