上皮样肉瘤

报告1例上皮样肉瘤.患者男,19岁.右侧臀部出现结节并渐增多伴破溃4个月来诊.皮损组织病理检查显示真皮及皮下组织内有一肿瘤浸润,瘤细胞由上皮样细胞和梭形细胞构成,部分细胞有异形性,瘤团内见小的坏死灶.免疫组化染色显示肿瘤细胞表达角蛋白(CK)和波形蛋白(VIM),而不表达CD34、平滑肌肌动蛋白(SMA)、上皮膜抗原(EMA)、S-100蛋白及CD68.患者的临床表现、组织病理改变及免疫组化染色均符合上皮样肉瘤的特点.     

上皮样肉瘤

报告1例上皮样肉瘤。患者女,36岁。右膝关节及周围结节、溃疡10个月余。皮损组织病理检查:真皮中下层可见瘤细胞团块样浸润,中央见坏死灶,周边瘤细胞由上皮样细胞、梭形细胞构成,部分细胞异形性明显。免疫组化染色显示肿瘤细胞表达CK、上皮膜抗原(EMA)、vimentin、CD34、Ki-67(50%~60%)及平滑肌肌动蛋白(SMA),而不表达CD31和Ⅷ因子。患者的临床表现、组织病理改变及免疫组化均符合上皮样肉瘤的特点。     

上皮样肉瘤

报告1例跖部上皮样肉瘤.患者男,40岁.右足跖部结节2年,溃疡4～5个月.皮肤科检查:右足跖中央一5 cm×2 cm、深约1 cm的溃疡,周边少许肉芽样组织生长.皮损组织病理检查:真皮中下部可见栅状肉芽肿样瘤细胞团块,中央有坏死表现,周边主要由上皮样细胞和梭形细胞组成,核分裂象增多.免疫组化染色显示肿瘤细胞表达细胞角蛋白(CK)、上皮膜抗原(EMA)、波形蛋白(vimentin)和CD34,而不表达CD31和S-100蛋白.患者的临床表现、组织病理改变及免疫组化染色均符合上皮样肉瘤的特点.     

下肢巨大疣状皮肤结核1例

患者女,45岁。左下肢丘疹、结节及斑块15年。皮肤组织病理示:表皮假上皮瘤样增生,真皮内见大量上皮样细胞、淋巴细胞、组织细胞及少量多核巨细胞聚集。抗酸染色(-)、PAS染色(-),PPD试验(3+),T细胞斑点试验(+)。诊断:疣状皮肤结核。     

发生在外阴部位的上皮样肉瘤样血管内皮瘤1例及文献复习

对1例发生于阴茎的上皮样肉瘤样血管内皮瘤进行常规HE染色、免疫组化染色及荧光原位杂交,观察其结果并结合既往文献分析。组织病理表现HE下呈成片或模糊结节状上皮样细胞或梭形细胞组成,缺乏血管内皮分化的特征,免疫组化一般表现为:AE1/AE3(+)、ERG(+)、FLI-1(+)、INI-1无缺失、CD31表达不恒定、CD34(-)、desmin(-),部分患者免疫组化FOSB可阳性或荧光原位杂交检测到t(7,19)(q22,q13)/SERP1NE1-FOSB,需要与上皮样肉瘤,上皮样血管内皮瘤等鉴别。上皮样肉瘤样血管内皮瘤是少见的软组织肿瘤,发生于阴茎罕见,HE下常不能诊断,需要免疫组化确诊,基因检测可辅助诊断,虽然大部分报道该病为隐匿性病程,但仍有极少数发生转移,早期诊断及长期随访很重要。     

