滤泡树突状细胞肉瘤的临床病理观察

目的 探讨滤泡树突状细胞肉瘤(FDCS)的临床病理特点及鉴别诊断.方法 应用组织学、免疫组织化学及EB病毒编码的RNA(EBER)原位杂交技术,对5例FDCS进行临床和病理学观察,并复习文献进行总结讨论.结果 5例FDCS患者中,男性3例,女性2例;年龄28～75岁,中位年龄54岁.病变位于淋巴结内2例,位于扁桃体、胃及肝脏各1例.FDCS的组织学生长方式为柬状、漩涡状和(或)弥漫片状.细胞呈梭形、卵圆形,境界欠清楚,胞质轻度嗜酸性,核圆形、卵圆形或梭形,可见小核仁,核分裂象为1～22/个/10个高倍视野,有时可见Warthin-Finkeldey样多核瘤巨细胞.5例FDCS行CD21、CD23 和 CD35免疫组化检测,其中3例为CD21和CD23阳性表达,4例为CD35 阳性表达.4例行D2-40和CXCL13免疫组化检测,其中4例为D2-40阳性表达,3例为CXCL13阳性表达.仅1例FDCS检测到 EBER表达.结论 FDCS是一种极少见的、至少为中度恶性的肿瘤,其组织学表现具有多样性,但也有一定的特征性,需要借助免疫组化的方法与其他形态学类似的肿瘤相鉴别.

Clinicopathological study on the follicular dendritic cell sarcoma

Objective To investigate the clinicopathologic features and differential diagnosticmethods for follicular dendritic cell sarcoma. Methods Histological and immunohistochemical examinationsand EBER in situ hybridization were used to investigate the pathological features of 5 cases of folliculardendritic cell sarcoma, and related literature was reviewed. Results There were 3 males and 2 females witha median age of 54 years (range, 28-75 years). The location of lesions included lymph node (2 cases),tonsil ( 1 case), stomach ( 1 case), and liver ( 1 case). The growth patterns were fascicular or whorls and/or diffuse. The neoplastic cells were spindle or ovoid in shape with indistinct border and slightly eosinophiliccytoplasm. The nuclei were round, oval or spindle in shape with small distinct nucleoli. Warthin-Finkeldey-like multinucleated giant cells were detected in two cases. Mitotic figures were found in 1-22/10 HPF.Immunohistochemical staining showed that CD21 and CD23 (3 of 5), CD35 (4 of 5), D2-40 (4 of 4), andCXCL13 (3 of 4) were positive in neoplastic ceils. EBER was detected in one of five cases by in situhybridization. Four cases were followed-up for 6～25 months and no recurrence or death was observed yet.Conclusion Follicular dendritic cell sarcoma is an extremely rare and should be considered as a moderatelymalignant tumor, and may present histological pelymorphism with certain distinctive features.lmmunohistochemistry is necessary in differential diagnosis to distinguish from other tumors.