下肢平滑肌肉瘤误为慢性血肿1例

One Case of Lower Extremity Leiomyosarcoma Take for Chronic Hematoma

本文报道1例下肢平滑肌肉瘤误为慢性血肿诊疗经过。56岁女性患者,摔伤致左髋部疼痛不适半年,酸胀伴活动费力1月。安排骨盆平片、骨盆核磁共振平扫及增强、3相核素全身骨扫描报告皆提示慢性血肿、因患者于半年前有明确摔伤情况,有高度怀疑异位骨化可能性。行肺部X光及全身骨扫描未见肺部转移病灶及全身骨转移病灶。常规门诊行大腿肿物穿刺活检,但因活检组织量过少,无法确定组织来源,入院后行肿物探查活检术,术中冰冻活检提示良性病变,考虑免疫组化结果未出,恶性肿瘤未能完全排除,积极行肿瘤广泛切除术。术后病理及免疫组化提示局部有致密的梭形细胞与上皮样细胞瘤细胞排列呈束状,核分裂像多见,间质血管丰富Bcl-2阴性,CD 34阴性,CK 7阴性,CK.Pan点状阳性,EMA阴性,S 100阴性,Desmin阳性,SMA阳性,考虑梭形细胞恶性肿瘤,符合原发性平滑肌肉瘤。

Objective 1 case of lower extremity leiomyosarcoma Take for chronic Hematoma was reported in this study.A 56 years old woman represented pain at left hip for half a year and activity dif iculty for 1 month because of fal . pelvic plain film,MRI scan and weighted imaging and three-phase whole bone scintigraphy al promoted chronic Hematoma and high probability of heterotopic ossification.The chest X-ray and whole body bone scan results showed no metastatic lesion. Thigh mass biopsy in conversional outpatient could not af irm the histologic origin due to little biopsy tissue samples. The mass detection biopsy and intraoperative frozen biopsy showed benign lesion. The malignancy was not excluded completely considering the absent of immunohistochemical result and it is essential to operate tumor wide excision. The results of pathology and immunohistochemistry after operation showed as fol ows：local dense spindle cel s were observed, epithelioid tumor cel s were arranged in beam,mitotic figures were commonly observed,stromal vessels were abundant,Bcl-2,CD34,CK 7,EMA and S 100 were negative,CK.Pan,Desmin and SMA were positive. This case accords with primary leiomyosarcoma.