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目的 探讨隆突性皮纤维肉瘤 (DFSP)中肌样 /肌纤维母细胞性分化的本质及其临床病理学意义。方法 采用常规HE切片对 12 4例DFSP进行筛选 ,对 6例伴有肌样 /肌纤维母细胞性分化的DFSP病例进行免疫组织化学标记 ,其中 2例加做电镜检测。结果 肌样 /肌纤维母细胞性分化多出现在纤维肉瘤型DFSP(FS DFSP)中 ,表现为肿瘤周边部或肿瘤内散在性分布的深嗜伊红色小结节或短条束 ,由梭形细胞组成 ,细胞多无异型性 ,核分裂象也罕见 ,形态上似平滑肌细胞或肌纤维母细胞。免疫组织化学标记显示肌样区域细胞表达α 平滑肌肌动蛋白和肌特异性肌动抗原 ,不表达CD34 ;电镜观察证实细胞含有质膜下微丝束、局灶性致密体及微胞饮囊泡样结构 ,与肌纤维母细胞相一致。结论 DFSP中的肌样 /肌纤维母细胞性分化可能是肿瘤间质中肌纤维母细胞增生的结果 ,并非代表了瘤细胞的真性肌纤维母细胞性分化。
Objective To investigate the nature and clinicopathological significance of myogenic/muscular fibroblast differentiation in dermatofibrosarcoma of the dermis (DFSP). Methods Conventional HE slices were used to screen 124 cases of DFSP. Six cases of DFSP with muscle-like/myofibroblastic differentiation were immunohistochemically labeled, and 2 cases were examined by electron microscopy. RESULTS Myometrial/myofibroblast differentiation mostly occurred in fibrosarcoma type DFSP (FS DFSP), showing a deep eosinophilic nodules or short bundles scattered in the periphery of the tumor or within the tumor, consisting of spindle cells. Composition, the cells are not abnormal, mitotic figures are also rare, the shape of smooth muscle cells or myofibroblasts. Immunohistochemical staining showed that muscle-like cells expressed α-smooth muscle actin and myo-specific actin antigen, but not CD34; Electron microscopy demonstrated that the cells contained submural microfilaments, focal dense bodies, and microcellular vesicles. Like structure, consistent with myofibroblasts. Conclusions Myoblastic/myofibroblast differentiation in DFSP may be the result of myofibroblast hyperplasia in the tumor stroma, and does not represent a true myofibroblastic differentiation of the neoplastic cells.