摘要
目的探讨成人肺部炎性肌纤维母细胞瘤(inflammatory myofibroblastic tumor,IMT)的临床病理学特征、鉴别诊断及预后。方法收集25例成人肺部IMT手术切除标本,分析其临床病理学特征及影像学表现,采用免疫组化法对25成人肺部IMT进行检测,并复习相关文献。结果25例肺部IMT中男性11例,女性14例,年龄19~62岁,平均41岁。肿瘤最大径0.8~6.0 cm,平均2.8 cm。CT表现为境界清楚的实性结节,周围型占84%(21/25),中央型占16%(4/25)。镜下表现为呈束状排列的梭形细胞,细胞较丰富,异型性不明显或轻度异型,1例部分细胞明显异型,可见核深染、泡状核及核仁,4例见核分裂(4/25),数量1~4个/10 HPF,间质散在分布浆细胞及淋巴细胞,可见杜顿样多核巨细胞,免疫表型:肿瘤细胞vimentin(25/25)、ALK-D5F3(22/25)、SMA(18/25)、desmin(5/25)、S-100(4/25)、CD34(2/25)和BCL-2(4/25)阳性,CK均阴性,Ki-67增殖指数为0~1%。患者术后随访1~124个月,均无复发或死亡。结论肺部IMT是一种少见的间叶源性肿瘤,预后良好,镜下肿瘤细胞病理特征及ALK-D5F3、SMA等免疫组化标记在诊断中有重要价值。
Purpose To investigate the clinicopathological features,differential diagnosis,and prognosis of inflammatory myofibroblastic tumor(IMT)in adults.Methods A total of twenty-five adult pulmonary IMT surgical resection cases were collected,the clinical and radiologic features were reviewed,the histological sections and immunohistochemical staining were analyzed,with review of the literature.Results There were 11 males and 14 females in the twenty-five cases,and the age of the patients ranged from 19 to 62 years,with an average age of 41 years.The diameter of the tumor was 0.8-6.0 cm,and the average diameter was 2.8 cm.The CT showed solid nodules with clear demarcation.The peripheral type accounted for 84%,and the central type accounted for 16%.Microscopically,the tumor showed spindle cells arranged in fascicles,with abundant cells,no atypia or mild atypia.Tumor cells in one case were atypia,with hyperchromatic nuclei,vesicular nuclei,and nucleoli.Four cases(16%)showed mitoses,ranging 1-4/10 HPF.Plasma cells and lymphocytes were scattered in the tumor stroma,and Dutton-like multinucleated giant cells were noted.Immunohistochemistry demonstrated the tumor cells were positive for vimentin(25/25),ALK-D5F3(22/25),SMA(18/25),desmin(5/25),S-100(4/25),CD34(2/25)and BCL-2(4/25),but negative for CK,and Ki-67 was 0-1%.There was no recurrence or death in the follow-up period of 1-124 months after surgical resection.Conclusion Pulmonary IMT is a rare mesenchymal tumor with good prognosis.Microscopically,the tumor cells are spindle-shaped,abundant,and arranged in bundles,and the infiltration of lymphocytes and plasma cells can be seen in the interstitium.Immunohistochemical markers such as ALK-D5F3 and SMA are of great value in the diagnosis of IMT.
作者
王冉月
武春燕
侯立坤
谢惠康
董正伟
张伟
张莉萍
WANG Ran-yue;WU Chun-yan;HOU Li-kun;XIE Hui-kang;DONG Zheng-wei;ZHANG Wei;ZHANG Li-ping(Department of Pathology,Tongji University Affiliated Shanghai Pulmonary Hospital,Shanghai 200433,China)
出处
《临床与实验病理学杂志》
CAS
CSCD
北大核心
2022年第10期1213-1216,共4页
Chinese Journal of Clinical and Experimental Pathology
基金
上海肺科医院发展基金。
关键词
肺肿瘤
炎性肌纤维母细胞瘤
免疫组织化学
lung neoplasms
inflammatory myofibroblastic tumor
immunohistochemistry