上皮样肉瘤一例

【摘要】目的 报告1例长期误诊的上皮样肉瘤。方法 对1例上皮样肉瘤患者临床表现、辅助检查、诊疗过程进行分析,并复习相关文献。结果 男性患者,30岁,因“右手食指皮疹10年,加重半年”就诊。10年前患者右手食指指腹出现一个绿豆大淡红色丘疹,自行破溃形成溃疡,先后行三次食指切除术,术后创面无法愈合。半年来右上肢及头部出现多个结节,出现咳嗽、咯中量白色粘痰,痰中带血丝。皮肤组织病理检查结果：（右臂内侧皮肤）真皮可见结节状肿瘤团块,肿瘤细胞梭形,部分细胞胞浆丰富,呈上皮样表现,细胞有异性,可见核分裂像,局灶可见坏死;免疫组化染色：CD34(间质血管+),CD21(-),CK(部分细胞+),CD31(间质血管+),CD68(+),S-100(-),Vimentin(++),Desmin(-),诊断为上皮样肉瘤。结论 上皮样肉瘤是一种少见的软组织肿瘤,早期的临床表现及组织病理学缺乏特异性,因而很容易误诊。     

臀部疣状皮肤结核误诊1例

患儿女,10岁,右臀部环状斑块8余年,曾多次误诊为股癣。皮损组织病理示:表皮角化不全,毛囊角栓,表皮假上皮瘤样增生;真皮浅中层弥漫炎细胞浸润,以淋巴细胞为主;真皮内可见上皮样细胞结节,浸润的细胞有淋巴细胞、多核巨细胞及组织细胞等。抗酸染色(-),PPD试验(3+)。诊断:疣状皮肤结核。     

上皮样肉瘤1例

患者男,26岁。左上肢多发性结节、溃疡4年。皮肤组织病理检查示:真皮肿瘤团块呈结节状分布,结节由多数上皮细胞样细胞和少数梭形细胞组成,中央有大片状坏死区。免疫组化染色结果示:EMA(2+),波形蛋白(2+),CD34(+),CK(2+)。诊断为上皮样肉瘤     

皮脂腺痣并发小汗腺汗孔癌1例

患者男,39岁。左侧头皮、面部丘疹、结节、斑块39年,部分菜花样隆起1年。皮损组织病理检查:面部前额斑块病理片显示表皮角化过度,乳头瘤样增生,真皮层皮脂腺明显增生。菜花样增生物病理片示真皮可见一个或多个上皮肿瘤细胞团,呈巢索状;肿瘤细胞团内见多角形、核位于细胞中央的的鳞状细胞样瘤细胞和含丰富的糖原且细胞膜清楚的浅染瘤细胞,核分裂相多,有病理性核分裂;瘤细胞浸润真皮及皮下,可见局灶有导管分化。免疫组化提示肿瘤结节混合性CK(细胞角蛋白)阳性,肿瘤内导管结构EMA(上皮膜抗原)强阳性,PAS染色可见胞浆内糖原染色阳性。根据临床资料、组织病理及免疫组化诊断为皮脂腺痣并发小汗腺汗孔癌。     

在线形表皮痣上发生基底细胞上皮瘤

本文报告一例线形表皮痣上发生基底细胞上皮瘤的病人.患者,男性,42岁.因先天性痣出血,长大而来治疗.近10年来发生多发性结节,缓慢增大,刺激后出血.体检:疣状痣自右胁到脐和耻骨,沿右腿内侧向下发展呈带形分布.伴散在粉红到黑色结节,其中最大2×2cm.几个结节有蒂.先天性痣组织象显示典型的表皮痣特征.结节组织象显示:表皮基底细胞层有几处发生肿瘤.周围呈栅状排列的细胞,在肿瘤和间质之间有收缩空隙.先天性错构瘤伴发上皮瘤是众所周知的事实.上皮瘤通常发生于皮脂腺痣.痣样基底细胞综合征、伴有黑头粉刺的线形单侧基底细胞痣,毛囊性基底细胞痣上也均可发生基底细胞上皮瘤.而在线形表皮痣上发生基底细胞上皮瘤是罕见的.Pack等复习     

Multiple Cutaneous Epithelioid Hemangioendothelioma: A Case with Spindle Cells

A case of multiple cutaneous epithelioid hemangioendothelioma (EH) in a Japanese male is reported. The patient was a 52-year-old Japanese bureaucrat. Clinically, about 10 purplish-red, elastic soft or hard papules and nodules had appeared on both lower extremities and the left buttock over the past 20 years. They were excised, but some of them recurred. Histologically, the papules and nodules were well-circumscribed tumors located in the superficial and deep dermis. They appeared to arise from medium-sized vessels and were composed of proliferations of characteristic epithelioid endothelial cells with intracytoplasmic vacuolization and spindle cells. No other extracutaneous tumors were found. We diagnosed the present case as multiple cutaneous EH with spindle cells. The presence of epithelioid endothelial cells and absence of pleomorphism and mitoses of nuclei of spindle cells made differential diagnosis from Kaposi's sarcoma possible. The protracted clinical course seems characteristic of EH in various organs including skin.     

