软组织网状神经束膜瘤1例报道并文献复习

Reticular perineurioma of soft tissue:a case report and review of the literature

目的 探讨软组织网状神经束膜瘤的临床病理特点和鉴别诊断。方法 对 1例网状神经束膜瘤进行光镜、免疫组化和电镜观察。结果 肿瘤位于左尺骨远端软组织。长而纤细的肿瘤细胞突起网状、格子样、吻合状生长 ,排列于黏液水肿性、纤维性和胶原化的背景中 ,细胞纺锤状 ,胞质弱嗜酸性 ,核星形 ,无核分裂象。免疫表型 :肿瘤细胞EMA和Vim阳性。电镜 :肿瘤细胞可见长形的纤细的胞质突起 ,突起上有较多的吞饮小泡。结论 网状神经束膜瘤是软组织神经束膜瘤的富有特征性的亚型 ,预后良好 ,诊断主要依靠常规病理、免疫组化和超微结构的综合观察。

Purpose To study the clinicopathological characteristics and differential diagnosis of reticular perineurioma. Methods One case of reticular perineurioma was analyzed by light microscopy, immunohistochemistry and electron microscope. Results The tumor located at the far end of left ulna. Microscopically, the tumor was characterized by a lace like or reticular lesional growth pattern with delicate anastomosing and intersecting strands of cells setting in a variable myxoid, fibrillar or collagenous stroma. Cytologically, the cells varied from fusiform to more spindle shaped with indistinct cell membranes and bipolar cytoplasmic processes, the cytoplasm was palely eosinophilic. No mitoses were identified. Immunohistochemically, the tumor cells were EMA and vimentin positive. Ultrastructurally, the tumor cells had tapering nuclei with long, delicate cytoplasmic processes associated with prominent subplasmalemmal pinocytotic vesicles. There were occasional rudimentary intercellular junctions and a well formed basal lamina. Conclusion Reticular perineurioma represents a striking morphologic variant of soft tissue perineurioma with an apparently benign clinical course.