局限型腱鞘巨细胞瘤临床病理分析

目的探讨局限型腱鞘巨细胞瘤(L-GCTS)的临床病理特征及免疫表型。方法对54例局限型腱鞘巨细胞瘤进行临床病理分析,对其中16例行免疫组织化学染色并复习相关文献。结果本组患者男女之比为1:1.7,平均年龄为36.7岁(8~62岁)。以右手拇指最多见,平均最大径1.6 cm,多有完整包膜。肿瘤主要由大的滑膜样单核细胞、小的组织细胞样单核细胞、泡沫细胞、纤维母细胞及破骨细胞样多核巨细胞构成。根据组织形态特征,将其分为增生型、纤维组织细胞瘤样型和纤维化型3种组织学类型。免疫组织化学显示clusterin在滑膜样大单核细胞中呈强阳性表达,CD163在组织细胞样小单核细胞中呈强阳性表达。CD68和Vimentin在4种细胞中均有表达,但表达强弱不等。Ki-67阳性细胞均为单核细胞,增殖指数3%~12%,平均5%。结论L-GCTS是一种向滑膜上皮分化的肿瘤,根据其组织形态,可将其分为3种亚型,反映不同时段的形态特征,各型间常有重叠。彻底的局部切除肿物是最主要的治疗方法,为了预防复发,局部放射治疗或靶向治疗可作为一种辅助治疗手段。

Clinicopathologic analysis of localized-type giant cell tumor of the tendon sheath

ObjectiveTo investigate the clinicopathologic features and immunophenotype of localized-type giant cell tumor of the tendon sheath (L-GCTS). MethodsA clinicopathologic analysis of 54 cases of L-GCTS was performed. Among them, immunohistochemical staining was performed on 16 cases. The related literature was also reviewed. ResultsThe male-to-female ratio of L-GCTS patients was 1:1.7, and the mean age was 36.7 (8-62) years old. L-GCTS was often located on the right thumb, with an average diameter of 1.6 cm, and many had complete capsules. The tumor was mainly composed of large synovial mononuclear cells, small histologic cell-like monocytes, fibroblasts, and osteoclast-like multinucleated giant cells. According to the histological features, it was divided into three histological types: proliferative, fibrous histiocytoma-like, and fibrotic. Immunohistochemical staining showed that clusterin was strongly positively expressed only in large synovial-like mononuclear cells, and CD163 showed strongly positive expression in the small histiocytoid cells. Both CD68 and vimentin were expressed in all four types of cells, but the expression varied. Ki-67 positive cells were monocytes, and the proliferation index was 3%~12% (average, 5%). ConclusionL-GCTS are tumors that differentiate towards the synovial epithelium, and can be divided into three subtypes according to their tissue morphology, reflecting the morphological characteristics of different time periods. There is often overlap between the types. Complete local resection of the tumor is the most important treatment. In order to prevent recurrence, local radiotherapy or targeted therapy can be used as an adjuvant therapy.