上皮样肉瘤1例

患者男,19岁。右小腿皮疹伴疼痛1年,皮疹切除术后约3个月时右足底部出现皮疹,伴疼痛,部分破溃。组织病理示肿瘤团块呈结节状,结节由上皮样细胞及呈漩涡状排列的梭形细胞组成。免疫组化示波形蛋白(+),EMA(+)。诊断:上皮样肉瘤。     

上皮样肉瘤1例

患者男,61岁。左上肢多发性结节2年。皮损组织病理示:瘤组织位于真皮层,呈结节状,结节中心坏死,坏死周边肿瘤细胞呈上皮样或梭形,核分裂相易见。免疫组化染色示:CK(2+),EMA(2+),Vim(+),CD34(3+),CD31(+)。诊断:上皮样肉瘤。     

Spindle cell hemangioendothelioma: report of three cases

Three cases of spindle cell hemangioendothelioma were studied. Two had multiple nodules and the third had a single, recurrent lesion in the dermis or subcutis of the distal extremities. The tumor initiated at the age of 3 months in one patient and at the ages of 11 or 12 years in the remaining two. Local recurrence after surgical excision was observed in all cases. Microscopically the tumors were composed of two components; cavernous blood spaces and a proliferation of spindle cells. Among these spindle cells, there were occasional epithelioid endothelial cells with intracytoplasmic lumina. Phleboliths were observed in two cases. Most of the endothelial cells lining the cavernous spaces were positive for factor VIII-associated antigen in all cases; the intracytoplasmic lumina were also positive in two cases. The spindle cells were negative for that antigen in all cases. However, they were positive for desmin in one case. Electronmicroscopically, the spindle cells resembled primitive mesenchymal cells.     

皮肤上皮样肉瘤临床病理分析

目的报告1例罕见的多部位受累的上皮样肉瘤。方法回顾性分析患者的临床及病理资料、治疗及随访,并复习相关文献。结果患者男,47岁,先后发现腰部、颏下、耳前、头皮多部位肿块达十余个,组织病理检查示肿瘤由上皮样细胞和梭形细胞构成肉芽肿样结构,位于真皮胶原束之间,中央大片状坏死,肿瘤细胞轻-中度异型性。免疫组化显示细胞角蛋白(AE1/AE3)、上皮细胞膜抗原(EMA)和波形蛋白(vimentin,VIM)阳性,S-100和CD34灶状阳性。结论上皮样肉瘤是临床少见的软组织低度恶性肿瘤,多发性者罕见,容易误诊为良性肉芽肿性病变或其他恶性肿瘤,应引起临床及病理医师的足够重视。     

Cutaneous mycobacterial spindle cell pseudotumor: a potential mimic of soft tissue neoplasms

A 55-year-old man with scleroderma treated with prednisone and etanercept presented with enlarging sporotrichoid nodules on the forearm. Microscopically, there were large circumscribed dermal and subcutaneous nodules of spindled and epithelioid cells, resembling a spindle cell neoplasm. Small foci of neutrophils were also present, and a subsequent Ziehl-Neelsen stain highlighted beaded acid-fast bacilli in the interstitium. Tissue culture demonstrated Mycobacterium chelonae. Cutaneous mycobacterial spindle cell pseudotumor is an exceedingly rare lesion, with only 6 previously reported cases. Although these included patients with autoimmune disease receiving immunosuppressive therapy, this is the first case reported in association with a tumor necrosis factor alpha inhibitor, etanercept. Furthermore, this represents the first mycobacterial spindle cell pseudotumor described in association with M. chelonae. Mycobacterial spindle cell pseudotumor should be considered in the differential diagnosis of cutaneous spindle cell proliferations, especially in immunocompromised patients.     

