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目的：探讨恶性颗粒细胞瘤的病理学诊断和鉴别诊断要点及组织学起源。方法：对３例恶性颗粒细胞瘤进行临床病理、免疫组化及超微结构观察研究。结果：男性２例，女性１例，平均年龄为４９岁。部位分别为颈部１例，右大腿２例。其中２例分别于术后２年半及７年复发，并伴有区域淋巴结转移。组织学上３例与良性颗粒细胞瘤十分相似，局部区域出现梭形瘤细胞，空泡状核及明显的核仁，其中１例在肿瘤的周边部可见到瘤细胞与外周神经束支之间有直接移行关系。免疫酶标结果显示瘤细胞强阳性表达Ｓ－１００蛋白和神经特异性烯醇化酶（ＮＳＥ），１例电镜检测显示胞浆内充满膜包被复合性溶酶体。结论：对临床明显恶性而组织学上却极似良性的恶性颗粒细胞瘤，以下几点能提示恶性诊断：（１）肿瘤超过４ｃｍ；（２）核分裂象超过２个／１０ＨＰＦ；（３）核呈空泡状并有明显的核仁；（４）出现梭形瘤细胞；（５）有肿瘤性坏死。此外，免疫组化标记及超微结构观察有助于鉴别诊断及揭示组织学起源。
Objective: To investigate the pathological diagnosis, differential diagnosis and histological origin of malignant granulosa cell tumor. METHODS: Three cases of malignant granulosa cell tumors were studied for clinical pathology, immunohistochemistry and ultrastructure observation. Results: There were 2 males and 1 female. The average age was 49 years old. The sites were 1 in the neck and 2 in the right thigh. Two of these patients recurred at 2 and a half years and 7 years after operation, with regional lymph node metastasis. Histologically, 3 cases were very similar to benign granulosa cell tumors. There were spindle-shaped tumor cells, vacuolar nucleus and obvious nucleoli in the local area. Among them, 1 case showed tumor cells and peripheral nerve bundle branches in the peripheral part of the tumor. There is a direct transition relationship. The results of immuno-enzyme labeling showed that the tumor cells strongly expressed S-100 protein and nerve-specific enolase (NSE). One case showed electron microscopy showed that the cytoplasm was full of membrane-coated complex lysosomes. Conclusions: For malignant malignant granulosa cell tumors that are clinically malignant and histologically very like benign, the following points can indicate malignant diagnosis: (1) tumors exceeding 4 cm; (2) mitotic figures more than 2/10 HPF; (3) nuclear Was vacuolized with obvious nucleoli; (4) spindle-shaped tumor cells; (5) tumor necrosis. In addition, immunohistochemical markers and ultrastructural observations aid differential diagnosis and reveal histological origin.