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目的:探讨皮肤平滑肌肉瘤的临床病理特点和诊断要点及预后。方法:对2例皮肤平滑肌肉瘤组织病理学、免疫组化观察,并复习相关文献。结果:例1为皮下平滑肌肉瘤,具有结节型的生长形态,瘤细胞丰富,异型性较大,核分裂活跃;例2为真皮平滑肌肉瘤,具有弥漫型的生长形态,瘤细胞较少,分化好,核分裂象不明显。免疫组化2例均表达SMA、MSA、Vim,1例灶性表达Desmin。2例随访迄今均无复发及转移。结论:皮肤平滑肌肉瘤少见,可分为真皮和皮下两种类型,两者具有不同的组织起源和预后特点,我们要注意区分,诊断除核分裂象计数外,尚需进行综合评估,对某些病例建议采用恶性潜能未定的平滑肌肉瘤的诊断,治疗首选外科手术切除。
Objective: To investigate the clinicopathological features, diagnosis points and prognosis of leiomyosarcoma in skin. Methods: Two cases of skin leiomyosarcoma histopathological and immunohistochemical observation, and review the relevant literature. Results: Example 1 is subcutaneous leiomyosarcoma, with nodular growth morphology, rich tumor cells, atypia, mitotic activity; Example 2 dermal leiomyosarcoma with diffuse growth morphology, less tumor cells, well differentiated , Mitosis is not obvious. Two cases of immunohistochemical expression of SMA, MSA, Vim, 1 case of focal expression Desmin. No recurrence and metastasis occurred in 2 cases so far. Conclusions: Skin leiomyosarcoma is rare and can be divided into two types: dermis and subcutaneous. Both of them have different origins and prognoses. We should pay attention to the distinction and diagnosis except for mitosis count, and still need to make a comprehensive assessment. In some cases It is recommended to use the diagnosis of malignant potential undetermined leiomyosarcoma, the preferred surgical resection.