男，50岁，声嘶半年，右侧声带肿物大小1*0.8cm

本例图片采用麦克奥迪MoticBA410显微镜+MoticPro285A摄像头采集制作。

点评专家：刘红刚（38楼  链接：>>点击查看<< ）

获奖名单：Renghis（6楼  链接：>>点击查看<< ）

支持：假肉瘤性肌纤维母细胞性增生，或称为非典型性纤维性息肉（atypical fibrous polyp）。本例除间质增生，表面上皮也呈假上皮瘤样增生。要是肿瘤，表面上皮往往会萎缩。

非典型性纤维性息肉

炎性肌纤维母细胞瘤

atypical fibrous polyp, the tumor size, pattern and all appearence don't favor of the diagnosis of IMT.

爱恋老师：您好！你是李老师吧！好久不见！我是进修医生。

您好，请问您哪个医院的进修医生呢，我不是李老师哦

建议排除树突细胞肿瘤

考虑是良性病变，鳞状上皮下是增生的肌纤维母细胞，应该同时表达SMA和VIMENTIN。

Inflammatory Myofibroblastic Tumor

The characteristic histologic finding is an unencapsulated,loosely organized proliferation of spindle-shaped cells in a myxoid or fibrous vascular background stroma, with variable inflammatory cells and occasionally collagen deposition and calcifications.A storiform to fascicular pattern may be seen. The myofibroblasts have round to oval nuclei with dense chromatin (and an often prominent nucleolus), surrounded by ample cytoplasm and frequently with long cytoplasmic extensions (“tadpole cells”; see figure 1). Remarkable atypia may be seen, but the cells generally maintain a normal nuclear-to-cytoplasmic ratio. Mitotic figures may be seen, but they are not increased or atypical.
The inflammatory infiltrate is inconstant and includes lymphocytes,plasma cells, histiocytes, and eosinophils. The proliferation respects the surface epithelium and surroundingmesenchymal tissues.

考虑为非典型性纤维组织细胞瘤；

1.瘤体小，最大径1cm；2.表面被覆黏膜完整，未见溃疡；3.瘤细胞短束状，隐约旋涡状排列，且排列较紧密，为长梭形、胖梭形、上皮样及多核巨细胞等，间质血管不是很丰富，以小近圆形的血管多见，间质炎症浸润较明显；4.IHC：CD68+、SMA+、CD34-、Ki-67标记指数近于0%，IHC上皮标记阴性，不支持肉瘤样癌。

鉴别诊断：.炎性肌纤维母细胞瘤：非典型性纤维性息肉等。

感觉象良性病变，因为是一突出小肿物所以愿意考虑非典型纤维性息肉 不是很想考虑炎性肌纤维母

Inflammatory Myofibroblastic Tumor

The characteristic histologic finding is an unencapsulated,loosely organized proliferation of spindle-shaped cells in a myxoid or fibrous vascular background stroma, with variable inflammatory cells and occasionally collagen deposition and calcifications.A storiform to fascicular pattern may be seen. The myofibroblasts have round to oval nuclei with dense chromatin (and an often prominent nucleolus), surrounded by ample cytoplasm and frequently with long cytoplasmic extensions (“tadpole cells”; see figure 1). Remarkable atypia may be seen, but the cells generally maintain a normal nuclear-to-cytoplasmic ratio. Mitotic figures may be seen, but they are not increased or atypical.
The inflammatory infiltrate is inconstant and includes lymphocytes,plasma cells, histiocytes, and eosinophils. The proliferation respects the surface epithelium and surroundingmesenchymal tissues.

上皮的标记做了几种，都是阴性，但是没做EMA，我们有过CK- 而EMA+的肉瘤样癌，是否需要加做一下，总感觉梭形细胞有异型，核裂易见，与鳞状上皮的关系很融洽，不能排除恶性。

同意炎症性肌纤维母细胞瘤

 同意炎性肌纤维母细胞瘤，鳞状上皮本身不够癌。

炎症性及纤维母细胞瘤，加做ALK

学习了

非常感谢刘红刚老师在百忙之中作出的精彩点评！感谢广大网友的积极参与！谢谢永恒爱恋提供的好病例供大家学习！

呵呵，学习了，IMT