肺恶性孤立性纤维瘤一例报告

Malignant solitary fibrous tumor of the lung:a case study

目的探讨肺恶性孤立性纤维瘤的临床病理特征、诊断及鉴别诊断。方法应用HE染色及免疫组织化学分析一例肺恶性孤立性纤维瘤的临床病理特点。结果患者男性,54岁,因咳嗽1月余,发现肺占位一周入院。病理学检测示:瘤细胞形态单一,梭形或卵圆形,片状弥漫排列;富于细胞区和细胞稀疏区交替排列,有血管外皮瘤样区域及致密的胶原样瘢痕沉积;灶性间质粘液变,局部区域富于血管并伴脉管扩张,细胞无明显异型。免疫组织化学观察发现肿瘤细胞vimetin、CD34、CD99和BCL2阳性,p53、SMA、Des、HMB45、MC、calretinin和D2-40阴性。结论肺恶性孤立性纤维瘤的发生率较低,应该加深对其临床病理特点的理解,结合临床与病理免疫组织化学确诊,避免误诊。

Objective To investigate the pathological characteristics,diagnosis and differential diagnosis of malignant solitary fibrous tumor(SFT)of the lung.Methods The clinical pathological characteristics of a case of lung SFT was analyzed by HE stain and immunohistochemistry(IHC).Results The54-year-old male patient had been coughing over a month,and was hospitalized a week after detection of a space-occupying lesion in lung.Under microscope,pathological examination of specimen showed fusiform or ovoid tumor cells with no obvious atypia,arranged in a diffusive spotty pattern,the area with abundant cells or sparse cells appeared alternatively,the compact collagen-like tissue deposited in the hemangiopericytoma-like areas,the mucoid degeneration was observed in the interstitial between spotty,and abundant vessels and vascular dilatation were also found.IHC showed the tumor cells were vimetin,CD34,CD99and BCL2positive,while p53,SMA,Des,HMB45,MC,calretinin and D2-40negative.Conclusion Lung SFT isrelatively rare.Its clinical pathological characteristics should be well understood,and it is necessary to combine tumor morphological features with immunohistochemistry to avoid misdiagnosis.