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目的探讨肝组织细胞肉瘤(HS)的临床病理学特征、免疫组化及其鉴别诊断。方法收集2例原发性肝HS的临床和病理资料,进行影像学和光镜观察及免疫组化染色,并复习相关文献。结果 2例HS均为男性,年龄分别为50岁和51岁。患者均表现为右上腹部疼痛不适。影像学示肝右叶占位。镜下肿瘤与周围肝组织分界不清,呈侵袭性生长;肿瘤细胞弥漫分布,体积大、圆形或椭圆形,大部分区域瘤细胞黏附性差;瘤细胞胞质丰富、嗜伊红,部分呈泡沫状或充满微空泡;亦可见多核瘤巨细胞,部分瘤巨细胞内可见吞噬的红细胞;背景中常见小淋巴细胞、浆细胞、中性及嗜酸性粒细胞等反应性细胞。免疫组化示肿瘤细胞CD68、CD163和lysozyme(+);CK、Her Par-1、AFP、HMB45、CD3、CD20、CD1a、CD21、CD35和MPO均(-)。结论肝HS是一种极其罕见的淋巴组织恶性肿瘤,仅从组织形态学上难与滤泡树突细胞肉瘤、恶性黑色素瘤、淋巴瘤、透明细胞型肝细胞癌等相鉴别,诊断与鉴别诊断还依赖于组织形态与免疫组化结果。目前对组织细胞肉瘤尚无统一的确切的治疗方案,预后较差。
Objective To investigate the clinicopathological characteristics, immunohistochemistry and differential diagnosis of hepatocellular sarcoma (HS). Methods The clinical and pathological data of 2 cases of primary liver HS were collected and observed by imaging and light microscopy and immunohistochemistry. The related literatures were reviewed. Results Two cases of HS were male and the age was 50 years old and 51 years old respectively. Patients showed a right upper quadrant pain and discomfort. Image shows the right lobe of the liver. Microscopic tumor and the surrounding liver tissue unclear boundaries, was invasive growth; tumor cells diffuse distribution, bulky, round or oval, tumor adhesion in most areas is poor; tumor cells cytoplasm rich, eosinophilic, some were Foamy or filled with micro-vacuoles; also visible multi-nuclear giant cell tumor cells, some tumor giant cells can be seen phagocytosed red blood cells; common background small lymphocytes, plasma cells, neutral and eosinophils and other reactive cells. Immunohistochemistry showed that the tumor cells CD68, CD163 and lysozyme (+); CK, Her Par-1, AFP, HMB45, CD3, CD20, CD1a, CD21, CD35 and MPO both (-). Conclusions Hepatic HS is an extremely rare malignant tumor of lymphoid tissue. It is difficult to diagnose and differentiate only HSC from follicular dendritic cell sarcoma, malignant melanoma, lymphoma and clear cell hepatocellular carcinoma It also depends on the morphology and immunohistochemistry results. At present there is no uniform treatment of cell sarcoma, the prognosis is poor.