本帖最后由 pathology 于 2016-1-16 17:23 编辑
本周病例(2015.12.7—2015.12.13)
1、你考虑什么诊断?
(回肠)骨外骨肉瘤(Extraskeletal osteosarcoma)
本例免疫组化:Vim(+)、SOX9(+)、PCK(-)、EMA(-)、DOG1(-)、CD117(-)、CD34(-)、S-100(-)、Desmin(-)、SMA(-)、Mart-1(-)、HMB45(-)、beta-catenin(-)、CD56(-)、Syn(-)、LCA(-)、Ki-67 index 5-10%
Extraskeletal osteosarcoma (ESOS) is a rare soft tissue tumor which constitutes ~4% of osteosarcomas. ESOS affects an older age group than osteosarcoma of bone (median age is 61 years), and shows a male preponderance (male to female ratio 1.9:1). The most commonly affected sites are the thigh and buttocks, followed by the retroperitoneum. Presentation in the mesentery is rare, with only 6 cases reported in the literature. ESOS may also arise from other unusual sites, including breast, cerebellum, esophagus, gallbladder, hand, liver, kidney, larynx, parotid gland, small intestine and uterus.
2、需要做什么鉴别诊断?
GIST、肉瘤样癌、未分化多形性肉瘤、钙化性纤维性假瘤、NHL、转移性肿瘤等
3、本病预后如何?
骨外骨肉瘤是高度侵袭性肿瘤,预后差,即使完整切除仍有复发和转移可能。
-----------------------------------------
本期病例比较少见,作为常见肿瘤发生于罕见部位,广泛的取材、细致的组织学观察寻找骨样基质和肿瘤性成骨,选择足够的免疫标记排除其他常见肿瘤后方可诊断。综合回答思路,rattlebox、kint123加一分,fusuyong、jessayhome、ayydz、xllyjw2008累积半分,molly011、lwm321、mxqlotus鲜花鼓励!
希望大家一如既往的支持病理每周一题, |