6例滑膜肉瘤临床病理分析

Pathological analysis of synovial sarcoma： 6 cases

目的探讨滑膜肉瘤的临床病理特征、诊断与鉴别诊断，以提高对该肿瘤的认识和诊断水平。方法收集6例滑膜肉瘤进行回顾性分析，观察其形态学及免疫组化特点，并复习相关文献资料。结果6例滑膜肉瘤，原发部位：肺3例，膝关节2例，足底1例；双相型分化2例，单相纤维性分化4例；2例双相型滑膜肉瘤肿瘤细胞细胞角蛋白（CK）、上皮膜抗原（EMA）、TLE-1、钙黏附蛋白-E（E—cadherin）、波形蛋白（vimentin）不同程度阳性，平滑肌肌动蛋白（SMA）、CD34分别1例阳性，S-100、结蛋白（desmin）均阴性；4例单相纤维性滑膜肉瘤vimentin全部阳性，CK、EMA、CD99分别2例阳性，Bcl-2全部阳性，钙调宁蛋白（calponin）有3例阳性，S-100、SMA分别1例阳性，desmin、CD34、甲状腺转录因子-1（1TrF-1）均阴性；6例病例Ki-67阳性标记指数10％～60％不等。结论滑膜肉瘤镜下形态多样，具有向上皮和纤维双相分化的特点，需与纤维肉瘤、转移性腺癌、肺梭形细胞癌等肿瘤相鉴别，确诊有赖于组织形态和免疫组化相结合，必要时可进行分子遗传学检测。

Objective To explore the pathological characteristics and differential diagnosis of synovial sarcoma, so as to improve the understanding and diagnosis of this sarcoma. Methods Retrospective analysis was performed using da- ta from six patients with synovial sarcoma. The morphological and immunohistochemical characteristics were observed, while related literature was reviewed. Results For these synovial sarcoma patients, the primary site was the lungs （3 cases）, the knee joint （2 cases） and planta pedis （ 1 case）. There were 2 cases of bipolar differentiation and 4 cases of single - phase fiber differentiation. For the bipolar synovial sarcoma, positive expression was found for cytokeratin （CK） , epithelial membrane antigen （ EMA）, transducin - like enhancer protein 1 （ TLE - 1 ） , E - cadherin and vimentiu to va- rious degrees, in addition to positive expression of smooth muscle actin （SMA） and CD34 in 1 case and negative expres- sion of S - 100 and desmin in both cases. For the single - phase fibrous synovial sarcomas, there were positive expression of vimentin and Bcl - 2 in all cases, positive CK, EMA and CD99 in 2 cases, positive calponin in 3 cases, positive S - 100 and SMA in 1 case and negative desmin, CD34, TTF- 1 in all cases. The positive Ki-67 labeling index ranged from 10% to 60%. Conclusions Synovial sarcoma has morphological diversity through microscopy, which can differen- tiate towards the epithelial and fiber and need to be distinguished from fibrosarcoma, metastatic adenocarcinoma, spindle -shaped carcinoma. Diagnosis depends on both tissue morphology and immunohistochemistry, while molecular genetic testing may be carried out when necessary.