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What's the appropriate frozen section diagnosis?

What's your best guess?

Hemangiopericytoma or malignant solitary fibrous tumor, probably low grade, but careful mitotic count is needed for this determination. 

 试着说说

首先考虑为恶性间叶组织肿瘤。

倾向恶性神经鞘瘤、恶性SFT、纤维肉瘤，需免疫组化鉴别。

 胶原组织在里面， 还有图四有局部的HPC样血管。

以下是引用mjma在2009-11-14 8:53:00的发言： Hemangiopericytoma or malignant solitary fibrous tumor, probably low grade, but careful mitotic count is needed for this determination.

除此之外,是否还需要排除滑膜肉瘤?

需要做免疫组化鉴别:CD34,CK7,CK19,BCL-2,CD99,EMA,VIM,S-1OO,DES,等.

My impression based on the FS photomicrographs was made boldly with a hunch and aided by the excellent FS quality. In real practice I would have been more cautious. The high cellularity of the neoplasm, a vague storiform growth pattern, vacuolated cytoplasm seen at least focally, thick collagenous fibers, and many collapsed small vessels (capillaries). While all of these are consistent with a few types of soft tissue neoplasm, I was most impressed by the last high power photo of FS - it looks just like the hemangiopericytoma I am familiar with. The anatomic location and patient's old age should bring out a few differential diagnoses with such a hypercellular spindle cell neoplasm. Others aside, I will say that cells in sarcomatoid synovial sarcoma and malignant peripheral nerve sheath tumor usually are more uniform in the nuclear size and shape (elongated or oval) and more intersecting and fascicular in architecture. Cells in hemangiopericytomas have moderately pleomorphic nuclear size and shape, and they can display storiform growth and clear cells focally. Immunohistochemical confirmation on permanent sections is needed without exception.

 冰冻切片报告间叶源性恶性肿瘤就可以，诊断与鉴别诊断待常规石蜡切片及免疫组化。

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