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- 舌背部肿物
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lanyueliang 离线
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请见文献中病例
Shogo Tajima & Kenji Koda, A case of a CD56-expressing ectomesenchymal chondromyxoid tumor of the tongue: potential diagnostic usefulness of commonly available CD56 over CD57. Int J Clin Exp Pathol 2015;8(3):3328-3333
Ectomesenchymal chondromyxoid tumors (ECTs) are rare. Only approximately 55 cases have been reported in the English literature. Distinguishing ECTs from soft tissue myoepithelioma (STM) is often difficult owing to morphological and immunohistochemical similarities. Here, we present a case of an ECT arising from the anterior dorsum of the tongue in a 24-year-old woman. Grossly, the tumor was soft, had a myxoid appearance, and measured 8 × 7 × 7 mm. Microscopically, it was well-demarcated, lacked a fibrous capsule, and predominantly consisted of short, spindle to ovoid cells in a myxoid background. Vimentin, glial fibrillary acidic protein (GFAP), and S-100 protein were strongly positive on immunohistochemical analysis. While CD56 was moderately immunopositive, cytokeratin (AE1/AE3) and alpha-smooth muscle actin (αSMA) showed focal weak positivity. Thus, the immunohistochemical findings suggested a diverse immunophenotype, indicating mesenchymal (vimentin and αSMA positive), neurogenic (S100, GFAP, and CD56 positive), and epithelial differentiation (cytokeratin positive). This reflected the fact that ECTs probably arise from uncommitted ectomesenchymal cells that have the potential for multilineage differentiation. The immunohistochemical staining pattern observed for ECTs slightly differs from that of STMs. Strongly positive staining for GFAP and weakly positive staining for cytokeratin are observed in ECTs, whereas the opposite is typically observed for STMs. These findings indicated that the patterns of expression on immunohistochemistry differ between ECTs and STMs, although inevitably, there was some overlap. Thus, CD56 expression in the case presented here is noteworthy, and it could potentially become an adjunct diagnostic marker for ECT instead of previously used CD57.
- 王军臣
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本帖最后由 海上明月 于 2015-10-15 21:30:38 编辑
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- 【定义】发生在舌前部的良性外胚间叶软骨黏液样肿瘤。
- 【流行病学】在1995年，首次有19例病例报道。后来，陆续又有一些病例的报道。报道年龄范围从9到78岁，无性别倾向。
- 【临床特点】 多数肿瘤为存在于舌背黏膜前部无症状的，缓慢生长的实性结节，质硬或软，有弹性。
- 【大体检查】切面为胶冻样，偶有出血灶。
- 【组织病理学】
- 肿瘤通常界限清楚，但无包膜。有时，肌纤维和神经束内陷在肿瘤内。肿瘤由圆形，杯状，纺锤形或多边形细胞构成，细胞核大小一致，有中等含量弱嗜碱性的胞质。有些肿瘤核有多形性，染色质密集，多个核，但有丝分裂少见。另外，有报道出现黏液囊肿样的改变。pH 0.4和2.5时阿尔辛蓝染色阳性，但细胞外基质黏蛋白卡红弱阳性。PAS染色阴性。在镜下鉴别诊断中，应排外其他黏液性或软骨性疾病，如局灶性黏蛋白沉积症、黏液潴留、软组织黏液瘤、神经鞘黏液瘤、纤维性病变的黏液变性、软骨肉瘤、软骨样迷芽瘤和多形性腺瘤或来源于小涎腺肌上皮瘤的变异。
- 【免疫表型】在几乎所有报道的病例中，多克隆和单克隆抗神经胶质酸性蛋白(GFAP)反应阳性，大多数病例中抗角蛋白单克隆抗体阳性，而S-100、CD57和平滑肌肌动蛋白染色结果不一致。
- 【组织发生】瘤细胞可能来源于未分化的外胚间叶前体细胞，从神经嵴迁移而来。
- 【预后及预测因素】治疗方法采用外科切除，复发率非常低。
- ----摘自网络
- 【定义】发生在舌前部的良性外胚间叶软骨黏液样肿瘤。
口腔——舌前部外胚间叶软骨黏液样瘤
- 王军臣
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本帖最后由 海上明月 于 2015-09-15 23:23:56 编辑
从生长方式、粘液样基质、细胞形态和增殖活性看，初步考虑为中间型软组织肿瘤（低度恶心潜能）。具体分类，就目前的资料有点困难。间叶源性的可能性大，神经源性也需要鉴别或排除。
有没有如下标记呢？
CD68（Kp-1）
CD57
NF
B-catenin
melanin A
CK5
试试看。
SMA和calponin的标记有点矛盾。能否标记MSA重复一下。
等候，再分析。
谢谢！
- 王军臣
