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- 2012年第24期--右声带肿块（已点评）
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SMA
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<< ）
标签：肿块
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本帖最后由 草原 于 2012-07-10 22:26:10 编辑
- 只要你的脚还在地面上，就别把自己看得太轻；只要你还生活在地球上，就别把自己看得太大
×参考诊断
炎性肌纤维母细胞瘤
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本帖最后由 草原 于 2012-07-10 22:24:01 编辑
可考虑符合炎性肌纤维母细胞瘤。
依据是镜下病变位于黏膜下，可见梭形细胞较弥漫性增生，形态符合肌纤维母细胞分化，核仁明显，免疫组化染色SMA明显阳性；背景中可见少量慢性炎症细胞浸润。进一步完善免疫组化染色可协助诊断，Desmin可有不同程度的表达，CK可灶状阳性或阴性。如S-100 阴性可除外神经分化肿瘤。此例为梭形细胞另外分子遗传学改变可见间变性淋巴瘤激酶(ALK)基因重排和表达、ALK基因和Rb-2蛋白基因融合。
鉴别诊断如下：纤维组织细胞瘤和纤维组织细胞肉瘤。本例病变内可见少数多核巨细胞，考虑符合为反应性改变，偶见核分裂象，不太支持恶纤组。病史较长可除外结节性筋膜炎。梭形细胞癌CK多阳性。被覆鳞状上皮增生，其异型性不明显，符合徦上皮瘤样增生。喉部平滑肌肉瘤罕见，形态应更一致，核端钝圆一些。
Renghis回复较全面
仅供参考！
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.
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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.
