学习了,谢谢

 学习了

  学习了,谢谢

 

学习了，谢谢！

 学习了,谢谢.

 不过副节瘤有时会有很多核分裂，坏死，细胞异型性很大，甚至有瘤巨细胞，这都不是恶性的指证吧，希望高手指点。

 学习了

 有明确的远隔器官转移吗？怎么诊断恶性的了？

学习

This clearly malignant neoplasm seems to be focally circumscribed, focally necrotic and involving the subcutis. Is this mainly a skin (dermis) tumor or a soft tissue (subcutis) tumor? There are no histopathologic features of glandular or squamous or differentiated mesenchymal differentiation. Possibilities are many, including and not limited to lymphoma (such as anaplastic large cell lymphoma), metastatic poorly differentiated carcinoma, melanoma/clear cell sarcoma of tendon sheath and aponeurosis, metastatic neuroendocrine neoplasm, and, less likely, alveolar soft part sarcoma. Is there any pertinent clinical history (previously known cancer, other organs [like ovary] involved by tumor, etc.)? The architectural pattern, nuclear features, anatomic location, and patient's age are not supportive of alveolar rhabdomyosarcoma, Merkel cell carcinoma or desmoplastic small round cell tumor. Without additional clues, immunohistochemistry is essential in differential diagnosis. I would start with the following panel and determine whether further workup is necessariy after first results are evaluated - cytokeratin (AE1/AE3), CD45, CD30, EMA, CD3, CD45RO, CD20, CD79a, S100, synaptophysin, and NSE. This may be criticized as an expensive "shot gun" approach, but on a difficult case like this we as pathologists have to try our best to characterize the seemingly unknown. 学习mjma老师的讲解并试译如下：
这一明显恶性的肿瘤似乎有局部边界、局部坏死并累犯上皮下层。这是上皮性肿瘤还是软组织肿瘤？没有腺体或鳞状细胞或间质分化的组织学特征。可能的诊断有很多，包括但不仅限于：淋巴瘤（如间变性大细胞淋巴瘤）、转移性低分化癌、腱鞘和腱膜的黑色素瘤/透明细胞肉瘤、转移性神经内分泌肿瘤，以及可能性小的腺泡状软组织肉瘤。是否有恰当的临床病史（先前存在癌、其它器官如卵巢被肿瘤累犯，等等）？组织结构、核特征、解剖部位、患者年龄均不支持腺泡状横纹肌肉瘤、Merkel细胞癌或促结缔组织增生性小圆细胞肿瘤。如果没有其它线索，免疫组化的鉴别意义就显得重要。我会先做下面一组免疫组化，再决定是否需要做进一步工作：CK(AE1/AE3), CD45, CD30, EMA, CD3, CD45RO, CD20, CD79a, S100, Syn, NSE. 这可能被批评为费钱的“撒大网”的方法，但对于这样一个困难病例，我们病理医生必须尽力去寻找未知病变的特征。(abin)