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目的探讨肾上腺皮质癌(ACC)皮肤转移的临床表现、病理学特点及诊断,提高对本病的认识。方法分析1例ACC皮肤转移的临床表现、组织病理及免疫组织化学,复习相关文献并进行讨论。结果患者右臀部肿物进行性增大伴轻度疼痛1月余。ACC行腹腔镜下左肾上腺区肿瘤切除术2年。皮肤科情况:右臀部为一直径约5cm近圆形暗红色肿块,局部皮温略高,质地硬,境界较清楚,压痛明显。肿块组织病理示:真皮内可见境界清楚的肿瘤细胞团块,细胞核大,圆形或椭圆形,呈不典型性,有核丝分裂相,胞浆丰富呈嗜酸性或淡染;免疫组织化学染色示:肿瘤细胞Synaptophysin,Vimentin强阳性;Calretinin,Inhibin阳性;Chromogranin A,SMA,CD10,CK,S100,HMB45,Melan A,Desmin,CEA均阴性。结合免疫组织化学和病史,符合ACC皮肤转移。结论 ACC皮肤转移国内尚未见报道,国外罕有报道。组织病理及免疫组织化学对本病的诊断及鉴别诊断有重要作用。
Objective To investigate the clinical manifestations, pathological features and diagnosis of adrenocortical carcinoma (ACC) skin metastasis and to improve the understanding of this disease. Methods The clinical manifestations, histopathology and immunohistochemistry of 1 case of ACC skin metastasis were analyzed and the related literatures were reviewed and discussed. Results patients with right hip mass progressive increase with mild pain more than 1 month. ACC laparoscopic left adrenal area tumor resection for 2 years. Dermatology: the right hip is a diameter of about 5cm round, dark red mass, the local skin temperature slightly higher, hard texture, the state more clearly, tenderness significantly. Histopathological examination of the tumor showed that there were clear tumor cells in the dermis. The nuclei were large, round or oval in shape, and were atypical, with mitotic phases and abundant cytoplasm showing eosinophilic or light staining. Immunohistochemical staining The tumor cells were strongly positive for Synaptophysin and Vimentin; Calretinin and Inhibin were positive; Chromogranin A, SMA, CD10, CK, S100, HMB45, Melan A, Desmin and CEA were all negative. Combined with immunohistochemistry and history, consistent with ACC skin metastasis. Conclusions ACC skin metastasis has not been reported in China and rarely reported abroad. Histopathology and immunohistochemistry have an important role in the diagnosis and differential diagnosis of this disease.