软组织恶性纤维组织细胞瘤临床病理特点和预后相关因素

目的:观察软组织恶性纤维组织细胞瘤(malignant fibrous histocytoma of soft tissue,ST-MFH)临床病理特点,探讨影响其预后的有关因素.方法:分析41例ST-MYH的临床资料,经光镜和免疫组织化学染色检查,对原发肿瘤体积、初次手术方式、术后有无放化疗、核分裂相计数(mitosis count,MC)、病理组织分级、增殖细胞核抗原(proliferating cell nuclear antigen,PCNA)标记指数6项与预后相关指标进行统计学分析.结果:MFH是老年人常见的、高度恶性的软组织肉瘤.席纹状-多形性型是该肿瘤的基本形态.免疫组化染色是诊断ST-MFH较好的辅助手段,其中AAT、ACT和溶菌酶有较高的敏感性,而CD68则更具有特异性.有可能影响预后的6项因素做多因素统计分析,初次手术方式、肿瘤细胞的MC和肿瘤体积有统计学意义;PCNA虽具有高表达性,但差异无显著性.结论:ST-MFH因其成份复杂、形态多变,采取光镜和系列免疫组化抗体标记,从多方面给予认证非常必要.对ST-MFH的预后,仍有较多不确定因素.本组6项因素中对生存期有一定影响的仅有初次手术方式、肿瘤的MC与肿瘤体积3项,而被认为对肿瘤预后有重要意义的PCNA差异却无显著性.

Clinico-pathologic features and prognostic factors of malignant fibrous histiocytoma of soft tissue sarcoma

Objective: To study the correlative factors of the prognosis by observing the clinico pathologic features of malignant fibrous histocytoma of soft tissue(ST MFH). Methods: The data of 41 patients were examined by the light microscope and immunohistochemical stains. Six targets in the prognosis were analyzed by the statistics. They were primary tumor size, first operative pattern, the treatment after the operation, mitosis count, histologic grade and proliferating cell nuclear antigen labelling index ( PCNA LI ). Results: MFH was a high malignant soft tissue sarcoma(STS) often found in elder people. Storiform pleomorphic type was a basic form in the four subtypes of the ST MFH. Immunohistochemical stain was a better supplementary method to diagnose ST MFH, in which AAT, ACT and lysozyme were more sensitive makers, and CD68 was more specific. First operative pattern, mitosis count of the tumor and primary tumor size had the statistic significance in the prognosis . PCNA expressed higher, which had no significance. Conclusion: It was necessary that we should combine every status in diagnosing MFH, by means of light microscopy and a series of immunohistochemical stains, for it has many complex components and various changes of the morphology. ST MFH has still many undetermined factors as to its prognosis. Three targets ( first operative pattern, mitosis count of the tumor and primary tumor size), but not PCNA LI play their roles in it.