右侧胸腔原发低度恶性纤维组织细胞瘤1例及文献复习

Primary low-grade fibrous histiocytoma of the right thoracic cavity:a case report and literature review

目的探讨胸膜低度恶性纤维组织细胞瘤的临床特征、病理特征及诊断。方法应用HE染色及免疫组织化学技术观察并分析本院诊断的1例低度恶性纤维组织细胞瘤(男性患者,59岁,弹棉花工人,肿块位于右侧胸腔)临床病理特征及免疫组织化学表型,并总结相关文献。结果大体标本呈灰白灰褐色,5 cm×4 cm×3 cm;镜下见上皮样细胞、多核巨细胞伴坏死,富于巨细胞的软组织肿瘤核分裂象多见;免疫组织化学表型:vimentin、CD68、CD163阳性,Ki-67增值指数40%,AE1/AE3、S100、desmin、H3.3G34W、H3K36M、PAX-8、STAT6阴性。结论恶性纤维组织细胞瘤较为罕见,大多数病例恶性程度高,其中低度恶性更为罕见,容易误诊,在形态学、免疫组织化学上具备一定的特殊性。

Objective To explore the clinical features,pathological features and diagnosis of low-grade malignant fibrous histiocytoma of pleura.Methods HE staining and immunohistochemical techniques were used to observe and analyze the clinico-pathological features and immunohistochemical phenotype of a case of low-grade malignant fibrous histiocytoma(male patient,59 years old,cotton flicking worker,mass located in the right thoracic cavity)diagnosed in our hospital,and the relevant literature was summarized.Results The gross specimen is gray white and gray brown,5 cm×4 cm×3cm.Epithelioid cells and multinucleated giant cells with necrosis can be seen under a microscope.Mitotic images of soft tissue tumors rich in giant cells are more common;immunohistochemical phenotypes:vimentin,CD68 positive and CD163 were positive,Ki-67 value-added index was 40%,AE1/AE3,S100,desmin,H3.3g34W,H3K36M,PAX-8,STAT6 were negative.Conclusion Malignant fibrous histiocytoma is rare.Most cases are highly malignant,and the low-grade malignant case is more rare.It is easy to be misdiagnosed.It has some particularity in morphology and immunohistochemistry.