外阴粒细胞肉瘤一例临床病理分析并文献复习

Granulocytic sarcoma of the vulva：a clinicopathological analysis and review of literature

目的 探讨外阴粒细胞肉瘤（GS）的临床病理特征、诊断与鉴别诊断.方法 对泰州市人民医院1例外阴GS的临床表现、组织学特点及免疫组织化学进行综合分析并复习相关文献.结果 患者75岁,因发现无痛性外阴肿物而入院,B型超声显示左侧大阴唇等回声区,内部回声不均匀.大体切面实性,鱼肉状,边界不清.光学显微镜下观察片层状恶性肿瘤细胞弥漫分布,小至中等大小,胞质少,核圆形或椭圆形,染色质细腻,核分裂多见;免疫组织化学肿瘤细胞表达髓过氧化物酶（MPO）、CD43、溶菌酶和CD117.结论 外阴GS非常罕见,仅凭形态学易误诊为淋巴瘤、尤文肉瘤、小细胞癌等,掌握其病理形态并正确诊断对患者的合理治疗和预后具有重要意义.

Objective To investigate the clinicopathologic features, diagnosis and differential diagnosis of granulocytic sarcoma（GS）of the vulva. Methods One patient with GS of the vulva was analyzed on morphological characteristics,immunohistochemical stainings and clinical data with review of the literature. Results The patient was a 75-year-old lady. She was admitted to the hospital for a painless lump found in her left vulvar region. B-ultrasound revealed a solitary isoechoic mass at she left labia minora with an internal heterogeneous echo. Grossly, the tumor was described as a solid neoplasm with fish-fresh like cut surface and an ill-defined margin. Microscopically, the malignant cells grew in a diffuse sheet pattern and were small to medium in size,with scant cytoplasm.The nuclei were round or oval,and had finely dispersed chromatin. The mitotic rates were high.Immunohistochemically,the tumour cells expressed for myeloperoxidase（MPO）,CD43, lysozyme and CD117. Conclusions GS of the vulva is extremely rare. In routine histopathology, it may be misdiagnosed as lymphoma, Ewing sarcoma and small cell carcinoma et al. Awareness of the morphology and precise diagnosis of GS of the vulva have significance for appropriate treatment and prognosis of the patients.