Spindle cell variant of epithelioid sarcoma: an easily misdiagnosed tumour

Epithelioid sarcoma is a histologically distinct soft tissue sarcoma of high grade malignancy. We report a case of epithelioid sarcoma in a young man who presented with multiple nodules over the left forearm, with bony invasion and pulmonary metastases. The histological features of the dermal tumour were those of a malignant spindle cell tumour with positive cytokeratin and vimentin staining and differed from the classical epithelioid sarcoma in its absence of typical necrobiotic nodular epithelioid pattern. It was the clinical presentation and the histology of the subcutaneous nodules that led to the final diagnosis of epithelioid sarcoma. This case illustrates a predominance of spindle cell pattern in the dermal tumour of epithelioid sarcoma, which has previously been reported as fibroma-like variant of epithelioid sarcoma.     

Cellular neurothekeoma with melanocytosis

Cellular neurothekeoma (CNT) is a benign dermal tumor mainly affecting the head and neck and the upper extremities. It is characterized histologically by interconnecting fascicles of plump spindle or epithelioid cells with ample cytoplasm infiltrating in the reticular dermis. The histogenesis of CNT has been controversial, although it is generally regarded as an immature counterpart of classic/myxoid neurothekeoma, a tumor with nerve sheath differentiation. Two rare cases of CNT containing melanin-laden cells were described. Immunohistochemical study with NKI/C3, vimentin, epithelial membrane antigen, smooth muscle antigen, CD34, factor XIIIa, collagen type IV, S100 protein and HMB-45 was performed. Both cases showed typical growth pattern of CNT with interconnecting fascicles of epithelioid cells infiltrating in collagenous stroma. One of the nodules contained areas exhibiting atypical cytological features. Melanin-laden epithelioid or dendritic cells were diffusely scattered throughout one nodule, and focally present in the peripheral portion of the other nodule. Both nodules were strongly immunoreactive to NKI/C3 and vimentin, but negative to all the other markers employed. CNT harboring melanin-laden cells may pose diagnostic problems because of their close resemblance to nevomelanocytic lesions and other dermal mesenchymal tumors. These peculiar cases may also provide further clues to the histogenesis of CNT.     

细胞角蛋白阴性的上皮样肉瘤

报告1例细胞角蛋白（CK）阴性的上皮样肉瘤。患者男，40岁。左前臂结节2年，渐增多8个月伴破溃1个月来诊。皮损组织病理检查显示真皮内有一环状肿瘤团块，团块由两种形态的细胞构成，一种细胞数量多、形态多样、胞质丰富。数量少的细胞呈梭形，分布于肿瘤边缘。免疫组化染色显示肿瘤细胞表达上皮膜抗原（EMA）、波形蛋白（vimentin）和CD34，而不表达CK，CD68和结蛋白（desmin）。患者的临床表现、组织病理改变及免疫组化染色均符合上皮样内瘤的特点。     

A case of perforating dermatofibroma with floret‐like giant cells

Dermatofibromas are slow‐growing solitary nodules, composed mostly of a dermal proliferation of spindle cells and epithelioid cells. Some dermatofibromas present with multinucleated giant cells, such as Touton, foreign body, and osteoclast‐like cells. We report a case of dermatofibroma containing both Touton giant cells and floret‐type cells. A 12‐year‐old boy presented with a 6‐mm, firm, nontender, dusky‐red to greyish dermal nodule on his left popliteal fossa. As suggested clinically by the central opening, perforation of the epidermis with partial extrusion of the dermal components, including macrophages and vertically oriented collagen bundles, via transepidermal elimination, were detected. In the upper dermis, collagen trapping and mostly epithelioid cells with many giant cells were seen, while the lower part contained mainly spindle cells in a storiform pattern. Multinucleated giant cells scattered in the upper dermis were mainly floret‐type multinucleated giant cells with star‐shaped cytoplasmic projections, associated with some Touton giant cells. To our knowledge, this is the first report of a perforating dermatofibroma with floret‐type multinucleated giant cells.