摘要
目的对局限型腱鞘巨细胞瘤(localized-type giant cell tumor of tendon sheath,L-GCTS)与色素绒毛结节性滑膜炎(pigmented villonodular synvitis,PVNS)进行临床病理比较研究,并探讨两者之间的关系。方法收集2007—2016年山东大学齐鲁医院东营分院手术切除的L-GCTS 54例,选择16例L-GCTS和10例PVNS进行免疫组化染色,分析其临床病理特征,并复习相关文献。结果L-GCTS好发于手指及足趾小关节,患者多以生长缓慢的无痛性肿块为主要临床表现。PVNS好发于膝、髋、肩、踝等大关节,患者多以患处疼痛、肿胀和功能障碍为主要临床表现。L-GCTS主要由大的滑膜样单核细胞、小的组织细胞样单核细胞、泡沫细胞、纤维母细胞、破骨细胞样多核巨细胞及各种炎细胞构成。免疫组化显示:clusterin在滑膜样大单核细胞中呈强阳性表达,CD163在组织细胞样小单核细胞中呈强阳性表达。PVNS主要由被覆单层或复层滑膜样上皮、含有丰富小血管和炎细胞的绒毛结节状结构构成。含铁血黄素较多,但破骨细胞样多核巨细胞较少。SMA和CD34能反映出阳性的小血管数量明显增多。L-GCTS仅用关节镜行滑膜切除术可达到较满意的疗效,且复发率很低。PVNS复发率较高,易用开放式滑膜切除术治疗,必要时需辅以放射治疗或新型系统治疗。结论L-GCTS和PVNS均为起源于关节滑膜、滑囊或腱鞘的病变,但其发生部位、临床及病理特征均有明显差异。L-GCTS可能是一种显示滑膜分化的肿瘤,而PVNS可能有不同的亚型,一种为反应性炎症性病变,另外亚型可能为D-GCTS。
Objective To carry out a clinicopathologic comparative study of the localized-type giant cell tumor of tendon sheath(L-GCTS)and pigmented villonodular synvitis(PVNS),and to discuss the relation between them.Methods A total of 54 cases of L-GCTS and 10 cases of PVNS were selected from Qilu Hospital of Shandong University at Dongying from 2007 to 2016.Immunohistochemical study was performed in 16 cases of L-GCTS and 10 cases of PVNS.The clinicopathologic features were analyzed and the relevant literature was reviewed.Results L-GCTS was mostly seen at the small joints of the fingers and toes.The main clinical manifestation were slow growth painless mass.PVNS was well distributed in knee,hip,shoulder,ankle and other large joints.The main clinical manifestation were pain,swelling and dysfunction in the affected area.L-GCTS were mainly composed of large synovial-like mononuclear cells,small histiocytoid cells,foamy cells,fibroblasts,osteoclasts-like giant cell and various inflammatory cells.Immunohistchemistry showed that clusterin was strong positive in large synovial-like mononuclear cell and CD163 was strongly positive in small histiocytoid cells.PVNS were mainly composed of the villonodular structure of a single or complex lamella epithelium in which there were rich small vessels and inflammatory cells.There were more hemosiderin,but there were fewer osteoclasts-like giant cells.SMA and CD34 showed a significant increase in the number of small vessels that were positive.L-GCTS only used arthroscopic synovectomy to achieve satisfactory result,and the recurrence rate was very low.PVNS recurrence rate was higher,and it was easy to use open synovial excision treatment,radiotherapy or novel systemic therapy is required on occasion.Conclusion L-GCTS and PVNS are all lesion derived from synovium of the joint,bursa mucosa or tendon sheath.Howerver,there are significant differences in the location and clinicopathologic features.L-GCTS may be a tumor that shows synovial differentiation.PVNS may have different subtypes:one is reactive inflammatory lesions,and the other subtypes may be D-GCTS.
作者
丁洪基
王贵珍
王灿
李龙龙
张迪
孙鹏飞
DING Hong-ji;WANG Gui-zhen;WANG Can;LI Long-long;ZHANG Di;SUN Peng-fei(Department of Pathology,Qilu Hospital of Shandong University at Dongying,Dongying 257000,China;Department of Clinical Laboratory,Qilu Hospital of Shandong University at Dongying,Dongying 257000,China)
出处
《诊断病理学杂志》
2021年第11期897-902,共6页
Chinese Journal of Diagnostic Pathology
关键词
腱鞘
巨细胞瘤
滑膜炎
绒毛结节
免疫组织化学
Tendon sheath
Giant cell tumor
Synvitis
Villonodular
Immunohistchemistry
