胸膜孤立性纤维性肿瘤10例临床病理观察及文献复习

A clinicopathologic study and literature review of 10 patients with pleural solitary fibrous tumor

目的 探讨胸膜孤立性纤维性肿瘤（SFT）的临床病理特征,提高对其临床及病理改变的认识。方法 对10例胸膜SFT的临床资料和组织学形态进行回顾性分析,并采用免疫组织化学染色（Envision法）研究其形态及免疫表型特点。结果 10例患者中,男性6例,女性4例,发病年龄47~76岁,平均57.5岁。肿瘤分别位于脏层胸膜（4例）,壁层胸膜（4例）,叶间裂（2例）,患者多因咳嗽,胸痛,胸膜腔肿块,肺部肿块就诊。影像学多显示：占位性病变和软组织团块影,其中2例显示有胸腔积液。病理组织学显示：肿瘤界限清晰,由交替性分布的细胞丰富区及稀疏区组成,部分可有粘液变。免疫组织化学显示：梭形细胞表达Bcl-2、CD34和vimentin。结论 SFT是一种较为少见的间叶性梭形细胞肿瘤,好发于胸膜。其确诊主要依赖于病理组织形态学及免疫组织化学染色。完整的手术切除是临床治疗SFT的必要手段,但少数SFT生长活跃,具有侵袭性,需长期随访。

Objective To investigate the clinicopathological features of pleural solitary fibrous tumor （SIT）, and to improve understanding of their clinical and pathological changes. Methods The clinical and histological data of 10 cases of pleural SFT were retrospectively analyzed, and their morphology and phenotype were characterized by immunohistochemical staining （Envision method）. Results In 10 patients, there were 6 males and 4 females with age from 47 to 76 years （mean age 57. 5 years）. Tumors were located in visceral pleura （4 cases）, pa- rietal pleura （4 cases）, and fissures （2 cases）, respectively. Most patients were diagnosed because of cough, chest pain, pleural cavity tumor and lung tumor. Radiography showed a space-occupying lesion or soft tissue mass shadow with 2 cases of pleural effusion. Histopathology revealed that tumor boundaries were clear and characterized by the al- ternating distribution of cell rich regions and cell sparse regions. Some tumors had mucus changes. Immunohisto- chemistry revealed that spindle cells expressed Bcl-2, CD34 and vimentin. Conclusion SFF is a rare mesenchymal spindle cell tumor, which mainly occurs in pleura. Its diagnosis relies on histopathological and immunohistochemieal staining. A complete surgical resection is necessary for clinical treatment of pleural SFT, but a few SFFs show progressively growing and invasive, thus a long-term follow-up is needed.