局限性和弥漫性腱鞘巨细胞瘤52例临床及病理

目的：探讨两种类型腱鞘巨细胞瘤（GCT）的临床病理特点。方法：对52例GGT患者的临床、病理及免疫组化进行比较。结果：局限性GCT（F－CT）40例，87．5％发生在手指，平均直径1．3cm，包膜完整，6．7％术后复发；弥漫性GCT（D－GCT）12例，全局发生在大关节，平均直径2．5cm，无包膜，呈浸润性生长，42．9％术后复发。F－GCT与D－GCT组织形态相似，但单核细胞的梭形化及滑膜样裂隙较明显，细胞异型及坏死均为2．5％；D－GCT慢性炎细胞及含铁血黄素较明显，细胞异型及坏死均为16．7％。免疫组化显示两种类型中核细胞Vim( )、68( )、PCNA( )，而多核巨细胞Vim( )、CD68（＋）、PCNA（－）。在2例D－GCT中另见散在性SMA（＋）、Des( )、S－100（＋）的大细胞。结论：F－GCT与D－GCT的生长方式和术后复发率明显不同。

Focal and diffuse giant cell tumors of tendon sheath: A comparative study of 52 cases

Objective To investigate the clinical and pathological features of the two types of focal and diffuse giant cell tumors (GCTs) of the tendon sheath. Methods The clinical, pathological and immunohistochemical aspects of GCTs were analyzed and compared in 52 cases. Results Forty cases were focal GCTs, in which 87.5% of the tumors localized in fingers and well encapsulated, with average diameter of 1.3 cm. After operation, the recurrent rate of focal GCTs was 6.7% . Twelve cases were diffuse GCTs, in which all of the tumors involved in large joints and showed an invasive growth pattern without capsules. The average size of diffuse GCTs was 2.5 cm. Local recurrence of the tumor was 42.9% after surgical removal. Both types of the tumor had some similarities in their morphology: composing predominantly of mononuclear cells with variable proportions of multinuclear cells, foam cells and chronic inflammatory cells, as well as hemosiderin deposition. Focal necrosis, fibrosis, osteoid stroma, synovial like clefts and cholesterol like crystals were also observed in the tumors. The spindle mononuclear cells and synovial like clefts were more obvious in focal GCTs, but chronic inflammatory cells and hemosiderin deposition were commonly found in diffuse GCTs. Atypia of the tumor cells and focal necrosis were observed in 2.5% of focal and 16.7% diffuse GCTs respectively. Immunohistochemical study showed that mononucleated tumor cells were positive for vimentin, CD68 and PCNA, and multinuclear giant cells positive for vimentin and CD68, but negative for PCNA. Expression of SMA, desmin and S 100 in large tumor cells were also found in 2 cases of diffuse GCTs. Conclusions Both types of GCT have different patterns of growth and recurrent rate . The knowledge of clinicopathologic features of GCTs is helpful to distinguish focal GCT from diffuse one, and to make a differential diagnosis from other tumors.