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性别 | 女 | 年龄 | 61岁 | 临床诊断 | 待查 |
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一般病史 | 绝经15年,发现“阴道壁囊肿”5年 | ||||
标本名称 | 阴道壁囊肿 | ||||
大体所见 | 亮白色实性包块1枚,3.5cm×3cm×2.5cm,切片亮白色,质软,中心稍韧。 |
本例图片采用麦克奥迪MoticBA410显微镜+MoticamPro285A摄像头采集制作。
点评专家:王曦(60楼 链接:>>点击查看<< )
获奖名单:lanyueliang(15楼 链接:>>点击查看<< )
知之者不如好之者,好之者不如乐之者。(语出幽梦影)
xiajuan_0502 离线
以下为译文,请大家指正:
此病变的鉴别诊断包括:1)浸袭性血管粘液瘤;2)纤维上皮性息肉;3)血管肌纤维母细胞瘤;4)富于细胞性血管纤维瘤;5)浅表性血管粘液瘤;6)浅表性肌纤维母细胞瘤及7)平滑肌瘤。事实上,第2至6项其形态学和IHC非常类似,仅有细微的差异。部分病理学家认为是起源于同一干细胞具有不同的分化倾向。因此,我认为关键是认识到其为良性及其属于此类范畴,至于确切的名称并不重要。原单位诊断“浅表性肌纤维母细胞瘤”,肿瘤细胞ER、PR及desmin呈阳性,CD34和caldesmon阴性。我同意此诊断,因为肿瘤分界清楚,有一纤细的间质束将其与粘膜分开(因此不是1项,也不是2项),血管不明显,尽管存在,但没有明显的血管周上皮样细胞可见(因此不是3至5项)。免疫组化结果与此病变相符。但并不排除其它诊断。乳腺的肌纤维母细胞瘤,与此基本是同一病变,但乳腺外其形态学多变,CD34可阴性或阳性。
无疑,对于本病例无人做出确切诊断,但这不重要,我认为Lanyueliang的分析非常好,所以我推荐其为获奖者。
The differential diagnosis for this kind of lesion in this location includes 1) aggressive angiomyxoma, 2) fibroepithelial stromal polyp, 3) angiomyofibroblastoma, 4) cellular angiofibroma, 5) superficial angiomyxoma, 6) superficial myofibroblastoma, and 7) leiomyoma. To be honest, at least for #2 to #6, their morphology and IHC pattern are quite similar, often with only subtle differences. Some pathologists would consider them as from the same stem cell origin with variable tendency of differentiation. Therefore, I would think it is more important to recognize that it is benign, and it is in this category. What exactly the name to use is not really that important. Having said that, the original hospital's diagnosis for this case is "superficial myofibroblastoma". The tumor cells are reported to be positive for ER, PR and desmin, negative for CD34 and caldesmon. I would agree with this diagnosis, as the tumor appears demarcated with a thin rim of stroma to separate it from the mucosa (so not the #1, may not be the #2), the vasculature is not prominent, even though exists, and no apparent perivascular epithelioid cells seen (so may not be #3-5). The staining pattern is consistent with this entity, even though not necessarily exclude others either. You probably have heard of myofibroblastoma from breast pathology. This is pretty much the same entity, but outside of mammary gland. It can have variable morphological pattern, and CD34 could be positive or negative.
Of course, no one has really made the exact call in this case. But as I said, it does not really matter. I think Lanyueliang did very well with the analysis of this case, so I would recommend he/she be the winner.
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