软组织软骨瘤临床病理学特征分析

目的:探讨软组织软骨瘤(STC)临床病理学特征及其组织学发生机制.方法:对11例STC的临床表现、组织学形态及免疫组化表型进行分析.结果:临床上主要表现为局部缓慢性生长的无痛性肿块,少数伴有局部压痛,术后罕见复发.影像学显示,与骨无关联的软组织内肿块伴有程度不等的钙化.镜下肿瘤组织境界清楚,分叶状,由成熟透明软骨或纤维软骨构成,可伴有程度不等的钙化、黏液变及囊性变；软骨瘤细胞形态不一,多无异形性,核分裂像罕见；少数软骨小叶周边梭形间质细胞密集,无胞周空晕或陷窝状结构.免疫组化显示,所有成分均表达vimentin,成熟软骨细胞及梭形软骨细胞还部分表达S100及CD34；软骨结节周边梭形间质细胞部分表达a-SMA、MSA及CD34,散在表达CD163；透明软骨基质CollagenⅡ表达程度不等,Collagen Ⅰ及CollagenⅢ呈阴性表达或局灶弱阳性表达；纤维软骨基质及钙化区表达Collagen Ⅰ及CollagenⅢ,CollagenⅡ表达阴性或局灶弱阳性表达.结论:STC是一种较为少见的软组织良性软骨性肿瘤,STC的形成可能最初由间充质细胞演化为具有CD34阳性表达的梭形间质细胞,继而向软骨方向分化形成STC,但这一演化机制有待深入研究.

Clinicopathologic characteristics of soft tissue chondromas

OBJECTIVE: To investigate the clinicopathological features of soft tissue chondromas(STCs) and their histogenesis.METHODS:Eleven STCs were analyzed by the clinical manifestations,imaging features,histopathological characteristics and immunohistochemical phenotypes.RESULTS: Clinically,the presenting symptom was usually a slowly and insidiously growing mass.Imagings usually revealed a lobulated soft tissue mass partly with calcifications of variable density and showed not any relationship to the adjacent bone.Histologically,all of the tumors composed of mature hyaline cartilage or fibrocartilage were well circumscribed and lobulated with partly or completely calcified,focal myxoid and cystic changes.The appearance of the most chondrocytes were varied from dysplastic spindle-shaped to mature chondrocytes without noticeable cytologic atypia and mitotic figures.The spindle cells arround some of the cartilage lobules were without any lacuna or peri-cell halo.Immunohistochemistry was diffusely positive for vimentin in all tissues and the mature hyaline cartilage cells and spindle-shaped chondrocytes were also variedly positive for S-100 and for CD34.The mesenchymal spindle cells arround the cartilage lobules were partly positive for a-SMA,MSA and CD34,scatteredly for CD163.The mature hyaline cartilage matrix stained variedly for Collagen Ⅱ and negative or focally for Collagen Ⅰ and Collagen Ⅲ;The fibrocartilage matrix including calcified region were strongerly positive for Collagen Ⅰ and Collagen Ⅲ,negative or focally for Collagen Ⅱ.CONCLUSIONS: STCs are relatively rare benign cartilaginous tumors of soft parts more probably origined from the CD34-positive mesenchymal spindle cells.This pathogenesis of STCs based on some immunohistochemical phenotypes should be explored deeply.