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目的探讨组织病理学为小圆细胞的各种鼻颅底恶性肿瘤的特征和诊断中免疫组化指标的选择策略。方法回顾性复习既往10年组织病理学特点为小圆细胞的鼻颅底恶性肿瘤122例,比较组织学特征和免疫组化结果。结果122例患者组织学上是分化差的小圆细胞,全部经免疫组化检测明确诊断,多数患者都在检测5～6个标记物后作出诊断,个别甚至检测20多个标记物才确诊。其中恶性淋巴瘤43例,嗅神经母细胞瘤15例,原始神经外胚叶恶性肿瘤10例,胚胎性横纹肌肉瘤7例,浆细胞瘤4例,间叶性软骨肉瘤3例,尤文氏(Ewing)肉瘤2例,恶性黑色素瘤2例,肝细胞癌颅底转移2例。结论本组患者病理组织学特征可确定病变为小圆细胞恶性肿瘤,但难以单凭此作出具体诊断;根据患者的临床特点和病理组织学特征作出可能的诊断考虑,并据此选择合适的免疫组化指标进行检测,可有效地减少诊断延误,使患者得到及时和准确的治疗。
Objective To investigate the characteristics of various nasal skull base tumors with histopathology of small round cells and to choose the strategy of immunohistochemistry in the diagnosis. Methods A retrospective review of 122 cases of nasal skull base malignant tumors characterized by histopathology in the past 10 years was performed retrospectively. Histological features and immunohistochemical results were compared. Results 122 patients were histologically poorly differentiated small round cells, all confirmed by immunohistochemical detection, most patients were detected after the detection of 5-6 markers, some even detected more than 20 markers before the diagnosis. Including 43 cases of malignant lymphoma, olfactory neuroblastoma in 15 cases, 10 cases of primitive neuroectodermal malignancy in 10 cases, 7 cases of embryonal rhabdomyosarcoma, plasmacytoma in 4 cases, mesenchymal sarcoma in 3 cases, Ewing ) Sarcoma in 2 cases, 2 cases of malignant melanoma, 2 cases of hepatocellular carcinoma skull base metastasis. Conclusion The histopathological features of this group of patients can be confirmed as small-cell malignant tumor, but it is difficult to make a specific diagnosis alone. According to the clinical features and histopathological characteristics of patients, possible diagnostic considerations and the appropriate choice of immune Tissue indicators for testing, which can effectively reduce the diagnosis delay, so that patients receive timely and accurate treatment.