梭形细胞/多形性脂肪瘤7例临床病理分析

Spindle cell/pleomorphic lipoma of soft tissue:a clinicopathologic analysis of seven cases

目的 探讨梭形细胞/多形性脂肪瘤（spindle cell/pleomorphic,SCL/PL）的临床病理学特征、诊断及鉴别诊断。方法 回顾性分析7例SCL/PL的临床及病理学特征,并复习相关文献,并将其与脂肪瘤样型孤立性纤维性肿瘤、硬化型脂肪肉瘤、梭形细胞脂肪肉瘤进行对比分析。结果 7例患者年龄41~77岁,平均54岁,均为男性。肿瘤部位：手部2例,颈部3例,肩部2例。病史1~8年。梭形细胞脂肪瘤镜下由温和的梭形细胞、束状排列的胶原纤维及数量不等的脂肪细胞组成。多形性脂肪瘤可见特征性的大的、多形性、花环状细胞。免疫表型：梭形细胞及多形性细胞CD34阳性,脂肪细胞S-100阳性。术后随访5~59个月,未见复发及转移。结论 SCL/PL为较少见的良性肿瘤,应与一些良性、局部侵袭性及低度恶性的软组织肿瘤及肿瘤样病变相鉴别。

Purpose To study the clinicopathologic features of spindle cell/pleomorphic lipoma in the soft tissue. Methods HE and immunohistochemistry were used to observe the clinical, radiological and histological features of spindle cell/pleomorphic lipoma of soft tissue and to make the diagnosis and differential diagnosis. The literature was reviewed. Results Seven cases of spindle cell/pleomor- phic lipoma of soft tissue were respectively located in the hand （n = 2）, neck （n = 3 ） and shoulder （n = 2）. Age ranged from 41 -77 years, with a mean age of 54 years. All were male. Histologically, the lesions appeared well circumscribed and characterized micro- scopically by a mixture of mature adipocytes, spindle cells and collagen fibers in variable proportions. Immunohistochemical study showed that the spindle cells were positive for CD34, while negative for S-100 protein. The patients were followed up for 5-59 months, no recurrence or metastasis occurred. Conclusions The spindle cell/pleomorphic lipoma of soft tissue is very rare. The diagnosis could be made by combination of the histological characteristics and immunohistochemical results with differentiation from the other fat containing and spindle cell tumors.