鼻腔上颌窦嗜酸性细胞乳头状瘤2例临床病理观察

目的分析罕见病例鼻腔上颌窦嗜酸性细胞乳头状瘤（OSP）的临床及病理学特点。方法用影像学、组织病理学、免疫组化和组化方法 ,结合文献对2例OSP进行观察、分析。结果镜下见2例病变一致,瘤组织主要为乳头状结构,瘤细胞梭形、短梭形、圆形、柱状,胞质内有丰富的嗜酸性颗粒;细胞核小,深染,无异型。乳头的瘤细胞2～10余层,灶性区域细胞呈实体团状,有的表层细胞有纤毛,底部细胞多有明显的细胞间桥,密布充满黏液的细胞,形成微囊和微脓肿。乳头间可见退变细胞、细胞分泌物和陈旧性出血形成的无结构之坏死;有的乳头间质炎细胞浸润,纤维增生、透明变性。细胞微囊内黏液AB染色呈强阳性、PAS阴性;瘤细胞CK显强阳性,Vim间质阳性,Ki67阳性细胞〈5%,Cga、Syn、阴性。结论 OSP罕见,易复发,恶变率高,系潜在恶性肿瘤。早期诊断和手术治疗对本瘤的预后至关重要。

Clinical Pathological Observation of 2 Cases with Oncocytic Schneiderian Papilloma in Nasal Cavity and in Maxillary Sinus

Objective To study the clinical and pathological features of oncocytic schneiderian papilloma （OSP）.Methods Imaging,histopathology,immunohistochemistry and histochemistry,combined with literature reviewing,were applied in the observation of the 2 OSP cases.Results The observation under microscope showed the same lesions in 2 cases,the tissues were in papillose structure while the tumor cells were in spindal,or short spindal,or round,or columnar shapes;lots of acidophilic granule were located in the cytoplasm,the small nuclei,dark stained,were of no atypism;there were 2 to 10 layers of cells in papilloma and cells of solid clusters were found in the focal area,some superficial cells had cilia while the intracellular bridges were easily seen among the cells of basis layers,which were densely covered with cells filled by mucus,microcapsules and microabscess were formed;degenerative cells,cell secretion and unstructured necrosis caused by stale hemorrhage existed among the papilla,some papilla were infiltrated by interstitial inflammatory cells with fibroplasias and hyaline degeneration;AB staining of the mucus inside the microcapsules were strong positive while PAS was negative;the tumor cell CK was strong positive and vimentin were positive in mesenchymal,the positive Ki-67 cells were under 5%;Cga and Syn were negative.Conclusions OSP is rare but easy to reoccur with high canceration rate,it is a kind of potential malignant tumor;earlier diagnosis and surgical treatment play an important role its prognosis.