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广东省2008年7月病理读片会(三)

 


更新时间:2008-07-16 17:24:14  出片单位:广东省妇幼保健院

 


病史摘要
例1
病理号:077312。患者,女性,32岁,阴道疼痛3月余,无出血。查体:右侧阴道侧壁扪及实性包块,无压痛,欠活动
临床诊断:平滑肌肿瘤?

诊断考虑
1 侵袭性的血管黏液瘤
2 血管肌纤维母细胞瘤
3 黏液性上皮样平滑肌瘤
4 副脊索瘤
5 骨外黏液样软骨肉瘤
6 PECOMA
7 上皮样肿瘤

免疫表型
阳性:EMA, Vimentin, SMA, Desmin, Caldesmon,
CD34, ER, PR
阴性:CK, S-100, HMB45, CD117, p53
Ki-67 index<1%

特殊染色
PAS灶性(+), AB-PAS(+)
最后诊断
(阴道)黏液性上皮样平滑肌瘤(Myxoid epithelioid leiomyoma)
诊断依据
大体:边界尚清实性肿物,切面灰白实性质中,有粘液感
镜下:显著的黏液样背景,肿瘤细胞排列呈巢状、条索状、网状,细胞呈上皮样,细胞之间边界欠清,细胞无异型,核分裂罕见,未见坏死,间质血管不明显
免疫表型:EMA, Vimentin, SMA, Desmin,
Caldesmon为阳性
特殊染色: PAS灶性(+), AB-PAS(+)

Leiomyoma of vulva occurs over a wide age range, but predominantly in the fourth and the fifth decades, typically presenting as a painless, well-circumscried subcutaneous mass that is usually <3cm.
Similar to uterine leiomyoma, tumor may have a spindled (usual) appearance or (rarely) be epitheliod. Common to the vulva, the spindled smoth muscle cells may be seperated by variable amounts of myxohyaline material, which imparts a lacy or plexiform appearance.

Christopher D. M. Fletcher . Diagnostic Histopathology of Tumors, 3rd[M] .Elsevier,2007:741-742.
 

Tumors with three or more of the following criteria should be classified as a sarcoma:
(1)>5cm in size;
(2)infiltrative margins;
(3)>5 mitoses/10 high-power fields;
(4)moderate to severe cytologic atypia

Christopher D. M. Fletcher . Diagnostic Histopathology of Tumors, 3rd[M] .Elsevier,2007:744.
 

鉴别诊断

 

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