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目的:探讨鼻腔鼻窦畸胎癌肉瘤(SNTCS)的临床病理学特征、免疫学表型、诊断及鉴别诊断。方法:分析1例SNTCS的临床表现,对标本进行病理学和免疫组织化学(SP法)染色观察并复习相关文献。结果:肿瘤组织由3个胚层构成,有外胚层的成熟和未成熟的鳞状细胞巢、神经上皮细胞团及嗅母细胞样细胞,中胚层的肉瘤样成分和骨组织,以及内胚层的呼吸道上皮及腺管样结构,部分为腺癌;其中幼稚的透明细胞鳞状细胞巢非常具有特征性。此外,尚可见弥漫大片胞质丰富的淡染区及胞质较少的深染区,二者疏密有间。免疫组织化学染色显示不同的胚层对应相应的免疫标记,鳞状上皮、腺上皮和呼吸道上皮CK、EMA等阳性,神经上皮细胞团及嗅母细胞样细胞S-100、NSE、Syn等阳性,肉瘤样区Vim阳性,淡染区Vim、CD99及CK等不同程度阳性,深染区NSE和GFAP阳性。结论:SNTCS是具有畸胎瘤和癌肉瘤特征的罕见恶性肿瘤,具有特征性的组织病理学和免疫组织化学染色特点,应多取材多切片,以免误诊和漏诊。
Objective: To investigate the clinical and pathological features, immunological phenotype, diagnosis and differential diagnosis of nasal sinuses teratogenic carcinosarcoma (SNTCS). Methods: The clinical manifestations of 1 case of SNTCS were analyzed. The specimens were observed by pathology and immunohistochemical staining (SP method) and reviewed the relevant literature. Results: Tumor tissues consisted of 3 germ layers with mature and immature squamous cell nests of ectoderm, neuroepithelial cell clusters and odontoblast-like cells, mesodermal sarcomatoid components and bone tissue, and endoderm respiratory Epithelial and duct-like structure, part of the adenocarcinoma; which naive clear cell squamous cell very characteristic. In addition, still visible diffuse large cytoplasm rich light stained area and dark cytoplasm less stained area, the two are dense. Immunohistochemical staining showed that different germ layers corresponded to the corresponding immunolabeling, positive of squamous epithelium, glandular epithelium, and epithelial cells of the respiratory tract such as CK and EMA, neuronal epithelial cell mass and the positive of S-100, NSE, Syn and other sarcoma Vim positive samples, light staining areas Vim, CD99 and CK were positive to varying degrees, deep staining area NSE and GFAP positive. CONCLUSIONS: SNTCS is a rare malignant tumor characterized by teratoma and carcinosarcoma. It has characteristic histopathological and immunohistochemical staining features. Multiple sections should be taken to avoid misdiagnosis and missed diagnosis.