滑膜肉瘤的组织来源和诊断问题初探

PRIMARY STUDY OF HISTOGENESIS AND DIAGNOSIS OF SYNOVIOSARCOMA

本文报道了14例滑膜肉瘤的超微结构和免疫组化研究结果。在电镜与免疫组化观察中发现:该肿瘤同时显示上皮和间叶组织的某些特征。文中讨论了该肿瘤的组织来源、分化、类型和诊断问题,认为该肿瘤并不起源于滑膜,也不向滑膜分化,而是一种软组织的腺肉瘤或癌肉瘤;单向型滑膜肉瘤是一个可以成立的独立亚型;电镜和免疫组化发现上皮和间叶组织特点的同时存在是该肿瘤诊断的有效指标。

Fourteen cases of synoviosarcoma wereinvestigated by electron microscopy andimmunohistochemical technique(PAP) usingkeratin and EMA as epithelial markers,vimentin as a mesenchymal marker. of the14 cases 9 were biphasic (BS) and 5 weremonophasic synoviosarcoma (MS). In BS, epithelial-like cells, glandular,tubular of slit-like structures, junctionalcomplex, microvilli at the luminar surfaceand basal lamellae at bottom could be easilyseen. Spindle cells both in BS and MS weresimilar. These cells had somewhat similaritywith epithelia-like cells, such as slendercell processes or microvilli, the externallamellae and cell junctions. The spindlecells also formed some slit-like structures.Collagenization was mild in matrix.Wheth-er in BS or MS, epithelial or spindle cells,there were positive reactions for keratin,EMA and vimentin. The present study suggests that syno-viosarcoma is neither a tumor of synoviumorigin nor a sarcoma of synovial differenti-ation, but a carcinosarcoma or adenosarcomaof soft tissues; the monophasic type is nota variant of fibrosarcoma either.It really isa distinct variant of synoviosarcoma. Theexpressions of both epithelial and me-senchymal features are useful criteria fordiagnosis of synoviosarcoma.