舌假血管型鳞状细胞癌临床病理观察

Pseudovascular squamous cell carcinoma of tongue: a clinicopathological analysis

目的探讨假血管型鳞状细胞癌(PSCC)的临床病理特点、诊断和鉴别诊断要点以及治疗与预后。方法报道1例发生于舌的假血管型鳞状细胞癌,观察其组织形态特点、免疫组化及特殊染色结果,并结合文献总结该类型肿瘤的临床病理特点及预后。结果患者女性,56岁。舌前部带蒂外生型肿物,大小6 cm×5 cm×1.5 cm。镜下肿瘤组织伴显著的棘层松解特点,大部分区域呈血管瘤样结构,腔内衬覆上皮样或鞋钉样肿瘤细胞,管腔及网状结构内见游离的肿瘤细胞、较多红细胞及炎细胞。肿瘤细胞上皮样或梭形,核仁明显,核分裂象多见(>20个/10HPF)。免疫组化:肿瘤细胞CK、CK5/6、p63、vimentin、CD56及CD99弥漫(+);EMA、CD34、CD31、E-cadherin及其他肌源性、神经源性及黑色素标记物(-);Ki-67阳性指数70%。AB染色(+),PAS染色(-)。结论假血管型鳞状细胞癌是一种罕见类型的鳞状细胞癌,可能是棘层松解性鳞癌的一种特殊亚型,具有独特的组织形态特点,免疫组化有助与血管肉瘤及其他多种软组织肉瘤和癌鉴别。该肿瘤转移及复发率高,预后差,应手术扩大切除并进行必要的区域淋巴结清扫,术后放、化疗效果不明确。

Objective To investigate the clinical and pathological features, diagnosis and differential diagnosis,treatment and prognosis of pseudovascular squamous cell carcinoma（ PSCC）. Methods One case of pseudovascular squamous cell carcinoma of the tongue was reported for the first time. The morphological features,immunohistochemistry and special staining results were described. And also the literatures were reviewed in order to summarize the clinicopathological features and prognosis of this type of tumor. Results A 56-year-old female patient with a polypoid tumor on the anterior portion of the tongue,measuring 6 cm × 5 cm × 1. 5 cm,was admitted to our hospital. Microscopiclly,the tumor was characterized with marked acantholysis. Most area of the tumor was angioma-like. The cavity was lined with epithelioid or hobnail tumor cells and the lumina of these spaces contained tumor cells, lots of erythrocytes and inflammatory cells. These tumor cells were epithelioid or spindle,with marked nucleolus. Mitotic figures were common（ 20/10 HPF）. Immunohistochemistry revealed that the tumor cells were diffusely positive for CK,CK5/6,p63,vimentin,CD56 and CD99,but negative for EMA,CD34,CD31,E-cadherin and other markers of myogenic,neurogenic and melanin. The index of Ki-67 was about 70%. AB staining was positive while PAS was negative. Conclusions Pseudovascular squamous cell carcinoma is a rare type of squamous cell carcinoma,and it may be a special subtype of acantholytic squamous cell carcinoma. This tumor has special histological characteristics. Immunohistochemistry can help to distinguish it from angiosarcoma and other soft tissue sarcomas or carcinomas. The metastasis and recurrence rate of pseudovascular squamous cell carcinoma is high and the prognosis is poor. Extended resection should be performed inluding regional lymph node dissection. The effect of radiotherapy and chemotherapy is uncertain.